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Results for “Brain Stem Infarctions”

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PubMed1977

The neuropathology of malignant external otitis.

A case report of malignant external otitis is presented with particular emphasis on the neuropathological sequelae. The most striking finding was a mycotic aneurysm of the basilar artery with resultant thrombosis and brain stem infarction. Diffuse pachymeningitis was also present. The severity of the changes described in this case further point out the need for early recognition and adequate treatment of this potentially fatal disease complex.

Aneurysm, Infected↗
PubMed1994

Isolated oculomotor nerve palsy following midbrain infarction.

A 62 year-old male patient presented with isolated oculomotor nerve palsy following a small infarction of the medial ventral midbrain, documented by magnetic resonance imaging. There was a 12-year history of hypertension, but no diabetes mellitus. Angiography revealed atherosclerosis of the paramedian mesencephalic arteries. Magnetic resonance imaging may be useful in patients with small brain stem infarctions.

Cerebral Angiography↗
PubMed1982

Cerebellar infarction with obstructive hydrocephalus.

The authors review 15 patients with acute cerebellar infarction accompanied by obstructive hydrocephalus. These patients were among 1700 consecutive patients with acute cerebrovascular disease who were examined by angiography and also, except for the initial 320 cases. by computerized tomography (CT) scan. The CT scans were helpful in diagnosis and management of the patients. It demonstrated cerebellar mass lesions as being low density, isodense, or high density, according to the amount of hemorrhage into the infarcted area. Such cerebellar mass lesions caused acute compression of the posterior fossa. The clinical picture was determined mainly by the extent of the initially infarcted area in the vertebrobasilar territory and the speed of enlargement of the subsequently developing cerebellar mass lesion. Suboccipital decompressive surgery was performed in 10 patients and was generally beneficial. The postoperative prognosis depended mainly on the presence or absence of coexisting brain-stem infarction. Five patients who were managed conservatively died during the acute stage. Prompt and correct diagnosis of this illness is required to ensure adequate therapy.

Adult↗
PubMed1993

An immunologic abnormality common to Bickerstaff's brain stem encephalitis and Fisher's syndrome.

The nosological position of Bickerstaff's brain stem encephalitis (BBE) has yet to be established, and its etiology is not clear. Because anti-GQ1b antibody frequently occurs in patients with Fisher's syndrome (FS) and there are clinical similarities between FS and BBE, we investigated anti-ganglioside antibodies in sera from 3 BBE patients who had transient long tract signs in addition to acute ophthalmoplegia and cerebellar-like ataxia in order to clarify the etiology and nosological position of BBE. High IgG anti-GQ1b antibody titers were present in all 3 sera samples but decreased with the clinical course of the illness. In contrast, no anti-GQ1b antibody was found in sera from patients with other neurologic diseases which were able to produce transient brain stem disturbance: multiple sclerosis, neuro-Behçet's disease, brain stem infarction, herpes simplex virus encephalitis, and Wernicke's encephalopathy. The finding that BBE and FS shared common autoantibody suggests that autoimmune mechanism common to FS is likely in BBE, and that both conditions represent a distinct disease with a wide spectrum of symptoms that include ophthalmoplegia and ataxia.

Adult↗
PubMed1986

Acute obstructive hydrocephalus: an unusual complication after cardiopulmonary bypass.

A case of acute obstructive hydrocephalus in a patient undergoing an aortic valve replacement is presented. This condition came about as a result of massive left cerebellar hemisphere infarction, probably due to a calcific embolism from the aortic valve. The cerebrospinal fluid circulation was blocked by compression of the fourth ventricle and the Sylvius aqueduct secondary to ischemic edema. Following external ventricular drainage, the hydrocephalus resolved but a neurological deficit secondary to the cerebellar and brain stem infarction became evident. The diagnostic, prognostic and therapeutic implications of this unusual complication following cardiac surgery are discussed.

Acute Disease↗
PubMed1986

[Pemphigoid and cerebral infarct. Syntropy of 2 diseases? Case report].

We report on two patients who suffered from bullous pemphigoid and developed cerebral infarctions during the course of this autoimmune dermatosis. The first patient who had a bullous dermatosis for three weeks presented with a sudden paresis of her right arm. She improved under steroid therapy and developed a left sided hemiparesis after steroids were reduced for diagnostic purposes. The second patient developed signs of brain stem infarction during the course of full-blown bullous pemphigoid. Neither patient had known risk factors, signs of atherosclerosis or cardiac embolism. Both patients improved with steroids and azathioprine.

Aged↗
PubMed1998

MR of hypoxic encephalopathy in children after near drowning: correlation with quantitative proton MR spectroscopy and clinical outcome.

BACKGROUND AND PURPOSE: Quantitative MR spectroscopy has a proved role in the investigation of hypoxia caused by near drowning. To date, no studies have addressed the MR imaging changes that may also accompany this condition. The purpose of this study was to describe the MR imaging findings in children with hypoxic encephalopathy caused by near drowning and to compare these findings with the results of qualitative and quantitative proton MR spectroscopy and clinical outcome. METHODS: Twenty-two children (6 months to 11 years old) admitted to the pediatric intensive care unit after near drowning incidents underwent cerebral MR imaging and quantitative proton MR spectroscopy. Clinical and imaging studies were reviewed retrospectively, and subjects were grouped according to outcome: good result, persistent vegetative state, and death. Images were scored for edema, basal ganglia changes, and cortical changes, and were compared with MR spectra and outcome at days 1 to 2, 3 to 4, and 5 or more. RESULTS: Six patients had a good outcome, four remained in a persistent vegetative state, and 12 died. Generalized/occipital edema correlated with poor outcome. Indistinct lentiform nuclei margins on T1-weighted images were a frequent finding (78%). Basal ganglia T2 hyperintensity correlated with poor outcome, progressing from a patchy/peripheral distribution to diffuse high intensity. Patchy high T2 signal in the cortex or subcortical lines were specific but insensitive for poor outcome, as were brain stem infarcts. CONCLUSION: MR images in children with hypoxic encephalopathy after near drowning show a spectrum of changes. The most sensitive prognostic result may be achieved by combining MR imaging with qualitative and quantitative MR spectroscopic data.

Brain Diseases↗
PubMed2004

Meningitis due to Fusobacterium necrophorum in an adult.

BACKGROUND: Fusobacterium necrophorum may cause a number of clinical syndromes, collectively known as necrobacillosis. Meningitis is a significant cause of mortality, rarely reported in the adult population. CASE PRESENTATION: We report a fatal case of meningitis, caused by Fusobacterium necrophorum, secondary to otitis media in an alcoholic male. Diagnosis was delayed due to the typical slow growth of the organism. The clinical course was complicated by encephalitis and by hydrocephalus. The patient failed to respond to metronidazole and penicillin. The patient died on day 12 from increased intracranial pressure and brain stem infarction. CONCLUSIONS: This case emphasizes the need for a high index of clinical suspicion to make the diagnosis of Fusobacterium necrophorum meningitis. We recommend the use of appropriate anaerobic culture techniques and antimicrobial coverage for anaerobic organisms when the gram stain shows gram negative bacilli.

Brain↗
PubMed1980

Rehabilitation outcome: comparative analysis of different patient types.

Postdischarge progress in 11 types of patients was analyzed with regard to eating, dressing, transfers, bladder management, ambulation, cognition, language comprehension and speech, placement (living arrangement), and mortality rates. Of 273 patients admitted, 263 were available for foillow-up, which disclosed that patients with lower bladder management and cognition scores are more likely to be directed into restrictive discharge placements (p < 0.05), and that CVA patients with right and left cerebral hemisphere involvement, cancer patients, and patients with brain stem infarctions make significant postdischarge gains in ADL (p < 0.05). The majority of patients showed continual improvement after discharge, some making significant gains in functional competency. Such program evaluation offers a systematic method for forecasting post-discharge outcome.

Activities of Daily Living↗
PubMed1992

Cyclorotation of the eyes and the subjective visual vertical.

Pathological CR of the eyes and deviations of the SVV are among the most sensitive clinical brain stem signs. In acute unilateral brain stem infarctions, deviations of the SVV occur in 94% of cases and CR of one or both eyes is found in 88%. Deviations of CR and the SVV are typically ipsiversive with pontomedullary lesions and contraversive with pontomesencephalic lesions. They may involve a complete OTR, the triad of lateral head tilt, skew deviation and CR. There is a directional linkage between CR and the SVV (i.e. either right or left tilt), but the net tilt angles do not always match quantitatively. Pathological CR and deviations of the SVV obviously represent dysfunction of the VOR in the roll plane, which is subserved by both otolith and vertical canal inputs.

Animals↗
PubMed1982

Comparison of N-isopropyl (I-123) p-iodoamphetamine brain scans using Anger camera scintigraphy and single-photon emission tomography.

N-isopropyl (I-123) p-iodoamphetamine (IMP), which is extracted by the brain in proportion to regional blood flow, has been shown to be useful with single-photon emission tomography (SPECT) in the assessment of pathologic states related to blood flow. Because emission tomographic equipment is not yet available at most hospitals, the authors compared IMP brain images obtained with an Anger camera with those obtained by SPECT to determine the usefulness of IMP scintigraphy. Thirty-nine pairs of studies were performed on 12 control patients, 14 patients with stroke, three patients with tumors, and a miscellaneous group of eight patients. Planar scintigraphy showed good correlation with SPECT in determining the presence or absence of abnormality in all patients except one with a very small brain stem infarction that was not detected by planar imaging. Anger images showed poor contrast resolution compared with SPECT images. It is thus expected that SPECT will result in better lesion detection when smaller lesions are studied. Planar scintigraphy is not capable of providing quantitative measurement of regional cerebral blood flow.

Amphetamines↗
PubMed2006

Segmental disruption of internal elastic lamina in spontaneous vertebral artery dissection combined with redundancy of multiple cervical arteries.

A 49-year-old man developed a spontaneous vertebral artery dissection leading to cerebellar and brain stem infarction. Cerebral angiograph demonstrated redundancy, including kinks, loops and coils, in multiple cervicocephalic arteries, in addition to the dissecting artery. Histological examination of the superficial temporal artery revealed segmental disruptions of the internal elastic lamina and intimal abnormalities. These ultrastructural abnormalities may impair vessel wall integrity and predispose to nontraumatic arterial dissection and vascular tortuosity.

Basement Membrane↗
PubMed1999

[Transpetrosal presigmoid approach for removal of giant petroclival tumors].

OBJECTIVE: To discuss the operative technique, advantage and postoperative complications in 41 patients with giant petroclival tumors treated with the supra- and infratentorial transpetrousal presigmoid approach. METHODS: Clinical data were obtained from the review of charts and radiographic images of the 41 patients after operation with temporo-occipotal free osseous flap, partial petrosectomy and mastoidectomy were performed around the labyrinth. The semicircular canals, cochlea and tympanic cavity were protected during the operation. After the super petrous was ligated and cut off, the petroclival region in front of the sigmoid sinus was exposed. RESULTS: In the 41 patients 20 had meningiomas, 20 epidermoid cysts, and one schwannoma. Total resection was performed in 34 patients, subtotal resection in 16, and greater partial resection in one. Major postoperative complications included temporal aphasia (10 patients), cerebral edema (6), brain stem infarct (2), IIIth, VIIth, VIth and posterial group cranial nerves palsies (16, 16, 8, 6 respectively), and cerebrospinal fluid leakage (4 cases). CONCLUSIONS: This approach can expose sufficiently the petroclival region. It can also reveal the area of adjacent sella, interpeduncular and formen magnum, and homolateral III-XIIth cranial nerves. The postoperative complications may be related to operative techniues and tumorous characteristics.

Adolescent↗
PubMed1999

Dynamic behavior of heart rate in ischemic stroke.

BACKGROUND AND PURPOSE: Traditional spectral and nonspectral methods have shown that heart rate (HR) variability is reduced after stroke. Some patients with poor outcome, however, show randomlike, complex patterns of HR behavior that traditional analysis techniques are unable to quantify. Therefore, we designed the present study to evaluate the complexity and correlation properties of HR dynamics after stroke by using new analysis methods based on nonlinear dynamics and fractals ("chaos theory"). METHODS: In addition to the traditional spectral components of HR variability, we measured instantaneous beat-to-beat variability and long-term continuous variability analyzed from Poincaré plots, fractal correlation properties, and approximate entropy of R-R interval dynamics from 24-hour ambulatory ECG recordings in 30 healthy control subjects, 31 hemispheric stroke patients, and 15 brain stem stroke patients (8 medullary, 7 pontine) in the acute phase of stroke and 6 months after stroke. RESULTS: In the acute phase, the traditional spectral components of HR variability and the long-term continuous variability from Poincaré plots were impaired (P<0.01) in patients with hemispheric and medullary brain stem stroke, but not in patients with pontine brain stem stroke, in comparison with control subjects. At 6 months after stroke, measures of HR variability in hemispheric stroke patients were still lower (P<0.05) than those of the control subjects. Various complexity and fractal measures of HR variability were similar in patients and control subjects. The conventional frequency domain measures of HR variability as well as the Poincaré measures showed strong correlations (Pearson correlation coefficient, r=0.68 to r=0.90) with each other but only weak correlations (r=0.09 to r=0.56) with the complexity and fractal measures of HR variability. CONCLUSIONS: Hemispheric and medullary brain stem infarctions seem to damage the cardiovascular autonomic regulatory system and appear as abnormalities in the magnitude of HR variability. These abnormalities can be more easily detected with the use of analysis methods of HR variability, which are based on moment statistics, than by methods based on nonlinear dynamics. Abnormal HR variability may be involved in prognostically unfavorable cardiac complications and other known manifestations of autonomic failure associated with stroke.

Acute Disease↗
PubMedDate not supplied

EEG monitoring for induced hypotension for surgery of intracranial aneurysms.

EEG was monitored at bilateral scalp sites outside the operative field during hypotensive aneurysm surgery in 21 patients. Mean arterial blood pressure at axillary level was 50-60 mm Hg (average 55 mm) for 1.9-5.3 hours (average 3.6). Four new deficits were noted immediately post-operatively, all related to the operated site: these were attributable to intra-operative rupture with forced vascular clipping, vasospasm, or edema. In no instance was hypotension solely responsible for a new deficit. EEG showed persistent slowing in relation to surgery in only 1 patient, where aneurysmal rupture led to severe hypotension, forced clipping of 1 posterior cerebral artery, and subsequent brain stem infarction. In the 3 other patients with fresh focal postoperative deficits, no persistent intraoperative EEG changes were observed. EEG monitoring did not detect ischemia in these 3 patients because 1) hypotension was moderate and did not per se cause new deficit, and 2) EEG electrodes did not survey the area at maximal risk, namely the operative field. EEG scalp electrodes near but outside the operative site do not seem useful for monitoring cerebral function in the region of aneurysm surgery. Epidural or cortical electrodes in the operative field may prove to be more useful.

Adult↗
PubMed1981

Short- and long-term results of microvascular anastomosis in the vertebrobasilar system, a critical analysis.

During the past five years, 22 patients were operated on and 21 occipital artery-caudal, loop-posterior, inferior cerebellar artery anastomoses were completed. All but one patient had suffered either TIAs of the vertebrobasilar system or brain stem stroke with complete or partial recovery. All the patients had significant atherosclerotic occlusive disease of both vertebral arteries and bilateral hypoplasia of the posterior communicating arteries. Three patients died shortly after surgery because of brain stem infarction and myocardial infarction. In one of these patients no anastomosis was performed. Two other patients also died 2.5 years after the operations because of a metastatic carcinoma and a stroke. Diplopia and cerebellar ataxia were developed in one patient and meningitis in another patient postoperatively with partial and complete recovery, respectively. Fifteen of the remaining 16 patients have either improved or remained the same. One patient has gotten worse. Sixteen patients had anastomosis, a patency rate of 87.5 percent. The blood flow of the occipital artery was measured intraoperatively following the completion of anastomosis in 5 patients. The mean blood flow varied between 15-80 ML/min. with an average of 46 ML/min. The neurological mortality and morbidity in this operation, in addition to the neurological condition of the patient prior to surgery, seem to be significantly related to the position of the patient during the surgery and how well his vital signs, especially blood pressure, are kept within normal limits. A lateral semiprone position, with the head and neck flexed and about 5 degrees above the heart level, seems to be a satisfactory position. With careful selection of the patients and the maintenance of normal vital signs, especially during surgery, good results can be obtained.

Adult↗
PubMed1995

Phantom limb pain: are cutaneous nociceptors and spinothalamic neurons involved in the signaling and maintenance of spontaneous and touch-evoked pain? A case report.

A patient suffered multiple fractures of the right leg and a left brain-stem infarction involving the anterolateral fasciculus of the central nociceptive system following multiple trauma. Later, the right leg was amputated, resulting in spontaneous and touch-evoked phantom pain and mechanical stump allodynia. However, quantitative sensory testing revealed considerable impairment of sensations normally mediated by cutaneous nociceptors and central spinothalamic systems on the right body side, including the stump but nearly intact touch and vibration senses. Quantitative assessment of peripheral nociceptive C-fiber function (axon reflex vasodilatation and flare) showed no abnormalities on both sides. Sympathetic blocks did not change spontaneous and evoked pain. Epidural and spinal anesthesia abolished evoked pain but had no effect on spontaneous phantom pain. Extirpation of a neuroma of the sciatic nerve did not alter spontaneous and evoked pain. TENS resulted in an increase in pain. We concluded the following. (i) Painful somatosensory memories that are responsible for phantom limb pain are located in the brain, most probably in the thalamus or cortex. (ii) Touch-evoked phantom pain and stump allodynia are not mediated by cutaneous nociceptive C and A delta fibers and spinal nociceptive pathways (spinothalamic tract). Activity in the lemniscal system (low-threshold mechanoreceptive A beta afferents, dorsal columns and medial lemnicus system) may be transferred to central pain signaling neurons in the thalamus or cortex resulting in touch-evoked pain sensations. (iii) Ongoing activity in cutaneous nociceptive C fibers and spinal nociceptive systems is not necessary to maintain central processes that account for spontaneous and touch-evoked pain sensations. Activity in nociceptors of deep somatic tissues might be more important.

Amputation Stumps↗