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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Harlequin syndrome is a rare neurological condition that results in unilateral facial flushing and sweating. Although the syndrome is generally a benign condition with complete resolution if appropriate treatment is initiated, unilateral facial flushing can be a sign of several serious conditions and should be thoroughly investigated. Sudden onset of facial flushing related to harlequin syndrome developed in a patient who had bilateral lung transplant with postoperative epidural anesthesia for pain control. Differential diagnosis includes neurovascular disease (acute stroke), malignant neoplasm of brain or lung, Horner syndrome, idiopathic hyperhidrosis, and Frey syndrome. Harlequin syndrome is often easily treated by discontinuing the anesthetic or adjusting placement of the epidural catheter.
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PMID:Harlequin syndrome as a complication of epidural anesthesia. 2488 29

Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma were presented. We examined the point similar to that of stroke. During the initial visit of our hospital, the patients showed the hemiplegia in 10 cases (62.5%), Horner syndrome in 4 cases (25%), the painless onset in 1 case (6.3%). And one case showed the impairment of consciousness due to vagal reflex in severe pain onset, which was similar to those of subarachnoid hemorrhage. MRI images are useful to confirm the diagnosis. The frequent site of hematoma was the lower cervical spinal cord. The oval shaped hematomas shifted to the left or right in spinal canals, compressed spinal cords in axial image, which was a cause of hemiplegia. Many cases developed during active periods, and the hemorrhage might be relevant to oral antithrombotic agent, C hepatitis, and chronic renal failure. Rapidly progressive cases were indications for emergency surgery, but conservative therapy is also possible and was better prognosis.
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PMID:[Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma -stroke mimic and pitfalls for diagnosis]. 2494 75

The superior cervical ganglion (SCG) plays an important role in neuropathies including Horner's syndrome, stroke, and epilepsy. While mammalian SCGs seem to share certain organizational features, they display natural differences related to the animal size and side and the complexity and synaptic coverage of their dendritic arborizations. However, apart from the rat SCG, there is little information concerning the number of SCG neurons and synapses, and the nature of relationships between body weight and the numbers and sizes of neurons and synapses remain uncertain. In the recognition of this gap in the literature, in this chapter, we reviewed the current knowledge on the SCG structure and its remodeling during postnatal development across a plethora of large mammalian species, focusing on exotic rodents and domestic animals. Instrumentally, we present stereology as a state-of-the-art 3D technology to assess the SCG 3D structure unbiasedly and suggest future research directions on this topic.
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PMID:Stereological and allometric studies on neurons and axo-dendritic synapses in superior cervical ganglia. 2495 16

Dissection of the internal carotid artery is a rare cause of stroke overall, but causes 22% of strokes in younger patients. A common clinical presentation is as Claude Bernard Horner syndrome. We report a craniotomy with 30 degrees rotation of the neck (standard position) in a patient with no major risk factors for carotid dissection, who showed a Pourfour du Petit syndrome due to a dissection of the internal carotid artery. To the best of our knowledge, this is the first reported case in which a common surgical position causes an internal carotid artery dissection in a patient without relevant risk factors. The presentation with Pourfour du Petit syndrome is extremely unusual.
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PMID:Surgical Position, Cause of Extracranial Internal Carotid Artery Dissection, Presenting as Pourfour Du Petit Syndrome: Case Report and Literature Review. 2624 49

Neuro-ophthalmological emergencies constitute vision or life-threatening conditions if diagnosis and treatment are not promptly undertaken. Even with immediate therapy, these clinical entities carry a high rate of morbidity. They may present with diplopia, visual loss, and/or anisocoria. Arteritic anterior ischemic optic neuropathy is an ominous condition, which can cause permanent and severe vision loss, stroke, or aortic dissection, requiring immediate steroid therapy. Pituitary apoplexy may go unnoticed if only computed axial tomography is performed. Diseases affecting the cavernous sinus and orbital apex region, such as cavernous sinus thrombosis or mucormycosis, can give rise to simultaneous vision loss and diplopia and, if not treated, may extend to the brain parenchyma causing permanent neurological sequela. An isolated third nerve palsy may be the harbinger of a cerebral aneurysm, carrying a significant risk of mortality. Horner syndrome can be the initial presentation of a carotid dissection, an important cause of stroke in the young adult. The neurohospitalist should be familiar with the workup and management of neuro-ophthalmological emergencies.
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PMID:Neuro-Ophthalmological Emergencies. 2642 50

Dissection refers to a tear in the wall of an artery, with the two main types being intracranial or extracranial. Dissections tend to occur most commonly in the young, sometimes secondary to trauma involving the neck. To confirm a dissection, some type of vessel imaging is necessary, including magnetic resonance angiography (MRA), computed tomography angiography (CTA), or angiography. The most common presentation of a dissection (especially extracranial) is pain, usually head and neck pain along with a Horner's syndrome. Patients may also present with ischemic symptoms, including transient ischemic attack (TIA) or stroke, which may also be a complication of a dissection. Although headache is a common presentation, there is little research into phenotype or long-term outcomes. There are a number of case reports detailing the phenotypes of headaches that may be present in dissection, including a migraine-like or hemicrania-like headache. Dissections are usually treated with some type of anti-platelet or anti-coagulation, although there are only a few randomized controlled trials. In a new acute headache, dissection is an important diagnosis to keep in mind.
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PMID:Headache in Intracranial and Cervical Artery Dissections. 2675 10

OBJECTIVE Dissection of the carotid and vertebral arteries can result in the development of aneurysmal dilations. These dissecting pseudoaneurysms can enlarge and cause symptoms. The objective of this study is to provide insight into the progression of dissecting pseudoaneurysms and the treatments required to manage them. METHODS A review of the electronic medical records was conducted to detect patients with carotid and vertebral artery dissection. An imaging review was conducted to identify patients with dissecting pseudoaneurysms. One hundred twelve patients with 120 dissecting pseudoaneurysms were identified. Univariate and multivariate analyses were conducted to assess the factors associated with undergoing further interventions other than medical treatment, pseudoaneurysm enlargement, pseudoaneurysms resulting in ischemic and nonischemic symptoms, and clinical outcome. RESULTS Overall, 18.3% of pseudoaneurysms were intracranial and 81.7% were extracranial, and the average size was 7.3 mm. The mean follow-up time was 29.3 months; 3.3% of patients had a recurrent transient ischemic attack, no patients had a recurrent stroke, and 14.2% of patients had recurrence of nonischemic symptoms (headache, neck pain, Horner syndrome, or cranial nerve palsy). Follow-up imaging demonstrated that 13.8% of pseudoaneurysms had enlarged, 30.2% had healed, and 56% had remained stable. In total, 20.8% of patients had an intervention other than medical treatment. Interventions included stenting, coiling, flow diversion, and clipping. Predictors of intervention included increasing size, size > 10 mm, location in the C2 (petrous) segment of the internal carotid artery (ICA), younger age, hyperlipidemia, pseudoaneurysm enlargement, and any symptom development. Significant predictors of enlargement included smoking, history of trauma, C2 location, hyperlipidemia, and larger initial pseudoaneurysm size. Predictors of pseudoaneurysm resulting in recurrent ischemic and nonischemic symptoms included increasing size and location in the petrous segment of the ICA. Smoking was a predictor of unfavorable outcome. CONCLUSIONS Dissecting pseudoaneurysms have a benign course and most will not cause symptoms or enlarge on follow-up. Medical treatment can be a sufficient, initial treatment for dissecting pseudoaneurysms.
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PMID:Dissecting pseudoaneurysms: predictors of symptom occurrence, enlargement, clinical outcome, and treatment. 2682 74

Dissection of the cervical arteries is an important cause of stroke in young adults. A haematoma in the wall of the cervical vessel leads to stenosis or occlusion and thereby risk of stroke. The most frequent local symptoms in carotid-artery dissection are head- and neck pain accompanied by Horner's syndrome, while typical symptoms in vertebral-artery dissection are pain in the back of the neck and head. The mural haematoma is best visualized by magnetic resonance imaging. Antithrombotic versus anticoagulation treatment to prevent stroke have recently shown to be equally effective.
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PMID:[Dissection of the cervical arteries]. 2704 96

Internal carotid artery dissection (ICAD) is a rare entity that either results from traumatic injury or can be spontaneously preceded or not by a minor trauma such as sporting activities. It represents a major cause of stroke in young patients. The diagnosis should be suspected with the combination of Horner's syndrome, headache or neck pain, and retinal or cerebral ischaemia. The confirmation is frequently made with a magnetic resonance angiography (MRA). Although anticoagulation with heparin followed by vitamin-K-antagonists is the most common treatment, there is no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid dissection. We describe a patient with ICAD following deep sea scuba diving, who presented with Horner's syndrome and neck pain and was successfully treated with anticoagulants.
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PMID:Horner's Syndrome due to a Spontaneous Internal Carotid Artery Dissection after Deep Sea Scuba Diving. 2752 39

Although there have been reports of carotid artery pseudoaneurysm formation after adenoidectomy and/or tonsillectomy secondary to iatrogenic injury, there are no case reports of successful endovascular reconstruction of the injured artery in the pediatric population. In most pediatric cases, the internal carotid artery (ICA) is sacrificed. The authors report on a 6-year-old girl who presented with odynophagia, left-sided Horner's syndrome, hematemesis, and severe anemia 6 months after a tonsillectomy. On examination she was found to have a pulsatile mass along the left posterior lateral oropharynx, and imaging demonstrated a dissection of the extracranial left ICA and an associated pseudoaneurysm. The lesion was managed endovascularly with stent-assisted coil embolization and ICA reconstruction. The child had a somewhat complicated postoperative course, requiring additional coil embolization for treatment of a minor recurrence of the pseudoaneurysm at 5 months after the initial treatment and then presenting with extrusion of a portion of the coil mass into the oropharyngeal cavity a year later. She underwent surgical removal of the extruded coils and repair of the defect and has since been free of symptoms or signs of recurrence. The authors conclude that this strategy definitively protected the patient against an oral exsanguination or aspiration event secondary to aneurysm rupture and reduced her risk of stroke by preserving vessel patency and caliber. Moreover, they note that covered stent reconstruction surrenders endovascular access and cannot immediately provide these benefits.
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PMID:Vessel-preserving stent-assisted coil embolization of an extracranial internal carotid artery pseudoaneurysm that developed after tonsillectomy in a pediatric patient: initial case report. 2768 45


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