ABSTRACT
Antecedentes: Los infartos cerebelosos suponen una entidad rara con una incidencia baja del total de ictus isquémicos. El territorio más prevalente de los infartos cerebelosos son los de la arteria cerebelosa posterior inferior (PICA). Cuando los infartos se limitan al cerebelo, los pacientes típicamente experimentan síntomas no específicos, esto hace considerar otros diagnósticos de forma errónea. Descripción del caso clínico: paciente femenina de 54 años, con antecedente de hipertensión arterial, quien presentaba cefalea insidiosa y progresiva acompañado de vértigo, alteración en la marcha y deterioro progresivo del estado de conciencia. Se realizó imagen de Resonancia Magnética Cerebral (IRM), la cual reveló zonas hiper intensas bilaterales en región cerebelosa que delimitaban territorio vascular de la arteria cerebelosa posterior inferior además dilatación moderada del sistema ventricular. Fue intervenida quirúrgicamente, realizándose craniectomía suboccipital descompresiva; posterior a la cirugía presentó mejoría clínica. Conclusiones: El ictus isquémico cerebeloso bilateral es una forma infrecuente de ictus y su presentación clínica es muy diversa. El desarrollo de las neuroimágenes, juegan un papel importante para ayudar a los médicos a seleccionar el tratamiento adecuado. Alrededor de la mitad de los pacientes con infartos cerebelosos que presentan deterioro neurológico progresivo y son tratados con craniectomía suboccipital descompresiva tienen buenos resultados. El pilar fundamental de este caso fue el hacer un diagnóstico temprano de esta entidad, ya que permitió prevenir las posibles complicaciones graves asociadas al infarto cerebeloso, las cuales ocurren durante la primera semana del ictus y, por lo tanto, asegurar un pronóstico favorable para el paciente...(AU)
Subject(s)
Humans , Female , Middle Aged , Cerebellum/blood supply , Infarction, Posterior Cerebral Artery/diagnosis , Arteries , Magnetic Resonance Imaging , Infarction, Posterior Cerebral Artery/complications , Early DiagnosisABSTRACT
Introduction: More than half of all worldwide deaths and disabilities were caused by stroke. Large artery atherosclerosis is identified as a high etiological risk factor because it accounts for 20% of ischemic stroke. Objectives: To identify the significance of TRAIL and adropin release and the relative changes related to S100B levels, as well as the relationship between these biomarkers and the final infarct core, the clinical outcome, and the presence of large artery atherosclerosis in acute stroke patients. Materials and methods: Over a one-year period, demographic, clinical, and neuroimaging findings of 90 consecutive patients with acute ischemic stroke were evaluated. Results: The mean age of participants was 69.28 ± 10 and 39 patients were female. The increased level of S100B and the decreased levels of sTRAIL with adropin were significantly associated with moderate to severe neurologic presentation (p=0.0001, p=0.002, p=0.002, respectively). On the control CT, a large infarct core was significantly associated with decreased serum levels of sTRAIL and adropin (p=0.001 and p=0.000, respectively); however, the levels of S100B were not significantly associated with good ASPECTS score (p=0.684). Disability and an unfavorable outcome were significantly related to the decreased level of sTRAIL and adropin (p=0.001 and p=0.000 for THRIVE score>5, respectively). Decreased sTRAIL and adropin levels and an increased S100B level were correlated with the presence of large artery atherosclerotic etiologic factors (p=0.000, p=0.000, p=0.036, respectively). Conclusion: TRAIL and adropin serum levels were associated with poor clinical outcomes and greater infarcted area in acute ischemic stroke patients.
Introducción. Más de la mitad de todas las muertes y discapacidades en todo el mundo fueron causadas por accidentes cerebrovasculares. La aterosclerosis de las grandes arterias se identifica como un factor de alto riesgo etiológico debido a que representa el 20 % de los accidentes cerebrovasculares isquémicos. Objetivo. Determinar la importancia de la liberación de TRAIL y adropina y los cambios relativos relacionados con los niveles de S100B, así como la relación entre estos biomarcadores y el núcleo final del infarto, el resultado clínico y la presencia de aterosclerosis de arterias grandes en pacientes con accidente cerebrovascular agudo. Materiales y métodos. Durante un año, se evaluaron los hallazgos demográficos, clínicos y de neuroimágenes de 90 pacientes con accidente cerebrovascular isquémico agudo. Resultados. La edad media de los pacientes fue de 69,28 ± 10 y 39 eran mujeres. El aumento del nivel de S100B y la disminución de los niveles de sTRAIL y adropina se asociaron significativamente con una presentación neurológica moderada a grave en los pacientes (p=0,0001, p=0,002 y p=0,002, respectivamente). En la TC de control, un gran núcleo de infarto se asoció significativamente con una disminución del nivel sérico de sTRAIL y adropina (p=0,001 y p=0,000, respectivamente); sin embargo, los niveles de S100B no se asociaron significativamente con una buena puntuación en el ASPECT (p=0,684). La discapacidad y el resultado desfavorable se relacionaron significativamente con la disminución de los niveles de sTRAIL y adropina (p=0,001 y p=0,000 para una puntuación >5 en el THRIVE, respectivamente). La disminución de los niveles de sTRAIL y adropina y el aumento del nivel de S100B, se correlacionaron con la presencia de un factor etiológico aterosclerótico de arterias grandes entre la población de estudio (p=0,000, p=0,000 y p=0,036, respectivamente). Conclusiones. Los niveles séricos de TRAIL y adropina se asociaron con un resultado clínico deficiente y una mayor área infartada en pacientes con ataque cerebrovascular isquémico agudo.
Subject(s)
Stroke , Infarction, Posterior Cerebral Artery , TNF-Related Apoptosis-Inducing LigandABSTRACT
PURPOSE: Horizontal visual field defects are generally caused by lesions before the optic chiasm, but we report a case with bilateral inferior altitudinal defects secondary to bilateral occipital lobe infarction. CASE SUMMARY: A 57-year-old male with a history of diabetes and hypertension presented with a month of blurring in the inferior visual field. His corrected visual acuity was 1.0 in the right eye and 0.63 in the left eye, and the intraocular pressure was normal in each eye. Pupillary response, ocular movement, and color vision tests were normal in both eyes. There was no specific finding of the optic disc and macula on fundus examination. Visual field examination revealed an inferior congruous homonymous hemianopia with horizontal meridian sparing and a left incongruous homonymous quadrantanopia. Optical coherence tomography for peripapillary retinal nerve fiber layer thickness revealed a mild decrease in the inferior disc of both eyes. Brain magnetic resonance imaging confirmed the presence of an acute infarction confined with upper medial calcarine fissures of bilateral occipital lobe and the right splenium of the corpus callosum, which were consistent with inferior altitudinal hemianopia and left superior incongruous quadrantanopia, respectively. Brain magnetic resonance angiography showed multiple stenosis of bilateral posterior cerebral arteries. CONCLUSIONS: The altitudinal visual field defects could be caused by the occipital lesion medial to the calcarine fissure, and unusual visual defects could be due to a combination of multiple lesions.
Subject(s)
Humans , Male , Middle Aged , Brain , Color Vision , Constriction, Pathologic , Corpus Callosum , Hemianopsia , Hypertension , Infarction , Infarction, Posterior Cerebral Artery , Intraocular Pressure , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Nerve Fibers , Occipital Lobe , Optic Chiasm , Posterior Cerebral Artery , Retinaldehyde , Tomography, Optical Coherence , Visual Acuity , Visual FieldsABSTRACT
We report an extremely rare case of a patient with hypoxic-ischemic brain injury who recovered consciousness and motor and cognitive functions due to paradoxical response after zolpidem administration. A 32-year-old woman who had attempted suicide by hanging was admitted. The patient had stabilized in a state of drowsy mentality, quadriparesis, dysphagia, and impaired cognition. Brain magnetic resonance imaging was suggestive of hypoxic ischemic brain injury and unilateral infarction in the right posterior cerebral artery territory. Due to sleep disturbance, zolpidem was administered, and paradoxically consciousness level and function returned to near-normal during the duration of the drug-effect. In addition to previous reports, our case characteristically showed remarkable motor and cognitive function recovery, not only consciousness level. The drug-effect time was gradually decreased after 18 months and absent after 3 years. We have reviewed related literature and discussed possible neuropharmacological and neurobiological mechanism.
Subject(s)
Adult , Female , Humans , Brain Injuries , Brain , Cognition , Consciousness , Deglutition Disorders , Hypoxia-Ischemia, Brain , Infarction , Infarction, Posterior Cerebral Artery , Magnetic Resonance Imaging , Posterior Cerebral Artery , Quadriplegia , Suicide, AttemptedABSTRACT
BACKGROUND AND PURPOSE: We aimed to assess whether early resting-state functional connectivity (RSFC) changes measured via functional magnetic resonance imaging (fMRI) could predict recovery from visual field defect (VFD) in acute stroke patients. METHODS: Patients with VFD due to acute ischemic stroke in the visual cortex and age-matched healthy controls were prospectively enrolled. Serial resting-state (RS)-fMRI and Humphrey visual field (VF) tests were performed within 1 week and at 1 and 3 months (additional VF test at 6 months) after stroke onset in the patient group. The control group also underwent RS-fMRI and a Humphrey VF test. The changes in RSFCs and VF scores (VFSs) over time and their correlations were investigated. RESULTS: In 32 patients (65±10 years, 25 men), the VFSs were lower and the interhemispheric RSFC in the visual cortices was decreased compared to the control group (n=15, 62±6 years, seven men). The VFSs and interhemispheric RSFC in the visual cortex increased mainly within the first month after stroke onset. The interhemispheric RSFC and VFSs were positively correlated at 1 month after stroke onset. Moreover, the interhemispheric RSFCs in the visual cortex within 1 week were positively correlated with the follow-up VFSs. CONCLUSIONS: Interhemispheric RSFCs in the visual cortices within 1 week after stroke onset may be a useful biomarker to predict long-term VFD recovery.
Subject(s)
Humans , Follow-Up Studies , Infarction, Posterior Cerebral Artery , Magnetic Resonance Imaging , Prospective Studies , Recovery of Function , Stroke , Visual Cortex , Visual FieldsABSTRACT
Introduccion: La arteria de Percheron se origina de un solo tronco arterial talamoperforante que proporciona suministro bilateral a los tálamos paramedianos y al mesencéfalo rostral. Esta es una variante anatómica que permite la irrigación bilateral de los tálamos, a partir de un tronco común de origen asimétrico en la arteria cerebral posterior. Las lesiones en esta área dan origen a una variedad de manifestaciones clínicas. Caso clínico: Presentamos el caso de una paciente femenina blanca de 89 años, quien fue admitida en el Hospital Virgen de los Lirios de Alcoy, diagnosticada con Infarto talámico bilateral de la arteria de Percherón. Discusión: Son muchos los factores por el cual este infarto es infradiagnosticado, entre ellos, la baja estimación de la frecuencia de este infarto junto con la gran heterogeneidad clínica y además la baja sensibilidad de la Tomografía computarizada en la fase hiperaguda. En general el pronóstico a largo plazo es bueno, este varía con respecto a los patrones radiológicos encontrados, siendo más afectados los casos en los que involucra mesencefalo...(AU)
Subject(s)
Humans , Female , Aged, 80 and over , Brain Stem , Infarction , Infarction, Posterior Cerebral Artery , Thalamus , Tomography, X-Ray ComputedABSTRACT
El ataque cerebrovascular isquémico (ACV) es una de las principales causas de morbimortalidad a nivel mundial y nacional. Se estudiaron 35 pacientes identificándose que las arterias que presentaron mayor frecuencia de oclusión en el ACV isquémico agudo fueron la arteria cerebral media y la arteria cerebral posterior. Consideramos necesario que los especialistas puedan localizaran atómicamente los ACV para la aplicación de terapias neuroprotectoras mejorando las opciones de tratamiento y previniendo obstrucciones secundarias.
Ischaemic stroke (CVA) is one of the leading causes of morbidity and mortality at a global and national level. We studied 35 patients, determined the arteries that presented a higher frequency of occlusion in acute ischemic stroke and identified the middle cerebral artery and the posterior cerebral artery. We consider it necessary that specialists can locate anatomically strokes in order to apply neuroprotective therapies to improve treatment options and preventing secondary obstructions.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Infarction, Middle Cerebral Artery/epidemiology , Infarction, Posterior Cerebral Artery/epidemiology , Brain Ischemia/complications , Stroke/complications , Acute Disease , Magnetic Resonance Imaging , Infarction, Middle Cerebral Artery/pathology , Infarction, Posterior Cerebral Artery/pathology , Severity of Illness IndexABSTRACT
No abstract available.
Subject(s)
Infarction, Posterior Cerebral Artery , Meningioma , Posterior Cerebral ArteryABSTRACT
No abstract available.
Subject(s)
Infarction, Posterior Cerebral Artery , Meningioma , Posterior Cerebral ArteryABSTRACT
Spontaneous opening and closing of both eyes usually occurs in the normal awake state, unless a deliberate and voluntary attempt is made to open only one eye. We present a rare case of a male patient who was unable to open both eyes simultaneously after bilateral posterior cerebral artery infarction. He was able to close both eyes voluntarily. However, he was unable to keep both eyes open simultaneously and either the right or left eye remained closed. Upon a verbal command to open both eyes, the opened eye closed and the contralateral eye opened. When the closed eye was forced open, the opened eye closed. We thus presented a case of right-left dissociation of voluntary eyelid opening following bilateral posterior cerebral artery infarction, which was treated with botulinum toxin type A injection. Differential diagnosis to other movement disorders of the eyelids was discussed.
Subject(s)
Humans , Male , Blinking , Botulinum Toxins , Botulinum Toxins, Type A , Diagnosis, Differential , Eyelids , Infarction, Posterior Cerebral Artery , Movement Disorders , Posterior Cerebral ArteryABSTRACT
Patients with hereditary hemorrhagic telangiectasia (HHT) are at risk of developing pulmonary arteriovenous malformations (pAVMs). Paradoxical embolism may occur through pAVMs or patent foramen ovale (PFO) and lead to cerebral infarction. We present a case of cerebral infarction with both pAVM associated with HHT and PFO. Evidence of a right-to-left shunt can suggest other treatment options for stroke prevention, and patients without evidence of conventional stroke etiologies require a thorough evaluation.
Subject(s)
Humans , Arteriovenous Malformations , Cerebral Infarction , Embolism, Paradoxical , Foramen Ovale, Patent , Infarction, Posterior Cerebral Artery , Posterior Cerebral Artery , Stroke , Telangiectasia, Hereditary HemorrhagicABSTRACT
Patients with hereditary hemorrhagic telangiectasia (HHT) are at risk of developing pulmonary arteriovenous malformations (pAVMs). Paradoxical embolism may occur through pAVMs or patent foramen ovale (PFO) and lead to cerebral infarction. We present a case of cerebral infarction with both pAVM associated with HHT and PFO. Evidence of a right-to-left shunt can suggest other treatment options for stroke prevention, and patients without evidence of conventional stroke etiologies require a thorough evaluation.
Subject(s)
Humans , Arteriovenous Malformations , Cerebral Infarction , Embolism, Paradoxical , Foramen Ovale, Patent , Infarction, Posterior Cerebral Artery , Posterior Cerebral Artery , Stroke , Telangiectasia, Hereditary HemorrhagicABSTRACT
Kluver-Bucy syndrome is defined as a rare neurobehavioral disorder with hyperphagia, hyperorality, hypersexuality, and visual agnosia. This syndrome is usually resulting from bilateral lesions of the anterior temporal lobe including amygdala. Although it could occur after various diseases, stroke is uncommon etiology. We report a patient with Kluver-Bucy syndrome due to bilateral posterior cerebral artery territory infarction.
Subject(s)
Humans , Agnosia , Amygdala , Cerebral Infarction , Hyperphagia , Infarction , Infarction, Posterior Cerebral Artery , Kluver-Bucy Syndrome , Posterior Cerebral Artery , Stroke , Temporal LobeABSTRACT
No abstract available.
Subject(s)
Delayed Emergence from Anesthesia , Embolization, Therapeutic , Infarction, Posterior Cerebral Artery , Posterior Cerebral ArteryABSTRACT
No abstract available.
Subject(s)
Delayed Emergence from Anesthesia , Embolization, Therapeutic , Infarction, Posterior Cerebral Artery , Posterior Cerebral ArteryABSTRACT
Cerebral achromatopsia, which refers to a loss of color vision, is a rare complication of posterior circulation stroke. We report two patients who presented with achromatopsia and dyschromatopsia (incomplete form of achromatopsia) respectively after acute posterior cerebral artery infarction. Lingual and fusiform gyri within the occipito-temporal area are known to be responsible for color perception.
Subject(s)
Humans , Color Perception , Color Vision , Color Vision Defects , Infarction, Posterior Cerebral Artery , Posterior Cerebral Artery , StrokeABSTRACT
During routine dissection in the laboratory was observed the presence of a variation of the superior cerebellarartery in a brain of a young adult male. This artery belongs to the vertebral-basilar system and is branch ofthe basilar artery, prior to its bifurcation giving rise to the posterior cerebral arteries. This variation is clinicallyimportant due to cerebellar infarctions that affect a significant portion of the population, and records of thistype of variation become important especially for the few records that are found in literature.
Subject(s)
Humans , Male , Adult , Posterior Cerebral Artery/anatomy & histology , Infarction , Infarction, Posterior Cerebral Artery , Posterior Cerebral Artery , DissectionABSTRACT
Hemiplegic stroke patients may have abnormal awareness or perception of the affected limb (s). For example, patients may experience their limb as not belonging to them (asomatognosia) or attribute their own body parts to other persons (somatoparaphrenia). Disturbed sensation of limb ownership (asomatognosia, somatoparaphrenia) for the hemiplegic limb has been reported in patients with right insula lesion. We report a case of a 70-year-old right handed female who had somatoparaphrenia and neglect dyslexia after right posterior cerebral artery and posterior corpus callosal infarction. Additionally, she showed visual defect, dyschromatopsia, and hemispatial neglect
Subject(s)
Aged , Female , Humans , Dyslexia , Extremities , Hand , Human Body , Infarction , Infarction, Posterior Cerebral Artery , Ownership , Perceptual Disorders , Posterior Cerebral Artery , Sensation , StrokeABSTRACT
BACKGROUND: Acute onset of a sensory alien hand phenomenon has been observed only from a supratentorial lesion involving the non-dominant hand, mostly from a right posterior cerebral artery infarction. A single acute vascular lesion resulting in a dominant hand sensory alien hand syndrome has not been previously documented. CASE REPORT: A 78-year old right-handed woman exhibited right sensory alien hand phenomenon from a left pontine hemorrhage. Disturbance of proprioceptive input and visuospatial perception are likely to play a role in manifesting the sign. CONCLUSIONS: Dominant-hand sensory alien hand phenomenon may occur in an acute setting from a left pontine hemorrhage.
Subject(s)
Female , Humans , Alien Limb Phenomenon , Emigrants and Immigrants , Hand , Hemorrhage , Infarction, Posterior Cerebral ArteryABSTRACT
Neurological deficits can occur following snake bite. It is usually due to intracerebral haemorrhage or subarachnoid bleed as a result of depletion of clotting factors. A healthy 14-years-old male developed bilateral ptosis and altered sensorium within 3 hours of snake bite. CT Brain revealed bilateral cerebellar and right occipital infarction with mass effect. Clotting time and bleeding time were normal. The possible mechanism for infarction in this patient is discussed.