Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement

Abnormal changes in gray matter volume and structural covariate network in patients with chronic pontine infarction / 国际脑血管病杂志

Objective:To investigate the changes in gray matter volume (GMV) and abnormalities in structural covariant network (SCN) patterns in patients with chronic pontine infarction (PI).Methods:Patients with unilateral chronic PI (case group) with the first onset admitted to the First Affiliated Hospital of Zhengzhou University and Tianjin Medical University General Hospital from October 2014 to June 2021 were prospectively included. At the same time, healthy subjects matched with age, gender and education years (normal control group) were included. High-resolution three-dimensional T 1 structural MRI images and behavioral scores of the subjects were collected. The voxel-based morphometry and two-sample t test were used to explore the differences in GMV between the groups. Using GMV differential brain regions as seed points, SCN was constructed to explore the abnormality of structural covariant patterns in patients with PI. Spearman rank correlation analysis was used to analyze the correlation between GMV in differential brain regions and behavioral scores. Results:A total of 60 patients with PI were enrolled, including 33 left PI and 27 right PI, while 34 healthy controls were also enrolled. Compared with the normal control group, the GMV in bilateral posterior cerebellar lobe decreased significantly in the left PI group, and the GMV in left anterior and posterior cerebellar lobes and the right posterior cerebellar lobe decreased significantly in the right PI group (Gaussian random field correction with voxel level P<0.001 and cluster level P<0.05, cluster voxel >20), and there was a significant correlation between GMV values in the left anterior and posterior cerebellar lobes and the right posterior cerebellar lobe and the motor function score ( P<0.05). In addition, compared with the normal control group, the right PI group had broader covariate brain regions and a significant increase in the number of structural connections between covariate brain regions (family-wise error correction with voxel level P<0.05, cluster voxel >20). Conclusions:The GMV in bilateral posterior cerebellar lobe decreases significantly in patients with chronic PI, and were secondary to broader covariate brain regions and structural connections. This may be the neural mechanism of impaired behavioral function in patients with PI.

A Study On The Morphological Variations Of The Human Liver And Its Clinical Implications In Gujarat Region

Background:liver is a soft, friable and largest gland in the body, occupying the upper part of the abdominal cavity just beneath the right diaphragm. The greater part of it is situated under cover of the ribs, extending to the left to reach the left diaphragm. Objective: to determine gross anatomical variations of liver and their clinical and surgical implications. To study variations in lobes, fissures and accessory lobes were observed. Material And Methods:a total of 50 formalin-fixed adult human livers, irrespective of the sex, were studied over a period of three years from Dr M K shah medical college. These livers were specifically observed for any variant or anomalous surface morphology. Result:out of 50 specimens, 16 were considered normal without any ac-accessory fissures, lobes, or presence of a pones hepatis. 34 livers had one or more morphological variations.14 liver has accessory fissure, 10 liver are present with riedel’s lobe present in liver, 10 liver are present with pons hepatic. Conclusion:liver being the largest abdominal organ, the knowledge of its normal and variant morphology is essential for the clinicians. In general, accessory hepatic fissures/sulci are potential sources of diagnostic errors during imaging. On ultrasound or computerized tomography, any collection of fluid in these fissures may be mistaken for a liver cyst, intrahepatic hematoma, or liver abscess, which would require further radiologic workup.

Sequential treatment with tirofiban and argatroban in acute isolated pontine infarction caused by branch atheromatous disease / 国际脑血管病杂志

Objective:To investigate the efficacy and safety of sequential treatment with tirofiban and argatroban in acute isolated pontine infarction (AIPI) caused by branch atheromatous disease (BAD).Methods:Consecutive patients with AIPI caused by BAD within 48 h of onset and admitted to Zhengzhou Central Hospital from April 2021 to April 2022 were enrolled retrospectively. The patients were divided into sequential treatment group and tirofiban group according to their therapeutic modalities. In the tirofiban group, tirofiban was pumped intravenously within 48 h after admission, and dual antiplatelet therapy with aspirin and clopidogrel was added 4 h before tirofiban was discontinued. On the basis of tirofiban treatment, the sequential treatment group was followed by argatroban for 5 days when tirofiban is discontinued. The main outcome measure was the modified Rankin Scale (mRS) score at 3 months after the onset . A score of <2 was defined as a good outcome. The secondary outcome measure was all the adverse events during the treatment and follow-up. Multivariate logistic regression analysis was used to determine the independent factors of the outcomes. Results:A total of 64 patients with AIPI caused by BAD were enrolled, including 32 in the sequential treatment group and 32 in the tirofiban group. There was no statistical difference in baseline data between the two groups, but the rate of good outcomes at 3 months after onset in the sequential treatment group was significantly higher than that in the tirofiban group (78.1% vs. 50.0%; χ2=5.497, P=0.019). Multivariate logistic regression analysis showed that after adjusting for low-density lipoprotein cholesterol, the higher baseline National Institutes of Health Stroke Scale score was independently associated with the poor outcomes (odds ratio 2.067, 95% confidence interval 1.343-3.182; P=0.001), while the sequential treatment was independently associated with the good outcomes (odds ratio 0.248, 95% confidence interval 0.064-0.957; P=0.043). Conclusion:Early application of sequential treatment with tirofiban and argatroban in AIPI caused by BAD may effectively improve the outcomes of patients, and the safety is good.

Clinical and imaging features of bilateral Wallerian degeneration of the middle cerebellar peduncles secondary to isolated pontine infarction / 国际脑血管病杂志

Objective:To investigate the clinical and imaging features of bilateral Wallerian degeneration of the middle cerebellar peduncles secondary to isolated pontine infarction.Methods:Patients diagnosed as bilateral Wallerian degeneration of cerebellar middle peduncle after isolated pontine infarction admitted to the Second Affiliated Hospital of Zhengzhou University from June 2017 to December 2021 were retrospectively included. Patients with bilateral Wallerian degeneration of cerebellar middle peduncle after isolated pontine infarction reported between January 2001 and December 2021 were collected by searching Chinese and English databases, and their clinical and imaging characteristics were summarized.Results:A total of 48 patients with bilateral Wallerian degeneration of cerebellar middle peduncle after isolated pontine infarction were included, including 14 patients admitted to the Second Affiliated Hospital of Zhengzhou University, and 34 patients collected by searching the Chinese and English databases. Thirty-three patients were males (68.75%) and 15 were females (31.25%). Their age was 65.8±10.7 years old (range, 37-88 years). Most patients had vascular risk factors, and hypertension was the most common. Dysarthria and limb weakness were the main clinical symptoms at admission. The infarct sites of all 48 patients were located in the blood supply area of paramedian pontine arteries, of which 37 (77.08%) were unilateral (18 on the left and 19 on the right), 6 (12.50%) were bilateral sides, and 5 (10.42%) had incomplete data. When Wallerian degeneration was diagnosed, 8 patients (16.67%) had dizziness or ataxia, 6 (12.50%) had aggravated original symptoms, and the remaining 34 (70.83%) had no new symptoms or aggravated original symptoms. All patients showed symmetrical abnormal signals in bilateral middle cerebellar peduncles, with obvious hyperintensity on T 2 or diffusion-weighted imaging (DWI). One patient showed T 2 hyperintensity in bilateral middle cerebellar peduncle on the next day after the onset of the infarction, which was the earliest case to find secondary Wallerian degeneration after isolated pontine infarction. Conclusions:Wallerian degeneration should be considered when symmetrical lesions of bilateral middle cerebellar peduncles occur after isolated pontine infarction. Wallerian degeneration may occur early after isolated pontine infarction. Most cases have no new symptoms or aggravated original symptoms. Conventional MRI can identify it early.

A case of bilaterally horizontal gaze palsy with facial palsy caused by tegmental pontine infarction / 中华神经科杂志

Internuclear ophthalmoplegia mainly affects the horizontal movement disorder of the eyeball. "One and a half syndrome" is characterized by a combination of one eyeball on the affected side cannot be adducted and abducted, and the other eyeball cannot be adducted, but can be abducted accompanied by horizontal nystagmus due to the lesion of tegmental pontine. At present, articles have successively reported "eight and a half syndromes""nine syndromes""thirteen and a half syndromes" and so on. The rapid identification of "one and a half syndrome" spectrum is helpful for clinicians to make right positioning and clinical decision-making. A case of bilateral peripheral facial paralysis with bilaterally horizontal gaze palsy caused by pontine dorsal tegmental lesions is now reported, so as to improve the understanding of the anatomical location and heterogeneity of pontine lesion.

Coartación de aorta / Coarctation of the Aorta

Resumen La coartación de aorta es una cardiopatía congénita con altas tasas de morbilidad y mortalidad, que usualmente es subdiagnosticada a pesar de la disponibilidad de herramientas diagnósticas. El grado de severidad de las manifestaciones clínicas de la coartación de aorta va a depender del grado de obstrucción, así como de la presencia de defectos cardiacos y lesiones extracardíacas asociados. En la población pediátrica la modalidad terapéutica mayormente utilizada es la reparación quirúrgica; mientras que la angioplastia con balón y la colocación de una endoprótesis son menos utilizadas en esta población, ya que asocian mayor riesgo de reestenosis con la consecuente reintervención, estas técnicas son principalmente utilizadas en pacientes mayores. A pesar del éxito en la reparación de la coartación de aorta, los pacientes deben continuar un seguimiento estrecho a largo plazo, que incluye mediciones de la presión arterial de manera periódica, así como estudios por imagen de la estructura cardíaca, debido a la aparición tardía de complicaciones cardiovasculares asociadas.

Abstract Coarctation of the aorta is a congenital heart disease with high rates of morbidity and mortality, which is usually underdiagnosed despite the availability of diagnostic tests. The degree of severity of the clinical manifestations of coarctation of the aorta will depend on the level of obstruction, as well as the presence of cardiac defects and associated extracardiac lesions. In the pediatric population the most used therapeutic modality is surgical correction; while balloon angioplasty and stent placement are less used in this population, since they are associated with a greater risk of restenosis with the subsequent reintervention; these techniques are mostly used in older patients. Despite the success in the repair of coarctation of the aorta, patients should continue a close long-term follow-up, which includes periodic blood pressure measurements, as well as imaging studies that assess the cardiac structure, due to the late onset of associated cardiovascular complications.

Neuralgia del Trigémino / Trigeminal neuralgia

Resumen La neuralgia del trigémino (NT) es una enfermedad cuya prevalencia es alta y corresponde a un porcentaje importante de neuralgias faciales; en donde las personas más afectadas son mayores de 50 años. Su manifestación clínica suele ser de cuadros de dolor facial severo y recurrentes, unilateral; en la distribución de una o más divisiones del nervio trigémino y no se explica con otro diagnóstico. El diagnóstico se basa en el cuadro clínico y usualmente no se encuentra déficit sensorial, sin embargo, si está presente se deben hacer neuroimágenes para descartar otras causas. En primera instancia está el manejo farmacológico. La carbamazepina se ha establecido como efectivo, llegando a producir un alivio del dolor dentro de las 24 horas. Cuando la farmacoterapia falla, se opta por la cirugía que se divide generalmente en dos: técnicas que destruyen la porción sensitiva del nervio; y la descompresión microvascular (DMV), que es la que tiene mejores resultados.

Abstract Trigeminal neuralgia is a disease whose prevalence is high and corresponds to a significant percentage of facial neuralgia; where the most affected people are over 50 years old. The clinical picture is usually of episodes of severe and recurring facial pain, unilateral; in the distribution of one or more divisions of the trigeminal nerve and this is not explained with another diagnosis. Diagnosis is based on the clinic and usually no sensory deficit is found, however, if present, neuroimaging should be done to rule out other causes. In the first instance is the pharmacological management. Carbamazepine has been established as effective, leading to pain relief within 24 hours. When pharmacological therapy fails, surgery is generally divided into two: techniques that destroy the sensitive portion of the nerve and microvascular decompression, which has the best results.

Correlation between serum uric acid level and short-term outcome of acute isolated pontine infarction / 国际脑血管病杂志

Objective To investigate the correlation between serum uric acid level and short-term outcome of acute isolated pontine infarction. Methods From April 2016 to April 2018, consecutive patients with acute isolated pontine infarction admitted to the Department of Neurology, Kaifeng Central Hospital were enrolled. The baseline clinical data were collected. Fasting venous blood was collected on the day of admission or the morning of the next day for blood biochemical tests. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological deficit. According to the modified Rankin Scale score at discharge or 14 dafter onset, the patients were divided into good outcome group (≤2) and poor outcome group ( > 2 ). Multivariate logistic regression analysis was used to determine the independent risk factors for short-term poor outcome. Results A total of 137 patients were enrolled in the study, 108 (78.8% ) had a good outcome, and 29 (21.2% ) had a poor outcome. The baseline NIHSS score (median [ interquartile range]: 2.5 [1.0-4.0] vs. 8.5 [5.5-10.0 ]; Z= 6.092, P< 0.001 ) and total cholesterol levels (4.290 ± 0.101 mmol/L vs. 4.763 ± 0.171 mmol/L; t=2.214, P=0.028] in the good outcome group were significantly lower than those in the poor outcome group, while serum uric acid level (329.769 ± 8.122μmol/L vs. 257.103 ± 14.290μmol/L; t=4.190, P<0.001) was significantly higher than that in the poor outcome group. Multivariate logistic regression analysis showed that high serum uric acid levels were independently associated with short-term good outcomes in patients with isolated pontine infarction (odds ratio [ OR] 0.377, 95% confidence interval [ CI] 0.203-0.702; P=0.002), while high NIHSS score (OR 1.762, 95% CI 1.375-2.258; P<0.001) and hypertension (OR 5. 353, 95% CI 1.333-21.502; P= 0.018 ) were independently associated with short-term poor outcomes. Conclusion High baseline serum uric acid levels are associated with short-term good outcomes in patients with acute isolated pontine infarction.

Clinical characteristics and risk factors for bilateral pontine infarction:comparison with unilateral pontine infarction / 国际脑血管病杂志

Objective To compare and analyze the etiology,clinical manifestations and imaging differences of bilateral pontine infarction (BPI) and unilateral pontine infarction (UPI),and investigate the possible independent risk factors for BPI.Methods Consecutive patients with pontine infarction admitted to the Department of Neurology,the First People's Hospital of Kunshan from January 2015 to December 2017 were enrolled retrospectively.They were divided into BPI group and UPI group.The risk factors,laboratory findings,National Institutes of Health Stroke Scale (NIHSS) scores,clinical manifestations,and basilar artery lesions were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for BPI relative to UPI.Results A total of 131 patients with pontine infarction were enrolled,aged 66.22 ± 12.29 years,97 patients (72.52％) were male;14 (10.69％) were BPI,and 117 (89.31％) were UPI.In terms of clinical symptoms,consciousness disorder (35.71％ vs.6.83％;x2 =8.657,P =0.003),quadriplegia (50.00％ vs.5.12％;x2 =30.202,P ＜ 0.001),and dysphagia (71.42％ vs.29.91％;x2 =7.804,P =0.005) in the BPI group were more common than those in the UPI group.In terms of etiological classification,vertebrobasilar large artery disease (VLAD) was more common in the BPI group (85.71％ vs.27.35％;x2 =16.567,P ＜ 0.001),while small artery disease (SAD) was more common in the UPI group (49.57％ vs.7.14％;x2 =7.460,P =0.006).In addition,the baseline NIHSS scores (12.43 ±11.1 vs.3.78 ±3.98;t=2.873,P=0.013),white blood cell count ([9.21±2.81] ×109/L vs.[6.92± 2.40] ×109/L;t=3.191,P=0.002),baseline systolic blood pressure (170.57 ±31.21 mmHg vs.156.75 ±23.50 mmHg,1 mmHg =0.133 kPa;t =2.004,P =0.047),as well as the proportion of patients with severe stenosis or occlusion in basilar artery (78.57％ vs.8.55％;x2 =40.49,P ＜ 0.001) and with other site infarction (78.57 ％ vs.11.11％;x2 =33.652,P ＜ 0.001) in the BPI group were significantly higher than those in the UPI group.Multivariate logistic regression analysis showed that severe basilar artery stenosis or occlusion (odds ratio [OR] 20.195,95％ confidence interval [CI]2.308-176.703;P =0.007),baseline NIHSS score (OR 1.147,95％ CI 1.019-1.292;P =0.023),and infarction at other sites (OR 19.483,95％ CI 2.969-127.868;P =0.002) were independently associated with BPI.Conclusion Compared with UPI,patients with BPI had more severe clinical symptoms and most of them with other site infarction.Severe stenosis or occlusion of the basilar artery was an independent risk factor for BPI.

Risk factors for progressive motor deficit in patients with acute isolated pontine infarction / 国际脑血管病杂志

Objective To investigate the risk factors for progressive motor deficit (PMD) in patients with acute isolated pontine infarction.Methods Patients with new onset of acute isolated pontine infarction admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University from January 2016 to December 2018 were enrolled retrospectively.The demography,vascular risk factors,laboratory examinations,and imaging features were compared between PMD group and non-PMD group.Multivariate logistic regression analysis was used to determine the independent risk factors for PMD.Results A total of 117 patients with acute isolated pontine infarction were enrolled,including 46 females (39.3％) and 71 males (60.7％),aged 70.62 ± 9.07 years.Twenty-six patents (22.2％) were in the PMD group and 91 (77.8％) were in the non-PMD group.The blood glucose at admission (7.28[6.68-8.27] mmol/L vs.6.66[5.64-7.87]mmol/L;Z =-2.367,P =0.018] and the proportion of hypertension (80.8％ vs.57.1％;x2=4.811,P=0.028),paramedian pontine infarction (80.8％ vs.45.1％;x2=10.355,P=0.001),and lower pontine infarction (46.2％ vs.25.3％;x2 =4.205,P =0.040) in the PMD group was significantly higher than those in the non-PMD group.Multivariate logistic regression analysis showed that hyperglycemia at admission (odds ratio 1.444,95％ confidence interval 1.048-1.988;P=0.024) and paramedian pontine infarction (odds ratio 3.266,95％ confidence interval 1.061-10.055;P =0.030) were the independent risk factors for PMD in patients with acute isolated pontine infarction.Conclusion Hyperglycemia at admission and paramedian pontine infarction were the independent risk factors for PMD in patients with acute isolated pontine infarction.

Pontine Hypoplasia and Cri-du-chat Syndrome in a Preterm Infant / 고신대학교의과대학학술지

A premature infant with gestational age 36⁺⁴ weeks was admitted with respiratory distress syndrome. Surfactant and ventilation were firstly done to improve his respiration. After extubation, weak, high-pitched cry and asymmetric face with micrognathia and hypertelorism were detected. Therefore, cytogenetic analysis was performed, and his karyotype was 46, XY, del(5) (p14p15.33). Pontine hypoplasia was detected on cranial magnetic resonance imaging (MRI). Therefore, karyotyping and cranial MRI should be performed in case of preterm infants with suspicion of Cri-du-chat syndrome (CdCS).

Research advances on factors relevant to the progression of acute isolated pontine infarction / 中华神经科杂志

Progression of acute isolated pontine infarction (IPI) is a common clinical event that positively correlates with the patients' adverse prognosis.Therefore,exploration on the relevant factors and predictors to the progression of IPI has become the current research hotspot.To date,the relevant factors that have been proposed include basilar artery branch disease,female,hypertension and blood pressure fluctuation,hyperglycemia,morphological features of the lesions (ventral surface of pons involvement,located at the lower pons,multiple axial slices affected,conglomerated beads shape),severe white matter diseases,atherosclerosis,long diameter and midline location of basilar artery,and so on.However,the interpretation on existing results has to be cautious as the definition for progressive IPI,criteria for inclusion and exclusion,and examinations are inconsistent in different studies.The investigation on relevant factors to the progression of IPI still requires standardized,large-scale prospective clinical studies.

Síndrome de Millard-Gubler secundario a angioma cavernoso: reporte de un caso / Millard-Gubler syndrome secondary to cavernous angioma: report of a case

RESUMEN El síndrome de Millard-Gubler es considerado un síndrome protuberancial debido a una lesión pontina inferior y caracterizado, desde el punto de vista clínico, por parálisis facial y del VI par, ipsilateral a la lesión y parálisis braquiocrural contralateral; frecuentemente es de causa vascular, menos frecuente de causa traumática o por efecto de masa secundario a un tumor. Se realiza reporte de un caso de un paciente de 45 años de edad que acude al servicio hospitalario de la Fundación Centro Colombiano y Enfermedades Neurológicas FIRE con cuadro clínico caracterizado en pérdida de la fuerza muscular en hemicuerpo izquierdo, y déficit motor de la hemicara derecha, disartria y deterioro del estado de consciencia. La TAC de cráneo simple al ingreso evidenció sangrado extenso del tallo cerebral. De acuerdo con los hallazgos clínicos se concluye que el paciente presentó un síndrome de Millard-Gubler.

SUMMARY The Millard Gubler syndrome is considered a protuberant syndrome due to a lower pontine lesion and characterized, from the clinical point of view, by facial paralysis and VI pares, ipsilateral to the lesion and contralateral brachiocrural palsy; frequently it is of vascular cause, less frequent of traumatic cause or by effect of mass secondary to a tumor. A case report is presented of a 45-year-old patient who attends the hospital service of the Fundación Centro Colombiano y Neurológicas FIRE with a clinical picture characterized by loss of muscle strength in the left side of the body, and motor deficit of the right side of the face, dysarthria and deterioration of the state of consciousness. The simple skull CT on admission showed extensive brainstem bleeding. According to the clinical findings, it is concluded that the patient presented a Millard Gubler syndrome.

Síndrome de Locked-In: Reporte de Caso y Revisión de Literatura / Locked-In Syndrome: Case Report And Review Of Literature

RESUMEN El Síndrome de Locked-In también conocido como Síndrome de Enclaustramiento, de Deseferentización o de Encerramiento, se definió por primera vez en 1966 por Plum y Posner. Las causas pueden agruparse en vasculares y no vasculares, siendo las primeras las más frecuentes. Clínicamente este síndrome se caracteriza porque la conciencia y el estado de vigila están conservados, pero existe cuadriplejía, anartria, disfagia y dificultad para coordinar la mecánica ventilatoria, representando las complicaciones pulmonares la principal causa de muerte. En la mayoría de los casos, el paciente conserva la movilidad ocular vertical, por tanto, el único método de comunicación es por medio de parpadeo ocular y movimientos verticales oculares. A continuación, se hace la presentación de un caso y revisión de la literatura con los aspectos fisiopatológicos, clínicos, diagnósticos y terapéuticos más relevantes.

ABSTRACT Locked-In Syndrome, also known as Enclaustration, Deseferentization, or Enclosure Syndrome, was first defined in 1966 by Plum and Posner. Causes can be grouped into vascular and non-vascular, the former being the most frequent. Clinically this syndrome is characterized by consciousness and the state of watch conserved, but there is quadriplegia, anartria, dysphagia and difficulty to coordinate the ventilatory mechanics, representing pulmonary complications the main cause of death. In most cases, the patient retains vertical eye mobility, so the only method of communication is through eye blinking and vertical eye movements. Next, a case presentation and review of the literature with the most relevant pathophysiological, clinical, diagnostic and therapeutic aspects is done.

Relationship between different topographic location and neurological deterioration in acute new isolated pontine infarction / 中国医师杂志

Objective To investigate the relationship between different topographic locations and neurological deteriorations (ND) in patients with acute new isolated pontine infarction.Methods One hundred sixty-eight patients with acute new isolated pontine infarction during arch 2012 to March 2016 were identified by diffusion weighted imaging (DWI) for retrospective review.Patients were divided into two groups according to their clinical symptoms:patients with ND and patients without ND.According to neuroimaging of DWI,the topographic location of pontine infarction was divided into three types:The upper,middle,and lower ones,and the correlations of ND with risk factors,laboratory examination results,clinical manifestations and different topographic locations were explored by statistical tests.Results Of 168 patients,26.8％ (45/168) were diagnosed with ND,and 73.2％ (123/168) were diagnosed without ND.Univariate analysis showed that there were differences in female ratio [62.2％ (28/45) vs 41.5％ (51/ 123)],smoking ratio [13.3％ (6/45) vs 26.0％ (32/123)],mean length of hospital stay [(22.83 ± 7.12)d vs (19.31 ± 7.65)d],ratio of worse short-term clinical outcomes [77.8％ (35/45) vs 33.3％ (41/123)],and ratio of lower pontine infarction [55.6％ (25/45) vs 26.0％ (32/123)] between two groups (P ＜ 0.05).Logistic regression analysis showed that lower pontine infarction was the independent risk factor of ND (OR =1.953,95％ CI:1.092-3.535,P =0.029).Conclusions Topographic location of lower pons lesions may be reliable predictor of ND in acute new isolated pontine infarction.

Correlation between lesion pattern and etiological mechanism in acute isolated pontine infarction / 国际脑血管病杂志

Objective To investigate the correlation between lesion pattern and etiological mechanism in acute isolated pontine infarction.Methods The clinical data in patients with acute isolated pontine infarction were collected retrospectively. Diffusion weighted imaging (DWI) was used to identify the lesion patterns. The correlation between the lesion pattern and etiological subtype was analyzed. Results A total of 146 patients with acute isolated pontine infarction were enrolled in the study, including 136 unilateral infarctions and 8 bilateral infarctions. The DWI lesion pattern analysis showed that there were 98 patients with paranasal infarction, 11 with anterolateral infarction, 18 with tegmentum infarction, and 19 with multiple infarction. Among all the etiological subtypes, basilar artery branch disease (BABD) accounted for the greatest proportion (n = 72, 49.3%), followed by large arterial occlusive disease ( n = 32, 21.9%), small arterial occlusive disease ( n = 25, 17.1%), and other causes/unknown causes ( n = 12, 8.2%). Cardioembolism was minimal (n =5, 3.4%). The distribution patterns of DWI lesions in acute isolated pontine infarction were significantly correlated with the etiological subtypes (C = 0.516, P < 0.001). Among them, 60 patients with paramedian infarction ( χ2 =16.915, P <0.001), 1 with anterolateral infarction ( χ2 =7.701, P = 0.006), 1 with tegmentum infarction ( χ2 =17.401, P <0.001) were closely associated with BABD; 9 patients with paramedian infarction ( χ2 =12.534, P <0.001), 6 with anterolateral infarction ( χ2 =24.365, P <0.001), and 10 with tegmentum infarction ( χ2 =18.312, P < 0.001) were significantly associated with small arterial occlusive disease. Conclusions There are significant correlation between the lesion pattern and etiological mechanism in acute isolated pontine infarction. The cause of acute isolated pontine infarction can be predicted in early stage by DWI revealed infarction distribution characteristics.

Unilateral Sudden Deafness Accompanied by Short Circumferential Pontine Artery Territorial Infarction

No abstract available.

Síndrome de enclaustramiento: presentación de un caso / Locked-in syndrome: case report

El síndrome de enclaustramiento (Locked-in syndrome) es una entidad neurológica altamente discapacitante, producida por lesiones en la porción ventral de la protuberancia; de etiología principalmente vascular. Clínicamente se manifiesta por tetraplejía, anartria, preservación de la conciencia y capacidad de expresarse mediante movimientos oculares. Presentamos el caso de un paciente masculino de 33 años, transferido de otra institución de salud con un cuadro clínico progresivo y poco específico, caracterizado principalmente por deterioro del estado de conciencia, dificultad respiratoria, cefalea de intensidad moderada y vómitos. Mediante pruebas de imágenes se comprobó la presencia de un área de isquemia en la región irrigada por el sistema vertebrobasilar. Se realizó un enfoque diagnóstico y terapéutico invasivo de orden endovascular.

Locked-in syndrome is a highly disabling neurological entity, due to lesions in the ventral portion of the pons, mainly vascular etiology. Clinical features are quiadriplegia, anarthria, preservation of consciousness and the ability to express by ocular movements. We shown a case of a 33 years-old man, who was transfer from another institution with a progressive and poorly specific clinical manifestations, mainly characterized by diminishing of consciousness, breathing difficulty, headache and vomiting, with the presumptive diagnosis of central nervous system infection. We performed image diagnostic tests and they shown and ischemic feature in the region of the vertebrobasilar irrigation. It was perform an endovascular diagnostic therapeutic approach.

A Comparative Study of the Histological Changes in Cerebral Cortex, Hippocampus, Cerebellum, Pons & Medulla of the Albino Rat Due to Lead Toxicity.

Introduction: Lead, a heavy metal is well known for its toxic effects on the central nervous system. Clinically, overall effects of lead on different organ system are called plumbism. Diverse writing can be seen on the subject, but rarely there has been a comparison in any of these writings on different parts within the brain of the changes happening as the result of lead exposure. This study was taken up to draw a comparison and correlation of damaging effects on different parts of brain at microscopic level as a result of lead toxicity so that the affected elements in the tissue can be further connected to the histopathological and clinical outcomes of the lead toxicity. Materials and Methods: To conduct the study albino rats of Charles Foster strain were administered orally with 4% lead acetate in drinking water. The behavioral and clinical changes during the period of lead administration were closely observed that extended from irritability, agitation and aggressive behavior in the beginning to drastic fall in activity, indifference towards varieties of stimulus and severe motor deficit. At the end of an average of 17 days the rats were sacrificed for both gross and microscopic examination of brain for changes in the cerebral cortex, hippocampus, cerebellum, pons & medulla. The elements of the tissue observable as per the selected staining were the neurons, fibers, glia & the vessels. Results: The changes showed up with similarities between different parts as the shrinkage of neurons, damaged fibers, stunting of cell processes and increased glial cell population, whereas there were dissimilarities with regards to the extent of shrinkage of neuron and distribution of perineuronal spaces, vacuoles & the glial cells. Discussion and Conclusion: The comparative picture of the changes as a result of lead exposure showed widespread damage to nearly all the elements of the nervous tissue with reactive changes e.g. gliosis, and variations in the extend of changes in the selected brain parts. As a result these changes observed can be of used to correlate in the overall outcome of plumbism in relation to the functions of different parts of the brain.