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Vlašković T, Brkić BG, Stević Z, Kostić D, Stanisavljević N, Marinković I, Vojvodić A, Nikolić V, Puškaš L, Blagojević M, Marinković S. Anatomic and MRI bases for medullary infarctions with patients' presentation. J Stroke Cerebrovasc Dis 2022; 31:106730. [PMID: 36029688 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There is a low incidence of the medullary infarctions and sparse data about the vascular territories, as well as a correlation among the anatomic, magnetic resonance imaging (MRI) and neurologic signs. MATERIALS AND METHODS Arteries of the 10 right and left sides of the brain stem were injected with India ink, fixed in formalin and microdissected. The enrolled 34 patients with medullary infarctions underwent a neurologic, MRI and Doppler examination. RESULTS Four types of the infarctions were distinguished according to the involved vascular territories. The isolated medial medullary infarctions (MMIs) were present in 14.7%. The complete MMIs comprised one bilateral infarction (2.9%), whilst the incomplete and partial MMIs were observed in 5.9% and 8.9%, respectively. The anterolateral infarctions (ALMIs) were very rare (2.9%). The complete and incomplete lateral infarctions (LMIs), noted in 35.3%, comprised 11.8% and 23.6%, respectively, that is, the anterior (5.9%), posterior (8.9%), deep (2.9%), and peripheral (5.9%). Dorsal ischemic lesions (DMIs) occurred in 11.8%, either as a complete (2.9%), or isolated lateral (5.9%) or medial infarctions (2.9%). The remaining ischemic regions belonged to various combined infarctions of the MMI, ALMI, LMI and DMI (35.3%). The infarctions most often affected the upper medulla (47.1%), middle (11.8%), or both (29.5%). Several motor and sensory signs were manifested following infarctions, including vestibular, cerebellar, ocular, sympathetic, respiratory and auditory symptoms. CONCLUSIONS There was a good correlation among the vascular territories, MRI ischemia features, and neurologic findings regarding the medullary infarctions.
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Affiliation(s)
- Tatjana Vlašković
- Psychiatrist, University of Belgrade, Faculty of Medicine, Laza Lazarević Hospital of Psychiatry, Faculty of Medicine, Belgrade, Serbia
| | - Biljana Georgievski Brkić
- Associate Researcher of Radiology, University of Belgrade, Faculty of Medicine, Sveti Sava Hospital, Department of CT and MRI, Belgrade, Serbia
| | - Zorica Stević
- Professor of Neurology, University of Belgrade, Faculty of Medicine, Clinical Center, Clinic of Neurology
| | - Dejan Kostić
- Assistant Professor of Radiology, Military Medical Academy, Institute of Radiology, Belgrade, Serbia
| | - Nataša Stanisavljević
- Hematologist, University of Belgrade, Clinical Hospital Center Bezanijska Kosa, Department of Hematology, Belgrade, Serbia
| | - Ivan Marinković
- Neurologist, Clinical Neuroscience, Neurology, Helsinki University Central Hospital, University of Helsinki, Finland.
| | - Aleksandra Vojvodić
- Teaching Assistant in Dermatovenerology, University of Belgrade, Media Group Hospital, Belgrade, Serbia
| | - Valentina Nikolić
- Professor of Anatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Laslo Puškaš
- Professor of Anatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Miloš Blagojević
- Associate Professor of Anatomy, University of Belgrade, Faculty of Veterinary Medicine, Institute of Anatomy, Belgrade, Serbia
| | - Slobodan Marinković
- Professor of Neuroanatomy, University of Belgrade, Faculty of Medicine, Institute of Anatomy, Department of Neuroanatomy, Belgrade, Serbia
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An unusual case of sudden hearing loss in a young man. JAAPA 2013; 26:38-41. [PMID: 24049939 DOI: 10.1097/01.jaa.0000432572.44559.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute-onset hearing loss of unknown cause may be the result of a tranverse temporal bone fracture. CT imaging is indicated for patients with acute focal neurologic deficits of uncertain cause.
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Hemi- and monoataxia in cerebellar hemispheres and peduncles stroke lesions: topographical correlations. THE CEREBELLUM 2012; 11:917-24. [PMID: 22351351 DOI: 10.1007/s12311-012-0362-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Limb ataxia of sudden onset is due to a vascular lesion in either the cerebellum or the brainstem (posterior circulation, PC, territory). This sign can involve both the upper and the lower limb (hemiataxia) or only one limb (monoataxia). The topographical correlates of limb ataxia have been studied only in brainstem strokes. Therefore, it is not yet known whether this sign is useful to localize the lesion within the entire cerebellar system, both the cerebellar hemisphere and the cerebellar brainstem pathways. Limb ataxia was semi-quantified according to the International Cooperative Ataxia Rating Scale in 92 consecutive patients with acute PC stroke. Limb ataxia was present in 70 patients. Four topographical patterns based on magnetic resonance imaging findings were identified: picaCH pattern (posterior inferior cerebellar artery infarct); scaCH pattern (superior cerebellar artery infarct); CH/CP pattern (infarct involving both the cerebellum and the brainstem cerebellar pathways); and CP pattern (infarct involving the brainstem cerebellar pathways). Hemiataxia was present in (47/70; 67.1%) and monoataxia in (23/70; 32.9%) of patients. Monoataxia involved the upper limb in (19/70; 27.1%) and the lower limb in (4/70; 5.7%) of patients. Limb ataxia usually localized the lesion ipsilaterally (picaCH, scaCH, CH/CP, and CP patterns involving the medulla and sometimes the pons) (53/70; 75.7%), but it might be due also to contralateral (CP pattern involving the pons or midbrain) (16/70; 22.9%) or bilateral lesions (1/70). Limb ataxia usually localizes the lesion ipsilaterally but the infarct might be sometimes contralateral. The occurrence of monoataxia may suggest that the cerebellar system is somatotopically organized.
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