1/5. Brainstem infarction after delayed thrombosis of a stented vertebral artery fusiform aneurysm: case report.OBJECTIVE AND IMPORTANCE: Recent technological advances have provided clinicians with stents that can be navigated throughout the tortuous proximal vessels of the posterior intracranial circulation. There have been few reports of fusiform and wide-necked aneurysms treated with stents. Of the known risks involved in stent placement in the intracranial circulation, delayed stent thrombosis has not been well described. CLINICAL PRESENTATION: A 34-year-old man who experienced the sudden onset of a severe headache with increasing lethargy was found on computed tomographic imaging to have a subarachnoid hemorrhage. Angiography revealed a left vertebral artery fusiform aneurysm that incorporated the posteroinferior cerebellar artery origin. INTERVENTION: A low-porosity magic Wallstent (boston Scientific, Natick, MA) was placed in the left vertebral artery across the aneurysm and the origin of the posteroinferior cerebellar artery. Angiography performed 9 days later revealed significant reduction in filling of the aneurysm. The patient returned 3 months after stent placement with severe neurological deterioration from a brainstem infarction caused by complete thrombotic occlusion of the left vertebral artery at the stented segment of the vessel. CONCLUSION: Stenting of fusiform aneurysms has provided an alternative to surgical clipping or parent vessel reconstruction. With the increasing frequency of intracranial stent placement for various cerebrovascular disease entities, we must become aware of potential complications associated with these procedures. Such awareness may influence decision-making processes regarding treatment and follow-up care.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. basilar artery stenosis mimicking the lacunar syndrome of pure motor hemiparesis.BACKGROUND: Stereotyped, repeated transient ischemic attacks manifesting as pure motor hemiparesis are most often attributed to ischemia of the internal capsule or ventral pons resulting from in situ disease of the small penetrating arteries. CASE DESCRIPTION: We report a 61-year-old man presenting with recurrent episodes of left-sided weakness consistent with the lacunar syndrome of pure motor hemiparesis. Subsequent neuroimaging revealed infarction of the right ventral pons and a critical basilar artery stenosis as the inciting lesion. Despite maximal antithrombotic therapy, he continued to have repeated symptoms. angioplasty and stenting were attempted but both failed due to plaque recoil and technical difficulties. After the procedure, the patient had no further ischemic episodes and remained symptom-free at two months. CONCLUSIONS: This case illustrates the imprecise and discordant relationship between the mode of presentation of a stroke syndrome and its presumed pathophysiology. The lacunar syndrome of pure motor hemiparesis should be recognized by clinicians as a mode of stroke presentation due not only to small vessel disease, but also to large artery atherosclerotic disease such as basilar artery stenosis. Prompt institution of treatment can lead to a good clinical outcome.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
3/5. Claude's syndrome in association with posterior cerebral artery stenosis.BACKGROUND: We report a case of a 61 year old man with midbrain infarction causing Claude's syndrome attributable to stenosis of the posterior cerebral artery. CASE DESCRIPTION: The patient presented with a pupil-sparing left third nerve palsy and contralateral ataxia. A background history of treated hypertension and cigarette smoking was obtained. magnetic resonance imaging revealed an area of infarction involving the left medial midbrain. magnetic resonance angiography revealed significant stenosis of the left posterior cerebral artery. Antiplatelet therapy was instituted and the patient made a satisfactory recovery. CONCLUSIONS: This is the first reported case of Claude's syndrome arising in association with stenosis of the posterior cerebral artery. Intracranial large vessel disease should be considered as a potential aetiologic factor in patients with similar midbrain ischaemia.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
4/5. Postpartum cerebellar infarction and haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome.pregnancy is considered to be a hypercoagulable state per se with an increased risk for cerebrovascular events, however cerebellar infarction has been rarely described in pregnant women. A nulliparous pre-eclamptic woman at 25 weeks' gestation was submitted to an echocardiographic exam that showed an impaired cardiac structure and function. After 2 h, the patient underwent caesarean section for diagnosis of haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. Afterwards her platelet count raised, and eight days later she developed nystagmus, ataxia, dysmetria and motor deficit in the right limbs and sensory impairment in the right side of the face and in the left limbs. Cerebral magnetic resonance imaging (MRI) demonstrated a right cerebellar and median posterior bulbar infarction. Colour-coded sonography of cerebral vessels showed an occlusion of the right vertebral artery. Coagulation pattern analysis evidenced double heterozygosis of the methylenetetrahydrofolate reductase (MTHFR) gene and single mutation of the prothrombin gene. This case report gives evidence of the importance of considering the different risk factors involved in stroke occurrence during pregnancy.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
5/5. Brainstem infarcts as an early manifestation of streptococcus anginosus meningitis.BACKGROUND AND PURPOSE: vasculitis and infarcts are well-established sequelae of bacterial meningitis. However, early large-vessel involvement is rare, particularly within the brainstem. There has been one previous case report of a young male who presented with pontine infarct as an early manifestation of Streptococcus milleri meningitis. We present another case of brainstem infarction associated with meningitis caused by streptococcus anginosus. CASE DESCRIPTION: We report a 58-year-old man who developed constitutional symptoms and gait instability, followed by progressive stupor. On examination, he had a glasgow coma scale of 8 with intact brainstem reflexes and no focal findings. magnetic resonance imaging documented bilateral pontine infarcts. S. anginosus was isolated from cerebrospinal fluid. Despite proper antibiotic treatment, the patient remained comatose and care was withdrawn. Postmortem examination revealed the meningitis was predominantly localized at the base of the brain. In addition, ventriculitis, multiple abscesses, and multiple infarcts in the pons and midbrain were found. CONCLUSION: S. anginosus, which is part of the normal human flora, causes invasive pyogenic infections and is an uncommon cause of bacterial meningitis. This type of infection is mostly situated at the base of the brain and has a propensity to encase the basilar artery and its perforators, thus causing brainstem stroke early in its course.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |