1/433. Bilateral subclavian steal syndrome through different paths and from different sites--a case report.Cases of cerebro-subclavian steal syndrome have been reported in the medical literature since 1960. This most often occurs on the left side because of the higher rate of involvement of the left subclavian artery in comparison to the other brachiocephalic branches of the aortic arch. With the use of the internal mammory artery as a conduit for coronary artery bypass, in the past three decades increasing numbers of coronary-subclavian steal in addition to the cerebro-subclavian steal have been observed. The authors report a case of bilateral subclavian steal syndrome through both vertebral arteries, the right common carotid artery, and the left internal mammory artery, without significant signs and symptoms of cerebral ischemia or anginal pain.- - - - - - - - - - ranking = 1keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
2/433. Carotid endarterectomy and intracranial thrombolysis: simultaneous and staged procedures in ischemic stroke.PURPOSE: The feasibility and safety of combining carotid surgery and thrombolysis for occlusions of the internal carotid artery (ICA) and the middle cerebral artery (MCA), either as a simultaneous or as a staged procedure in acute ischemic strokes, was studied. methods: A nonrandomized clinical pilot study, which included patients who had severe hemispheric carotid-related ischemic strokes and acute occlusions of the MCA, was performed between January 1994 and January 1998. Exclusion criteria were cerebral coma and major infarction established by means of cerebral computed tomography scan. Clinical outcome was assessed with the modified Rankin scale. RESULTS: Carotid reconstruction and thrombolysis was performed in 14 of 845 patients (1.7%). The ICA was occluded in 11 patients; occlusions of the MCA (mainstem/major branches/distal branch) or the anterior cerebral artery (ACA) were found in 14 patients. In three of the 14 patients, thrombolysis was performed first, followed by carotid enarterectomy (CEA) after clinical improvement (6 to 21 days). In 11 of 14 patients, 0.15 to 1 mIU urokinase was administered intraoperatively, ie, emergency CEA for acute ischemic stroke (n = 5) or surgical reexploration after elective CEA complicated by perioperative intracerebral embolism (n = 6). Thirteen of 14 intracranial embolic occlusions and 10 of 11 ICA occlusions were recanalized successfully (confirmed with angiography or transcranial Doppler studies). Four patients recovered completely (Rankin 0), six patients sustained a minor stroke (Rankin 2/3), two patients had a major stroke (Rankin 4/5), and two patients died. In one patient, hemorrhagic transformation of an ischemic infarction was detectable postoperatively. CONCLUSION: Combining carotid surgery with thrombolysis (simultaneous or staged procedure) offers a new therapeutic approach in the emergency management of an acute carotid-related stroke. Its efficacy should be evaluated in interdisciplinary studies.- - - - - - - - - - ranking = 2.6101112644268keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
3/433. Continuous EEG monitoring in the intensive care unit: early findings and clinical efficacy.The assessment of the neurocritical care patient involves serial assessment of neurologic status using bedside clinical examination and a variety of periodic neurophysiologic testing. Continuous electroencephalographic (CEEG) monitoring in the intensive care unit offers a unique means to track neurologic function directly and regionally. CEEG is becoming more widespread with a growing but small body of literature. The purpose of this paper is to outline the current experience with intensive care unit CEEG monitoring. The basic methods and caveats are discussed. We review the underlying rationale for using CEEG which is that secondary neurologic injury commonly occurs in the intensive care unit and at times is hard to detect. CEEG has a proven role in detecting secondary injuries, namely seizures and brain ischemia. The basic tenets of establishing clinical effectiveness for CEEG in the ICU are discussed while acknowledging a need for further study of clinical effectiveness. We review our initial clinical experience of CEEG in 300 patients and outline the clinical efficacy in terms of cost reduction and improvement in outcome (P < 0.01) using CEEG. Finally, several controversial aspects of CEEG are enumerated, and the need for additional study to answer these pressing questions is presented.- - - - - - - - - - ranking = 0.00041016693368205keywords = injury (Clic here for more details about this article) |
4/433. Cerebral perfusion index: a new marker for clinical outcome in acute stroke.Single-photon emission computed tomography (SPECT) and transcranial Doppler (TCD) ultrasound are of good prognostic value in acute stroke, and combined they may be an accurate way to determine a target group of patients with maximum therapeutic response. Seventy consecutive patients were studied (42 with middle cerebral artery strokes, 18 with transient ischemic attacks {TIAs}; 10 were excluded due to failure of insonation). Two SPECT studies were performed at 2.1 /- 1.2 and 13.8 /- 3.1 days after onset. Serial TCD studies were done at 10 hours and at the time of the SPECT studies. Neurological deficit was scored on admission and 2 weeks later (using the Canadian Neurological Scale). Cerebral perfusion index (CPI) was derived by multiplying the values for TCD and SPECT patterns. Positive correlation was obtained in all 16 patients in whom cerebral angiography was performed within the first 3 days after onset. The occlusive TCD pattern and absence of perfusion on SPECT were common in the stroke group (19/42 patients) and were never seen in those with TIAs. A normal TCD pattern and normal perfusion on SPECT were more common in the patients with TIAs (9/18 vs 8/42, p = 0.02; 5/10 vs 1/40, p = 0.0003). The occlusive TCD and SPECT patterns were associated with the highest mean infarction volume (147 /- 87 vs 19 /- 21, p less than 0.0001) and all nonocclusive TCD and SPECT patterns were associated with the better short-term outcome (43.2 /- 33.9 vs 92.4 /- 20.2, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.034608153070942keywords = artery (Clic here for more details about this article) |
5/433. diagnosis of MCA-occlusion and monitoring of systemic thrombolytic therapy with contrast enhanced transcranial duplex-sonography.A case of a successful systemic thrombolysis of an acute middle carotid artery occlusion is reported. The case underlines the role of contrast-enhanced transcranial color-coded duplex sonography as a noninvasive technique for rapid diagnosis of vessel occlusion in acute stroke. The diagnostic potential of transcranial color-coded duplex sonography for indication and monitoring of intravenous systemic thrombolytic therapy is demonstrated.- - - - - - - - - - ranking = 0.86156738771623keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
6/433. Articulatory processes and phonologic dyslexia.BACKGROUND-OBJECTIVE: Grapheme-to-phoneme conversion (GPC) allows the pronunciation of nonword letter strings and of real words with which the literate reader has no previous experience. Although cross-modal association between visual (orthographic) and auditory (phonemic-input) representations may contribute to GPC, many cases of deep or phonologic alexia result from injury to anterior perisylvian regions. Thus, GPC may rely upon associations between orthographic and articulatory (phonemic-output) representations. METHOD-RESULTS-CONCLUSION: Detailed analysis of a patient with phonologic alexia suggests that defective knowledge of the position and motion of the articulatory apparatus might contribute to impaired transcoding from letters to sounds.- - - - - - - - - - ranking = 0.00041016693368205keywords = injury (Clic here for more details about this article) |
7/433. diffusion-weighted magnetic resonance imaging: detection of ischemic injury 39 minutes after onset in a stroke patient.A neurologist witnessed the in-hospital onset of an ischemic stroke in a 71-year-old right-handed male who suddenly developed global aphasia and right hemiplegia. diffusion-weighted magnetic resonance imaging (DWI) 39 minutes after the ictus demonstrated high signals in the left internal carotid artery territory. T1- and T2-weighted images failed to detect this change. magnetic resonance angiography showed occlusions in branches of the left anterior and middle cerebral arteries and an atheromatous stenotic lesion in the ipsilateral proximal internal carotid artery. The patient was treated with intravenous heparin and low molecular dextran solution. Repeated magnetic resonance imagings identified an infarction slightly smaller than the abnormality demonstrated by the initial DWI. DWI detects hyperacute ischemic injury within 1 hour of symptom onset in human ischemic stroke.- - - - - - - - - - ranking = 1.7251856101009keywords = carotid artery, carotid, artery, injury (Clic here for more details about this article) |
8/433. Central deafness in a young child with moyamoya disease: paternal linkage in a Caucasian family: two case reports and a review of the literature.A case of 'central deafness' is presented in a 3-year-old male Caucasian child with moyamoya disease (MMD); a rare, progressive and occlusive cerebrovascular disorder predominantly affecting the carotid artery system. documentation of normal peripheral auditory function and brainstem pathway integrity is provided by acoustic admittance, otoacoustic emission and brainstem auditory evoked potential measurements. The lack of behavioral response to sound, and absent middle and long latency auditory evoked potentials suggest thalamo-cortical dysfunction. magnetic resonance imaging showed diffuse ischemic damage in subcortical white matter including areas of the temporal lobes. In addition, there were multiple and focal cortical infarctions in both cerebral hemispheres, focused primarily in the frontal, parietal and temporal areas. Taken together, these structural and functional abnormalities in addition to severely delayed speech and language development are consistent with the diagnosis of central deafness and suggest a disconnection between higher brainstem and cortical auditory areas. The child's father also has MMD, but was diagnosed only recently. The presence of paternal linkage is informative since it rules out x-linked recessive and maternal inheritance. To our knowledge, this represents the first documented case of paternal linkage in MMD with central deafness in a Caucasian child with no apparent Japanese ancestry. Herein, we focus on central auditory dysfunction and consider how lesion-induced changes have contributed to a deficit in basic auditory responsiveness, including a severe disturbance in receptive and expressive auditory-based speech and language skills.- - - - - - - - - - ranking = 0.86156738771623keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
9/433. Outcome of acute ischemic lesions evaluated by diffusion and perfusion MR imaging.BACKGROUND AND PURPOSE: diffusion and perfusion MR imaging have been reported to be valuable in the diagnosis of acute ischemia. Our purpose was to ascertain the value of these techniques in the prediction of ischemic injury and estimation of infarction size, as determined on follow-up examinations. methods: We studied 18 patients with acute ischemic stroke who underwent echo-planar perfusion and diffusion imaging within 72 hours of symptom onset. Quantitative volume measurements of ischemic lesions were derived from relative mean transit time (rMTT) maps, relative cerebral blood volume (rCBV) maps, and/or apparent diffusion coefficient (ADC) maps. Follow-up examinations were performed to verify clinical suspicion of infarction and to calculate the true infarction size. RESULTS: Twenty-five ischemic lesions were detected during the acute phase, and 14 of these were confirmed as infarcts on follow-up images. Both ADC and rMTT maps had a higher sensitivity (86%) than the rCBV map (79%), and the rCBV map had the highest specificity (91%) for detection of infarction as judged on follow-up images. The rMTT and ADC maps tended to overestimate infarction size (by 282% and 182%, respectively), whereas the rCBV map appeared to be more precise (117%). Significant differences were found between ADC and rMTT maps, and between rCBV and rMTT maps. CONCLUSION: Our data indicate that all three techniques are sensitive in detecting early ischemic injury within 72 hours of symptom onset but tend to overestimate the true infarction size. The best methods for detecting ischemic injury and for estimating infarction size appear to be the ADC map and the rCBV map, respectively, and the diffusion abnormality may indicate early changes of both reversible and irreversible ischemia.- - - - - - - - - - ranking = 0.0012305008010461keywords = injury (Clic here for more details about this article) |
10/433. Failure of a saphenous vein extracranial-intracranial bypass graft to protect against bilateral middle cerebral artery ischemia after carotid artery occlusion: case report.OBJECTIVE AND IMPORTANCE: We present the case of a patient who experienced bilateral middle cerebral artery infarctions after Hunterian ligation and trapping of a ruptured right cavernous aneurysm, despite a high-flow extracranial-intracranial bypass. This is a rare complication, and it highlights the need for further refinements in our understanding of the hemodynamic insufficiency created by major vessel sacrifice. CLINICAL PRESENTATION: The patient was a 59-year-old woman who experienced multiple episodes of massive epistaxis before undergoing angiography, which revealed left internal carotid artery occlusion and an irregular right cavernous aneurysm. The patient was then transferred to our center for treatment. The patient was neurologically intact at presentation, and her epistaxis was controlled by nasal packing. INTERVENTION: The patient underwent an extracranial-intracranial bypass from the external carotid artery to the M2 segment of the right middle cerebral artery, followed by trapping of the aneurysm. Despite evidence of graft patency, the patient experienced bilateral middle cerebral artery distribution infarctions after surgery. CONCLUSION: Although extracranial-intracranial bypasses protect the majority of patients who undergo carotid artery ligation from ischemic complications, this case demonstrates that hemodynamic insufficiency can occur even with a high-flow saphenous vein graft. Better ways to quantitate the hemodynamic needs of the brain after major vessel sacrifice may facilitate matching of the revascularization strategy to the specific needs of each patient, thus further reducing the likelihood of ischemic complications.- - - - - - - - - - ranking = 6.2732287855102keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
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