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Results for “Brain Stem Infarctions”

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PubMed1988

[Meningovascular syphilis. Apropos of 4 cases].

In four cases of stroke, it is only the systematic practice of serologic tests for syphilis that has permitted the true diagnosis and the true treatment. We observed cerebral, brain-stem and medullar infarction and one case of cerebellar haemorrhage. Meningo vascular syphilis is now the most frequent of the central nervous system lesion. Cerebrospinal fluid is always abnormal in active disease. The decrease of cell count is the best control of the treatment that needs high doses of Penicillin G.

Aged↗
PubMed1986

Rupture of posterior inferior cerebellar artery by single blow to head.

Two cases of isolated traumatic subarachnoid hemorrhage from the posterior inferior cerebellar artery are described. The rupture was caused in one instance by a fist blow to the face and in the other by a kick to the head. One patient survived for three days, the other patient for three weeks. In the latter patient, intimal fibrosis was progressing and the brain stem was partly infarcted. Necrosis and fragmentation of the wall adjacent to the rupture suggested both devitalization due to stretching and jarring as pathogenetic mechanisms. These lesions can be distinguished from berry aneurysms by their location along the trunk of the artery instead of in the fork of the bifurcation, by the lack of a fibrous aneurysmal sac, and often by fragmentation of the arterial wall at the edge and also near and opposite the rupture.

Arteries↗
PubMed1981

[Occlusion of the basilar artery. A review with 17 personal cases (author's transl)].

Occlusion of the basilar artery is mainly of atherosclerotic origin; embolic occlusion, dissecting aneurysm, trauma and arteritis are less frequent. Pathologic and angiographic findings allow to classify basilar artery occlusions in three types: segmental (superior, medial or inferior), plurisegmental and extensive. The infarcted areas involve brain stem, especially pons and cerebellum, also diencephalon and cerebral hemispheres, in various combinations. Clinically, there is typically a prodromic stage, with transient ischemic attacks (vertigo, headaches, visual disturbances, motor deficit). Few weeks later, a decreased level of consciousness and motor anomalies are the most important signs. A fatal outcome is noted in 85,98 p. 100. Among laboratory examinations, only angiography proves the occlusion: it also shows the arterial supply (carotido-basilar reflux; inter-cerebellar anastomosis). Computed tomography usually eliminates an expanding mass of the posterior fossa. Management is only of general type. Surgical management of carotid arteries stenosis may ameliorate the anastomotic flow.

Arterial Occlusive Diseases↗
PubMed1998

[Headache, general malaise and left-side ptosis].

A 82-year-old female was admitted to hospital because of deteriorated general condition, severe diffuse headache and complete left-sided ptosis. A computed tomography scan of the head revealed no subarachnoid haemorrhage. Based on the hypothesis that the symptoms resulted from an infarction in the brain stem, the previous medication with Aspirin was continued. After repeated vomitus hypotensive dehydration developed and was adequately treated. Because of confusion, elevated white blood counts and signs of meningism, a spinal puncture was performed. Only the serology for Borrelia-IgG was positive, therefore the patient received Rocephin. During treatment only the ptosis persisted, therefore the substitution with sodium and the medication with Prednisone were stopped. Afterwards the symptoms reappeared and the laboratory results showed insufficiency of the pituitary. A magnetic resonance scan showed a microadenoma of the pituitary with local bleeding. Nine months after pituitary apoplexy, with hormonal substitution only a divergent strabism on the left side persisted. Clinical findings, course and therapy of pituitary apoplexy are discussed.

Aged↗
PubMed1981

Neurologic complications of coronary artery bypass grafting: case-control study.

In a retrospective case-control study, we identified 18 patients who had neurologic symptoms associated with coronary artery bypass grafting, or 1.3% of all patients who had this operation. Cerebral infarction and anoxic encephalopathy accounted for almost all the complications. The overall mortality was 33%, higher among those with an intraoperative compared with a postoperative deficit. Prior cerebrovascular risk factors as well as intraoperative hypotension were no more prevalent in patients with complications than in age-matched controls who had the same operation.

Brain Stem↗
PubMedDate not supplied

Secondary brain stem hemorrhage in stroke.

The occurrence of secondary brain stem hemorrhage was studied in 435 autopsies from patients with recent cerebral hemorrhage, infarction or ruptured cerebral aneurysms. The frequency of secondary brain stem hemorrhage was found to be 45% in cerebral hemorrhage, 15% in cerebral infarction, and 36% in ruptured aneurysms. In the majority of cases the secondary brain stem hemorrhage occurred a few days after the onset of cerebral hemorrhage or infarction. Ruptured aneurysms showed a more widespread temporal distribution of secondary brain stem hemorrhage. The median survival time was 2 days in cases of cerebral hemorrhage, 4 days in ruptured aneurysm and 4 days in cerebral infarction. The frequency of secondary brain stem hemorrhage was significantly lower in patients younger than 20 years. No significant difference was found in its distribution between the sexes. Secondary occipital lobe infarction was present in 3.5% of the patients. It is concluded that secondary brain stem hemorrhage is a common major contribution to the cause of death in stroke.

Adolescent↗
PubMed1984

Visualization of brain infarction with nuclear magnetic resonance imaging.

Nine patients with cerebral or cerebellar hemispheric infarction and two patients with brain stem lesions were studied with NMR imaging in order to examine the lesion with different weightings on the various NMR parameters. The time interval between examination and the acute onset of the stroke varied from one day to six months. The lesions were clearly detected by the T1 weighted inversion recovery sequence but the tissue contrast was better using the spin echo sequence with a long repetition rate and a long echo delay (SE2000/100). In two patients the brain stem lesions were invisible with CT, but were easily depicted with NMR. In one of them the further progress of the lesion was also confirmed and visualized with the follow-up NMR study.

Adult↗
PubMed2001

Clinical study of vestibular-evoked myogenic potentials and auditory brainstem responses in patients with brainstem lesions.

A total of 13 patients, who were diagnosed with localized brainstem lesions using MRI, were investigated. The diagnoses were multiple sclerosis in five patients, brainstem hemorrhage in three patients, pontomedullary infarction in one patient and Wallenberg's syndrome in four patients. In addition, 42 ears of 21 normal adult volunteers were also examined. In a patient with upper brainstem lesions mainly affecting the midbrain, the auditory brainstem response (ABR) was abnormal but the vestibular-evoked myogenic potential (VEMP) was normal. In four patients with middle brainstem lesions which mainly affected the pons, both ABR and VEMP were abnormal. In five patients with lower brainstem lesions which mainly affected the medulla, the ABR was normal but the VEMP was abnormal. In those patients with middle-to-lower brainstem lesions, a disappearance of VEMP reactions, delay of the positive-negative (PN) wave, increase in PN interpeak latency and decrease in PN amplitude on the affected side were confirmed. In conclusion, the VEMP test comprises a useful new diagnostic method for identifying lower brainstem lesions.

Adolescent↗
PubMed1989

[Topography and structure of secondary brain damage in edema associated with supratentorial foci of encephalomalacia].

The paper comprises 70 cases of extensive supratentorial infarctions. The topography and structure of secondary lesions occurring in the region of herniation and displacements caused by the coexisting brain edema were analysed. The extent of edema served as criterion in the division of the material into three groups in dependence on the occurrence of herniations and displacements. Most frequent was herniation of hippocampal uncus and most rare that of the cerebellar vermis. In group I showing no herniations selective necrosis was noted of neurons particularly sensitive to ischemia and anoxia, especially in Sommer's sector of the hippocampus. In group II secondary necrosis was visible in the regions of herniae, and in the group III also in the translocated deep brain structures in the hemisphere contralateral to the infarct and in the brain stem where, moreover, secondary hemorrhages were present. Supratentorial secondary hemorrhages were less frequent. They were noted in the thalamus both on the side of the infarct and in the contralateral hemisphere. Supratentorial necroses were more frequent. Their intensity varied from selective necrosis to Jacob's edematous necrosis. Severe displacement of deep structures and of the brain stem was associated with development of secondary internal hydrocephalus, especially in the hemisphere contralateral to the herniation. To the most important pathogenetic factors causing development of secondary morphological lesions belong disturbances of blood supply occurring as the result of pressure differences between the supra- and infratentorial space, resulting from pressure and displacement of arterial vessels, damage of their walls and distrubances of venous flow and also development of secondary internal hydrocephalus. Extensive necroses and hemorrhages increase the area of primary necrosis. Lesions resulting from herniation, displacement and compression of vessels were superposed on the picture of brain edema both present or passed. Secondary necroses damaging bilaterally structures belonging to the limbic system and reticular formation may be an additional factor in the development of edematous encephalopathy and the development of a psychoorganic syndrome after stroke.

Adult↗
PubMed2001

Intranuclear ubiquitin immunoreactivity in the pigmented neurons of the substantia nigra in fire fatalities.

To evaluate the significance of immunohistochemical staining of ubiquitin (heat shock protein) in the midbrain for medico-legal investigation of death in fires, we examined forensic autopsy cases of fire fatalities (n = 35) in comparison with controls (n = 27; brain stem injury, acute myocardial infarction and carbon monoxide poisoning other than fire fatality). There were two intranuclear staining patterns in the nuclei of pigmented substantia nigra neurons: a type of inclusion (possible Marinesco bodies) and a diffuse staining. Percentage of nuclear ubiquitin positivity (Ub-positive %) in fire fatalities (2.7-44.7%; mean, 18.5%) was significantly higher than in brain stem injury (n = 9; 0-10.4%; mean, 4.5%) and myocardial infarction (n = 14; 1.5-14.6%; mean, 6.9%), independently of blood carboxyhemoglobin (COHb) levels. Age-dependent increase in Ub-positive % was observed in lower COHb (< 60%) cases. The intranuclear diffuse ubiquitin staining was not observed in cases of high blood cyanide level (> 1.0 microg/ml). These observations showed that intranuclear ubiquitin immunoreactivity of the pigmented substantia nigra neurons in the midbrain was induced by severe stress in fires.

Aged↗
PubMed2005

I.V. infusion of brain-derived neurotrophic factor gene-modified human mesenchymal stem cells protects against injury in a cerebral ischemia model in adult rat.

I.V. delivery of mesenchymal stem cells prepared from adult bone marrow reduces infarction size and ameliorates functional deficits in rat cerebral ischemia models. Administration of the brain-derived neurotrophic factor to the infarction site has also been demonstrated to be neuroprotective. To test the hypothesis that brain-derived neurotrophic factor contributes to the therapeutic benefits of mesenchymal stem cell delivery, we compared the efficacy of systemic delivery of human mesenchymal stem cells and human mesenchymal stem cells transfected with a fiber-mutant F/RGD adenovirus vector with a brain-derived neurotrophic factor gene (brain-derived neurotrophic factor-human mesenchymal stem cells). A permanent middle cerebral artery occlusion was induced by intraluminal vascular occlusion with a microfilament. Human mesenchymal stem cells and brain-derived neurotrophic factor-human mesenchymal stem cells were i.v. injected into the rats 6 h after middle cerebral artery occlusion. Lesion size was assessed at 6 h, 1, 3 and 7 days using MR imaging, and histological methods. Functional outcome was assessed using the treadmill stress test. Both human mesenchymal stem cells and brain-derived neurotrophic factor-human mesenchymal stem cells reduced lesion volume and elicited functional improvement compared with the control sham group, but the effect was greater in the brain-derived neurotrophic factor-human mesenchymal stem cell group. ELISA analysis of the infarcted hemisphere revealed an increase in brain-derived neurotrophic factor in the human mesenchymal stem cell groups, but a greater increase in the brain-derived neurotrophic factor-human mesenchymal stem cell group. These data support the hypothesis that brain-derived neurotrophic factor contributes to neuroprotection in cerebral ischemia and cellular delivery of brain-derived neurotrophic factor can be achieved by i.v. delivery of human mesenchymal stem cells.

Adult↗
PubMed1998

Differentiation of recent and old cerebral infarcts by diffusion-weighted MRI.

We performed MRI, including diffusion-weighted imaging, in 15 patients with recurrent strokes with acute ischaemia and at least one old lesion according to the clinical history and/or CT. Routine MRI showed similar signal intensity changes in both situations. Diffusion-weighted images, however, were positive in all acute or subacute infarcts. The high signal of acutely disturbed diffusion due to intracellular oedema could also be identified in small brain stem lesions. Spatial resolution was increased by applying separate gradients in each axis instead of creating anisotropy-independent trace images.

Adult↗