Les infarctus bulbaires

Hauw, Jean‐Jacques; Agopian, P. Der; Trelles, Luis; Escourolle, R

doi:10.1016/0022-510x(76)90050-2

Cited by 38 publications

(9 citation statements)

References 20 publications

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“…Combined ipsilateral, medial and lateral medullary ischemia has been reported in vertebral artery occlusion. 23 " 25 This was the only patient in whom the vertebral artery dissection extended intracranially and was also the only patient with a significant fixed residual neurologic deficit. The patient without lateral medullary findings had a cerebellar infarct confirmed by CT. Lateral medby guest on May 11, 2018 http://stroke.ahajournals.org/ Downloaded from FIGURE …”

Section: Discussionmentioning

confidence: 99%

Spontaneous dissection of the extracranial vertebral arteries.

Caplan¹,

Zarins²,

Hemmati³

1985

Stroke

195

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SUMMARY Though the syndrome of carotid artery dissection is well known, "spontaneous" vertebral artery dissection is rarely recognized. We now report clinical and radiologic findings in five patients with presumed vertebral dissection, one pathologically confirmed.Mean age was 35.2 years (range 27-41). Two were men; three women. None had hypertension, vascular disease, or trauma. Headache and neck or occipital pain was prominent in all, often preceding other symptoms. Four of five patients had unilateral partial alteral medullary syndromes, in one accompanied by medial medullary signs. One patient had a cerebellar infarct. Angiography in four patients showed severe irregular stenosis of the distal extracranial vertebral artery (three bilaterally and subsequently has been widely reported.3 " 5 Migraine 6 ' 7 and fibromuscular dysplasia 8 have been associated with arterial dissection. Intramural clot separates the media often compromising the lumen; clot can dissect into the lumen through the torn intima. Because of intimal and endothelial disruption platelet nidi can form in the lumen and reduced flow potentiates the development of intraluminal clot. Distal ischemia is caused by emoblization of luminal clot or reduced distal flow. Dissections and intimal tears are usually traumatic and are termed "spontaneous" when no definite trauma is recalled by the patient. Though "spontaneous" dissection of the vertebral artery has been reported, 19 " 14 the clinical and radiologic features are less well known than the findings in carotid dissection. We now report clinical and radiologic findings in 4 patients with presumed vertebral artery dissection and radiographic and pathologic findings in 1 patient with surgically proven vertebral dissection. The clinical and radiologic signs of spontaneous vertebral dissection closely resemble those described in vertebral artery trauma and chiropractic manipulation. She recalled no unusual recent neck motion or trauma. Two hours after awakening, she suddenly noted tingling at the corner of her left mouth and tongue, dizziness, vomiting, and a sensation that her body was being pulled to the left. Later her right hand felt cold. On examination, blood pressure and general examination were normal. Neurological abnormalities included: coarse horizontal nystagmus to the left, left facial hypalgesia, diminished left corneal response, and left limb dysmetria. She veered to the left when she walked. CT was normal. Bilateral vertebral angiography showed moderately severe narrowing and irregular stenosis of the third segment of the right vertebral artery and severe stenosis of a short segment of the third portion of the left vertebral artery ( fig. la, b). Warfarin anticoagulation was begun. Neurologic examination returned to normal and she had no symptoms. A left vertebral angiogram 5 months after onset was normal with no residual stenosis ( fig. lc). Warfarin was stopped. Two years after the original episode, the patient had no neurologic signs or symptoms. Patient 2fJ.R., a 39 year old man ha...

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Section: Discussionmentioning

confidence: 99%

Spontaneous dissection of the extracranial vertebral arteries.

Caplan¹,

Zarins²,

Hemmati³

1985

Stroke

195

View full text Add to dashboard Cite

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“…Necropsy studies, modern neuroimaging, and retrospective case series have clarified many posterior circulation vascular syndromes including: brainstem lacunes,51-55 intracranial branch atheromatous disease,56-58 medullary59-61 cerebellar62-70 pontine25 thalamic and midbrain infarcts,71 embolism,72-75 extracranial and intracranial dissections,76-80 dolichoectasia,81-84 "top of the BA"85,86 and PCA territory infarcts 87,88. Large stroke registries89-95 reported stroke causes and mechanisms, risk factors, and outcomes in unselected stroke patient populations.…”

Section: Introductionmentioning

confidence: 99%

New England Medical Center Posterior Circulation Stroke Registry: I. Methods, Data Base, Distribution of Brain Lesions, Stroke Mechanisms, and Outcomes

Caplan¹,

Chung²,

Wityk³

et al. 2005

J Clin Neurol

114

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Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs before strokes, and 16% had only posterior circulation TIAs. Embolism was the commonest stroke mechanism accounting for 40% of cases (24% cardiac origin, 14% arterial origin, 2% had potential cardiac and arterial sources). In 32%, large artery occlusive lesions caused hemodynamic brain infarction. Stroke mechanisms in the posterior and anterior circulation are very similar. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes), while the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Infarcts that included the distal territory were twice as common as those that included the proximal or middle territories. Most distal territory infarcts were attributable to embolism. Thirty day mortality was low (3.6%). Embolic stroke mechanism, distal territory location, and basilar artery occlusive disease conveyed the worst prognosis.

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“…Studies of cerebellar infarct patients, especially those within posterior inferior cerebellar arteries (PICAs) territory showed a very high frequency of occlusive ICVA lesions 23-25. The causative vascular occlusive lesions involved the ICVAs in patients with lateral medullary,26-29 and hemimedullary infarcts 29,30. BA occlusions were the usual cause of bilateral pontine infarcts 31-35.…”

Section: Introductionmentioning

confidence: 99%

New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions

Caplan¹,

Wityk²,

Pazdera³

et al. 2005

J Clin Neurol

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Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, the extracranial (ECVA) and intracranial vertebral arteries (ICVA) were the commonest sites of severe occlusive disease followed by the basilar artery (BA). Severe occlusive lesions were found in >1 large artery in 148 patients; 134 had unilateral or bilateral severe disease at one arterial location. Single arterial site occlusive disease occurred most often in the ECVA (52 patients, 15 bilateral) followed by the ICVA (40 patients, 12 bilateral) and the BA (46 patients). Involvement of the ICVAs and the BA was very common and some patients also had ECVA lesions. Hypertension, smoking, and coronary and peripheral vascular disease were most prevalent in patients with extracranial disease while diabetes and hyperlipidemia were more common when occlusive lesions were only intracranial. Intra-arterial embolism was the most common mechanism of brain infarction in patients with ECVA and ICVA occlusive disease. ICVA occlusive lesions infrequently caused infarction limited to the proximal territory (medulla and posterior inferior cerebellum). BA lesions most often caused infarcts limited to the middle posterior circulation territory (pons and anterior inferior cerebellum). Posterior cerebral artery occlusive lesions were predominantly embolic. Penetrating artery disease caused mostly pontine and thalamic infarcts. Prognosis was poorest in patients with BA disease. The best prognosis surprisingly was in patients who had multiple arterial occlusive lesions; they often had position-sensitive transient ischemic attacks during months or years.

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Les infarctus bulbaires

Cited by 38 publications

References 20 publications

Spontaneous dissection of the extracranial vertebral arteries.

Spontaneous dissection of the extracranial vertebral arteries.

New England Medical Center Posterior Circulation Stroke Registry: I. Methods, Data Base, Distribution of Brain Lesions, Stroke Mechanisms, and Outcomes

New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions

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