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Query: UMLS:C0013362 (dysarthria)
 3,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We reported a case of subacute subarachnoid hemorrhage with watery clear cerebrospinal fluid. Emergent magnetic resonance image was useful not only for diagnosis by fluid attenuated inversion recovery image but also for evaluation of cerebral ischemia and vasospasm by magnetic resonance angiography, diffusion weighted image and perfusion weighted image. A 50-year-old man presented disturbance of consciousness and dysarthria. Neither computed tomographic scan nor cerebrospinal fluid study could diagnose subarachnoid hemorrhage clearly. However, emergent fluid attenuated inversion recovery image showed the show subarachnoid hemorrhage as high signal intensity. Diffusion weighted image showed multiple, round hypersignals both in the white and gray matter. In the area with diffusion hypersignal, the apparent diffusion coefficient value was 0.57 x 10(3) mm2/sec. Perfusion weighted image showed normal cerebral blood volume but prolonged mean transit time in the territory of the right middle cerebral artery. Magnetic resonance angiography revealed an aneurysm at the anterior communicating artery and severe vasospasm on the bilateral anterior cerebral artery, the right middle cerebral artery. Thus we are able to diagnose subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. The hyperintensity of the diffusion weighted image and the fluid attenuated inversion recovery image was caused by cerebral ischemia from vasospasm. After conservative therapy during the period of vasospasm, successful surgical clipping was performed with full clinical recovery.
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PMID:[A case of subacute subarachnoid hemorrhage without xanthochromic cerebrospinal fluid--usefulness of emergent MRI]. 1283 76

A 66-year-old male presented with dysarthria and right hemiparesis. Cerebral angiography at onset showed obliteration of the basilar artery and dilatation in the left vertebral artery. The patient's clinical symptoms were exaggerated and he was finally diagnosed to as suffering locked-in syndrome. Magnetic resonance imaging showed a brain stem infarction from the pons to the left middle cerebellar peduncle. We determined that the patient suffered dissection of the left vertebral artery at the basilar artery and treated, using the conservative therapy him of strict blood pressure control. A second angiography 13 days after onset showed recanalization of the basilar artery. At 29 days after onset, the patient fell into a coma with subarachnoid hemorrhage and acute hydrocephalus. Cerebral angiography revealed improvement in the irregularity and dilatation of the basilar artery, but the point of rupture could not be clearly identified. After performing proximal occlusion of the left vertebral artery by intravascular surgery, both right STA-SCA anastomosis and proximal occlusion of the right vertebral artery were carried out. Unfortunately, the patient died. Based on there data, it is appointed out that patients with a dissection of the vertebrobasilar artery must be followed up by serial angiography, and even if an angiographical improvement of the dissection is observed, the risk of subarachnoid hemorrhage still exists in patients suffering ischemic stroke.
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PMID:[Vertebrobasilar artery dissection with subarachnoid hemorrhage after brain stem infarct showing an improvement on angiography: case report]. 1288 96

A 77-year-old man suffered subarachnoid hemorrhage due to a ruptured aneurysm of the distal anterior inferior cerebellar artery (AICA). He had a history of hearing disturbance in the left ear for more than 3 years. Computed tomography on three separate occasions had found no abnormalities. One month before the hemorrhage, he came to our outpatient service complaining of vertigo. Magnetic resonance (MR) imaging and MR angiography detected no abnormality. Conventional angiography demonstrated an aneurysm of 8 mm diameter in the distal AICA region after the hemorrhage. Filling and wash out of the aneurysm sac by contrast medium was markedly delayed, which suggested that MR imaging had failed to detect the flow void because of the slow blood flow in the dome. The aneurysm was clipped successfully. He was discharged with mild dysarthria on the 33rd postoperative day. MR angiography has limitations in detecting unruptured aneurysms and there is certainly a high risk group of false negatives, including aneurysms located in the distal region of the main trunk.
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PMID:Distal anterior inferior cerebellar artery aneurysm occult on magnetic resonance angiography one month prior to rupture--case report. 1292 94

Arterial dissections frequently involve the main trunk of the posterior circulation and are recognised as an important cause of stroke in young individuals. However, dissection confined to cerebellar arteries is rare. We encountered two patients with superior cerebellar artery (SCA) dissection. A 37-year-old man presented with dysarthria, right limb ataxia, and severe headache. Magnetic resonance imaging revealed cerebellar infarction in the right SCA territory. Angiography demonstrated stenosis and fusiform dilation of the SCA in the anterior pontine segment. Recovery with antiplatelet treatment was nearly complete. A 45-year-old man was admitted with decreased consciousness after sudden onset of headache. Computed tomography demonstrated subarachnoid haemorrhage with hydrocephalus. Angiography revealed fusiform dilation of the left SCA in the anterior pontine segment. After ventricular drainage, endovascular embolisation was performed without ischaemic complications. The patient's condition improved sufficiently to return to daily life. In our search only four reported cases involved the SCA. Clinical manifestation and treatment for patients with cerebellar arterial dissections are discussed.
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PMID:Dissection of the superior cerebellar artery: a report of two cases and review of the literature. 1473 84

A 63-year-old man presented with sudden severe headache. Computed tomography (CT) demonstrated subarachnoid hemorrhage. Cerebral angiography demonstrated an aneurysm of the anterior communicating artery. Left frontotemporal craniotomy and neck clipping of the aneurysm via the pterional approach were performed. CT obtained 18 hours after surgery revealed cerebellar hemorrhage, and magnetic resonance (MR) imaging 17 days postoperatively demonstrated that the hemorrhage was located within the folia. Neurological examination after surgery revealed slight dysarthria after drainage of cerebrospinal fluid (CSF) but no other neurological deficits. Follow-up CT and MR imaging showed characteristic findings of postoperative cerebellar hemorrhage clearly different from those of hypertension. The cerebellar hemorrhage was probably secondary to overdrainage of CSF. He was discharged without deficits.
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PMID:Remote cerebellar hemorrhage following supratentorial craniotomy--case report. 1525 44

We report 2 cases of multiple aneurysms (AN) associated with main trunk artery occlusion. CASE 1: A 52-year-old male was admitted to our hospital with dysarthria and weakness of the right side of the body. Computed tomography (CT) showed cerebral infarction in the left corona radiata. MR angiography and conventional angiography showed occlusion of the left middle cerebral artery (MCA) and saccular aneurysms (ANs) at the origin of the anterior communicating artery (A-com) and bifurcation of the right MCA. Subsequent 123I-IMP-single photon emission tomography (SPECT) revealed marked reduction of cerebral blood flow and disturbed reactivity to acetazolamide in the left cerebral hemisphere. Superficial temporal artery (STA)-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for AN of the A-com and right MCA. At 5 months after the first operation, neck clipping was performed successfully for the non-ruptured A-com AN and right MCA AN. CASE 2: A 65-year-old male was admitted to our hospital. CT revealed subarachnoid hemorrhage (SAH), and 3D-computed tomographic angiography (CTA) and cerebral angiography showed basilar top AN, A-com AN and right MCA AN associated with right internal carotid artery occlusion. Right ACA and MCA territories were visualized from the A-com artery and posterior cerebral artery. STA-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for ANs. In the same operation, successful neck clipping was performed for BA top AN and right MCA AN. In such cases as these, particularly in ischemic cases associated with main trunk artery occlusion, it was important to consider surgery for AN after STA-MCA anastomosis in anticipation of improved cerebral blood flow and reduce hemodynamic stress for AN.
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PMID:[Two cases of main trunk artery occlusion associated with multiple cerebral aneurysms]. 1708 68

An intracranial saccular aneurysm is not commonly diagnosed in a patient with head injury. We present a patient with a history of minor head trauma and a CT scan of the brain revealing minimal subarachnoid hemorrhage 17 days prior to admission, complaining of severe headache, dysarthria and focal right limb seizures 3 hours prior to admission. A traumatic aneurysm was suspected based on clinical history and radiological findings including hematoma in the falx region on a CT scan of the brain and an aneurysm of the pericallosal artery on magnetic resonance angiography and four-vessel cerebral angiography. However, at craniotomy, an intracranial non-traumatic saccular aneurysm at the bifurcation of the pericallosal artery was found. The patient recovered fully after successful clipping the aneurysm.
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PMID:Delayed rupture of pre-existing cerebral aneurysm in a young patient with minor head trauma. 1795 76

A 61-year-old woman with diabetes mellitus was admitted to our hospital with right hemiparesis and dysarthria. Brain MRI showed bilateral cerebral peduncular infarctions. Three days after admission, she was unable to generate any voluntary movements, except for those of the eye, suggesting locked-in syndrome (LIS). She could not speak, but showed good comprehension by blinking in response to verbal commands. Brain CT 5 days later revealed subarachnoid hemorrhage (SAH) around quadrigeminal and ambient cistern. Cerebral angiogram on the following day revealed no aneurysm, occlusion of right persistent primitive trigeminal artery (PPTA) and a little flow of the bilateral vertebral arteries. Eye movements were impossible in all directions on the 11th day and MRI showed new infarctions of the midbrain and the ventral portion of the pons. However, an EEG on the 20th day was almost normal. We speculated that low blood flow in the basilar artery from the PPTA caused bilateral cerebral peduncular infarctions, and that weakness of the PPTA caused SAH.
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PMID:[Locked-in syndrome due to bilateral cerebral peduncular infarctions with occlusion of persistent primitive trigeminal artery]. 1801 21

A 71-year-old female, without medical or family history for cerebrovascular disease, presented with basilar and bilateral carotid dolichoectasia manifesting as dysarthria and hemisensory disturbance, which resolved spontaneously within a day. She suffered brainstem infarction 28 months later, manifesting as drowsiness, dysarthria, and right hemiparesis. Her consciousness level progressively deteriorated to stupor within 4 days. Computed tomography taken on the 5th day confirmed cerebellar infarct in the perfusion area of the superior cerebellar artery but did not show subarachnoid hemorrhage. She died of acute respiratory failure on the 7th day. Autopsy demonstrated a tear in the lateral wall of the broad-based aneurysm on the ectatic basilar artery and diffuse subarachnoid hemorrhage. Vertebrobasilar ectasia is a dynamic vasculopathy that may rapidly progress in the affected basilar artery following an indolent clinical course. The prognosis for patients with vertebrobasilar ectasia may depend mainly on the pathological changes in the basilar artery.
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PMID:Atypical megadolichoectasia manifesting as brain infarction rapidly followed by fatal subarachnoid hemorrhage. 1922 35

A 34-year-old woman with a previous history of severe headache ("thunderclap") was admitted with a diagnosis of aneurysmal subarachnoid hemorrhage (SAH). The patient developed symptomatic vasospasm on day 5 that resolved rapidly after having increased arterial blood pressure. She experienced also short-lasting excruciating headache. On day 12, while velocities had normalised, as revealed by transcranial Doppler (TCD), for more than 48 h, she developed aphasia and right hemiplegia associated with diffuse segmental vasospasm on the left middle cerebral artery. Intra-arterial infusion of vasodilatory agents was required. Recurrence of symptomatic vasospasm was noted on day 25, with a great number of territories involved as shown in the cerebral angiogram. A second intra-arterial treatment was needed. The patient complained of multiple episodes of extremely severe headache ("thunderclap"), with also transient dysarthria and hemiparesia on day 30. She was discharged on day 38 after full recovery. The clinical and TCD/radiological findings were consistent with a reversible cerebral vasoconstriction syndrome overlapping SAH related symptomatic vasospasm.
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PMID:Possible overlap between reversible cerebral vasoconstriction syndrome and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. 1938 33


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