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Li J, Chen L. Brainstem Infarction Due to a Basilar Arterial Web. Radiology 2023; 309:e231106. [PMID: 37962506 DOI: 10.1148/radiol.231106] [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] [Indexed: 11/15/2023]
Affiliation(s)
- Jun Li
- From the Department of Neurology, Affiliated Hospital of Guizhou Medical University, No. 28 Guiyi St, Yunyan District, Guiyang, Guizhou 550031, China (J.L.); and Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (L.C.)
| | - Lizhang Chen
- From the Department of Neurology, Affiliated Hospital of Guizhou Medical University, No. 28 Guiyi St, Yunyan District, Guiyang, Guizhou 550031, China (J.L.); and Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (L.C.)
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Vlašković T, Brkić BG, Stević Z, Kostić D, Stanisavljević N, Marinković I, Vojvodić A, Nikolić V, Puškaš L, Blagojević M, Marinković S. Anatomic and MRI bases for medullary infarctions with patients' presentation. J Stroke Cerebrovasc Dis 2022; 31:106730. [PMID: 36029688 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106730] [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: 06/21/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There is a low incidence of the medullary infarctions and sparse data about the vascular territories, as well as a correlation among the anatomic, magnetic resonance imaging (MRI) and neurologic signs. MATERIALS AND METHODS Arteries of the 10 right and left sides of the brain stem were injected with India ink, fixed in formalin and microdissected. The enrolled 34 patients with medullary infarctions underwent a neurologic, MRI and Doppler examination. RESULTS Four types of the infarctions were distinguished according to the involved vascular territories. The isolated medial medullary infarctions (MMIs) were present in 14.7%. The complete MMIs comprised one bilateral infarction (2.9%), whilst the incomplete and partial MMIs were observed in 5.9% and 8.9%, respectively. The anterolateral infarctions (ALMIs) were very rare (2.9%). The complete and incomplete lateral infarctions (LMIs), noted in 35.3%, comprised 11.8% and 23.6%, respectively, that is, the anterior (5.9%), posterior (8.9%), deep (2.9%), and peripheral (5.9%). Dorsal ischemic lesions (DMIs) occurred in 11.8%, either as a complete (2.9%), or isolated lateral (5.9%) or medial infarctions (2.9%). The remaining ischemic regions belonged to various combined infarctions of the MMI, ALMI, LMI and DMI (35.3%). The infarctions most often affected the upper medulla (47.1%), middle (11.8%), or both (29.5%). Several motor and sensory signs were manifested following infarctions, including vestibular, cerebellar, ocular, sympathetic, respiratory and auditory symptoms. CONCLUSIONS There was a good correlation among the vascular territories, MRI ischemia features, and neurologic findings regarding the medullary infarctions.
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Affiliation(s)
- Tatjana Vlašković
- Psychiatrist, University of Belgrade, Faculty of Medicine, Laza Lazarević Hospital of Psychiatry, Faculty of Medicine, Belgrade, Serbia
| | - Biljana Georgievski Brkić
- Associate Researcher of Radiology, University of Belgrade, Faculty of Medicine, Sveti Sava Hospital, Department of CT and MRI, Belgrade, Serbia
| | - Zorica Stević
- Professor of Neurology, University of Belgrade, Faculty of Medicine, Clinical Center, Clinic of Neurology
| | - Dejan Kostić
- Assistant Professor of Radiology, Military Medical Academy, Institute of Radiology, Belgrade, Serbia
| | - Nataša Stanisavljević
- Hematologist, University of Belgrade, Clinical Hospital Center Bezanijska Kosa, Department of Hematology, Belgrade, Serbia
| | - Ivan Marinković
- Neurologist, Clinical Neuroscience, Neurology, Helsinki University Central Hospital, University of Helsinki, Finland.
| | - Aleksandra Vojvodić
- Teaching Assistant in Dermatovenerology, University of Belgrade, Media Group Hospital, Belgrade, Serbia
| | - Valentina Nikolić
- Professor of Anatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Laslo Puškaš
- Professor of Anatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Miloš Blagojević
- Associate Professor of Anatomy, University of Belgrade, Faculty of Veterinary Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Slobodan Marinković
- Professor of Neuroanatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Department of Neuroanatomy, Belgrade, Serbia
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Wang T, Zhang J, Zou D, Chen Y. Massive Brainstem and Cerebellum Infarction Due to Traumatic Extracranial Vertebral Artery Dissection in a Motor Traffic Accident: An Autopsy Case Report. Am J Forensic Med Pathol 2021; 42:194-197. [PMID: 33031123 DOI: 10.1097/paf.0000000000000619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Traumatic unilateral vertebral artery (VA) injury can cause focal thrombosis and may block the basilar artery which can further lead to ischemic stroke and massive cerebral infarction and subarachnoid hemorrhage and even rapid death. Here, we present an autopsy case with a traumatic extracranial VA dissection in a motor traffic accident, and the identification of cause of death underwent 2 autopsies. A 62-year-old male pedestrian collided with the right rearview mirror of a car and fell down to the ground. He complained pains in the head and neck. Head computed tomography (CT) showed a right linear temporal bone fracture and a small left temporal subdural hematoma. Neck CT and magnetic resonance imaging (MRI) examination showed left transverse process fracture of the sixth cervical vertebra (C6) and left extracranial VA injury. After 6 days of hospitalization, the left temporal subdural hematoma had been nearly absorbed, and the man was discharged home. On day 15 after the traffic accident, the man suffered sudden unconsciousness accompanied by frequent vomiting at home. The man was taken to hospital, and there were no obvious abnormal findings by head CT examination. However, the man soon fell into a coma state and died 2 days later. The first autopsy was performed 7 days after death and confirmed a left transverse process fracture of C6 and that the deceased died of cerebral infarction and secondary subarachnoid hemorrhage caused by blunt force in the motor traffic accident. In the civil lawsuit, the traffic accident wrecker put forward the objection whether the deceased had fatal diseases. The second autopsy (84 days after the death) findings verified the left extracranial VA injury. Histopathological examination further showed intimal dissection and thrombus formation of the left extracranial VA and secondary basal arterial thromboembolism. Massive infarction of the brainstem and cerebellum was disclosed. Therefore, the deceased died of delayed massive brainstem and cerebellum infarction because of left extracranial VA dissection in the motor traffic accident.
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Affiliation(s)
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, China, Shanghai, China
| | - Donghua Zou
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, China, Shanghai, China
| | - Yijiu Chen
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, China, Shanghai, China
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Rudilosso S, Mena L, Esteller D, Olivera M, Mengual JJ, Montull C, Castrillo L, Urra X, Gómez-Choco M. Higher Cerebral Small Vessel Disease Burden in Patients with White Matter Recent Small Subcortical Infarcts. J Stroke Cerebrovasc Dis 2021; 30:105824. [PMID: 33906070 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105824] [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] [Received: 11/02/2020] [Revised: 02/10/2021] [Accepted: 04/04/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease (CSVD). We assessed whether the topography of RSSI was related to CSVD markers on magnetic resonance imaging (MRI). MATERIAL AND METHODS We screened the local registries of two independent stroke centers in Catalonia and selected patients with a symptomatic RSSI on MRI performed during admission. RSSI location was classified into brainstem, supratentorial subcortical structures (SSS), and centrum semiovale (CSO) regions. Clinical variables, including vascular risk factors, were collected. Radiological markers of CSVD on MRI were evaluated individually and by means of the global CSVD burden score. The associations between each RSSI location and CSVD markers were studied in uni- and multivariate logistic regression analysis. RESULTS Among 475 patients with RSSI, 152 (32%) had an infarct in the brainstem, 227 (48%) in SSS, and 96 (20%) in CSO region. The median CSVD burden score was 2 (IQR, 1-3). After adjusting for confounding factors, a RSSI in CSO was associated with higher periventricular and deep white matter hyperintensity scores [OR 1.64 (95% CI, 1.16-2.33), and OR 1.44 (95% CI, 1.07-1.93), respectively]. Higher CSVD burden score was positively associated with CSO [OR 1.48 (95% CI, 1.22-1.81)] and inversely associated with SSS [0.85 (95% CI, 0.72-0.99)] location after adjusting for relevant confounders. CONCLUSIONS CSO RSSI were related to a higher burden of CSVD, particularly to white matter hyperintensities, compared to other RSSI locations. The pathophysiological significance of such findings should be investigated in the future with advanced neuroimaging techniques.
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Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona. Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain..
| | - Luis Mena
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain..
| | - Diana Esteller
- Department of Neurology, Hospital Clínic of Barcelona, Spain..
| | - Marta Olivera
- Department of Neurology, Hospital Clínic of Barcelona, Spain..
| | - Juan José Mengual
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain..
| | - Caterina Montull
- Department of Radiology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain.
| | - Laura Castrillo
- Department of Radiology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain.
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona. Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain..
| | - Manuel Gómez-Choco
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain.; Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.
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Galassi G, Genovese M, Meacci M, Malagoli M. Varicella zoster virus reactivation antedating ipsilateral brainstem stroke. Dermatol Online J 2018; 24:13030/qt4gj9h9jf. [PMID: 30677856] [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] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023] Open
Abstract
itor Title: Varicella zoster virus reactivation antedating ipsilateral brainstem stroke Authors: Giuliana Galassi1, Maurilio Genovese2, Marisa Meacci3, Marcella Malagoli2 Affiliations: 1Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Italy, 2Neuroradiology Service, University Hospital of Modena, Italy, 3Department of Laboratory Medicine and Patholgy, Microbiology and Virology Unit, University Hospital of Modena, Italy Corresponding Author: Giuliana Galassi, MD, Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Via P. Giardini 1455, Modena, Italy, Tel: 39-3497325802, Email: giulianagalassi46@gmail.com Abstract: Varicella zoster virus (VZV) infection and reactivation are associated with a number of neurologic conditions. Unifocal large vessel infarcts may follow zoster in the trigeminal or cervical distribution as a result of transaxonal transport of virus from trigeminal or cervical afferent fibers that innervate vessels. Ophthalmic zoster (HZO) might cause ophthalmoplegic syndromes, with secondary optic neuritis. Mechanisms include local orbital muscle inflammation and, viral spread from the ophthalmic branch of the fifth nerve with associated vasculopathy. A 72-year-old man developed a vesicular rash in the territory of C5-T5-6. Within four weeks, the patient developed headache, dysphagia, left facial and extremity ataxic weakness. Magnetic resonance imaging (MRI) revealed a right pontine infarction. A 66-year-old woman presented with right-sided painfull HZO. One week later she developed complete external ophthalmoplegia and blurred vision. MRI showed ill-defined signal alteration in the retrobulbar tissue. Three weeks later, the patient was admitted because of dysarthria, deviated tongue, left-sided limb weakness, and tactile hypoesthesia. Spinal fluid contained 23 lymphocytes/mm3 and increased protein. The serum contained antibodies to VZV IgG and IgM in both cases. The patients received intravenously acyclovir with improvement. This report confirms unusual occurrence of ipsilateral brainstem stroke after VZV reactivation in immunocompetent subjects.
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Affiliation(s)
- Giuliana Galassi
- Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena
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Kimura H, Takeuchi J, Tsutada T, Ohata K, Osawa M, Itoh Y. [A case of neurosarcoidosis with recurrent brainstem infarction, obstructive hydrocephalus and brainstem atrophy]. Rinsho Shinkeigaku 2018; 58:445-450. [PMID: 29962442 DOI: 10.5692/clinicalneurol.cn-001155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/08/2023]
Abstract
We report the case of a 42-year-old female with neurosarcoidosis who was hospitalized in year 2017 for gait disturbance. In 2011, she suddenly had vertigo that lasted for a few days. In 2013, she noticed left hemiplegia. A brain MRI revealed an acute infarction on the right side of the upper pons extending longitudinally from the ventral surface. In 2017, she again had left lower limb paralysis. A Brain MRI showed another infarction on the right side of the mid-pons. Hydrocephalus and brainstem atrophy were also noted. The patient was referred to our hospital. Upon neurological examination, she presented with down beat nystagmus, muscle weakness on the left side, and a broad-based spastic gait. CSF findings included an increased number of cells and protein levels with decreased glucose levels. A contrast-enhanced MRI revealed basilar meningitis causing hydrocephalus. A contrast CT scan revealed inguinal lymph node swelling, and scintigram found gallium accumulation. We diagnosed sarcoidosis via a lymph node biopsy. We speculate that chronic basilar meningitis obstructed the patient's branching penetrating arteries inducing infarction together with obstruction of the spinal fluid flow causing hydrocephalus and cerebral atrophy.
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Affiliation(s)
| | | | | | - Kenji Ohata
- Department of Neurosurgery, Osaka City University
| | - Masahiko Osawa
- Department of Pathology, Osaka City University Graduate School of Medicine
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Gehlen M, Schaefer N, Schwarz-Eywill M, Maier A. Ultrasound to detect involvement of vertebral artery in giant cell arteritis. Clin Exp Rheumatol 2018; 36 Suppl 111:169-170. [PMID: 29352850] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Martin Gehlen
- Der Fürstenhof, Department of Rheumatology, Bad Pyrmont, Germany; and European Medical School Oldenburg-Groningen, Netherlands.
| | - Nikolaus Schaefer
- European Medical School Oldenburg-Groningen, Netherlands; Radboud University Medical Centre, Netherlands; and Medizinisches Zentrum StädteRegion Aachen, Germany
| | - Michael Schwarz-Eywill
- Der Fürstenhof, Department of Rheumatology, Bad Pyrmont, Germany; and European Medical School Oldenburg-Groningen, Netherlands
| | - A Maier
- St. Josef Stift Sendenhorst, Germany
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Abstract
An 80-year-old man with angina pectoris abruptly developed Claude's syndrome, which consisted of left-sided partial oculomotor nerve palsy without ptosis and right-sided hemiataxia. There were no other neurological abnormalities. Cranial magnetic resonance imaging indicated an infarction of the left inferior paramedian mesencephalic artery, which may have involved the most caudal portion of the oculomotor fascicules. With anti-platelet therapy, the patient became asymptomatic within 10 days. The oculomotor fascicular arrangement in humans remains unclear. Our case suggests that in the oculomotor fascicles, the fibers to the levator palpebrae superioris may be located more in the rostral region than previously hypothesized.
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Affiliation(s)
- Hiromasa Tsuda
- Department of Neurology, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Japan
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Affiliation(s)
- Nicholas R Plummer
- Acute Stroke Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Thomas Thorp
- Acute Stroke Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Sulaiman Sultan
- Acute Stroke Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
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Affiliation(s)
- M-H Chen
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan, ROC.
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Luger S, Harter PN, Mittelbronn M, Wagner M, Foerch C. Brain stem infarction associated with familial Mediterranean fever and central nervous system vasculitis. Clin Exp Rheumatol 2013; 31:93-95. [PMID: 23710607] [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] [Received: 12/30/2012] [Accepted: 03/06/2013] [Indexed: 06/02/2023]
Abstract
Familial Mediterranean fever (FMF) is an autoinflammatory autosomal recessive disease caused by mutations of the Mediterranean fever (MEFV) gene on chromosome 16p. Clinically, it is characterized by recurrent episodes of fever and painful polyserositis. An association of FMF with systemic vasculitis, namely Henoch-Schönlein purpura, polyarteritis nodosa and Behçet's disease has been described. Neurological manifestations of FMF occur rarely and include demyelinating (MS-like) lesions, posterior reversible encephalopathy syndrome, and pseudotumour cerebri. Hitherto hardly known, we herein present a young patient with a genetically proven FMF who suffered a brain stem infarction during a typical FMF attack. After a careful diagnostic workup including cerebrospinal fluid analysis, intra-arterial angiography and leptomeningeal biopsy, a FMF-associated central nervous system vasculitis was identified as the cause of stroke. The pathophysiological background and potential therapeutic strategies are discussed.
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Affiliation(s)
- Sebastian Luger
- Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
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Affiliation(s)
- Sheng-Hsiang Lin
- Department of Internal Medicine, New Taipei City Hospital, New Taipei City, Taiwan
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Abstract
Stroke is an important disease, because it is usually devastating and often fatal. Left atrial appendage (LAA) thrombi are well known as a cause for cerebral infarction, but pulmonary vein thrombi remain unknown. To detect LAA thrombi, transoesophageal echocardiography (TOE) is usually used. More recently, a 64-slice multidetector CT (64-MDCT) has proved to be an option for identifying them. The patient was 77-year-old male, and had a lacuna infarction in pons. A 64-MDCT demonstrated a 3 to 4 mm thrombus at the proximal side of right upper pulmonary vein. After 2 months warfarin therapy, the thrombus disappeared. When assessing the possible cause for cerebral infarction, it is important to identify thrombi within the LAA, and in the left pulmonary vein. 64-MDCT seems to be more suitable and reliable than TOE to detect thrombi of the pulmonary vein, because of no influence of pulmonary air.
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Affiliation(s)
- Hidekazu Takeuchi
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
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Hantson P, Wittebole X, Rombaux P, Cosnard G. Locked-in syndrome as an unusual complication of acute otitis media. B-ENT 2012; 8:131-134. [PMID: 22896933] [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: 06/01/2023] Open
Abstract
BACKGROUND A 32-year-old woman developed altered consciousness two days after initial symptoms of acute otitis media, with purulent discharge from the right ear. She was quadriplegic, with spontaneous eye opening, mild neck stiffness, and lacking vestibular-ocular reflexes. METHODOLOGY Upon admission, the patient was subjected to brain computed tomography (CT), magnetic resonance imaging (MRI), and lumbar puncture. RESULTS CT was consistent with pansinusitis, right middle ear otitis, mastoiditis, and sphenoiditis. No brainstem lesion was evident; brain MRI demonstrated ischemic and secondary hemorrhagic lesions in the pons and cerebral peduncles. The dura mater in the petroclival space was intensely inflamed, and likely responsible for reduced basilar arterial blood flow. Lumbar puncture yielded clear cerebrospinal fluid; gram stain examination was negative and culture remained sterile. Streptococcus pneumoniae and Haemophilus influenzae were cultured from the purulent ear discharge. CONCLUSION The final diagnosis was locked-in syndrome consecutive to inflammatory changes compressing the basilar artery.
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Affiliation(s)
- P Hantson
- Department of Intensive Care, Université catholique de Louvain, Cliniques St-Luc, Brussels, Belgium.
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Vesza Z, Várallyay G, Szőke K, Bozsik G, Manhalter N, Bereczki D, Ertsey C. Trigemino-autonomic headache related to Gasperini syndrome. J Headache Pain 2010; 11:535-8. [PMID: 20803228 PMCID: PMC3476227 DOI: 10.1007/s10194-010-0251-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 08/12/2010] [Indexed: 12/19/2022] Open
Abstract
We report the association of ipsilateral trigemino-autonomic headache to a case of right-sided nuclear facial and abducens palsy (Gasperini syndrome), ipsilateral hypacusis and right hemiataxia, caused by the occlusion of the right anterior inferior cerebellar artery. Short-lasting attacks of mild to moderate ipsilateral fronto-periorbital head pain, accompanied by lacrimation and mild conjunctival injection during more severe attacks, were present from the onset of symptoms, with a gradual worsening over the next few months and remitting during naproxen therapy. Magnetic resonance imaging showed an infarct in the right cerebellar peduncle, extending toward the pontine tegmentum, also involving the ipsilateral spinal trigeminal nucleus and tract and the trigeminal entry zone. Gasperini syndrome may be accompanied by ipsilateral trigemino-autonomic head pain.
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Affiliation(s)
- Zsófia Vesza
- Department of Neurology, Semmelweis University, Balassa u. 6., 1083 Budapest, Hungary
| | - György Várallyay
- MR Research Center, Szentágothai Knowledge Center, Semmelweis University, Balassa u. 6., 1083 Budapest, Hungary
| | - Kristóf Szőke
- Department of Neurology, Semmelweis University, Balassa u. 6., 1083 Budapest, Hungary
| | - György Bozsik
- Department of Neurology, Semmelweis University, Balassa u. 6., 1083 Budapest, Hungary
| | - Nóra Manhalter
- PhD Programme, Semmelweis University, Budapest, Hungary
- Department of Neurology, Nyírő Gyula Hospital, Lehel u. 59., 1135 Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Balassa u. 6., 1083 Budapest, Hungary
| | - Csaba Ertsey
- Department of Neurology, Semmelweis University, Balassa u. 6., 1083 Budapest, Hungary
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Abstract
OBJECTIVE The pathogenesis of isolated pontine infarctions is still unclear, being attributed both to small or large vessel disease. The extension of infarcted tissue to the pons surface has been indicated as a possible marker of basilar branch atheromatous disease and some neuroimaging evidence confirms this finding. METHODS On the basis of Kim's et al., study, we performed a revision of the literature addressing this topic. RESULTS Several authors confirm an association between basilar artery branch disease and isolated pontine infarction; moreover, the enlargement of pontine lesion seems to be associated with neurological worsening. We therefore performed a brief analysis of possible mechanisms of progression. CONCLUSIONS Prospective studies could be useful to evaluate predictors of neurological worsening in pontine stroke. Improvement of neuroimaging techniques is needed for a deeper comprehension of the etiopathogenesis of isolated pontine infarction.
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Takashima R, Odaka M, Watanabe Y, Hirat K, Yoshida A. [Case of basilar artery occlusion caused by mucormycotic embolism in the course of myelodysplastic syndrome]. Brain Nerve 2009; 61:1079-1082. [PMID: 19803408] [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: 05/28/2023]
Abstract
We report the case of a man in his sixties with mucormycosis in whom initial cerebellar infarction progressed into pontine infarction due to basilar artery occlusion. He had received blood transfusions for myelodysplastic syndrome for 1 year and suddenly developed ataxic speech and gait disturbances. On the basis of the diagnosis of cerebellar infarction and pneumonia, he was administered antifungal medications (micafungin sodium, fosfluconazole, and amphotericin B) in addition to glycerin, after which the patient suffered from high fever associated with meningeal irritation and consciousness disturbance. Diffusion-weighted images derived from brain magnetic resonance imaging (MRI) revealed the presence of high-signal intensity lesions extending to the bilateral pons. He died of tonsillar herniation associated with brainstem edema. Autopsy revealed mucormycosis occluding and invading the basilar artery, which caused fatal brainstem infarction. This case highlights the importance of the opportunistic infection, namely, mucormycosis, which is caused by Mucor.
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Affiliation(s)
- Ryotaro Takashima
- Department of Neurology, Dokkyo Medical University, Kitakobayashi 880, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan
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Kim JS, Cho KH, Kang DW, Kwon SU, Suh DC. Basilar artery atherosclerotic disease is related to subacute lesion volume increase in pontine base infarction. Acta Neurol Scand 2009; 120:88-93. [PMID: 19630153 DOI: 10.1111/j.1600-0404.2008.01124.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although basilar artery atherosclerotic disease (BAD) is frequent in patients with pontine base infarction, it remains unknown whether BAD is related to the lesion size or clinical outcome. METHODS We studied 56 patients with unilateral pontine base infarction who underwent (i) diffusion-weighted MRI within 48 h after stroke onset and (ii) follow-up MRI and MR angiography in the subacute stage. Neurologic progression was defined as increased National Institutes of Health Stroke Scale score by > or = 2 during admission. Clinical outcome was dichotomized as good and poor (> or = 3) according to the modified Rankin Scale at 1 month after stroke onset. RESULTS Twenty-two patients (39%) had BAD and 15 patients (27%) had neurologic progression. Follow-up MRI performed at median 3.5 +/- 1.1 days after the initial MRI showed the lesion volume significantly increased (P < 0.001). The BAD was not significantly related to demographic characteristics, risk factors, initial and follow-up lesion volume, neurologic progression and clinical outcome, but was closely related to the subacute increase in lesion volume (P = 0.004 for 20% increase, P = 0.029 for 50% increase). CONCLUSIONS BAD is related to subacute increase in lesion volume, but not to ultimate poor clinical outcome in patients with pontine base infarction.
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Affiliation(s)
- J S Kim
- Stroke Center and Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
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19
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Stranjalis G, Papavlassopoulos F, Kouyialis AT, Korfias S, Bontozoglou N, Sakas DE. Occult traumatic dissection of vertebral artery with an excellent outcome. Br J Neurosurg 2009; 18:389-91. [PMID: 15702842 DOI: 10.1080/02688690400005222] [Citation(s) in RCA: 2] [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] [Indexed: 10/26/2022]
Abstract
We present the case of a young male with severe head injury, cervico-thoracic fractures, and an initially unrecognized brainstem infarct due to unilateral dissection of vertebral artery, who made an unusually excellent recovery. This report stresses the importance of prompt clinico-imaging diagnosis and prophylactic anticoagulant treatment in such cases.
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Affiliation(s)
- G Stranjalis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece.
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20
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Abstract
BACKGROUND The presence of fixed, dilated pupils after cardiac surgery is an ominous sign, typically indicating severe diffuse hypoxic-ischemic brain injury. Rarely, however, this finding can be seen as a result of focal midbrain ischemia. It is important to differentiate between these syndromes, as the latter might be amenable to acute stroke treatments, and because they affect consciousness very differently. CASE A 46-year-old man with diffuse atherosclerosis underwent coronary artery bypass grafting and closure of an incidentally discovered patent foramen ovale. He underwent neurologic evaluation on post-operative day 6 because he was not speaking and appeared to have a new right hemiparesis. Eye movements, pupillary, and lid function were all normal at this time. MRI showed multiple posterior circulation infarcts, involving both cerebral peduncles. On post-operative day 12, he became unresponsive, quadriplegic, and had bilaterally fixed, dilated pupils. CT showed low attenuation in nearly the entirety of both cerebral peduncles. DISCUSSION Midbrain infarction is rare. Bilateral midbrain infarction is even rarer and typically presents as locked-in syndrome with preservation of pupillary function and at least vertical eye movements. In our review of the literature, we found only three other cases of midbrain infarction associated with bilateral mydriasis. As in our case, these characteristically involved the anteromedial midbrain bilaterally. CONCLUSIONS Fixed, dilated pupils after cardiac surgery can rarely be caused by bilateral anteromedial midbrain infarctions. It is important to differentiate this from the much more common diffuse hypoxic-ischemic injury.
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Affiliation(s)
- Joseph D Burns
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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21
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Adams DM. Ethics consultation and "facilitated" consensus. J Clin Ethics 2009; 20:44-55. [PMID: 19385322] [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: 05/27/2023]
Affiliation(s)
- David M Adams
- Department of Philosophy at California State Polytechnic University-Pomona, USA.
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22
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Mateen F, Rajput A, Toth C, Fladeland D, Wijdicks EFM. A man in the barrel with neck pain. Rev Neurol Dis 2009; 6:E101-E104. [PMID: 19898271] [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: 05/28/2023]
Affiliation(s)
- Farrah Mateen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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24
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Velázquez-Fragua R, Roche-Herrero MC. [Weber's syndrome in a child following surgery to correct displacement of a catheter]. Rev Neurol 2007; 45:764-765. [PMID: 18075992] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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25
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Willey JZ, Prabhakaran S, DelaPaz R. Retroperitoneal infection complicated by bacterial meningitis and ventriculitis with secondary brainstem infarction. Neurocrit Care 2007; 6:192-4. [PMID: 17572862 DOI: 10.1007/s12028-007-0009-9] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Retroperitoneal abscesses have been previously reported to cause infectious meningitis. Cerebral infarction is a known complication of basilar meningitis. SUMMARY OF CASE We present a case where a comatose patient with a known retroperitoneal abscess was diagnosed via Magnetic Resonance Imaging (MRI) with extensive brainstem infarction secondary to basilar meningitis.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Columbia University, 710 West 168th Street, New York, NY 10032, USA.
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26
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Grigoriadis S, Gomori JM, Grigoriadis N, Cohen JE. Clinically successful late recanalization of basilar artery occlusion in childhood: What are the odds? J Neurol Sci 2007; 260:256-60. [PMID: 17482211 DOI: 10.1016/j.jns.2007.03.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [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: 10/13/2006] [Revised: 03/25/2007] [Accepted: 03/29/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Acute basilar artery occlusion is an infrequent but potentially fatal cause of stroke, both in adults and children. We present our experience with a 6-year-old child and we investigate the rationality for late treatment of acute basilar occlusion in children. METHODS We report the case of a 6-year-old boy with acute basilar artery occlusion presented with a full blown locked-in syndrome, admitted to the endovascular suite 44 h after the stroke onset, and we review all the reported cases of basilar artery occlusions presented with locked-in syndrome in children. RESULTS Six hours following admission the basilar artery was partially recanalized by intra-arterial thrombolysis combined with mechanical clot angioplasty. After 12 h, the patient was awake, oriented, his speech function was fully restored and he had only a mild right hemiparesis that recovered completely after a month. CONCLUSIONS To our knowledge, this is the first report of complete clinical recovery after delayed (50 h) endovascular recanalization of basilar artery in a child. Intra-arterial thrombolysis combined with cerebral angioplasty, can successfully restore the patency of the basilar artery and the neurologic deficit of children with acute basilar artery occlusion, even after a considerable delay.
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Affiliation(s)
- Savvas Grigoriadis
- Hadassah Stroke Center, Hadassah University Hospital, Jerusalem, Israel.
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Katchanov J, Bohner G, Schultze J, Klingebiel R, Endres M. Tuberculous meningitis presenting as mesencephalic infarction and syringomyelia. J Neurol Sci 2007; 260:286-7. [PMID: 17588607 DOI: 10.1016/j.jns.2007.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 12/21/2006] [Revised: 05/03/2007] [Accepted: 05/07/2007] [Indexed: 10/23/2022]
Abstract
Cerebral ischaemia is a serious complication of tuberculous meningitis (TBM) with the anterior circulation most commonly affected. Acute syringomyelia is a very rare complication of TBM. Here, we report an unusual presentation of TBM with a third nerve palsy as a result of posterior circulation stroke as well as a syringomyelia.
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Affiliation(s)
- Juri Katchanov
- Department of Neurology, University Hospital Charité Mitte, Charitèplatz 1, 10117 Berlin, Germany.
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Affiliation(s)
- Satoshi Kataoka
- Department of Neurology, Chugoku Rosai Hospital, Hiroshima, Japan.
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Strecker K, Schneider JP, Sabri O, Wegner F, Then Bergh F, Schwarz J, Hesse S. Responsiveness to a dopamine agent in Holmes tremor--case report. Eur J Neurol 2007; 14:e9-e10. [PMID: 17388980 DOI: 10.1111/j.1468-1331.2006.01665.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Suresh S, Berman J, Connell DA. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skeletal Radiol 2007; 36:449-52. [PMID: 17216270 DOI: 10.1007/s00256-006-0215-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 08/14/2006] [Accepted: 08/28/2006] [Indexed: 02/02/2023]
Abstract
A 60-year-old man with a 4-year history of intractable neck pain and radicular pain in the C5 nerve root distribution presented to our department for a CT-guided transforaminal left C5 nerve root block. He had had a similar procedure on the right 2 months previously, and had significant improvement of his symptoms with considerable pain relief. On this occasion he was again accepted for the procedure after the risks and potential complications had been explained. Under CT guidance, a 25G spinal needle was introduced and after confirmation of the position of the needle, steroid was injected. Immediately the patient became unresponsive, and later developed a MR-proven infarct affecting the left vertebral artery (VA) territory. This is the first report of a major complication of a cervical root injection under CT guidance reported in the literature. We present this case report and the literature review of the potential complications of this procedure.
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Affiliation(s)
- S Suresh
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, London, UK.
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Han Z, Leung TW, Lam W, Soo Y, Wong KS. Spontaneous basilar artery dissection. Hong Kong Med J 2007; 13:144-6. [PMID: 17406043] [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: 05/14/2023] Open
Abstract
Dissection of the basilar artery is rare. We report a 51-year-old man who developed acute pontine infarction associated with dissection of the distal basilar artery. There was no trauma or unaccustomed movement of the head and neck prior to the stroke. The dissection was diagnosed non-invasively by magnetic resonance imaging and magnetic resonance angiography. Cervicocerebral artery dissection is a common cause of stroke in young patients particularly when conventional cardiovascular risk factors are absent. Magnetic resonance angiography combined with magnetic resonance imaging is a useful diagnostic tool prior to invasive angiography.
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Affiliation(s)
- Z Han
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Abstract
BACKGROUND In Primary Angiitis of the Central Nervous System (PACNS), disease is typically limited to the brain and spinal cord although other organs may be affected. Uveitis is occasionally seen in systemic vasculitides but is not a recognized manifestation of PACNS. We describe two patients who developed PACNS following the onset of uveitis. CASE DESCRIPTIONS Case 1--a 47-year-old male suffered multiple TIAs and left pontine stroke shortly after two episodes of diffuse uveitis. A cerbral angiogram demonstrated multiple caliber changes within several intracranial vessels. Cyclophosphamide was added after his stroke occurred during pulse methylprednisolone therapy. Case 2--a 35-year-old male suffered a spinal cord TIA followed by hemispheric and brainstem infarctions two months after an episode of uveitis and Bell's palsy treated with oral prednisone. A cerebral angiogram demonstrated multiple caliber changes within several intracranial vessels. He was successfully treated with oral prednisone and cyclophosphamide. CONCLUSIONS Uveitis should be considered a recognized feature of PACNS. Combination immunosuppressive therapy with prednisone and cyclophosphamide may be necessary for successful treatment.
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Affiliation(s)
- A R Woolfenden
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
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Leaver AM, Refshauge KM, Maher CG, Latimer J, Herbert RD, Jull G, McAuley JH. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial. BMC Musculoskelet Disord 2007; 8:18. [PMID: 17324291 PMCID: PMC1810535 DOI: 10.1186/1471-2474-8-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 02/26/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Manipulation is a common treatment for non-specific neck pain. Neck manipulation, unlike gentler forms of manual therapy such as mobilisation, is associated with a small risk of serious neurovascular injury and can result in stroke or death. It is thought however, that neck manipulation provides better results than mobilisation where clinically indicated. There is long standing and vigorous debate both within and between the professions that use neck manipulation as well as the wider scientific community as to whether neck manipulation potentially does more harm than good. The primary aim of this study is to determine whether neck manipulation provides more rapid resolution of an episode of neck pain than mobilisation. METHODS/DESIGN 182 participants with acute and sub-acute neck pain will be recruited from physiotherapy, chiropractic and osteopathy practices in Sydney, Australia. Participants will be randomly allocated to treatment with either manipulation or mobilisation. Randomisation will occur after the treating practitioner decides that manipulation is an appropriate treatment for the individual participant. Both groups will receive at least 4 treatments over 2 weeks. The primary outcome is number of days taken to recover from the episode of neck pain. Cox regression will be used to compare survival curves for time to recovery for the manipulation and mobilisation treatment groups. DISCUSSION This paper presents the rationale and design of a randomised controlled trial to compare the effectiveness of neck manipulation and neck mobilisation for acute and subacute neck pain.
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Affiliation(s)
- Andrew M Leaver
- Back Pain Research Group, Discipline of Physiotherapy, University of Sydney, PO Box 170 Lidcombe NSW 1825 Australia.
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Serrano-Pozo A, Montes-Latorre E, González-Marcos JR, Gil-Peralta A. Cardiac embolism in a Claude's syndrome without involvement of the red nucleus. Eur J Neurol 2007; 14:e1-2. [PMID: 17250704 DOI: 10.1111/j.1468-1331.2007.01501.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kloska SP, Schlegel PM, Sträter R, Niederstadt TU. Causality of pediatric brainstem infarction and basilar artery fenestration? Pediatr Neurol 2006; 35:436-8. [PMID: 17138016 DOI: 10.1016/j.pediatrneurol.2006.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 05/18/2006] [Accepted: 06/19/2006] [Indexed: 11/23/2022]
Abstract
Pediatric arterial thromboembolic stroke is an uncommon condition and rarely is reported to be associated with a cerebral artery fenestration. This clinical report discusses the case of a child with brainstem infarction and basilar artery fenestration. A cardiac source of thromboembolic events could be excluded; however, detailed coagulation analysis revealed in addition an apoliopoprotein(a) size polymorphism. Because we assume that the two concurrent pathologies in combination caused the arterial thromboembolic stroke, the evaluation of all potential triggers including vascular anomalies and coagulation disorders should be considered in unexplained pediatric infarction.
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Affiliation(s)
- Stephan P Kloska
- Department of Clinical Radiology, University of Muenster, Muenster, Germany.
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Roth J, Margalit NS, Kesler A, Korn A, Ram Z. Peri-operative brainstem infarct in a patient with antiphospholipid antibody (APLA) syndrome. Acta Neurochir (Wien) 2006; 148:1111-4; discussion 1115. [PMID: 16944054 DOI: 10.1007/s00701-006-0869-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 08/20/2005] [Accepted: 06/28/2006] [Indexed: 11/30/2022]
Abstract
Antiphospholipid antibody (APLA) syndrome is a major risk factor for arterial and venous thrombosis. Surgical risks in patients known to suffer from APLA syndrome are usually related to haemorrhage or to thrombo-embolic events, such as deep venous thrombosis and pulmonary emboli. The rare published reports of patients with APLA syndrome undergoing neurosurgical procedures relate to haemostatic complication, with none alerting to the peri-operative risk of stroke in these patients. We present a case of a peri-operative stroke in a patient undergoing resection of a foramen magnum meningioma. We discuss the association of peri-operative stroke and APLA syndrome and emphasize the high risk it imposes for neurosurgical procedures in these patients. In addition, we suggest an anticoagulation treatment algorithm for APLA syndrome patients undergoing craniotomies.
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Affiliation(s)
- J Roth
- Neurosurgical Department, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Sawlani V, Behari S, Salunke P, Jain VK, Phadke RV. “Stretched loop sign” of the vertebral artery: a predictor of vertebrobasilar insufficiency in atlantoaxial dislocation. ACTA ACUST UNITED AC 2006; 66:298-304; discussion 304. [PMID: 16935639 DOI: 10.1016/j.surneu.2006.02.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 08/20/2005] [Accepted: 02/02/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vertebrobasilar territory infarction is one of the rarer presentations of CVJ anomalies. A new radiologic sign due to stretching of the short third segment of VA detected on MRA/DSA may identify patients of AAD at risk of developing VBI. METHODS Seven patients who presented with VBI were found to have a coexisting mobile (n = 6) or fixed (n = 1) AAD. None of these patients had the presence of any of the known risk factors for cerebrovascular disease. On identification of VBI on CT/MRI, DSA (n = 7) and MRA (n = 1) were performed to assess bilateral vertebral arteries. The course of normal VA was also studied in 5 control patients without AAD or VBI. RESULTS Digital subtraction angiography/MRA showed obstruction of VA at the C1 through C2 level on one side in each of these cases. The third segment of the contralateral VA showed a shortened and straighter loop termed as the stretched loop sign of the VA. On DSA, the latter manifested as (a) opening of the distal loop of the VA as it emerges from the foramen transversarium of the atlas and traverses on the dorsum of the posterior arch of atlas (n = 3), (b) shortened and stretched VA that runs laterally and posteriorly forming the proximal loop after emerging from the foramen transversarium of the axis (n = 2), or (c) both (n = 2). All patients presented with the clinical manifestations of VBI. Only 2 of these had preexisting myelopathy and long tract signs conventionally attributable to AAD. CONCLUSION Vertebrobasilar territory infarction in AAD may occur because of the obstruction of the third segment of VA. A shorter and straighter loop of the third segment of VA coexisting with an abnormal translational mobility between the atlas and the axis may be the etiopathogenetic factor.
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Affiliation(s)
- Vijay Sawlani
- Department of Neuroradiology, Morriston Hospital, Swansea, SA6 6NL, UK
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Simsek S, Yigitkanli K, Belen D, Bavbek M. Halo traction in basilar invagination: technical case report. ACTA ACUST UNITED AC 2006; 66:311-4; discussion 314. [PMID: 16935643 DOI: 10.1016/j.surneu.2005.12.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 11/24/2005] [Accepted: 12/19/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the management of basilar invagination, traction therapy may help by pulling down the odontoid process away from the brain stem that may result in clinical and radiological improvement. We aimed to discuss the role of the halo vest apparatus traction on the reduction of severe anterior compression pathologies in basilar invagination. CASE DESCRIPTION We describe a simple and safe cervical traction method by the halo vest apparatus that is followed by rigid posterior occipitocervical fixation and foramen magnum decompression in a patient who presented with basilar invagination and symptoms of severe brain stem compression. An MR-suitable halo vest apparatus was used for reduction of the deformity. The reduction of the basilar invagination was achieved gradually by distracting the halo crown in stages. CONCLUSION The halo vest apparatus can be safely used in complex craniocervical junction anomalies. An effective cervical traction can be performed in basilar invagination, and reduction of the deformity may be achieved without the risk of overdistraction. In some cases, even partial reduction of the deformity may facilitate brain stem and spinal cord relief without any need of posterior decompression. Patients may benefit from ambulatory functions because bed rest is eliminated in this procedure. Neurovascular structures and the degree of the reduction can be observed on MRIs when an MR-suitable device is used.
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Affiliation(s)
- Serkan Simsek
- Neurosurgery Department, Ministry of Health, Diskapi Educational and Research Hospital, Ankara 06110, Turkey
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Sviri GE, Britz GW, Lewis DH, Ghodke B, Mesiwala AH, Haynor DH, Newell DW. Brainstem hypoperfusion in severe symptomatic vasospasm following aneurysmal subarachnoid hemorrhage: role of basilar artery vasospasm. Acta Neurochir (Wien) 2006; 148:929-34; discussion 934-5. [PMID: 16826319 DOI: 10.1007/s00701-006-0802-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 09/01/2005] [Accepted: 05/02/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The hemodynamic effects of vertebrobasilar vasospasm are ill defined. The purpose of this study was to determine the effects of basilar artery (BA) vasospasm on brainstem (BS) perfusion. METHODS Forty-five patients with delayed ischemic neurological deficits (DIND) following aneurysmal subarachnoid hemorrhage (SAH) underwent cerebral angiography prior to decision-making concerning endovascular treatment. BA diameter was compared with baseline angiogram. Regional brainstem (BS) cerebral blood flow (CBF) was qualitatively estimated by (99m)Tc ethyl cysteinate dimer single photon emission computed tomography (ECD-SPECT). FINDINGS Delayed BS hypoperfusion was found in 22 (48.9%) of 45 patients and BA narrowing of more than 20% was found in 23 (51.1%). Seventeen of 23 (73.9%) patients with BA narrowing of more than 20% experienced BS hypoperfusion compared to 6 of 22 (27.3%) patients with minimal or no narrowing (p = 0.0072). Patients with severe and moderate BS hypoperfusion had higher degree of BA narrowing compared to patients with normal BS perfusion and mild BS hypoperfusion (p < 0.001). The three-month outcome of patients n-22) with BS hypoperfusion was significantly worse compared to patients (n-23) with unimpaired (p = 0.0377, odd ratio for poor outcome 4, 1.15-13.9 95% confidence interval). INTERPRETATION These findings suggest that the incidence of BA vasospasm in patients with severe symptomatic vasospasm is high and patients with significant BA vasospasm are at higher risk to experience BS ischemia. Further studies should be done to evaluate the effects of endovascular therapy on BS perfusion and the impact of BS ischemia on morbidity and mortality of patients with severe symptomatic vasospasm.
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Affiliation(s)
- G E Sviri
- Department of Neurosurgery, Rambam (Maimonides Medical Center), Haifa, Israel.
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Vaishya S, Ramesh T. Spontaneous relapsing and recurring large multiloculated posterior fossa enteric cyst. Acta Neurochir (Wien) 2006; 148:985-8. [PMID: 16791436 DOI: 10.1007/s00701-006-0798-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 09/15/2005] [Accepted: 04/18/2006] [Indexed: 11/28/2022]
Abstract
Intracranial enterogenous cyst is an uncommon entity. We report a case of enterogenous cyst of the posterior fossa situated posterolateral to the brain stem and extending into the left CP angle cistern. Patient had spontaneous regression and recurrence of the cyst. Clinical features and radiological findings are described. Near total excision of the cyst was carried out through the retro mastoid route. Patient made a good postoperative recovery.
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Affiliation(s)
- S Vaishya
- Max Institute of Neurosciences, Max Superspeciality Hospital, New Delhi, India.
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Abstract
BACKGROUND AND PURPOSE Sildenafil citrate has been shown to enhance neurogenesis, angiogenesis, synaptogenesis, and neurological outcome by augmentation of cyclic guanosine monophosphate (cGMP) levels in animal models of ischemic stroke. Whether sildenafil citrate may be helpful for recovery in human stroke is unknown at this time. METHODS A 41-year-old woman with locked-in syndrome due to pontine infarction began receiving 150 mg of oral sildenafil citrate daily on a compassionate use basis in August 2003 and continues treatment at this time. Magneto-encephalography (MEG) was performed at 12 and 17 months after stroke. RESULTS No serious adverse events have occurred. Significant milestone recoveries including standing, use of both arms, talking, and full return of swallowing have occurred, particularly after nine months of treatment. The MEG showed a significantly increased amplitude in the somatosensory cortex. CONCLUSION Daily use of high dose sildenafil citrate appears to be safe in this patient with stroke resulting in locked-in syndrome. Further studies will be required to establish safety and efficacy.
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Affiliation(s)
- Brian Silver
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan 48202, USA
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Martin DP, Jankowski CJ, Keegan MT, Torsher LC. Postoperative coma in a patient with complete basilar syndrome after anterior cervical discectomy. Can J Anaesth 2006; 53:738. [PMID: 16803926 DOI: 10.1007/bf03021636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Foerch C, Berkefeld J, Halbsguth A, Ziemann U, Neumann-Haefelin T. Brain stem infarction caused by proximal internal carotid artery stenosis in a patient with a persisting primitive trigeminal artery. Cerebrovasc Dis 2006; 22:200-2. [PMID: 16766871 DOI: 10.1159/000093808] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2004] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christian Foerch
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Ahmed N, Riazn A, Shuaib A, Siddiqi Z. Foville's syndrome masquerading as Wernicke's encephalopathy. N Z Med J 2006; 119:U1928. [PMID: 16633387] [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: 05/08/2023]
Affiliation(s)
- Nizam Ahmed
- University of Alberta Hospital, Edmonton, Alberta, Canada.
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Dickerman RD, Morgan B. Re: Poor surgical technique in cervical plating leading to vertebral artery injury and brain stem infarction--case report (Cho KH, Shin YS, Yoon SH, et al, Surg Neurol 2005;64:221-5). Surg Neurol 2006; 65:317-8; author reply 318-9. [PMID: 16488269 DOI: 10.1016/j.surneu.2005.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Indexed: 05/06/2023]
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Tsai YF, Doufas AG, Huang CS, Liou FC, Lin CM. Postoperative coma in a patient with complete basilar syndrome after anterior cervical discectomy. Can J Anaesth 2006; 53:202-7. [PMID: 16434763 DOI: 10.1007/bf03021828] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Ischemic brainstem stroke resulting from occlusion of the basilar artery during cervical spine surgery in a previously asymptomatic patient is a rare event. We report the development of a large ischemic brainstem stroke, resulting from occlusion of the basilar artery during anterior cervical discectomy, in a patient without previous neurological deficit, or signs of vertebrobasilar insufficiency. CLINICAL FEATURES A 55-yr-old, diabetic and hypertensive male who developed a cervical spine infection, underwent surgery for anterior discectomy at C5-C6. During the 2.5-hr long procedure the patient was lying supine with his neck hyperextended. Except for a temporary reduction in systolic blood pressure, the intraoperative course was uneventful. At the end of surgery the patient remained unconscious with flaccid paralysis in all extremities, fixed pinpoint pupils, low respiratory rate, and no response to painful stimuli. Naloxone administration did not improve the clinical picture, while brain computed tomography showed a large brainstem and cerebellar stroke, implicating basilar artery occlusion. The patient died five days later from stroke complications. Intraoperative surgical manipulation with a severely inflamed vertebral system, as well as prolonged neck hyperextension occluding the blood flow of vertebrobasilar arteries might have contributed to fatal brainstem stroke in this patient. CONCLUSION Neck surgery carries a potential risk for posterior circulation stroke, and this report heightens awareness of this rare, but serious complication.
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Affiliation(s)
- Yung-Fong Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Tao Yuan, Taiwan
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