Tetraparesis following an Anterior Circulation Stroke: A Case Report

Saleh, Christian; E, Michel-de Cazotte; Hund-Georgiadis, Margret

doi:10.1159/000495457

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…MRA imaging exhibited that TMP led to enhanced signal intensity of bilateral ACA and ipsilateral AComA in ischemic rats. AComA bridging bilateral ACA supports the anterior portion of Willis circle (Saleh et al, 2018 ), suggesting the augmented collateral flow through ACA to MCA territory of the ischemic side after TMP intervention. Specifically, MRI-ASL displayed poor hypoperfusion in the MCA territory of model rats, while TMP improved CBF of the periinfarct cortex and striatum.…”

Section: Discussionmentioning

confidence: 72%

Tetramethylpyrazine promotes stroke recovery by inducing the restoration of neurovascular unit and transformation of A1/A2 reactive astrocytes

Lin

et al. 2023

Front. Cell. Neurosci.

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2,3,5,6-Tetramethylpyrazine (TMP) as an active ingredient extracted from a traditional Chinese herbal medicine Ligusticum chuanxiong Hort. has been proved to penetrate blood-brain barrier (BBB) and show neuroprotective effects on cerebral ischemia. However, whether TMP could regulate astrocytic reactivity to facilitate neurovascular restoration in the subacute ischemic stroke needs to be urgently verified. In this research, permanent occlusion of the middle cerebral artery (MCAO) model was conducted and TMP (10, 20, 40 mg/kg) was intraperitoneally administrated to rats once daily for 2 weeks. Neurological function was evaluated by motor deficit score (MDS). Magnetic resonance imaging (MRI) was implemented to analyze tissue injury and cerebral blood flow (CBF). Magnetic resonance angiography (MRA) was applied to exhibit vascular signals. Transmission electron microscopy (TEM) was performed to detect the neurovascular unit (NVU) ultrastructure. Haematoxylin and eosin (HE) staining was utilized to evaluate cerebral histopathological lesions. The neurogenesis, angiogenesis, A1/A2 reactivity, aquaporin 4 (AQP4) and connexin 43 (Cx43) of astrocytes were observed with immunofluorescent staining. Then FGF2/PI3K/AKT signals were measured by western blot. Findings revealed TMP ameliorated neurological functional recovery, preserved NVU integrity, and enhanced endogenous neurogenesis and angiogenesis of rats with subacute ischemia. Shifting A1 to A2 reactivity, suppressing excessive AQP4 and Cx43 expression of astrocytes, and activating FGF2/PI3K/AKT pathway might be potential mechanisms of promoting neurovascular restoration with TMP after ischemic stroke.

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Section: Discussionmentioning

confidence: 72%

Tetramethylpyrazine promotes stroke recovery by inducing the restoration of neurovascular unit and transformation of A1/A2 reactive astrocytes

Lin

et al. 2023

Front. Cell. Neurosci.

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“…Statistics show that 80% of stroke cases are cerebral infarction, and the high incidence rate is also associated with high mortality and disability rate [4]. Cerebral infarction can cause many serious clinical symptoms, such as sudden fainting, hemiplegia, and aphasia [5]. Among them, hemiplegia refers to hemiplegia, which is mainly caused by the central nervous system damage caused by the blood supply disorder of cerebral infarction.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation Evaluation of Hemiplegic Patients with Anterior Circulation Cerebral Infarction Based on Cranial Magnetic Stimulation

Tao

Rao

et al. 2021

Journal of Healthcare Engineering

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Cerebral infarction is a common cerebrovascular disease in clinical medicine. Cerebral infarction in the anterior circulation accounts for about 90% of cerebral infarction. Its treatment and rehabilitation has always been a research hotspot in the medical field. Functional retraining can enhance the afferent impulses received by receptors, make the plasticity development of cerebral cortex function, and improve the loss of function. Based on the patient’s individual condition, exercise therapy carries out the corresponding comprehensive functional training plan, which also includes the training of patients’ daily living ability, turning over, bridge exercise, trunk rotation, etc., in order to improve the motor function of patients. The other is psychotherapy, which can cause emotional fluctuations, depression, anxiety, and other negative emotions due to the occurrence of diseases. In the rehabilitation treatment, relevant personnel can conduct psychological counseling for patients through timely and effective communication, so as to better establish patients’ confidence in rehabilitation and improve the effect of rehabilitation treatment. The third is acupuncture treatment. Acupuncture is a traditional rehabilitation treatment in China. The rehabilitation effect of stroke has been proved by a large number of clinical practice. Acupuncture at Hegu, Quchi, Zusanli, and Taichong points can dredge channels and improve blood circulation. This paper mainly studies and analyzes the effect of behavior rehabilitation of hemiplegic patients with cerebral anterior circulation infarction treated by cranial magnetic stimulation. The rehabilitation treatment status of hemiplegic patients with anterior circulation cerebral infarction in a hospital was selected, and 100 cases were studied. Among them, 50 cases were treated with conventional rehabilitation therapy, and the other 50 cases were treated with cranial magnetic stimulation. The motor function, activities of daily living, and language expression ability of the two groups were compared for statistical analysis. After transcranial magnetic stimulation treatment, the abilities of the study group were better than those of the control group, P < 0.05 , with statistical significance. Based on the reliable experimental data, we can draw a conclusion that the treatment of cranial magnetic stimulation has a significant effect on the rehabilitation of hemiplegic patients with cerebral anterior circulation infarction, which is higher than the conventional treatment and rehabilitation methods, and can be popularized in clinical application.

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“…The patient's aphasia and quadriparesis improved gradually after the procedure, and GCS score also improved to 15 (E4V5M6) and NIHSS score decreased lower limb, total aphasia, and left conjugate deviation of the eyes were present, suggesting that the ischemic state was more dominant in the left ACA territory than the right hemisphere because of difference in collateral blood flow from the middle cerebral artery (MCA) or posterior cerebral artery. In four of the previous cases, [4][5][6][7] the patients were diagnosed as ischemic stroke in the late phase and head CT revealed low intensity lesions suggestive of a large ischemic core, and hence, MTs were not indicated. The clinical outcomes of these four cases were poor, with no improvement of weakness in bilateral lower limbs.…”

Section: Discussionmentioning

confidence: 99%

“…13) Stroke should be suspected with sudden onset neurological symptoms and neuroimaging such as MRI/MRA or CT angiogram is useful to distinct between AIS and stroke mimics. 14) Five case reports of azygos ACA occlusion were previously published [4][5][6][7][8] (Table 1). Since the azygos ACA supplies both hemispheres, complete occlusion might result in large bilateral frontal infarctions and severe symptoms, such as quadriparesis, disturbance of consciousness and aphasia.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy for Azygos Anterior Cerebral Artery Occlusion: A Case Report and Literature Review

Asai

Oyama

Takita

et al. 2021

JNET

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Objective Azygos anterior cerebral artery (ACA) is a well-known anomaly of the second segment of the ACA. Although cases of intracerebral aneurysms related to this anomaly have been reported, acute ischemic stroke (AIS) related to the azygos ACA is extremely rare. Case Presentation An 84-year-old man developed disturbance of consciousness (Glasgow Coma Scale [GCS] E3V1M5), quadriparesis and aphasia, with a National Institutes of Health Stroke Scale (NIHSS) score of 32. Magnetic resonance imaging (MRI) showed no early ischemic changes, although a head magnetic resonance angiogram (MRA) demonstrated a single A2 trunk without any A3 branches that were suspected bilateral ACA occlusions. Mechanical thrombectomy for the occluded A2 trunk with contact aspiration using a Penumbra 4MAX aspiration catheter was performed, and the clot was retrieved and complete recanalization was achieved after two attempts (Thrombolysis in Cerebral Infarction scale 3) without any complications (onset to recanalization time: 187 min). The final angiogram demonstrated the recanalization of the single A2 and bilateral A3 branches, so we diagnosed as azygos ACA occlusion. MRI performed the next day revealed several small infarctions in bilateral frontal lobes, but ischemic symptoms gradually improved. NIHSS score decreased to two in 2 weeks and modified Rankin Scale (mRS) score at 90 days was one. Conclusion In this case, occlusion of the azygos ACA led to a large ischemic penumbra that spread widely and bilaterally in the ACA area, resulting in sudden onset of severe ischemic symptoms, including quadriparesis and aphasia. However, due to complete and rapid recanalization with contract aspiration, a large part of the ACA territory bilaterally was salvaged and the patient recovered extremely well.

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Tetraparesis following an Anterior Circulation Stroke: A Case Report

Cited by 8 publications

References 4 publications

Tetramethylpyrazine promotes stroke recovery by inducing the restoration of neurovascular unit and transformation of A1/A2 reactive astrocytes

Tetramethylpyrazine promotes stroke recovery by inducing the restoration of neurovascular unit and transformation of A1/A2 reactive astrocytes

Rehabilitation Evaluation of Hemiplegic Patients with Anterior Circulation Cerebral Infarction Based on Cranial Magnetic Stimulation

Mechanical Thrombectomy for Azygos Anterior Cerebral Artery Occlusion: A Case Report and Literature Review

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