PubMed · 8414062
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M P Berger, J J Rams, D A Davis, M P Spencer. 1993. Asymptomatic microemboli.. https://doi.org/10.1212/wnl.43.9.1865
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BACKGROUND: Currently to an increasing extent aggressive therapeutic approaches in ischemic stroke are discussed. These approaches include intraarterial and systemic thrombolysis to reduce infarction size and also decompressive surgical measures to prevent from fatal consequences of elevated intracranial pressure. This report gives an overview over these strategies. Their specific values are discussed. STRATEGIES: In acute vertebrobasilar artery occlusion an attempt of intraarterial thrombolysis is indicated because of the mostly poor prognosis of large brainstem infarction. Acute artery occlusion in carotid territory has a better prognosis, so that the indication of intraarterial thrombolysis has to be regarded more critically. In view of recent reports systemic rt-PA-thrombolysis seems to be justified in well defined cases independently from site of occlusion. At present there is no longer doubt about the benefit of decompressive surgery in space occupying cerebellar stroke. The value of surgery in malignant brain infarction in carotid territory is not clear due to date. Further randomised studies are necessary to learn more about benefit, risks and required proceedings in space occupying supratentorial infarction. CONCLUSIONS: A well defined group of patients suffering from ischemic stroke seems to benefit from aggressive therapeutic approaches in ischemic stroke. Concerning the selection of patients and management of those approaches a close cooperation with an experienced center is required.
We report on a patient who developed primary position upbeat nystagmus (ppUBN) due to a unilateral medial medullary infarction. On oculography, the slow phases of the nystagmus sometimes had an exponentially decreasing velocity waveform, indicating that the nystagmus was due to impairment of the vertical position-to-velocity neural integrator. On magnetic resonance imaging, the lesion was caudal to the vestibular nuclei and to the most rostral of the perihypoglossal nuclei, the nucleus intercalatus, a structure that was also involved in a previously reported case of ppUBN due to a unilateral medullary lesion. On the basis of these imaging and oculographic observations, we propose that a unilateral lesion of the nucleus intercalatus is sufficient to cause ppUBN and that the nucleus intercalatus is a part of the vertical position-to-velocity neural integrator in the human ocular-motor system.
Lesions of the visual system do not necessarily lead to deficits in visual function. In some cases, there may even occur Positive Spontaneous Visual Phenomena (PSVP) following cerebral damage. We present data from a male patient with continuous, long-term visual illusions after having experienced cerebral infarction at the age of 56. Basing on conventional Magnetic Resonance Imaging, lesions could be located in areas supported by the lateral and medial occipital artery. Initially, homonymous hemianopsia of the right visual field was found in perimetric examinations, but in the course of six months, visual function recovered completely. Ever since the incident, the patient has been suffering from permanent photopsia, intense colourful visual hallucinations and perseverations located in the former defective area which continued unabated even after the remission of his visual field defects. While many authors have published data on PSVP lasting for several seconds, usually vanishing completely within days or weeks after cerebral lesion, in our patient the symptoms continued over a period of so far nine months. Surprisingly, he was even able to make drawings of his illusions so that we were able to include some of his pictures.