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Background: Catastrophic antiphospholipid syndrome (CAPS) is a multi-system autoimmune disease characterized by extensive thrombosis. Pediatric CAPS is extremely rare and associated with a high mortality rate, especially when midbrain infarction is involved. Hence, early diagnosis and prompt initiation of appropriate treatment for CAPS complicated by midbrain infarction are of utmost importance in achieving favorable outcomes. Case presentation: In this report, we present the case of a 14-year-old girl who presented with neurological symptoms and digestive system infection and was initially diagnosed with an "intracranial infection". After a series of rigorous diagnostic procedures, the patient was ultimately diagnosed with primary CAPS and was immediately transferred to the intensive care unit where she was treated with anticoagulation, glucocorticoids, intravenous immunoglobulin (IVIG) therapy, and multiple plasma infusions. Twenty-seven days after admission, the patient's condition improved with standardized treatment, and she was discharged and followed up regularly. Conclusion: This case report provides a description of the clinical features observed in a pediatric patient with CAPS and concurrent midbrain infarction, highlighting the crucial role of early diagnosis and timely treatment in influencing patient prognosis.

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Resumen Los accidentes cerebrovasculares mesencefálicos son poco frecuentes y por lo general están acompañados de otras lesiones concomitantes. La presencia simultánea de signos ipsi y contrala terales obliga a pensar en un síndrome alterno por compromiso del tronco encefálico. La resonancia magnética nuclear es el estudio de elección para caracterizar y localizar la lesión. Presentamos el caso de un hombre de 71 años que sufrió parálisis del tercer par derecho y hemiataxia izquierda, cuadro infrecuente, conocido como síndrome de Claude.

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Abstract Midbrain strokes are rare and are usually accompanied by other concomitant injuries. The simultaneous presence of ipsi and contralateral signs makes it necessary to think of a brainstem syndrome due to involvement of the brainstem. Mag netic nuclear resonance is the study of choice to characterize and locate the lesion. We report the case of a 71-year-old man who presented right third cranial nerve palsy and hemiataxia, a rare condition known as Claude's syndrome.

RESUMEN

Midbrain strokes are rare and are usually accompanied by other concomitant injuries. The simultaneous presence of ipsi and contralateral signs makes it necessary to think of a brainstem syndrome due to involvement of the brainstem. Magnetic nuclear resonance is the study of choice to characterize and locate the lesion. We report the case of a 71-year old man who presented right third cranial nerve palsy and hemiataxia, a rare condition known as Claude's syndrome.

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Los accidentes cerebrovasculares mesencefálicos son poco frecuentes y por lo general están acompañados de otras lesiones concomitantes. La presencia simultánea de signos ipsi y contralaterales obliga a pensar en un síndrome alterno por compromiso del tronco encefálico. La resonancia magnética nuclear es el estudio de elección para caracterizar y localizar la lesión. Presentamos el caso de un hombre de 71 años que sufrió parálisis del tercer par derecho y hemiataxia izquierda, cuadro infrecuente, conocido como síndrome de Claude.

Asunto(s)

Infartos del Tronco Encefálico , Enfermedades del Nervio Oculomotor , Anciano , Ataxia/complicaciones , Infartos del Tronco Encefálico/complicaciones , Infartos del Tronco Encefálico/diagnóstico , Humanos , Masculino , Nervio Oculomotor , Enfermedades del Nervio Oculomotor/complicaciones , Enfermedades del Nervio Oculomotor/diagnóstico , Parálisis/complicaciones

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BACKGROUND AND PURPOSE: Post-stroke cognitive impairment is a common and well-known consequence of supra-tentorial infarct, but its prevalence and severity after infra-tentorial infarct is unclear. We compared the frequencies and prognostic value of domain-specific cognitive deficits after supra-tentorial and infra-tentorial infarct. METHODS: In a consecutive cohort of patients with first-ever stroke (N = 244) admitted to Helsinki University Hospital, 37 patients had an infra-tentorial infarct. Patients were assessed with a comprehensive neuropsychological examination 3 months post-stroke covering 9 cognitive domains and functional disability was assessed at 15 months with the modified Rankin Scale. RESULTS: There were no statistically significant differences between the frequencies of cognitive deficits in patients with infra-tentorial vs supra-tentorial infarct. Altogether 73% of patients with infra-tentorial infarct and 82% of patients with supra-tentorial infarct had impairment in at least one cognitive domain. Further 42% of patients with infra-tentorial infarct and 47% of those with supra-tentorial infarct had deficits in 3 or more cognitive domains. In patients with infra-tentorial infarct, visuo-constructional deficits were significantly associated with functional disability at 15 months (OR 9.0, 95%CI 1.3-62.5, p = 0.027). In patients with supratentorial infarct, executive deficits (OR 2.9, 95%CI 1.5-5.8, p = 0.002) and visuo-constructional deficits (OR 2.9, 95%CI 1.5-5.7, p = 0.001) showed associations with functional disability at 15 months. CONCLUSION: Cognitive deficits are as common in patients with infra-tentorial infarct as in those with supra-tentorial infarct, and it is important to recognize them to meet the needs of rehabilitation.

Asunto(s)

Disfunción Cognitiva , Infarto , Accidente Cerebrovascular , Disfunción Cognitiva/epidemiología , Humanos , Infarto/epidemiología , Pruebas Neuropsicológicas , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología

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BACKGROUND: The prognosis for unilateral lateral medullary infarction (ULMI) is generally good but may be aggravated by respiratory failure with fatal outcome. Respiratory failure has been reported in patients with severe bulbar dysfunction and large rostral medullary lesions, but its associated factors have not been systematically studied. We aimed to assess clinical and radiological characteristics associated with respiratory failure in patients with pure acute ULMI. MATERIALS AND METHODS: Seventy-one patients (median age 55 years, 59 males) with MRI-confirmed acute pure ULMI were studied retrospectively. Clinical characteristics were assessed and bulbar symptoms were scored using a scale developed for this study. MRI lesions were classified into 4 groups based on their vertical extent (localized/extensive) and the involvement of the open and/or closed medulla. Clinical characteristics, bulbar scores and MRI lesion characteristics were compared between patients with and without respiratory failure. RESULTS: Respiratory failure occurred in 8(11%) patients. All patients with respiratory failure were male (p = 0.336), had extensive lesions involving the open medulla (p = 0.061), progression of bulbar symptoms (p=0.002) and aspiration pneumonia (p < 0.001). Peak bulbar score (OR, 7.9 [95% CI, 2.3-160.0]; p < 0.001) and older age (OR, 1.2 [95%CI, 1.0-1.6]; p=0.006) were independently associated with respiratory failure. CONCLUSIONS: Extensive damage involving the open/rostral medulla, clinically presenting with severe bulbar dysfunction, in conjunction with factors such as aspiration pneumonia and older age appears to be crucial for the development of respiratory failure in pure ULMI. Further prospective studies are needed to identify other potential risk factors, pathophysiology, and effective preventive measures for respiratory failure in these patients.

Asunto(s)

Síndrome Medular Lateral/diagnóstico por imagen , Pulmón/fisiopatología , Imagen por Resonancia Magnética , Bulbo Raquídeo/diagnóstico por imagen , Respiración , Insuficiencia Respiratoria/etiología , Adulto , Anciano , Femenino , Humanos , Síndrome Medular Lateral/complicaciones , Síndrome Medular Lateral/fisiopatología , Masculino , Bulbo Raquídeo/fisiopatología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo

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The incidence of dural venous sinus thrombosis (DVST) and the cerebral venous infarct have not exactly known, but DVST is closely related to the skull fracture around the venous sinus. A 56-year-old man experienced massive watery discharge after hitting on his face by a falling machine. He was alert and no cerebrospinal fluid discharge on admission. Air-density was shown on the jugular fossa in the brain computed tomography. On the 3th day of trauma, he suddenly had dyspnea and loss of consciousness and became comatose. Acute edema on medulla, pons and right cerebellar hemisphere and focal infarct on right medulla were visualized on the brain magnetic resonance imaging. And the sigmoid sinus and the jugular vein were occluded and venous circulation on the right posterior fossa was diminished on the cerebral angiography. Air-density on the sinus may be an indicator into developing venous thrombosis and brainstem venous infarct could be followed by the DVST round the jugular bulb.

RESUMEN

@#ObjectiveTo study the dynamic changes of facial nerve F wave in patients with brainstem infarction，and to explore its value in diagnosis and prognosis evaluation of acute brainstem infarction. MethodsFifty-three patients with brainstem infarction were enrolled in our hospital. Electrophysiological examinations were performed on the 3rd，7th，14th，1st and 3rd days of onset，including the occurrence rate and latency of facial nerve F wave，and compared with the healthy side. Three months after onset，the patients were divided into good prognosis group（mRS≤2） and poor prognosis group（mRS>2） according to mRS neurological function score，and 10 healthy adults were included as control group with the same detection method. The incidence and latency of facial nerve F wave at different time points were compared. Results53 patients with brainstem infarction showed a decrease in the occurrence rate of f wave and an extension in the latency period on the 3rd，7th and 14th days of onset respectively，with a statistically significant difference compared with the healthy side（P<0.05）. However，the incubation period recovered at 3 months after onset，with no significant difference compared with the healthy side（P>0.05），while the occurrence rate was still statistically significant compared with the healthy side（P<0.05）. In patients with different types of brainstem infarction，the occurrence rate and incubation period of f wave in each group decreased to different degrees on the 3rd and 7th day，and the difference was not statistically significant（P>0.05）. The occurrence rate and incubation period of f wave in Raymond-Cestan syndrome group first recovered from the 14th day，with significant difference compared with other groups（P<0.05）. The occurrence rate and incubation period of f wave in Millard-Gubber syndrome group were higher than those in other groups at the 1st and 3rd month of onset，the difference was statistically significant（P<0.05）. On the 3rd and 7th day of onset，the incubation period and occurrence rate of f wave in the two groups increased and decreased，with no significant difference（P>0.05）. From the 14th day on，the incubation period and f wave occurrence in the group with good prognosis first recovered in the group with poor prognosis，with significant difference（P<0.05）. At the 3rd month of onset，the occurrence rate of F wave in the group with good prognosis was significantly higher than that in the group with poor prognosis，and the difference was statistically significant. However，the incubation period of the two groups had obvious recovery，and the difference was not statistically significant（P>0.05）. ConclusionThe changes of facial nerve F wave and latency can occur in patients with brainstem infarction in the early stage，but there is no differential diagnosis value for different types of cerebral infarction in the acute stage，which can provide valuable objective basis for prognosis evaluation after the acute stage.

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BACKGROUND: Hyperekplexia is a rare neurologic disorder characterized by pronounced startle responses to tactile or acoustic stimuli and increase tone. Acquired hyperekplexia is usually seen in brainstem pathologies and when it develops acutely it can be easily misdiagnosed as a convulsive seizure. CASE REPORT: A 38-year-old man presented with acute onset generalized brief involuntary jerky movements and a decreased level of consciousness. He was initially diagnosed with convulsive status epilepticus for which he received multiple antiseizure medications without any improvement. Further investigations revealed abnormal oculocephalic reflex response and that his movements were in fact hyperkeplexia caused by brainstem infarction with basilar artery thrombus secondary to right vertebral artery dissection. Emergent thrombectomy was performed and he was eventually discharged to a rehabilitation facility. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of hyperekplexia and how to differentiate it from convulsive stats epilepticus because the pathology and the emergent treatment of these 2 serious conditions are different. An underlying acquired brainstem pathology (especially basilar artery thromboembolism) should be suspected in any patient with untypical convulsive like movements along with focal neurologic signs compatible with brain stem pathology even when computed tomography imaging is normal. © 2020 Elsevier Inc.

Asunto(s)

Hiperekplexia , Estado Epiléptico , Adulto , Humanos , Masculino , Reflejo de Sobresalto , Convulsiones , Estado Epiléptico/diagnóstico , Estado Epiléptico/etiología , Síndrome

RESUMEN

OBJECTIVE: Acute unilateral lateral medullary infarction (ULMI) is complicated by respiratory failure in 2-6% of patients. However, studies investigating milder respiratory disorders not leading to overt respiratory failure, i.e., sleep-disordered breathing (SDB) and its outcome, are lacking. The aim of our study was to identify and prospectively follow SDB in acute ULMI. METHODS: We prospectively followed 28 patients with MRI-confirmed acute ULMI. Polysomnography (PSG) was performed 1-3 times in the acute phase (at 1-4, 5-10, and 14-21 days after onset of symptoms) and after 3-6 months. PSG recordings in the acute phase were analyzed and compared to the follow-up. RESULTS: Apnea-hypopnea index (AHI) ≥ 5/h, AHI ≥ 15/h, and AHI ≥ 30/h in the acute phase were observed in 22 (79%), 19 (68%), and 10 (36%) patients, respectively. CSA, OSA, mixed CSA/OSA, or multiple interchanging SDB types were observed in the acute phase in 12 (43%), 2 (7%), 2 (7%), and 6 (21%) patients, respectively. Peak AHI varied in individual patients (median at 7 (3-14) days after onset). At follow-up, AHI and central AHI tended to decrease (p = 0.007, p = 0.003, respectively), obstructive AHI did not change (p = 0.396). Sleep architecture partially improved with significantly higher percentage of N2 and lower percentage of wakefulness after sleep onset (p = 0.007, p = 0.012, respectively). CONCLUSIONS: Our data show that SDB, particularly CSA, is common in the acute phase of ULMI and that the frequency of central events decreases in the subacute phase. Further studies are needed to clarify the clinical significance and possible treatment options of SDB in these patients.

Asunto(s)

Síndrome Medular Lateral/epidemiología , Síndromes de la Apnea del Sueño/epidemiología , Adulto , Anciano , Femenino , Humanos , Síndrome Medular Lateral/complicaciones , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Síndromes de la Apnea del Sueño/complicaciones

RESUMEN

Objective: We report a case of vertebral artery dissecting aneurysm that caused right lateral medullary infarction, which was treated by endovascular therapy. Case Presentations: A 57-year-old man developed right-side headache and dysarthria on the day before presentation, and exhibited mouth dropping and dysphagia the following day. Initial MRI demonstrated right lateral medullary infarction with atherothrombotic change with no vessel lesion, and we started infusion and medication administration. Later MRI revealed bilateral vertebral artery dissection, and we treated the growing right vertebral artery dissecting aneurysm by stenting and coils. Conclusion: The possibility of dissecting lesions should be considered in cases of medullary infarction. Stenting and coil treatment is a useful option for bilateral dissecting vertebral aneurysms.

RESUMEN

OBJECTIVE: To screen the optimal acupuncture regimen for cricopharyngeal achalasia (CPA) after brain stem infarction and compare the therapeutic effect between the combined therapy of catheter balloon dilation and acupuncture and the simple application of catheter balloon dilation. METHODS: The patients suffering from neuropathic dysphagia in CPA after brain stem infarction were selected as the subjects. After confirmed in the diagnosis with video fluoroscopic swallowing study (VFSS), they were randomized into 6 groups, 15 cases in each one, named group A (routine treatment), group B (catheter balloon dilation), group C1 (treated with acupuncture in local area), group C2 (treated with acupuncture based on zangfu differentiation), group C3 (treated with acupuncture at the local area and the acupoints based on zangfu differentiation) and group D (catheter balloon dilation combined with the optimal acupuncture). Two phases were included in the study. In the first phase of study, the therapeutic effect was compared among the three acupuncture groups, named C1, C2 and C3 group, so as to screen the optimal acupuncture regimen. In the group C1, the main acupoints included Fengchi (GB 20), Wangu (GB 12), Yifeng (TE 17) and three-tongue points (Extra). In the group C2, the main acupoints were Neiguan (PC 6), Tongli (HT 5), Zusanli (ST 36) and Sanyinjiao (SP 6) as well as the supplementary acupoints in accordance with the syndrome differentiation. In the group C1 and group C2, after deqi, the electroacupuncture was used, with continuous dense wave, 5 to 8 Hz in frequency. The needles were retained for 30 min. Acupuncture was given once a day, 5 treatments a week. Before treatment, in 6 weeks of treatment or after removal of gastric tube, the rehabilitation was evaluated. In the group C3, the acupoints, manipulation and treating course were same as the group C1 and group C2. In the 2nd phase of study, theresults of rehabilitation treatment were compared among the group A, group B and group D. The treatment was given once a day, 5 times a week. Before treatment, after gastric tube removal or in 6 weeks of treatment, the evaluation was conducted. The feeding-swallowing function grade and VFSS were adopted in the evaluation among the above 6 groups. RESULTS: ① In the VFSS comparison at 1st phase of study after treatment, the food transporting ability at oral dysphagia, the results in the group C3 and group C1 were better obviously than the group C2 (both P<0.05). For the improvement in aspiration, the result in the group C3 was better obviously than the group C2 (P<0.05). In comparison of the three acupuncture groups with the group A, the difference was not significant statisticallys in the extubation rate among the four groups (P>0.05). The severity of dysphagia in the group C3 was milder than the group C2 and group A (both P<0.05). ② In the VFSS comparison at the 2nd phase of study, for the food transporting ability, the results in the group D and the group B were obviously better than the group A (both P<0.05). Regarding the function at the pharyngeal dysphagia and aspiration, the results in the group D were better than the group B and group A, those in the group B were better than the group A (all P<0.05). The difference in the extubation rate among the group A, group B and group D after treatment was significant statistically (P<0.01), of which, the extubation rate in the group D was the highest and the rate in the group A was the lowest. The dysphagia degree in the group D was milder than the group B and group A and that in the group B was milder than the group A (all P<0.05). CONCLUSION: In the study of the different acupuncture methods, the acupuncture at the local acupoints and the acupoints selected based on zangfu differentiation is the optimal acupuncture regimen for cricopharyngeal achalasia after brain stem infarction. The catheter balloon dilation combined with acupuncture present the synergistc effect on cricopharyngeal achalasia after brain stem infarction, obviously relieve dysphagia and reduce aspiration.

Asunto(s)

Terapia por Acupuntura , Infartos del Tronco Encefálico , Acalasia del Esófago , Puntos de Acupuntura , Terapia por Acupuntura/métodos , Infartos del Tronco Encefálico/complicaciones , Cateterismo , Dilatación , Acalasia del Esófago/etiología , Acalasia del Esófago/terapia , Humanos , Resultado del Tratamiento

RESUMEN

Infarct locations in children with arterial ischemic stroke have primarily been reported to be lobar or in the basal ganglia, and those in patients with Down syndrome (DS) and antiphospholipid syndrome (APS) are typically wide and multiple. No solitary brain stem infarctions have ever been reported in children with DS until now. Here, we report a case of brain stem infarction in a 6-year-old boy with DS who had no cardiac, renal, or intestinal complications. He exhibited ataxic gait and medial longitudinal fasciculus (MLF) symptoms at first presentation. Neuroimaging revealed a localized and isolated lesion in the midbrain. Although he did not satisfy the diagnostic criteria of APS, he showed persistently elevated levels of anticardiolipin antibody (21 U/mL; normal value <10 U/mL). Although he had the risks of a multiple vascular systems disorder, DS, and persistently elevated levels of antiphospholipid antibodies, his lesion was not similar to any of the previously reported cerebral infarctions in DS or in APS. To our knowledge, this is the first report of limited solitary brain stem infarction in a child with DS.

Asunto(s)

Infartos del Tronco Encefálico/fisiopatología , Síndrome de Down/complicaciones , Anticuerpos Anticardiolipina/análisis , Anticuerpos Anticardiolipina/sangre , Síndrome Antifosfolípido/fisiopatología , Tronco Encefálico/fisiopatología , Infartos del Tronco Encefálico/metabolismo , Infarto Cerebral/fisiopatología , Niño , Síndrome de Down/fisiopatología , Humanos , Infarto/fisiopatología , Japón , Masculino

RESUMEN

OBJECTIVE@#To screen the optimal acupuncture regimen for cricopharyngeal achalasia (CPA) after brain stem infarction and compare the therapeutic effect between the combined therapy of catheter balloon dilation and acupuncture and the simple application of catheter balloon dilation.@*METHODS@#The patients suffering from neuropathic dysphagia in CPA after brain stem infarction were selected as the subjects. After confirmed in the diagnosis with video fluoroscopic swallowing study (VFSS), they were randomized into 6 groups, 15 cases in each one, named group A (routine treatment), group B (catheter balloon dilation), group C1 (treated with acupuncture in local area), group C2 (treated with acupuncture based on differentiation), group C3 (treated with acupuncture at the local area and the acupoints based on differentiation) and group D (catheter balloon dilation combined with the optimal acupuncture). Two phases were included in the study. In the first phase of study, the therapeutic effect was compared among the three acupuncture groups, named C1, C2 and C3 group, so as to screen the optimal acupuncture regimen. In the group C1, the main acupoints included Fengchi (GB 20), Wangu (GB 12), Yifeng (TE 17) and three-tongue points (Extra). In the group C2, the main acupoints were Neiguan (PC 6), Tongli (HT 5), Zusanli (ST 36) and Sanyinjiao (SP 6) as well as the supplementary acupoints in accordance with the syndrome differentiation. In the group C1 and group C2, after , the electroacupuncture was used, with continuous dense wave, 5 to 8 Hz in frequency. The needles were retained for 30 min. Acupuncture was given once a day, 5 treatments a week. Before treatment, in 6 weeks of treatment or after removal of gastric tube, the rehabilitation was evaluated. In the group C3, the acupoints, manipulation and treating course were same as the group C1 and group C2. In the 2nd phase of study, theresults of rehabilitation treatment were compared among the group A, group B and group D. The treatment was given once a day, 5 times a week. Before treatment, after gastric tube removal or in 6 weeks of treatment, the evaluation was conducted. The feedingswallowing function grade and VFSS were adopted in the evaluation among the above 6 groups.@*RESULTS@#① In the VFSS comparison at 1st phase of study after treatment, the food transporting ability at oral dysphagia, the results in the group C3 and group C1 were better obviously than the group C2 (both 0.05). The severity of dysphagia in the group C3 was milder than the group C2 and group A (both <0.05). ② In the VFSS comparison at the 2nd phase of study, for the food transporting ability, the results in the group D and the group B were obviously better than the group A (both <0.05). Regarding the function at the pharyngeal dysphagia and aspiration, the results in the group D were better than the group B and group A, those in the group B were better than the group A (all <0.05). The difference in the extubation rate among the group A, group B and group D after treatment was significant statistically (<0.01), of which, the extubation rate in the group D was the highest and the rate in the group A was the lowest. The dysphagia degree in the group D was milder than the group B and group A and that in the group B was milder than the group A (all <0.05).@*CONCLUSION@#In the study of the different acupuncture methods, the acupuncture at the local acupoints and the acupoints selected based on differentiation is the optimal acupuncture regimen for cricopharyngeal achalasia after brain stem infarction. The catheter balloon dilation combined with acupuncture present the synergistc effect on cricopharyngeal achalasia after brain stem infarction, obviously relieve dysphagia and reduce aspiration.

Asunto(s)

Humanos , Puntos de Acupuntura , Terapia por Acupuntura , Métodos , Infartos del Tronco Encefálico , Cateterismo , Dilatación , Acalasia del Esófago , Terapéutica , Resultado del Tratamiento

RESUMEN

OBJECTIVE: The prognosis of patients with isolated brainstem infarction (BSI) differs on an individual patient basis. This study was undertaken to analyze the influences of different imaging and clinical features with the prognosis of patients with BSI. METHODS: The study population was derived from a multicenter study of intracranial atherosclerosis in China. In the present study, 300 patients were selected who had experienced non-cardiogenic brain stem infarction within the prior 7 days. Evaluations included clinical characteristics, location and size of the brainstem infarction, and whether the infarction was located in multiple perforating branches of the brainstem. Poor prognosis was defined as the presence of disability within 1 year from the onset of disease. RESULTS: In total, 281 patients were followed up at 1 year post-infarction. Of these 281 patients, 84 (29.9%) exhibited disability at 1 year; these patients showed a median National Institutes of Health Stroke Scale score of 6 on admission. Multiple logistic regression analysis showed that patients with BSI located in the territory of multiple perforating arteries, who were discharged without administration of statins, showed a poor 1-year prognosis. CONCLUSION: Isolated BSI involving multiple perforating arteries, without statin medication at discharge, indicated poor prognosis for patients with BSI.

Asunto(s)

Infartos del Tronco Encefálico/patología , Cabeza/patología , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infartos del Tronco Encefálico/diagnóstico por imagen , Infartos del Tronco Encefálico/epidemiología , China/epidemiología , Imagen de Difusión por Resonancia Magnética , Femenino , Estudios de Seguimiento , Cabeza/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia , Adulto Joven

RESUMEN

Here, we report a case of a 64-year-old female with acute-onset vertigo, nausea, and vomiting. In an emergency imaging examination, the results of computed tomography (CT) and diffusion weighted imaging (DWI) were negative. However, on 1 day post-hospital admission, a small acute infarct in the posterolateral aspect of the left medulla was detected by DWI. Extra attention should be payed to the false-negative imaging results to avoid diagnosis and treatment delay.

Asunto(s)

Imagen de Difusión por Resonancia Magnética , Síndrome Medular Lateral/diagnóstico por imagen , Bulbo Raquídeo/diagnóstico por imagen , Angiografía Cerebral , Diagnóstico Diferencial , Reacciones Falso Negativas , Femenino , Humanos , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Tomografía Computarizada por Rayos X

RESUMEN

Objective To evaluate the characteristics of dysphagia after brain stem infarction,and to determine the mechanism of aspiration.Methods The fluoroscopic videos of 12 dysphagia patients who had suffered brain stem infarction and 10 healthy counterparts were analyzed quantitatively using a digital analysis system.Each participant was requested to twice swallow 5ml of thick liquid.The observations included the oral transit time (OTT),the swallow response time (SRT),the hyoid movement time (HMT),the upper esophageal sphincter opening time (UOT) and the laryngeal closure time (LCT).An 8-point penetration-aspiration scale (PAS) was used to evaluate the severity of aspiration,and the results were correlated with the other 5 quantitative observations.Results The average OTT [(3.091±1.803)s],HMT [(1.498±0.550)s] and LCT [(0.651±0.186)s] of the brain stem infarction patients were all significantly longer than those of the healthy controls.However,no significant differences were found between the patients and the healthy volunteers in terms of SRT or UOT.Aspiration severity was significantly correlated with SRT but not with LCT.Conclusion Dysphagia after brain stem infarction involves both the oral and pharyngeal phases.OTT,HMT and LCT can be used to quantify dysphagia after brain stem infarction,while SRT is a predictor of aspiration.

RESUMEN

Moyamoya disease (MMD) is a rare cerebrovascular disease with an unknown etiology and is characterized by intrinsic fragility in the intracranial vascular walls such as the affected internal elastic lamina and thinning medial layer. The association of MMD with intracranial arterial dissection is extremely rare, whereas that with basilar artery dissection (BAD) has not been reported previously. A 46-year-old woman developed brain stem infarction due to BAD 4 years after successful bilateral superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis for ischemic-onset MMD. She presented with sudden occipitalgia and subsequently developed transient dysarthria and mild hemiparesis. Although a transient ischemic attack was initially suspected, her condition deteriorated in a manner that was consistent with left hemiplegia with severe dysarthria. Magnetic resonance (MR) imaging revealed brain stem infarction, and MR angiography delineated a double-lumen sign in the basilar artery, indicating BAD. She was treated conservatively and brain stem infarction did not expand. One year after the onset of brain stem infarction, her activity of daily living is still dependent (modified Rankin Scale of 4), and there were no morphological changes associated with BAD or recurrent cerebrovascular events during the follow-up period. The association of MMD with BAD is extremely rare. While considering the common underlying pathology such as an affected internal elastic lamina and fragile medial layer, the occurrence of BAD in a patient with MMD in a stable hemodynamic state is apparently unique.

Asunto(s)

Disección Aórtica/etiología , Arteria Basilar , Infartos del Tronco Encefálico/etiología , Aneurisma Intracraneal/etiología , Enfermedad de Moyamoya/cirugía , Procedimientos Neuroquirúrgicos , Actividades Cotidianas , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/fisiopatología , Disección Aórtica/terapia , Arteria Basilar/diagnóstico por imagen , Infartos del Tronco Encefálico/diagnóstico por imagen , Infartos del Tronco Encefálico/fisiopatología , Infartos del Tronco Encefálico/terapia , Angiografía Cerebral/métodos , Imagen de Difusión por Resonancia Magnética , Evaluación de la Discapacidad , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/fisiopatología , Aneurisma Intracraneal/terapia , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/diagnóstico por imagen , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

Objective To investigate the relation between microembolic signals (MES) and vertebral basilar artery ste?nosis in patients with brainstem infarction. Methods A total of 156 patients with acute brainstem infarction, who were de?termined the cerebral infarction lesion and vertebral basilar artery stenosis by cranial magnetic resonance imaging and CT an?giography, and were monitored by transcranial Doppler via occipital window of basilar arterial MES monitoring in 7 days of the onset, were divided into microembolus signal negative group (n=136) and positive group (n=20). The clinical data were compared between two groups. The differences of different degrees of stenosis were analyzed in two groups. The differences of different locations of stenosis in patients with vertebral basilar artery stenosis were analyzed in two groups. Logistic regres?sion analysis was used to analyse the factors affecting MES. Results There were no significant differences in age, gender, history of hypertension and diabetes mellitus between the two groups (P<0.05). There were significant differences in the dif?ferent degrees of stenosis between two groups, no or mild stenosis was found in MES-negative group and severe stenosis in MES-positive group (P<0.05). There were 70 cases with no vertebral basilar artery stenosis, 86 cases with mild, moderate and severe stenosis, in which 14 cases were MES-positive and 72 cases were negative. There were significant differences in different locations of stenosis between the two groups. The proportion of multiple infarctions was significantly higher in MES-positive group than that of MES-negative group (P<0.05). The intracranial vertebral basilar artery stenosis and 75%of ver?tebral basilar artery stenosis were the independent risk factors of MES-positive. Conclusion Severe stenosis of the verte?bral basilar artery is more vulnerable to occur MES of posterior circulation, leading to cerebral infarction. Microemboli may be the cause of multiple infarctions in patients with vertebral basilar artery stenosis.

RESUMEN

Objective To investigate the correlation of brain stem diffusion-weighted imaging (DWI) lesion score with vertebrobasilar artery stenosis as revealed by magnetic resonance angiography (MRA) in patients with acute brain stem infarction. Methods A total of 253 patients diagnosed as acute brain stem infarction by means of brain magnetic resonance imaging were analyzed retrospectively. Of them 211 patients were enrolled in the present study, and they were qualified with the enrolling standard, and they underwent examination of brain DWI and MRA simultaneously. The DWI lesion scores and imaging data were analyzed comparatively and statistically. Results Significant correlation was found between DWI lesion score and the main trunk stenosis degree of vertebrobasilar artery in patients with acute brain stem infarction (P=0.009). An increase in overall stenosis degree was found along with an increase in DWI lesion score (P=0.005). When the DWI lesion score was ≥4, occlusion of the main trunk of vertebrobasilar artery could be predicted with sensitivity of 74.5% and specificity of 93.2%, respectively (P=0.000). Conclusions The DWI lesion score increases as the degree of main trunk stenosis of vertebrobasilar artery increased in patients with acute brain stem infarction. The DWI lesion score, in certain extent, may predict the existence and degree of stenosis of the main trunk of vertebrobasilar artery.

RESUMEN

Epidermoids are generally recognized as benign tumors; however, total resection is often difficult. The recurrence from the residual capsule, dissemination of the tumor, and aseptic meningitis are common problems. The aim of the present study was to analyze and report on the clinical characteristics of intracranial epidermoids, particularly complications and cases with a poor clinical outcome. 24 patients with intracranial epidermoids who were treated surgically at Tokyo Women's Medical University Hospital between 1997 and 2007 were examined. The location and size of the tumor, pre-and postoperative symptoms, adherence of the tumor to cranial nerves, and proliferative capacity were determined. The most frequent site of the tumor was the cerebello-pontine (C-P) angle (16/24); eight of these patients presented with hearing loss and six presented with trigeminal neuralgia. In many cases, hearing loss and diplopia persisted after surgery. All epidermoids located in the C-P angle were attached to and/or compressed the trigeminal nerves, therefore, the origin is suggested to be the dura mafer of petrous bone around the trigeminal nerve. Of all 24 patients, the tumor recurred in four (after 3, 5, 10 and 20 years). One patient had a poor prognosis, with dissemination and brain stem infarction. Epidermoids can recur from residual capsule adhering to the brain stem or cranial nerves up to 10-20 years after the initial surgery. Long-term follow-up imaging studies are required when complete resection of the tumor capsule is not possible. In rare cases, spontaneous cyst rupture, dissemination, and brain stem infarction result in a poor prognosis.