ABSTRACT
Symptomatic hemorrhagic transformation is common in supratentorial and cerebellar infarction, but is rare in brainstem infarction. It is seldom reported in basilar artery occlusion. Although early arterial recanalization by thrombolytic agent has became the new trend of treatment, for some neurologists anticoagulant is still a conventional alternative treatment of basilar artery occlusion, especially in longer-existing ischemic deficits. We report a case of massive pontine hemorrhage associated with enoxaparin (low-molecular-weight heparin) treatment for basilar artery occlusion. On the basis of the clinical information and neuroimaging, an embolism was the most likely cause of stroke. The case presented herein adds massive pontine hemorrhagic transformation to the list of possible complications of anticoagulants for basilar artery occlusion. Apart from no evidence-based benefit in treatment of basilar artery occlusion, anticoagulant may contribute to devastating hemorrhagic transformation.
Subject(s)
Aged , Anticoagulants/adverse effects , Cerebral Hemorrhage/chemically induced , Enoxaparin/adverse effects , Humans , Male , Pons/pathology , Tomography, X-Ray Computed , Vertebrobasilar Insufficiency/drug therapyABSTRACT
Vertebro basilar insufficiency (VBI) is a well known cause of vertigo. Brain Single Photon Emission Computed Tomography (SPECT) is an important diagnostic tool to detect and to quantitate the perfusion abnormalities in different areas of the brain. Effect of an antivertigo drug Betahistine on improving the hypoperfusion in different areas of the brain in vertigo patients was studied using brain SPECT. Betahistine at a dose of 16 mg three times daily was shown to improve perfusion in the hypoperfused areas of the brain resulting in relief from symptoms of vertigo. The cerebellar region, which is the most important area involved in vertigo patients with vascular pathology, showed almost complete normalisation of perfusion following Betahistine therapy.
Subject(s)
Betahistine/administration & dosage , Female , Humans , Male , Middle Aged , Radiopharmaceuticals/diagnosis , Technetium Tc 99m Exametazime/diagnosis , Tomography, Emission-Computed, Single-Photon , Treatment Outcome , Vasodilator Agents/administration & dosage , Vertebrobasilar Insufficiency/drug therapy , Vertigo/drug therapyABSTRACT
O autor descreve um caso de discinesia tardia (DT) de aparecimento após a suspensão do uso da flunarizina (Fz). A paciente procurou atendimento por síndrome de Parkinson (SP) atípica, pelo parasitismo de movimentos córeo-atetósicos, refratária a L-dopa e anticolinérgicos. Usava a Fz para o tratamento de vertigens por provável insuficiência vértebro-basilar. Suspenso o uso da Fz houve melhora progressiva da SP mas na mesma medida que desaparecia a SP a DP se fez mais evidente e persiste 24 meses após a suspensão da Fz. O objetivo é alertar para esse efeito colateral grave da Fz, uma droga cuja comercialização não é liberada em vários países do mundo mas que se indica atualmente para afecções comuns como a enxaqueca como faz o Goodman e Gilman (1990) mas não aponta como efeitos colaterais nem a SP nem a DT