Artery of Percheron infarction: a case report.

BACKGROUND: The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with or without midbrain involvement. Acute artery of Percheron infarcts represent 0.1 to 2% of total ischemic stroke. However, of thalamic strokes, occlusion of artery of Percheron is the cause in 4 to 35% of cases. Early diagnosis of artery of Percheron infarction can be challenging because it is infrequent and early computed tomography or magnetic resonance imaging may be negative. Thus, it can be confused with other neurological conditions such as tumors and infections. CASE PRESENTATION: This is a retrospective case study of a 56-year-old white man admitted to Umeå University Hospital and diagnosed with an artery of Percheron infarction. Medical records and the neuroradiological database were reviewed, and the diagnosis was made based on typical symptoms and radiological findings of artery of Percheron infarction. We report the case of a 56-year-old man with a history of overconsumption of alcohol who was found in his home unconscious and hypothermic. He had a Reaction Level Scale-85 score of 4. He developed ventricular fibrillation on arrival at our emergency department, and cardiopulmonary resuscitation successfully restored sinus rhythm within an estimated 2 minutes of onset. He was then put on cardiopulmonary bypass for rewarming. The initial head computed tomography performed on admission was wrongly assessed as unremarkable. Bilateral ischemia in the paramedian thalamic nuclei and pons were first documented on a follow-up computed tomography on day 24 after hospitalization. He died on day 35 after hospitalization. CONCLUSIONS: Artery of Percheron infarcts are rare. The radiological diagnosis can initially often be judged as normal and in combination with variability in the neurological symptoms it is a rather difficult condition to diagnose. For these reasons few clinicians have much experience with this type of infarct, which may delay diagnosis and initiation of appropriate treatment.

Autologous bone marrow transplantation in patients with subacute and chronic spinal cord injury.

Stem cell transplants into spinal cord lesions may help to improve regeneration and spinal cord function. Clinical studies are necessary for transferring preclinical findings from animal experiments to humans. We investigated the transplantation of unmanipulated autologous bone marrow in patients with transversal spinal cord injury (SCI) with respect to safety, therapeutic time window, implantation strategy, method of administration, and functional improvement. We report data from 20 patients with complete SCI who received transplants 10 to 467 days postinjury. The follow-up examinations were done at 3, 6, and 12 months after implantation by two independent neurologists using standard neurological classification of SCI, including the ASIA protocol, the Frankel score, the recording of motor and somatosensory evoked potentials, and MRI evaluation of lesion size. We compared intra-arterial (via catheterization of a. vertebralis) versus intravenous administration of all mononuclear cells in groups of acute (10-30 days post-SCI, n=7) and chronic patients (2-17 months postinjury, n=13). Improvement in motor and/or sensory functions was observed within 3 months in 5 of 6 patients with intra-arterial application, in 5 of 7 acute, and in 1 of 13 chronic patients. Our case study shows that the implantation of autologous bone marrow cells appears to be safe, as there have been no complications following implantation to date (11 patients followed up for more than 2 years), but longer follow-ups are required to determine that implantation is definitively safe. Also, we cannot yet confirm that the observed beneficial effects were due to the cell therapy. However, the outcomes following transplantation in acute patients, and in one chronic patient who was in stable condition for several months prior to cell implantation, are promising. It is evident that transplantation within a therapeutic window of 3-4 weeks following injury will play an important role in any type of stem cell SCI treatment. Trials involving a larger population of patients and different cell types are needed before further conclusions can be drawn.

Lung function impairment in relation to asbestos-induced pleural lesions with reference to the extent of the lesions and the initial parenchymal fibrosis.

OBJECTIVES: The study focused on the effect of pleural lesions on the lung function of asbestos-exposed workers. METHODS: A clinical check-up, chest radiography, high-resolution computed tomography (HRCT), and lung function testing were performed on 162 asbestos-exposed workers without any sign of parenchymal fibrosis on their chest radiographs. According to the HRCT scans, two subgroups were delineated, 97 subjects with pleural lesions and 65 referents without pleural lesions. Four categories of pleural lesions were specified according to the extent. Parenchymal changes, if identified on the HRCT scans, were recorded. RESULTS: The radiographic sensitivity and specificity for pleural lesion detection when compared with that of HRCT were 64.9% and 98.5%, respectively. The HRCT scans showed parenchymal abnormalities in 46.3% of the participants, more frequently in those with pleural lesions (67.0% versus 15.4%, P<0.0001). After the effect of parenchymal fibrosis was taken into account, pleural lesions were found to have a significant effect on the decrease in total lung capacity, forced vital capacity, and forced expiratory volume in 1 second, if being classified into category 2 or higher. CONCLUSIONS: Pleural lesions proved to have a negative effect on lung function, depending on their extent. The effect of the initial parenchymal fibrosis detectable in the HRCT scans only was also significant. A normal chest radiograph does not exclude the presence of pleural lesions or initial parenchymal fibrosis, with a possible negative effect on lung function.