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At least 415 records · Page 23Linked to original sources
PubMed2006

Brainstem hypoperfusion in severe symptomatic vasospasm following aneurysmal subarachnoid hemorrhage: role of basilar artery vasospasm.

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.

Adult↗
PubMed2005

Pregnancy, patent foramen ovale and stroke: a case of pseudoperipheral facial palsy.

The pathogenetic role of patent foramen ovale (PFO) in embolic stroke and its prognostic and therapeutic implications have not yet been clearly defined. Nonetheless, recent availability of non-invasive diagnostic techniques, such as the transcranial Doppler (TCD), has increased the frequency with which this anomaly is diagnosed. Here we present the case of a young woman affected by post-partum peripheral facial palsy: further exams disclosed not only its truncal-ischaemic origin, but also, significantly, the presence of PFO, as well as of anticardiolipin antibodies (acL). Given the increased embolic risk in labouring women, this study highlights the importance of searching for PFO in case of a stroke during pregnancy.

Adult↗
PubMed2001

Early thrombolysis in stroke due to basilar artery occlusion.

Basilar artery occlusion is usually associated with a poor prognosis. Nevertheless, intra-arterial thrombolysis has been shown to improve clinical outcome in selected cases. We report the case of a 29-year-old patient who suffered a severe ischemic stroke due to basilar artery occlusion and who was treated with intra-arterial thrombolysis within 3 h of symptoms onset; treatment was followed by an almost full functional recovery. The young age of the patient, short segment occlusion in the middle tract of the artery, good collateral supply, and early recanalization may account for the favorable prognosis.

Adult↗
PubMed2005

Odontoid compression of the brainstem without basilar impression-- "odontoid invagination".

We report five patients with odontoid invagination, in which the odontoid process bulges upward into the foramen magnum and compresses the brainstem without deformity of the occipital bone. Two patients had a craniovertebral abnormality associated with Chiari malformation without instability of the craniovertebral junction (stable odontoid invagination). The other three patients had dislocation of the craniovertebral junction due to iatrogenic destruction of the occipital condyle, rheumatoid arthritis or an anomaly of C2 (unstable odontoid invagination). Patients with stable odontoid invagination underwent a transoral odontoidectomy followed by occipitocervical fixation. Those with unstable odontoid invagination underwent cervical traction followed by posterior fixation in reducible cases, while in irreducible cases odontoidectomy with subsequent occipitocervical fixation was performed. Decompression of the neuraxis together with symptomatic improvement was achieved in all patients and none became unstable or developed new symptoms during follow-up ranging from 3 to 15 years.

Adult↗
PubMed2006

Diagnostic value of vestibular evoked myogenic potentials in cerebellar and lower-brainstem strokes.

BACKGROUND: Vestibular evoked myogenic potentials (VEMPs) provide assessment of vestibular function. They consist in picking up compound muscle action potentials in the sternocleidomastoid (SCM) muscles in response to auditory stimulation of the vestibulum. VEMP testing has found application mainly in peripheral vestibular disorders, whereas reports about VEMPs in central vestibular lesions are rather scarce. AIMS OF THE STUDY: Based on the physiological connections between the cerebellum and the vestibular nuclei, we investigated the influence on VEMPs of cerebellar and lower-brainstem strokes. We examined whether or not this method may be suitable as a clinical tool for the evaluation of the extent of cerebellar strokes. PATIENTS AND METHODS: Nineteen patients with cerebellar ischemic stroke and 15 patients with lower-brainstem ischemic stroke (11 in the pons, four in the medulla) were included. The latencies and amplitudes of P13 and N23 in both groups of patients were compared with those obtained in a control group of 53 normal individuals. RESULTS: VEMP responses were obtained in all patients and controls. At the group level, mean peak latencies and amplitudes, and the number of subjects with significantly deviant values did not differ between patients and controls. There were no latency or amplitude differences ipsilaterally or contralaterally to the lesion. At the individual level, there was no correlation between laterality of lesion and that of P13 or N23 abnormalities in patients with cerebellar strokes; however, there were two patients (one pontine, one medullar stroke) who presented P13 and N23 latency abnormalities ipsilaterally to the lesion. CONCLUSION: Cerebellar strokes do not influence VEMPs. Moreover, despite previous reports, we were unable to find at a group level any statistically significant VEMP changes in patients with lower-brainstem strokes as compared with controls. Therefore, VEMPs do not appear a suitable tool for assessment of brainstem integrity in patients with posterior fossa strokes. However, they could constitute a sensitive method for documentation of involvement of the central vestibular pathways in patients with brainstem stroke.

Acoustic Stimulation↗
PubMed2005

Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: case report.

BACKGROUND: The authors present a patient who experienced late (5-year follow-up) morphological progression of a dissecting aneurysm of the distal basilar artery after treatment with a combined microsurgical and neuroendovascular Hunterian strategy. In addition to postulating about the possible reasons underlying the evolution of this lesion, the role of stenting is discussed. CASE DESCRIPTION: The patient was 37 years old when she suffered a subarachnoid hemorrhage from spontaneous basilar artery dissection. At the time of the hemorrhage, minimal aneurysmal enlargement was noted angiographically, and she was therefore treated nonoperatively. On reimaging 5 months later, massive enlargement of the aneurysm was noted. The patient was treated with staged bilateral vertebral artery sacrifice using a combination of microsurgical and neuroendovascular techniques. The dominant vertebral artery was clip-ligated distal to the posteroinferior cerebellar artery, whereas the contralateral vertebral artery was coil-occluded cervically 1 week later. CONCLUSIONS: Despite the patient remaining asymptomatic, follow-up angiography 5 years after the initial hemorrhage revealed further enlargement of the aneurysm as well as a newly discovered inferiorly projecting daughter sac measuring 5 mm in diameter. Clearly, certain aneurysms exist for which indirect approaches involving hemodynamic attenuation fail to prevent progression. With greater refinements in stent technology, such lesions may be more effectively treated.

Adult↗
PubMed2005

Transarterial coil embolization of a high-flow vertebrojugular fistula due to penetrating craniocervical trauma: case report.

BACKGROUND: Vertebrojugular fistulas after penetrating cervical trauma (gunshot or stab wounds) are rarely reported. Successful endovascular coil embolization of an acute fistulizing vertebral artery pseudoaneurysm involving an obstructed internal jugular vein is presented and the various treatment strategies for such a lesion are described. CASE DESCRIPTION: A 23-year-old man presented from an outside institution after sustaining 2 gunshot wounds in a civilian conflict. Neuroimaging revealed a right vertebral artery pseudoaneurysm, which formed a fistulous connection with the internal jugular vein. Because venous outflow obstruction was present just below the fistula, a high-flow shunt was directed intracranially. Both the pseudoaneurysm and arteriovenous fistula were accessed percutaneously via a transfemoral route and coil embolization was performed. Perfusion of the basilar artery circulation was assumed by the contralateral vertebral artery. The ipsilateral posteroinferior cerebellar artery filled through retrograde flow down the vertebral confluence. CONCLUSIONS: Coil embolization is a safe and reliable strategy by which to obliterate an acute traumatic vertebrojugular fistula as well as pseudoaneurysm. Serial angiographic follow-up is mandatory to document a persistent cure.

Adult↗
PubMed2005

Endovascular management of exsanguinating vertebral artery transection.

BACKGROUND: Vertebral artery (VA) transection is a rarely described entity that may present dramatically with a life-threatening external hemorrhage. CASE DESCRIPTION: A 25-year-old man that was victim of a terrorist attack presented a gunshot wound to the mouth with massive bleeding. The bullet perforated the oropharynx and injured the right VA. Combined antegrade and retrograde endovascular embolization by means of detachable coils allowed rapid control of the bleeding. CONCLUSION: Bleeding related to VA transection can be managed safely by means of endovascular combined approaches.

Adult↗
PubMed2006

Halo traction in basilar invagination: technical case report.

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.

Atlanto-Axial Joint↗
PubMed2005

Pleomorphism of the clinical manifestations of neurocysticercosis.

Neurocysticercosis (NCC) remains a major public health problem in developing countries as it is the most common helminthic infection of the central nervous system. Clinical manifestations are non-specific and pleomorphic. Case reports on uncommon presentations of NCC are few. We report six interesting cases of NCC with unusual clinical presentation that demonstrate this spectrum of pleomorphism. These include extrapyramidal disease (parkinsonism and focal dystonia), Kluver-Bucy syndrome, Weber's syndrome, dementia and cortical blindness. The clinical details and possible mechanisms for the uncommon presentations are also discussed. Thus, a high level of suspicion should be kept for NCC, especially in endemic zones and developing countries.

Adult↗
PubMed2006

[Acute bilateral deafness and facial diplegia as a presentation of occlusion of the basilar artery].

INTRODUCTION: Sudden bilateral deafness and facial weakness are unusual presentations of brain stem stroke. OBSERVATION: We report the case of a patient who presented successively sudden bilateral deafness and facial diplegia in correlation with a brain stem stroke but without any ischemic pontine lesion. DISCUSSION: Unlike our case, all of the earlier publications, have reported the presence of ischemic pontine lesions in patients with bilateral deafness and facial diplegia. Selective vulnerability of inner ear to ischemia has been hypothesized but cannot explain the facial diplegia. CONCLUSION: Our case would suggest extra-neuraxis failure by ischemia of the acoustico-facial nerve.

Acute Disease↗
PubMed1999

Ondine's curse in association with diabetes insipidus following transient vertebrobasilar ischemia.

Ischemic lesions of the brainstem can lead to complex neurologic deficits. Failure of the automatic control of ventilation (Ondine's curse syndrome) is a possible but rare syndrome following localized brainstem dysfunction. We report on a 49-year-old man with intermittent bradycardia, cranial nerves' dysfunctions and a slight right-sided hemiparesis. An acute brainstem ischemia was diagnosed and treated immediately with high-dose heparin. Cerebral angiography revealed a proximal occlusion of the left vertebral artery but a normal right vertebral artery and a hyperplastic right posterior inferior cerebellar artery. Cranial Computed Tomography and MRI scan demonstrated multiple ischemic lesions in the posterior circulation. During a 4-week treatment course the patient underwent six episodes of acute severe hypoxia and hypercapnia requiring orotracheal intubation twice and manual ventilation by air mask over a few minutes for four times after a tracheostomy had been performed. Twice a short-term episode of hypothalamic Diabetes insipidus was observed following hypoventilation. We conclude that both Ondine's curse syndrome and diabetes insipidus were due to transient vertebrobasilar ischemia.

Brain Stem Infarctions↗