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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.
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.
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@#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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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.
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Humans , Acupuncture Points , Acupuncture Therapy , Methods , Brain Stem Infarctions , Catheterization , Dilatation , Esophageal Achalasia , Therapeutics , Treatment OutcomeABSTRACT
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.
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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.
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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.
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No abstract available.
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Brain Stem Infarctions , Infarction , Trigeminal NeuralgiaABSTRACT
Objective To investigate the magnetic resonance imaging (MRI) features and classification of brainstem stroke with hyperglycemia in relation to the clinical outcome and the onset of brainstem stroke, and identify the risk factors and explore the pathogenesis of brainstem stroke. Methods This case-control study involved 218 hyperglycemic patients with acute cerebral stroke and 218 stroke patients with normal blood glucose (control group). The mRS scores of the patients were used to compare the clinical outcomes of the patients with different types ofbrainstem infarct. Results The risk factors and MRI features of the two groups were compared, and according to the MRI features,brainstem stroke was classified into 5 types, namely the midbrain infarct, pontine infarct, medullary infarct, entire brainstem infarct, and brainstem lacunar infarct. For midbrain, pontine, and medullary infracts, 3, 5 and 3 subtypes were identified, respectively. The incidence of brainstem stroke was significantly higher in hyperglycemic patients (P<0.05). Hyperglycemic stroke patients had significantly higher incidence of hypertension and higher systolic blood pressure (SBP), fibrin (Fib), triglyceride (TG),cholesterin (TCHO), and low-density lipoprotein (LDL-C) levels than normoglycemic patients (P<0.05), but the diastolic blood pressure (DBP) and high-density lipoprotein (HDL) showed no significant differences between them (P>0.05). No significant differences were found in TG, Fib, TCHO, HDL-C,LDL-C, number of patients with hypertension, time course of hypertension, SBP or DBP between hyperglycemic and normoglycemic patients (P>0.05). In hyperglycemic patients, the level of FBG, postprandial blood sugar, glycosylated hemoglobin and other risk factors were comparable between the patients with brainstem infarct and those with infarct in other locations (P>0.05). More than half (50.4%)of the patients with brainstem infarction had mRS scores of 2-5, and the rest (49.6%) had scores of 0-1.Conclusion Hyperglycemia is closely associated with brainstem infarction and more likely to compromise the perforating branches of blood vessels in the posterior circulation to cause brainstem stroke. Brain stem infarction causes higher rates of mortality and disability.
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Objective To investigate the effect of stroke unite on brain stem infarction.Methods 102 patients with brain stem infarction from Janualy 2005 to May 2009 were randomly divided into two groups:treatment group with stroke unite(n=52) and control group(n=50).Patients in treatment group were administrated stroke unite for four weeks.Cases in control group were given traditional treatment for the same time.The primary efficacy was evaluated by NIHSS(the National Institutes of Health stroke scale,NIHSS),ADL(Activities of daily living,ADL) and clinical effective.The data were analyzed by SPSS12.0 software package.The difference was significant if P
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We present two cases with dissecting aneurysm of intracranial vertebral artery. One of them had brain stem infarction and the other one developed subarachnoid hemorrhage. Cerebral angiogram revealed fusiform dilatation with proximal and distal narrowing of the affected vessel. Magnetic resonance imaging showed subacute blood clot inthe right vertebral artery which suggested dissection. Differentiation from vasospasm and from atherosclerosis is critical. At surgical exposure, the aneurysms were appeared as dark-purplish sausage like masses. The proximal portions of the intracranial vertebral arteries were clipped. The post-operative courses were benign and at present they regained their normal daily lives.