ABSTRACT
We treated five patients with hemispheric ischemic stroke with intravenous recombinant tissue plasminogen activator (rtPA), within 3-6 h after stroke onset. Regional cerebral blood flow was evaluated with single photon emission computed tomography (rCBF-SPECT) before and after treatment. One patient with aphasia and a moderately severe hemiparesis, who had a small flow deficit, was treated 5 h and 30 min after the onset of his stroke and had a prompt and complete recovery. The post treatment rCBF-SPECT showed normal flow. One patient with a very large flow deficit died of transtentorial herniation. In three other patient clinical condition remained unchanged, in one of them despite restoration of flow, demonstrated by transcranial doppler examination. In all these patients the rCBF-SPECT remained abnormal. rCBF-SPECT is a valuable tool in the explanatory analysis of fibrinolytic treatment in ischemic stroke.
Subject(s)
Cerebral Cortex/blood supply , Cerebrovascular Disorders/therapy , Tissue Plasminogen Activator/administration & dosage , Tomography, Emission-Computed, Single-Photon , Aged , Cerebrovascular Disorders/diagnostic imaging , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Infusions, Intravenous , Male , Middle Aged , Recombinant Proteins/administration & dosage , Regional Blood Flow/drug effects , Regional Blood Flow/physiologyABSTRACT
Four patients with a solitary arteriovenous fistula were treated by transvascular balloon embolization technique, which resulted in complete fistula closure in three patients and partial closure in one. There were two vertebral arteriovenous fistulas, one peroneal arteriovenous fistula, and one radial arteriovenous fistula. The first two fistulas were spontaneous, the other two were traumatic. The only partial occlusion of the peroneal fistula was, in our opinion, due to a technical failure, the balloon was inflated slightly proximal to the fistular orificium instead of in the orificium itself. There were no complications, and there was no morbidity. In our opinion transvascular balloon embolization technique is the treatment of choice for solitary arteriovenous fistulas.
Subject(s)
Arteriovenous Fistula/therapy , Adolescent , Adult , Aged , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/etiology , Embolization, Therapeutic , Female , Humans , Male , Middle Aged , RadiographyABSTRACT
Two patients with angiographically proved basilar artery occlusion were treated with systemic recombinant tissue plasminogen activator (rtPA) according to protocol. The first patient was in a locked-in state and gradually deteriorated. On repeat angiography the basilar artery remained occluded. He died and necropsy revealed a pontine haemorrhagic infarction. The second patient, who was comatose and with decerebrate posturing, made a remarkable recovery. Angiography showed reperfusion. Therapy was initiated in the first patient after six hours and in the second after two hours. Treatment with rtPA is promising but probably not feasible for every patient. Success may depend on duration of occlusion and composition of occluding thrombus.
Subject(s)
Basilar Artery , Brain Ischemia/therapy , Brain Stem/blood supply , Intracranial Embolism and Thrombosis/therapy , Tissue Plasminogen Activator/administration & dosage , Vertebrobasilar Insufficiency/therapy , Adult , Basilar Artery/diagnostic imaging , Basilar Artery/drug effects , Brain Ischemia/diagnostic imaging , Cerebral Angiography , Follow-Up Studies , Humans , Intracranial Embolism and Thrombosis/diagnostic imaging , Male , Middle Aged , Recombinant Proteins/administration & dosage , Subtraction Technique , Tomography, X-Ray Computed , Vertebrobasilar Insufficiency/diagnostic imagingSubject(s)
Adenocarcinoma , Lung Neoplasms , Spinal Cord Neoplasms/secondary , Female , Humans , Middle AgedABSTRACT
Neurological complications in patients with Acquired Immuno Deficiency Syndrome (AIDS) are frequent and in addition to central nervous system syndromes, involvement of the peripheral nervous system is increasingly seen. We evaluated the indications and results of myelographic examination in six AIDS-patients with signs of peripheral nervous system disease, out of 200 AIDS-patients with neurological complications. Five of these patients had a polyradiculopathy, with proven cytomegalovirus (CMV) infection in four cases. There were two abnormal myelographic examinations with findings of cauda equina nerve root involvement, both in patients with proven CMV-polyradiculopathy. These abnormal findings had no direct therapeutic consequences. Myelography is not essential for establishing the diagnosis, which is based on cerebrospinal fluid (CSF) analysis, but may be indicated to exclude a spinal cord or nerve root compressive lesion.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnostic imaging , Cytomegalovirus Infections , Myelography , Polyradiculopathy/diagnostic imaging , Acquired Immunodeficiency Syndrome/complications , Adult , Evaluation Studies as Topic , Homosexuality , Humans , Iohexol , Lumbosacral Region , Male , Middle Aged , Polyradiculopathy/etiologySubject(s)
Aneurysm, Infected/etiology , Endocarditis, Bacterial/complications , Intracranial Aneurysm/etiology , Adult , Aneurysm, Infected/diagnostic imaging , Cerebral Angiography , Endocarditis, Bacterial/etiology , Humans , Intracranial Aneurysm/diagnostic imaging , Male , Streptococcal Infections , Streptococcus pyogenes , Tomography, X-Ray ComputedABSTRACT
A patient with a mobile schwannoma of the cauda equina is described. There was considerable discrepancy between the localization of the tumor at myelography and the findings at both initial surgery and repeat myelography, confirmed by definitive surgery. Such mobility is rare, but should be kept in mind when surgery is performed for a tumor of the cauda equina.