Intravenous Versus Intra-arterial Thrombolysis for Acute Ischemic Stroke Secondary to Basilar Artery Occlusion

No abstract available.

Isolated Dizziness. Admission? or Discharge?

PURPOSE: Dizziness is a common chief complaint in patients presenting at emergency deparments. As central dizziness can be life-threatening, it is important to differentiate central from peripheral dizziness. VBI (vertebrobasilar insufficiency) or PICA (posterior inferior cerebellar artery) infarction can present as only isolated dizziness without other neurologic symptoms, thus mimicking peripheral dizziness. It is difficult to differentiate from isolated dizziness in emergency departments because of limitations attendant to time, space, laboratory tests and diagnostic procedures. This study was performed with the goal of devising a protocol to positively identify isolated dizziness at the bedside in emergency departments. METHODS: We retrospectively reviewed the medical records of 384 patients with isolated dizziness who visited the emergency department of Kyunghee Medical Center from January 1, 2006 to December 31, 2006. We analyzed age, gender, the risk factors of cerebral vascular accident, neurologic examinations, and features of dizziness and performed a logistic regression analysis. RESULTS: In logistic regression analysis, age of at least 65 years, cerebral vascular accident history, disequilibrium character, cranial nerve system, and tandem gait abnormality were significantly associated with central dizziness. Negative predictive value and sensitivity of the protocol were 99.6% and 98.7%, respectively. CONCLUSION: In patients presenting with isolated dizziness in the emergency department, patients less than 65 years old, and without history of cerebral vascular accident, disequilibrium character, cranial nerve system, or tandem gait abnormality can be safely discharged after conservative management without further evaluation.

Ondine's Curse in a Patient with Right Medullary and Bilateral Cerebellar Infarctions: A Case Report

Failure of automatic control of ventilation (Ondine's curse syndrome) is a rare syndrome that sometimes occurs following localized brainstem dysfunction. In this report, we present a case of a 52-year-old male who was admitted to the hospital with sudden-onset nausea. On examination, no lateralization signs were presented. After one hour, his consciousness was altered and he became apneic. After endotracheal intubation and mechanical ventilation, his mentality improved and he was able to ventilate spontaneously. Cranial magnetic resonance imaging demonstrated acute infarction in both cerebellar inferior aspects involving the right side of the medulla. Eleven hours later, the patient's consciousness altered again. Computed tomography demonstrated newly developed hydrocephalus and emergent craniotomy, and extraventricular drainage were performed. The patient improved in both consciousness and respiratory status but complained of mild ataxia and left arm weakness. We recommend cautious examination and early diagnosis and therapeutic decisions in cases of patients with atypical presentation of stroke.