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1.
Rev. méd. Chile ; 146(11): 1356-1360, nov. 2018. graf
Article in Spanish | LILACS | ID: biblio-985711

ABSTRACT

Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.


Subject(s)
Humans , Female , Aged, 80 and over , Giant Cell Arteritis/diagnostic imaging , Basilar Artery/diagnostic imaging , Vertebral Artery/diagnostic imaging , Oculomotor Nerve Diseases/diagnostic imaging , Brain Ischemia/diagnostic imaging , Oculomotor Nerve/diagnostic imaging , Temporal Arteries/diagnostic imaging , Giant Cell Arteritis/etiology , Giant Cell Arteritis/pathology , Basilar Artery/pathology , Vertebral Artery/pathology , Magnetic Resonance Imaging/methods , Oculomotor Nerve Diseases/etiology , Oculomotor Nerve Diseases/pathology , Brain Ischemia/etiology , Brain Ischemia/pathology , Ultrasonography, Doppler/methods , Oculomotor Nerve/pathology
2.
Acta cir. bras ; 30(10): 654-659, graf
Article in English | LILACS | ID: lil-764395

ABSTRACT

PURPOSE:To demonstrate the relationship between of sphingosine-1-phosphate (S1P) expression and subarachnoid hemorrhage (SAH).METHODS:The basilar arteries from a "double-hemorrhage" rabbit model of SAH were used to investigate the relation between S1P expression and SAH. Various symptoms, including blood clots, basilar artery cross-sectional area, and S1P phosphatase expression were measured at day 3, 5, 7, 9.RESULTS: The expression of S1P was enhanced in the cerebral vasospasm after subarachnoid hemorrhage in the rabbits. And S1P expression was consistent with the basilar artery cross-sectional area changes at day 3, 5, 7, 9.CONCLUSION: Sphingosine-1-phosphate expression in the cerebral arterial may be a new indicator in the development of cerebral vasospasm after subarachnoid hemorrhage and provide a new therapeutic method for SAH.


Subject(s)
Animals , Rabbits , Lysophospholipids/analysis , Sphingosine/analogs & derivatives , Subarachnoid Hemorrhage/pathology , Vasospasm, Intracranial/pathology , Basilar Artery/pathology , Disease Models, Animal , Flow Cytometry , Random Allocation , Sphingosine/analysis , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/metabolism , Time Factors , Vasospasm, Intracranial/etiology , Vasospasm, Intracranial/metabolism
3.
Indian J Pediatr ; 2009 Oct; 76(10): 1053-1055
Article in English | IMSEAR | ID: sea-142403

ABSTRACT

Locked-in syndrome is characterized by upper motor neuron quadriplegia, paralysis of lower cranial nerves, bilateral horizontal gaze palsy and anarthria, with preserved consciousness. It is due to a ventral pontine lesion following a basilar artery occlusion. We report the first Indian case report of locked-in syndrome, a 10-year old girl in whom the syndome was preceded by a ‘herald hemiparesis’. Although the exact etiology for the basilar artery occlusion could not be determined, treatment with low molecular weight heparin and warfarin was followed by partial recovery.


Subject(s)
Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/drug therapy , Basilar Artery/pathology , Child , Female , Follow-Up Studies , Heparin, Low-Molecular-Weight/therapeutic use , Humans , India , Magnetic Resonance Angiography , Neuropsychological Tests , Quadriplegia/diagnosis , Quadriplegia/drug therapy , Quadriplegia/etiology , Rare Diseases , Recovery of Function , Severity of Illness Index , Stroke/complications , Stroke/diagnosis , Stroke/drug therapy , Treatment Outcome , Warfarin/therapeutic use , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/drug therapy , Basilar Artery/pathology , Child , Female , Follow-Up Studies , Heparin, Low-Molecular-Weight/therapeutic use , Humans , India , Magnetic Resonance Angiography , Neuropsychological Tests , Quadriplegia/diagnosis , Quadriplegia/drug therapy , Quadriplegia/etiology , Rare Diseases , Recovery of Function , Severity of Illness Index , Stroke/complications , Stroke/diagnosis , Stroke/drug therapy , Treatment Outcome , Warfarin/therapeutic use
4.
Endovascular Journal. 2008; 1 (1): 41-46
in English | IMEMR | ID: emr-86440

ABSTRACT

Symptomatic basilar artery stenosis has a poor prognosis. Surgical bypasses are technically demanding and of no proven benefit. A new generation of intravascular stents that are flexible enough to navigate the tortuosities of the vertebral artery may provide a new therapeutic approach. Our two cases, 57 and 52 year-old men experienced a vertebrobasilar ischemia with repeat vertigo and falls. Magnetic resonance angiography from vertebrobasilar arteries revealed severe middle basilar artery stenosis in case 1 and Transcranial Doppler [TCD] shown severe vertebrobasilar artery stenosis in the other one. The patients underwent uncomplicated angioplasty and stenting of the basilar arteries, with excellent angiographie results. During follow-up [12 months in case I and 8 months in case 2], the patients were well and free of symptoms. The new flexible intravascular stents provides a novel therapeutic approach for patients with basilar artery stenosis


Subject(s)
Humans , Male , Basilar Artery/pathology , Constriction, Pathologic , Stents , Vertebral Artery , Treatment Outcome , Ultrasonography, Doppler, Transcranial , Magnetic Resonance Angiography
5.
Arq. neuropsiquiatr ; 65(2A): 345-347, jun. 2007. ilus
Article in English | LILACS | ID: lil-453940

ABSTRACT

The most frequently diagnosed complication of vertebrobasilar dolichoectasia (VBD) is the compression of structures adjacent to the vertebral and basilar arteries. A giant VBD with only slight compressive symptoms is unusual. In this setting, the diagnosis of VBD may be casually revealed after the occurrence of a posterior circulation stroke, another potential complication. We report a 48-year-old woman who presented a two-month history of continuous buzz and a slight right-sided hearing loss that was followed by a cerebellar ischemic stroke. Brain CT and MRI revealed a marked compression of the brainstem due to an ectatic, tortuous and partially thrombosed basilar artery (BA). The largest cross-sectional diameter of BA was 18 mm. The patient had a good functional recovery within the two-month follow-up after stroke with modified Rankin scale score (mRSS)=2. At the one-year follow-up, patient still kept the complaints of continuous buzz, slight right-sided hearing loss and the mRSS was the same. We call attention for an unusual giant VBD that caused an impressive brainstem compression with displacement of important structures in an oligosymptomatic patient. Diagnosis was made only after the occurrence of a stroke. Despite of the good functional recovery after stroke, the presence of significant atherosclerotic changes and the large BA diameter may indicate a poor outcome. However, after one year, she remains oligosymptomatic.


A complicação mais freqüentemente encontrada na dolicoectasia vertebrobasilar (DVB) é a compressão de estruturas adjacentes às artérias vertebrais e à artéria basilar. Uma DVB gigante apenas com sintomas compressivos leves é infreqüente. Nesse caso, o diagnóstico pode ser descoberto ao acaso após uma isquemia da circulação posterior, outra complicação possível da DVB. Relatamos o caso de uma mulher de 48 anos com história de zumbido e perda auditiva leve a direita por 2 meses, desenvolvendo, a seguir, uma isquemia cerebelar. A tomografia e a ressonância magnética demonstraram uma compressão acentuada do tronco cerebral devido a uma artéria basilar (AB) ectásica, tortuosa e preenchida parcialmente por trombo. O maior diâmetro axial da AB tinha 18 mm. A paciente apresentou boa recuperação funcional dentro dos primeiros dois meses após a isquemia, com escore de Rankin modificado (ERM)=2. Após um ano, a paciente ainda mantinha as queixas de zumbido e perda auditiva leve à direita, e o ERM ainda se mantinha=2. Chamamos a atenção para um caso raro de DVB gigante que causou impressionante compressão do tronco cerebral, com deslocamento de importantes estruturas, numa paciente oligossintomática. O diagnóstico só foi realizado após a ocorrência da isquemia. Apesar da boa recuperação funcional inicialmente observada, a presença de alterações ateroscleróticas e o grande diâmetro da AB podem indicar um prognóstico ruim. Contudo, após um ano a paciente ainda se mantinha oligossintomática.


Subject(s)
Female , Humans , Middle Aged , Nerve Compression Syndromes/etiology , Stroke/etiology , Vertebrobasilar Insufficiency/complications , Basilar Artery/pathology , Brain Stem/pathology , Cerebral Infarction/etiology , Dilatation, Pathologic , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Vertebrobasilar Insufficiency/diagnosis
6.
Arq. méd. ABC ; 31(2): 87-90, jul.-dez. 2006. ilus
Article in Portuguese | LILACS | ID: lil-457913

ABSTRACT

O zumbido é um sintoma otoneurológico que afeta considerável parcela da população. Embora os mecanismos fisiopatológicos associados a ele não estejam completamente elucidados, é muito freqüente sua associação à perda auditiva. Alguns tipos de zumbido, entretanto, apresentam características peculiares, como o zumbido pulsátil. Esse pode ser causado por alterações vasculares congênitas, neoplásicas e traumáticas, dentre outras muitas. O presente estudo relata dois casos de pacientes com zumbido pulsátil, devido a alterações anatômicas de artéria basilar, sendo um com tortuosidade e outro megadolicobasilar, entidade pouco descrita na literatura. Em ambos os casos, pelas características causais associadas, que restringem o tratamento cirúrgico, optou-se pelo uso de clonazepan. Os pacientes apresentaram redução da sintomatologia durante o sono, principal queixa, permanecendo em acompanhamento ambulatorial.


Tinnitus is an otoneurological symptom that affects a considerable part of the population. Although pathophysiologicalmechanisms associated to this symptom are not completely disclosed, it is very common the association with hearing loss. Some kinds of tinnitus, however, can have specific characteristics, as a pulsatile tinnitus. It can be caused by vascular alterations, neoplasms or traumas, besides other pathologies. This paper reports two cases of patients with pulsatile tinnitus due to anatomical alterations of basilar artery; the first one due to an arterial deviousness and the second with a dolichomegabasilar, acondition rarely reported in literature. Due to the causal characteristics of this cases and the difficulties of surgicaltreatment, we prescribed clonazepam. The symptom did not disappear, but it was reduced during the sleep. The patients are being followed-up in our outpatient care unit nowadays.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Basilar Artery/pathology , Clonazepam , Tinnitus
7.
Col. med. estado Táchira ; 14(3): 37-38, jul.-sept. 2005. ilus
Article in Spanish | LILACS | ID: lil-531049

ABSTRACT

La Megadolicoectasia basilar (MDEB), es una enfermedad vascular raramente vista: consiste en una elongación excesiva y tortuosa de la arteria basilar. Puede estar asociada a diversas manifestaciones neurológicas como: cefalea, vértigo, pérdida de audición ideopática, y compromiso de nervios craneales por compresión. Conociendo la incierta incidencia de esta patología, reportamos el caso de un paciente masculino con 41 años raza blanca, en cuyos estudios de imagen (RMN, ARTERIOGRAFIA CONVENCIONAL, ANGIOTAC) se evidenció esta patología.


Subject(s)
Humans , Adult , Female , Basilar Artery/pathology , Headache/diagnosis , Diagnostic Imaging/methods , Vascular Diseases/pathology , Cranial Nerve Injuries/etiology , Vertigo/diagnosis , Tinnitus/diagnosis , Hypertension/etiology , Neurology , Auditory Perceptual Disorders/etiology
8.
Rev. méd. Chile ; 132(3): 357-360, mar. 2004. ilus
Article in Spanish | LILACS | ID: lil-384179

ABSTRACT

Locked-in syndrome is a dramatic clinical condition, the patient is awake, can listen and breath, but is unable to move any muscle, conserving only the vertical eye movements. The most common cause of locked-in syndrome is the thrombosis of the basilar artery and commonly leads to death, frequently due to pneumonia. Intravenous and intra arterial thrombolysis have been used successfully in a selective group of patients with ischemic stroke. There is only one report of two patients with locked-in syndrome who were treated successfully with intra arterial thrombolysis. Other authors, based in their experiences, do not recommend this treatment. We report two female patients aged 63 and 26 years, with Locked-in syndrome due to a basilar thrombosis who were treated successfully with intra arterial thrombolysis using ecombinant tissue plasminogen activator (r-TPA). The lapses between the onset of the symptoms and thrombolysis were 5 and 8 hours respectively. A complete recanalization was obtained in both patients during the thrombolysis. One year after, the first patient has only a moderate ataxia, walking with assistance and the other has a normal neurological examination (Rev MÚd Chile 2004; 132: 357-60 ).


Subject(s)
Humans , Adult , Female , Vertebrobasilar Insufficiency/therapy , Thrombolytic Therapy , Vertebrobasilar Insufficiency , Basilar Artery/pathology
9.
Article in English | WPRIM | ID: wpr-20654

ABSTRACT

Effects of pH on vascular tone and L-type Ca2+ channels were investigated using Mulvany myograph and voltage-clamp technique in rabbit basilar arteries. In rabbitbasilar arteries, high K+ produced tonic contractions by 11+/-0.6 mN (mean+/-S.E., n=19). When extracellular pH (pHo) was changed from control 7.4 to 7.9 ([alkalosis]o), K+-induced contraction was increased to 128+/-2.1% of the control (n=13). However, K+-induced contraction was decreased to 73+/-1.3% of the control at pHo 6.8 ([acidosis]o, n=4). Histamine (10 micrometer) also produced tonic contraction by 11+/-0.6 mN (n=17), which was blocked by post-application of nicardipine (1 micrometer). [alkalosis]o and [acidosis]o increased or decreased histamine-induced contraction to 134+/-5.7% and 27+/-7.6% of the control (n=4, 6). Since high K+- and histamine-induced tonic contractions were affected by nicardipine and pHo, the effect of pHo on voltage-dependent L-type Ca2+ channel (VDCCL) was studied. VDCCL was modulated by pHo: the peak value of Ca2+ channel current (IBa) at a holding of 0 mV decreased in [acidosis]o by 41+/-8.8%, whereas that increased in [alkalosis]o by 35+/-2.1% (n=3). These results suggested that the external pH regulates vascular tone partly via the modulation of VDCC in rabbit basilar arteries.


Subject(s)
Animals , Arteries/pathology , Basilar Artery/pathology , Calcium/metabolism , Calcium Channels/chemistry , Electrophysiology , Histamine/chemistry , Hydrogen-Ion Concentration , Muscle Cells/cytology , Muscle Contraction , Muscle, Smooth/pathology , Patch-Clamp Techniques , Potassium/chemistry , Rabbits , Stress, Mechanical , Time Factors
11.
Medical Journal of the Islamic Republic of Iran. 2001; 15 (2): 93-101
in English | IMEMR | ID: emr-57658

ABSTRACT

While a wide array of pathological changes occur in cerebral arteries following subarachnoid hemorrhage [SAH], the most consistent is endothelial damage. Since the endothelium normally modulates reflexes that influence vascular tone, any damage to it may represent a significant contributor to cerebral vasospasm following SAH. This experimental study investigates the correlation between endothelial injury of rat basilar [BA] and middle cerebral arteries [MCA] and vasospasm following a double SAH. Animals were divided into three groups of control [nonsurgical-noninjected], saline-injected, and blood-injected rats. Rats in the blood-injected group were injected with two 0.3 mL doses of autologous blood into the subarachnoid space at intervals of 72 hours. Rats were killed at different time intervals to study the time course of endothelial injury along with vasospasm following the second SAH with scanning electron microscopy and image analysis system, respectively. Cerebral arteries exposed to blood demonstrated severe pathological alterations during acute [30 min. to 2 hrs.] and chronic [48 hrs.] periods of time post second SAH. Concurrent with endothelial injury, there was widening of inter-endothelial tight junctions. Morphometric evaluation revealed severe arterial constriction starting at 30 min. [p<0.01] and again at 48 hrs. [p<0.05] post second SAH. The correlation between the time course of ultrastructural alteration of endothelial cells with arterial constriction provides further morphological contribution to the major complication of SAH-cerebral vasospasm


Subject(s)
Animals, Laboratory , Endothelium, Vascular/injuries , Vasospasm, Intracranial , Middle Cerebral Artery/pathology , Basilar Artery/pathology , Microscopy, Electron, Scanning , Rats, Sprague-Dawley
13.
Rev. mex. radiol ; 45(1,supl): 37-45, jul. 1991. ilus, tab
Article in Spanish | LILACS | ID: lil-102251

ABSTRACT

Se analizan 17 enfermos con patología vascular del sistema vértrebrobasilar que requirieron de angiografía por substracción digital (ASD) y/o resonancia magnética(RM) para su evaluación. Además, en la RM se realizó un nuevo método de cortes paralelos al eje del clivus,para obtener mejores imágenes de los vasos del sistema vértebrobasilar. Los hallazgos obtenidos por RM con la técnica propuesta nos permitieron observar el segmento V4 de las arterias vertebrales en un 82.4%; unión vértebrobasilar 82.4%; arteria basilar proximal 94.1%; arteria basilar medial 76.5%; arteria basilar distal 82.4%y bifurcación basilar 41.2%. Los resultados mostraron que dicha investigación mejora la visualización de las estructuras vasculares del sistema vértebrobasilar comparado con el plano de corte sagital y coronal. Los autores concluyen que el empleo de RM con cortes paralelos al eje del clivus justifica la realización de angiografía por substracción digital (ASD) en ciertos grupos de pacientes.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Male , Female , Basilar Artery/pathology , Magnetic Resonance Imaging/methods , Vertebral Artery/pathology , Vertebrobasilar Insufficiency/diagnosis
14.
Rev. venez. neurol. neurocir ; 3(2): 102-6, jul.-dic. 1989. ilus
Article in Spanish | LILACS | ID: lil-103409

ABSTRACT

Presentamos un caso de hidrocefalia abstructiva debido a ectasia de la arteria basilar donde la lesión se estableció por compresión del suelo del III ventrículo, condicionando un cuadro de deterioro severo y progresivo de la memoria y de la marcha, con hipertensión endocraneana importante; no mejoró con una derivación ventriculo-peritoneal, fallese por un accidente isquémico del tallo cerebral. Discutimos los mecanismos causantes de esta entidad neurológica, revisamos la literatura con respecto a esta rara asociación


Subject(s)
Basilar Artery/pathology , Cerebral Angiography , Tomography, Emission-Computed
15.
Rev. neurol. Argent ; 13(2): 79-91, jun. 1987. tab, ilus
Article in Spanish | LILACS | ID: lil-66409

ABSTRACT

Se presentan 10 pacientes con ectasias sintomáticas de arterias cerebrales. Todos los pacientes son de sexo masculino y padecían de hipertensión arterial leve o moderada. Las ectasias estaban presentes en la arteria basilar en el 20%, en las arterias carótidas en el 20% y en ambos sistemas en el 60% restante. Predominaron los síntomas motores y sensitivos, ataxia, diplopía y demencia. Asismismo se presenta el segundo caso en la literatura con hemorragia subaracnoidea a partir de la ruptura de una arteria basilar ectásia. Se discute la presencia de trastornos autonómicos en un paciente con severo compromiso neurológico por compresión del tronco encefálico. Todos los pacientes fueron estudiados con tomografía computada cerebral con infusión de sustancia de constraste y arteriografía cerebral de los cuatro vasos. En uno de los casos la tomografía cerebral resultó insuficiente para el diagmnóstico de ectasia, sugiriendo un tumor del ángulo pontocerebeloso. Cinco pacientes fueron tratados con antiagregantes plaquetarios y dos pacientes recibieron anticoagulación. La evolución clínica fue desfavorable, no observándose benefício aparente en los casos tratados


Subject(s)
Middle Aged , Humans , Male , Carotid Arteries/pathology , Basilar Artery/pathology , Cerebral Arterial Diseases/pathology , Dilatation, Pathologic/complications , Dilatation, Pathologic , Hypertension/complications , Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/complications
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