Abordaje interhemisférico contralateral. Nota técnica / Contralateral interhemispheric approach. Technical note

El abordaje interhemisférico contralateral es una variante del abordaje interhemisférico transcalloso que permite optimizar el acceso a lesiones ubicadas en los ventrículos laterales o en sus paredes. La planificación del ángulo de entrada mediante neuronavegador nos permitió el manejo de un Cavernoma ubicado sobre el núcleo caudado e inmediato a la cápsula interna sin realizar callosotomía convencional ni comprometer las estructuras sensibles adyacentes.

Contralateral interhemispheric approach is a variant of the well-know interhemispheric transcallosal approach that allows to optimize the lateral wall ventricle lesions management. Neuronavigation planning allowed us to deal with a caudate nucleus cavernoma contiguous to internal capsule without conventional callosotomy and additional damage neither.

Stereotactic biopsy for lesions in brainstem and deep brain: a single-center experience of 72 cases

Stereotactic biopsies for lesions in the brainstem and deep brain are rare. This study aimed to summarize our 6-year experience in the accurate diagnosis of lesions in the brain stem and deep brain and to discuss the technical note and strategies. From December 2011 to January 2018, 72 cases of intracranial lesions in the brainstem or deep in the lobes undergoing stereotactic biopsy were retrospectively reviewed. An individualized puncture path was designed based on the lesion's location and the image characteristics. The most common biopsy targets were deep in the lobes (43 cases, 59.7%), including frontal lobe (33 cases, 45.8%), temporal lobe (4 cases, 5.6%), parietal lobe (3 cases, 4.2%), and occipital lobe (3 cases, 4.2 %). There were 12 cases (16.7%) of the brainstem, including 8 cases (11.1%) of midbrain, and 4 cases (5.6%) of pons or brachium pontis. Other targets included internal capsule (2 cases, 2.8%), thalamus (3 cases, 4.2%), and basal ganglion (12 cases, 16.7%). As for complications, one patient developed acute intracerebral hemorrhage in the biopsy area at 2 h post-operation, and one patient had delayed intracerebral hemorrhage at 7 days post-operation. The remaining patients recovered well after surgery. There was no surgery-related death. The CT-MRI-guided stereotactic biopsy of lesions in the brainstem or deep in the brain has the advantages of high safety, accurate diagnosis, and low incidence of complications. It plays a crucial role in the diagnosis of atypical, microscopic, diffuse, multiple, and refractory lesions.

Treatment of hemiplegic stroke warning syndrome: comparison between tirofiban and aspirin combined with clopidogrel / 国际脑血管病杂志

Objective:To investigate the clinical safety and efficacy of tirofiban in the treatment of hemiplegic stroke warning syndrome.Methods:Patients with hemiplegic stroke warning syndrome admitted to Jining First People's Hospital without receiving intravenous thrombolysis from January 2018 to May 2020 were enrolled retrospectively. Some patients were given tirofiban intravenous infusion for at least 24 h in acute phase, then received oral antiplatelet therapy (tirofiban group); some only received aspirin+ clopidogrel dual antiplatelet therapy (control group). The primary endpoint was muscle strength at the paralytic side and National Institutes of Health Stroke Scale (NIHSS) score at day 7 after onset. The secondary endpoint was the modified Rankin Scale (mRS) score at 3 months after onset, and ≤2 was defined as good clinical outcome. The safety endpoint was the bleeding events during treatment. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 30 patients with hemiplegic stroke warning syndrome were enrolled, including 19 (63.3%) in the tirofiban group and 11 (36.7%) in the control group. There was no significant difference in baseline clinical data between the two groups, and no drug-related bleeding complications occurred during treatment. The muscle strength at paralytic side and NIHSS score at day 7 after onset, NIHSS score at discharge and good clinical outcome rate at 3 months in the tirofiban group were significantly better than those in the control group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that tirofiban was an independent protective factor for good outcome after adjusting the NIHSS score at the beginning of treatment (odds ratio 0.040, 95% confidence interval 0.040-0.449; P=0.009). Conclusions:Tirofiban is safe and effective in the treatment of patients with hemiplegic stroke warning syndrome in acute phase. It can effectively block the progress of the disease, improve the outcome of patients, and will not increase the risk of bleeding.

Capsular warning syndrome / 国际脑血管病杂志

Capsule warning syndrome (CWS) is a special clinical subtype of transient ischemic attack involving internal capsule, no cortical involvement and showing stereotyped attack. Although CWS is rare in clinical practice, most patients have poor outcomes. Therefore, a comprehensive and in-depth understanding of CWS is helpful to improve the outcomes and quality of life of patients. This article reviews the recent research progress of CWS.

Clinical and radiological characteristics of hemiplegic arm raising related to yawning in stroke patient / 解放军医学杂志

Objective To investigate the clinical and radiological characteristics of parakinesia brachialis oscitans (PBD) related to yawning in stroke patient and its mechanism.Methods We reported 4 patients with involuntary raising of the paralyzed limbs when yawning in neurological unit of Hainan Branch of Chinese PLA General Hospital,and analyzed their clinical characteristics together with published cases in literatures.Results In this group of stroke patients,when they yawned,their paralyzed upper limb could lift upward involuntarily.Totally 22 patients with ischemic (n=20) and hemorrhagic (n=2) stroke were enrolled.Brain imaging showed infarcts in the middle cerebral artery (MCA) in 17 patients and in the brain stem in 5 patients.This phenomenon occurred 4 hours to 4 months (14.57 ± 31.66d) after stroke onset,and lasted from 1 week to 3 years (6.70 ± 11.66 months).Corticobulbar tract and pyramidal tract were both damaged in these 22 patients.The mechanism might be that after corticobulbar tract and pyramidal tract damaged,their dominant role in the cranial nerve nuclei of the brainstem and the anterior horn cells of the spinal cord disappeared,and the projection of oxytocinergic neurons from paraventricular nucleus functions,thus causing yawning and muscle contraction.Conclusion PBO may be a rare phenomenon of abnormal movement after stroke.This phenomenon indicates damaging of pyramidal tract,and PBO disappears gradually with the recovery of pyramidal tract function.

Bilateral Lesions in the Posterior Limb of Internal Capsule Attributed to Combination Therapy of Isoniazid and Rifampin

Transient isoniazid-induced brain lesions have rarely been reported. The lesions were in the dentate nucleus of cerebellum and thalamus. Meanwhile, the neurotoxicity of rifampin has not been reported evidently. We observed bilateral lesions in the internal capsule in a young woman after taking a combination of isoniazid and rifampin. She transiently suffered numbness in both hands, dysarthria, and left side motor weakness while taking the medication. Isoniazid may induce structural lesions in various brain areas including the internal capsule.

Early predictor of neurodevelopmental outcome in the high risk infants / 中华实用儿科临床杂志

One of the challenge of pediatricians at follow -up for high risk babies is how to identify early in-fants who is at risk of neurodevelopment disability and timely intervention,another is to find infants who will not have a neurodevelopment sequel in order to avoid unnecessary excessive intervention as soon as possible.Accurate diagnosis can be achieved through comprehensive analysis by combined with the basic knowledge,neuroimaging and follow -up of neonatal brain injury.

Prominent Cognitive Dysfunction without Motor Impairment Following Anterior Choroidal Artery Infarction: a Case Report

Neurological deficits commonly associated with anterior choroidal artery infarction (AChAI) include hemiplegia, hemisensory loss, and homonymous hemianopsia, while neuropsychological and perceptual deficits are uncommon. Prominent cognitive function impairment has rarely been reported. Here, we report a case of AChAI with prominent cognitive function impairment without motor deterioration. In contrast to the typical clinical features of AChAI, near complete and rapid motor recovery was observed, while cognitive impairment persisted despite rehabilitation therapy.

Internal Capsular Infarction Presented as Monoataxia

No abstract available.

Risk factors for cerebral infarction in patients with capsular warning syndrome / 国际脑血管病杂志

Objective To investigate the risk factors for the occurrence of cerebral infarction in patients with capsular warning syndrome (CWS). Methods Consecutive patients with transient ischemic attack (TIA) meeting the CWS clinical manifestations were col ected retrospectively. They were divided into either a cerebral infarction group or a non-cerebral infarction group according to the brain diffusion weighted imaging findings. The independent risk factors for patients with CWS were identified through the comparison of demographic and baseline clinical data. Results A total of 39 patients were enrol ed, including 25 males (64. 1%) and 14 females (35. 9%), and their mean age was 58. 9 ± 10. 3 years. There were 21 patients in the cerebral infarction group and 18 in the non-cerebral infarction group. Compared with the non-cerebral infarction group, the age of patients in the cerebral infarction group was older (62. 5 ± 9. 3 years vs. 54. 8 ± 10. 2 years;t=2. 470, P=0. 018). The constituent ratio of the patients with a history of previous stroke or transient ischemic attack was higher (33. 3% vs. 5. 6%; P=0. 049), the fasting blood glucose level was higher (8. 2 ± 3. 2 mmol/L vs. 6. 0 ± 1. 3 mmol/L; t=2. 748, P=0. 009), and ABCD2 score was higher (5. 2 ± 1. 1 vs. 3. 5 ± 1. 1;t=4. 734, P<0. 001). Multivariate logistic regression analysis showed that the ABCD2 score was an independent risk factor for cerebral infarction in patients with CWS (odds ratio, 4. 529, 95% confidence interval 1. 233-16. 627;P=0. 023). Conclusions The higher ABCD2 score was an independent risk factor for the occurrence of cerebral infarction in patients with CWS. It can be used as an evaluation tool for predicting the risk of cerebral infarction in patients with CWS.

Alteraciones neuropsicológicas asociadas en pacientes con infarto lacunar / Neuropsychological disorders associated with patients with lacunar infarct / Alterações neuropsicológicas associadas em pacientes com enfarte lacunar

Existe poca evidencia del deterioro cognoscitivo que defina el perfil del paciente con Infarto Lacunar (IL). El propósito de este estudio fue identificar las alteraciones neuropsicológicas en este tipo de pacientes. La muestra estuvo compuesta por 16 pacientes con IL y 16 participantes sanos con una edad promedio de 63 ± 9.41 y 64.75 ± 9.06 años y una escolaridad de 7.55 ± 4.34 y 7.94 ± 3.51, respectivamente. Se valoró la función cognoscitiva mediante un instrumento de tamizaje y una batería neuropsicológica. El análisis estadístico se llevó a cabo a través de la prueba Kruskal-Wallis y la U de Man-Whitney. Los pacientes con IL se caracterizan por la alteración de dominios como planeación, fluidez verbal, cambio atencional, habilidad visoconstructiva y velocidad de procesamiento de la información (p < 0.050). El IL se relaciona con el deterioro del funcionamiento ejecutivo y de velocidad de procesamiento, debido a la interrupción de circuitos frontocortico-subcorticales asociados con su correcto desempeño.

There is little evidence of cognitive impairment to define the profile of patients with Lacunar Infarction (IL). The purpose of this study was to identify the neuropsychological disorders in these patients. The sample consisted of 16 patients with IL and 16 healthy control participants with an average age of 63 ± 9.41 and 64.75 ± 9.06 years, and average schooling of 7.55 ± 4.34 and 7.94 ± 3.51, respectively. Cognitive function was assessed using a screening tool and a neuropsychological battery. Statistical analysis was carried out by the Kruskal-Wallis and Mann-Whitney U tests. Patients with IL are characterized by the alteration of domains such as planning, verbal fluency, attention switching, visoconstructive skill and information processing speed (p <0.050). The IL is related to the impairment of executive functioning and processing speed, due to the interruption of frontocortico-subcortical circuits associated with their proper performance.

Existe pouca evidência da deterioração cognoscitiva que defina o perfil do paciente com Enfarte Lacunar (IL). O propósito deste estudo foi identificar as alterações neuropsicológicas neste tipo de pacientes. A mostra foi composta por 16 pacientes com IL e 16 participantes sãos com uma idade média de 63 ± 9.41 e 64.75 ± 9.06 anos e uma escolaridade de 7.55 ± 4.34 e 7.94 ± 3.51, respectivamente. Avaliou-se a função cognoscitiva mediante um instrumento de tamizagem e uma bateria neuropsicológica. A análise estadística foi feita através do teste Kruskal-Wallis e a U de Man-Whitney. Os pacientes com IL se caracterizan pela alteração de dominios como planejamento, fluêcia verbal, mudança atencional, habilidade visoconstructiva e velocidade de processamento da informação (p < 0.050). O IL se relaciona com a deterioração do funcionamento executivo e da velocidade de processamento, devido à interrupção de circuitos frontocortico-subcorticais associados com seu correto desempenho.

Capsular Warning Syndrome / 国际脑血管病杂志

Capsular warning syndrome (CWS) is a subtype of recurrent stereotyped transient ischemic attacks that heralds a subsequent stroke.The mainly presumed mechanism is repeated bursts of ischemia in the region of penetrating arteries,since the structural changes of large arteries is rare in series of imaging examinations.The majority of the infarct is located in the internal capsule or pontine.CWS is usually therapeutically resistant to simple traditional antithrombotic treatment,while combined antiplatelet treatment,thrombolysis,endovascular intervention and antiepileptics may protect part of the patients from developing into permanent infarcts.

Measurement of the volume of internal capsule in healthy Chinese adults of the Han nationality on the high-resolution MRI / 中华放射学杂志

ObjectiveTo explore the normal range of the volume of internal capsules in Chinese adults of the Han nationality and its relationship with age,body habitus,and craniocerebral volume.Methods One thousand healthy volunteers (age range =18 to 80 years) were divided into 5 groups according to their age;Group A ( 18 to 30 years old),group B (31 to 40 years),group C (41 to 50 years),group D (51 to 60 years),and group E (61 to 80 years).Each group consisted of 100 males and 100 females.MR imaging was performed in all of the volunteers using T1 weighted three-dimensional nagnetization prepared rapid acquisition gradient echo sequence. After three dimension data reconstruction,the volumes of bilateral internal capsules were manually measured. The volumes of bilateral internal capsules were compared by paired sample t test.The internal capsule volumes were compared between male and female by independent sample t test,and the differences among 5 age groups were compared by one-way ANOVA.The relationship between the volumes of internal capsule and age,body habitus or cerebral volume were analyzed using bivariate correlation.ResultsThe left and right internal capsule volumes were (2809 ± 393) and (2677 ± 343 ) mm3 respectively.The left internal capsule volumes were significantly larger than that of right (t =12.078,P ＜ 0.05 ).The left and right side of internal capsule volumes in male were (2863 ± 396) and (2744 ±358) mm3 respectively,and (2754 ±385) and (2609 ±314) mm3 in female.The left and right internal capsule volumes were larger in males than in female (t =1.982,2.851 ;P ＜ 0.05 ).The left internal capsule volume of the 5 age groups were ( 3273 ± 361 ),( 2943 ± 299 ),( 2777 ± 255 ),( 2607 ± 199 ),(2444 ±213) mm3,and the right were (2993 ± 361 ),(2814 ± 270),(2682 ± 239),(2543 ± 219),(2351 ±210) mm3.There were significant differences among 5 age groups between left and right internal capsule volume ( F =55.244,34.493 ; P ＜ 0.05 ).There was significant negative correlation between the volume of left and right internal capsule and age ( r =- 0.718,- 0.637 ; P ＜ 0.05 ).Conclusions1.5 T MR scanner can be used to accurately measure the internal capsule volumes.There is a significant negative correlation between age and internal capsule volumes.

Diffusion Tensor Magnetic Resonance Imaging as a Prognostic Indicator in the Deep Intracerebral Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVE: Diffusion tensor MR imaging (DTI) provides a means to visualize the course of the corticospinal tract within the white matter. The purpose of this study was to investigate the corticospinal tract in patients with deep intracerebral hemorrhage (ICH) involving the posterior limb of the internal capsule, to correlate with the motor impairment of the extremities, and to predict with motor improvement after stereotactic evacuation of the ICH. METHODS: Ten patients with deep intracerebral hemorrhage (ICH) on the basal ganglia or thalamic region were included to this study. All patients underwent the stereotactic catheter insertion. The DTI was obtained within 5 days after the hemorrhagic attack, focusing on the posterior limb of the internal capsule (PIC). The patients were evaluated using the motor grading system (grade 0 to 5) initially and 2 months later. The Mann-Whitney U test was used for the statistical analysis. RESULTS: The motor scales improved only in the patients with the partially or non-involved PIC. The p value was 0.007 for upper extremities and 0.008 for lower extremities. In patients with the totally preserved PIC, follow-up motor scales improved in comparison with the preoperative state. In patients with the partially preserved PIC, follow-up motor scales improved according to the hierarchical organization principles. CONCLUSION: The DTI can show the degree and locations of the involvement by the hemorrhages to PIC and the DTI may be used as a good indicator to the motor function outcome in the patients with hemorrhagic stroke at basal ganglia or thalamic region.

Visualization of Jejunal Bleeding by Capsule Endoscopy in a Case of Eosinophilic Enteritis

Eosinophilic enteritis is a rare disease characterized by tissue eosinophilia, which can affect different layers of bowel wall. Normally, the disease presents as colicky abdominal pain, and rarely as an acute intestinal obstruction or perforation. In this paper, we report a case of eosinophilic enteritis, hitherto unreported, presenting as an ileal obstruction, and followed by jejunal bleeding, which was visualized by capsule endoscopy. A 62-year-old man received a 15 cm single segmental ileal resection at a point 50 cm from the IC valve due to symptoms of obstruction, which were diagnosed as eosinophilic enteritis. Seventeen days after operation, intermittent abdominal pain occurred again, and subsided upon 30 mg per day treatment with prednisolone. Fourteen days after this pain attack, the patient exhibited hematochezia, in spite of continuous prednisolone treatment. Capsule endoscopy showed fresh blood spurting from the mid-to-distal jejunum, in the absence of any mass or ulcer. This hematochezia rapidly disappeared following a high-dose steroid injection, suggesting it was a manifestation of jejunal eosinophilic enteritis.

Proton Magnetic Resonance Spectroscopic Changes of the Primary Motor Cortex and Supplementary Motor Area in Hemiparetic Patients with Corticospinal Tract Injury due to Deep Intracerebral Hematoma

This study was conducted to investigate the metabolic changes in the motor and motor association cortices following axonal injury in the internal capsule that was caused by deep intracerebral hematoma. Using proton magnetic resonance spectroscopy (1H MRS), the authors studied the primary motor cortices (M-1) and sup-plementary motor areas (SMA) of 9 hemiparetic patients with documentable hemi-paresis of varying severity, and we studied 10 normal volunteers as controls. To measure the M-1 and SMA biochemical changes, 4 separate single volumes of inter-est(VOIs) were located bilaterally in the affected and unaffected hemisphere (AH and UH).1H MRS provided a neuronal and axonal viability index by measuring levels of N-acetylaspartate (NAA) and creatine/phosphocreatine (Cr). The M-1/SMA NAA/Cr ratios of the AH and UH in patients, and the AH and normal volunteers were com-pared. The NAA/Cr ratios of the M-1 and SMA in AH, and the SMA in UH were sig-nificantly lower than those of normal volunteers. These 1H MRS findings indicate that axonal injury in the descending motor pathway at the level of internal capsule could induce metabolic changes in the higher centers of the motor pathway.

Memory Impairment after Stroke of Internal Capsule-basal Ganglia / 中国心理卫生杂志

Objective:to study memory impairment of patients with stroke in internal capsule-basal ganglia.Method:40 inpatients with stroke in internal capsule-basal ganglia and 25 aged matched normal control received assessment with MMSE (mini mental state examination), WMS-RC (Wechsler memory scale-Chinese revised), AVMT (auditory verbal memory test) and MPS (memory for pictorial scenes test). The patients were assessed in 20 days after stroke while the loci were determined by cranial CT or MRI.Result:among patients, the total scores of these memory tests were associated with cerebral atrophy, educational level, and leukoaraiosis. The volume of lesion and leukoaraiosis played a major role in memory coding strategy in MPS test. There were still significant differences in above memory tests between patients without cerebral atrophy and the matched controls.Conclusion:damage of sub-cortical rgions, such as lesions of internal capsule-basal ganglia, may cause memory impairment.

Correlation beteween Motor Disturbance and Involvement of the Internal Capsule in Hypertensive Intracerebral Hemorrhage

The treatment of patients with hypertensive intracerebral hemorrhage (ICH) is still controversial. Fifty-two cases with hypertensive thalamic or putaminal hemorrhage were classified into three groups on the basis of the location of the hematoma in the internal capsule on eht CT image. All the cases were confined to the anterior(Type A, 17 cases)., posterior(Type P, 25 cases) and mixed portion(Type M, 10 cases) of the posterior limb of the internal capsule, and were assigned to receive medical treatment, extraventricular drainage(EVD), or stereotactic aspiration using urokinase. This study was designed to assess the correlation between hematoma extension and the severity of motor disturbance in patients treated with stereotactic aspiration. The severity of motor weakness was found not to be related to hematoma extension, but the prognosis was frequently poor in type P and type M. The outcome was better in the stereotactic aspiration group, as compared with medical and EVD groups, especially when the hematoma was located at the posterior portion of the posterior limb of the internal capsule(p<0.05). The study suggests that stereotactic aspiration may improve the outcome of hypertensive ICH with severe motor weakness, even if the hematoma is small.

Internal capsular lesion associated with dizziness

It has been known that the vestibular system is concerned with feelings of dizziness or vertigo. The vestibulo-thalamic pathway has also been described previously. However, there has been no confirmative report so far regarding the pathway through the internal capsule to the cortex. We have experienced 13 patients with symptoms of dizziness and/or vertigo whose lesions are located only around the internal capsule, mainly at the posterior limb and/or the genu. It is suggestive that fibers with dizziness may pass through a part of the internal capsule, probably through some part of the posterior limb and/or the genu.

Computed Tomographic Findings of Good Prognosis in Hypertensive Putaminal Hemorrhage

Computed tomographic findings were analyzed in 46 patients with hypertensive putaminal hemorrhage accompainied by hemiparesis. It has been important prognostic index whether to involve or not to involve posterior limb of internal capsule. To study the reason for this, the relationship between the extent of a hematoma and the level ar which the pyramidal tract was destroyed was investigated. From the consideration of the process of destruction of the pyramidal tract by a hematoma, it seemed that computed tomographic findings at the level of the body of the lateral ventricle rather than at the prognosis of hemiparesis.