Avellis' syndrome: the neurological-topographical correlation.
Explore the source record for details and available documents.
Adult↗
SEARCH · Search PubMed
Results for “Brain Stem Infarctions”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Auditory agnosia caused by a tectal germinoma.
Explore the source record for details and available documents.
Animals↗
Asymmetrical skin temperature in ischemic stroke.
BACKGROUND AND PURPOSE: Sympathetic dysfunction is known to manifest commonly in stroke as cardiovascular and sudomotor dysregulation, but the knowledge so far obtained concerning skin temperature and vasomotor changes in cerebrovascular diseases is contradictory. The purpose of the present study was to evaluate cutaneous temperature in ischemic stroke in a prospective follow-up study. METHODS: Skin temperature was measured at five sites on each side of the body at rest and after a heating stimulus in 44 patients with a hemispheric infarction, and in 19 patients with a brain stem infarction, in the acute phase and at 1 month and at 6 months after the infarction. RESULTS: Skin temperatures on the forearm, leg, and foot on the side contralateral to the site of infarction were significantly lower than on the ipsilateral side during the whole 6-month follow-up period. Asymmetrical temperature was associated with the presence of pyramidal tract signs in hemispheric infarction and with the presence of Wallenberg's syndrome in brain stem infarction. In hemispheric infarction, the degree of asymmetrical temperature correlated with the severity of limb paresis. CONCLUSIONS: A temperature decline in the limbs contralateral to the site of infarction seems to be a frequent, long-lasting consequence of autonomic failure in patients with stroke. The phenomenon seems to be associated with pyramidal tract signs and the presence of Wallenberg's syndrome.
Acute Disease↗
Diagnostic significance of symptomatology in brain stem ischaemic infarction.
Explore the source record for details and available documents.
Adult↗
Involuntary tonic spasms of a limb due to a brain stem lacunar infarction.
BACKGROUND AND PURPOSE: Although repetitive involuntary movements are a well-recognized manifestation of carotid occlusive disease, similar movements have not been reported with a lacunar infarction outside of the basal ganglia or subthalamic nucleus. We describe a man with tonic spasms associated with a lacunar infarction in the right ventral pons. CASE DESCRIPTION: Involuntary tonic spasms of a paretic limb developed acutely in a 69-year-old hypertensive man with a clinical presentation of pure motor hemiparesis. Magnetic resonance imaging demonstrated a lacunar infarction of the ventral pons. There was no evidence for carotid occlusive disease. An electroencephalogram recorded during the movements showed no abnormality. The abnormal movements responded well to treatment with oral diazepam. CONCLUSIONS: A brain stem lacunar infarction may be associated with involuntary tonic limb spasms clinically similar to those reported as paroxysmal symptoms of multiple sclerosis.
Aged↗
"Fou rire prodromique" as the presentation of pontine ischaemia secondary to vertebrobasilar stenosis.
"Fou rire prodromique" (prodrome of crazy laughter) is a rare form of pathological laughter of uncertain pathophysiology. A patient is presented with pathological laughter as the first manifestation of pontine ischaemia due to vertebrobasilar stenosis. A 65 year old man developed uncontrollable and unemotional laughter for almost an hour followed by transient right facial-brachial paresis. He had fluctuation of laughter, right facial brachial paresis, and occasional crying. Magnetic resonance imaging, magnetic resonance angiogram (MRA), and an angiogram showed small left pontine and cerebellar infarcts, left vertebral artery occlusion, and right vertebral and basilar artery stenosis. His condition deteriorated to bilateral brain stem infarction and he died. Necropsy confirmed the extensive brain stem infarction. Pathological laughter can be the very first presenting manifestation of ischaemia of the ventrotegmental junction of the upper pons. It is hypothesised that the pathological laughter in this patient was secondary to ischaemic ephaptic stimulation of the descending corticopontine/ bulbar pathways.
Aged↗
Evaluation and graduation of brain stem auditory evoked potentials in patients with neurological diseases.
Based on normative data from 40 subjects, criteria for evaluating brain stem auditory evoked potentials have been elaborated. This system contained six grades from normal to diffusely abnormal, and was used in evaluating recordings from 142 patients, including 38 patients with definite and 48 with probable and possible multiple sclerosis, 18 patients with brain stem infarctions, six patients with other organic brain stem lesions, six patients with a postcommotional syndrome and 26 patients without any brain stem involvement. A statistically significant difference was found between normal persons and patients without evidence of brain stem lesions versus patients with such evidence, as well as between subgroups of slightly and severely affected patients. The system was found useful as a way of describing recordings, in company groups of patients and in a follow up of a few patients.
Adult↗
[Cheiro-oral syndrome with pontine infarct--report of a case].
A case of cheiro-oral syndrome presumably due to brain stem infarction was reported. A 41-year-old man suddenly experienced the numbness of the palm and the lips on the left side at 2 p. m. March 30, 1982 and was admitted to our clinic at 5 p.m. on that day. Neurological examination on admission revealed hypesthesia of the palm and the lips on the left side, but pain and temperature sensibilities were preserved. Neither astereognosia nor extinction phenomenon was there. CT scan showed no abnormal findings. At 9 p.m. his speaking became somewhat obscure and he became unable to swallow fluid. And after ten hours or so, he became quadriplegic, anarthric and lost almost all voluntary movement below the eye, while his consciousness was preserved ("Locked-in" syndrome). CT scan taken on the 9th hospital day revealed brain stem infarction. He expired on the 58 th hospital day because of the exacerbation of pneumonia. At autopsy both vertebral arteries and basilar artery were markedly sclerotic. The rostral two-thirds of the basilar artery was occluded by organized thrombus. The serial microscopic sections through the midbrain and the medulla oblongata showed extensive infarction of the basis pontis. The tegmentum pontis remained free, except that a small offshoot of the infarct reached into the medial part of the medial lemniscus.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Giant fusiform aneurysm of the vertebro-basilar artery presenting with stroke.
The authors describe a case of giant fusiform aneurysm of the basilar artery presenting with ischemic symptoms. Angiography and CT revealed vertebro-basilar fusiform aneurysmal dilatation. Fusiform vertebro-basilar aneurysm is associated with various complications particularly brain stem infarction. Similar lesions in the literature are reviewed and the relationship between this clinical entity and cerebral ischemia, particularly brain-stem infarction are discussed.
Basilar Artery↗
Brain stem ischemia from intracranial dural arteriovenous fistula: case report.
BACKGROUND: Intracranial dural arteriovenous fistulas (AVFs) with spinal perimedullary venous drainage are rarely reported, but most of the patients initially have presented with myelopathy or subarachnoid hemorrhage. This is the first report of the intracranial dural AVF patient who presented with brain stem infarction. CASE DESCRIPTION: A 38-year-old woman experienced nausea and vomiting with an acute onset, followed by vertigo. Magnetic resonance imaging showed ischemic lesion in the medulla oblongata, and she was then sent to our hospital. On admission, she had nystagmus, swallowing difficulties, Homer syndrome, and right hemiparesis and hemisensory disturbance. Cerebral angiography revealed dural AVF draining into spinal perimedullary veins at the left transverse-sigmoid sinus. The patient was treated by transvenous embolization under local anesthesia. A microcatheter proceeded to the left sigmoid sinus via the internal jugular vein, and embolization of the sinus was performed using coils without complications. The patient's swallowing difficulties improved over a few days after the embolization, and one month later, there remained only a slight mild hemiparesis and hemisensory disturbance. Six months after the onset, there was no ischemic lesion in the brain stem on magnetic resonance imaging. CONCLUSIONS: In this case, we showed the possibility of brain stem infarction, caused by the intracranial dural AVF.
Adult↗
Clinical experience with diffusion-weighted MR in patients with acute stroke.
PURPOSE: Our purpose was to evaluate the clinical efficacy, sensitivity, and specificity of echo-planar diffusion-weighted MR imaging in patients with acute infarction. METHODS: We retrospectively analyzed 194 cases of acute ischemic stroke diagnosed clinically within 24 hours of onset and studied with echo-planar diffusion-weighted MR imaging. Examinations were considered to be positive for infarction when an increase in signal was noted on images acquired at a high b value but absent on images with a low b value. A final clinical diagnosis of acute stroke was used as the standard of reference. A subset of 48 patients scanned within 6 hours was also analyzed. RESULTS: Diffusion-weighted MR imaging studies were positive in 133 of 151 cases of infarction (88% sensitivity) and negative in 41 of 43 cases with no infarction (95% specificity). Two cases identified as positive on diffusion-weighted images had nonischemic diagnoses (1.5% false-positive rate). Diffusion-weighted imaging had a positive predictive value of 98.5% and a negative predictive value of 69.5%. Use of T2-weighted sequences as well as diffusion-weighted imaging produced no false-positive findings. Of the negative scans, 69.5% corresponded to transient ischemic attacks or infarcts (mostly small brain stem infarcts). When only cases scanned within 6 hours of onset were considered, the sensitivity rose to 94% and the specificity to 100%. CONCLUSION: Despite bias due to dependence between diffusion-weighted imaging and the final diagnosis, this analysis suggests high sensitivity and specificity for echo-planar diffusion-weighted imaging in the diagnosis of acute cerebral infarction, although negative scans did not rule out an ischemic pathogenesis.
Acute Disease↗
Cerebellar infarction with brain stem compression. Diagnosis and surgical treatment.
Explore the source record for details and available documents.
Adult↗
Basilar artery occlusion in rats.
The basilar artery is one of the three major sources of blood supply to the circle of Willis. To investigate the effects of basilar artery occlusion, we surgically exposed and coagulated the basilar artery in 25 rats. Basilar artery occlusion at any single point between the foramen magnum and the circle of Willis in 11 rats did not produce histologically detectable infarcts in the brain at 12-24 hours. Two-point occlusions of the basilar artery in 12 rats produced variable infarcts between the occlusion sites but no ischemic lesions elsewhere. After either single- or double-point occlusions, the proximal basilar artery refilled within 2-3 minutes. When the basilar artery was occluded above and below the origins of the anterior inferior cerebellar arteries, the artery segments between the occlusion points initially collapsed but refilled within 2-3 minutes in two rats. Basilar artery occlusions invariably suppressed cortical somatosensory evoked potentials by greater than 50%. Regardless of whether a brain stem infarct developed, somatosensory evoked potential amplitudes recovered to greater than baseline levels by 4 hours in seven of 17 rats and returned to baseline levels by 24 hours in every rat tested. We conclude that the occluded basilar artery receives extensive retrograde collateral blood flow and that somatosensory evoked potentials are exquisitely sensitive to basilar artery occlusion but are insensitive to whether brain stem infarcts develop.
Animals↗
Symmetrical optokinetic after-nystagmus loss in Wallenberg's syndrome and multiple sclerosis.
We have demonstrated abolition of OKAN in either horizontal direction with retention of caloric responses in 3 patients with unilateral brain stem infarcts. In one further patient with diffuse brain stem disease, we have been able to show bilateral loss of horizontal OKAN in the acute phase, with recovery during remission. These findings support the conclusion that the velocity storage mechanism or connections to it, are permanently disabled by unilateral medullary infarcts and may be temporarily disabled by demyelinating disease. Retention of caloric responses in the absence of OKAN would appear to be of assistance in the differential diagnosis between peripheral and central vestibular pathway lesions.
Humans↗
[High b-value diffusion-weighted imaging of acute brain infarction].
High b-value diffusion-weighted (DW) imaging obtained with a b-value of 2,000 s/mm2 offers theoretical advantages over DW imaging obtained with a b-value of 1,000 s/mm2 for detection of acute brain infarction. The purpose of this study was to determine whether high b-value DW images (b=2,000) are better than b=1,000 images for detection of diffusion change in patients with acute brain infarction. We compared diffusion-weighted (DW) images obtained with a b-value of 1,000 s/mm2 with those obtained with a b-value of 2,000 s/mm2 in 84 patients with small lesions (brain stem infarction, lacuna infarction) examined within 24 hours of clinical onset. Qualitative analysis was performed concerning lesion conspicuity. In quantitative analysis, contrast ratios (CR) were measured and findings of b=1,000 and b=2,000 images were compared. False-negative rate of b=1,000 and b=2,000 images were 23.8% and 3.6%, respectively, relative to the presense or absense of infarction on the follow-up MR or CT images. On qualitative analysis, lesions were more conspicuous on b=2,000 images. On quantitative analysis, as the b-value increased, mean CR increased. DW images aquired with a b-value of 2,000 s/mm2 were better than DW images aquired with a b-value of 1,000 s/mm2 for detection of diffusion change in patients with acute brain infarction.
Acute Disease↗
Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery.
BACKGROUND: Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery is rare. We present a case confirmed by 6 years of follow-up and autopsy. CASE DESCRIPTION: A 63-year-old man suffered from brain stem infarction. Computed tomography and angiography showed a fusiform aneurysm on the proximal portion of the basilar artery. At the time of the third attack 5 years later, complete thrombosis of the aneurysm was found, and the proximal basilar artery was occluded. On autopsy, an atherosclerotic aneurysm 15 mm in diameter was found. CONCLUSIONS: A large atherosclerotic fusiform aneurysm of the basilar artery often causes brain stem infarction and involves a risk of complete thrombosis of the aneurysm and subsequent parent artery occlusion.
Aged↗
Updated results of a pilot study of low dose craniospinal irradiation plus chemotherapy for children under five with cerebellar primitive neuroectodermal tumors (medulloblastoma).
PURPOSE: Children under 5 years old with medulloblastoma (MB) have a poor prognosis. They are more susceptible to the deleterious effects of craniospinal irradiation (CSART) and have a higher relapse rate when treated with low-dose CSART alone. We, thus, embarked on a prospective trial testing the usefulness of very low dose CSART and adjuvant chemotherapy. This is an update of a previous report on these patients. METHODS AND MATERIALS: Between January 1988 and March 1990, 10 patients with medulloblastoma were treated using 18 Gy radiation therapy (RT) to the craniospinal axis, a posterior fossa (PF) boost to 50.4-55.8 Gy and chemotherapy consisting of vincristine (VCR) weekly during RT. This was followed by VCR, cis-diamminedichloroplatinum (CDDP), and lomustine (CCNU) for eight, 6-week cycles. Patients between 18 and 60 months of age without evidence of tumor dissemination were eligible for study. Follow-up was available until September 1994 with a median follow-up for living patients of 6.3 years from diagnosis. RESULTS: Actuarial survival at over 6 years is 70 +/- 20%. Three of the 10 patients relapsed and died. In one patient, the relapse developed in the spine and brain outside the posterior fossa, in the second, concurrently in the posterior fossa, brain and spine, and the third, only in the spine. One surviving child developed a brain stem infarct 4.8 years after diagnosis and has since almost fully recovered. A mean intelligence quotient (IQ) score of 103 in six patients surviving at least 1 year is unchanged from the baseline group score of 107. Five children tested at baseline and 2 years following treatment had IQ scores of 101 and 102, respectively. Six children tested at baseline and at 3 years had IQ scores of 106 and 96, respectively. Excluding the child tested shortly after his brain stem infarct, baseline and 3 year IQ scores were 103 and 97, respectively. Five of the seven long-term survivors grew at rates significantly below their expected velocities during the follow-up period, while the others grew normally. Three patients have received growth hormone, and none have required thyroid replacement. CONCLUSIONS: These data suggest that medulloblastoma patients can be cured with chemotherapy and reduced doses of craniospinal irradiation. The low doses of CSART given by us in conjunction with cis-platin-based chemotherapy produce minimal neurocognitive damage. Growth velocities in very young children so treated are, however, dramatically reduced. Better means of improving the therapeutic ratio are still needed.
Age Factors↗
Dysphagia associated with cricopharyngeal dysfunction.
In protracted forms of dysphagia associated with neuromuscular dysfunction, myotomy of the upper esophageal sphincter has been suggested. The literature, however, is unclear about the indications and outcome of this procedure. In this article, 3 cases are presented of dysphagia associated with the failure of relaxation of the cricopharyngeus during swallowing. Two patients had brain stem infarctions and the 3rd had an inflammatory disease of the brain stem. In all patients, barium swallow revealed aspiration of contrast material into the trachea with failure of relaxation of the cricopharyngeal sphincter. Indirect laryngoscopy demonstrated partial paralysis of one or both vocal cords. In one, an emg of the laryngeal muscles showed normal results. A complete evaluation by the speech pathologist failed to reveal abnormality of the oral musculature in all patients. All patients required gastrostomies for their nutritional needs. Therapeutic modification and control of rate, quantity and consistency of food along with counseling for prevention of aspiration. Oral feeding, without aspiration, was achieved in the 3 patients within the treatment period, allowing removal of the gastrostomy. Cricopharyngeal myotomy, therefore, was not necessary in these patients, despite the long duration of the swallowing problem.
Brain Stem↗