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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We reported a case of fibromuscular dysplasia (FMD) presenting lateral medullary syndrome accompanied with left truncal ataxia, left Horner's syndrome and superficial sensory deficit in the right extremities. He was 46-year-old man and had no remarkable risk factors for the cerebrovascular disease such as hypertension, diabetes mellitus and valvular heart disease. Cerebral angiography was performed and there was the string-of-beads-like shadow in the left vertebral artery, revealing a localized FMD. Wedge-shaped area of low signal intensity in the left lower medulla was recognized in magnetic resonance imaging (spin echo Tr/Te 600/30). It was suggested that the lesion of the lower medulla caused the patient's several symptoms. In Japan, there have been a few case reports of cervical or intracranial FMD, but we cannot find any report of FMD localizing in the unilateral vertebral artery. In general, it has been said that the etiology of lateral medullary syndrome under fifty years old differs from those of geriatric patients. The authors pointed out the significance of FMD as one of those risk factors causing lateral medullary syndrome and also discussed the mechanism of the sensory disturbance sparing face.
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PMID:[A case of fibromuscular dysplasia presenting lateral medullary syndrome]. 238 16

We reported a 72-year-old male with ischemic oculopathy due to ophthalmic artery stenosis followed by ipsilateral border zone infarction due to internal carotid artery stenosis. The patient had history of hypertension and diabetes mellitus. He had severe headache and visual disturbance of the right eye. He was diagnosed right neovascular glaucoma and left diabetic retinopathy (simple type), and received diuretics, beta-blockade and other anti-hypertensive drugs. One month later, he noticed left mild hemiparesis in a morning, and he experienced progression of left hemiparesis over a week. He was admitted to our hospital on the 11th day. He showed left complete hemiplegia, left sensory disturbance, anosognosia and left unilateral spatial neglect. His right eye was diagnosed neovascular glaucoma but left eye was normal. The 5th days CT showed low density area in the right terminal zone and bilateral periventricular lucency. At the same area, the 46th days MRI showed high intensity area in the T2-weighted image and low intensity area in the T1-weighted image. Cerebral angiography performed on the 33rd day, disclosed severe kinking at the cervical segment and 50% stenosis at the intracavernous segment in the right internal carotid artery, and 90% stenosis and post-stenotic dilatation of the right ophthalmic artery. Left internal carotid artery had each 60% stenosis at the cervical segment and the intracavernous segment. Left ophthalmic artery had severe stenosis from its beginning to distal part. This infarction was considered berder zone infarction by it's localization (terminal zone) and internal carotid artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of ischemic oculopathy followed by border zone infarction]. 258 88

A case of non-traumatic spinal epidural hematoma (SEH) with spontaneous resolution was reported. A 80-year-old woman was admitted to our hospital for her paraplegia of acute onset. She had had no specific previous history, and she did not either receive any drug or suffer from hypertension. On admission, general status was unremarkable. Flaccid paralysis of lower extremities and bilateral sensory disturbance of all modalities below the level of Th4 were observed. Deep tendon reflexes were normal in upper extremities, while absent in lower extremities. Babinski's sign was not elicited. From the findings of CT and metrizamide CT myelography, SEH of ventral type was presumed. MRI revealed hematoma compressing spinal cord over two vertebral segments, and widely spreading even to C7 rostrally and to Th10 caudally. Urgent surgical intervention was taken into consideration, but was not performed because of her rapid improvement: sensory disturbance alleviated from day to day, and she became able to walk within the 3rd day of hospitalization. Almost complete recovery from motor and sensory dysfunction was achieved in about 7 days after admission. Only 4 cases of spontaneous recovery of SEH have been reported so far, and this patient is the 5th such case. Although CT and metrizamide CT myelography are useful in diagnosing SEH, MRI is also proved to be an accurate and efficacious method for evaluation of its size, location and extent in the spinal canal.
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PMID:[A case of acute spinal epidural hematoma with spontaneous resolution and its MRI]. 258 89

A patient, 30-year-old man, was admitted to Shinshu University Hospital with gait disturbance and numbness of both arms and legs in June 1985. General physical findings were normal except for facial asymmetry, i.e. mild right facial hemiatrophy. Blood pressure was normal and there were no signs of arteriosclerosis. Neurological examination revealed marked bilateral pyramidal tract signs, muscular weakness of all extremities predominant of the right side, spastic gait and sensory disturbance with impairment of pin prick and light touch sensation in the second and third trigeminal nerve regions and extremities of the left side, and mild loss of vibratory sense and numbness in all extremities. X-ray examination of the cervical spine and the myelogram of the spinal canal were normal. CT scan of the brain performed 3 hours after the myelography showed that the left vertebral artery extended from the left side of the medulla oblongata to the midline and distorted it by compression. MRI confirmed the findings of the CT scan. Vertebral angiography disclosed that the elongated left vertebral artery crossed the ventral aspect of the medulla oblongata. Compression of the medulla oblongata by the vertebral artery was diagnosed and neurovascular decompression was performed. About one month after the operation his spastic gait and muscular weakness were slightly improved, but these symptoms progressed thereafter. One year after operation his spastic gait was more marked than preoperatively. In many cases with dolichoectatic intracranial arteries, hypertension and arteriosclerosis have been reported to be usually associated with this condition. In other opinions dolichoectasia has been suggested to be a congenital disease, because such vessels are occasionally present in children.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case report of quadriparesis due to compression of the medulla oblongata by the elongated left vertebral artery]. 274 80

Fifty-three patients with infarction of the corona radiata adjacent to the body of the lateral ventricle were clinically evaluated in order to determine the clinical characteristics of this infarction and localization of the pyramidal tract in this area, as well as its somatotopy and etiology. Clinical characteristics included the following: (1) this type of infarction was observed in 9.1% of all patients with cerebral infarction; (2) although 81.1% of the patients of this type had clear consciousness and neuropsychological symptoms in some patients; (3) motor paralysis usually occurred in the upper limbs; (4) monoplegia occurred in 13.2% of patients, with monoplegia of upper and lower limbs being associated with infarction of the anterior and posterior portion, respectively, of the corona radiata adjacent to the body of the lateral ventricle; (5) pure motor hemiplegia was observed in 45.3% of patients; (6) facial paralysis and dysarthria were observed in 54.7% and 58.5% of patients, respectively, and the incidence of these symptoms was the highest in the infarction of the anterior portion of the corona radiata; (7) sensory disturbance, which was usually recognized as a mild subjective feeling of abnormality and localized to the limbs, was reported by 47.2% of patients; (8) risk factors included hypertension, diabetes and high hematocrit and triglyceride levels; (9) arteriosclerosis was often noted in areas between the siphon of the internal carotid artery and the main stem of the anterior and middle cerebral arteries; (10) 64.2% of patients were able to conduct independent activities of daily life (ADL) 1 month after the onset of the disease and more marked paralysis remained in the infarction of the middle portion than in the anterior or posterior portion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical characteristics of infarction of the corona radiata adjacent to the body of the lateral ventricle]. 275 54

The patient, a man aged 57, was admitted to our clinic on May 1, 1987, because of severe vertigo and unsteadiness in standing. Since the age of 55 he had been suffered from hypertension and atrial fibrillation. In September, 1986, he experienced vertigo but recovered soon without therapy. On April 25, 1987, while working, he noticed severe vertigo, nausea and vomiting. He was admitted to a hospital, and then transferred to our clinic. On admission, he was alert and the mentality was normal. Slight ptosis abducent nerve paresis, hypalgesia on the forehead, nose and cheek, facial paresis of peripheral type and hypacusis were detected on the left side. No anisocoria was observed. Sweating was impaired over the left side of the face. Elevation of the soft palate was limited on the left side and the tongue deviated to the left on protrusion. Dysarthria was detected. Though there was no muscular weakness in the extremities, incoordination and dysmetria were noted in the left arm and leg. He could not stand up because of vertigo and unsteadiness. There was no sensory disturbance in the trunk and extremities. Deep tendon reflexes were well elicited and no pathological reflex was observed. These clinical manifestations, except for the ipsilateral palatal and lingual disturbances, were typical of the lateral inferior pontine syndrome caused by occlusion of anterior inferior cerebellar artery, and the lesion was clearly demonstrated by horizontal and coronal MRI. The palatal and lingual disturbances might be due to the involvements of the corticobulbar tracts of the 10th and 12th nerves after the fibers had decussated.
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PMID:[Lateral inferior pontine syndrome: a case report]. 280 19

Symptomatic common carotid artery occlusion (CCAO) is rare. We studied 17 patients with ischemic cerebrovascular symptoms and unilateral CCAO on angiography to help clarify clinical and radiologic features. Mean age was 62 years; 65% were women. Predominant symptoms and signs included visual-ipsilateral monocular or retrochiasmal symptoms (88%), motor weakness (88%), sensory disturbance (59%), dizziness/lightheadedness (53%), and syncope (24%). Dysarthria, headache, or involuntary limb shaking occurred less frequently. Positionally related symptoms occurred in approximately two-thirds of the patients. TIAs were often multiple and preceded a stroke or occurred without subsequent stroke in 82%. Hemispheric TIAs contralateral to the CCAO occurred in 41%. Ten patients (59%) suffered stroke, seven (70%) of which were ipsilateral to the CCAO. Vascular risk factors included cigarette use (76%), hypertension (71%), diabetes mellitus (41%), and hyperlipidemia (41%); 82% had two or more risk factors. Known cardiac disease was present in 59%. CCAO was present at the origin of the vessel in most patients. Most had atherosclerotic narrowing of multiple extracranial large vessels. During follow-up, none of the patients had a spontaneous second infarct; five had TIAs, including two with amaurosis fugax, all in the CCAO territory. More restricted external carotid collaterals may, in part, explain the higher frequency of ipsilateral stroke and contralateral TIAs than reported for internal carotid occlusion.
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PMID:Common carotid artery occlusion. 279 68

Clinical features of cerebellar infarction in the territory of the superior cerebellar artery (SCA) were investigated in six male patients, ranging in age from 50 to 69 years. In all patients, there were MR images of infarction located in the area supplied by the SCA. The lesion was on the left-side in 2, right-side in 3 and bilateral (recurrent) in 1 patient. The onset of disease occurred with nausea, vomiting and floating sensation, with no overt brain stem signs other than symptoms of unilateral cerebellar ataxia and dysarthria. Five of the 6 patients had heart disease and cerebral angiography without definite evidence of SCA occlusion, strongly suggesting occlusion of the artery at its periphery due to cardiogenic embolism. A comparison of these 6 patients with those reported previously in Japan suggests that patients with SCA occlusion may be divided into two distinct subgroups: one manifesting diffuse brain stem signs in addition to cerebellar signs, and the other showing cerebellar signs as the only neurologic manifestation. In the former group, comprising the vast majority of patients, SCA occlusion occurred at the origin of the vessel due to a thrombus under a state of hypertension, diabetes mellitus or malignancy, producing signs of brain stem involvement, such as dissociating sensory disturbance and Horner's sign. While in the latter group, which included these 6 patients, paucity of brain stem signs, absence of definite cerebral angiographic evidence of SCA occlusion, and the presence of heart disease were distinguishing clinical features. Cardiogenic cerebral embolism was probably the underlying pathology in many of the cases and the functional prognosis was favorable.
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PMID:[Cerebellar infarction in the territory of the superior cerebellar artery, presenting a predominant cerebellar symptom--with special reference to its pathophysiology]. 761 47

A 53-year-old man with hypertension was admitted to our hospital, for somnolence, horizontal gaze palsy, right hemiparesis and right sensory disturbance. Brain CT scan revealed a high density area from the left lower pontine tegmentum to the left tegmentum of the lower midbrain. As he became alert, he reported visual hallucination. Two weeks after onset of stroke, he complained tactile hallucination on his right half body with sensory disturbance. After disappearance of the visual hallucination, the tactile hallucination had been persisted. This is the first report of peduncular hallucinosis with long-persisted tactile hallucination due to brainstem bleeding. Tactile hallucination was suggested to be associated with sensory disturbance and extensive destruction of the brain stem tegmentum.
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PMID:[A case of the brainstem tactile hallucinosis due to pontine hemorrhage]. 761 53

A 61-year-old man was referred to our department with spontaneously remitting sensorimotor disturbance and bowel and bladder dysfunctions. He had no specific previous history and neither received any drug nor suffered from hypertension. On onset, complete flaccid paralysis of lower extremities, almost complete sensory disturbance of all modalities below the level of Th12, and bowel and bladder dysfunctions were observed. MRI and CT scan revealed an epidural hematoma in the posterior region of the spinal cord at Th11 level. Afterwards he continued to improve gradually both clinically and radiologically. Four days subsequent to onset, on admission to our department, he had slight sensorimotor disturbance, and bowel and bladder dysfunctions still existed. MRI demonstrated a shrinking and flattened hematoma. We performed laminectomy and evacuation of the hematoma. Grossly and histologically, no underlying lesion was revealed. Postoperative course was not eventful. He was discharged without residual deficits. In our case, surgery accomplished three goals: definitive diagnosis, secure decompression and prevention of recurrence. We believe, the possibility of spontaneous resolution of spontaneous spinal epidural hematomas (SSEDHs) with spontaneous remission may be high, but prompt surgical evacuation should be the treatment of choice for such cases, even if no underlying lesion is revealed by MRI, except in cases where operative morbidity and mortality rate is high and in cases with no neurological deficits other than pain. A review of the literature indicated that not all SSEDHs with spontaneous remission resolved spontaneously and completely.
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PMID:[A case of spontaneous spinal epidural hematoma with spontaneous remission before surgery]. 825 23


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