WorldWideScience

Sample records for cerebellar artery infarction

  1. Cerebellar cortical infarct cavities and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Cocker, Laurens J.L. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Kliniek Sint-Jan Radiologie, Brussels (Belgium); Compter, A.; Kappelle, L.J.; Worp, H.B. van der [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Luijten, P.R.; Hendrikse, J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands)

    2016-09-15

    Cerebellar cortical infarct cavities are a newly recognised entity associated with atherothromboembolic cerebrovascular disease and worse physical functioning. We aimed to investigate the relationship of cerebellar cortical infarct cavities with symptomatic vertebrobasilar ischaemia and with vascular risk factors. We evaluated the MR images of 46 patients with a recent vertebrobasilar TIA or stroke and a symptomatic vertebral artery stenosis ≥50 % from the Vertebral Artery Stenting Trial (VAST) for the presence of cerebellar cortical infarct cavities ≤1.5 cm. At inclusion in VAST, data were obtained on age, sex, history of vertebrobasilar TIA or stroke, and vascular risk factors. Adjusted risk ratios were calculated with Poisson regression analyses for the relation between cerebellar cortical infarct cavities and vascular risk factors. Sixteen out of 46 (35 %) patients showed cerebellar cortical infarct cavities on the initial MRI, and only one of these 16 patients was known with a previous vertebrobasilar TIA or stroke. In patients with symptomatic vertebrobasilar ischaemia, risk factor profiles of patients with cerebellar cortical infarct cavities were not different from patients without these cavities. Cerebellar cortical infarct cavities are seen on MRI in as much as one third of patients with recently symptomatic vertebral artery stenosis. Since patients usually have no prior history of vertebrobasilar TIA or stroke, cerebellar cortical infarct cavities should be added to the spectrum of common incidental brain infarcts visible on routine MRI. (orig.)

  2. Acute bilateral cerebellar infarction in the territory of the medial branches of posterior inferior cerebellar arteries.

    Science.gov (United States)

    Gurer, G; Sahin, G; Cekirge, S; Tan, E; Saribas, O

    2001-10-01

    The most frequent type of cerebellar infarcts involved the posterior inferior cerebellar artery (PICA) and superior cerebellar artery territories but bilateral involvement of lateral or medial branches of PICA is extremely rare. In this report, we present a 55-year-old male who admitted to hospital with vomiting, nausea and dizziness. On examination left-sided hemiparesia and ataxic gait were detected. Infarct on bilateral medial branch of PICA artery territories was found out with cranial magnetic resonance imaging (MRI) technique and 99% stenosis of the left vertebral artery was found out with digital subtraction arteriography. The patient was put on heparin treatment. After 3 weeks, his complaints and symptoms had disappeared except for mild gait ataxia.

  3. Sudden deafness as an initial presenting symptom of posterior inferior cerebellar artery infarction: two case reports.

    Science.gov (United States)

    Lee, E J; Yoon, Y J

    2014-11-01

    This paper reports on two patients with posterior inferior cerebellar artery infarction whose only presenting complaint was acute unilateral hearing loss. In the two cases reported, sudden hearing loss was an initial symptom, with no other neurological signs. Infarction in the territory of the posterior inferior cerebellar artery was diagnosed using brain magnetic resolution imaging. The patients had some degree of hearing improvement 3 or 4 days after initial treatment. In this article, new cases of posterior inferior cerebellar artery infarction presenting as sudden deafness, without prominent neurological signs, are described. Otologists should be aware that hearing loss can sometimes appear as a warning sign of impending posterior inferior cerebellar artery infarction.

  4. Anterior and posterior inferior cerebellar artery infarction with sudden deafness and vertigo.

    Science.gov (United States)

    Murakami, Takenobu; Nakayasu, Hiroyuki; Doi, Mitsuru; Fukada, Yasuyo; Hayashi, Miwa; Suzuki, Takeo; Takeuchi, Yuichi; Nakashima, Kenji

    2006-12-01

    We report a patient with anterior and posterior inferior cerebellar artery infarction, which manifested as profound deafness, transient vertigo, and minimal cerebellar signs. We suspect that ischaemia of the left internal auditory artery, which originates from the anterior inferior cerebellar artery, caused the deafness and transient vertigo. A small lesion in the middle cerebellar peduncle in the anterior inferior cerebellar artery territory and no lesion in the dentate nucleus in the posterior inferior cerebellar artery territory are thought to explain the minimal cerebellar signs despite the relatively large size of the infarction. Thus a relatively large infarction of the vertebral-basilar territory can manifest as sudden deafness with vertigo. Neuroimaging, including magnetic resonance imaging, is strongly recommended for patients with sudden deafness and vertigo to exclude infarction of the vertebral-basilar artery territory.

  5. Post-traumatic cerebellar infarction due to vertebral artery foramina fracture: case report

    OpenAIRE

    Moscote-Salazar Luis Rafael; Rubiano Andres M.; Calderon-Miranda Willem Guillermo; Agrawal Amit

    2016-01-01

    Posttraumatic cerebral infarction is an uncommon cause of morbidity and mortality and many studies have highlighted that trauma needs to considered as causative factor for cerebellar infarction. We present a case of cerebellar infarction in a 35 year old young patient secondary to vertebral fracture involving the vertebral foramen and vertebral artery injury. CT scan cervical spine showed C2-3 fracture on left side with fracture extending into the left vertebral foramen. A CT scan angiogram c...

  6. Post-traumatic cerebellar infarction due to vertebral artery foramina fracture: case report

    Directory of Open Access Journals (Sweden)

    Moscote-Salazar Luis Rafael

    2016-03-01

    Full Text Available Posttraumatic cerebral infarction is an uncommon cause of morbidity and mortality and many studies have highlighted that trauma needs to considered as causative factor for cerebellar infarction. We present a case of cerebellar infarction in a 35 year old young patient secondary to vertebral fracture involving the vertebral foramen and vertebral artery injury. CT scan cervical spine showed C2-3 fracture on left side with fracture extending into the left vertebral foramen. A CT scan angiogram could not be performed because of poor neurological status. Possibly the infarction was due to left vertebral artery injury. Without surgical intervention prognosis of these patients remain poor. Prognosis of patients with traumatic cerebellar infarction depends on the neurological status of the patient, intrinsic parenchymal damage and more importantly extrinsic compression of the brainstem by the edematous cerebellar hemispheres.

  7. Sudden sensorineural hearing loss as prodromal symptom of anterior inferior cerebellar artery infarction.

    Science.gov (United States)

    Martines, Francesco; Dispenza, Francesco; Gagliardo, Cesare; Martines, Enrico; Bentivegna, Daniela

    2011-01-01

    Sudden sensorineural hearing loss is a clinical condition characterized by a sudden onset of unilateral or bilateral hearing loss. In recent years sudden deafness has been frequently described in association with anterior inferior cerebellar artery (AICA) infarction generally presenting along with other brainstem and cerebellar signs such as ataxia, dysmetria and peripheral facial palsy. The authors report a rare clinical case of a 53-year-old man who suddenly developed hearing loss and tinnitus without any brainstem or cerebellar signs. Computed tomography of his brain was normal, and the audiological results localized the lesion causing deafness to the inner ear. Surprisingly, magnetic resonance imaging showed an ischemic infarct in the right AICA territory. This case represents the fifth in the literature to date but it confirms that AICA occlusion can cause sudden deafness even without brainstem or cerebellar signs. Therefore, we recommend submitting the patient for neuroimaging, as an emergency, in order to exclude infarction of the AICA territory. By doing this, it may be possible to limit the extent of the lesion by commencing early therapy.

  8. Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Jingbo; Lv Xianli; Jiang Chuhan; Li Youxiang [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China)

    2010-06-15

    Background: Superior cerebellar artery (SCA) syndrome shows ipsilateral cerebellar ataxia and Horner's syndrome, contralateral superficial sensory disturbance, as well as nystagmus toward the impaired side, vertigo, and nausea. Occasionally, unilateral lesions may produce bilateral hypogeusia and contralateral hypoacusia. Objective: To report 2 patients with unilateral lower midbrain ischemic lesions of the inferior colliculus level caused by transarterial embolization for tentorial dural arteriovenous fistulas (TDAVFs). Methods: Hospital records for 21 patients with TDAVFs mainly treated by endovascular techniques between 2005 and 2008 were reviewed. Two patients with MRI evidence of unilateral SCA territory infarction were investigated. Results: Of 21 patients, 2 treated transarterially with Onyx-18 (a nonahesive liquid embolic agent) developed infarctions in the territory of SCA. One patient had lateral SCA infarction characterized by ipsilateral gait ataxia, contralateral hemihypoesthesia, with additional ipsilateral ocular motor palsy and bilateral gustatory loss. And the other patient had medial SCA infarction characterized by ipsilateral ataxia contralateral hemihypoesthesia with additional contralateral hypoacusia. Conclusion: SCA infarction can be caused by transarterial injection of Onyx-18 via SCA or the posterior cerebral artery (PCA) for TDAVFs and additionally presented with gustatory loss and deafness, which is generally not a feature of the SCA syndrome.

  9. Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture.

    Science.gov (United States)

    Muratsu, Hirotsugu; Doita, Minoru; Yanagi, Toshihide; Sekiguchi, Kenji; Nishida, Kotaro; Tomioka, Masao; Kurosaka, Masahiro

    2005-06-01

    Neurologic deficit secondary to a Jefferson fracture is rare, as the fracture fragments tend to spread outward. To the authors' knowledge, only five cases of vertebral artery injury associated with C1 fracture have been reported. A 75-year-old man with diffuse spinal hyperostosis hit the top of his head and sustained a Jefferson fracture. The patient presented with vertigo and slurred speech. Magnetic resonance (MR) imaging demonstrated cerebellar infarction, and MR angiography (MRA) showed bilateral vertebral artery occlusion associated with a Jefferson fracture. The patient was placed in a halo vest for a total of 11 weeks and treated with anticoagulant therapy. Vertigo gradually improved, and the patient was able to walk with a cane. Previously slurred speech was completely resolved. This case demonstrates that a Jefferson fracture can cause vertebral artery occlusion, resulting in cerebellar infarction. The clinician should be aware of the possibility and implications of vertebral artery injuries, especially if a fracture involving the foramen transversarium with displacement is documented or if there is a neurologic deficit above the level of injury. Advances in noninvasive imaging such as MRA will facilitate accurate evaluation of these potentially life-threatening vascular injuries.

  10. Gravity-dependent nystagmus and inner-ear dysfunction suggest anterior and posterior inferior cerebellar artery infarct.

    Science.gov (United States)

    Shaikh, Aasef G; Miller, Benjamin R; Sundararajan, Sophia; Katirji, Bashar

    2014-04-01

    Cerebellar lesions may present with gravity-dependent nystagmus, where the direction and velocity of the drifts change with alterations in head position. Two patients had acute onset of hearing loss, vertigo, oscillopsia, nausea, and vomiting. Examination revealed gravity-dependent nystagmus, unilateral hypoactive vestibulo-ocular reflex (VOR), and hearing loss ipsilateral to the VOR hypofunction. Traditionally, the hypoactive VOR and hearing loss suggest inner-ear dysfunction. Vertigo, nausea, vomiting, and nystagmus may suggest peripheral or central vestibulopathy. The gravity-dependent modulation of nystagmus, however, localizes to the posterior cerebellar vermis. Magnetic resonance imaging in our patients revealed acute cerebellar infarct affecting posterior cerebellar vermis, in the vascular distribution of the posterior inferior cerebellar artery (PICA). This lesion explains the gravity-dependent nystagmus, nausea, and vomiting. Acute onset of unilateral hearing loss and VOR hypofunction could be the manifestation of inner-ear ischemic injury secondary to the anterior inferior cerebellar artery (AICA) compromise. In cases of combined AICA and PICA infarction, the symptoms of peripheral vestibulopathy might masquerade the central vestibular syndrome and harbor a cerebellar stroke. However, the gravity-dependent nystagmus allows prompt identification of acute cerebellar infarct. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Right cerebellar infarction due to ipsilateral neck-rotation-induced right vertebral artery compression and occlusion, demonstrated by CT angiography

    Directory of Open Access Journals (Sweden)

    Rongli Wu, MD

    2015-01-01

    Full Text Available Rotation-induced vertebral artery compression and occlusion with the outcome of cerebellar infarction (as opposed to the outcome of transient ischemia from hemodynamic insufficiency, known as bow hunter's stroke is extremely rare. We report a 40-year-old male who suffered from ipsilateral neck-rotation-induced right vertebral artery compression and occlusion that resulted in right cerebellar infarction. In most reported cases, the rotation-compressed vertebral artery is located at the C1–2 level; however, our patient's compressed artery was located at the C6–7 level as demonstrated clearly by 3-dimensional CT angiography. This case report is based on a literature review and an investigation of the likely factors of this specific incident via the patient's personal details, clinical course, and diagnostic images.

  12. [Case of cerebellar and spinal cord infarction presenting with acute brachial diplegia due to right vertebral artery occlusion].

    Science.gov (United States)

    Fujii, Takayuki; Santa, Yo; Akutagawa, Noriko; Nagano, Sukehisa; Yoshimura, Takeo

    2012-01-01

    A 73-year-old man was admitted for evaluation of sudden onset of dizziness, bilateral shoulder pain, and brachial diplegia. Neurological examination revealed severe bilateral weakness of the triceps brachii, wrist flexor, and wrist extensor muscles. There was no paresis of the lower limbs. His gait was ataxic. Pinprick and temperature sensations were diminished at the bilateral C6-C8 dermatomes. Vibration and position senses were intact. An MRI of the head revealed a right cerebellar infarction and occlusion of the right vertebral artery. An MRI of the cervical spine on T₂ weighted imaging (T₂WI) showed cord compression at the C3/4-C5/6 level secondary to spondylotic degeneration without any intramedullary signal changes of the cord. On the following day, however, high-signal lesions on T₂WI appeared in the C5-C6 spinal cord, suggesting cord infarction. Unilateral vertebral artery occlusion does not usually result in cervical cord infarction because of anastomosis of arteries. Because of the long-term mechanical compression in our case, it was likely that cervical cord ischemia was present before the onset of symptoms. On the basis of chronic cord compression, our case suggests that occlusion of a unilateral vertebral artery could cause cervical cord infarction.

  13. Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Mimata, Yoshikuni; Sato, Kotaro; Suzuki, Yoshiaki [Iwate Prefectural Chubu Hospital, Department of Orthopaedic Surgery, Kitakami (Japan); Murakami, Hideki [Iwate Medical University, Department of Orthopaedic Surgery, School of Medicine, Morioka (Japan)

    2014-01-15

    Vertebral artery injury can be a complication of cervical spine injury. Although most cases are asymptomatic, the rare case progresses to severe neurological impairment and fatal outcomes. We experienced a case of bilateral cerebellar and brain stem infarction with fatal outcome resulting from vertebral artery injury associated with cervical spine trauma. A 69-year-old male was admitted to our hospital because of tetraplegia after falling down the stairs and hitting his head on the floor. Marked bony damage of the cervical spine was not apparent on radiographs and CT scans, so the injury was initially considered to be a cervical cord injury without bony damage. However, an intensity change in the intervertebral disc at C5/C6, and a ventral epidural hematoma were observed on MRI. A CT angiogram of the neck showed the right vertebral artery was completely occluded at the C4 level of the spine. Forty-eight hours after injury, the patient lapsed into drowsy consciousness. The cranial CT scan showed a massive low-density area in the bilateral cerebellar hemispheres and brain stem. Anticoagulation was initiated after a diagnosis of the right vertebral artery injury, but the patient developed bilateral cerebellar and brain stem infarction. The patient's brain herniation progressed and the patient died 52 h after injury. We considered that not only anticoagulation but also treatment for thrombosis would have been needed to prevent cranial embolism. We fully realize that early and appropriate treatment are essential to improve the treatment results, and constructing a medical system with a team of orthopedists, radiologists, and neurosurgeons is also very important. (orig.)

  14. Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column: a case report.

    Science.gov (United States)

    Mimata, Yoshikuni; Murakami, Hideki; Sato, Kotaro; Suzuki, Yoshiaki

    2014-01-01

    Vertebral artery injury can be a complication of cervical spine injury. Although most cases are asymptomatic, the rare case progresses to severe neurological impairment and fatal outcomes. We experienced a case of bilateral cerebellar and brain stem infarction with fatal outcome resulting from vertebral artery injury associated with cervical spine trauma. A 69-year-old male was admitted to our hospital because of tetraplegia after falling down the stairs and hitting his head on the floor. Marked bony damage of the cervical spine was not apparent on radiographs and CT scans, so the injury was initially considered to be a cervical cord injury without bony damage. However, an intensity change in the intervertebral disc at C5/C6, and a ventral epidural hematoma were observed on MRI. A CT angiogram of the neck showed the right vertebral artery was completely occluded at the C4 level of the spine. Forty-eight hours after injury, the patient lapsed into drowsy consciousness. The cranial CT scan showed a massive low-density area in the bilateral cerebellar hemispheres and brain stem. Anticoagulation was initiated after a diagnosis of the right vertebral artery injury, but the patient developed bilateral cerebellar and brain stem infarction. The patient's brain herniation progressed and the patient died 52 h after injury. We considered that not only anticoagulation but also treatment for thrombosis would have been needed to prevent cranial embolism. We fully realize that early and appropriate treatment are essential to improve the treatment results, and constructing a medical system with a team of orthopedists, radiologists, and neurosurgeons is also very important.

  15. Positional occlusion of the vertebral artery in a case of rheumatoid atlantoaxial subluxation presenting with multiple cerebral and cerebellar infarction.

    Science.gov (United States)

    Fujiwara, Hiroyasu; Kaito, Takashi; Makino, Takahiro; Yonenobu, Kazuo

    2012-08-01

    We report an uncommon case of positional occlusion of the vertebral artery associated with rheumatoid arthritis (RA). Plain radiography showed reducible atlantoaxial subluxation, and dynamic vertebral arteriography demonstrated positional occlusion of the left vertebral artery. The patient was treated with C1-2 posterior fusion and has since experienced no recurrent symptoms. Insufficiency of the vertebrobasilar artery is a relatively uncommon complication with cervical lesions in RA patients. However, when RA patients manifest recurrent cerebral and cerebellar symptoms, this condition should be kept in mind and actions taken to avoid further irreversible cerebral damage. Recommended imaging methods include vertebral dynamic lateral plain radiography of the cervical spine and vertebral arteriography at multiple cervical positions.

  16. Clinical analysis of cerebellar infarction with vertebral artery hypoplasia%伴椎动脉发育不良的小脑梗死临床分析

    Institute of Scientific and Technical Information of China (English)

    唐澍; 马志刚; 廖琴; 孙玉衡; 胡洪涛

    2016-01-01

    Objective To summarize the clinical features and vascular lesions in patients who suffered from cerebellar infarction with vertebral artery hypoplasia(VAH). Methods Retrospective analysis was used in the research. The selected patients suffered from cerebellar infarction with VAH or stenosis (stenosis rate≥50%). Seventy-one patients with cerebellar infarction were enrolled. There were 34 patients in VAH group and 37 patients in vertebral artery stenosis group. The age, sex, risk factors, clinical manifestations and characteristics of vascular examination were compared. Results The age, sex, risk factors between two groups had no significant differences (P>0.05). The scores of National Institutes of Health Stroke Scale (NIHSS) between two groups had no significant difference (P>0.05). The proportion of early neurological deterioration in VAH group (41.2%, 14/34) was higher than that in vertebral artery stenosis group (18.9%, 7/37), χ2=4.21, P<0.05. There were more patients with anterior circulation artery stenosis in the VAH group (35.3%, 12/34), compared with that in artery stenosis group (13.5%, 5/37),χ2=4.62, P<0.05. Except the ipsilateral vertebral artery, other arteries stenosis in VAH group (44.1%, 15/34) was significantly higher than that in vertebral artery stenosis group (13.5%, 5/37),χ2=8.20, P<0.05. Conclusions Cerebellar infarction with vertebral artery hypoplasia is more likely to have multiple cerebral arterial stenosis (stenosis rate ≥50%). The patients who suffered from cerebellar infarction with vertebral artery hypoplasia might be prone to early neurological deterioration.%目的:总结伴有椎动脉发育不良(VAH)的小脑梗死患者的临床特征和血管病变情况。方法采用回顾性分析方法,选择伴VAH和椎动脉粥样硬化狭窄率≥50%的初发小脑梗死患者,按照椎动脉病变分为VAH组(34例)和椎动脉狭窄组(椎动脉狭窄≥50%,37例),比较两组年龄、性别构成、危险

  17. Os odontoideum with cerebellar infarction: a case report.

    Science.gov (United States)

    Sasaki, H; Itoh, T; Takei, H; Hayashi, M

    2000-05-01

    A case report. To report the case of a child with os odontoideum associated with cerebellar infarction and to discuss the correlation between atlantoaxial instability with os odontoideum and vertebrobasilar artery insufficiency. Knowledge of the influence of atlantoaxial instability on vertebrobasilar artery insufficiency remains limited despite the publication of several reports. A 5-year-old boy with ataxic gait disturbance was hospitalized in the pediatric ward. Magnetic resonance imaging revealed multiple cerebellar infarctions, and cerebral angiogram showed occlusions of several branches of the basilar artery and a winding of the left vertebral artery. Stress lateral radiographs of the cervical spine showed atlantoaxial instability with os odontoideum. Posterior C1-C2 transarticular screw fixation with iliac bone graft was applied to obtain firm stability and fusion. There was no damage to the vertebral arteries or spinal nerves in the perioperative period. Solid union of the grafted bone and rigid stability of the atlantoaxial joint were seen on lateral flexion-extension radiographs 1 year after the operation. There has been no sign of recurrent arterial insufficiency, and the patient has been free from cerebellar dysfunction to date. Atlantoaxial instability may cause insufficiency of the vertebral artery as well as spinal cord injury. More attention should be paid to the possible relation between atlantoaxial instability and vertebrobasilar artery insufficiency.

  18. Cerebellar infarct patterns: The SMART-Medea study

    Directory of Open Access Journals (Sweden)

    Laurens J.L. De Cocker, MD

    2015-01-01

    Conclusions: Small cerebellar infarcts proved to be much more common than larger infarcts, and preferentially involved the cortex. Small cortical infarcts predominantly involved the posterior lobes, showed sparing of subcortical white matter and occurred in characteristic topographic patterns.

  19. Cerebellar infarct patterns : The SMART-Medea study

    NARCIS (Netherlands)

    De Cocker, Laurens J L; Geerlings, Mirjam I; Hartkamp, NS; Grool, Anne M; Mali, Willem P; Van der Graaf, Yolanda; Kloppenborg, Raoul P; Hendrikse, J; Doevendans, PAFM

    2015-01-01

    OBJECTIVE: Previous studies on cerebellar infarcts have been largely restricted to acute infarcts in patients with clinical symptoms, and cerebellar infarcts have been evaluated with the almost exclusive use of transversal MR images. We aimed to document the occurrence and 3D-imaging patterns of

  20. Cerebellar infarct patterns: The SMART-Medea study.

    Science.gov (United States)

    De Cocker, Laurens J L; Geerlings, Mirjam I; Hartkamp, Nolan S; Grool, Anne M; Mali, Willem P; Van der Graaf, Yolanda; Kloppenborg, Raoul P; Hendrikse, Jeroen

    2015-01-01

    Previous studies on cerebellar infarcts have been largely restricted to acute infarcts in patients with clinical symptoms, and cerebellar infarcts have been evaluated with the almost exclusive use of transversal MR images. We aimed to document the occurrence and 3D-imaging patterns of cerebellar infarcts presenting as an incidental finding on MRI. We analysed the 1.5 Tesla MRI, including 3D T1-weighted datasets, of 636 patients (mean age 62 ± 9 years, 81% male) from the SMART-Medea study. Cerebellar infarct analyses included an assessment of size, cavitation and gliosis, of grey and white matter involvement, and of infarct topography. One or more cerebellar infarcts (mean 1.97; range 1-11) were detected in 70 out of 636 patients (11%), with a total amount of 138 infarcts identified, 135 of which showed evidence of cavitation. The average mean axial diameter was 7 mm (range 2-54 mm), and 131 infarcts (95%) were smaller than 20 mm. Hundred-thirty-four infarcts (97%) involved the cortex, of which 12 in combination with subcortical white matter. No infarcts were restricted to subcortical branches of white matter. Small cortical infarcts involved the apex of a deep (pattern 1) or shallow fissure (pattern 2), or occurred alongside one (pattern 3) or opposite sides (pattern 4) of a fissure. Most (87%) cerebellar infarcts were situated in the posterior lobe. Small cerebellar infarcts proved to be much more common than larger infarcts, and preferentially involved the cortex. Small cortical infarcts predominantly involved the posterior lobes, showed sparing of subcortical white matter and occurred in characteristic topographic patterns.

  1. Fatal remote cerebellar hemorrhage after supratentorial unruptured aneurysm surgery in patient with previous cerebellar infarction

    Science.gov (United States)

    Koh, Eun-Jeong; Park, Jung-Soo

    2017-01-01

    Abstract Rationale: Remote cerebellar hemorrhage (RCH) is a rare complication of supratentorial and spinal surgeries, seldom requiring intervention but occasionally causing significant morbidity or even mortality. Although a number of theories have been proposed, the exact pathophysiology of RCH remains incompletely understood. Patient concerns: We present a 62-year-old patient with RCH encountered following surgical clipping of an unruptured middle cerebral artery bifurcation aneurysm in a patient with previous cerebellar infarction. Lessons: It is extremely rare, but sometimes, RCH can be life-threatening. It is necessary to check the patient's general condition, underlying diseases and medical history. And controlled drainage of the CSF seems to be most important. Arachnoidplasty may be a consideration and the position of the drain string might have to be carefully determined. PMID:28121936

  2. The bihemispheric posterior inferior cerebellar artery

    Energy Technology Data Exchange (ETDEWEB)

    Cullen, Sean P. [Brigham and Women' s Hospital and Children' s Hospital, Department of Radiology and Neurosurgery, Boston, MA (United States); Ozanne, Augustin; Alvarez, Hortensia; Lasjaunias, Pierre [Service de Neuroradiologie Diagnostic et Therapeutique, Hopital de Bicetre-Universite Paris-sud Orsay (France)

    2005-11-01

    Rarely, a solitary posterior inferior cerebellar artery (PICA) will supply both cerebellar hemispheres. We report four cases of this variant. We present a retrospective review of clinical information and imaging of patients undergoing angiography at our institution to identify patients with a bihemispheric PICA. There were four patients: three males and one female. One patient presented with a ruptured arteriovenous malformation, and one with a ruptured aneurysm. Two patients had normal angiograms. The bihemispheric PICA was an incidental finding in all cases. The bihemispheric vessel arose from the dominant left vertebral artery, and the contralateral posterior inferior cerebellar artery was absent or hypoplastic. In all cases, contralateral cerebellar supply arose from a continuation of the ipsilateral PICA distal to the choroidal point and which crossed the midline dorsal to the vermis. We conclude that the PICA may supply both cerebellar hemispheres. This rare anatomic variant should be considered when evaluating patients with posterior fossa neurovascular disease. (orig.)

  3. Cerebellar infarcts in the New England Medical Center Posterior Circulation Stroke Registry.

    Science.gov (United States)

    Chaves, C J; Caplan, L R; Chung, C S; Tapia, J; Amarenco, P; Teal, P; Wityk, R; Estol, C; Tettenborn, B; Rosengart, A

    1994-08-01

    We report the clinical findings and stroke mechanisms of 63 patients with cerebellar infarcts. We divided the intracranial vertebrobasilar circulation into the proximal territory (P), fed by the intracranial vertebral arteries and their branches; the middle territory (M), fed by the proximal and middle basilar artery and its branches; and the distal territory (D), fed by the rostral basilar artery and its branches. Cerebellar infarcts were classified by vascular territories P, M, D, P&D, and middle-plus (P&M, M&D, and P&M&D). Patients with P infarcts (11 patients) frequently had vertigo, gait instability, limb ataxia, and headache, whereas patients with D infarcts (15 patients) most often had limb ataxia, gait instability, and dysarthria. Patients with P&D infarcts (17 patients) had signs and symptoms of both groups combined. Infarcts in which the middle territory was involved, either alone (three patients) or combined with other territories (17 patients) were dominated by brainstem signs and symptoms. The predominant stroke mechanisms in the P, D, and P&D groups were embolic due to intra-arterial or cardiac embolism. When the M territory was involved, either alone or with P, D, or P&D territories, stroke mechanisms were more varied, and there was often large-artery occlusion with hemodynamic ischemia.

  4. Acute arterial infarcts in patients with severe head injuries

    Directory of Open Access Journals (Sweden)

    Deepak Agrawal

    2012-01-01

    Full Text Available Aims and Objectives: To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Materials and Methods: Patients with severe head injury (Glasgow coma score (GCS ≤8 presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS at 1 month post-injury or at death (whichever came earlier. Results: Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1% had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3-85 years. Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1-3 was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21 in patients with severe head injury without arterial infarct. Conclusions: A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-a-vis patient without these findings.

  5. Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction: imaging correlations.

    Science.gov (United States)

    Huh, Young Eun; Kim, Ji Soo

    2011-12-01

    Horizontal head-shaking may induce nystagmus in peripheral as well as central vestibular lesions. While the patterns and mechanism of head-shaking nystagmus are well established in peripheral vestibulopathy, they require further exploration in central vestibular disorders. To define the characteristics and mechanism of head-shaking nystagmus in central vestibulopathies, we investigated spontaneous nystagmus and head-shaking nystagmus in 72 patients with isolated cerebellar infarction. Spontaneous nystagmus was observed in 28 (39%) patients, and was mostly ipsilesional when observed in unilateral infarction (15/18, 83%). Head-shaking nystagmus developed in 37 (51%) patients, and the horizontal component of head-shaking nystagmus was uniformly ipsilesional when induced in patients with unilateral infarction. Perverted head-shaking nystagmus occurred in 23 (23/37, 62%) patients and was mostly downbeat (22/23, 96%). Lesion subtraction analyses revealed that damage to the uvula, nodulus and inferior tonsil was mostly responsible for generation of head-shaking nystagmus in patients with unilateral posterior inferior cerebellar artery infarction. Ipsilesional head-shaking nystagmus in patients with unilateral cerebellar infarction may be explained by unilateral disruption of uvulonodular inhibition over the velocity storage. Perverted (downbeat) head-shaking nystagmus may be ascribed to impaired control over the spatial orientation of the angular vestibulo-ocular reflex due to uvulonodular lesions or a build-up of vertical vestibular asymmetry favouring upward bias due to lesions involving the inferior tonsil.

  6. Cerebellar arteries originating from the internal carotid artery: angiographic evaluation and embryologic explanations

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Young; Han, Moon Hee; Yu, In Gyu; Chang, Ki Hyun [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Eui Jong [Kyunghee Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Dae Ho [Soonchunhyang Univ. College of Medicine, Asan(Korea, Republic of)

    1997-06-01

    To find and describe the cerebellar arteries arising from the internal carotid artery, explain them embryologically, and evaluate their clinical implication. To determine the point in the internal carotid artery from which the cereballar artery arose anomalously, consecutive angiographic studies performed in the last three years were reviewed. The distribution of such anomalous cerebellar arteries, the point in the internal carotid artery from which the anomalous vessels originated, and associated findings were analyzed. Five anomalous origins of cerebellar arteries arising arising directly from the internal carotid artery were found in five patients. Three anterior inferior cerebellar arteries (AICA) and one common trunk of an AICA and a posterior inferior cerebellar artery (PICA) were found to originate from the internal carotid artery at a point close to the origin of the primitive trigeminal artery. A PICA arose from an artery presenting a course similar to the proatlantal intersegmental artery. Intracranial aneurysms in two patients, Moyamoya disease in one, and facial arteriovenous malformation in one. In our series, AICAs supplied from the arteries considered to be persistent trigeminal artery variants were the most common type. A correlation between type of anomalous cerebellar artery and type of carotid-vertebrobasilar anastomosis may exist. Cerebellar arteries originating anomalously from the internal carotid artery seem to occur as a result of the persistence of carotid-vertebrobasilar anastomoses associated with incomplete fusion of the longitudinal neural arteries. An understanding of these anomalous cerebellar arteries may help prevent accidents during therapeutic embolization and surgical treatment, as well as misinterpretation.

  7. Effect of edaravone on acute brainstem-cerebellar infarction with vertigo and sudden hearing loss.

    Science.gov (United States)

    Inoue, Yuta; Yabe, Takao; Okada, Kazunari; Nakamura, Yuka

    2014-06-01

    We report 2 cases with acute brainstem and brainstem-cerebellar infarction showed improvement of their signs and symptoms after administration of edaravone. Case 1, a 74-year-old woman who experienced sudden vertigo, also had dysarthria and left hemiplegia. Magnetic resonance imaging (MRI) showed an abnormal region in the right ventrolateral medulla oblongata. The patient's vertigo and hemiplegia improved completely after treatment. Case 2, a 50-year-old man who experienced sudden vertigo and sensorineural hearing loss (SNHL), developed dysarthria after admission. MRI revealed acute infarction in the right cerebellar hemisphere. Magnetic resonance angiography revealed dissection of the basilar artery and occlusion of the right anterior inferior cerebellar artery. The patient's vertigo and hearing remarkably improved. We have described 2 patients whose early symptoms were vertigo and sudden SNHL, but who were later shown to have ischemic lesions of the central nervous system. Edaravone is neuroprotective drug with free radical-scavenging actions. Free radicals in the ear are responsible for ischemic damage. Edaravone, a free radical scavenger, may be useful in the treatment of vertigo and SNHL. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

    Directory of Open Access Journals (Sweden)

    Taylor J. Bergman

    2016-12-01

    Full Text Available Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  9. Cerebellar infarct with neurogenic pulmonary edema following viper bite

    Directory of Open Access Journals (Sweden)

    Salil Gupta

    2012-01-01

    Full Text Available Russell′s viper (Daboia russelli bites are well known to cause bleeding complications. However, thrombotic complications are rare. We present the case details of a female who was bitten by a Russell′s viper (Daboia russelli in her village. She then developed features of envenomation in the form of hemorrhagic episodes. She received 27 vials of polyvalent anti-snake venom to which the hemorrhagic complications responded. After about 48 h of the bite she developed features of cerebellar infarct along with pulmonary edema which was in all probability neurogenic in origin. She was managed with mechanical ventilation and extra ventricular drainage with good recovery. We discuss the likely pathogenesis of the infarct and pulmonary edema occurring in a patient with viper bite and other features of envenomation.

  10. Crossed cerebellar diaschisis after stroke identified noninvasively with cerebral blood flow-weighted arterial spin labeling MRI

    Science.gov (United States)

    Strother, Megan K.; Buckingham, Cari; Faraco, Carlos C.; Arteaga, Daniel; Lu, Pengcheng; Xu, Yaomin; Donahue, Manus J.

    2015-01-01

    Background and Purpose Crossed cerebellar diaschisis (CCD) is most commonly investigated using hemodynamic PET and SPECT imaging. However, noninvasive MRI offers advantages of improved spatial resolution, allowing hemodynamic changes to be compared directly with structural findings and without concerns related to ionizing radiation exposure. The aim of this study was to evaluate relationships between CCD identified from cerebral blood flow (CBF)-weighted arterial spin labeling (ASL) MRI with cerebrovascular reactivity (CVR)-weighted blood oxygenation level dependent (BOLD) MRI, Wallerian degeneration, clinical motor impairment, and corticospinal tract involvement. Methods Subjects (n=74) enrolled in an ongoing observational stroke trial underwent CBF-weighted ASL and hypercapnic CVR-weighted BOLD MRI. Hemispheric asymmetry indices for basal cerebellar CBF, cerebellar CVR, and cerebral peduncular area were compared between subjects with unilateral supratentorial infarcts (n=18) and control subjects without infarcts (n=16). CCD required (1) supratentorial infarct and (2) asymmetric cerebellar CBF (>95% confidence interval relative to controls). Results In CCD subjects (n=9), CVR (p=0.04) and cerebral peduncular area (p < 0.01) were significantly asymmetric compared to controls. Compared to infarct subjects not meeting CCD criteria (n=9), CCD subjects had no difference in corticospinal tract location for infarct (p=1.0) or motor impairment (p=0.08). Conclusions CCD correlated with cerebellar CVR asymmetry and Wallerian degeneration. These findings suggest that noninvasive MRI may be a useful alternative to PET or SPECT to study structural correlates and clinical consequences of CCD following supratentorial stroke. PMID:26724658

  11. Impaired modulation of the otolithic function in acute unilateral cerebellar infarction.

    Science.gov (United States)

    Choi, Seo Young; Lee, Seung-Han; Kim, Hyo Jung; Kim, Ji-Soo

    2014-06-01

    To define the cerebellar contribution in modulating the otolithic signals, we investigated the otolithic function in 27 patients with acute unilateral cerebellar infarctions in the territory of the posterior inferior cerebellar artery (PICA, n = 17, 63%), combined PICA and superior cerebellar artery (SCA) (n = 7, 30%), SCA (n = 2, 7%), and anterior inferior cerebellar artery (n = 1, 4%) from 2010 to 2012. The patients had evaluation of the ocular tilt reaction [head tilt, ocular torsion (OT), and skew deviation], tilt of the subjective visual vertical (SVV), cervical vestibular evoked myogenic potentials (VEMPs) in response to air conducted tone bursts, and ocular VEMPs induced by tapping the head at AFz. The evaluation was completed within 2 weeks after symptom onset. Patients often showed OT or SVV tilt (15/27, 55.6%) that was either ipsi- (n = 6) or contraversive (n = 9). Overall, there were no differences in the amplitudes and latencies of cervical and ocular VEMPs between the ipsi- and contralesional sides. However, individual analyses revealed frequent abnormalities of cervical (11/27, 41%) and/or ocular (9/27, 33%) VEMPs. While 11 (73%) of the 15 patients with the OTR/SVV tilt showed abnormalities of cervical (n = 9) and/or ocular (n = 7) VEMP responses, only three (25%) of the 12 patients without the OTR/SVV tilt had abnormal cervical (n = 2) and/or ocular (n = 2) VEMPs (73% vs. 25%, Fisher's exact test, p = 0.021). The concordance rate in the results of cervical and ocular VEMPs was marginally significant (19/27, 70%, p = 0.052, binominal). Unilateral cerebellar lesions may generate otolithic imbalances, as evidenced by the OTR/SVV tilt and asymmetric ocular or cervical VEMP responses, but without directionality according to the lesion side. Patients with the OTR/SVV tilt had abnormal VEMPs more often than those without.

  12. Moyamoya disease associated with an anterior inferior cerebellar artery arising from a persistent trigeminal artery

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Sawada, A.; Takase, Y.; Kudo, S. [Department of Radiology, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan); Koizumi, T. [Department of Neurosurgery, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan)

    2002-07-01

    The authors present a case of moyamoya disease associated with a persistent trigeminal artery from which the anterior inferior cerebellar artery arose. We reviewed previously reported cases of moyamoya disease associated with persistent carotid-basilar arterial anastomosis and investigated the embryology of this rare arterial variation. (orig.)

  13. Morphology and biomechanical properties of cerebellar arteries in adults

    Directory of Open Access Journals (Sweden)

    Olga A. Fomkina

    2016-06-01

    Full Text Available The goal was to analyze the variability of a number of morphometric and biomechanical parameters of cerebellar arteries in adults aged 20-74 years. Material and Methods ― 179 samples of cerebellar arteries, obtained by autopsy of adults without acute cerebrovascular pathology have been studied; 24 preparations of arterial complexes «arterial circle – cerebral arteries» from scientific collection of Human Anatomy Department of Saratov State Medical University (Saratov, Russia have been also investigated. Research methods were: preparation, microscopy, experiments on uniaxial longitudinal stretching at a tensile testing machine Tira Test 28005 (TIRA GmbH, Germany. We studied outer diameter, angle of divergence, overall strength and maximal relative deformation of superior (SCA, anterior inferior (AICA and posterior inferior cerebellar arteries (PICA. Results and Conclusion ― It was revealed that SCA was characterized by the largest diameter and angle of divergence, the most strength and extensibility. AICA and PICA had no significant differences of the studied parameters. It was noted that AICA originated in the lower third part of basilar artery 1.5 times more likely than in the middle third part of this artery.

  14. Crossed cerebellar diaschisis in acute isolated thalamic infarction detected by dynamic susceptibility contrast perfusion MRI.

    Directory of Open Access Journals (Sweden)

    Alex Förster

    Full Text Available PURPOSE: Crossed cerebellar diaschisis (CCD is a state of neural depression caused by loss of connections to injured neural structures remote from the cerebellum usually evaluated by positron emission tomography. Recently it has been shown that dynamic susceptibility contrast perfusion weighted MRI (PWI may also be feasible to detect the phenomenon. In this study we aimed to assess the frequency of CCD on PWI in patients with acute thalamic infarction. METHODS: From a MRI report database we identified patients with acute isolated thalamic infarction. Contralateral cerebellar hypoperfusion was identified by inspection of time to peak (TTP maps and evaluated quantitatively on TTP, mean transit time (MTT, cerebral blood flow and volume (CBF, CBV maps. A competing cerebellar pathology or an underlying vascular pathology were excluded. RESULTS: A total of 39 patients was included. Common symptoms were hemiparesis (53.8%, hemihypaesthesia (38.5%, dysarthria (30.8%, aphasia (17.9%, and ataxia (15.4%. In 9 patients (23.1% PWI showed hypoperfusion in the contralateral cerebellar hemisphere. All of these had lesions in the territory of the tuberothalamic, paramedian, or inferolateral arteries. Dysarthria was observed more frequently in patients with CCD (6/9 vs. 6/30; OR 8.00; 95%CI 1.54-41.64, p = 0.01. In patients with CCD, the median ischemic lesion volume on DWI (0.91 cm³, IQR 0.49-1.54 cm³ was larger compared to patients with unremarkable PWI (0.51 cm³, IQR 0.32-0.74, p = 0.05. The most pronounced changes were found in CBF (0.94±0.11 and MTT (1.06±0.13 signal ratios, followed by TTP (1.05±0.02. CONCLUSIONS: Multimodal MRI demonstrates CCD in about 20% of acute isolated thalamic infarction patients. Lesion size seems to be a relevant factor in its pathophysiology.

  15. Cerebellar hemorrhage after embolization of ruptured vertebral dissecting aneurysm proximal to PICA including parent artery

    Directory of Open Access Journals (Sweden)

    Akira Tamase

    2014-01-01

    Full Text Available Background: Some complications related to vertebral artery occlusion by endovascular technique have been reported. However, cerebellar hemorrhage after vertebral artery occlusion in subacute phase is rare. In this report, we describe a patient who showed cerebellar hemorrhage during hypertensive therapy for vasospasm after embolization of a vertebral dissecting aneurysm. Case Description: A 56-year-old female with a ruptured vertebral dissecting aneurysm proximal to the posterior inferior cerebellar artery developed cerebellar hemorrhage 15 days after embolization of the vertebral artery, including the dissected site. In this patient, the preserved posterior inferior cerebellar artery fed by retrograde blood flow might have been hemodynamically stressed during hypertensive and antiplatelet therapies for subarachnoid hemorrhage, resulting in cerebellar hemorrhage. Conclusion: Although cerebellar hemorrhage is not prone to occur in the nonacute stage of embolization of the vertebral artery, it should be taken into consideration that cerebellar hemorrhage may occur during hypertensive treatment.

  16. Distal posterior inferior cerebellar artery aneurysm in a child

    Directory of Open Access Journals (Sweden)

    J. Francisco Salomão

    1992-06-01

    Full Text Available The case of a 7-year-old boy presenting with recurrent episodes of subarachnoid hemorrhage due to a distal posterior inferior cerebellar artery aneurysm (PICA, successfully operated, is reported.' The low incidence of intracranial aneurysms in the first decade of life and the rare occurrence of distal PICA aneurysms are unusual features of this case. The theories regarding the origin of intracranial berry aneurysms are discussed.

  17. [Aneurysm of the anterior inferior cerebellar artery: case report].

    Science.gov (United States)

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  18. Infarto cerebelar: análise de 151 pacientes Cerebellar infarction: analysis of 151 patients

    Directory of Open Access Journals (Sweden)

    Jefferson Rosi Jr

    2006-06-01

    Full Text Available Este estudo apresenta o tratamento de 151 pacientes com infarto cerebelar, sendo 98 homeNs (65% e 53 mulheres (35%, com média de idade de 62,4 anos. Hidrocefalia obstrutiva foi diagnosticada em 7,9% dos pacientes associada com um infarto cerebelar extenso e em todos os 11 pacientes operados (7,2%. Quatro pacientes foram submetidos a derivação ventricular externa com 3 óbitos (75% e 7 foram submetidos a craniectomia descompressiva suboccipital com 2 óbitos (28,5%. A mortalidade no grupo clínico foi de 15 pacientes (10,7%. Vertigem, vômito, sinal de Romberg e dismetria foram os sinais e sintomas de envolvimento cerebelar mais frequentemente observados. Infarto cerebelar devido a embolismo provocado por cirurgia cardiovascular ocorreu em 57 pacientes (37,7%.Infarto cerebelar como fato isolado ocorreu em 59 pacientes (39% e infartos cerebelares associados a infartos de outras regiões ocorreram em 92 pacientes (61%. A ressonância magnética foi o melhor método para o diagnóstico das lesões, embora a tomografia pôde mostrar infarto cerebelar em 68 pacientes (78%.This report presents the treatment of 151 patients with cerebellar infarction, 98 men (65% and 53 women (35%, mean age 62.4 years old. Occlusive hydrocephalus was diagnosed in 7.9% of the patients associated with an extensive cerebellar infarction and in all 11 surgical patients (7.2%. Four patients underwent an external ventricular drainage with 3 deaths (75% and 7 underwent a decompressive suboccipital craniectomy with 2 deaths (28.5%. Mortality of the clinical group was 15 patients (10.7%. Vertigo, vomiting, Romberg sign and dysmetria were the signs and symptoms of cerebellar involvement that were more frequentely observed. Cerebellar infarction from embolism after cardiovascular surgery occurred in 57 patients (37.7%.Cerebellar infarction, as a isolated fact, occurred in 59 patients (39% and cerebellar plus infarction in other regions occurred in 92 patients (61%. Magnetic

  19. Recent Advances in Cerebellar Ischemic Stroke Syndromes Causing Vertigo and Hearing Loss.

    Science.gov (United States)

    Kim, Hyun-Ah; Yi, Hyon-Ah; Lee, Hyung

    2016-12-01

    Cerebellar ischemic stroke is one of the common causes of vascular vertigo. It usually accompanies other neurological symptoms or signs, but a small infarct in the cerebellum can present with vertigo without other localizing symptoms. Approximately 11 % of the patients with isolated cerebellar infarction simulated acute peripheral vestibulopathy, and most patients had an infarct in the territory of the medial branch of the posterior inferior cerebellar artery (PICA). A head impulse test can differentiate acute isolated vertigo associated with PICA territory cerebellar infarction from more benign disorders involving the inner ear. Acute hearing loss (AHL) of a vascular cause is mostly associated with cerebellar infarction in the territory of the anterior inferior cerebellar artery (AICA), but PICA territory cerebellar infarction rarely causes AHL. To date, at least eight subgroups of AICA territory infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the AICA). Audiovestibular loss from cerebellar infarction has a good long-term outcome than previously thought. Approximately half of patients with superior cerebellar artery territory (SCA) cerebellar infarction experienced true vertigo, suggesting that the vertigo and nystagmus in the SCA territory cerebellar infarctions are more common than previously thought. In this article, recent findings on clinical features of vertigo and hearing loss from cerebellar ischemic stroke syndrome are summarized.

  20. Infantile intracranial aneurysm of the superior cerebellar artery.

    Science.gov (United States)

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-02-29

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes. 2016 BMJ Publishing Group Ltd.

  1. 119例小脑梗死的临床分析%Analysis for Clinical Features of Cerebellar Infarction in 119 Patients

    Institute of Scientific and Technical Information of China (English)

    吴菁; 陈伟; 董幼镕; 翟宇; 孙旭红; 潘辉; 李强; 方洁; 刘建仁

    2016-01-01

    ABSTRACT Aim To investigate the etiological type of Chinese Ischemic Stroke Subclassiifcation (CISS), the lesion distribution, the concomitant lesions outside the cerebellum and the clinical manifestations in patients with acute cerebellar infarction.MethodsThe MRI images, the etiological examination ifndings and the clinical manifestations of 119 patients with acute cerebellar infarction who were admitted to our hospital from January 2012 to December 2015 were retrospectively analyzed.ResultsAmong 119 cases of cerebellar infarction patients, 78 cases were classiifed to unilateral cerebellar infarction (UCI), 41 caseswere bilateral cerebellar infarction (BCI). The main etiological type of CISS was large artery atherosclerosis (LAA), followed by cardiogenic stroke (CS), mixing mechanism, penetrating artery disease (PAD) and other etiologies. There was no signiifcant difference in CISS between the BCI group and the UCI group. In the UCI group, posterior inferior cerebellar artery (PICA) infarction had the highest occurrence rate (36%), and there was a difference between the two groups (P The main etiology of cerebellar infarction was large artery atherosclerosis, PICA infarction could be observed most frequently in unilateral cerebellar infarction. Bilateral cerebellar infarction was often associated with concomitant lesions outside the cerebellum in posterior circulation. Unilateral and bilateral cerebellar infarction had certain differences in cerebellar artery involvement and concomitant lesions outside the cerebellum, prompting difference of their mechanism. Bilateral cerebellar infarction tended to present more conscious disturbance and other serious CNS function defect than unilateral cerebellar infarction.%目的:探讨小脑梗死的中国缺血性脑卒中分型诊断(CISS)、受累血管区域、合并小脑外梗死病灶以及临床表现。方法回顾性分析自2012年1月至2015年12月119例急性小脑梗死住院患者的头颅MRI影像、病因

  2. Ipsilateral Cerebral and Contralateral Cerebellar Hyperperfusion in Patients with Unilateral Cerebral Infarction; SPM Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Sun Pyo; Yoon, Joon Kee; Choi, Bong Hoi; Joo, In Soo; Yoon, Seok Nam [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2008-10-15

    Cortical reorganization has an important role in the recovery of stroke. We analyzed the compensatory cerebral and cerebellar perfusion change in patients with unilateral cerebral infarction using statistical parametric mapping (SPM). Fifty seven {sup 99m}Tc-Ethylene Cystein Diethylester (ECD) cerebral perfusion SPECT images of 57 patients (male/female=38/19, mean age=56{+-}17 years) with unilateral cerebral infarction were evaluated retrospectively. Patients were divided into subgroups according to the location (left, right) and the onset (acute, chronic) of infarction. Each subgroup was compared with normal controls (male/female=11/1, mean age =36{+-}10 years) in a voxel-by-voxel manner (two sample t-test, p<0.001) using SPM. All 4 subgroups showed hyperperfusion in the ipsilateral cerebral cortex, but not in the contralateral cerebral cortex. Chronic left and right infarction groups revealed hyperperfusion in the ipsilateral primary sensorimotor cortex, meanwhile, acute subgroups did not. Contralateral cerebellar hyperperfusion was also demonstrated in the chronic left infarction group. Using {sup 99m}Tc-ECD SPECT, we observed ipsilateral cerebral and contralateral cerebeller hyperperfusion in patients with cerebral infarction. However, whether these findings are related to the recovery of cerebral functions should be further evaluated.

  3. Renal infarction resulting from traumatic renal artery dissection.

    Science.gov (United States)

    Kang, Kyung Pyo; Lee, Sik; Kim, Won; Jin, Gong Yong; Na, Ki Ryang; Yun, Il Yong; Park, Sung Kwang

    2008-06-01

    Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

  4. [Myocardial infarction with normal coronary arteries].

    Science.gov (United States)

    Espinosa, R; Badui, E; Narvaez, M G; Hurtado, R

    1986-01-01

    We retrospectively studied 36 cases of myocardial Infarction (MI) with normal coronary arteries, which had been obtained from a total of 538 patients with MI admitted to our Hospital in the last 3 years. All patients had coronary angiogram and left ventriculogram. The following data was reviewed: age, sex, coronary risk factors, clinical picture, short and long term follow up. The angiography findings were correlated. The average age of the patients was 42 years, 75% were male and 25% female. The 36 cases represent 7% of the total MI. Cigarette smoking was the only important risk factor. MI was the first manifestation of ischemic heart disease in 94% of the cases. The ejection fraction was normal in 94%; 27.6% presented some complication during the acute event. In the long term follow; up to 88% of the patients are asymptomatic. The physiopathologic mechanisms are analyzed.

  5. Anterior spinal and bulbar artery supply to the posterior inferior cerebellar artery revealed by a ruptured aneurysm: case report.

    Science.gov (United States)

    Gabrieli, Joseph; Sourour, Nader-Antoine; Chauvet, Dorian; Di Maria, Federico; Chiras, Jacques; Clarençon, Frédéric

    2017-02-01

    The posterior inferior cerebellar artery (PICA) is a vessel located between the intra- and extracranial circulation. The artery is characterized by a complex embryological development and numerous anatomical variants. The authors present a case of the PICA supplied by both a hypertrophic anterior spinal artery and a hypoplastic bulbar artery. This unusual arrangement somehow completes the list of previously published variants, and the spontaneous rupture of a related aneurysm confirmed the fragility of this network. The authors discuss anatomical and treatment considerations.

  6. Methylenetetrahydrofolate reductase homozygous mutation in a young boy with cerebellar infarction.

    Science.gov (United States)

    Spalice, Alberto; Del Balzo, Francesca; Perla, Francesco Massimo; Properzi, Enrico; Carducci, Carla; Antonozzi, Italo; Iannetti, Paola

    2009-06-08

    Posterior circulation vascular occlusive disease in children is a rare and uncommonly reported event. Among the numerous risk factors, the methylenetetrahydrofolate reductase (MTHFR) mutation is considered to be a common genetic cause of thrombosis in adults and children. Recently, a link between the MTHFR mutation and cerebrovascular disorders was reported in children. Diffusion tensor imaging (DTI) is a great improvement on magnetic resonance imaging (MRI), making the in vivo anatomical and pathological study of the brain and its fibers possible. In our patient cerebellar infarction was associated with MTHFR mutation and, in a standard neurological examination, DTI revealed normal white matter tracts.

  7. Surgical treatment for ruptured anterior inferior cerebellar artery aneurysms

    Directory of Open Access Journals (Sweden)

    TONG Xiao-guang

    2013-03-01

    Full Text Available Background Anterior inferior cerebellar artery (AICA aneurysm is an extremely raretumor, which can cause severe results after ruptured. This article retrospectively analyzed the clinical symptoms, imaging manifestations, surgical approaches, endovascular therapy and postoperative outcomes of 12 cases with AICA aneurysms, so as to provide reference for clinical practice. Methods Clinical data of patients with AICA aneurysms, who were treated in our hospital between June 2004 and June 2012, were carefully collected and studied. Glasgow Outcome Scale (GOS scores were used to evaluate the patients' living status. Results There were 12 patients (the average age was 54 years old with 13 ruptured aneurysms, accounting for 0.19% of all aneurysms (6467 cases treated in the same period. CT showed simple subarachnoid hemorrhage (SAH in 6 patients, simple ventricular hemorrhage in 1 patient and SAH complicated with ventricular hemorrhage in 5 patients. According to Hunt-Hess Grade, 2 patients were classified as Grade Ⅰ; 7 were Grade Ⅱ; 3 were Grade Ⅲ. Digital subtraction angiography (DSA showed there were 10 saccular aneurysms and 3 fusiform aneurysms. Three aneurysms were located in the proximal segment of AICA (the junction of AICA and basilar artery, 3 premeatal segment (first bifurcation of AICA, 3 meatal and 4 postmeatal. The mean diameter was 3.90 mm. Three patients with 4 aneurysms were treated with microsurgery, of which clipping was carried out in 2 patients with 3 aneurysms and trapping in 1 case. Other 9 patients were treated with endovascular therapy, of which 2 cases underwent coil embolization, 3 stent-assisted coil, and 4 parent artery occlusion (PAO. Postoperative complications included facial paralysis (1 case, dysphagia and coughing when drinking (1 case and contralateral hemianopia in both eyes (1 case. Follow-up was available in all of these cases for a mean of 36.41 months, with GOS scores 3 in 1 case, 4 in 2 cases and 5 in 9

  8. Recirculation usually precedes malignant edema in middle cerebral artery infarcts

    DEFF Research Database (Denmark)

    Nielsen, T H; Ståhl, N; Schalén, W;

    2012-01-01

    In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 2-5 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue....

  9. Central Hypoventilation Syndrome Complicated with Lateral Medullary Infarction after Endovascular Treatment of the Vertebral Artery Dissecting Aneurysm: A Case Report.

    Science.gov (United States)

    Tanaka, Katsuhiro; Kanamaru, Hideki; Morikawa, Atsunori; Kawaguchi, Kenji

    2016-10-01

    Lateral medullary infarction rarely leads to central hypoventilation syndrome (CHS). CHS is a life-threatening disorder characterized by hypoventilation during sleep. We report the first case of CHS as a complication of lateral medullary infarction after endovascular treatment. A 65-year-old man presented twice with severe headache. Computed tomography revealed subarachnoid hemorrhage and cerebral angiography showed a right vertebral dissecting aneurysm involving the posterior inferior cerebellar artery. After emergent endovascular patent artery occlusion, he developed Wallenberg syndrome and experienced apnea and a conscious disturbance episode due to CHS on postoperative days 6 and 16. Intensive respiratory care including intubation, tracheostomy, mechanical ventilation, and rehabilitation prevented subsequent recurrence of apnea and the CHS resolved completely. CHS after unilateral medullary infarction involving respiratory centers tends to occur in the acute and subacute phase and may be lethal without careful respiratory management.

  10. ‘YES YES HEAD TREMOR’ case developing after cerebellar infarction

    Directory of Open Access Journals (Sweden)

    Uygar Utku

    2015-12-01

    Full Text Available Movement disorders, developing after cerebellar infarctions, are rare. One of them is 'Yes / Yes tremor' head tremor. A 73-year-old female patient was brought to the emergency department of our hospital with complaints of dizziness, nausea and vomiting. There was hypertension on her past history. She was taking anti-hypertension drug. Her neurological examination was normal except for right dysmetria, disdiadikokinesia and damaged knee-heel test. Electrocardiography was atrial fibrillation with rapid ventricular response. On the right cerebellar hemisphere, brain computerized tomography revealed consistent lesions with acute ischemic stroke. The patient showed clinically significant improvement in time and discharged with coumadine. When she came for drug control after two weeks, we detected her ‘Yes / Yes’ revealed style of head tremor started three days ago. The tremor was resting-postural. Its activity increased with excitement, decreased after resting and stopped while sleeping. She was intolerant although we initiated the treatment with primidone 250 mg tablets divided into eight. After continuing the treatment with gabapentine titrated 300 mg tablets, the head tremor of patient improved remarkedly in a short period of time. The phenomenon is presented due to its rarity and remarkableness.

  11. MR imaging findings of renal infarction induced by renal artery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jun Woo; Kim, Suck; Kim, Yong Woo; Hu, Jin Sam; Choi, Sang Yoel; Moon, Tae Yong; Lee, Suck Hong; Kim, Byung Su; Lee, Chang Hun [Pusan National Univ., Pusan (Korea, Repulic of). Coll. of Medicine

    1998-02-01

    To assess the usefulness of diffusion-weighted imaging (DWI) in evaluating serial parenchymal changes in renal infarction induced by renal artery ligation, by comparing this with the conventional spin echo technique and correlating the results with the histopathological findings. In 22 rabbits, renal infarction was induced by ligation of the renal artery. Spin-echo T1-weighted imaging (T1WI), turbo spin-echo (TSE) T2-weighted imaging (T2WI), and DWI were performed, using a 1.5-T superconductive unit, at 30 minutes, 1 hour, 2,3,6, 12 and 24 hours, and 2, 3, 7 and 20 days after left renal artery ligation. Changes in signal intensity on T1WI, T2WI, and DWI were correlated with histopathologic findings. Diffusion-weighted imaging is useful for the detection of hyperacute renal infarction, and the apparent diffusion coefficient may provide additional information concerning its evolution. (author). 21 refs., 9 figs.

  12. Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

    Science.gov (United States)

    Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

    2008-02-01

    Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

  13. Retrograde Stent Placement for Coil Embolization of a Wide-Necked Posterior Inferior Cerebellar Artery Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Hong Gee; Chun, Young IL; Choi, Jin Woo; Cho, Joon; Moon, Won Jin [University College of Medicine, Seoul (Korea, Republic of); Solander, Sten [University of North Carolina School of Medicine, Chapel Hill (United States)

    2012-07-15

    Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.

  14. Spontaneous carotid artery dissection causing a juvenile cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S.; Huebsch, P.; Schindler, E.

    1988-11-01

    The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred.

  15. Spontaneous coronary artery dissection as a cause of myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Aytekin; Aksakal; U?ur; Arslan; Mehmet; Yaman; Mehmet; Urumda?; Ahmet; Hakan; Ate?

    2014-01-01

    Spontaneous coronary artery dissection(SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative’s funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending(LAD) artery and left circumflex(LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case.

  16. Parent artery occlusion with Onyx for distal aneurysms of posterior inferior cerebellar artery: A single-centre experience in a series of 15 patients

    Directory of Open Access Journals (Sweden)

    Qi Wu

    2013-01-01

    Full Text Available Background: Aneurysms located at distal posterior inferior cerebellar artery (PICA are rare. These aneurysms are difficult for surgical or endovascular treatment, especially for ruptured aneurysms. Aims: To investigate the clinical and radiologic efficacy of parent artery occlusion (PAO with embolic agent Onyx in the treatment of distal PICA aneurysm. Materials and Methods: Case records of 15 consecutive patients with 15 ruptured distal PICA aneurysms treated with Onyx embolization were reviewed retrospectively. The follow-up ranged between 6 and 52 months. Cerebral angiography or cerebra computed tomography-angiogram (CTA was performed for follow-up radiological study. Two aneurysms had origin from tonsillomedullary segment, nine from telovelotonsillar segments, and four from cortical segments. All patients were treated with Onyx to occlude aneurysm and proximal portion of vessel in front of aneurysm via endovascular approach. Results: Aneurysm was occluded completely in every patient. One patient died because of intra-procedure haemorrhage. Fourteen patients had good recovery and the last follow-up Glasgow outcome scale was 5. Head CT scan was performed in every survived patient before discharge. CT in 3 patients revealed cerebellar infarctions but without any neurological deficits. None of the 14 patients had rebleeding or fresh neurologic deficits during the follow-up period. Aneurysmal recanalization had not been observed in any of the survived patients. Conclusions: Onyx occlusion of proximal parent artery and aneurysm in the treatment of distal PICA aneurysm is safe and effective according to this study. Morphology and location of aneurysm are important to decide the therapeutic strategy.

  17. Spontaneous renal artery dissection complicating with renal infarction.

    Science.gov (United States)

    Tsai, Tsung-Han; Su, Jung-Tsung; Hu, Sung-Yuan; Chao, Chih-Chung; Tsan, Yu-Tse; Lin, Tzu-Chieh

    2010-12-01

    Spontaneous renal artery dissection (SRAD) is a rare entity. We reported a 30-year-old healthy man presenting with sudden onset of left flank pain. Abdominal plain film and sonography were unremarkable. The contrast-enhanced abdominal computed tomographic (CT) scan demonstrated a dissecting intimal flap of the left distal renal artery (RA) complicating infarction. Selective angiography of the renal artery disclosed a long dissection of left distal RA with a patent true lumen and occlusion of left accessory RA. Conservative treatment with control of blood pressure and antiplatelet agent was prescribed. The patient was discharged with an uneventful condition on day 5.

  18. [Craniectomy in space-occupying middle cerebral artery infarcts].

    Science.gov (United States)

    Schwab, S; Rieke, K; Krieger, D; Hund, E; Aschoff, A; von Kummer, R; Hacke, W

    1995-06-01

    Space occupying supratentorial ischemic stroke has a high mortality. The benefit of decompressive surgery in these patients is still matter of debate. In a prospective study we performed craniectomy in 37 patients with acute middle cerebral artery infarction and progressive deterioration under conservative antiedematous therapy. Twenty-one patients treated conservatively during the same period served as control group. All survivors were reexamined between one to two years after surgical decompression. In addition, neuropsychological tests were performed, including an Aachener Aphasie Test (AAT) in those patients with infarction of speech-dominant hemisphere. Clinical evaluation was graded using the Barthel index (BI). Mortality rate in the operated group was 37%. Twenty-three patients survived acute stroke and were reexamined. Despite complete hemispheric infarction, no patient suffered from complete hemiplegia or was permanently wheel chair bound. In speech dominant hemispheric infarction (n = 8) only mild to moderate aphasia could be detected. Mean BI was 64. Mortality rate in the conservatively treated group was 76%. The clinical outcome following craniectomy for the treatment of severe ischemic hemispheric infarction is unexpectedly good. Therefore, decompressive surgery should be considered in cases of space-occupying hemispheric infarctions and conservatively uncontrollable intracranial pressure.

  19. [Spontaneous renal artery dissection with renal infarction: a case report].

    Science.gov (United States)

    Oki, Takashi; Adachi, Hiroyuki; Tahara, Hideo; Kino, Sigeo

    2011-11-01

    A 58-year-old woman visited our hospital with nausea and right flank pain. At first abdominal ultrasonography was performed, suggesting a right renal infarction. Computed tomography (CT) study of the abdomen with intravenous contrast was performed to determine the cause of the symptoms. The scan revealed poor enhancement in the lower half of the right kidney. She was diagnosed with a right renal infarction. She was initially treated with anticoagulant therapy, but 5 days later, she complained of nausea. This time, CT demonstrated exacerbation of a right renal infarction with renal artery dissection. Based on this finding, we performed a right nephrectomy. The result of pathology was segmental arterial mediolysis. She was discharged 12 days after the surgery and is doing well at 6 months after discharge. Spontaneous renal artery dissection is a rare disease. It constitutes approximately 0.05% of arteriographic dissections. In addition, spontaneous renal artery dissection shows nonspecific symptoms. Together, these two factors may cause a delay in diagnosis.

  20. Evaluation of Cognitive Impairment After Posterior Cerebral Artery Infarction

    Directory of Open Access Journals (Sweden)

    Nilgün Çınar

    2013-02-01

    Full Text Available OBJECTIVE: The assessment of cognitive impairment after posterior cerebral artery (PCA ischemic infarction has not been well documanted. MATERIAL and METHODS: Twenty-six oriented, cooperated and non-aphasic consecutive patients with right or left (10/16 PCA infarction who were hospitalized between the years 2010-2012 were enrolled to the study. The branches of PSA were dealt as cortical and subcortical infarct under two groups. Short mental state examination test and cognitive test battery (CTB created from Wechsler memory scale (WMS, word-catogory association test and similarity test parameters were applied to the patients at the first week and third month follow-up visits and the groups were compared with each other. RESULTS: There was a significant improvement in catogory association test and total score of cognitive test battery (CTB in right PCA group, also there was a significant improvement in catogory association test in left PCA group at the first and 3th month evaluations. At the first month evaluations, total score of CTB of the subcortical segment PCA infarcts are lower than the cortical segment PCA infarcts. At the 3th month evaluations the scores increased in the both groups; but the scores in the subcortical PCA infarcts were lower than the cortical PCA infarcts. CONCLUSION: Our findings suggest that there was a cognitive impairment in patients with PCA infarction. The impairment in verbal fluency which was showed by catogory association test was found more prominent in the second evaluation. Further studies including functional imaging methods and cortical function tests are needed.

  1. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block

    Energy Technology Data Exchange (ETDEWEB)

    Suresh, S. [The Royal National Orthopaedic Hospital NHS Trust, London (United Kingdom); Berman, J. [The Royal National Orthopaedic Hospital NHS Trust, Anaesthetic Department, London (United Kingdom); Connell, David A. [The Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, London (United Kingdom)

    2007-05-15

    A 60-year-old man with a 4-year history of intractable neck pain and radicular pain in the C5 nerve root distribution presented to our department for a CT-guided transforaminal left C5 nerve root block. He had had a similar procedure on the right 2 months previously, and had significant improvement of his symptoms with considerable pain relief. On this occasion he was again accepted for the procedure after the risks and potential complications had been explained. Under CT guidance, a 25G spinal needle was introduced and after confirmation of the position of the needle, steroid was injected. Immediately the patient became unresponsive, and later developed a MR-proven infarct affecting the left vertebral artery (VA) territory. This is the first report of a major complication of a cervical root injection under CT guidance reported in the literature. We present this case report and the literature review of the potential complications of this procedure. (orig.)

  2. Persistent trigeminal artery: in situ thrombosis and associated perforating vessel infarction.

    Science.gov (United States)

    Gaughen, John R; Starke, Robert M; Durst, Christopher R; Evans, Avery J; Jensen, Mary E

    2014-06-01

    We report a patient with progressive brainstem infarction despite medical therapy. The patient was transferred to our institution for potential angioplasty of basilar stenosis. Imaging review demonstrated persistent trigeminal artery in situ thrombosis and associated perforating vessel infarction. Persistent trigeminal arteries are commonly associated with an atretic basilar artery and interventional treatment can result in significant morbidity and mortality.

  3. Anatomical study on the "perforator-free zone": reconsidering the proximal superior cerebellar artery and basilar artery perforators.

    Science.gov (United States)

    Garcia-Gonzalez, Ulises; Cavalcanti, Daniel D; Agrawal, Abhishek; Spetzler, Robert F; Preul, Mark C

    2012-03-01

    The proximal superior cerebellar artery (pSCA) is often considered a perforator-free area. Precise anatomical knowledge of this region clarifies the pathophysiology underlying posterior fossa ischemic syndromes and helps avoid treatment-related complications. To anatomically evaluate perforating branches arising from the pSCA and the upper basilar artery (BA). Forty-four SCAs from 20 cadaveric heads were examined to determine patterns of the pSCA; its morphometry for medial and lateral branches; and frequency, number, diameter, distribution, and vascular territory of perforators arising from the pSCA and rostral BA. SCA arose as a single trunk in 36 sides (90%): mean diameter at origin was 1.38 mm; mean length was 14.4 ± 7.9 mm. Ninety-nine pSCA perforator branches were present in 82% of specimens (mean, 2.3 ± 1.6; range, 0-7 perforators/side). Of these, 59% were direct, belonging to the interpeduncular group in 85% of cases; 28% were short circumflex, belonging to lateral and medial pontine group; and 13% were long circumflex, reaching the medullary perforation zone (basal cerebellar group). Median distance to the first perforator was 2.0 mm (range, 0.1-15 mm). There were 132 perforator branches in the last centimeter of the BA. The pSCA should not be regarded as a perforator-free area. Although the pSCA territories likely overlap with the posterior cerebral artery, BA, and anterior inferior cerebellar artery, the pSCA segment cannot be surgically manipulated with impunity.

  4. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

    Directory of Open Access Journals (Sweden)

    Fabricio C Lamis

    2014-01-01

    Full Text Available Background: Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. Case Description: The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA and SCA and had an uneventful recovery. Conclusions: Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

  5. Medical image of the week: artery of Percheron infarction

    Directory of Open Access Journals (Sweden)

    Ta TT

    2017-03-01

    Full Text Available No abstract available. Article truncated after 150 words. A 55-year-old African-American man presented to the Emergency Department for acute altered mental status which started 4 hours ago. His medical history was significant for heart failure with reduced ejection fraction, diabetes mellitus, marijuana and opioid use. On admission, the patient appeared to be in a deep sleep, unarousable, with grimacing to noxious stimuli. He occasionally moved all extremities. He was intubated for airway protection. Initial CT head non-contrast demonstrated a previous right MCA infarct, with no new acute hemorrhage. MRI/MRA brain revealed complete infarction of the artery of Percheron (AOP, likely due to a left ventricular thrombus (Figure 1. The patient remained somnolent throughout hospitalization with minimal neurologic improvement, and was ultimately transferred to a long-term care facility after a tracheostomy and PEG placement. The artery of Percheron is a rare, normal intracranial vascular variant in which a single arterial trunk originates from the posterior cerebral artery, giving rise …

  6. Giant partially thrombosed 4 th ventricular posterior inferior cerebellar artery aneurysm; microsurgical management

    Directory of Open Access Journals (Sweden)

    Forhad Hossain Chowdhury

    2014-01-01

    Full Text Available A 42-year-old woman presented with a 3-month history of progressive occipital headache, vomiting, walking difficulty, and repeated fall. She had no history of sudden and severe headache. She had positive cerebellar signs, predominantly on the right side. Computerized tomography (CT scan, CT angiogram, and magnetic resonance image (MRI of the brain showed suspected partially thrombosed giant 4 th ventricular posterior inferior cerebellar artery aneurysm. Patient developed severe hypersensitivity reaction during both CT scan and MRI after contrast injection. Though needed, digital subtraction angiogram (DSA of cerebral vessels was not done. The aneurysm was managed by microsurgical clipping of the aneurysm neck and partial excision of thrombosed aneurysm. Here, we report the details of management of these difficult giant aneurysm without DSA.

  7. Cilioretinal Artery Territory Infarction Associated With Papilledema in a Patient With Neurofibromatosis Type 2.

    Science.gov (United States)

    Mahroo, Omar A; Mohamed, Moin D; Graham, Elizabeth M; Mann, Samantha S; Plant, Gordon T; Afridi, Shazia K; Hammond, Christopher J

    2016-03-01

    Cilioretinal artery territory infarction can occur in isolation or in association with other vascular compromise of the retinal circulation. Our patient, an 18-year-old woman with neurofibromatosis type 2, developed a cilioretinal artery territory infarction in the setting of papilledema. Our case, together with one previous report, suggests that cilioretinal artery territory infarction in the context of papilledema, although rare, is a real entity.

  8. 急性桥臂梗死的临床特点%Clinical features of acute middle cerebellar peduncles infarction

    Institute of Scientific and Technical Information of China (English)

    赵媛; 马文平

    2013-01-01

    Objective To study the clinical features of acute middle cerebellar peduncles infarction.Methods The clinical data of 27 patients with acute middle cerebellar peduncles infarction were analyzed retrospectively.Results This group patients had the manifestation of dizziness 20 cases,with unstable walking 9 cases; nausea,vomiting 10 cases,tinnitus 4 cases,hearing loss 5 cases,horizontal nystagmus 5 cases,ocular motility disorders 2 cases,peripheral facial paralysis 3 cases,central facial palsy 2 cases,upper motor neuron paralysis on one side 5 cases,quadriplegia 1 case,hemifacial sensory disturbance 4 cases,ataxia 9 cases.Head CT examination showed 10 cases (37%) with cerebellar peduncle infarction.Head MRI examination of 23 patients showed cerebellar peduncle with new infarction of long T1 WI,T2WI,DWI high signal (100%),including unilateral 21 cases,bilateral 2 cases.Conclusions The main manifestation of middle cerebellar peduncle infarction are vestibular nerve and cerebellar impairment,and including the manifestation of trigeminal nerve,facial nerve,abducens nerve and pyramidal tract impairment.The diagnostic accuracy of MRI on it is very high,should be used as the first choice for examination.%目的 研究急性桥臂梗死的临床特点.方法 对27例急性桥臂梗死患者的临床资料进行回顾性分析.结果 本组患者表现为头晕20例,其中伴行走不稳9例;恶心、呕吐10例,耳鸣4例,听力减退5例,水平性眼震5例,一侧眼球外展受限2例,中枢性面瘫2例,周围性面瘫3例,一侧肢体中枢性瘫痪5例,四肢瘫痪1例,一侧面部痛觉减退4例,共济失调9例.头颅CT检查示桥臂梗死10例(37%).头颅MRI检查23例患者,均示桥臂长T1、长T2、DWI高信号的新梗死灶(100%),其中21例为单侧、2例为双侧桥臂梗死.结论 急性桥臂梗死以前庭神经和小脑损害的表现为主,以及存在三叉神经、面神经、展神经和锥体束受累的表现.MRI对其诊断的准确性

  9. Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms

    Directory of Open Access Journals (Sweden)

    Luiz de Abreu Junior

    Full Text Available Abstract Objective: To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms. Materials and Methods: We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant. Results: The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom. Conclusion: Vascular loops do not appear to be associated with otoneurological manifestations.

  10. Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms*

    Science.gov (United States)

    de Abreu Junior, Luiz; Kuniyoshi, Cristina Hiromi; Wolosker, Angela Borri; Borri, Maria Lúcia; Antunes, Augusto; Ota, Vanessa Kiyomi Arashiro; Uchida, Daniela

    2016-01-01

    Objective To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms. Materials and Methods We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant. Results The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom. Conclusion Vascular loops do not appear to be associated with otoneurological manifestations. PMID:27818543

  11. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

    Energy Technology Data Exchange (ETDEWEB)

    Fang, Yi-Bin, E-mail: fangyibin@163.com; Zhao, Kai-Jun, E-mail: zkjwcfzwh@163.com; Wu, Yi-Na, E-mail: wuyina0923@163.com; Zhou, Yu, E-mail: yzhou-2011@126.com; Li, Qiang, E-mail: lqeimm@126.com; Yang, Peng-Fei, E-mail: 15921196312@163.com; Huang, Qing-Hai, E-mail: ocinhqh@163.com; Zhao, Wen-Yuan, E-mail: doczhaowy@163.com; Xu, Yi, E-mail: xuyichyy@163.com; Liu, Jian-Min, E-mail: chstroke@163.com [Second Military Medical University, Department of Neurosurgery, Changhai Hospital (China)

    2015-06-15

    PurposeThe treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.MethodsA retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.ResultsThe immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).ConclusionsOur preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.

  12. Evaluation of crossed cerebellar diaschisis in 30 patients with major cerebral artery occlusion by means of quantitative I-123 IMP SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Miyazawa, Nobuhiko; Toyama, Keiji; Arbab, A.S.; Arai, Takao; Nukui, Hideaki [Yamanashi Medical Univ., Tamaho (Japan); Koizumi, Kiyoshi

    2001-12-01

    Quantitative crossed cerebellar diaschisis (CCD) and the correlation with a reduction in supratentorial regional cerebral blood flow (rCBF) and cerebrovascular reserve capacity (CVR) were investigated in clinically stable patients with major cerebral artery occlusion by the iodine-123-N-isopropyl-p-iodoamphetamine (I-123 IMP) single photon emission computed tomography (SPECT) method. Thirty patients with major cerebral artery occlusion underwent SPECT by the I-123 IMP autoradiographic method. Regional CBF was measured in the cerebral hemisphere, frontal and parietal lobes, temporo-parietal lobe, and cerebellum both at rest and after administration of acetazolamide. Eighteen of 30 patients (60%) had CCD. CCD was significantly related to magnetic resonance imaging evidence of infarction. Quantitative CCD was 17% and the CVR in the cerebellum was preserved in patients with CCD. There was a significant difference in CBF and CVR between the affected and normal sides in all regions of interest in the patients without CCD [CBF (ml/100 g/min): hemisphere (H), normal side (N): 31.4{+-}6.8, affected side (A): 27.5{+-}7.4; p<0.05. CVR: H, N: 0.56{+-}0.38, A: 0.42{+-}0.18; p<0.01]. CCD is common in patients with major cerebral artery occlusion, and quantitative I-123 IMP SPECT is helpful in detecting CCD in clinically stable patients with occlusion of major cerebral arteries. (author)

  13. Spontaneous healing and complete disappearance of a ruptured posterior inferior cerebellar artery dissecting aneurysm.

    Science.gov (United States)

    Su, Tsung-Ming; Cheng, Ching-Hsiao; Chen, Wu-Fu; Hsu, Shih-Wei

    2014-05-01

    A 7-month-old baby presented with a 4-day history of drowsiness and vomiting after a falling accident. Magnetic resonance imaging demonstrated diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and variable stages of subdural hematoma in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was noted in the right craniocervical junction. Ophthalmological examination revealed bilateral retinal petechial hemorrhages. Conventional cerebral angiography revealed a dissecting aneurysm in the right posterior inferior cerebellar artery (PICA). Endovascular embolization was suggested, but the family refused. After conservative treatment, follow-up MRI revealed that the PICA aneurysm had remodeled and ultimately disappeared completely at the 10th month. This case illustrates the relatively plastic nature of intracranial aneurysms in pediatric patients. More studies are necessary to clarify the natural history of spontaneously thrombosed aneurysms to assist in their overall management.

  14. Severe Spasm of the Renal Artery after Blunt Abdominal Trauma Simulating End-Organ Infarction

    Directory of Open Access Journals (Sweden)

    Adem Ucar

    2010-01-01

    Full Text Available Traumatic occlusion of the renal artery is a serious injury. Management differs according to the grade of injury. In most circumstances, emergency surgical revascularization or endovascular intervention is required. We describe the case of a child with multiorgan injuries and spasm of the main renal artery after blunt trauma simulating arterial occlusion or end-organ infarction.

  15. Motor recovery by anterior choroidal artery territory in a patient with middle cerebral artery infarct

    Institute of Scientific and Technical Information of China (English)

    Ji Heon Hong; Sung Ho Jang

    2010-01-01

    In this study,the uninjured periventricular area of a female patient who presented with complete paralysis of the left extremities following middle cerebral artery infarction was analyzed using diffusion tensor tractography,transcranial magnetic stimulation,and functional magnetic resonance imaging.Diffusion tensor tractography revealed interrupted corticospinal tract at the infarct lesion in the corona radiata at 2 weeks after onset,which descended through the spared periventricular area at 6 months after onset.Transcranial magnetic stimulation and functional magnetic resonance imaging revealed a motor pathway of the affected hand that was compatible with the lateral corticospinal tract.At 6 months after onset,motor function in the affected extremities recovered to normal levels,which suggested that motor function in the affected hand recovered by the corticospinal tract that passed through the spared periventricular area.The arterial territory of the spared periventricular area corresponded with the anterior choroidal artery.These results suggest that care should be taken in spared periventricular areas in patients with lesions at the corona radiata level.

  16. Intestinal Infarction Through Arterial Vascular Obstruction - Case Series from 1st and 3rd Surgery Clinics Cluj-Napoca.

    Science.gov (United States)

    Jeican, Ionuţ Isaia; Mocan, Mihaela; Gheban, Dan

    2016-01-01

    This article presents a case series of intestinal infarction through obstruction of superior mesenteric artery - two cases of acute mesenteric artery embolism, two cases of acute mesenteric artery thrombosis and a case of volvulus.

  17. Genome-Wide Association Study for Coronary Artery Calcification With Follow-Up in Myocardial Infarction

    NARCIS (Netherlands)

    O'Donnell, Christopher J.; Kavousi, Maryam; Smith, Albert V.; Kardia, Sharon L. R.; Feitosa, Mary F.; Hwang, Shih-Jen; Sun, Yan V.; Province, Michael A.; Aspelund, Thor; Dehghan, Abbas; Hoffmann, Udo; Bielak, Lawrence F.; Zhang, Qunyuan; Eiriksdottir, Gudny; van Duijn, Cornelia M.; Fox, Caroline S.; de Andrade, Mariza; Kraja, Aldi T.; Sigurdsson, Sigurdur; Elias-Smale, Suzette E.; Murabito, Joanne M.; Launer, Lenore J.; van der Lugt, Aad; Kathiresan, Sekar; Krestin, Gabriel P.; Herrington, David M.; Howard, Timothy D.; Liu, Yongmei; Post, Wendy S.; Mitchell, Braxton D.; O'Connell, Jeffrey R.; Shen, Haiqing; Shuldiner, Alan R.; Altshuler, David; Elosua, Roberto; Salomaa, Veikko; Schwartz, Stephen M.; Siscovick, David S.; Voight, Benjamin F.; Bis, Joshua C.; Glazer, Nicole L.; Psaty, Bruce M.; Boerwinkle, Eric; Heiss, Gerardo; Blankenberg, Stefan; Zeller, Tanja; Wild, Philipp S.; Schnabel, Renate B.; Schillert, Arne; Ziegler, Andreas; Muenzel, Thomas; White, Charles C.; Rotter, Jerome I.; Nalls, Michael; Oudkerk, Matthijs; Johnson, Andrew D.; Newman, Anne B.; Uitterlinden, Andre G.; Massaro, Joseph M.; Cunningham, Julie; Harris, Tamara B.; Hofman, Albert; Peyser, Patricia A.; Borecki, Ingrid B.; Cupples, L. Adrienne; Gudnason, Vilmundur; Witteman, Jacqueline C. M.

    2011-01-01

    Background-Coronary artery calcification (CAC) detected by computed tomography is a noninvasive measure of coronary atherosclerosis, which underlies most cases of myocardial infarction (MI). We sought to identify common genetic variants associated with CAC and further investigate their associations

  18. A rare case of acute renal infarction due to idiopathic renal arterial thrombosis

    Institute of Scientific and Technical Information of China (English)

    FU Zhi-fang; ZHANG Zhi-gang; LIU Xin-min

    2008-01-01

    @@ Because of the lack of specific clinical signs and symptoms,acute renal infarction is apt to be missed in diagnosis and hence has a"low"incidence.In this report,a case of acute renal infarction due to idiopathic renal arterial thrombosis is presented.

  19. Power doppler ultrasound findings of renal infarct after experimental renal artery occlusion: comparison with spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Eun; Shinn, Kyung Sub; Kim, Hak Hee; Mun, Seok Hwan; Lee, Young Joon; Lee, Bae Young; Choi, Byung Gil; Lee, Jae Mun; Lee, Hee Jeong [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To evaluate the efficacy of power Doppler ultrasonography (PDUS) in depicting renal infarction in rabbits during experimental renal segmental arterial occlusion, and to compare the results with those of CT scanning. In 28 rabbits weighing 2.5 4kg, the segmental renal artery was occluded through the left main renal artery by embolization with Ivalon (Nycomed, Paris, France). Power Doppler ultrasonography and spiral CT scanning were performed before and at 2, 5, 8, 15, and 24 hours, and 3 and 7 days after occlusion of the segmental renal artery. The location of infarcted areas and collaterals, as seen on PDUS and CT scans, was evaluated by two radiologists. In all cases, as seen on power Doppler ultrasonography, infarcted areas-when compared with normal parenchyma, clearly demonstrated wedge-shaped perfusion defects in the kidney. The location of the lesion closely corresponded to the location seen during CT scanning. After renal arterial occlusion, transiently congested capsular arteries, which were named 'capsular sign', were seen in 63% of rabbits in the two and five-hour groups. No significant cortical rim sign was demonstrated on power Doppler ultrasonography, though it was noted on spiral CT at 15 and 24 hours, and 3 and 7 days after renal arterial occlusion. Power Doppler ultrasonography was useful for the diagnosis of renal infarction. Congested capsular artery seen in the early stage of renal infarction might be a characteristic finding of this condition, as seen on power Doppler ultrasonography.

  20. Renal infarction caused by spontaneous renal artery dissection: treatment with catheter-directed thrombolysis and stenting.

    Science.gov (United States)

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Ki Cheon

    2009-03-01

    Spontaneous renal artery dissection (SRAD) is rare and presents a diagnostic and therapeutic challenge. We report a case of a 36-year-old man who had an SRAD-complicated renal infarction. The patient experienced severe unilateral flank pain. Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. The patient was treated with catheter-directed thrombolysis and frenal artery stenting.

  1. Musical, visual and cognitive deficits after middle cerebral artery infarction

    Directory of Open Access Journals (Sweden)

    Stephanie Rosemann

    2017-03-01

    Full Text Available The perception of music can be impaired after a stroke. This dysfunction is called amusia and amusia patients often also show deficits in visual abilities, language, memory, learning, and attention. The current study investigated whether deficits in music perception are selective for musical input or generalize to other perceptual abilities. Additionally, we tested the hypothesis that deficits in working memory or attention account for impairments in music perception. Twenty stroke patients with small infarctions in the supply area of the middle cerebral artery were investigated with tests for music and visual perception, categorization, neglect, working memory and attention. Two amusia patients with selective deficits in music perception and pronounced lesions were identified. Working memory and attention deficits were highly correlated across the patient group but no correlation with musical abilities was obtained. Lesion analysis revealed that lesions in small areas of the putamen and globus pallidus were connected to a rhythm perception deficit. We conclude that neither a general perceptual deficit nor a minor domain general deficit can account for impairments in the music perception task. But we find support for the modular organization of the music perception network with brain areas specialized for musical functions as musical deficits were not correlated to any other impairment.

  2. Acute Myocardial Infarction by Right Coronary Artery Occlusion Presenting as Precordial ST Elevation on Electrocardiography

    OpenAIRE

    Kim, Sung Eun; Lee, Jun-Hee; Park, Dae-Gyun; Han, Kyoo-Rok; Oh, Dong-Jin

    2010-01-01

    It is rare to observe ST-segment elevation in only the anterior leads and not the inferior leads during right coronary artery occlusion. We describe a case with acute myocardial infarction (MI) by right coronary artery occlusion who developed ST-segment elevation only in the precordial leads V1 to V3.

  3. Echocardiographic prediction of the site of coronary artery obstruction in acute myocardial infarction.

    Science.gov (United States)

    Pierard, L A; Sprynger, M; Carlier, J

    1987-02-01

    In 49 patients with acute myocardial infarction (AMI), the infarction topography was assessed by cross-sectional echocardiography and the location of coronary artery obstruction were correlated. A ventricular segmentation of 5 right and 16 left ventricular segments was used. The site of coronary obstruction was determined in 45 patients by coronary angiography and by necropsy in 4 patients. The exact location of the obstruction could not be found in 4 patients. The infarct related vessel was the left main artery in 1 patient, the left anterior descending artery (LAD) in 19, the left circumflex in 6 and the right coronary artery in 24. Specific segments were identified for each of the 3 coronary arteries: anteroseptal and anterior segments for LAD, right ventricular segments for the right coronary artery and basal anterolateral segment for the left circumflex. Specific segments (specificity 100%) were also identified for the principal coronary branches: basal anterior for the first anterior descending diagonal (sensitivity 71%), basal anteroseptal for the first septal perforator (83%), middle anterior for the second diagonal (100%), middle anteroseptal for the second septal (89%), basal posteroseptal for a dominant right coronary artery (89%), right ventricular anterolateral segment for the right ventricular marginal branch (83%). Echocardiographic identification of the topography of AMI can be useful in recognizing the infarct-related vessel and identifying the site of coronary artery obstruction.

  4. Acute Simultaneous Thrombotic Occlusion of Multiple Coronary Arteries in Acute Myocardial Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Mahdi Daei

    2017-05-01

    Full Text Available Introduction Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI, and has a high mortality rate. Case Presentation We report a case of myocardial infarction with cardiogenic shock, left bundle branch block, and multiple ST segment elevation on the electrocardiogram and thrombotic occlusion of the left circumflex, optus marginal, and left anterior descending arteries on emergency coronary angiography. Thrombus aspiration was performed at left circumflex, optus marginal, and left anterior descending arteries. Conclusions In patients with STEMI, multiple coronary thrombosis is unusual and associated with high patient mortality.

  5. Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion

    Directory of Open Access Journals (Sweden)

    Akiko Marutani

    2016-01-01

    Conclusion: This report describes a case of de novo development of a saccular distal PICA aneurysm after atherosclerotic basilar artery occlusion. We believe that increased hemodynamic stress at the PICA might have contributed to the occurrence and rupture of the aneurysm. STA-SCA bypass, introduced in the territory of the cerebellar hemisphere, reduces hemodynamic stress, which would prevent the occurrence of de novo aneurysm and recurrent bleeding.

  6. Combined Ipsilateral Oculomotor Nerve Palsy and Contralateral Downbeat Nystagmus in a Case of Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    Kosuke Matsuzono

    2014-04-01

    Full Text Available We report a patient with acute cerebral infarction of the left paramedian thalamus, upper mesencephalon and cerebellum who exhibited ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus. The site of the infarction was considered to be the paramedian thalamopeduncular and cerebellar regions, which are supplied by the superior cerebellar artery containing direct perforating branches or both the superior cerebellar artery and the superior mesencephalic and posterior thalamosubthalamic arteries. Contralateral and monocular downbeat nystagmus is very rare. Our case suggests that the present downbeat nystagmus was due to dysfunction of cerebellar-modulated crossed oculovestibular fibers of the superior cerebellar peduncle or bilateral downbeat nystagmus with one-sided oculomotor nerve palsy.

  7. Genetics of coronary artery disease and myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Xuming Dai; Szymon Wiernek; James P Evans; Marschall S Runge

    2016-01-01

    Atherosclerotic coronary artery disease(CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction(MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MIassociated genetic variants identified using candidate gene approaches and genome-wide association studies(GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.

  8. US Features of Experimentally-induced Transient Ischemia and Infarct of Renal Segmental Artery of Rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Kwan [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Seung Hyup; Moon, Min Hoan [Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

    2004-09-15

    The goal of this study was to analyze and compare the changes in renal parenchymal morphology and cortical perfusion following transient arterial ischemia and infarct in rabbits using ultrasonography (US). Six rabbits were divided into the ischemia (n=3) and infarct groups (n=3). In the ischemia group, a lower polar branch of the left renal artery was surgically ligated for a duration of 60 minutes and then released, in order to induce transient renal ischemia and reperfusion. In the infarct group, a lower polar branch of the left renal artery was permanently ligated without release, in order to induce renal infarction. Gray-scale and contrast-enhanced color/power Doppler US were performed in the two groups at specific times, namely before ligation, immediately after release or ligation (for the ischemia and infarct groups, respectively?), and on the 1st, 3rd, 7th, 14th and 28th postoperative days. The left kidneys of all rabbits were harvested after the last US, for the purpose of evaluating the pathologic correlations. In the US images, swelling, hypo- or hyperechoic areas of the involved parenchyma, tissue loss and perfusion defects were more predominant in the infarct group than in the ischemia group. In successive images, hyperechoic renal parenchyma with no reperfusion changed into renal infarct, while that with reperfusion became normal tissue. In the pathologic analysis, the specimens obtained from the ischemia group revealed mild parenchymal infarct with interstitial fibrosis, whereas those from the infarct group revealed extensive tissue loss and scarring in the involved area of the lower pole. Gray-scale and contrast-enhanced color/power Doppler US can demonstrate the morphological and hemodynamic changes in cases of renal ischemia and infarct

  9. Beneficial Effects of Delayed Opening the Infarct -related Artery on Late Phase Left Ventricular Function in Acute Anterior Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Ma Likun; Yu Hua; Huang Xiangyang; Chu Jun; Feng Kefu; Ding Xiaomei; Yan Ji; Gu Tongyuan

    2004-01-01

    Objectives To assess the effect of delayed opening the infarct - related artery(IRA) by percutanous coronary intervention (PCI) on the late phase left ventricular function after acute anterior myocardial infarction. Methods 64 patients with initial Q -wave anterior myocardial infarction and the infarct- related arteries were total occluded conformed by angiogram at 2 to 14 days after onset were divided into successful PCI group and control group (not receiving PCI or the IRA not re - opened). 2 - DE was performed at early phase ( about 3 weeks) , 2 and 6months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion abnormality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Results VWMA scores, left ventricular ejection fraction (LVEF), left ventricular end - diastolic and end-systolic volume indices (LVEDVI and LVDSVI)were similar in 2 groups at early phase and 2 months.There were no differences between early phase and 2months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with the early phase and 2 months (P > 0.05 ). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P <0.01,P < 0. 05 ). The congestive heart failure events were taken place in 19% of patients in control group compared with 2% in successful PCI group ( P > 0.05 ).Conclusions Although the infarct size does not changed, delayed opening the IRA has beneficial effect to the late phase left ventricular dilatation after acute anterior myocardial infarction.

  10. [Cerebral artery infarction presented as an unusual complication of acute middle otitis].

    Science.gov (United States)

    Moscote-Salazar, Luis Rafael; Alcalá-Cerra, Gabriel; Castellar-Leones, Sandra Milena; Gutiérrez-Paternina, Juan José

    2013-01-01

    acute otitis media is a frequent disease in the pediatric age. About 2 % of all cases develop intracranial complications such as meningitis. The cerebral infarction originates meningitis and usually occurs in the venous system. The presence of a cerebral artery infarction secondary to acute otitis media is a rare cause described in the literature. a girl of 12 months who presented a febrile syndrome due to acute otitis media and mental confusion. On physical examination, she appeared sleepy with anisocoria, mydriasis in the right eye and left hemiparesis. The computed tomography examination showed extensive cerebral artery infarction. The patient's parents refused the proposed surgical treatment and the girl died 48 hours later. regardless of the current technological advances, the clinical prognosis of cerebral infarction associated with acute otitis media is bad. The focused neurological signs and progressive clinical deterioration should raise suspicion that antimicrobial therapy is not effective.

  11. Factors associated with failure to identify the culprit artery by the electrocardiogram in inferior ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Tahvanainen, Minna; Nikus, Kjell C; Holmvang, Lene;

    2011-01-01

    Right and left circumflex coronary artery occlusions cause inferior myocardial infarction. To improve the targeting of diagnostic and therapeutic measures individually, factors interfering with identification of the culprit artery by the electrocardiogram (ECG) were explored.......Right and left circumflex coronary artery occlusions cause inferior myocardial infarction. To improve the targeting of diagnostic and therapeutic measures individually, factors interfering with identification of the culprit artery by the electrocardiogram (ECG) were explored....

  12. OCCLUSION OF ARTERY OF PERCHERON: A RARE AETIOLOGY OF BILATERAL THALAMIC INFARCT

    Directory of Open Access Journals (Sweden)

    Mane Makarand, Mane Priyanka, Mohite Rajsinh , Bhattad Prashant, Bangar Kushal, Mahajani Anup

    2015-10-01

    Full Text Available The Artery of Percheron, a rare anatomical variant of brain vascularisation, arises from the posterior cerebral artery. Occlusion of this artery leads to bilateral paramedian thalamic infarct leads to dysfunction of central nervous system. Incidence of bilateral thalamic infarct secondary to occlusion of artery of Percheron is unknown because of its rarity. Here we report a case of 35 year old female presented with altered state of consciousness and the underlying cause was occlusion of Artery of Percheron which leads to bilateral thalamic infarct detected on MRI scanning. It showed hyperintensities on T2W1 and FLAIR, and hypointensity on T1W1, restricted to bilateral ventromedial thalami showing corresponding area of high signal intensity on diffusion weighted images and hypointensity on apparent diffusion coefficient images indicating diffusion restriction, suggestive of infarct. On further investigation magnetic resonance arteriogram (MRA of the brain demonstrated a single common artery arising from the left P1 segment which divided into two branches distally supplying bilateral thalami. Patient became alright after 2 weeks of medical line of treatment.

  13. Superior cerebellar artery aneurysms: incidence, clinical presentation and midterm outcome of endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Peluso, Jo P.P.; Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2007-09-15

    The aim of this retrospective study was to determine the incidence, clinical presentation and midterm clinical and imaging outcome of endovascular treatment of 34 superior cerebellar artery (SCA) aneurysms in 33 patients. Between January 1995 and January 2007, 2,112 aneurysms were treated in our institution, and 36 aneurysms in 35 patients were located on the SCA (incidence 1.7%). Two of three distal SCA aneurysms were excluded. All the remaining 34 SCA aneurysms, of which 22 (65%) were ruptured and 12 (35%) were unruptured, in 33 patients were treated by endovascular techniques. There were 6 men and 27 women ranging from 29-72 years. In 14 patients (42%) multiple aneurysms were present. Initial angiographic occlusion was (near) complete in 32 aneurysms (94%) and incomplete in 2 aneurysms (6%). Complications leading to permanent morbidity or death occurred in two patients (6.1%, 95% CI 0.6 to 20.60%). Outcome at 6 months follow-up in 31 surviving patients was GOS5 in 26 (84%), GOS4 in 4 (13%) and GOS3 in 1 patient (3%). There were no episodes of (re)bleeding during 118 patient-years of follow-up. The 6-month angiographic follow up in 28 SCA aneurysms and extended angiographic follow-up in 19 showed stable occlusion in 27 aneurysms. No additional treatments were performed. SCA aneurysms are rare with an incidence of 1.7% of treated aneurysms at our institution. They are frequently associated with other aneurysms. Endovascular treatment is effective and safe in excluding the aneurysms from the circulation. (orig.)

  14. Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections.

    Science.gov (United States)

    Hong, Jeong-Ho; Ahn, Seong Joon; Woo, Se Joon; Jung, Cheolkyu; Chang, Jun Young; Chung, Jin-Heon; Han, Moon-Ku

    2014-11-15

    We report 2 cases of central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections and a literature review. The 2 patients were two healthy women, in which cosmetic facial injections with autologous fat and filler were performed, respectively. The patients had no light perception at the final visit and their conditions led to memory retrieval disturbance in case 1 and right arm weakness, dysarthria, facial palsy, and ophthalmoplegia in case 2. Neuroimaging showed multifocal small infarctions in the ipsilateral frontal lobe with occlusion of the ophthalmic artery in case 1 and multiple infarctions in the ipsilateral anterior and middle cerebral artery territories with subsequent hemorrhagic transformation in case 2. Poor visual prognosis and neurological complications can occur in healthy adults undergoing cosmetic facial injection, and all patients should be informed of this risk before the procedure.

  15. A ruptured aneurysm arising at the leptomeningeal collateral circulation from the extracranial vertebral artery to the posterior inferior cerebellar artery associated with bilateral vertebral artery occlusion.

    Science.gov (United States)

    Chonan, Masashi; Nishimura, Shinjitu; Kimura, Naoto; Ezura, Masayuki; Uenohara, Hiroshi; Tominaga, Teiji

    2014-02-01

    We report an extremely rare case of a small ruptured aneurysm of the leptomeningeal collateral circulation from the vertebral artery (VA) to the posterior inferior cerebellar artery (PICA); this aneurysm was associated with bilateral VA occlusion. A 72-year-old woman with sudden headache, nausea, and subarachnoid hemorrhage (SAH) was admitted to our hospital. On admission, no evidence of cerebral signs or cranial nerve palsy was found. Computed tomography imaging showed SAH predominantly in the posterior fossa, and digital subtraction angiography revealed bilateral VA occlusion and the left VA aneurysm located proximal to the VA union. In addition, a small aneurysm was observed at the leptomeningeal collateral circulation located between the extracranial left VA and the left PICA. The patient underwent radical surgery on the day of the onset of the symptoms associated with SAH. However, the VA aneurysm was unruptured and surgically trapped. The small aneurysm arising at the leptomeningeal collateral circulation was ruptured during the surgery and was electrocoagulated; the collateral circulation was preserved, and no neurologic deficits were observed. The postoperative course was uneventful. SAH with the occlusion of major vessels should be diagnosed with utmost caution to allow preoperative neurologic and radiological assessments.

  16. The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.

    Science.gov (United States)

    Harris, P L; Woollard, K; Bartoli, A; Makey, A R

    1980-01-01

    Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed.

  17. MRI Study of Hypoperfusion in Contralateral Cerebellar Hemisphere after Supratentorial Cerebral Infarction%幕上脑梗死后对侧小脑半球低灌注的磁共振成像研究

    Institute of Scientific and Technical Information of China (English)

    王琳琳; 程敬亮; 张勇; 王斐斐; 孟云; 张文博; 杨子涛; 杨运俊

    2011-01-01

    Objective To evaluate the value of MR perfusion weighted imaging( PWI ) for the changes of contralateral cerebellar hemisphere after acute infarction of unilateral supratentorial middle cerebral artery blood-supply area. Materials and Methods Collect 38 patients of supratentorial acute cerebral infarction with bilateral cerebellar hemisphere perfusion weighted imaging, to judge perfusion change of lesions contralateral cerebellum after supratentorial cerebral infarction by measuring the bilateral cerebellum involving relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF)and relative mean transit time (rMTI) and relative time to peak(rTTP). Results 38 patients, 16 cases(42% ) involving contralateral cerebellum the rTTP prolonged and compared with ipsilateral extend about ( 133.28± 70.25 ) %; compared with ipsilateral rMTT extend about ( 82.78 ± 91.22 ) %, but without statistical significance ( P = 0.112, P > 0. 05 ); compared with ipsilateral rCBF decrease about (53.74 ±41.56)% ;compared with ipsilateral rCBV decrease about ( 100.58 ±91.72) %. to measured cerebral hemisphere infarcted volume in DWI imaging, to calculate correlation of primary inrarction focal volume with lesions contralateral cerebellum hypoperfusion. Conclusion Partial patients with supratentorial cerebral infarction can cause contralateral cerebellum hypoperfusion, and related with the volume of primary focal infarction, indicating that these patients may crossed cerebellar diaschisis.%目的 探讨磁共振灌注成像评价急性期单侧幕上大脑中动脉区脑梗死后对侧小脑半球灌注量改变的诊断价值.资料与方法 搜集 38 例幕上急性期脑梗死患者进行双侧小脑半球磁共振灌注成像(perfusion-weightedimaging,PWI),通过测量双侧小脑半球相对脑血容量(relalive cerebral blood volume,rCBV)、相对脑血流量(relalivecerebral blood flow,rCBF)和平均通过时间(relalive mean transit time

  18. Vertebral artery dissection associated with generalized convulsive seizures

    DEFF Research Database (Denmark)

    Amin, Faisal Mohammad; Larsen, Vibeke Andrée; Tfelt-Hansen, Peer

    2013-01-01

    showed a left-sided pontine infarction, an infarct in the left cerebellar hemisphere and a right vertebral artery dissection (VAD). The patient was treated with heparin and an oral anticoagulant for 6 months. Recovery of neurologic function was excellent. In patients with symptoms of disturbances...

  19. Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarction

    NARCIS (Netherlands)

    Claessen, B.E.P.M.; Hoebers, L.P.; van der Schaaf, R.J.; Kikkert, W.J.; Engstrom, A.E.; Vis, M.M.; Baan, J.,Jr; Koch, K.T.; Meuwissen, M.; van Royen, N.; de Winter, R.J.; Tijssen, J.G.P.; Piek, J.J.; Henriques, J.P.S.

    2010-01-01

    Background Recently, a chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) and not multivessel disease (MVD) alone was identified as an independent predictor of mortality after ST elevation myocardial infarction (STEMI). Patients with diabetes mellitus (DM) constitute a patient g

  20. Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarction

    NARCIS (Netherlands)

    Claessen, B.E.P.M.; Hoebers, L.P.; van der Schaaf, R.J.; Kikkert, W.J.; Engstrom, A.E.; Vis, M.M.; Baan, J.,Jr; Koch, K.T.; Meuwissen, M.; van Royen, N.; de Winter, R.J.; Tijssen, J.G.P.; Piek, J.J.; Henriques, J.P.S.

    2010-01-01

    Background Recently, a chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) and not multivessel disease (MVD) alone was identified as an independent predictor of mortality after ST elevation myocardial infarction (STEMI). Patients with diabetes mellitus (DM) constitute a patient g

  1. Coronary flow of the infarct artery assessed by transthoracic Doppler after primary percutaneous coronary intervention predicts final infarct size.

    Science.gov (United States)

    Trifunovic, Danijela; Sobic-Saranovic, Dragana; Beleslin, Branko; Stankovic, Sanja; Marinkovic, Jelena; Orlic, Dejan; Vujisic-Tesic, Bosiljka; Petrovic, Milan; Nedeljkovic, Ivana; Banovic, Marko; Djukanovic, Nina; Petrovic, Olga; Petrovic, Marija; Stepanovic, Jelena; Djordjevic-Dikic, Ana; Tesic, Milorad; Ostojic, Miodrag

    2014-12-01

    Coronary microcirculatory function after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction is important determinant of infarct size (IS). Our aim was to investigate the utility of coronary flow reserve (CFR) and diastolic deceleration time (DDT) of the infarct artery (IRA) assessed by transthoracic Doppler echocardiography after pPCI for final IS prediction. In 59 patients, on the 2nd day after pPCI for acute anterior myocardial infarction, transthoracic Doppler analysis of IRA blood flow was done including measurements of CFR, baseline DDT and DDT during adenosine infusion (DDT adeno). Killip class, myocardial blush grade, resolution of ST segment elevation, peak creatine kinase-myocardial band and conventional echocardiographic parameters were determined. Single-photon emission computed tomography myocardial perfusion imaging was done 6 weeks later to define final IS (percentage of myocardium with fixed perfusion abnormality). IS significantly correlated with CFR (r = -0.686, p 20 %), the best cut-off for CFR was <1.73 (sensitivity 65 %, specificity 96 %) and for DDT adeno ≤720 ms (sensitivity 81 %, specificity 96 %). CFR and DDT during adenosine are independent and powerful early predictors of final IS offering incremental prognostic information over conventional parameters of myocardial and microvascular damage and tissue reperfusion.

  2. Effects of different treatments on cerebellar ataxia induced by acute cerebellar infarction.Chen%不同方法治疗急性小脑梗塞后小脑共济失调的疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈国梁; 陈晓明

    2014-01-01

    目的:比较不同方法治疗急性小脑梗塞后小脑共济失调的疗效。方法:将我院确诊的急性小脑梗塞后小脑共济失调患者80例随机分为以下四组,每组20例。 A组:常规药物治疗组(补充B族维生素、胞二磷胆碱、抗血小板药物和对症支持治疗);B组:常规药物治疗组+功能性电刺激;C组:常规药物治疗组+作业疗法;D组:常规药物治疗组+功能性电刺激+作业疗法。结果:B组、C组和D组的疗效明显高于A组(P<0.05);D组的疗效最为明显,高于其他三组(P<0.05)。结论:单独或联合使用功能性电刺激和/或作业疗法治疗急性小脑梗塞后小脑共济失调的疗效明显高于常规药物组,而联合使用功能性电刺激和作业疗法的治疗效果最为明显。%Objective:To compare the efficacy of different treatments, such as routine drug therapy, functional electrical stimulation and occupational therapy ,on cerebellar ataxia induced by acute cerebellar infarction. Methods:Eighty patients with cerebellar ataxia induced by acute cerebellar infarction were divided into 4 different groups with 20 each: group A: routine drug therapy including Vitamin B, cytoplasmic two choline, antiplatelet drugs and supportive treatment;group B:routine drug therapy and functional electrical stimulation;group C: routine drug therapy and occupational therapy; group D: routine drug therapy, functional electrical stimulation and occupational therapy. Results:Effects of group B, C and D were significantly higher than that in group A(P<0.05);group C and D were not statistically significant difference;effect of group D was the most obvious, higher than the other three groups (P<0.05). Conclusion:Efficacy of single or combined use of functional electrical stimulation and/or occupational therapy in the treatment of acute cerebellar infarction cerebellar ataxia was obviously higher than that of routine drug therapy. And the

  3. Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction

    Science.gov (United States)

    Maddox, Thomas M.; Stanislawski, Maggie A.; Grunwald, Gary K.; Bradley, Steven M.; Ho, P. Michael; Tsai, Thomas T.; Patel, Manesh R.; Sandhu, Amneet; Valle, Javier; Magid, David J.; Leon, Benjamin; Bhatt, Deepak L.; Fihn, Stephan D.; Rumsfeld, John S.

    2016-01-01

    IMPORTANCE Little is known about cardiac adverse events among patients with nonobstructive coronary artery disease (CAD). OBJECTIVE To compare myocardial infarction (MI) and mortality rates between patients with nonobstructive CAD, obstructive CAD, and no apparent CAD in a national cohort. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of all US veterans undergoing elective coronary angiography for CAD between October 2007 and September 2012 in the Veterans Affairs health care system. Patients with prior CAD events were excluded. EXPOSURES Angiographic CAD extent, defined by degree (no apparent CAD: no stenosis >20%; nonobstructive CAD: ≥1 stenosis ≥20% but no stenosis ≥70%; obstructive CAD: any stenosis ≥70% or left main [LM] stenosis ≥50%) and distribution (1,2, or 3 vessel). MAIN OUTCOMES AND MEASURES The primary outcome was 1-year hospitalization for nonfatal MI after the index angiography. Secondary outcomes included 1-year all-cause mortality and combined 1-year MI and mortality. RESULTS Among37 674 patients, 8384 patients (22.3%) had nonobstructive CAD and 20 899 patients (55.4%) had obstructive CAD. Within 1 year, 845 patients died and 385 were rehospitalized for MI. Among patients with no apparent CAD, the 1-year MI rate was 0.11% (n = 8, 95% CI, 0.10%–0.20%) and increased progressively by 1-vessel nonobstructive CAD, 0.24% (n = 10, 95% CI, 0.10%–0.40%); 2-vessel nonobstructive CAD, 0.56% (n = 13, 95% CI, 0.30%–1.00%); 3-vessel nonobstructive CAD, 0.59% (n = 6, 95% CI, 0.30%–1.30%); 1-vessel obstructive CAD, 1.18% (n = 101, 95% CI, 1.00%–1.40%); 2-vessel obstructive CAD, 2.18% (n = 110, 95% CI, 1.80%–2.60%); and 3-vessel or LM obstructive CAD, 2.47% (n = 137, 95% CI, 2.10%–2.90%). After adjustment, 1-year MI rates increased with increasing CAD extent. Relative to patients with no apparent CAD, patients with 1-vessel nonobstructive CAD had a hazard ratio (HR) for 1-year MI of 2.0 (95% CI, 0.8–5.1); 2-vessel

  4. Segmental arterial mediolysis accompanied by renal infarction and pancreatic enlargement: a case report

    Directory of Open Access Journals (Sweden)

    Ito Nobuhisa

    2012-09-01

    Full Text Available Abstract Introduction Due to recent advances in imaging diagnostic techniques, there are an increasing number of case reports of segmental arterial mediolysis. However, there are only a limited number of reports on segmental arterial mediolysis-related abnormalities of abdominal organs other than the intestine. This report describes a case of segmental arterial mediolysis accompanied by abnormalities of abdominal organs without clinical symptoms. Case presentation A 52-year-old Japanese man with hematuria and no prior medical history was referred to a urologist and was diagnosed as having urinary bladder cancer. He underwent trans-urethral resection of the bladder tumor and intra-vesical instillation therapy, which was followed by observation. During follow-up, although no abdominal symptoms were observed, an abdominal computed tomography scan revealed a dissection of the superior mesenteric artery. A false lumen partially occluded by a thrombus was located distal to this occlusion. The lumen was irregularly shaped with narrow and wide sections. Similar irregularities were also observed in the wall of the inferior mesenteric artery. Arterial dissection with thromboembolism in the left renal artery and renal infarction was also observed. Follow-up computed tomography after two months revealed an enlargement of the pancreatic tail adjacent to the splenic artery. Follow-up three-dimensional computed tomography showed gradual re-expansion of the true lumen of the superior mesenteric artery, improvement in arterial wall irregularities, and a reduction in the pancreas enlargement and renal infarction. Over the following 15 months, these changes gradually normalized. On the basis of the vascular changes in multiple arterial systems that resolved spontaneously, we considered that the lesions were associated with segmental arterial mediolysis. Conclusions We present a rare case of segmental arterial mediolysis accompanied by abnormalities of abdominal

  5. Strophanthus hispidus attenuates the Ischemia-Reperfusion induced myocardial Infarction and reduces mean arterial pressure in renal artery occlusion

    Directory of Open Access Journals (Sweden)

    Rohit Gundamaraju

    2014-01-01

    Full Text Available Background: The myocardium is generally injured in the case of reperfusion injury and arterial damage is caused by hypertension. In reference to these statements, the present study was focused. Cardiac glycosides were said to have protective effects against myocardial infarction and hypertension. Strophanthus hispidus was thus incorporated in the study. Objective: The prime objective of the study was to investigate the protective effects of Strophanthus hispidus against ischemia-reperfusion myocardial Infarction and renal artery occluded hypertension in rats. Materials and Methods: The animal model adopted was surgically-induced myocardial ischemia, performed by means of left anterior descending coronary artery occlusion (LAD for 30 min followed by reperfusion for another 4 h. Infarct size was assessed by using the staining agent TTC (2,3,5-triphenyl tetrazolium chloride. Hypertension was induced by clamping the renal artery with renal bulldog clamp for 4 h. Results: The study was fruitful by the effect of Strophanthus hispidus on infarction size, which got reduced to 27.2 ± 0.5and 20.0 ± 0.2 by 500 mg/Kg and 1000 mg/Kg ethanolic extracts which was remarkably significant when compared with that of the control group 52.8 ± 4.6. The plant extract did reduce heart rate at various time intervals. There was also a protective effect in the case of mean arterial blood pressure were the 500 mg/Kg and 1000 mg/Kg of the plant extract did reduce the hypertension after 60 minutes was 60.0 ± 4.80 and 50.50 ± 6.80. Conclusion: The results suggest that 500 mg/Kg and 100 mg/Kg ethanolic extract of Strophanthus hispidus was found to possess significant cardiac protective and anti-hypertensive activity.

  6. The Systematic Evaluation of Identifying the Infarct Related Artery Utilizing Cardiac Magnetic Resonance in Patients Presenting with ST-Elevation Myocardial Infarction

    Science.gov (United States)

    Hamo, Carine E.; Klem, Igor; Rao, Sunil V.; Songco, Vincent; Najjar, Samer; Lakatta, Edward G.; Raman, Subha V.; Harrington, Robert A.; Heitner, John F.

    2017-01-01

    Background Identification of the infarct-related artery (IRA) in patients with STEMI using coronary angiography (CA) is often based on the ECG and can be challenging in patients with severe multi-vessel disease. The current study aimed to determine how often percutaneous intervention (PCI) is performed in a coronary artery different from the artery supplying the territory of acute infarction on cardiac magnetic resonance imaging (CMR). Methods We evaluated 113 patients from the Reduction of infarct Expansion and Ventricular remodeling with Erythropoetin After Large myocardial infarction (REVEAL) trial, who underwent CMR within 4±2 days of revascularization. Blinded reviewers interpreted CA to determine the IRA and CMR to determine the location of infarction on a 17-segment model. In patients with multiple infarcts on CMR, acuity was determined with T2-weighted imaging and/or evidence of microvascular obstruction. Results A total of 5 (4%) patients were found to have a mismatch between the IRA identified on CMR and CA. In 4/5 cases, there were multiple infarcts noted on CMR. Thirteen patients (11.5%) had multiple infarcts in separate territories on CMR with 4 patients (3.5%) having multiple acute infarcts and 9 patients (8%) having both acute and chronic infarcts. Conclusions In this select population of patients, the identification of the IRA by CA was incorrect in 4% of patients presenting with STEMI. Four patients with a mismatch had an acute infarction in more than one coronary artery territory on CMR. The role of CMR in patients presenting with STEMI with multi-vessel disease on CA deserves further investigation. PMID:28060863

  7. Quality of life after surgical decompression for space-occupying middle cerebral artery infarction: systematic review

    NARCIS (Netherlands)

    Middelaar, T. van; Nederkoorn, P.J.; Worp, H.B. van der; Stam, J.; Richard, E.

    2015-01-01

    BACKGROUND AND PURPOSE: In patients with space-occupying middle cerebral artery infarction, surgical decompression strongly reduces risk of death and increases the chance of a favorable outcome. This comes at the expense of an increase in the risk of survival with (moderately) severe disability. We

  8. Acute myocardial infarction with normal coronary arteries in a patient with dermatomyositis. Case report.

    Science.gov (United States)

    Badui, E; Valdespino, A; Lepe, L; Rangel, A; Campos, A; Leon, F

    1996-08-01

    The authors present a forty-year-old man, with a history of dermatomyositis for the past twelve years, managed intermittently with prednisone. During an exacerbation of his illness he developed an acute anterior wall myocardial infarction with normal coronary arteries. A literature review indicates this represents a rare association.

  9. [Left-ventricular function and physical exertion tolerance in patients with myocardial infarction with isolated lesion of the coronary arteries].

    Science.gov (United States)

    Golikov, A P; Levshunov, S P; Belozerov, G E

    1989-01-01

    Myocardial infarction area and left-ventricular myocardial contractility, determined by sectoral scanning, and exercise tolerance were assessed in 47 myocardial infarction patients with isolated coronary arterial lesions. The area under myocardial infarction was shown to be dependent on the site of the atherosclerotic process rather than the degree of stenosis in patients with isolated coronary arterial lesions. A relationship was established between the incidence of complications developing in the acute phase of infarction and the degree of stenosis. The disease was complicated more frequently in patients with coronary arterial occlusion as compared to those with severe coronary-arterial stenosis. High stress tolerance, irrespective of the site of myocardial infarction, is an evidence of great functional potentials in this category of patients.

  10. [Acute myocardial infarction with normal coronary arteries as initial manifestation of polyarteritis nodosa. A case report].

    Science.gov (United States)

    Badui, E; Rangel, A; Ramos, M A; Enciso, R; Solorio, S; Lepe, L; Miranda, J

    1997-01-01

    A thirty four-year-old-white man in good health developed an acute anterior wall myocardial infarction (AMI), Killip II with normal coronary arteries. No thrombolytic therapy was given. Selective angiography revealed multiple aneurysms in mesenteric and renal arteries. The diagnosis of polyarteritis nodosa (PAN) was performed. AMI in PAN is secondary to arteritis with thrombosis, or to atherosclerosis due to steroid therapy. This case, having multiorgan vascular aneurysms involvement without previous cardiac symptomatology nor steroid therapy, presented as his first cardiac complication an AMI with normal coronary arteries probably due to selective arteritis.

  11. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Marcelo A. Nakazone

    2010-01-01

    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  12. Isolated hypoplastic circumflex coronary artery: a rare cause of haemorrhagic myocardial infarction in a young athlete.

    Science.gov (United States)

    Riede, Florian-Nikolaus; Bulla, Stefan; Grundmann, Sebastian; Werner, Martin; Riede, Urs-Nikolaus; Otto, Claudia

    2013-06-06

    Hypoplastic coronary artery disease is a rare condition that may lead to myocardial infarction and sudden death. Here we describe for the first time an isolated hypoplasia of the left circumflex artery (LCX). An otherwise healthy and athletically active 16-year-old boy was admitted to the intensive care unit (ICU) after out-of-hospital cardiac arrest. He died 12 hours after the initial event. Autopsy revealed an isolated hypoplastic LCX and acute haemorrhagic infarction in the posterolateral myocardium. The existence of isolated hypoplasia of the LCX challenges our understanding of coronary artery development. Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1558483061962648.

  13. Double coronary artery thrombosis presenting as acute extensive anterior ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ching-Wei Lee

    2013-07-01

    Full Text Available Simultaneous thrombosis of more than one coronary artery is an uncommon angiographic finding in acute ST-segment elevation myocardial infarction (STEMI, and usually leads to cardiogenic shock or even sudden cardiac death. We reported a 56-year-old man presenting with persistent chest tightness and ST-segment elevation over precordial leads in electrocardiography (ECG. Emergent coronary angiogram showed total occlusion of both the proximal right coronary artery (RCA and the proximal left anterior descending artery (LAD. We performed thrombus aspiration and stenting over the LAD with thrombolysis in myocardial infarction (TIMI III flow to the distal LAD. However, diminishing collateral flow to the distal RCA complicated with complete atrioventricular block (CAVB and cardiogenic shock developed thereafter. Because distal embolization of the collateral circulation from the LAD to the distal RCA was suspected, thrombus aspiration and stenting over the proximal RCA were performed. After reperfusion of the RCA, the patient's hemodynamic status stabilized and he recovered uneventfully.

  14. Comparative effects of percutaneous coronary intervention for infarct-related artery only or for both infarct-and non-infarct-related arteries in patients with ST-elevation myocardial infarction and multi-vessel disease

    Institute of Scientific and Technical Information of China (English)

    HAN Ya-ling; WANG Bin; WANG Xiao-zeng; LI Yi; WANG Shou-li; JING Quan-min; WANG Geng; MA Ying-yan; LUAN Bo

    2008-01-01

    Background Rapid recanalization of infarct-related artery (IRA) has become the major target during primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (MI),but strategy for treatment of non-IRA lesions in this setting remains unclear.This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease.Methods A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries (luminal narrowing≥70%) undergoing primary PCI were included.Of them,149 patients underwent primary PCI for IRA only (group 1),and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction (AMI) (group 2).Drug-eluting stents (DESs) were deployed in more than 90% of the patients.Results The two groups did not differ with respect to baseline clinical and angiographic characteristics.No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events (11.5% vs 15.1%,P>0.05) and target lesion revascularization (8.1% vs 7.6%,P>0.05) between the two groups.However,patients in group 1 had higher rates of recurrent angina (10.1% vs 2.1%,P<0.05) and depressed left ventricular ejection fraction evaluated by echocardiography (0.56±0.22 vs 0.63±0.25,P <0.05).Conclusion With the use of DESs,complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation MI and multi-vessel disease.

  15. Serum uric acid is a risk factor for large-artery atherosclerosis cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    Jianjun Guo; Qingyu Shen; Jie Li; Xiaoming Rong; Ying Peng; Yamei Tang

    2011-01-01

    Using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification for acute ischemic stroke, 371 patients with either acute large-artery atherosclerosis or small-artery occlusion cerebral infarction were recruited to investigate the potential impact of elevated serum uric acid on cerebrovascular disorders. The results showed that patients who have suffered from large-artery atherosclerosis, relative to small-artery occlusion patients, were characterized by elevated serum uric acid but reduced high-density lipoprotein cholesterol and triglyceride levels. Logistic regression showed that elevated uric acid and lower triglyceride levels were the main risk factors for patients with large-artery atherosclerosis. The findings of this study suggest that hyperuricemia may be a risk factor for stroke.

  16. [Hemiplegia in posterior cerebral artery infarctions: analysis of various responsible mechanisms].

    Science.gov (United States)

    Ortiz, N; Barraquer Bordas, L; Dourado, M; Rey, A; Avila, A

    1993-01-01

    When cerebral infarction determines hemiplegia or hemiparesia which accompany a hemilateral sensitive deficit and hemianopsia and even neuropsychologic symptoms (aphasic alterations in the case of injury to the left hemisphere, heminegligence and anosognosy in the case of injury to the right hemisphere) the involvement of a sylvian artery syndrome is usually considered. Nonetheless, recent contributions have reported that such symptoms may appear in infarctions of the territory of the posterior cerebral artery. Two clinical-radiologic observations in this line are presented. Nuclear magnetic resonance demonstrated injury to the posterior arm of the internal capsule in one case and in the other the lesion developed over three times, in the latter of which injury to the cerebral peduncle was produced causing hemiparesia. The authors emphasize that hemiplegia or hemiparesia in some infarctions of the posterior cerebral artery may be due to 1) mesencephalic infarction in the posterior plane of the retromamillar Foix and Hillemand pediculum (or G. Lazorthes interpedunculum), 2) infarction or "ischemic penumbra" in the internal capsule by involvement of any of the perforating branches of the posterior cerebrum irrigating the thalamus, except for the medial posterior choroid artery or even of the Foix and Hillemand thalamus-tuberian pediculum (or Lazorthes inferior and anterior) which principally initiates at the posterior communicating branch with a fragment of the posterior branch of the internal capsule perhaps not always being under its control. In this case, the thrombus occupying the posterior cerebrum may extend to the cited communicating branch or a hemodynamic deficit may be produced in the territory of the same.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct.

    Science.gov (United States)

    Xu, Yongfeng; Liu, Lan

    2016-07-01

    Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients.

  18. Angioplasty and stenting for severe vertebral artery oriifce stenosis:effects on cerebellar function remodeling veriifed by blood oxygen level-dependent functional magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    Bo Liu; Zhiwei Li; Peng Xie

    2014-01-01

    Vertebral artery oriifce stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood lfow and perfusion in the posterior circulation after inter-ventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso-nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery oriifce stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat-ment only. The intervention group received vertebral artery oriifce angioplasty and stenting+identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent function-al magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery oriifce stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

  19. Ipsilateral mamillary body atrophy after infarction of the posterior cerebral artery territory: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Sawada, Akihiro; Takase, Yukinori; Nomiyama, Keita; Egashira, Ryoko; Kudo, Sho [Saga Medical School, Department of Radiology, Saga (Japan)

    2005-11-01

    We describe herein magnetic resonance (MR) features of ipsilateral mamillary body atrophy after infarction of the posterior cerebral artery (PCA) territory. During the period May 2000 through July 2004, 13 patients with infarction of the PCA territory underwent cranial MR imaging in the chronic stage. Two 1.5-T scanners were used to obtain axial T1- and T2-weighted images with conventional spin-echo and fast spin-echo pulse sequences, respectively. The slice thickness was 6 mm, with a 2-mm interslice gap. Five of the 13 patients with PCA territory infarction had ipsilateral mamillary body atrophy. However, this asymmetry of the mamillary bodies was unclear in two of the five patients because of the thickness of the axial image slices. All five patients had a temporo-parieto-occipital infarction. The remaining eight patients had a parieto-occipital or an occipital infarction. Unilateral transneuronal mamillary body degeneration after infarction of the ipsilateral PCA territory including the posteromedial temporal lobe can be detected on conventional thick axial MR images. (orig.)

  20. Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth?

    Institute of Scientific and Technical Information of China (English)

    YANG Xiao-feng; YAO Yu; HU Wei-wei; LI Gu; XU Jin-fang; ZHAO Xue-qun; LIU Wei-guo

    2005-01-01

    Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone. Methods: Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS)was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction. Results: Ten out of 24patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction. Conclusion: Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.

  1. Cardioembolic occlusion of the internal carotid artery presented with infarction in the posterior cerebral artery territory

    Institute of Scientific and Technical Information of China (English)

    XUE Su-fang; JIA Jian-ping

    2010-01-01

    @@ Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct (fetal) origin of the posterior cerebral artery (PCA) from the internal carotid artery (ICA), or in the presence of a persistent trigeminal artery (PTA) or persistent hypoglossal artery (PHA).1,2

  2. Comparative study of effects of bone marrow cell vs. Ad5-HGF administration via non infarct-related artery injection in myocardial infarction in swine

    Institute of Scientific and Technical Information of China (English)

    Liansheng Wang; Jun Huang; Zhijian Yang; Wei Wang; Dongchao Ma; Shunlin Xu; Yuqing Zhang; Fang Zhou; Bo Chen; Kejiang Cao

    2007-01-01

    Objective: To evaluate the effect of transplanting bone marrow-derived mesenchymal stem cells (BM-MSCs) or adenovirus5-hepatocyte growth factor(Ad5-HGF) via non-infarct-related artery injection in swine myocardial infarction models. Methods :BMMSCs were obtained from swine bone marrow and expanded in vitro to a purity of >50%. A myocardial infarction(MI) was created by ligating the distal left anterior descending artery in swine. Either BM-MSCs (5 × 106/ml) or Ad5-HGF (4 × 109 pfu) were transfused via the right coronary artery (non-infarcted artery) four weeks after MI. Gate-controled cardiac perfusion imaging was performed at the end of four and seven weeks after LAD ligation, to evaluate heart function and cardiac perfusion. Morphologic and histologic characteristics of the hearts were also studied. Results: (1)The gate-controlled cardiac perfusion imaging showed that the improvement in LVEF was greater in both treatment groups than in control group at the 4th weeks. (2)In both treatment groups, capillary density was significantly higher than that of control group (P < 0.05). Conclusion:BM-MSCs or Ad5-HGF transplantation via non-infarcted artery administration can stimulate angiogenesis and improve heart function, but there was no difference in therapeutic efficacy between BM-MSCs and Ad5-HGF.

  3. Cerebral infarction in patient with minimal change nephrotic syndrome.

    Science.gov (United States)

    Babu, A; Boddana, P; Robson, S; Ludeman, L

    2013-01-01

    We report a case of 68-year-old Caucasian man who presented with cerebral infarcts secondary to arterial thrombosis associated with nephrotic syndrome. His initial presentation included edema of legs, left hemiparesis, and right-sided cerebellar signs. Investigations with computed tomography and magnetic resonance imaging of brain showed multiple cerebral infarcts in middle cerebral and posterior cerebral artery territory. Blood and urine investigations also showed impaired renal function, hypercholesterolemia, hypoalbuminaemia, and nephrotic range proteinuria. Renal biopsy showed minimal change disease. Cerebral infarcts were treated with antiplatelet agents and nephrotic syndrome was treated with high dose steroids. Patient responded well to the treatment and is all well till date.

  4. A Combination of Low Doses of Fluvastatin and Valsartan Decreases Arterial Stiffness in Patients After Myocardial Infarction: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jurij Hanžel

    2015-12-01

    Conclusions: The treatment resulted in a significant and sustained improvement of arterial stiffness in male patients with a history of myocardial infarction, which highlights the need for further study of this new approach.

  5. 小脑梗死31例致残特点分析及CT、MRI确诊率比较%Mutilation characteristics analysis and CT, MRI dignosis rate comparison in 31 cerebellar infarction cases

    Institute of Scientific and Technical Information of China (English)

    杨光宇; 陈伟群; 谢道俊

    2002-01-01

    Background: Functional disturbance caused by cerebellar infarction are diversified according to lesion site and size, mutilation characteristics are different. it is difficult to diagnose because its manifestation is complicated. It can show symptoms like vestibule disease, Compartmental syndrome or be masked by brain stem or occipital lobe infarction. In recent years, Diagnosis rate of this disease increase as utilization of CT and MRI. But CT is influenced by bone structure of posterior cranial fossa, so it can't exam small infarction focus. MRI is better.

  6. Prognostic factors for perioperative myocardial infarction and immediate mortality in patients who underwent coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mirtha López Ramírez

    2016-03-01

    Conclusions: Older age and higher body mass index were protective prognostic factors for perioperative acute myocardial infarction events. Prolonged surgical time and complications were independently associated with perioperative infarction and mortality after coronary artery bypass graft surgery. Low preoperative glomerular filtration rate was also associated with mortality.

  7. Acute myocardial infarction in a 35-year-old man with coronary artery aneurysm most probably caused by Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

    Saeed Alipour Parsa; Isa Khaheshi; Koosha Paydary; Habib Haybar

    2014-01-01

    We present a 35-year-old man with history of Kawasaki disease who referred with myocardial infarction, and angiography, revealing aneurysm of left main and left anterior descending coronary arteries. The patient underwent percutaneous coronary intervention and thrombectomy and was discharged after 6 d. Coronary artery sequels of Kawasaki disease should be considered as one of the underlying causes of acute myocardial infarction in young adults.

  8. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Ahmet Yanık

    2016-01-01

    Full Text Available A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month.

  9. Fluid Intake Related to Brain Edema in Acute Middle Cerebral Artery Infarction.

    Science.gov (United States)

    Dharmasaroja, Pornpatr A

    2016-02-01

    Evidence of the appropriate amount of fluid intake during the first few days after acute stroke was scarce. Concerns were raised in patients with acute malignant middle cerebral infarction, who tended to have malignant brain edema later. The purpose of the study was to evaluate the effect of fluid intake on the occurrence of malignant brain edema in patients with acute middle cerebral artery infarction. Patients with acute middle cerebral artery infarction who had National Institute of Health Stroke Scale (NIHSS) score of at least 15 were included. Baseline characteristics and amount of fluid intake during the first few days were compared in patients with and without malignant brain edema. One hundred ninety-three patients were studied. Mean NIHSS score was 20. Malignant brain edema occurred in 69 patients (36%). Higher amount of fluid intake (>1650 ml or >28 ml/kg/day or >93% of daily maintenance fluid) showed a significant association with malignant brain edema (OR = 13.86, 95% CI 5.11-37.60, p value edema, 39 patients (39/65, 60%) died and only 11% (7/65 patients) had favorable outcome. High amount of fluid intake in the first few days of acute middle cerebral infarction was related to the occurrence of malignant brain edema.

  10. Delayed cerebral infarction due to stent folding deformation following carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Kwon Duk; Lee, Kyung Yul; Suh, Sang Hyun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.

  11. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction.

    Science.gov (United States)

    Serrano, C V; Bortolotto, L A; César, L A; Solimene, M C; Mansur, A P; Nicolau, J C; Ramires, J A

    1999-01-01

    Differentiation of right coronary artery (RCA) from left circumflex artery (LCxA) occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction (IMI). We studied 133 patients with IMI, 92 patients with RCA occlusion and 41 patients with LCxA occlusion. Risk factors such as previous MI, arterial hypertension, diabetes, smoking, and dislipemia, were similar for RCA and LCxA occlusions. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCxA occlusion, 50% vs. 17%, respectively (P<0.001). Arterial hypotension was more prevalent (P<0.05) among patients with RCA (18%) rather than those with LCxA occlusion (2%). RCA occlusion presented an association with sinus bradycardia, an association not observed with LCxA occlusion (15% vs. 0%, respectively; P<0.01). Total atrioventricular block was only present among patients with RCA (18%). Proximal occlusions of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (13% vs. 1% and 1%, respectively; P<0.0001 and P<0.001). Therefore, regarding patients with IMI: (1) sinus bradycardia is more frequent when the infarct-related artery is the RCA; (2) proximal occlusions of the right coronary predispose low heart rates; and (3) occlusion of the LCxA rarely induces sinus bradycardia.

  12. Laparoscopic nephrectomy for complete renal infarction due to post traumatic renal artery thrombosis.

    Science.gov (United States)

    Gidaro, Stefano; Schips, Luigi; Cindolo, Luca; Ziguener, Richard

    2008-06-01

    We report a case of post traumatic thrombosis of the renal artery with renal infarction and associated liver injury. Conservative treatment was initially planned in consideration of the delayed diagnosis (> 3 hours), but the patient subsequently developed hypertension not controllable with anti-hypertensive drugs. He underwent laparoscopy with nephrectomy and liver injury repair. Hypertension resolved after nephrectomy without further medical treatment. Laparoscopic nephrectomy is not a standard procedure for renal trauma but it could be an option in selected patients.

  13. Motor outcomes of patients with a complete middle cerebral artery territory infarct*

    Institute of Scientific and Technical Information of China (English)

    Sung Ho Jang; Min Cheol Chang

    2013-01-01

    Detailed knowledge of motor outcomes enables to establish proper goals and rehabilitation strate-gies for stroke patients. Several previous studies have reported functional or motor outcomes in patients with a middle cerebral artery territory infarct. However, little is known about motor outcome in patients with a complete middle cerebral artery territory infarct. In this study, we investigated the motor outcomes in 23 patients with a complete middle cerebral artery territory infarct. Al of these patients received comprehensive rehabilitative management, including movement therapy and neuromuscular electrical stimulation of the affected finger extensors and ankle dorsiflexors, for more than 3 months. Motor outcomes were measured at 6 months after stroke onset using the Medical Research Council, Motricity Index, the modified Brunnstrom Classification, and Functional Ambula-tion Category scores. The motor function of the lower extremities was found to be better than that of the upper extremities. After receiving rehabilitation treatments for 3-6 months, about 70%of these patients were able to walk independently (Functional Ambulation Category scores>3), but no pa-tient achieved functional hand recovery.

  14. Fibromuscular dysplasia of renal arteries presenting with bilateral renal infarction in a young man.

    Science.gov (United States)

    Basile, Carlo; Lisi, Piero; Chimienti, Domenico; Antonelli, Maurizio; Bruno, Andrea; Giambersio, Silvia; Zurlo, Maria Teresa; Petronelli, Sergio

    2013-01-01

    Fibromuscular dysplasia (FMD) describes a group of conditions which cause nonatheromatous arterial stenoses, most commonly of the renal and carotid arteries, typically in young women. We report the case of a previously healthy 43-year-old white man presenting with acute bilateral flank pain. The pain was more severe on the left side. Initially treated for ureteral colic, he was transferred to the nephrology unit upon recognition of a rising serum creatinine. He was found to have FMD of bilateral renal arteries with resultant infarctions in both kidneys. He was treated with intravenous heparin and, then, warfarin at discharge. At a 16-month review, the patient remained pain-free with normal renal function and with antiplatelet and dual antihypertensive therapy. In conclusion, renal infarction complicating FMD is rare, with most cases involving causative cardiovascular risk factors, including coagulopathy, ischemic heart disease, atrial fibrillation or structural cardiac abnormalities, none of which was present in this case. What makes this case interesting are the clinically significant bilateral renal infarctions due to atypical asymmetric FMD in both kidneys in a young man.

  15. Successful Removal of a Metastatic Gastrointestinal Stromal Tumor in the Craniovertebral Junction using an Occipital Artery to Posterior Inferior Cerebellar Artery Bypass

    Directory of Open Access Journals (Sweden)

    Yukitomo Ishi

    2014-05-01

    Full Text Available Gastrointestinal stromal tumors (GISTs are rare mesenchymal neoplasms arising from the gastrointestinal tract. The authors present a case of the successful removal of a metastatic GIST in the craniovertebral junction, using an occipital artery to posterior inferior cerebellar artery (OA-PICA bypass. The patient is a 54-year-old male who underwent his first surgery for a small-bowel tumor at the age of 45 and was diagnosed with GIST. Nine years after his primary diagnosis, the patient suffered from severe neck pain. MRI demonstrated a large demarcated mass adjacent to the right atlas. The right vertebral artery (VA, completely engulfed by the tumor, showed a narrowing and ended in the PICA. Poor collateral blood supply in the right PICA territory was presumed. To prevent ischemic complications, an OA-PICA bypass was performed prior to the tumor resection. After the OA-PICA bypass, the tumor associated with the right VA was successfully removed, and the patient was discharged without any neurological deficits.

  16. Endovascular treatment of vertebral artery dissecting aneurysm involving posterior inferior cerebellar artery%累及小脑后下动脉椎动脉夹层动脉瘤的血管内介入治疗效果

    Institute of Scientific and Technical Information of China (English)

    何川; 张鹏; 张鸿祺

    2015-01-01

    Objective To analyze stenting and dual catheter technique in protection of posterior inferior cerebellar artery and its imaging and clinical follow-up results in the endovascular treatment of vertebral artery dissecting aneurysms. Methods From January 2012 to December 2014,the clinical data of 4 patients with vertebral artery dissecting aneurysm involving posterior inferior cerebellar artery treated with endovascular method and admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. The whole brain DSA examinations were performed at 6 months after procedure. The clinical follow-up period ranged from 12 to 24 months. Results Three of the 4 patients were treated with posterior inferior cerebellar artery-vertebral artery stenting,one patient was treated by using bidirectional dual catheter technique to protect posterior inferior cerebellar artery. The interventional therapy of 4 patients were all successful. Immediately after procedure,angiography revealed that the posterior inferior cerebellar arteries were patent,no ischemic symptoms were observed. The angiography at 6 months after procedure revealed no recurrence of aneurysms;the posterior inferior cerebellar arteries were patent without in-stent stenosis. No new symptoms of neurological deficit were observed during 12 to 24-month follow-up. Conclusion In the interventional treatment of vertebral artery dissecting aneurysms of posterior inferior cerebellar artery,using the posterior inferior cerebellar artery-vertebral artery stenting technique and bidirectional dual catheter technique may safely and effectively protect the posterior inferior cerebellar artery.%目的:分析椎动脉夹层动脉瘤的血管内介入治疗中支架置入和双导管技术保护小脑后下动脉(PICA)的方法及其影像和临床随访结果。方法回顾性纳入首都医科大学宣武医院神经外科2012年1月至2014年12月收治的4例累及PICA的椎动

  17. Effect of extracranial electric stimulation at cerebellar fastigial nucleus on serum C-reactive protein of patients with acute cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Some reports indicate that electric and/or chemical stimulation at various brain sites of experimental animals can raise regional cerebral blood flow and improve cerebral circulation; however, its mechanism is still unclear.OBJECTIVE: To observe the effects of electric stimulation at cerebellar fastigial nucleus on serum C-reactive protein of patients with acute cerebral infarction.DESIGN: Non-randomized synchronized contrast study.SETTING: The Second People's Hospital of Xinxiang City.PARTICIPANTS: A total of 54 patients with acute cerebral infarction were selected from the Department of Neurology, the Second People's Hospital of Xinxiang from December 2005 to December 2006. There were 31 males and 23 females, and their ages ranged from 56 to 80 years. All patients met the diagnostic criteria of the Fourth National Cerebrovascular Academic Meeting, were finally diagnosed by using CT examination,and provided the confirmed consent. Based on therapeutic demands, patients were divided into electric stimulation group and routine treatment group with 27 cases in each group. In addition, 21 healthy subjects,including 11 males and 10 females and aging 53 - 78 years, were selected as the control group. All the subjects in the control group did not have any histories of cerebrovascular diseases and severe body diseases.METHODS: Based on routine drug therapy, patients in the electric stimulation group were also treated by using CVFT-010M cerebral circulation function therapeutic device (made in Shanghai). Electrode was fixed at bilateral mastoid in the first group and at extensible sides of upper limbs in the second group. Electric stimulation was given twice a day and lasted for 30 minutes each time. Ten days were regarded as a course.Parameters of device: mode Ⅲ, frequency 198%, and intensity 90% - 110% (bionic current). Patients in the routine treatment group received the routine drug treatment. Content of serum C-reactive protein was measured in both

  18. Imaging features of gray-scale and contrast-enhanced color doppler US for the differentiation of transient renal arterial ischemia and arterial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Kwan; Kim Seung Hyup [Seoul National University Hospital, Seoul (Korea, Republic of); Moon, Min Hwan; Jung, Sung Il [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-09-15

    To characterize the imaging features on gray-scale and contrast-enhanced color Doppler US images which differentiate renal ischemia from renal infarction. The segmental renal arteries of eight healthy rabbits were surgically ligated. In four of these rabbits, the ligated renal artery was released 60 minutes after arterial occlusion to cause transient ischemia. In the remaining four rabbits, the arterial ligation was retained to cause a permanent infarction. The gray-scale and contrast-enhanced color Doppler US imaging features of the involved renal parenchymal of both ischemia and infarction groups were compared with respect to the presence or absence of parenchymal swelling, echogenicity changes, tissue loss and perfusion defects. Parenchyma swelling, echogenic changes, tissue loss and perfusion defects were found to be more extensive in the infarction than the ischemia group. The hyperechoic areas reperfused with blood flow recovered normal echogenicity and perfusion, whereas the hyperechoic areas without reperfusion became renal infarcts. Gray-scale and contrast-enhanced color Doppler US showed that the hyperechoic areas with reperfusion may reverse to normal parenchyma and allow the differentiation of renal ischemia from renal infarction.

  19. A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Kazumasa Emori

    2016-01-01

    Full Text Available A 46-year-old male with a history of hypertension visited the emergency department (ED by ambulance complaining of sudden pain in the left side of his back. Ultrasonography (USG performed at ED revealed splenic infarction along with occlusion and dissection of the celiac and splenic arteries without abdominal artery dissection. Contrast enhanced computed tomography (CT revealed the same result. Consequently, spontaneous isolated celiac artery dissection (SICAD was diagnosed. Because his blood pressure was high (159/70 mmHg, antihypertensive medicine was administered (nicardipine and carvedilol. After his blood reached optimal levels (130/80 mmHg, symptoms disappeared. Follow-up USG and contrast enhanced CT performed 8 days and 4 months after onset revealed amelioration of splenic infarction and improvement of the narrowed artery. Here, we report a case of SICAD with splenic infarction presenting with severe left-sided back pain and discuss the relevance of USG in an emergency setting.

  20. Medial reorganization of motor function in corona radiata following middle cerebral artery infarction A case report

    Institute of Scientific and Technical Information of China (English)

    Sung Ho Jang

    2009-01-01

    Peri-lesional reorganization is one of the motor recovery mechanisms following stroke. A 23-year-old female who presented with complete paralysis of the right extremities at the onset of infarct in the left middle cerebral artery territory was included. She slowly recovered some function, and could extend the affected knee with resistance after 9 months. Diffusion tensor tractography, functional MRI, and transcranial magnetic stimulation testing were performed at 7 years after onset. Results showed that diffusion tensor tractography of the affected (left) hemisphere passed through the medial corona radiata at, or around, the wall of the lateral ventricle. The contralateral primary sensorimotor cortex was activated during affected knee movements. The motor-evoked potential, which was obtained from the affected leg, exhibited corticospinal tract characteristics. Results indicated that motor function of the affected leg recovered via the corticospinal tract, which descended through the corona radiata medial to the infarct. The motor function of the affected leg was reorganized to the medial corona radiata following infarct to the middle cerebral artery territory.

  1. Akinetic Mutism Following Bilateral Anterior Cerebral Artery Territory Infarction Due to Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Zeynep Özözen Ayas

    2014-04-01

    Full Text Available BACKGROUND AND PURPOSE: Bilateral anterior cerebral artery (ACA territory infarction is rare localization in stroke which should always prompt a search for an anterior communicating artery (ACoA aneurysm. The common neurological manifestations are contralateral weakness predominate in the lower extremite, behavior disturbance, motor inertia, muteness, incontinence, grasp reflex, diffuse rigidity, akinetic mutism. CASE DESCRIPTION: We describe a 38-year-old woman presented with a left sided hemiparesia and decrease of speech for last days. She was a smoker and morbide obese. She had no any diagnosed disease. Her neurological examination had weakness of left extremites affected leg more than the arm and akinetic mutism like as no spontaneously speech and move and grasp reflex. CT showed bilateral ACA infarction which included cingulate gyrus, the right side more than left and subarachnoid hemorrhage in the interhemispheric fissure. MRI angiography showed the appearance of AcoA aneurysm. CONCLUSION: We report a patient with bilateral infarction in the ACA which a rare localization and clinicians must be alert to exist AcoA aneurysm which may bleed, different symptoms and signs like as akinetic mutism, primitive reflexes.

  2. Is the time between onset of pain and restoration of patency of infarct-related artery shortened in patients with myocardial infarction? The effects of the Kielce Region System for Optimal Management of Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Marcin Sadowski

    2014-09-01

    Full Text Available Introduction : The importance of delay in the restoration of infarct-related artery patency in patients with myocardial infarction was discussed, and actions were undertaken in the Kielce Region aimed at shortening this time within the System for Optimal Management of Acute Myocardial Infarction. Aim of the research: To evaluate the effectiveness of shortening time delays during transport of patients and diagnostics of myocardial infarction in the Kielce Region. Material and methods: Time delays were analysed in 5,934 patients with ST-segment elevation myocardial infarction (STEMI, hospitalised in cardiology wards with interventional cardiology on 24-hour duty, during the period 2008–2012. Time delays were analysed between the onset of myocardial infarction pain and undertaking treatment – T1 and T2 time – within which a patient with myocardial infarction, after admission to hospital, has intervention performed on infarct-related coronary artery. Results : During the period 2008–2012, the median T1 time was successfully shortened from 355 to 203 min, and the T2 time from 101 to 48 min. Conclusions: The effectiveness of the system was confirmed, and the necessity for further improvement of the system indicated.

  3. Association of atherosclerotic renal artery stenosis with major adverse cardiovascular events after acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Zheng Bin; Liu Jinghua; Ma Qin; Zhao Donghui; Wang Xin; Zheng Ze

    2014-01-01

    Background Patients with atherosclerotic renal artery stenosis (ARAS) are in substantial risk of cardiovascular adverse events.We investigated whether myocardial infarction patients with ARAS are in additional risk of cardiovascular events.Methods In this retrospective study,257 patients with type 1 myocardial infarction were enrolled.Median follow-up was 42 months.Composite endpoint events are analyzed by definitions of ARAS as ≥50% or ≥70% diameter stenosis.Results Defining ARAS as ≥70% diameter stenosis,ARAS was a significant predictor for composite endpoint events including death,non-fatal myocardial infarction,ischaemic stroke and intracranial haemorrhage,rehospitalisation for cardiac failure (HR:4.381; 95% Cl:1.770-10.842) by Cox regression analysis,but not for death.Diabetes mellitus was also a significant predictor for composite endpoint events (HR:2.756; 95% Cl:1.295-5.863).However,defining ARAS ≥50% diameter stenosis,ARAS was no longer a significant predictor for composite endpoint events or death.Conclusions Although not associated with mortality,ARAS ≥70% is associated with major adverse cardiac events after acute myocardial infarction.For prognosis,≥70% diameter stenosis is a more appropriate criteria for ARAS definition than ≥50% diameter stenosis.

  4. The Usefulness of the TOAST Classification and Prognostic Significance of Pyramidal Symptoms During the Acute Phase of Cerebellar Ischemic Stroke.

    Science.gov (United States)

    Dziadkowiak, Edyta; Chojdak-Łukasiewicz, Justyna; Guziński, Maciej; Noga, Leszek; Paradowski, Bogusław

    2016-04-01

    Cerebellar stroke is a rare condition with very nonspecific clinical features. The symptoms in the acute phase could imitate acute peripheral vestibular disorders or a brainstem lesion. The aim of this study was to assess the usefulness of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification in cerebellar stroke and the impact of clinical features on the prognosis. We retrospectively analyzed 107 patients with diagnosed ischemic cerebellar infarction. We studied the clinical features and compared them based on the location of the ischemic lesion and its distribution in the posterior interior cerebellar artery (PICA), superior cerebellar artery (SCA), and anterior inferior cerebellar artery (AICA) territories. According to the TOAST classification, stroke was more prevalent in atrial fibrillation (26/107) and when the lesion was in the PICA territory (39/107). Pyramidal signs occurred in 29/107 of patients and were more prevalent when the lesion was distributed in more than two vascular regions (p = 0.00640). Mortality was higher among patients with ischemic lesion caused by cardiac sources (p = 0.00094) and with pyramidal signs (p = 0.00640). The TOAST classification is less useful in assessing supratentorial ischemic infarcts. Cardioembolic etiology, location of the ischemic lesion, and pyramidal signs support a negative prognosis.

  5. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    Science.gov (United States)

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  6. Coronary angiography and pathogenesis of coronary artery disease in young male survivors of myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Szamosi, A.; Hamsten, A.; Walldius, G.; Faire, U. de

    Coronary angiography was performed 3 to 6 months after myocardial infarction in 107 males below the age of 45 (mean age 39.7+-3.9, range 23-44 years). The coronary angiograms were allocated to various groups according to the presence or absence of obvious atheromatous changes. Metabolic evaluation included determination of cholesterol and triglyceride concentrations in the major serum lipoproteins. Marked elevation of low density lipoprotein (LDL) cholesterol concentration was found in patients with angiographic evidence of atheromatosis, in contrast to patients with normal coronary angiograms or with single occlusion and no other abnormalities. Thus, there was a correlation between angiographic appearance of the coronary arteries and disturbances of LDL metabolism. It is proposed that coronary angiography may distinguish between atheromatous and nonatheromatous pathogenesis of myocardial infarction at young age.

  7. Fetal-Type Variants of the Posterior Cerebral Artery and Concurrent Infarction in the Major Arterial Territories of the Cerebral Hemisphere

    Directory of Open Access Journals (Sweden)

    Stephen L. Lambert BS

    2016-09-01

    Full Text Available Fetal-type or fetal posterior cerebral artery (FPCA is a variant of cerebrovascular anatomy in which the distal posterior cerebral artery (PCA territory is perfused by a branch of the internal carotid artery (ICA. In the presence of FPCA, thromboembolism in the anterior circulation may result in paradoxical PCA territory infarction with or without concomitant infarction in the territories of the middle (MCA or the anterior (ACA cerebral artery. We describe 2 cases of FPCA and concurrent acute infarction in the PCA and ICA territories—right PCA and MCA in Patient 1 and left PCA, MCA, and ACA in Patient 2. Noninvasive angiography detected a left FPCA in both patients. While FPCA was clearly the mechanism of paradoxical infarction in Patient 2, it turned out to be an incidental finding in Patient 1 when evidence of a classic right PCA was uncovered from an old computed tomography scan image. Differences in anatomical details of the FPCA in each patient suggest that the 2 FPCAs are developmentally different. The FPCA of Patient 1 appeared to be an extension of the embryonic left posterior communicating artery (PcomA. Patient 2 had 2 PCAs on the left (PCA duplication, classic bilateral PCAs, and PcomAs, and absent left anterior choroidal artery (AchoA, suggesting developmental AchoA-to-FPCA transformation on the left. These 2 cases underscore the variable anatomy, clinical significance, and embryological origins of FPCA variants.

  8. Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Ma Likun; Yu Hua; Huang Xiangyang; Feng Kefu; Han Xiaoping; Ye Qi

    2006-01-01

    Objectives The long-term benefit of late reperfusion of infarct-related artery (IRA) after acute myocardial infarction (AMI) is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography (LDSE) can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time.Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments (57%) were viable during LDSE. 26 patients (38%) with viability and 43(62%) without. In viable group, left ventricular ejection fraction (LVEF) was increased (P<0.05),and left ventricular end systolic volume index (LVESVI) and wall motion score (WMS) were decreased (P<0.05 and P<0.01) significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased (P<0.01), and LVESVI and left ventricular end diastolic volume index (LVEDVI) were increased (P<0.05) significantly after 6 months, and the WMS did not changed (P>0.05). LVEF increased (P<0.05) and WMS decreased (P<0.05) on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling.Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.

  9. A bypass case due to an acute inferior myocardial infarction caused by vascular occlusion of the left subclavian artery and left anterior descending artery

    Directory of Open Access Journals (Sweden)

    Altas Y

    2016-07-01

    Full Text Available Yakup Altas, Ali Veysel Ulugg Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey Abstract: ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient’s history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. Keywords: electrocardiography, myocardial infarction, coronary circulation

  10. Malignant infarction of the middle cerebral artery in a porcine model. A pilot study

    Science.gov (United States)

    Martínez-Valverde, Tamara; Sánchez-Guerrero, Ángela; Campos, Mireia; Esteves, Marielle; Gandara, Dario; Torné, Ramon; Castro, Lidia; Dalmau, Antoni; Tibau, Joan

    2017-01-01

    Background and purpose Interspecies variability and poor clinical translation from rodent studies indicate that large gyrencephalic animal stroke models are urgently needed. We present a proof-of-principle study describing an alternative animal model of malignant infarction of the middle cerebral artery (MCA) in the common pig and illustrate some of its potential applications. We report on metabolic patterns, ionic profile, brain partial pressure of oxygen (PtiO2), expression of sulfonylurea receptor 1 (SUR1), and the transient receptor potential melastatin 4 (TRPM4). Methods A 5-hour ischemic infarct of the MCA territory was performed in 5 2.5-to-3-month-old female hybrid pigs (Large White x Landrace) using a frontotemporal approach. The core and penumbra areas were intraoperatively monitored to determine the metabolic and ionic profiles. To determine the infarct volume, 2,3,5-triphenyltetrazolium chloride staining and immunohistochemistry analysis was performed to determine SUR1 and TRPM4 expression. Results PtiO2 monitoring showed an abrupt reduction in values close to 0 mmHg after MCA occlusion in the core area. Hourly cerebral microdialysis showed that the infarcted tissue was characterized by reduced concentrations of glucose (0.03 mM) and pyruvate (0.003 mM) and increases in lactate levels (8.87mM), lactate-pyruvate ratio (4202), glycerol levels (588 μM), and potassium concentration (27.9 mmol/L). Immunohistochemical analysis showed increased expression of SUR1-TRPM4 channels. Conclusions The aim of the present proof-of-principle study was to document the feasibility of a large animal model of malignant MCA infarction by performing transcranial occlusion of the MCA in the common pig, as an alternative to lisencephalic animals. This model may be useful for detailed studies of cerebral ischemia mechanisms and the development of neuroprotective strategies. PMID:28235044

  11. Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings.

    Science.gov (United States)

    Yoon, Kibo; Song, Soon Young; Lee, Chang Hwa; Ko, Byung Hee; Lee, Seunghun; Kang, Bo Kyeong; Kim, Mi Mi

    2017-04-01

    The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

  12. Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach.

    Science.gov (United States)

    Chwajol, Markus; Hage, Ziad A; Amin-Hanjani, Sepideh; Charbel, Fady T

    2013-01-01

    Extracranial aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with only 22 reported cases in the English literature. For saccular extracranial distal PICA aneurysms not amenable to coiling, a surgically placed clip is not protected by the cranium postoperatively, and can be subject to movement in the mobile cervical region. Furthermore, fusiform or complex aneurysms cannot be clipped primarily. Resection and primary reanastomosis is a useful surgical approach not previously described for these extracranial lesions. We report three cases of extracranially located distal PICA aneurysms successfully treated with this surgical strategy at our center. One patient harboring a broad necked saccular aneurysm originally underwent successful primary clipping of the aneurysm but sustained a second subarachnoid hemorrhage (SAH) on postoperative day 25 due to clip dislodgement from vigorous neck movement. The other two patients were found to have fusiform and complex aneurysms, respectively. All three patients were ultimately treated with resection and end-to-end PICA anastomosis, which successfully obliterated their aneurysms. Resection and primary reanastomosis of extracranial distal PICA aneurysms averts the risk of clip dislodgement due to neck movement and/or compression by soft tissues in the upper cervical region. It is a safe and efficacious technique, which we propose as the preferred management strategy for these rare vascular lesions.

  13. Capsaicin, arterial hypertensive crisis and acute myocardial infarction associated with high levels of thyroid stimulating hormone.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Di Bella, Gianluca; Cerrito, Marco; Coglitore, Sebastiano

    2009-05-01

    Chili peppers are rich in capsaicin. The potent vasodilator calcitonin gene-related peptide (CGRP) is stored in a population of C-fiber afferents that are sensitive to capsaicin. CGRP and peptides released from cardiac C fibers have a beneficial effect in myocardial ischemia and reperfusion. It has been reported that capsaicin pretreatment deplete cardiac C-fiber peptide stores. Furthermore, it has also been reported that capsaicin-treated pigs significantly increase mean arterial blood pressure compared with controls and that the decrease in CGRP synthesis and release contributes to the elevated blood pressure. It has also been reported that sub-clinical hypothyroidism is associated with a significant risk of coronary heart disease (CHD). We present a case of arterial hypertensive crisis and acute myocardial infarction in a 59-year-old Italian man with high levels of thyroid stimulating hormone and with an abundant ingestion of peppers and of chili peppers which occurred the day before.

  14. Pathophysiology of acute middle cerebral artery infarct by multimodal computed tomography: A pilot study in Thai patients

    Directory of Open Access Journals (Sweden)

    Pornpatr A Dharmasaroja

    2015-01-01

    Full Text Available Multimodal computed tomography, including non-contrast computed tomography (CT, computed tomography perfusion (CTP and computed tomography angiography (CTA, has been increasingly used. Aims: The purpose of this study was to study pathophysiology of acute middle cerebral artery infarct using multimodal CT and to evaluate the safety and feasibility of this method in our center. Materials and Methods: Patients who had moderate to severe stroke (NIHSS score > 10, suspected of anterior circulation infarct and presented within 4 hours after stroke onset were prospectively included. Multimodal CTs, using low-osmolar contrast agents, were performed in all patients. Results: Twenty-two patients were included. Mean NIHSS was 16. All patients received intravenous thrombolysis. Favorable outcome was found in nine patients (41%. CTP was unable to identify ischemic lesions in three patients with small subcortical infarct. Most patients (82% with large middle cerebral artery infarct still had some salvageable brain (penumbra which partly recovered in a follow-up imaging. Eleven patients (50% had major artery occlusion. Two patients had creatinine rising within 72 hours. Conclusions: Multimodal CT does provide information about status of major artery and the volume of salvageable/infarct brain tissue and is safely and easily applicable in our center.

  15. Amnesia syndrome following left anterior thalamic infarction; with intrahemispheric and crossed cerebro-cerebellar diaschisis on brain SPECT.

    Science.gov (United States)

    Kim, M. H.; Hong, S. B.; Roh, J. K.

    1994-01-01

    We report a 61-year-old right-handed man developing disturbance of memory after a discrete thalamic infarction. Neuropsychological assessment revealed deficits in memory with retrograde and anterograde components, especially for verbal material. Brain MRI showed a left anterior thalamic infarction with normal angiographic findings. Despite the small lesion in the thalamus, he showed prolonged memory disturbance and a Brain SPECT image revealed decreased uptake in the ipsilateral fronto-temporo-parietal cortex and contralateral cerebellum. This diaschisis, a phenomenon caused by disconnection of the neural pathway helped us to evaluate the functional state of the patient and this imaging technique was valuable for obtaining to get more information for the evaluation of the neurological state and neuronal connections. In conclusion our findings correspond well with the understanding of amnesia as a disconnection syndrome because of the evidence of diaschisis on the Brain SPECT image. PMID:7702792

  16. The Vanishing Stenosis: ST Elevation Myocardial Infarction and Rhythm Disturbance due to Coronary Artery Spasm—Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    J. Gosai

    2010-01-01

    Full Text Available A 62-year-old lady was admitted with clinical and electrocardiograph features of acute myocardial infarction. Urgent coronary arteriography was performed, demonstrating a single discrete stenosis of one coronary artery. Following intracoronary injection of GTN, this stenosis completely resolved, as the symptoms did. The causes of acute myocardial infarction with normal coronary arteries are reviewed.

  17. Vertebral Artery Hypoplasia and Posterior Circulation Infarction in Patients with Isolated Vertigo with Stroke Risk Factors.

    Science.gov (United States)

    Zhang, Dao Pei; Lu, Gui Feng; Zhang, Jie Wen; Zhang, Shu Ling; Ma, Qian Kun; Yin, Suo

    2017-02-01

    We aimed in this study to investigate the prevalence of vertebral artery hypoplasia (VAH) in a population with isolated vertigo in association with stroke risk factors, to determine whether VAH is an independent risk factor for posterior circulation infarction (PCI). We sequentially enrolled 245 patients with isolated vertigo with at least 1 vascular risk factor, who were divided into PCI and non-PCI groups, according to present signs of acute infarction on diffusion-weighted magnetic resonance imaging. All patients underwent magnetic resonance angiography and cervical contrast-enhanced magnetic resonance angiography to screen for VAH. Univariate and multivariate logistic regression analyses were performed to identify the significant risk factors for PCI. VAH was found in 64 of 245 patients (26%). VAH (odds ratio [OR] = 2.70, 95%confidence interval [CI] 1.17-6.23, P = .020), median stenosis of the posterior circulation (OR = 7.09, 95%CI = 2.54-19.79, P vertigo with PCI complicated by VAH was mainly small-artery occlusion. Our findings suggest that VAH is an independent risk factor for PCI in patients with isolated vertigo with confirmed risk from stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. [The relationship between conventional ECG and the culprit coronary artery in acute myocardial infarct].

    Science.gov (United States)

    César, L A; Moretti, M A; Ramires, J A; Nussbacher, A; Consolim, F M; Moffa, P J; da Luz, P L; Bellotti, G M; Pileggi, F

    1994-08-01

    To evaluate electrocardiogram (ECG) in detecting acute myocardial infarction (AMI) during the first 12 hours of symptoms and its relationship to the culprit coronary artery. We studied 68 patients aged 55.6 (30 to 76) years, 61 males, with AMI confirmed by elevated CKMB isoenzyme and cinecoronariography (CINE). In all of them we obtained two ECG: first (i), with or = 5 days during evolution. ECG were analyzed in order to disclose up and downward ST-T segments > or = 1 mm, new Q waves > or = 0.04 s and R/S > or = 1 plus downward ST-T segment in leads V1 and V2. Then we have done correlation between these and the culprit coronary lesions at CINE. The culprit coronary lesions were: right coronary artery (RCA) in 16, left circumflex (LC) in 26 and left anterior descending (LAD) in 31 cases. According to the ECG, the RCA determined inferior AMI in all patients and the LC only in 62% of cases. Posterior AMI due to LC was seen in 81% of cases at ECG and, associated with lateral AMI, in 52%. Lone lateral AMI was seen in 5% and true posterior in 14% of cases, all of them due to LC. False negative ECG (i) in AMI is in fact due to LC occlusion which, frequently, causes posterior wall more then inferior wall myocardial infarction at ECG.

  19. Artery of Percheron Infarction as an Unusual Cause of Korsakoff’s Syndrome

    Directory of Open Access Journals (Sweden)

    Yongxing Zhou

    2015-01-01

    Full Text Available The Korsakoff syndrome is defined as “an abnormal mental state in which memory and learning are affected out of all proportion to other cognitive functions in an otherwise alert and responsive patient.” Confabulation refers to false or erroneous memories arising, not deliberately, in the context of a neurological amnesia and is often thought of as pathognomonic of the Korsakoff syndrome. Although the exact pathophysiology is unknown, various studies have identified brain lesions in the thalami, mammillary bodies, and frontal cortex. We report a case of a 68-year-old male presenting with acute altered mental status on July 16, 2015. The neuropsychological dysfunctions included prominent Korsakoff’s syndrome, which became apparent when the altered mental status resolved. Amnesia was accompanied by prominent confabulation, disorientation, and lack of insight into his own disability. Neuroradiological data indicated that the intralaminar and dorsomedial nuclei in bilateral thalami were infarcted by occlusion of the artery of Percheron. We believe that ours is one of few reported cases of Korsakoff syndrome in a patient with infarction involving the territory of the artery of Percheron. We conclude that bilateral thalamic lesions could cause Korsakoff’s syndrome and the intralaminar and dorsomedial nuclei might be important structures in the pathogenesis of confabulation.

  20. Punding following posterior cerebral artery infarction: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Lin CI

    2017-03-01

    Full Text Available Cho-I Lin,1 Yu-Ching Lin,1–3 Wei-Chih Lien,1 Pei-Chun Hsieh,1 Sheng-Han Lin,1 Ta-Shen Kuan1,2 1Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan Introduction: Punding is a complex stereotyped behavior, characterized by excessiveness, non-goal orientation, and repetitiveness. It is mostly associated with Parkinson’s disease, and very few cases in non-Parkinson’s disease have been reported. We report a case of punding associated with supratentorial ischemic stroke.Case presentation: We present a 70-year-old man with left posterior cerebral artery infarction with quetiapine-induced punding manifesting as repetitive unidirectional body turning. Remission of punding behavior ensued after cessation of quetiapine and administration of clonazepam.Conclusion: This case describes the clinical course of quetiapine-induced punding in a patient with left posterior cerebral artery infarction. It suggests clonazepam may serve as a treatment option for poststroke punding. Keywords: punding, stereotyped behavior, stroke, quetiapine, clonazepam

  1. Corrected thrombolysis in myocardial infarction frame counts in diabetic patients with angiographically normal coronary arteries.

    Science.gov (United States)

    Turkoglu, Sedat; Ozdemir, Murat; Tacoy, Gulten; Tavil, Yusuf; Abaci, Adnan; Timurkaynak, Timur; Cengel, Atiye

    2008-08-01

    To evaluate corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) in patients with angiographically normal coronary arteries and diabetes mellitus, a condition known to be associated with microvascular dysfunction. Patients who underwent coronary angiography in Gazi University Hospital, Ankara, Turkey between January 2000 and January 2005 were studied. Corrected TIMI frame count was calculated over the left anterior descending (LAD), left circumflex (Cx) and right coronary arteries (RCA) in 118 diabetic and 122 non-diabetic patients with normal coronary angiogram. The mean CTFC values of the LAD, Cx, and the RCA were similar in diabetics and nondiabetics 21.0 +/= 7.5 versus 21.3 +/= 9.6, 23.3 +/= 9.7 versus 23.5 +/= 10.8, 17.9 +/= 6.7 versus 18.7 +/=7.4 respectively, p>0.05 for all comparisons. In stepwise multivariate linear regression analysis, body surface area had a significant correlation with CTFC of all the 3 coronary arteries. We conclude that CTFC in diabetics and non-diabetics with angiographically normal coronary arteries is similar. Since microvascular disease is an inherent component of diabetes, our finding may reflect the inadequacy of CTFC in predicting microvascular disease in diabetic patients with normal coronary angiograms.

  2. Combined Myocardial Infarction in a Young Patient with Anomalous Coronary Artery Anatomy: A Case Report

    Directory of Open Access Journals (Sweden)

    Hadadi László

    2016-03-01

    Full Text Available Introduction: combined myocardial infarction (MI is defined as the simultaneous ischemic injury of two different myocardial territories, raising the possibility of multiple culprit lesions. The anomalous origin of a coronary artery could represent an important challenge during percutaneous coronary intervention (PCI. Case presentation: A 46 year old, smoker Caucasian male presented to a territorial hospital four hours after the onset of severe angina. Consecutive electrocardiograms showed complete atrioventricular block and inferior ST segment elevation (STE, later PQ prolongation with right bundle branch block plus STE in leads V4-V6. After administration of thrombolytic treatment, the patient was transferred to the regional PCI center. Emergent coronary angiography revealed acute occlusion of the left anterior descending artery (LAD and a thrombus containing, severe stenosis of the anomalously originated right coronary artery (RCA. Rescue PCI with stent implantation in the LAD and RCA was performed nine hours after pain onset. At the 1 year follow-up visit the patient had no angina or heart failure symptoms. Conclusion: this is the first report of a combined MI caused by acute, sequentially occurring thrombotic occlusion of two coronary arteries, one of them with anomalous origin, in a patient treated by rescue PCI following partially successful thrombolysis.

  3. Predictors of malignant brain edema in middle cerebral artery infarction observed on CT angiography.

    Science.gov (United States)

    Kim, Hoon; Jin, Seon Tak; Kim, Young Woo; Kim, Seong Rim; Park, Ik Seong; Jo, Kwang Wook

    2015-03-01

    Patients with middle cerebral artery (MCA) infarction accompanied by MCA occlusion with or without internal carotid artery (ICA) occlusion have a poor prognosis, as a result of brain cell damage caused by both the infarction and by space-occupying and life-threatening edema formation. Multiple treatments can reduce the likelihood of edema formation, but tend to show limited efficacy. Decompressive hemicraniectomy with duroplasty has been promising for improving functional outcomes and reducing mortality, particularly improved functional outcomes can be achieved with early decompressive surgery. Therefore, identifying patients at risk for developing fatal edema is important and should be performed as early as possible. Sixty-four patients diagnosed with major MCA infarction with MCA occlusion within 8 hours of symptom onset were retrospectively reviewed. Early clinical, laboratory, and computed tomography angiography (CTA) parameters were analyzed for malignant brain edema (MBE). Twenty of the 64 patients (31%) had MBE, and the clinical outcome was poor (3month modified Rankin Scale >2) in 95% of them. The National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early Computed Tomography Score, Clot Burden Score, and Collateral Score (CS) showed statically significant differences in both groups. Multivariable analyses adjusted for age and sex identified the independent predictors of MBE: NIHSS score >18 (odds ratio [OR]: 4.4, 95% confidence interval [CI]: 1.2-16.0, p=0.023) and CS on CTA <2 (OR: 7.28, 95% CI: 1.7-30.3,p=0.006). Our results provide useful information for selecting patients in need of aggressive treatment such as decompressive surgery.

  4. The Effect of PAI-1 4G/5G Polymorphism and Clinical Factors on Coronary Artery Occlusion in Myocardial Infarction.

    Science.gov (United States)

    Parpugga, Tajinder Kumar; Tatarunas, Vacis; Skipskis, Vilius; Kupstyte, Nora; Zaliaduonyte-Peksiene, Diana; Lesauskaite, Vaiva

    2015-01-01

    Data on the impact of PAI-1-675 4G/5G genotype for fibrinolysis during myocardial infarction are inconsistent. The aim of our study was to evaluate the association of clinical and genetic (PAI-1-675 4G/5G polymorphism) factors with coronary artery occlusion in patients with myocardial infarction. PAI-1-675 4G/5G detection was achieved by using Sanger sequencing in a sample of patients hospitalized for stent implantation due to myocardial infarction. We categorized the patients into two groups: patients with coronary artery occlusion and patients without coronary artery occlusion according to angiographic evaluation. We identified n = 122 (32.4%) 4G/4G, n = 186 (49.5%) 4G/5G, and n = 68 (18.1%) 5G/5G PAI-1 genotype carriers. Univariate and multivariate analysis showed that only the 4G/5G genotype was associated with coronary artery occlusion (OR: 1.656 and 95% CI: 1.009-2.718, p = 0.046). Our results showed that carriers of PAI-1 4G/5G genotype with myocardial infarction have increased odds of coronary artery occlusion more than 1.6 times in comparison to the carriers of homozygous genotypes.

  5. Decompressive craniectomy for malignant middle cerebral artery infarction: Impact on mortality and functional outcome

    Directory of Open Access Journals (Sweden)

    Mohammed Azman Mohammad Raffiq

    2014-01-01

    Full Text Available Background: Malignant middle cerebral artery (MCA infarction is a devastating clinical entity affecting about 10% of stroke patients. Decompressive craniectomy has been found to reduce mortality rates and improve outcome in patients. Methods: A retrospective case review study was conducted to compare patients treated with medical therapy and decompressive surgery for malignant MCA infarction in Hospital Kuala Lumpur over a period of 5 years (from January 2007 to December 2012. A total of 125 patients were included in this study; 90 (72% patients were treated with surgery, while 35 (28% patients were treated with medical therapy. Outcome was assessed in terms of mortality rate at 30 days, Glasgow Outcome Score (GOS on discharge, and modified Rankin scale (mRS at 3 and 6 months. Results: Decompressive craniectomy resulted in a significant reduction in mortality rate at 30 days (P < 0.05 and favorable GOS outcome at discharge (P < 0.05. Good functional outcome based on mRS was seen in 48.9% of patients at 3 months and in 64.4% of patients at 6 months (P < 0.05. Factors associated with good outcome include infarct volume of less than 250 ml, midline shift of less than 10 mm, absence of additional vascular territory involvement, good preoperative Glasgow Coma Scale (GCS score, and early surgical intervention (within 24 h (P < 0.05. Age and dominant hemisphere infarction had no significant association with functional outcome. Conclusion: Decompressive craniectomy achieves good functional outcome in, young patients with good preoperative GCS score and favorable radiological findings treated with surgery within 24 h of ictus.

  6. The primary percutaneous coronary intervention for acute anterior myocardial infarction in a middle-aged male patient with bilateral coronary artery to pulmonary artery fistulas.

    Science.gov (United States)

    Altay, Servet; Cakmak, Huseyin Altug; Velibey, Yalcin; Erer, Betul

    2012-11-14

    A 38-year-old man admitted to emergency department with 2 h of typical substernal chest pain, shortness of breath and nausea. The ECG revealed sinus rhythm with a 3 mm ST elevation in precordial leads V1-V6. The coronary angiography revealed acute total occlusion in left anterior descending artery (LAD) with normal circumflex and right coronary artery (RCA) along with bilateral fistulas arising from the proximal LAD and ostial RCA draining into the main pulmonary artery. Therefore, primary percutaneous coronary intervention and bare metal stent implantation was performed to culprit LAD lesion. The electrocardiographically gated 64-slice multidetector-row CT showed two large, tortuous abnormal vessels which arose from the both ostial part of the RCA and LAD draining into the main pulmonary artery. We report an unusual case of bilateral coronary artery to pulmonary artery fistulas leading to acute anterior myocardial infarction in a middle-aged male patient.

  7. Near-infrared diffuse reflectance imaging of infarct core and peri-infarct depolarization in a rat middle cerebral artery occlusion model

    Science.gov (United States)

    Kawauchi, Satoko; Nishidate, Izumi; Nawashiro, Hiroshi; Sato, Shunichi

    2014-03-01

    To understand the pathophysiology of ischemic stroke, in vivo imaging of the brain tissue viability and related spreading depolarization is crucial. In the infarct core, impairment of energy metabolism causes anoxic depolarization (AD), which considerably increases energy consumption, accelerating irreversible neuronal damage. In the peri-infarct penumbra region, where tissue is still reversible despite limited blood flow, peri-infarct depolarization (PID) occurs, exacerbating energy deficit and hence expanding the infarct area. We previously showed that light-scattering signal, which is sensitive to cellular/subcellular structural integrity, was correlated with AD and brain tissue viability in a rat hypoxia-reoxygenation model. In the present study, we performed transcranial NIR diffuse reflectance imaging of the rat brain during middle cerebral artery (MCA) occlusion and examined whether the infarct core and PIDs can be detected. Immediately after occluding the left MCA, light scattering started to increase focally in the occlusion site and a bright region was generated near the occlusion site and spread over the left entire cortex, which was followed by a dark region, showing the occurrence of PID. The PID was generated repetitively and the number of times of occurrence in a rat ranged from four to ten within 1 hour after occlusion (n=4). The scattering increase in the occlusion site was irreversible and the area with increased scattering expanded with increasing the number of PIDs, indicating an expansion of the infarct core. These results suggest the usefulness of NIR diffuse reflectance signal to visualize spatiotemporal changes in the infarct area and PIDs.

  8. Echocardiographic assessment of coronary artery flow in normal canines and model dogs with myocardial infarction.

    Science.gov (United States)

    Park, Nohwon; Kim, Jaehwan; Lee, Miyoung; Lee, Soyun; Song, Sunhye; Lee, Seungjun; Kim, Soyoung; Park, Yangwoo; Eom, Kidong

    2014-01-01

    This study was conducted to evaluate the usefulness of coronary arterial profiles from normal dogs (11 animals) and canines (six dogs) with experimental myocardial infarction (MI) induced by ligation of the left coronary artery (LCA). Blood velocity of the LCA and right coronary artery (RCA) were evaluated following transthoracic pulsed-wave Doppler echocardiography. The LCA was observed as an infundibular shape, located adjacent to the sinus of Valsalva. The RCA appeared as a tubular structure located 12 o'clock relative to the aorta. In normal dogs, the LCA and RCA mean peak diastolic velocities were 20.84 ± 3.24 and 19.47 ± 2.67 cm/sec, respectively. The LCA and RCA mean diastolic deceleration times were 0.91 ± 0.14 sec and 1.13 ± 0.20 sec, respectively. In dogs with MI, the LCA had significantly (p < 0.01) lower peak velocities (14.82 ± 1.61 cm/sec) than the RCA (31.61 ± 2.34 cm/sec). The RCA had a significantly (p < 0.01) rapid diastolic deceleration time (0.71 ± 0.06 sec) than that found in the LCA (1.02 ± 0.22 sec) of MI dogs. In conclusion, these profiles may serve as a differential factor for evaluating cardiomyopathy in dogs.

  9. Direction of flow in posterior communicating artery on magnetic resonance angiography in patients with occipital lobe infarcts

    NARCIS (Netherlands)

    Jongen, JCF; Franke, CL; Ramos, LMP; Wilmink, JT; van Gijn, J

    2004-01-01

    Background and Purpose - In some people the blood supply to the posterior cerebral artery occurs partly or even exclusively via the carotid system. This anatomic configuration may influence the risk of occipital lobe infarction. We studied the presence and direction of flow in the posterior communic

  10. A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    傅向华

    2003-01-01

    A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction!050000$河北医科大学第二医院河北医科大学心脏介入中心@傅向华

  11. Clinical applications of non-invasive imaging techniques in suspected coronary artery disease and in acute myocardial infarction

    NARCIS (Netherlands)

    Nucifora, Gaetano

    2015-01-01

    Non-invasive cardiac imaging modalities play a crucial role in the diagnostic process and clinical management of patients without known coronary artery disease and patients with acute myocardial infarction. The first part of the thesis discusses the use of non-invasive imaging modalities (including

  12. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Abildstrøm, Steen Z; Hansen, Peter R

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the clinical efficacy of clopidogrel treatment on death and recurrent myocardial infarction (MI) among MI patients revascularized by coronary artery bypass graft surgery (CABG). BACKGROUND: The benefit from post-operative clopidogrel in CABG-...

  13. Acute myocardial infarction in chronic Chagas' cardiomyopathy: report of two cases with no obstructive coronary artery lesions

    Directory of Open Access Journals (Sweden)

    Silvia G. Lage

    1986-04-01

    Full Text Available This report describes two patients with chronic Chagas' Heart Disease who developed clinical and laboratorial signs of myocardial infarction. Both patients presented sudden oppressive chest pain, without precipitating factor. In the first case, the highest MB-CK value was 65 IU, 22 hours after the beginning of the pain. On the second case, it was 77 IU at 18 hours after the beginning of the pain. In both cases ECG changes suggesting non-transmural infarction were present. The 99mTc PYP myocardial scintigram of the first case was positive. Coronary angiograms performed on the 18th and 9th day, respectively, after the acute infarction did not display obstructive lesions. Possible mechanisms causing myocardial infarction with normal coronary arteries in Chagas' Disease may include: embolic event's, particularly when there is associated congestive heart failure; coronary thrombosis and coronary spasms.

  14. Development of anterior inferior cerebellar artery pseudoaneurysm after gamma knife surgery for vestibular schwannoma. A case report and review of the literature.

    Science.gov (United States)

    Sunderland, Geraint; Hassan, Faizul; Bhatnagar, Priya; Mitchell, Patrick; Jayakrishnan, Vijayam; Forster, David; Mendelow, Alexander David

    2014-08-01

    Gamma knife surgery (GKS) is a well-established modality for controlling the progression of vestibular schwannomas. Adverse effects of this treatment are extremely rare but include cyst formation and malignant transformation. We report a case of anterior inferior cerebellar artery (AICA) pseudoaneurysm development rupture presenting as a poor WFNS grade subarachnoid haemorrhage. This is only the fourth case of aneurysm development (AICA aneurysm) following GKS reported but due to its serious nature we believe this potential complication warrants awareness in those offering this treatment.

  15. Atypical Unilateral Posterior Reversible Encephalopathy Syndrome Mimicking a Middle Cerebral Artery Infarction.

    Science.gov (United States)

    Çamlıdağ, İlkay; Cho, Yang-Je; Park, Mina; Lee, Seung Koo

    2015-01-01

    Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.

  16. The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Maryam Esmaeilzadeh

    2015-10-01

    Full Text Available Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion.Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea.This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction

  17. Atypical unilateral posterior reversible encephalopathy syndrome mimicking a middle cerebral artery infarction

    Energy Technology Data Exchange (ETDEWEB)

    Camidag, Ilkay [Dept. of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkmenistan); Cho, Yang Je; Park, Mina; Lee, Seung Koo [Yonsei University Severance Hospital, Seoul (Korea, Republic of)

    2015-10-15

    Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.

  18. [Infarct in the area of the left anterior cerebral artery. II. Language disorders].

    Science.gov (United States)

    Bogousslavsky, J; Assal, G; Regli, F

    1987-01-01

    Language disturbances and other neuropsychological dysfunctions were evaluated in 10 right-handed patients with left anterior cerebral artery (ACA) infarcts with CT correlation. Transcortical motor aphasia was present in 4 cases, related to involvement of the supplementary motor area (SMA) or the underlying and immediately anterior white matter. In 4 patients with sparing of the SMA but with involvement of the cingulate region, only alterations of verbal memory were found. Sensory or mixed transcortical aphasia was not observed, in any of the patients, including those in whom the supplementary sensory area (SSA) or the underlying white matter were involved, casting doubt upon the presumed receptive role in language function attributed to the SSA by some authors. Buccolingual-facial apraxia was related to subcortical lesions. A callosal disconnection syndrome was uncommon (2 patients) and no hemi-neglect was encountered, even in those cases with cingulate involvement.

  19. Primary angioplasty for infarction due to isolated right ventricular artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Anwar; A; Chahal; Min-Young; Kim; Alexander; N; Borg; Yahya; Al-Najjar

    2014-01-01

    We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery(RCA), successfully treated by balloon angioplasty. A 58-yearold gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4 R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient’s blood pressure dropped to 80/40 mm Hg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient’s symptoms. Repeat echocardiography showed complete resolution of theST-elevation in leads V4 R and V5 R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d inpatient stay without any complications.

  20. Red cell distribution width predicts totally occluded infarct-related artery in NSTEMI.

    Science.gov (United States)

    Açıkgöz, Sadık Kadri; Akboğa, Mehmet Kadri; Açıkgöz, Eser; Yayla, Çağrı; Şensoy, Barış; Aydoğdu, Sinan

    2016-08-01

    Objective Since non-ST segment elevation myocardial infarction (NSTEMI) patients with totally occluded infarct-related artery (TO-IRA) have worse prognosis, it is important to recognize TO-IRA in NSTEMI. Red cell distribution width (RDW) and mean platelet volume (MPV) are novel markers of inflammation and oxidative stress and were associated with poor clinical outcomes in acute coronary syndrome. In the present study, association of RDW and MPV with the presence of TO-IRA in NSTEMI was investigated. Methods Data of 201 consecutive patients who underwent coronary angiography with a diagnosis of NSTEMI were analyzed. Independent predictors of TO-IRA were investigated with logistic regression analysis. Results Sixty-six (32.8%) of the patients had TO-IRA. In patients with TO-IRA, RDW and troponin-T were significantly higher and left ventricular ejection fraction (LVEF) was lower. MPV did not differ between groups. Circumflex (CX) IRA was more common in TO-IRA group. The ROC curve analysis showed that the RDW at a cut-point of 13.95% has 76% sensitivity and 66% specificity in detecting TO-IRA. RDW, troponin-T, LVEF and CX-IRA were independent predictors of TO-IRA in NSTEMI, but MPV was not. Conclusion RDW is a cheap and readily available marker that may have a role to predict TO-IRA in NSTEMI.

  1. Comparison of carotid artery intima - media thickness and risk factors of atherosclerosis in lacunar versus non-lacunar cerebral infarcts

    Directory of Open Access Journals (Sweden)

    Seyed Ali Mousavi

    2007-07-01

    Full Text Available

    BACKGROUND: Increases in the thickness of the intima-media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtypes of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examined the relationship between the vascular risk factors, including carotid artery intimamedia thickness (IMT, and lacunar versus non-lacunar infarcts.
    METHODS: We collected data from patients admitted to hospital with acute ischemic stroke. 195 Patients and 96 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and non-lacunar infarcts with age, sex, and potential vascular risk factors.
    RESULTS: Of 195 adult patients with acute ischemic stroke, 87 were considered lacunar and 108 were considered nonlacunar strokes. Between these two groups of patients, we did not find a significantly different percentage of diabetes,
    smoking, hypertension, dyslipidemia, myocardial infarction, or previous history of ischemic stroke, alcohol, obesity,
    atherogen diet, exercise, and IMT. However, patients with lacunar infarct, diabetes mellitus (P = 0.02, and hypertension
    (P = 0.02 had a significantly higher percentage of history of prior CVA (P = 0.03 and a significantly higher percentage
    of non-lacunar infarct.
    CONCLUSIONS: The present results indicated that diabetes mellitus and hypertension are more common in patients with lacunar infarcts, and history of CVA is more common in patients with non–lacunar infarcts. We further concluded that IMT cannot differentiate subtypes of ischemic stroke. Because risk factors and clinical presentation of ischemic stroke differ among races, more national studies

  2. Remote cerebellar hemorrhage after lumbar spinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Cevik, Belma [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: belmac@baskent-ank.edu.tr; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)

    2009-04-15

    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  3. Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate

    Science.gov (United States)

    Akhtar, Naveed; Salam, Abdul; Alboudi, Ayman; Kamran, Kainat; Ahmed, Arsalan; Khan, Rabia A.; Mirza, Mohsin K.; Inshasi, Jihad

    2017-01-01

    Objective and Methods. The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following DHC under 48 or over 48 hours using the modified Rankin scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4 at three months. Results. In total, 137 patients underwent DHC. Functional outcome analyzed as mRS 0–4 versus mRS 5-6 showed no difference in this split between early and late operated on patients [P = 0.140] and mortality [P = 0.975]. Multivariate analysis showed that age ≥ 55 years, MCA with additional infarction, septum pellucidum deviation ≥1 cm, and uncal herniation were independent predictors of poor functional outcome at three months. In the “best” multivariate model, second infarct growth rate [IGR2] >7.5 ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] and second infarct growth rate [IGR2] were nearly double [P < 0.001] in patients with early surgery [under 48 hours]. Conclusions. The outcome and mortality in malignant middle cerebral artery stroke patients operated on over 48 hours of stroke onset were comparable to those of patients operated on less than 48 hours after stroke onset. Our data identifies IGR, temporal lobe involvement, and middle cerebral artery with additional infarct as independent predictors for early surgery.

  4. Large deep infarcts found in proximal middle cerebral artery steno-occlusive disease: MRI and angiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Bum Ha; Kim, Eui Jong; Choi, Woo Suk; Jang, Dae Il; Chung, Kyung Cheon; Oh, Joo Hyung; Yoon, Yup; Hong, Hoon Pyo [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1998-11-01

    To determine the nature of large deep-seated infarcts without cortical infarct in patients with steno-occlusive disease of the proximal middle cerebral artery (MCA) using magnetic resonance images (MRI) and angiography. By means of MRI and MR angiography (MRA), we examined 24 patients with large deep cerebral infarctions (>3cm in size) involving the basal ganglia, corona radiata and/or centrum semiovale, as well as steno-occlusive lesion of the proximal MCA. According to location, infarctions were classified into five groups, as follows:Group 1:basal ganlgia and corona radiata; 2:basal ganglia, corona radiata and centrum semiovale;3:corona radiata and centrum semiovale;4:corona radiata;5:basal ganglia only. We evaluated the topography of the lesions and correlated the results with the findings of angiography (all 24 MRA;the 13:conventional angiography). Involvement of the head of the caudate nucleus and the internal capsule were also evaluated. Fifteen of 24 cases (63%) were assigned to group 1 (4 proximal MCA(M1) occlusion and 11 stenosis), and five of 24 (21%) with M1 occlusions to group 2. Group 3 comprised only one case with M1 occlusion. Two cases with both occlusion and stenosis were included in group 4, and only one case-with M1 stenosis-in group 5. Infarctions at the caudate nucleus were seen in five cases, and at the internal capsule in two. On conventional angiography (13 cases) cortical branches of the MCA were delineated through the leptomeningeal collaterals of anterior or posterior cerebral arteries. Most large deep cerebral infarctions found in proximal MCA diseases are thought to extend cephalad to the corona radiata. When large deep-seated infarctions with proximal MCA occlusion is observed more frequently than stenosis.=20.

  5. Surgery-related thrombosis critically affects the brain infarct volume in mice following transient middle cerebral artery occlusion.

    Directory of Open Access Journals (Sweden)

    Xiaojie Lin

    Full Text Available Transient middle cerebral artery occlusion (tMCAO model is widely used to mimic human focal ischemic stroke in order to study ischemia/reperfusion brain injury in rodents. In tMCAO model, intraluminal suture technique is widely used to achieve ischemia and reperfusion. However, variation of infarct volume in this model often requires large sample size, which hinders the progress of preclinical research. Our previous study demonstrated that infarct volume was related to the success of reperfusion although the reason remained unclear. The aim of present study is to explore the relationship between focal thrombus formation and model reproducibility with respect to infarct volume. We hypothesize that suture-induced thrombosis causes infarct volume variability due to insufficient reperfusion after suture withdrawal. Seventy-two adult male CD-1 mice underwent 90 minutes of tMCAO with or without intraperitoneal administration of heparin. Dynamic synchrotron radiation microangiography (SRA and laser speckle contrast imaging (LSCI were performed before and after tMCAO to observe the cerebral vascular morphology and to measure the cerebral blood flow in vivo. Infarct volume and neurological score were examined to evaluate severity of ischemic brain injury. We found that the rate of successful reperfusion was much higher in heparin-treated mice compared to that in heparin-free mice according to the result of SRA and LSCI at 1 and 3 hours after suture withdrawal (p<0.05. Pathological features and SRA revealed that thrombus formed in the internal carotid artery, middle cerebral artery or anterior cerebral artery, which blocked reperfusion following tMCAO. LSCI showed that cortical collateral circulation could be disturbed by thrombi. Our results demonstrated that suture-induced thrombosis was a critical element, which affects the success of reperfusion. Appropriate heparin management provides a useful approach for improving reproducibility of reperfusion

  6. Cerebellar Mutism

    OpenAIRE

    1994-01-01

    Of a series of 15 children operated for cerebellar tumor at University Hospital Rotterdam-Dijkzigt, The Netherlands, 5 developed “cerebellar mutism” and subsequent dysarthria after surgery, and 2 had mild speech problems.

  7. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial.

    Science.gov (United States)

    Hofmeijer, Jeannette; Kappelle, L Jaap; Algra, Ale; Amelink, G Johan; van Gijn, Jan; van der Worp, H Bart

    2009-04-01

    Patients with space-occupying hemispheric infarctions have a poor prognosis, with case fatality rates of up to 80%. In a pooled analysis of randomised trials, surgical decompression within 48 h of stroke onset reduced case fatality and improved functional outcome; however, the effect of surgery after longer intervals is unknown. The aim of HAMLET was to assess the effect of decompressive surgery within 4 days of the onset of symptoms in patients with space-occupying hemispheric infarction. Patients with space-occupying hemispheric infarction were randomly assigned within 4 days of stroke onset to surgical decompression or best medical treatment. The primary outcome measure was the modified Rankin scale (mRS) score at 1 year, which was dichotomised between good (0-3) and poor (4-6) outcome. Other outcome measures were the dichotomy of mRS score between 4 and 5, case fatality, quality of life, and symptoms of depression. Analysis was by intention to treat. This trial is registered, ISRCTN94237756. Between November, 2002, and October, 2007, 64 patients were included; 32 were randomly assigned to surgical decompression and 32 to best medical treatment. Surgical decompression had no effect on the primary outcome measure (absolute risk reduction [ARR] 0%, 95% CI -21 to 21) but did reduce case fatality (ARR 38%, 15 to 60). In a meta-analysis of patients in DECIMAL (DEcompressive Craniectomy In MALignant middle cerebral artery infarction), DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY), and HAMLET who were randomised within 48 h of stroke onset, surgical decompression reduced poor outcome (ARR 16%, -0.1 to 33) and case fatality (ARR 50%, 34 to 66). Surgical decompression reduces case fatality and poor outcome in patients with space-occupying infarctions who are treated within 48 h of stroke onset. There is no evidence that this operation improves functional outcome when it is delayed for up to 96 h after stroke onset

  8. Intra-arterial thrombolysis with r-tPA for the treatment of acute cerebral infarction 6 to 9 hours after onset

    Institute of Scientific and Technical Information of China (English)

    毕敏

    2013-01-01

    Objective To determine the safety and efficacy of intra-arterial recombinant tissue plasminogen activator(r-tPA)for the treatment of acute cerebral infarction(ACI)in patients under the guidance of computed

  9. Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report

    Directory of Open Access Journals (Sweden)

    Amandeep Kumar

    2013-01-01

    Full Text Available Introduction: Life-threatening, space occupying, infarction develops in 10-15% of patients after middle cerebral artery infarction (MCAI. Though decompressive craniectomy (DC is now standard of care in patients with non-dominant stroke, its role in dominant MCAI (DMCAI is largely undefined. This may reflect the ethical dilemma of saving life of a patient who may then remain hemiplegic and dysphasic. This study specifically addresses this issue. Materials and Methods: This retrospective analysis studied patients with DMCAI undergoing DC. Patient records, operation notes, radiology, and out-patient files were scrutinized to collate data. Glasgow outcome scale (GOS, Barthel index (BI and improvement in language and motor function were evaluated to determine functional outcome. Results: Eighteen patients between 22 years and 72 years of age were included. 6 week, 3 month, 6 month and overall survival rates were 66.6% (12/18, 64% (11/17, 62.5% (10/16 and 62.5% (10/16 respectively. Amongst ten surviving patients with long-term follow-up, 60% showed improvement in GOS, 70% achieved BI score >60 while 30% achieved full functional independence. In this group, motor power and language function improved in 9 and 8 patients respectively. At last follow-up, 8 of 10 surviving patients were ambulatory with (3/8 or without (5/8 support. Age <50 years corresponded with better functional outcome amongst survivors (P value -0.0068. Conclusion: Language and motor outcomes after DC in patients with DMCAI are not as dismal as commonly perceived. Perhaps young patients (<50 years with DMCAI should be treated with the same aggressiveness that non-DMCAI is currently dealt with.

  10. Visual agnosia and posterior cerebral artery infarcts: an anatomical-clinical study.

    Directory of Open Access Journals (Sweden)

    Olivier Martinaud

    Full Text Available BACKGROUND: To evaluate systematically the cognitive deficits following posterior cerebral artery (PCA strokes, especially agnosic visual disorders, and to study anatomical-clinical correlations. METHODS AND FINDINGS: We investigated 31 patients at the chronic stage (mean duration of 29.1 months post infarct with standardized cognitive tests. New experimental tests were used to assess visual impairments for words, faces, houses, and objects. Forty-one healthy subjects participated as controls. Brain lesions were normalized, combined, and related to occipitotemporal areas responsive to specific visual categories, including words (VWFA, faces (FFA and OFA, houses (PPA and common objects (LOC. Lesions were located in the left hemisphere in 15 patients, in the right in 13, and bilaterally in 3. Visual field defects were found in 23 patients. Twenty patients had a visual disorder in at least one of the experimental tests (9 with faces, 10 with houses, 7 with phones, 3 with words. Six patients had a deficit just for a single category of stimulus. The regions of maximum overlap of brain lesions associated with a deficit for a given category of stimuli were contiguous to the peaks of the corresponding functional areas as identified in normal subjects. However, the strength of anatomical-clinical correlations was greater for words than for faces or houses, probably due to the stronger lateralization of the VWFA, as compared to the FFA or the PPA. CONCLUSIONS: Agnosic visual disorders following PCA infarcts are more frequent than previously reported. Dedicated batteries of tests, such as those developed here, are required to identify such deficits, which may escape clinical notice. The spatial relationships of lesions and of regions activated in normal subjects predict the nature of the deficits, although individual variability and bilaterally represented systems may blur those correlations.

  11. Visual agnosia and posterior cerebral artery infarcts: an anatomical-clinical study.

    Science.gov (United States)

    Martinaud, Olivier; Pouliquen, Dorothée; Gérardin, Emmanuel; Loubeyre, Maud; Hirsbein, David; Hannequin, Didier; Cohen, Laurent

    2012-01-01

    To evaluate systematically the cognitive deficits following posterior cerebral artery (PCA) strokes, especially agnosic visual disorders, and to study anatomical-clinical correlations. We investigated 31 patients at the chronic stage (mean duration of 29.1 months post infarct) with standardized cognitive tests. New experimental tests were used to assess visual impairments for words, faces, houses, and objects. Forty-one healthy subjects participated as controls. Brain lesions were normalized, combined, and related to occipitotemporal areas responsive to specific visual categories, including words (VWFA), faces (FFA and OFA), houses (PPA) and common objects (LOC). Lesions were located in the left hemisphere in 15 patients, in the right in 13, and bilaterally in 3. Visual field defects were found in 23 patients. Twenty patients had a visual disorder in at least one of the experimental tests (9 with faces, 10 with houses, 7 with phones, 3 with words). Six patients had a deficit just for a single category of stimulus. The regions of maximum overlap of brain lesions associated with a deficit for a given category of stimuli were contiguous to the peaks of the corresponding functional areas as identified in normal subjects. However, the strength of anatomical-clinical correlations was greater for words than for faces or houses, probably due to the stronger lateralization of the VWFA, as compared to the FFA or the PPA. Agnosic visual disorders following PCA infarcts are more frequent than previously reported. Dedicated batteries of tests, such as those developed here, are required to identify such deficits, which may escape clinical notice. The spatial relationships of lesions and of regions activated in normal subjects predict the nature of the deficits, although individual variability and bilaterally represented systems may blur those correlations.

  12. Left medial parietal lobe and receptive language functions: mixed transcortical aphasia after left anterior cerebral artery infarction.

    Science.gov (United States)

    Ross, E D

    1980-02-01

    Three aphasic patients with infarctions involving the left anterior cerebral artery have been studied. Two had trancortical motor aphasia, and one had mixed transcortical (or isolation) aphasia. Based on computerized tomography in two patients and whole-brain sections in one, the patient with mixed transcortical aphasia had a lesion that went beyond the rolandic fissure to involve the anterior precuneus lobule of the left medial parietal lobe. In the patients with transcortical motor aphasia, the lesion was confined to the frontal lobe. From these cases and other data, it seems likely that the left medial parietal lobe has receptive language functions analogous to the motor language functions of the left medial frontal lobe, thus accounting for the mixed transcortical aphasia observed in the patient whose left anterior cerebral artery infarction involved both the medial parietal and medial frontal lobes.

  13. [Renal infarction and acute arterial obstruction of the lower extremity encountered after surgery for primary lung cancer].

    Science.gov (United States)

    Tamaki, Masafumi; Miura, Kazumasa; Norimura, Shoko; Kenzaki, Koichirou; Yosizawa, Kiyoshi

    2013-02-01

    The patient was 68-year-old who underwent left upper lobectomy and lymph node dissection. On the 4th postoperative day, he developed vomiting and lumbar pain. On 5th postoperative day, he complained of pain, sensory paralysis and cold sensation of the right lower extremity. Computed tomography(CT)examination revealed left renal infarction and acute arterial obstruction of the right common iliac artery. Emergency thrombectomy of the right lower extremity was performed. Postoperatively, he received anticoagulant therapy and was able to leave the hospital on the 20th postoperative day. Attention should be paid to the infarction of abdominal organs when developing abdominal symptoms after lung cancer surgery in elderly patients.

  14. Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4)

    DEFF Research Database (Denmark)

    Räber, Lorenz; Taniwaki, Masanori; Zaugg, Serge

    2015-01-01

    AIM: The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition, and phen......AIM: The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition......, and phenotype in non-infarct-related arteries of STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Between September 2009 and January 2011, 103 STEMI patients underwent intravascular ultrasonography (IVUS) and radiofrequency ultrasonography (RF-IVUS) of the two non......, P = 0.15). CONCLUSION: High-intensity rosuvastatin therapy over 13 months is associated with regression of coronary atherosclerosis in non-infarct-related arteries without changes in RF-IVUS defined necrotic core or plaque phenotype among STEMI patients....

  15. Ventricular-arterial uncoupling in heart failure with preserved ejection fraction after myocardial infarction in dogs - invasive versus echocardiographic evaluation

    Directory of Open Access Journals (Sweden)

    Bartunek Jozef

    2010-06-01

    Full Text Available Abstract Background Heart failure with preserved left ventricular ejection fraction and abnormal diastolic function is commonly observed after recovery from an acute myocardial infarction. The aim of this study was to investigate the physiopathology of heart failure with preserved ejection fraction in a model of healed myocardial infarction in dogs. Methods Echocardiography, levels of neurohormones and conductance catheter measurements of left ventricular pressure-volume relationships were obtained in 17 beagle dogs 2 months after a coronary artery ligation, and in 6 controls. Results Healed myocardial infarction was associated with preserved echocardiographic left ventricular ejection fraction (0.57 ± 0.01, mean ± SEM and altered Doppler mitral indices of diastolic function. NT-proBNP was increased, aldosterone was decreased, and norepinephrine was unchanged. Invasive measurements showed a markedly decreased end-systolic elastance (2.1 ± 0.2 vs 6.1 ± 0.8, mmHg/ml, p Conclusions In the canine model of healed myocardial infarction induced by coronary ligation, heart failure is essentially characterized by an altered contractility with left ventricular-arterial uncoupling despite vascular compensation rather than by abnormal diastolic function

  16. PROLONGED MULTIPLE SPASMS OF SMOOTH CORONARY ARTERIES PRESENTING AS ACUTE MIOCARDIAL INFARCTION, COMPLETE AV BLOCK AND SYNCOPE

    Directory of Open Access Journals (Sweden)

    Franci Cesar

    2004-11-01

    Full Text Available Background. A variant form of angina pectoris (VAP is caused by coronary vessel spasm and occures in patients with and without varying degrees of obstructive coronary artery disease. Although the prognosis of VAP without significant organic stenosis is generally good, multivessel spasm is associated with a high risk of life-threatening abnormalities of rhythm and conduction.Patient and methods. We describe a patient who presented with prolonged chest pain, associated with hypotension, lost of consciousness, complete AV block and widespread ST segment elevations consistent with inferoanterior acute myocardial infarction. Urgent selective coronary angiography revealed spasms in right coronary artery and in left circumflex artery that were relieved by intracoronary injection of nitroglycerin. All coronary arteries were otherwise patient, without signs of atherosclerosis. The patient was treated with diltiazem and nitrates. She made a complete recovery and resumed her normal activities.Conclusions. Simultaneous multiple spasms of native coronary arteries represent a rare syndrome characterized by significantly higher incidence of potentially life-threatening arrhythmia. Less commonly, prolonged coronary spasm may mimic acute myocardial infarction. Modern management of acute coronary syndromes, including urgent coronarography, enables a prompt differentiation between prolonged coronary spasm and atherosclerotic coronary disease, warranting different treatment strategies. Medical treatment with nitrates and calcium channel blockers in most cases prevents recurrence of vasospasms and arrhythmias.

  17. Technetium stannous pyrophosphate myocardial scintigrams in the recognition of myocardial infarction in patients undergoing coronary artery revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Platt, M.R.; Parkey, R.W.; Willerson, J.T.; Bonte, F.J.; Shapiro, W.; Sugg, W.L.

    1976-04-01

    Myocardial imaging using technetium 99m stannous pyrophosphate (/sup 99m/Tc-PYP) has been utilized preoperatively and three to five days postoperatively to detect myocardial infarction in 48 patients undergoing aortocoronary bypass grafting, including 7 having valve replacement (5 aortic, 2 mitral) in addition to revascularization. In the total group of patients operated on there were 3 deaths (6%). Preoperatively, 26 patients had unstable angina and 10 had severe left main coronary artery disease. Eleven of the 48 (23%) were women. ECG and enzyme-proved infarctions occurred in 6 of the 48 patients (12%), but the addition of /sup 99m/Tc-PYP myocardial imaging demonstrated scintigraphic evidence of infarction in 15 patients (31%), including 2 who died in the operating room. The /sup 99m/Tc-PYP myocardial imaging technique, which has proved safe, simple, and relatively inexpensive in these patients, suggests that the incidence of infarction after coronary bypass operations is somewhat higher than has been previously recognized from just ECG and enzyme changes. This technique also has been of value in helping to exclude myocardial infarction in difficult clinical situations such as postoperative arrhythmias and the postpericardiotomy syndrome.

  18. Drug-Induced Myocardial Infarction Secondary to Coronary Artery Spasm in Teenagers and Young Adults

    Directory of Open Access Journals (Sweden)

    Menyar Ayman

    2006-01-01

    Full Text Available There is no published registry for drug-induced acute myocardial infarction (AMI with subsequent patent coronary angiogram in teenagers. To highlight the mechanism and impact of drug-induced MI with patent coronary arteries among teenagers who have relatively few coronary risk factors in comparison with older patients, we conducted a review of the literature. In this review most of the pertinent published (English and non-English articles through the Medline, Scopus, Cochrane Database of Systematic Reviews, and EBSCO Host research databases from 1970 to 2005 have been revised. Teenagers and young adults with AMI and subsequent patent coronary angiogram were included. In those cases drug-induced coronary spasm was highlighted. Among 220 articles (>12000 cases related with AMI with normal coronary angiogram, 50 articles (~100 cases reported the role of drug in AMI secondary to coronary artery spasm (CAS. There is no well-conducted trial for AMI secondary to CAS in young adults but only a series of case reports, and the diagnosis in most of cases was based on the clinical and laboratory findings without provocation. CAS was associated with 12 illicit substances in teenagers (i.e., cocaine, marijuana, alcohol, butane, and amphetamine. Smoking is not only the initiative but also might harbor other illicit substances that increase the risk for CAS. Cocaine-associated AMI is the most frequent in various research papers. CAS was reported with 19 types of medications (i.e., over-the-counter, chemotherapy, antimigraine, and antibiotics without strong relation to age. Despite drug-induced AMI being not a common event, attention to smoking and drugs in teenagers and young adults will have major therapeutic and prognostic implications.

  19. Infarct related artery only versus complete revascularization in ST-segment elevation myocardial infarction and multi vessel disease: a meta-analysis

    Science.gov (United States)

    Devarapally, Santhosh R.; Arora, Sameer

    2017-01-01

    Background The 2015 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) focused update on primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) only gives a class II b (weak) indication for non-infarct artery intervention at the time of primary PCI. Recent randomized controlled trials, however, suggest strong evidence supporting complete revascularization. Methods A systematic search was conducted in PUBMED, MEDLINE, EMBASE and Cochrane central register for randomized controlled trials comparing complete versus infarct artery (IRA) only revascularization in patients with STEMI. A meta-analysis was performed using the data extracted from each study. Summary risk ratios (RR) and 95% confidence intervals (CI) were calculated for five outcomes. Results Six trials fulfilled the inclusion criteria yielding 1,792 patients. Follow up ranged from 6 months to 2.5 years. The incidence of major adverse cardiac events (MACE) was significantly lower in the complete revascularization group compared to the IRA only revascularization (13.8% vs. 25.1%, RR =0.51; 95% CI: 0.41–0.64, P<0.00001). It was attributed to significantly lower repeat revascularization rate in the complete revascularization group (8.2% vs. 18.9%, RR =0.41; 95% CI: 0.31–0.54, P<0.00001). This meta-analysis also showed a significant reduction in cardiovascular mortality (2.0% vs. 4.6%, RR =0.42; 95% CI: 0.24–0.74; P=0.003), non-fatal myocardial infarction (4.37% vs. 5.76%, RR =0.64; 95% CI: 0.34–1.20; P=0.16) and all-cause mortality rates [(4.6% vs. 6%), RR =0.75; 95% CI: 0.49–1.14, P=0.17] in the complete revascularization group, compared to the IRA revascularization group. Conclusions In patients who present with STEMI, complete revascularization is associated with lower rates of MACE and cardiovascular deaths as compared to revascularization of the IRA alone. Even though the outcomes of all-cause mortality and

  20. Malignant hemispheric infarction of the middle cerebral artery. Diagnostic considerations and treatment options.

    Science.gov (United States)

    Godoy, D; Piñero, G; Cruz-Flores, S; Alcalá Cerra, G; Rabinstein, A

    2016-06-01

    Malignant hemispheric infarction (MHI) is a specific and devastating type of ischemic stroke. It usually affects all or part of the territory of the middle cerebral artery although its effects may extend to other territories as well. Its clinical outcome is frequently catastrophic when only conventional medical treatment is applied. The purpose of this review is to analyse the available scientific evidence on the treatment of this entity. MHI is associated with high morbidity and mortality. Its clinical characteristics are early neurological deterioration and severe hemispheric syndrome. Its hallmark is the development of space-occupying cerebral oedema between day 1 and day 3 after symptom onset. The mass effect causes displacement, distortion, and herniation of brain structures even when intracranial hypertension is initially absent. Until recently, MHI was thought to be fatal and untreatable because mortality rates with conventional medical treatment could exceed 80%. In this unfavourable context, decompressive hemicraniectomy has re-emerged as a therapeutic alternative for selected cases, with reported decreases in mortality ranging between 15% and 40%. In recent years, several randomised clinical trials have demonstrated the benefit of decompressive hemicraniectomy in patients with MHI. This treatment reduces mortality in addition to improving functional outcomes. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Atypical cerebral and cerebellar language organisation: a case study.

    Science.gov (United States)

    van Dun, Kim; De Witte, Elke; Van Daele, Wendy; Van Hecke, Wim; Manto, Mario; Mariën, Peter

    2015-01-01

    In the majority of right-handed subjects, language processing is subserved by a close interplay between the left cerebral hemisphere and right cerebellum. Within this network, the dominant fronto-insular region and the contralateral posterior cerebellum are crucially implicated in oral language production. We report atypical anatomoclinical findings in a right-handed patient with an extensive right cerebellar infarction and an older left fronto-insular stroke. Standardised neurolinguistic and neurocognitive test batteries were performed. In addition, fMRI, DTI, and SPECT results are reported. In this patient, disruption of the cerebellocerebral language network due to vascular damage in the left fronto-insular region and right posterior inferior cerebellar artery (PICA) territory did not induce any speech or language deficits. By contrast, executive and behavioural disturbances were found after the right cerebellar stroke. Evidence from fMRI and DTI suggests atypical bilateral language representation (Laterality Index = +0,11). At the cerebellar level, fMRI showed more activated voxels in the left than in the right hemisphere (Laterality Index = +0,66). We hypothesise congenital bilateral language representation in this patient which might be more advantageous than a typically lateralised distribution of linguistic functions to compensate acute damage to critical language regions. The more activated left cerebellum possibly compensated the functional loss in the right cerebellum after acute damage due to bilateral organisation of language function. However, more research is needed to confirm this hypothesis.

  2. Arterial baroreceptor reflex control of renal sympathetic nerve activity following chronic myocardial infarction in male, female, and ovariectomized female rats.

    Science.gov (United States)

    Pinkham, Maximilian I; Whalley, Gillian A; Guild, Sarah-Jane; Malpas, Simon C; Barrett, Carolyn J

    2015-07-15

    There is controversy regarding whether the arterial baroreflex control of renal sympathetic nerve activity (SNA) in heart failure is altered. We investigated the impact of sex and ovarian hormones on changes in the arterial baroreflex control of renal SNA following a chronic myocardial infarction (MI). Renal SNA and arterial pressure were recorded in chloralose-urethane anesthetized male, female, and ovariectomized female (OVX) Wistar rats 6-7 wk postsham or MI surgery. Animals were grouped according to MI size (sham, small and large MI). Ovary-intact females had a lower mortality rate post-MI (24%) compared with both males (38%) and OVX (50%) (P renal SNA. As a result, the male large MI group (49 ± 6 vs. 84 ± 5% in male sham group) and OVX large MI group (37 ± 3 vs. 75 ± 5% in OVX sham group) displayed significantly reduced arterial baroreflex range of control of normalized renal SNA (P renal SNA was unchanged regardless of MI size. In males and OVX there was a significant, positive correlation between left ventricle (LV) ejection fraction and arterial baroreflex range of control of normalized renal SNA, but not absolute renal SNA, that was not evident in ovary-intact females. The current findings demonstrate that the arterial baroreflex control of renal SNA post-MI is preserved in ovary-intact females, and the state of left ventricular dysfunction significantly impacts on the changes in the arterial baroreflex post-MI.

  3. Protective Effects of Overexpression of bcl-xl Gene on Local Cerebral Infarction in Transgenic Mice Undergoing Permanent Occlusion of Middle Cerebral Artery

    Institute of Scientific and Technical Information of China (English)

    Furong WANG; Yongsheng JIANG; Suming ZHANG; Wenwu XIAO; Suiqiang ZHU

    2008-01-01

    In order to investigate the protective effects of the overexpression of bcl-xl gene on local cerebral infarction in the transgenic mice subject to permanent occlusion of middle cerebral artery, the models of bcl-xl transgenic mice were established and subjected to cerebral infarction by intralu- minal occlusion of the middle cerebral artery. The infarct volume and the neurological scores were observed and comparison between the wild type mice and the transgenic mice was made. It was found that the infarct volume and the neurological scores in the transgenic mice were significantly decreased as compared with those in the wild type mice. It was suggested that the overexpression of bcl-xl gene in transgenic mice could reduce the infarct volume and improve the neurological function of the mice.

  4. Neuroprotective mechanisms of puerarin in middle cerebral artery occlusion-induced brain infarction in rats

    Directory of Open Access Journals (Sweden)

    Chang Yi

    2009-01-01

    Full Text Available Abstract Puerarin, a major isoflavonoid derived from the Chinese medical herb Radix puerariae (kudzu root, has been reported to be useful in the treatment of various cardiovascular diseases. In the present study, we examined the detailed mechanisms underlying the inhibitory effects of puerarin on inflammatory and apoptotic responses induced by middle cerebral artery occlusion (MCAO in rats. Treatment of puerarin (25 and 50 mg/kg; intraperitoneally 10 min before MCAO dose-dependently attenuated focal cerebral ischemia in rats. Administration of puerarin at 50 mg/kg, showed marked reduction in infarct size compared with that of control rats. MCAO-induced focal cerebral ischemia was associated with increases in hypoxia-inducible factor-1α (HIF-1α, inducible nitric oxide synthase (iNOS, and active caspase-3 protein expressions as well as the mRNA expression of tumor necrosis factor-α (TNF-α in ischemic regions. These expressions were markedly inhibited by the treatment of puerarin (50 mg/kg. In addition, puerarin (10~50 μM concentration-dependently inhibited respiratory bursts in human neutrophils stimulated by formyl-Met-Leu-Phe. On the other hand, puerarin (20~500 μM did not significantly inhibit the thiobarbituric acid-reactive substance reaction in rat brain homogenates. An electron spin resonance (ESR method was conducted on the scavenging activity of puerarin on the free radicals formed. Puerarin (200 and 500 μM did not reduce the ESR signal intensity of hydroxyl radical formation. In conclusion, we demonstrate that puerarin is a potent neuroprotective agent on MCAO-induced focal cerebral ischemia in vivo. This effect may be mediated, at least in part, by the inhibition of both HIF-1α and TNF-α activation, followed by the inhibition of inflammatory responses (i.e., iNOS expression, apoptosis formation (active caspase-3, and neutrophil activation, resulting in a reduction in the infarct volume in ischemia-reperfusion brain injury. Thus

  5. Weber's syndrome with recovery ct demonstration of an end-zone infarction in the territory of the mesencephalic artery

    Directory of Open Access Journals (Sweden)

    R. Oliveira-Souza

    1991-03-01

    Full Text Available Weber's syndrome is one of the classically described brainstem syndromes. The mesencephalic artery and the syndromes resulting from occlusion of its branches have been attracting increasing interest in the past few years. We present here a case of Weber's syndrome emphasizing that (1 it is one of the major syndromes deriving from infarction in the territory of the mesencephalic artery; (2 that at least two clinical patterns of Weber's syndrome may be distinguished on the basis of the presence or lack of abnormal somnolence, mental confusion, and abulia; and (3 that each one of these patterns seems to be correlated with damage to distinct zones within the general territory of the mesencephalic artery.

  6. Usefulness of predischarge exercise electrocardiographic testing in detecting the late patency status of the infarct-related artery.

    Science.gov (United States)

    Kountouris, Evaggelos; Pappa, Eugenia; Korantzopoulos, Panagiotis; Pappas, Kostas; Karanikis, Paulos; Dimitroula, Vasiliki; Ntatsis, Anastasios; Siogas, Kostas

    2004-05-01

    Predischarge exercise electrocardiographic testing (PEET) represents a widely accepted clinical tool for prognostic and functional assessment of patients who experience an uncomplicated acute myocardial infarction (AMI). However, there are no data suggesting any relation between PEET results and patency status of the infarct-related artery (IRA). The aim of this study was to investigate whether ST and/or QT-dispersion (QTD) changes induced by a low-level PEET, after uncomplicated ST-elevation AMI, are related to the late patency status of the IRA. We prospectively evaluated 61 consecutive patients who had suffered a first uncomplicated ST-elevation AMI. All of them successfully carried out four stages of the modified Bruce protocol exercise testing before discharge, and thereafter were subjected to coronary angiography. Exercise-induced ST elevation and QTD shortening were found significantly more frequently in patients with persistently occluded IRA, as compared to patients with patent IRA (ST elevation 65% vs 27%, P = 0.006; QTD shortening 80% vs 29%, P positive predictive value of 75%, whereas the absence of both predicted the patency of IRA with a negative predictive value of 100%. These results indicate that ST-elevation and QT-dispersion changes induced by a predischarge exercise testing after a first ST-elevation AMI may effectively predict the late patency status of the infarct-related artery.

  7. Excess salt increases infarct size produced by photothrombotic distal middle cerebral artery occlusion in spontaneously hypertensive rats.

    Directory of Open Access Journals (Sweden)

    Hiroshi Yao

    Full Text Available Cerebral circulation is known to be vulnerable to high salt loading. However, no study has investigated the effects of excess salt on focal ischemic brain injury. After 14 days of salt loading (0.9% saline or water, spontaneously hypertensive rats (SHR and normotensive Wistar-Kyoto rats (WKY were subjected to photothrombotic middle cerebral artery occlusion (MCAO, and infarct volume was determined at 48 h after MCAO: albumin and hemoglobin contents in discrete brain regions were also determined in SHR. Salt loading did not affect blood pressure levels in SHR and WKY. After MCAO, regional cerebral blood flow (CBF, determined with two ways of laser-Doppler flowmetry (one-point measurement or manual scanning, was more steeply decreased in the salt-loaded group than in the control group. In SHR/Izm, infarct volume in the salt-loaded group was 112±27 mm3, which was significantly larger than 77±12 mm3 in the control group (p = 0.002, while the extents of blood-brain barrier disruption (brain albumin and hemoglobin levels were not affected by excess salt. In WKY, salt loading did not significantly increase infarct size. These results show the detrimental effects of salt loading on intra-ischemic CBF and subsequent brain infarction produced by phototrhombotic MCAO in hypertensive rats.

  8. Incident Type 2 Myocardial Infarction in a Cohort of Patients Undergoing Coronary or Peripheral Arterial Angiography.

    Science.gov (United States)

    Gaggin, Hanna K; Liu, Yuyin; Lyass, Asya; van Kimmenade, Roland R J; Motiwala, Shweta R; Kelly, Noreen P; Mallick, Aditi; Gandhi, Parul U; Ibrahim, Nasrien E; Simon, Mandy L; Bhardwaj, Anju; Belcher, Arianna M; Harisiades, Jamie E; Massaro, Joseph M; D'Agostino, Ralph B; Januzzi, James L

    2017-01-10

    Despite growing recognition of type 2 myocardial infarction (T2MI; related to supply/demand mismatch), little is known about its risk factors or its association with outcome. A single-center cohort of patients undergoing coronary or peripheral angiography with or without intervention was prospectively enrolled and followed for incident type 1 and T2MI, and major adverse cardiovascular events (MACE, a composite of all-cause death, nonfatal myocardial infarction [MI], heart failure, stroke, transient ischemic attack, peripheral arterial complication, and cardiac arrhythmia), as well. T2MI was adjudicated using criteria from the Third Universal Definition of MI. Baseline characteristics, blood samples, and angiography information were obtained. Major end points subsequent to first MI were assessed using landmark analyses to compare the rates of first events only where everyone with a prior history of any MACE before MI were censored and adjusted for follow-up times. Cox proportional hazard models were used for time-to-event analyses with age and sex forced into all models and additional covariates evaluated by using the stepwise option for the selection. One thousand two hundred fifty-one patients were enrolled and followed for a median of 3.4 years. Of these patients, 152 (12.2%) had T2MI during follow-up; T2MI was frequently recurrent. Multivariable predictors of T2MI were older age, lower systolic blood pressure, history of coronary artery disease, heart failure, chronic obstructive pulmonary disease, diabetes mellitus, nitrate use, and elevated concentrations of glucose, N-terminal pro-B type natriuretic peptide, and cystatin C. Patients with T2MI had higher rates of subsequent adverse events than those without T2MI (per 100 person-years: MACE, 53.7 versus 21.1, P<0.001; all-cause death, 23.3 versus 3.3, P<0.001; cardiovascular death, 17.5 versus 2.6, P<0.001; heart failure events, 22.4 versus 7.4, P<0.001); these rates are similar to those seen in patients with

  9. The role of matrix metalloproteinase-2 promoter polymorphisms in coronary artery disease and myocardial infarction.

    Science.gov (United States)

    Alp, Ebru; Menevse, Sevda; Tulmac, Murat; Yilmaz, Akin; Yalcin, Ridvan; Cengel, Atiye

    2011-04-01

    The matrix metalloproteinase (MMP) family are key enzymes involved in the breakdown of the extracellular matrix in normal physiological processes, including tissue remodeling, and disease processes, such as arthritis and metastasis. The promoter polymorphism in the MMP2 gene may be responsible for multiple diseases related to extracellular matrix degradation. Therefore, we aimed to investigate the relationship between genotypes or haplotypes of -1575 G/A, -1306 C/T, -790 T/G, and -735 C/T promoter polymorphisms and coronary artery disease (CAD) with or without myocardial infarction (MI) history. This study included 298 patients with angiographically confirmed CAD and 299 age matched controls. Genomic DNA was isolated from whole blood and genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism method. No significant associations were found between -1575 G/A, -1306 C/T, and -790 T/G polymorphisms and CAD with or without MI history. However, the frequency of the -735 TT genotype was significantly lower in the controls than in the patients with MI alone when compared with the CC genotype (p=0.021). Only the distribution of the ACGC haplotype in CAD patients exhibited a significant difference than that in controls (p<0.05). The distribution of other haplotypes did not differ between CAD patients and controls. The present investigation is the first report to detect an association between MMP2 promoter polymorphisms and CAD with or without MI history in the Turkish population. Further case-control studies in CAD development might be contributed to clarify the role of these polymorphisms.

  10. Assessment value of transcranial Doppler hemodynamic typing for prognosis of patients with acute middle cerebral artery infarction

    Institute of Scientific and Technical Information of China (English)

    Jing Xie

    2016-01-01

    Objective:To analyze the assessment value of transcranial Doppler hemodynamic typing for prognosis of patients with acute middle cerebral artery infarction.Methods:A total of 54 cases of patients with acute middle cerebral artery infarction who received treatment in our hospital from January 2014 to June 2015 were included for study, and according to different types, they were divided into total occlusion group 17 cases, partial occlusion group 28 cases and non-occlusion group 9 cases. Differences in levels of infarction-related proteins, coagulation-related indicators, illness-related factors, etc in circulating blood of three groups were compared, and the correlation of middle cerebral arterial systolic velocity (Vs) and diastolic velocity (Vd) with above indicators was further analyzed.Results:Vs and Vd values of non-occlusion group were higher than those of total occlusion group and partial occlusion group, and Vs and Vd values of partial occlusion group were higher than those of total occlusion group; serum Gelsolin, PT, APTT and TT values of non-occlusion group were higher, SAA, Apo- CⅡ, HbA1c, GSP, Aβ, HSP70, FIB, D-D, Copeptin, P-selectin, PTX3, TPO and FFA values were lower, and compared with partial occlusion group and total occlusion group, differences were significant; Gelsolin, PT, APTT and TT values of partial occlusion group were higher than those of total occlusion group, and SAA, Apo- CⅡ, HbA1c, GSP, Aβ, HSP70, FIB, D-D, Copeptin, P-selectin, PTX3, TPO and FFA values were lower than those of total occlusion group; middle cerebral arterial Vs and Vd values were directly proportional to Gelsolin, PT, APTT and TT values, and inversely proportional to SAA, Apo- CⅡ, HbA1c, GSP, Aβ, HSP70, FIB, D-D, Copeptin, P-selectin, PTX3, TPO and FFA values.Conclusions:Transcranial Doppler hemodynamic typing can be the reliable way to judge the severity of acute middle cerebral artery infarction, and has great value in assessing disease prognosis.

  11. Does Preinterventional Flat-Panel Computer Tomography Pooled Blood Volume Mapping Predict Final Infarct Volume After Mechanical Thrombectomy in Acute Cerebral Artery Occlusion?

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Marlies, E-mail: marlies.wagner@kgu.de [Hospital of Goethe University, Institute of Neuroradiology (Germany); Kyriakou, Yiannis, E-mail: yiannis.kyriakou@siemens.com [Siemens AG, Health Care Sector (Germany); Mesnil de Rochemont, Richard du, E-mail: mesnil@em.uni-frankfurt.de [Hospital of Goethe University, Institute of Neuroradiology (Germany); Singer, Oliver C., E-mail: o.singer@em.uni-frankfurt.de [Hospital of Goethe University, Department of Neurology (Germany); Berkefeld, Joachim, E-mail: berkefeld@em.uni-frankfurt.de [Hospital of Goethe University, Institute of Neuroradiology (Germany)

    2013-08-01

    PurposeDecreased cerebral blood volume is known to be a predictor for final infarct volume in acute cerebral artery occlusion. To evaluate the predictability of final infarct volume in patients with acute occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA) and successful endovascular recanalization, pooled blood volume (PBV) was measured using flat-panel detector computed tomography (FPD CT).Materials and MethodsTwenty patients with acute unilateral occlusion of the MCA or distal ACI without demarcated infarction, as proven by CT at admission, and successful Thrombolysis in cerebral infarction score (TICI 2b or 3) endovascular thrombectomy were included. Cerebral PBV maps were acquired from each patient immediately before endovascular thrombectomy. Twenty-four hours after recanalization, each patient underwent multislice CT to visualize final infarct volume. Extent of the areas of decreased PBV was compared with the final infarct volume proven by follow-up CT the next day.ResultsIn 15 of 20 patients, areas of distinct PBV decrease corresponded to final infarct volume. In 5 patients, areas of decreased PBV overestimated final extension of ischemia probably due to inappropriate timing of data acquisition and misery perfusion.ConclusionPBV mapping using FPD CT is a promising tool to predict areas of irrecoverable brain parenchyma in acute thromboembolic stroke. Further validation is necessary before routine use for decision making for interventional thrombectomy.

  12. Risk factors and ankle brachial indexes in cerebral infarction combined with peripheral arterial disease

    Institute of Scientific and Technical Information of China (English)

    Huihua Liu; Jun Wang

    2006-01-01

    BACKGROUND: Ankle brachial index(ABI)is widely involved in researches and clinical application of peripheral vascular injury of patients with diabetes (DM);however ,the application in cerebral infarction(CI)is rare.OBJECTIVE: To investigate the possible risk factor of cerebral infarction plus peripheral arterial disease(PAD),compare metabolic characteristics of patients who having CI plus PAD or only having CI,and understand the significance of ABI on screening and diagnosing CI plus PAD of lower limb.DESIGN: Contrast observation based on CI patients.SETTING: Deparment of Neurology,Nanxishan Hospital of Guangxi Zhang Autonomous Region.PARTICIPANTS:A total of 124 CI patients were selected from Department of Neurology.Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2005 to April 2006,including 72 males and 52 females aged from 45 to 88 years.All patients met the diagnostic criteria of cerebrovascular disease established by National Academic Conference of Cerebrovascular Diseases in 1995 and determined as cerebral infarction with MRI or CT examination.All patients provided informed consent.There were 46 cases(37.2%)with CI plus PAD and 78 cases(62.8%)only with CI.METHODS: Blood pressure of bilateral ankles and upper extremities was measured at plain clinostatism with DINAMAP blood pressure monitor(GE Company).The ratio between average systolic pressure of lateral ankle and average systolic pressure of both upper extremities was regarded as ABI.The normal ABI was equal to or more than 0.9.If ABI<0.9 occurred at one side,patients were diagnosed as PAD.On the second morning after hospitalization,blood was collected to measure fasting blood glucose(FBG),2-hour postprandial blood glucose(PBG2h),glycosylated hemoglobin(HbAlc),triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C).Among them,blood glucose.lipid and other biochemical markers were measured with enzyme chemistry assay

  13. Combined intra-arterial thrombolysis and neuprotectant agents reduce cerebral infarction in rabbits with experimental acute cerebral ischemia

    Institute of Scientific and Technical Information of China (English)

    Pei Shi

    2006-01-01

    BACKGROUND:The intra-arterial thrombolytic therapy is one of main methods for more patients to obtain bene-fits.The percentage of arterial recanalization treated with intre-arterial therapy is higher than with intra-venous therapy.next,the dose of thrombolytic medicines is lower and the therapeutic time window may be possibly longer.Related researches are focus on intra-artedal thrombolysis combining with neuprotectant agents to treat acute ischemic stroke.The results show that combination of them can further prolong the therapeutic time window.improve the percentage of arterial recanalization and reduce cerebral infarction volume.OBJECTIVE:To observe the effect of single thmmbolitic therapy combined with neuroprotectant agents in the treatment of acute ischemic stroke.DESIGN:Randomized block design.SETTING:Xinhua Hospital of Xixiang City.Henan Province.MATERIALS:Thirty-six adult male white rabbits.weighing 1.5-2.0 kg.dean grade.were provided by Expedmental Animal Center of Xinxiang Medical College.All rabbits were randomly divided into three groups:intra-arterial thrombolysis control group.corenalin control group and combination group with 12 in each group.Urekinase was provided by Beijing Saisheng Pharmaceutical Co.,Ltd.(batch number:020923);corenalin by Sanjing Pharmaceutical Co.,Ltd.of Harbin Pharmacautical Group(batch number:021106):nimodipine by Shandong Xihua Pharmaceutical Co.,Ltd.(batch number:020611):contrast medium IOPAMlR0300 by Bracco s.P.a.Milano italian (batch number:0584);2,3,5-triphenyltetrazolium chloride(TTC)by Beijing Mashi Fine ChemicaL Product Co.,Ltd.(batch number:020926).METHODS: The experiment was camed out in the Department of Intervention. Second People's Hospital of Xinxiang from September 2002 to May 2003.①According to techniques of Benes et al and Zhu et al,animal models with acute ischemia were established.Two hours later.the therapy began.Intra-artedal thrombolysis control group:5 000 U/kg urokinase was dripped in Ieft common

  14. Peripheral type facial palsy in a patient with dorsolateral medullary infarction with infranuclear involvement of the caudal pons.

    Science.gov (United States)

    Park, Jong-Ho; Yoo, Han-Uk; Shin, Hyung-Woo

    2008-09-01

    The corticobulbar tract fibers descend near the corticospinal tract, mostly to the upper medulla, where they decussate and ascend in the dorsolateral medulla to connect with the contralateral facial nucleus. Therefore, central type facial palsy can be present in patients with ipsilateral dorsolateral upper medullar lesion. We describe a 71-year-old man with lateral medullary infarction who showed ipsilateral peripheral type facial palsy. Brain diffusion-weighted image showed hyperintensities on the left dorsolateral portion of upper medulla and adjacent inferomedial tegmentum of the lower pons. Transfemoral cerebral angiography depicted prominence of ipsilateral posterior inferior cerebellar artery with focal stenosis. Left posterior inferior cerebellar artery might supply the inferolateral tegmentum of the lower pons, which is usually supplied from anterior inferior cerebellar artery. The peripheral type facial palsy in our patient may have resulted from facial infranuclear involvement of the caudal pons extended from dorsolateral upper medullary lesion in ascending pathway of corticobulbar tract fibers.

  15. ST-elevation acute myocardial infarction due to arterial thrombosis in a 29-year-old woman with normal coronary arteries

    Science.gov (United States)

    Male, Eneida; Morton, Talitha; Farber, Adam

    2017-01-01

    Acute myocardial infarction (AMI) is rare in young adults. We present a case of a 29-year-old black woman who presented with an acute onset of chest pain while sleeping. Anterior wall ST-elevation AMI was diagnosed based on clinical presentation, electrocardiographic findings, and elevated cardiac biomarkers. Coronary angiography revealed a totally occluded proximal left anterior descending artery. The obstructing lesion, thrombus, was removed. There was no evidence of atherosclerotic disease or dissection. An evaluation for a hypercoagulable state was unrevealing. Echocardiography 1 year later revealed normal left ventricular wall motion and systolic function. PMID:28127135

  16. Results of emergency coronary artery bypass grafting for acute myocardial infarction: importance of intraoperative and postoperative cardiac medical therapy.

    Science.gov (United States)

    Sezai, Akira; Hata, Mitsumasa; Yoshitake, Isamu; Kimura, Haruka; Takahashi, Kana; Hata, Hiroaki; Shiono, Motomi

    2012-01-01

    The results of emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) are less than satisfactory, and readmission for cardiac events is common. 105 patients underwent emergency CABG for AMI. We examined the long-term results of emergency CABG for AMI from the viewpoints of preoperative, intraoperative, and postoperative factors. The operative mortality rate was 11.4%. Risk factors for early death were age ≥80 years, shock, veno-arterial bypass, creatine kinase isoenzyme Mb ≥100 U/L, non-use of a left internal thoracic artery graft and an extracorporeal circulation time ≥120 min. Risk factors for late cardiac events were ejection fraction <40%, non-use of human atrial natriuretic peptide (hANP) therapy, angiotensin II receptor blockers (ARB) and aldosterone blockers, and a 3-month postoperative brain natriuretic peptide level ≥200 pg/ml. Early results of this study are similar to those seen in previous reports, whereas late phase results yield some new and interesting findings. We suggest that intraoperative hANP, and postoperative aldosterone blocker and ARB, following CABG for AMI, will, through control of the renin-angiotensin-aldsterone system, inhibit left ventricular remodelling, reduce the extent of infarction, and improve cardiac function, yielding a favourable long-term prognosis.

  17. Cerebellar ataxias.

    Science.gov (United States)

    Manto, Mario; Marmolino, Daniele

    2009-08-01

    The term 'cerebellar ataxias' encompasses the various cerebellar disorders encountered during daily practice. Patients exhibit a cerebellar syndrome and can also present with pigmentary retinopathy, extrapyramidal movement disorders, pyramidal signs, cortical symptoms (seizures, cognitive impairment/behavioural symptoms), and peripheral neuropathy. The clinical diagnosis of subtypes of ataxias is complicated by the salient overlap of the phenotypes between genetic subtypes. The identification of the causative mutations of many hereditary ataxias and the development of relevant animal models bring hope for effective therapies in neurodegenerative ataxias. We describe the current classification of cerebellar ataxias and underline the recent discoveries in molecular pathogenesis. Cerebellar disorders can be divided into sporadic forms and inherited diseases. Inherited ataxias include autosomal recessive cerebellar ataxias, autosomal dominant cerebellar ataxias/spinocerebellar ataxia) and episodic ataxias, and X-linked ataxias. From a motor control point of view, the leading theories of ataxia are based on neural representations or 'internal models' to emulate fundamental natural processes such as body motion. Recent molecular advances have direct implications for research and daily practice. We provide a framework for the diagnosis of ataxias. For the first time, the therapeutic agents under investigation are targeted to deleterious pathways.

  18. [Foix-Chavany-Marie syndrome: anarthria and severe dyphagia after sequential bilateral infarction of the middle cerebral artery].

    Science.gov (United States)

    Guhra, M; Poppenborg, M; Hagemeister, C

    2008-02-01

    Bilateral lesions of the opercula frontoparietalia are uncommon and cause a symptom cluster including anarthria, severe dysphagia, inability to chew and sometimes facial paresis. At the same time there is an automatic-voluntary dissociation, meaning that the affected muscles are functional within the scope of involuntary movements. This syndrome is known as Foix-Chavany-Marie syndrome (FCMS), (bilateral) anterior operculum syndrome or facio-pharyngo-glosso-masticatory diplegia. We report the case of a patient who suffered from FCMS after having infarctions in the territory of the middle cerebral artery on each side 4 years apart.

  19. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain.

    Science.gov (United States)

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert

    2013-09-18

    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous-day and night -but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later.

  20. Frequency of infarct-related artery with myocardial bridging in patients with ST-elevation myocardial infarction and its impact upon percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Myocardial bridging (MB) as a congenital condition with a reported frequency of 5%-12% in diagnostic coronary angiography may be an important factor causing myocardial ischemia. However, its frequency in the infarct-related artery (IRA) of patients with ST-elevation myocardial infarction (STEMI) and the impact upon percutaneous coronary intervention (PCI) remain undetermined. In this study, we investigated MB frequency and its impact upon primary PCI in patients with STEMI.Methods The data of coronary angiography for 554 consecutive patients with STEMI who had undergone successful primary PCI were retrospectively analyzed to identify a frequency of MB in the IRA and its association with gender and age. According to the angiographic findings, the patients were divided into MB patients and non-MB patients. The endpoints of this study included immediate angiographic findings after primary PCI and 6-month major adverse cardiac events (MACE) (death, recurrent myocardial infarction, target lesion or vessel revascularization) between the MB patients and the non-MB patients.Results A frequency of MB in the IRA of 46 patients (8.3%) was identified in this series; it was more common in patients ≥65 years old (36/206) than in those <65 years old (10/348) (17.5% vs 2.9%, P<0.001). The trend of MB in the IRA was observed more frequently in women without significant difference than in men (10.2% vs 7.8%). TIMI grade III flow was achieved in 91.9% (509/554) of all patients following primary PCI, in 60.9% (28/46) of the MB patients and in 94.7% (481/508) of the non-MB patients respectively (P<0.001). The in-hospital mortality was 4.7% (26/554) in this series including 13.0% (6/46) of the MB patients and 3.9% (20/508) of the non-MB patients (P<0.001). A significant difference in 6 months MACE was seen between the MB patients (19%) and the non-MB patients (6.2%) (P<0.001). Conclusions MB in the IRA is relatively common in elderly patients with STEMI with a more evident

  1. Curative effect observation of electrical stimulation to cerebellar fastigial nucleus on nerve function recovery of cerebral infarction patients%电刺激小脑顶核对脑梗死患者神经功能恢复的疗效观察

    Institute of Scientific and Technical Information of China (English)

    彭昌鼎; 孙鸣; 王昌铭; 吉国泰; 姬向丽

    2002-01-01

    Objective To observe curative effect of electrical stimulation cerebellar fastigial nucleus on nerve function recovery of cerebral infarction patients.Method The patients were treated with electrical stimulation cerebellar fastigial nucleus except for routine drugs,the electrode were placed on the bilateral mastoid processes,giving pulse electric current for forty minutes two times per day,for a 10 day couse treatment.The parameter was set at model 1,frequency was 131% ~ 136% and intensity was 70% ~ 90% .Result Total effective rate of therapeutic group and control group were 91.7% and 71.4% separately.χ 2=4.860(P< 0.05).The nerver function defect score was manifestly decreased.There was a significant difference between the therapeutic group and control group,and between before and after treatment in therapeutic group(P< 0.01).Conclusion The experiment suggested that the treatment of cerebral infarction by drugs except adding electrical stimulation of cerebellar fastigial nucleus is better than by drugs along.The electrical stimulation of cerebellar fastigial nucleus has obvious protective effect.It can promote recovery of cerebral infarction.

  2. [Myocardial infarction by spontaneous dissection of coronary arteries in a subject with type IV Ehlers-Danlos syndrome].

    Science.gov (United States)

    Catanese, V; Venot, P; Lemesle, F; Delille, F; Runge, I; Kuchly, B

    1995-10-07

    Acute myocardial infarction with spontaneous coronary dissection was fatal in a 33-years-old man. Autopsy and family history revealed type IV Ehlers-Danlos syndrome. In this disease, conjunctive tissue is fragilized due to a deficit in type III collagen which leads to spontaneous ruptures in large and medium sized arteries. The present case is the first with a proven rupture of the coronary arteries. This disease should be entertained in young people with no atherogenous risk factor and an acute coronary disorder since peripheral skin and joint syndromes may be discreet or missing. Treatment is difficult in case of spontaneous coronary dissection. Thrombolysis is not possible and diagnosis may require angiography which is in itself dangerous due to the fragility of the coronary vessels.

  3. Maternal Floor Infarction/Massive Perivillous Fibrin Deposition Associated with Hypercoiling of a Single-Artery Umbilical Cord: A Case Report.

    Science.gov (United States)

    Taweevisit, Mana; Thorner, Paul Scott

    2016-01-01

    Maternal floor infarction is a rare and idiopathic placental disorder associated with adverse obstetric outcomes and a high rate of recurrence in subsequent pregnancies. The pathogenesis of maternal floor infarction is unclear but has been linked to diverse underlying maternal conditions, including gestational hypertension/preeclampsia, immune-mediated diseases, and thrombophilia. Few reports link maternal floor infarction to fetoplacental conditions. We report a 34-week, macerated, growth-restricted male fetus for which the placenta showed maternal floor infarction. The umbilical cord showed excessive coiling and a single umbilical artery. These cord changes are postulated to have resulted in increased placental villous resistance and decreased fetal blood flow, creating a hydrostatic pressure gradient between the villous stroma and the intervillous space. The pressure changes could then lead to trophoblast damage and fibrinoid deposition, contributing to the maternal floor infarction in this case.

  4. Screening Preoperative Peptide Biomarkers for Predicting Postoperative Myocardial Infarction after Coronary Artery Bypass Grafting

    Science.gov (United States)

    Jiang, Zhibin; Hu, Ping; Liu, Jianxin; Wang, Dianjun; Jin, Longyu; Hong, Chao

    2014-01-01

    Postoperative myocardial infarction (PMI) is one of the most serious complications of cardiac surgeries. No preoperative biomarker is currently available for predicting PMI after cardiac surgeries. In the present study, we used a phage display peptide library to screen potential preoperative peptide biomarkers for predicting PMI after coronary artery bypass grafting (CABG) surgery. Twenty patients who developed PMI after CABG and 20 age-, sex-, and body mass index-matched patients without PMI after CABG were enrolled as a discovery cohort. Another 50 patients who developed PMI after CABG and 50 randomly selected patients without PMI after CABG were enrolled as a validation cohort to validate the potential peptide biomarkers identified in the discovery cohort. Fifty randomly selected healthy volunteers were also enrolled in the validation phase as a healthy control group. In the discovery/screening phase, 17 out of 20 randomly selected phage clones exhibited specific reaction with purified sera IgG from the PMI group, among which 11 came from the same phage clone with inserted peptide sequence GVIMVIAVSCVF (named PMI-1). In the validation phase, phage ELISA showed that serum IgG from 90% of patients in the PMI group had a positive reaction with PMI-1; in contrast, only 14% and 6% of patients in the non-PMI group and the healthy control group had a positive reaction with PMI-1, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the PMI-1 phage clone to preoperatively identify patients who would develop PMI after CABG were 90.0%, 86.0%, 86.5, 89.5% and 88.0%, respectively. The absorbance value of the PMI-1 phage clone showed statistically significant correlation with the peak postoperative serum cardiac troponin I level (r = 0.349, p = 0.012) in the PMI group. In conclusion, we for the first time identified a mimic peptide (PMI-1) with high validity in preoperative prediction of PMI after CABG. PMID

  5. Cerebellar Hypoplasia

    Science.gov (United States)

    ... such as ataxia telangiectasia. In an infant or young child, symptoms of a disorder that features cerebellar hypoplasia might include floppy muscle tone, developmental or speech delay, problems with walking ...

  6. Surgical dissection of the internal carotid artery under flow control by proximal vessel clamping reduces embolic infarcts during carotid endarterectomy.

    Science.gov (United States)

    Yoshida, Kazumichi; Kurosaki, Yoshitaka; Funaki, Takeshi; Kikuchi, Takayuki; Ishii, Akira; Takahashi, Jun C; Takagi, Yasushi; Yamagata, Sen; Miyamoto, Susumu

    2014-01-01

    To evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA). Sixty-seven patients (59 men; age, 70.5 ± 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting. New postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect. The proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions.

    LENUS (Irish Health Repository)

    Rodríguez-Granillo, Gastón A

    2012-01-05

    Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.

  8. Cerebellar and cerebral autoregulation in migraine.

    Science.gov (United States)

    Reinhard, Matthias; Schork, Joscha; Allignol, Arthur; Weiller, Cornelius; Kaube, Holger

    2012-04-01

    Silent ischemic brain lesions frequently occur in migraine with aura and are most often located in cerebellar border zones. This may imply an impairment of cerebellar blood flow autoregulation. This study investigated the characteristics of interictal cerebellar autoregulation in migraine with and without aura. Thirty-four patients (n=17, migraine without aura; n=17, migraine with aura) and 35 age- and sex-matched controls were studied. Triple simultaneous transcranial Doppler monitoring of one posterior inferior cerebellar artery, right posterior cerebral artery, and left middle cerebral artery was performed. Autoregulation dynamics were assessed from spontaneous blood pressure fluctuations (correlation coefficient index Dx) and from respiratory-induced 0.1-Hz blood pressure oscillations (phase and gain). Compared with controls, the autoregulatory index Dx was higher (indicating less autoregulation) in the posterior inferior cerebellar artery (P=0.0062) and middle cerebral artery (P=0.0078) in migraine with aura, but not in migraine without aura. Phase and gain did not significantly differ between migraine patients and controls. No significant associations of autoregulation with clinical factors were found, including frequency of migraine attacks and orthostatic intolerance. This first-time analysis of cerebellar autoregulation in migraine did not show a specific cerebellar dysautoregulation in the interictal period. More static autoregulatory properties (index Dx) are, however, impaired in persons with migraine with aura both in the cerebellar and anterior circulation. The cerebellar predilection of ischemic lesions in migraine with aura might be a combination of altered autoregulation and additional factors, such as the end artery cerebellar angioarchitecture.

  9. Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    James J McCarthy

    2011-05-01

    Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

  10. Unaltered mRNA expression of calcitonin-like receptor and receptor activity modifying proteins in human arteries in stroke and myocardial infarction

    DEFF Research Database (Denmark)

    Eskesen, Karen; János, Tajti; Tibor, Hortobágyi;

    2007-01-01

    -dependent change in total RNA and level of mRNA for p-actin or GAPDH could be detected in vessels removed from 1 and 5 days post mortem. The expression of beta-actin appears lower in coronary artery than in pulmonary artery and middle cerebral artery with no significant difference for GAPDH; both worked well......-R and RAMPs in arteries from patients with hemorrhagic stroke, arteriosclerosis and acute myocardial infarction when compared to patients without these diagnoses. Thus the mRNA expression seems to be unaltered in these disorders....

  11. Acute cerebellar ataxia

    Science.gov (United States)

    Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA ... Acute cerebellar ataxia in children, particularly younger than age 3, may occur several weeks after an illness caused by a virus. ...

  12. Coronary artery anomalies presenting with ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Jlenia Marchesini

    2011-11-01

    Full Text Available ST-segment elevation MI (STEMI is a rare presentation in patients with coronary artery anomalies. In these patients, the identification of the culprit lesion and its treatment may be difficult, particularly in the emergency setting of primary percutaneous coronary intervention (PCI. From January 2008 to April 2011, 1015 STEMI patients received coronary artery angiography and primary PCI in our centre. Of these, 5 (0.4% patients showed a coronary artery anomaly. In this paper we reported two rare cases: i the first is a single coronary artery originating from right sinus of Valsalva; ii the second is a separate origin of 3 coronary arteries originating from the right sinus of Valsalva. In conclusion, coronary artery anomalies presenting with STEMI are really uncommon, but often are a challenge. The integration between traditional coronary artery angiography and multidetector computerized tomography is crucial to optimize the interventional and medical management of these patients

  13. Thrombus aspiration plus intra-infarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    YAN Hong-bing; ZHANG Xiao-jiang; LI Wen-zheng; LI Shi-ying; SONG Li; WANG Jian; WU Zheng; CHI Yun-peng; ZHENG Bin; ZHAO Han-jun; LI Qing-xiang

    2010-01-01

    Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery (IRA) bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction (STEMI). This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group (97.22% vs. 87.04%, X~2=7.863, P=0.049). The peak of CK-MB (83.9 (68.9-310.5) U/L vs. 126.1 (74.7-356.7) U/L, P=0.034) and Tnl (42.7 (14.7-113.9) ng/ml vs. 72.5 (59.8-135.3) ng/ml, FMD.029) were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, (45.7±8.3)% to (42.9±12.1)%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference (Log-rank X~2=2.865, P=0.09). There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.

  14. Impact of Percutaneous Coronary Intervention for Chronic Total Occlusion in Non-Infarct-Related Arteries in Patients With Acute Myocardial Infarction (from the COREA-AMI Registry).

    Science.gov (United States)

    Choi, Ik Jun; Koh, Yoon-Seok; Lim, Sungmin; Choo, Eun Ho; Kim, Jin Jin; Hwang, Byung-Hee; Kim, Tae-Hoon; Seo, Suk Min; Kim, Chan Joon; Park, Mahn-Won; Shin, Dong Il; Choi, Yun-Seok; Park, Hun-Jun; Her, Sung-Ho; Kim, Dong-Bin; Park, Chul Soo; Lee, Jong-Min; Moon, Keon Woong; Chang, Kiyuk; Kim, Hee Yeol; Yoo, Ki-Dong; Jeon, Doo Soo; Chung, Wook-Sung; Ahn, Youngkeun; Jeong, Myung Ho; Seung, Ki-Bae; Kim, Pum-Joon

    2016-04-01

    Chronic total occlusion (CTO) in a non-infarct-related artery (IRA) is an independent predictor of clinical outcomes in patients with acute myocardial infarction (AMI). This study evaluated the impact of successful percutaneous coronary intervention (PCI) for CTO of a non-IRA on the long-term clinical outcomes in patients with AMI. A total of 4,748 patients with AMI were consecutively enrolled in the Convergent Registry of Catholic and Chonnam University for AMI registry from January 2004 to December 2009. We enrolled 324 patients with CTO in a non-IRA. To adjust for baseline differences, propensity matching (96 matched pairs) was used to compare successful PCI and occluded CTO for the treatment of CTO in non-IRA. The primary clinical end points were all-cause mortality and a composite of the major adverse cardiac events, including cardiac death, MI, stroke, and any revascularization during the 5-year follow-up. Patients who received successful PCI for CTO of non-IRA had lower rates of all-cause mortality (16.7% vs 32.3%, hazard ratio 0.459, 95% CI 0.251 to 0.841, p = 0.012) and major adverse cardiac events (21.9% vs 55.2%, hazard ratio 0.311, 95% CI 0.187 to 0.516, p <0.001) compared with occluded CTO group. Subgroup analyses revealed that successful PCI resulted in a better mortality rate in patients with normal renal function compared to patients with chronic kidney disease (p = 0.010). In conclusion, successful PCI for CTO of non-IRA is associated with improved long-term clinical outcomes in patients with AMI.

  15. Case report on vertebral artery dissection in mixed martial arts.

    Science.gov (United States)

    Slowey, Michael; Maw, Graeme; Furyk, Jeremy

    2012-04-01

    A 41-year-old man presented to the ED with severe vertigo 2 days after a grappling injury while training in mixed martial arts. Imaging revealed a cerebellar infarct with complete occlusion of the right vertebral artery secondary to dissection. Management options are discussed as is the ongoing controversy regarding the safety of the sport. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. Long-term outcome of native artery versus bypass graft intervention in prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    LIU Wei; LIU Yu-yang; Venkata K.Mukku; SHI Dong-mei; L(U) Shu-zheng; ZHOU Yu-jie

    2013-01-01

    Background Patients with prior coronary artery bypass graft (CABG) have a poor outcome after acute myocardial infarction (AMI).Little is known about the treatment strategy and outcome of percutaneous coronary intervention (PCI) in these patients.The purpose of this study was to investigate the impact of graft versus native artery PCI on the outcomes of prior CABG patients with AMI.Methods Between September 2005 and October 2011,a total of 140 consecutive patients with previous CABG undergoing PCI for the treatment of AMI were included.Clinical/procedural characteristics and long-term clinical outcomes were compared between graft and native artery PCI patients.Results The mean time interval to prior CABG was (5.6±4.2) years.Thirty patients received graft PCI,success rate being 90%.One hundred and ten patients received native artery PCI,success rate being 90.7% (P >0.05).There were no significant differences in the basic characteristics between the two groups.All patients received drug eluting stents (DESs).Three patients died during hospitalization in the graft-PCI group (10% vs.native PCI 0,P <0.05).After a median followup of two years,major adverse cardiac events (MACE) (myocardial infarction,target vessel revascularization,total death) were 20% with no significant difference between the two groups.Cox regression analysis showed that both diabetes mellitus (DM,HR 3.57,95% CI 1.03-5.75,P <0.05) and primary PCI (HR 5.932,95% Cl 1.91-18.4,P <0.05) were independent predictors of MACE.Conclusions More patients with prior CABG underwent native artery PCI for AMI.PCI to culprit graft vessels had higher in-hospital mortality.DM and primary PCI,but not graft PCI,were predictors for adverse long-term outcome.

  17. Permanent ligation of the left anterior descending coronary artery in mice: a model of post-myocardial infarction remodelling and heart failure.

    Science.gov (United States)

    Muthuramu, Ilayaraja; Lox, Marleen; Jacobs, Frank; De Geest, Bart

    2014-12-02

    Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure. Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling. Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail.

  18. Impact of primary percutaneous coronary intervention on blood perfusion in nonculprit artery in patients with anterior ST elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    WANG Jian; LIU Jing-hua; ZHENG Bin; ZHANG Ming; WANG Shao-ping; ZHENG Ze

    2013-01-01

    Background Recent studies have demonstrated that epicardial flow in nonculprit arteries,which has been assumed to be normal,was slowed in the setting of ST-elevation myocardial infarction (STEMI).However,the impact of primary percutaneous coronary intervention (PCI) on blood perfusion in nonculprit arteries in patients with STEMI has not been clarified.The purpose of this study was to investigate the impact of primary PCI on blood perfusion in nonculprit arteries in patients with STEMI and correlated clinical factors.Methods A total of 117 patients with anterior wall STEMI,the culprit artery being the left anterior descending artery (LAD),undergoing primary PCI (the study group) and 100 patients with normal coronary angiography (the control group) were enrolled.To observe the differences of corrected TIMI frame count (cTFC) and myocardial blush grade (MBG) before and after primary PCI in both culprit and nonculprit arteries,the left circumflex coronary artery (LCX),cTFC and MBG in the LAD and LCX were measured in the study group and control group.The study group was divided into three groups; reflow in the culprit artery group (the R group),no reflow in culprit artery group (the NR group),and no reflow in both the culprit artery and nonculprit artery group (the NRB group) according to MBG grade.The level of serum C-reactive protein (CRP),catecholamine,and fibroblast growth factor-21 (FGF21) were assayed.The clinical and angiographic characteristics were also analyzed.Results cTFC (28.1±24.3 vs.20.3±19.3,P <0.05) and MBG in the LCX were different in the study group compared to the control group before primary PCI.cTFC (25.2±22.3 vs.28.1±24.3,P <0.05) and the MBG level in the LCX were improved after successful primary PCI,but were not recovered to the normal level.Patients with no reflow in the culprit artery had a higher incidence of no-reflow in the nonculprit artery (78% vs.19%,P <0.0001),and the levels of CRP ((3.29±1.31) mg/dl vs.(2.51±1.14) mg

  19. Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

    Directory of Open Access Journals (Sweden)

    Huakun Liu

    2016-01-01

    Full Text Available The aim of this study was to compare the clinical outcomes of early versus delayed carotid artery stenting (CAS for symptomatic cerebral watershed infarction (sCWI patients due to stenosis of the proximal internal carotid artery. We retrospectively collected clinical data of those who underwent early or delayed CAS from March 2011 to April 2014. The time of early CAS and delayed CAS was within a week of symptom onset and after four weeks from symptom onset. Clinical data such as second stroke, the National Institutes of Health Stroke Scale (NHISS score, and modified Rankin Scale (mRS score and periprocedural complications were collected. The rate of second stroke in early CAS group is lower when compared to that of delayed CAS group. There was no significant difference regarding periprocedural complications in both groups. There was a significant difference regarding mean NHISS score 90 days after CAS in two groups. Early CAS group had a significant better good outcome (mRS score ≤ 2 than delayed CAS group. We suggest early CAS for sCWI due to severe proximal internal carotid artery stenosis as it provides lower rate of second stroke, comparable periprocedural complications, and better functional outcomes compared to that of delayed CAS.

  20. Effect of angiotensin converting enzyme inhibition after acute myocardial infarction in patients with arterial hypertension. TRACE Study Group, Trandolapril Cardiac Event

    DEFF Research Database (Denmark)

    Gustafsson, F; Torp-Pedersen, C; Køber, L;

    1997-01-01

    OBJECTIVE: To evaluate the influence of a history of arterial hypertension on the efficacy of the angiotensin converting enzyme (ACE) inhibitor trandolapril in patients with acute myocardial infarction (AMI) and left ventricular dysfunction. METHODS: A retrospective analysis of data from...... to patients with a history of arterial hypertension. ACE inhibition might be of particular importance in this group of patients but further studies to establish the clinical impact are necessary....

  1. Aneurisma da artéria cerebelar ântero-inferior: relato de caso Aneurysm of the anterior inferior cerebellar artery: case report

    Directory of Open Access Journals (Sweden)

    Juan Oscar Alarcón Adorno

    2002-12-01

    Full Text Available Os aneurismas intracranianos do sistema vértebro-basilar representam cerca de 5 a 10% de todos os aneurismas cerebrais. Os aneurismas da artéria cerebelar ântero-inferior (AICA são considerados raros, podendo causar síndrome do ângulo ponto cerebelar, com ou sem hemorragia subaracnóidea. Desde 1948, foram descritos poucos casos na literatura. Apresentamos o caso de uma paciente, de 33 anos, na qual, após investigação de quadro de hemorragia subaracnóidea, diagnosticou-se aneurisma sacular da AICA esquerda. Foi submetida a clipagem do aneurisma, com ótimo resultado pós operatório.The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA are considered rare, can cause cerebello pontine angle (CPA syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  2. Early and long-term outcome of elective stenting of the infarct-related artery in patients with viability in the infarct-area: Rationale and design of the Viability-guided Angioplasty after acute Myocardial Infarction-trial (The VIAMI-trial

    Directory of Open Access Journals (Sweden)

    Visser Cees A

    2004-11-01

    Full Text Available Abstract Background Although percutaneous coronary intervention (PCI is becoming the standard therapy in ST-segment elevation myocardial infarction (STEMI, to date most patients, even in developed countries, are reperfused with intravenous thrombolysis or do not receive a reperfusion therapy at all. In the post-lysis period these patients are at high risk for recurrent ischemic events. Early identification of these patients is mandatory as this subgroup could possibly benefit from an angioplasty of the infarct-related artery. Since viability seems to be related to ischemic adverse events, we initiated a clinical trial to investigate the benefits of PCI with stenting of the infarct-related artery in patients with viability detected early after acute myocardial infarction. Methods The VIAMI-study is designed as a prospective, multicenter, randomized, controlled clinical trial. Patients who are hospitalized with an acute myocardial infarction and who did not have primary or rescue PCI, undergo viability testing by low-dose dobutamine echocardiography (LDDE within 3 days of admission. Consequently, patients with demonstrated viability are randomized to an invasive or conservative strategy. In the invasive strategy patients undergo coronary angiography with the intention to perform PCI with stenting of the infarct-related coronary artery and concomitant use of abciximab. In the conservative group an ischemia-guided approach is adopted (standard optimal care. The primary end point is the composite of death from any cause, reinfarction and unstable angina during a follow-up period of three years. Conclusion The primary objective of the VIAMI-trial is to demonstrate that angioplasty of the infarct-related coronary artery with stenting and concomitant use of abciximab results in a clinically important risk reduction of future cardiac events in patients with viability in the infarct-area, detected early after myocardial infarction.

  3. Induction of collateral artery growth and improvement of post-infarct heart function by hepatocyte growth factor gene transfer

    Institute of Scientific and Technical Information of China (English)

    Wei WANG; Zhi-jian YANG; Dong-chao MA; Lian-sheng WANG; Shun-lin XU; You-rong ZHANG; Ke-jiang CAO; Fu-min ZHANG; Wen-zhu MA

    2006-01-01

    Aim: To study the effect of adenovirus5-mediated human hepatocyte growth factor (Ad5-HGF) transfer on post-infarct heart failure in a swine model. Methods: Twelve young Suzhong swine were randomly divided into 2 groups: the Ad5-HGF group (n=6) and the null-Ad5 group(n=6). Four weeks after left anterior descending coronary artery (LAD) ligation, Ad5-HGF was transferred into the myocardium via the right coronary artery. Coronary angiography and gated cardiac perfusion imaging were performed at the end of4 and 7 weeks after LAD ligation, respectively, to evaluate collateral artery growth and cardiac perfusion. Then all animals were killed, the expression of HGF and α-smooth muscle actin (α-SMA) were evaluated by enzyme-linked immunosorbent assay and immunohistochemistry. Results: Compared with the null-Ad5 group, higher expression of human HGF was observed in the myocardium in the Ad5-HGF group (109.3 ±7.8 vs 6.2±2.6, t=30.685, P<O.01). The left ventricular ejection fraction was higher in the Ads-HGF group than in the null-Ad5 group (43.9±4.3 vs 30.4±2.8, t=6.514, P<0.01). From the 4th week to the 7th week after operation, 1eft ventricular end systolic volume (42.1±3.0 vs31.0±4.9, t=12.800, P<0.01) and left ventricular end diastolic volume (62.2±4.2 vs 55.0±4.8 t=13.207, P<0.01) were improved in the Ad5-HGF group. Cardiac perfusion was significantly improved in the Ad5-HGF group. In the Ad5-HGF group, growth of collateral arteries was obviously greater (average rank sum 9.17 vs 3.83, n=6, u=-2.687, P<0.01), and the number of α-SMA+ vessels/mm2 was significantly greater (56.1±4.2 vs 16.4±3.5, t=17.731, P<0.01) than in the null-Ad5 group. Conclusion: High expression levels of human HGF were observed in the myocardium because of non-infarct-related vessel transfer. HGF can increase the number of functional arterioles and improve collateral artery growth. HGF can improve cardiac perfusion and heart function.

  4. Quantitative assessment of harmonic power doppler myocardial perfusion imaging with intravenous levovist™ in patients with myocardial infarction: comparison with myocardial viability evaluated by coronary flow reserve and coronary flow pattern of infarct-related artery

    Directory of Open Access Journals (Sweden)

    Nagai Kunihiko

    2005-08-01

    Full Text Available Abstract Background Myocardial contrast echocardiography and coronary flow velocity pattern with a rapid diastolic deceleration time after percutaneous coronary intervention has been reported to be useful in assessing microvascular damage in patients with acute myocardial infarction. Aim To evaluate myocardial contrast echocardiography with harmonic power Doppler imaging, coronary flow velocity reserve and coronary artery flow pattern in predicting functional recovery by using transthoracic echocardiography. Methods Thirty patients with anterior acute myocardial infarction underwent myocardial contrast echocardiography at rest and during hyperemia and were quantitatively analyzed by the peak color pixel intensity ratio of the risk area to the control area (PIR. Coronary flow pattern was measured using transthoracic echocardiography in the distal portion of left anterior descending artery within 24 hours after recanalization and we assessed deceleration time of diastolic flow velocity. Coronary flow velocity reserve was calculated two weeks after acute myocardial infarction. Left ventricular end-diastolic volumes and ejection fraction by angiography were computed. Results Pts were divided into 2 groups according to the deceleration time of coronary artery flow pattern (Group A; 20 pts with deceleration time ≧ 600 msec, Group B; 10 pts with deceleration time Conclusion The preserved microvasculature detecting by myocardial contrast echocardiography and coronary flow velocity reserve is related to functional recovery after acute myocardial infarction.

  5. Cerebellar stroke-manifesting as mania

    Directory of Open Access Journals (Sweden)

    Venkatesan Jagadesan

    2014-01-01

    Full Text Available Secondary mania resulting from cerebral Cortex are described commonly. But secondary mania produced by cerebellar lesions are relatively uncommon. This case report describes a patient who developed cerebellar stoke and manic features simultaneously. 28 years old male developed giddiness and projectile vomiting. Then he would lie down for about an hour only to find that he could not walk. He became quarrelsome. His Psycho motor activities and speech were increased. He was euphoric and was expressing grandiose ideas. Bender Gestalt Test showed signs of organicity. Score in Young mania relating scale was 32; productivity was low in Rorschach. Neurological examination revealed left cerebellar signs like ataxia and slurring of speech. Computed tomography of brain showed left cerebellar infarct. Relationship between Psychiatric manifestations and cerebellar lesion are discussed.

  6. Clinical efficacy of intra-aortic balloon pumping in treating patients with acute myocardial infarction with left main coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    赵昕

    2012-01-01

    Objective To evaluate the efficacy and safety of intra-aortic balloon pump(IABP) counter pulsation in the treatment of ST-segment elevation myocardial infarction(STEMI) with concurrent left main coronary artery(LM-CA) disease. Methods A retrospective analysis was performed

  7. Long-term outcome and quality of life after craniectomy in speech-dominant swollen middle cerebral artery infarction.

    Science.gov (United States)

    Sundseth, Jarle; Sundseth, Antje; Thommessen, Bente; Johnsen, Lars G; Altmann, Marianne; Sorteberg, Wilhelm; Lindegaard, Karl-Fredrik; Berg-Johnsen, Jon

    2015-02-01

    Decompressive craniectomy in malignant middle cerebral artery infarction (MMCAI) reduces mortality. Whether speech-dominant side infarction results in less favorable outcome is unclear. This study compared functional outcome, quality of life, and mental health among patients with speech-dominant and non-dominant side infarction. All patients undergoing decompressive craniectomy for MMCAI were included. Demographics, side of infarction, and speech-dominant hemisphere were recorded. Outcome at follow-up was assessed by global functioning (modified Rankin Scale score), neurological impairment (National Institutes of Health Stroke Scale score), dependency (Barthel Index), anxiety and depression (Hospital Anxiety and Depression scale), and quality of life (Short Form-36). Twenty-nine out of 45 patients (mean age ± SD, 48.1 ± 11.6 years; 58 % male) were alive at follow-up, and 26 were eligible for analysis [follow-up, median (interquartile range): 66 months (32-93)]. The speech-dominant hemisphere was affected in 13 patients. Outcome for patients with speech-dominant and non-dominant side MMCAI was similar regarding neurological impairment (National Institutes of Health Stroke Scale score, mean ± SD: 10.3 ± 7.0 vs. 8.9 ± 2.7, respectively; p = 0.51), global functioning [modified Rankin Scale score, median (IQR): 3.0 [2-4] vs. 4.0 [3-4]; p = 0.34], dependence (Barthel Index, mean ± SD: 16.2 ± 5.0 vs. 13.1 ± 4.8; p = 0.12), and anxiety and depression (Hospital Anxiety and Depression scale, mean ± SD: anxiety, 5.0 ± 4.5 vs. 7.3 ± 5.8; p = 0.30; depression, 5.0 ± 5.2 vs. 5.9 ± 3.9; p = 0.62). The mean quality of life scores (Short Form-36) were not significantly different between the groups. There was no statistical or clinical difference in functional outcome and quality of life in patients with speech-dominant compared to non-dominant side infarction. The side affected should not influence suitability for decompressive

  8. Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts

    NARCIS (Netherlands)

    Horsch, A D|info:eu-repo/dai/nl/341748145; Dankbaar, J W|info:eu-repo/dai/nl/314079408; Stemerdink, T A; Bennink, E|info:eu-repo/dai/nl/358202906; van Seeters, T; Kappelle, L J; Hofmeijer, J; de Jong, H W; van der Graaf, Y|info:eu-repo/dai/nl/072825847; Velthuis, B K|info:eu-repo/dai/nl/176956301

    2016-01-01

    BACKGROUND AND PURPOSE: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatm

  9. Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts

    NARCIS (Netherlands)

    Horsch, A D; Dankbaar, J W; Stemerdink, T A; Bennink, E; van Seeters, T; Kappelle, L J; Hofmeijer, J; de Jong, H W; van der Graaf, Y; Velthuis, B K

    2016-01-01

    BACKGROUND AND PURPOSE: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatm

  10. Middle cerebral artery occlusion in presence of low perfusion pressure increases infarct size in rats

    DEFF Research Database (Denmark)

    Sillesen, H; Nedergaard, Majken; Schroeder, T;

    1988-01-01

    A model was set up in order to evaluate the importance of hemispheric perfusion pressure when the middle cerebral artery (MCA) is occluded in anaesthetized rats. In 6 animals the internal carotid artery (ICA) was occluded prior to ipsilateral MCA occlusion; in 17 animals the MCA only was occluded...

  11. Focal brain ischemia in the rat: methods for reproducible neocortical infarction using tandem occlusion of the distal middle cerebral and ipsilateral common carotid arteries.

    Science.gov (United States)

    Brint, S; Jacewicz, M; Kiessling, M; Tanabe, J; Pulsinelli, W

    1988-08-01

    This article describes a 3-year experience with focal neocortical ischemia in three rat strains. Multiple groups of adult Wistar (n = 50), Fisher 344 (n = 31), and spontaneously hypertensive (n = 72) rats were subjected to permanent occlusion of the distal middle cerebral (MCA) and ipsilateral common carotid arteries (CCA). Twenty-four hours later the animals were killed, and frozen brain sections were stained with hematoxylin and eosin to demarcate infarcted tissue. The infarct volume for each section was quantified with an image analyzer, and the total infarct volume was calculated with an iterative program that summed all interval volumes. Neocortical infarct volume was the largest and most reproducible in the spontaneously hypertensive rats (SHR). Statistical power analysis to project the numbers of animals necessary to detect a 25 or 50% change in infarct volume with alpha = 0.05 and beta = 0.2 revealed that only the SHR model was practical in terms of requisite animals: i.e., less than 10 animals per group. Tandem occlusion of the distal MCA and ipsilateral CCA in the SHR strain provides a surgically simple method for causing large neocortical infarcts with reproducible topography and volume. The interanimal variability in infarct volume that occurs even in the SHR strain dictates that randomized, concomitant controls are necessary in each study to ensure the accurate assessment of experimental manipulations or pharmacologic therapies.

  12. Correlation of echocardiographic epicardial fat thickness with severity of coronary artery disease in patients with acute myocardial infarction.

    Science.gov (United States)

    Wang, Tao; Liu, Qiang; Liu, Cuixia; Sun, Ling; Li, Daixu; Liu, Aihua; Jia, Ruyi

    2014-11-01

    The aim of this study was to test the hypotheses that epicardial adipose tissue (EAT) can be a marker of severe coronary artery disease in patients with acute myocardial infarction. Overall, 373 cases who underwent coronary angiography were classified into 2 groups by SYNTAX score: low-score and high-score group. EAT was measured by transthoracic echocardiography. Obtained data were compared using Pearson correlation analyses and univariate and multiple logistic regression analysis. The results showed that EAT in the high-score group was significantly greater than in the normal group (5.6 ± 1.1 vs. 4.1 ± 1.0 mm, P correlation with SYNTAX score (r = 0.61, P score (≥ 33) [AUC: 0.86, 95% confidence interval (CI): 0.822-0.898, P score.

  13. 三维动脉自旋标记脑血流灌注加权成像在交叉性小脑神经机能联系不能的应用价值%Application of three-dimensional arterial spin labeling cerebral blood flow perfusion imaging in crossed cerebellar diaschisis

    Institute of Scientific and Technical Information of China (English)

    黄泽春; 汪文胜; 成丽娜; 谢甜甜; 李松涛; 欧阳兵; 颜刘清; 陈楷哲

    2015-01-01

    Objective To evaluate the use of three-dimensional arterial spin labeling perfusion weighted imaging (3D ASL) in the diagnosis of crossed cerebellar diaschisis (CCD) role by observing the whole brain perfusion of cerebral blood flow,. and to investigate the relationship between the primary brain lesions with CCD. Methods Tha data of 58 cases with supratentorial lesions associated with unilateral middle cerebral artery blood supply combined with contralateral cerebellar hemisphere hypoperfusion were collected..The cerebral blood flow of bilateral cerebellar hemisphere cerebellar was measured using 3D ASL and the asymmetry index (AI) was calculated. CCD was diagnosed if the AI was greater than 10%..The correlations between supratentorial lesion and CCD was analyzed..Results In 58 cases with unilateral supratentorial lesions supplied by middle cerebral artery resulted in contralateral hypoperfusion in infratentorial cerebellar hemisphere, especially in the lower part of cerebellar hemisphere. 55 of the unilateral supratentorial lesions were cerebral infarction, 3 were brain injury. All the supratentorial lesions involved the white matter along the cortex-pons-cerebellar tract..The lower CBF valued in the supratentorial brain tissue and the lower CBF valued in the contralateral cerebellar hemisphere,.which showed a positive correlation..There was no correlation between the occurrence of CCD and the size of low perfusion in supratentorial brain tissue..ASL was done twice in 4 patients and 3 times in 2 patients,.and there was no obvious changes of the CBF in the cerebellum CCD lesion hemisphere..CCD occurred during 1 day and 1 years 2 months after the disease..The occurrence of CCD was related to the location of supratentorial cerebral lesions and not related to the time of onset and duration..Conclusion As a new perfusion method,.3D ASL,.is capable of noninvasive evaluating the occurrence of CCD,.which has a good diagnostic value and can quantitatively assess the degree

  14. Asymmetry in the brain influenced the neurological deficits and infarction volume following the middle cerebral artery occlusion in rats

    Directory of Open Access Journals (Sweden)

    Zhang Meizeng

    2008-12-01

    Full Text Available Abstract Background Paw preference in rats is similar to human handedness, which may result from dominant hemisphere of rat brain. However, given that lateralization is the uniqueness of the humans, many researchers neglect the differences between the left and right hemispheres when selecting the middle cerebral artery occlusion (MCAO in rats. The aim of this study was to evaluate the effect of ischemia in the dominant hemisphere on neurobehavioral function and on the cerebral infarction volume following MCAO in rats. Methods The right-handed male Sprague-Dawley rats asserted by the quadrupedal food-reaching test were subjected to 2 hours MCA occlusion and then reperfusion. Results The neurological scores were significantly worse in the left MCAO group than that in the right MCAO group at 1 h, 24 h, 48 h and 72 h (p 0.05 respectively. There was a trend toward better neurobehavioral function recovery in the right MCAO group than in the left MCAO group. The total infarct volume in left MCAO was significantly larger than that in the right (p Conclusion The neurobehavioral function result and the pathological result were consistent with the hypothesis that paw preference in rats is similar to human handedness, and suggested that ischemia in dominant hemisphere caused more significant neurobehavioral consequence than in another hemisphere following MCAO in adult rats. Asymmetry in rat brain should be considered other than being neglected in choice of rat MCAO model.

  15. Noradrenaline-induced increases in calcium and tension in skeletal muscle conductance and resistance arteries from rats with post-infarction heart failure

    DEFF Research Database (Denmark)

    Trautner, Simon; Amtorp, Ole; Boesgaard, Soren

    2006-01-01

    We tested the hypothesis that arterial reactivity to noradrenaline is augmented in congestive heart failure (CHF), which could contribute to the deleterious changes in peripheral vascular resistance and compliance in this condition. From male Wistar rats with post-infarction CHF and sham-operated......, endothelial dysfunction nor changes in baseline vascular tone could be demonstrated in the skeletal muscle vascular bed of this animal model of heart failure.......We tested the hypothesis that arterial reactivity to noradrenaline is augmented in congestive heart failure (CHF), which could contribute to the deleterious changes in peripheral vascular resistance and compliance in this condition. From male Wistar rats with post-infarction CHF and sham......-operated rats, skeletal muscle conductance and resistance arteries (mean lumen diameters: 514 and 186 microm) were isolated and mounted on wire myographs, and wall tension was recorded in response to cumulative application of acetylcholine and noradrenaline to the vessel segments. In a subset of experiments...

  16. [Emergency coronary artery bypass grafting for acute myocardial infarction presenting as cardio-pulmonary arrest during a marathon race; report of a case].

    Science.gov (United States)

    Umeda, Yukio; Imaizumi, Matsuhisa; Okada, Waichiro; Yokoya, Hirokazu; Tanaka, Tsuneo

    2014-10-01

    We report a case of coronary artery bypass grafting for acute myocardial infarction which presented as cardio-pulmonary arrest during a marathon race. A 57-year-old man collapsed at the 18-km point in the Toyohashi half marathon. He was treated with an automated electrical defibrillator( AED) for ventricular fibrillation in an ambulance. Immediately after arriving at our emergency department, he was diagnosed with acute myocardial infarction by electrocardiography. Emergency coronary angiography revealed severe stenosis of the left anterior descending artery. Percutaneous coronary intervention was tried, but it was given up because calcification of the stenotic lesion was severe. He was then referred to our department for emergency coronary artery bypass grafting. Complete re-vascularization was accomplished and the patient has been doing well with no signs of angina.

  17. Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery.

    Science.gov (United States)

    Sevuk, Utkan; Kaya, Sedat; Ayaz, Firat; Aktas, Ulas

    2016-01-01

    Paraplegia is an extremely rare complication after coronary artery bypass grafting (CABG) and the underlying mechanisms remain poorly understood. We report a patient who developed paraplegia after CABG and review the literature on spinal cord ischemia following CABG surgery.

  18. Perinatal Cerebellar Injury in Human and Animal Models

    Directory of Open Access Journals (Sweden)

    Valerie Biran

    2012-01-01

    Full Text Available Cerebellar injury is increasingly recognized through advanced neonatal brain imaging as a complication of premature birth. Survivors of preterm birth demonstrate a constellation of long-term neurodevelopmental deficits, many of which are potentially referable to cerebellar injury, including impaired motor functions such as fine motor incoordination, impaired motor sequencing and also cognitive, behavioral dysfunction among older patients. This paper reviews the morphogenesis and histogenesis of the human and rodent developing cerebellum, and its more frequent injuries in preterm. Most cerebellar lesions are cerebellar hemorrhage and infarction usually leading to cerebellar abnormalities and/or atrophy, but the exact pathogenesis of lesions of the cerebellum is unknown. The different mechanisms involved have been investigated with animal models and are primarily hypoxia, ischemia, infection, and inflammation Exposure to drugs and undernutrition can also induce cerebellar abnormalities. Different models are detailed to analyze these various disturbances of cerebellar development around birth.

  19. Increasing mean arterial pressure in cardiogenic shock secondary to myocardial infarction: effects on hemodynamics and tissue oxygenation.

    Science.gov (United States)

    Perez, Pierre; Kimmoun, Antoine; Blime, Vincent; Levy, Bruno

    2014-04-01

    There are very few data regarding the effects of norepinephrine uptitration on global and regional hemodynamics in cardiogenic shock. We studied 25 patients with shock secondary to myocardial infarction successfully treated with percutaneous coronary intervention. Before the inclusion, 16 of 25 patients presented a cardiac arrest in the presence of medical staff. Norepinephrine was titrated to increase mean arterial pressure (MAP) from 65 to 85 mmHg during 1 h. Swan-Ganz variables, arterial and mixed venous blood gases, lactate, and thenar near-infrared spectroscopy variables (muscle tissue oxygen saturation [StO2] and its changes during a vascular occlusion test) were measured before, 1 h after norepinephrine uptitration, and 1 h after norepinephrine downtitration. To obtain a MAP at 85 mmHg, norepinephrine was increased from 0.6 (0.28-1.2) to 1.53 µg · kg · min (0.76-2.6 µg · kg · min) (P cardiogenic shock complicated by postreperfusion disease is associated with better cardiac performance and improved microcirculatory variables.

  20. 枕动脉-小脑下后动脉吻合术治疗颅内段椎动脉梭形动脉瘤四例%Fusiform aneurysm of the vertebral artery: treatment by the trapping and occipital artery-posterior inferior cerebellar artery bypass in 4 cases

    Institute of Scientific and Technical Information of China (English)

    张永力; 石祥恩; 周忠清; 刘方军; 孙玉明

    2009-01-01

    @@ 对部分椎动脉瘤,尤其是累及小脑下后动脉(posteriorInferior cerebellar artery,PICA)的梭彤夹层动脉瘤,因无法火闭动脉瘤的同时,保证小脑下后动脉通畅,需要行枕动脉-PICA吻合术.因发病率低,手术困难,治疗风险大,文献报道较少[1].

  1. Distal posterior inferior cerebellar artery aneurysm: case report Aneurisma da artéria cerebelar posterior e inferior distal: relato de caso

    Directory of Open Access Journals (Sweden)

    Ricardo Ramina

    2005-06-01

    Full Text Available The majority of posterior inferior cerebellar artery (PICA aneurysms are usually found on the bifurcation of the vertebral artery (VA - PICA junction. Aneurysms arising from more peripheral PICA segments named distal PICA aneurysm are uncommon. The major clinical manifestation is that of an intracranial bleeding and the site of hemorrhage is related to the PICA segment originating the aneurysm. Lesions originating from distal PICA segments, particularly those arising from the telovelotonsillar segment, are associated with hemorrhage extending into the ventricular system, mainly the IV ventricle. A case of a 50-year-old woman with sudden headaches and vomiting, and intraventricular hemorrhage (four ventricles caused by an aneurysm of the telovelotonsillar segment of the PICA, is presented. No signs of subarachnoidal hemorrhage were found in the computerized tomography. The aneurysm was clipped and the patient presented a favorable outcome. Anatomical aspects and clinical series are reviewed.A maioria dos aneurismas da artéria cerebelar posterior inferior (PICA é geralmente encontrada na junção artéria vertebral (VA - PICA. Aneurismas originando-se nos segmentos mais distais da PICA são considerados raros. A manifestação clínica em geral por hemorragia intracraniana, e o local desta está relacionado ao segmento que origina o aneurisma. Lesões localizadas em segmentos mais distais da PICA, em especial os originados do segmento telovelotonsilar, estão associados a hemorragias no sistema ventricular, particularmente no quarto ventrículo. Relatamos o caso de mulher de 50 anos de idade que desenvolveu quadro de cefaléia súbita e vômitos, com hemorragia nos quatro ventrículos, causada por ruptura de aneurisma localizado no segmento telovelotonsilar da PICA. Não havia sinais de hemorragia subaracnóidea na tomografia computadorizada de crânio. O aneurisma foi clipado e a paciente apresentou evolução favorável. Aspectos anatômicos e

  2. [Development of transmural myocardial infarction in young persons with intact coronary arteries during methadone use for the treatment of heroine addiction].

    Science.gov (United States)

    Ioseliani, D G; Semitko, S P; Gromov, D G; Kostianiov, I Iu; Klochko, M A; Koledinskiĭ, A G; Topchian, I S

    2004-01-01

    Linkage between acute coronary syndrome and narcotic drug (cocaine) intake was first described by D. Colleman in 1982. However risk of development of acute myocardial infarction during replacement therapy after opioid withdrawal has not been elucidated. The paper contains description of two cases of development of myocardial infarction in young persons with intact coronary arteries who received synthetic opioid methadone for facilitation of heroine discontinuation. These clinical cases should draw attention of physicians to side effects of the use of methadone for the treatment of heroine addiction.

  3. Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery: An Unusual Case Report

    OpenAIRE

    Sen,Halil Murat; Guven, Mustafa; Aras, Adem Bozkurt; Cosar,Murat

    2017-01-01

    Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has n...

  4. Structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction, comorbided with arterial hypertension

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2013-12-01

    Full Text Available Recently, much attention was paid to left ventricular diastolic dysfunction and its role in the occurrence of chronic heart failure. In patients after myocardial infarction, diastolic dysfunction often precedes systolic dysfunction and predicts prognosis. In patients after myocardial infarction, diastolic dysfunction is caused by a violation of early diastolic relaxation in the area of increasing stiffness. Diastolic dysfunction is formed by hypertrophy, fibrosis, myocardial ischemia and arterial hypertension. Given the important role of diastolic dysfunction in the formation of heart failure in postinfarction patients with concomitant arterial hypertension, the mechanisms of its impact on clinical features and structural-functional changes of the heart is an actual problem. Objective: To determine the structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction with concomitant arterial hypertension. Materials and methods: In 91 patients with post-infarction cardiosclerosis and preserved left ventricular ejection fraction (EF > 45 % with arterial hypertension were investigated structural and functional changes in the heart and clinical features of heart failure by assessing clinical status and ultrasound of the heart. Prescription myocardial infarction ranged from 2 months to 3 years. Patients were divided into 3 groups. The first group included 50 patients with diastolic dysfunction and symptoms of heart failure (mean age 64,1 ± 1,2 years. In the second group were 31 patients with diastolic dysfunction without heart failure symptoms (mean age 59,5 ± 1,6 years. The third group consisted of 10 patients without diastolic dysfunction and manifestations of heart failure (mean age 57 ± 2,8 years. Results and discussion: 10% patients with postinfarction cardiosclerosis and concomitant hypertension with diastolic heart failure had NYHA

  5. Cerebral venous thrombosis presenting with cerebellar ataxia and cortical blindness.

    Science.gov (United States)

    Ben Sassi, Samia; Mizouni, Habiba; Nabli, Fatma; Kallel, Lamia; Kefi, Mounir; Hentati, Fayçal

    2010-01-01

    Venous infarction in the cerebellum has been reported only rarely, probably because of the abundant venous collateral drainage in this region. Bilateral occipital infarction is a rare cause of visual loss in cerebral venous thrombosis. We describe a 50-year-old woman with a history of ulcerative colitis who developed acute cerebellar ataxia and cortical blindness. She had bilateral cerebellar and occipital lesions related to sigmoid venous thrombosis and achieved complete recovery with anticoagulation therapy. Cerebral venous thrombosis should be considered in cases of simultaneous cerebellar and occipital vascular lesions.

  6. Relationship between site of myocardial infarction, left ventricular function and cytokine levels in patients undergoing coronary artery surgery.

    Science.gov (United States)

    Kiris, Ilker; Kapan, Sahin; Narin, Cuneyt; Ozaydın, Mehmet; Cure, Medine Cumhur; Sutcu, Recep; Okutan, Huseyin

    The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography. The levels of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured. Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05). The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI.

  7. Detection of misery perfusion in the cerebral hemisphere with chronic unilateral major cerebral artery steno-occlusive disease using crossed cerebellar hypoperfusion: comparison of brain SPECT and PET imaging

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Yoshiyasu; Ogasawara, Kuniaki; Saito, Hideo; Takahashi, Yoshihiro; Ogasawara, Yasushi; Kobayashi, Masakazu; Ogawa, Akira [Iwate Medical University, Department of Neurosurgery, Morioka (Japan); Iwate Medical University, Cyclotron Research Center, Morioka (Japan); Terasaki, Kazunori [Iwate Medical University, Cyclotron Research Center, Morioka (Japan); Yoshida, Kenji; Beppu, Takaaki; Kubo, Yoshitaka; Fujiwara, Shunrou [Iwate Medical University, Department of Neurosurgery, Morioka (Japan); Tsushima, Eiki [Hirosaki University, Graduate School of Health Sciences, Hirosaki (Japan)

    2013-10-15

    In patients with unilateral internal carotid or middle cerebral artery (ICA or MCA) occlusive disease, the degree of crossed cerebellar hypoperfusion that is evident within a few months after the onset of stroke may reflect cerebral metabolic rate of oxygen in the affected cerebral hemisphere relative to that in the contralateral cerebral hemisphere. The aim of the present study was to determine whether the ratio of blood flow asymmetry in the cerebellar hemisphere to blood flow asymmetry in the cerebral hemisphere on positron emission tomography (PET) and single photon emission computed tomography (SPECT) correlates with oxygen extraction fraction (OEF) asymmetry in the cerebral hemisphere on PET in patients with chronic unilateral ICA or MCA occlusive disease and whether this blood flow ratio on SPECT detects misery perfusion in the affected cerebral hemisphere in such patients. Brain blood flow and OEF were assessed using {sup 15}O-PET and N-isopropyl-p-[{sup 123}I]iodoamphetamine ({sup 123}I-IMP) SPECT, respectively. All images were anatomically standardized using SPM2. A region of interest (ROI) was automatically placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres using a three-dimensional stereotaxic ROI template, and affected-to-contralateral asymmetry in the MCA territory or contralateral-to-affected asymmetry in the cerebellar hemisphere was calculated. Sixty-three patients with reduced blood flow in the affected cerebral hemisphere on {sup 123}I-IMP SPECT were enrolled in this study. A significant correlation was observed between MCA ROI asymmetry of PET OEF and the ratio of cerebellar hemisphere asymmetry of blood flow to MCA ROI asymmetry of blood flow on PET (r = 0.381, p = 0.0019) or SPECT (r = 0.459, p = 0.0001). The correlation coefficient was higher when reanalyzed in a subgroup of 43 patients undergoing a PET study within 3 months after the last ischemic event (r = 0.541, p = 0.0001 for PET; r = 0.609, p < 0

  8. ST-Segment Elevation Myocardial Infarction and Normal Coronary Arteries after Consuming Energy Drinks.

    Science.gov (United States)

    Gharacholou, S Michael; Ijioma, Nkechinyere; Banwart, Emma; Munoz, Freddy Del Carpio

    2017-01-01

    The use of energy drinks, which often contain stimulants, is common among young persons, yet there have been few reports of adverse cardiac events. We report the case of a 27-year-old man who was admitted to our facility with an acute ST-segment elevation myocardial infarction in the setting of using energy drinks. Angiography revealed no obstructive coronary disease. The patient had elevation of cardiac troponin. Noninvasive testing with echocardiography and cardiac magnetic resonance imaging demonstrated both abnormalities in resting wall motion at the anterior apex along with late gadolinium enhancement of the anterior wall, respectively. The patient also underwent formal invasive evaluation with an intracoronary Doppler study demonstrating normal coronary flow reserve and acetylcholine provocation that excluded endothelial dysfunction and microvascular disease. The patient recovered and has abstained from consuming additional energy drinks with no reoccurrence of symptoms. A review of some of the potential cardiac risks associated with consuming energy drinks is presented.

  9. [Simultanagnosia and scene agnosia induced by right posterior cerebral artery infarction: a case report].

    Science.gov (United States)

    Kobayashi, Yasutaka; Muramatsu, Tomoko; Sato, Mamiko; Hayashi, Hiromi; Miura, Toyoaki

    2015-01-01

    A 68-year-old man was admitted to our hospital for rehabilitation of topographical disorientation. Brain magnetic resonance imaging revealed infarction in the right medial side of the occipital lobe. On neuropsychological testing, he scored low for the visual information-processing task; however, his overall cognitive function was retained. He could identify parts of the picture while describing the context picture of the Visual Perception Test for Agnosia but could not explain the contents of the entire picture, representing so-called simultanagnosia. Further, he could morphologically perceive both familiar and new scenes, but could not identify them, representing so-called scene agnosia. We report this case because simultanagnosia associated with a right occipital lobe lesion is rare.

  10. A Right Middle Cerebral Artery Infarct After Frontal Eosinophilic Granuloma Resection in an 8-Year-Old Boy with Factor V Leiden.

    Science.gov (United States)

    Cakir, Ertugrul; Arslan, Erhan; Yazar, Ugur; Reis, Gokce Pinar

    2015-01-01

    Stroke in children is relatively uncommon. We describe an 8-year-old boy diagnosed with primary eosinophilic granuloma (EG) of the frontal bone. After excision of the EG, the postoperative course was eventful. The patient had an acute right middle cerebral artery (MCA) infarct and had been comatose with a diminished Glasgow Coma Scale (GCS) score of 5. Urgent decompressive hemicraniectomy with duraplasty was performed. The postoperative course after the second operation was uneventful. Hematological tests revealed a diagnosis of factor V Leiden. The patient was discharged with left hemiparesis and GCS of 15. To the best of our knowledge, no such clinical picture of MCA infarction after EG excision has been described before. Neurosurgeons should be aware of inherited thrombophilias, such as factor V Leiden, if the postoperative clinical course worsens because of cerebral artery thrombosis. Also, decompressive hemicraniectomy could be life saving and should be performed urgently without any hesitation.

  11. Dobutamine stress thallium-201 single-photon emission tomography versus echocardiography for evaluation of the extent and location of coronary artery disease late after myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Elhendy, A.; Bax, J.J.; Domburg, R.T. van; Cornel, J.H.; Roelandt, J.R.T.C. [Thoraxcenter, Univ. Hospital Rotterdam-Dijkzigt, Rotterdam (Netherlands); Valkema, R.; Reijs, A.E.M.; Krenning, E.P. [Dept. of Nuclear Medicine, University Hospital Rotterdam-Dijkzigt, Rotterdam (Netherlands)

    1999-05-01

    Dobutamine stress echocardiography and thallium-201 myocardial perfusion scintigraphy are clinically useful methods for the evaluation of coronary artery disease (CAD). However, the relative merits of these imaging modalities in the evaluation of the extent of CAD after myocardial infarction have not been well studied. The aim of this study was to compare the accuracy of dobutamine stress echocardiography and simultaneous {sup 201}Tl single-photon emission tomography (SPET) imaging for the diagnosis and localization of CAD late after acute myocardial infarction. Dobutamine (up to 40 {mu}g kg{sup -1} min{sup -1})-atropine (up to 1 mg) stress echocardiography in conjunction with stress-reinjection {sup 201}Tl SPET was performed for the evaluation of myocardial ischaemia in 90 patients with previous myocardial infarction who underwent coronary angiography. Significant CAD was predicted on bases of myocardial ischemia (new or worsening wall motion abnormalities on echocardiography and reversible perfusion defects on {sup 201}Tl SPET). Significant CAD ({>=} 50% luminal diameter stenosis) was detected in 73 (81%) patients. The sensitivity, specificity and accuracy of echocardiography in detecting remote ischaemia for the diagnosis of remote CAD (present in 53 patients) were, respectively, 79% (CI 70%-88%), 85% (CI 77%-93%) and 81% (CI 73%-90%), while the corresponding figures for {sup 201}Tl SPET were 75% (CI 66%-85%), 78% (CI 69%-87%) and 76% (CI 67%-86%) respectively (P = NS vs echocardiography). The sensitivity, specificity and accuracy of echocardiography in detecting peri-infarction ischaemia for the diagnosis of infarct-related artery stenosis (present in 70 patients) were, rspectively, 77% (CI 68%-86%), 85% (CI 78%-92%) and 79% (CI 70%-87%) while the corresponding figures for {sup 201}Tl SPET were 73% (CI 64%-82%), 85% (CI 78%-92%) and 76% (CI 67%-84%) respectively (P = NS vs echocardiography). The agreement between the two methods for the diagnosis of peri-infarction

  12. A dynamic concept of middle cerebral artery occlusion and cerebral infarction in the acute state based on interpreting severe hyperemia as a sign of embolic migration

    DEFF Research Database (Denmark)

    Olsen, T S; Lassen, N A

    1984-01-01

    The present study investigates the pathogenesis of focal cerebral hyperemia, its effect on brain tissue and discusses its pathophysiological and therapeutic importance in the light of interpreting severe hyperemia as a sign of arterial reopening probably due to embolic migration. Cerebral...... as well as in non-infarcted tissue. Apparently, it is the severity of the initial ischemic episode and not the hyperemia that determines whether or not tissue necrosis develops. Interpreting severe hyperemia as a sign of arterial reopening and embolic migration (evidenced by partial reopening affecting...

  13. Migrating bullet: A case of a bullet embolism to the pulmonary artery with secondary pulmonary infarction after gunshot wound to the left globe

    Directory of Open Access Journals (Sweden)

    Eugene Duke

    2014-01-01

    Full Text Available Bullet embolism is a rare phenomenon following gunshot injuries. We present a case of a 25-year-old male who sustained a gunshot wound to his left globe with the bullet initially lodged in his right transverse sinus. The bullet ultimately embolized to a left lower lobe pulmonary artery resulting in a pulmonary infarct. A discussion of select prior cases, pathophysiology, and management strategies follows.

  14. Elastase-2, an angiotensin II-generating enzyme, contributes to increased Ang II in resistance arteries of mice with myocardial infarction.

    Science.gov (United States)

    Becari, Christiane; Silva, Marcondes A B; Durand, Marina T; Prado, Cibele M; Oliveira, Eduardo B; Ribeiro, Mauricio S; Salgado, Helio C; Salgado, Maria Cristina O; Tostes, Rita C

    2017-02-21

    Angiotensin II (Ang II), whose generation largely depends on angiotensin-converting enzyme activity, mediates most of the renin-angiotensin-system effects. Elastase-2 (ELA-2), a chymotrypsin-serine protease elastase family member 2A, alternatively generates Ang II in rat arteries. Myocardial infarction (MI) leads to intense RAS activation, but mechanisms involved on Ang II-generation in resistance arteries are unknown. We hypothesized that ELA-2 contributes to vascular Ang II generation and to cardiac damage in mice submitted to MI. Concentration-effect curves to Ang I and Ang II were performed in mesenteric resistance arteries from male wild type (WT) and ELA-2 knockout (ELA-2KO) mice submitted to left anterior descending coronary artery ligation (myocardial infarction, MI). MI size was similar in WT (29.5 ± 9 %) and ELA-2KO (32 ± 4%) mice. Ejection fraction and fractional shortening after MI similarly decreased in both strains. However, MI decreased stroke volume and cardiac output in WT, but not in ELA-2KO mice. Ang I-induced contractions increased in WT mice submitted to MI (MI-WT) compared to Sham-WT mice. No differences were observed in Ang I reactivity between arteries from Sham-ELA-2KO and ELA-2KO submitted to MI (MI-ELA-2KO). Ang I contractions increased in arteries from MI-WT vs. MI-ELA-2KO mice. Chymostatin attenuated Ang I-induced vascular contractions in WT mice (P ELA-2KO arteries. These results provide the first evidence that ELA-2 contributes to increased Ang II formation in resistance arteries and modulates cardiac function after MI, implicating ELA-2 as a key player in ACE-independent dysregulation of the RAS.

  15. Comparison of Triggering and Nontriggering Factors in ST-Segment Elevation Myocardial Infarction and Extent of Coronary Arterial Narrowing.

    Science.gov (United States)

    Ben-Shoshan, Jeremy; Segman-Rosenstveig, Yafit; Arbel, Yaron; Chorin, Ehud; Barkagan, Michael; Rozenbaum, Zach; Granot, Yoav; Finkelstein, Ariel; Banai, Shmuel; Keren, Gad; Shacham, Yacov

    2016-04-15

    Various physical, emotional, and extrinsic triggers have been attributed to acute coronary syndrome. Whether a correlation can be drawn between identifiable ischemic triggers and the nature of coronary artery disease (CAD) still remains unclear. In the present study, we evaluated the correlation between triggered versus nontriggered ischemic symptoms and the extent of CAD in patients with ST-segment elevation myocardial infarction (STEMI). We conducted a retrospective, single-center observational study including 1,345 consecutive patients with STEMI, treated with primary percutaneous coronary intervention. Acute physical and emotional triggers were identified in patients' historical data. Independent predictors of multivessel CAD were determined using a logistic regression model. A potential trigger was identified in 37% of patients. Physical exertion was found to be the most dominant trigger (65%) followed by psychological stress (16%) and acute illness (12%). Patients with nontriggered STEMI tended to be older and more likely to have co-morbidities. Patients with nontriggered STEMI showed a higher rate of multivessel CAD (73% vs 30%, p <0.001). In a multivariate regression model, nontriggered symptoms emerged as an independent predictor of multivessel CAD (odds ratio 8.33, 95% CI 5.74 to 12.5, p = 0.001). No specific trigger was found to predict independently the extent of CAD. In conclusion, symptoms onset without a recognizable trigger is associated with multivessel CAD in STEMI. Further studies will be required to elucidate the putative mechanisms underlying ischemic triggering.

  16. Middle Cerebral Artery Atherosclerotic Plaques in Recent Small Subcortical Infarction: A Three-Dimensional High-resolution MR Study

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Zou

    2015-01-01

    Full Text Available Purpose. Conventional two-dimensional vessel wall imaging has been used to depict the middle cerebral artery (MCA wall in patients with recent small subcortical infarctions (RSSIs. However, its clinical use has been limited by restricted spatial coverage, low signal-to-noise ratio (SNR, and long scan time. We used a novel three-dimensional high-resolution MR imaging (3D HR-MRI technique to investigate the presence, locations, and contrast-enhanced patterns of MCA plaques and their relationship with RSSI. Methods. Nineteen consecutive patients with RSSI but no luminal stenosis on MR angiography were prospectively enrolled. 3D HR-MRI was performed using a T1w-SPACE sequence at 3.0 T. The presence, locations, and contrast-enhanced patterns of the MCA plaques on the ipsilateral and contralateral sides to the RSSI were analyzed. Results. Eighteen patients successfully completed the study. MCA atherosclerotic plaques occurred more frequently on the ipsilateral than the contralateral side to the RSSI (72.2% versus 33.3%, P=0.044. The occurrence of superiorly located plaques was significantly higher on the ipsilateral than the contralateral side of the MCA (66.7% versus 27.8%; P=0.044. Conclusions. Superiorly located plaques are closely associated with RSSI. 3D high-resolution vessel wall imaging may be a potential tool for etiologic assessment of ischemic stroke.

  17. The flavonoid fisetin attenuates postischemic immune cell infiltration, activation and infarct size after transient cerebral middle artery occlusion in mice

    Science.gov (United States)

    Gelderblom, Mathias; Leypoldt, Frank; Lewerenz, Jan; Birkenmayer, Gabriel; Orozco, Denise; Ludewig, Peter; Thundyil, John; Arumugam, Thiruma V; Gerloff, Christian; Tolosa, Eva; Maher, Pamela; Magnus, Tim

    2012-01-01

    The development of the brain tissue damage in ischemic stroke is composed of an immediate component followed by an inflammatory response with secondary tissue damage after reperfusion. Fisetin, a flavonoid, has multiple biological effects, including neuroprotective and antiinflammatory properties. We analyzed the effects of fisetin on infarct size and the inflammatory response in a mouse model of stroke, temporary middle cerebral artery occlusion, and on the activation of immune cells, murine primary and N9 microglial and Raw264.7 macrophage cells and human macrophages, in an in vitro model of inflammatory immune cell activation by lipopolysaccharide (LPS). Fisetin not only protected brain tissue against ischemic reperfusion injury when given before ischemia but also when applied 3 hours after ischemia. Fisetin also prominently inhibited the infiltration of macrophages and dendritic cells into the ischemic hemisphere and suppressed the intracerebral immune cell activation as measured by intracellular tumor necrosis factor α (TNFα) production. Fisetin also inhibited LPS-induced TNFα production and neurotoxicity of macrophages and microglia in vitro by suppressing nuclear factor κB activation and JNK/Jun phosphorylation. Our findings strongly suggest that the fisetin-mediated inhibition of the inflammatory response after stroke is part of the mechanism through which fisetin is neuroprotective in cerebral ischemia. PMID:22234339

  18. Obesity and premature coronary artery disease with myocardial infarction in Puerto Rican young adults.

    Science.gov (United States)

    Marcial, José M; Altieri, Pablo I

    2015-01-01

    A cross-sectional study examined adults aged 21 to 35 years who underwent left cardiac catheterization in the Cardiovascular Center for Puerto Rico and the Caribbean during 2008-2012 due to myocardial infarction. Demographic characteristics, clinical risk factors, and the extent of CAD were documented. Chi-square statistic or Fisher's exact test was used to compare the distribution of demographic, clinical, and lifestyle characteristics across CAD extent. Polytomous logistic regression models were fitted to estimate the prevalence odds ratios (POR) with 95% confidence intervals (Cl) for non-obstructive and obstructive coronary disease (OCD) compared with normal coronary anatomy. Statistical analyses were performed using Stata 11.0. Sixty-three (n = 63) adults were evaluated (81% were men). The mean age was 31 ± 4 years. The most frequent clinical risk factors were history of tobacco use, hyper tension, and dyslipidemia. Obesity was present in 45.9% of subjects and OCD was present in 52.38% of subjects. Obesity and family history of CAD were significantly associated with OCD when adjusted by age. Obese patients had 5.94 times the possibility of having OCD than normal weight patients. Obesity was the most important treatable predictor of premature obstructive CAD in our young adult population.

  19. Effects of meldonium on cognitive and clinico-functional status of elderly patients with acute myocardial infarction and arterial hypertension

    Directory of Open Access Journals (Sweden)

    Dotsenko N.J.

    2013-03-01

    Full Text Available 40 elderly patients with a diagnosis of acute myocardial infarction developed on the background of arterial hypertension were examined. The patients were divided into two groups: the main – 20 patients (18 men, 2 women, age 70.0 ± 1.8 years, and the control group – 20 patients (19 men, 1 woman, age 69.5 ± 1.6 years, who received the standard treatment of acute myocardial infarction and hypertension. "Standard therapy" included acetylsalicylic acid and clopidogrel, statins, beta-blockers and ACE inhi¬bitors, if necessary, drugs to control hypertension, according to the recom¬mendations of the Ukrainian Society of Cardiologists. In addition, the first group of patients undergoing standard therapy of AMI and hypertension was administered Vazonat® for 15 days intravenously at a dose of 1000 mg per day. Effect of Vazonat® (meldonium therapy on the clinical and functional status, exercise capacity, and cognitive status in patients with acute myocardial infarction and hypertension against the background of dyscirculatory encephalopathy was studied explored. Psycho-emotional state of patients was studied by Beck's depression scale. Cognitive status was assessed by neuropsychological tests (Schulte tables, Luria’s test for memorizing of 10 words and Luria’s pictograms. In was shown dynamics a positive effects of Vazonat® therapy on the improvement of cardio¬hemo¬dynamics (noted reduction in LVED with 55.20 ± 1.7 mm to 51.28 ± 1.5 mm (p > 0.1, an increasing transmitral flow Ve/Va from 0.98 ± 0.03 to 1.10 ± 0.04 (p < 0.05, an increasing exercise tolerance (at 6MWT distance increased by 12.8% in the main group (from 289.6 ± 12.2 m to 326.0 ± 13.5 m, an increasing the speed of active attention – time of sensorimotor reactions decreased from 68.55 ± 6.2 sec to 54.35 ± 3.52 sec (p < 0.05, increasing productivity of short-term memory, increasing the number of words in the Luria test from 5.90 ± 0.42 to 7.25 ± 0.38 (p < 0

  20. Effect of vertebral artery hypoplasia on the territory-related perfusion of posterior inferior cerebellar artery%椎动脉发育不全对小脑后下动脉供血区脑灌注的影响

    Institute of Scientific and Technical Information of China (English)

    马乾坤; 张道培; 张杰文; 张淑玲; 鹿桂凤; 尹所

    2016-01-01

    目的:探讨椎动脉发育不全(vertebral artery hypoplasia,VAH )对小脑后下动脉供血区脑灌注的影响。方法选择2014-12—2015-07年龄≥30岁并行头颅磁共振灌注成像和头颈部三维对比增强磁共振血管造影检查的头晕或眩晕患者244例。获脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP)灌注图,测量一侧小脑后下动脉供血区及对侧镜像区的灌注参数值(CBF、CBV、MTT、TTP),计算椎动脉直径较小侧/对侧镜像区的灌注参数相对比值(rCBF、rCBV、rMTT、rTTP)。定义 VAH 为椎动脉直径≤2 mm,或双侧椎动脉不对称比≥1.7:1,分为 VAH 组和 non-VAH(Non-hypoplasitic vertebral artey)组,对临床资料和小脑、延髓灌参数相对比值进行比较。结果共纳入114例患者,男女各57例;VAH 组31例(27.2%),左侧5例(16%),右侧26例(84%);Non-VAH 组83例。2组间 VA 直径较小侧与对侧的 rTTP和 rCBF≤0.85的例数存在显著统计学差异(P 值分别为0.005,0.031);rCBF 倾向于有统计学差异(P =0.098);rCBV、rMTT 及 rCBV≤0.85例数无显著统计学差异。结论VAH 可以造成小脑后下动脉供血区域低灌注改变,且以 TTP 延长或 CBF 降低为主。%Objective To investigate the effect of vertebral artery hypoplasia on the territory perfusion of posterior inferi-or cerebellar artery (PICA).Methods 244 patients with vertigo or dizziness (age≥30 years old)from December 2014 to July 201 5 were selected as subjects who underwent brain perfusion-weighted imaging (pWI)and three-dimensional dynamic con-trast-enhanced MRA (3D DCE-MRA).The perfusion figures of cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)were obtained.The perfusion parameters including CBF,CBV,MTT and TTP val-ues were measured at PICA areas and at the opposite mirror-imaging areas.Relative perfusion parameter values (rCBF,rCBV, rMTT and rTTP)defined as the ratio of the

  1. Acute myocardial infarction with isolated congenitally corrected transposition of the great arteries.

    Science.gov (United States)

    Zimmermann, Jeremy; Altman, J Ryan; Gantt, D Scott

    2016-04-01

    Congenital cardiac abnormalities diagnosed at the time of acute coronary syndrome are rare. A 43-year-old man presented to the emergency department complaining of recurring, severe chest pain. Subsequent emergent coronary angiography demonstrated unusual coronary anatomy: 1) one small caliber bifurcating vessel originating from the right sinus of Valsalva; 2) one very large vessel arising from the posterior sinus; and 3) no coronary artery from the normal left sinus of Valsalva. The large vessel from the posterior sinus was totally occluded in its midportion and was treated with intravascular ultrasound-guided percutaneous coronary intervention. Further diagnostic workup, including two-dimensional transthoracic echocardiogram and computed tomographic coronary angiography, demonstrated isolated corrected transposition of the great arteries with a dilated systemic ventricle and systolic dysfunction with an ejection fraction of 30%. The patient's clinical course was complicated by recurrent nonsustained ventricular tachycardia, treated with medical therapy and a dual-chamber implantable cardioverter defibrillator. This case is an example of a common clinical presentation with a very uncommon congenital heart disorder. Similar cases may become more frequent as the number of adult congenital heart patients increases in the population.

  2. Usefulness of hypertriglyceridemia in predicting myocardial infarction late after coronary artery bypass operation.

    Science.gov (United States)

    Voors, A A; van Brussel, B L; Kelder, J C; Plokker, H W

    1997-05-15

    We prospectively followed 446 consecutive patients who had coronary bypass operations 15 years earlier. Serum levels of cholesterol and triglycerides were measured before and 5 years after bypass, and we established the relation between these lipid levels and the incidence of myocardial infarction (MI) and cardiac mortality during 15 years of follow-up. Follow-up was complete in 99.8% of the patients and averaged 15.4 years for the survivors. Multivariate Cox proportional-hazards analysis revealed that patients with preoperative hypertriglyceridemia (> or = 2.0 mmol/L [176 mg/dl]) had a 2.1 times increased risk for MI during follow-up (p = 0.04). Hypertriglyceridemic patients 5 years after surgery had a 2.2 times increased risk for MI during the subsequent follow-up period, although this difference was not statistically significant (p = 0.09). The only significant risk factor for MI 5 years after surgery was smoking. Hypercholesterolemia (> or = 6.5 mmol/L [254 mg/dl]) both before and 5 years after surgery was not a risk factor for MI during follow-up. Cardiac mortality was not significantly related to either hypercholesterolemia or hypertriglyceridemia. Independent predictors for cardiac mortality were poor left ventricular function, diabetes mellitus, incomplete revascularization, and the use of sequential bypass grafts. These data provide evidence that hypertriglyceridemia, both before and 5 years after surgery, have predictive value for the incidence of MI during long-term follow-up after venous coronary bypass surgery.

  3. Acute Myocardial Infarction Due to Coronary Artery Embolism in a 22-Year-Old Woman with Mitral Stenosis with Atrial Fibrillation Under Warfarinization: Successful Management with Anticoagulation.

    Science.gov (United States)

    Sinha, Santosh Kumar; Jha, Mukesh Jitendra; Razi, Mahmadula; Chaturvedi, Vikash; Erappa, Yatish Besthenahalli; Singh, Shravan; Mishra, Vikas; Khanra, Dibbendhu; Singh, Karandeep

    2017-04-07

    BACKGROUND Coronary artery embolization is an exceedingly rare cause of myocardial infarction, but a few cases in association with prosthetic mechanical valves have been reported. We report a case of embolic myocardial infarction caused by a thrombus in the left atrium with deranged coagulation profile in a patient with critical mitral stenosis under warfarinization. CASE REPORT A 22-year-old woman was taken to the catheterization lab for early coronary intervention in lieu of non-ST elevation myocardial infarction. Electrocardiography showed T↓ in V1 to V4, and atrial fibrillation with controlled ventricular rate. Coronary angiography showed total occlusion of the mid-left anterior descending artery with thrombus. After upstream treatment with tirofiban, the apparent thrombus was dislodged distally while passing a BMW wire. No abnormalities were seen by intravascular ultrasound study. Echocardiography revealed critical mitral stenosis, and left atrial clot with mild left ventricular dysfunction. Coagulation profile revealed sub-therapeutic international normalized ratio levels. The sequential angiographic images, normal intravascular ultrasound study, and presence of atrial fibrillation are confirmatory of coronary embolism as the cause of myocardial infarction. Anticoagulation and treatment of acute coronary syndrome were initiated and she was referred for closed mitral valvulotomy. CONCLUSIONS Coronary artery thromboembolism as a nonatherosclerotic cause of acute coronary syndrome is rare. The treatment consists of aggressive anticoagulation, antiplatelet therapy, and interventional options, including simple wiring when possible. In this context, primary prevention in the form of patient education on optimal anticoagulation with oral vitamin K antagonist and medical advice about imminent thromboembolic risks are of extreme importance.

  4. Role of basilar artery hypoplasia in patients with pontine penetrating artery infarction%基底动脉发育不全在脑桥穿支动脉梗死患者中的作用研究

    Institute of Scientific and Technical Information of China (English)

    张道培; 许予明; 张洪涛; 张淑玲

    2012-01-01

    目的 探讨基底动脉发育不全(BAH)与脑桥穿支动脉梗死的关系及其临床特点.方法 选择头颅MRI确诊的急性脑梗死患者328例,根据诊断分为BAH组27例和无BAH组301例.其中急性后循环穿支动脉梗死患者79例,通过头颅磁共振血管造影术评估基底动脉直径(BAH定义为直径<2 mm)、椎动脉V4段发育不全(V4AH)及胚胎大脑后动脉(FTP)情况.结果 BAH组后循环梗死、动脉发育不全(单侧V4AH、双侧V4AH、单侧FTP、双侧FTP、双侧V4AH和FTP)比例明显高于无BAH组(P<0.01).79例急性后循环穿支动脉梗死患者中,BAH 24例(30.4%),其中脑桥穿支动脉梗死15例(62.5%),后循环其他部位穿支动脉梗死9例(37.5%).在脑桥穿支动脉梗死患者中,合并BAH的比例明显高于未合并BAH的比例(62.5% vs 12.7%,P<0.01).结论 BAH与脑桥穿支动脉梗死的发生有密切关系,这些患者多合并V4AH和FTP.%Objective To study the relation between basilar artery hypoplasia(BAH) and pontine penetrating artery infarction and the clinical characteristics of BAH patients. Methods Three hundred and twenty-eight patients with acute cerebral infarction established by head MRI were divided into BAH group(n = 27) and non-BAH group(n = 301) according to their diagnosis. Basilar artery diameter (which was defined <2 mm according to BAH) , vertebral artery V4 hypoplasia (V4AH) and fetal type posterior(FTP) artery condition were assessed in 79 patients with acute posterior penetrating artery circulation ischemic stroke according to MRI. Results The proportions of posterior circulation ischemic stroke and the unilateral V4AH,bilateral V4AH,unilateral FTP,bilateral FTP, bilateral V4AH and FTP were significantly higher in BAH group than in non-BAH group(P<0. 01). Of the 79 patients with acute posterior circulation penetrating artery infarction,24(30. 4%)were diagnosed with BAH including 15(62. 5%) with pontine penetrating artery infarction and 9(37. 5

  5. Vertebral Artery Dissection Associated with Generalized Convulsive Seizures: A Case Report

    Directory of Open Access Journals (Sweden)

    Faisal Mohammad Amin

    2013-07-01

    Full Text Available A 46-year-old male with juvenile myoclonic epilepsy was admitted to the neurological department for convulsive seizures just after lamotrigine was discontinued. On admission he was awake but had a right-sided hemiparesis with Babinski sign and ataxic finger-nose test on the left side. An MR scan showed a left-sided pontine infarction, an infarct in the left cerebellar hemisphere and a right vertebral artery dissection (VAD. The patient was treated with heparin and an oral anticoagulant for 6 months. Recovery of neurologic function was excellent. In patients with symptoms of disturbances of posterior circulation after epileptic seizures, VAD should be considered.

  6. Noradrenaline-induced increases in calcium and tension in skeletal muscle conductance and resistance arteries from rats with post-infarction heart failure.

    Science.gov (United States)

    Trautner, Simon; Amtorp, Ole; Boesgaard, Soren; Andersen, Claus B; Galbo, Henrik; Haunsoe, Stig; Sheykhzade, Majid

    2006-05-10

    We tested the hypothesis that arterial reactivity to noradrenaline is augmented in congestive heart failure (CHF), which could contribute to the deleterious changes in peripheral vascular resistance and compliance in this condition. From male Wistar rats with post-infarction CHF and sham-operated rats, skeletal muscle conductance and resistance arteries (mean lumen diameters: 514 and 186 microm) were isolated and mounted on wire myographs, and wall tension was recorded in response to cumulative application of acetylcholine and noradrenaline to the vessel segments. In a subset of experiments, wall tension and cytosolic free calcium ion concentration [Ca(2+)](i) were recorded simultaneously during noradrenaline application, using wire myography and the FURA-2 technique. No significant differences were found in the arterial baseline levels of [Ca(2+)](i) or tension between CHF and sham rats. In the resistance arteries of CHF rats, the noradrenaline-induced increases in [Ca(2+)](i) were significantly enhanced (P=0.003). Despite the augmented [Ca(2+)](i) levels, the tension responses to noradrenaline were unaltered in these arteries. In the conductance arteries, there were no significant differences in noradrenaline-induced [Ca(2+)](i) or tension responses between CHF and control rats. CHF did not alter vascular morphology or change vascular relaxations to acetylcholine in either type of artery. In conclusion, these results do not support the contention that arterial reactivity to noradrenaline is augmented in the skeletal muscle vascular bed in CHF. On the contrary, the unchanged contractile responsiveness in the resistance arteries despite the enhanced levels of [Ca(2+)](i) during noradrenaline application suggests that the contractile function of these vessels is compromised in CHF. Neither vascular remodeling, endothelial dysfunction nor changes in baseline vascular tone could be demonstrated in the skeletal muscle vascular bed of this animal model of heart failure.

  7. Radiological imaging features of the basal ganglia that may predict progression to hemicraniectomy in large territory middle cerebral artery infarct

    Energy Technology Data Exchange (ETDEWEB)

    Mian, Asim Z.; Edasery, David; Sakai, Osamu; Mustafa Qureshi, M. [Boston University School of Medicine, Department of Radiology, Boston Medical Center, Boston, MA 02118 (United States); Holsapple, James [Boston University School of Medicine, Department of Neurosurgery, Boston Medical Center, Boston, MA (United States); Nguyen, Thanh [Boston University School of Medicine, Department of Neurology, Boston Medical Center, Boston, MA (United States)

    2017-05-15

    Predicting which patients are at risk for hemicraniectomy can be helpful for triage and can help preserve neurologic function if detected early. We evaluated basal ganglia imaging predictors for early hemicraniectomy in patients with large territory anterior circulation infarct. This retrospective study evaluated patients with ischemic infarct admitted from January 2005 to July 2011. Patients with malignant cerebral edema refractory to medical therapy or with herniating signs such as depressed level of consciousness, anisocoria, and contralateral leg weakness were triaged to hemicraniectomy. Admission images were reviewed for presence of caudate, lentiform nucleus (putamen and globus pallidus), or basal ganglia (caudate + lentiform nucleus) infarction. Thirty-one patients with large territory MCA infarct, 10 (32%), underwent hemicraniectomy. Infarction of the caudate nucleus (9/10 vs 6/21, p = 0.002) or basal ganglia (5/10 vs 2/21, p = 0.02) predicted progression to hemicraniectomy. Infarction of the lentiform nucleus only did not predict progression to hemicraniectomy. Sensitivity for patients who did and did not have hemicraniectomy were 50% (5/10) and 90.5% (19/21). For caudate nucleus and caudate plus lentiform nucleus infarcts, the crude- and age-adjusted odds of progression to hemicraniectomy were 9.5 (1.4-64.3) and 6.6 (0.78-55.4), respectively. Infarction of the caudate nucleus or basal ganglia correlated with patients progressing to hemicraniectomy. Infarction of the lentiform nucleus alone did not. (orig.)

  8. Comparison of myocardial infarction with sequential ligation of the left anterior descending artery and its diagonal branch in dogs and sheep.

    Science.gov (United States)

    Kim, W G; Shin, Y C; Hwang, S W; Lee, C; Na, C Y

    2003-04-01

    We report a comparison of the effects of myocardial infarction in dogs and sheep using sequential ligation of the left anterior descending artery (LAD) and its diagonal branch (DA), with hemodynamic, ultrasonographic and pathological evaluations. Five animals were used in each group. After surgical preparation, the LAD was ligated at a point approximately 40% of the distance from the apex to the base of the heart, and after one hour, the DA was ligated at the same level. Hemodynamic and ultrasonographic measurements were performed preligation, 30 minutes after LAD ligation, and 1 hour after DA ligation. As a control, two animals in each group were used for the simultaneous ligation of the LAD and the DA. Two months after the coronary ligation, the animals were evaluated as previously, and killed for postmortem examination of their hearts. All seven animals in the dog group survived the experimental procedures, while in the sheep group only animals with sequential ligation of the LAD and DA survived. Statistically significant decreases in systemic arterial blood pressure and cardiac output, and an increase in the pulmonary artery capillary wedge pressure (PACWP) were observed one hour after sequential ligation of the LAD and its DA in the sheep, while only systemic arterial pressures decreased in the dog. Ultrasonographic analyses demonstrated variable degrees of anteroseptal dyskinesia and akinesia in all sheep, but in no dogs. Data two months after coronary artery ligation showed significant increases in central venous pressure, pulmonary artery pressure, and PACWP in the sheep, but not in the dog. Left ventricular end-diastolic dimension and left ventricular end-systolic dimension in ultrasonographic studies were also increased only in the sheep. Pathologically, the well-demarcated thin-walled transmural anteroseptal infarcts with chamber enlargement were clearly seen in all specimens of sheep, and only-mild-to-moderate chamber enlargements with endocardial

  9. Loss of PDZK1 causes coronary artery occlusion and myocardial infarction in Paigen diet-fed apolipoprotein E deficient mice.

    Directory of Open Access Journals (Sweden)

    Ayce Yesilaltay

    Full Text Available BACKGROUND: PDZK1 is a four PDZ-domain containing protein that binds to the carboxy terminus of the HDL receptor, scavenger receptor class B type I (SR-BI, and regulates its expression, localization and function in a tissue-specific manner. PDZK1 knockout (KO mice are characterized by a marked reduction of SR-BI protein expression ( approximately 95% in the liver (lesser or no reduction in other organs with a concomitant 1.7 fold increase in plasma cholesterol. PDZK1 has been shown to be atheroprotective using the high fat/high cholesterol ('Western' diet-fed murine apolipoprotein E (apoE KO model of atherosclerosis, presumably because of its role in promoting reverse cholesterol transport via SR-BI. PRINCIPAL FINDINGS: Here, we have examined the effects of PDZK1 deficiency in apoE KO mice fed with the atherogenic 'Paigen' diet for three months. Relative to apoE KO, PDZK1/apoE double KO (dKO mice showed increased plasma lipids (33% increase in total cholesterol; 49 % increase in unesterified cholesterol; and 36% increase in phospholipids and a 26% increase in aortic root lesions. Compared to apoE KO, dKO mice exhibited substantial occlusive coronary artery disease: 375% increase in severe occlusions. Myocardial infarctions, not observed in apoE KO mice (although occasional minimal fibrosis was noted, were seen in 7 of 8 dKO mice, resulting in 12 times greater area of fibrosis in dKO cardiac muscle. CONCLUSIONS: These results show that Paigen-diet fed PDZK1/apoE dKO mice represent a new animal model useful for studying coronary heart disease and suggest that PDZK1 may represent a valuable target for therapeutic intervention.

  10. Predictor′s analysis of anterior circulation cerebral infarction after the endovascular treatment of anterior communicating artery aneurysms

    Directory of Open Access Journals (Sweden)

    Liqian Sun

    2014-01-01

    Full Text Available Background: Despite increasing acceptance of endovascular coiling for treating anterior communicating artery (ACoA aneurysms, anterior circulation cerebral infarction (ACI after embolization remains a limitation. With higher incidence, higher morbidity and higher mortality, it is one of the main factors influencing the ACoA aneurysms prognosis. Determining the risk factors leading to ACI after embolization will have clinical significance. Through retrospective case analysis, this study investigated the risk factors related to ACI after embolization in order to provide information to serve the clinical practice. Materials and Methods: A retrospective review was performed of patients who had undergone coiling of ACoA aneurysms from 2008 to 2012. All patients had ruptured prior to the completion of embolization. Cases with acute stroke symptoms without alternative diagnoses after embolization were diagnosed as ACI. A total of 32 risk factors such as age, sex, hypertension, diabetes mellitus, modified Fisher grade, Hunt-Hess grade, ventricular hemorrhage, etc. were analyzed using univariate and logistic regression analysis. Results: Univariate analysis showed that negative fluid volume balance (P = 0.041 <0.05 and modified Fisher grade (P = 0.049 <0.05 reached statistical significance, suggesting that they might be risk factors for ACI after embolization. Multiple logistic regression analysis showed that modified Fisher grade was significantly associated with ACI after embolization, suggesting that it was an independent risk factor (odds ratios (OR: 4.968, 95% confidence intervals (CI: 1.013-24.360, P = 0.048. Conclusion: Modified Fisher grade is an independent risk factor for ACI after embolization.

  11. Plaques of Nonstenotic Basilar Arteries with Isolated Pontine Infarction on Three-dimensional High Isotropic Resolution Magnetic Resonance Imaging

    Institute of Scientific and Technical Information of China (English)

    Xian-Jin Zhu; Wei-Jian Jiang; Lei Liu; Li-Bin Hu; Wu Wang; Zun-Jing Liu

    2015-01-01

    Background:There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries (BA).Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition (VISTA) and investigate the differences between the patients with and without isolated pontine infarction (IPI).Methods:Twenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography (TOF MRA) were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014.BA was classified as "normal" or"irregular" based on TOF MRA,and "normal wall","slight wall-thickening",and "plaque" based on three-dimensional VISTA images.Outcomes from MRA and VISTA were compared.Patients were categorized as IPI and non-IPI groups based on the diffusion-weighted imaging.Clinical and plaque characteristics were compared between the two groups.Results:A total of 1024 image slices including 311 (30.37%) plaque slices,427 (41.70%) slight wall-thickening slices,and 286 (27.93%) normal wall slices for the entire BA from 23 patients were finally included for analysis.VISTA images detected plaques in all the 9 (100%) irregular MRA patients and 7 of 14 (50%) normal MRA patients.IPI was found in 1 1 (47.83%) patients.Compared to non-IPI group,the IPI group had a higher percentage of plaque slices (P =0.001) and lower percentage of normal wall slices (P =0.014) than non-IPI group.Conclusions:Three-dimensional VISTA images enable detection of BA plaques not visualized by MRA.BA plaques could be found in both the IPI and non-IPI group.However,IPI group showed plaques more extensively in BA than the non-IPI group.

  12. Morfologia da artéria cerebelar superior do macaco prego (Cebus apella L., 1766: divisões e anastomoses Morphology of the superior cerebellar artery of the “macaco prego” (Cebus paella L., 1766: divisions and anastomoses

    Directory of Open Access Journals (Sweden)

    Rosimeire Alves da Silva

    2002-04-01

    Full Text Available Dando continuidade a estudos já existentes na área de mapeamento da vascularização cerebral do Cebus apella e considerando a semelhança desse animal com outros primatas descritos, inclusive os humanos, estudou-se a morfologia das artérias cerebelares superiores, que destinam a irrigar a superfície superior do cerebelo. 57 hemisférios cerebelares foram injetados com látex corado e fixados em solução de formol a 10%, dissecados sob mesoscopia de luz com microdissecações. As artérias cerebelares superiores são simétricas em 84,21% e assimétricas em 7,01%, ramificam-se em 4 ramos: sendo 1 para o mesencéfalo e 3 troncos principais para a superfície superior do cerebelo e regiões anterior dessa superfície. Estas artérias terminam na fissura póstero-superior ou pós-semilunar após emitir vários ramos colaterais de hierarquia decrescente de calibreIn order to continue studies already done in the area of mapping the cerebral vascularization of Cebus paella and taking into consideration the resemblance of this animal with other primates described, humans included, we studied the morphology of the superior cerebellar arteries determined to perfuse the superior surface of the cerebellum. Fifty-seven cerebellar hemispheres were injected with stained latex, fixed in 10% formol solution and dissected under light mesoscopy. The superior cerebellar arteries are symmetrical in 84,21% and asymmetrical in 7,01%, and give off four branches, one to the mesencephalon and three mains branches to the upper surface of the cerebellum and its anterior portion. These arteries end in the posterior superior or post-semilunar fissure, after giving off many collaterals of decreasing diameter

  13. Paroxysmal atrial fibrillation during acute myocardial infarction associated with subclinical hyperthyroidism, severe three vessels coronary artery disease and elevation of prostate-specific antigen after TURP.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo

    2010-01-21

    Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. Paroxysmal atrial fibrillation is a frequent complication of acute myocardial infarction. It has been reported that subclinical hyperthyroidism is not associated with CHD or mortality from cardiovascular causes but it is sufficient to induce an increase in atrial fibrillation rate and increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. It has also been reported that serum prostate-specific antigen (PSA) decreases drastically in patients who undergo transurethral resection of the prostate(TURP). We present a case of paroxysmal atrial fibrillation during acute myocardial infarction associated with subclinical hyperthyroidism, severe three vessels coronary artery disease and elevation of PSA after TURP in a 78-year-old Italian man.

  14. The relationship between electrocardiogram and infarction-related artery in 69 cases of acute inferior myocardial infarction%急性下壁心肌梗死心电图与梗死相关动脉关系分析

    Institute of Scientific and Technical Information of China (English)

    耿黎明

    2009-01-01

    The results of electrocardiogram and coronary angiography were compared in 69 patients with acute inferior myocardial infarction(right ventricle, later wall). The sensitivity and specificity of ST segment elevation Ⅲ> Ⅱ in diagnosis of right coronary artery (RCA) as the infarction related artery (IRA) were 92.00% and 84. 21% respectively;those for ST segment depression avL > Ⅰ were 90. 00% and 89. 5% respectively. Therefore if ST-elevation Ⅲ > Ⅱ , ST-depression avL > Ⅰ and no depression on STV1 and V2 in acute inferior myocardial infarction may highly indicate that RAC be the IRA;on the contrary, the LCX be the IRA.%对69例急性下壁(右室、后壁)心肌梗死患者心电图改变与冠状动脉造影资料进行对比分析.结果 示ST段抬高Ⅲ>Ⅱ判断右冠状动脉(RCA)为梗死相关动脉(IRA)的敏感性和特异性分别为92.00%、84.21%,ST段压低avL>Ⅰ判断RCA为IRA的敏感性和特异性分别为90.00%、89.47%.显示急性下壁心肌梗死ST段抬高Ⅲ>Ⅱ、ST段压低avL>Ⅰ和V1、V2导联ST段无压低高度提示RCA为IRA;反之,提示左回旋支为IRA.

  15. Effect of Late Revascularization of a Totally Occluded Coronary Artery After Myocardial Infarction on Mortality Rates in Patients with Renal Impairment

    Science.gov (United States)

    Hastings, Ramin; Hochman, Judith S.; Dzavik, Vladimir; Lamas, Gervasio A.; Forman, Sandra A.; Schiele, Francois; Michalis, Lampros K.; Nikas, Dimitris; Jaroch, Joanna; Reynolds, Harmony R.

    2012-01-01

    Renal dysfunction is an independent predictor of cardiovascular events and a negative prognostic indicator after myocardial infarction (MI). Randomized data comparing percutaneous coronary intervention (PCI) to medical therapy in MI patients with renal insufficiency are needed. The Occluded Artery Trial (OAT) compared optimal medical therapy alone to PCI with optimal medical therapy in 2201 high risk patients with an occluded infarct artery >24 hours post-MI with serum creatinine ≤2.5 mg/dl. The primary endpoint was a composite of death, MI, and class IV heart failure (HF). Analyses were carried out utilizing estimated glomerular filtration rates (eGFR) as a continuous variable and by eGFR categories. Long term follow up data (maximum 9 years) were used for this analysis. Lower eGFR (ml/min/1.73m2) was associated with development of the primary outcome (6-year life-table rate 16.9% in eGFR>90; 19.2% in eGFR 60–89; 34.9% in eGFR<60; p-value <0.0001), death, and class IV HF, with no difference in rates of reinfarction. On multivariable analysis, eGFR was an independent predictor of death and HF. There was no effect of treatment assignment on the primary endpoint regardless of eGFR, and there was no significant interaction between eGFR and treatment assignment on any outcome. In conclusion, lower eGFR at enrollment was independently associated with death and HF in OAT participants. Despite this increased risk, the lack of benefit from PCI in the overall trial was also seen in patients with renal dysfunction and persistent occlusion of the infarct artery in the subacute phase post MI. PMID:22728005

  16. [Spinal cord infarction].

    Science.gov (United States)

    Naumann, N; Shariat, K; Ulmer, S; Stippich, C; Ahlhelm, F J

    2012-05-01

    Infarction of the spinal cord can cause a variety of symptoms and neurological deficits because of the complex vascular supply of the myelon. The most common leading symptom is distal paresis ranging from paraparesis to tetraplegia caused by arterial ischemia or infarction of the myelon. Venous infarction, however, cannot always be distinguished from arterial infarction based on the symptoms alone.Modern imaging techniques, such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) assist in preoperative planning of aortic operations to reliably identify not only the most important vascular structure supplying the spinal cord, the artery of Adamkiewicz, but also other pathologies such as tumors or infectious disorders. In contrast to CT, MRI can reliably depict infarction of the spinal cord.

  17. Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.

    Science.gov (United States)

    Akgüllü, Çağdaş; Eryılmaz, Ufuk; Zencir, Cemil; Güngör, Hasan

    2014-12-01

    We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

  18. Hemicraniectomy after middle cerebral artery infarction with life-threatening Edema trial (HAMLET). Protocol for a randomised controlled trial of decompressive surgery in space-occupying hemispheric infarction.

    Science.gov (United States)

    Hofmeijer, Jeannette; Amelink, G Johan; Algra, Ale; van Gijn, Jan; Macleod, Malcolm R; Kappelle, L Jaap; van der Worp, H Bart

    2006-09-11

    Patients with a hemispheric infarct and massive space-occupying brain oedema have a poor prognosis. Despite maximal conservative treatment, the case fatality rate may be as high as 80%, and most survivors are left severely disabled. Non-randomised studies suggest that decompressive surgery reduces mortality substantially and improves functional outcome of survivors. This study is designed to compare the efficacy of decompressive surgery to improve functional outcome with that of conservative treatment in patients with space-occupying supratentorial infarction The study design is that of a multi-centre, randomised clinical trial, which will include 112 patients aged between 18 and 60 years with a large hemispheric infarct with space-occupying oedema that leads to a decrease in consciousness. Patients will be randomised to receive either decompressive surgery in combination with medical treatment or best medical treatment alone. Randomisation will be stratified for the intended mode of conservative treatment (intensive care or stroke unit care). The primary outcome measure will be functional outcome, as determined by the score on the modified Rankin Scale, at one year.

  19. Spinal Cord Infarction

    Science.gov (United States)

    ... arteries that supply it. It is caused by arteriosclerosis or a thickening or closing of the major ... infarction is caused by a specific form of arteriosclerosis called atheromatosis, in which a deposit or accumulation ...

  20. 后循环梗死:病变分布和CT血管造影%Posterior circulation infarction: distribution of lesions and CT angiography

    Institute of Scientific and Technical Information of China (English)

    吉利; 刘贤; 宋玉强; 王倩

    2014-01-01

    Objective To investigate the correlation between the distribution of lesions on MRI and the findings of computerized tomography angiography (CTA) in patients with posterior circulation infarction.Methods Patients with acute posterior circulation infarction were enrolled in the study.The sites of the infarcts were divided into proximal,middle and distal infarctions according to the results of MRI.All the patients received head and neck CTA.The correlation between the distribution of posterior circulation infarcts and the sites of vertebrobasilar system lesions was analyzed.Results A total of 203 patients with acute posterior circulation infarction were enrolled.Their primary clinical symptoms and signs were unilateral limb weakness (n =77,37.93%),dizziness (n =129,63.55%),dysarthria (n =31,15.27%),nausea and vomiting (n =61,30.05%),headache (n =79,38.92%),gait abnormal (n =50,24.63%),nystagmus (n=34,16.75%),and ataxia (n=21,10.34%).Proximal infarction (n=35,17.24%):medullary infarction (n =28,13.79%),posterior inferior cerebellar artery infarction (n =7,3.45%); middle infarction (n =95,46.79%):pontine infarction (n =80,39.4%),anterior inferior cerebellar infarction (n =15,7.39%); distal infarction (n=73,35.96%):middle cerebral infarction (n=6,2.96%),superior cerebellar infarction (n =16,7.88%),thalamic infarction (n =34,(16.75%),occipital lobe infarction (n =10,4.93%),temporal lobe infarction (n =7,3.44%).Extracranial vertebral artery lesions were most common in the distal infarction group.It reached 53.42%,and was significantly higher than 22.86% in the proximal infarction group (P =0.003) and 33.68% in the middle infarction group (P =0.010).Intracranlal vertebral artery lesions were most common in the proximal infarction group.It reached 57.14%,and then followed by the middle infarction (41.05%).They were all significantly higher than 15.07% in the distal infarction group (all P =0.000).Basilar artery lesions

  1. Influence of a history of arterial hypertension and pretreatment blood pressure on the effect of angiotensin converting enzyme inhibition after acute myocardial infarction. Trandolapril Cardiac Evaluation Study

    DEFF Research Database (Denmark)

    Gustafsson, F; Køber, L; Torp-Pedersen, C

    1998-01-01

    inhibition after AMI complicated by left ventricular dysfunction may be of particular importance in patients with a history of arterial hypertension or a relatively high pretreatment blood pressure. However, further investigations are necessary to establish the clinical impact of these results.......OBJECTIVE: To evaluate the influence of a history of arterial hypertension and the level of pretreatment blood pressure on the efficacy of the angiotensin converting enzyme (ACE) inhibitor trandolapril on mortality and morbidity in patients with acute myocardial infarction (AMI) and left...... for a broad spectrum of potential confounders. Also, benefit from ACE inhibition increased with increasing blood pressure at the time of randomization. Significant interactions between benefit from ACE inhibition and hypertension history, and systolic and diastolic blood pressure were found. CONCLUSION: ACE...

  2. Incomplete brain infarction of reperfused cortex may be quantitated with iomazenil

    DEFF Research Database (Denmark)

    Nakagawara, J; Sperling, B; Lassen, N A

    1997-01-01

    with ischemic stroke to detect viable neurons in cortex that appeared structurally intact on conventional neuroimaging studies. METHODS: Fourteen patients were selected by (1) angiography within 24 hours of onset showing embolic occlusion of an intracranial artery, (2) cerebral blood flow showing ischemia...... of moderate severity in 12 cases and spontaneous reflow in 2 cases, and (3) thrombolysis with reperfusion within 24 hours in most cases. Thirty reperfused cortical areas that remained structurally intact, 7 infarcted cortical areas, and 6 contralateral cerebellar areas with reduced blood flow were selected...

  3. Chronic aspirin treatment affects collagen deposition in non-infarcted myocardium during remodeling after coronary artery ligation in the rat

    NARCIS (Netherlands)

    E.A.J. Kalkman (Ed); R-J. van Suylen (Robert-Jan); J.P.M. van Dijk (J. P M); P.R. Saxena (Pramod Ranjan); R.G. Schoemaker (Regien)

    1995-01-01

    textabstractLow-dose aspirin (acetylsalicylic acid; ASA), inhibiting platelet thromboxane production in favor of endothelium formation of prostaglandins, is successfully used as primary or secondary prophylaxis against myocardial infarction. Although prognosis may be improved, effects of long-term

  4. In-Hospital and Long-Term Prognosis after Myocardial Infarction in Patients with Prior Coronary Artery Bypass Surgery; 19-Year Experience

    Directory of Open Access Journals (Sweden)

    Predrag M. Mitrovic

    2009-01-01

    Full Text Available To present a 19-year experience of the prognosis of patients with acute myocardial infarction (AMI and prior coronary artery bypass surgery (CABS, 748 patients with AMI after prior CABS (postbypass group and a control group of 1080 patients with AMI, but without prior CABS, were analyzed. All indexes of infarct size were lower in the postbypass group. There was more ventricular fibrillation in the postbypass group. In-hospital mortality was similar (p = 0.3675. In the follow-up period, postbypass patients had more heart failure, recurrent CABS, reinfarction, and unstable angina than did control patients. Cumulative survival was better in the control group than in the postbypass group (p = 0.0403. Multiple logistic regression model showed that previous angina (p = 0.0005, diabetes (p = 0.0058, and age (p = 0.0102 were independent predictor factors for survival. Use of digitalis and diuretics, together with previous angina, also influenced survival (p = 0.0092, as well as male gender, older patients, and diabetes together (p = 0.0420. Patients with AMI after prior CABS had smaller infarct, but more reinfarction, reoperation, heart failure, and angina. Previous angina, diabetes, and age, independently, as well as use of digitalis and diuretics together with angina, and male gender, older patients, and diabetes together, influenced a worse survival rate in these patients.

  5. Assessment of arcuate fasciculus with diffusion-tensor tractography may predict the prognosis of aphasia in patients with left middle cerebral artery infarcts

    Energy Technology Data Exchange (ETDEWEB)

    Hosomi, Akiko; Nagakane, Yoshinari; Kuriyama, Nagato; Mizuno, Toshiki; Nakagawa, Masanori [Kyoto Prefectural University of Medicine, Department of Neurology, Graduate School of Medical Science, Kyoto (Japan); Yamada, Kei; Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto (Japan)

    2009-09-15

    It is often clinically difficult to assess the severity of aphasia in the earliest stage of cerebral infarction. A method enabling objective assessment of verbal function is needed for this purpose. We examined whether diffusion tensor (DT) tractography is of clinical value in assessing aphasia. Thirteen right-handed patients with left middle cerebral artery infarcts who were scanned within 2 days after stroke onset were enrolled in this study. Magnetic resonance data of ten control subjects were also examined by DT tractography. Based on the severity of aphasia at discharge, patients were divided into two groups: six patients in the aphasic group and seven in the nonaphasic group. Fractional anisotropy (FA) and number of arcuate fasciculus fibers were evaluated. Asymmetry index was calculated for both FA and number of fibers. FA values for the arcuate fasciculus fibers did not differ between hemispheres in either the patient groups or the controls. Number of arcuate fasciculus fibers exhibited a significant leftward asymmetry in the controls and the nonaphasic group but not in the aphasic group. Asymmetry index of number of fibers was significantly lower (rightward) in the aphasic group than in the nonaphasic (P = 0.015) and control (P = 0.005) groups. Loss of leftward asymmetry in number of AF fibers predicted aphasia at discharge with a sensitivity of 0.83 and specificity of 0.86. Asymmetry of arcuate fasciculus fibers by DT tractography may deserve to be assessed in acute infarction for predicting the fate of vascular aphasia. (orig.)

  6. Central Hypoventilation Syndrome Complicated with Lateral Medullary Infarction after Endovascular Treatment of the Vertebral Artery Dissecting Aneurysm: A Case Report

    OpenAIRE

    TANAKA, Katsuhiro; Kanamaru, Hideki; Morikawa, Atsunori; Kawaguchi, Kenji

    2016-01-01

    Lateral medullary infarction rarely leads to central hypoventilation syndrome (CHS). CHS is a life-threatening disorder characterized by hypoventilation during sleep. We report the first case of CHS as a complication of lateral medullary infarction after endovascular treatment. A 65-year-old man presented twice with severe headache. Computed tomography revealed subarachnoid hemorrhage and cerebral angiography showed a right vertebral dissecting aneurysm involving the posterior inferior cerebe...

  7. Correlation analysis between the carotid artery ather osclerosis severity of patients with lacunar infarct and the level of serum uric acid, high-sensitivity C-reactive protein

    Directory of Open Access Journals (Sweden)

    WANG Shu

    2013-01-01

    Full Text Available Background Nowadays, clinical practice shows that the number of patients with cerebral infarction increases year by year in young and middle-aged adults with unclear causes. This paper aims to investigate the correlation between the level of serum uric acid (UA, high-sensitivity C-reactive protein (hsCRP and the degree of carotid atherosclerosis by detecting the level of UA, hsCRP and carotid intima-media thickness (IMT in young and middle-aged patients with lacunar infarct. Methods By using Holland Philips HT-11 color Doppler ultrasonic diagnostic apparatus with linear type probe and 7.50MHz frequency, IMT of end-diastolic distal and bifurcation of arteria carotis communis and proximal internal carotid artery were measured respectively on 186 patients with definitely diagnosed lacunar infarct. As a result, average values were taken as the IMT values. IMT < 1.00 mm was regarded as negative result and 1.00 mm ≤IMT < 1.20 mm was thickening of carotid artery intima. Carotid artery plaque formation was regarded with echo structure existing in the lumen or abnormal blood flow deficits into the lumen, or local IMT ≥1.20 mm at vertical and horizontal scan. At the same time, the levels of UA and hsCRP were detected, and correlation analysis was made between them and IMT. Results The values of UA, hsCRP and IMT in the case group were higher than that in the control group (P = 0.000. The differences among the case subgroups including IMT thickening group, plaque formation group and IMT normal group were statistically significant (P < 0.01, for all. There was linear correlation between the levels of UA, hsCRP and IMT ( r = 0.923, P = 0.000; r = 0.955, P = 0.008. Conclusion UA and hsCRP involve in the formation of atherosclerosis plaque and play an important role in the first-onset lacunar infarct patients without hypertension and other risk factors.

  8. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

    Directory of Open Access Journals (Sweden)

    Chadi Tannoury

    2015-01-01

    Full Text Available Study Design. This case illustrates complications to a vertebral artery injury (VAI resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  9. Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the Infarct-Related Left Anterior Descending Artery

    Science.gov (United States)

    Celik, Ahmet; Kalay, Nihat; Korkmaz, Hasan; Dogdu, Orhan; Sahin, Omer; Elcik, Deniz; Karacavus, Seyhan; Dogan, Ali; Inanc, Tugrul; Ozdogru, Ibrahim; Oguzhan, Abdurrahman; Topsakal, Ramazan

    2011-01-01

    Background Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.

  10. Long-term Prognosis of Patients With Non-ST-segment Elevation Acute Myocardial Infarction and Coronary Arteries Without Significant Stenosis.

    Science.gov (United States)

    Redondo-Diéguez, Alfredo; Gonzalez-Ferreiro, Rocío; Abu-Assi, Emad; Raposeiras-Roubin, Sergio; Aidhodjayeva, Ozoda; López-López, Andrea; Castiñeira-Busto, María; Peña-Gil, Carlos; García-Acuña, Jose María; González-Juanatey, José Ramón

    2015-09-01

    There is debate regarding the prognostic significance of the absence of significant coronary lesions in patients with non-ST-segment elevation acute myocardial infarction. We investigated long-term prognosis in a contemporary cohort of these patients. Retrospective observational study of 5203 patients with acute coronary syndrome. Propensity score matching was used to create 2 groups of 367 patients with non-ST-segment elevation acute myocardial infarction matched by the absence or presence of significant coronary lesions. In the matched cohort, we determined the impact of the absence of significant coronary lesions on mortality or readmission for acute coronary syndrome for 4.8 (2.6) years after discharge. Mortality or readmission for acute coronary syndrome was lower among patients without significant lesions (26.4% vs 32.7%; P = .09). Mortality in both groups was 19.1%. In contrast, patients without significant lesions had a lower incidence of readmission for acute coronary syndrome (2.0/100 vs 3.9/100 person-years; P = .003). The incidence of mortality or readmission for acute coronary syndrome was similar in patients without significant lesions and those with significant 1-vessel disease (26.4% vs 27.5%; P = .19), but lower than that in patients with 2-vessel disease (37.8%; P = .007) and 3-vessel disease or left main coronary artery disease (41.1%; P = .002). Patients with non-ST-segment elevation acute myocardial infarction and coronary arteries without significant lesions have similar long-term mortality but lower readmission rates for acute coronary syndrome than patients with significant lesions. Mortality or readmission for acute coronary syndrome is similar in patients without significant lesions and patients with 1-vessel disease, but lower than in patients with disease in 2 or more vessels. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Relation between preoperative renal dysfunction and cardiovascular events (stroke, myocardial infarction, or heart failure or death) within three months of isolated coronary artery bypass grafting.

    Science.gov (United States)

    Holzmann, Martin J; Sartipy, Ulrik

    2013-11-01

    Renal dysfunction is related to long-term mortality and myocardial infarction after coronary artery bypass grafting (CABG). We aimed to investigate the association between preoperative renal dysfunction and early risk of stroke, myocardial infarction, or heart failure after CABG. From the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, we included all 36,284 patients who underwent primary isolated CABG from 2000 to 2008 in Sweden. The Swedish National Inpatient Registry was used to obtain the primary end point, which was rehospitalization for stroke, myocardial infarction, or heart failure ≤90 days after CABG. Logistic regression models were used to estimate the risk for the primary outcome and the secondary outcome of death from any cause, while adjusting for confounders. During 90 days of follow-up, there were 2,462 cardiovascular events and 617 deaths. In total, 17% of patients developed acute kidney injury postoperatively. Odds ratios with 95% confidence intervals for cardiovascular events after adjustment for age, gender, atrial fibrillation, left ventricular ejection fraction, diabetes mellitus, peripheral vascular disease, and history of myocardial infarction, heart failure, or stroke was 1.24 (1.06 to 1.45) in patients with an estimated glomerular filtration rate of 15 to 45 ml/min/1.73 m(2) but became nonsignificant after acute kidney injury was introduced into the statistical model. The risk of death was significantly increased in patients with estimated glomerular filtration rate of 15 to 45 ml/min/1.73 m(2) (odds ratio 1.76, 95% confidence interval 1.38 to 2.25) even after adjustment for all confounders. Renal dysfunction was associated with all-cause mortality but not with cardiovascular events during the first 3 postoperative months after primary isolated CABG.

  12. Acute Marijuana Use and Cerebellar Infarction

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2004-04-01

    Full Text Available Three adolescent cases of ischemic stroke involving the posterior fossa circulation and cerebellum occurred within days after the illicit use of marijuana and presented over a span of 5 years at St Louis University School of Medicine, MO.

  13. Late reperfusion of a totally occluded infarct-related artery increases granulocyte-colony stimulation factor and reduces stroma-derived factor-1alpha blood levels in patients with ongoing ischemia after acute myocardial infarction.

    Science.gov (United States)

    Kuo, Li-Tang; Chen, Shih-Jen; Cherng, Wen-Jin; Yang, Ning-I; Lee, Chen-Chin; Cheng, Chi-Wen; Verma, Subodh; Wang, Chao-Hung

    2009-07-01

    After acute myocardial infarction (AMI), reopening of a totally occluded infarct-related artery (IRA) at a subacute stage is still controversial in symptom-free patients. However, in patients with persistent ischemic symptoms and inadequate collaterals to the infarct area, recanalization is thought to provide beneficial effects. In addition to augmenting myocardial perfusion, we hypothesized that the benefit of recanalization involves the manipulation of circulating stem cell-mobilizing cytokines. This study included 30 patients with a totally occluded IRA and ongoing ischemic symptoms (the study group) and 30 patients with a partially occluded IRA (the control group). All patients underwent successful angioplasty and/or stenting. Before and immediately after the coronary intervention, blood granulocyte-colony-stimulating factor (G-CSF), stem-cell factor (SCF), vascular endothelial growth factor (VEGF), and stroma-derived factor-1 (SDF-1alpha) were measured. After recanalization, G-CSF levels significantly increased in the study group compared to the control group (P=0.03). SDF-1alpha levels in the study group decreased relative to the controls (P=0.02). However, no significant changes in VEGF or SCF levels between the two groups were found. In the multivariate analysis, reopening of a totally occluded IRA was independently and significantly associated with changes in G-CSF and SDF-1alpha levels after recanalization. In conclusion, our data suggest that the benefits of late reperfusion of a totally occluded IRA in patients with ongoing myocardial ischemia may involve mechanisms associated with stem cell-mobilizing and plaque-stabilizing cytokines. This study provides the rationale to investigate serial changes in cytokines and the numbers of circulating progenitors after reperfusion in the future.

  14. The effect of lipid regulation with atorvastatin on the blood lipid levels and carotid artery plaques in patients with atherosclerotic cerebral infarction

    Directory of Open Access Journals (Sweden)

    Shu XU

    2015-11-01

    Full Text Available Objective To analyze the effect of intensive lipid regulation treatment with atorvastatin on the blood lipid levels and carotid artery plaques in patients with atherosclerotic cerebral infarction.  Methods Ninety-two patients with atherosclerotic cerebral infarction were randomly divided into two groups: observation group (treated by atorvastatin calcium with the dosage of 20 mg/d, N = 46 and control group (treated by diet without lipid-rich food, N=46. Besides, other drugs given to the patients in two groups were the same. The blood lipid levels and the changes of carotid artery plaques in two groups were analyzed and compared before treatment and 3 months after treatment. Results After treatment, the concentrations of total cholesterol [TC, (4.23 ± 0.92 mmol/L vs (5.24 ± 0.68 mmol/L], triglyceride [TG, (2.46 ± 0.28 mmol/L vs (3.33 ± 0.47 mmol/L], low-density lipoprotein cholesterol [LDL-C, (2.52 ± 0.38 mmol/L vs (4.78 ± 0.86 mmol/L] in the patients of observation group were all decreased and significantly lower than those in the control group (P = 0.000, for all, and the concentration of high-density lipoprotein cholesterol [HDL-C, (1.13 ± 0.41 mmol/L vs (0.85 ± 0.32 mmol/L] in the patients of observation group was increased and significantly than that in the control group (P = 0.003. The carotid artery plaque size [(20.25 ± 0.32 mm2 vs (24.42 ± 10.33 mm2] and thickness [(0.59 ± 0.13 mm vs (1.93 ± 0.23 mm] of carotid artery plaques and intima?media thickness [IMT, (1.32 ± 0.67 mm vs (1.63 ± 0.56 mm] of common carotid artery (CCA in the patients of observation group were all significantly lower than those in patients in the control group (P = 0.000, 0.000, 0.010, respectively. Comparing serum alanine aminotransferase (ALT, aspartate aminotransferase (AST, creatine kinase (CK and creatinine (Cr levels after treatment with before treatment, there was no significant difference between 2 groups (P > 0.05, for all.  Conclusions

  15. Multidetector computed tomography of the head in acute stroke: predictive value of different patterns of the dense artery sign revealed by maximum intensity projection reformations for location and extent of the infarcted area

    Energy Technology Data Exchange (ETDEWEB)

    Gadda, Davide; Vannucchi, Letizia; Niccolai, Franco; Neri, Anna T.; Carmignani, Luca; Pacini, Patrizio [Ospedale del Ceppo, U.O. Radiodiagnostica, Pistoia (Italy)

    2005-12-01

    Maximum intensity projections reconstructions from 2.5 mm unenhanced multidetector computed tomography axial slices were obtained from 49 patients within the first 6 h of anterior-circulation cerebral strokes to identify different patterns of the dense artery sign and their prognostic implications for location and extent of the infarcted areas. The dense artery sign was found in 67.3% of cases. Increased density of the whole M1 segment with extension to M2 of the middle cerebral artery was associated with a wider extension of cerebral infarcts in comparison to M1 segment alone or distal M1 and M2. A dense sylvian branch of the middle cerebral artery pattern was associated with a more restricted extension of infarct territory. We found 62.5% of patients without a demonstrable dense artery to have a limited peripheral cortical or capsulonuclear lesion. In patients with a 7-10 points on the Alberta Stroke Early Programme Computed Tomography Score and a dense proximal MCA in the first hours of ictus the mean decrease in the score between baseline and follow-up was 5.09{+-}1.92 points. In conclusion, maximum intensity projections from thin-slice images can be quickly obtained from standard computed tomography datasets using a multidetector scanner and are useful in identifying and correctly localizing the dense artery sign, with prognostic implications for the entity of cerebral damage. (orig.)

  16. Significance of exercise-induced ST segment depression in patients with myocardial infarction involving the left circumflex artery. Evaluation by exercise thallium-201 myocardial single photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Koitabashi, Norimichi; Toyama, Takuji; Hoshizaki, Hiroshi [Gunma Prefectural Cardiovascular Center, Maebashi (Japan)] [and others

    2000-04-01

    The significance of exercise-induced ST segment depression in patients with left circumflex artery involvement was investigated by comparing exercise electrocardiography with exercise thallium-201 single photon emission computed tomography (Tl-SPECT) and the wall motion estimated by left ventriculography. Tl-SPECT and exercise electrocardiography were simultaneously performed in 51 patients with left circumflex artery involvement (angina pectoris 30, myocardial infarction 21). In patients with myocardial infarction, exercise-induced ST depression was frequently found in the V{sub 2}, V{sub 3} and V{sub 4} leads. In patients with angina pectoris, ST depression was frequently found in the II, III, aV{sub F}, V{sub 5} and V{sub 6} leads. There was no obvious difference in the leads of ST depression in patients with myocardial infarction with ischemia and without ischemia on Tl-SPECT images. In patients with myocardial infarction, the lateral wall motion of the infarcted area evaluated by left ventriculography was more significantly impaired in the patients with ST depression than without ST depression (p<0.01). Exercise-induced ST depression in the precordial leads possibly reflects wall motion abnormality rather than ischemia in the lateral infarcted myocardium. (author)

  17. Plasminogen activator inhibitor-1 5G/5G genotype is associated with early spontaneous recanalization of the infarct-related artery in patients presenting with acute ST-elevation myocardial infarction.

    Science.gov (United States)

    Cagliyan, Caglar E; Yuregir, Ozge O; Balli, Mehmet; Tekin, Kamuran; Akilli, Rabia E; Bozdogan, Sevcan T; Turkmen, Serdar; Deniz, Ali; Baykan, Oytun A; Aslan, Huseyin; Cayli, Murat

    2013-05-01

    We aimed to examine the association between plasminogen activator inhibitor-1 (PAI-1) genetic polymorphism and early spontaneous recanalization in patients presenting with acute ST-elevation myocardial infarction. Patients admitted to our emergency department with ST-elevation myocardial infarction in the first 6 h of symptom onset were included. An immediate primary percutaneous coronary intervention was performed. Patients were grouped according to the initial patency of the infarct-related artery (IRA) as follows: total occlusion (TO) group [Thrombolysis in Myocardial Infarction (TIMI) 0-1 flow in the IRA], partial recanalization group (TIMI 2 flow in the IRA), and complete recanalization (CR) group (TIMI 3 flow in the IRA). PAI-1 4G/5G polymorphism was detected using the real-time PCR method. There were 107 patients in the TO group, 30 patients in the partial recanalization group, and 45 patients in the CR group. When we evaluated degrees of patency according to the PAI-1 genotype, TO of the IRA was the highest in patients with the PAI 4G/4G genotype (PAI-1 4G/4G: 66.7%, PAI-1 4G/5G: 65.9%, PAI-1 5G/5G: 40.4%) and CR of the IRA was the highest in patients with the PAI 5G/5G genotype (PAI-1 5G/5G: 38.5%, PAI-1 4G/5G: 19.8%, PAI-1 4G/4G: 17.9%). The distribution of genotypes in different degrees of patency of IRA was statistically significant (P=0.029). In logistic regression analysis, the PAI-1 5G/5G genotype was associated independently with the spontaneous CR of the IRA (odds ratio: 2.875, 95% confidence interval [1.059-7.086], P=0.038). Patients with the PAI-1 5G/5G genotype seem to be luckier than others in terms of early spontaneous recanalization of the IRA. Further prospective studies with large patient populations are required for more precise results.

  18. Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery: An Unusual Case Report.

    Science.gov (United States)

    Sen, Halil Murat; Guven, Mustafa; Aras, Adem Bozkurt; Cosar, Murat

    2017-05-01

    Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has not been described. We describe the case of a 65-year old female who lost cerebrospinal fluid after inadvertent opening of the dura during surgery. Computerized tomography performed when the patient became unable to speak revealed a bilateral cerebellar hemorrhage.

  19. A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Trethowan Brian A

    2011-11-01

    Full Text Available Abstract Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION, posterior ischaemic optic neuropathy (PION, and central retinal artery occlusion (CRAO. These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass; general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone, alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

  20. [Infarction of the spinal cord in the posterior spinal arterial supply area as a result of intervertebral disc embolism (author's transl)].

    Science.gov (United States)

    Budka, H; Perneczky, A; Pusch, S

    1979-09-14

    A female patient aged 49 developed an acute transverse lesion of the spinal cord from D11 downwards. Autopsy revealed spinal cord infarcts mainly in the dorsal parts corresponding to the posterior spinal arterial supply area, caused by multiple arterial and venous fibrocartilaginous emboli. This particular cause of spinal vascular syndrome has been reported previously only in 11 patients, all outside Austria. This case report serves to stress the poor clinical delineation of a distinct "posterior spinal syndrome". The source of the emboli is the intervertebral disc, mainly the nucleus pulposus. The spinal cord vessels are probably entered by the following route: extrusion of disc material into the venous bone marrow sinus (probably favoured by trauma or endocrine factors) yield basivertebral veins yield internal vertebral venous plexus; the spread is supported by blood stream changes caused by increased intraabdominal/intrathoracic pressure; there is also the possibility of direct penetration of disc material into the internal vertebral plexus, as demonstrated in dogs yield radicular veins yield meningeal and cord veins; sometimes entry occurs through arteriovenous shunts into cord arteries. The true incidence of this condition is unknown since cases are likely to be overlooked in the absence of extensive histopathological investigation.

  1. Pediatric cerebellar stroke associated with elevated titer of antibodies to β2-glycoprotein.

    Science.gov (United States)

    Spalice, Alberto; Del Balzo, Francesca; Perla, Francesco Massimo; Papetti, Laura; Nicita, Francesco; Ursitti, Fabiana; Properzi, Enrico

    2011-06-01

    Antibodies to 2-glycoprotein I (anti-2GPI) have been associated with recurrent thrombosis and pregnancy morbidity. However, the prevalence of anti-2GPI in children suffering from cerebral and cerebellar infarction is unknown. We report on a 10-month-old boy who had an ischemic cerebellar stroke, secondary to antiphospholipid syndrome with high titers of immunoglobulin G anti-2GPI (first titer: 132U) anticardiolipin antibodies and lupus anticoagulant tests were negative. All other causes of infarction were excluded. To our knowledge, this is the first reported case of childhood cerebellar ischemic stroke with only anti-2GPI but no antibodies detectable in standard antiphospholipid assays.

  2. 小脑后下动脉远端动脉瘤破裂的血管内治疗%Endovascular treatment of ruptured distal posterior inferior cerebellar artery aneurysms

    Institute of Scientific and Technical Information of China (English)

    陈状; 李林; 公方和; 王伟民

    2012-01-01

    Objective To investigate the clinical characteristics and endovascular treatment of ruptured distal posterior inferior cerebellar artery (PICA) aneurysms. Methods Clinical data of 11 patients with ruptured distal PICA aneurysms were analyzed retrospectively, including grade Ⅰ in 1 patient, grade Ⅱ in 5 patients, grade Ⅲ in 4 and grade Ⅳ in 1. All the patients were treated by endovascular treatment with coiling alone. Results Embolization alone of aneurysm was achieved in 7 patients, and embolization of aneurysm and parent artery occlusion at the same time in 4. All the patients were followed up for 1 to 4 years. Recurrence occurred in 1 patient 2 years after surgery, who was retreated by endovascular treatment. The occluded parent artery of 1 patient was recanalized 1 year after surgery without recurrence of aneurysm. The other 9 aneurysms were completely embolized. The modified rankin scale score 1 year after surgery was 0 in 2 patients, 1 in 8 and 2 in 1. Conclusions The embolization of ruptured distal PICA aneurysms by coiling with or without parent arteries occlusion is feasible, relatively safe, and can effectively prevent short- and medium-term rebleeding. Regular DSA follow-up is necessary to find and treat recurrence.%目的 总结小脑后下动脉(posterior inferior cerebellar artery,PICA)远端动脉瘤破裂的临床特征及血管内治疗方法.方法 回顾性分析11例破裂PICA远端动脉瘤病人的临床资料.术前Hunt-Hess分级:Ⅰ级1例,Ⅱ级5例,Ⅲ级4例,Ⅳ级1例.全部以单纯弹簧圈行血管内治疗.结果 单纯闭塞动脉瘤7例,同时闭塞动脉瘤及载瘤动脉4例.所有病人随访1~4年,术后2年复发1例,再次行血管内治疗;术后1年载瘤动脉再通1例,但仍未见动脉瘤复发;余9例动脉瘤均栓塞完全.术后1年改良rankin评分(modified rankin scale,MRS):0分2例,1分8例,2分1例.结论 对于PICA远端动脉瘤,以单纯弹簧圈闭塞动脉瘤或者同时闭塞动脉瘤和载瘤

  3. Controlateral cavernous syndrome, brainstem congestion and posterior fossa venous thrombosis with cerebellar hematoma related to a ruptured intracavernous carotid artery aneurysm.

    Science.gov (United States)

    Aldea, Sorin; Guedin, Pierre; Roccatagliata, Luca; Boulin, Anne; Auliac, Stéphanie; Dupuy, Michel; Cerf, Charles; Gaillard, Stéphan; Rodesch, Georges

    2011-06-01

    Intracavernous carotid artery aneurysms (ICCAs) are rarely associated with life-threatening complications. We describe a 55-year-old woman who, after the rupture of an intracavernous carotid artery aneurysm, presented with a contralateral cavernous sinus syndrome and severe posterior fossa and spinal cord symptoms. Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a "locked-in" state. The patient fully recovered with anticoagulation therapy. Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications related to venous thrombosis.

  4. Prevalence, Risk Factors, and Outcome of Myocardial Infarction with Angiographically Normal and Near-Normal Coronary Arteries: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Samad Ghaffari

    2016-12-01

    Full Text Available Context: Coronary artery diseases are mostly detected using angiographic methods demonstrating arteries status. Nevertheless, Myocardial Infarction (MI may occur in the presence of angiographically normal coronary arteries. Therefore, this study aimed to investigate the prevalence of MI with normal angiography and its possible etiologies in a systematic review. Evidence Acquisition: In this meta-analysis, the required data were collected from PubMed, Science Direct, Google Scholar, Scopus, Magiran, Scientific Information Database, and Medlib databases using the following keywords: “coronary angiograph”, “normal coronary arteries”, “near-normal coronary arteries”, “heart diseases”, “coronary artery disease”, “coronary disease”, “cardiac troponin I”, “Myocardial infarction”, “risk factor”, “prevalence”, “outcome”, and their Persian equivalents. Then, Comprehensive Meta-Analysis software, version 2 using randomized model was employed to determine the prevalence of each complication and perform the meta-analysis. P values less than 0.05 were considered to be statistically significant. Results: Totally, 20 studies including 139957 patients were entered into the analysis. The patients’ mean age was 47.62 ± 6.63 years and 64.4% of the patients were male. The prevalence of MI with normal or near-normal coronary arteries was 3.5% (CI = 95%, min = 2.2%, and max = 5.7%. Additionally, smoking and family history of cardiovascular diseases were the most important risk factors. The results showed no significant difference between MIs with normal angiography and 1- or 2-vessel involvement regarding the frequency of major adverse cardiac events (5.4% vs. 7.3%, P = 0.32. However, a significant difference was found between the patients with normal angiography and those with 3-vessel involvement in this regard (5.4% vs. 20.2%, P < 0.001. Conclusions: Although angiographic studies are required to assess the underlying

  5. 脑循环功能治疗仪联合电动起立床对小脑梗死后平衡障碍的疗效%The effects of therapeutic equipment that aim to improve cerebrovascular function combined with automatic standing bed on balance disorder following cerebellar infarction

    Institute of Scientific and Technical Information of China (English)

    王晓菊; 李雪萍

    2015-01-01

    Objective To investigate the effects of therapeutic equipment that aimed to improve cerebrovascular func⁃tion combined with electric standing bed on balance disorder following cerebellar infarction. Methods Fifty patients with balance disorder after cerebellar infarction were randomized into study and control groups. Agreed routine rehabilitation ther⁃apy including automatic standing bed and medication were given to both groups. In addition, therapeutic equipment that aim to improve cerebrovascular function were delivered to patients in study group. The effects were assessed using Fugl-Meyer balance function scale and Barthel index (BI) before and after 4 weeks of treatment. Results Study group and control group did not present difference between FM-B grade and BI before treatment (P>0.05). Both FM-B and BI were improved after treatment (P0.05),治疗后与治疗前比较2组均有改善(P<0.05),治疗组优于对照组(P<0.05)。治疗组总显效率高于对照组(P<0.05)。治疗过程中未见明显不良反应。结论小脑梗死后平衡障碍患者在常规康复治疗基础上辅以脑循环功能治疗仪联合电动起立床训练,可提高平衡能力和日常生活能力。

  6. Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone? MRI evaluation of zonal anatomy and infarction after PAE

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yen-Ting [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Department of Radiology, Taichung Veterans General Hospital, Taichung City (China); Amouyal, Gregory; Pereira, Helena; Del Giudice, Costantino; Dean, Carole [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Correas, Jean-Michel [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Hopital Necker, Radiology Department, Paris (France); Pellerin, Olivier; Sapoval, Marc [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Inserm (Institut national de la sante et de la recherche medicale) U970, Paris (France); Universite Paris Descartes, Paris (France); Thiounn, Nicolas [Assistance Publique Hopitaux de Paris, Hopital Europeen Georges-Pompidou, Urology, Paris (France)

    2016-10-15

    To assess the impact of prostatic arterial embolisation (PAE) on various prostate gland anatomical zones. We retrospectively reviewed paired MRI scans obtained before and after PAE for 25 patients and evaluated changes in volumes of the median lobe (ML), central gland (CG), peripheral zone (PZ) and whole prostate gland (WPV) following PAE. We used manual segmentation to calculate volume on axial view T2-weighted images for ML, CG and WPV. We calculated PZ volume by subtracting CG volume from WPV. Enhanced phase on dynamic contrasted-enhanced MRI was used to evaluate the infarction areas after PAE. Clinical results of International Prostate Symptom Score and International Index of Erectile Function questionnaires and the urodynamic study were evaluated before and after PAE. Significant reductions in volume were observed after PAE for ML (26.2 % decrease), CG (18.8 %), PZ (16.4 %) and WPV (19.1 %; p < 0.001 for all these volumes). Patients with clinical failure had smaller volume reductions for WPV, ML and CG (all p < 0.05). Patients with significant CG infarction after PAE displayed larger WPV, ML and CG volume reductions (all p < 0.01). PAE can significantly decrease WPV, ML, CG and PZ volumes, and poor clinical outcomes are associated with smaller volume reductions. (orig.)

  7. Novel compound heterozygous mutations in a child with Ataxia-Telangiectasia showing unrelated cerebellar disorders.

    Science.gov (United States)

    Piane, Maria; Molinaro, Anna; Soresina, Annarosa; Costa, Silvia; Maffeis, Marianna; Germani, Aldo; Pinelli, Lorenzo; Meschini, Roberta; Plebani, Alessandro; Chessa, Luciana; Micheli, Roberto

    2016-12-15

    We report the case of a 6-year-old female patient with Ataxia Telangiectasia, an extremely rare condition, who developed in addition a left cerebellar astrocytoma and a right cerebellar infarction, considered as two independent events. Children with AT have an increased risk of developing cancer, but only few cases of glioma are reported and, at our knowledge, no other case of unrelated cerebellar glioma and cerebellar infarction in with the same AT patient have been described. The molecular analysis of ATM (Ataxia Telangiectasia Mutated) gene showed that the patient is compound heterozygote for two previously unreported mutations: c.3291delC (p.Phe1097fs) at exon 25 and c.8198A>C (p.Gln2733Pro) at exon 58. The role of the identified ATM gene mutations in the pathogenesis of Ataxia Telangiectasia and the coexisting cerebellar disorders is discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Fatal outcome after brain stem infarction related to bilateral vertebral artery occlusion - case report of a detrimental complication of cervical spine trauma

    Directory of Open Access Journals (Sweden)

    Beauchamp Kathryn M

    2011-07-01

    Full Text Available Abstract Background Vertebral artery injury (VAI after blunt cervical trauma occurs more frequently than historically believed. The symptoms due to vertebral artery (VA occlusion usually manifest within the first 24 hours after trauma. Misdiagnosed VAI or delay in diagnosis has been reported to cause acute deterioration of previously conscious and neurologically intact patients. Case presentation A 67 year-old male was involved in a motor vehicle crash (MVC sustaining multiple injuries. Initial evaluation by the emergency medical response team revealed that he was alert, oriented, and neurologically intact. He was transferred to the local hospital where cervical spine computed tomography (CT revealed several abnormalities. Distraction and subluxation was present at C5-C6 and a comminuted fracture of the left lateral mass of C6 with violation of the transverse foramen was noted. Unavailability of a spine specialist prompted the patient's transfer to an area medical center equipped with spine care capabilities. After arrival, the patient became unresponsive and neurological deficits were noted. His continued deterioration prompted yet another transfer to our Level 1 regional trauma center. A repeat cervical spine CT at our institution revealed significantly worsened subluxation at C5-C6. CT angiogram also revealed complete occlusion of bilateral VA. The following day, a repeat CT of the head revealed brain stem infarction due to bilateral VA occlusion. Shortly following, the patient was diagnosed with brain death and care was withdrawn. Conclusion Brain stem infarction secondary to bilateral VA occlusion following cervical spine trauma resulted in fatal outcome. Prompt imaging evaluation is necessary to assess for VAI in cervical trauma cases with facet joint subluxation/dislocation or transverse foramen fracture so that treatment is not delayed. Additionally, multiple transportation events are risk factors for worsening when unstable cervical

  9. Cerebellar diaschisis in pontine infractions: a report of five cases

    Energy Technology Data Exchange (ETDEWEB)

    Tsuda, Yoshiyasu [Kagawa Medical School (Japan). Second Dept. of Internal Medicine; Ayada, Yoshihide [Kagawa Medical School (Japan). Second Dept. of Internal Medicine; Izumi, Yoshinari [Kagawa Medical School (Japan). Second Dept. of Internal Medicine; Ichihara, Sin-Ichiro [Kagawa Medical School (Japan). Second Dept. of Internal Medicine; Hosomi, Naohisa [Kagawa Medical School (Japan). Second Dept. of Internal Medicine; Ohkawa, Motoomi [Kagawa Medical School (Japan). Dept. of Radiology; Matsuo, Hirohide [Kagawa Medical School (Japan). Second Dept. of Internal Medicine

    1995-05-01

    We evaluate regional cerebral and cerebellar perfusion to prove the occurrence and follow the persistence of crossed cerebellar diaschisis in infratentorial pontine infarction. Six consecutive patients exhibiting mild hemiparetic symptoms or a heavy feeling in the head (mean age 65 years; four women, two men) and diagnosed as having pontine infarction by magnetic resonance imaging were sugjected to evaluation. Lesions due to infarction were located at the upper basis pontis in five partients and the upper tegmentum pontis in one, and medially at the paramedian portion in four and laterally in two. Regional cerebral and cerebellar perfusion was evaluated semiquantitatively by iodine-123 N-isopropyl-p-iodoamphetamine (IMP) single-photon emission tomography (SPET); this was done during the acute stage in five cases (mean time after onset: 0.7 months) and during the chronic stage in three (mean time after onset: 14.8 months) Significant asymmetry in cerebellar perfusion, which was reduced in the contralateral or ipsilateral cerebellar hemisphere, was demonstrated semiquantitatively in four cases during the acute stage and in one during the chronic stage, as compared with normal controls. This asymmetry continued to the chronic stage (6.5 and 33.0 months) in two cases, while no patient showed any significant asymmetries in cerebral perdusion in any region of interest in either SPET study. The pontine lesion may damage the pyramidal tract and corticocerebellar pathway, and interruption of the cerebrocerebellar pontine circuits may be regarded as the cause of the crossed cerebellar diaschisis observed in five of the six reported patients with pontine infarction. (orig.)

  10. Cerebellar giant cell glioblastoma multiforme in an adult

    Directory of Open Access Journals (Sweden)

    Sudhansu Sekhar Mishra

    2014-01-01

    Full Text Available Cerebellar glioblastoma multiforme (GBM is a rare tumor that accounts for only 1% of all cases of GBM and its giant cell variant is even much rarely encountered in adults. A case of cerebellar giant cell GBM managed at our institution reporting its clinical presentation, radiological and histological findings, and treatment instituted is described. In conjunction, a literature review, including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options, and the behavior of such malignant tumor is presented. It is very important for the neurosurgeon to make the differential diagnosis between the cerebellar GBM, and other diseases such as metastasis, anaplastic astrocytomas, and cerebellar infarct because their treatment modalities, prognosis, and outcome are different.

  11. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke

    DEFF Research Database (Denmark)

    Thomsen, Barbara Blicher; Garosi, Laurent; Skerritt, Geoff

    2016-01-01

    Background: In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined to the hospita...

  12. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke

    DEFF Research Database (Denmark)

    Thomsen, Barbara; Garosi, Laurent; Skerritt, Geoff;

    2016-01-01

    Background: In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined to the hospita...

  13. Bilateral otogenic cerebellar abscesses.

    Directory of Open Access Journals (Sweden)

    Nadkarni T

    1993-01-01

    Full Text Available An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.

  14. Microsurgical anatomy and clinic significance of posterior inferior cerebellar artery%小脑后下动脉的显微解剖研究及其临床意义

    Institute of Scientific and Technical Information of China (English)

    吴江; 张世明; 徐峰

    2010-01-01

    目的 研究小脑后下动脉的显微解剖,为神经外科手术提供临床解剖资料.方法 手术显微镜下观察测量20具(共40侧)人脑标本的小脑后下动脉(PICA)的起始行径、直径、主要分支、穿动脉及分布,检查PICA与脑神经根的关系.结果 40侧标本共发出PICA 35支,平均管径(1.6±0.6)mm,距离椎基底动脉汇合点平均(16±5)mm.在35支PICA中28支PICA走行在第Ⅻ脑神经根之间,7支走行在第Ⅻ脑神经根下方,32支走行在第Ⅺ脑神经根之间.结论 PICA是椎基动脉系统重要的分支,变异多,走行与脑神经关系密切,熟悉解剖结构,在后颅窝手术中予以保护具有重要意义.%Objective To study the microsurgical anatomy of the posterior inferior cerebellar artery (PICA) for neurosurgery. Methods Twenty Chinese adult brain samples (40 sides) were measured with microscope for the diameters, lengths, origins, courses, and the branches of the PICA. The relationship between the PICA and cranial nerves was also checked. Results There were 35 PICAs in 20 brain samples.The mean diameter of the PICAs was (1.6±0.6) mm, the mean length from PICAs' origin of vertebral artery to the vertebrobasilar junction was (16±5) mm. In 35 PICAs,28 PICAs go through the rootlets of Ⅻ cranial nerves,7 PICAs go inferior Ⅻ cranial nerves, and 32 PICAs go through the rootlets of Ⅺ cranial nerves. Conclusions PICA is an important branch artery with more variation and complex relationship to the cranial nerves trend in the vertebral artery system. It is necessary to master the microsurgical anatomy of PICA and to be careful protection during the neurosurgical operations.

  15. Analysis the relationship between infarct pattern and collateral circulation in patients with internal carotid artery occlusion%颈动脉闭塞患者脑梗死类型及侧支循环关系分析

    Institute of Scientific and Technical Information of China (English)

    李喜朋; 张洪涛; 王连芹; 聂彦国; 李永才

    2011-01-01

    Objective: To study the infarct pattern in patients with internal carotid artery occlusion (ICAO) and analyse the relationship between infarct pattern and collateral circulation. Methods: the MRI, DSA and TCD results of 27 patients with cerebral infarction who were confirmed ICAO by DSA were analyzed. Results: 8 cases (29.6%) were single infarction, 19 cases (70.4%) were multiple infarction. 6 cases (22.2%) were cortical infarct, 10 cases (37.0%) were subcortical infarct, 7 cases (25.9%) were diffused infarct and 8 cases (29.6%) were interfacial infarct. In the ways of collateral circulation, 14 cases were compensated by anterior communicating artery, 10 cases by posterior communicating artery, 6 cases by ophthalmic artery and 11 cases by pia mater. Among the 8 cases with single infarction, 6 cases had two kinds of compensatory ways, 2 cases had one kind of compensatory way, however among the 19 cases with multiple infarction, only 5 cases had two kinds of compensatory way, 14 cases had one kind of compensatory way. Conclusion: The infarct pattern in patients with ICAO are various. Subcortical and nterfacial infarcts are the common pattern. There are various ways of collateral circulation to compensate the blood supplying of brain after ICAO, and the compensatory ways of single infarct are more than others.%目的:探讨颈内动脉闭塞(ICAO)患者的梗死类型及其与侧支循环的关系.方法:分析经脑血管造影证实为ICAO的27例脑梗死患者的头颅核磁共振、脑血管造影及经颅多普勒结果.结果:8例(29.6%)为单发梗死,19例(70.4%)为多发性梗死.皮层区域梗死6例(22.2%),皮质下梗死10例(37.0%),弥散性梗死7例(25.9%),交界区梗死8例(29.6%).侧支循环途径包括经前交通动脉代偿14例,经后交通动脉代偿10例,经眼动脉代偿6例,经软膜吻合8例.8例单发梗死中,6例有2种代偿方式,2例有1种代偿方式,而19例多发梗死中,仅5例有2种代偿方式,14例有1种代偿方式.

  16. Multimodality imaging of pulmonary infarction

    Energy Technology Data Exchange (ETDEWEB)

    Bray, T.J.P., E-mail: timothyjpbray@gmail.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); Mortensen, K.H., E-mail: mortensen@doctors.org.uk [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); University Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 318, Cambridge CB2 0QQ (United Kingdom); Gopalan, D., E-mail: deepa.gopalan@btopenworld.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom)

    2014-12-15

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis.

  17. Successfull management of a life threatening cerebellar haemorrhage following spine surgery - a case report -.

    Science.gov (United States)

    Pallud, Johan; Belaïd, Hayat; Aldea, Sorin

    2009-06-01

    Cerebellar haemorrhages are rare life-threatening complications following spine surgery that present challenges for their diagnostic and their therapeutic management. Their patho-physiology remains unclear.We report a case of a life-threatening cerebellar haemorrhage secondary to an occult dural tear following a planned L5-S1 laminectomy. The patient was treated with emergent external ventriculostomy following by a posterior fossa decompressive craniectomy. Cerebellar haemorrhages have to be suspected systematically when unexpected neurological signs occur after spine surgery since their rapid management lead to favourable outcomes. The present imaging findings allow us proposing that cerebellar haemorrhages result primarily from superior cerebellar venous stretching and tearing, and that cerebellar infarction and swelling occur secondarily.

  18. Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries.

    Science.gov (United States)

    Hermens, Jeannine A J M; van Es, Jan; von Birgelen, Clemens; Op den Akker, Jeroen W; Wagenaar, Lodewijk J

    2014-08-01

    Patients with acute chest pain, electrocardiographic ST-elevation and significant elevation of cardiac troponin but without obstructive coronary artery disease represent a diagnostic and therapeutic dilemma. Cardiac magnetic resonance imaging (CMR) can elucidate underlying alternative causes of troponin elevation including detection of (minor) myocardial infarction (MI) by identifying myocardial scarring as delayed enhancement. Of 77 patients, who were admitted between March 2009 and December 2012 with electrocardiographic (ECG) and biochemical evidence of acute MI without obstructive coronary artery disease, 45 patients underwent CMR that showed in 11/77 (14%) late gadolinium enhancement (LGE), compatible with myocardial scarring. We analyzed clinical, echocardiographic, and CMR data of these patients. Elevated troponin I levels were observed in all patients (median 1.3 ng/l, IQR 0.44-187) with median peak creatinine phosphokinase of 485 U/l (IQR 234-618). Echocardiographic wall motion abnormalities were detected in 8/11 (73%) patients; in 75% of these segments, ECG abnormalities were observed in corresponding leads. CMR detected LGE in the inferior (4/11), the inferolateral (5/11), the inferoseptal (2/11), the anterior (3/11), apical (3/11) and in the lateral segments (2/11). In addition, in all but two patients, these segments matched ECG abnormalities in corresponding leads. CMR identified microvascular obstruction in 4/11 (36%) patients. Patients with clinical, ECG, and biochemical signs of acute MI but unobstructed coronary arteries may have CMR-detectable myocardial scars. Information on myocardial scarring may help to make the diagnosis and draw therapeutic consequences. This case series underlines the value of contrast-enhanced CMR for myocardial tissue characterization.

  19. A myocardial infarction-associated SNP at 6p24 interferes with MEF2 binding and associates with PHACTR1 expression levels in human coronary arteries

    Science.gov (United States)

    Won, Hong-Hee; Lo, Ken Sin; Do, Ron; Henderson, Christopher A.; Lavoie-St-Amour, Claire; Langlois, Simon; Rivas, Daniel; Lehoux, Stephanie; Kathiresan, Sekar; Tardif, Jean-Claude; Musunuru, Kiran; Lettre, Guillaume

    2015-01-01

    Objective Coronary artery disease (CAD), including myocardial infarction (MI), is the main cause of death in the world. Genome-wide association studies (GWAS) have identified dozens of single nucleotide polymorphisms (SNPs) associated with CAD/MI. One of the most robust CAD/MI genetic associations is with intronic SNPs in the gene PHACTR1 on chromosome 6p24. How these PHACTR1 SNPs influence CAD/MI risk, and whether PHACTR1 itself is the causal gene at the locus, is currently unknown. Approach and results Using genetic fine-mapping and DNA re-sequencing experiments, we prioritized an intronic SNP (rs9349379) in PHACTR1 as causal variant.We showed that this variant is an expression quantitative trait locus (eQTL) for PHACTR1 expression in human coronary arteries. Experiments in endothelial cell extracts confirmed that alleles at rs9349379 are differentially bound by the transcription factors MEF2. We engineered a deletion of this MEF2 binding site using CRISPR/Cas9 genome-editing methodology. Heterozygous endothelial cells carrying this deletion express 35% less PHACTR1. Finally, we found no evidence that PHACTR1 expression levels are induced when stimulating human endothelial cells with VEGF, TNFα or shear stress. Conclusions Our results establish a link between intronic SNPs in PHACTR1, MEF2 binding and transcriptional functions at the locus, PHACTR1 expression levels in coronary arteries and CAD/MI risk. Because PHACTR1 SNPs are not associated with the traditional risk factors for CAD/MI (e.g. blood lipids or pressure, diabetes), our results suggest that PHACTR1 may influence CAD/MI risk through as yet unknown mechanisms in the vascular endothelium. PMID:25838425

  20. Iatrogenic postoperative cerebellar cyst.

    Science.gov (United States)

    Sharif, Robin; Moscovici, Samuel; Wygoda, Marc; Eliahou, Ruth; Spektor, Sergey

    2016-12-01

    Cerebellar cyst is a known but uncommon entity. It is congenital in most cases, or may develop after brain parenchyma injuries or interventions. To our knowledge, de novo cerebellar cyst after extra-axial tumor excision, has not been described in the literature. We present the first reported case of a de novo cerebellar cyst developing in a 70-year-old woman following retrosigmoid craniotomy for vestibular schwannoma excision, and discuss the possible causes. Following cyst fenestration, there was no clinical or radiological evidence of a residual cyst. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. The microvasculature of the human cerebellar meninges.

    Science.gov (United States)

    Nonaka, Hiroko; Akima, Michiko; Hatori, Tsutomu; Nagayama, Tadashi; Zhang, Zean; Ihara, Fumie

    2002-12-01

    The vascular architecture of the human cerebellar meninges was investigated. The surface meninges were poor in vasculature. In the sulci, the meninges were highly vascular but had few capillaries. The venous blood vessels gave long side branches at right angles to the parent vessels in a cruciform pattern, running horizontally along the cerebellar sulci. They were situated at the origin of the secondary or tertiary sulci. Anastomoses between these horizontal branches gave a crosshatched appearance. Short branches often extended to the bases of the sulci, terminating in T-shaped bifurcations with numerous tiny branches, like the roots of a tree. The arteries ran perpendicular to venous branches which were parallel to each other exclusively along the sagittal plane. These arteries bifurcated to straddle the horizontally running veins at the origin of the secondary or tertiary sulci. They gave off many small branches like teeth of a fork from each artery in the secondary or tertiary sulci after they bifurcated to straddle the venous branches and penetrated the cerebellar cortex at the bases of sulci. These fork-like ramifications in the bases of the sulci were most likely responsible for the ready development of pronounced ischemic state. They might also play an important role in the occurrence of ischemic damage at the bases of sulci in cases of severe generalized ischemia.

  2. Relationship between diffusion tensor fractional anisotropy and long-term motor outcome in patients with hemiparesis after middle cerebral artery infarction.

    Science.gov (United States)

    Koyama, Tetsuo; Marumoto, Kohei; Miyake, Hiroji; Domen, Kazuhisa

    2014-10-01

    Magnetic resonance diffusion tensor fractional anisotropy (DTI-FA) is often used to characterize neural damage after stroke. Here we assessed the relationship between DTI-FA and long-term motor outcome in patients after middle cerebral artery (MCA) infarction. Fractional anisotropy (FA) maps were generated from diffusion tensor brain images obtained from 16 patients 14-18 days postinfarction, and tract-based spatial statistics (TBSS) analysis was applied. Regions of interest were set within the right and left corticospinal tracts, and mean FA values were extracted from individual TBSS data. Hemiparesis motor outcome was evaluated according to Brunnstrom stage (BRS: 1-6, severe-normal) for separate shoulder/elbow/forearm, hand, and lower extremity functions, as well as the motor component score of the Functional Independence Measure (FIM-motor: 13-91, null-full) 5-7 months after onset. Ratios between FA values in the affected and unaffected hemispheres (rFA) were assessed by BRS and FIM-motor scores. rFA values were .636-.984 (median, .883) and BRS scores were 1-6 (median, 3) for shoulder/elbow/forearm, 2-6 (median, 3) for hand, and 3-6 (median, 5) for the lower extremities. FIM-motor scores were 51-90 (median, 75). Analysis revealed significant relationships between rFA and BRS data (correlation coefficient: .687 for shoulder/elbow/forearm, .579 for hand, and .623 for lower extremities) but no significance relationship between rFA and FIM-motor scores. The results suggest that DTI-FA is applicable for predicting the long-term outcome of extremity functions after MCA infarction. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Bare-metal stenting of large coronary arteries in ST-elevation myocardial infarction is associated with low rates of target vessel revascularization.

    Science.gov (United States)

    Shugman, Ibrahim M; Hee, Leia; Mussap, Christian J; Diu, Patrick; Lo, Sidney; Hopkins, Andrew P; Nguyen, Phong; Taylor, David; Rajaratnam, Rohan; Leung, Dominic; Thomas, Liza; Juergens, Craig P; French, John K

    2013-04-01

    During percutaneous coronary intervention (PCI) performed in the emergent setting of ST-segment elevation myocardial infarction (STEMI), uncertainty about patients' ability to comply with 12 months dual antiplatelet therapy after drug-eluting stenting is common, and thus, selective bare-metal stent (BMS) deployment could be an attractive strategy if this achieved low target vessel revascularization (TVR) rates in large infarct-related arteries (IRAs) (≥3.5 mm). To evaluate this hypothesis, among 1,282 patients with STEMI who underwent PCI during their initial hospitalization, we studied 1,059 patients (83%) who received BMS, of whom 512 (48%) had large IRAs ≥3.5 mm in diameter, 333 (31%) had IRAs 3 to 3.49 mm, and 214 (20%) had IRAs <3 mm. At 1 year, TVR rate in patients with BMS was 5.8% (2.2% with large BMS [≥3.5 mm], 9.2% with BMS 3-3.49 mm [intermediate], and 9.0% with BMS <3.0 mm [small], P < .001). The rates of death/reinfarction among patients with large BMS compared with intermediate BMS or small BMS were lower (6.6% vs 11.7% vs 9.0%, P = .042). Among patients who received BMS, the independent predictors of TVR at 1 year were the following: vessel diameter <3.5 mm (odds ratio [OR] 4.39 [95% CI 2.24-8.60], P < .001), proximal left anterior descending coronary artery lesions (OR 1.89 [95% CI 1.08-3.31], P = .027), hypertension (OR 2.01 [95% CI 1.17-3.438], P = .011), and prior PCI (OR 3.46 [95% CI 1.21-9.85], P = .02). The predictors of death/myocardial infarction at 1 year were pre-PCI cardiogenic shock (OR 8.16 [95% CI 4.16-16.01], P < .001), age ≥65 years (OR 2.63 [95% CI 1.58-4.39], P < .001), left anterior descending coronary artery culprit lesions (OR 1.95 [95% CI 1.19-3.21], P = .008), female gender (OR 1.93 [95% CI 1.12-3.32], P = .019), and American College of Cardiology/American Heart Association lesion classes B2 and C (OR 2.17 [95% CI 1.10-4.27], P = .026). Bare-metal stent deployment in STEMI patients with IRAs ≥3.5 mm was associated

  4. [Streptokinase in impending heart infarct].

    Science.gov (United States)

    Kiemeneij, F; Schuilenburg, R M

    1989-02-18

    A patient is described with an impending myocardial infarction due to presence of an intracoronary thrombus in an otherwise normal left anterior descending artery. This case illustrates that intracoronary and intravenous administration of streptokinase can be of value in the treatment of impending myocardial infarction.

  5. Association of the Fibonacci Cascade with the distribution of coronary artery lesions responsible for ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Gibson, C Michael; Gibson, William J; Murphy, Sabina A; Marble, Susan J; McCabe, Carolyn H; Turakhia, Minang P; Kirtane, Ajay J; Karha, Juhana; Aroesty, Julian M; Giugliano, Robert P; Antman, Elliott M

    2003-09-01

    This is the first study to demonstrate the appearance of the Fibonacci Cascade within the distribution of coronary artery lesions in the human heart. The propensity for this ratio to appear in nature may also be because this ratio optimizes the efficiency of packing structures in a limited space in such a way that wasted space is minimized and the supply of energy or nutrients is optimized.

  6. 后颅凹减压加脑室外引流治疗大面积小脑梗死78例分析%Analysis of posterior fossa decompression and brain outdoor drainage in the treatment of 78 cases of large area of cerebellar infarction

    Institute of Scientific and Technical Information of China (English)

    马清涛

    2014-01-01

    Objective:To explore the effect of posterior fossa decompression and brain outdoor drainage in the treatment of large area of cerebellar infarction.Methods:78 patients with large area of cerebellar infarction were selected from March 2009 to June 2014.Patients were prone position with general anesthesia.6.0 cm×7.0 cm window was opened along the suboccipital midline.The right occipital horn of lateral ventricle drainage was given.Part of the softening of necrotic brain tissue was removed.The incision was sutured.After operation,patients were given intensive care.After 1 week,external ventricular drainage tube was pulled out. Results:On the second day after operation,78 patients with consciousness were restored,and there was no death.After 3 months to 5 years follow-up,according to the physiscal self-maintenance scale,the patients were assessed:46 cases(59%) were gradeⅠ;14 cases(17.9%) were grade Ⅱ;8 patients(10.3%) were grade Ⅲ;6 patients were grade Ⅳ;4 cases(5.1%) were grade Ⅴ.The complications after operation:11 cases(14.1%) had vertigo;11 cases(14.1%) had dysphagia;5 cases(6.4%) had hearing loss;16 cases(20.5%) had ataxia;5 cases(6.4%) had hoarseness.Conclusion:The effect of posterior fossa decompression and brain outdoor drainage in the treatment of large area of cerebellar infarction is significant.The operation is simple and easy to operate.It is worthy of popularization.%目的:探讨后颅凹减压加脑室外引流治疗大面积小脑梗死的临床效果。方法:2009年3月-2014年6月收治大面积小脑梗死患者78例,患者取俯卧位,采取全身麻醉,沿枕下正中开6.0 cm×7.0 cm窗口,行右侧枕角脑室外引流术,切除部分软化坏死的脑组织,缝合切口。术后进行重症监护,1周后拔出脑室外引流管。结果:78例患者术后第2天均恢复意识,无死亡病例发生,经过3个月~5年的随访,根据日常生活能力量表(physiscal self-maintenance scale

  7. Observation of the clinical effect of alprostadil combined with granisetron in the treatment of dizziness after cerebellar infarction%前列地尔联合格拉司琼治疗小脑梗死后眩晕的疗效观察

    Institute of Scientific and Technical Information of China (English)

    曾彪; 阙清松; 孙军德

    2016-01-01

    Objective To investigate the clinical treatment effect of alprostadil combined with granisetron in the treat‐ment of dizziness after cerebellar infarction ,so as to provide reference basis for the clinical study .Methods Forty patients with cerebellar infarction from 2011 to 2014 in our hospital were chosen .They were randomly divided into the treatment group (al‐prostadil combined with granisetron group )of 20 cases and control group(simply alprostadil group)of 20 cases .The clinical o‐verall treatment effect ,Barthel index and Berg balance scale score of the two groups were observed and compared .Results The total efficiency rates of two groups were compared ,the rate of treatment group was higher than that of control group ,the difference was significant(P<0.05) .The differences of the Barthel index and Berg balance scale score of two groups before the treatment were not significant .After treatment ,the above indicators of the two groups after the treatment were significantly in‐creased ,the differences were significant(P<0.05) .After treatment ,the above indicators of treatment group after the treatment were significantly higher than those of control group ,the differences were significant(P<0.05) .Conclusion The symptoms of vertigo of alprostadil combined with granisetron in the treatment of dizziness after cerebellar infarction can be significantly im‐proved ,and the combination therapy can improve clinical effect .%目的:探讨前列地尔联合格拉司琼治疗小脑梗死后眩晕的临床效果。方法选取2011—2014年我院收治的小脑梗死后眩晕患者40例为研究对象,随机分成治疗组和对照组各20例,分别给予前列地尔联合格拉司琼治疗和单纯前列地尔治疗。观察2组临床治疗效果、Barthel指数评分和Berg平衡量表评分。结果临床总有效率组间比较,治疗组高于对照组,差异有统计学意义(P<0.05)。治疗前2组Barthel指数评分和Berg平衡量表

  8. 小脑后下动脉远端动脉瘤的临床治疗%Clinical treatment of aneurysm of distal part of posterior inferior cerebellar artery

    Institute of Scientific and Technical Information of China (English)

    王云彦; 李学恩; 李刚; 李新钢

    2011-01-01

    目的 总结小脑后下动脉( PICA)远端动脉瘤的临床特点,探讨其临床治疗方式的选择.方法 回顾性研究16例PICA远端动脉瘤的临床特点及治疗.6例行后正中入路开颅动脉瘤夹闭术;4例行枕下远外侧入路动脉瘤夹闭术;6例行血管内栓塞术.结果 术后15例恢复良好,1例死亡,1例合并交通性脑积水,行脑室-腹腔分流术.15例出院时均无神经系统阳性体征,随访患者恢复良好.结论 对于PICA远端动脉瘤的治疗,应根据患者的临床情况及动脉瘤和PICA的形态,可以选择开颅夹闭或血管内栓塞.%Objective To study the clinical features and surgical treatment of aneurysms of distal part of posterior inferior cerebellar artery (PICA).Methods The clinical features and treatment of sixteen cases with aneurysms of distal part of PICA within last 3 years were studied retrospectively.Six patients underwent clipping of aneurysm through the middle posterior approach,four underwent clipping through suboccipital lateral approach,and the other underwent endovascular embolization.Results The postoperative course of fifteen patients was uneventful and one patient dead from the respiratory and circulatory complications.Fifteen patients were discharged without neurological deficits and remained well in follow - up.Conclusions As for a given patient with aneurysms of distal part of PICA,whether surgical or endovascular treatment should be selected depending on the attitude of the neurosurgeon and the patient,especially the clinical condition of the patient and morphology of the artery and aneurysm.

  9. 基底动脉发育不良与后循环梗死的相关性%Association between basilar artery hypoplasia and posterior circulation infarction

    Institute of Scientific and Technical Information of China (English)

    张志勇; 刘尊敬; 田朝晖; 唐文雄; 刘玮; 薛爽; 焦劲松

    2014-01-01

    其卒中防治工作。%Objective To explore the relationship between basal artery hypoplasia ( BAH ) and posterior circulation ischemic stroke and its clinical characteristics to improve the understanding of BAH. Methods A total of 328 hospitalized patients from April 2012 to April 2014 were enrolled retrospectively. With normal course and regular shape of basilar artery on brain magnetic resonance angiography ( MRA) , other causes of posterior circulation ischemic stroke were excluded.They were divided into BAH ( n=48 ) and non-BAH (n=280) groups according to the morphology and diameter of basilar artery on head MRA. We compared the general information and intracranial vascular variations between two groups, especially the incidence rate of posterior circulation infarction and mean blood flow velocity ( Vm ) of basal artery by analyzing clinical information and MRI findings.Meantime, their clinical outcomes were observed through follow-ups.And detailed clinical features were discussed for the patients with posterior circulation infarction in the BAH group.Results ( 1 ) The concurrent lesions included vertebral artery intracranial segment hypoplasia (n=24, VAH), fetal type posterior artery (n=18, FTPA), persistent trigeminal artery (n=1) and giant fenestration variation on vertebral artery ( n=1 ) in the BAH group.In comparison, it was more liable to cranial vascular variations in the BAH group ( P BAH group ( P<0.05).(3) these cases with stroke in two groups had no mortality during a follow-up period of 4-28 months.There were 3 cases with recurrent posterior circulation stroke in the non-BAH group.The number of cases with mRS scoring 2 points or less in the BAH group was more than that in the non-BAH group at discharge, 30 or 90 days after discharge ( P<0.05 ) .( 4 ) these cases with posterior circulation stroke in the BAH group often presented as lacunar syndrome (9/17), paramedian infarction in pons (9/17) and bilateral VAH plus unilateral FTPA (8/17).Conclusion As a relatively rare disease, BAH

  10. Striatocapsular infarction: MRI and MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Croisille, P. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Turjman, F. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Croisile, B. (Dept. of Neurology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Tournut, P. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Laharotte, J.C. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Aimard, G. (Dept. of Neurology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Trillet, M. (Dept. of Neurology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Duquesnel, J. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Froment, J.C. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre

    1994-08-01

    We present a case of left striatocapsular infarction manifest clinically as a transient right hemiparesis. MRI showed a left striatocapsular infarct. Striatocapsular infarction, unlike lacunar infarction, is often associated with occlusive disease of the carotid artery. In order to screen the carotid vessels, cervical MR angiography (MRA) was performed during the same examination, demonstrating a left internal carotid artery occlusion, confirmed by contrast arteriography. MRA, a noninvasive modality, can be a useful adjunct to MRI, when diagnostic information concerning the cervical carotid artery is needed. (orig.)

  11. Analysis of MMP-7 and TIMP-2 gene polymorphisms in coronary artery disease and myocardial infarction: A Turkish case-control study.

    Science.gov (United States)

    Alp, Ebru; Yilmaz, Akin; Tulmac, Murat; Ugras Dikmen, Asiye; Cengel, Atiye; Yalcin, Ridvan; Menevse, Emine Sevda

    2017-02-01

    Matrix metalloproteinase (MMP) and tissue inhibitors of metalloproteinase (TIMP) have a significant role in tissue remodeling related to cardiac function. In earlier studies, MMP-7 A-181G (rs11568818), C-153T (rs11568819), C-115T (rs17886546), and TIMP-2 G-418C (rs8179090) polymorphisms have been studied in various diseases. However, association between coronary artery disease (CAD) and these polymorphisms has been poorly studied. The goal of this study is to investigate the association of CAD and myocardial infarction (MI) with MMP-7 or TIMP-2 polymorphisms. This study included 122 CAD patients and 132 control individuals. DNA was extracted from whole blood. Polymerase chain reaction-restriction fragment length polymorphism and automated direct sequencing method were used for genotyping of these polymorphisms. No significant differences were found between MMP-7 A-181G, C-115T, and TIMP-2 G-418C polymorphism and CAD or MI in a Turkish population. Despite the fact that the genotypes of MMP-7 C-153T polymorphism had no significant differences among MI and control groups, allele frequencies of C-153T polymorphism were significantly different between the two groups. Our study is the first report to clarify the appreciable relationship between MMP-7 C-153T polymorphism and MI development in CAD patients. However, these findings also need to be confirmed in other populations so we can improve our knowledge about the genetic factors affecting the development of CAD. Copyright © 2017. Published by Elsevier Taiwan.

  12. Analysis of MMP-7 and TIMP-2 gene polymorphisms in coronary artery disease and myocardial infarction: A Turkish case-control study

    Directory of Open Access Journals (Sweden)

    Ebru Alp

    2017-02-01

    Full Text Available Matrix metalloproteinase (MMP and tissue inhibitors of metalloproteinase (TIMP have a significant role in tissue remodeling related to cardiac function. In earlier studies, MMP-7 A-181G (rs11568818, C-153T (rs11568819, C-115T (rs17886546, and TIMP-2 G-418C (rs8179090 polymorphisms have been studied in various diseases. However, association between coronary artery disease (CAD and these polymorphisms has been poorly studied. The goal of this study is to investigate the association of CAD and myocardial infarction (MI with MMP-7 or TIMP-2 polymorphisms. This study included 122 CAD patients and 132 control individuals. DNA was extracted from whole blood. Polymerase chain reaction-restriction fragment length polymorphism and automated direct sequencing method were used for genotyping of these polymorphisms. No significant differences were found between MMP-7 A-181G, C-115T, and TIMP-2 G-418C polymorphism and CAD or MI in a Turkish population. Despite the fact that the genotypes of MMP-7 C-153T polymorphism had no significant differences among MI and control groups, allele frequencies of C-153T polymorphism were significantly different between the two groups. Our study is the first report to clarify the appreciable relationship between MMP-7 C-153T polymorphism and MI development in CAD patients. However, these findings also need to be confirmed in other populations so we can improve our knowledge about the genetic factors affecting the development of CAD.

  13. Omega-3 Status and the Relationship between Plasma Asymmetric Dimethylarginine and Risk of Myocardial Infarction in Patients with Suspected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Heidi Borgeraas

    2012-01-01

    Full Text Available Background. Asymmetric dimethylarginine (ADMA is an endogenous inhibitor of nitric oxide synthase. A previous rat study revealed an ADMA lowering effect following treatment with omega-3 polyunsaturated fatty acids (n-3 PUFAs. We sought to examine if an association between plasma ADMA and risk of acute myocardial infarction (AMI was modified by serum n-3 PUFA status. Methods. The cohort included 1364 patients who underwent coronary angiography for suspected coronary artery disease in 2000-2001. Fatal and nonfatal AMI events were registered until December 31, 2006. Risk associations with AMI were estimated across ADMA quartiles (linear trend and the upper decile. Results. No association between concentration of any n-3 PUFA and ADMA was observed. Only ADMA levels in upper decile were significantly associated with AMI with a multivariate adjusted hazard ratio (HR (95% confidence interval versus the rest of the population of 2.11 (1.34, 3.32. The association was strengthened among patients with below median levels of α-linolenic acid (ALA (HR 3.12 (1.64, 5.93, but was only influenced by longer chain n-3 PUFA after additional adjustments for HbA1c, estimated glomerular filtration rate, and hypercholesterolemia. Conclusions. The association of ADMA with risk of AMI is influenced by serum n-3 PUFA and particularly ALA.

  14. Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Knežević Božidarka

    2008-01-01

    Full Text Available Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

  15. Association of stroke and myocardial infarction in children.

    Science.gov (United States)

    Nakashima, M; Takashima, S; Hashimoto, K; Shiraishi, M

    1982-02-01

    A 9-year-old boy with cerebrovascular accident (CVA) and old myocardial infarction with mural thrombi is reported. The cause of the myocardial infarction was congenital coronary artery fistula originating from the left coronary artery and emptying into the right atrium. Although a common cause of strokes in adults, myocardial infarction has infrequently been reported as the source of emboli in children.

  16. Regulatory effect of Dimethyl Sulfoxide (DMSO) on astrocytic reactivity in a murine model of cerebral infarction by arterial embolization.

    Science.gov (United States)

    Lapuente Chala, Catalina; Rengifo Valbuena, Carlos Augusto; Avila Rodríguez, Marco Fidel; Céspedes Rubio, Angel

    2013-01-01

    The pathophysiology of cerebral ischemia is essential for early diagnosis, neurologic recovery, the early onset of drug treatment and the prognosis of ischemic events. Experimental models of cerebral ischemia can be used to evaluate the cellular response phenomena and possible neurological protection by drugs. To characterize the cellular changes in the neuronal population and astrocytic response by the effect of Dimethyl Sulfoxide (DMSO) on a model of ischemia caused by cerebral embolism. Twenty Wistar rats were divided into four groups (n= 5). The infarct was induced with α-bovine thrombin (40 NIH/Unit.). The treated group received 90 mg (100 μL) of DMSO in saline (1:1 v/v) intraperitoneally for 5 days; ischemic controls received only NaCl (placebo) and two non-ischemic groups (simulated) received NaCl and DMSO respectively. We evaluated the neuronal (anti-NeuN) and astrocytic immune-reactivity (anti-GFAP). The results were analyzed by densitometry (NIH Image J-Fiji 1.45 software) and analysis of variance (ANOVA) with the Graph pad software (Prism 5). Cerebral embolism induced reproducible and reliable lesions in the cortex and hippocampus (CA1)., similar to those of focal models. DMSO did not reverse the loss of post-ischemia neuronal immune-reactivity, but prevented the morphological damage of neurons, and significantly reduced astrocytic hyperactivity in the somato-sensory cortex and CA1 (p DMSO on astrocyte hyperreactivity and neuronal-astroglial cytoarchitecture , gives it potential neuroprotective properties for the treatment of thromboembolic cerebral ischemia in the acute phase.

  17. Left leg apraxia after anterior cerebral artery territory infarction: functional analysis using single-photon emission computed tomography.

    Science.gov (United States)

    Ito, Ikuno; Ito, Kimiteru; Shindo, Naoko

    2013-01-01

    Left hand apraxia is known as a unique symptom of callosal apraxia, but lower limb symptoms are rarely mentioned. We report a patient who experienced left ideomotor apraxia affecting both the upper and lower limbs after a stroke in the territory of the right anterior cerebral artery. His spontaneous gait was normal, but he was unable to move his left leg intentionally either by verbal command or by imitation. His leg symptoms gradually improved over time. We evaluated the change in cerebral blood flow in this patient using single-photon emission computed tomography. The results showed an increase in blood flow in the posterior corpus callosum; therefore, we suggested that the callosal pathway might contribute to left leg as well as left hand volitional movement. Copyright © 2013 S. Karger AG, Basel.

  18. Double infarction in one cerebral hemisphere.

    Science.gov (United States)

    Bogousslavsky, J

    1991-07-01

    Thirty-two patients whose first stroke was due to double infarct in one cerebral hemisphere were identified among 1,911 consecutive patients from the Lausanne Stroke Registry. The double infarct involved territories of the superficial middle cerebral artery, superficial posterior cerebral artery, lenticulostriate, anterior choroidal artery, or borderzone. The most common combination involved territories of the anterior middle cerebral artery plus the posterior middle cerebral artery. In the patients with the double infarct, the prevalence of potential cardiac sources of embolism (19%) was similar to that found in the registry in general, but the double infarct was closely associated with tight (greater than or equal to 90% of the lumen diameter) stenosis or occlusion (75%) of the internal carotid artery. The most common neurological picture mimicked large infarction in the middle cerebral artery territory, but nearly half of the patients with double infarct in one cerebral hemisphere had a specific clinical syndrome, which was not found in the 1,879 remaining patients from the registry, including hemianopia-hemiplegia (in 6), acute conduction aphasia-hemiparesis (in 2), and acute transcortical mixed aphasia (in 6), in relation to characteristic combinations of infarcts. These unique clinical and etiological correlates warrant the recognition of double infarct in one cerebral hemisphere from other acute ischemic strokes.

  19. Arterial healing following primary PCI using the Absorb everolimus-eluting bioresorbable vascular scaffold (Absorb BVS) versus the durable polymer everolimus-eluting metallic stent (XIENCE) in patients with acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Räber, Lorenz; Onuma, Yoshinobu; Brugaletta, Salvatore

    2015-01-01

    Aims: The Absorb bioresorbable vascular scaffold (Absorb BVS) provides similar clinical outcomes compared with a durable polymer-based everolimus-eluting metallic stent (EES) in stable coronary artery disease patients. ST-elevation myocardial infarction (STEMI) lesions have been associated...... with delayed arterial healing and impaired stent-related outcomes. The purpose of the present study is to compare directly the arterial healing response, angiographic efficacy and clinical outcomes between the Absorb BVS and metallic EES. Methods and results: A total of 191 patients with acute STEMI were...... randomly allocated to treatment with the Absorb BVS or a metallic EES 1:1. The primary endpoint is the neointimal healing (NIH) score, which is calculated based on a score taking into consideration the presence of uncovered and malapposed stent struts, intraluminal filling defects and excessive neointimal...

  20. Multiorgan with renal infarction following treatment of cerebral infarction.

    Science.gov (United States)

    Kim, Ji Hee; Kang, Chung; Moon, Hyo Jeong; Joo, Min Cheol

    2013-08-01

    Acute renal infarction is a rare disease and it is often difficult to make a clinical diagnosis due to the non-specific clinical presentations and lack of the physicians' awarenesses. We experienced a case of a 72-year-old man who was diagnosed as multiorgan with renal infarction during the bridge therapy of cerebral infarction with atrial fibrillation. Computed tomogram (CT) with intravenous contrast of the abdomen and pelvis revealed left renal infarction with renal artery occlusion, multifocal splenic infarction, and ischemic colitis on rectum and sigmoid colon. The patient was treated with low molecular weight heparin for 10 days, his symptoms were improved and laboratory findings were normalized. Follow-up CT was performed on the 43th day, there were persisted left renal infarction with atrophic change shown and the splenic perfusion was improved.

  1. Cirurgia de revascularização no infarto agudo do miocárdio Coronary artery bypass following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Luiz Antônio Castilho Teno

    1990-04-01

    .3 cases, and unknown, 1 (4.3%. The range of CKMB was 15 U to 104 U (mean: 58.7 U. The left ventricle was normal in 5 cases and the other cases had variable degrees of hypocontractility. The coronary artery involved was: only lesions of the related AMI-coronary, 9 (39.1% cases; lesion of the AMI coronary associated with lesions of other arteries, 8 (34.7% cases; lesion of the AMI artery associated with previous myocardial infarction, 3 (13% cases, and occluded AMI coronary associated with lesions of other arteries, 3 (13% cases. The time of AMI surgery was 2 hours to 2 weeks (mean: 4.6 days. The relation bypass/patient was 1.7. The myocardial protection was made with discret hypothermia and crystaloid cardioplegic solution. The myocardial anoxia ranges 14 minutes to 50 minutes (mean: 16.3 minutes. The hemodynamic conditions were stable in all but 3 cases that needed inotropic drugs and longer time of assisted circulation. The postoperative follow-up shows complications in 10 (43.4% and 3 (13% deaths. The deaths were related with cardiac, pulmonary and neurological causes. The surgical approach in the AMI is growing up, despite os the increment of the mortality and postoperative complications. Selection of patients for operation during AMI must be individualized.

  2. Cerebellar anatomy as applied to cerebellar microsurgical resections

    Directory of Open Access Journals (Sweden)

    Alejandro Ramos

    2012-06-01

    Full Text Available OBJECTIVE: To define the anatomy of dentate nucleus and cerebellar peduncles, demonstrating the surgical application of anatomic landmarks in cerebellar resections. METHODS: Twenty cerebellar hemispheres were studied. RESULTS: The majority of dentate nucleus and cerebellar peduncles had demonstrated constant relationship to other cerebellar structures, which provided landmarks for surgical approaching. The lateral border is separated from the midline by 19.5 mm in both hemispheres. The posterior border of the cortex is separated 23.3 mm from the posterior segment of the dentate nucleus; the lateral one is separated 26 mm from the lateral border of the nucleus; and the posterior segment of the dentate nucleus is separated 25.4 mm from the posterolateral angle formed by the junction of lateral and posterior borders of cerebellar hemisphere. CONCLUSIONS: Microsurgical anatomy has provided important landmarks that could be applied to cerebellar surgical resections.

  3. Diagnosis value of CTA on posterior inferior cerebellar artery aneurysm(report of 2 cases)%CTA对小脑后下动脉动脉瘤的诊断价值(附2例报告)

    Institute of Scientific and Technical Information of China (English)

    李平

    2014-01-01

    目的:探讨CTA对小脑后下动脉( PICA)动脉瘤的诊断价值。方法对2例PICA动脉瘤患者的临床资料进行回顾性分析。结果2例患者为老年,急性发病,经CT确诊蛛网膜下腔出血,发病后3 h内初次CTA检查均为阴性结果。经防止脑血管痉挛、增高血容量、保护脑细胞等治疗3~7 d后,病情好转1例,无效1例。再次行CTA检查发现PICA动脉瘤3个,其中1例患者为左侧PICA 2个动脉瘤合并脑积水,另1例患者左侧PICA有1个动脉瘤。2例患者的PICA动脉瘤均获得良好的影像信息。结论 CTA可作为PI-CA动脉瘤首选的检查方法,能提供其全面的影像资料。对首次CTA检查阴性者,经短期治疗后进行CTA复查仍为理想的选择。%Objective To explore the diagnosis value of CTA on posterior inferior cerebellar artery ( PICA ) aneurysm.Methods The clinical data of 2 patients with PICA aneurysms were analyzed retrospectively .Results Two patients were elderly,acute onset,CT confirmed subarachnoid hemorrhage ,CTA of the first time were negative within 3 h after the onset .After the treatments of preventing cerebral vasospasm , increasing blood volume , protecting brain cells and etc for 3-7 d, one case improved ,one case were invalid .Given CTA examination again then found 3 aneurysms, one case with 2 aneurysms located on the left side of the PICA , accompanying with hydrocephalus ,and the other case with 1 aneurysm located on the left side of the PICA .Two patients obtained a good image evaluation and rich information .Conclusions In view of the particularity of the PICA aneurysms , CTA can be used as the preferred method of examination , which can provide comprehensive imaging data .When CTA examination of the first time is negative , giving CTA again remains an ideal choice after short-term treatment .

  4. The risk analysis and regularity of posterior circulation infarction in vertigo patients with vertebral artery dysplasia%眩晕并椎动脉发育不良患者后循环梗死的规律及危险性分析

    Institute of Scientific and Technical Information of China (English)

    鹿桂凤; 张道培; 张杰文; 张淑玲; 马乾坤; 尹所

    2016-01-01

    Objective To explore the prevalence of vertebral artery dysplasia (VAH)and its risk and regularity of poste-rior circulation infarction (PCI)in vertigo patients with VAH.Method We sequentially enrolled 245 patients suspected of vas-cular vertigo,detected by Magnetic Resonance Angiography (MRA)to judge if merged with VAH,who were divided into cere-bral infarction group and non-infarction group according to whether VAH formed fresh infarction or not measured by Diffu-sion-weighted Imaging (DWI).Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for PCI stroke.Finally,we analyzed the characteristics and regularity of PCI with VAH.Result The prevalence of VAH was 26.1% in vertigo patients.Multivariate logistic regression analysis showed that VAH (OR=2.59,95%CI:1.07-6. 27,P=0.035),stenosis of the posterior circulation (OR=6.04,95%CI:1.94-1 7.07,P=0.002)and diabetes mellitus (OR=3.21,95%CI:1.36-7.57,P=0.008)were independent risk factors for PCI.The TOAST subtypes of PCI with VAH were mainly attributed to small arteries occlusions (10/18).8 patients with cerebral infarctions which were located at pons,thala-mus and temporal occipital lobe infarction occurred on the opposite VAH,4 patients with cerebellar and medullary infarction occurred in the ipsilateral VAH (4/6).Conclusion VAH is common in vertigo patients,which may be an independent risk factor for PCI with certain regularity of its infarction distribution.%目的:探讨椎动脉发育不良(vertebralartery dysplasia,VAH)在眩晕患者中的发生率及其相关后循环梗死的规律和危险性。方法连续入组245例眩晕患者(可疑为血管性),采用磁共振血管成像检查合并 VAH 情况,根据磁共振弥散加权成像是否出现后循环新鲜梗死灶分为梗死组和非梗死组,对相关血管危险因素进行单因素和多因素分析;并分析 VAH合并后循环梗死的特点和规律。结果VAH 发生率26.1%(64/245)

  5. Risk Factors and Relation Between Clinical,Biochemical Marker and Stenosis Extent of Coronary Artery in Young Adults With Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Weiping Zhang; Zuyi Yuan; Yan Liu; Prabindra Maharjan; Yan Zhao

    2008-01-01

    Objectives To analyze risk factors and the relation between clinical,biochemical marker and the stenosis extent of coronary artery in patients below the age of 45 years with acute myocardial infarction (AMI).Methods A retrospective investigation was performed on 92 patients below the age of 45 with AMI at the First Affiliated Hospital of Medical School of Xi'an Jiaotong University in 2003~2007.The etiology,morbidity,risk factors,clinical features and results of coronary angiography were studied.Various clinical and biochemical markers were assessed to find out what were associated with the stenosis extent of coronary artery.Meanwhile,the differences between one-vessel disease (group A)and two-vessel or multi-vessel disease (group B) patients with AMI were comparatively analyzed.Results Risk factors analysis revealed that a history of cigarette smoking,metabolic disorders and abusive drinking were mainly found in young AMI patients below the age of 45 years,and metabolic disorder mainly consists of decreased high-density lipoprotein cholesterol (HDL-C) and hypertriglyceridemia.AMI in patients below the age of 45 years account for 10.3%of all AMI.Angiographically,the incidence of one-vessel affected was most frequent in the young adults (73.75%).The most committed vessel was LAD(80.00% ).A higher incidence with history of hypertension and diabetes or impaired glucose tolerance was found in group B,but a history of preceding angina 1 month earlier was more frequently found in group A.Improved Genisi scores of coronary angiography was lower in group A than in group B (7.49±3.63vs 15.08±6.08).Correlation analysis showed that Iog(LDL-C/HDL-C) (r=0.238,P=0.037),TC/HDL-C(r=0.232,P=0.046) were directly correlated with angiographic scores,and HDL-C(r=-0.202,P=0.042) was inversely correlated.Multielement gradual linear regression analysis showed log(LDL-C/HDL-C),TC/HDL-C were associated with the extent of stenosis of coronary artery.Furthermore,the correlation was linear

  6. Cerebellar Hypoplasia and Autism

    OpenAIRE

    1989-01-01

    The size of the cerebellar hemisphere and vermal lobules was measured in ten autistic and eight normal control subjects at the Neuropsychology Research Laboratory, Children’s Hospital Research Center, and the Departments of Neurosciences and Radiology, School of Medicine, University of California at San Diego, LaJolla.

  7. Relationship of levels of Vitamin D with flow-mediated dilatation of brachial artery in patients of myocardial infarction and healthy control: A case–control study

    Science.gov (United States)

    Malik, Sarthak; Giri, Subhash; Madhu, S. V.; Rathi, Vinita; Banerjee, B. D.; Gupta, Nikhil

    2016-01-01

    Background: Cardiovascular diseases (CVD) remain the leading cause of death worldwide. Vitamin D deficiency has been linked to increased risk of adverse CV events. Vitamin D deficiency may be responsible for endothelial dysfunction which in turn affects the onset and progression of coronary artery disease and its risk factors, directly or indirectly through various mechanisms. Materials and Methods: It was case–control study. A total of 50 cases of acute myocardial infarction (AMI) (aged 40–60 years), admitted to medicine emergency/CCU, were taken as per ACC/AHA 2007 guidelines. An equal number of age- and sex-matched controls were also taken. Risk factors of AMI, flow-mediated dilatation (FMD), and 25(OH)D levels were studied in all cases and controls. Correlation was also studied between FMD and 25(OH)D. Results: The mean values of FMD were 18.86 ± 5.39% and 10.35 ± 4.90% in controls and cases, respectively (P GTN) was also studied and was found to be 26.175 ± 4.25% and 18.80 ± 5.72% in controls and cases, respectively (P GTN and 25(OH)D levels (r = 0.743, P < 0.01). Conclusion: In this study, it was found that FMD was markedly impaired in patients of AMI when compared to controls. It was also found that majority of the study population was Vitamin D deficient; however, the deficiency was more severe in patients of AMI. We also found out that FMD was positively correlated (r = 0.841) to the deficiency state of Vitamin D in all the study subjects. PMID:27730081

  8. Myocardial infarction determined by technetium-99m pyrophosphate single-photon tomography complicating elective coronary artery bypass grafting for angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Burns, R.J.; Gladstone, P.J.; Tremblay, P.C.; Feindel, C.M.; Salter, D.R.; Lipton, I.H.; Ogilvie, R.R.; David, T.E.

    1989-06-15

    The incidence of acute myocardial infarction (AMI) complicating coronary artery bypass grafting (CABG) has previously been based on concordance of electrocardiographic, enzymatic and scintigraphic criteria. Technetium-99m pyrophosphate (Tc-PPi) single-photon emission computed tomography now enables detection of AMI with high sensitivity and specificity. Using this technique, perioperative AMI was detected in 12 of 58 patients (21%) undergoing successful elective CABG for stable angina pectoris. Stepwise multivariate logistic regression analysis was performed to compare the predictive value of preoperative (New York Heart Association class, left ventricular ejection fraction and use of beta blockers) and intraoperative (number of grafts constructed, use of internal mammary anastomoses, use of sequential saphenous vein grafts, smallest grafted distal vessel lumen caliber and aortic cross-clamp time) variables. Preoperative New York Association class (p = 0.04) and smallest grafted distal vessel lumen caliber (p = 0.03) were significant multivariate predictors of perioperative AMI. Only 1 perioperative patient with AMI (and 1 pyrophosphate-negative patient) developed new Q waves. Serum creatine kinase-MB was higher in patients with AMI by repeated measures analysis of variance (p = 0.0003). Five AMIs occurred in myocardial segments revascularized using sequential saphenous vein grafts, and 7 in segments perfused by significantly stenosed epicardial vessels with distal lumen diameter and perfusion territory considered too small to warrant CABG. At 6-month follow-up, the mean left ventricular ejection fraction increased from 0.61 to 0.65 in Tc-PPI-negative patients (p = 0.01), but not in perioperative patients with AMI.

  9. Association of genetic polymorphisms in ADH and ALDH2 with risk of coronary artery disease and myocardial infarction: a meta-analysis.

    Science.gov (United States)

    Han, Hongguang; Wang, Huishan; Yin, Zongtao; Jiang, Hui; Fang, Minhua; Han, Jingsong

    2013-09-10

    Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are the major enzymes responsible for alcohol metabolism in humans. Emerging evidences have shown that functional polymorphisms in ADH and ALDH genes might play a critical role in increasing coronary artery disease (CAD) and myocardial infarction (MI) risks; however, individually published studies showed inconclusive results. The aim of this meta-analysis is to evaluate the associations between the genetic polymorphisms of ADH and ALDH genes with susceptibility to CAD and MI. A literature search was conducted on PubMed, Embase, Web of Science and Chinese BioMedical databases from inception through December 1st, 2012. Crude relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Twelve case-control studies were included with a total of 9616 subjects, including 2053 CAD patients, 1436 MI patients, and 6127 healthy controls. Meta-analysis showed that mutant genotypes (GA+AA) of the rs671 polymorphism in the ALDH2 gene were associated with increased risk of both CAD and MI (CAD: RR=1.20, 95%CI: 1.03-1.40, P=0.021; MI: RR=1.32, 95%CI: 1.11-1.57, P=0.002). However, there were no significant associations of ADH genetic polymorphisms to CAD and MI risks (CAD: RR=0.92, 95%CI: 0.73-1.15, P=0.445; MI: RR=0.93, 95%CI: 0.84-1.03, P=0.148). In conclusion, this meta-analysis provides strong evidence that ALDH2 rs671 polymorphism may be associated with increased risks of CAD and MI. However, further studies are still needed to accurately determine whether ADH genetic polymorphisms are associated with susceptibility to CAD and MI.

  10. Echocardiographic assessment of global longitudinal right ventricular function in patients with an acute inferior ST elevation myocardial infarction and proximal right coronary artery occlusion.

    Science.gov (United States)

    Hutyra, Martin; Skála, Tomáš; Horák, David; Köcher, Martin; Tüdös, Zbyněk; Zapletalová, Jana; Přeček, Jan; Louis, Albert; Smékal, Aleš; Táborský, Miloš

    2015-03-01

    Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p -15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS -20%, 5th day RV-LS -20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

  11. Intronic Polymorphisms in the CDKN2B-AS1 Gene Are Strongly Associated with the Risk of Myocardial Infarction and Coronary Artery Disease in the Saudi Population

    Directory of Open Access Journals (Sweden)

    Sayed AbdulAzeez

    2016-03-01

    Full Text Available Recent genome-wide association studies identified single nucleotide polymorphisms (SNPs on the chromosome 9p21.3 conferring the risk for CAD (coronary artery disease in individuals of Caucasian ancestry. We performed a genetic association study to investigate the effect of 12 candidate SNPs within 9p21.3 locus on the risk of CAD in the Saudi population of the Eastern Province of Saudi Arabia. A total of 250 Saudi CAD patients who had experienced an myocardial infarction (MI and 252 Saudi age-matched healthy controls were genotyped using TaqMan assay. Controls with evidenced lack of CAD provided 90% of statistical power at the type I error rate of 0.05. Five percent of the results were rechecked for quality control using Sanger sequencing, the results of which concurred with the TaqMan genotyping results. Association analysis of 12 SNPs indicated a significant difference in the genotype distribution for four SNPs between cases and controls (rs564398 p = 0.0315, χ2 = 4.6, odds ratio (OD = 1.5; rs4977574 p = 0.0336, χ2 = 4.5, OD = 1.4; rs2891168 p = 1.85 × 10 − 10, χ2 = 40.6, OD = 2.1 and rs1333042 p = 5.14 × 10 − 9, χ2 = 34.1, OD = 2.2. The study identified three protective haplotypes (TAAG p = 1.00 × 10 − 4; AGTA p = 0.022 and GGGCC p = 0.0175 and a risk haplotype (TGGA p = 2.86 × 10 − 10 for the development of CAD. This study is in line with others that indicated that the SNPs located in the intronic region of the CDKN2B-AS1 gene are associated with CAD.

  12. Effect of pioglitazone on arterial baroreflex sensitivity and sympathetic nerve activity in patients with acute myocardial infarction and type 2 diabetes mellitus.

    Science.gov (United States)

    Yokoe, Hiroshi; Yuasa, Fumio; Yuyama, Reisuke; Murakawa, Kousuke; Miyasaka, Yoko; Yoshida, Susumu; Tsujimoto, Satoshi; Sugiura, Tetsuro; Iwasaka, Toshiji

    2012-06-01

    Pioglitazone has been shown to reduce the occurrence of fatal and nonfatal myocardial infarction (MI) in type 2 diabetes mellitus (DM). However, the mechanisms of such favorable effects remain speculative. The aim of this study was to investigate the effect of pioglitazone on arterial baroreflex sensitivity (BRS) and muscle sympathetic nerve activity (MSNA) in 30 DM patients with recent MI. Patients were randomly assigned to those taking pioglitazone (n = 15) and those not taking pioglitazone (n = 15) at 4 weeks after the onset of MI. BRS, MSNA, calculated homeostasis model assessment of insulin resistance index (HOMA-IR), and plasma adiponectin were measured at baseline and after 12 weeks. Pioglitazone increased plasma adiponectin (from 6.9 ± 3.3 μg/dL to 12.2 ± 7.1 μg/dL) and reduced HOMA-IR (from 4.0 ± 2.2 to 2.1 ± 0.9). In the pioglitazone group, MSNA decreased significantly (from 37 ± 7 bursts/min to 25 ± 8 bursts/min) and BRS increased significantly (from 6.7 ± 3.0 to 9.9 ± 3.2 ms/mm Hg) after 12 weeks. Furthermore, a significant relationship was found between the change in MSNA and HOMA-IR (r = 0.6, P = 0.042). Thus, pioglitazone decreased the sympathetic nerve traffic through the improvement of insulin resistance in DM patients with recent MI, which indicate that the sympathoinhibitory effects of pioglitazone may, at least in part, have contributed to the beneficial effects of pioglitazone.

  13. The dynamics of mortality in follow-up time after an acute myocardial infarction, lower extremity arterial disease and ischemic stroke

    Directory of Open Access Journals (Sweden)

    Grobbee Diederick E

    2010-11-01

    Full Text Available Abstract Background Most studies providing data on survival in patients with atherosclerosis only address a single disease site: heart, brain or legs. Therefore, our objective was to determine risk of death after first hospital admission for atherosclerotic disease located at different sites. Methods A nationwide cohort of patients hospitalized for the first time for acute myocardial infarction (AMI, peripheral arterial disease of the lower extremities (PAD or ischemic stroke was identified through linkage of national registers. The mortality rate in AMI patients was compared to mortality rate in ischemic stroke and PAD patients by estimating relative risks (with 95%CI. Cox's proportional hazard models were used to estimate sex differences in risk of death. Results Case fatality was high for ischemic stroke patients (men:21.0%, women:23.8% and AMI patients (men:12.7%, women:20.9% though low for PAD patients (men:2.4%, women:3.5%. The five-year risk of death was similar for male AMI compared to PAD patients (men: RR1.04; 95%CI 0.98-1.11. The risk of death for ischemic stroke patients remained the highest though the differences with AMI and PAD patients attenuated. Conclusions The dynamics of mortality over follow-up time clearly differ between atherosclerotic diseases, located at different vascular beds. The risk of death increases considerably over follow-up time for PAD patients, and 5 years after first hospital admission the differences in risks of death between AMI- and PAD patients and between AMI- and ischemic stroke patients have largely attenuated. Clinicians should be aware of these dynamics of mortality over follow-up time to provide optimal secondary prevention treatment.

  14. The electrocardiogram characteristics of left circumflex artery as infarction related artery in acute myocardial infarction%左回旋支作为急性心肌梗死时梗死相关动脉的心电图特征

    Institute of Scientific and Technical Information of China (English)

    郭晨贤; 沈智杰; 王肖龙

    2015-01-01

    目的:分析左回旋支(left circumflex artery,LCX)作为急性心肌梗死(acute myocardial infarction,AMI)时梗死相关动脉(infarct-related artery,IRA)的心电图特征。方法选取 AMI时 IRA 为 LCX 及右冠(right coronary artery,RCA)的患者94例,对患者的急诊心电图特点进行回顾性分析,分别比较Ⅰ导联及 aVL 导联、下壁相关导联、胸导联 ST 段改变情况以及在下壁相关导联都抬高的情况下 STⅡ与 STⅢ的变化关系。结果入组患者中 IRA 为 LCX 和 RCA 的分别为30例和64例。①Ⅰ、aVL 导联与 IRA 相关性分析:IRA 为 LCX 的患者,Ⅰ导联 ST 段压低3例,不变或抬高27例;IRA 为 RCA 的患者Ⅰ导联 ST 段压低22例,不变或抬高42例,两组比较,差异有统计学意义(P =0.013);IRA 为 LCX 的患者 aVL 导联 ST 段压低3例,不变或抬高27例;IRA 为 RCA 的患者 aVL 导联 ST 段压低26例,不变或抬高38例,两组比较,差异有统计学意义(P =0.003)。②Ⅱ、Ⅲ、aVF 导联与 IRA 相关性分析:IRA 为 LCX 的心电图中,下壁导联 ST 段抬高10例,未抬高20例;IRA 为 RCA 的心电图中,下壁相关导联 ST 段抬高51例,未抬高13例,两组比较,差异有统计学意义(P <0.01)。在下壁导联均抬高样本中,IRA 为LCX 者,STⅡ≥STⅢ7例,STⅢ>STⅡ3例;RCA 的样本中,STⅡ≥STⅢ15例,STⅢ>STⅡ36例,两组比较,差异有统计学意义(P <0.05)。③胸导联 ST 段变化与 IRA 的相关性分析,两组差异无统计学意义。结论AMI 时 IRA 为 LCX 的急诊心电图可表现为Ⅰ、aVL 导联无明显压低,Ⅱ、Ⅲ、aVF 导联亦可无明显抬高,而当下壁导联抬高且 IRA 为 LCX 时,主要表现为 STⅡ≥STⅢ。%Objective To analyze the electrocardiogram characteristics of left circumflex artery as infarction related artery(IRA)in acute myocardial infarction

  15. Depression after myocardial infarction.

    Science.gov (United States)

    Ziegelstein, R C

    2001-01-01

    Depression is an independent risk factor for increased postmyocardial infarction morbidity and mortality, even after controlling for the extent of coronary artery disease, infarct size, and the severity of left ventricular dysfunction. This risk factor takes on added significance when one considers that almost half of patients recovering from a myocardial infarction have major or minor depression and that major depression alone occurs in about one in five of these individuals. Despite the well-documented risk of depression, questions remain about the mechanism of the relationship between mood disturbance and adverse outcome. The link may be explained by an association with lower levels of social support, poor adherence to recommended medical therapy and lifestyle changes intended to reduce the risk of subsequent cardiac events, disturbances in autonomic tone, enhanced platelet activation and aggregation, and systemic immune activation. Unfortunately, questions about the pathophysiologic mechanism of depression in this setting are paralleled by uncertainties about the optimal treatment of depression for patients recovering from a myocardial infarction and by a lack of knowledge about whether treating depression lowers the associated increased mortality risk. Ongoing research studies will help to determine the benefits of psychosocial interventions and of antidepressant therapy for patients soon after myocardial infarction. Although the identification of depression as a risk factor may by itself be a reason to incorporate a comprehensive psychological evaluation into the routine care of patients with myocardial infarction, this practice should certainly become standard if studies show that treating depression reduces the increased mortality risk of these patients.

  16. Consensus Paper: Neuroimmune Mechanisms of Cerebellar Ataxias.

    Science.gov (United States)

    Mitoma, Hiroshi; Adhikari, Keya; Aeschlimann, Daniel; Chattopadhyay, Partha; Hadjivassiliou, Marios; Hampe, Christiane S; Honnorat, Jérôme; Joubert, Bastien; Kakei, Shinji; Lee, Jongho; Manto, Mario; Matsunaga, Akiko; Mizusawa, Hidehiro; Nanri, Kazunori; Shanmugarajah, Priya; Yoneda, Makoto; Yuki, Nobuhiro

    2016-04-01

    In the last few years, a lot of publications suggested that disabling cerebellar ataxias may develop through immune-mediated mechanisms. In this consensus paper, we discuss the clinical features of the main described immune-mediated cerebellar ataxias and address their presumed pathogenesis. Immune-mediated cerebellar ataxias include cerebellar ataxia associated with anti-GAD antibodies, the cerebellar type of Hashimoto's encephalopathy, primary autoimmune cerebellar ataxia, gluten ataxia, Miller Fisher syndrome, ataxia associated with systemic lupus erythematosus, and paraneoplastic cerebellar degeneration. Humoral mechanisms, cell-mediated immunity, inflammation, and vascular injuries contribute to the cerebellar deficits in immune-mediated cerebellar ataxias.

  17. 心肌梗死相关冠状动脉的腔内超声研究%Intravascular ultrasound study of arteries related myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陈绍良; 徐玲; 段宝祥; 常芸; 刘玲玲

    2000-01-01

    Objective To characterize the lesion in acute myocardial infarction(AMI)-related artery (IRA)by the intravascular ultrasound(IVUS)and angiography image at the culprit site. Methods twenty-five patients with AMI undenwent IVUS study of the IRA immediately following PTCA to the culprit lesion. The IVUS images were analyzed quantitatively and qualitatively and were compared with the angiography. Results ①At the PTCA site, mean area was narrowed down 50%-70% and mean cross-sectional area(CSA) of the plaque was(50±18)% of the arterial CSA;②The atherosclerosis was found in 70% of the proximal and distal segments by IVUS and 30% of these segments by the angiogram(P=0.001);③All the plaques were defined as 69% "Soft" and 31% "hard".The hard plaques were larger than the soft plaques [(50±16)% VS (37±19)% CSA.P=0.01]:④With the increase in plaque area there was a significant increase in arterial ross-sectional area in an the injured segments(r=0.49,P=0.003)as well as in distal and proximal control segments to culprit site.Conclusion IVUS revealed a significant plaque burden at the culprit lesion Of IRA and atherosclerosis in the proximal and distal control segments to the lesion.%目的 比较心肌梗死相关冠状动脉造影和血管内超声下粥样斑块的特征.方法 25例急性心肌梗死患者的梗死相关动脉(IRA)在成功经皮冠状动脉腔内成形术(PTCA)后即刻行冠状动脉内超声检查,结果与冠状动脉造影进行定量和定性比较.结果 ①在PTCA部位,平均面积狭窄50%-70%,斑块横截面积是血管横截面积的(50±18)%;②冠状动脉内超声下病变的近端和远端粥样硬化发生率为70%,而冠状动脉造影下上述部位的病变率仅30%(P=0.001);③69%斑块属于软斑块,硬斑块占31%,但是其斑块面积却大于前者[(50±16)% vs (39±19)%,P=0.01;④PTCA部位所有近端与远端参考段血管腔内斑块面积与血管横截面积之间相关良好(r-0.49,P=0.0001),病变段血管

  18. Splenic infarction

    Science.gov (United States)

    Splenic infarction is the death of tissue (necrosis) in the spleen due to a blockage in blood flow. ... Common causes of splenic infarction include: Blood clots Blood diseases such as sickle cell anemia Infections such as endocarditis

  19. Cerebellar and afferent ataxias.

    Science.gov (United States)

    Pandolfo, Massimo; Manto, Mario

    2013-10-01

    Ataxia is the predominant manifestation of many acquired and inherited neurologic disorders affecting the cerebellum, its connections, and the afferent proprioceptive pathways. This article reviews the phenomenology and etiologies of cerebellar and afferent ataxias and provides indications for a rational approach to diagnosis and management. The pathophysiology of ataxia is being progressively understood and linked to the functional organization of the cerebellum. The impact of cerebellar diseases on different neurologic functions has been better defined and shown not to be limited to loss of motor coordination. The role of autoimmunity is increasingly recognized as a cause of sporadic cases of ataxia. Large collaborative studies of long duration are providing crucial information on the clinical spectrum and natural history of both sporadic ataxias (such as the cerebellar form of multiple system atrophy) and inherited ataxias. New dominant and recessive ataxia genes have been identified. On the therapeutic front, progress mostly concerns the development of treatments for Friedreich ataxia. Ataxia is the clinical manifestation of a wide range of disorders. In addition to accurate clinical assessment, MRI plays a major role in the diagnostic workup, allowing us to distinguish degenerative conditions from those due to other types of structural damage to the cerebellar or proprioceptive systems. Diagnostic algorithms based on clinical features, imaging, and neurophysiologic and biochemical parameters can be used to guide genetic testing for hereditary ataxias, the diagnosis of which is likely to be greatly improved by the introduction of new-generation DNA-sequencing approaches. Some rare forms of ataxia can be treated, so their diagnosis should not be missed. Proven symptomatic treatments for ataxia are still lacking, but intensive physical therapy appears to be helpful.

  20. Migraine Infarction. Case Report

    Directory of Open Access Journals (Sweden)

    Yoany Mesa Barrera

    2015-03-01

    Full Text Available Migraine is considered like a risk factor for ischemic ictus in adult young people. In spite of the criteria established for the treatment of the migraine infarct, they are not always fulfilled strictly, permitting certain flexibility in the aforementioned treatment. The case of a patient with a background of migraine with auras, who suffers an ischemic cerebral migraine infarct at the course of a migraine crisis, is presented. The ictus was manifested like an especial right hemiparesis of the female sex in fertile age. The prognosis is good with low risk of recurrence, with unstable disorders and dysarthria. The laboratories studies were normal and the cerebral infarct was detected in the magnetic resonance, at the half left cerebral artery's territory. The patient had favorable evolution without sequel.

  1. 大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄的关系%Relationship between the patterns of acute middle cerebral artery deep perforator infarctions and arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    郑晋华; 邵蓓; 牛晓婷; 吕志坤

    2010-01-01

    目的 探讨大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄之间的关系.方法 回顾性连续分析2007年2月至2009年4月我院住院的152例脑梗死患者的临床资料.依据磁共振弥散加权成像(DWI)分为大脑中动脉深穿支小梗死组(小PAI组,直径≤3.20 cm)、大脑中动脉深穿支大梗死组(大PAI组,直径>3.20 cm)、大脑中动脉深穿支+大脑中动脉皮质支梗死组(PAI+PI组)、大脑中动脉深穿支+分水岭梗死组(PAI+BZ组)、大脑中动脉深穿支+大脑中动脉皮质支+分水岭梗死组(PAI+PI+BZ组).比较各组之间动脉狭窄检出率及动脉重度狭窄或闭塞检出率.结果 各组动脉狭窄检出率分别为16/87、9/11、17/17、11/12、23/25,小PAI组与其余4组相比差异有统计学意义(χ~2=21.780、48.065、30.567、55.523,P值均为0.000);各组动脉重度狭窄或闭塞检出率分别为1/87、2/11、12/17、9/12、21/25,小PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=56.505、55.465、79.283,P值均为0.000),大PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=7.337、7.425、11.633,P值分别为0.007、0.006、0.001);小PAI两亚组(2.00 cm<直径≤3.20 cm亚组与直径≤2.00 cm亚组)动脉狭窄检出率差异无统计学意义(χ~2=0.253,P=0.615).结论 小PAI组动脉狭窄检出率及动脉重度狭窄或闭塞检出率均较低;大PAI组、PAI+PI组、PAI+BZ组及PAI+PI+BZ组动脉狭窄检出率均较高,且PAI+PI组、PAI+BZ组、PAI+PI+BZ组动脉苇度狭窄或闭塞检出率均较高.%Objective To explor the relationship between the different types of perforating artery fresh infarcts of the middle cerebral artery and related arterial stenosis.Methods All 152 acute ischemic stroke patients hospitalized in our hospital from February 2007 to April 2009 were retrospectively reviewed.Lesions of middle cerebral artery were classified on diffusion weighted imaging

  2. Genetics Home Reference: lissencephaly with cerebellar hypoplasia

    Science.gov (United States)

    ... Conditions lissencephaly with cerebellar hypoplasia lissencephaly with cerebellar hypoplasia Enable Javascript to view the expand/collapse boxes. ... Open All Close All Description Lissencephaly with cerebellar hypoplasia (LCH) affects brain development, resulting in the brain ...

  3. Relationship of levels of Vitamin D with flow-mediated dilatation of brachial artery in patients of myocardial infarction and healthy control: A case-control study

    Directory of Open Access Journals (Sweden)

    Sarthak Malik

    2016-01-01

    Full Text Available Background: Cardiovascular diseases (CVD remain the leading cause of death worldwide. Vitamin D deficiency has been linked to increased risk of adverse CV events. Vitamin D deficiency may be responsible for endothelial dysfunction which in turn affects the onset and progression of coronary artery disease and its risk factors, directly or indirectly through various mechanisms. Materials and Methods: It was case-control study. A total of 50 cases of acute myocardial infarction (AMI (aged 40-60 years, admitted to medicine emergency/CCU, were taken as per ACC/AHA 2007 guidelines. An equal number of age- and sex-matched controls were also taken. Risk factors of AMI, flow-mediated dilatation (FMD, and 25(OHD levels were studied in all cases and controls. Correlation was also studied between FMD and 25(OHD. Results: The mean values of FMD were 18.86 ± 5.39% and 10.35 ± 4.90% in controls and cases, respectively (P < 0.05. The endothelial dilatation after glyceryl trinitrate (GTN was also studied and was found to be 26.175 ± 4.25% and 18.80 ± 5.72% in controls and cases, respectively (P < 0.05. The mean levels of 25(OHD in controls and cases were 25.45 ± 12.17 and 14.53 ± 8.28 ng/ml, respectively. In this study, 56% of subjects were Vitamin D deficient, 25% were Vitamin D insufficient, and only 19% had Vitamin D in normal range. A positive correlation coefficient was found between FMD and 25(OH Vitamin D levels (r = 0.841, P < 0.01. In this study, a positive correlation coefficient was also found between endothelial dilatation after GTN and 25(OHD levels (r = 0.743, P < 0.01. Conclusion: In this study, it was found that FMD was markedly impaired in patients of AMI when compared to controls. It was also found that majority of the study population was Vitamin D deficient; however, the deficiency was more severe in patients of AMI. We also found out that FMD was positively correlated (r = 0.841 to the deficiency state of Vitamin D in all the study

  4. Preliminary clinical study on endovascular treatment of posterior inferior cerebellar artery aneurysms%小脑后下动脉瘤血管内栓塞治疗的初步临床研究

    Institute of Scientific and Technical Information of China (English)

    赵兵; 钟鸣; 谭显西; 郑匡; 张明升; 尹剑; 何文根

    2009-01-01

    Objective To study the methods and results of endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms. Methods Twenty-one patients with PICA aneurysms were treated with endovascular treatment. The locations of aneurysm on PICA were evaluated through the DSA. Eight patients received single coil embolization, 5 received liquid Glue embolization, 2 received coil embolization combined with liquid Glue, 2 received coil embolization assisted with stents, and 4 underwent ocelasion of the parent PICA. Outcome was evaluated with the Glasgow outcome scale (COS). Results There were complete (100%) occlusion in 5 patients, near complete (>90% ) occlusion in 2, and incomplete (85%) occlusion in 1 in single coil embolization. Seven patients with Glue embolization (n = 5 ) or combination with coils ( n = 2 ) exhibited complete ( 100% ) occlusion. There were near complete ( >90% ) occlusion in 2 cases with coil assisted with stents. Complete occlusion of the parent PICA was achieved in 3 patients, and near complete occlusion of PICA in one case. One patient suffered from new neurological deficits, and one patient treated with coils and stents died. None of the patients suffered from re-bleeding. These patients received follow-up during a mean period of (22±8) months. Overall long-term outcome was good ( GOS score 4 or 5 ) in 17 patients, poor ( COS score 2 or 3) in 3, and fatal ( GOS score 1 ) in one case. Conclusions According to the location of aneurysms on PICA, aneurysms can be effectively and safely treated with endovaecular embolization.%目的 探讨小脑后下动脉(PICA)瘤栓塞治疗的方法及效果.方法 回顾性分析21例PICA瘤经血管内栓塞治疗的临床资料,根据DSA资料估计动脉瘤的解削分段.采取单纯弹簧圈栓塞8例、单纯液体胶栓塞5例、弹簧圈联合液体胶栓塞2例、支架辅助弹簧圈栓塞2例、球囊辅助弹簧圈PICA闭塞4例,用格拉斯哥预后(GOS)评分评估疗效.结果

  5. 枕下远外侧入路治疗小脑后下动脉近端动脉瘤%Management of the proximal posterior inferior cerebellar artery aneurysms via far lateral approach with linear scalp incision

    Institute of Scientific and Technical Information of China (English)

    施铭岗; 佟小光

    2014-01-01

    目的 通过直线切口远外侧入路来治疗小脑后下动脉(PICA)近端动脉瘤.方法 回顾性分析应用枕下直线切口行远外侧入路外科处理PICA近端动脉瘤11例临床资料,并判断其疗效.11例破裂PICA近端动脉瘤,Hunt-Hess分级为Ⅰ~Ⅱ级6例,Ⅲ级3例,Ⅳ级2例.结果 11例破裂PICA近端动脉瘤均因血管内栓塞困难改为开颅夹闭或孤立术.无一例死亡,3例术后出现吞咽困难,出院时症状好转,2例手术直接夹闭困难,行枕动脉(OA)和PICA吻合,动脉瘤孤立术,其余8例无手术并发症.结论 未能行血管内栓塞治疗的PICA近端动脉瘤,可通过直线远外侧入路动脉瘤直接夹闭或行动脉搭桥动脉瘤孤立术,特别是夹层动脉瘤,直线切口远外侧入路治疗PICA动脉瘤,能充分暴露病变并取得较好的临床效果.%Objective To study the efficacyof surgical management of the proximal posterior inferior cerebellar artery(PICA) aneurysms by far lateral approach with linear scalp incision.Methods To manage the proximal PICA aneurysms by the far lateral approach and analyze its clinical outcome.According to Hunt-Hess Grade Score,of all 11 cases with the proximal PICA ruptured aneurysms,6 cases were of Ⅰ-Ⅱ grade,3 cases of Ⅲ and 2 cases of Ⅳ.Results All of 11 cases with the proximal PICA ruptured aneurysms were excluded for endovascular management because of their size,location and morphology,and then underwent craniotomy to clip or trap through OA-PICA bypass via far lateral approach with linear scalp incision.Postoperatively,therewasno mortality,3 cases had swallowing difficulty and improved by the time of discharge,2 cases underwent OA-PICA bypass after failure of direct clipping,the rest (8 cases) had no surgical complications.Condusions The proximal PICA aneurysms can be managed by directly clipping or bypass to trap the aneurysm via the far lateral approach with linear scalp incision,the bypass operation is the more suitable to the

  6. Tractography demonstrates dentate-rubro-thalamic tract disruption in an adult with cerebellar mutism

    NARCIS (Netherlands)

    Baarsen, K. van; Kleinnijenhuis, M.; Konert, T.; Walsum, A.M. van Cappellen v; Grotenhuis, A.

    2013-01-01

    A 55-year-old female is presented with transient cerebellar mutism caused by a well-circumscribed left pontine infarction due to postoperative basilar perforator occlusion. Although conventional T2 imaging shows a well-demarcated lesion confined to the pontine region, diffusion tensor imaging shows

  7. Tractography demonstrates dentate-rubro-thalamic tract disruption in an adult with cerebellar mutism

    NARCIS (Netherlands)

    Baarsen, van K.; Kleinnijenhuis, M.; Konert, T.; Cappellen van Walsum, A.; Grotenhuis, A.

    2013-01-01

    A 55-year-old female is presented with transient cerebellar mutism caused by a well-circumscribed left pontine infarction due to postoperative basilar perforator occlusion. Although conventional T2 imaging shows a well-demarcated lesion confined to the pontine region, diffusion tensor imaging shows

  8. Comparison of five-year outcomes of patients with and without chronic total occlusion of noninfarct coronary artery after primary coronary intervention for ST-segment elevation acute myocardial infarction.

    Science.gov (United States)

    Tajstra, Mateusz; Gasior, Mariusz; Gierlotka, Marek; Pres, Damian; Hawranek, Michał; Trzeciak, Przemysław; Lekston, Andrzej; Polonski, Lech; Zembala, Marian

    2012-01-15

    The aim of the present study was to evaluate the effect of concurrent chronic total occlusion (CTO) in a noninfarct-related artery (IRA) on the long-term prognosis in patients with ST-segment elevation myocardial infarction and multivessel coronary disease. Of 1,658 consecutive patients with ST-segment elevation myocardial infarction, 666 with multivessel coronary disease who underwent percutaneous coronary intervention from 1999 to 2004 were included in the present analysis. The patients were divided into 2 groups: no CTO and CTO. The first group included 462 patients without CTO (69%) and the second group included 204 patients with CTO in a non-IRA (31%). The in-hospital mortality rate was 6.3% and 21.1% (p < 0.0001) and the 5-year mortality rate was 22.5% and 40.2% (p < 0.0001) for the no-CTO and CTO patients, respectively. Multivariate analysis revealed that after correction for baseline differences CTO in a non-IRA was a strong, independent predictor of 5-year mortality in patients undergoing percutaneous coronary intervention (hazard ratio 1.85; 95% confidence interval 1.35 to 2.53; p = 0.0001). In conclusion, the presence of CTO in a non-IRA in patients with ST-segment elevation myocardial infarction and multivessel coronary disease is a strong and independent risk factor for greater 5-year mortality.

  9. SNPs in microRNA binding sites in 3'-UTRs of RAAS genes influence arterial blood pressure and risk of myocardial infarction

    DEFF Research Database (Denmark)

    Nossent, Anne Yaël; Hansen, Jakob Liebe; Doggen, Carine

    2011-01-01

    We hypothesized that single nucleotide polymorphisms (SNPs) located in microRNA (miR) binding sites in genes of the renin angiotensin aldosterone system (RAAS) can influence blood pressure and risk of myocardial infarction.......We hypothesized that single nucleotide polymorphisms (SNPs) located in microRNA (miR) binding sites in genes of the renin angiotensin aldosterone system (RAAS) can influence blood pressure and risk of myocardial infarction....

  10. 心肌梗死对左心室同步性影响的实验研究%The effect of myocardial infarction induced by distal left ascending artery occlusion on left ventricular synchronism: an experimental study

    Institute of Scientific and Technical Information of China (English)

    孙寅光; 张奇; 蒲里津; 阮雯; 沈卫峰

    2008-01-01

    目的 探讨左前降支远端堵闭后心肌梗死对左心室同步性的影响.方法 在选择性堵闭左前降支远端制备猪心肌梗死模型前2 h内(心肌梗死前)和心肌梗死后7~14 d内各进行一次常规超声心动图和速度向量成像检查,测量心肌梗死前后左心室舒张末期内径、舒张末期容积、收缩末期内径、收缩末期容积和球形指数0等重构指标.比较心肌梗死前后左心室6个节段心肌运动收缩期速度、应变、应变率及其达峰时间.结果 前壁心肌梗死后早期左心室舒张末期长径和收缩末期长径增大,收缩末期容积增大,射血分数降低.左心室6节段收缩速度、应变和应变率均显著减低,只有平均应变率达峰时间心肌梗死后显著延长.结论 心肌梗死后左心室同步性异常加重左心室的收缩功能异常.%Objective To study the effect of myocardial infarction induced by distal left ascending artery occlusion on left ventrieular(LV) synchronism. Methods Routine echocardiography and vector velocity imaging were performed within 2 hours before and 7-14 days after myocardial infarction by occluding distal left ascending coronary arteries in experimental pigs. Routine eehocardiographie parameters of LV, including end diastolic and systolic diameters, volumes, and spherical indexes were measured or calculated. Six segmental peak systolic velocity, strain and strain rate were compared between pre- and post-myocardial infarction. Results After myocardial infarction, LV end diastolic, end systolic long diameter and end systolic volume increased with decreased ejection fraction. With the 6 segmental systolic velocity, strain and strain rate significantly reduced,the mean 6-segmental time to peak strain rate delayed significantly. Conclusions Abnormal synchronism after myocardial infarction may aggravate LV systolic dysfunction.

  11. In vivo visualization of the PICA perfusion territory with super-selective pseudo-continuous arterial spin labeling MRI.

    Science.gov (United States)

    Hartkamp, Nolan S; De Cocker, Laurens J; Helle, Michael; van Osch, Matthias J P; Kappelle, L Jaap; Bokkers, Reinoud P H; Hendrikse, Jeroen

    2013-12-01

    In this work a method is described to discern the perfusion territories in the cerebellum that are exclusively supplied by either or both vertebral arteries. In normal vascular anatomy the posterior inferior cerebellar artery (PICA) is supplied exclusively by its ipsilateral vertebral artery. The perfusion territories of the vertebral arteries were determined in 14 healthy subjects by means of a super-selective pseudo-continuous ASL sequence on a 3T MRI scanner. Data is presented to show the feasibility of determining the PICA perfusion territory. In 10 subjects it was possible to accurately determine both PICA perfusion territories. In two subjects it was possible to determine the perfusion territory of one PICA. Examples in which it was not possible to accurately determine the PICA territory are also given. Additionally, the high variability of the extent of the PICA territory is illustrated using a statistical map. The posterior surface of the cerebellum is entirely supplied by the PICA in six subjects. The most posterior part of the superior surface is supplied by the PICA in eight subjects, and the inferior half of the anterior surface in six subjects. The inferior part of the vermis is supplied by the PICA in all subjects. Two subjects were found with interhemispheric blood flow to both tonsils from one PICA without contribution from the contralateral PICA. With the method as presented, clinicians may in the future accurately classify cerebellar infarcts according to affected perfusion territories, which might be helpful in the decision whether a stenosis should be considered symptomatic.

  12. 载瘤动脉闭塞治疗小脑后下动脉以远椎动脉瘤二例报告并文献复习%Treatment of vertebral aueurysms distal to the origin of posterior inferior cerebellar artery by occluding the parent artery: a report of 2 cases and literature review

    Institute of Scientific and Technical Information of China (English)

    刘智良; 秦家振; 魏群; 徐如祥; 戴宜武; 邓其峻; 王国福; 罗永春; 卢洪流; 杨志军; 李运军

    2011-01-01

    目的探讨载瘤动脉闭塞治疗小脑后下动脉(PICA)以远椎动脉瘤的方法和效果。方法中山大学附属佛山第一人民医院神经外科自2006年1月至2007年1月对2例PICA以远椎动脉瘤破裂患者行介入载瘤动脉电解可脱弹簧圈(GDC)闭塞治疗,分析患者的临床特征、影像学特点和栓塞疗效。 结果2例患者术后PICA以远载瘤动脉合并动脉瘤均成功获得完全闭塞,无术后并发症发生。术后3个月造影复查证实动脉瘤体无充盈,同时PICA通畅,4年内无再出血发生。 结论对于开颅手术夹必困难的PICA以远椎动脉瘤,在PICA远端处闭塞一侧载瘤椎动脉是一种安全、有效的治疗方法。%Objective To summarize the clinical characteristics, therapeutic strategy and outcome of the vertebral aneurysms distal to the origin of posterior inferior cerebellar artery (PICA).Methods Two patients with vertebral posterior aneurysms distal to the origin of PICA, admitted to our hospital from January 2006 to January 2007 and received endovascular treatment of Gugliemi detachable coils (GDC), were submitted to a retrospective analysis of clinical features, radiological characteristics and therapeutic effects. Results Total occlusion was achieved in these 2 patients and no immediate complication occurred after the treatment. They were followed up for 3 months to 4 years; the postoperative digital subtraction angiography (DSA) revealed that the PICA was unobstructed and no rehaemorrhagia was noted. Conclusion Endovascular therapy with microcoil placement may be a safe and available alternative for the treatment of some complicated aneurysms of vertebral artery aneurysms distal to the origin of PICA, which is difficult to be clipped.

  13. Characteristics of vascular lesions in patients with posterior circulation infarction according to age and region of infarct

    Institute of Scientific and Technical Information of China (English)

    Daopei Zhang; Shuling Zhang; Hongtao Zhang; Yuming Xu

    2012-01-01

    Patients with posterior circulation infarction underwent CT angiography and magnetic resonance angiography. Intracranial and extracranial vasculopathy was evaluated according to age group and location of stroke. Patients aged > 60 years and 60 years than 60 years, whereas vertebrobasilar artery developmental anomalies occurred with similar frequency in patients aged 60 years. Patients with infarction of the brainstem or cerebellum were more likely to have vertebral artery stenosis or occlusion, basilar artery stenosis or occlusion, vertebral artery dominance or tortuosity, and basilar artery tortuosity, and patients with infarction of the thalamus, medial temporal, or occipital lobes were more likely to have stenosis or occlusion of the vertebral or basilar arteries. Vertebrobasilar artery tortuosity, vertebral artery dominance (hypoplasia), and congenital variations of the vertebrobasilar system may lead to posterior circulation infarction at different locations in different age groups.

  14. Neurotransplantation therapy and cerebellar reserve.

    Science.gov (United States)

    Cendelin, Jan; Mitoma, Hiroshi; Manto, Mario

    2017-08-10

    Neurotransplantation has been recently the focus of interest as a promising therapy to substitute lost cerebellar neurons and improve cerebellar ataxias. However, since cell differentiation and synaptic formation are required to obtain a functional circuitry, highly integrated reproduction of cerebellar anatomy is not a simple process. Rather than a genuine replacement, recent studies have shown that grafted cells rescue surviving cells from neurodegeneration by exerting trophic effects, supporting mitochondrial function, modulating neuroinflammation, stimulating endogenous regenerative processes, and facilitating cerebellar compensatory properties thanks to neural plasticity. On the other hand, accumulating clinical evidence suggests that the self-recovery capacity is still preserved even if the cerebellum is affected by a diffuse and progressive pathology. We put forward the period with intact recovery capacity as "restorable stage" and the notion of reversal capacity as "cerebellar reserve". The concept of cerebellar reserve is particularly relevant, both theoretically and practically, to target recovery of cerebellar deficits by neurotransplantation. Reinforcing the cerebellar reserve and prolonging the restorable stage can be envisioned as future endpoints of neurotransplantation. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  15. Falls in degenerative cerebellar ataxias

    NARCIS (Netherlands)

    van de Warrenburg, Bart P C; Steijns, Janneke A G; Munneke, Marten; Kremer, Berry P H; Bloem, Bastiaan R

    2005-01-01

    We retrospectively and prospectively assessed the frequency and characteristics of falls in patients with degenerative cerebellar ataxias. The results show that falls occur very frequently in patients with degenerative cerebellar ataxias and that these falls are serious and often lead to injuries or

  16. Childhood Cerebellar Ataxia

    Science.gov (United States)

    Fogel, Brent L.

    2012-01-01

    Childhood presentations of ataxia, an impairment of balance and coordination caused by damage to or dysfunction of the cerebellum, can often be challenging to diagnose. Presentations tend to be clinically heterogeneous but key considerations may vary based on the child's age at onset, the course of illness, and subtle differences in phenotype. Systematic investigation is recommended for efficient diagnosis. In this review, we outline common etiologies and describe a comprehensive approach to the evaluation of both acquired and genetic cerebellar ataxia in children. PMID:22764177

  17. A case of cerebellar psychopathology.

    Science.gov (United States)

    Rosinski, Amy; Goldman, Mona; Cameron, Oliver

    2010-01-01

    Pathology of the cerebellum has traditionally been associated with motor symptoms, vertigo, and nystagmus. Patients with cerebellar disorders do not usually receive psychiatric evaluations. The authors seek to alert clinicians to the association between cerebellar disease and psychiatric symptoms. The authors describe a patient with uncommon psychiatric morbidity associated with cerebellar dysfunction, and provide a brief review of previous research on this phenomenon. Neurology consultants suggested that physical exam findings and behavioral changes could be accounted for by cerebellar cognitive affective syndrome. This syndrome involves dysfunction of the cerebellum, including classic cerebellar findings, in addition to cognitive difficulties and affective/personality changes. The suspected etiology was post-infectious cerebellitis from Epstein-Barr virus infection.

  18. Toxic agents causing cerebellar ataxias.

    Science.gov (United States)

    Manto, Mario

    2012-01-01

    The cerebellum is particularly vulnerable to intoxication and poisoning, especially so the cerebellar cortex and Purkinje neurons. In humans, the most common cause of a toxic lesion to the cerebellar circuitry is alcohol related, but the cerebellum is also a main target of drug exposure (such as anticonvulsants, antineoplastics, lithium salts, calcineurin inhibitors), drug abuse and addiction (such as cocaine, heroin, phencyclidine), and environmental toxins (such as mercury, lead, manganese, toluene/benzene derivatives). Although data for the prevalence and incidence of cerebellar lesions related to intoxication and poisoning are still unknown in many cases, clinicians should keep in mind the list of agents that may cause cerebellar deficits, since toxin-induced cerebellar ataxias are not rare in daily practice. Moreover, the patient's status may require immediate therapies when the intoxication is life-threatening. 2012 Elsevier B.V. All rights reserved.

  19. Subcortical infarction resulting in acquired stuttering.

    Science.gov (United States)

    Ciabarra, A M; Elkind, M S; Roberts, J K; Marshall, R S

    2000-10-01

    Stuttering is an uncommon presentation of acute stroke. Reported cases have often been associated with left sided cortical lesions, aphasia, and difficulties with other non-linguistic tests of rhythmic motor control. Three patients with subcortical lesions resulting in stuttering are discussed. In one patient the ability to perform time estimations with a computerised repetitive time estimation task was characterised. One patient had a pontine infarct with clinical evidence of cerebellar dysfunction. A second patient had a left basal ganglionic infarct and a disruption of timing estimation. A third patient had a left subcortical infarct and a mild aphasia. These findings expand the reported distribution of infarction that can result in acquired stuttering. Subcortical mechanisms of speech control and timing may contribute to the pathophysiology of acquired stuttering.

  20. 回旋支闭塞致急性下壁心肌梗死心电图特点分析%Electrocardiogram Characteristics of Acute Inferior Myocardial Infarction Caused by Occlusion of Left Circumflex Artery

    Institute of Scientific and Technical Information of China (English)

    李群; 王军; 李世敬; 王德昭; 陈步星

    2015-01-01

    Objective To investigate electrocardiogram ( ECG) characteristics of acute inferior myocardial infarction ( AIMI) attributing to occlusion of left circumflex artery ( LCX) and predictive value of ST-segment changes on infarct-related artery ( IRA) . Methods We retrospectively analyzed the clinical characteristics, electrocardiogram and coronary angiography of 240 patients with AIMI who underwent primary percutaneous coronary intervention ( PCI) within 12 hours of symptom onset. Results The IRAs were the right coronary artery (RCA) in 177 patients (73. 8%) and the LCX in 63 cases (26. 2%). There were no significant differences in the patients' demographics and risk factors between the two groups. Significant differ-ences were found in ST segment deviation of lead Ⅰ, Ⅲ, Ⅲ-Ⅱ, aVL, aVF, aVL-I, V1 , V6 between both groups ( P0.05);两组心电图Ⅰ、Ⅲ、Ⅲ-Ⅱ、aVL、aVF、aVL-I、V1、V6导联ST段偏移情况比较差异有统计学意义(P<0.01);受试者工作特征曲线分析显示:Ⅰ导联ST段压低(ST-segment depres-sion, STD)、ST段抬高( ST-segment elevation, STE)Ⅲ导联<Ⅱ导联、STD aVL导联<Ⅰ导联提示IRA为左回旋支,其诊断敏感度和特异度均较高。结论 AIMI时心电图显示Ⅰ导联STD、STE Ⅲ导联<Ⅱ导联及STD aVL导联<Ⅰ导联对判断回旋支闭塞有一定的预测价值。

  1. Silent ST segment elevation myocardial infarction with multi-segmental renal infarction: an unusual presentation.

    Science.gov (United States)

    Chang, Hung-Yu; Yang, Yung-Nien

    2011-01-01

    A 36-year-old diabetic man came to our institution presenting with constant left flank pain. Left renal embolic infarction was found by abdominal computed tomography. Silent ST segment elevation myocardial infarction was noted on 12-lead electrocardiogram. Emergent coronary angiography revealed large thrombus burdens with complete occlusion at the left anterior descending artery ostium, which may be the embolic origin. Silent ST segment elevation myocardial infarction with acute flank pain and multiple segmental renal infarction is an unusual presentation. High vigilance may prevent delay of the "golden hour" to treat acute myocardial infarction.

  2. Degenerative cerebellar diseases and differential diagnoses; Degenerative Kleinhirnerkrankungen und Differenzialdiagnosen

    Energy Technology Data Exchange (ETDEWEB)

    Reith, W.; Roumia, S.; Dietrich, P. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2016-11-15

    Cerebellar syndromes result in distinct clinical symptoms, such as ataxia, dysarthria, dysmetria, intention tremor and eye movement disorders. In addition to the medical history and clinical examination, imaging is particularly important to differentiate other diseases, such as hydrocephalus and multi-infarct dementia from degenerative cerebellar diseases. Degenerative diseases with cerebellar involvement include Parkinson's disease, multiple system atrophy as well as other diseases including spinocerebellar ataxia. In addition to magnetic resonance imaging (MRI), nuclear medicine imaging investigations are also helpful for the differentiation. Axial fluid-attenuated inversion recovery (FLAIR) and T2-weighted sequences can sometimes show a signal increase in the pons as a sign of degeneration of pontine neurons and transverse fibers in the basilar part of the pons. The imaging is particularly necessary to exclude other diseases, such as normal pressure hydrocephalus (NPH), multi-infarct dementia and cerebellar lesions. (orig.) [German] Klinisch imponieren Kleinhirnsyndrome durch Ataxie, Dysarthrie, Dysmetrie, Intentionstremor und Augenbewegungsstoerungen. Neben der Anamnese und klinischen Untersuchung ist die Bildgebung v. a. wichtig um andere Erkrankungen wie Hydrozephalus und Multiinfarktdemenz von degenerativen Kleinhirnerkrankungen zu differenzieren. Zu den degenerativen Erkrankungen mit Kleinhirnbeteiligung gehoeren der Morbus Parkinson, die Multisystematrophie sowie weitere Erkrankungen einschliesslich der spinozerebellaeren Ataxien. Neben der MRT sind auch nuklearmedizinische Untersuchungen zur Differenzierung hilfreich. Axiale Fluid-attenuated-inversion-recovery(FLAIR)- und T2-gewichtete Sequenzen koennen mitunter eine Signalsteigerung im Pons als Ausdruck einer Degeneration der pontinen Neuronen und transversalen Bahnen im Brueckenfuss zeigen. Die Bildgebung ist aber v. a. notwendig, um andere Erkrankungen wie Normaldruckhydrozephalus

  3. A rare complication of a unilateral vertebral artery occlusion, which resulted in a basilar emboli after a C5-C6 bifacet dislocation in a professional rugby player: case study.

    Science.gov (United States)

    Davies, Simon R

    2011-03-01

    Vertebral artery damage after cervical fracture and especially cervical dislocations is a recognized phenomenon. The incidence of significant intracranial neurology after unilateral vertebral damage is extremely rare, and to our knowledge, no such injury has been sustained while playing sport. To describe a rare vascular complication of a bifacet C5-C6 dislocation. Case report and clinical discussion. We present a 28-year old white man who was a professional rugby player. He sustained a hyperflexion injury while playing scrum half in a recent league match, which resulted in a C5-C6 dislocation, diagnosed clinically and with a plain radiograph. The patient on admission had complete neurologic loss below C6. The patient underwent immediate computed tomography and magnetic resonance imaging (MRI) scans that revealed a 50% displacement of C5 on C6 with a complete unifacet dislocation and the other facet partially dislocated. The MRI revealed signal changes in the cord at the C5-C6 level and an intimal tear in the left vertebral artery. The decision was taken to reduce the dislocation when medically stable. A few hours after injury, after an episode of vomiting, the patient sustained a respiratory arrest owing to the embolization of a clot from the left vertebral artery into the basilar artery. Despite rapid embolectomy and subsequent permanent left vertebral artery occlusion, the patient sustained multiple infarcts in the cerebellar, thalamic, occipital, and pontine regions of the brain that eventually proved fatal. This case shows a rare complication of unilateral vertebral artery occlusion. Despite early identification of a basilar infarct and a successful embolectomy, intracranial infarction occurred. Although there is no guideline for the treatment of vertebral artery damage, early reduction and anticoagulation may reduce the risk of cerebral infarction. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. ST-segment depression in aVR as a predictor of culprit artery in acute inferior wall ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ahmed Hafez el-neklawy

    2014-03-01

    Conclusions: ST depression in aVR is common in patients with LCX-related acute inferior myocardial infarction. The ST changes in this lead are associated with an excellent specificity and a good sensitivity in differentiating LCX from RCA as the IRA.

  5. SNPs in MicroRNA Binding Sites in 3′-UTRs of RAAS Genes Influence Arterial Blood Pressure and Risk of Myocardial Infarction

    NARCIS (Netherlands)

    Nossent, A.Yael; Hansen, Jakob L.; Doggen, Carine; Quax, Paul H.A.; Sheikh, Soren P.; Rosendaal, Frits R.

    2011-01-01

    Background We hypothesized that single nucleotide polymorphisms (SNPs) located in microRNA (miR) binding sites in genes of the renin angiotensin aldosterone system (RAAS) can influence blood pressure and risk of myocardial infarction. Methods Using online databases dbSNP and TargetScan, we ident

  6. Sleep disorders in cerebellar ataxias

    Directory of Open Access Journals (Sweden)

    José L. Pedroso

    2011-04-01

    Full Text Available Cerebellar ataxias comprise a wide range of etiologies leading to central nervous system-related motor and non-motor symptoms. Recently, a large body of evidence has demonstrated a high frequency of non-motor manifestations in cerebellar ataxias, specially in autosomal dominant spinocerebellar ataxias (SCA. Among these non-motor dysfunctions, sleep disorders have been recognized, although still under or even misdiagnosed. In this review, we highlight the main sleep disorders related to cerebellar ataxias focusing on REM sleep behavior disorder (RBD, restless legs syndrome (RLS, periodic limb movement in sleep (PLMS, excessive daytime sleepiness (EDS, insomnia and sleep apnea.

  7. Renal infarction complicating fibromuscular dysplasia.

    Science.gov (United States)

    Gavalas, M; Meisner, R; Labropoulos, N; Gasparis, A; Tassiopoulos, A

    2014-01-01

    Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal and extracranial carotid arteries. We present 3 cases of renal infarction complicating renal artery FMD in 42-, 43-, and 46-year-old females and provide a comprehensive review of the literature on this topic. In our patients, oral anticoagulation therapy was used to treat all cases of infarction, and percutaneous angioplasty was used nonemergently in one case to treat refractory hypertension. All patients remained stable at 1-year follow-up. This is consistent with outcomes in previously published reports where conservative medical management was comparable to surgical and interventional therapies. Demographic differences may also exist in patients with renal infarction and FMD. A higher prevalence of males and a younger age at presentation have been found in these patients when compared to the general population with FMD.

  8. Cerebral Lesions in Patients Undergoing Coronary Artery Bypass Grafting in Relation to Asymptomatic Carotid and Vertebral Artery Stenosis

    DEFF Research Database (Denmark)

    Wiberg, Sebastian; Schoos, Mikkel; Sillesen, Henrik

    2015-01-01

    OBJECTIVES: Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the associations between neurologically asymptomatic CAS ...

  9. Contrast MR imaging of acute cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kogame, Saeko; Syakudo, Miyuki; Inoue, Yuichi (Osaka City Univ. (Japan). Faculty of Medicine) (and others)

    1992-04-01

    Thirty patients with acute and subacute cerebral infarction (13 and 17 deep cerebral infarction) were studied with 0.5 T MR unit before and after intravenous injection of Gd-DTPA. Thirteen patients were studied within 7 days after neurological ictus, 17 patients were studied between 7 and 14 days. Two types of abnormal enhancement, cortical arterial and parenchymal enhancement, were noted. The former was seen in 3 of 4 cases of very acute cortical infarction within 4 days after clinical ictus. The latter was detected in all 7 cases of cortical infarction after the 6th day of the ictus, and one patient with deep cerebral infarction at the 12th day of the ictus. Gd-DTPA enhanced MR imaging seems to detect gyral enhancement earlier compared with contrast CT, and depict intra-arterial sluggish flow which was not expected to see on contrast CT scans. (author).

  10. [Percutaneous angioplasty of the left renal artery in a patient with acute infarction of the left kidney with persistent occlusion of the right renal artery treated with angiotensin converting enzyme inhibitor].

    Science.gov (United States)

    Latacz, Paweł; Rudnik, Andrzej; Gutowska, Aleksandra; Zając, Mariola; Kondys, Marek; Ludyga, Tomasz; Kazibudzki, Marek; Cierpka, Lech

    2011-01-01

    A case of a 67 year-old woman with acute renal syndrome during treatment of angiotensin converting enzyme is presented. In angiography was affirmed acute occlusion left renal artery (LRA) with chronic occlusion right renal artery. Percutaneous angioplasty with implantation stent of the LRA were performed with optimal effect. In this article, the clinical management of patients with angiographically documented acute occlusion renal artery is discussed.

  11. Cerebellar Malformations and Cognitive Disdorders

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-10-01

    Full Text Available The behavioral developmental profile of 27 children and adults (17 males and 10 females with congenital cerebellar malformations was determined in a clinical, neuroradiological and neuropsychological study at the Scientific Institute 'E Medea', University of Milano, Italy.

  12. Gamma-Hydroxybutyrate (GHB), gamma-butyrolactone (GBL), and 1,4-butanediol (1,4-BD) reduce the volume of cerebral infarction in rodent transient middle cerebral artery occlusion.

    Science.gov (United States)

    Sadasivan, Shankar; Maher, Timothy J; Quang, Lawrence S

    2006-08-01

    gamma-Hydroxybutyric acid (GHB), an endogenous organic acid catabolite of gamma-aminobutyric acid (GABA), has been shown to have tissue-protective effects in various organs, including the brain. We examined the potential neuroprotective effect of GHB and its chemical precursors, gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD), in the rodent ischemic stroke model by intraluminal filament middle cerebral artery occlusion (MCAO). Adult male Sprague-Dawley rats underwent transient left-sided MCAO and received intraperitoneal treatment with 300 mg/kg of GHB, GBL, 1,4-BD, or control vehicle given at 30 min before, as well as 180 and 360 min after the onset of ischemia. Infarct volumes were determined 24 h after MCAO. In transient MCAO, the mean volume of infarction for control rats was 464.4 +/- 17.9 cu.mm versus 273.6 +/- 53.1, 233.3 +/- 44.7, and 275.4 +/- 39.9 cu.mm for rats treated with 1,4-BD (P GBL (P GBL, and 1,4-BD protect against rat focal cerebral ischemia from transient MCAO.

  13. 急性脑梗死早期行微导管动脉溶栓治疗的护理%The nursing coordination of acute cerebral infarction patients undergoing early arterial thrombolysis

    Institute of Scientific and Technical Information of China (English)

    陈叶香; 易萍; 吕美云

    2011-01-01

    目的 探讨急性脑梗死早期动脉溶栓治疗护理配合的重要性.方法 对37例急性脑梗死早期选择性行微导管动脉溶栓治疗的患者,进行规范的术前准备、术中护理配合、术后的病情观察与护理.结果 37例患者治疗3个月后随访,21例发病6 h内行动脉溶栓治疗预后好的患者占80.95%,16例发病6~24 h行动脉溶栓治疗预后好的患者占68.75%,提高了患者的生存质量.结论 急性脑梗死早期选择性行微导管动脉溶栓治疗疗效良好,行微导管动脉溶栓治疗中规范的术前准备、术中护理配合、术后的病情观察与护理至关重要.%Objective To approach the importance of nursing coordination of early arterial thrombolysis in acute cerebral infarction (ACI). Methods 37 cases of ACI early selective micro-catheter arterial thrombolytic therapy were observed and nursed after the standard preoperative preparation, intraoperative nursing coordination, postoperative condition observation and nursing care. Results 80.95% of 21cases had much improvement of symptoms after arterial thrombolytic therapy and care within 6h;68.75% within 6 ~ 24 h. The rate of disability in patients with ACI were significantly reduced and the quality of life of patients were improved.Conclusions Early selective micro-catheter arterial thrombolytic therapy is of benefit for the acute cerebral infarction patient. The standard preoperative preparation, intraoperative nursing coordination, postoperative condition observation and nursing care are essential.

  14. Hemoglobin A1c is associated with severity of coronary artery stenosis but not with long term clinical outcomes in diabetic and nondiabetic patients with acute myocardial infarction undergoing primary angioplasty.

    Science.gov (United States)

    She, Jianqing; Deng, Yangyang; Wu, Yue; Xia, Yulong; Li, Hongbing; Liang, Xiao; Shi, Rui; Yuan, Zuyi

    2017-08-08

    Acute myocardial infarction (AMI) patients with type 2 diabetes mellitus are known to present with multiple vessel lesions during coronary angiography. The underlying mechanism remains elusive and there is a shortage of serum prediction markers. In this study, we investigate the relationship between admission HbA1c and severity of coronary artery stenosis and subsequent prognosis in AMI patients with or without diabetes. We measured admission HbA1c, and vessel scores based on the number of diseased coronary vessels with significant stenosis in 628 patients diagnosed with AMI. Simple and multi-regression analysis were performed to investigate the correlation between HbA1c and the severity of coronary artery stenosis. Major adverse cardiovascular events (MACE), including new-onset myocardial infarction, acute heart failure and cardiac death, were documented during the follow-up. 272 non-DM participants and 137 DM participants were separated into two groups based on HbA1c levels for survival analysis during a 2-year follow up. 448 non-DM patients and 180 DM patients were included in the initial observational analysis. 272 non-DM patients and 137 DM patients were included in the follow-up survival analysis. The admission HbA1c level was found to be significantly positively correlated to the number of affected vessels suffering from significant coronary artery stenosis both in DM (R square = 0.012; 95% CI 0.002 to 0.623, P = 0.049) and non DM patients (R square = 0.025; 95% CI 0.009 to 0.289, P = 0.037). Kaplan-Meier survival analysis revealed no significant difference with regard to different HbA1c levels either in DM or non-DM patients at the end of follow-up. In patients with AMI, admission HbA1c is an important predictor for the severity of coronary artery stenosis in non-DM and DM patients. Further studies are needed to determine whether longer term follow-up could further identify the prognosis effect of HbA1c on MACE.

  15. Complex partial seizures: cerebellar metabolism

    Energy Technology Data Exchange (ETDEWEB)

    Theodore, W.H.; Fishbein, D.; Deitz, M.; Baldwin, P.

    1987-07-01

    We used positron emission tomography (PET) with (/sup 18/F)2-deoxyglucose to study cerebellar glucose metabolism (LCMRglu) and the effect of phenytoin (PHT) in 42 patients with complex partial seizures (CPS), and 12 normal controls. Mean +/- SD patient LCMRglu was 6.9 +/- 1.8 mg glucose/100 g/min (left = right), significantly lower than control values of 8.5 +/- 1.8 (left, p less than 0.006), and 8.3 +/- 1.6 (right, p less than 0.02). Only four patients had cerebellar atrophy on CT/MRI; cerebellar LCMRglu in these was 5.5 +/- 1.5 (p = 0.054 vs. total patient sample). Patients with unilateral temporal hypometabolism or EEG foci did not have lateralized cerebellar hypometabolism. Patients receiving phenytoin (PHT) at the time of scan and patients with less than 5 years total PHT exposure had lower LCMRglu, but the differences were not significant. There were weak inverse correlations between PHT level and cerebellar LCMRglu in patients receiving PHT (r = -0.36; 0.05 less than p less than 0.1), as well as between length of illness and LCMRglu (r = -0.22; 0.05 less than p less than 0.1). Patients with complex partial seizures have cerebellar hypometabolism that is bilateral and due only in part to the effect of PHT.

  16. Prognostic Importance of Lesion Location on Functional Outcome in Patients with Cerebellar Ischemic Stroke: a Prospective Pilot Study.

    Science.gov (United States)

    Picelli, Alessandro; Zuccher, Paola; Tomelleri, Giampaolo; Bovi, Paolo; Moretto, Giuseppe; Waldner, Andreas; Saltuari, Leopold; Smania, Nicola

    2017-02-01

    To date, few studies focused on prediction of functional recovery after cerebellar stroke. The main aim of this prospective pilot study was to determine the association between cerebellar lesion location and functional outcome in adults with acute cerebellar infarction. We examined 14 patients with first-ever unilateral cerebellar ischemic stroke within 7 days and at 90 days from the onset of stroke by means of the International Cooperative Ataxia Rating Scale. Cerebellar lesions were traced from magnetic resonance imaging performed within 72 h since stroke and region of interest were generated. The association between the International Cooperative Ataxia Rating Scale score and lesion location was determined with the voxel-based lesion-symptom mapping methods implemented in the MRIcro software. Colored lesion-symptom maps representing the z statistics were generated and overlaid onto the MNI-ICBM 152 linear probabilistic atlas of the human brain and the Johns Hopkins University white matter templates. Our results documented that injuries to the V, VI, VIIA Crus I, VIIA Crus II, VIIB, VIIIA, and VIIIB lobules and the middle cerebellar peduncle are significantly associated with the International Cooperative Ataxia Rating Scale (ICARS) score at 1 week after the onset of stroke. Furthermore, we found that injuries to the VI, VIIA Crus I, VIIA Crus II, VIIB, VIIIA, and VIIIB lobules, the dentate nucleus, and the middle cerebellar peduncle are significantly associated with the ICARS score at 3 months since the cerebellar stroke onset. The findings of this pilot study might improve prognostic accuracy of functional outcome in patients with acute cerebellar infarction.

  17. Chronic total occlusion in a non-infarct-related artery is closely associated with increased five-year mortality in patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention (from the CREDO-Kyoto AMI registry).

    Science.gov (United States)

    Watanabe, Hiroki; Morimoto, Takeshi; Shiomi, Hiroki; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Kimura, Takeshi

    2017-02-03

    We sought to investigate the clinical impact of chronic total occlusion (CTO) in a non-infarct-related artery (IRA) on long-term cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI). Among 5,429 patients enrolled in the CREDO-Kyoto AMI registry, the current study population consisted of 2,045 STEMI patients with multivessel disease (MVD) who underwent primary PCI within 24 hours after symptom onset. The cumulative five-year, 30-day and 30-day to five-year incidences of all-cause death were all significantly higher in the CTO group than in the non-CTO group (37.0% versus 22.0%, log-rank pfive years, during the initial 30 days, and beyond 30 days and up to five years (hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.18-1.84, p=0.0009; HR: 1.49, 95% CI: 1.04-2.13, p=0.03; and HR: 1.61, 95% CI: 1.23-2.07, p=0.0006, respectively). CTO in a non-IRA was associated with increased five-year mortality in STEMI patients with MVD. This was consistently seen even after excluding early deaths within 30 days of the index STEMI event.

  18. Intracoronary artery transplantation of cardiomyoblast-like cells from human adipose tissue-derived multi-lineage progenitor cells improve left ventricular dysfunction and survival in a swine model of chronic myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Okura, Hanayuki [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Saga, Ayami; Soeda, Mayumi [Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Miyagawa, Shigeru; Sawa, Yoshiki [Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Daimon, Takashi [Division of Biostatistics, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 (Japan); Ichinose, Akihiro [Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); Matsuyama, Akifumi, E-mail: akifumi-matsuyama@umin.ac.jp [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); RIKEN Program for Drug Discovery and Medical Technology Platforms, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045 (Japan)

    2012-09-07

    Highlights: Black-Right-Pointing-Pointer We administered human CLCs in a swine model of MI via intracoronary artery. Black-Right-Pointing-Pointer Histological studies demonstrated engraftment of hCLCs into the scarred myocardium. Black-Right-Pointing-Pointer Echocardiography showed rescue of cardiac function in the hCLCs transplanted swine. Black-Right-Pointing-Pointer Transplantation of hCLCs is an effective therapeutics for cardiac regeneration. -- Abstract: Transplantation of human cardiomyoblast-like cells (hCLCs) from human adipose tissue-derived multi-lineage progenitor cells improved left ventricular function and survival of rats with myocardial infarction. Here we examined the effect of intracoronary artery transplantation of human CLCs in a swine model of chronic heart failure. Twenty-four pigs underwent balloon-occlusion of the first diagonal branch followed by reperfusion, with a second balloon-occlusion of the left ascending coronary artery 1 week later followed by reperfusion. Four weeks after the second occlusion/reperfusion, 17 of the 18 surviving animals with severe chronic MI (ejection fraction <35% by echocardiography) were immunosuppressed then randomly assigned to receive either intracoronary artery transplantation of hCLCs hADMPCs or placebo lactic Ringer's solution with heparin. Intracoronary artery transplantation was followed by the distribution of DiI-stained hCLCs into the scarred myocardial milieu. Echocardiography at post-transplant days 4 and 8 weeks showed rescue and maintenance of cardiac function in the hCLCs transplanted group, but not in the control animals, indicating myocardial functional recovery by hCLCs intracoronary transplantation. At 8 week post-transplantation, 7 of 8 hCLCs transplanted animals were still alive compared with only 1 of the 5 control (p = 0.0147). Histological studies at week 12 post-transplantation demonstrated engraftment of the pre DiI-stained hCLCs into the scarred myocardium and their expression of

  19. Migrainous infarction

    DEFF Research Database (Denmark)

    Laurell, K; Artto, V; Bendtsen, L

    2011-01-01

    Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included......Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included...

  20. Ischemia as a potential etiologic factor in idiopathic unilateral sudden sensorineural hearing loss: Analysis of posterior circulation arteries.

    Science.gov (United States)

    Kim, Chulho; Sohn, Jong-Hee; Jang, Min Uk; Hong, Sung-Kwang; Lee, Joong-Seob; Kim, Hyung-Jong; Choi, Hui-Chul; Lee, Jun Ho

    2016-01-01

    The association between idiopathic sudden sensorineural hearing loss (ISSNHL) and the radiologic characteristics of the vertebrobasilar artery is unclear. We hypothesized that the degree and direction of vertebrobasilar artery curvature in the posterior circulation contribute to the occurrence of ISSNHL. We consecutively enrolled patients diagnosed with unilateral ISSNHL in two tertiary hospitals. Magnetic resonance images were performed in all patients to exclude specific causes of ISSNHL, such as vestibular schwannoma, chronic mastoiditis, and anterior inferior cerebellar artery infarct. We measured the following parameters of posterior circulation: vertebral and basilar artery diameter, the degree of basilar artery curvature (modified smoker criteria), and vertebral artery dominance. Pure tone audiometries were performed at admission and again 1 week and 3 months later. A total of 121 ISSNHL patients (mean age, 46.0 ± 17.3 years; 48.8% male) were included in these analyses. The proportion of patients with the left side hearing loss was larger than the proportion with the right side hearing loss (left, 57.9%; right, 42.1%). The majority of patients were characterized by a left dominant vertebral artery and right-sided basilar artery curvature. The direction of the basilar artery curvature was significantly associated with hearing loss lateralization (p = 0.036). Age and sex matched multivariable analyses revealed the absence of diabetes and right-sided basilar artery curvature as significant predictors for left sided hearing loss. There was no statistical difference between atherosclerotic cardiovascular risk score (high versus low) and hearing outcomes at 3 months. In ISSNHL, the laterality of hearing loss was inversely associated with the direction of basilar artery curvature. Our results, therefore, indicate the importance of vascular assessment when evaluating ISSNHL.

  1. [Cerebellar cognitive affective syndrome secondary to a cerebellar tumour].

    Science.gov (United States)

    Domínguez-Carral, J; Carreras-Sáez, I; García-Peñas, J J; Fournier-Del Castillo, C; Villalobos-Reales, J

    2015-01-01

    Cerebellar cognitive affective syndrome is characterized by disturbances of executive function, impaired spatial cognition, linguistic difficulties, and personality change. The case of an 11 year old boy is presented, with behavior problems, learning difficulties and social interaction problems. In the physical examination he had poor visual contact, immature behavior, reduced expressive language and global motor disability with gait dyspraxia, with no defined cerebellar motor signs. In the neuropsychological evaluation he has a full scale overall intellectual quotient of 84, with signs of cerebellar cognitive affective syndrome. A tumour affecting inferior cerebellar vermis was observed in the magnetic resonance imaging, which had not significantly grown during 5 years of follow up. The cerebellum participates in controlling cognitive and affective functions. Cerebellar pathology must be considered in the differential diagnosis of children with cognitive or learning disorder with associated behavioral and emotional components. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  2. Correlation of Cognitive Impairment and Areas of Middle Cerebral Artery Territory Infarction%大脑中动脉供血区不同梗死灶所致认知障碍的特点

    Institute of Scientific and Technical Information of China (English)

    张卫; 恽晓平; 于一宁

    2014-01-01

    目的:从大脑中动脉供血区角度探讨不同梗死部位缺血性卒中与认知障碍之间的关系。方法应用蒙特利尔认知评估量表(MoCA)北京版,对首次急性发病2周左右的缺血性卒中患者进行认知功能评估,记录其MoCA评分及各单项认知领域评分。按照大脑中动脉供血区梗死,MoCA评分≥15分,且至少有一个认知领域障碍的条件,筛选出132例患者资料。再按梗死部位分组,将各组MoCA结果进行相关分析。结果大脑中动脉供血区梗死与视空间/执行、注意、语言和记忆损害有关(B=-1.875~-1.094, P<0.05)。额叶梗死与视空间/执行、注意、抽象和记忆功能损害有关(B=-1.760~-1.329, P<0.05);颞叶梗死引起视空间/执行和记忆功能损害显著(B=-1.849~-1.735, P<0.05);顶叶梗死导致视空间/执行、注意和记忆功能损害(B=-1.695~-1.482, P<0.05);基底节梗死与视空间/执行、注意、语言和记忆功能损害有关(B=-1.932~-1.041, P<0.01)。结论大脑中动脉不同供血区梗死所致认知功能损害的领域不同。%Objective To explore the correlation of cognitive impairment and areas of middle cerebral artery (MCA) territory infarction. Methods The Montreal Cognitive Assessment (MoCA) was used to evaluate neuropsychological statuses in the patients who developed first-time acute cerebral infarction for 2 weeks. MoCA scores and sub-scores were recorded. 132 patients were selected with MCA occlu-sion, scores of MoCA were more than 15, and cognitive impairment in at least one domain, and then subgrouped by infarction site. The cor-relation between the results of neuropsychological cognitive assessment and the sites of infarction was analyzed. Results MCA occlusion was correlated with the impairments of visual spatial/executive, attention, language and memory (B=-1.875~-1.094, P<0.05). Infarction in frontal lobe was correlated with the impairments of visual spatial/executive, attention

  3. Renal infarction associated with adrenal pheochromocytoma.

    Science.gov (United States)

    Thewjitcharoen, Yotsapon; Atikankul, Taywin; Sunthornyothin, Sarat

    2013-09-01

    The coexistence of pheochromocytoma and renal artery stenosis had been reported occasionally from the possible mechanism of catecholoamine-induced vasospasm and extrinsic compression of renal artery in some reported cases. However, renal infarction caused by pheochromocytoma is an uncommon phenomenon. Herein, we report an interesting case of adrenal pheochromocytoma associated with renal artery thrombosis, which should be included in the differential diagnosis of pheochromocytoma patients who present with abdominal pain.

  4. Safety of anticoagulation after hemorrhagic infarction.

    Science.gov (United States)

    Pessin, M S; Estol, C J; Lafranchise, F; Caplan, L R

    1993-07-01

    Cerebral hemorrhagic infarction visualized on CT, secondary to embolic stroke in an anticoagulated individual, is usually associated with clinically stable or improving neurologic signs; fear of transforming the hemorrhagic infarction into a hematoma, however, usually prompts cessation of anticoagulation until the blood has cleared on CT, despite the recognized risk of recurrent embolism during this non-anticoagulated period. We now report our experience with 12 patients with hemorrhagic infarction who remained anticoagulated. Eleven men and one woman, ages 33 to 77, developed hemorrhagic infarction while on heparin, warfarin, or both, for prevention of recurrent embolism. Patients were either continued on uninterrupted anticoagulation from stroke onset (n = 6), or anticoagulation was withheld for several days and then resumed (n = 4), or it was withheld for 5 and 14 days (n = 2) after stroke onset and then continued uninterrupted despite the CT appearance of hemorrhagic infarction. Eleven patients had a definite cardioembolic source for stroke (atrial fibrillation, seven; ventricular thrombus, two; and ventricular dyskinesia, two). One patient had carotid occlusion with local intra-arterial embolism. Hemorrhagic infarcts varied in size and were located in the middle cerebral artery territory in 11 patients and posterior cerebral artery territory in one. All patients remained clinically stable or improved on anticoagulation. Serial CTs showed fading hemorrhagic areas. When the risk of recurrent embolism is high, anticoagulation may be safely used in some patients with hemorrhagic infarction.

  5. Percutaneous transluminal coronary angioplasty for culprit lesions in patients with post myocardial infarction angina based on dextrocardia and anomalous coronary arteries. Case reports and methods.

    Science.gov (United States)

    Yabe, Y; Tsukahara, R

    1995-05-01

    Four cases of successful coronary angioplasty for anomalous coronary arteries, including dextrocardia associated with three-vessel disease, single left coronary artery with proximal left anterior descending lesion, anomalous right coronary artery (RCA) from adjacent left coronary sinus of Valsalva associated with proximal RCA lesion, and anomalous left circumflex angulated lesion bifurcated from the RCA, were encountered. Four cases with 8 target lesions who had a mean age of 63.5 +/- 11.5 years old are presented. All the targets lesions were completely dilated through balloon angioplasty, including use of a newly developed support device for cases with large jeopardized myocardium. The factors for complete revascularization were appropriate selection of catheters and originality and ingenuity of procedural technique based on the anatomic characteristics.

  6. Patients With and Without Diabetes Without Significant Angiographic Coronary Artery Disease Have the Same Risk of Myocardial Infarction in a Real-World Population Receiving Appropriate Prophylactic Treatment

    DEFF Research Database (Denmark)

    Olesen, Kevin K W; Madsen, Morten; Egholm, Gro

    2017-01-01

    OBJECTIVE: The risk of myocardial infarction (MI) in patients with diabetes is greater than for patients without diabetes. Consequently, prophylactic treatment is recommended for patients with diabetes and risk factors for ischemic heart disease. We aimed to estimate the risk of adverse cardiac...... without CAD were more often treated with statins (75.3% vs. 46.0%) and aspirin (65.7% vs. 52.7%) than patients without diabetes and CAD. CONCLUSIONS: In a real-world population, patients with diabetes with high rates of statin and aspirin treatment had the same risk of cardiovascular events as patients...

  7. 视网膜血管管径与颈动脉狭窄患者脑梗死发生的相关性分析%Relation between retinal vessel diameters and carotid artery stenosis patients with cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    赵露; 谢国丽; 王佳琳; 王艳玲

    2016-01-01

    目的 观察探讨视网膜血管管径与颈动脉狭窄患者脑梗死发生的相关性.方法 彩色多普勒血流显像检查确诊的颈动脉狭窄患者87例174只眼纳入研究.患者中,男性49例,女性38例;平均年龄(65.25±7.85)岁.以是否有脑梗死将患者分为脑梗死组和对照组,分别为34、53例.两组患者间年龄(t=1.916)、男性构成比(x2=0.142)、颈动脉狭窄程度(x2=0.785)比较,差异均无统计学意义(P=0.059、0.706、0.675).散瞳后拍摄以黄斑和视盘之间中点为中心周围45°彩色眼底像,包括视盘、黄斑、颞侧黄斑区上下血管弓以及距离视盘边缘2个视盘直径(DD)的鼻侧区域.应用IVAN计算机图像分析软件,测量距视盘边缘1/2~1DD范围内视网膜动静脉的血管直径.主要参数为视网膜中央动脉直径(CRAE)、视网膜中央静脉直径(CRVE)、视网膜动静脉比值(ARV).视网膜血管管径与脑梗死关系行logistic回归分析.结果 脑梗死组CRVE、CRAE、AVR分别为(132.90±20.67)、(243.47±43.92)μm和0.56±0.10;对照组分别为(145.26±21.59)、(224.99±32.35) μm和0.68±0.13.两组CRVE、CRAE、AVR比较,差异均有统计学意义(t=-2.648、2.257、-4.631,P<0.05).多因素logistic回归分析,控制年龄、吸烟、低密度脂蛋白混杂因素后,CRAE与脑梗死发生相关性降低,CRVE与脑梗死发生呈显著相关(P=0.015、0.011).结论 CRAE降低、CRVE增加是颈动脉狭窄患者脑梗死发生的危险因素;对颈动脉狭窄患者脑梗死发生有一定预测价值.%Objective To investigate the relationship between retinal vessel diameters and cerebral infarction of carotid artery stenosis patients.Methods Eighty seven patients (174 eyes) with carotid stenosis were included in this study.There were 49 males and 38 females,with an average age of (65.25±7.85) years.Thirty-four patients were suffered from cerebral infarction (cerebral infarction group),and the other 53 patients had no cerebral

  8. Cognition and Emotion in Cerebellar Disorders

    Science.gov (United States)

    ... cerebral cortical “association” areas important for thought, reasoning, motivation, memory and feelings. Damage to the non-motor ... tolerance. Psychosocial interaction may be impaired, particularly in children with cerebellar damage. Dementia is uncommon in cerebellar ...

  9. Acute transcortical mixed aphasia. A carotid occlusion syndrome with pial and watershed infarcts.

    Science.gov (United States)

    Bogousslavsky, J; Regli, F; Assal, G

    1988-06-01

    Four of 1,200 consecutive patients with their first stroke showed acute transcortical mixed aphasia (TMA) characterized by nonfluent speech with impaired naming, semantic paraphasias, echolalia, impaired comprehension, good repetition, reading, and writing on dictation. All 4 had left internal carotid artery (ICA) occlusion with ipsilateral anterior pial territory infarction (precentral-central sulcus artery territory) and watershed infarction between the middle and posterior cerebral artery territories, which spared and 'isolated' the perisylvian speech areas. Although rare, acute TMA is highly suggestive of infarction due to ICA occlusion, in that it is probably related to simultaneous embolism (anterior pial infarction) and haemodynamic insufficiency (posterior watershed infarction).

  10. 小脑梗死与后循环血管病变的关系%A study of correlation between of cerebellar infarction and posterior circulation arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    李卫东; 黄光; 赵涵

    2008-01-01

    目的 探讨MRI所示的小脑梗死灶与DSA发现的后循环血管病变的相关性. 方法 回顾性分析27例小脑梗死患者的临床资料.将每一例小脑梗死患者头部MRI发现的梗死灶与DSA所见的后循环病变血管进行对照. 结果 小脑梗死位于左侧小脑半球17例,右侧10例.DSA发现大动脉狭窄[包括单纯椎动脉近段(V1)狭窄、V1段狭窄伴颅内段椎动脉狭窄及锁骨下动脉+头臂干狭窄]17例, 与之对应的MRI发现的梗死部位为:责任血管区域性小脑梗死7例,多位于小脑下后动脉(PICA)供血区(5/7);责任血管区不完全性梗死10例,较多位于小脑上动脉(SCA) 供血区(4/10).分支动脉狭窄8例,其中MRI见责任血管区域性小脑梗死4例,均位于PICA供血区;责任血管区不完全性梗死4例,分布于PICA、SCA 及小脑下前动脉供血区.2例DSA后循环动脉未见明显异常,头部MRI见PICA和小脑下前动脉供血区有多发性小梗死灶. 结论小脑梗死的MRI表现与后循环动脉狭窄性病变部位具有相关性.大动脉狭窄的病例中,椎动脉V1段狭窄最常见,其梗死部位多位于PICA供血区.

  11. Pregnancy associated plasma protein-A as a marker for myocardial infarction and death in patients with stable coronary artery disease: A prognostic study within the CLARICOR Trial

    DEFF Research Database (Denmark)

    Iversen, Kasper K; Teisner, Børge; Winkel, Per

    2011-01-01

    OBJECTIVE: Pregnancy associated plasma protein-A (PAPP-A) is a potential new marker for vulnerable plaques in the coronary arteries only examined in stable coronary disease (CAD) in patients undergoing coronary angiography. Here we address the prognostic value of serum PAPP-A in unselected stable...

  12. The free radical spin-trap alpha-PBN attenuates periinfarct depolarizations following permanent middle cerebral artery occlusion in rats without reducing infarct volume

    DEFF Research Database (Denmark)

    Christensen, Thomas; Bruhn, Torben; Diemer, Nils Henrik

    2003-01-01

    The effect of the free radical spin-trap alpha-phenyl-butyl-tert-nitrone (alpha-PBN) in permanent focal cerebral ischemia in rats was examined in two series of experiments. In the first, rats were subjected to permanent occlusion of the middle cerebral artery (MCAO) and treated 1 h after occlusion...

  13. Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction.

    Science.gov (United States)

    Smits, Pieter C; Abdel-Wahab, Mohamed; Neumann, Franz-Josef; Boxma-de Klerk, Bianca M; Lunde, Ketil; Schotborgh, Carl E; Piroth, Zsolt; Horak, David; Wlodarczak, Adrian; Ong, Paul J; Hambrecht, Rainer; Angerås, Oskar; Richardt, Gert; Omerovic, Elmir

    2017-03-30

    Background In patients with ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to restore blood flow in an infarct-related coronary artery improves outcomes. The use of PCI in non-infarct-related coronary arteries remains controversial. Methods We randomly assigned 885 patients with STEMI and multivessel disease who had undergone primary PCI of an infarct-related coronary artery in a 1:2 ratio to undergo complete revascularization of non-infarct-related coronary arteries guided by fractional flow reserve (FFR) (295 patients) or to undergo no revascularization of non-infarct-related coronary arteries (590 patients). The FFR procedure was performed in both groups, but in the latter group, both the patients and their cardiologist were unaware of the findings on FFR. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, revascularization, and cerebrovascular events at 12 months. Clinically indicated elective revascularizations performed within 45 days after primary PCI were not counted as events in the group receiving PCI for an infarct-related coronary artery only. Results The primary outcome occurred in 23 patients in the complete-revascularization group and in 121 patients in the infarct-artery-only group that did not receive complete revascularization, a finding that translates to 8 and 21 events per 100 patients, respectively (hazard ratio, 0.35; 95% confidence interval [CI], 0.22 to 0.55; Pratio, 0.80; 95% CI, 0.25 to 2.56), myocardial infarction in 7 and 28 patients, respectively (2.4% vs. 4.7%) (hazard ratio, 0.50; 95% CI, 0.22 to 1.13), revascularization in 18 and 103 patients (6.1% vs. 17.5%) (hazard ratio, 0.32; 95% CI, 0.20 to 0.54), and cerebrovascular events in 0 and 4 patients (0 vs. 0.7%). An FFR-related serious adverse event occurred in 2 patients (both in the group receiving infarct-related treatment only). Conclusions In patients with STEMI and multivessel

  14. Locations of cerebral infarctions in tuberculous meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Hsieh, F.Y.; Chia, L.G. (Section of Neurology, Taichung Veterans General Hospital (Taiwan)); Shen, W.C. (Section of Neuroradiology, Taichung Veterans General Hospital (Taiwan))

    1992-06-01

    The locations of cerebral infarctions were studied in 14 patients with tuberculous meningitis (TBM) and 173 patients with noninflammatory ischemic stroke (IS). In patients with TBM, 75% of infarctions occurred in the 'TB zone' supplied by medial striate and thalamoperforating arteries; only 11% occurred in the 'IS zone' supplied by lateral striate, anterior choroidal and thalamogeniculate arteries. In patients with IS, 29% of infarctions occurred in the IS zone, 29% in the subcortical white matter, and 24% in (or involving) the cerebral cortex. Only 11% occurred in the TB zone. Bilaterally symmetrical infarctions of the TB zone were common with TBM (71%) but rare with IS (5%). (orig.).

  15. Study of intra-arterial interventional treatment in acute cerebral infarction%急性脑梗死患者动脉内介入治疗的临床体会

    Institute of Scientific and Technical Information of China (English)

    张海欣; 顾芳; 赵淑芹; 胡磊; 宋钦

    2012-01-01

    Objective To study the method and results of intra-arterial interventional treatment( selective intra-arterial fibrinolysis ) in acute cerebral infarction( ACI ). Methods 106 patients with ACI were divided into two groups: 53 cases in selective intra-arterial fibrinolytic therapy group( SIAF ) and intra-venously thrombolysis group ( IVF ); SIAF was selective entered into the obliterative artery with improved Seldingers techniche, pumped urokinase ( UK ) in a dose of 500,000 i. u. in NS. 60ml within 40 minutes; Arteriography was done all the time to know if the obliterative artery was unobstructed. If it remain obstmcte, then pumps 300,000i. u. of UK. The treatment was finished as long as it was unobstructed; IVF was injected 1000,000 i. u. of UK in NS. 150ml by intravenous drip within 40 minutes, others was same with SIAF. Results The artery was recanalization after thrombolysis, 44 patients in SIAF,33 patients in IVF,P <0. 05 ; the patients'condition was good,42 in SIAF,30 in IVF,P <0. 01; fatal cases,6 in SIAF, 12 in IVF,P < 0. 05. Conclusion Selective intra-arterial fibrinolysis is a effective method of treating ACI,the response to treatment is dramatic.%目的 研究急性脑梗死患者动脉内介入治疗(选择性动脉内溶栓)的方法 及疗效.方法 106例急性脑梗死患者,分为选择性动脉内溶栓组(SIAF组)、静脉溶栓组(IVF组)各53例;SIAF组采用改良Seldinger技术,选择性进入闭死的动脉,40分钟内泵入尿激酶50万单位+0.9%氯化钠60ml,随时做造影了解动脉通否,不通者再泵入尿激酶30万单位,只要闭死动脉再通,即撤除之.IVF组40分钟内静脉滴入尿激酶100万单位+0.9%氯化钠150ml,不通者再滴入尿激酶30万单位,余同上.结果 溶栓后再通者SIAF组44例,IVF组33例(P<0.05);病情好转者SIAF组42例,IVF组30例;SIAF组死亡6例,IVF组死亡12例(P<0.05).结论 急性脑梗死患者动脉内介入治疗,效果明显.

  16. Language Impairment in Cerebellar Ataxia

    NARCIS (Netherlands)

    van Gaalen, Judith; de Swart, Bert J. M.; Oostveen, Judith; Knuijt, Simone; van de Warrenburg, Bart P. C.; Kremer, Berry (H. ) P. H.

    Background: Several studies have suggested that language impairment can be observed in patients with cerebellar pathology. The aim of this study was to investigate language performance in patients with spinocerebellar ataxia type 6 (SCA6). Methods: We assessed speech and language in 29 SCA6 patients

  17. Cerebellar Zones: A Personal History

    NARCIS (Netherlands)

    J. Voogd (Jan)

    2011-01-01

    textabstractCerebellar zones were there, of course, before anyone noticed them. Their history is that of young people, unhindered by preconceived ideas, who followed up their observations with available or new techniques. In the 1960s of the last century, the circumstances were fortunate because thr

  18. Language Impairment in Cerebellar Ataxia

    NARCIS (Netherlands)

    van Gaalen, Judith; de Swart, Bert J. M.; Oostveen, Judith; Knuijt, Simone; van de Warrenburg, Bart P. C.; Kremer, Berry (H. ) P. H.

    2014-01-01

    Background: Several studies have suggested that language impairment can be observed in patients with cerebellar pathology. The aim of this study was to investigate language performance in patients with spinocerebellar ataxia type 6 (SCA6). Methods: We assessed speech and language in 29 SCA6 patients

  19. Cerebellar arteriovenous malformations in children

    Energy Technology Data Exchange (ETDEWEB)

    Griffiths, P.D. [Sheffield Univ. (United Kingdom). Acad. Dept. of Radiol.; Blaser, S.; Armstrong, D.; Chuang, S.; Harwood-Nash, D. [Division of Neuroradiology, The Hospital for Sick Children and University of Toronto, Toronto (Canada); Humphreys, R.P. [Division of Neurosurgery, The Hospital for Sick Children and University of Toronto, Toronto (Canada)

    1998-05-01

    We review the presentation, imaging findings and outcome in 18 children with cerebellar arteriovenous malformations (AVM). This group is of particular interest because of the reported poor outcome despite modern imaging and neurosurgical techniques. All children had CT and 15 underwent catheter angiography at presentation. Several of the children in the latter part of the study had MRI. Of the 18 children, 17 presented with a ruptured AVM producing intracranial haemorrhage. The remaining child presented with temporal lobe epilepsy and was shown to have temporal, vermian and cerebellar hemisphere AVM. This child had other stigmata of Osler-Weber-Rendu syndrome. Three other children had pre-existing abnormalities of possible relevance. One had a vascular malformation of the cheek and mandible, one a documented chromosomal abnormality and another a midline cleft upper lip and palate. Six of the 17 children with a ruptured cerebellar AVM died within 7 days of the ictus. Vascular pathology other than an AVM was found in 10 of the 14 children with a ruptured cerebellar AVM who had angiography: 4 intranidal aneurysms, 5 venous aneurysms and 2 cases of venous outflow obstruction (one child having both an aneurysm and obstruction). The severity of clinical presentation was directly related to the size of the acute haematoma, which was a reasonable predictor of outcome. (orig.) With 4 figs., 4 tabs., 23 refs.

  20. Novel adjunctive treatments of myocardial infarction

    DEFF Research Database (Denmark)

    Schmidt, Michael Rahbek; Pryds, Kasper; Bøtker, Hans Erik

    2014-01-01

    Myocardial infarction is a major cause of death and disability worldwide and myocardial infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve...... by endovascular infusion of cold saline all reduce infarct size and may confer clinical benefit for patients admitted with acute myocardial infarcts. Equally promising, three follow-up studies of the effect of remote ischemic conditioning (RIC) show clinical prognostic benefit in patients undergoing coronary...... clinical outcome, but reperfusion may induce further myocardial damage itself. Development of adjunctive therapies to limit myocardial reperfusion injury beyond opening of the coronary artery gains increasing attention. A vast number of experimental studies have shown cardioprotective effects of ischemic...

  1. Myocardial infarction in young adults

    OpenAIRE

    Egred, M; Viswanathan, G; Davis, G.

    2005-01-01

    Although myocardial infarction (MI) mainly occurs in patients older than 45, young men or women can suffer MI. Fortunately, its incidence is not common in patients younger than 45 years. However, the disease carries a significant morbidity, psychological effects, and financial constraints for the person and the family when it occurs at a young age. The causes of MI among patients aged less than 45 can be divided into four groups: (1) atheromatous coronary artery disease; (2) non-atheromatous ...

  2. Acute multiple infarction involving the anterior circulation.

    Science.gov (United States)

    Bogousslavsky, J; Bernasconi, A; Kumral, E

    1996-01-01

    To evaluate the frequency and clinical, topographic, and etiologic patterns of acute multiple infarction involving the anterior circulation. Data analysis from a prospective acute stroke registry in a community-based primary care center. Among 751 patients with first ischemic stroke in the anterior circulation over a 4-year period, 40 patients (5%) had acute multiple infarcts involving the anterior circulation. On computed tomography and magnetic resonance imaging with gadolinium enhancement, there were four topographic patterns of infarction: (1) superficial infarcts (11 patients [28%]); (2) superficial and deep infarcts (12 patients [30%]); (3) deep infarcts (three patients [8%]); and (4) infarcts involving the anterior and the posterior circulation (14 patients [35%]). Both cerebral hemispheres were involved in one fourth of the cases. A specific clinical picture was found in up to 20% of the patients. This included global aphasia with left hemianopia, hemisensory loss or hemiparesis (in right-handed patients), transcortical mixed aphasia with hemianopia, and acute pure cognitive impairment ("dementia"). Large-artery disease was found in 13 patients (33%); a cardiac source of embolism was found in 11 patients (28%); and both were found in three patients (8%). Bilateral infarcts were related to cardioembolism (four patients) and bilateral large-artery disease (three patients). One month after stroke, one fourth of the patients were independent, one third had some disability, and 40% were either dead or completely dependent. Acute multiple infarcts involving the anterior circulation may be bilateral more frequently than is currently thought, and they are often associated with posterior circulation infarcts. They mainly involve the pial hemispheral territories, commonly being caused by cardioembolism or bilateral carotid atheroma. They may be associated with a specific neurologic-neuropsychological dysfunction pattern in up to one fifth of the patients, allowing

  3. Hepatic infarction following abdominal interventional procedures.

    Directory of Open Access Journals (Sweden)

    Fujiwara H

    2004-04-01

    Full Text Available To clarify the incidence, background, and progress of hepatic infarction following interventional procedures, cases of hepatic infarction following interventional procedures at our department during the last decade were identified by reviewing the clinical records of 1982 abdominal angiography and interventional procedures and records of abdominal CT. Nine episodes (0.5% in 8 patients were identified as hepatic infarction following an interventional procedure. Five episodes were preceded by embolization of the hepatic or celiac artery at emergency angiography for postoperative bleeding with hemorrhagic shock. Three episodes followed the elected interventional procedure for hepatocellular carcinoma, and the remaining episode occurred after 12 months of chemoinfusion through an indwelling catheter in the hepatic artery and portal vein. Hepatic arterial occlusion in all episodes and portal venous flow abnormality in 5 episodes were observed on angiography. Four patients whose liver function was initially impaired died of hepatic infarction, although the extent of the disease on CT did not appear to be related to the mortality. Multiple risk factors, including arterial insufficiency, were observed in each patient. The incidence of hepatic infarction following interventional procedures in this series was low but sometimes fatal, and occurred most frequently in emergency embolization in hemorrhagic shock.

  4. Elongation and dilatation of the basilar artery in CT imaging; Wydluzenie i poszerzenie tetnicy podstawowej w obrazie KT

    Energy Technology Data Exchange (ETDEWEB)

    Lasek, W.; Burzynska-Makuch, M.; Pilecki, S.; Grzegorzewski, M.; Boron, Z. [Akademia Medyczna, Bydgoszcz (Poland)

    1994-12-31

    During two years 5 rare cases of elongation and dilatation of basilar artery were recognized in CT examination. In patients with cranial nerve deficits, cerebellar, brainstem and ponto-cerebellar angle signs artery megadolichobasilaris should be taken into account. CT examination is the sufficient method to see the diagnosis. (author). 15 refs, 3 tabs, 4 figs.

  5. Thrombolytic treatment given at the and of the first week of stroke due to pulmonary embolism in a patient with middlee cerebral artery infarction

    Directory of Open Access Journals (Sweden)

    Çetin Kürşad Akpınar

    2014-08-01

    Full Text Available Thrombolytic treatment is the most effective and commonly used method into firs 4,5 hours of acute ischemic stroke and massive pulmonary embolism. It is known that thrombolytic treatment is definitely contraindicated in cases who had an ischemic stroke into last three months. In this paper, it was reported that thrombolytic treatment had given for pulmonary embolism which developed one week after stroke in a case with stroke due to middle cerebral artery occlusion. Here, we presented a case which is rarely seen and required difficulty in deciding.

  6. Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study

    Directory of Open Access Journals (Sweden)

    Karin Kogstad Else

    2000-11-01

    Full Text Available Abstract Objectives 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. Design Randomized, controlled, parallel-group design (intervention/conventional care. Setting Akershus County, southeast of Oslo City, Norway. Participants 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. Interventions 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control.

  7. Dual anterior descending coronary artery associated with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Siqueira Luciane da L. V.

    2003-01-01

    Full Text Available The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation.

  8. Digital subtraction angiography in cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sin Young; Kim, Ji Hun; Suh, Hong Kil; Kim, Hyo Heon; Kwack, Eun Young; Lee, Il Seong [College of Medicine Hallym University, Seoul (Korea, Republic of)

    1995-01-15

    The usefulness and radiographic findings of the angiography in cerebral infarction are well known. We attempted to evaluate the angiographic causes, findings, and the usefulness of DSA in cerebral infarction. The authors reviewed retrospectively DSA images of 51 patients who were diagnosed as having cerebral infarction by brain CT and/or MRI and clinical settings. DSA was performed in all 51 patients, and in 3 patients, conventional angiogram was also done. Both carotid DSA images were obtained in AP, lateral, oblique projections, and one or both vertebral DSA images in AP and lateral. The authors reviewed the patient's charts for symptoms, operative findings and final diagnosis, and analysed DSA findings of cerebral atherosclerosis with focus on 6 major cerebral arteries. Among the 51 patients of cerebral infarction 43 patients (84.3%) had cerebral atherosclerosis, 1 dissecting aneurysm, 1 moyamoya disease and 6 negative in angiogram. DSA findings of cerebral atherosclerosis were multiple narrowing in 42 patients (97.7%), tortuosity in 22 (51.2%), dilatation in 14, occlusion in 12, avascular region in 8, collaterals in 7, ulcer in 6, and delayed washout of contrast media in 3. In cerebral atherosclerosis, internal carotid artery was involved in 37 patients (86.0%), middle cerebral artery in 29 (67.4%) posterior cerebral artery in 28, anterior cerebral artery in 26, vertebral artery in 22, and basilar artery in 15. Intracranial involvement of cerebral atherosclerosis (64.9%) was more common than extracranial involvement (16.2%). In cerebral infarction MRA may be the screening test, but for more precise evaluation of vascular abnormality and its extent, DSA should be considered.

  9. Acute posteroinferior wall myocardial infarction secondary to football chest trauma.

    Science.gov (United States)

    Espinosa, R; Badui, E; Castaño, R; Madrid, R

    1985-12-01

    Myocardial infarction secondary to nonpenetrating chest trauma is rare. We present the case of a sportsman who developed an acute transmural posteroinferior wall myocardial infarction due to chest trauma by a football. The angiographic study revealed total obstruction of the proximal right coronary artery.

  10. Reasons for failed electrocardiographic identification of the infarct-related artery in patients with ST-elevation acute myocardial infarction%体表心电图错误判断或无法判断梗死相关动脉的原因分析

    Institute of Scientific and Technical Information of China (English)

    张晓江; 颜红兵; 郑斌; 宋莉; 王健; 迟云鹏

    2010-01-01

    目的 将体表心电图(ECG)预测的梗死相关动脉(IRA)与冠状动脉造影结果 进行对比分析,以了解判断错误的原因和可能机制.方法 搜集2004年10月至2009年7月就诊的急性ST段抬高心肌梗死(STEMI)患者,入选发病时间≤12 h并且术前有≥2份18导联ECG,排除既往有陈旧性心肌梗死、冠状动脉旁路移植术后、起搏器置入术后或ECG显示有左束支传导阻滞的患者.所有患者入院后都在2 h内施行了急诊冠状动脉造影.采用最常用的ECG标准判断IRA,并与冠状动脉造影结果 进行对比分析.结果 入选STEMI患者1024例,其中854例能够通过ECG判断IRA,96例判断错误,74例无法判断.判断错误和无法判断的170例患者中有76例(44.7%)IRA为左回旋支,66例(38.8%)为右冠状动脉,20例(11.8%)为左前降支,7例(4.1%)为中间支,1例(0.6%)为左主干;27例(15.9%)合并双支病变,47例(27.6%)合并三支病变;8例(4.7%)合并早期复极综合征;6例(3.5%)患者冠状动脉造影提示小分支闭塞.结论 侧支循环影响ECG对IRA的判断.ECG无法判断IRA时最常见于左回旋支病变.解剖变异、早期复极综合征或小分支闭塞也会影响IRA的判断.%Objective The infarct-related artery (IRA) could not always be identified by electrocardiogram (ECG). In the present study, we attempted to explore the reason for failed IRA identification by ECG based on the comparison between ECG records and coronary angiographic findings. Methods All 18-lead ECG records were compared with respective angiographic findings in 1024 consecutive patients with ST elevation myocardial infarction (STEMI) between October 2004 and July 2009.More than two continous18-1ead ECG records were performed within 12 hours of the symptom onset in all patients. Patients with previous myocardial infarction, coronary artery bypass surgery, pacemaker implantation or ECG evidence of left bundle branch block and angiography was performed more than 12 hours

  11. Serum sP-Selectin Level and Brachial Artery Flow Mediated Dilation as Predictors of No Reflow in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary PCI

    Directory of Open Access Journals (Sweden)

    Ayman Saleh, Hany Awadallah, Hamdy Soliman , Eman Hasan , *Mohamed Omar

    2016-07-01

    Full Text Available Background: no reflow phenomenon is associated with major adverse cardiac events, prediction of no reflow using laboratory and noninvasive imaging techniques can help in early prevention and management of this phenomenon. Objectives: to investigate the predictive value of serum sP-selectin and endothelial dysfunction assessed by using brachial artery flow mediated dilation (FMD in patients with STEMI undergoing primary PCI to address patients with high incidence of no reflow. Methods: the prognostic performance, clinical and angiographic correlates of sP-selectin and FMD was assessed in 96 patients admitted in National Heart Institute and Ain Shams University Hospitals by STEMI and underwent primary PCI as a reperfusion strategy. Each patient was subjected to (history taking, clinical examination, laboratory investigations including withdrawal of serum samples for detection of sP-selectin levels, echocardio-graphy, assessment of endothelial dysfunction by measuring the FMD, assessment of the angiographic results using TIMI flow grade and myocardial blush grade. Follow up of the patients during hospital stay and after one month for the incidence of MACE. Results: a significant correlation between patients with high serum sP-selectin and TIMI flow ≤ II was found (P=0.038 and between the serum levels of the sP-selectin and the MBG score (P=0.009, also a significant correlation between the FMD and the MBG score among the study cases (P=0.029 as well as a significant correlation between the FMD and the serum P-selectin level among study cases (P=0.016. There were no statistical significance between TIMI flow grade and brachial artery FMD (P=0.075. Also no significant correlation was found between the patients' serum levels of sP-selectin, brachial artery FMD and the incidence of MACE during the hospital stay or during one month of follow up after discharge (P=0.127 and P=0.693, respectively. Conclusions: serum sP-selectin level in patients with

  12. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size.

    Science.gov (United States)

    Feng, Chao; Bai, Xue; Xu, Yu; Hua, Ting; Liu, Xue-Yuan

    2013-01-01

    Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'. In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

  13. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size

    Directory of Open Access Journals (Sweden)

    Chao Feng

    2013-01-01

    Full Text Available OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

  14. Event-related potentials indicating impaired emotional attention in cerebellar stroke--a case study.

    Science.gov (United States)

    Adamaszek, M; Olbrich, S; Kirkby, K C; Woldag, H; Willert, C; Heinrich, A

    2013-08-26

    The cerebellum has been implicated in affective and attentional processes, but little is known about corresponding neural signatures. We investigated early and late components of event-related potentials (ERPs) to emotionally arousing pictures, with and without competing attentional tasks, in a patient with an ischemic right posterior cerebellar infarction, at two months post infarct and two year follow-up. The early posterior negativity (EPN) response to highly arousing emotional cues in the competing visual attention condition revealed that the augmentation over occipital areas, as typically seen in normals, was absent post-infarct but was restored after two years. The late positive potentials (LPP) response to highly arousing emotional cues showed augmentation over frontal areas post-infarct, and over centro-parietal regions after two years. These ERP findings suggest a specific pattern of disruption of neural function associated with emotional-behavioral disturbances following cerebellar lesions, which can revert to normal with long term recovery. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Paradoxical cardiac and cerebral arterial gas embolus during percutaneous lead extraction in a patient with a patent foramen ovale.

    Science.gov (United States)

    Arnott, Clare; Kelly, Keith; Wolfers, Darren; Cranney, Gregory; Giles, Robert

    2015-01-01

    A 42 year-old man presented for elective percutaneous lead extraction for pacemaker redundancy. The procedure was performed supine under general anaesthesia via the right femoral vein and was complicated by acute inferior ST elevation and hypotension. Urgent transoesophageal echocardiogram showed inferior left ventricular hypokinesis, right ventricular impairment, a patent foramen ovale and air in the left ventricle. Coronary angiography demonstrated normal coronary arteries, the ST changes resolved and the leads were subsequently removed intact. Post-operatively the patient displayed nystagmus, was managed with hyperbaric oxygen therapy, and had complete resolution of his symptoms. An MRI brain confirmed an acute left cerebellar infarction, and a diagnosis of paradoxical air embolus to the coronary and cerebral circulations was made. This case illustrates the risks associated with paradoxical embolism in patients with PFOs undertaking percutaneous lead extractions. It also highlights the need for further consideration into techniques to avoid this complication in all high-risk percutaneous procedures.

  16. Cardiogenic shock as a complication of acute mitral valve regurgitation following posteromedial papillary muscle infarction in the absence of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Frati Giacomo

    2008-11-01

    Full Text Available Abstract A 48 year old man was transferred to our department with cardiogenic shock, pyrexia, a high white cell count and significant serum troponin T level. Clinical evaluation revealed severe mitral regurgitation secondary to a flail of both mitral valve leaflets. An emergency cardiac catheterisation did not reveal any significant coronary artery disease. Left ventricular angiogram and echocardiography demonstrated a good left ventricular function and massive mitral regurgitation. Blood cultures were negative for aerobics, anaerobics and fungi. The patient underwent emergency mitral valve replacement with a mechanical valve. Intraoperatively, the posteromedial papillary muscle was found to be ruptured. Histology of the papillary muscle revealed myocardial necrosis with no signs of infection. Cultures obtained from a mitral valve specimen were negative. The patient's recovery was uneventful and he was discharged on the 6th postoperative day.

  17. Coronary microembolization with normal epicardial coronary arteries and no visible infarcts on nitrobluetetrazolium chloride-stained specimens: Evaluation with cardiac magnetic resonance imaging in a swine model

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Hang; Yun, Hong; Zeng, Meng Su [Dept. of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai (China); Ma, Jian Ying; Chen, Zhang Wei; Chang, Shu Fu [Dept. of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai (China)

    2016-02-15

    To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. Eleven pigs underwent intracoronary injection of small-sized microspheres (42 µm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 ± 2.0% at baseline to 20.3 ± 2.3% at 6 hours and 31.5 ± 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.

  18. Cerebellar ataxia and functional genomics : Identifying the routes to cerebellar neurodegeneration

    NARCIS (Netherlands)

    Smeets, C J L M; Verbeek, D S

    2014-01-01

    Cerebellar ataxias are progressive neurodegenerative disorders characterized by atrophy of the cerebellum leading to motor dysfunction, balance problems, and limb and gait ataxia. These include among others, the dominantly inherited spinocerebellar ataxias, recessive cerebellar ataxias such as

  19. Cerebellar ataxia and functional genomics : Identifying the routes to cerebellar neurodegeneration

    NARCIS (Netherlands)

    Smeets, C J L M; Verbeek, D S

    2014-01-01

    Cerebellar ataxias are progressive neurodegenerative disorders characterized by atrophy of the cerebellum leading to motor dysfunction, balance problems, and limb and gait ataxia. These include among others, the dominantly inherited spinocerebellar ataxias, recessive cerebellar ataxias such as Fried

  20. A clinical study of single subcortical cerebral infarction of middle cerebral artery territory%大脑中动脉供血区皮层下单个脑梗死的临床研究

    Institute of Scientific and Technical Information of China (English)

    杨磊; 于玲; 秦伟; 张小雨; 李悦; 徐霁华; 胡秀朝; 袁俊亮; 顾华

    2016-01-01

    Objective To explore the clinical characteristics of single subcortical cerebral infarction of middle cerebral artery (MCA) territory and the possible pathogenesis.Methods A total of 344 cases diagnosed as single subcortical cerebral infarction of MCA territory were enrolled in the study and divided into the parent artery disease (PAD) group and the non-PAD group according to whether the MCA stenosis was presented or not.A total of 312 cases diagnosed as single subcortical cerebral infarction of MCA territory were divided into the BAD group and the SVD group according to the relationship between the lesion sites and MCA.Differences in the clinical and imaging feature were compared between different groups.Results A total of 32 patients were in the PAD group.Compared with the non-PAD group,patients in the PAD group were found with higher prevalence of asymptomatic cerebral arterial atherosclerosis [93.8% (30/32) vs 57.1% (178/312),P < 0.001],higher prevalence of branch atheromatous disease [75.0% (24/32) vs 58.7% (183/312),P =0.072].A total of 183 patients were in the BAD group.Compared with the BAD group,patients in the SVD group were older[(64.7 ± 11.2) years vs (61.7 ± 12.2) years,P =0.031],more with hypertension [65.9% (85/129) vs 53.0% (97/183),P =0.027] and smoking [41.9% (54/129) vs 57.9% (106/183),P =0.006] and more severe leukoaraiosis.Conclusions Single subcortical cerebral infarction of MCA territory has different etiology and pathogenesis.Evidence of systemic atherosclerosis should be carefully searched in patients with branch atheromatous disease.%目的 探讨大脑中动脉供血区皮层下单个脑梗死的临床特征及可能的发病机制.方法 回顾性分析344例大脑中动脉供血区皮层下单个脑梗死患者资料.根据大脑中动脉是否存在狭窄分为载体动脉疾病(PAD)组和载体动脉正常组(non-PAD组),分别为32例和312例.non-PAD组再根据头部MRI显示的病灶与大脑中动脉的关系

  1. Nonsurgical cerebellar mutism (anarthria) in two children.

    Science.gov (United States)

    Mewasingh, Leena D; Kadhim, Hazim; Christophe, Catherine; Christiaens, Florence J; Dan, Bernard

    2003-01-01

    Cerebellar mutism (anarthria) is a well-described complication of posterior fossa tumor resection. It is accompanied by a characteristic behavior including irritability and autistic features. This syndrome is typically reversible within days to months. Underlying pathophysiology is unknown. We describe two children who presented with a similar clinical finding after nonsurgical cerebellar involvement, hemolytic-uremic syndrome in one and cerebellitis in the other. Postmortem pathologic findings in the first patient indicated cerebellar ischemic necrosis. Single-photon emission computed tomography in the second patient revealed diffuse cerebellar hypoperfusion with no supratentorial abnormalities, refuting a phenomenon of diaschisis between cerebellar and frontal connections. These findings confirm that this clinical syndrome may occur in a nonsurgical, nontraumatic context. They are consistent with recent integrative hypotheses explaining cerebellar anarthria.

  2. Thoracic Sympathectomy for Severe Refractory Multivessel Coronary Artery Spasm.

    Science.gov (United States)

    Cardona-Guarache, Ricardo; Pozen, Jonah; Jahangiri, Arehzo; Koneru, Jayanthi; Shepard, Richard; Roberts, Charlotte; Abbate, Antonio; Cassano, Anthony

    2016-01-01

    Coronary artery spasm is a rare but potentially fatal disease. Herein, we report a case of recurrent ST-segment myocardial infarctions and ventricular fibrillation complicating severe multivessel coronary artery spasm successfully treated with bilateral thoracic surgical sympathectomy.

  3. Postnatal Migration of Cerebellar Interneurons

    Science.gov (United States)

    Galas, Ludovic; Bénard, Magalie; Lebon, Alexis; Komuro, Yutaro; Schapman, Damien; Vaudry, Hubert; Vaudry, David; Komuro, Hitoshi

    2017-01-01

    Due to its continuing development after birth, the cerebellum represents a unique model for studying the postnatal orchestration of interneuron migration. The combination of fluorescent labeling and ex/in vivo imaging revealed a cellular highway network within cerebellar cortical layers (the external granular layer, the molecular layer, the Purkinje cell layer, and the internal granular layer). During the first two postnatal weeks, saltatory movements, transient stop phases, cell-cell interaction/contact, and degradation of the extracellular matrix mark out the route of cerebellar interneurons, notably granule cells and basket/stellate cells, to their final location. In addition, cortical-layer specific regulatory factors such as neuropeptides (pituitary adenylate cyclase-activating polypeptide (PACAP), somatostatin) or proteins (tissue-type plasminogen activator (tPA), insulin growth factor-1 (IGF-1)) have been shown to inhibit or stimulate the migratory process of interneurons. These factors show further complexity because somatostatin, PACAP, or tPA have opposite or no effect on interneuron migration depending on which layer or cell type they act upon. External factors originating from environmental conditions (light stimuli, pollutants), nutrients or drug of abuse (alcohol) also alter normal cell migration, leading to cerebellar disorders. PMID:28587295

  4. Reduced infarct size in neuroglobin-null mice after experimental stroke in vivo

    DEFF Research Database (Denmark)

    Raida, Zindy; Hundahl, Christian Ansgar; Kelsen, Jesper;

    2012-01-01

    , then permanent cerebral ischemia would lead to larger infarct volumes in neuroglobin-null mice than in wild-type mice. METHODS: Using neuroglobin-null mice, we estimated the infarct volume 24 hours after permanent middle cerebral artery occlusion using Cavalieri's Principle, and compared the infarct volume...... in neuroglobin-null and wild-type mice. Neuroglobin antibody staining was used to examine neuroglobin expression in the infarct area of wild-type mice. RESULTS: Infarct volumes 24 hours after permanent middle cerebral artery occlusion were significantly smaller in neuroglobin-null mice than in wild-types (p 

  5. Crossed cerebral - cerebellar diaschisis : MRI evaluation.

    Directory of Open Access Journals (Sweden)

    Chakravarty A

    2002-07-01

    Full Text Available MRI, done later in life, in two patients with infantile hemiplegia syndrome showed significant volume loss in the cerebellar hemisphere contralateral to the side of the affected cerebrum. The cerebellar volume loss seemed to correlate with the degree of volume loss in the contralateral cerebral hemisphere. These observations provide morphological evidence of the phenomenon of crossed cerebral-cerebellar diaschisis (CCD. Functional neuroimaging studies in support of the concept of CCD has been critically reviewed.

  6. Autosomal recessive cerebellar ataxias : the current state of affairs

    NARCIS (Netherlands)

    Vermeer, S.; van de Warrenburg, B. P. C.; Willemsen, M. A. A. P.; Cluitmans, M.; Scheffer, H.; Kremer, B. P.; Knoers, N. V. A. M.

    2011-01-01

    Among the hereditary ataxias, autosomal recessive cerebellar ataxias (ARCAs) encompass a diverse group of rare neurodegenerative disorders in which a cerebellar syndrome is the key clinical feature. The clinical overlap between the different cerebellar ataxias, the occasional atypical phenotypes, an

  7. Genetics Home Reference: VLDLR-associated cerebellar hypoplasia

    Science.gov (United States)

    ... Conditions VLDLR-associated cerebellar hypoplasia VLDLR-associated cerebellar hypoplasia Enable Javascript to view the expand/collapse boxes. ... Open All Close All Description VLDLR -associated cerebellar hypoplasia is an inherited condition that affects the development ...

  8. Acute capsular infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kashihara, M.; Matsumoto, K.

    1985-05-01

    Sixty-three patients with lacunar-type of acute capsular infarction were treated in our service during the last 2 years. Their lesions were identified by computed tomography (CT) and classified into six types according to their locations: anterior, lateral, posterior, superior, inferior and multiple. The lesions were thought to be in the watershed areas of the regional arterial supplies, and the areas were considered to be prone to ischemia. The clinical course of each type showed characteristic features of ischemic strokes. In the majority of the patients with the lateral type, reversible ischemic neurological deficit (RIND) was seen as the predominant symptom, transient ischemic attack (TIA) was noted in the patients with the superior type, and major completed stroke was observed in those with posterior type.

  9. Crossed cerebellar hyperperfusion in brain perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Jinnouchi, Seishi; Nagamachi, Shigeki; Nishii, Ryuuichi; Futami, Shigemi; Tamura, Shozo [Miyazaki Medical Coll., Kiyotake (Japan); Kawai, Keiichi

    2000-10-01

    Crossed cerebellar diaschisis is a well-known brain SPECT finding in stroke patients. Few reports, however, have described supratentorial and contralateral cerebellar hyperperfusion (crossed cerebellar hyperperfusion, CCH). We assessed the incidence of CCH in 33 patients with cerebral hyperperfusion. Brain SPECT showed CCH in five patients out of 20 epilepsy and three of 13 patients with acute encephalitis. These eight patients with CCH had recent epileptic attack. CCH was found in ECD SPECT as well as HM-PAO. The contralateral cerebellar activity correlated with the cerebral activity in patients with CCH. CCH would have a relation with supratentrial hyperfunction in epilepsy and acute encephalitis. (author)

  10. [Peripheral neuropathies associated with hereditary cerebellar ataxias].

    Science.gov (United States)

    Anheim, M; Tranchant, C

    2011-01-01

    Inherited cerebellar ataxias constitute a complicated and heterogeneous group of neurodegenerative disorders affecting the cerebellum and/or spinocerebellar tract, spinal cord and peripheral nerves. A peripheral neuropathy is frequently seen in inherited cerebellar ataxias although it rarely reveals the disease. Moreover, the peripheral neuropathy is helpful for the diagnostic procedure and contributes to the functional prognosis of the disease. Thus, electroneuromyography is essential in the algorithm for the diagnosis of inherited cerebellar ataxias, as well as brain MRI (looking especially for cerebellar atrophy) and the assessment of several biomarkers (alpha-foetoprotein, vitamin E, albumin, LDL cholesterol, lactic acid, phytanic acid).

  11. [Myocardial infarction related to the association of physical exertion and the ingestion of cold drinks].

    Science.gov (United States)

    Marcuschamer Miller, J; Pérez de Juan Romero, M A; Castellano Reyes, C; Murrieta Gutiérrez, T; Fernández Domínguez, L

    1987-01-01

    We describe 3 young individuals with acute myocardial infarction that developed after extenous stress followed by the intake of cold fluids. The patients had retrosternal chest pain and EKG changes suggestive of posterior-inferior myocardial infarction. Coronartiography demonstrated 40% and 50% narrowing of the right coronary artery. The remaining case had normal coronary arteries.

  12. 颈内动脉系统TIA型脑梗死与高同型半胱氨酸血症关系的临