RESUMEN
An 82-year-old woman developed a droopy right eyelid with ipsilateral hemiparesis. Her ocular symptom was caused by weakness of the right frontalis, which is usually seen in patients with peripheral facial nerve palsy. However, head MRI showed acute cerebral infarction of the left lenticulostriate artery, and electroneurography did not detect damage to the right facial nerve. To explain the pathophysiology in this patient, asymmetrical bilateral cortex innervation to the right upper face was hypothesized. This case suggested that patients with some hemispheric strokes could develop upper facial weakness mimicking facial nerve palsy, and clinicians should pay attention to this potential pitfall in the differential diagnosis of facial nerve palsy.
Asunto(s)
Parálisis Facial , Imagen por Resonancia Magnética , Humanos , Femenino , Anciano de 80 o más Años , Parálisis Facial/etiología , Parálisis Facial/diagnóstico , Diagnóstico Diferencial , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/complicaciones , Infarto Cerebral/etiología , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Enfermedad Cerebrovascular de los Ganglios Basales/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/etiologíaRESUMEN
BACKGROUND: We aimed to investigate the association of characteristics of lenticulostriate artery (LSA) morphology and parental atheromatous disease (PAD) with single subcortical infarction (SSI) and to explore whether the LSA morphology is correlated with proximal plaque features in asymptomatic PAD. METHODS AND RESULTS: Patients with acute SSI were prospectively enrolled and classified as large- and small-SSI groups. The clinical data and imaging features of LSA morphology (branches, length, dilation, and tortuosity) and middle cerebral artery plaques (normalized wall index, remodeling index, enhancement degree, and hyperintense plaques) were evaluated. Logistic regression was performed to determine the association of large SSIs with morphologic features of LSAs and plaques. The Spearman correlation between the morphologic characteristics of LSAs and plaque features in asymptomatic PAD was analyzed. Of the 121 patients recruited with symptomatic PAD, 102 had coexisting asymptomatic contralateral PAD. The mean length of LSAs (odds ratio, 0.84 [95% CI, 0.73-0.95]; P=0.007), mean tortuosity of LSAs (odds ratio, 1.13 [95% CI, 1.05-1.22]; P=0.002), dilated LSAs (odds ratio, 22.59 [95% CI, 2.46-207.74]; P=0.006), and normalized wall index (odds ratio, 1.08 [95% CI, 1.01-1.15]; P=0.022) were significantly associated with large SSIs. Moreover, the normalized wall index was negatively correlated with the mean length of LSAs (r=-0.348, P<0.001), and the remodeling index was negatively correlated with the mean tortuosity of LSAs (r=-0.348, P<0.001) in asymptomatic PAD. CONCLUSIONS: Our findings suggest that mean length of LSAs, mean tortuosity of LSAs, dilated LSAs, and normalized wall index are associated with large SSIs. Moreover, plaque features in asymptomatic PAD are correlated with morphologic features of LSAs.
Asunto(s)
Placa Aterosclerótica , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Estudios Prospectivos , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/patología , Angiografía por Resonancia Magnética , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Enfermedad Cerebrovascular de los Ganglios Basales/patología , Enfermedades Asintomáticas , Angiografía Cerebral/métodosRESUMEN
BACKGROUND AND PURPOSE: Early neurologic deterioration (END) often occurs during hospitalization in single small subcortical infarction (SSSI). The objective was to identify imaging predictors of END. MATERIALS AND METHODS: SSSIs in the lenticulostriate artery within 72 hours of stroke onset from January 2015 to June 2021 were consecutively enrolled. The posteriority and laterality indexes were assessed on the second section from the top of the corona radiata section showing the lateral ventricle on DWI. A multivariate logistic analysis was used to explore the predictors of END. RESULTS: A total of 402 patients were included in this study, among whom 93 (23.1%) experienced END. The optimal cutoff points of the posteriority and laterality indexes for predicting END were given by a receiver operating characteristic curve. A multivariate logistic analysis showed that the posteriority index of ≥0.669 (OR: 2.53; 95% CI: 1.41-4.56; P = .002) and the laterality index of ≥0.950 (OR: 2.03; 95% CI: 1.03-4.00; P = .042) were independently associated with the risk of END. Accordingly, the SSSIs were further divided into 4 types: anterior lateral type (AL-type), anterior medial type (AM-type), posterior lateral type (PL-type), and posterior medial type (PM-type). After the multivariate analysis, in comparison with the AL-type, the AM-type (OR: 3.26; 95% CI: 1.10-9.65), PL-type (OR: 4.68; 95% CI: 1.41-15.56), and PM-type (OR: 6.77; 95% CI: 2.53-18.04) carried significantly elevated risks of END. The PM-type was associated with the highest risk of END. CONCLUSIONS: The PM-type was found to be associated with the highest risk of END.
Asunto(s)
Infarto Cerebral , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Infarto Cerebral/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/métodos , Estudios Retrospectivos , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagenRESUMEN
Mineralizing lenticulostriate vasculopathy is a well-recognized risk factor for basal ganglia stroke after minor head trauma in infants and young children; it is diagnosed on head computed tomography by the presence of basal ganglia calcification, seen as punctate hyperdensities on axial and linear hyperdensities on reconstructed coronal and sagittal images. In children with anterior fontanel window, its presence is suggested by branching hyperechogenic stripes in the basal ganglia region on cranial ultrasound. Brain magnetic resonance imaging, including susceptibility-weighted sequences and brain magnetic resonance angiography, fail to detect calcification or vascular abnormalities. Although its etiology remains unknown, mineralizing lenticulostriate vasculopathy is considered to represent end-stage pathology of lenticulostriate vasculopathy, a neonatal radiographic condition detected during routine neonatal cranial ultrasonographic examination and represents nonspecific finding associated with a multitude of etiologies. The significance of mineralizing lenticulostriate vasculopathy lies in the fact that it has emerged as one of the most common risk factors for basal ganglia stroke in Indian children, accounting for one-fourth to one-half of all causes of stroke in some studies. The outcome of stroke in children with mineralizing lenticulostriate vasculopathy appears to be favorable with the majority achieving complete or nearly complete recovery of their motor functions. Stroke recurrence following repeat head trauma is seen in a small proportion of children despite aspirin treatment.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales , Calcinosis , Traumatismos Craneocerebrales , Accidente Cerebrovascular , Lactante , Recién Nacido , Niño , Humanos , Preescolar , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/complicaciones , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/diagnóstico por imagen , Ganglios Basales/diagnóstico por imagen , Enfermedad Cerebrovascular de los Ganglios Basales/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Calcinosis/complicaciones , Factores de RiesgoRESUMEN
OBJECTIVE: Our aim was to examine the frequency and type of placental abnormalities in neonates with LSV. STUDY DESIGN: We prospectively reviewed cranial ultrasounds (cUS) from neonates born at ≤32 weeks of gestation at Parkland Hospital between 2012 and 2014. Our cohort included neonates with LSV and gestational age and sex matched controls with normal cUS. We retrieved placental pathology reports retrospectively and compared placental abnormalities in both groups. RESULTS: We reviewed 1351 cUS from a total of 407 neonates. Placental pathology evaluations were complete for 64/65 (98%) neonates with LSV and 68/70 (97%) matched controls. There were no significant differences for any type of placental abnormities between LSV and control groups. However, infants with highest stage LSV were more likely to have large for gestational age (LGA) placentas (p = 0.01). CONCLUSION: The association between LSV and LGA placenta may indicate a shared vascular response to an adverse prenatal environment.
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Enfermedad Cerebrovascular de los Ganglios Basales , Recien Nacido Prematuro , Lactante , Recién Nacido , Humanos , Femenino , Embarazo , Placenta , Estudios Retrospectivos , Edad Gestacional , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Enfermedad Cerebrovascular de los Ganglios Basales/complicacionesRESUMEN
Acute basal ganglia infarct following minor head trauma in association with mineralisation of lenticulostriate arteries is an increasingly recognised entity in childhood stroke. Three cases with a classical history and phenotypical features of mineralising angiopathy are described. Case 1 was a 2-year-old girl who presented with acute onset hemiparesis with a same-side upper motor neuron (UMN)-type facial palsy following minor head trauma. Case 2 was a 14-month-old boy who presented with a left side hemiparesis and a left UMN-type facial nerve palsy following a minor fall. Case 3 was an 8-month-old boy who, following a fall from his cot, had a sudden-onset hemiparesis on the right side and deviation of the angle of the mouth to the left. In brain computed tomography, all three cases demonstrated characteristic basal ganglia calcification of the mineralising angiopathy. Magnetic resonance imaging of the brain demonstrated features supportive of acute infarcts in the lentiform nucleus, caudate nucleus and putamen. Two of the patients had iron deficiency anaemia with haemoglobin of 7.0 g/dL and 7.8 g/dL, respectively. On follow-up, Case 1 had mild residual weakness and the other two made a complete recovery. None of the patients had a recurrence of stroke. Basal ganglia stroke with mineralising angiopathy should be considered in toddlers presenting with sudden-onset focal neurological deficits preceded by minor head trauma.Abbreviations: ADC: apparent diffusion coefficient; CT: computed tomography; DWI: diffusion-weighted imaging; Hb: haemoglobin; IDA: iron deficiency anaemia; MRI: magnetic resonance imaging; SLV: sonographic lenticulostriate vasculopathy; SWI: susceptibility weighted imaging; UMN: upper motor neuron.
Asunto(s)
Anemia , Enfermedad Cerebrovascular de los Ganglios Basales , Traumatismos Craneocerebrales , Accidente Cerebrovascular , Anemia/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Preescolar , Traumatismos Craneocerebrales/complicaciones , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Paresia/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagenRESUMEN
Lenticulostriate vasculopathy (LSV) is a relatively common fi nding in routine cranial ultrasound examination that has been associated with many infectious and non-infectious conditions. The aim of this review was to provide a better understanding of LSV ultrasound fi nding, as well as the need for further laboratory and imaging examinations in infants. The most of the published studies represented small series, with few prospective long-term studies involving the control groups. Authors have mostly found an association between LSV, especially higher-grade (although there is no universally accepted classifi cation) with congenital cytomegalovirus (CMV) infection, classifying those children as at risk for sensorineural hearing loss. In contrast, some authors pointed out that LSV could be found relatively often, and believe that isolated LSV, especially lower-grade, is not predictive for an unfavourable outcome and a long-term prognosis. Therefore, although 35 years have passed since the first publication of LSV, there is still no consensus among experts on the clinical signifi cance of isolated LSV, but caution is certainly needed given the fact that most infants with congenital CMV are asymptomatic.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Encéfalo , Niño , Ecoencefalografía , Humanos , Lactante , Estudios Prospectivos , UltrasonografíaAsunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales , Isquemia Encefálica , COVID-19 , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Ganglios Basales/diagnóstico por imagen , Enfermedad Cerebrovascular de los Ganglios Basales/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico por imagen , Humanos , SARS-CoV-2 , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagenRESUMEN
BACKGROUND: Stroke in children easily causes long-term dysfunction. Whether the prognoses of motor and anxiety disorders are related to the affected stroke area has not been reported. METHODS: One hundred nine cases of children with ischaemic stroke were reviewed and divided into three groups: lenticular nucleus lesions only (lenticular nucleus group), lenticular nucleus and caudate head lesions (caudate head group), and lenticular nucleus and thalamus lesions (thalamus group). Overall prognosis was evaluated by the mRS score. The SCAS-P was used to evaluate anxiety in children aged ≥6 years. RESULTS: mRS scores were ≤ 2 points (mean: 0.62), no significant difference among groups. 3/21 (14.2%) patients in the caudate head group changed handedness, which is significantly higher than other groups. Patients with lesions in thalamus group had significantly higher SCAS-P scores. CONCLUSIONS: The overall prognosis of children with basal ganglia ischaemic stroke is good. However, hand preference changes and anxiety disorders may develop. Patients in the caudate head groups are more likely to suffer from fine motor disorders and changes in handedness. Patients within the thalamus group are more prone to anxiety than patients in the other groups. Anxiety disorders should be noted in children with basal ganglia stroke.
Asunto(s)
Trastornos de Ansiedad/fisiopatología , Enfermedad Cerebrovascular de los Ganglios Basales/fisiopatología , Núcleo Caudado , Cuerpo Estriado , Lateralidad Funcional , Accidente Cerebrovascular Isquémico/fisiopatología , Destreza Motora/fisiología , Tálamo , Adolescente , Ganglios Basales , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Enfermedad Cerebrovascular de los Ganglios Basales/psicología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/psicología , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Accidente Cerebrovascular/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
Optimal treatment of patients with intracranial subocclusive thrombus remains unclear. Such a rare case successfully managed with endovascular mechanical thrombectomy is presented. A 71-year-old man experienced a sudden onset of dysarthria and motor deficits. At the time of admission his National Institutes of Health Stroke Scale (NIHSS) score was 4. DWI demonstrated incomplete infarction within the left lenticulostriate artery (LSA) territory, MRA showed partial flow defect in the distal left M1 segment and non-visualization of the LSA, and ECG revealed atrial fibrillation, thus ischemic stroke caused by cardiogenic embolism was diagnosed. Tissue plasminogen activator was administered, but symptoms progressed and NIHSS score increased up to 8. Diagnostic angiogrpahy confirmed presence of the subocclusive thrombus within the distal left M1 segment and complete occlusion of LSA at its origin. Since conservative therapy was ineffective, mechanical thrombectomy utilizing ADAPT (a direct aspiration first-pass thrombectomy) technique was performed resulting in compete recanalization of the LSA accompanied by the prompt regress of neurological symptoms. Eventally, the patient demonstrated nearly full recovery (modified Rankin Scale score 1). Thus, mechanical thrombectomy should be considered as a reasonable option in cases of acute cerebral stroke caused by subocclusive thrombus and progressive neurological deficits despite standard conservative therapy. J. Med. Invest. 67 : 372-374, August, 2020.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/cirugía , Trombosis Intracraneal/cirugía , Trombectomía/métodos , Anciano , Enfermedad Cerebrovascular de los Ganglios Basales/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Infarto Cerebral/etiología , Humanos , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/etiología , MasculinoRESUMEN
OBJECTIVE: To elucidate the timeframe and spatial patterns of cortical reorganization after different stroke-induced basal ganglia lesions, we measured cortical thickness at 5 time points over a 6-month period. We hypothesized that cortical reorganization would occur very early and that, along with motor recovery, it would vary based on the stroke lesion site. METHODS: Thirty-three patients with unilateral basal ganglia stroke and 23 healthy control participants underwent MRI scanning and behavioral testing. To further decrease heterogeneity, we split patients into 2 groups according to whether or not the lesions mainly affect the striatal motor network as defined by resting-state functional connectivity. A priori measures included cortical thickness and motor outcome, as assessed with the Fugl-Meyer scale. RESULTS: Within 14 days poststroke, cortical thickness already increased in widespread brain areas (p = 0.001), mostly in the frontal and temporal cortices rather than in the motor cortex. Critically, the 2 groups differed in the severity of motor symptoms (p = 0.03) as well as in the cerebral reorganization they exhibited over a period of 6 months (Dice overlap index = 0.16). Specifically, the frontal and temporal regions demonstrating cortical thickening showed minimal overlap between these 2 groups, indicating different patterns of reorganization. CONCLUSIONS: Our findings underline the importance of assessing patients early and of considering individual differences, as patterns of cortical reorganization differ substantially depending on the precise location of damage and occur very soon after stroke. A better understanding of the macrostructural brain changes following stroke and their relationship with recovery may inform individualized treatment strategies.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/fisiopatología , Infarto Encefálico/fisiopatología , Corteza Cerebral/diagnóstico por imagen , Plasticidad Neuronal , Paresia/fisiopatología , Recuperación de la Función , Adulto , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Infarto Encefálico/diagnóstico por imagen , Estudios de Casos y Controles , Corteza Cerebral/patología , Femenino , Neuroimagen Funcional , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neostriado/diagnóstico por imagen , Neostriado/fisiopatología , Vías Nerviosas , Tamaño de los Órganos , Índice de Severidad de la Enfermedad , Rehabilitación de Accidente CerebrovascularRESUMEN
OBJECTIVE: To present an atypical case of deep intracerebral hemorrhage caused by the rupture of an aneurysm of the distal lenticulostriate artery. A 42-year-old woman presenting with right-sided mild hemiparesis was diagnosed with an acute left-sided hemorrhage within the basal nuclei. Cerebral angiography revealed a microaneurysm of the distal portion of the left lenticulostriate artery. Conservative treatment under close neurological surveillance was recommended. After a few days of hospital stay, the patient's neurological symptoms improved, and she was discharged. The patient has remained asymptomatic for more than 6 months. Aneurysms of the distal lenticulostriate artery are extremely rare.
OBJETIVO: Presentar un caso atípico de hemorragia intracerebral profunda causada por la ruptura de un aneurisma de la arteria lenticuloestriada distal; se revisa la bibliografía y se analizan la fisiopatología y el tratamiento. Se presentó a la sala de emergencias una mujer de 42 años con hemiparesia leve del hemicuerpo derecho. Se la diagnosticó con una hemorragia aguda en los núcleos de la base izquierdos. La panangiografía cerebral reveló un microaneurisma de la porción distal de la arteria lenticuloestriada izquierda. Se recomendó tratamiento conservador bajo estrecha vigilancia neurológica. Después de unos cuantos días de hospitalización, los síntomas neurológicos de la paciente mejoraron y la paciente recibió el alta. La paciente ha permanecido asintomática durante más de seis meses. Los aneurismas de la arteria lenticuloestriada distal son extremadamente raros.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Hemorragia Cerebral/etiología , Aneurisma Intracraneal/complicaciones , Adulto , Enfermedad Cerebrovascular de los Ganglios Basales/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/terapia , Angiografía Cerebral , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Angiografía por Tomografía Computarizada , Tratamiento Conservador , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Imagen por Resonancia Magnética , Paresia/etiologíaRESUMEN
OBJECTIVES: Incidence rate of basal ganglia infarction (BGI) after mild head trauma was reported higher in children with basal ganglia calcification (BGC). We would like to review patients with BGC showed in head CT scan to see the incidence rate of stroke in these patients and the correlation of variables in these cases. PATIENTS AND METHODS: CT imaging data of cases with diagnosis of mild traumatic brain injury (mTBI) in a large tertiary pediatric center between Mar. 2014 and Mar. 2019 was retrospectively reviewed. Cases with findings of punctate calcification in the region of basal ganglion in CT scan were included. Correlation of variables of these cases (age, side and volume of basal ganglion calcification) with the diagnosis of BGI was the focus of this study. RESULTS: 37 patients (26 males, 9 females, median age: 3.88±3.54) were included in this study. 17 cases (45.9 %) were diagnosed of BGI and were admitted into the department of neurosurgery. Altogether 63 sides of BGC were categorized into two groups based on whether BGI happened and ROC curve was drawn. ROC curve showed when the cut-off point was 6.55 mm3, the sensitivity was 88.9 % and the specificity was 87.5 %; the area under curve was 0.849 (p<0.01). All the cases were divided into two groups according to whether basal ganglia infarction occurred or not. Mann-Whitney U test showed significant difference between these two groups in age (p=0.01). ROC curve of how age affect BGI after mTBI were drawn. The cut-off point was 3.25 years, and the sensitivity was 65.0 % and the specificity was 88.2 %; the area under curve was 0.746 (p=0.01). All patients received conservative treatment and recovered. CONCLUSION: Incidence rate is higher in children with BGC after mild head injury than that of other children. Larger BGC volume indicates higher risk of developing infarction after minor head injury. Older children with BGC are less-likely getting BGI after mTBI.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Conmoción Encefálica/diagnóstico por imagen , Infarto Encefálico/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Adolescente , Enfermedad Cerebrovascular de los Ganglios Basales/epidemiología , Enfermedades de los Ganglios Basales/diagnóstico por imagen , Enfermedades de los Ganglios Basales/epidemiología , Conmoción Encefálica/epidemiología , Infarto Encefálico/epidemiología , Calcinosis/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Tomografía Computarizada MultidetectorAsunto(s)
Apatía , Enfermedades de los Ganglios Basales/complicaciones , Neoplasias Encefálicas/complicaciones , Hemangioma Cavernoso del Sistema Nervioso Central/complicaciones , Enfermedad de Parkinson Secundaria/etiología , Anciano , Enfermedad Cerebrovascular de los Ganglios Basales/complicaciones , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Enfermedades de los Ganglios Basales/diagnóstico por imagen , Enfermedades de los Ganglios Basales/metabolismo , Neoplasias Encefálicas/diagnóstico por imagen , Núcleo Caudado/diagnóstico por imagen , Núcleo Caudado/metabolismo , Enfermedades de los Pequeños Vasos Cerebrales/complicaciones , Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Diagnóstico Diferencial , Progresión de la Enfermedad , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Femenino , Hemangioma Cavernoso del Sistema Nervioso Central/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson Secundaria/diagnóstico , Enfermedad de Parkinson Secundaria/tratamiento farmacológico , Enfermedad de Parkinson Secundaria/metabolismoRESUMEN
OBJECTIVE: We evaluated a prospective cohort of 150 patients under observation in our centre for lacunar strokes. The purpose of this study was to investigate if lacunar stroke of varying size, shape and locations had different risk factors between them and possibly different mechanisms and causes. PATIENTS AND METHODS: 150 patients with a lacunar stroke were included in the present study. Infarcts were classified by size, shape and location. We evaluated the correlation between several risk factors of stroke and the radiological characteristics of the infarcts. RESULTS: Older age was associated with the presence of a basal ganglia lesion (p < 0.001) and with the presence of a smaller lesion (trend to statistical significance, p = 0.07). Patients with infarcts >15 mm had higher NIHSS score at admission (p 0.01). CONCLUSION: The different subtypes of lacunar infarcts have distinct pathogenesis. Further studies, with a larger numbers of patients, are necessary to confirm our data.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Infartos del Tronco Encefálico/diagnóstico por imagen , Accidente Vascular Cerebral Lacunar/diagnóstico por imagen , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To describe the prognosis of subtle findings on fetal brain imaging in pregnant women with primary CMV infection during pregnancy. METHODS: This was a retrospective study. The data included: timing of infection, amniocentesis results, imaging findings, obstetric outcome, and developmental assessment. RESULTS: For the 27 included patients, the time of infection was: periconception, first, second, third trimesters or unknown in 14.8%, 29.7%, 40.7%, 7.4%, and 7.4%, respectively. Seventy-four percent had only MRI findings; white matter hyperintense T2 signal (HT2) (51.8%), mild ventriculomegaly (18.5%), HT2 and temporal cyst (7.4%), dilated occipital horn (7.4%), Periventricular pseudo cyst (PVPC) with dilated occipital horn (3.7%), isolated PVPC (7.4%), choroid plexus cyst (3.7%). In 26% of fetuses, additional ultrasound findings were observed: Lenticulostriatal vasculopathy (LSV) (11.1%), LSV with PVPC (3.84%), isolated PVPC (3.84%), mild ventriculomegaly (3.84%), and bilateral temporal cysts (3.84%). In 66.6%, the MRI had false-positive findings (due to noninfected neonates). All children are developing normally, and one has a hearing deficit. Postnatal ultrasound (US) was normal in 21/27, with LSV in five, and a resolving subependymal cyst in one patient. CONCLUSION: Subtle imaging findings are more common on MRI than US and the prognosis is most likely favorable. Performing amniocentesis will significantly reduce the false-positive rate.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Quistes del Sistema Nervioso Central/diagnóstico por imagen , Infecciones por Citomegalovirus/diagnóstico por imagen , Hidrocefalia/diagnóstico por imagen , Imagen por Resonancia Magnética , Complicaciones Infecciosas del Embarazo/diagnóstico , Ultrasonografía Prenatal , Amniocentesis , Infecciones por Citomegalovirus/congénito , Reacciones Falso Positivas , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Pronóstico , Estudios Retrospectivos , Sustancia Blanca/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: Early studies have indicated that the cortico-rubro-spinal tracts play important roles in motor dysfunction after stroke. However, the differential involvement of the rubral branches in capsular and pontine stroke, and their associations with the motor impairment are still unknown. METHODS: The present study recruited 144 chronic stroke patients and 91 normal controls (NC) from three hospitals, including 102 cases with capsular stroke (CS) and 42 cases with pontine stroke (PS). The rubral branches, including bilateral corticorubral tracts (CRT), dentatorubral tracts (DRT), and rubrospinal tracts (RST), and the cortico-spinal tract (CST) were reconstructed based on the dataset of the Human Connectome Project. Group differences in diffusion scalars of each rubral branch were compared, and the associations between the diffusion measures of rubral branches and the Fugl-Meyer assessment (FMA) scores were tested. RESULTS: The bilateral CRT of the CS cases showed significantly lower factional anisotropy (FA) than in the NC. The bilateral DRT of the PS cases had lower FA than in the NC. Both CS and PS cases had significantly lower FA of the bilateral RST than the NC. Besides, the stroke patients demonstrated significantly lower FA in bilateral CSTs than the NC. Partial correlation analysis identified significantly positive correlations between the FA of the ipsilesional and CRT and the FMA scores in the CS group, and significantly positive correlations between the FA of the RST bilaterally and the FMA scores in the CS and PS groups. Furthermore, the association between RST integrity and FMA scores still survived after controlling for the effect of the CST. Finally, multiple regression modelling found that rubral tract FA explained 39.2% of the variance in FMA scores for CS patients, and 48.8% of the variance in FMA scores for PS patients. CONCLUSIONS: The bilateral rubral branches were differentially involved in the chronic capsular and pontine stroke, and the impairment severity of each rubral branch was dependent on lesion locations. The integrity of the rubral branches is related to motor impairment in both the chronic capsular and pontine stroke.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Infartos del Tronco Encefálico/diagnóstico por imagen , Núcleos Cerebelosos/diagnóstico por imagen , Corteza Cerebral/diagnóstico por imagen , Tractos Piramidales/diagnóstico por imagen , Núcleo Rojo/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Adulto , Anciano , Anisotropía , Enfermedad Cerebrovascular de los Ganglios Basales/fisiopatología , Infartos del Tronco Encefálico/fisiopatología , Estudios de Casos y Controles , Núcleos Cerebelosos/fisiopatología , Corteza Cerebral/fisiopatología , Enfermedad Crónica , Conectoma , Imagen de Difusión Tensora , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vías Nerviosas/diagnóstico por imagen , Vías Nerviosas/fisiopatología , Puente/irrigación sanguínea , Tractos Piramidales/fisiopatología , Núcleo Rojo/fisiopatología , Médula Espinal/fisiopatología , Accidente Cerebrovascular/fisiopatología , Sustancia Blanca/irrigación sanguínea , Sustancia Blanca/fisiopatologíaRESUMEN
BACKGROUND: A common-stem origin of lenticulostriate arteries (CS-LSAs) is an anatomical variation that supplies a moderate to large section of the basal ganglia. We hypothesized that CS-LSAs with a patent orifice are located at distal positions of the acute-occluded middle cerebral artery (MCA) and that the blood flow of CS-LSAs is supplied by pail arterial anastomoses and results in hypoperfusion of CS-LSAs, similar to a deep watershed (DWS) infarction. OBJECTIVE: Our study evaluated the possibility of CS-LSAs in patients with DWS infarction and MCA occlusion and also assessed the safety of endovascular therapy (ET) in these patients. METHODS: A cohort of consecutive patients with DWS infarction and MCA occlusion and in whom full recanalization via ET was achieved were identified. Patients were divided into two groups based on the presence of CS-LSAs observed during ET. In addition, radiological and clinical data were retrospectively analyzed. RESULTS: Thirty-three patients were included, and CS-LSAs were observed in 48.5% (16/33) of patients. The possibility (72.2%, 13/18) of CS-LSAs was high in patients with DWS infarction companied with basal ganglia infarction. A good clinical outcome was similar in patients with CS-LSAs and basal ganglia infarction and in patients without CS-LSAs and basal ganglia infarction (69.2% vs. 81.8%, P = 0.649). CONCLUSIONS: The possibility of CS-LSAs was 48.5% in patients with DWS infarction and MCA occlusion, and the revascularization procedure was safe and feasible in these patients despite the moderate-to-large basal ganglia infarction.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Ganglios Basales/irrigación sanguínea , Ganglios Basales/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Anciano , Angiografía de Substracción Digital , Enfermedad Cerebrovascular de los Ganglios Basales/mortalidad , Infarto Cerebral/mortalidad , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/mortalidad , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: In acute ischemic stroke, infarct location and volume have, separately, been used to determine long-term outcomes after stroke. Little information exists on the combination of these imaging characteristics on rehabilitation outcomes. We evaluated the association between infarct lesion location volume with the Functional Independence Measure (FIM) measure during inpatient rehabilitation facility (IRF) in ischemic stroke patients. METHODS: Between 2012 and 2014, we prospectively enrolled consecutive acute ischemic stroke patients admitted from a Comprehensive Stroke Center and followed to an IRF in Chicago, Illinois. We adjudicated infarct volumes in specific lesion locations using a validated brain atlas. Volumes were calculated using an automated pipeline. FIM measure was extracted from IRF charts. We analyzed the association between acute infarct characteristics and functional measures using adjusted Spearman's correlation. RESULTS: Among 162 stroke patients (mean age 67.6 years, 48.1% male, 58.6% Caucasian), the median FIM at IRF was 52 (IQR 36-62). In an adjusted analysis, infarct volumes in the left basal ganglia (rs = - 0.45, p = 0.02) and left frontal lobe (rs = - 0.38, p = 0.04) were negatively correlated with FIM scores. CONCLUSIONS: There is an association between specific infarct lesion location volume and subsequent FIM scores assessed at IRF. Our findings suggest that imaging during index stroke hospitalization could be used to predict outcomes assessed during IRF.