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Kuzume D, Morimoto Y, Tsutsumi S, Yamasaki M, Hosomi N. [A case of bilateral middle cerebellar peduncle infarction with hot cross bun sign]. Rinsho Shinkeigaku 2024; 64:190-193. [PMID: 38369329 DOI: 10.5692/clinicalneurol.cn-001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
A 71-year-old man with hypertension and diabetes mellitus presented to our hospital because he felt lightheaded. Diffusion-weighted images (DWI) on brain MRI showed high signal lesions in the left cerebellar hemisphere and the right pons. The diagnosis of cerebellar infarction was made, but he refused treatment. One month later, he came to our hospital because his body leaned to the left. Neurological examination revealed dysarthria and cerebellar truncal ataxia. An electrocardiogram showed atrial fibrillation. DWI on brain MRI showed high signal lesions in the bilateral cerebellar hemispheres and middle cerebellar peduncles (MCP). Dabigatran 300 mg/day was administered for cardiogenic cerebral embolism. On the 12th day of onset, he was transferred to a rehabilitation hospital. At 72 years old, T2*-weighted images on brain MRI showed hot cross bun sign (HCBs) in the pons. We considered that HCBs were caused by antegrade or retrograde degeneration (or both) of pontine infarcts and bilateral MCP infarcts in the pontine cerebellar tract. It seemed preferable to use T2*-weighted images or proton density-weighted images rather than T2-weighted images to detect HCBs. When HCBs is detected, it should be noted that HCBs can be caused by bilateral MCP infarcts in addition to multiple system atrophy.
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Fu S, Yang Z. Motor cortex stimulation for the treatment of trigeminal neuralgia after brainstem infarction: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2024; 49:54-57. [PMID: 38615166 PMCID: PMC11017023 DOI: 10.11817/j.issn.1672-7347.2024.230233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Indexed: 04/15/2024]
Abstract
Secondary trigeminal neuralgia after brainstem infarction is rare and rarely reported. A patient with secondary trigeminal neuralgia after brainstem infarction was admitted to the Department of Neurosurgery, Xiangya Hospital, Central South University. The patient was a 44 years old male who underwent motor cortex stimulation treatment after admission. The effect was satisfactory in the first week after surgery, but the effect was not satisfactory after one week. This disease is relatively rare and the choice of clinical treatment still requires long-term observation.
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Affiliation(s)
- Shiyu Fu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China.
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Oster C, Stolte B, Asan L, Pul R, Klebe S, Köhrmann M, Breuckmann K, Rischpler C, Deuschl C, Dolff S, Kleinschnitz C, Hagenacker T. Brainstem Infarction in Immunodeficiency Identified as Adenosine Deaminase 2 Deficiency: Case Report. J Clin Immunol 2023; 43:1597-1602. [PMID: 37306896 PMCID: PMC10258773 DOI: 10.1007/s10875-023-01526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE We present the case of a 24-year-old male with CNS granulomatosis due to an immunodeficiency syndrome which was identified as deficiency of adenosine deaminase 2 (DADA2) as a cause of brainstem infarction. METHODS Case report and detailed description of the clinical course of diagnosis and treatment. CASE The patient's medical history consisted of an unknown immunodeficiency syndrome. Based on former findings, common variable immunodeficiency (CVID) was diagnosed. The patient suffered from three consecutive brainstem strokes of unknown etiology within 3 years. An MRI scan detected gadolinium-enhancing, granulomatous-suspect lesions in the interpeduncular cistern, temporal lobe, and tegmentum. Laboratory analysis was compatible with CVID, with leukopenia and immunoglobulin deficiency. Because granulomatous CNS inflammation was suspected, the patient received methylprednisolone immunosuppressive therapy, which led to partially regressive MRI lesions. However, in contrast to imaging, the patient showed a progressive cerebellar syndrome, indicating plasma exchange therapy and immunoglobulin treatment, which led to rapid symptom amelioration. After a relapse and a further stroke, expanded analysis confirmed DADA2 (and not CVID) as the inflammatory cause for recurrent stroke. After starting the therapy with immunoglobulins and adalimumab, no further strokes occurred. CONCLUSION We present the case of a young adult with diagnosis of DADA2 as a cause for recurrent strokes due to vasculitis. This stroke etiology is rare but should be considered as a cause of recurrent stroke of unknown origin in young patients to avoid a disabling disease course by disease-specific treatment options.
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Affiliation(s)
- Christoph Oster
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benjamin Stolte
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Livia Asan
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Refik Pul
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stephan Klebe
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katharina Breuckmann
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Romozzi M, Bramato G, Luigetti M. Weber Syndrome. Acta Neurol Belg 2023; 123:1101-1103. [PMID: 34997560 DOI: 10.1007/s13760-021-01861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/27/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Marina Romozzi
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Giulia Bramato
- UOC Geriatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Luo M, Qiu Z, Tang X, Wu L, Li S, Zhu J, Jiang Y. Inhibiting Cyclin B1-treated Pontine Infarction by Suppressing Proliferation of SPP1+ Microglia. Mol Neurobiol 2023; 60:1782-1796. [PMID: 36572839 DOI: 10.1007/s12035-022-03183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022]
Abstract
Pontine infarction is the major subtype of brainstem stroke causing severe neurological deficits. The pathophysiology and treatment of pontine infarction was rarely studied. A rat model of acute pontine infarction was established via injection of endothelin-1 in the pons. Single-cell RNA sequencing was applied to detect the cellular response in pontine infarction. Based on this finding, a potential treatment for pontine infarction targeting microglia was verified. Occlusion of penetrating artery caused by endothelin-1 led to pontine infarction. Single-cell RNA sequencing revealed a subtype of activated microglia, SPP1+ microglia, which were different from M1-like or M2-like depolarization. SPP1+ microglia interacted with oligodendrocytes and contributed to the demyelination of nerve tracts. Cyclin B1 regulated the proliferation of SPP1+ microglia. Cucurbitacin E, a cyclin B1 inhibitor, reduced the proliferation of SPP1+ microglia around the injured myelin sheath and alleviated the demyelination. Moreover, cucurbitacin E treatment decreased the ischemic infarction volume and neurological deficits after pontine infarction. SPP1+ microglia contributed to axonal demyelination in the pontine infarction, and inhibition of SPP1+ microglia provided neuroprotection for pontine infarction.
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Affiliation(s)
- Ming Luo
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China
| | - Zhihua Qiu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China
| | - Xiangyue Tang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China
| | - Li Wu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China
| | - Shaojun Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China
| | - Juehua Zhu
- Department of Neurology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215300, China.
| | - Yongjun Jiang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China.
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Isenberg AL, Haugbøl S. [Not Available]. Ugeskr Laeger 2023; 185:V09220576. [PMID: 36760190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Sudden pain of the eye, nose or face can be a symptom of stroke located to the pons. This case report is about a 73-year-old women with acute debut of right-sided hemiparesis, ataxia, gait disturbance, dysarthria, hemisensory defects and contralateral burning eye pain. MRI showed acute ischaemia of the left pons. The case adds to the growing literature of this rare presentation of posterior circulation stroke.
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Abstract
INTRODUCTION Cerebrovascular fenestration malformation is a relatively rare vascular dysplasia, and an 8-shaped basilar artery fenestration malformation is even rarer. The characteristics of transcranial Doppler cerebral blood flow in cerebrovascular fenestration malformations have rarely been studied or reported. PATIENT CONCERNS A 58-year-old woman presented with hypertension, diabetes, with no history of smoking or drinking. The patient had no relevant family history. The patient experienced left limb weakness for 2 days, which gradually worsened. DIAGNOSIS Head and neck computed tomography angiography revealed an 8-shaped fenestration deformity of the lower segment of the basilar artery with multiple stenoses of the local vessels. Transcranial Doppler cerebral blood flow examination at a depth of 85 cm revealed an eddy current in the lower segment of the basilar artery. INTERVENTIONS Tirofiban was administered intravenously for 3 days and subsequently changed to oral clopidogrel antiplatelet treatment. OUTCOMES The modified Rankin Scale score at 3 months after disease onset was 0, indicating that the patient recovered well after treatment. CONCLUSION A basilar artery 8-shaped fenestration is extremely rare and has seldom been reported. Cerebral vascular fenestration can lead to an acute cerebral infarction and its pathogenesis may include local hemodynamic abnormalities and thrombosis. Eddy currents can be detected by transcranial Doppler cerebral blood flow examination.
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Affiliation(s)
- WenSheng Zhang
- Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Guangdong Province, China
- * Correspondence: WenSheng Zhang, MMed, Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Guangdong Province, China (e-mail: )
| | - WeiFang Xing
- Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Guangdong Province, China
| | - HongLi Gu
- Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Guangdong Province, China
| | - JinZhao He
- Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Guangdong Province, China
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Rosa F, Renzetti P, Castellan L, Roccatagliata L. Cavernous sinus thrombosis associated with intraparenchymal hemorrhage and brainstem venous infarction as a rare complication of fronto-orbital infection. Neurol Sci 2021; 43:731-734. [PMID: 34664179 DOI: 10.1007/s10072-021-05658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- F Rosa
- Diagnostic Imaging Department, San Paolo Hospital- ASL 2, via Genova 30, Savona, Italy.
| | - P Renzetti
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - L Castellan
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - L Roccatagliata
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy.
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Sinha S, Naik BB, Ghanekar J. Wall eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome as a false localising sign in intracranial haemorrhage due to snake bite. BMJ Case Rep 2021; 14:e244830. [PMID: 34521743 PMCID: PMC8442054 DOI: 10.1136/bcr-2021-244830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/03/2022] Open
Abstract
A 48-year-old woman presented with sudden-onset altered sensorium 2 days after a snake bite (unidentified species) and was found to have a large right frontal intracerebral haemorrhage (ICH) with transtentorial herniation (TTH) causing brain stem compression. A day later, neurological examination revealed internuclear ophthalmoplegia (INO) fitting the clinical description of wall eyed bilateral INO syndrome. INO is a rare ocular motor sign, the most common causes being brain stem infarction, haemorrhage or demyelinating disease. It rarely acts as a false localising sign, such as in this case, and in an even rarer cause for ICH, that is, haemotoxic snake bite without initial evidence of coagulopathy. An emphasis needs to be laid on detailed physical examination, often considered a lost art nowadays, to help detect subtle clinical signs which could herald ominous complications of conditions like TTH and help in early diagnosis and treatment of the same.
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Affiliation(s)
- Shruti Sinha
- Internal Medicine, Mahatma Gandhi Mission's Medical College Kamothe, Navi Mumbai, Maharashtra, India
| | - Bhaimangesh Bhanudas Naik
- Internal Medicine, Mahatma Gandhi Mission's Medical College Kamothe, Navi Mumbai, Maharashtra, India
| | - Jaishree Ghanekar
- Internal Medicine, Mahatma Gandhi Mission's Medical College Kamothe, Navi Mumbai, Maharashtra, India
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Ablefoni M, Ullrich S, Surov A, Hoffmann KT, Meyer HJ. Diagnostic benefit of high b-value computed diffusion-weighted imaging in acute brainstem infarction. J Neuroradiol 2020; 49:47-52. [PMID: 32987036 DOI: 10.1016/j.neurad.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging (DWI) is a cornerstone in diagnostic of ischemic stroke. The aim of this study was to investigate the usefulness of high-b-value computed DWI (c-DWI) in comparison to standard DWI in patients with acute brainstem infarction. MATERIALS AND METHODS 56 patients with acute brainstem infarction were retrospectively analysed by two readers. DWI was obtained with the b-values 0, 500 and 1000 s/mm² on either a 1.5 or 3 T magnetic resonance imaging (MRI) scanner. c-DWI was calculated with a monoexponential model with high b-values 2000, 3000, 4000 and 5000 s/mm². All c-DWI series with high-b-values were compared to the standard DWI sequence at b-value of 1000 s/mm² in terms of image artifacts, lesion extent and contrast. RESULTS There was no statistically significant difference between 1.5 and 3 T MRI regarding the measured ischemic lesion size. There were no statistically significant differences between the ischemic lesion sizes on DWI at b-values of 1000 s/mm² and on c-DWI at higher b-values. Overall, the contrast between the lesion and the surrounding normal areas improved with increasing b-value on the isotropic DWIs: maximum at b = 5000, followed by that at b 2000 and b 1000 s/mm², in order. The best relation between artifacts and lesion contrast was identified for b 2000 s/mm². CONCLUSION High b-value DWI derived from c-DWI has a higher visibility for ischemic brainstem lesions compared to standard DWI without additional time cost. The b-2000 image is recommended to use in clinical routine, higher b-value images lead to more imaging artifacts, which might result in misdiagnosis.
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Affiliation(s)
- Maxime Ablefoni
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Sebastian Ullrich
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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Kobayashi S, Suzuki K, Takekawa H, Watanabe Y, Okamura M, Suzuki A, Tsukui D, Hirata K. [Bilateral Medial Medulla Infarction Mimicking Guillain-Barré Syndrome and its Variants]. Brain Nerve 2020; 72:901-905. [PMID: 32741771 DOI: 10.11477/mf.1416201617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 70-year-old man presented with dizziness and unsteadiness when standing and was hospitalized in another hospital. Magnetic resonance imaging (MRI) of the brain on Day 1 showed no abnormalities. The patient developed respiratory failure on Day 1and flaccid tetraplegia on Day 3, and was transferred to our hospital. Progressive upper and lower limb weakness and bulbar symptoms suggested Guillain-Barré syndrome or its variant. Diffusion-weighted MRI on Day 6 disclosed high signal intensities in the bilateral medial portion of the medulla, and the patient was diagnosed with bilateral medial medulla infarction. Bilateral medial medulla infarction should be considered when a patient shows progressive tetraplegia, and bulbar palsy and follow-up MRI is important to confirm the diagnosis. (Received January 23, 2020; Accepted April 21, 2020; Published August 1, 2020).
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Ohira J, Ohara N, Hinoda T, Morimoto T, Kohara N. Patient characteristics with negative diffusion-weighted imaging findings in acute lateral medullary infarction. Neurol Sci 2020; 42:689-696. [PMID: 32656715 DOI: 10.1007/s10072-020-04578-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) on magnetic resonance imaging (MRI) shows limited sensitivity in the acute-phase brainstem infarctions, including lateral medullary infarction (LMI), and the detailed characteristics of acute LMI patients with initially negative DWI-MRI findings have not been reported previously. Therefore, we aimed to investigate the differences in the backgrounds or symptoms of acute LMI patients with initially negative findings in standard axial DWI-MRI and those with positive findings. METHODS In this retrospective cohort study, we collected the data for 35 consecutive acute LMI patients who were hospitalized in our hospital from January 2011 to December 2018. Initial standard axial DWI-MRI was assessed, and the patients were divided into positive and negative groups. The characteristics of the two groups were compared, and the usefulness of additional thin-slice coronal DWI-MRI was also investigated. RESULTS Nine (26%) acute LMI patients were initially negative on standard axial DWI-MRI. The patients were independently associated with smoking history (78% vs. 23%, p = 0.021) and headache (78% vs. 31%, p = 0.046). Thin-slice coronal DWI-MRI showed positive findings in 50% of the patients with negative findings in standard axial DWI-MRI. All four patients with negative findings in both standard axial and thin-slice coronal DWI-MRI had smoking history and headache. CONCLUSION Smoking history and headache were associated with initial negative results in standard axial DWI-MRI in acute LMI. Additional thin-slice coronal DWI-MRI was sometimes useful in detecting acute LMI. Follow-up MRI is important for patients showing negative findings in initial DWI-MRI.
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Affiliation(s)
- Junichiro Ohira
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan.
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan
| | - Takuya Hinoda
- Department of Radiology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan
| | - Takeshi Morimoto
- Clinical Research Center, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan
- Department of Clinical Epidemiology, Hyogo College of Medicine, 663-8501, 1-1 Mukogawa, Nishinomiya, Hyogo, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan
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Vaahtera K, Lunetta P. Death associated with an unruptured giant intracranial aneurysm. Leg Med (Tokyo) 2010; 12:200-2. [PMID: 20444637 DOI: 10.1016/j.legalmed.2010.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 03/29/2010] [Accepted: 03/30/2010] [Indexed: 11/19/2022]
Abstract
Deaths due to or associated with unruptured giant intracranial aneurysms are extremely rare. We describe a case of a sudden death associated with an unruptured giant vertebrobasilar aneurysm in a symptomatic 18-year-old male. Post-mortem examination revealed three giant fusiform and thrombosed aneurysms (vertebrobasilar junction, internal carotid arteries), an old infarct with some sub-acute changes in the brain stem and medulla, an incipient pneumonia, and a high blood alcohol concentration (2.4 o/oo). The association of these findings suggest the role of a multi-factorial respiratory dysfunction as a pathophysiological mechanism leading to death. In fatal cases related to giant intracranial aneurysm, a number of triggers and contributing factors, with potential medico-legal implications, must be appropriately considered in the chain of events leading to death.
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Affiliation(s)
- Katarina Vaahtera
- Hjelt-Institute, Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
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Abstract
BACKGROUND The locked-in syndrome is typically caused by basilar artery thrombosis, resulting in ventral pontine infarction. Infectious basilar arteritis is a rare alternative etiology. CASE SUMMARY We present a 24-year-old female with a prodrome of facial pain without fever or meningismus, who developed a locked-in syndrome due to an invasive fungal infection after bone marrow transplantation. The clinical course and neuroimaging demonstrating sinusitis with adjacent pontine infarction but without basilar artery thrombosis are presented. The infectious differential diagnosis and management of invasive fungal infection are discussed. CONCLUSION Facial pain without fever or meningismus may be an early symptom of invasive fungal rhinosinusitis, which may involve small basilar pontine perforating arteries, leading to a locked-in syndrome in immunosuppressed patients. Early recognition and treatment may prevent life-threatening neurologic complications.
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Affiliation(s)
- Nathan P Young
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, MN 55905, USA
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Akiguchi I, Yamamoto Y, Harada K. [Brainstem infarction (pons)]. Nihon Rinsho 2006; 64 Suppl 8:214-9. [PMID: 17469555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Ichiro Akiguchi
- The Center of Neurological and Cerebrovascular Diseases, Takeda Hospital
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SZEGOE L. [A CASE OF HOMOLATERAL ATROPHY ASSOCIATED WITH SYNDACTYLY AND OLIGODACTYLY IN KLIPPEL-TRENAUNAUY-WEBER SYNDROME]. Dermatol Wochenschr 1965; 151:20-5. [PMID: 14271842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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18
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TOSELLI C, SALVI G. [CLINICAL CONTRIBUTION TO THE STUDY OF FOVILLE TYPE ALTERNATE SYNDROMES]. Ann Ottalmol Clin Ocul 1963; 89:754-62. [PMID: 14109532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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DENYS WJ. [Posttraumatic dyskinesia: Benedikt syndrome]. Acta Neurol Psychiatr Belg 1963; 63:225-34. [PMID: 14027061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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TUSET, BOUCHACOURT, COULONJOU, FORCE, BAUCHAMP, BRIEND. [Foville's syndrome caused by melanosarcoma of the brain stem]. Rev Otoneuroophtalmol 1962; 34:255-7. [PMID: 13994962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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21
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22
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WAREMBOURG H, NIQUET G, LEKIEFFRE J, THOREUX M, COUPIN J. [Onset of meningeal tuberculosis with Weber's syndrome]. Lille Med 1960; 5:3. [PMID: 13831350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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23
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BONARETTI T. [A "bilateral" Foville syndrome with particular development caused by a probable inflammatory cerebellopontine process]. Riv Patol Nerv Ment 1959; 80:1113-26. [PMID: 13802436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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24
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SZEGO L, SELENYI A, ALMASSY G. [Klippel-Trenaunay-P. Weber syndrome complicated by Kaposi's sarcoma (sarcoma idiopathicum varicosum et osteohypertrophicum)]. Borgyogy Venerol Sz 1957; 11:203-12. [PMID: 13499606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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26
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MICHON P, DORNIER R, LARCAN A, HURIET C. [Inferior syndrome of the red nucleus (Claude's syndrome) in a paretic subject]. Rev Med Nancy 1957; 82:178-81. [PMID: 13421192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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MALFATTI G. [The so-called Weber syndrome]. Otorinolaringol Ital 1957; 25:462-7. [PMID: 13504847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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SALVI G. [Parinaud syndrome combined with Weber syndrome: a clinical case]. Ann Ottalmol Clin Ocul 1956; 82:275-84. [PMID: 13340537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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PERLMUTTER I, STRAIN RE. Weber's syndrome: report of a case presenting a diagnostic problem. J Fla Med Assoc 1955; 42:389-90. [PMID: 13271713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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31
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VOGEL G. [Demonstration of a case of basilar aneurysm with Weber's syndrome]. Wien Z Nervenheilkd Grenzgeb 1954; 10:143-7. [PMID: 13226941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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BAYULKEM F, UNLUTURK C. [Case of Weber's syndrome]. Turk Tip Cemiy Mecm 1950; 16:613-20. [PMID: 14828698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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JAYLE GE, OURGAUD AG. [Classification test for oculomotor disorders of the horizontal gaze; about two new cases of atypical Foville syndrome]. Rev Otoneuroophtalmol 1949; 21:86-93. [PMID: 18127118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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ETCHEPAREBORDA JA, GONI AR, CASTRO JA. [Benedikt syndrome following trauma; associated Parinaud syndrome]. Rev Asoc Med Argent 1948; 62:743-745. [PMID: 18111074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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GIANNELLI V. [Henry Claude outward action syndrome]. Rass Studi Psichiatr 1947; 36:357-389. [PMID: 20269897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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DELMAS-MARSALET P, FAURE J, ARNE L. [Lower protuberant Foville syndrome]. J Med Bord 1946; 123:73. [PMID: 21022607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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