Cerebellar infarct following orchidopexy under spinal anesthesia / Infarto cerebelar após orquidopexia sob raquianestesia

Abstract The report describes a case of peri-operative stroke that presented as diplopia and gait difficulty on 2nd post-operative day after routine orchidopexy under spinal anesthesia in an otherwise healthy young boy. Magnetic resonance imaging of the brain revealed acute infarct in bilateral cerebellar hemispheres, left half of medulla and left thalamus. A diagnosis of acute stroke (infarct) was made and patient was started on oral aspirin 75 mg.day-1, following which his vision started improving after 2 weeks. Possible mechanisms of development of stroke in the peri-operative period are discussed, but, even after extensive investigations, the etiology of infarct may be difficult to determine. Acute infarct after elective non-cardiac, non-neurological surgery is rare; it may not be possible to identify the etiology in all cases. Clinicians must have a high index of suspicion to diagnose such unexpected complications even after routine surgical procedures in order to decrease the morbidity and long term sequelae.

Resumo O presente relato descreve um caso de acidente vascular cerebral perioperatório que resultou em diplopia e dificuldade de marcha no segundo dia após orquidopexia de rotina sob raquianestesia em um jovem, em outros aspectos, saudável. Ressonância magnética cerebral revelou infarto agudo em hemisférios cerebelares bilaterais, metade esquerda do bulbo e tálamo esquerdo. Um diagnóstico de acidente vascular cerebral agudo (infarto) foi feito e o paciente começou a receber tratamento com aspirina oral (75 mg.dia-1), após o qual sua visão começou a melhorar após duas semanas. Possíveis mecanismos de desenvolvimento de acidente vascular cerebral no período perioperatório são discutidos, mas, mesmo após extensas investigações, a etiologia do infarto pode ser difícil de determinar. O infarto agudo após cirurgia eletiva não cardíaca e não neurológica é raro; talvez não seja possível identificar a etiologia em todos os casos. Os médicos devem ter um elevado grau de suspeita para diagnosticar essas complicações inesperadas, mesmo após procedimentos cirúrgicos de rotina, para diminuir a morbidade e as sequelas em longo prazo.

Treatments with Balloon Catheter Dilatation and Botulium Toxin Injection in a Patient with Pharyngeal Dysphagia Secondary to Cricopharyngeal Dysfunction / 대한소화기학회지

No abstract available.

A Case of Cerebellar Infarction Caused by Acute Subclavian Thrombus Following Minor Trauma

Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.

Peripartum neurological emergencies in a critical care unit

To assess the proportion of eclampsia among patients admitted to the critical care unit [CCU] with an acute neurological emergency in the peripartum period, and careful clinical, laboratory, and radiological evaluation of non-eclampsia cases responsible for such presentation. A case series study that included women with acute deterioration of consciousness, with or without convulsions or neurological deficits, during pregnancy or puerperium, received in the CCU of Ibn Sina Teaching Hospital in Mosul, Iraq, from September 1st 2005 to August 31st 2006. A total of 30 women were included. They received careful clinical, radiological, and laboratory evaluation in an attempt to identify the cause of their presentation. Eclampsia was found to be responsible for two thirds of cases [20 patients]. The remaining one third was diagnosed as cerebral venous thrombosis [CVT] [7 patients], peripartum cerebral infarction [one patient], intracerebral hemorrhage [one patient], and acute fatty liver of pregnancy [one patient]. Four of the women with CVT had preeclampsia during pregnancy. Imaging studies, particularly MRI and MR venography, provided the final diagnosis in most cases. Eclampsia was found more common in women presenting during their first pregnancy, while CVT was more common in multiparous women [p=0.0001]. Cortical blindness was significantly associated with eclampsia instead of CVT [p=0.01]. Acute neurological symptoms in the peripartum period represent a diverse group of conditions, requiring careful clinical evaluation and early access to imaging studies

Reliability of Persian early computed tomography score in patients with brain infarction

The one-third middle cerebral artery [1/3 MCA] method and Alberta Stroke Program Early Computed Tomography Score [ASPECTS] were used to detect significant early ischemic changes on brain computed tomography [CT] of patients with acute stroke. We designed the Persian Early CT Score [PECTS] and compared it with the above systems. The tomograms were chosen from the stroke data bank of Ghaem Hospital, Mashhad, in 2008. The inclusion criteria were the presence of MCA territory infarction and performance of CT within 6 hours after stroke onset. Axial CTs were performed on a third-generation CT scanner [Siemens, ARTX, Germany]. Section thickness above posterior fossa was 10 mm [130 kV, 150 mAs]. Films were made at window level 35 HU. The brain CTs were scored by four independent radiologists based on the ASPECTS, 1/3 MCA method, and PECTS. The readers were blinded to the clinical information except the symptom side. Cochrane Q and Kappa tests were used for statistical analysis. Twenty four CT scans with sufficient quality were available. The difference in distribution of dichotomized 7 ASPECT scores between the four raters was significant; Q=13.071, df=3, P=0.04. The difference in distribution of dichotomized >1/3 and

Ischemic stroke following mild head injury is it the cause.

Recognition of childhood stroke is difficult. Newer diagnostic modalities like magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) have made this task much easier. Head trauma usually causes hemorrhage. We are presenting seven cases of mild head injury presenting as ischamic stroke. Neuroimaging suggested infarct involving left basal ganglia and internal capsule in five and bilateral involvement in two cases. MRA done in three was normal.

Infarto cerebelar: análise de 151 pacientes / Cerebellar infarction: analysis of 151 patients

Este estudo apresenta o tratamento de 151 pacientes com infarto cerebelar, sendo 98 homeNs (65 por cento) e 53 mulheres (35 por cento), com média de idade de 62,4 anos. Hidrocefalia obstrutiva foi diagnosticada em 7,9 por cento dos pacientes associada com um infarto cerebelar extenso e em todos os 11 pacientes operados (7,2 por cento). Quatro pacientes foram submetidos a derivação ventricular externa com 3 óbitos (75 por cento) e 7 foram submetidos a craniectomia descompressiva suboccipital com 2 óbitos (28,5 por cento). A mortalidade no grupo clínico foi de 15 pacientes (10,7 por cento). Vertigem, vômito, sinal de Romberg e dismetria foram os sinais e sintomas de envolvimento cerebelar mais frequentemente observados. Infarto cerebelar devido a embolismo provocado por cirurgia cardiovascular ocorreu em 57 pacientes (37,7 por cento).Infarto cerebelar como fato isolado ocorreu em 59 pacientes (39 por cento) e infartos cerebelares associados a infartos de outras regiões ocorreram em 92 pacientes (61 por cento). A ressonância magnética foi o melhor método para o diagnóstico das lesões, embora a tomografia pôde mostrar infarto cerebelar em 68 pacientes (78 por cento).

Aspectos neurológicos del púrpura trombótico trombocitopénico: Presentación de un caso / Thrombotic thrombocytopenic purpura with neurological involvement: Report of one case

Neurological manifestations, secondary to perfusion problems, vasogenic edema or small infarcts, are common in thrombotic purpura. Moreover, they are the first symptoms of the disease in 50% of patients. We report a 50 year-old woman who presented with focal intermittent neurological signs with aphasia and right hemiparesis, who then developed progressive impairment of consciousness with stupor and generalized tonic-clonic seizures. Despite the severe neurological impairment, first neuroimaging studies were normal. A second magnetic resonance imaging showed small cortical infarcts, that were visible only with the technique of diffusion weighted imaging. The standard electroencephalograms showed focal left temporal slowing and low voltage first and then diffuse slowing accordind to the clinical condition of the patients. She was treated with plasmapheresis and had a partial neurological recovery at the fifth day, but died at the twelfth day of therapy .