ABSTRACT
We report on the successful repeated treatment of a patient with rapidly progressive severe brain-stem stroke by application of I.V. tissue plasminogen activator (tPA). This treatment twice led to a prompt remission of severe brain-stem symptoms, although a permanent therapeutic success could not be achieved. Unfortunately, the patient died a few days later from pneumonia and sepsis. Necropsy revealed bilateral partial brain-stem infarctions and a subtotal stenosis of the vertebrobasilar junction with superimposed fresh thrombus. The clinically dramatic response to tPA indicates that this type of treatment is potentially successful in high-grade subtotal basal cerebral artery stenosis with progressive stroke symptoms. In particular, application of tPA should be considered if stroke progression cannot stopped by therapeutic heprinization. A prospective randomized oligocentric study is advocated.
Subject(s)
Brain Stem/blood supply , Cerebral Infarction/therapy , Tissue Plasminogen Activator/administration & dosage , Vertebrobasilar Insufficiency/therapy , Aged , Basilar Artery/pathology , Brain Stem/pathology , Cerebral Angiography , Cerebral Infarction/pathology , Dose-Response Relationship, Drug , Drug Administration Schedule , Humans , Magnetic Resonance Imaging , Male , Neurologic Examination/drug effects , Recurrence , Vertebral Artery/pathology , Vertebrobasilar Insufficiency/pathologyABSTRACT
The rapidly progressing deficits of a patient with known central neurofibromatosis (NF) led to a MRI control scan. Contrary to the previous non-enhanced examinations we now saw multiple cerebral and spinal tumors, whose localisation and extension made surgical removal impossible. Gadolinium enhanced MRI is extremely useful in diagnosing and defining the extent of intracranial and intraspinal lesions, does not involve radiation exposure and should therefore be recommended generously in follow-up patients with known NF. This is the only feasible way to allow an early careful surgical removal of the tumors before reaching a point of no return.
Subject(s)
Brain Neoplasms/diagnosis , Magnetic Resonance Imaging , Neurofibromatosis 1/diagnosis , Spinal Cord Neoplasms/diagnosis , Adult , Brain/pathology , Follow-Up Studies , Humans , Male , Spinal Cord/pathologyABSTRACT
In order to determine whether in amblyopes retinal conduction delays contribute to the cortical measureable delays in the visual evoked cortical potential (VECP), peak latencies of the pattern electroretinogram (ERG) are measured in amblyopic children. The results are compared with those of the normal fellow eyes and those of a healthy control group. Simultaneously the latencies in the VECP are recorded and the determination of the retinocortical times is performed. Statistically retinal b-wave (Q) and a-wave (P) of the pattern ERG of amblyopic eyes do not show significant delays of peak latency. In retincortical times, however, there are significant prolongations. During occlusion therapy retinocortical values of normal fellow eyes are also delayed in comparison with the control group. A pathological conduction delay of visual information on the retinal level up to the generators of the pattern ERG can thus be excluded in amblyopia. The total latency delay in the VECP of amblyopes consists solely in a prolongation of retinocortical times.
