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RESUMEN Alteraciones autonómicas agudas por infartos cerebrales se han descrito con frecuencia comprometiendo la región insular, dentro de las anormalidades se han documentado alteraciones de severidad variable del ritmo cardíaco, incluyendo la bradicardia extrema sintomática; en la literatura solo hay un reporte de caso de bradi-cardia extrema asociado a un infarto talámico paramediano bilateral, a continuación, describimos un segundo caso de un infarto talámico con la misma presentación.
SUMMARY Acute autonomic disturbances due to cerebral in farcts has been describe frequently with association of the insular cortex, within the describe abnormalities had been document a variety of cardiac disturbances including extreme symptomatic bradycardia; In the literature just exist a case report of extreme bradycardia associate with a bilateral paramedian thalamic infarct, in the following article, we describe a second case of this infarct with the same presentation.
Subject(s)
Thalamic Nuclei , Bradycardia , Cerebral Infarction , Nystagmus, PathologicABSTRACT
Objective To research the location in cerebral circulations of recurrent stroke.Methods We included patients with acute cerebral infarction from the Department of Neurology of People's Hospital of Peking University within three years.We followed up the patients by telephone and electronic medical record to determine whether they belong to recurrent group or not.We recorded the clinical and image variables of recurrent group.We classified the recurrent group by whether the loci of recurrent stroke is in the same circulation.We determined the independent risk factors of the same circulation loci by Cox regression.Results There are 106 cases of recurrent stroke.Within 5 years,46.2％ of the cases had recurrent loci in the same circulation as first stroke loci.53.8％ of the cases had recurrent loci in the different circulation from first stroke loci.According to logistic regression,whether the recurrent loci was in the same circulation was not related to age,sex,hypertension,diabetes mellitus,smoking,but related to the survival time.The shorter the survival time was the more ratio of same circulation loci happened.The longer the survival time was the more ratio of different circulation loci happened.37％ of cases with recurrent strokes happened in the first year occupied the most cases in the 5 years.Conclusions With the long time study of the location of recurrent stroke,we get the conclusion that the longer the survival time is the more ratio of different circulation stroke happen.So we emphasize the importance of medicine for the stroke in long time.At the same time we conclude the rationality of endovascular treatments within 1 year from first stroke because recurrent loci is more often in the same circulation in 1 year.
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Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA. A 66-year-old man with no previous medical history developed left hemiparesis. A computed tomography scan revealed no acute lesion and he received IV rt-PA within 1.5 hours after symptom onset. Emergent magnetic resonance imaging showed significant diffusion-perfusion mismatch. He received IAT 2 hours after IV rt-PA administration, but IAT failed because of total occlusion of the cervical internal carotid artery. We initially planned to perform STA-MCA bypass the next morning because he had received IV rt-PA, but, 8 hours after IV rt-PA administration, his hemiparesis worsened from motor grade 3/4 to motor grade 1/2. Because of the large perfusion defect in both MCA divisions, double-barrel STA-MCA bypass was performed 10 hours after IV rt-PA administration. His symptoms rapidly improved after surgery and his modified Rankin Scale score 3 months later was grade 0. We suggest that emergent double-barrel bypass can be a viable option in patients who have perfusion defects of both MCA divisions in acute ischemic stroke after IV rt-PA administration.
Subject(s)
Aged , Humans , Administration, Intravenous , Carotid Artery, Internal , Cerebral Arteries , Cerebral Infarction , Cerebral Revascularization , Endarterectomy, Carotid , Magnetic Resonance Imaging , Neurologic Manifestations , Paresis , Perfusion , Reperfusion , Stroke , Tissue Plasminogen ActivatorABSTRACT
Objective To observe the clinical effect of plasmin combined with aspirin in treating acute cerebral infarction and to explore the influence to blood rheology and nerve function.Methods 148 cases with acute cerebral infarction were randomly divided into two groups.The control group (n =74) was treated by honghua injection.The study group (n =74) was treated by plasmin combined with aspirin.After treatment,the clinical effect,blood rheology and neurological recovery were observed.Results The total effective rate of the study group was 97.2％,which was significantly higher than that of the control group(74.3％) (x2 =15.88,P ＜ 0.05).The blood rheology indexes of the two groups had improved and neural function of the two groups was restored,but those in the study group were obviously better than control group (t =3.56,3.42,4.26,3.22,4.16,all P ＜ 0.05).Conclusion Plasmin combined with aspirin in treating acute cerebral infarction has accurate clinical curative effect,can markedly improve the blood rheology and promote nerve functional recovery,is worth of clinical spreading.
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A 69-year-old woman had syncope and aphasia. Magnetic resonance imaging showed multiple cerebral infarctions in both hemispheres. Cardiogenic embolisms were suspected, but no arrhythmic causes were shown. Transesophageal echocardiography revealed a highly calcified mitral annulus (MAC) with a rough intraluminal surface and mild mitral regurgitation, but no thrombus or tumor in the left heart system. However, recurrent multiple cerebral embolisms occurred in spite of strict anticoagulation therapy. We speculated that spontaneous rupture of the MAC was the cause of the scattered cerebral embolisms, and we therefore planned to remove the MAC as safely as possible and to endothelialize the deficit of MAC with autologous pericardium. Operative findings revealed that the MAC in P2-P3 had ruptured longitudinally and the ostium of the left atrium was connected to the ostium of the left ventricle as an inter-atrioventricular tunnel beneath the posterior mitral annulus with a fragile calcified wall. The finding suggested that calcified particles that had peeled away from the MAC by normal heart beating resulted in the cerebral infarctions. Therefore, she underwent resection of the MAC and mitral valve replacement with reinforcement of the decalcified posterior mitral annulus between the posterior left ventricular wall and the left atrial wall using autologous pericardium, which enabled both appropriate insertion of a mechanical prosthetic valve and endothelial continuity covering the surface of the residual MAC. No systemic embolism has occurred for two and a half years after surgery. This is the first case report of cerebral embolism caused by a spontaneously ruptured MAC.
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Objective To study the characteristics of working memory impairment in patients with lacunar cerebral infarctions(LCI).Methods 42 patients proved by clinics were chosen,and divided into two groups:multiple and single LCI groups,versus left,right and double side infarction groups.Their working memory status were evaluated and compared with Digit Ordering Test,Corsi block task,House Visual Span Test and Stroop Digit Counting Test.All scores were analyzed statistically.Results(1)All scores of the four types of Tests in multiple LCI group were significantly lower than those in single group(P0.05).Conclusions Multiple LCI is closely related to working memory impairment.Left brain infarction may induce verbal working memory impairment,and right infarction may induce spatial working memory impairment,but object working memory impairment may related to double side of brain infarction.It suggested that in the physiological structure,different components of working memory regions had dissymmetrical effect in two sides of brain.
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BACKGROUND: Treatment with heparin has been an area of great controversy among neurologists. The goal of this study was to compare the actual usage patterns of intravenous heparin according to the stroke subtype, location, severity of the stroke, different hospitals, and various departments. METHODS: The records of 1204 patients with acute ischemic stroke admitted to 10 teaching hospitals between January 2000 and December 2000 were reviewed. The patients were divided into two groups of whether or not they were given intravenous heparin. Cases of acute ischemic stroke were subdivided according to the TOAST classification. Patients with NIH Stroke Scale scores were categorized as having mild, moderate, and severe stroke. Terminal hospital stays were subdivided further by department: internal medicine, neurology, neurosurgery, rehabilitation medicine, and others. RESULTS: 512 patients (42.5%) were treated with heparin. The usage of heparin in the case of large artery atherosclerosis occupied 46%, small vessel occlusion 31 percent, cardioembolism 73%, other determined etiology 33%, and undetermined etiology 46%. Heparin was used to treat 46% of the patients with a lesion of anterior circulation, 49% of posterior circulation, and 38% of both anterior and posterior circulation. Heparin was more frequently used for moderate and severe strokes compared to mild strokes. CONCLUSIONS: The utilization of intravenous heparin was more frequent in treatment of the cardioembolism subtype and moderate-to-severe strokes. Practice variation according to the hospitals and discharge departments were manifested.