Background and purposeTo assess the anatomical distribution of the ischemic strokes of the brainstem, the effect of anatomical distribution on clinical features and prognosis, and the association between etiology and anatomical involvement.MethodsA retrospective search of the patient database of our institution was performed for a total of 227 patients who were admitted to the Department of Neurology, Medical Faculty of Bezmialem Vakif University between January 2012 and September 2014. Patients with adequate diagnostic data and 3-month follow-up visit were included in the study.ResultsTwenty-one (9%), 136 (60%), and 65 (29%) patients had an infarction only at the mesencephalon, pons, and medulla, respectively. However, a single patient (0.5%) had an infarction both at the mesencephalon and pons, 3 (1.5%) at the pons and medulla, and 1 (0.5%) at the mesencephalon, pons, and medulla. While anterior involvement was more common in the mesencephalon and pons, posterior and lateral involvement occurred more frequently in the medulla. Large arterial atherothrombosis was the predominant cause of the strokes in all anatomical sites, particularly in infarcts involving the pons. Cardioembolic events were more common in patients with mesencephalic infarcts. Also, ischemia due to dissection was more common in infarctions involving the medulla, especially the lateral medulla. In subjects with simultaneous infarcts at other sites in addition to the brainstem, there was a significantly higher co-occurrence of medullary infarcts with cerebellar infarcts, mesencephalic infarcts with posterior cerebral artery infarcts, and pons infarcts with anterior circulation and multiple infarcts.ConclusionDetermination of risk factors and infarct localization as well as prediction of etiological parameters may assist in improving survival rates and therapeutic approaches.

Background and purpose: We aimed to examine the incidence of cognitive impairment among patients with stroke, the associated risk factors, progression of the cognitive impairment, and the association between the localization of the lesion(s) as detected by magnetic resonance imaging and the affected areas of cognitive function. Methods: A total of 40 patients over 18 years of age enduring a transient ischemic stroke or minor stroke within the past 3 months who had a minimum life expectancy of 1 year were included in this study. Same number, age-, and sex-matched individuals were included as controls. Patients were inquired on the presence of risk factors for stroke. A series of neuropsychological test batteries were administered in patient and control subjects for assessing cognitive functions. These tests were readministered at 6 and 12 months of follow-up to assess the progression of cognitive functions. Results: In this study among the patients with stroke, a significant impairment was seen in multiple cognitive functional tests following ischemic stroke as compared to control groups. The most common risk factors for stroke included hypertension (72.5%), hyperlipidemia, and cigarette smoking. The number of cognitive domains with an impairment was highest (in four cognitive tests) among those with coronary artery disease and atrial fibrillation, followed by those who had a .50% stenosis in Doppler (three cognitive tests). These findings suggest that the frequency of risk factors associated with stroke does not correlate with the frequency of risk factors associated with cognitive dysfunction. The stroke localizations were classified among the patients with stroke and reviewed in accordance with cognitive impairment. Conclusion: Neuropsychological tests, clinical findings, and imaging studies should be used to document the poststroke cognitive dysfunction.

BackgroundPosterior circulation infarction accounts for approximately 25% of the ischemic strokes. A number of different conditions may be associated with the development of brainstem infarction. Prognosis and recurrence rate of brainstem infarction due to large-artery atherothrombosis is still controversial.MethodsA total of 826 patients with ischemic stroke were admitted to our clinic during a 15-month period. Patients with clinical and radiological evidence of brainstem infarction were comprehensively assessed with appropriate vascular imaging modalities and for cardiological causes. Subjects with an established diagnosis of large-artery atherothrombosis were followed up for 1 year in terms of prognosis and recurrence rates.ResultsOf the 101 patients with an established brainstem infarction, the diagnostic work-up indicated the presence of large-artery atherothrombosis as the causative factor in 53. A recurrent stroke was detected in the posterior circulation within the first 3 months in 5.8% and within 1 year in 9.8% of these individuals. The 1-year mortality rate was 11.7%. All patients with recurrent stroke had intracranial vascular narrowing at baseline.ConclusionOur findings demonstrate a particularly high rate of recurrence and mortality at 1 year among patients who have a brainstem infarction due to intracranial arterial stenosis.

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Intravenózní podání trombolytik během prvních 4,5 hodiny od vzniku příhody představuje již po řadu let spolehlivý způsob léčby pacientů s akutní ischemickou cévní mozkovou příhodou. Vzhledem k vysokému výskytu komplikací a nízké úspěšnosti trombolytické léčby, zvláště u pacientů s uzávěrem proximálních tepen, je však nutno vypracovat účinnější léčebné postupy. Podle výsledků nejnovějších randomizovaných kontrolovaných studií jsou endovaskulární výkony ve spojení s intravenózním podáním trombolytik nedílnou součástí léčby tohoto onemocnění. Endovaskulární léčba stent-retrievery zajistila vyšší úspěšnost výkonu a rychlejší rekanalizaci, tedy i lepší výsledky, zvláště u nemocných, u nichž byl uzávěr proximálních tepen bez rozsáhlejšího postižení tkáně prokázán zobrazovacími metodami.