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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The origin of the vertebral artery is a frequent site for the development of stenosing lesions. The flow deficit caused by the stenosis of one vertebral artery is normally compensated for by intracranial anastomosis between the carotid and basilar arteries or by the opposite vertebral artery. A number of patients, however, have inadequate intracranial anastomosis and hypoplasia or stenosis of the opposite vertebral artery, and symptoms of brain ischemia develop. We describe here four cases in which a new technique, a subclavian vertebral artery autogenous vein bypass graft, was used to deal with the diseased segment of the vertebral artery. Transient postoperative problems included lymphocele and Horner syndrome. All four bypasses were patent at the time of angiography one week postoperatively. All four patients were relieved of symptoms of vertebrobasilar insufficiency.
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PMID:Vertebral artery bypass. 94 61

Internal carotid artery dissection is a major cause of ischemic stroke in the young. Pain is the leading symptom and is associated with other focal signs such as Horner's syndrome and painful tinnitus or with signs of cerebral or retinal ischemia. We report two patients with angiographically confirmed extracranial internal carotid artery dissection presenting with cephalic pain as the only manifestation. The first patient had a diffuse headache and a latero-cervical pain lasting for 12 days, reminiscent of carotidynia. The second patient experienced an exploding headache suggestive of subarachnoid hemorrhage, which was ruled out by computed tomography of the head and cerebrospinal fluid study. These patients demonstrate that recognition of carotid artery dissection as a cause of carotidynia and headache suggestive of subarachnoid hemorrhage may permit an earlier diagnosis and possibly the prevention of a stroke through the use of anticoagulation.
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PMID:Pain as the only manifestation of internal carotid artery dissection. 142 63

A typical case history of spontaneous dissection of the internal carotid artery is presented. In young patients with cerebral ischemia, initial pain in the affected side of the head and neck, a possible provocative mechanism and a transient or even persistent Horner's syndrome are highly suggestive. The angiographic picture of carotid artery dissection is characteristic. Spontaneous resolution is common, and recurrence rare. Surgical treatment can therefore be reserved for individual cases with recurrent ischemia and caused by emboli originating in the dissected segment of the artery.
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PMID:[Spontaneous dissection of the internal carotid artery]. 152 41

A 73-year-old man was admitted complaining of violent involuntary movement in the left upper and lower extremities. He had a ten-year history of hypertension and had had a left thalamic hemorrhage 6 years before admission. On neurological examination Horner's sign in the right eye, typical hemiballism in the left extremities and right hemiparesis, which was caused by the previous left thalamic hemorrhage, were observed. CT scan and MRI revealed recent hemorrhage in the right subthalamic nucleus. Haloperidol, tiapride and diazepam were administered to ameliorate the ballism, but they had to be reduced in amount because of the development of parkinsonism. Two months after onset, when there was still moderate ballism, he suffocated due to a swallowing disturbance. After two hours' coma, consciousness returned gradually. Twenty-four hours after suffocation, the neurological examination revealed normal consciousness and no deterioration in other neurological symptoms, but the ballism had almost disappeared without medication. No change was detected in MRI findings and the blood flows in the basal ganglia before and after suffocation. It is interesting that transient hypoxia due to suffocation reduced hemiballism in this patient without neuroradiological findings of ischemia in the basal ganglia. The mechanisms of reduction of hemiballism after transient hypoxia were discussed.
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PMID:[Improvement in hemiballism after transient hypoxia in a case of subthalamic hemorrhage]. 225 25

A 58-year-old woman developed bilateral internuclear ophthalmoplegia, probable right oculosympathetic paresis (Horner's syndrome), and right facial dysesthesias with acute cervical hyperextension upon sustaining a rear-end automobile collision. There was no head trauma. A nuclear magnetic resonance scan revealed a discrete area of increased signal in the tegmentum of the pons to the left. Extensive recovery was noted 1 year later. The acute cervical hyperextension suggested acute shearing and stretching of axons from brain stem deceleration rather than transient vertebral artery ischemia. Internuclear ophthalmoplegia representing intracranial pathology without direct head trauma has not previously been described with acute cervical hyperextension injury.
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PMID:Bilateral internuclear ophthalmoplegia due to acute cervical hyperextension without head trauma. 252 55

We reported a 51-year-old male with ischemic disturbance of right inner ear resembling Meniere's disease. The patient had a sudden-onset episode of vertigo, right severe hearing disturbance, nausea, vomiting and gait disturbance. Two days after, he had hypersomnia, vertical gaze palsy, double vision, left Horner's sign, and sensory disturbance of pain and temperature of right half body involving face. Brain MRI disclosed high intensity area in T2-weighted image and proton density in bilateral paramedian thalamo-mesencephalic region and right cerebellum (area of the anterior inferior cerebellar artery). Cerebral angiography showed 90% or more stenosis of the right vertebral artery, 50% stenosis of the left vertebral artery before the posterior inferior cerebellar artery (PICA), and 60% stenosis of distal portion of the basilar artery. Furthermore, stem portion of the posterior cerebral artery, and the right anterior cerebellar artery and the left vertebral artery after the PICA were absent or occluded. Right deafness was evaluated to be Jerger type II, namely disturbance of inner ear. Caloric tests showed no response, and right auditory brainstem response showed no waves. Main cause of this vertigo and right deafness was considered to be disturbance of inner ear due to ischemia of right labyrinthine artery, though this patient was not a typical case of the anterior cerebellar artery syndrome. Ischemic disturbances of inner ear have been reported only in patients with the anterior cerebellar artery syndrome, therefore this patient who had only acute ischemic disturbance of inner ear and did not have disturbance of caudo-lateral portion of the pons was considered to be very rare.
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PMID:[A case of ischemic disturbance of inner ear]. 259 43

From 1975 to 1988, 25 patients with a vertebral artery (VA) injury were treated. Admission neurologic status was intact in 14 patients (56 percent). Eight patients had deficits due to direct nerve or spinal cord injury, two patients had symptoms referable to vertebrobasilar ischemia, and one patient had a contralateral deficit due to an associated carotid artery injury. Twenty-two of 25 patients (88 percent) underwent diagnostic arteriography. Twelve patients (48 percent) with 9 occlusive and 3 minimal injuries were observed. Seven patients (28 percent), three with exsanguinating hemorrhage, were treated by operative exploration and VA ligation. Six patients (24 percent), two with a VA pseudoaneurysm and four with an arteriovenous fistula, were managed by percutaneous transcatheter embolization. The neurologic status was unchanged or improved in 22 patients (88 percent) at discharge. Two patients developed Horner's syndrome after VA ligation. Transient posterior circulation ischemia occurred in a single patient after percutaneous transcatheter embolization. There was no mortality. The majority of VA injuries are best managed by nonoperative methods. Untoward neurologic sequelae are rare. Operative intervention and VA ligation should be reserved for patients with active hemorrhage or large pseudoaneurysms and arteriovenous fistulas which cannot be embolized.
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PMID:Trends in the management of traumatic vertebral artery injuries. 275 37

A new cerebral syndrome is described which occurs rather frequently with ischemia affecting the common pathway of the internal carotid and middle cerebral arteries. The syndrome consists of contralateral brachiofacial hemiparesis, possibly with hemianopia and/or aphasia, and ipsilateral thermoregulatory hemihypohidrosis with an ipsilateral central Horner syndrome. It is caused by an ischemic lesion of the crossed pathways descending from the cerebrum and the uncrossed hypothalamo-spinal sympathetic pathways descending through the subthalamic region. It is suggested to name the syndrome "telodiencephalic ischemic syndrome".
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PMID:The telodiencephalic ischemic syndrome. 615 86

In order to assess the prevalence and characteristics of cephalic pain in internal carotid artery (ICA) dissection, and to compare clinical and angiographic features of patients with painful and non-painful dissections, we observed 65 patients with angiographically diagnosed extracranial ICA dissection from 1972 to 1990. Forty-eight patients (74%) complained of a cephalic pain which was inaugural in 38 (58.5%). It was homolateral to the dissection in 79% of cases and lasted from 1 h to 30 days, with a median of 5 days. Signs of cerebral or retinal ischemia were observed in 79% of patients, often delayed and occurring up to 29 days after the onset of pain. A painful Horner's syndrome was present in 31% of patients, and was the only manifestation of dissection in 16%. The clinical presentation of the dissections and angiographic findings were similar in patients with and without pain except for a past history of migraine which was more frequent in patients with painful dissections. Cephalic pain is frequent and often inaugural in carotid dissection. Its recognition is important for early diagnosis and treatment.
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PMID:Head pain in non-traumatic carotid artery dissection: a series of 65 patients. 820 21

Raynaud's syndrome is a clinical entity characterized by episodic vascular spasm and digital ischemia occurring in response to cold or emotional stimuli. Most patients with Raynaud's syndrome are successfully managed with medical therapy. Surgical sympathectomy is rarely performed and its use remains controversial. Of 3,219 patients seen with the diagnosis of Raynaud's disease, phenomenon or syndrome over the last 10 years at Mayo Clinic, 20 cervical or thoracic sympathectomies were performed in 14 (0.4%) patients. Of all patients who underwent cervico thoracic sympathectomy (68) for various reasons during the same time period, 20.5% (14/68) were performed for Raynaud's syndrome. Surgical sympathectomy was reserved for those rare patients with persistent, severe symptoms (pain, ulcer) despite intensive medical treatment. Surgical therapy was also used for those few patients with occupations involving exposure to cold and disabling, refractory symptoms in hopes of allowing them to return to work. Transaxillary (12 limbs) or supraclavicular (8 limbs) exposure and resection of the sympathetic chain with T1-T4 ganglions was usually performed. Initial resolution or improvement of symptoms was achieved in 19/20 (95%) of limbs. Both patients with digital ulceration healed. Although improved in some, persistent or recurrent symptoms were present in all patients after six months postoperatively. Increased sensitivity of digital vessels to circulating catecholamines, nerve fiber regeneration or incomplete sympathectomy have been postulated to lead to recurrence. Five patients developed Horner's syndrome postoperatively. A portion of the stellate ganglion was intentionally resected in 3 of the 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cervicothoracic sympathectomy for Raynaud's syndrome. 837 Sep 99


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