RESUMEN
Artery of Percheron (AOP) is an uncommon anatomical variation in the posterior circulation neurovasculature. It is a single artery arising from P1 segment of posterior cerebral artery (PCA) which supplies bilateral paramedian thalami and the rostral midbrain and as a result, occlusion of it leads to bilateral thalamic and mesencephalic infarction. Due to very low incidence (ranges from 0.1% to 2% of all ischemic strokes) and varied presentation, the diagnosis of AOP infarction requires strong clinical and radiological suspicion and hence, AOP infarction is often missed and patients are rarely thrombolysed. Here we discuss a patient with acute altered sensorium who recovered completely in short time following treatment with intra-venous thrombolysis for bilateral medial thalamic ischemic stroke due to AOP occlusion.
Asunto(s)
Arteria Cerebral Posterior , Terapia Trombolítica , Humanos , Terapia Trombolítica/métodos , Arteria Cerebral Posterior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Fibrinolíticos/uso terapéutico , Tálamo/irrigación sanguínea , Tálamo/diagnóstico por imagen , Tálamo/patología , Resultado del Tratamiento , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: Available data on the clinical course of patients with acute ischemic stroke due to medium vessel occlusion (MeVO) are mostly limited to those with M2 segment occlusions. Outcomes are generally better compared with more proximal occlusions, but many patients will still suffer from severe morbidity. We aimed to determine the clinical course of acute ischemic stroke due to MeVO with and without intravenous alteplase treatment. METHODS: Patients with MeVO (M2/M3/A2/A3/P2/P3 occlusion) from the INTERRSeCT (The Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) and PRoveIT (Precise and Rapid Assessment of Collaterals Using Multi-Phase CTA in the Triage of Patients With Acute Ischemic Stroke for IA Therapy) studies were included. Baseline characteristics and clinical outcomes were summarized using descriptive statistics. The primary outcome was a modified Rankin Scale score of 0 to 1 at 90 days, describing excellent functional outcome. Secondary outcomes were the common odds ratio for a 1-point shift across the modified Rankin Scale and functional independence, defined as modified Rankin Scale score of 0 to 2. We compared outcomes between patients with versus without intravenous alteplase treatment and between patients who did and did not show recanalization on follow-up computed tomography angiography. Logistic regression was used to provide adjusted effect-size estimates. RESULTS: Among 258 patients with MeVO, the median baseline National Institutes of Health Stroke Scale score was 7 (interquartile range: 5-12). A total of 72.1% (186/258) patients were treated with intravenous alteplase and in 41.8% (84/201), recanalization of the occlusion (revised arterial occlusive lesion score 2b/3) was seen on follow-up computed tomography angiography. Excellent functional outcome was achieved by 50.0% (129/258), and 67.4% (174/258) patients gained functional independence, while 8.9% (23/258) patients died within 90 days. Recanalization was observed in 21.4% (9/42) patients who were not treated with alteplase and 47.2% (75/159) patients treated with alteplase (P=0.003). Early recanalization (adjusted odds ratio, 2.29 [95% CI, 1.23-4.28]) was significantly associated with excellent functional outcome, while intravenous alteplase was not (adjusted odds ratio, 1.70 [95% CI, 0.88-3.25]). CONCLUSIONS: One of every 2 patients with MeVO did not achieve excellent clinical outcome at 90 days with best medical management. Early recanalization was strongly associated with excellent outcome but occurred in <50% of patients despite intravenous alteplase treatment.
Asunto(s)
Fibrinolíticos/uso terapéutico , Infarto de la Arteria Cerebral Anterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Angiografía Cerebral , Circulación Cerebrovascular , Angiografía por Tomografía Computarizada , Progresión de la Enfermedad , Femenino , Humanos , Infarto de la Arteria Cerebral Anterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Anterior/fisiopatología , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/fisiopatología , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/fisiopatología , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/fisiopatología , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Calcitonin gene-related peptide (CGRP) is involved in nociception and neurogenic inflammation in migraine, but also serves as a potent vasodilator acting on intracranial arteries. This latter effect raises concern about the possibility of drugs inhibiting CGRP precipitating cerebral ischemia. We describe a 41-year-old woman with migraine without aura who developed a right thalamic infarction following a first dose of erenumab, a CGRP-receptor blocker. Stroke onset occurred during a typical migraine. Imaging demonsrated right posterior cerebral artery near-occlusion initially with normalization of the vessel at follow-up imaging 2 months later, suggesting vasospasm as a possible mechanism. Extensive evaluation revealed no other specific cause of stroke or vascular risk factors aside from long-term use of oral contraceptive pills. CGRP inhibitors might be associated with ischemic stroke due to blockade of normal cerebral vasodilatory regulatory function.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/efectos adversos , Infarto de la Arteria Cerebral Posterior/inducido químicamente , Migraña sin Aura/tratamiento farmacológico , Arteria Cerebral Posterior/efectos de los fármacos , Vasoespasmo Intracraneal/inducido químicamente , Adulto , Femenino , Humanos , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/fisiopatología , Migraña sin Aura/diagnóstico , Arteria Cerebral Posterior/diagnóstico por imagen , Arteria Cerebral Posterior/fisiopatología , Terapia Trombolítica , Resultado del Tratamiento , Grado de Desobstrucción Vascular/efectos de los fármacos , Vasoespasmo Intracraneal/diagnóstico por imagen , Vasoespasmo Intracraneal/tratamiento farmacológico , Vasoespasmo Intracraneal/fisiopatologíaRESUMEN
OBJECTIVE: We assessed patient clinical outcomes based on occlusion location, focusing on distal occlusions to understand if occlusion location was an independent predictor of outcome, and tested the relationship between occlusion location and baseline ischemic core, a known predictor of modified Rankin Scale (mRS) score at 90 days. METHODS: We analyzed a prospectively collected cohort of thrombolysis-eligible ischemic stroke patients from the International Stroke Perfusion Imaging Registry who underwent multimodal CT pretreatment. For the primary analysis, logistic regression was used to predict the effect of occlusion location and ischemic core on the likelihood of excellent (mRS 0-1) and favorable (mRS 0-2) 90-day outcomes. RESULTS: This study included 945 patients. The rates of excellent and favorable outcome in patients with distal occlusion (M2, M3 segment of middle cerebral artery, anterior cerebral artery, and posterior cerebral artery) were higher than M1 occlusions (mRS 0%-1%, 55% vs 37%; mRS 0%-2%, 73% vs 50%, p < 0.001). Vessel occlusion location was not a strong predictor of outcomes compared to baseline ischemic core (area under the curve, mRS 0-1, 0.64 vs 0.83; mRS 0-2, 0.70 vs 0.86, p < 0.001). There was no interaction between occlusion location and ischemic core (interaction coefficient 1.00, p = 0.798). CONCLUSIONS: Ischemic stroke patients with a distal occlusion have higher rate of excellent and favorable outcome than patients with an M1 occlusion. The baseline ischemic core was shown to be a more powerful predictor of functional outcome than the occlusion location, but the relationship between ischemic core and outcome does not different by occlusion locations.
Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/fisiopatología , Angiografía por Tomografía Computarizada , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Infarto de la Arteria Cerebral Anterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Anterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Anterior/fisiopatología , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Infarto de la Arteria Cerebral Media/fisiopatología , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/fisiopatología , Masculino , Persona de Mediana Edad , Imagen de Perfusión , Pronóstico , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/fisiopatología , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía Computarizada por Rayos XAsunto(s)
Apéndice Atrial , Fibrilación Atrial/terapia , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Infarto de la Arteria Cerebral Posterior/etiología , Tromboembolia/etiología , Trombosis/etiología , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Sustitución de Medicamentos , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Inhibidores del Factor Xa/administración & dosificación , Fibrinolíticos/administración & dosificación , Humanos , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Hemorragias Intracraneales/etiología , Masculino , Inhibidores de Agregación Plaquetaria/administración & dosificación , Tromboembolia/diagnóstico por imagen , Tromboembolia/tratamiento farmacológico , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Percheron infarction, arising from occlusion of the Artery of Percheron, is few, which can result in bilateral thalamic and mesencephalic infarctions. We herein showcase a confirmed case of the Percheron infarction at the admission day, in which the patient advanced into severe multiple posterior circulation infarcts, along with petechial hemorrhage within the infarcts, even given the right therapy without delay. It reminds us that whether we could or should take this special infarction as a forewarning of more harmful infarcts getting in the way, or at least a precaution of poor vessel condition.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central , Infarto de la Arteria Cerebral Posterior , Arteria Cerebral Posterior/anomalías , Anciano , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/fisiopatología , Angiografía Cerebral/métodos , Hemorragia Cerebral/etiología , Circulación Cerebrovascular , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Infarto de la Arteria Cerebral Posterior/complicaciones , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/fisiopatología , Infusiones Intravenosas , Angiografía por Resonancia Magnética , Piperazinas/administración & dosificación , Inhibidores de Agregación Plaquetaria/administración & dosificación , Arteria Cerebral Posterior/diagnóstico por imagen , Arteria Cerebral Posterior/efectos de los fármacos , Arteria Cerebral Posterior/fisiopatología , Tomografía Computarizada por Rayos X , Vasodilatadores/administración & dosificación , Alcaloides de la Vinca/administración & dosificaciónRESUMEN
BACKGROUND: There are limited data comparing posterior (PC) and anterior (AC) circulation acute ischemic strokes (AIS). We aimed to identify specific features of PC and AC strokes regarding clinical, etiological, radiological, and outcome factors. METHODS: Patients from the Acute STroke Registry and Analysis of Lausanne, a prospective cohort of consecutive AIS, from years 2003 to 2008 were included. The stroke territory was determined by a combination of neuroimaging and clinical symptoms. Patients with uncertain localization or with simultaneous AC and PC strokes were excluded. Multivariate associations between territory and multiple variables were investigated. RESULTS: A total of 1449 patients were included, 466 (32.2%) had a PC territory stroke and 983 (67.8%) an AC. On multivariate analysis, those with PC AIS had lower National Institutes of Health Stroke Scale at admission, more often showed decreased consciousness, visual field defects, and vestibulo-cerebellar signs, but less hemisyndromes, dysarthria, and cognitive symptoms compared to AC AIS patients. Male sex, arterial dissection, lacunar mechanisms, and endovascular recanalization were more frequent in PC strokes, whereas cardioembolic strokes and IV-thrombolysis rates were lower. Less early ischemic signs on admission CT, overall arterial pathology, and 24-hour recanalization were present in PC strokes but intracranial arterial pathology was more prevalent than in AC. The adjusted clinical outcome at 3 months was similar in both groups. CONCLUSIONS: In this large retrospective consecutive AIS series, there were specific differences in clinical presentation, etiology, and arterial pathology between PC and AC strokes which did not influence clinical outcome. These findings could lead to a tailored diagnostic work-up, acute treatment strategies, and secondary prevention.
Asunto(s)
Infarto de la Arteria Cerebral Anterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Neuroimagen/métodos , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Humanos , Infarto de la Arteria Cerebral Anterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Anterior/fisiopatología , Infarto de la Arteria Cerebral Anterior/psicología , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/fisiopatología , Infarto de la Arteria Cerebral Posterior/psicología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Suiza , Terapia Trombolítica , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Ceguera Cortical/etiología , Gastrectomía/efectos adversos , Infarto de la Arteria Cerebral Posterior/etiología , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/etiología , Anticoagulantes/uso terapéutico , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética , Gastrectomía/métodos , Humanos , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complicaciones Posoperatorias/diagnóstico por imagen , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
Severe orolingual angioedema is a life-threatening complication of alteplase treatment for acute ischemic stroke that occurs during alteplase infusion or in the first 2 hours afterward. Currently, there are no proven therapies, although glucocorticoids, antihistamines, and adrenaline are sometimes used. Intubation is required if significant airway compromise supervenes. The incidence is .2%-5.1%, and risk factors include treatment with angiotensin-converting enzyme inhibitors and total insular infarcts. Here we report a case of alteplase-induced severe angioedema, which resolved briskly following icatibant treatment.
Asunto(s)
Angioedema/tratamiento farmacológico , Antagonistas del Receptor de Bradiquinina B2/uso terapéutico , Bradiquinina/análogos & derivados , Fibrinolíticos/efectos adversos , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Angioedema/inducido químicamente , Angioedema/diagnóstico , Bradiquinina/uso terapéutico , Humanos , Infarto de la Arteria Cerebral Posterior/diagnóstico , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVES: Patients with posterior circulation infarction (PCI) have more subtle symptoms than anterior circulation infarction (ACI) and could come too late for acute intervention. This study aimed to describe the clinical presentation, management, and outcome of PCI in the NORSTROKE registry. METHODS: All patients with PCI admitted to the Department of Neurology at Haukeland University Hospital and registered in the NORSTROKE database 2006-2013 were included (n=686). Patients with ACI (n=1758) were used for comparison. RESULTS: Patients with PCI were younger (68.2 vs 71.8, P<.001), had longer median time from symptom onset to admission (3.8 hours vs 2.2 hours, P<.001), and were less likely to arrive at hospital within 4.5 hours from symptom onset (56.2% vs 72.5%, P<.001, ictus known). Patients with PCI scored lower on baseline National Institute of Health Stroke Scale (NIHSS) total score (3.2 vs 6.3, P<.001), and lower or equally on all items of NIHSS, except for ataxia in two limbs. Patients with PCI were less likely to receive i.v. thrombolytic treatment (9.9% vs 21.5%, OR 0.66, CI 0.47-0.94). On day 7, patients with PCI scored lower on NIHSS (2.8 vs 4.9, P<.001), modified Rankin Scale (2.0 vs 2.3, P<.001), and higher on Barthel Index (84.5 vs 76.0, P<.001). CONCLUSIONS: Our study is, to our knowledge, the largest series reporting comprehensively on PCI verified by diffusion-weighted imaging. PCI patients are younger than ACI and have better outcome. PCI and ACI are equally investigated in the acute setting, but thrombolysis rates remain 50% lower in PCI.
Asunto(s)
Fibrinolíticos/uso terapéutico , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Terapia Trombolítica/métodos , Anciano , Anciano de 80 o más Años , Imagen de Difusión por Resonancia Magnética/métodos , Femenino , Humanos , Infarto de la Arteria Cerebral Posterior/epidemiología , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Sistema de Registros , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/prevención & control , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Trastornos Neurológicos de la Marcha/etiología , Infarto de la Arteria Cerebral Posterior/diagnóstico , Trombosis Intracraneal/diagnóstico , Disección de la Arteria Vertebral/diagnóstico , Vómitos/etiología , Anticoagulantes/uso terapéutico , Preescolar , Diagnóstico Diferencial , Humanos , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Trombosis Intracraneal/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Disección de la Arteria Vertebral/complicaciones , Disección de la Arteria Vertebral/tratamiento farmacológicoRESUMEN
BACKGROUND AND PURPOSE: Growing number of vertebral artery dissection has been detected due to higher awareness and improved imaging techniques, even after seemingly minor head turning in young- or middle-aged adults without predisposing risk factors for cerebrovascular disease. Treatment options for this condition at this time are limited and there is a troubling shortage of controlled studies. SUMMARY OF CASE: Our patient suffered a bilateral vertebral artery dissection complicated by posterior circulation stroke. We decided to treat acute stroke with intravenous thrombolytic therapy. Patient's condition worsened despite the treatment so emergency angiography was performed to assess the arterial patency. Additional dose of recombinant tissue plasminogen activator together with mechanical thrombectomy was administered using intraarterial route. The patient recovered well and at 12-month follow-up visit he had only right marginal incomplete hemianopia. CONCLUSIONS: Vertebral artery dissection should be taken into consideration in differential diagnosis of posterior circulation stroke or TIA in young patients with a history of even as subtle precipitating events as forceful head movements. Combined thrombolytic therapy may provide safe and effective treatment of stroke-complicated cases. This case report shows that expanded diagnostic protocol for acute ischemic stroke, including computed tomography perfusion study and angiography of cervical and cranial vessels, assures rapid and correct diagnosis.
Asunto(s)
Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/cirugía , Trombectomía , Activador de Tejido Plasminógeno/uso terapéutico , Disección de la Arteria Vertebral/tratamiento farmacológico , Disección de la Arteria Vertebral/cirugía , Adulto , Terapia Combinada , Fibrinolíticos/uso terapéutico , Humanos , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Masculino , Radiografía , Terapia Trombolítica/métodos , Resultado del Tratamiento , Disección de la Arteria Vertebral/diagnóstico por imagenRESUMEN
The patients with ST-elevation myocardial infarction are primarily managed with percutaneous coronary intervention (PCI) or thrombolysis. It is well accepted that rescue PCI should be implemented in case of unsuccessful thrombolysis. However, the reverse, rescue thrombolysis, that is, administering of thrombolytic therapy in a patient in whom primary PCI fails, is not well defined. There are no available data about rescue thrombolysis so far. We represent a 43-year-old male patient with Buerger disease (thromboangiitis obliterans) who was admitted to our emergency department for cardiac shock related to inferior and right ventricular ST-elevation myocardial infarction. He was found to have occlusion of both right coronary artery and left anterior descending artery and managed with rescue thrombolysis. It was subsequently recognized that he had concurrent stroke caused by posterior cerebral artery (PCA) occlusion and improved with thrombolysis. It is reported for the first time that rescue thrombolysis has been put into practice and yielded great result after unsuccessful primary PCI.
Asunto(s)
Fibrinolíticos/uso terapéutico , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Terapia Recuperativa , Choque Cardiogénico/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Adulto , Humanos , Infarto de la Arteria Cerebral Posterior/complicaciones , Infarto de la Arteria Cerebral Posterior/diagnóstico , Infarto de la Arteria Cerebral Posterior/cirugía , Masculino , Intervención Coronaria Percutánea , Choque Cardiogénico/complicaciones , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/cirugíaRESUMEN
BACKGROUND: Approximately 5-10% of all acute ischemic strokes (AIS) occur in the territory of the posterior cerebral artery (PCA). Little is known about intravenous thrombolysis (IVT) in this infarct subgroup in terms of outcome and intracerebral hemorrhage rates. The aim of our study was to evaluate differences between supratentorial PCA infarcts and anterior circulation infarcts regarding baseline characteristics, stroke severity, outcome, safety and clinical findings, which would implicate a change in the existing thrombolysis practice in patients with PCA stroke. METHODS: All patients with AIS in the supratentorial PCA territory receiving IVT between 01/2006 and 01/2010 were selected from the Erlangen Thrombolysis Database (group 1, n = 21). They were compared to all IVT patients with strokes in other supratentorial vascular territories over the same period of time (group 2, n = 398). Baseline demographic data, as well as clinical and laboratory findings were analyzed. The outcome was assessed using the modified Rankin Scale at 3 months. RESULTS: Only serum glucose levels at baseline (110.5 ± 36.1 vs. 127.2 ± 48.2 mg/dl; p = 0.036) and the baseline National Institutes of Health Stroke Scale score (median 6.5 vs. 9; p = 0.016) were significantly lower in group 1 compared to group 2. Favorable clinical outcome (57.1 vs. 48.6%; p = 0.445) and intracerebral hemorrhage rates (4.8 vs. 4%; p = 1.000) were comparable in both groups. CONCLUSIONS: No substantial differences were found between supratentorial PCA and anterior circulation infarcts. Our data on safety and efficacy support the present common thrombolysis practice in supratentorial PCA infarct patients, though an indication for IVT should rather be based on the existence of functionally disabling deficit than merely on the National Institutes of Health Stroke Scale.
Asunto(s)
Fibrinolíticos/administración & dosificación , Fibrinolíticos/uso terapéutico , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Terapia Trombolítica/métodos , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/complicaciones , Femenino , Fibrinolíticos/efectos adversos , Hemodinámica/fisiología , Humanos , Procesamiento de Imagen Asistido por Computador , Infarto de la Arteria Cerebral Posterior/mortalidad , Inyecciones Intravenosas , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Seguridad , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiología , Terapia Trombolítica/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PCA stroke was under-represented in or excluded from the clinical trials examining thrombolysis based on the PWI-DWI mismatch concept. We present 6 patients with PCA stroke treated with thrombolysis in an extended time window by using MR imaging criteria. Symptoms included aphasia, sensorimotor hemiparesis, hemineglect, and homonymous hemianopia. Initial MR imaging demonstrated circumscribed ischemic lesions in the thalamus or hippocampus; MR angiography showed PCA occlusion with corresponding hypoperfusion. Follow-up MR imaging showed partial/complete recanalization in 4 patients with minor infarction growth, while in 1 patient, PCA occlusion persisted, resulting in a large PCA infarction. Three patients improved within 2 hours; at discharge, homonymous hemianopia had resolved in 3 patients. At 3-month follow-up, 4 patients had an mRS score of 0 or 1. These results support the approach to treat patients with PCA stroke with thrombolysis based on the mismatch concept. Because rehabilitation options for hemianopia are limited, thrombolysis may enhance the chance of a favorable outcome.
Asunto(s)
Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/patología , Imagen por Resonancia Magnética , Terapia Trombolítica/métodos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Sistema de Registros , Resultado del TratamientoAsunto(s)
Infarto de la Arteria Cerebral Posterior/diagnóstico , Arteria Cerebral Posterior/anomalías , Tálamo/irrigación sanguínea , Adulto , Anticoagulantes/uso terapéutico , Diagnóstico Diferencial , Humanos , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Ataxia/patología , Infartos del Tronco Encefálico/patología , Circulación Cerebrovascular/fisiología , Infarto de la Arteria Cerebral Posterior/patología , Angiografía por Resonancia Magnética/métodos , Paresia/patología , Anciano , Ataxia/complicaciones , Ataxia/fisiopatología , Infartos del Tronco Encefálico/tratamiento farmacológico , Infartos del Tronco Encefálico/fisiopatología , Medios de Contraste , Fibrinolíticos/uso terapéutico , Humanos , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/fisiopatología , Masculino , Paresia/complicaciones , Paresia/fisiopatología , Arteria Cerebral Posterior/patología , Arteria Cerebral Posterior/fisiopatología , Tegmento Mesencefálico/irrigación sanguínea , Tegmento Mesencefálico/patología , Tegmento Mesencefálico/fisiopatología , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento , Núcleos Talámicos Ventrales/irrigación sanguínea , Núcleos Talámicos Ventrales/patología , Núcleos Talámicos Ventrales/fisiopatologíaRESUMEN
We report the case of a 70-year-old man who presented with short-term memory impairment and a homonymous left inferior quadrantanopia secondary to simultaneous bilateral posterior cerebral artery (PCA) territory infarction. As in more than a quarter of cases of PCA infarction, no aetiological cause was identified. Unlike the transient nature of symptoms in some cases following unilateral infarction, his deficits persisted on 2-month follow-up.
Asunto(s)
Hemianopsia/etiología , Infarto de la Arteria Cerebral Posterior/diagnóstico , Trastornos de la Memoria/etiología , Memoria a Corto Plazo , Anciano , Anticolesterolemiantes/uso terapéutico , Antihipertensivos/uso terapéutico , Aspirina/uso terapéutico , Atorvastatina , Confusión/tratamiento farmacológico , Confusión/etiología , Dominancia Cerebral/fisiología , Quimioterapia Combinada , Fibrinolíticos/uso terapéutico , Ácidos Heptanoicos/uso terapéutico , Humanos , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Trastornos de la Memoria/tratamiento farmacológico , Perindopril/uso terapéutico , Pirroles/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
Authors report a case of young female suffering from the acute ischaemic stroke with right-sided hemiplegia, hemianopsia and hemihypoaesthesia during a migrainous attack without aura. Magnetic resonance imaging detected infarction in the left occipital lobe and occlusion of branches of the posterior cerebral artery (PCA). Combined treatment with systemic thrombolysis and sonothrombolysis was used, leading to the early PCA recanalization, and to a favourable clinical outcome after 1 month. Intravenous thrombolytic treatment administered within the therapeutic window may be useful in cerebral ischaemia associated with migraine when an arterial occlusion is documented.