INTRODUCTION: Hemifacial spasm (HFS) is a disorder characterized by a complex of symptoms with hyperactive motor dysfunction of the facial nerve. It is indicated that HFS in the majority of cases can be caused by a blood vessel compressing the nerve adjacent to the brainstem. PATIENTS AND METHODS: We studied and treated 44 patients with HFS. Magnetic resonance imaging (MR) and MR-angiography of the brain were performed in patients with HFS to asses the presence of an artery of the vertebrobasilar system compressing the root of the facial nerve. We evaluate the response to treatment with Botulinum toxin in these cases. 14 patients were excluded (6 patients presented HFS due to other lesions and in 8 patients the MR was not performed). The remaining 30 patients with idiopathic HFS underwent MR/MRA (3D-FISP) and it was also performed in 14 patients with synkineses after facial palsy to be used as controls. RESULTS: The MRA documented an abnormal position of the arteries surrounding the facial nerve (ipsilaterally to HFS) in 22 patients. The compressing artery was the PICA in 3 patients (10%), the AICA in 3 patients, the vertebral artery in 7 patients and the basilar artery in 8 patients, one patient showed a combined compression by AICA and PICA. The remaining 8 patients had a normal MRI. At the control group only one patient presented an abnormal AICA and the other had a normal MRI-MRA. Patients were followed-up for 22.4 months and after Botulinum toxin treatment patients kept 4.81 months free of symptoms. CONCLUSIONS: We recommend to perform MR studies in all HFS patients to rule out a secondary cause of the disease and MRA to evaluate the underlying vertebrobasilar abnormalities if surgery is planned. Botulinum toxin is a useful treatment in these patients and only after its failure, microvascular decompression will be considered.

Basilar Artery↗

PubMedDate not supplied

[Determination of Doppler parameters in the study of basal cerebral veins: basal vein of Rosenthal and middle cerebral vein].

INTRODUCTION: To date, little attention has been paid to the study of the venous system by means of transcranial Doppler ultrasound. The objective of our study was to learn how to localize cerebral blood flow and find the normal values of different ultrasonographic parameters. PATIENTS AND METHODS: We studied 20 healthy persons in whom the arterial system of the circle of Willis had previously been shown to be normal. Transcranial Doppler scan was done with the person lying face upwards, using a transtemporal 2 MHz catheter. In the study we included persons in whom at least one of the two veins could be studied unilaterally. RESULTS: We studied twelve men and eight women aged between 25 and 78 years. The basal vein of Rosenthal, localized bilaterally in 70% of the cases, was identified as a wave of low pulsation between segments P1 and P2 of the posterior cerebral artery, going away from the catheter at a speed of about 11 cm/second. The middle cerebral vein was found bilaterally in only 35% of the cases as a wave near to the middle cerebral artery but in the opposite direction, at an average velocity of approximately 11.7 cm/second and of low pulsation. CONCLUSIONS: In spite of the technical problems, which can be solved using contrast agents, it is possible to study the cerebral venous system by means of transcranial Doppler. Our Unit is the first in Spain to show this. We therefore wish to promote the use of transcranial Doppler in cerebral venous disorders.

Adult↗

PubMedDate not supplied

[Acute pseudobulbar paralysis: the use of diffusion techniques with magnetic resonance].

INTRODUCTION: Acute pseudobulbar palsy produced by bilateral cerebral infarctions is a rare syndrome, which includes among its symptoms mutism, severe dysphagia and diverse sensory-motor signs. CLINICAL CASES: We report two middle-aged patients who suddenly developed a severe dysarthria and dysphagia, which impeded their ability to speak and to feed themselves, with spasmodic laughing and crying and slight motor deficit ('pure' pseudobulbar palsy). The acute lesions, using conventional and diffusion-weighted magnetic resonance imaging, corresponded partially to the anterior choroidal artery (case 1: acute lesion in the left periventricular white matter and a subacute one in the right semioval centrum; case 2: acute lesions in the right frontal subcortical white matter and in the periventricular white matter adjacent to the left lateral ventricle). The favorable evolution of these patients in contrast to previously described patients with acute pseudobulbar palsy could indicate that the motor deficit is a prognostic factor for this syndrome. CONCLUSIONS: Diffusion-Weighted magnetic resonance imaging permits differentiation with high precision of the acute lesions in patients who present old ones. Sometimes multiple acute lacunar infarctions (MALI) are found to be responsible of the syndrome. Hypertension and diabetes are the risk factors for the small vessel disease underlying these MALI.

Acute Disease↗

PubMedDate not supplied

[Lack of correlation between plasma homocysteine levels and cerebral microangiopathy in patients wtih transient ischemic attack].

OBJECTIVE: The aim of this study is to evaluate cerebral MRI findings in patients with atherothrombotic transient ischemic attacks (TIA) and its correlation with plasma homocysteine (Hcy) levels. PATIENTS AND METHODS: A total of 62 consecutive patients with the diagnosis of TIA of atherothrombotic origin were studied. MRI examinations were performed in all patients for the evaluation of the presence of infarct and/or white matter hyperintensities (WMHI). Plasma Hcy levels were determined according to the method described by Smolin and Schneider modified. RESULTS: Plasma Hcy levels were significantly (p < 0.036) higher in patients with MRI-detected infarcts (9.69 +/- 2.06 mumol/l) compared with patients without infarcts (8.65 +/- 1.7 mumol/l. There was no correlation (p < 0.33) between plasma Hcy levels and the presence or absence of WMHI seen on MRI. CONCLUSIONS: In TIA patients, plasma Hcy levels were significantly higher in patients with cerebral infarcts, but did not correlate with the presence of WMHI. Our results suggest that mild hyperhomocysteinemia would be associated with large-medium vessel rather than with small vessel disease.

Adult↗

PubMedDate not supplied

[Diffusion-weighted magnetic resonance in the diagnosis of acute subcortical infarcts].

INTRODUCTION: The diagnostic efficacy of radiological studies in acute subcortical infarcts is limited by the low sensitivity of conventional computerized tomography (CT) and magnetic resonance (MR) in detecting small-sized infarcts, and the difficulty in differentiating acute from chronic lesions. Diffusion-weighted MR (DMR) has shown great sensitivity and specificity in the detection of small vessel ischemic lesions during the acute phase. OBJECTIVE: To determine the diagnostic value of DMR in the study of patients with subcortical infarcts during the acute phase. PATIENTS AND METHODS: We made a prospective analysis of 100 consecutive patients with a clinical diagnosis of subcortical infarct. In all cases MR examination was done within the first 10 days (average 3.9 days) following onset, using conventional and diffusion-weighted sequences. RESULTS: In all cases the DMR showed the presence of ischemic lesions which explained, at least partly, the clinical features of the stroke. In 42 patients (42%) the DMR gave relevant information for diagnosis, as compared with the conventional MR studies, by confirming the presence of an ischemic lesion responsible for the clinical picture. The percentage rose to 50% when the examination was done within the first two days. CONCLUSIONS: DMR gives useful information in a high percentage of patients with acute subcortical infarcts. This is due to its great sensitivity in the detection of acute lesions of small size, and capacity to distinguish acute from chronic lesions.

Acute Disease↗

PubMedDate not supplied

[Postprandial limb shaking].

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Aged↗