RESUMEN
BACKGROUND: A persistent trigeminal artery (PTA) is a non-involuted embryonic vessel that connects the cavernous part of the internal carotid artery with the posterior circulation. In the adult it is associated with multiple pathological conditions including trigeminal neuralgia, ophthalmoplegia, hypopituitarism, intracavernous fistula, brain aneurysms and posterior circulation strokes. The latter may occur through steal phenomena or thrombosis in the anterior circulation. PTA associated vertebrobasilar hypoplasia has yet to be associated to TIA like events, however, in the reported case, that seems to be the case with reported vertigo being probably linked to vertebrobasilar insufficiency. CASE REPORT: We present a case of an 82-year-old man with sudden onset neurological deficits, including left hemiparesis with crural predominance, vertical nystagmus, right internuclear ophthalmoplegia, dysarthria and dysmetria on the left arm. CT angiography disclosed basilar artery hypoplasia in the proximal two thirds and a persistent trigeminal artery. He was diagnosed with acute ischemic stroke. He was submitted to rt-PA with partial reversion of deficits. CONCLUSION: The ischemic events related to PTA remain a rare cause of stroke with specific pathophysiological mechanisms and implications. They may occur through steal phenomena or thrombosis in the anterior circulation. Upon literature review, in the described case both mechanisms seem possible, however the transient episodes of vertigo could have been the first sign of vertebrobasilar insufficiency.
Asunto(s)
Accidente Cerebrovascular/etiología , Insuficiencia Vertebrobasilar/congénito , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Activadores Plasminogénicos/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/patología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/patología , Vértigo/etiologíaRESUMEN
We describe the case of a patient with atypical hemiplegic migraine and associated basilar symptoms, where a large patent foramen ovale (PFO) and hypoplasia of basilar artery were found. The longer period of 4-year remission of the headache attacks was coincident with the percutaneous PFO closure. When 5 years after, hemiplegic migraine attacks relapsed, with more relevant basilar symptoms, a mild re-opening of PFO was found. The atypical presentation of attacks with basilar symptoms and prolonged hemiplegia does not strictly fit the diagnostic criteria of ICHD-II.
Asunto(s)
Arteria Basilar/anomalías , Encéfalo/patología , Foramen Oval Permeable/complicaciones , Migraña con Aura/etiología , Migraña con Aura/fisiopatología , Insuficiencia Vertebrobasilar/complicaciones , Adulto , Anticoagulantes , Arteria Basilar/patología , Arteria Basilar/fisiopatología , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Procedimientos Quirúrgicos Cardíacos , Foramen Oval Permeable/fisiopatología , Foramen Oval Permeable/cirugía , Hemiplejía/tratamiento farmacológico , Hemiplejía/etiología , Hemiplejía/fisiopatología , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Migraña con Aura/patología , Recurrencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Insuficiencia Vertebrobasilar/congénito , Insuficiencia Vertebrobasilar/fisiopatologíaRESUMEN
BACKGROUND AND PURPOSE: Stroke MRI protocols provide useful information about underlying vessel pathologies in the anterior circulation by means of intracranial time-of-flight angiography. However, these protocols mostly fail in the posterior circulation to differentiate between congenital variants and secondary thrombosis. Therefore, a high-resolution anatomic True Fast Imaging in Steady State Precession sequence, added to a commonly used stroke imaging protocol, was evaluated. METHODS: MRIs of all emergency admissions to the stroke unit over 2 months were analyzed. Variations in the posterior circulation as displayed by time-of-flight and by the True Fast Imaging in Steady State Precession sequence, respectively, were graded by 2 readers blinded to the diagnosis. RESULTS: In the time-of-flight angiography, 50% of patients presented with distinctive vertebrobasilar alterations. Half of these were judged as high-grade anomalies, of which the True Fast Imaging in Steady State Precession sequence identified 25% as hypoplasia. In 40% of all patients with posterior ischemia, the True Fast Imaging in Steady State Precession sequence confirmed an acquired occlusion of the vertebrobasilar arteries. CONCLUSIONS: The addition of an anatomic (True Fast Imaging in Steady State Precession) to a functional sequence (time-of-flight) in stroke MRI protocols enables the differentiation between artery occlusions and hypoplastic variants of the vertebral arteries.
Asunto(s)
Infarto de la Arteria Cerebral Posterior/patología , Angiografía por Resonancia Magnética , Insuficiencia Vertebrobasilar/congénito , Insuficiencia Vertebrobasilar/patología , Anciano , Arteria Basilar/anomalías , Arteria Basilar/patología , Angiografía Cerebral , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Estudios Retrospectivos , Arteria Vertebral/anomalías , Arteria Vertebral/patologíaRESUMEN
Embryologic development of the basilar artery occurs along two axis systems: longitudinal fusion and axial fusion. Longitudinal fusion consists of midline fusion of paired ventral arteries and reflects the simplified pattern of arterial anatomy found in the spinal cord. Axial fusion consists of fusion of the distal basilar artery, which arises from the caudal division of the internal carotid artery, to the midbasilar agenesis to the posterior inferior cerebellar artery termination of the vertebral arteries. Persistent longitudinal nonfusion (or complete duplication) of the basilar artery is very rare, and persistent axial nonfusion is even rarer. We report one case of persistent longitudinal nonfusion of the basilar artery in a 3-year-old boy and a case of persistent axial nonfusion of the basilar artery in a 43-year-old man.
Asunto(s)
Angiografía de Substracción Digital , Arteria Basilar/anomalías , Angiografía Cerebral , Epilepsia Tónico-Clónica/congénito , Procesamiento de Imagen Asistido por Computador , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Insuficiencia Vertebrobasilar/congénito , Adulto , Anticonvulsivantes/uso terapéutico , Arteria Basilar/embriología , Arteria Basilar/patología , Cerebelo/irrigación sanguínea , Preescolar , Diagnóstico Diferencial , Quimioterapia Combinada , Epilepsia Tónico-Clónica/diagnóstico , Epilepsia Tónico-Clónica/tratamiento farmacológico , Humanos , Masculino , Fenobarbital/uso terapéutico , Sensibilidad y Especificidad , Arteria Vertebral/anomalías , Arteria Vertebral/patología , Insuficiencia Vertebrobasilar/diagnósticoRESUMEN
We report three patients with persistent trigeminal arteries, in all of whom the proximal basilar artery was hypoplastic. We draw attention to this common observation, which should not be mistaken for acquired narrowing.
Asunto(s)
Arteria Basilar/anomalías , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Angiografía por Resonancia Magnética , Núcleos del Trigémino/irrigación sanguínea , Insuficiencia Vertebrobasilar/congénito , Adulto , Arteria Basilar/patología , Tronco Encefálico/irrigación sanguínea , Angiografía Cerebral , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional/fisiología , Insuficiencia Vertebrobasilar/diagnósticoRESUMEN
A 43-year-old male with a left hemiparesis due to brain-stem infarction associated with bilateral persistent trigeminal arteries is reported. The clinicopathological and radiographic significance of persistent carotid-basilar arterial anastomoses in vertebrobasilar territory ischaemic attacks is also discussed.
Asunto(s)
Arteria Basilar/anomalías , Tronco Encefálico/irrigación sanguínea , Arteria Carótida Interna/anomalías , Angiografía Cerebral , Infarto Cerebral/diagnóstico , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Imagen por Resonancia Magnética , Insuficiencia Vertebrobasilar/congénito , Adulto , Infarto Cerebral/cirugía , Humanos , Masculino , Examen Neurológico , Insuficiencia Vertebrobasilar/diagnósticoRESUMEN
We observed a rare cerebrovascular anomaly in a patient with brain-stem infarction. Two right vertebral arteries arose from the subclavian artery and communicated directly with each other under the transverse foramen of the fourth cervical vertebra. The left vertebral artery consisted of a rudimentary artery that arose from the left subclavian artery, ran through the transverse foramen of the sixth cervical vertebra and then tapered down to disappear at the fourth/fifth cervical vertebrae, plus a second, accessory artery that arose from a branch of the left thyrocervical trunk, ran through the transverse foramen of the fifth cervical vertebra and tapered off to disappear at the first/second cervical vertebrae.
Asunto(s)
Angiografía Cerebral , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Arteria Vertebral/anomalías , Insuficiencia Vertebrobasilar/congénito , Adulto , Humanos , Masculino , Tomografía Computarizada por Rayos X , Arteria Vertebral/diagnóstico por imagen , Insuficiencia Vertebrobasilar/diagnóstico por imagenRESUMEN
The case of a newborn presenting from birth with arthrogryposis multiplex congenita resting mainly on the legs, severe hypotonia, consciousness anomalies, clonic fits, recurrent apnea and bradycardia, absent sucking and swallowing is described. At the age 4 months a further episode of apnea and bradycardia was followed by death. The neuropathologic analysis disclosed a number of bilateral, cystic and symmetric infarcts in the thalamus and hypothalamus, spreading caudally to the tegmentum of the mesencephalon and the pons. Such distribution of lesions does suggest a vascular topography, i.e. in the territories supplied by branches of the vertebro-basilar arteries. There was light clinical and neuropathological evidence of prenatal occurrence of the vascular injuries, possibly at the end of the 7th month by a defective arterial perfusion of the fetus due to protracted menaces of premature birth. We would outline the existence and frequency of the thalamic and dorsal brain stem necrotic involvement by acute anoxia-ischemia occurring in the third trimester of gestation or at birth, and the relative peculiarity of their clinical picture.