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Results for “Brain Stem Infarctions”

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At least 145 records · Page 8Linked to original sources
PubMed1996

The effect of botulinum toxin A on the function if a person with poststroke quadriplegia.

The purpose of this case report is to describe a 50-year-old man, who was 5 months post-brain-stem infarction, before and after botulinum toxin A injections to the biceps brachii and quadriceps femoris muscles. Prior to the injections, he exhibited quadriparesis and involuntary movements of the limbs in directions opposite to those that were being volitionally attempted. For example, as he began to reach with his arms (extend his elbows), his elbows would flex, and when he attempted to flex his legs, they would extend. The patient was evaluated prior to the injections, after the botulinum toxin A injections and 2 weeks of intensive inpatient rehabilitation, and 6 weeks after injections. Evaluations included the Functional Independence Measure (FIM), the Sickness Impact Profile (SIP), and evaluations of walking, bed mobility, and transfers. Prior to the injections, the patient walked 9.1 m (30 ft) with a bilateral platform walker and required total assistance for toilet transfers and maximal assistance for walking and for bed, chair, and wheelchair transfers. Levels of assistance were those defined by the FIM. After the injections and 2 weeks of rehabilitation, he walked distances greater than 45.7 m (150 ft) with one platform on his walker, required maximal assistance for toilet transfers, and required minimal assistance for walking and for bed, chair, and wheelchair transfers. Walking speed, FIM scores, and six areas of the SIP improved 2 and 6 weeks after injections.

Activities of Daily Living↗
PubMed2001

A new method to investigate brain stem structural-functional correlations using digital post-processing MRI--reliability in ischemic internuclear ophthalmoplegia.

We investigated the reliability of a new digital post-processing magnetic resonance imaging (MRI) technique in ischemic brain stem lesions to identify relations of the lesion to anatomical brain stem structures. The target was a medial longitudinal fasciculus (MLF) lesion, which was evident from ipsilateral internuclear ophthalmoplegia (INO). Sixteen patients with acute unilateral INO and an isolated acute brain stem lesion in T2- and EPI-diffusion weighted MRI within 2 days after the onset of symptoms were studied. The MRI slice direction was parallel and perpendicular to a slice selection of a stereotactic anatomical atlas. The individual slices were normalized and projected in the digitalized atlas. The eye movement disorder was monitored by electro-oculography. In all patients with clinical or subclinical electro-oculographically documented INO and MRI proven brain stem infarction the lesion covered or at least partially overlapped the ipsilateral MLF at one or more atlas levels. We conclude that digital post-processing MRI with normalizing and projecting brain stem lesions in an anatomical atlas is a reliable method to demonstrate the anatomical structures involved by the lesion. Combined with electrophysiological brain stem testing, this method may be a useful tool to identify incompletely understood pathways mediating brain stem reflexes or the generators of evoked potentials.

Adult↗
PubMed1983

The "Locked-In" syndrome following chiropractic manipulation of the cervical spine.

Reported is a case of a 34-year-old man, previously in good health, who underwent chiropractic manipulation of the cervical spine for treatment of a recent whiplash injury. Immediately following manipulation, the patient became unresponsive and was found to have sustained a brain stem infarction resulting in the "Locked-In" syndrome. Ten months following the initial insult, he remained tetraplegic and mute but able to communicate by eye blinking and vertical eye movements.

Adult↗
PubMed1973

Cisternal puncture complications. Treatment of coccidioidal meningitis with amphotericin B.

Of two patients who had acute neurologic damage from cisternal punctures, one died 17 hours following a tap which produced major subarachnoid hemorrhage, the other patient recovered from probable brain stem infarction associated with cisterna magna amphotericin injection. Subarachnoid hemorrhage is the commonest major complication of cisternal puncture, with at least 30 reported fatalities. Other serious complications result from direct puncture of brain substance.Cisternal puncture is not an appropriate alternative to a difficult lumbar puncture, and indications for its use are limited. The occasional required cisternal tap should be performed only by persons carefully trained in the technique, preferably utilizing fluoroscopic guidance, and only where neurosurgical assistance is readily available.Post-puncture subarachnoid hemorrhage accompanied by progressive obtundation requires emergency evaluation and consideration of posterior fossa decompression.

Adult↗
PubMed1979

Fatal basilar artery occlusion following cervical spine injury.

A patient rendered acutely quadriplegic in an automobile accident was shown by angiography to have occlusion of the left vertebral artery. One month later, he abruptly became unconscious, apneic and died. Autopsy showed an organised thrombus in the left vertebral artery and a fresh thrombus occluding the entire basilar artery. This case differs from previously reported cases of traumatic vertebral artery thrombosis wherein symptoms of brain stem infarction were more immediately evident.

Adult↗
PubMed1986

Human brain infarcts: Gd-DTPA-enhanced MR imaging.

During Food and Drug Administration phase II and III clinical trials for gadolinium DTPA, the paramagnetic agent was used to study 11 patients with 20 subacute and chronic cerebral infarcts. Five patients had numerous periventricular and deep white-matter lesions, probably due to chronic ischemic disease. Magnetic resonance (MR) imaging was performed 4-30 days after the ictus, preceded by computed tomography (CT) in all but one case. In most cases, the nonenhanced spin-echo (SE) images, obtained at 500-msec repetition times and 30-msec echo times, failed to demonstrate the infarct, and in general the gadolinium-enhanced SE 500/30 images matched the contrast material-enhanced CT scans in pattern. Periventricular lesions and small, deep, white-matter infarcts that were chronic and asymptomatic were not enhanced by gadolinium MR. However, three small, symptomatic capsular and brain-stem infarcts showed definite enhancement. Usually the enhancement was visible at 3 minutes, increasing to a peak at 30 minutes. At 55 minutes, the enhancement increased in the medium-aged infarcts (8-14 days), while it decreased in the late infarcts (15-30 days). The T2 relaxation time-weighted pulse sequences were most sensitive for demonstrating all infarcts, but without the aid of a contrast agent, they were frequently poor in specificity.

Adult↗
PubMed1974

Ptosis.

Twenty-five examples of ptosis occuring with an acute stroke are analysed. Thirteen of these patients had hemispheral infarctions in which ptosis could not be explained by third nerve or sympathetic dysfunction. The ptosis in these `cerebral' cases was bilateral, with other factors such as pyramidal tract damage determining the asymmetry of the ptosis. In some patients, the eyelid was ptosed on the side of a hemiparesis, narrowing the palpebral fissure. The anatomical basis for this is probably damage to pyramidal neurones or their fibres. The 10 cases of ptosis in relationship to brain-stem infarction included two patients with isolated complete ptosis in one eye in association with a contralateral third nerve palsy.

Aged↗
PubMed2003

[Acoustic neuroma surgery. Results and complications in 348 cases].

OBJECTIVES: The aim of this study was to evaluate post-operative complications after acoustic neuroma surgery. METHODS: This was a retrospective study of 348 patients, who had acoustic neuroma surgery between 1984 and 1999. Symptoms, pre-operative evaluation, surgery and post-operative complications were analysed. RESULTS: 174 men and 174 women had an operation. Mean age was 51.8 years (11-78). 31 patients had a grade I tumour, 106 a grade II, 71 a grade III and 140 had a grade IV tumour. 195 patients have been operated through the translabyrinthine approach, 110 through the retrolabyrinthine approach, 42 through the sub-occipital approach, and one through the transcochlear approach. Mortality was 0.85%, 59.2% patients had a post-operative facial paralysis. Most of patients had post-operative dizziness, and 30% still had vestibular disturbances after one year. 9 patients (2.6%) had a cerebrospinal rhinorrhea and 24 patients had a cerebrospinal wound leak (6.9%). 22 patients had post-operative meningitis (6.3%). 2 patients had a cerebello pontine angle haemorrhage, and 3 patients had a brain stem infarct. CONCLUSION: Transpetrous approaches are safe for acoustic neuroma removal and the post-operative complication rate is low. The retrolabyrinthine approach seems to be a good hearing preservative approach, regardless of tumour volume.

Adolescent↗
PubMed1990

[Cerebellar infarction: analysis of 33 cases].

During the past 9 years and 2 months we have encountered 33 cases with cerebellar infarction. These patients were classified into 3 types according to their clinical course. Type 1 (18 cases); The course was benign, and symptoms and signs improved without surgical treatment. Type 2 (11 cases); The course was progressive with deterioration of consciousness between 24-72 hours after the onset. Type 3 (4 cases); The course was rapid resulting in lapse into coma within a few hours. Also, its prognosis was fatal due to coexisting brain-stem infarction regardless of any treatment. Surgical intervention was required for Type 2 in which the lesion included the region of the vermis or occupied more than one-third of the cerebellar hemisphere, and had subsequently compressed the brain-stem and caused obstructive hydrocephalus. In 9 cases out of Type 2, ventricular drainage alone was performed and prompt improvement of consciousness level was detected except in one case. We consider that ventricular drainage is not so invasive a method, and it is beneficial. However, in 2 cases of Type 1 and 4 cases of Type 2, hemorrhagic infarction occurred. Thus, one should be aware of the possibility of hemorrhagic infarction, even though it may be asymptomatic infarction. If prompt improvement of consciousness is not detected after ventricular drainage, suboccipital craniectomy should be recommended.

Adult↗
PubMed1992

[Repeated treatment of subtotal vertebrobasilar stenosis with tissue plasminogen activator (tPA)].

We report on the successful repeated treatment of a patient with rapidly progressive severe brain-stem stroke by application of I.V. tissue plasminogen activator (tPA). This treatment twice led to a prompt remission of severe brain-stem symptoms, although a permanent therapeutic success could not be achieved. Unfortunately, the patient died a few days later from pneumonia and sepsis. Necropsy revealed bilateral partial brain-stem infarctions and a subtotal stenosis of the vertebrobasilar junction with superimposed fresh thrombus. The clinically dramatic response to tPA indicates that this type of treatment is potentially successful in high-grade subtotal basal cerebral artery stenosis with progressive stroke symptoms. In particular, application of tPA should be considered if stroke progression cannot stopped by therapeutic heprinization. A prospective randomized oligocentric study is advocated.

Aged↗
PubMed1987

Intravenous infusion of Diazemuls in the control of status-like epileptic seizures of different etiology.

This report concerns three patients in whom continuous intravenous infusion of Diazemuls (diazepam dissolved in soya bean oil and emulsified) diluted in 5.5% glucose was used for the controlling of epileptic seizures (status). Diazemuls infusion was effective in one patient with complex partial status epilepticus; in another patient with convulsion secondary to a brain stem infarct, the convulsions were abolished; while only reduced jerking was achieved in the third patient suffering from myoclonic jerks caused by anoxic brain damage. Infusion time ranged from 15 to 33 h. The serum concentrations of diazepam obtained during the infusions were higher than recommended in the literature for treatment of status epilepticus, but could not be correlated to either clinical efficacy or infusion rate.

Aged↗
PubMedDate not supplied

Sensorineural hearing loss: more than meets the eye?

PURPOSE: To assess the value of MR in patients with sensorineural hearing loss (SNHL) caused by lesions other than acoustic neuromas. METHODS: MR studies of 51 patients with SNHL were retrospectively reviewed; patients with acoustic neuroma were excluded to focus on the more uncommon causes. RESULTS: Twenty patients had labyrinthine lesions. Six patients had viral labyrinthitis, one patient had bacterial labyrinthitis, and one patient had luetic labyrinthitis. Three patients had hemorrhage in the labyrinth, two posttraumatic and one spontaneous from an adjacent temporal bone tumor. Only one of the two patients with traumatic labyrinthine hemorrhage had evidence of a fracture on high-resolution CT. In one patient with CT-proved cochlear otosclerosis, peri-cochlear foci of enhancement were seen on contrast-enhanced MR. Four patients had presumed labyrinthine schwannomas. A middle ear cholesteatoma in one patient invaded the cochlea and resulted in marked cochlear enhancement due to granulation tissue. Thirteen patients had intracanalicular and cerebellopontine angle lesions. The lesions included arteriovenous malformations (three patients), sarcoidosis (three patients), metastasis (two patients), lymphoma (two patients), lipomas (two patients), and postshunt meningeal fibrosis (one patient). Eighteen patients had intra-axial lesions responsible for SNHL. The most common intra-axial lesions were brain stem infarcts and multiple sclerosis. Traumatic lesions in the inferior colliculi, sarcoidosis, lymphoma, and extrinsic compression of the colliculi from a pineal tumor were also noted. CONCLUSION: MR can demonstrate numerous lesions responsible for SNHL other than acoustic neuromas. The entire acoustic pathways, including the labyrinth, internal auditory canal, cerebellopontine angle, and brain stem should be carefully scrutinized for lesions in patients with SNHL. The use of contrast media markedly increases the yield of MR in this clinical situation by demonstrating inflammatory and neoplastic labyrinthine lesions and meningeal pathology (both neoplastic and inflammatory) in the internal auditory canal and cerebellopontine angle cistern.

Adolescent↗
PubMed1993

Progressive intracranial occlusive disease associated with deficiency of protein S. Report of two cases.

BACKGROUND AND PURPOSE: Deficiency of the free fraction of protein S has been associated with arterial or venous stroke. The pathogenesis of vascular occlusion in patients with protein S deficiency is not known. We present two cases of cerebral infarction and deficiency of protein S in which the subjects had progressive intracranial occlusions. CASE DESCRIPTION: A 16-year-old girl was admitted because of left brain stem infarction and protein S deficiency. Cerebral angiography disclosed stenosis of the right intracranial vertebral artery and occlusion of the left posterior cerebral artery. A second angiogram performed 18 months later disclosed occlusion of the right vertebral intracranial artery. In the second case, a 17-year-old girl was admitted because of left hemispheric cerebral infarction and protein S deficiency. Cerebral angiography showed stenosis of the left anterior cerebral artery, left supraclinoid internal artery, and left middle cerebral artery. A second cerebral angiogram performed 5 months later disclosed occlusion of the left anterior cerebral artery and poor hemispheric perfusion through the left middle cerebral artery. CONCLUSIONS: Based on our cases, we postulate that some patients with prothrombotic states may develop progressive intracranial arterial occlusions, possibly secondary to a permanent thrombogenic stimulus. We suggest routinely searching for prothrombotic states in young patients with intracranial occlusion, especially if the occlusion is progressive and other causes are not obvious.

Adolescent↗
PubMed1990

Recurrent cranial nerve palsies, midbrain infarction and hydrocephalus due to megadolichobasilar artery.

A 67-year-old man presented four recurrent, alternating facial palsies, two right abducens palsies and eventually a right extrinsic third nerve palsy due to brain-stem infarction in a 37-year time-span. Neuroradiological examinations showed hydrocephalus and an elongated, tortuous, ectasic basilar artery. This patient presented in his lifetime the whole clinical spectrum of the dolichoectasic basilar artery complications.

Aged↗
PubMed1984

Initial experience with MR-imaging of intracranial midline-lesions and lesions of the cervical spine at half Tesla.

Fifty-two patients were examined both with computed tomography using a different third generation scanner and by magnetic resonance imaging (MRI) at half Tesla field strength (Philips Gyroscan 5 S). Excellent contrast and spatial resolution as well as initial comparative results of normal anatomy and also selected clinical cases were demonstrated with the spin-echo (SE) and/or inversion recovery (IR) technique. The clinical material included a residual prolactinoma after transphenoidal surgery, follow-up of a recurrent partly calcified solid and cystic intra-/supra-sellar craniopharyngioma, low-grade glioma under stereotactic-like conditions, suspected pinealoma, recurrent astrocytoma (II-III) and ganglioneuroma at the posterior aspect of the middle and/or lower brain stem, small scar after lower brain stem infarction, stenosing degenerative disease of the cervical spine and multicystic lesion with an underlying benign ependymoma of the cervical spinal cord. MRI--although duplicating some CT results--provided better two- or three-dimensional anatomical detail as well as display of relevant vessels without need of contrast agent. It also gave more specific information in suprasellar tumours containing fat, afforded uniquely specific diagnosis in a bleeding venous malformation of the midbrain and defined more sensitively extra-/intra-axial lesions of the brain stem and cervical spinal cord. Small bony structures (erosions) and punctate calcifications may be missed by MRI. Although ferromagnetic material distorts the MR image, compared with CT, it is not impaired by non-ferromagnetic clips. This is an advantage with respect to postoperative control examinations.

Adolescent↗
PubMed1996

Hemodynamics in an arterial union--simulation study on therapeutic unilateral vertebral artery occlusion.

Hemodynamic changes following unilateral vertebral artery (VA) occlusion were investigated in a rat model. The left carotid artery was resected and anastomosed to the right side in an end-to-side fashion to create a half-ring bypass. The distal side of the bypass was regarded as a union of VAs. Changes in the geometry, histology and hemodynamics in the union were investigated after the recipient artery was ligated. Intimal thickening was most prominently observed in the recipient arterial segment distal to the ligation site, where the lumen was obliterated. However, the portion of the lumen within 2.6 +/- 0.6 (mean +/- s.d.) mm, a distance of 2.9 +/- 0.6 times the internal diameter from the union, was not obliterated. The angle of the union was positively related to the length of this residual lumen. The results of this study explain some of the pathogenesis in unsuccessful aneurysmal thrombosis or brain stem infarction after therapeutic unilateral VA occlusion.

Animals↗
PubMed1991

[A case of anti-phospholipid antibody syndrome associated with subdural hematoma].

We report a case of a 47-year-old man with anti-phospholipid antibody syndrome associated with subdural hematoma. The patient had several episodes of arthritis during his thirties. He developed venous thrombosis in his right lower leg at the age of 35, when laboratory studies demonstrated prolongation of activated partial thromboplastin time (APTT) and a biological false-positive result occurred on a syphilis test. When bulbar palsy and Horner's syndrome in the right eye suddenly appeared at the age of 42, he was diagnosed as having brain stem infarction. At the age of 47, he developed constructional apraxia, dyscalculia, skilled movement disturbances and generalized convulsions. Subdural hematoma and multiple lacunes in the cerebral white matter were demonstrated with brain MRI. Furthermore, the patient was positive for Rumpel-Leede phenomenon. Laboratory studies revealed mild thrombocytopenia, prolonged bleeding time and APTT, positive antinuclear antibody and positive test results for both lupus anticoagulant and an anti-cardiolipin antibody, namely anti-phospholipid antibodies. Based on these findings, we consider that the tendency of this patient to bleed may have been due to antiphospholipid antibodies, attacking the platelet membranes and that the bridging veins in the subdural space may be the site at which the bleeding tendency easily appears. Anti-phospholipid antibody syndrome accompanied by hemorrhagic complications had rarely been reported. We suggest that special attention should be given to hemorrhagic complications in patients with anti-phospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction.

Antiphospholipid Syndrome↗
PubMed2003

[Angiographic features of anoxic encephalopathy in the acute phase: a case report].

We present an angiographic feature of anoxic encephalopathy in the acute phase. A 68-year-old woman suddenly presented with deep coma. Examinations of her blood and electrocardiography did not reveal the origin of consciousness disturbance, and computed tomographic (CT) scans demonstrated no significant findings. We immediately performed cerebral angiography because we suspected brain stem infarction. A 3-vessel study (bilateral carotid and left vertebral angiography) revealed remarkable delays in cerebral circulation time or arteriovenous circulation time, although it did not show occlusion of cerebral vessels. The follow-up brain magnetic resonance (MR) images revealed anoxic encephalopathy, which might be derived from transient cardiac arrest. The patient has been in a vegetative state for one year. Although many reports have described CT scans and MR images of anoxic encephalopathy in the acute or subacute phases, there have been no reports about the angiographic features. We found remarkable delays in cerebral circulation time in the acute phase of anoxic encephalopathy, which was considered to be caused by cytotoxic edema from severe hypoxia or ischemia.

Acute Disease↗