1/27. diffusion-weighted magnetic resonance imaging in a case of methanol intoxication.BACKGROUND: methanol intoxication is an uncommon clinical problem leading to profound metabolic acidosis with serious neurological deterioration. We describe methanol induced brain lesions on diffusion-weighted MR images and discuss the pathophysiology of these lesions in light of diffusion changes. CASE REPORT: brain imaging was performed in a 32 year-old man in a coma with focal neurological signs. Bilateral putaminal [hyperintensity] was seen on fast spin echo T2-weighted sequences, on Fluid Attenuated Inversion Recovery (FLAIR) and on diffusion weighted images. Decreased ADC values were observed bilaterally in the putamina. In addition, FLAIR images showed diffuse hypersignal in the subarachnoidal space. The patient showed rapid neurological deterioration while blood chemical tests revealed a severe metabolic acidosis and plasma methanol levels of 21 mmol/L. The patient died from hepatic failure thirty six hours after admission. CONCLUSION: Although decreased ADC values on diffusion-weighted imaging are commonly associated with arterial ischemic stroke, this pattern can also be observed in the case of putaminal necrosis following methanol ingestion.- - - - - - - - - - ranking = 1keywords = stroke (Clic here for more details about this article) |
2/27. Area-selective stimulus-provoked seizures in post-anoxic coma.We describe the case of a 70-year-old patient in whom hemiconvulsive seizures occurred during metabolic derangement, multiple stroke and post-anoxic coma following cardiac arrest. We employed the methods of clinical and EEG evaluation and CT brain scan. We found that hemiconvulsive seizures were provoked following a light tactile stimulus in the left-trigeminal area and occasionally a strong tapping in the right-trigeminal area. We conclude that this type of stimulus-provoked seizure is extremely rare and could be explained by diffuse and severe brain damage.- - - - - - - - - - ranking = 1keywords = stroke (Clic here for more details about this article) |
3/27. Bilateral deafness as a prodromal symptom of basilar artery occlusion.Bilateral deafness is a rare but possible symptom for ischemia of the vertebrobasilar system, primarily derived from occlusion of anterior inferior cerebellar arteries or their branches. patients 1 and 2 developed sudden bilateral deafness, soon followed by coma. The proximal segment of the basilar artery was occluded due to atherothrombosis in Patient 1 and arterial dissection in Patient 2. thrombolytic therapy failed to recanalize the basilar arterial flow. Both patients died of extensive infarction in the vertebrobasilar arterial territory. Sudden bilateral deafness can be a warning sign of imminent brainstem ischemia by occlusion of the basilar artery regardless of age. Prompt and intensive management for stroke is needed for patients with sudden bilateral deafness.- - - - - - - - - - ranking = 1keywords = stroke (Clic here for more details about this article) |
4/27. Sudden coma from acute bilateral internal carotid artery territory infarction.Six patients with bilateral internal carotid artery occlusion who presented with sudden loss of consciousness, quadriplegia, and initially intact brainstem reflexes are described. They soon lost brainstem reflexes and died within 3 days. The presumed causes of internal carotid artery occlusion were atherothrombosis in three patients and cardiogenic embolism in the others. This catastrophic stroke syndrome mimics severe brainstem stroke and has an extremely poor prognosis.- - - - - - - - - - ranking = 2keywords = stroke (Clic here for more details about this article) |
5/27. Area-selective stimulus-provoked seizures in post-anoxic coma.We describe the case of a 70-year-old patient in whom hemiconvulsive seizures occurred during metabolic derangement, multiple stroke and post-anoxic coma following cardiac arrest. We employed the methods of clinical and EEG evaluation and CT brain scan. We found that hemiconvulsive seizures were provoked following a light tactile stimulus in the left-trigeminal area and occasionally a strong tapping in the right-trigeminal area. We conclude that this type of stimulus-provoked seizure is extremely rare and could be explained by diffuse and severe brain damage.- - - - - - - - - - ranking = 1keywords = stroke (Clic here for more details about this article) |
6/27. Acute basilar artery occlusion treated by thromboaspiration in a cocaine and ecstasy abuser.Thromboaspiration was performed in a young adult in a coma because of acute basilar artery occlusion associated with cocaine and ecstasy abuse 30 hours after symptom onset. There was complete recanalization of the basilar artery and favorable recovery. Because cocaine and ecstasy abuse has been reported to be a risk factor for ischemic stroke and fatal brain hemorrhage, thromboaspiration may be an alternative therapy to thrombolysis.- - - - - - - - - - ranking = 1keywords = stroke (Clic here for more details about this article) |
7/27. A fatal case of spongiform leukoencephalopathy linked to "chasing the dragon".BACKGROUND: "Chasing the dragon" involves placing heroin on aluminum foil, heating it from below with a flame, and inhaling the pyrolysate through a straw. It has rarely been associated with the development of a progressive spongiform leukoencephalopathy. CASE REPORT: A 43-year-old woman presented with 2 weeks of bizarre behavior, forgetfulness, and slowed speech and movements. serum, cerebrospinal fluid, and head computed tomography (CT) scan were normal. The patient progressed to coma and expired during week 4 of hospital admission. The family confirmed that she "chased the dragon." cause of death at post mortem examination was spongiform leukoencephalopathy. CONCLUSION: The diagnosis of heroin pyrolysate-induced spongiform leukoencephalopathy should be considered in a patient with a history of "chasing the dragon" and neurobehavioral changes, including confusion, apathy, cerebellar signs, and motor restlessness.- - - - - - - - - - ranking = 1.8965919364837keywords = heat (Clic here for more details about this article) |
8/27. carbon monoxide brain toxicity: clinical, magnetic resonance imaging, magnetic resonance spectroscopy, and neuropsychological effects in 9 people.carbon monoxide (CO) exposure is a common cause of toxic brain damage, whereby effects range from transient neurological dysfunction to coma and death. A spectrum of severity of magnetic resonance imaging (MRI) findings after CO brain toxicity, including globus pallidus and white matter lesions, is well documented. Reports of MR spectroscopy (MRS) findings re main sparse. This article reports 9 people exposed to CO because of an apartment house's faulty gas heater. Four, with transient loss of consciousness after chronic moderate level CO exposure, suffered intellectual impairment without MRI abnormalities. The MRS of 1 individual demonstrated decreased n-acetyl aspartase in the basal ganglia, bilaterally. Of 5 exposed to high levels for about 12 hours, 1 died prior to clinical and/or MRI evaluation. One who suffered coma recovered but was lost to evaluation. Three, who were unconscious for hours to days, exhibited T2 MRI white matter signal abnormalities. MRS showed decreased basal ganglia n-acetyl aspartase in 2. One of these suffers a Parkinsonian syndrome. All 3 are intellectually impaired. This study demonstrates that although MRI and MRS are useful markers of CO-induced brain damage, they are not always sensitive to resultant intellectual dysfunction.- - - - - - - - - - ranking = 1.8965919364837keywords = heat (Clic here for more details about this article) |
9/27. Paroxysmal apnea and vasomotor instability following medullary infarction.BACKGROUND: Central hypoventilation and paroxysmal hypertension are uncommon complications of medullary infarction. To our knowledge, the combination of these autonomic complications of medullary stroke has not previously been reported. OBJECTIVE: To describe a patient who experienced life-threatening paroxysmal attacks of central apnea and vasomotor instability 3 months after medullary infarction, a combination of symptoms that is unusual. PATIENT, methods, AND RESULTS: Following a right lateral medullary infarction, an otherwise stable 70-year-old woman developed recurrent episodes of apnea (PCO2), > 100 mm Hg), blood pressure instability (systolic blood pressure, > 200 to < 100 mm Hg), and mental status changes (from agitation to coma) within hours of removal from mechanical ventilation. These attacks occurred repeatedly after removal from mechanical ventilation and were prevented by diaphragm pacing with a phrenic nerve pacemaker and nocturnal mechanical ventilation via a tracheostomy. CONCLUSIONS: A syndrome of life-threatening central hypoventilation and vasomotor instability can occur after medullary infarction. Placement of a phrenic nerve pacemaker can prevent these complications, without the functional limitations imposed by continuous mechanical ventilation.- - - - - - - - - - ranking = 1keywords = stroke (Clic here for more details about this article) |
10/27. Postoperative coma in a patient with complete basilar syndrome after anterior cervical discectomy.PURPOSE: Ischemic brainstem stroke resulting from occlusion of the basilar artery during cervical spine surgery in a previously asymptomatic patient is a rare event. We report the development of a large ischemic brainstem stroke, resulting from occlusion of the basilar artery during anterior cervical discectomy, in a patient without previous neurological deficit, or signs of vertebrobasilar insufficiency. CLINICAL FEATURES: A 55-yr-old, diabetic and hypertensive male who developed a cervical spine infection, underwent surgery for anterior discectomy at C5-C6. During the 2.5-hr long procedure the patient was lying supine with his neck hyperextended. Except for a temporary reduction in systolic blood pressure, the intraoperative course was uneventful. At the end of surgery the patient remained unconscious with flaccid paralysis in all extremities, fixed pinpoint pupils, low respiratory rate, and no response to painful stimuli. naloxone administration did not improve the clinical picture, while brain computed tomography showed a large brainstem and cerebellar stroke, implicating basilar artery occlusion. The patient died five days later from stroke complications. Intraoperative surgical manipulation with a severely inflamed vertebral system, as well as prolonged neck hyperextension occluding the blood flow of vertebrobasilar arteries might have contributed to fatal brainstem stroke in this patient. CONCLUSION: neck surgery carries a potential risk for posterior circulation stroke, and this report heightens awareness of this rare, but serious complication.- - - - - - - - - - ranking = 6keywords = stroke (Clic here for more details about this article) |
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