11/65. Patent foramen ovale complicated by paradoxical embolism and brain infarct in a patient with advanced ovarian cancer.BACKGROUND: Recent investigations of patients with cerebral and peripheral arterial emboli of unknown cause suggest that paradoxical embolism through a patent foramen ovale might be responsible for more arterial embolic events than previously realized. CASE: A 60-year-old woman with advanced ovarian cancer presented with sudden onset of expressive aphasia and right upper hemiplegia postoperatively. A patent foramen ovale diagnosed by echocardiography with contrast combined with the presence of thrombosis in her right femoral vein leads us to speculate that her stroke was secondary to a paradoxical embolism. CONCLUSION: Paradoxical embolism should be considered in the differential diagnosis of ovarian cancer patients with embolic stroke and it may be appropriate to include a cardiac echo as part of the diagnostic evaluation.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
12/65. Comparison of 1.5 and 8 tesla high-resolution magnetic resonance imaging of lacunar infarcts.PURPOSE: We present a case report comparing 1.5 fast spin-echo (FSE) and high-resolution 8 Tesla (T) gradient echo (GE) MRI of a patient with multiple lacunar infarcts. methods: A 51-year-old man with a history of previous lacunar infarctions was studied with two-dimensional Fourier transform axial 8 T GE MRI using the following parameters: 3 mm thick slices skip 3 mm, flip-angle approximately 20 degrees, TR 800 milliseconds, TE 12 milliseconds, 1024 x 1024 matrix, field of view (FOV) 20 cm, and bandwidth 50 kHz. These images were then compared with routine clinical 1.5 T T2-weighted FSE images with 5 mm thick sections, 256 x 256, FOV 20, TR 5650, TE 102, and 16 echo train length. RESULTS: The majority of the infarctions were seen as areas of high signal intensity on both the 1.5 and 8 T images. They were seen in the corona radiata or the basal ganglia. More lesions were seen on the 8 T images. Low intensity signal was best demonstrated on the 8 T images at segments of the periphery of a few of the larger infarcts. There were a few small punctate low signal intensity regions localized at the termination of some of the microvessels on the 8 T images only. The foci of decreased signal intensity in regions of chronic hemorrhage appeared larger on the 8 T images compared with the 1.5 T images. The 8 T images demonstrated direct visualization of many small vessels, primarily in the deep white matter, which were not visible on the 1.5 T images. On the 8 T images, some of the infarcts appeared to be located between the medullary veins of the deep white matter. CONCLUSION: This case report indicates that GE 8 T images demonstrate more infarctions compared with the FSE 1.5 T images. It is possible to simultaneously identify the microvessels of the brain, small foci of hemorrhage, and lacunar infarctions using 8 T MRI.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
13/65. Prominent matched hypoperfusion in an intact cerebellum after a solitary middle cerebellar peduncle infarct.We examined the cerebellar metabolism of a 61-year-old man with a small infarct in the left middle cerebellar peduncle and an intact cerebellum. Positron emission tomographic images obtained 28 days after onset showed prominent hypoperfusion and hypometabolism (almost 50% below the normal level) in the left cerebellar hemisphere. This case report shows that neural deafferentation may cause prominent hypometabolism without morphologic changes in the cerebellum. An arrest in synaptic activity may be the most important factor for the adaptive decrease in oxygen metabolism seen in ischemic brain.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
14/65. Sudden deafness and anterior inferior cerebellar artery infarction.BACKGROUND AND PURPOSE: Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness, and gait ataxia. Few reports have carefully examined the deafness associated with the AICA infarction. Furthermore, previous neurological reports have not emphasized the inner ear as a localization of sudden deafness. The aim of this study was to investigate the incidence of deafness associated with the AICA infarction and the sites predominantly involved in deafness. methods: Over 2 years, we prospectively identified 12 consecutive patients with unilateral AICA infarction diagnosed by brain MRI. Pure-tone audiogram, speech discrimination testing, stapedial reflex testing, and auditory brainstem response were performed to localize the site of lesion in the auditory pathways. electronystagmography was also performed to evaluate the function of the vestibular system. RESULTS: The most common affected site on brain MRI was the middle cerebellar peduncle (n=11). Four patients had vertigo and/or acute auditory symptoms such as hearing loss or tinnitus as an isolated manifestation from 1 day to 2 months before infarction. Audiological testings confirmed sensorineural hearing loss in 11 patients (92%), predominantly cochlear in 6 patients, retrocochlear in 1 patient, and combined on the affected side cochlear and retrocochlear in 4 patients. electronystagmography demonstrated no response to caloric stimulation in 10 patients (83%). CONCLUSIONS: In our series, sudden deafness was an important sign for the diagnosis of AICA infarction. Audiological examinations suggest that sudden deafness in AICA infarction is usually due to dysfunction of the cochlea resulting from ischemia to the inner ear.- - - - - - - - - - ranking = 0.75keywords = brain (Clic here for more details about this article) |
15/65. Perioperative stroke in the brain and spinal cord following an induced hypotension.A 49-year-old woman presented with stupor and paraplegia following an induced hypotension. The temporal relationship to the induced hypotension and the absence of a clear embolic source on diagnostic tests support a causal association between the hypotensive episode and the ischemic infarct. However, despite the association, a cause-and-effect relationship could not be automatically inferred.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
16/65. A case of multiple brain infarctions associated with erysipelothrix rhusiopathiae endocarditis.A 63-year-old woman was admitted to our hospital because of fever and altered mentality. Brain magnetic resonance imaging showed multiple infarctions at the basal ganglia, cerebellum, and subcortical white matter with petechial hemorrhage, which was more easily seen on gradient echo images. erysipelothrix rhusiopathiae was cultured from her blood, and echocardiography showed septic vegetations in the mitral valve. She recovered fully after 6 weeks of appropriate antibiotic treatment.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
17/65. Neuropsychological manifestations in a case of bilateral thalamic infarction.Neuropsychological manifestation has been reported with lesions of the anterior and non-specific thalamic nuclei and mammilothalamic tract (MMT). These have been reported in the setting of arterial infarction and/or haemorrhage. Cerebral venous sinus thrombosis (CVT) is a rare cause of brain infarction. It occurs in the setting of oral contraceptive administration or pregnancy. Inherited thrombophilias are documented risk factors. The most frequent being heterozygous factor v Leiden mutation. We report a single case of bilateral thalamic infarction due to cerebral vein and sinus thrombosis. Clinically the case manifested with memory impairment and dysexecutive symptoms. Predisposing factor for venous thrombosis was a homozygous factor v Leiden mutation. The patient was treated with anticoagulation and made a good recovery.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
18/65. Radical "visual capture" observed in a patient with severe visual agnosia.We report the case of a 79-year-old female with visual agnosia due to brain infarction in the left posterior cerebral artery. She could recognize objects used in daily life rather well by touch (the number of objects correctly identified was 16 out of 20 presented objects), but she could not recognize them as well by vision (6 out of 20). In this case, it was expected that she would recognize them well when permitted to use touch and vision simultaneously. Our patient, however, performed poorly, producing 5 correct answers out of 20 in the Vision-and-touch condition. It would be natural to think that visual capture functions when vision and touch provide contradictory information on concrete positions and shapes. However, in the present case, it functioned in spite of the visual deficit in recognizing objects. This should be called radical visual capture. By presenting detailed descriptions of her symptoms and neuropsychological and neuroradiological data, we clarify the characteristics of this type of capture.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
19/65. Unexpected accumulation of thallium-201 in bilateral thalamic venous infarction induced by arteriovenous fistula in the posterior fossa: report of a case.We encountered unexpected accumulation of thallium-201 in a patient with thalamic dementia resulting from bithalamic venous infarction induced by arteriovenous fistula in the posterior fossa The site and degree of abnormal accumulation varied between early and delayed thallium-201 SPECT images. This unexpected and complicated accumulation of thallium-201 appeared to depend on not only breakdown of the blood-brain barrier but also on the hemodynamics of this type of venous infarction.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
20/65. Semantic memory deficit with a left thalamic infarct.Previous studies of patients with thalamic lesions have reported consistent word finding difficulties without a proposed etiology. The authors describe a patient with a focal left thalamic infarct, pronounced word finding problems, and a relatively selective impairment in semantic memory for object recall from features. The thalamus is proposed to facilitate electrical activity between brain regions that encode object features, resulting in object recall. Thalamic dysfunction disrupting object recall is a plausible etiology for impaired word finding in some patients.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
| <- Previous || Next -> |