Thirteen-and-a-Half syndrome stroke: A case report

@#We describe a 52-year old woman who developed one- and-a-half syndrome with an ipsilateral trigeminal and facial nerve palsy from a lacunar infarct of the left paramedian pontine area likely involving the median-paramedian perforators of the basilar artery.

Vertebral artery occlusion with lateral medullary syndrome and cervical cord infarct

@#Wallenberg syndrome (lateral medullary syndrome) is a type of posterior circulation stroke resulting in brainstem infarction which is most often caused by occlusion of vertebral artery or posterior inferior cerebellar artery or both.1 Here we report a case of right lateral medullary syndrome secondary to vertebral artery occlusion with associated left cerebellar and cervical cord infarct resulting in quadriparesis.

Evaluación inicial del paciente con mareos y vértigo / Initial evaluation of the patient with dizziness and vertigo

El paciente que consulta por mareos o vértigo es sin duda un desafío para el médico que trabaja en un servicio de urgencia. Esto se da en parte por la dificultad de los pacientes de definir el síntoma, a la amplia gama de diagnósticos diferenciales y su potencial riesgo de desenlace negativo, como en el caso del accidente cerebrovascular de fosa posterior. En esta revisión narrativa, el objetivo: es explicar el enfrentamiento inicial del paciente con mareos y vértigo, describir las pruebas y métodos diagnósticos complementarios, distinguir los diagnósticos diferenciales más frecuentes y explicar el manejo inicial. Método:se realizó una revisión bibliográfica de literatura científica sobre esta patología, basado en la propuesta de Edlow (2016), donde se enfatiza en un enfoque basado en temporalidad, factores desencadenantes y contexto del síntoma.(AU)

The patient who consults for dizziness or vertigo is undoubtedly a challenge for the emergency physician. This is partly due to the difficulty of the patients to define the symptom, the wide range of differential diagnoses and their potential risk of negative outcome, as in the case of posterior circulation stroke. In this narrative review, the objective is to explain the initial approach of the patient with dizziness and vertigo, describe the tests and complementary diagnostic methods, distinguish the most frequent differential diagnoses and explain the initial management. A bibliographic review of the scientific literature on this pathology was carried out, based on the proposal of Edlow (2016), which emphasizes an approach based on temporality, trigger factors and context of the symptom. (AU)

Functional Outcome of Patients with Posterior Circulation Stroke

OBJECTIVE: To compare functional outcome of posterior circulation (PC) stroke with middle cerebral artery (MCA) stroke. METHOD: We reviewed retrospectively 2, 226 records of stroke patients admitted to our hospital from June 1992 to October 2001, and selected PC stroke patients as a case with exclusion criteria; the presence of other neurological disease, the history of previous stroke, or multiple brain lesions. Also, we considered MCA stroke patients matched to a case as a control. 28 patients were selected as a case and 24 patients as a control. We compared FIM gains and efficiencies. RESULTS: Self care FIM efficiency (0.56+/-0.45) of PC stroke was higher than that (0.43+/-0.24) of MCA stroke and sphincter FIM efficiency (0.04+/-0.10) of the former was lower than that (0.10+/-0.11) of the latter. But, we couldn't detect any difference in cognitive (0.09+/-0.14 vs. 0.14+/-0.14), motor (1.10+/-0.71 vs. 0.87+/-.51), and total FIM efficiency (1.20+/-0.73 vs. 1.02+/-0.60). CONCLUSION: Our study shows the functional outcome of PC stroke previously reported as controversial or rather poor result is favorable like that of MCA stroke, under active rehabilitation intervention. And so we think that comprehensive rehabilitation management is needed for functional regain even in patients with PC stroke.