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https://www.readbyqxmd.com/read/27888078/basilar-artery-herniation-into-the-sphenoid-sinus-secondary-to-traumatic-skull-base-fractures-case-report-and-review-of-the-literature
#1
Arthur Wang, John Wainwright, Jared Cooper, Michael S Tenner, Adesh Tandon
BACKGROUND: Traumatic clival fractures occur with < 0.6% frequency and can be associated with significant neurovascular injuries. The most serious of these injuries is to the basilar artery in which the artery is dissected or is fully occluded resulting in infarction of the brainstem and cerebellum. Among early reports of these injuries, postmortem autopsy showed entrapment, or incarceration, of the basilar artery at the clival fracture site. A literature search revealed 11 cases of entrapment of the basilar artery within a clival fracture...
November 22, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27854093/posterior-reversible-encephalopathy-syndrome-mimicking-brainstem-infarction-a-dilemma
#2
Tsung-Han Ho, Chia-Lin Tsai, Yaw-Don Hsu, Jiunn-Tay Lee, Fu-Chi Yang, Chia-Ching Hsu, Chun-Chieh Lin
PURPOSE: We had recently reported one case at American Journal of Emergency Medicine about centralvariant posterior reversible encephalopathy syndrome (PRES) in an 84-year-old woman with an initial misdiagnosis as central pontine myelinolysis (CPM). Here, we introduce another case of centralvariant PRES in a 49-year-old man mimicking as acute brainstem infarction in the cranial computed tomography (CT) findings. CASE REPORT: A 49-year-old man was admitted to the emergency department with a 5-day history of vertigo, cognitive decline, and difficulty in walking...
June 15, 2016: Acta Neurologica Taiwanica
https://www.readbyqxmd.com/read/27824897/functional-plasticity-after-unilateral-vestibular-midbrain-infarction-in-human-positron-emission-tomography
#3
Sandra Becker-Bense, Hans-Georg Buchholz, Bernhard Baier, Mathias Schreckenberger, Peter Bartenstein, Andreas Zwergal, Thomas Brandt, Marianne Dieterich
The aim of the study was to uncover mechanisms of central compensation of vestibular function at brainstem, cerebellar, and cortical levels in patients with acute unilateral midbrain infarctions presenting with an acute vestibular tone imbalance. Eight out of 17 patients with unilateral midbrain infarctions were selected on the basis of signs of a vestibular tone imbalance, e.g., graviceptive (tilts of perceived verticality) and oculomotor dysfunction (skew deviation, ocular torsion) in F18-fluordeoxyglucose (FDG)-PET at two time points: A) in the acute stage, and B) after recovery 6 months later...
2016: PloS One
https://www.readbyqxmd.com/read/27781047/functional-independence-following-endovascular-treatment-for-basilar-artery-occlusion-despite-extensive-bilateral-pontine-infarcts-on-diffusion-weighted-imaging-refuting-a-self-fulfilling-prophecy
#4
Diogo C Haussen, Renato A C Oliveira, Vikas Patel, Raul G Nogueira
BACKGROUND AND PURPOSE: Extensive brainstem diffusion-weighted imaging (DWI) hyperintensity has been associated with poor outcomes. We aim at documenting a series of patients with extensive DWI pontine lesions who achieved independence following endovascular therapy and aggressive medical therapy in the setting of posterior circulation basilar artery occlusion (BAO). METHODS: This is a retrospective endovascular database review of a single-operator experience over a 9-year period for patients with (1) complete BAO, (2) extensive bilateral pontine DWI changes and (3) 90-day modified Rankin scale 0-2...
September 2016: Interventional Neurology
https://www.readbyqxmd.com/read/27772756/hypertrophic-olivary-degeneration-case-series-and-review-of-literature
#5
Shyam Sabat, Neil Mannering, Amit Agarwal
Hypertrophic Olivary Degeneration (HOD) is a rare neurological condition caused by trans-synaptic degeneration in the brainstem and cerebellum, resulting in varied clinical symptoms, classical being palatal tremors, along with characteristic imaging presentation. Large number of pathologic lesions can cause this condition, ranging from ischemic stroke to neoplasm. The most common conditions include hemorrhage, vascular malformations and infarct. Magnetic resonance scan (MRI) is the imaging modality of choice which shows signal changes with hypertrophy of the inferior olivary nucleus, as well as the primary underlying pathology...
November 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27704247/childhood-acute-basilar-artery-thrombosis-successfully-treated-with-mechanical-thrombectomy-using-stent-retrievers-case-report-and-review-of-the-literature
#6
Giancarlo Nicosia, Domenico Cicala, Giuseppe Mirone, Pietro Spennato, Vincenzo Trischitta, Claudio Ruggiero, Gianluigi Guarneri, Mario Muto, Giuseppe Cinalli
INTRODUCTION: Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents...
October 4, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/27680211/critical-neural-targets-for-the-level-of-human-consciousness-arousal-arrest-and-unconsciousness-after-sumatriptan-administration
#7
Jaakko W Långsjö, Kai Lehtimäki, Jyrki Ruohonen, Anne Sajanti, Satu Sandell, Hannu T Heikkilä, Antti Brander, Kari Saarinen, Lauri Herrala
BACKGROUND: Insufficient understanding of the mechanisms of consciousness can make unconsciousness a diagnostic challenge, directly effecting the treatment and the outcome of the patient. Consciousness is a product of brainstem arousal (wakefulness, the level of consciousness) and cortical information integration (awareness, the contents of consciousness). The thalamus serves as a critical hub in the arousal pathway. The nuclei within the internal medullary lamina, together with the associated thalamocortical connections, have been implicated as being especially important for human consciousness...
September 28, 2016: Brain Injury: [BI]
https://www.readbyqxmd.com/read/27663557/traumatic-basilar-artery-entrapment-with-patency-of-pontine-perforators-and-absence-of-significant-brainstem-infarction-report-of-an-unusual-case
#8
Stefan Kliesch, Christian Bauknecht, Georg Bohner, Thomas Liebig, Eberhard Siebert
We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.
September 23, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27660039/recurrent-hemorrhagic-venous-infarctions-caused-by-thrombosis-of-a-pontine-developmental-venous-anomaly-and-protein-s-mutation
#9
Yuri Nakamura, Kei-Ichiro Takase, Takuya Matsushita, Satoshi Yoshimura, Ryo Yamasaki, Hiroyuki Murai, Kazufumi Kikuchi, Jun-Ichi Kira
A 34-year-old man presented with an acute onset of upbeat nystagmus, slurred speech, and limb and truncal ataxias. The patient had a history of limb ataxia and gait disturbance previously treated as brainstem encephalitis with corticosteroids 3 years previously. Brain magnetic resonance imaging showed pontine developmental venous anomaly (DVA) and hemorrhagic infarction within the drainage territory of the DVA. Three months later, the patient exhibited recurrent limb ataxia, double vision, and numbness of the left side of the body...
September 19, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27651328/diagnostic-accuracy-of-whole-brain-ct-perfusion-in-the-detection-of-acute-infratentorial-infarctions
#10
Christine Bollwein, Annika Plate, Wieland H Sommer, Kolja M Thierfelder, Hendrik Janssen, Maximilian F Reiser, Andreas Straube, Louisa von Baumgarten
INTRODUCTION: Although the diagnostic performance of whole-brain computed tomographic perfusion (WB-CTP) in the detection of supratentorial infarctions is well established, its value in the detection of infratentorial strokes remains less well defined. We examined its diagnostic accuracy in the detection of infratentorial infarctions and compared it to nonenhanced computed tomography (NECT), aiming to identify factors influencing its detection rate. METHODS: Out of a cohort of 1380 patients who underwent WB-CTP due to suspected stroke, we retrospectively included all patients with MRI-confirmed infratentorial strokes and compared it to control patients without infratentorial strokes...
November 2016: Neuroradiology
https://www.readbyqxmd.com/read/27647028/primary-hemorrhagic-neurovascular-diseases-phnvds-in-tibetans-a-retrospective-observational-study
#11
Anqi Xiao, Ruiqi Chen, Hao Li, Lu Ma, Sen Lin, Xin Hu, Chao You
BACKGROUND: Although there have been many studies on primary hemorrhagic neurovascular diseases (PHNVDs) in different populations, a study focusing on PHNVDs in Tibetan people was still lacking. This study aimed to explore the notable characteristics of Tibetan PHNVDs by comparing the most three common PHNVDs (aneurysmal subarachnoid hemorrhage, spontaneous intracerebral hemorrhage and arteriovenous malformation) in our institution between Tibetan and Han patients. METHODS: In this retrospective observational study, the hospital information system (HIS) was utilized to access the records of patients with PHNVDs...
September 16, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27646318/traumatic-basilar-artery-entrapment-with-patency-of-pontine-perforators-and-absence-of-significant-brainstem-infarction-report-of-an-unusual-case
#12
Stefan Kliesch, Christian Bauknecht, Georg Bohner, Thomas Liebig, Eberhard Siebert
We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.
2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27638081/ischemic-syndromes-causing-dizziness-and-vertigo
#13
K-D Choi, H Lee, J-S Kim
Dizziness/vertigo and imbalance are the most common symptoms of vertebrobasilar ischemia. Even though dizziness/vertigo usually accompanies other neurologic symptoms and signs in cerebrovascular disorders, a diagnosis of isolated vascular vertigo is increasing markedly by virtue of recent developments in clinical neurotology and neuroimaging. It is important to differentiate isolated vertigo of a vascular cause from more benign disorders involving the inner ear, since therapeutic strategies and prognosis differ between these two conditions...
2016: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/27637648/surgical-approach-to-ponto-mesencephalic-cavernoma
#14
Yasuhiko Kaku, Hiroaki Takei, Masafumi Miyai, Kentarou Yamashita, Jouji Kokuzawa
BACKGROUND AND AIMS: The surgical treatment of intrinsic brainstem lesions remains a major challenge. In this article we present the results of using an infratentorial-supracerebellar (ITSC) approach for the resection of intrinsic ponto-mesencephalic lesions. MATERIALS AND METHODS: The authors reviewed the cases of 16 patients. In seven of them, a paramedian ITSC transcollicular approach was used to resect intrinsic mid-brain lesions, and in the other nine patients, an intermediate or lateral ITSC infra-trochlear approach was used for ponto-mesencephalic lesions...
2016: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/27606031/partial-oculomotor-nerve-palsy-in-a-7-year-old-child
#15
Anil Israni, Biswaroop Chakrabarty, Atin Kumar, Sheffali Gulati
Oculomotor nerve palsy can be due to varied causes that include diabetic neuropathy, myasthenia gravis, brainstem infarction, demyelinating conditions, and cerebral aneurysms. Among the aneurysmal causes of oculomotor nerve palsy, aneurysm of the posterior communicating artery has been observed to be the most common. Pupillary dysfunction is considered to be an important feature of aneurysmal oculomotor nerve paresis. A case of a 7-year-old boy with partial oculomotor nerve palsy with pupillary sparing is being reported here, the etiology of which is tortuous and ectatic distal internal carotid artery...
April 2016: Journal of Pediatric Neurosciences
https://www.readbyqxmd.com/read/27593970/acute-bithalamic-infarct-manifesting-as-sleep-like-coma-a-diagnostic-challenge
#16
Asaf Honig, Ruth Eliahou, Roni Eichel, Ari Aharon Shemesh, Tamir Ben-Hur, Eitan Auriel
Bilateral thalamic infarction (BTI) typically presents as a sleep-like coma (SLC) without localizing signs, posing a diagnostic challenge that may lead the treating physician to search for toxic or metabolic causes and delay treatment. We review our experience with BTI of different etiologies, and emphasize the critical role of timely imaging, diagnosis, and management in a series of 12 patients with a presentation of SLC and acute BTI who were managed in our Medical Centers from 2006-2015. In 11/12, urgent head CT scans showed normal brain tissue, while diffusion-weighted (DWI) MRI revealed symmetric bilateral thalamic hyperintense lesions with variable degrees of brainstem involvement...
September 1, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27543449/shaggy-lame-fox-syndrome-in-pribilof-island-arctic-foxes-alopex-lagopus-pribilofensis-alaska
#17
T R Spraker, P A White
A previously unrecognized condition is described in wild free-ranging Pribilof arctic foxes (Alopex lagopus pribilofensis) from the Pribilof Islands, Alaska, USA. This condition is called shaggy lame fox syndrome (SLFS) denoting the primary clinical signs first observed. Criteria used to suspect SLFS on gross examination included emaciation, failure to shed winter pelage and moderate to severe polyarthritis. Criteria used to confirm SLFS histologically included polyarthritis (characterized by lymphoplasmacytic synovitis, tenosynovitis, bursitis, periosteal bony proliferation, and periarticular lymphoplasmacytic vasculitis) and systemic leukocytoclastic vasculitis...
August 19, 2016: Veterinary Pathology
https://www.readbyqxmd.com/read/27484878/brainstem-monitoring-in-the-neurocritical-care-unit-a-rationale-for-real-time-automated-neurophysiological-monitoring
#18
James L Stone, Julian E Bailes, Ahmed N Hassan, Brian Sindelar, Vimal Patel, John Fino
Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring...
August 2, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27424849/cough-reflex-attenuation-and-swallowing-dysfunction-in-sub-acute-post-stroke-patients-prevalence-risk-factors-and-clinical-outcome
#19
N Vilardell, L Rofes, W V Nascimento, D Muriana, E Palomeras, P Clavé
BACKGROUND: Cough and swallowing impairments in post-stroke patients (PSP) have been associated with increased risk for respiratory complications. AIMS: To assess the prevalence of alterations in protective cough responses in subacute PSP and its association with oropharyngeal dysphagia (OD), clinical, and neurotopographic stroke factors and clinical outcomes. METHODS: Three months after stroke, the cough reflex test (CRT) was performed by nebulizing incremental citric acid concentrations (7...
July 18, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/27411797/massive-spontaneous-symptomatic-hemorrhagic-transformation-following-pontine-infarction-a-case-report
#20
Yu-Hsiang Su, Sheng-Feng Sung
PURPOSE: Spontaneous hemorrhagic transformation is common in anterior circulation infarction, but is rarely seen in brainstem infarction. We report a case of massive symptomatic brainstem hemorrhagic transformation in a patient with pontine infarction treated with only antiplatelet agents. CASE REPORT: A 59-year-old man presented with acute dysarthria and right sided weakness. His Glasgow coma scale was E3 V5 M6. His pupils were pinpoint in size and minimally reactive to light...
March 2016: Acta Neurologica Taiwanica
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