Search PubMed⌕ Search

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.

At least 127 records · Page 7Linked to original sources
PubMed2000

[Diagnosis of acute cerebral infarction using diffusion-weighted imaging by low field (0.2 T) magnetic resonance image].

The purpose of this study is to confirm the diagnosis of acute cerebral infarction on diffusion-weighted imaging using low field (0.2 T) magnetic resonance image(MRI). Acute cerebral infarctions in 51 patients were examined on diffusion-weighted imaging using low field MRI within 48 hours after clinical symptoms. Diffusion-weighted imaging was examined using line scan method. Twenty-four cases were cortical infarction, and twenty-two cases were perforating infarction. In five cases out of 51 cases, ischemic regions were not detected as abnormal high signal intensity area on diffusion-weighted imaging. Four cases of no abnormal detection were transient ischemic attack, and the other one was a perforating infarction. The earliest detection time in cortical infarction cases was 1 hour and 20 minutes. On the other hand, the earliest detection time in perforating infarction cases was 3 hours. Detective ability for acute cerebral infarction on diffusion-weighted imaging by low field MRI was depending on both size and lesion of infarction. That is to say, either small size or brain stem infarction was hard to detect. Thin slice and vertical slice examination for the infarction may improve to diagnose in low field MRI. Our conclusion is acute cerebral infarction was able to be diagnosed on diffusion-weighted imaging by low field as well as high field MRI.

Acute Disease↗
PubMed1979

Pathogenesis of transient ischemic attacks within the vertebrobasilar arterial system.

Regional cerebral blood flow (rCBF) was measured by xenon 133 inhalation in 36 patients with vertebrobasilar arterial insufficiency (VBI), three patients with brain stem infarction, and 15 age-matched normal controls before and after inducing postural hypotension. Probes mounted over the suboccipital area by means of a helmet were used to measure rCBF over the brain stem and cerebellar regions. When lying flat, rCBF values measured over both cerebral hemispheres and the brain stem-cerebellar regions in patients with VBI were not significantly different from normal controls. Unlike carotid transient ischemic attacks, regional flow reduction rarely persisted for three weeks after transient ischemic symptoms in patients with VBI. When postural hypotension was induced, rCBF became significantly reduced in patients with VBI whether or not they were treated with papaverine. Dysautoregulation was restricted to vertebral, basilar, and posterior cerebral arterial distribution in patients with VBI of 1 to 12 months' duration, but was more widespread and involved both cerebral hemispheres in long-standing VBI. Hemodynamic factors and dysautoregulation appear to play a part in the pathogenesis of symptoms of VBI.

Adult↗
PubMed1997

Teaching diagnostic reasoning: using a classroom-as-clinic methodology with videotapes.

OBJECTIVES: The purpose of this study was to examine the effect of a "classroom-as-clinic" format, using videotaped occupational therapy evaluations, on students' diagnostic reasoning skills. In the classroom-as-clinic format, students write a problem list on the basis of preliminary client information before viewing the videotape. METHOD: A post-hoc experimental design was used to compare the accuracy of treatment plan problem lists for two groups of senior occupational therapy students--one group viewed two videotapes of client-therapist interactions without a classroom-as-clinic format (n = 82), and one group viewed the same videotapes within the context of a classroom-as-clinic format (n = 45). Both groups viewed the same two videotapes. Videotape 1 was of a client with a brain stem infarct, and Videotape 2 was of a client with traumatic brain injury. RESULTS: Subjects experiencing a classroom-as-clinic format identified significantly more occupational therapy problems for Videotape 1 than those who did not have preevaluation information. There was no significant difference between the two subject groups in the accuracy of their problem lists for Videotape 2. Only subjects in the non-classroom-as-clinic group showed a significant improvement from Videotape 1 to Videotape 2 in occupational therapy problem identification. CONCLUSION: This study suggests that to be truly effective when used videotapes, the classroom-as-clinic methodology needs to be combined with explicit coaching in problem sensing and problem definition.

Adult↗
PubMed1987

[Pharmacodynamic action of cavinton on regional volume blood flow, central hemodynamics and the bioelectric activity of the brain in the acute stage of a cerebral infarct].

Forty-two patients with acute cerebral infarction were studied for the regional volumetric cerebral blood flow (rVCBF) and central hemodynamics (by integral rheography of the body) before and after the intravenous administration of 10 or 20 mg of cavinton (vinpocetine). It was found that in the absence of changes in the central hemodynamics an increase in the cerebral blood flow was the predominant characteristic, but parodoxical reactions were occasionally observed in the acute period of an extensive hemispherical infarct. The findings of quantitative frequency analysis of the EEG conducted in 40 patients correlated with the results of the study of the blood flow and indicated a more favourable prognosis in brain stem infarction or mild cortical infarction. Treatment of extensive cortical infarction was associated with cases of parodoxical deterioration of brain function which should be taken into account in prescribing cavinton to patients during the acute stage of cerebral infarction.

Acute Disease↗
PubMed2007

Pitfalls in the diagnosis of cerebellar infarction.

BACKGROUND: Cerebellar infarctions are an important cause of neurologic disease. Failure to recognize and rapidly diagnose cerebellar infarction may lead to serious morbidity and mortality due to hydrocephalus and brain stem infarction. OBJECTIVES: To identify sources of preventable medical errors, the authors obtained pilot data on cerebellar ischemic strokes that were initially misdiagnosed in the emergency department. METHODS: Fifteen cases of misdiagnosed cerebellar infarctions were collected, all seen, or reviewed by the authors during a five-year period. For each patient, they report the presenting symptoms, the findings on neurologic examination performed in the emergency department, specific areas of the examination not performed or documented, diagnostic testing, the follow-up course after misdiagnosis, and outcome. The different types of errors leading to misdiagnosis are categorized. RESULTS: Half of the patients were younger than 50 years and presented with headache and dizziness. All patients had either incomplete or poorly documented neurologic examinations. Almost all patients had a computed tomographic scan of the head interpreted as normal, and most of these patients underwent subsequent magnetic resonance imaging showing cerebellar infarction. The initial incorrect diagnoses included migraine, toxic encephalopathy, gastritis, meningitis, myocardial infarction, and polyneuropathy. The overall mortality in this patient cohort was 40%. Among the survivors, about 50% had disabling deficits. Pitfalls leading to misdiagnosis involved the clinical evaluation, diagnostic testing, and establishing a diagnosis and disposition. CONCLUSIONS: This study demonstrates how the diagnosis of cerebellar infarction can be missed or delayed in patients presenting to the emergency department.

Adult↗
PubMed1982

Treatment of chronic aspiration as a complication of cerebrovascular accident.

Chronic aspiration remains one of the most difficult complications to treat in the patient recovering from brain stem infarction. Aspiration in these patients is often due to an incompetent glottis in association with dysfunction of the pharyngeal phase of swallowing. A systematic approach to the evaluation and treatment of these patients is presented with illustrative case presentations. Such individual treatment protocols allow for optimum rehabilitation of the post-stroke victim.

Brain Stem↗
PubMedDate not supplied

Acute stroke evaluated by time-to-peak mapping during initial and early follow-up perfusion CT studies.

BACKGROUND AND PURPOSE: Early diagnosis of perfusion deficits in patients with acute stroke could guide treatment decisions and improve prognosis. We investigated the sensitivity of perfusion CT studies using parametric time-to-peak maps to assess ischemic brain tissue with respect to early infarct signs on native CT scans. METHODS: First-pass, single-section perfusion CT was performed in 20 patients who presented with symptoms of acute stroke within 6 hours of onset. Initial CT perfusion studies were compared with follow-up studies within 30 hours in 10 patients. A manual, region of interest (ROI)-based, local evaluation procedure was performed to determine delayed time-to-peak values and diminished peak amplitudes. In addition, time-to-peak parameter maps were processed off-line from the dynamic CT data sets to identify areas of perfusion deficits, which were expressed as hemispheric lesion areas (HLAs). Evolution of the ischemic regions was assessed by comparing the HLA on the initial and follow-up studies as well as on the native CT scan of the follow-up studies. RESULTS: Diagnostic time-to-peak maps were generated in 19 of 20 initial and in nine of 10 follow-up perfusion CT studies. The initial time-to-peak map showed perfusion deficits in 14 of 20 patients. Hemispheric territorial infarcts were diagnosed with a sensitivity of 93%. Perfusion deficits in two patients with brain stem infarctions and three patients with lacunar strokes were missed. Follow-up time-to-peak maps showed the extent of reperfusion after various therapeutic strategies. CONCLUSION: Perfusion CT is potentially useful for detecting cerebral perfusion deficits in acute ischemic stroke before morphologic changes are observable on native CT scans. Compared with a locally restricted ROI-based evaluation, time-to-peak maps provide sensitive, global indications of malperfused brain areas, facilitate lesion localization, and allow assessment of the evolution of the infarction during follow-up.

Acute Disease↗
PubMed1984

Saphenous vein patch grafts in carotid endarterectomy.

The clinical data and findings on the early postoperative intravenous digital subtraction angiograms (IVDSA's) were studied in 61 patients undergoing 70 consecutive conventional carotid endarterectomies and in 46 patients undergoing 50 consecutive carotid endarterectomies with a saphenous vein patch graft (SVPG). The IVDSA's were considered normal in 50 of 70 conventional carotid endarterectomies and in 46 of 50 carotid endarterectomies with SVPG (p = 0.004). The internal carotid artery (ICA) origin was consistently larger and had a more normal configuration after carotid endarterectomy with SVPG. Ballooning at the endarterectomy site was an uncommon finding and occurred with similar frequency in both groups; that is, after three conventional carotid endarterectomies and two carotid endarterectomies with SVPG. In the conventional group, early symptomatic thrombosis occurred in the ICA in one patient and in the common carotid artery (CCA), ICA, and external carotid artery (ECA) in two patients. Silent ICA occlusion was seen in three patients in the conventional group. There were no occlusions in the SVPG group (p = 0.04). Stenosis at the distal end of the ICA arteriotomy was found after nine conventional carotid endarterectomies, and was mild (less than or equal to 33% reduction in the lumen) in seven patients, moderate (34% to 66%) in one, and severe (greater than or equal to 67%) in one. Mild distal ICA stenosis was seen in one case after carotid endarterectomy with a SVPG (p = 0.03). Stenosis of 33% or less was found at the proximal end of the CCA arteriotomy after two carotid endarterectomies in the conventional group and one carotid endarterectomy in the SVPG group. Four patients in the conventional group suffered a postoperative cerebral infarct and one patient in the SVPG group suffered a postoperative brain-stem infarct (p = 0.28). The authors' findings have led them to routinely use a SVPG in carotid endarterectomy.

Aged↗
PubMed1983

The analysis of acquired dysarthria in childhood.

A rare case of acquired dysarthria caused by a brain-stem infarct in a six-year-old boy is reported. Applying the analysis of Darley et al. (1969, 1975), 14 'dimensions' of dysarthria were recognised. The course of this dysarthria is described, by comparing samples of spontaneous speech, repetition and singing. The dysarthria is mainly characterised by imprecise consonants, distorted vowels, hypernasality and a breathy voice.

Brain Stem↗
PubMed1993

[Oculomotor paralysis as the leading symptom of meningovascular syphilis. Report of two patients and review of the literature].

A brain stem infarction in the area of the nerve fascicle of the oculomotor nerve could be demonstrated by NMR to be the cause of a complete oculomotor nerve palsy in a patient with neurosyphilis. A second case presented the very rare finding of an isolated bilateral incomplete oculomotor nerve paresis with external paresis on the right and internal paresis on the left side.

Brain Stem↗
PubMed1993

Seastroke: a new entity?

Three previously healthy young male patients had brain stem infarction (stroke) after swimming or wading in shallow water along the southeastern North Carolina coastline. Each patient remembered an unusual encounter with something in the water. None sustained any obvious local envenomation. Although these cases may be a highly unusual coincidence, I believe they represent a previously unidentified entity--"seastroke." I speculate that the injuries could be caused by contact with a toxic marine animal.

Adolescent↗
PubMed1995

Eye movement abnormalities in systemic lupus erythematosus.

OBJECTIVE: To describe eye movement abnormalities in patients with systemic lupus erythematosus (SLE). DESIGN: Between January 1, 1970, and June 30, 1995, 113 patients with a clinical diagnosis of SLE were examined. Of these, 33 had ocular motor abnormalities and a diagnosis of SLE as defined by the revised criteria of the American College of Rheumatology. SETTING: Patients hospitalized on the wards of the Los Angeles County-University of Southern California Medical Center, Los Angeles. SUBJECTS: Thirty-three patients, 82% women, ranging in age from 19 to 58 years (mean, 33.5 years). The average duration of SLE was 3.5 years, and 10 patients had been symptomatic for 5 years or longer. RESULTS: Of 55 ocular motor signs, 33 involved limitation of eye movements or abnormal eye position at rest; abnormal spontaneous eye movements occurred 12 times; ptosis was seen in eight patients and psychogenic signs in two. Sixteen patients (48%) had brain-stem infarcts; 11 had other known causes, including three with meningitis, two with hysteria, and one each with ocular myositis, pseudotumor cerebri, both ocular myositis and pseudotumor cerebri, Guillain-Barré syndrome, hyperosmolality, and hypoxic encephalopathy. In four patients with isolated sixth nerve palsies and two with isolated ptosis, the cause remained unknown. CONCLUSIONS: Ocular motor signs in SLE are uncommon and often transitory. When present, they help to ascertain the location, and often the cause, of neurologic involvement.

Adult↗
PubMed1991

"One-and-a-half" syndrome after a resection of a midline cerebellar astrocytoma: case report and discussion of the literature.

This report describes a rare complication after the resection of a tumor of the posterior fossa, the "one-and-a-half" syndrome. The one-and-a-half syndrome is a disturbance of horizontal eye movements in which patients have lateral gaze palsy in one direction and internuclear ophthalmoplegia in the other direction. The patient was a 54-year-old woman who developed headaches, diplopia, and blurred vision over 6 months. Computed tomographic scans and magnetic resonance imaging demonstrated an enhancing, mixed density, midline mass of the cerebellum. After a resection of the mass, an anaplastic astrocytoma, the patient complained of more severe diplopia and facial weakness. An examination disclosed a left one-and-a-half syndrome, left peripheral facial paralysis, dysarthria, dysphagia, mild left hemiparesis, dysmetria of the left upper limb, and truncal ataxia. The brain stem showed no abnormalities on postoperative computed tomographic scans. After 4 months of follow-up, the one-and-a-half syndrome had not improved, even though other signs had improved or resolved. This syndrome is caused by damage to structures within the pontine tegmentum: the medial longitudinal fasciculus, the ipsilateral paramedian pontine reticular formation, or the ipsilateral abducens nucleus. Multiple sclerosis and brain stem infarction are the most common causes of the one-and-a-half syndrome. Less frequently, it is caused by primary and metastatic tumors of the brain stem and cerebellum. Rarely, the one-and-a-half syndrome can develop postoperatively after the removal of tumors of the posterior fossa. The mechanism of pontine tegmental injury remains unknown.

Astrocytoma↗
PubMed1993

Types of basilar artery syndrome: clinicoradiologic correlation.

Twenty-two patients with ischemic stroke, as a single event, in the territory of basilar artery (BA) are reported. On the basis of the findings from computerized tomography (CT) and clinico-radiologic features, the authors propose that this heterogeneous entity--the basilar artery (BA) syndrome--can be divided into five subtypes. Type 1 (complete type), characterized by infarctions in the whole territory of BA, is incompatible with life; type 2, with extensive brain stem infarct, may result in a locked-in state; and type 3, with infarctions in part of the BA territory (incomplete form or "partial syndrome") may have a more variable clinical outcome. However, type 4, with a top of the BA syndrome, and type 5, with negative CT BA syndrome (angiographically verified), are often more benign. Although initial CT scanning may infrequently be unrevealing, serial and follow-up CT scannings have proven their usefulness in the majority of cases as a noninvasive tool, in contrast to cerebral angiography, for predicting the short-term prognosis of BA syndrome.

Aged↗
PubMed1981

Unilateral internuclear ophthalmoplegia. The lack of inhibitory involvement in medial rectus muscle activity.

Inability to adduct the left eye beyond the midline was found in a patient after brain stem infarction. Pursuit movements, refixation saccades, and the vestibulo-ocular reflex were restricted to the temporal hemifield. Only near convergence led to an adduction of 15 degrees in the left eye. Nasally directed saccades were slow, and temporally directed saccades showed glissadic back-drift. Electromyography revealed a lack of burst activity in the left medial rectus; however, inhibition of the left (homolateral) and the right (contralateral) medial rectus muscles during off-saccades and in off-positions of gaze was normal. These observations suggest that inhibition for medial rectus motor neurons is not mediated by the medial longitudinal fasciculus. The findings are compatible with the neurophysiological data, which show that reductions of activity in the medial rectus motoneurons are largely caused by disfacilitation via internuclear neurons rather than by inhibition.

Brain Stem↗
PubMed1989

[Cerebellar infarction in the area of the posterior cerebellar artery. Clinicopathology of 28 cases].

We report a neuropathological study of cerebellar infarctions involving the territory of the posterior inferior cerebellar artery (PICA) in 28 cases. Fifteen cases involved the PICA territory only. In 13 cases infarctions in the anterior inferior cerebellar artery (AICA) territory and/or in the superior cerebellar artery (SCA) territory were also present. A thorough post-mortem study of the arterial supply of the brain from the heart up to the cerebellar arteries, including the cervical spine segment of the vertebral arteries was performed in 27 cases. The territory of the cerebellar infarcts has been ascertained. In 15/28 cases (54 percent), infarction involved the PICA territory only (17 infarcts). All of these cases had a benign outcome and death was due to another cause. Six of these were recent infarctions. None had evidence of swelling and tonsillar herniation. Infarcts were generally of small size and involved the entire PICA territory in only 2 cases. Most of these cases were unexpected discovered at autopsy. Cerebellar infarction in the territory of the medial branch of the PICA (9/17 infarcts) drew grossly a set square with a dorsal base and a ventral top headed for the IVth ventricle. Five out of these cases were associated with infarction in the dorsal and lateral medullary territories. Retrospective clinical study showed that they had been unnoticed or overshadowed by other neurological disorders (4 cases), or presented as Wallenberg's syndromes (4 cases), or as a pure vestibular syndrome (due to an infarction involving only the cerebellum) mimicking an acute labyrinthine disorder (1 case). Infarctions in the territory of the lateral branch of the PICA (5/17 infarcts) always occurred without medullary involvement. All of them were unexpectedly discovered at autopsy, and were unnoticed during the life (3 infarcts) or were overshadowed by other neurological disorders (2 infarcts). That was also the case in 2 cases of infarction in the whole PICA territory (3/17 infarcts). Thus infarctions strictly localized to the entire PICA territory only were rare. Thirteen/28 cases (46 p. 100) of infarction in the whole PICA territory were associated with infarction in the AICA and/or the SCA territories. This resulted from an association with other infarctions and not from an abnormally large territory of the PICA. Cerebellar swelling with brain stem compression and tonsillar herniation occurred 8/13 cases (62 p. 100). There were other massive median and paramedian brain stem infarctions involving midbrain, pons or medulla in 55 p. 100 of 13 cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗