Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.

Stenting for Symptomatic Vertebral Artery Stenosis Associated with Bilateral Carotid Rete Mirabile: The Long-Term Clinical and Angiographic Outcome

Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rete mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

Extracranial and transcranial doppler sonography alterations in diabetic and non-diabetic patients with thrombotic stroke

Diabetes is a major risk factor for stroke. Some studies have shown that difference between clinical signs and prognosis in diabetic patients with stroke compared to non-diabetic patients with stroke is due to difference in pattern of cerebral vascular involvement. This study was done to compare the findings of extracranial and transcranial doppler sonography in diabetic and nondiabetic patients with thrombotic stroke. This case - control study was done on 70 diabetic patients and 70 non-diabetic patients with thrombotic stroke. All patients were new cases. Extracranial and transcranial Doppler sonography was performed for all subjects. Basilar artery stenosis was significantly more frequent in diabetic cases in comparison with non-diabetic patients [P<0.05]. The prevalenc of posterior circulation stenosis in diabetic patients was significantly higher than non-diabetic patients [P<0.05]. In diabetic patients, stenosis in vertebrobasilar circulation was more frequent. Higher morbidity and mortality in diabetic patients may be due to vascular stenosis pattern

Wallenberg syndrome as a sole presentation of celiac disease

Celiac sprue is a gluten sensitive enteropathy in which there is a small bowel villous atrophy associated with gastrointestinal and extraintestinal symptoms. True prevalence is difficult to ascertain because many patients have atypical symptoms or none at all. Few children display CNS symptoms such as peripheral neuropathy and cerebellar ataxia. So far, stroke in posterior circulation territory as a presentation for celiac disease has not been reported. We report a 15-year-old male patient who presented as Wallenberg syndrome without any positive medical history. Brain MRI confirmed infarction, and magnetic resonance angiography showed vertebral artery stenosis. Laboratory findings revealed anemia and positive serologic tests for celiac disease, and duodenal biopsy confirmed the disease. In any children with symptoms of vertebrobasilar insufficiency, celiac disease as a treatable cause must be considered

Cerebellar and thalamic infarctions in basilar artery migraine.

We report a 25 year old male who suffered thalamic and multiple cerebellar infarctions during infrequent attacks of basilar artery migraine. Migraine-related infarcts at these sites are uncommon.