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Pico F, Labreuche J, Seilhean D, Duyckaerts C, Hauw JJ, Amarenco P. Association of Small-Vessel Disease With Dilatative Arteriopathy of the Brain. Stroke 2007; 38:1197-202. [PMID: 17322076 DOI: 10.1161/01.str.0000259708.05806.76] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Clinical and imaging studies have reported an independent and intriguing association between intracranial arterial dolichoectasia (IADE) and markers of small-vessel disease (SVD) such as lacune(s). We used a large brain-autopsy collection to investigate the relation between IADE and pathologically assessed cerebral SVD. METHODS The entire arterial tree from the heart to the intracranial small intracerebral arteries was investigated in 381 consecutive autopsies from patients with stroke. Vascular risk factors, heart status (weight, coronary atherosclerosis, and myocardial infarction), prevalence and severity of atherosclerosis from heart to brain (aortic arch, carotid, vertebral, and intracranial arteries), dolichoectasia, cerebral SVD, and brain tissue lesions (lacune(s), état criblé) were evaluated. Analyses were adjusted for age, sex, and heart weight. RESULTS Twenty-three (6%) of 381 patients had IADE, affecting mainly the basilar artery, with a median basilar artery diameter of 6 mm (range, 4 to 9 mm). Patients with IADE had a >2-fold increase in the prevalence of basilar artery plaques and ulcerated plaques in the aortic arch (both P=0.006), but there were no associations with coronary or cervical artery plaques. SVD was more frequent in IADE-positive than in IADE-negative patients (45% vs 18%; P=0.004). The adjusted odds ratio was 3.85 (95% confidence interval, 1.56 to 9.52). Cerebral amyloid angiopathy was not observed in IADE-positive patients. CONCLUSIONS Compared with stroke patients without IADE, those with IADE were more likely to have pathologic evidence of cerebral SVD and its consequences, independent of age, arterial hypertension, or diabetes mellitus. IADE and cerebral SVD may have unidentified biologic processes in common.
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Yu W, Kostanian V, Fisher M. Endovascular recanalization of basilar artery occlusion 80 days after symptom onset. Stroke 2007; 38:1387-9. [PMID: 17322092 DOI: 10.1161/01.str.0000260186.93667.a2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute basilar artery occlusion portends high risk of stroke and death. Thrombolysis or endovascular therapy has been limited to patients who present within hours of symptom onset. Without recanalization, acute basilar artery occlusion almost always results in death or severe disability. SUMMARY OF CASE We report a case of basilar artery occlusion and successful endovascular recanalization 80 days after symptom onset. CONCLUSIONS Endovascular therapy can be feasible and safe for symptomatic basilar artery occlusion at chronic stage.
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Neuhaus O, Saleh A, van Oosterhout A, Siebler M. Cerebellar infarction after gamma knife radiosurgery of a vestibular schwannoma. Neurology 2007; 68:590. [PMID: 17310028 DOI: 10.1212/01.wnl.0000256344.92133.dc] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sethi KS, Garg A, Sharma MC, Ahmad FU, Sharma BS. Cervicomedullary compression secondary to massive calcium pyrophosphate crystal deposition in the atlantoaxial joint with intradural extension and vertebral artery encasement. ACTA ACUST UNITED AC 2007; 67:200-3. [PMID: 17254893 DOI: 10.1016/j.surneu.2006.05.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 05/30/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Deposition of CPPD crystals occurs in the fibrous and hyaline cartilage of the joints and intervertebral disks of the spine. Half of patients known to have chondrocalcinosis had asymptomatic calcification in the odontoid region. The cases of 12 patients with a spinal cord syndrome secondary to CPPD deposition in the odontoid region were published in the literature. In all those cases, the mass lesion was extradural in location with good outcome after surgical decompression via the transoral route. CASE DESCRIPTION We report on a rare case of large periodontoid CPPD deposition causing cervicomedullary compression, erosion of the overlying bone, and underlying dura with intradural extension and vertebral artery encasement. CONCLUSIONS Calcium pyrophosphate dihydrate is a rare cause of cervicomedullary compression. Intradural extension of periodontoid CPPD has not been reported on.
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Lee JS, Yong SW, Bang OY, Shin YS, Kim BM, Kim SY. Comparison of spontaneous intracranial vertebral artery dissection with large artery disease. ACTA ACUST UNITED AC 2007; 63:1738-44. [PMID: 17172613 DOI: 10.1001/archneur.63.12.1738] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare clinical and angiographic characteristics and stroke patterns between spontaneous intracranial vertebral artery dissection (VAD) and vertebral large artery disease (LAD) (atherosclerosis). DESIGN Retrospective study. SETTING Tertiary referral center for cerebrovascular diseases. Patients Twenty-two patients with spontaneous VAD and 25 with LAD in the intracranial portion of the vertebral artery. MAIN OUTCOME MEASURES We compared (1) clinical characteristics, including epidemiologic data, vascular risk factors including inflammatory markers, the presence of headache, and stroke syndromes and severity; (2) stroke pattern on diffusion-weighted imaging, which was classified as vertebral perforator infarct, basilar perforator infarct, small scattered infarct, large scattered infarct, and territorial infarct; and (3) angiographic findings, ie, the distribution of involved arteries, degree of stenosis, and the involvement on the anterior circulation and calcification of vertebral artery. RESULTS Although patients with VAD were younger, and more often had headaches and fewer vascular risk factors than those with LAD (P<.01 in all cases), these clinical features were also observed in some LAD patients. Diffusion-weighted imaging data showed that vertebral perforator infarct and small scattered infarct were most common in the VAD group, while territorial infarct and large scattered infarct were most common in the LAD group (P = .02). On angiography, LAD more frequently had anterior circulation arterial involvement (P = .002), higher degree of stenosis (P = .002), and calcifications (P = .008). CONCLUSION Our findings indicate that results of diffusion-weighted imaging and noninvasive vascular studies might provide clues to the clinical characteristics in differential diagnosis between VAD and LAD.
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Puca A, Marchese E, Esposito G, Calcagni ML, Di Lazzaro V. Middle cerebral artery dolichoectasia in a young woman with a previous stroke. Eur J Neurol 2007; 14:109-11. [PMID: 17222123 DOI: 10.1111/j.1468-1331.2006.01526.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We observed a 32-year-old female who had suffered from a left hemisphere ischemic stroke with right hemiparesis at the age of seven. At that time, a CT scan demonstrated a left ischemic lesion in nucleo-capsular region and a cerebral angiogram documented a complete occlusion of the supraclinoid segment of the internal carotid artery. When we observed the patient neurological examination demonstrated a moderate right brachio-crural hemiparesis. A brain MRI showed an old ischemic lesion involving the left nucleo-capsular and 'flow voids' suggestive for a vascular malformation in the left sylvian region. A cerebral rotational angiogram with 3-D reconstructions demonstrated a dolichoectatic left middle cerebral artery with an unusual 'corkscrew' aspect. Middle cerebral artery dolichoectasia is a rare pathological condition that may manifest with a stroke. The patients with intracranial arterial dolichoectasia (IADE) are most often hypertensive elderly men, and, to the best of our knowledge, an ischemic stroke associated with IADE has never been reported in children.
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Canyigit M, Arat A, Cil BE, Turkbey B, Saatci I, Cekirge S, Balkanci F. Distal Embolization After Stenting of the Vertebral Artery: Diffusion-Weighted Magnetic Resonance Imaging Findings. Cardiovasc Intervent Radiol 2007; 30:189-95. [PMID: 17200903 DOI: 10.1007/s00270-005-0384-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We retrospectively evaluated our experience with stenting of the vertebral artery in an effort to determine the risk of distal embolization associated with the procedure. METHODS Between June 2000 and May 2005, 35 patients with 38 stenting procedures for atherosclerotic disease of the vertebral origin in our institution were identified. The average age of the patients was 60.3 years (range 32-76 years). Sixteen of these patients (with 18 stents) had MR imaging of the brain with diffusion-weighted imaging and an apparent diffusion coefficient map within 2 days before and after procedure. RESULTS On seven of the 16 postprocedural diffusion-weighted MR images, a total of 57 new hyperintensities were visible. All these lesions were focal in nature. One patient demonstrated a new diffusion-weighted imaging abnormality in the anterior circulation without MR evidence of posterior circulation ischemia. Six of 16 patients had a total of 25 new lesions in the vertebrobasilar circulation in postprocedural diffusion-weighted MR images. One patient in this group was excluded from the final analysis because the procedure was complicated by basilar rupture during tandem stent deployment in the basilar artery. Hence, new diffusion-weighted imaging abnormalities were noted in the vertebrobasilar territory in 5 of 15 patients after 17 stenting procedures, giving a 29% rate of diffusion-weighted imaging abnormalities per procedure. No patient with bilateral stenting had new diffusion-weighted imaging abnormalities. CONCLUSION Stenting of stenoses of the vertebral artery origin may be associated with a significant risk of asymptomatic distal embolization. Angiography, placement of the guiding catheter, inflation of the stent balloon, and crossing the lesion with guidewires or balloon catheters may potentially cause distal embolization. Further studies to evaluate measures to increase the safety of vertebral artery stenting, such as the use of distal protection devices or short-term postprocedural anticoagulation, should be considered for patients with clear indications for this procedure.
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Cannas A, Solla P, Mascia MM, Floris GL, Tacconi P, Uselli S, Ambu R, Marrosu MG. Medulloblastoma induces unusual headache with clinical picture of basilar-type migraine complicated by ischaemic infarcts. Cephalalgia 2006; 26:1238-41. [PMID: 16961793 DOI: 10.1111/j.1468-2982.2006.01176.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gondim FDAA, Cruz-Flores S, Leacock RO. Neuroimaging and Pathology of the Progression of Unilateral to Bilateral Medial Medullary Stroke. Cerebrovasc Dis 2006; 22:202-4. [PMID: 16766872 DOI: 10.1159/000093809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Revuelta-Gutiérrez R, López-González MA, Soto-Hernández JL. Surgical treatment of trigeminal neuralgia without vascular compression: 20 years of experience. ACTA ACUST UNITED AC 2006; 66:32-6; discussion 36. [PMID: 16793433 DOI: 10.1016/j.surneu.2005.10.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 10/20/2005] [Indexed: 01/23/2023]
Abstract
BACKGROUND There are few reports on the outcome of surgical treatment of TGN without vascular compression. METHODS Between 1984 and 2004, 668 patients underwent MVD for TGN. In 21 patients (3.1%), vascular compression was absent. The surgical strategy in these cases involved the following: (1) dissection and exposure of the entire trigeminal nerve root; (2) slight neurapraxia with bipolar tips at the trigeminal nerve root; and (3) isolation of trigeminal nerve with Teflon sponge fragments. RESULTS The patients' (female/male, 20:1) ages ranged from 33 to 77 years. Their right side was the most frequently involved (61.9%). Their mean duration of pain before treatment was 7.6 years (range = 1-20 years). At surgical exploration, vascular compression or anatomical abnormalities were absent in 15 patients (71.4%), arachnoidal thickening was present in 5 (23.8%), and fiber dissociation of the trigeminal nerve was present in 1 (4.8%). Mean follow-up after surgery was 17.7 months (range = 4-65 months). Immediate relief from pain occurred in all 21 patients. On Kaplan-Meier analysis, recurrence was maintained at 14.8% for 12, 24, and 36 months, increasing to 43.2% at 48 months. Permanent hypoesthesia was present in 6 patients (28.6%), whereas loss of corneal reflex was observed transiently in 1 (4.8%). Motor function of the trigeminal nerve was intact in all patients. No other complication was found. CONCLUSION The proposed surgical plan of standard MVD plus slight trigeminal nerve root neurapraxia is a safe and effective management option for TGN without vascular compression.
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Endo K, Ichimaru K, Komagata M, Yamamoto K. Cervical vertigo and dizziness after whiplash injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:886-90. [PMID: 16432749 PMCID: PMC3489433 DOI: 10.1007/s00586-005-0970-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Revised: 03/27/2005] [Accepted: 05/24/2005] [Indexed: 10/25/2022]
Abstract
Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5+/-2.5 cm/s in the control group and 6.1+/-3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.
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Lin YH, Liu YC, Tseng WYI, Juang JM, Hung CS, Lin JW, Jeng JS, Yip PK, Kao HL. The impact of lesion length on angiographic restenosis after vertebral artery origin stenting. Eur J Vasc Endovasc Surg 2006; 32:379-85. [PMID: 16682238 DOI: 10.1016/j.ejvs.2006.02.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 02/22/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of lesion length on in-stent restenosis (ISR) of vertebral artery (VA) origin stenting. METHODS We retrospectively analyzed the medical and radiological records of patients receiving VA origin stenting from March 1999 to June 2005. They were subdivided according to lesion length. ISR was defined as >50% diameter narrowing in stent. RESULTS Eighty symptomatic patients (64 male, mean age 72 years) with 90 lesions treated with balloon expandable tubular coronary stents were enrolled. There were 34 patients with 38 short lesions (length<or=5 mm, group 1), 37 patients with 42 medium lesions (length>5 mm, <10 mm, group 2) and 9 patients with 10 long lesions (length>or=10 mm, group 3). Eighty seven bare-metal stents and 3 drug-eluting stents were implanted. Repeat angiography was done in 40 lesions (44%) at 11.7+/-9.6 months. The ISR rate in group 1, 2, 3 is 21%, 29%, and 50% (p=0.486). Multivariable Cox regression analysis showed lesion length was the only significant independent predictor of ISR (hazard ratio: 1.19, p=0.039). CONCLUSION ISR of VA origin stenting is common. Lesion length is an important predictor of ISR in VA origin stenting.
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Ozturk K, Uysal II, Arbag H, Buyukmumcu M, Erkan Ustun M, Salbacak A. A modified technique for bypass of the external carotid artery to the proximal posterior cerebral artery: an anatomical and technical study. Acta Otolaryngol 2006; 126:526-9. [PMID: 16698704 DOI: 10.1080/00016480500401050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS Our results support the proposition that bypass between the external carotid artery (ECA) and proximal posterior cerebral artery (PCA) can be achieved by using a short saphenous venous graft. The diameters of the ECA and vein graft may provide an increased blood flow with a straighter course. This technique may be helpful for management of patients with vertebrobasilar insufficiency or those requiring a high volume blood flow to the posterior circulation. OBJECTIVES We aimed to describe a modified technique using a short saphenous vein graft for bypass between the ECA and the PCA in order to use a small length of graft material and increase the patency of the anastomosis. MATERIALS AND METHODS Ten sides of five cadavers were dissected bilaterally. After a frontotemporal craniotomy and zygomatic arch osteotomy, the middle cranial fossa was exposed. A hole located approximately 2-3 cm posterolateral to the foramen rotunda was created extradurally. The sylvian fissure and the interpeduncular and ambient cisterns were opened. The proximal P2 segment of the PCA was identified. The ECA was found through a cervical incision. A short interposition saphenous vein graft was conducted to pass just behind the ramus mandible to the infratemporal fossa. The bypass between the ECA and P2 segment of the PCA was performed by using a short saphenous vein graft. The diameters of the ECA, P2 segment of PCA and both ends of the saphenous vein graft and its length were measured using an electronic micrometer. RESULTS The mean cross-clamping time of the PCA was 10.4+/-1.8 min. The mean diameters of the P2 segment of the PCA and ECA were 2.2+/-0.15 mm and 3.83+/-0.28 mm, respectively. The mean length of the saphenous vein graft was 88.8+/-3.8 mm.
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Horga Hernández A, Pujadas F, Purroy F, Delgado P, Huertas R, Alvarez-Sabín J. Upside down reversal of vision due to an isolated acute cerebellar ischemic infarction. J Neurol 2006; 253:953-4. [PMID: 16619124 DOI: 10.1007/s00415-006-0124-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Revised: 12/14/2005] [Accepted: 12/22/2005] [Indexed: 11/24/2022]
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Mrabet H, Touibi S, El Bahri-Ben Mrad F, Megdiche H, Mrabet A. [Fibromuscular dysplasia of the carotid and vertebro-basilar arteries (in French)]. J Neuroradiol 2006; 33:70-1. [PMID: 16528210 DOI: 10.1016/s0150-9861(06)77232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garcia-Porrua C, Pego-Reigosa R, Martinez-Vazquez F, Armesto V, Gonzalez-Gay MA. Bilateral vertebral artery occlusion in giant cell arteritis. Clin Exp Rheumatol 2006; 24:S101. [PMID: 16859605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Mitchell J. The vertebral artery: a review of anatomical, histopathological and functional factors influencing blood flow to the hindbrain. Physiother Theory Pract 2006; 21:23-36. [PMID: 16385941 DOI: 10.1080/09593980590911570] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An uncompromised blood flow to the brain is essential for normal neurological function. If the blood supply to the hindbrain, via the paired vertebral arteries, is reduced sufficiently, signs and symptoms of tertebrobasilar ischaemia may result. There are several factors that may cause a reduction in vertebral artery blood flow. These include exostoses, such as the retroarticular canal and lateral bridge of the atlas vertebra that may cause compression of the related part of the vertebral artery; or atherosclerosis of the artery wall occluding the vessel lumen. Functional factors, such as sustained end-of-range rotation of the cervical spine, may cause distortion of the vertebral artery in the suboccipital region, which may be reflected as decreased blood flow in the suboccipital and intracranial parts of the artery. A combination of such factors is likely to cause reduced blood flow to the hindbrain. It is the purpose of this review to highlight some of the factors that may compromise vertebral artery blood flow and, therefore, to provide some evidence on which to base our professional practice.
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Shin HY, Kim BJ, Kim YH, Kim ST, Chung CS, Lee KH, Kim GM. Hemimedullary syndrome with ipsilateral sensorimotor deficits. Eur Neurol 2006; 55:46-8. [PMID: 16479121 DOI: 10.1159/000091428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 11/22/2005] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW Cerebral small vessel diseases are responsible for 20-30% of ischemic strokes as well as for a considerable proportion of cerebral hemorrhages and encephalopathies. Less known than the manifestations in old age are those in young women comprising posterior encephalopathy and Susac's syndrome. RECENT FINDINGS Magnetic resonance imaging has allowed us to identify posterior encephalopathy, characterized by headache, seizures, visual disturbances and hypertension, as a frequent complication of preeclampsia/eclampsia syndrome in the perinatal and postpartum period. Magnetic resonance findings are pathognomonic with bilateral cortical-subcortical lesions in the posterior hemispheres typically sparing the calcarine fissure. Conversely, white matter lesions on magnetic resonance imaging particularly involving the corpus callosum, and a (subclinical) sensorineural hearing loss are diagnostic of the retinocochleocerebral vasculopathy called Susac's syndrome. SUMMARY Posterior encephalopathy can also follow from a broad spectrum of endotheliotoxic conditions like chemotherapy, immunosuppression and sepsis. Early recognition of the disorder is decisive for a benign outcome since therapy consists of removal of precipitating factors, lowering of blood pressure and treatment with magnesium sulfate. The retinocochleocerebral vasculopathy appears to be underdiagnosed. An autoimmune-mediated arteriolopathy is presumed and the disease is nearly always monophasic. A variety of therapeutic approaches have been recommended, none of which, however, is based on anything other than anecdotal evidence.
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du Mesnil de Rochemont R, Berkefeld J, Buchkremer M, Arndt H, Neumann-Haefelin T, Singer O, Steinmetz H, Zanella F, Sitzer M. Langzeitergebnisse nach Behandlung intrakranieller vertebrobasilärer Stenosen mit Stents. ROFO-FORTSCHR RONTG 2006; 178:96-102. [PMID: 16392063 DOI: 10.1055/s-2005-858635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Recurrent ischemic symptoms attributable to intracranial high-grade vertebrobasilar artery stenoses are associated with a high risk of ischemic stroke, particularly if these occur in spite of aggressive medical treatment. Long term efficacy data for endovascular stent angioplasty of symptomatic intracranial stenoses are lacking. The purpose of this prospective study is to determine the rates of deaths, of ischemic events and of restenosis during long-term follow-up. MATERIALS AND METHODS Between June 2001 and February 2004 twelve patients (11 male, 1 female; median 63 yrs; range, 46 - 75 yrs) with recurrent ischemic symptoms attributed to > or = 70 % intracranial vertebro-basilar artery stenoses, who had failed aggressive medical treatment, were included. Median follow-up was 24 months (range: 6 to 36 months). Intracranial stenoses were measured using 3D rotation angiography data sets and treated with balloon expandable stents. All patients were scheduled for follow-up including clinical (Barthel Index) and transcranial Doppler examinations and intraarterial angiography at 6 months after intervention. Clinical outcome was defined as the rate of stroke in any vascular territory or death during follow-up. Vascular outcome was determined by the rate of in-stent restenosis 50 % on follow-up as examined by intraarterial angiography at 6 months or by transcranial color-coded duplex sonography. RESULTS Stent placement was technically successful in all patients. No patient had further cerebral ischemic symptoms; two patients died (1 myocardial infarct, 1 sudden death) during follow-up of median 24 months. The degree of stenoses was reduced from median 81 % (range 69 - 94 %) to 19 % (range 10 - 36 %) immediately after stent placement and to 32 % (range 22 - 48 %) after 6 months. No restenosis > or = 50 % occurred during follow-up. CONCLUSION Based on this limited series, we believe that in patients, with recurrent symptoms despite aggressive medical treatment, endovascular stent placement in intracranial high-grade vertebrobasilar artery stenoses can be an effective and safe treatment option.
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Rezende MT, Spelle L, Mounayer C, Piotin M, Abud DG, Moret J. Hyperperfusion Syndrome After Stenting for Intracranial Vertebral Stenosis. Stroke 2006; 37:e12-4. [PMID: 16339466 DOI: 10.1161/01.str.0000196959.77184.49] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Hyperperfusion syndrome is a rare but well-described complication after endarterectomy or stenting in the carotid circulation.
Summary of Case—
A 66-year-old man who had vertebrobasilar insufficiency refractory to medical treatment because of an intracranial right side vertebral stenosis was referred to our institution for endovascular treatment. Stenting was performed, and after 24 hours, he became extremely agitated, and this was followed by a period of apathy without focal neurological deficits. MRI showed bilateral thalamic hemorrhage.
Conclusion—
To our knowledge, this is the first report of hyperperfusion syndrome with hemorrhagic presentation after intracranial vertebral artery stenting.
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von Büdingen HC, Staudacher T, von Büdingen HJ. Ultrasound diagnostics of the vertebrobasilar system. FRONTIERS OF NEUROLOGY AND NEUROSCIENCE 2006; 21:57-69. [PMID: 17290126 DOI: 10.1159/000092385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Despite the fact that ischemic stroke in the vertebrobasilar system (VBS) is significantly less frequent than in the carotid system, abnormalities found in Doppler and duplex examinations are about as prevalent in the VBS as in the carotid system. Because of the potentially severe clinical deficits associated with stroke of the VBS and the increased risk for stroke under conditions, such as underlying symptomatic vertebrobasilar stenosis and general anesthesia, it is highly desirable to have reliable methods available to identify pathological changes of the VBS. Furthermore, because the VBS via the circle of Willis can play a significant role as collateral blood supply system when vessels of the anterior circulation have been compromised, the knowledge of the VBS is necessary to estimate the overall integrity of the remaining blood flow to the brain.
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