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

A 65-year-old man had four drop attacks in several days and then a fixed stroke with quadriplegia. At autopsy infarction in the lower pons and upper medulla affected principally the corticospinal tracts. Tegmental destruction included reticular formation nuclei with rostral projections, but spared the lateral reticular formation nuclei, from which arise the descending reticulospinal tracts. This case is the first detailed autopsy report of a patient with drop attacks, and supports the view that at least some drop attacks are caused by transient ischemia of the corticospinal tracts.
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PMID:The pathology of drop attacks: a case report. 57 1

An experimental model of brainstem ischemia was developed by embolization technique with cylindrical silicone rubber emboli in cats. The embolus reached the basilar artery in 55 cats (58.5%) and stopped in the upper basilar artery (UB) in 32, the middle basilar artery (MB) in 22 and the lower basilar artery (LB) in one animal. When the basilar artery distal to the embolus was not visualized (type 1) by postoperative vertebral angiogram, Evans blue extravasation was observed in the brainstem caudal to the embolus. When only a filling defect of the basilar artery at the site of the embolus was noted (type 2), dye extravasation was observed in the brainstem around the site of the embolus. In UB type 1, the regional cerebral blood flow of pons and medulla oblongata decreased immediately after embolization, and six hours after embolization it was 11.4 +/- 5.7 (pons) and 11.7 +/- 4.6 ml/100 g/min (medulla oblongata). In UB type 1 and MB type 1 animals, coma, apnea, tetraplegia, and disturbance of swallowing were noted. These animals died within 50 hours after embolization. Animals of UB type 2 and MB type 2 showed neurological deficits, but survived for three days. This paper discusses this method of producing experimental brainstem ischemia, the sites of ischemic lesions, and clinicopathological findings.
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PMID:A new model of brainstem ischemia by embolization technique in cats. 194 37

The authors evaluated the relationship between sympathetic nerve activity and transcutaneous oxygen tension (TcpO2) in normal and ischemic lower extremities. Dorsal foot TcpO2 was measured by using oxygen-sensing electrodes with surface temperatures of 42 degrees C and 45 degrees C; in theory, changes in sympathetic activity should affect vasomotor tone and TcpO2 in skin beneath an electrode at 42 degrees C (submaximal vasodilation), but not at 45 degrees C (maximal vasodilation). The vasodilation index (TcpO2 at 42 degrees C/TcpO2 at 45 degrees C) was created as an index of vasomotor tone (vasodilation index increases as tone decreases). In normal limbs (n = 24) averages for TcpO2 at 42 degrees C, TcpO2 at 45 degrees C, and vasodilation index were 30.3 mmHg, 62.1 mmHg, and 0.47, respectively. In subjects (n = 5) with quadriplegia and reduced sympathetic tone secondary to cervical cord trauma, TcpO2 at 42 degrees C and vasodilation index were increased (45.0 mmHg and 0.61); TcpO2 at 45 degrees C did not change. When normal subjects (n = 7) were chilled for twenty minutes with a cooling blanket at 5 degrees C (to increase sympathetic tone) average vasodilation index dropped from 0.50 to 0.29. Among ischemic limbs (n = 34) vasodilation index was highly variable (range: 0-0.77); in general, vasodilation index fell as the ischemia worsened. In a subset of patients with ischemic limbs, the vasodilation index increased after the limb was wrapped in a warm dressing (average vasodilation index = 0.25 without dressing, 0.37 with dressing). The authors conclude: TcpO2 can be used to assess the degree of vasomotor tone (and sympathetic activity) in skin; tone generally increases as ischemia worsens; and local warmth can improve cutaneous circulation in ischemic limbs.
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PMID:The influence of sympathetic nerves on transcutaneous oxygen tension in normal and ischemic lower extremities. 359 97

Two young patients are described who made good recoveries from a "locked-in" syndrome presumed to be due to ventral pontine ischemia. The first patient recovered completely from quadriplegia and mutism. In the second patient the only permanent sequellae were slight dysarthria and mild spasticity. Since patients may recover nearly completely from a "locked-in" syndrome, aggressive supportive therapy seems justified during the initial weeks or months.
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PMID:Reversible "locked-in" syndromes. 404 98

The existence of treatable postischemic (PI) changes which influence neurological outcome has been documented by this group before. A global brain ischemia model without cardiac arrest was developed in monkeys. It includes high-pressure neck tourniquet inflation plus hypotension for a reproducible ischemic insult; survival with reproducible neurological deficit (ND) under continuous PI life-support for 7 days with control of extracranial variables; and new ND and histopathological damage scoring systems. Hypoxemia, hypercarbia, hypotension, uremia, sepsis, and other extracranial complications PI in 50 unsatisfactory experiments led to immediate worsening in ND and brain death (ND = 100%) in most of these monkeys. In contrast, all monkeys with the same initial insult, with life-support according to protocol, survived with a 7 day ND of 60% or less. In 46 experiments of seven treatment groups, after 16 or 18 min ischemia, life support was according to protocol for 7 days. The control 1 protocol (spontaneous breathing when feasible) resulted in a mean 7-day ND score of 53% (including quadriplegia). Immobilization with pancuronium and controlled ventilation ameliorate deficit to an ND score of 19% (P less than 0.05) (including quadriparesis); this became control 2 protocol. Immobilization resulted in less neuronal damage in the neocortex. Severe repetitive hypertension worsened ND to 46%, versus 19% in controls (P less than 0.05). In separate series, neither heparinization over 72 hours PI, nor hemodilution to hematocrit 25% with dextran 40, changed final ND significantly from that of their control groups. Histopathological damage scores correlated with ND scores.
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PMID:Effect of postcirculatory-arrest life-support on neurological recovery in monkeys. 676 78

Cardiovascular disease is the leading cause of mortality in those with a spinal cord injury (SCI). As a consequence of changes in body composition and level of activity, individuals with a SCI tend to have a high prevalence of multiple risk factors for coronary artery disease (CAD). In this report, we have demonstrated the usefulness of tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in six clinically asymptomatic subjects with quadriplegia. The average age of the subjects was 47 +/- 2 years, and they had a duration of injury of 15 +/- 2 years. On average, the individuals had five risk factors for CAD. After intravenous administration of dipyridamole and mild upper extremity exercise, the subjects reported no adverse symptoms and had no electrocardiographic evidence suggestive of ischemia. By contrast, three of the six subjects had reversible defects noted on thallium scintigraphy, and one additional subject had a fixed defect that was suggestive of infarction. The remaining two subjects had abnormal scans with fixed defects of the inferioposterior region, which may be ascribed to diaphragmatic attenuation, perhaps a result of partial diaphragmatic paralysis. Thus, dipyridamole thallium myocardial imaging is a safe and effective noninvasive method for the detection of myocardial ischemia or infarction in individuals with quadriplegia who are at increased risk for CAD.
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PMID:Tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in asymptomatic subjects with quadriplegia. 832 97

Delayed spinal cord ischemia after thoracic aortic aneurysm repair is an infrequent but devastating complication. The use of stent grafts to exclude aortic aneurysms is thought to decrease the incidence of the neurologic deficit because there is no period of significant aortic occlusion. We report a case of paraplegia that progressed to quadriplegia occurring 48 hours after the apparently successful deployment of a thoracic aortic stent graft.
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PMID:Delayed onset of ascending paralysis after thoracic aortic stent graft deployment. 1064 23

Management of the cervical spine in orotracheal intubation for general anesthesia is an important aspect of daily practice in anesthesiology. Also important are the requirements, techniques and consequences of patient position during surgery. We report a case of tetraplegia during the early postoperative period after stapedectomy for otosclerosis. After surgery, the spontaneously breathing patient was transferred to the recovery room, where a clinical picture of anesthesia and paralysis of all four limbs was evident. We ordered an emergency magnetic resonance image of the cervical spine, which revealed a massive acutely herniated disk at C6-C7 with signs of ischemia or necrosis of the medulla at the same level. After eight months, the patient was still paraplegic and lacked sensation in the lower limbs. Sensation and motor function in the upper limbs was nearly normal. We review the etiopathogenetic mechanisms that might be responsible for this clinical profile.
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PMID:[Tetraplegia in the immediate postoperative period of stapedectomy]. 1098 43

A patient with exanthem and fever showed progressive disturbance of consciousness and flaccid quadriplegia predominantly in the lower extremities. Antibiotics, aciclovir, high-dose methylprednisolone (1 g/day for 3 consecutive days) and IVIG (400 mg/kg/day for 5 consecutive days) were not effective. Nerve conduction study and SEP in the lower extremities showed peripheral and central conduction block. EEG showed irregular sharp and slow waves predominantly in the left hemisphere. ABR and SEP in the upper extremities were normal. Consecutive studies of cranial and spinal MRIs showed no abnormalities. A diagnosis of acute disseminated encephalomyelitis (ADEM) was made. We started administration of ultra-high-dose methylprednisolone (5.4 mg/kg/h for 47 hours), the dose for acute spinal cord injury based on the randomized controlled trial of The Third National Acute Spinal Cord Injury Study in the USA. After this, she regained consciousness and the quadriplegia improved. The abnormalities in the electrophysiological studies also normalized. It is thought that the neuroprotective mechanism of ultra-high-dose methylprednisolone could be attributed to its inhibition of lipid peroxidation, secondary, ischemia, energy failure and so on. If the usual treatment is not effective for severe encephalomyelitis cases, we can consider the administration of ultra-high-dose methylprednisolone as one of the new treatment options.
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PMID:[A patient of ADEM with central and peripheral conduction block improved with ultra-high-dose methylprednisolone]. 1247 95

Quadriplegia developed suddenly 1 month after coarctation repair in a 53-year-old human. Cervical cord ischemia caused by thrombosis in an enlarged anterior spinal artery collateral was diagnosed on magnetic resonance scan and spinal angiography. After urgent cord decompression and anticoagulation there was neurologic improvement over a period of several months. Urgent investigation of neurologic abnormalities occurring late after coarctation repair may enable intervention to avert permanent neurologic sequelae.
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PMID:Late quadriplegia after adult coarctation repair. 1253 28


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