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https://www.readbyqxmd.com/read/28072702/hypersomnia-due-to-injury-of-the-ventral-ascending-reticular-activating-system-following-cerebellar-herniation-a-case-report
#1
Sung Ho Jang, Chul Hoon Chang, Young Jin Jung, Hyeok Gyu Kwon
RATIONALE: We report on a patient with hypersomnia who showed injury of the lower ascending reticular activating system (ARAS) following cerebellar herniation due to a cerebellar infarct, detected on diffusion tensor tractography (DTT). PATIENT CONCERNS: A 53-year-old male patient was diagnosed as a left cerebellar infarct, and underwent decompressive suboccipital craniectomy due to brain edema at 2 days after the onset of a cerebellar infarct. Three weeks after onset when the patient started rehabilitation, he showed hypersomnia without impairment of consciousness; he fell asleep most of daytime without external stimulation and showed an abnormal score on the Epworth Sleepiness Scale: 15 (full score: 24, cut off for hypersomnia: 10)...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28068949/plaque-distribution-of-low-grade-basilar-artery-atherosclerosis-and-its-clinical-relevance
#2
Jin Yu, Ming-Li Li, Yu-Yuan Xu, Shi-Wen Wu, Min Lou, Xue-Tao Mu, Feng Feng, Shan Gao, Wei-Hai Xu
BACKGROUND: The underlying pathophysiology of BA distribution is unclear and intriguing. Using high-resolution magnetic resonance imaging (HR-MRI), we sought to explore the plaque distribution of low-grade basilar artery (BA) atherosclerosis and its clinical relevance. METHODS: We retrospectively analyzed the imaging and clinical data of 61 patients with low-grade atherosclerotic BA stenosis (<50%). On HR-MRI, the plaques were categorized based on the involvement of the ventral, dorsal, or lateral sides of BA wall...
January 10, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28068928/newly-recognized-cerebral-infarctions-on-postmortem-imaging-a-report-of-three-cases-with-systemic-infectious-disease
#3
Sakon Noriki, Kazuyuki Kinoshita, Kunihiro Inai, Toyohiko Sakai, Hirohiko Kimura, Takahiro Yamauchi, Masayuki Iwano, Hironobu Naiki
BACKGROUND: Postmortem imaging (PMI) refers to the imaging of cadavers by computed tomography (CT) and/or magnetic resonance imaging (MRI). Three cases of cerebral infarctions that were not found during life but were newly recognized on PMI and were associated with severe systemic infections are presented. CASE PRESENTATIONS: An 81-year-old woman with a pacemaker and slightly impaired liver function presented with fever. Imaging suggested interstitial pneumonia and an iliopsoas abscess, and blood tests showed liver dysfunction and disseminated intravascular coagulation (DIC)...
January 10, 2017: BMC Medical Imaging
https://www.readbyqxmd.com/read/27960164/clinical-stroke-syndromes
#4
Jong S Kim, Louis R Caplan
The main mechanism of stroke in patients who have extracranial atherosclerosis is artery to artery embolism, occasionally associated with hemodynamic disturbances. Although these mechanisms are also important in patients with intracranial atherosclerosis, branch occlusion and in-situ thrombotic occlusion play a relatively more important role in these patients. Accordingly, clinical stroke syndromes differ between extracranial atherosclerosis and intracranial atherosclerosis. In anterior circulation, middle cerebral artery atherosclerosis frequently produces subcortical infarction by way of branch occlusion...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27924054/frequency-and-predictors-of-dysphagia-in-patients-with-recent-small-subcortical-infarcts
#5
Simon Fandler, Thomas Gattringer, Sebastian Eppinger, Kathrin Doppelhofer, Daniela Pinter, Kurt Niederkorn, Christian Enzinger, Joanna M Wardlaw, Franz Fazekas
BACKGROUND AND PURPOSE: Detailed data on the occurrence of swallowing dysfunction in patients with recent small subcortical infarcts (RSSI) in the context of cerebral small vessel disease are lacking. This prompted us to assess the frequency of and risk factors for dysphagia in RSSI patients. METHODS: We identified all inpatients with magnetic resonance imaging-confirmed RSSI between January 2008 and February 2013. Demographic and clinical data were extracted from our stroke database, and magnetic resonance imaging scans were reviewed for morphological changes...
January 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27854093/posterior-reversible-encephalopathy-syndrome-mimicking-brainstem-infarction-a-dilemma
#6
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/27801767/pontine-warning-syndrome-a-chameleon-of-ischemic-stroke
#7
Alejandro Enriquez-Marulanda, Pablo Amaya-Gonzalez, Jorge L Orozco
INTRODUCTION: Crescendo transient ischemic attacks or "Stroke Warning Syndromes" consist of stereotyped frequent short-lasting episodes of focal neurological deficits. This is explained by intermittent hypoperfusion of the vascular territory of terminal arteries with insufficient collateral flow, presenting a high risk for subsequent infarction. Pontine warning syndrome (PWS) is a subtype of this atypical presentation of stroke/transient ischemic attack and is considered a challenge for diagnosis...
November 2016: Neurologist
https://www.readbyqxmd.com/read/27790399/acute-pontine-infarction-due-to-basilar-artery-dissection-from-strenuous-physical-effort-one-from-sexual-intercourse-and-another-from-defecation
#8
Su-Ho Kim, Yoon-Soo Lee, Sang-Jun Suh, Jeong-Ho Lee, Kee-Young Ryu, Dong-Gee Kang
A basilar artery dissection (BAD) is an extremely rare disease. It can lead to hemorrhage or infarction involving the brain stem, and is often associated with grave outcome. However, little is known about the pathophysiology of BAD, and its proper managements are yet in controversy. Herein, we report on two rare cases of basilar artery dissection from strenuous physical effort; one from sexual intercourse and another from defecation. The treatment modalities and the outcomes are also discussed.
June 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/27783098/-degenerative-cerebellar-diseases-and-differential-diagnoses
#9
W Reith, S Roumia, P Dietrich
CLINICAL/METHODICAL ISSUE: Cerebellar syndromes result in distinct clinical symptoms, such as ataxia, dysarthria, dysmetria, intention tremor and eye movement disorders. STANDARD RADIOLOGICAL METHODS: In addition to the medical history and clinical examination, imaging is particularly important to differentiate other diseases, such as hydrocephalus and multi-infarct dementia from degenerative cerebellar diseases. Degenerative diseases with cerebellar involvement include Parkinson's disease, multiple system atrophy as well as other diseases including spinocerebellar ataxia...
October 25, 2016: Der Radiologe
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
#10
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/27707197/location-of-acute-infarcts-and-agitation-and-aggression-in-stroke
#11
Wai Kwong Tang, Xiang Xin Liu, Huajun Liang, Yang Kun Chen, Winnie Chiu Wing Chu, Anil T Ahuja, Jill Abrigo, Vincent Chung Tong Mok, Gabor S Ungvari, Ka Sing Wong, Gianfranco Spalletta
The role of the infarct location in the development of poststroke agitation (PSA) is largely unknown. This study examined the association between the locations of infarcts and PSA at 9 months following the index stroke in 213 patients with the Chinese version of the Neuropsychiatric Inventory. Compared with the non-PSA group, PSA patients had a higher number and volume of acute pontine infarcts. Ventral pontine and lateral cerebellar infarcts were independent predictors of PSA in the multivariate analysis.
October 6, 2016: Journal of Neuropsychiatry and Clinical Neurosciences
https://www.readbyqxmd.com/read/27666438/disruption-of-a-mir-29-binding-site-leading-to-col4a1-upregulation-causes-pontine-autosomal-dominant-microangiopathy-with-leukoencephalopathy
#12
Edgard Verdura, Dominique Hervé, Françoise Bergametti, Clémence Jacquet, Typhaine Morvan, Carol Prieto-Morin, Alexandre Mackowiak, Eric Manchon, Hassan Hosseini, Charlotte Cordonnier, Isabelle Girard-Buttaz, Sophie Rosenstingl, Christian Hagel, Gregor Kuhlenbaümer, Elena Leca-Radu, Didier Goux, Lauren Fleming, Tom Van Agtmael, Hugues Chabriat, Françoise Chapon, Elisabeth Tournier-Lasserve
OBJECTIVE: Cerebral small vessel disease (cSVD) is a heterogeneous group of disorders. Screening of known cSVD genes identifies the causative mutation in <15% of familial cSVD cases. We sought to identify novel causes of cSVD. METHODS: We used linkage analysis and exome sequencing to identify the causal mutation in a French cSVD family. The identified candidate gene was then screened in 202 cSVD unrelated probands, including 1 proband from the first reported pontine autosomal dominant microangiopathy with leukoencephalopathy (PADMAL) family...
November 2016: Annals of Neurology
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
#13
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
#14
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...
November 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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
#15
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 19, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27567293/pathways-linked-to-internuclear-ophthalmoplegia-on-diffusion-tensor-imaging-in-a-case-with-midbrain-infarction
#16
Haruka Takeshige, Yuji Ueno, Koji Kamagata, Fuyuko Sasaki, Kazuo Yamashiro, Ryota Tanaka, Shigeki Aoki, Nobutaka Hattori
BACKGROUND: Midbrain infarction shows diverse patterns of ophthalmoplegia; however, the association of ophthalmoplegia with a precise microanatomy has not been fully studied. Here, we report a patient with characteristic ophthalmoplegia and explore the associated pathologic fiber tracts using diffusion-tensor imaging (DTI). METHODS: A 21-year-old woman with an 11-year history of mixed connective tissue disease (MCTD) abruptly developed bilateral internuclear ophthalmoplegia (INO) with upward gaze and convergence palsies...
November 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27532619/severe-white-matter-hyperintensity-is-associated-with-early-neurological-deterioration-in-patients-with-isolated-pontine-infarction
#17
Ki-Woong Nam, Jae-Sung Lim, Dong-Wan Kang, Yong-Seok Lee, Moon-Ku Han, Hyung-Min Kwon
OBJECTIVE: Pontine infarction is a common type of brain stem infarction and early neurological deterioration (END). We evaluated the possibility of severe white matter hyperintensity (WMH) as a predictor of END in isolated pontine infarction. METHODS: We recruited 2 types of patients with isolated pontine infarction within 24 h from symptom onset. END was defined as an increase of ≥1 point on the motor National Institutes of Health Stroke Scale (NIHSS) or ≥2 points on the total NIHSS score within 72 h from admission...
August 18, 2016: European Neurology
https://www.readbyqxmd.com/read/27525479/-salt-and-pepper-pontine-infarct
#18
Lance J Lyons, Susan W Law, John L Kubie
A paramedian pontine stroke may herald the unique symptom of "salt and pepper" eye pain, in which patients describe the sensation of pepper rubbed into the eye. While localization of the lesion is a common thread among published cases, the mechanism for the sensation of eye pain is still a matter of conjecture. It is important for clinicians to be aware of this unique symptom because strokes rarely present with eye pain and failure to establish this diagnosis might lead to a poor clinical outcome.
August 12, 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
https://www.readbyqxmd.com/read/27477571/cerebral-infarction-in-right-pons-during-the-course-of-mobile-mitral-annular-calcification-related-calcified-amorphous-tumor-during-a-long-time-hemodialysis
#19
Kazuyuki Saito, Mayumi Doi, Motohiro Karikusa, Konomi Sakata, Hiroki Sasaguri, Shuta Toru
We report here a 70 year-old male on maintenance hemodialysis who presented non-paralytic pontine exotropia. Brain MRI showed new right pons infarct. Transthoracic and transesophageal echocardiography revealed a mobile calcification at posterior mitral leaflet with rapid growing compared to 14 days ago. Neurological symptoms disappeared at least 10 days by a treatment with aspirin. Calcification reduced by a follow-up transthoracic echocardiography after 90 days from the beginning of neurological symptoms. We diagonosed him with cerebral infarction during the course of mobile mitral annular calcification-related calcified amorphous tumor...
August 31, 2016: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/27477418/alternating-hemiplegia-with-ipsilateral-supranuclear-facial-palsy-and-abducens-nerve-palsy-caused-by-pontine-infarction
#20
Shinichiro Maeshima, Tetsuya Tsunoda, Sayaka Okamoto, Yasunori Ozeki, Shigeru Sonoda
A 62-year-old right-handed man was diagnosed with a cerebral infarction in the ventromedial region of the left lower pons. He showed left abducens nerve palsy, left-sided supranuclear palsy of the lower part of the face and right hemiparesis. We hypothesized that the mechanism underlying the patient's ipsilateral supranuclear facial palsy involved the corticofacial fibers after they crossed the midline.
2016: Internal Medicine
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