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Isolated medial rectus palsy in an otherwise healthy individual is a very rare entity. However, this may point towards underlying systemic pathology. This is a case report of an otherwise healthy young adult male who presented with sudden onset non-progressive blurring of vision in right eye. A series of investigations were performed and the patient was diagnosed to have a rheumatological disorder. Isolated muscle palsies in young patient may be masking a systemic disorder and needs to be evaluated thoroughly.
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Aims and objectives: The present study makes a comparative analysis between the clinical profile of lacunar infarcts (LI) and that of atherothrombotic brain infarcts (ABI). Methods: Hospital-based descriptive study of 1809 consecutive patients admitted over a period of 24 years with a diagnosis of lacunar cerebral infarction (n = 864) or atherothrombotic cerebral infarction (n = 945). A comparative analysis of the demographic data, cerebral vascular risk factors, clinical data and hospital evolution between both subtypes of cerebral infarction was performed using a univariate and multivariate statistical methodology. Results: LI accounted for 26.5% and ABI for 28.9% of all cerebral infarctions in the registry. The variables directly and independently associated with ABI were: ischemic heart disease, previous transient ischemic attack, previous cerebral infarction, peripheral vascular disease, anticoagulant therapy, age > 85 years, vegetative symptoms, decreased level of consciousness, sensory deficit, visual deficit, speech disorders, and neurological, respiratory and urinary complications during hospital admission. In contrast, the absence of neurological symptoms at hospital discharge was directly associated with LI. Conclusions: LI and ABI have a distinct clinical profile. The best functional prognosis of LI during the acute phase of the disease is characteristic. In contrast, ICAs have a higher atherosclerotic burden and a worse prognosis.
Fundamentos y objetivo: El objetivo del estudio es efectuar un análisis comparativo entre el perfil clínico de los infartos lacunares (IL) y el perfil de los infartos cerebrales aterotrombóticos (ICA). Métodos: Estudio hospitalario descriptivo de 1809 pacientes consecutivos ingresados durante un período de 24 años con el diagnóstico de infarto cerebral de tipo lacunar (n = 864) o por infarto cerebral aterotrombótico (ICA) (n = 945). Se realizó un análisis comparativo de los datos demográficos, factores de riesgo vascular cerebral, datos clínicos y de evolución hospitalaria utilizando una metodología estadística univariada y, posteriormente, multivariada. Resultados: Los IL representaron el 26.5% y los ICA el 28.9% del total de infartos cerebrales del registro. Las variables asociadas directamente y de forma independiente con los ICA fueron: cardiopatía isquémica, ataque isquémico transitorio previo, infarto cerebral previo, enfermedad vascular periférica, uso de anticoagulantes, edad > 85 años, síntomas vegetativos, disminución del nivel de conciencia, déficit sensitivo, déficit visual, trastornos del habla y complicaciones neurológicas, respiratorias y urinarias durante el ingreso hospitalario. En cambio, la ausencia de sintomatología neurológica al alta se asoció directamente con los IL. Conclusiones: Los IL y los ICA tienen un perfil clínico diferenciado. Es característico el mejor pronóstico funcional de los IL durante la fase aguda de la enfermedad. En cambio, los ICA presentan mayor carga aterosclerótica y peor pronóstico evolutivo.
Subject(s)
Humans , Cerebral Infarction , Brain Ischemia , Stroke , Stroke, LacunarABSTRACT
Objective: To investigate the protective effects of icaritin (ICT), one of the active ingredients in Epimedii Folium, on mouse model of cerebral ischemia-reperfusion (I/R) in vivo. Methods: ICR mice were subjected to an 1 h transient middle cerebral artery occlusion (MCAO) and followed by 24 h of reperfusion. Neurological deficits, infarct volume, brain edema and survive rate were measured, respectively. The levels of brain IL-1β TNF-α ROS and DNA-binding activity of NF-κB p65 were measured by ELISA kits. The levels of malondialdehyde (MDA) and activities of superoxide dismutase (SOD) were detected by spectrophotometry, and the release of nitric oxide (NO) were detected by Griess kit. Results: ICT markedly reduced the neurological deficit scores, brain edema, infarct volume and increased the survival rate of the cerebral I/R mice. The expression of IL-1β TNF-α NO, MDA and DNA-binding activity of NF-κB p65 were significantly inhibited by ICT, while the activity of SOD were up-regulated at the same time. Conclusion: ICT possessed significant neuroprotective effects in cerebral I/R mice, which might be related to prevent neuroinflammatory and oxidative damage.
ABSTRACT
To systematically evaluate the importance of protein synthesis in ischemic preconditioning (PC)-induced ischemic tolerance (IT), temporary middle cerebral artery occlusion (MCAO)by Longa (20 min) was used for PC (ischemic precondioning). Twenty-four hours of reperfusion was allowed after PC and before permanent MCAO to establish ischemic tolerance (IT) to compare with non-PC (sham-operated) rats (n=5 for each group). Infarct size and neurological deficits were measured 24 h after PMCAO. Samples of brain were taken for the determination of HSP70 expression by Western blot analysis. The effects of the protein synthesis inhibitor cycloheximide administered just before PC or administered long after PC but just before PMCAO on IT were also determined (n=5 for each group). Our results showed that hemispheric infarct was significantly reduced (P＜0.01) only if PC was performed after 24 h, and PC significantly (P＜0.05) reduced neurological deficits (similar to reductions in infarct size). Cycloheximide eliminated ischemic PC-induced IT effects on both brain injury and neurological deficits if administered before PC but not if administered long after PC but before PMCAO. PC produced no brain injury but did increase HSP70 protein 24 h after PC. Cycloheximide eliminated that effect. The results suggest that PC is a powerful inducer of ischemic brain tolerance as reflected by the preservation of brain tissue and motor function. PC induces IT that is dependent on de novo protein synthesis.
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Objective To investigate the ischemic preconditioning time for inducing rat brain ischemia tolerance.Methods Procerebrum ischemic preconditioning injury was caused by occlusion of two-side common carotid artery for 10 minutes or 20 minutes,and subsequent cerebral ischemic injury was caused by occlusion of middle cerebral artery for 2 hours after 72 hours of reperfusion.The percentage of brain infarct size was calculated for the investigation of the proper ischemic preconditioning time for rat brain ischemia tolerance.Results Ischemic preconditionaing for 10 minutes and 20 minutes can reduce the percentage of brain infarct size significantly.The difference of the percentage of brain infarct size between 10-minute preconditioning group and 20-minute preconditioning group is insignificant,but the mean percentage of brain infarct size in 10-minute preconditioning group is less than that in 20-minute preconditioning group.Conclusion Ten minutes are the suitable time of ischemic preconditioning for rat brain ischemia tolerance.
ABSTRACT
Diagnosis and therapeutic monitoring of human brain infarcts are dependent on imaging techniques such as computed axial tomography and magnetic resonance imaging. Yet, the radiological findings, especially contrast enhancement(CE), are not well correlated with the histopathological findings of the infarcts. By imaging techniques, CE is observed along the cortical margin of the infarcts, delayed in time after the initial attack. Explanation of the CE in terms of histopathological changes is the purpose of this study. Brain infarction was evoked by injection of homologous blood clots into the right common carotid artery of the rats. Three weeks after the injection, infarcts were examined light and electron microscopically. To confirm the possible increased permeability of vessels, horseradish peroxidase was injected intravenously before sacrifice of some rats. Unaffected brain tissue contralateral to the infarcts was examined for control. The results were as follows. Capillaries of the normal brain showed endothelial cells connected with tight junctions and approximated intimately to basement membrance on which cytoplasmic processes of the astrocytes rest. Pinocytotic vesicles in the endothelial cells were rarely observed. Horseradish peroxidase was confined almost to the capillary lumens. In contrast, regenerated capillaries in the infarcts showed endothedial cells with thin cytoplasmic processes protruded into the lumens and many pinocytotic vesicles. Toght junction and basement membrance were well formed, but astrocytes were not observed. Horseradish peroxidase was noted in the pinocytotic vesicles and around the capillaries. The regenerated capillaries were noted almost exclusively along the cortical margin of the infarcts. From the above results, CE of human brain infarcts along the cortical margin may be explained by the permeable capillaries regenerated at the cortical periphery of the infarcts.
Subject(s)
Animals , Humans , Rats , Astrocytes , Brain Infarction , Brain , Capillaries , Capillary Permeability , Carotid Artery, Common , Cytoplasm , Diagnosis , Endothelial Cells , Horseradish Peroxidase , Magnetic Resonance Imaging , Permeability , Tight JunctionsABSTRACT
We report an autopsy case of neonatal giant cell hepatitis that was presumed to be related to bacterial sepsis, endotoxemia and to the subsequent parenteral alimentation and antibiotics treatment. The patient died of candidal endocarditis and multiple brain infarcts. This female baby was born by a normal full term spontaneous delivery. Six days after delivery she developed fever and lethargy as she suffered from Cheyne-Stokes respiration with severe grunting. Blood culture grew Enterobacter and Acinetobacter. After management of the sepsis her general condition improved. On the 23rd day of admission she was found to have deep jaundice and hepatosplenomegaly. The liver became larger progressively and the edge was palpable at the umbilical level. Grade II systolic murmur was heard along the left lower sternal border. She died on the 31st day of hospitalization. Postmortem examination showed severe jaundice, hepatosplenomegaly, a large vegetation on the mitral valve and multiple petechial hemorrhages of the viscera. Microscopically the liver showed features of massive giant cell transformation, mild fibrosis and inflammatory cells, suggestive of giant cell hepatitis. Numerous yeasts and candidal pseudohyphae were seen in the cardiac vegetation, focally extending into the myocardium. There was a focus of candidal vasculitis in the bowel wall. In addition there were multiple bilateral organizing infarcts in the cerebral hemisphere as well as diffuse white matter damage associated with septicemia.
Subject(s)
Female , Infant, Newborn , HumansABSTRACT
Experimental brain infarcts in rats were studied light and electron microscopically to investigate the factor(s) controlling contrast enhancement on CT scans of the infarcts. Brain infarction was induced by injection of fine autologous blood clots through the right internal carotid artery and the affected brain was processed for examination 1 day, 2 day, and 1, 2, 4, 6 and 8 weeks after the injection. The lesion of early, necro - degenerative stage(1 day to 1 week) showed structural disintegration of capillary endothelial cells with dissolution of tight junctions. The lesion of middle, regenerative stage(2 to 4 weeks) was characterized by proliferation of new capillaries, They had well - formed tight junctions and continuos basement membrane. The endothelial cells, however, had intraluminal villous projections and many pinocytotic vesicles, suggesting an increased permeability. The capillaries matured at late, reparative stage(8 weeks), appearing similar to those in normal brain tissue except that they were loosely surrounded by astrocytic foot processes. It was presumed that the ncreased permeability of new capillaries might play an important role for contrast enhancement observable clinically during the middle stage(2 to 4 weeks).