ABSTRACT
Serial brain SPECT imaging was performed on patients after subarachnoid hemorrhage and surgical clipping of intracranial aneurysms. A total of 20 HMPAO scans were performed on 9 patients in whom clinical vasospasm did not develop. Areas of diminished regional cerebral blood flow (rCBF) were found near the operative site in 17 of 20 studies, which did not correlate with the patients' neurologic condition and were suggestive of postoperative edema. Brain SPECT imaging has a potentially valuable role to play in the evaluation of postoperative patients susceptible to vasospasm; however, it is important to be aware of postoperative changes in rCBF that are not related to vasospasm.
Subject(s)
Brain/diagnostic imaging , Intracranial Aneurysm/diagnostic imaging , Ischemic Attack, Transient/diagnostic imaging , Organotechnetium Compounds , Oximes , Postoperative Complications/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Brain Edema/diagnostic imaging , Cerebrovascular Circulation/physiology , Female , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Ischemic Attack, Transient/etiology , Male , Middle Aged , Subarachnoid Hemorrhage/etiology , Technetium Tc 99m Exametazime , Time Factors , Tomography, Emission-Computed, Single-Photon/methodsABSTRACT
BACKGROUND AND PURPOSE: Lacunes are thought to occur in patients with hypertension or diabetes mellitus as a result of small-vessel disease. This study evaluated the importance of other stroke mechanisms in a population of patients with lacunar infarction. METHODS: We evaluated 108 consecutive patients with a lacune in the lenticulostriate distribution for other stroke risk factors such as carotid and cardiac disease. RESULTS: Hypertension was present in 68% of the patients and diabetes mellitus in 37%; both occurred in 28% and neither occurred in 23%. Noninvasive carotid studies identified atherosclerotic plaque as a possible embolic source in 23%. By previously established criteria, 18% were at high risk for cardioembolism. Of those with hypertension or diabetes mellitus, 36% were at risk for a carotid or cardiac embolus. Of those without hypertension or diabetes mellitus, 32% had a possible carotid or cardiac etiology. CONCLUSIONS: The high incidence of carotid and cardiac disease in those with and without hypertension or diabetes mellitus suggests the importance of other stroke mechanisms in this population. Patients with lacunar infarction should therefore be evaluated for other causes of stroke that may be treatable.
Subject(s)
Cerebral Infarction/complications , Aged , Arterial Occlusive Diseases/complications , Cerebral Arteries , Cerebral Infarction/diagnostic imaging , Coronary Disease/complications , Diabetes Complications , Embolism/complications , Female , Humans , Hypertension/complications , Intracranial Arteriosclerosis/complications , Male , UltrasonographyABSTRACT
A 62-year-old woman with a diagnosis of metastatic fallopian tube carcinoma was treated with cis-platinum and doxorubicin (Adriamycin) at a dosage of 50 mg/m2 intravenously every 3 weeks. After the 10th course of cis-platinum and doxorubicin, she complained of headache and inability to see. Physical examination was compatible with cortical blindness. The brain scan and computed tomographic scan were normal. Visual evoked potentials showed a delay in latency. Visual acuity completely returned over the next months, but right homonymous hemianopia persists. The temporal relationship between the findings and the treatment with platinum implicates this drug as the possible causative agent in the cortical blindness.
Subject(s)
Adenocarcinoma, Papillary/drug therapy , Blindness/chemically induced , Cisplatin/adverse effects , Fallopian Tube Neoplasms/drug therapy , Cisplatin/administration & dosage , Doxorubicin/administration & dosage , Drug Therapy, Combination , Evoked Potentials, Visual , Female , Humans , Middle Aged , Neoplasm MetastasisABSTRACT
The clinical and electro-oculographic eye abnormalities in chronic GM2 gangliosidosis have been described. The most prominent oculomotor disturbances in our patients involved the pursuit system. This was evident during performance of eye tracking and vestibulo-ocular reflex suppression. Saccadic eye movements were dysmetric but were normal in velocity. These findings point to disturbances of cerebellar oculomotor control. While the oculomotor defects are nonspecific in this chronic form of beta-hexosaminidase A deficiency, they broaden the spectrum of clinical features considered to be typical ocular manifestations in many storage diseases. Disturbances in the oculomotor system may be the only ocular sign of chronic GM2 gangliosidosis.
