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Results for “Brain Stem Infarctions”

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PubMed1993

Stroke subtypes among Hispanics living in Guayaquil, Ecuador. Results from the Luis Vernaza Hospital Stroke Registry.

BACKGROUND AND PURPOSE: Racial differences in stroke subtypes have been documented. Asians have a higher rate of cerebral hemorrhage than whites; however, there is little information about stroke subtypes among Hispanics. The purpose of this study was to determine the patterns of stroke subtypes in a population of Hispanics. METHODS: Five hundred consecutive patients with a first stroke were included. Patients were collected from hospital wards, the emergency department, and the outpatient clinic to ensure inclusion of patients with a wide range of stroke severity. Computed tomography was available in all cases. Patients with pure subarachnoid hemorrhage were excluded. RESULTS: There were 313 (62.6%) patients with an infarct and 187 (37.4%) with a hemorrhage. Hypertensive arteriolopathy was the most common cause of both infarcts and hemorrhages. The carotid territory was involved in 70.6% of the 313 patients with infarcts, the vertebrobasilar territory in 17.9%, multiple territories in 6.7%, and a watershed area in 4.8%. Hemorrhages were most often lobar (36.4%), followed by putaminal (30.5%), brain stem (9.1%), cerebellar (8%), thalamic (8%), ventricular (5.3%), and caudate (2.7%). CONCLUSIONS: This hospital-based stroke registry suggests that stroke in Hispanics has a pattern different from that in whites but similar to that in Asians. Cerebral hemorrhages occur three times more frequently in Hispanics than in whites.

Adult↗
PubMedDate not supplied

Brain damage in non-missile head injury secondary to high intracranial pressure.

A comprehensive neuropathological analysis was undertaken on 434 patients who died as a result of a non-missile head injury in order to determine the frequency and extent of brain damage secondary to high intracranial pressure (ICP) in head injury. Using the criterion of pressure necrosis in the parahippocampal gyrus as evidence of high ICP due to a supratentorial expanding lesion, it was established that the ICP had been high in 324 cases. In 42 of these there was no other brain damage attributable to a high ICP. There was evidence of secondary brain stem damage in 221 cases and in 44 of these the damage could be seen only microscopically. In 54 cases there was a contralateral peduncular lesion. Other abnormalities were infarction in the territories of various arteries and in the anterior lobe of the pituitary. There was a supracallosal hernia in 80 cases and haemorrhage in the oculomotor nerves in 48 cases. These results further emphasise the frequency and range of brain damage due to secondary vascular factors brought about by high ICP in a patient who has sustained a head injury.

Adolescent↗
PubMed2006

Fibronectin and neuroprotective effect of granulocyte colony-stimulating factor in focal cerebral ischemia.

Stroke is one of the leading causes of unnatural death and disability. No effective therapy is available. Recombinant human granulocyte colony-stimulating factor (rhG-CSF), as a mobilizing agent for bone marrow stem cells, can promote stem cell mobilization, homing to brain after cerebral ischemia. In the present study, the administration of G-CSF significantly increased number of CD34(+) cells in the marginal zone of the infarction. Rats receiving G-CSF had higher survival rate and lower infarction volume. Neurological behavior was improved, and the expression of fibronectin in the ischemic brain was increased, as compared to rats treated with vehicle. To mimic the ischemia-reperfusion injury in experimental animals, we employed hippocampal slice cultures that were first treated with oxygen and glucose deprivation (OGD) and then with oxygen-glucose resupply, finding that fibronectin significantly increased the neurite outgrowth of OGD hippocampal slices, upregulated the expression of Bcl-2 protein, and ameliorated the ultrastructure damage of OGD hippocampal slices.

Animals↗
PubMed1976

Computed tomography: evaluation of the posterior third ventricle.

The normal computed tomography (CT) appearances of the posterior third ventricle and related structures are presented. Seventy-six patients with lesions directly involving this ventricle were studied by CT, and results of other neuroradiological procedures evaluated. Primary tumors, metastases, hematomas, infarcts, and cysts may be reliably distinguished by CT, particularly if contrast enhancement is utilized. Size and density resolution limit the direct visualization of the aqueduct of Sylvius; stenosis however may be inferred. Small infarcts may be difficult to demonstrate by the use of CT scans without contrast enhancement, yet be shown by isotope scans.

Arachnoid↗
PubMed2006

Mesenchymal stem cells as trophic mediators.

Adult marrow-derived Mesenchymal Stem Cells (MSCs) are capable of dividing and their progeny are further capable of differentiating into one of several mesenchymal phenotypes such as osteoblasts, chondrocytes, myocytes, marrow stromal cells, tendon-ligament fibroblasts, and adipocytes. In addition, these MSCs secrete a variety of cytokines and growth factors that have both paracrine and autocrine activities. These secreted bioactive factors suppress the local immune system, inhibit fibrosis (scar formation) and apoptosis, enhance angiogenesis, and stimulate mitosis and differentiation of tissue-intrinsic reparative or stem cells. These effects, which are referred to as trophic effects, are distinct from the direct differentiation of MSCs into repair tissue. Several studies which tested the use of MSCs in models of infarct (injured heart), stroke (brain), or meniscus regeneration models are reviewed within the context of MSC-mediated trophic effects in tissue repair.

Animals↗
PubMed1996

[Traumatic basilar artery dissection presenting with "locked-in" syndrome: report of a case].

We encountered a case of traumatic basilar artery dissection presenting with "locked-in" syndrome. A 46-year-old-man fell approximately 2 meters and landed in an inverted position. He was admitted to our hospital after 4 days. He was in coma on admission, and neurological examination revealed that his pupils were 2 mm in size and reactive, the corneal reflex of both sides was absent, the pharyngeal reflex was absent, and quadriplegia was present. CT and MRI showed infarction at the ventral portion of the pons. 3D-CT and CT using a bone algorithm showed fractures of the upper clivus, the left petrous bone, and the left occipital condyle. Angiography showed a pearl and string sign at the upper basilar artery. It is suggested that the cause of the infarction of the ventral portion of the pons was the occlusion of the perforating arteries due to the basilar artery dissection, and the mechanism of the basilar artery dissection was the hyperextension or hyperflexion of the basilar artery by the movement of the brain stem caused by the traumatic impact. Repeated angiography revealed gradual improvement. Eventually he freed himself from the "locked-in" syndrome.

Basilar Artery↗
PubMedDate not supplied

[Functional structure and cerebrovascular circulation of the vestibulo-ocular formations of the brain stem of the human cerebrum].

This work is dedicated to the study of anatomo-physiological peculiarities of the construction and cerebrovascular circulation of the vestibulo-ocular formations of the brain stem of the human cerebrum. The analysis of anatomo-physiological data enable to convince that the arches of the vertical and horizontal vestibulo-ocular reflexes include many structures of the brain stem of the human cerebrum, which are located along its longitude from the superior colliculi to caudal sections of brain stem. There is an existence of separate mechanisms of horizontal and vertical vestibulo-ocular interaction. The peculiarity of cerebrovascular circulation of main vestibulo-ocular structures is their profuse vascularisation chiefly by branches of the vertebro basilar system of arteries, which widely connected between each other, providing sufficiently profuse circulation in normal conditions of vital activity. The anatomical information above has great importance for the correct interpretation of the symptoms of infarctions in vertebro-basilar pool of the cerebrum, diagnostics and expert appreciation of these pathological states.

Brain Stem↗
PubMedDate not supplied

Use of fluid attenuated inversion recovery (FLAIR) pulse sequences in MRI of the brain.

Fluid attenuated inversion recovery pulse sequences with a long echo time (TE) have been used to image the brain in one volunteer and four patients. The long inversion time used with this sequence suppresses the signal from CSF and the long TE produces very heavy T2 weighting. The marked reduction in flow artefact from CSF and the high T2 weighting enabled anatomical detail to be seen within the brain stem and produced high lesion contrast in areas close to CSF. Lesions were demonstrated with greater conspicuity than with conventional T2-weighted sequences in patients with cerebral infarction, low grade astrocytoma, and diplegia.

Adolescent↗
PubMed1993

Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke.

BACKGROUND AND PURPOSE: There have been few reports of strokes producing isolated or predominant ocular motor nerve palsies as a clinical manifestation. METHODS: We studied seven patients with brain stem stroke who had ocular motor palsies as the only or the predominant neurological manifestation, and we correlated their clinical features with radiological findings. RESULTS: Five patients had small strokes in the area of oculomotor nuclei or fascicles and showed various combinations of oculomotor disturbances. Three of these patients showed vertical gaze paresis of the opposite eye. One patient with a small hemorrhage near the aqueduct of Sylvius showed fourth nerve palsy on the contralateral side, and a patient with a small infarct in the pontine tegmentum showed isolated sixth nerve palsy. Nonocular minor neurological signs included trigeminal sensory changes in four patients and clumsy arm in two. Ocular and nonocular dysfunctions generally improved within several months. Radiological findings of the brain stem correlated well with the ocular signs. CONCLUSIONS: We conclude that acute brain stem stroke should be included in the differential diagnosis of isolated ocular motor nerve palsies and that appropriate diagnostic investigations should be performed in these cases.

Adult↗
PubMed1999

Vertebral and carotid artery dissection following chiropractic cervical manipulation.

A 50-year-old woman presented a sudden left occipital headache and a posterior circulation stroke after cervical manipulation for neck pain. Magnetic resonance imaging documented a left intracranial vertebral artery occlusive dissection associated with an ipsilateral internal carotid artery dissection with vessel stenosis in its prepetrous tract. This is the first reported case showing an associate vertebral and carotid artery dissection following cervical manipulation. Carotid dissection was asymptomatic and, therefore, its incidence may be underestimated. We emphasize that cervical manipulation should be performed only in patients without predisposing factors for artery dissection and after an appropriate diagnosis of neck pain.

Aortic Dissection↗
PubMed2006

[The preotective effects of total glycosides Rubus parviflolius on cerebral ischemic in rat].

OBJECTIVE: To observe the protective effects of total glycosides Rubus parviflolius (TGRP) on local cerebral ischemic. METHOD: The local cerebral ischemia in rat was made by middle cerebral artery occlusion(MACO). The infraction weight was determined by TTC stain. SOD, MDA, GSH and apoptotis were determined with different method respectively. RESULT: TGRP 20, 10 mg x kg(-1) ig markedly improved the abnormal nervous symptoms, incredsed the SOD, GSH activity and reduced contentes of MDA in brain of MACO rat, TGRP 20 mg x kg(-1) ig significantly decreased the numbers of apoptotic cells in ischemic cortex. CONCLUSION: TGRP has protective effects against cerebral infraction, and its mechanism may be related to anti-apoptotis and free radical.

Animals↗
PubMed1996

[Clinical features of anterior inferior cerebellar artery territory infarcts--a study of ten patients].

Clinical features of the anterior inferior cerebellar artery (AICA) territory infarcts were investigated in ten patients, ranging in age from 38 to 76 years. In all patients, there were MR images of infarction located in the area supplied by the AICA. The lesion was on the left side in 6 patients and right side in 4. The lesion of brain stem including the middle cerebellar peduncle was found in 7 patients and that extended to the cerebellum was in 3 patients. The main ipsilateral neurological signs were the VII and VIII cranial nerves palsy and cerebellar ataxia. The V and VI cranial nerves palsy. Horner's syndrome, and dysphagia were also present. The main contralateral sign was superficial sensory disturbance, but no hemiplegia. The underlying pathology included chiefly hyperlipidemia, hypertension, and diabetes mellitus. Cerebral angiography was performed in 8 patients, most of which was observed severe arteriosclerosis suggesting poor hemodynamics in the vertebral and basilar arteries. The prognosis was relatively good, but the VII, VIII, and V cranial nerves palsy and contralateral superficial sensory disturbance remained as the sequelae. As mentioned above, there were various neurological findings and MR images in AICA territory infarcts. Especially there were some patients whose lesion extended to the upper medulla and neurological findings were similar to the Wallenberg syndrome. It is important that one investigates not only axial slices but also coronal slices of MR image to estimate the extension of AICA territory infarct.

Adult↗
PubMedDate not supplied

[Ischemic cerebellar and brain stem lesions in CT findings].

The author analysed CT studies of 117 patients with ischaemic lesions of the cerebellum and brainstem. The clinical appearance in these cases is often unspecific. This was confirmed by false clinical diagnosis in most patients. CT diagnosis is particularly difficult in cases with mass effect which was found in 24.8% of the patients. Follow-up CT studies can help in proper diagnosis. The territory of the superior cerebellar artery was most frequently involved in the cerebellum, while the territory of the paramedian perforating in the brainstem. In 26.5% of the patients ischaemic lesions of the cerebellum and/or brainstem were bilateral, in 39.3% were accompanied by cerebral infarcts. It can be concluded that they are the component of general vascular insufficiency of the whole bain.

Adult↗
PubMed1989

Magnetic resonance imaging in posterior circulation infarction: impact on diagnosis and management.

To compare the diagnostic yield of magnetic resonance imaging (MRI) with computed tomography (CT) in posterior circulation infarction, we used proton MRI with a 0.3 Tesla magnet and a 3rd generation CT scanner in 25 patients. Age-matched controls were compared in a blinded fashion. Seventeen patients (68%) showed relevant pathology on MRI not seen on CT, 11 with normal CT and six with more extensive lesions, chiefly in the brain stem. Evidence of abnormal vertebrobasilar blood flow was seen in 8/25 (32%) of patients, suggested by vascular high intensity signals on MRI. Two tissue and one flow abnormality were seen in the control group. MRI provides additional information concerning infarct site, extent and pathogenesis in posterior circulation infarction.

Adult↗
PubMed1976

Computerized axial tomography findings in a group of patients with migrainous headaches.

Computerized axial tomography of the cranium has been carried out in 46 patients referred because recurring migrainous headaches. Increasing frequency or severity of headaches or a change in headache pattern were the usual reasons for referral. Abnormalities were found in 37 cases and fell into 4 categories. The most frequent (21 cases) consisted of a mild degree of oedema in the white matter of one or both cerebral hemispheres. This was usually bi-frontal (15 patients) but was more extensive in 2 patients. Varying degrees of cerebral atrophy, as determined by widening of the Sylvian, brain-stem and interhemispheric cisterns, and/or widening of the third and lateral ventricles as compared to a group of normal scans, was found in 8 cases. Areas of occipital infarction were found in 4 patients with permanent visual field defects. Unexpected small areas of infarction were found in the temporal lobe in 2 other cases. Cerebral tumours were found in 2 cases. The significance of these findings is discussed, as well as the possible role of migrainous vaso-spasm with consequent changes in cerebral blood flow in the pathogenesis of oedema and atrophy in migraine subjects.

Adolescent↗
PubMed1997

Early detection of neurological manifestations in achondroplasia.

Achondroplasia (ACh) is the most frequent bone dysplasia. The mode of inheritance is autosomal dominant. The incident of neurological complications ranges between 20% and 47%; frequently the symptoms are subtle but are due to such serious conditions as cervicomedullary compressive syndromes, syringomyelia or hydrocephalus; thus, the early identification of this disorder is very important. We made a prospective study of 39 patients (20 female, 19 male) with ACh; their ages ranged from 3 months to 17 years (mean 4 years and 6 months). All patients had hypotonia and psychomotor delay; 3 had recurrent apnea, 1 developed radicular syndrome and 1 had leg paresthesias. The CT scan was normal in 5, 20 had cortical atrophy and 18 communicating hydrocephalus; we identified foramen magnum abnormalities in 28 patients, and reduced craniocervical junction with cervicomedullary compression in 6. Myelography and myelotomography demonstrated spinal compression in 12 patients. The MRI showed cervicomedullary infarct in 1, syringomyelia in 2 and diastematomyelia in 1. The somatosensory evoked responses (SSER) were very useful in the early identification of brain stem and spinal abnormalities. We concluded that the neurological manifestations of pediatric patients with ACh are frequent and very important, demanding comprehensive clinical evaluation even in asymptomatic patients, especially those with severe hypotonia or SSER alterations.

Achondroplasia↗
PubMed2005

[Expression of Nestin following focal cerebral ischemia-reperfusion in rats].

OBJECTIVE: To study the expession of Nestin after focal ischemia-reperfusion in rats. METHODS: The model of acute reperfusion injury after cerebral ischemia in rat was made by middle cerebral artery occlusion. All animals were allowed 2 h ischemia and sacrificed after different durations of reperfusion (6 h, 12 h, 24 h, 72 h, 7 d, 14 d). The expression of Nestin was detected with an immunohistochemical approach. RESULTS: The number of Nestin- immunoreactive cells at 6 h after reperfusion in the ischemic side started to increase markedly and showed significant difference, compared with the Sham group (P < 0.05). The expression of Nestin and the number of Nestin positive cells with Brdu labeled peaked at 7 d after reperfusion and then were down-regulated at 14 d. CONCLUSION: The study implies cerebral ischemia could upregulate the expression of Nestin and induce the proliferation of nervous stem cells.

Animals↗