Anatomic and MRI bases for medullary infarctions with patients' presentation.

OBJECTIVE: There is a low incidence of the medullary infarctions and sparse data about the vascular territories, as well as a correlation among the anatomic, magnetic resonance imaging (MRI) and neurologic signs. MATERIALS AND METHODS: Arteries of the 10 right and left sides of the brain stem were injected with India ink, fixed in formalin and microdissected. The enrolled 34 patients with medullary infarctions underwent a neurologic, MRI and Doppler examination. RESULTS: Four types of the infarctions were distinguished according to the involved vascular territories. The isolated medial medullary infarctions (MMIs) were present in 14.7%. The complete MMIs comprised one bilateral infarction (2.9%), whilst the incomplete and partial MMIs were observed in 5.9% and 8.9%, respectively. The anterolateral infarctions (ALMIs) were very rare (2.9%). The complete and incomplete lateral infarctions (LMIs), noted in 35.3%, comprised 11.8% and 23.6%, respectively, that is, the anterior (5.9%), posterior (8.9%), deep (2.9%), and peripheral (5.9%). Dorsal ischemic lesions (DMIs) occurred in 11.8%, either as a complete (2.9%), or isolated lateral (5.9%) or medial infarctions (2.9%). The remaining ischemic regions belonged to various combined infarctions of the MMI, ALMI, LMI and DMI (35.3%). The infarctions most often affected the upper medulla (47.1%), middle (11.8%), or both (29.5%). Several motor and sensory signs were manifested following infarctions, including vestibular, cerebellar, ocular, sympathetic, respiratory and auditory symptoms. CONCLUSIONS: There was a good correlation among the vascular territories, MRI ischemia features, and neurologic findings regarding the medullary infarctions.

Anatomic and MRI Bases for Pontine Infarctions with Patients Presentation.

OBJECTIVES: There are scarce data regarding pontine arteries anatomy, which is the basis for ischemic lesions following their occlusion. The aim of this study was to examine pontine vasculature and its relationships with the radiologic and neurologic features of pontine infarctions. MATERIALS AND METHODS: Branches of eight basilar arteries and their twigs, including the larger intrapontine branches, were microdissected following an injection of a 10% mixture of India ink and gelatin. Two additional brain stems were prepared for microscopic examination after being stained with luxol fast blue and cresyl violet. Finally, 30 patients with pontine infarctions underwent magnetic resonance imaging (MRI) in order to determine the position and size of the infarctions. RESULTS: The perforating arteries, which averaged 5.8 in number and 0.39 mm in diameter, gave rise to paramedian and anteromedial branches, and also to anterolateral twigs (62.5%). The longer leptomeningeal and cerebellar arteries occasionally gave off perforating and anterolateral twigs, and either the lateral or posterior branches. Occlusion of some of these vessels resulted in the paramedian (30%), anterolateral (26.7%), lateral (20%), and combined infarctions (23.3%), which were most often isolated and unilateral, and rarely bilateral (10%). They were located in the lower pons (23.3%), middle (10%) or rostral (26.7%), or in two or three portions (40%). Each type of infarction usually produced characteristic neurologic signs. The clinical significance of the anatomic findings was discussed. CONCLUSIONS: There was a good correlation between the intrapontine vascular territories, the position, size and shape of the infarctions, and the type of neurologic manifestations.

Hetero-aggressive outbursts in patients' behaviour in emergency psychiatry.

INTRODUCTION: Hetero-aggressive behaviour in patients with mental disorders is frequent and requires special skills of doctors and other medical staff in order to urgently protect the patient and indicate hospitalization. OBJECTIVE: The objective of this paper was to examine the frequency of the most common diagnostic categories in psychiatric patients with hetero-aggressive behaviour. The secondary objective was to examine aspects of realized hospitalization (voluntary, involuntary) and socio-demographic characteristics of these patients. METHODS: The sample was formed of 100 patients who expressed hetero-aggressive behaviour just before and during admission for hospital treatment. The data was collected from auto-anamnesis and hetero-anamnesis, and they were based on general somatic, neurological and psychiatric examination. The statistical analysis used descriptive analysis and Pearson's chi2-test. RESULTS: The frequency of the most common diagnostic categories was: F20-F29 73%; F10-F19 19%; F60-F69 11%; F00-F09 8%; F30-F39 and F70-F79 6%. Involuntary hospitalization was implemented in 56%. Socio-demographic characteristics of examinees revealed that the most common were: male gender (63%) and younger age, dominant secondary school qualification (74%), unmarried (76%), unemployed (76%), frequently repeated hospitalizations (66%). CONCLUSION: The most common diagnostic categories to which the patients with hetero-aggressive behavioural outbursts belonged were from the schizophrenic circuit, followed by substance abuse, personality disorders, etc. Involuntary hospitalization was the most common form of hospitalization in patients with violent behaviour. Socio-demographic characteristics of examinees revealed this profile as the most common: male gender, younger age, secondary education, unmarried and unemployed, repeatedly hospitalized.