Treatment of Internal Carotid Artery Dissections with Endovascular Stent Placement: Report of Two Cases

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of traumarelated extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpet-rosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.

Clinical and Neuroradiologic Evaluations of Intracranial Lipoma

BACKGROUND: Intracranial lipomas are uncommon benign lesions of the central nervous system. They preferentially occur near the midline, most frequently in the pericallosal cistern, and are often associated with various neurologic and systemic anomalies. Since the advent of CT scanning and MR imaging, unexpected findings of intracralial lipomas have increased. We identified 11 cases of intracranial lipomas diagnosed by CT and MR and analyzed their characteristic clinical and radiologic findings. METHODS: We retrospectively reviewed 11 cases of intracranial lipomas. MR was used in all cases and CT in three. RESULTS: There were seven men and four women whose ages ranged from six months to 76 years, with a mean of 39 years. Six (55%) lipomas were located in the quadrigeminal plate and five (45%) in the pericallosal area. The pericallosal lipomas were divided into three cases of curvilinear type and two cases of tubulonodular type. Of the six quadrigeminal lipomas, five cases (83%) were associated with either hypoplasia of the unilateral (four) or bilateral (one) superior and/or inferior colliculus. One case of quadrigeminal lipoma was associated with hypoplasia of the cerebellar vermis, agenesis of the septum pellucidum, and glioblastoma multiforme. All cases of pericallosal tubulonodular type were associated with dysgenesis of the corpus callosum and enlarged ventricles. However, all cases of pericallosal curvilinear type were not associated with other anomalies. Four (36%) cases found incidentally were asymptomatic. Seizure was the most frequent clinical presentation in five (45%) cases, followed by headaches in three (27%) and mental retardation in one (9%). Of five seizures cases, three had secondary generalized seizures and two had generalized tonic clonic seizures. CONCLUSIONS: Quadrigeminal and pericallosal lipomas were the most common types of intracranial lipomas. Sixty-three percent of the lesions were associated with adjacent brain malformations of varying degrees. Four cases were asymptomatic, while the others presented with seizures, headache, and mental retardation. (J Korean Neurol Assoc 19(2):149~154, 2001)

Clinical and Neuroradiologic Evaluations of Intracranial Lipoma

BACKGROUND: Intracranial lipomas are uncommon benign lesions of the central nervous system. They preferentially occur near the midline, most frequently in the pericallosal cistern, and are often associated with various neurologic and systemic anomalies. Since the advent of CT scanning and MR imaging, unexpected findings of intracralial lipomas have increased. We identified 11 cases of intracranial lipomas diagnosed by CT and MR and analyzed their characteristic clinical and radiologic findings. METHODS: We retrospectively reviewed 11 cases of intracranial lipomas. MR was used in all cases and CT in three. RESULTS: There were seven men and four women whose ages ranged from six months to 76 years, with a mean of 39 years. Six (55%) lipomas were located in the quadrigeminal plate and five (45%) in the pericallosal area. The pericallosal lipomas were divided into three cases of curvilinear type and two cases of tubulonodular type. Of the six quadrigeminal lipomas, five cases (83%) were associated with either hypoplasia of the unilateral (four) or bilateral (one) superior and/or inferior colliculus. One case of quadrigeminal lipoma was associated with hypoplasia of the cerebellar vermis, agenesis of the septum pellucidum, and glioblastoma multiforme. All cases of pericallosal tubulonodular type were associated with dysgenesis of the corpus callosum and enlarged ventricles. However, all cases of pericallosal curvilinear type were not associated with other anomalies. Four (36%) cases found incidentally were asymptomatic. Seizure was the most frequent clinical presentation in five (45%) cases, followed by headaches in three (27%) and mental retardation in one (9%). Of five seizures cases, three had secondary generalized seizures and two had generalized tonic clonic seizures. CONCLUSIONS: Quadrigeminal and pericallosal lipomas were the most common types of intracranial lipomas. Sixty-three percent of the lesions were associated with adjacent brain malformations of varying degrees. Four cases were asymptomatic, while the others presented with seizures, headache, and mental retardation. (J Korean Neurol Assoc 19(2):149~154, 2001)

Comparative study of triflusal and ticlopidine on anti-platelet aggregatory effect and side effects

BACKGROUND AND PURPOSE: Platelet aggregation plays an important role in thrombogenesis. Thus antiplatelet agents, such as aspirin and ticlopidine, have been in usage to prevent for recurrent ischemic stroke. Triflusal is known to selectively inhibit cyclooxygenase in platelet rather than in vessel wall. And thus can be more beneficial in its antiplatelet aggregatory effect. There has been no comparative study between triflusal and ticlopidine on its antiplatelet aggregatory effect and side effects till now. Our comparative study between these two agents is to provide useful information on clinical utilization. METHODS: Triflusal(900mg/day) and ticlopidine(500mg/day) were administered in 31 and 37 patients, who suffered from acute ischemic stroke. Their efficacy in platelet aggregation and the incidence of clinical and laboratory side effects were compared in one week and one month after the administration of the drugs. RESULTS: Platelet aggregation was more effectively inhibited in triflusal group, especially induced by collagen or epinephrine(p<0.01). No significant difference was noted in the incidence of side effects in both groups. In five patients of the ticlopidine group, the drug was withdrawn due to skin rash and/or increased liver enzymes. CONCLUSION: Triflusal had more effectively inhibited platelet aggregation in this study. Severe side effects even requiring discontinuation of the drug were noted in five patients of ticlopidine group.

A case of posterior choroidal artery territory infarction presented with amnesia

Infarction in the territory of the posterior choroidal artery(PChA) is rare. The main clinical manifestations of the PCHA infarction are known to be visual field defect, sensory-motor dysfunction, neuropsychological disturbances. Neuropsychological disturbances include of transcortical aphasia and amnesia. The latter disturbance is very rare and reported to be transient. We report a 77 year old man who presented with severe selective amnesia due to PChA infarction. Neurologic examination revealed right homonymous hemianopsia. Brain MRI showed infarction of PChA territory and multiple lacunes in the preventricular deep white matter.

A case of posterior choroidal artery territory infarction presented with amnesia

Infarction in the territory of the posterior choroidal artery(PChA) is rare. The main clinical manifestations of the PCHA infarction are known to be visual field defect, sensory-motor dysfunction, neuropsychological disturbances. Neuropsychological disturbances include of transcortical aphasia and amnesia. The latter disturbance is very rare and reported to be transient. We report a 77 year old man who presented with severe selective amnesia due to PChA infarction. Neurologic examination revealed right homonymous hemianopsia. Brain MRI showed infarction of PChA territory and multiple lacunes in the preventricular deep white matter.

Medial Medullary Syndrome: Clinical Study of 9 Cases

BACKGROUND AND PURPOSE: Medial medullary syndrome (MMS) is characterized clinically by a triad of ipsilateral hypoglossal nerve palsy, contralateral or ipsilateral hemiparesis sparing the face, and sensory disturbance of position and/or vibration. However, this syndrome is quite rare, and its clinical and radiological findings have not yet been clearly characterized. METHODS: We reviewed 9 patients with AMS who were diagnosed based on their clinical and magnetic resonance imaging (MRI) findings. RESULTS: There were 8 men and I woman with average age of 60 (41 to 75) years. The risk factors included hypertension in 8, DM in 6, cigarette smoking in 4, hypercholesterolemia in 4, gout in I and atrial fibrillation with LV dysfunction in 1. Their, clinical findings included contralateral hemiparesis in 9 and contralateral hermhypesthesia in & Only one patient presented with ipsilateral lingual paresis. The motor weakness was mild in 5 and moderate in 4. MRI results showed the lesions were located in the upper medulla in 7 and lower medulla in 2. Alteration of vertebral artery flow signal void in MRI was observed in 6 patients. Three patients had additional infarcts in the lateral medullary area. Prognosis of the motor weakness was good in 5 and stationary in 4. CONCLUSION: Our patients generally presented with unilateral sensorimotor stroke. Ipsilateral h6miparesis and tongue weakness, unique signs of @, were found only rarely, and the absence of these findings often made it difficult to localize the lesion by clinical judgement only.

Primary Antiphospholipid Syndrome Presenting Dementia and Brain Atrophy

Antiphospholipid antibody syndrome (APS) has been considered as a distinct clinical entity, usually associated with systemic lupus erythematosus (SLE) or with other connective tissue disease. Prominent clinical features include venous thrombosis, arterial occlusions, thrombocytopenia, hemolytic anemia, recurrent fetal loss, livedo reticularis and neurologic manifestations. Antiphospholipid antibodies (aPL) represent a spectrum of phospholipid-binding antibodies, including the lupus anticoagulant(LA), anticardiolipin antibody (aCL), and the biologic false-positive serologic test for syphilis (BFP-STS). Primary antiphospholipid syndrome (PAPS) which has been recently described is a complication of autoimmune aPL with lack of serologic and clinical features of SLE. We present a young female patient with PAPS who showed progressive dementia, diffuse cerebral atrophy, renal arteriolar occlusions, livedo reticularis, and valvular heart disease. To our knowledge, our patient is the first described with the clinical and mangetic resonance imaging(M-RI) findings in this entity.