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1/23. Watershed infarction associated with dementia and cerebral atrophy.

    A 63-year-old man was admitted with progressive left hemiparesis and left homonymous hemianopsia of 1 month's duration. During the 2 months before admission, he had suffered from slowly progressive dementia. The diagnosis of right-sided watershed (WS) infarction was made. He exhibited slow progression of dementia and cerebral atrophy during the period of observation after discharge. There was a positive relationship between cerebral atrophy and the degree of dementia. In the present case, WS infarction caused by right internal carotid artery occlusion might be related to dementia and cerebral atrophy.
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2/23. Bilateral medial frontal infarction in a case of azygous anterior cerebral artery stenosis.

    We describe the unusual case of a 63-year-old woman with a history of arterial hypertension who presented a sudden weakness of the lower limbs followed by mutism, akinesia and dyspraxia. Magnetic resonance images showed a bilateral medial frontal infarction. Digital subtraction angiography documented a right azygous anterior cerebral artery with severe stenosis in its sub-callosal tract; the left anterior cerebral artery showed mild hypoplasia with only sub-frontal and fronto-polar branches. No embolic source was documented. Afterwards the patient presented a gradual and partial recovery of both motor and cognitive functions.
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ranking = 0.85714285714286
keywords = cerebral
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3/23. Cerebral vasculopathy and multiple infarctions in a woman with carcinomatous meningitis while on treatment with intrathecal methotrexate.

    We report on a 33-year-old woman with carcinomatous meningitis due to carcinoma of the breast who developed multiple cerebral infarctions within four days after intrathecal chemotherapy with methotrexate. MR angiography revealed a narrowing of basal cerebral arteries, which is consistent with vasculopathy. The vasculopathy was probably due to carcinomatous meningitis itself, an acute toxic effect of methotrexate, or a combination of both.
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keywords = cerebral
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4/23. Involuntary movements after anterior cerebral artery territory infarction.

    BACKGROUND AND PURPOSE: patients with anterior cerebral artery territory infarction presenting with involuntary movements have rarely been described in the literature. CASE DESCRIPTIONS: The author reports 9 such patients: 3 with asterixis, 5 with hemiparkinsonism (tremor, rigidity, hypokinesia), and 1 with both. Asterixis developed in the acute stage in patients with minimal arm weakness, whereas parkinsonism was usually observed after the motor dysfunction improved in patients with initially severe limb weakness. Asterixis correlated with small lesions preferentially involving the prefrontal area; parkinsonism is related to relatively large lesions involving the supplementary motor area. CONCLUSIONS: anterior cerebral artery territory infarction should be included in the differential diagnosis of asterixis and hemiparkinsonism.
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ranking = 0.85714285714286
keywords = cerebral
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5/23. Transtentorial herniation after unilateral infarction of the anterior cerebral artery.

    BACKGROUND: Fatal cerebral herniation is a common complication of large ("malignant") middle cerebral artery infarcts but has not been reported in unilateral anterior cerebral artery (ACA) infarction. CASE DESCRIPTION: We report a 47-year-old woman who developed an acute left hemiparesis during an attack of migraine. Cranial CT (CCT) was normal but demonstrated narrow external cerebrospinal fluid compartments. Transcranial Doppler sonography was compatible with occlusion of the right ACA. Systemic thrombolytic therapy with tissue plasminogen activator was initiated 105 minutes after symptom onset. Follow-up CCT 24 hours after treatment revealed subtotal ACA infarction with hemorrhagic conversion. Two days later, the patient suddenly deteriorated with clinical signs of cerebral herniation, as confirmed by CCT. An extended right hemicraniectomy was immediately performed. Within 6 months, the patient regained her ability to walk but remained moderately disabled. CONCLUSIONS: This is the first reported case of unilateral ACA infarct leading to almost fatal cerebral herniation. Narrow external cerebrospinal fluid compartments in combination with early reperfusion, hemorrhagic transformation, and additional dysfunction of the blood-brain barrier promoted by tissue plasminogen activator and migraine may have contributed to this unusual course.
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ranking = 1.2857142857143
keywords = cerebral
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6/23. Migrainous stroke causing bilateral anterior cerebral artery territory infarction.

    A 38-year-old man developed bilateral anterior cerebral artery territory infarction during the course of a migraine. magnetic resonance imaging showed bilateral ischemic lesions involving the cortex of the paramedian region of the frontal and parietal lobes, more prominent on the right. cerebral angiography was normal. To our knowledge, this is the first report of bilateral anterior cerebral artery territory infarction from migraine.
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ranking = 0.85714285714286
keywords = cerebral
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7/23. gait apraxia after bilateral supplementary motor area lesion.

    OBJECTIVES: The study aimed at addressing the issue of the precise nature of gait apraxia and the cerebral dysfunction responsible for it. methods: The case of a patient, affected by a bilateral infarction limited to a portion of the anterior cerebral artery territory is reported. The patient's ability to walk was formally assessed by means of a new standardised test. RESULTS: Due to an anomaly within the anterior cerebral artery system, the patient's lesion was centred on the supplementary motor regions of both hemispheres. He presented with clear signs of gait apraxia that could not be accounted for by paresis or other neurological deficits. No signs of any other form of apraxia were detected. CONCLUSIONS: The clinical profile of the patient and the analysis of 49 cases from previous literature suggest that gait apraxia should be considered a clinical entity in its own right and lesions to the supplementary motor areas are responsible for it.
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ranking = 0.42857142857143
keywords = cerebral
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8/23. Unusually prolonged progressing stroke: an expanding anterior cerebral artery infarction.

    Progressive clinical deterioration over a period of weeks coupled with MRI evidence of infarction growth is quite uncommon. In this report, we describe a patient with an occluded left anterior cerebral artery (ACA) at the origin of the A2 segment. His symptoms attributable to a posteriorly located small infarction within the ACA territory slowly progressed during the following 8 weeks. A follow-up MRI revealed that the infarction had expanded to involve the whole region of the left ACA. Occasional patients like ours indicate that stroke is a dynamic disorder with an extremely variable clinical course and state of tissue injury.
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ranking = 0.71428571428571
keywords = cerebral
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9/23. Reversible vascular changes in children with cerebral infarction.

    A case of cerebral infarction in a 4-year-old male is described. The child presented with an acute onset of right hemiplegia, central facial palsy, and dysarthria. He had no predisposing factors for cerebral infarction. A computed tomography scan showed a diffuse low-density area in the territory of the left miiddle cerebral artery. magnetic resonance angiography disclosed multiple irregular narrowings in the left anterior and middle cerebral arteries. He recovered spontaneously from the stroke with minimal long-term complications, and repeated angiography disclosed a complete regression of the vascular changes 2 months after the stroke. There was no recurrence of stroke after 2-year follow-up. This case demonstrates the importance of longitudinal angiographic follow-up in childhood cerebral infarction of idiopathic origin.
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ranking = 1.2857142857143
keywords = cerebral
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10/23. anterior cerebral artery dissections manifesting as cerebral hemorrhage and infarction, and presenting as dynamic angiographical changes--case report.

    A 65-year-old woman presented with multiple dissecting aneurysms of the anterior cerebral artery (ACA) manifesting as hemiparesis on the right with dominance in the lower extremity. Computed tomography revealed hematoma in the left frontal lobe, corresponding to the area perfused by the callosomarginal artery. Initial angiography showed string sign and occlusion in the distal portion of the left callosomarginal artery and abnormal feeding suggesting double lumen of the A2 portion of the left ACA. The patient was treated conservatively under a diagnosis of multiple spontaneous dissecting aneurysms of the left ACA. Repeat angiography on Day 8 showed improvement of the string sign and occlusion in the left callosomarginal artery, and change of the double lumen of the A2 portion into string sign. Further angiography on Day 36 showed normalization of the left callosomarginal artery and improvement of the string sign in the A2 portion. Multiple spontaneous dissecting aneurysms of the ACA are extremely rare. Serial angiography beginning in the early stage will be important for correct diagnosis.
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ranking = 1.2857142857143
keywords = cerebral
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