Severe Unilateral Proprioceptive Loss in Medullary- Rostral Spinal Cord Infarction. A Posterior Spinal Artery Syndrome.

We draw attention to a unique presentation, severe unilateral loss of limb proprioception, in patients with medullary and rostral spinal cord infarction. Two patients developed acute severe proprioceptive loss in the limbs ipsilateral to infarcts that involved the caudal medulla and rostral spinal cord. They also had symptoms and signs often found in lateral medullary infarction. The proprioceptive loss is attributable to injury to the gracile and cuneate nuclei and/or their projections to the medial lemniscus. The infarct territory is supplied by the posterior spinal branches of the vertebral artery near its penetration into the posterior fossa. The presence of severe ipsilateral proprioceptive loss in a patient with features of lateral medullary infarction indicates involvement of the rostral spinal cord.

A Case of Wallenberg's Syndrome Presenting with Spontaneous Thrombosis of a Vertebral Artery Aneurysm.

Complete spontaneous thrombosis of intracranial aneurysms is uncommon. Although this type of thrombosis is largely asymptomatic, in rare cases it can be accompanied by parent artery occlusion and ischemic stroke. There are limited reports of complete thrombosis of an unruptured aneurysm of the internal carotid artery and middle cerebral artery. Furthermore, there are no reports of occlusion of the vertebral artery caused by thrombosis of an aneurysm. The mechanisms of spontaneous thrombosis are not established. However, aneurysm morphology, arteriosclerosis, and stagnation of aneurysm flow have been suggested. Herein, we present a novel case of Wallenberg's syndrome caused by a fusiform aneurysm in which complete thrombosis of the proximal vertebral artery occurred. We discuss the mechanisms of thrombosis caused by an unruptured aneurysm, which may be useful for managing such patients who present with transient ischemic attacks.

Efficacy of Early Endoscopic Intervention for Restoring Normal Swallowing Function in Patients with Lateral Medullary Infarction.

Dysphagia is considered to be a significant barrier for recovery after lateral medullary infarction (LMI). However, there is still no gold standard treatment for dysphagia. The aim of this study was to explore an effect of an early treatment options for swallowing dysfunction after acute LMI. Medical records of acute LMI patients who had been admitted to the department of rehabilitation medicine from January 2014 to December 2017 were reviewed retrospectively. We compared the clinical efficacy of conventional dysphagia rehabilitation to early endoscopic intervention using either botulinum toxin injection into cricopharyngeal muscle or endoscopic balloon dilatation of the muscle. Outcomes, such as duration of parental feeding, albumin level at diet transition to enteral feeding, and complications, were analyzed. A total of 18 patients with LMI were included. While eight patients (8/9, 88.89%) in the endoscopic group were capable of orally ingesting their diet after intervention, the conversion from tube feeding to an oral diet was possible in only five patients (5/9, 55.56%) of the conventional group during hospitalization. However, the difference between the two groups was not significant (p-value ≤ 0.147, chi-square test). Only the final dietary level at the time of discharge was higher level in endoscopic group. The conversion interval from tube feeding to oral diet was also comparable between groups. There was no re-conversion from the oral diet to tube feeding in patients of either group during the median follow-up period of 20 months. Early endoscopic intervention may be a better option for dysphagia with LMI, compared to conventional dysphagia rehabilitation. However, a larger and prospective trial may be needed to confirm our observations.

[The use of the osteopathic correction for the combined treatment and rehabilitation of the patients presenting with the vertebral artery syndrome]. / Osteopaticheskaia korrektsiia v kompleksnoi terapii i reabilitatsii patsientov s sindromom pozvonochnoi arterii.

BACKGROUND: The pathological changes in the cervical spine frequently result in the disturbances of the blood supply in the vertebral-basiliar system. The degenerative-dystrophic processes in the cervical spine occupy the leading place in the pathogenesis of the vertebral artery syndrome (VAS) causing disorders of the microcirculation and innervation, as well as the restriction of mobility and the development of somatic dysfunctions. It can be assumed that the manual methods applied to manage this condition can be effective in the removal the functional abnormalities in the blood flow. AIMS: The objective of the present study was to evaluate the effectiveness of the osteopathic treatment as a component of combined therapy of the patients presenting with the vertebral artery syndrome. MATERIAL AND METHODS: This experimental prospective controlled randomized study was conducted during the period from January 2015 till January 2017. A total of 106 patients with VAS, aged from 20 to 60 (the average age was 43.1±1.0 years) took part in the study. The patients were divided into three groups. The experimental group was comprised of 40 patients who received the medicamentous and osteopathic treatment. The control group consisted of 40 patients given the medicamentous treatment alone. The group of comparison contained 26 patients treated with the use of pharmacotherapy and massage. The methods finding application in clinical neurology, clinical osteopathy, and ultrasonic diagnostics of the brachiocephalic vessels were employed to evaluate the health status of the patients and evaluate the effectiveness of their treatment. RESULTS: The combined treatment of the patients comprising the experimental group with the use of osteopathic correction and pharmacotherapy produced the positive effect and resulted in the normalization of the neurological status of the patients; specifically, the incidence of both subjective and objective (neurological) symptoms was reduced. Simultaneously, the incidence of somatic dysfunctions at all levels of their manifestation decreased as compared with their frequency in the patients of the control and comparison groups. The results of the ultrasound examination of the great vessels of the neck and the brain in the experimental group made possible the evaluation of the dynamics in the incidence of the major pathological changes in the vessels of the vertebral-basiliar basin (VBB). It was shown that the occurrence of such serious changes as venous dishemia, reduction of the vasoconstriction and vasodilation reserves in VBB, in the patients of the experimental group vessels fell down by 32.1% (p<0.001), in comparison with only 12% (p<0.05), in the control group and 6,27% in the group of comparison (p>0.05). CONCLUSION: The osteopathic manipulative treatment included in the combined therapy of patients with VAS based on the personified approach to the management of individual cases, detection and correction of each clinically significant functional disorder accompanying the pathological process greatly contributes to the regression of the neurological symptoms, elimination of somatic dysfunctions at different levels of the body, normalization of the blood flow in the vessels of the vertebral-basilar system. Taken together, these effects prolong the beneficial results of the combined rehabilitative treatment of the patients with the vertebral artery syndrome based on the application of standard pharmacotherapy and correction of the functional disorders with the use of the osteopathic methods.

Wallenberg Syndrome following neck cracking: a case report.

Cracking the neck is an age-old practice in contravention of its dangerous affects. One of these affects is Brain stem strokes and in this report we describe a patient with Wallenberg syndrome due to neck cracking who is the one of the rare cases in the literature.

Wallenberg's syndrome with extradural-extracranial origin of the posterior inferior cerebellar artery.

We report a case of lateral medullary syndrome (LMS) with extradural origin of the posterior inferior cerebellar artery (PICA). A 45-year-old construction worker presented with acute signs and symptoms of typical LMS. Prolonged work-related neck extension was reported just prior to the onset of symptoms. Cerebral angiography revealed a patent vertebrobasilar tree with an extradural origin of an otherwise normal appearing PICA ipsilaterally. Workup did not show evidence for cardioembolic or atheroembolic source. The presence of an extradural origin of PICA may be considered a predisposing factor for non-traumatic LMS associated with head and neck movement.

Stroke rehabilitation. 3. Rehabilitation management.

This self-directed learning module highlights new advances in the treatment of patients after stroke by means of a case study format. It is part of the chapter on stroke rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses both medical and rehabilitation issues that arise in the care of persons with strokes involving the right and left middle cerebral arteries and the vertebral artery. Cases were chosen to cover problems seen in both older and younger persons. Management of common sequelae that are typical of these stroke syndromes and identification of common co-morbidities are included.

[Swallowing rehabilitation in an elderly patient with Wallenberg's syndrome--role of videofluorography and the swallowing provocation test].

A 65-year-old man was admitted to our department due to severe dysphagia, dysarthria, and aspiration pneumonia. Dysphagia and dysarthria were caused by lateral medullary infarction (Wallenberg' s syndrome). After the patient recovered from pneumonia, the abnormality of swallowing was assessed by a swallowing provocation test and videofluorography. Two months after the start of swallowing training, a swallowing provocation test showed that the swallowing reflex had improved and videofluorography showed that the magnitude of aspiration to the trachea had decreased. The patient began taking food by mouth. These tests are useful for quantitative assessment of dysphagia and for deciding when to start oral intake in elderly patients.