RESUMEN
BACKGROUND: We describe for the first time the clinical features and mechanisms of a bilateral dorsomedial pons and left thalamus infarction with seesaw nystagmus and internuclear ophthalmoplegia. CASE PRESENTATION: A 62-year-old Chinese man was hospitalized for sudden-onset dizziness, diplopia, and gait disturbance. A neurological examination revealed seesaw nystagmus and internuclear ophthalmoplegia. Magnetic resonance imaging disclosed an acute infarction confined to the bilateral dorsomedial pons and left thalamus. Subsequently, 2 weeks of antithrombotic therapy led to an improvement in his symptoms. CONCLUSIONS: This case illustrates that the acute onset of seesaw nystagmus and internuclear ophthalmoplegia accompanied by risk factors for cerebrovascular diseases are highly suggestive of brainstem infarction.
Asunto(s)
Infartos del Tronco Encefálico/complicaciones , Infarto Cerebral/complicaciones , Nistagmo Patológico/etiología , Trastornos de la Motilidad Ocular/etiología , Puente , Tálamo , Infartos del Tronco Encefálico/diagnóstico , Infartos del Tronco Encefálico/diagnóstico por imagen , Infarto Cerebral/diagnóstico , Infarto Cerebral/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/patología , Trastornos de la Motilidad Ocular/diagnóstico , Trastornos de la Motilidad Ocular/patología , Puente/irrigación sanguínea , Puente/diagnóstico por imagen , Tálamo/irrigación sanguínea , Tálamo/diagnóstico por imagenRESUMEN
Dynamic exercise elicits fluctuations in blood pressure (BP) and cerebral blood flow (CBF). This study investigated responses in BP and CBF during cycling exercise and post-exercise hypotension (PEH) using positron emission tomography (PET). CBF was measured using oxygen-15-labeled water (H215O) and PET in 11 human subjects at rest (Rest), at the onset of exercise (Ex1), later in the exercise (Ex2), and during PEH. Global CBF significantly increased by 13% at Ex1 compared with Rest, but was unchanged at Ex2 and during PEH. Compared with at Rest, regional CBF (rCBF) increased at Ex1 (20~42%) in the cerebellar vermis, sensorimotor cortex for the bilateral legs (M1Leg and S1Leg), insular cortex and brain stem, but increased at Ex2 (28~31%) only in the vermis and M1Leg and S1Leg. During PEH, rCBF decreased compared with Rest (8~13%) in the cerebellum, temporal gyrus, piriform lobe, thalamus and pons. The areas showing correlations between rCBF and mean BP during exercise and PEH were consistent with the central autonomic network, including the brain stem, cerebellum, and hypothalamus (R2=0.25-0.64). The present study suggests that higher brain regions are coordinated through reflex centers in the brain stem in order to regulate the cardiovascular response to exercise.
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Presión Sanguínea/fisiología , Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Ejercicio Físico/fisiología , Tomografía de Emisión de Positrones/métodos , Encéfalo/irrigación sanguínea , Mapeo Encefálico , Tronco Encefálico/irrigación sanguínea , Tronco Encefálico/diagnóstico por imagen , Vermis Cerebeloso/irrigación sanguínea , Vermis Cerebeloso/diagnóstico por imagen , Corteza Cerebral/irrigación sanguínea , Corteza Cerebral/diagnóstico por imagen , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Radioisótopos de Oxígeno , Puente/irrigación sanguínea , Puente/diagnóstico por imagen , Corteza Sensoriomotora/irrigación sanguínea , Corteza Sensoriomotora/diagnóstico por imagen , Lóbulo Temporal/irrigación sanguínea , Lóbulo Temporal/diagnóstico por imagen , Tálamo/irrigación sanguínea , Tálamo/diagnóstico por imagen , Adulto JovenRESUMEN
BACKGROUND: Primary brainstem hemorrhage (BSH) has the highest mortality and morbidity as a subtype of intracerebral hemorrhage. A major limitation of BSH research is the lack of a corresponding animal model. The purpose of this study was to establish a novel rat model of BSH and to characterize the resulting brain injury, especially focusing on white matter injury. METHODS: BSH was produced by stereotactically injecting autologous whole blood into the pons. Time course of hematoma resolution was observed by 7-T magnetic resonance imaging. White matter injury was evaluated in detail by multiple parameters including diffuse tensor imaging (DTI), demyelination, axonal injury, oligodendrocyte degeneration, and oligodendrocyte precursor cell proliferation. Brain water content and neurobehavior were also evaluated. RESULTS: Blood infusion (30 µL) led to a stable, reproducible hematoma in the right basotegmental pons. The hematoma absorption started, became obvious, and was nearly completed at 7, 14, and 30 days, respectively. Hematoma caused obvious brain edema at 3 days. White mater injury was observed pathologically, which was in line with decreased fractional anisotropy (FA) in DTI in the pons. FA reduction was also noticed in the cerebral peduncle and medulla. Behavioral abnormality persisted for at least 14 days and neurofunction was recovered within 1 month. CONCLUSIONS: This novel model can produce a stable hematoma resulting in brain edema, white matter injury, and neurofunctional deficits, which could be useful for future investigation of pathophysiological mechanisms and new treatment evaluation after BSH.
Asunto(s)
Conducta Animal , Transfusión de Sangre Autóloga , Edema Encefálico/etiología , Hematoma/etiología , Hemorragias Intracraneales/etiología , Leucoencefalopatías/etiología , Imagen por Resonancia Magnética , Puente/irrigación sanguínea , Sustancia Blanca/patología , Animales , Edema Encefálico/patología , Edema Encefálico/fisiopatología , Edema Encefálico/psicología , Imagen de Difusión Tensora , Modelos Animales de Enfermedad , Hematoma/patología , Hematoma/fisiopatología , Hematoma/psicología , Hemorragias Intracraneales/patología , Hemorragias Intracraneales/fisiopatología , Hemorragias Intracraneales/psicología , Leucoencefalopatías/patología , Leucoencefalopatías/fisiopatología , Leucoencefalopatías/psicología , Masculino , Puente/patología , Puente/fisiopatología , Ratas Sprague-Dawley , Factores de Tiempo , Sustancia Blanca/fisiopatologíaRESUMEN
BACKGROUND AND PURPOSE: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) is a 10-point grading system to quantify ischemic changes in the posterior circulation. We analyzed whether pc-ASPECTS on CT angiography (CTA) source images (CTASI) predicted the final infarct extent and hemorrhagic transformation (HT) rate in patients with basilar artery occlusion. MATERIALS AND METHODS: A pc-ASPECTS score of 10 indicates absence of visible ischemic changes in the posterior circulation, and pc-ASPECTS score of 0 indicates ischemic changes in the midbrain, pons, and bilateral thalami, posterior circulation territories, and cerebellar hemispheres. We retrospectively studied patients with basilar artery occlusion on CTA within 24 hours from symptom onset. We applied pc-ASPECTS to noncontrast CT (NCCT), CTASI, and follow-up images by 3-reader-consensus and assessed HT on follow-up images. We calculated Spearman correlation coefficients and performed linear regression analysis. Final infarct extent and HT rates were compared across dichotomized CTASI pc-ASPECTS groups (>/= 8 vs < 8). RESULTS: Among 43 patients, median (range) onset to CTA time was 5.0 hours (range, 0.7-24 hours). Pc-ASPECTS on CTASI (r = 0.75; P < .001) but not NCCT (r = 0.29; P = .063) correlated with pc-ASPECTS on follow-up scans. Linear regression demonstrated a significant positive relationship between pc-ASPECTS on CTASI and follow-up scans (R(2) = 0.58; P < 01). Median follow-up pc-ASPECTS was lower in patients with a CTASI pc-ASPECTS < 8 compared with patients with a CTASI pc-ASPECTS of 8 or more, respectively (P < .001). HT rates were 27.3% vs 9.5%, respectively (P = .24). None of 8 patients without thrombolysis had HT on follow-up scans. CONCLUSIONS: The extent of hypoattenuation on CTASI predicts the final infarct extent in patients with basilar artery occlusion.
Asunto(s)
Angiografía Cerebral/métodos , Infarto Cerebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Infarto Cerebral/terapia , Embolización Terapéutica , Femenino , Humanos , Masculino , Mesencéfalo/irrigación sanguínea , Mesencéfalo/patología , Persona de Mediana Edad , Puente/irrigación sanguínea , Puente/patología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Tálamo/irrigación sanguínea , Tálamo/patología , Insuficiencia Vertebrobasilar/terapiaRESUMEN
BACKGROUND AND PURPOSE: Sildenafil citrate has been shown to enhance neurogenesis, angiogenesis, synaptogenesis, and neurological outcome by augmentation of cyclic guanosine monophosphate (cGMP) levels in animal models of ischemic stroke. Whether sildenafil citrate may be helpful for recovery in human stroke is unknown at this time. METHODS: A 41-year-old woman with locked-in syndrome due to pontine infarction began receiving 150 mg of oral sildenafil citrate daily on a compassionate use basis in August 2003 and continues treatment at this time. Magneto-encephalography (MEG) was performed at 12 and 17 months after stroke. RESULTS: No serious adverse events have occurred. Significant milestone recoveries including standing, use of both arms, talking, and full return of swallowing have occurred, particularly after nine months of treatment. The MEG showed a significantly increased amplitude in the somatosensory cortex. CONCLUSION: Daily use of high dose sildenafil citrate appears to be safe in this patient with stroke resulting in locked-in syndrome. Further studies will be required to establish safety and efficacy.
Asunto(s)
Infartos del Tronco Encefálico/tratamiento farmacológico , Piperazinas/administración & dosificación , Puente/patología , Cuadriplejía/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Insuficiencia Vertebrobasilar/tratamiento farmacológico , Adulto , Arteria Basilar/patología , Arteria Basilar/fisiopatología , Infartos del Tronco Encefálico/etiología , Infartos del Tronco Encefálico/fisiopatología , Angiografía Cerebral , GMP Cíclico/metabolismo , Relación Dosis-Respuesta a Droga , Potenciales Evocados Somatosensoriales/efectos de los fármacos , Potenciales Evocados Somatosensoriales/fisiología , Femenino , Humanos , Magnetoencefalografía , Manipulación Quiropráctica/efectos adversos , Neovascularización Fisiológica/efectos de los fármacos , Neovascularización Fisiológica/fisiología , Regeneración Nerviosa/efectos de los fármacos , Regeneración Nerviosa/fisiología , Plasticidad Neuronal/efectos de los fármacos , Plasticidad Neuronal/fisiología , Inhibidores de Fosfodiesterasa/administración & dosificación , Puente/irrigación sanguínea , Puente/fisiopatología , Purinas , Cuadriplejía/etiología , Cuadriplejía/fisiopatología , Recuperación de la Función/efectos de los fármacos , Recuperación de la Función/fisiología , Citrato de Sildenafil , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Sulfonas , Resultado del Tratamiento , Disección de la Arteria Vertebral/etiología , Disección de la Arteria Vertebral/fisiopatología , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/fisiopatologíaAsunto(s)
Infartos del Tronco Encefálico/inducido químicamente , Arterias Cerebrales/efectos de los fármacos , Fenilpropanolamina/efectos adversos , Preparaciones de Plantas/efectos adversos , Puente/patología , Accidente Cerebrovascular/inducido químicamente , Adulto , Bebidas/efectos adversos , Infartos del Tronco Encefálico/diagnóstico , Infartos del Tronco Encefálico/fisiopatología , Causalidad , Angiografía Cerebral , Arterias Cerebrales/patología , Arterias Cerebrales/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Arteria Cerebral Media/efectos de los fármacos , Arteria Cerebral Media/patología , Arteria Cerebral Media/fisiopatología , Puente/irrigación sanguínea , Arteria Cerebral Posterior/efectos de los fármacos , Arteria Cerebral Posterior/patología , Arteria Cerebral Posterior/fisiopatología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Hemorragia Subaracnoidea/inducido químicamente , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/fisiopatología , Simpatomiméticos/efectos adversosAsunto(s)
Síntomas Afectivos/etiología , Disección Aórtica/complicaciones , Arteria Basilar/patología , Infartos del Tronco Encefálico/complicaciones , Aneurisma Intracraneal/complicaciones , Risa , Puente/patología , Puente/fisiopatología , Adulto , Síntomas Afectivos/patología , Síntomas Afectivos/fisiopatología , Amígdala del Cerebelo/fisiología , Disección Aórtica/patología , Disección Aórtica/fisiopatología , Aneurisma Falso/complicaciones , Aneurisma Falso/patología , Aneurisma Falso/fisiopatología , Antiinflamatorios/uso terapéutico , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Arteria Basilar/fisiopatología , Infartos del Tronco Encefálico/patología , Infartos del Tronco Encefálico/fisiopatología , Deglución/fisiología , Humanos , Aneurisma Intracraneal/patología , Aneurisma Intracraneal/fisiopatología , Risa/fisiología , Imagen por Resonancia Magnética , Masculino , Puente/irrigación sanguínea , Tractos Piramidales/lesiones , Tractos Piramidales/fisiopatología , Centro Respiratorio/fisiopatología , Resultado del Tratamiento , Nervio Vago/fisiopatologíaRESUMEN
We report neurological information and experimental data regarding acquired neurogenic stuttering in a 57-year-old male following ischemic lesion to the orbital surface of the right frontal lobe and the pons. The experimental data consist of stuttering frequency measures under various conditions that are well known to enhance fluency in most individuals with developmental stuttering. Specifically, we report data for adaptation, unison reading, delayed auditory feedback (DAF), and frequency altered feedback (FAF). This work is the first published report of such a comprehensive examination of a variety of fluency-enhancing conditions in acquired stuttering. The patient read six 200-word texts under different conditions: Six solo readings (Text 1), five unison readings followed by five solo readings (Text 2), five readings with non-altered auditory feedback (Text 3), five readings with 50 ms delayed auditory feedback (Text 4), five readings with increased FAF (Text 5), and five readings with decreased FAF (Text 6). Results indicate that, unlike the typical situation for developmental stuttering, this individual with acquired neurogenic stuttering did not show increased fluency during an adaptation paradigm or under unison, DAF, and FAF conditions. We discuss possible implications of these findings and emphasize the need for further research on acquired neurogenic stuttering.
Asunto(s)
Isquemia Encefálica/complicaciones , Isquemia Encefálica/fisiopatología , Lóbulo Frontal/fisiología , Lateralidad Funcional/fisiología , Puente/irrigación sanguínea , Puente/fisiopatología , Tartamudeo/etiología , Estimulación Acústica/métodos , Isquemia Encefálica/diagnóstico , Retroalimentación , Humanos , Masculino , Persona de Mediana Edad , Puente/diagnóstico por imagen , Lectura , Índice de Severidad de la Enfermedad , Tartamudeo/diagnóstico , Tartamudeo/terapia , Tomografía Computarizada por Rayos XRESUMEN
The present research studied the mechanisms underlying the increase in brain temperature during REM sleep in the unrestrained rabbit carrying chronically implanted electrodes, thermistors and common carotid artery occluders. During the ultradian wake-sleep cycle at constant ambient temperature (25+/-2 degrees C), we recorded: (i) the ear pinna temperature as an indirect indicator of blood flow affecting heat loss from the systemic heat exchangers of the head, (ii) the temperature of the pons and hypothalamus as indirect indicators of the temperature of vertebral artery blood (systemic cooling only) and carotid artery blood (both systemic and selective cooling), respectively, and (iii) the changes induced in these temperatures by short-lasting bilateral common carotid artery occlusion. The results show that during REM sleep both systemic and selective brain cooling are depressed by a spontaneous decrease in the common carotid artery blood flow and the associated autoregulatory increase in the vertebral artery share of the cerebral blood supply.
Asunto(s)
Temperatura Corporal/fisiología , Encéfalo/fisiología , Hemodinámica/fisiología , Sueño REM/fisiología , Ciclos de Actividad/fisiología , Animales , Encéfalo/irrigación sanguínea , Arterias Carótidas/fisiología , Circulación Cerebrovascular/fisiología , Electrodos Implantados , Electroencefalografía , Electromiografía , Hipotálamo/irrigación sanguínea , Hipotálamo/fisiología , Ataque Isquémico Transitorio/fisiopatología , Puente/irrigación sanguínea , Puente/fisiología , ConejosRESUMEN
MRI including diffusion-weighted sequences (DW-MRI) has demonstrated its high sensitivity for acute supratentorial ischemic lesions. In this study we examined the sensitivity of different MRI sequences for the detection of acute brainstem and isolated thalamic infarctions. Diffusion- and T2-weighted MRI of 45 consecutive patients with signs and symptoms of infratentorial and thalamic infarction between 6/1997 and 1/2000 were analysed. The time between the onset of symptoms and the first MRI varied between 2 hours to 7 days with a median of 2 days. MRI repeats were performed in 4 patients in whom the clinical brainstem infarction had not been detected initially. Lesion detectability and size were evaluated for different brainstem and thalamic localizations. An acute brainstem or thalamic infarction as defined by the clinical condition could be identified in all patients by comparison of DW-MRI and T2-weighted images. Pons in farctions were the largest, followed by midbrain and thalamic lesions. Medulla oblongata infarctions were small in comparison. Pons, mid-brain and thalamic infarctions were reliably identified beginning 12 hours after the onset of symptoms. In contrast, detectability of medulla oblongata infarctions varied within the first 24 hours and their overall visibility was worse than that of other brainstem infarctions corresponding to their small size. However, regardless of loca tion, none of the 3 infarctions examined within the first 5 hours after the onset of symptoms could be identified. These lesions were demonstrated in follow-up examinations. In conclusion, pontine, midbrain and thalamic infarctions can reliably be visualized by a combination of DW-MRI and T2-weighted images beginning 12 hours after the ischemic attack. However, sensitivity seems to be lower earlier than 12 hours after ischemia and for medulla oblongata lesions.
Asunto(s)
Isquemia Encefálica/patología , Infartos del Tronco Encefálico/patología , Imagen por Resonancia Magnética/métodos , Enfermedades Talámicas/patología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/fisiopatología , Infartos del Tronco Encefálico/fisiopatología , Femenino , Humanos , Masculino , Bulbo Raquídeo/irrigación sanguínea , Bulbo Raquídeo/patología , Bulbo Raquídeo/fisiopatología , Mesencéfalo/irrigación sanguínea , Mesencéfalo/patología , Mesencéfalo/fisiopatología , Persona de Mediana Edad , Puente/irrigación sanguínea , Puente/patología , Puente/fisiopatología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Estadística como Asunto , Enfermedades Talámicas/fisiopatología , Tálamo/irrigación sanguínea , Tálamo/patología , Tálamo/fisiopatologíaRESUMEN
"Fou rire prodromique" (prodrome of crazy laughter) is a rare form of pathological laughter of uncertain pathophysiology. A patient is presented with pathological laughter as the first manifestation of pontine ischaemia due to vertebrobasilar stenosis. A 65 year old man developed uncontrollable and unemotional laughter for almost an hour followed by transient right facial-brachial paresis. He had fluctuation of laughter, right facial brachial paresis, and occasional crying. Magnetic resonance imaging, magnetic resonance angiogram (MRA), and an angiogram showed small left pontine and cerebellar infarcts, left vertebral artery occlusion, and right vertebral and basilar artery stenosis. His condition deteriorated to bilateral brain stem infarction and he died. Necropsy confirmed the extensive brain stem infarction. Pathological laughter can be the very first presenting manifestation of ischaemia of the ventrotegmental junction of the upper pons. It is hypothesised that the pathological laughter in this patient was secondary to ischaemic ephaptic stimulation of the descending corticopontine/ bulbar pathways.
Asunto(s)
Isquemia/complicaciones , Risa , Trastornos Mentales/etiología , Puente/irrigación sanguínea , Insuficiencia Vertebrobasilar/complicaciones , Anciano , Angioplastia , Anticoagulantes/uso terapéutico , Autopsia , Angiografía Cerebral , Parálisis Facial/etiología , Resultado Fatal , Heparina/uso terapéutico , Humanos , Isquemia/diagnóstico , Isquemia/terapia , Imagen por Resonancia Magnética , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/fisiopatología , Paresia/etiología , Tomografía Computarizada por Rayos X , Insuficiencia del Tratamiento , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar/terapiaRESUMEN
The blood-brain barrier (BBB), composed of the microvessels of cerebral capillary endothelial cells, regulates the passage of peptides into the brain in several ways, mainly by saturable transport or passive diffusion. Here we describe an additional mechanism by which this regulatory function can occur. Cerebral microvessels were isolated from different regions of the brain and incubated with the mu-opiate selective endomorphin-1 (Tyr-Pro-Trp-Phe-NH2) or the opiate-modulating Tyr-MIF-1 (Tyr-Pro-Leu-Gly-NH2), both tetrapeptides selectively tritiated at the Pro. Degradation was determined by HPLC. For both peptides, the metabolism by microvessels from the cerebral cortex was much greater than that by microvessels from the hypothalamus or pons. For endomorphin-1, the least degradation was in the pons; for Tyr-MIF-1 there was no difference in metabolism by microvessels from the pons or hypothalamus. The results show a novel mechanism at the BBB by which the BBB can selectively regulate the activity of different peptides in different regions of the brain.
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Barrera Hematoencefálica/fisiología , Corteza Cerebral/metabolismo , Hormona Inhibidora de la Liberación de MSH/metabolismo , Oligopéptidos/metabolismo , Animales , Capilares/metabolismo , Corteza Cerebral/irrigación sanguínea , Cromatografía Líquida de Alta Presión , Endotelio Vascular/metabolismo , Hipotálamo/irrigación sanguínea , Hipotálamo/metabolismo , Hormona Inhibidora de la Liberación de MSH/análogos & derivados , Masculino , Puente/irrigación sanguínea , Puente/metabolismo , Ratas , Ratas Sprague-DawleyRESUMEN
This is a case report of a 41-year old man who had ischaemic lesion in the pons following chiropractic manipulation. He had brainstem syndrome with right hemiparesis. He improved. After 4 a year follow-up he is in a very good condition.
Asunto(s)
Quiropráctica/efectos adversos , Ataque Isquémico Transitorio/etiología , Puente/irrigación sanguínea , Humanos , Masculino , Paresia/etiologíaAsunto(s)
Potenciales Relacionados con Evento P300/fisiología , Locus Coeruleus/fisiopatología , Puente/fisiopatología , Estimulación Acústica , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/fisiopatología , Electroencefalografía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estimulación Luminosa , Puente/irrigación sanguínea , Tiempo de Reacción/fisiologíaRESUMEN
OBJECT: In this study the authors review surgical experience with cavernous malformations of the brainstem (CMBs) in an attempt to define more clearly the natural history, indications, and risks of surgical management of these lesions. METHODS: The authors retrospectively reviewed the cases of 100 patients (38 males and 62 females; mean age 37 years) harboring 103 lesions at treated a single institution between 1984 and 1997. Clinical histories, radiographs, pathology records, and operative reports were evaluated. The brainstem lesions were distributed as follows: pons in 39 patients, medulla in 16, midbrain in 16, pontomesencephalic junction in 15, pontomedullary junction in 10, midbrain-hypothalamus/thalamus region in two patients, and more than two brainstem levels in five. The retrospective annual hemorrhage rate was most conservatively estimated at 5% per lesion per year. Standard skull base approaches were used to resect lesions in 86 of the 100 patients. Intraoperatively, all 86 patients were found to have a venous anomaly in association with the CMB. Follow up was available in 98% (84 of 86) of the surgical patients. Of these, 73 (87%) were the same or better after surgical intervention, eight (10%) were worse, and three (4%) died. Two surgical patients were lost to follow-up review. Incidences of permanent or severe morbidity occurred in 10 (12%) of the surgically treated patients. The average postoperative Glasgow Outcome Scale score for surgically treated patients was 4.5, with a mean follow-up period of 35 months. CONCLUSIONS: The natural history of CMBs is worse than that of cavernous malformations in other locations. These CMBs can be resected using skull base approaches, which should be considered in patients with symptomatic hemorrhage who harbor lesions that approach the pial surface. Venous anomalies are always associated with CMBs and must be preserved.
Asunto(s)
Tronco Encefálico/irrigación sanguínea , Malformaciones Arteriovenosas Intracraneales/cirugía , Adolescente , Adulto , Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/patología , Seno Cavernoso , Hemorragia Cerebral/fisiopatología , Venas Cerebrales/anomalías , Niño , Preescolar , Femenino , Estudios de Seguimiento , Escala de Coma de Glasgow , Humanos , Hipotálamo/irrigación sanguínea , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/patología , Malformaciones Arteriovenosas Intracraneales/fisiopatología , Masculino , Bulbo Raquídeo/irrigación sanguínea , Mesencéfalo/irrigación sanguínea , Persona de Mediana Edad , Puente/irrigación sanguínea , Radiografía , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Tálamo/irrigación sanguíneaRESUMEN
BACKGROUND AND PURPOSE: Apolipoprotein E (apoE) has been found relevant in a variety of central nervous system disorders. This experiment examined the effect of endogenous murine apoE on selective neuronal necrosis resulting from a transient forebrain ischemia insult. METHODS: ApoE deficient (n=16) and wild type (n=17) halothane-anesthetized mice were subjected to severe forebrain ischemia (10 minutes of bilateral carotid occlusion and systemic hypotension). After 3 days' recovery, brain injury was determined histologically. In other apoE-deficient and wild-type mice, regional cerebral blood flow (CBF) was determined by 14C-iodoantipyrine autoradiography 10 minutes before, 5 minutes after onset of, and 30 minutes after reperfusion from 10 minutes of forebrain ischemia. RESULTS: The percentage of dead hippocampal CA1 neurons (mean+/-SD) was greater in the apoE-deficient group (apoE deficient=67+/-30%; wild type=37+/-33%; P=0.011). A similar pattern was observed in the caudoputamen (P=0.002) and neocortex (P=0.014). Cerebral blood flow was similar between groups at each measurement interval. Marked hypoperfusion persisted in both groups at 30 minutes after ischemia. CONCLUSIONS: ApoE deficiency worsens ischemic outcome. This is not attributable to effects on CBF. A role of apoE in the cerebral response to global ischemia is consistent with prior reports that murine apoE deficiency increases infarct size resulting from focal cerebral ischemia.
Asunto(s)
Apolipoproteínas E/genética , Arteriopatías Oclusivas/metabolismo , Isquemia Encefálica/metabolismo , Circulación Cerebrovascular/fisiología , Animales , Apolipoproteínas E/deficiencia , Análisis de los Gases de la Sangre , Presión Sanguínea , Cerebelo/irrigación sanguínea , Corteza Cerebral/irrigación sanguínea , Modelos Animales de Enfermedad , Femenino , Hipocampo/irrigación sanguínea , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Neostriado/irrigación sanguínea , Puente/irrigación sanguínea , Tálamo/irrigación sanguíneaRESUMEN
Motor evoked potentials (MEPs) to transcranial magnetic stimulation were evaluated in a case of locked-in syndrome due to a large pontine infarction. In this patient, magnetic resonance imaging (MRI) and somatosensory evoked potentials demonstrated a tegmental involvement. One month after the attack, no MEP could be recorded from the right abductor digiti minimi (ADM) or either tibialis anterior muscle. On the contrary, MEPs were obtained from the left ADM, although with a prolonged latency and a reduced amplitude. When the patient was requested to think about the abduction of her paralyzed left little finger, the latency and the elicitability of these responses improved as compared with the relaxed condition. These severe MEP alterations correctly predicted a poor recovery of motor function in the chronic stage. However, although the tegmental involvement raises the question of an insufficient cortical motor arousal, preserved motor imagery suggested a normal cortical motor area activation.
Asunto(s)
Potenciales Evocados Motores , Imaginación/fisiología , Corteza Motora/fisiopatología , Cuadriplejía/psicología , Infarto Cerebral/complicaciones , Infarto Cerebral/psicología , Electromiografía , Potenciales Evocados Somatosensoriales , Resultado Fatal , Femenino , Mano/inervación , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Puente/irrigación sanguínea , Pronóstico , Tiempo de Reacción , Estimulación Magnética TranscranealRESUMEN
BACKGROUND AND PURPOSE: Pure hemisensory syndrome can be caused by small strokes occurring in a number of regions, including the thalamus and pons. Differentiation of the pontine sensory syndrome from the thalamic sensory syndrome has generally been made on the basis of distribution of sensory loss and involvement of specific sensory modalities but not without uncertainties and difficulties. Because the pontine tegmentum plays a pivotal role in generating horizontal eye movement, we attempted to discriminate these 2 syndromes by analyzing horizontal eye movements in stroke patients with pure hemisensory syndrome. METHODS: Horizontal saccade, pursuit, vestibulo-ocular reflex (VOR), and VOR cancellation (VORC) were evaluated using electro-oculography in 6 patients with hemisensory syndromes, 3 due to pontine stroke and 3 due to thalamic stroke, and all were verified by MRI or CT. In addition, somatosensory evoked potentials (SEPs) were recorded. RESULTS: Smooth pursuit and VORC directed toward the side of the lesion were impaired unilaterally in patients with pontine sensory stroke, whereas those 2 movements were intact bilaterally in patients with thalamic sensory stroke. Saccade and VOR were preserved in all patients. SEPs were normal in all patients with pontine and thalamic sensory strokes. No difference was found in the pattern of sensory disturbance between the 2 types of stroke patients. CONCLUSIONS: Ipsilateral impairment of the smooth pursuit system may be a sign of a pontine lesion in patients with hemisensory stroke.
Asunto(s)
Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/fisiopatología , Puente/fisiopatología , Movimientos Sacádicos/fisiología , Corteza Somatosensorial/fisiopatología , Trastornos Cerebrovasculares/complicaciones , Diagnóstico Diferencial , Electrooculografía , Potenciales Evocados Somatosensoriales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parestesia/diagnóstico , Parestesia/etiología , Parestesia/fisiopatología , Puente/irrigación sanguínea , Radiografía , Reflejo Vestibuloocular , Corteza Somatosensorial/irrigación sanguínea , Corteza Somatosensorial/diagnóstico por imagen , Tálamo/citología , Tálamo/fisiopatologíaRESUMEN
Strokes in the vertebrobasilar arterial distribution may result in a variety of physical findings and can be challenging to diagnose. We report a case of a 60-year-old woman with infarction of the left midbrain, right pons, and bilateral thalami with physical findings resembling transtentorial herniation.