1/10. subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent.A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/10. Reversal of aphasia with superficial temporal artery to middle cerebral artery anastomosis.Two patients with aphasia which markedly regressed following superficial temporal to middle cerebral artery anastomoses are reported. Added to the armamentarium of stroke therapy for the amelioration of focal ischemic disease, modern microvascular techniques allow the establishment of collaterals to recipient vessels of less than 1 mm in diameter. A neurological deficit which is supposed to be permanent is usually considered a contraindication to these procedures. This report details two cases in which aphasia and motor weakness markedly improved following a superficial temporal artery to middle cerebral artery anastomosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/10. Is cerebral arteritis the cause of the landau-kleffner syndrome? Four cases in childhood with angiographic study.Four children with landau-kleffner syndrome were studied over a six year period. They presented with acquired aphasia, epilepsy, and focal or generalized EEG discharges which were exacerbated during sleep. In addition, cerebral angiography demonstrated isolated arteritis of some branches of the carotid arteries in all cases. Computed tomographic and magnetic resonance images were normal. nicardipine in a dose of 1 to 2 mg/kg/day, added to conventional anticonvulsant drugs provided effective supplementary control of seizures, of paroxysmal EEG discharges, and of language and behavioural disturbances, even several years after the onset of the disorder and in patients whose response to other medications, including steroids, had been poor. Interruption of nicardipine administration was followed by relapse of the language disorder. Repeat angiography was performed in all four patients and showed recanalization of obstructed vessels in two cases. Focal cerebral vasculitis may be the pathogenesis of the landau-kleffner syndrome and calcium channel blockers such as nicardipine may be effective and specific therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/10. chorea and Broca aphasia induced by diabetic ketoacidosis in a type 1 diabetic patient diagnosed as moyamoya disease.We here report one case of hemichorea and Broca aphasia occurred with diabetic ketoacidosis. A 20-year-old woman with type 1 diabetes mellitus had experienced diabetic ketoacidosis fourth time after the onset of diabetes. At the third ketoacidotic episode, the patient was admitted to our hospital for the first time to show hemichorea of the left extremities. brain computed tomography (CT) demonstrated a high-density area in the right caudate head and low-density area in the right putamen. magnetic resonance angiography (MRA) demonstrated a stenosis at the root of the bilateral middle and anterior cerebral arteries. The hemichorea disappeared within 3 days. At the fourth ketoacidotic episode, not hemichorea but unconsciousness was there for 2 days even after ketoacidosis disappeared. After the unconscious state, Broca aphasia was demonstrated for 15 days. The cerebral angiography showed a finding compatible to moyamoya disease. These findings support that chorea and Broca aphasia induced by diabetic ketoacidosis was developed in addition to blood vessel abnormalities such as moyamoya disease. We suggest that poorly controlled diabetic patients with hemichorea should undergo cerebral angiography.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/10. Successful emergent angioplasty of neurosarcoid vasculitis presenting with strokes.BACKGROUND: sarcoidosis is a systemic disease with neurologic involvement in approximately 5% of cases. Ischemic events related to neurosarcoid vasculitis are rare. We report the successful treatment of symptomatic neurosarcoid vasculitis with angioplasty. CASE DESCRIPTION: A 41-year-old African American with a diagnosis of neurosarcoid presented with aphasia and right-sided weakness. He was treated medically with antiplatelet agents, heparinization, and hypertensive therapy. Despite this treatment, he experienced clinical worsening and radiographic extension of his infarcts. He underwent successful angioplasty of a severe focal stenosis of the left middle cerebral artery. After the procedure, he experienced marked improvement in his symptoms and at follow-up continues to improve. CONCLUSIONS: We report the angiographic demonstration of neurosarcoidosis with large vessel changes and resultant strokes and its successful treatment with balloon angioplasty.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/10. Use of stimulation mapping and corticography in the excision of arteriovenous malformations in sensorimotor and language-related neocortex.The excision of an arteriovenous malformation (AVM) located within eloquent neocortex presents a formidable neurosurgical challenge. Compromise of the vascular supply to normal surrounding brain or surgical trauma to essential neighboring neocortex may result in unacceptable postoperative neurological morbidity. In addition, successful removal of these lesions without the benefit of intraoperative corticography may leave in situ areas of highly epileptogenic brain, resulting in continued epilepsy. In this report, we describe eight patients who underwent craniotomy and excision of AVMs at our institutions. Six of these lesions were located in the dominant (left) hemisphere, and two were on the right. All patients underwent preoperative testing with Amytal administered via the carotid artery (Wada test). Subsequently, the patient was placed under local anesthesia, and we performed a craniotomy. Electrocorticography was used to identify epileptogenic brain in the region of the AVM and to establish after-discharge thresholds to electrical stimulation. Stimulation-mapping techniques were then used to delineate critical motor, sensory, and language areas. Trial occlusion of feeding vessels was also carried out to document postocclusion neurological deterioration, if any. At a later time, a second procedure was performed under general anesthesia to excise the lesion and any epileptogenic foci, using the cortical maps derived earlier. Using these techniques, it was possible to effect complete excision of these lesions in seven of eight patients without causing additional neurological deficits.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/10. Recovery from aphasia following extracranial-intracranial bypass surgery: case report.The boston Diagnostic aphasia Exam and brief measures of memory, stereognosis, and limb praxis were administered to an extracranial-intracranial bypass surgery patient with moderately severe transcortical aphasia preoperatively and postoperatively. Significant improvement in language function was documented 2 days following surgery. Three month followup demonstrated continued improvement across all major areas of language function. These improvements were not felt to be attributable to practice effect, the natural remission of aphasic symptomatology or change in general medical status. Our experience with this patient leads us to speculate that patients with multivessel occlusive disease limiting cerebral oxygen supply to the vascular borderzone area may be more likely to benefit from bypass surgery and an increase in cerebral blood flow than some other subgroups of patients with cerebrovascular disorders.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/10. central nervous system angioendothelosis. A treatable multiple infarct dementia.CNS neoplastic angioendothelosis is a treatable primary proliferative disorder of the endothelial cells of blood vessels characterized by a clinical neurological picture of multiple infarct dementia and an inordinate amount of local cerebral edema, so striking that it may simulate primary or metastatic central nervous system tumor. The malignant cells remain within the lumen of the vessels and rarely if ever metastasize or occur in peripheral blood. There is remarkable improvement in symptoms by treating with high dose steroids. antimetabolites and irradiation are suggested means of additional treatment.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/10. Anterior translocation of language in patients with left cerebral arteriovenous malformation.We studied seven patients with left cerebral atriovenous malformation (AVM) with superselective arterial injection of anesthetics during angiography to determine whether there was translocation of some language functions to other regions in the ispilateral hemisphere. All patients were right handed. With a catheter inserted into each target vessel, patients underwent aphasia examination in an A-B-A design: (A) baseline, no anesthetic; (B) 1 minute after anesthetic injection; and (A) 12 minutes after injection (when its effects had dissipated). The results showed that six of seven patients had no significant aphasia at baseline or 12 minutes after anesthetic injection. One patient had a mild conduction aphasia at baseline and after anesthetic effects had dissipated. In the six patients with temporoparietal AVM, anesthetic injections into vessels in the lower division of the middle cerebral artery (MCA) not feeding the AVM (e.g., the left angular artery) produced a wide range of language function--from conduction aphasia to dense Wernicke's syndromes. When upper division MCA vessels were injected (e.g., the prefrontal branch), all developed a major aphasic disorder with significant comprehension defects. A seventh patient with a frontal opercular AVM had a mild anomia, semantic paraphasias, and decreased word-list generation when the prefrontal branch was injected. Her comprehension, however, was intact. These data show that patients with posterior cerebral AVM can show language abnormalities where such deficits are not typically seen after acute brain injury. These findings support a posterior-to-anterior extension of some language skills under conditions of brain disease.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
10/10. aphasia outcome in stroke: a clinical neuroradiological correlation.Fourteen aphasic patients with acute onset of thromboembolic cerebrovascular insults demonstrable by angiography or radioscintigrams who were available for long-term follow-up have been studied. Their aphasia evolution was compared with acute angiographical and radioisotopic findings, and the lesions shown by follow-up computerized axial tomography (CT). Angiographical site of occlusion, evidence of early reopening of occluded vessels, and radioisotopic flow asymmetries including the "hot-stroke" luxury perfusion failed to correlate with aphasia outcome. Radioisotopic static images were more helpful by depicting lesion location and number but lacked the definition seen on the CT scan. The long-term CT scan by showing the size, location and number of lesions had a good correlation with aphasia outcome. Those patients with large dominant hemisphere involvements, either one large or many smaller lesions, fared poorly while those with lesser lesions did better. Bilateral lesions, at times evasive clinically, helped to account for significant aphasia residuals.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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