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Ye Q, Xiang T. A clinical characteristic analysis of five cases of rare bilateral cerebral peduncular infarction (BCPI) with the 'Mickey Mouse ears' sign. Brain Inj 2021; 35:363-367. [PMID: 33560892 DOI: 10.1080/02699052.2021.1872097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To investigate the clinical manifestations, magnetic resonance imaging (MRI) features, and prognosis of patients diagnosed with bilateral cerebral peduncular infarction (BCPI) with the 'Mickey Mouse ears' sign.Methods: This study, retrospectively summarized the clinical features, MRI and magnetic resonance angiography (MRA) manifestations, and prognosis of 5 patients diagnosed with BCPI and with the 'Mickey Mouse ears' sign from our hospital. In the meantime, we also systematically analyzed and summarized the clinical and imaging features, and prognosis in combination with relevant cases from the national and international literature that had been reported.Results: In our study, five cases presented tetraplegia whereas 4 cases presented disturbance of consciousness. In all cases, the 'Mickey Mouse ears' sign was observed in the mid-brain level using a diffusion-weighted imaging (DWI) cross-section. The MRA images showed thrombosis on either the basilar artery (BA), posterior cerebral artery (PCA), or superior cerebellar artery (SCA). All the studied patients received standardized treatment for cerebral infarction. However, three patients died and the remaining two were left in a locked-in syndrome state.Conclusions: BCPI is a very rare stroke disease and its main clinical manifestations are locked-in syndrome and persistent vegetative states. However, the obtained imaging features on the brain-MRI of patients diagnosed with BCPI with the 'Mickey Mouse ears' sign can predict a bad prognosis.
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Affiliation(s)
- Qing Ye
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Tao Xiang
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
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Kwon N, Choi WI, Kim HS. Isolated Bilateral Cerebral Peduncular Infarction Manifesting Pseudobulbar Palsy and Quadriparesis: a Case Report. BRAIN & NEUROREHABILITATION 2021. [DOI: 10.12786/bn.2021.14.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Namwoo Kwon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Woo In Choi
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Kwon N, Choi WI, Kim HS. Isolated Bilateral Cerebral Peduncular Infarction Manifesting Pseudobulbar Palsy and Quadriparesis: a Case Report. BRAIN & NEUROREHABILITATION 2020; 14:e16. [PMID: 36743434 PMCID: PMC9879499 DOI: 10.12786/bn.2021.14.e16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/08/2022] Open
Abstract
Bilateral cerebral peduncular infarction (BCPI) is a very rare disorder among stroke patients. The main clinical manifestations in the previously reported BCPI case reports was associated with locked-in syndrome or persistent vegetative state. Here, we present a 51-year-old woman who had pseudobulbar palsy and quadriplegia. Magnetic resonance imaging showed an acute infarction in the middle areas of the cerebral peduncle with a unique "Mickey Mouse ears" sign. Diffusion tensor imaging and tractography showed relatively preserved corticospinal tracts, but the corticobulbar tracts were not detected. Magnetic resonance angiography showed posterior cerebral artery and vertebrobasilar artery occlusion. Cerebral perfusion insufficiency due to stenosis or occlusion of the vertebrobasilar artery and its branches may lead to BCPI. The prognosis and clinical manifestations of BCPI are related to the extent of the infarction in the involved cerebral peduncle and whether other territories are involved. Isolated BCPI may present a severe pseudobulbar palsy with relatively preserved limb function depending on the involvement pattern.
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Affiliation(s)
- Namwoo Kwon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Woo In Choi
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Kikuchi Y, Miyamoto N, Urushida Y, Shimizu C, Amari M, Kawarabayashi T, Nakamura T, Takatama S, Naito I, Ikeda Y, Takatama M, Shoji M. Successful basilar artery dilatation in pure bilateral cerebral peduncular infarctions using balloon angioplasty. eNeurologicalSci 2020; 21:100282. [PMID: 33102821 PMCID: PMC7569187 DOI: 10.1016/j.ensci.2020.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/04/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
An extremely rare case of bilateral cerebral peduncular infarctions (BCPI) is reported. The detection of the pure Mickey Mouse ears sign on MRI is an indicator of a need for reperfusion therapy. Severe stenosis of the basilar artery (BA) and a poor collateral supply from both posterior cerebral arteries were seen. Balloon angioplasty for the BA stenosis ameliorated the stenosis and produced a favorable outcome.
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Key Words
- BA, Basilar artery
- BCPI, Bilateral cerebral peduncular infarctions
- Balloon angioplasty
- Bilateral cerebral peduncular infarctions
- Collateral circulation
- DWI, Diffusion-weighted imaging
- FLAIR, Fluid-attenuated inversion recovery
- HbA1c, Glycated hemoglobin
- LDL, Low-density lipoprotein
- MRA, Magnetic resonance angiography
- MRI, Magnetic resonance imaging
- Mickey mouse ears sign
- PCA, Posterior cerebral artery
- PICA, Posterior inferior cerebellar artery
- PcomA, Posterior communicating artery
- SCA, Superior cerebellar artery
- Vertebrobasilar artery stenosis
- mRS, modified Rankin Scale
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Affiliation(s)
- Yutaro Kikuchi
- Department of Neurology, Isesaki Municipal Hospital, 12-1 Tsunatorihonmachi, Isesaki, Gunma 372-0817, Japan
| | - Naoko Miyamoto
- Department of Neurosurgery, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
| | - Yuki Urushida
- Department of Neurology, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
| | - Chisato Shimizu
- Department of Neurology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho,Takasaki, Gunma 370-0829, Japan
| | - Masakuni Amari
- Department of Neurology, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
| | - Takeshi Kawarabayashi
- Department of Neurology, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
| | - Takumi Nakamura
- Department of Neurology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Shin Takatama
- Department of Neurosurgery, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
| | - Isao Naito
- Department of Neurosurgery, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Masamitsu Takatama
- Department of Neurology, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
| | - Mikio Shoji
- Department of Neurology, Geriatrics Research Institute and Hospital, 3-26-8 Otomocho, Maebashi, Gunma 371-0847, Japan
- Corresponding author.
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