Three cases of posterior circulation infarction related with cervical manipulation or trauma

BACKGROUND AND SIGNIFICANCE: Neck manipulation or trauma uncommonly be associated with serious and even fatal vascular complications. We presented the clinical and radiologic findings in 3 patients of brainstem and/or cerebellar infarct with basilar artery occlusion and extracranial vertebral artery stenosis or occlusion,. Cases : In the patient 1, the infarction of pons and lsft cerebellar hemisphere outbroke just after being seized by the collar. The angiographic findings were complete occlusion of basilar artery and left vertebral artery on C1 level and vertebrobasilar junctional occlusion of right vertebral artery. In the patient 2, extensive infarction of pons and left cerebellar hemisphere developed just after chiropractic manipulation of the neck. The angiographic findings were occlusions of left vertebral artery and distal portion of the basilar artery. In the patient 3, right cerebellar and medullary infarction of posteroinferior cerebellar artery territory occurred just after autobicycle accident. The angiographic finding was complete occlusion of left vertebral artery on C1 lever. They had not another risk factor of the stroke. CONCLUSIONS: We experienced and presented 3 cases of posterior circulation infarctio with vertebrobasilar stenoocclusion just following cervical manipulation or neck trauma.

5 cases of cardiac myxoma with neurologic manifestations

Cardiac myxoma is a rare but potentially treatable cause of stroke. The diagnosis is rarely made on typical triad of constitutional, embolic, and obstructive symptoms, and it is difficult because there is no specific history, physical examination, chest X-ray, or electrocardiographic findings, but with the development of echocardiography the correct diagosis is now usualy made. Neurologic manifestation is frequent(25-45%) and presented with embolic infarction, aneurysm formation, intracranial hemorrhage, and distant metastasis. We experienced five patients with cardiac myxoma who presented with these neurologic manifestations. Also we should be considered in the differential diagnosis of cerebral infarction, particularly when multiple cerebral infarction and constitutional or obstructive symptoms are conjoined in young age stroke. We describe five patients who presented with embolic infarction, cerebral metastasis and aneurysm formation.

Abnormalities of Coagulation System In Cerebral Infarction

OBJECTIVE: To define the abnormalities of coagulation system in cerebral infarction and the effect of aspirin. BACKGROUND: Toghi et al(1990,1993) suggested that the coagulation system was enhanced at all stages of cerebral infarction and long term use of antiplatelet medication in chronic stroke patients was effective in reducing the elevated coagulant proteins level. METHOD: We determined fibrinogen, antithrombin III (ATIII), thrombin-antithrombin III complex(TAT) in plasma from 40 stroke patients - 32 acute (30days), and compared 14 patients receiving aspirin from acute stage with 10 patients not receiving aspirin. RESULT: The concentrations of fibrinogen and TAT were significantly elevated in acute and subacute stages, especially in subacute stage(P<0.01), whereas AT-III was decreased only in acute stage (P<0 05). Fibrinogen levels were significantly decreased in patients receiving aspirin than in patients not receiving aspirin during subacute stage (P<0.01). CONCLUSION: These results suggest that the coagulation system is enhanced during acute and subacute stages and early use of aspirin is effective in reducing the elevated fibrinogen in subacute stage.