Bilateral Infarction of the Recurrent Arteries of Heubner Following Clipping of an Anterior Communicating Artery Aneurysm

A 50-year-old woman reported to the emergency department with thunderclap headache and vomiting. Non-enhanced brain computed tomography (CT) showed a subarachnoid hemorrhage of Hunt-Hess Grade II and Fisher Grade III. Brain angiography CT and transfemoral cerebral angiography (TFCA) revealed an aneurysm of the anterior communicating artery. A direct neck clipping was performed using the pterional approach. The post-operation CT was uneventful. Six days postoperatively, the patient became lethargic. The mean velocity (cm/s) of the middle cerebral artery peaked at 173 cm/s on the right side and 167 cm/s on the left. A TFCA revealed decreased perfusion in both recurrent arteries of Heubner (RAH), but no occlusion in either. Intra-arterial nimodipine injection was administered. On the 7th postoperative day, CT demonstrated a newly developed low-density lesion in the RAH territory bilaterally. The cause of the infarction was attributed to decreased perfusion caused by cerebral vasospasm. The patient was discharged with no definite neurologic deficit except for mild cognitive disorder.

Alien Hand Syndrome in Stroke: Case Report & Neurophysiologic Study

Alien Hand Syndrome is defined as unwilled, uncontrollable, but seemingly purposeful movements of an upper limb. Two major criteria for the diagnosis are complaint of a foreign limb and complex, autonomous, involuntary motor activity that is not part of an identifiable movement disorder. After a cerebrovascular accident in the corpus callosum, the parietal, or frontal regions, various abnormal involuntary motor behaviors may follow. Although different subtypes of Alien Hand Syndrome have been distinguished, this classification clearly does not cover the wide clinical variety of abnormal motor behaviors of the upper extremity. And there are few known studies about the neurophysiology of this syndrome using transcranial magnetic stimulation (TMS). We recently experienced 2 rare cases of Alien Hand Syndrome which occurred after anterior cerebral artery (ACA) infarction. A 72 year-old male with right hemiplegia following a left ACA infarct had difficulty with voluntarily releasing an object from his grasp. A 47 year-old female with left hemiplegia following a right ACA infarct had a problem termed 'intermanual conflict' in which the two hands appear to be directed at opposing purposes. Both of them had neurophysiologic studies done, and showed reduced amplitude by single pulse MEP and a lack of intracortical inhibition (ICI) by paired pulse TMS. No abnormalities were found in SSEP.

Bilateral Anterior Cerebral Artery Infarction Associated with Reversible Cerebral Vasoconstriction Syndrome

No abstract available.

Bilateral Periodic Limb Movement Disorder Developed after Anterior Cerebral Artery Infarction

Previous reports on the lesions causing stroke-related periodic limb movement in sleep (PLMS) have involved subcortical structures such as the basal ganglia/corona radiata or pons. We report a case of an 81-year-old female patient who presented with bilateral, right-side-predominant PLMS that developed after a left cortical infarction. The right-side PLMS may be attributable to the loss of cortical inhibition following a pyramidal tract lesion, while the left-side PLMS may be caused by activation of the contralateral motor cortex due to dysfunction of interhemispheric inhibition.

Crossed Transcortical Motor Aphasia, Left Spatial Neglect, and Limb and Magnetic Apraxia Due to Right Anterior Cerebral Artery Infarction

Crossed aphasia refers to language disturbance due to right-hemisphere lesions in right-handed individuals, while magnetic apraxia is described as 'forced grasping and groping' caused by lesions in the contralateral frontal lobe. This is a case report of a 70-year-old right handed woman who suffered from crossed transcortical motor aphasia and left hand magnetic apraxia due to right anterior cerebral artery infarction. The definite mechanism of this disorder is not yet understood, but neurophysiological observations suggest that affected supplementary motor areas may be responsible for this phenomenon.

Urinary Difficulty in Brain Lesion: Impact on Quality of Life: Multicenter Prospective Epidemiologic Study

OBJECTIVE: To asses the prevalence of urinary difficulty and the relationship of urinary difficulty and type of brain lesion from multicenter prospective epidemiologic study. METHOD: 394 patients including outpatients and inpatients who visited from multicenter department of rehabilitation medicine from January 2008 to June 2008 were evaluated. Study based on international prostate symptom score (IPSS) and Quality of life (QoL) score were assessed, and the correlation between the two indexes was analyzed. RESULTS: 140 patients (35.5%) complained urinary difficulty as patient's main symptom, while IPSS score was 13.7 showing above moderate symptom at 77.5%. For patients complained urinary difficulty, the average of quality of life score was 3.1. Among stroke, 37% of infarction and 34% of hemorrhage complained urinary difficulty while 40% of traumatic brain injury did. Patients with ACA infarction reported urinary difficulty most frequently. Nocturia (71%), frequency (53.3%), incomplete emptying (30%) were the most frequent symptoms. Sixty-six patients (46%) complaining urinary difficulty were taking medications and anticholinergics were most widely used (75%). Scores of IPSS and QoL according to type and site of brain lesion didn't show meaningful difference while QoL score correlated significantly with IPSS score (p<0.05). CONCLUSION: Among all the brain lesion patients, 35.5% complained urinary difficulty while IPSS and QoL score according to type and site of brain lesion didn't show meaningful difference. Urinary difficulty affects the life quality of brain lesion patients.

Multiple separated and multi-lobular aneurysms of the anterior communicating artery complex

The anterior communicating artery complex [ACoA] is the most common site of occurrence of intracranial aneurysms, harboring about 30 percent of these lesions. Multiple aneurysms account for 20 percent of all cerebral aneurysms. Multiple aneurysms on the same artery correspond to 2.8 percent of aneurysms, usually found in the internal carotid artery or middle cerebral artery. Multiple aneurysms of the ACoA are very rare and there are only a few cases reported in the literature. In cases of multiple aneurysms of the anterior communicating artery complex, not all lesions may be detected on preoperative radiological studies, due to the complex angio-archiecture around the ACoA. Careful dissection is mandatory to ensure the completeness of aneurysm surgery. Multiple separated and multi-lobular aneurysms of the anterior communicating artery are unusual lesions and should be studied as a special topic. The authors present four cases of these rare aneurysms, namely three multiple separated aneurysms and one multi-lobular aneurysm of the ACoC. Three of these patients presented with subarachnoid hemorrhage [SAH]. There were no familial or arteriovenous malformation.related aneurysms reported in our series. We propose a new classification for this type of aneurysm on the ACoA. The literature is reviewed. The results, physiopathology and management are dis cussed.

The Effect of Levodopa on Akinetic Mutism in Bilateral Anterior Cerebral Artery Infarction: A case report

Akinetic mutism is a clinical syndrome in which the patient is unable to speak (mutism) or move (akinesia). Various brain lesions can induce akinetic mutism. We attended a 71-year-old woman who presented with akinetic mutism caused by bilateral anterior cerebral artery infarction. The patient improved after the administration of levodopa com-bined with carbidopa, in response to visual and verbal stimuli. Increased verbal output and spontaneous motor activities were also noted. Levodopa may be helpful to the treatment of akinetic mutism.

Correlation between fibrinogen level and cerebral infarction / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the correlation between plasma fibrinogen level and cerebral infarction (CI) as well as the difference of fibrinogen among subtypes of CI.</p><p><b>METHODS</b>A case-controlled study was conducted with 131 cases of CI and 148 controls. Plasma fibrinogen levels were detected by the Clauss method.</p><p><b>RESULTS</b>High fibrinogen level (3.09 +/- 0.94 g/L) was correlated with CI (OR = 2.47, 95% CI: 1.51-4.04, P < 0.005) at the onset stage of the disease. Persistent high fibrinogen level (3.14 +/- 0.81 g/L) at 6-month after stroke onset was detected and correlated with CI (OR = 4.34, 95% CI: 1.80-10.51, P = 0.001). Higher fibrinogen level was correlated with total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), and posterior circulation infarction (POCI) (OR = 4.008, P < 0.001). Higher fibrinogen level was correlated with extracranial atherosclerosis (OR = 3.220, P < 0.05, but not with intracranial atherosclerosis.</p><p><b>CONCLUSION</b>Fibrinogen level may be a risk factor of CI and probably correlates with subtypes of CI and distributions of atherosclerosis.</p>

Representational Neglect in Left Anterior Cerebral Artery Infarction

We report a patient with a left anterior cerebral artery (ACA) infarct showing representational neglect. Representational neglect is some form of neglect to areas of imagined space. We believe that the description of our case gives further information about neglect syndrome and the functional asymmetry of the cerebral hemispheres because these observations are rare.

Anterior inferior cerebellar artery infarct with unilateral deafness.

We report the case of a young man with anterior inferior cerebellar artery infarct causing unilateral deafness. Clinical features and audiometry suggested cochlear localization for deafness. MRI brain showed an infarct in the right AICA territory with involvement of pons. Involvement of the internal auditory artery explains the cochlear deafness.

Symptoms and Signs of Stroke

The symptoms and signs of stroke vary according to the location of the lesions. Middle cerebral artery territory infarction produces symptoms such as contralateral hemiparesis (worse in the arm than in the leg), hemihypesthesia, dysarthria, aphasia (left lesion), and hemineglect (right lesion). Anterior cerebral artery infarction produces hemiparesis worse in the leg than in the arm, abulia, apathy, and urinary incontinence. Posterior cerebral artery infarction produces hemianopia. An occlusion of small penetrating branches such as lenticulostriate arteries or thalamogeniculate arteries is responsible for the so-called lacunar syndrome : pure hemiparesis, ataxic-hemparesis, dysarthria clumsy hand syndrome, or pure sensory stroke. The symptoms and signs of the brain stem infarction also vary greatly according to the area of involvement. Generally, they are characterized by virtigo, dizziness, diplopia, and ataxia. Major occlusion of the basilar artery may produce grave conditions characterized by altered consciousness, quadriparesis, and horizontal gaze paresis. Intracerebral hemorrhage occur in the basal ganglia, thalamus, lobar area, pons, and the cerebellum, in order of decreasing frequency. The symptoms and signs are dependent on the location and the amount of hemorrhages. The symptoms of subarachnoid hemorrhages are characterized by sudden headache and neck stiffness.

Post-stroke depression

This study was done on 45 stroke patients [25 males and 20 females with ages ranged from 40 to 65 years] within the first three months following stroke. Every patient was subjected to full history, thorough general and neurological examinations, routine laboratory investigations, computed tomography [CT] of the brain, mini mental state examination [MMSE] and Barthel ADL scale. Depression was diagnosed according to DSMIV criteria. Fifteen patients were depressed. Post-stroke depression was found to be more common in patients above 50 years, with positive family and past histories of depression and with left anterior hemispheric lesions being cortical more than subcortical ones. Scores of Barthel ADL scale showed no significant difference between post-stroke depressed and non depressed patients. It was advisable to manage early the post-stroke depression in order to improve the outcome of stroke

Distal anterior cerebral artery territory infarction caused by subfalcial herniation: CT findings

Subfalcial herniation secondary to a unilateral supratentorial space occupying lesion is frequently seen on the brain CT scan, however, the development of distal anterior cerebral artery infarction following compression of the terminal branches of the pericallosal artery against the falx during the period of subfalcial herniation is uncommon. For the last three years, we have experienced three cases of distal anterior cerebral artery infarction caused by subfalcial herniation on the brain CT scan. All patitnts had acute subdural hematomas resulting in subfalcial herniation on the first CT scan and subsequently developed focal infarctions in the ipsilateral paracentral lobule. The patients did not improve clinically and died several days after operation. The development of such infarction may reflect severe cerebral injury and portend a poor clinical outcome.