RESUMEN
Abstract Introduction: The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. Results: Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01). Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Síndrome del Robo de la Subclavia/fisiopatología , Insuficiencia Vertebrobasilar/fisiopatología , Presión Sanguínea/fisiología , Endarterectomía Carotidea/métodos , Complicaciones Posoperatorias/etiología , Valores de Referencia , Síndrome del Robo de la Subclavia/complicaciones , Insuficiencia Vertebrobasilar/complicaciones , Determinación de la Presión Sanguínea/métodos , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Accidente Cerebrovascular/etiología , Periodo PreoperatorioRESUMEN
INTRODUCTION: The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. METHODS: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD Ë 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. RESULTS: Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01). CONCLUSION: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.
Asunto(s)
Presión Sanguínea/fisiología , Endarterectomía Carotidea/métodos , Síndrome del Robo de la Subclavia/fisiopatología , Insuficiencia Vertebrobasilar/fisiopatología , Anciano , Anciano de 80 o más Años , Determinación de la Presión Sanguínea/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Valores de Referencia , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Accidente Cerebrovascular/etiología , Síndrome del Robo de la Subclavia/complicaciones , Insuficiencia Vertebrobasilar/complicacionesRESUMEN
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disease characterized by clonal hematopoietic stem cell disorder, with increased mortality and morbidity. Venous thrombosis is the most common cause of mortality in PNH. The relationship between PNH and cerebrovascular disease is unclear; few cases are reported in the literature, most of them related to cerebral venous thrombosis; In PNH the involvement of intracranial and extracranial arterial sites is very rare. We report a case of a 49-year-old woman who has a medical history of diabetes mellitus, hypertension, and PNH and presented multiple lacunar strokes in a routine consultation with a hematologist. A brain computed tomography (CT) scan showed lacunar infarcts, and magnetic resonance image showed acute ischemic stroke, multiple territory lacunar infarctions, and focal area of microbleeds in gradient echo sequence. A CT angiography showed V3 and V4 branches of the left vertebral artery occluded by a thrombus, and the posterior inferior cerebellar artery occluded, whereas the carotid system was normal. We discuss the presentation and physiopathology of stroke in PNH and other cases reported in the literature review.
Asunto(s)
Hemoglobinuria Paroxística/complicaciones , Trombosis Intracraneal/etiología , Accidente Vascular Cerebral Lacunar/etiología , Insuficiencia Vertebrobasilar/etiología , Angiografía Cerebral/métodos , Femenino , Hemoglobinuria Paroxística/diagnóstico , Humanos , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/fisiopatología , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Persona de Mediana Edad , Accidente Vascular Cerebral Lacunar/diagnóstico por imagen , Accidente Vascular Cerebral Lacunar/fisiopatología , Tomografía Computarizada por Rayos X , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/fisiopatologíaRESUMEN
INTRODUCTION: Crescendo transient ischemic attacks or "Stroke Warning Syndromes" consist of stereotyped frequent short-lasting episodes of focal neurological deficits. This is explained by intermittent hypoperfusion of the vascular territory of terminal arteries with insufficient collateral flow, presenting a high risk for subsequent infarction. Pontine warning syndrome (PWS) is a subtype of this atypical presentation of stroke/transient ischemic attack and is considered a challenge for diagnosis. CASE REPORT: We describe 2 cases of patients with PWS who were admitted to our institution. They presented acute neurological deficits that fluctuated during the course of their hospitalization; interestingly, this neurological worsening and improvement was associated with blood pressure fluctuations. In both cases, brain magnetic resonance imaging revealed an ischemic lesion in the paramedian pons due to basilar artery branch disease. No outstanding infectious or metabolic factors contributed to neurological worsening/fluctuations. These patients received standard medical care without IV-thrombolysis because of the presence of contraindications for IV tissue plasminogen activator. Permissive hypertension was promoted to achieve adequate perfusion during hospitalization. At discharge and follow-up, the patients showed partial resolution from their stroke symptoms. CONCLUSIONS: PWS is a diagnostic and management challenge for the clinician. Because of its low incidence, this syndrome has been underestimated and understudied. There is, currently, no standard treatment for this condition; however, it is paramount, during treatment, that hypotension/hypoperfusion be avoided, with the goal being asymptomatic normotension to permissive hypertension. The probable mechanism of disease is hypoperfusion due to basilar artery branch disease and perhaps cerebral vascular dysregulation in the affected area.
Asunto(s)
Infartos del Tronco Encefálico/fisiopatología , Ataque Isquémico Transitorio/fisiopatología , Puente/fisiopatología , Insuficiencia Vertebrobasilar/fisiopatología , Anciano , Presión Sanguínea , Infartos del Tronco Encefálico/diagnóstico por imagen , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Puente/irrigación sanguínea , Puente/diagnóstico por imagen , Insuficiencia Vertebrobasilar/diagnóstico por imagenRESUMEN
BACKGROUND: Despite growing literature on posterior vascular disease, specific information about the cognitive and functional profiles of patients with basilar artery occlusion disease (BAOD) is scarce. The aims of this study were (1) to compare the cognitive statuses of BAOD survivors versus healthy controls and (2) to correlate the functional capacity outcomes with the cognitive profiles of BAOD patients. METHODS: Comprehensive cognitive and functional assessments were carried out in 28 patients with BAOD and 27 age- and education level-matched healthy controls. RESULTS: Compared to matched controls, patients presented impairments in selective, sustained, and set-shifting attention, processing speed, visuospatial skills, mental flexibility, and monitoring rules. There were significant deficits in verbal episodic memory (immediate and delayed recall) and visuospatial episodic memory (immediate and delayed recall and recognition). Functional capacity outcomes were significantly related to the cognitive test results. Seventy-five percent of patients had a Modified Rankin Scale score of 0 or 1. CONCLUSIONS: Our results indicate good functional outcomes in a selected group of BAOD survivors, despite the presence of subnormal performance on some cognitive tests, including tests of attention, executive function, and long-term memory.
Asunto(s)
Trastornos del Conocimiento/fisiopatología , Función Ejecutiva/fisiología , Recuerdo Mental/fisiología , Psicología del Esquizofrénico , Accidente Cerebrovascular/complicaciones , Insuficiencia Vertebrobasilar/complicaciones , Adulto , Anciano , Atención/fisiología , Trastornos del Conocimiento/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Insuficiencia Vertebrobasilar/fisiopatología , Insuficiencia Vertebrobasilar/psicologíaRESUMEN
This article describes the case of a 67-year-old woman who presented with a typical left hemifacial spasm of 8-month duration. After 2 months, she experienced lacinating and sharp shock-like pain in the left side of her face affecting the V1 and V2 territories and a discrete attenuation of nauseous reflex on the left side. CT angiography and MRI revealed significant compression of left cranial nerves V, VII, VIII, IX and X by a giant and tortuous vertebro-basilar arterial complex. This case illustrates the nonlinearity of the relationship between the presence of the stressor factor and the actual manifestation of the disease.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/patología , Espasmo Hemifacial/etiología , Espasmo Hemifacial/patología , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/patología , Anciano , Arteria Basilar/anomalías , Arteria Basilar/diagnóstico por imagen , Arteria Basilar/patología , Malformaciones Vasculares del Sistema Nervioso Central/fisiopatología , Enfermedades de los Nervios Craneales/etiología , Enfermedades de los Nervios Craneales/patología , Enfermedades de los Nervios Craneales/fisiopatología , Nervios Craneales/patología , Nervios Craneales/fisiopatología , Femenino , Espasmo Hemifacial/fisiopatología , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Nervio Trigémino/patología , Nervio Trigémino/fisiopatología , Neuralgia del Trigémino/fisiopatología , Arteria Vertebral/anomalías , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/patología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/patología , Insuficiencia Vertebrobasilar/fisiopatologíaRESUMEN
BACKGROUND: There are few reports on the outcome of surgical treatment of TGN without vascular compression. METHODS: Between 1984 and 2004, 668 patients underwent MVD for TGN. In 21 patients (3.1%), vascular compression was absent. The surgical strategy in these cases involved the following: (1) dissection and exposure of the entire trigeminal nerve root; (2) slight neurapraxia with bipolar tips at the trigeminal nerve root; and (3) isolation of trigeminal nerve with Teflon sponge fragments. RESULTS: The patients' (female/male, 20:1) ages ranged from 33 to 77 years. Their right side was the most frequently involved (61.9%). Their mean duration of pain before treatment was 7.6 years (range = 1-20 years). At surgical exploration, vascular compression or anatomical abnormalities were absent in 15 patients (71.4%), arachnoidal thickening was present in 5 (23.8%), and fiber dissociation of the trigeminal nerve was present in 1 (4.8%). Mean follow-up after surgery was 17.7 months (range = 4-65 months). Immediate relief from pain occurred in all 21 patients. On Kaplan-Meier analysis, recurrence was maintained at 14.8% for 12, 24, and 36 months, increasing to 43.2% at 48 months. Permanent hypoesthesia was present in 6 patients (28.6%), whereas loss of corneal reflex was observed transiently in 1 (4.8%). Motor function of the trigeminal nerve was intact in all patients. No other complication was found. CONCLUSION: The proposed surgical plan of standard MVD plus slight trigeminal nerve root neurapraxia is a safe and effective management option for TGN without vascular compression.
Asunto(s)
Descompresión Quirúrgica/métodos , Procedimientos Neuroquirúrgicos/métodos , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Aracnoides/patología , Aracnoides/fisiopatología , Arteria Basilar/patología , Arteria Basilar/fisiopatología , Fosa Craneal Media/anatomía & histología , Fosa Craneal Media/patología , Fosa Craneal Media/cirugía , Descompresión Quirúrgica/instrumentación , Descompresión Quirúrgica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Estudios Prospectivos , Resultado del Tratamiento , Nervio Trigémino/patología , Nervio Trigémino/fisiopatología , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/fisiopatología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/patología , Insuficiencia Vertebrobasilar/fisiopatologíaRESUMEN
PURPOSE OF REVIEW: All functional classes of eye movements require exquisite coordination between cortical, basal ganglia and brainstem centers involved in ocular motor control. Vertebrobasilar stroke may produce a wide spectum of isolated or combined eye-movement disorders. The intent of this article is to summarize the curent knowledge of eye-movement disorders occurring in infarcts involving the different arterial territories of the vertebrobasilar circulation. RECENT FINDINGS: In the last few years there has been an improvement in our understanding of pathophysiological mechanisms that are related mainly to abnormal vergence disorders due to thalamic-subthalamic infarcts, as well as of the peculiar symptoms resulting from otolith pathway involvement occurring in lateral medullary infarcts. Moreover, progress in neuroimaging technology has implicated neurovascular contact of the trochlear nerve in instances of superior oblique myokimia. SUMMARY: Eye-movement disorders commonly occur in vertebrobasilar stroke, although they are often unappreciated. They may make it possible to establish specific anatomical correlates, as well as the probable nature of the underlying pathology.
Asunto(s)
Trastornos de la Motilidad Ocular/etiología , Insuficiencia Vertebrobasilar/complicaciones , Ganglios Basales/fisiopatología , Tronco Encefálico/fisiopatología , Corteza Cerebral/fisiopatología , Humanos , Vías Nerviosas/fisiopatología , Trastornos de la Motilidad Ocular/diagnóstico , Trastornos de la Motilidad Ocular/fisiopatología , Síndrome , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar/fisiopatologíaAsunto(s)
Humanos , Masculino , Infarto Cerebral/diagnóstico , Insuficiencia Vertebrobasilar/diagnóstico , Vértigo/fisiopatología , Infarto Cerebral/fisiopatología , Diagnóstico Diferencial , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/fisiopatología , Insuficiencia Vertebrobasilar/fisiopatología , Vértigo/diagnósticoRESUMEN
To determine whether flow through the subclavian artery might be affected during extracorporeal membrane oxygenation (ECMO), 40 neonates were examined with color Doppler ultrasound during and after ECMO. Retrograde flow in the right vertebral artery, noted in 12 of the 40 neonates (30%), was consistent with vertebral steal. Brachial systolic velocity was significantly less (P less than .01) on the right than on the left side in neonates both with and without vertebral steal. When the arterial cannula was removed after ECMO, vertebral artery flow became antegrade with symmetric velocity. Brachial velocities became symmetric in infants without vertebral steal, but mild asymmetry persisted in neonates who had had vertebral steal. Only one neonate had clinical signs of arm ischemia, which resolved promptly after removal of the cannula. No surviving neonates (n = 11) had neurologic findings related to the vertebrobasilar insufficiency over a 12-22-month period of observation. Vertebral steal appears to be common during ECMO and is resolved after removal of the cannula.