Cerebrovascular Brainstem Diseases with Isolated Cranial Nerve Palsies

Thömke, Frank; Gutmann, Ludwig; Stoeter, P.; Hopf, Hanns Christian

doi:10.1159/000047768

Cited by 37 publications

(14 citation statements)

References 60 publications

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“…PNS ischemia typically results from small-vessel occlusion of the vasa nervorum presenting as mononeuropathies, 63 most commonly related to vasculitis or diabetes mellitus. Isolated cranial neuropathies have previously been attributed to a mechanism similar to PNS ischemia but are now believed to result more commonly from MRI-defined microinfarcts in the brainstem 64 and are thus more similar to small-vessel infarctions. As a result of the differences in pathogenesis of ischemia between CNS and PNS ischemia, treatments for ischemia of the PNS and CNS differ.…”

Section: Definition Of Cns Infarction Should Be Limited To Cns Tissuementioning

confidence: 99%

An Updated Definition of Stroke for the 21st Century

Sacco¹,

Kasner²,

Broderick³

et al. 2013

Stroke

2,614

1,029

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Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term “stroke” is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

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Section: Definition Of Cns Infarction Should Be Limited To Cns Tissuementioning

confidence: 99%

An Updated Definition of Stroke for the 21st Century

Sacco¹,

Kasner²,

Broderick³

et al. 2013

Stroke

2,614

1,029

View full text Add to dashboard Cite

show abstract

“…In the subgroup analyses performed in the present study, isolated OCNP was identified as an independent risk factor for stroke even after adjusting for patient age and the presence of common cardiovascular risk factors such as HTN, diabetes, etc. Other possible mechanisms have been proposed, and these include roles for inflammation, infectious processes and hypercoagulability [6,8,25,26,27]. These factors were not evaluated in the present study, but would be factors to consider in future studies.…”

Section: Discussionmentioning

confidence: 98%

“…It has been reported that vascular causes account for 20% of CN3 palsies, for 18.6% of CN4 palsies and for 17.7% of CN6 palsies [6]. Other etiologies such as aneurysm, trauma, neoplasm, brain stem infarction, infection, inflammation, sinus thrombosis and multiple sclerosis have also been proposed [7,8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Increased Risk of Stroke in Patients with Isolated Third, Fourth, or Sixth Cranial Nerve Palsies: A Nationwide Cohort Study

Hoi¹,

Chen²,

Fuh³

et al. 2016

Cerebrovasc Dis

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Background and Purpose: The aim of this nationwide cohort study was to evaluate whether the occurrence of isolated 3rd, 4th or 6th cranial nerve (CN) palsies is associated with a higher risk of ischemic stroke. Methods: This study utilized data from Taiwan Longitudinal Health Insurance Database during 1995-2012. Subjects aged 20 years or older who had isolated CN 3/4/6 palsies diagnosed by a neurologist or ophthalmologist between January 2000 and December 2011 were included. A set of propensity score matched, randomly sampled patients who had never been diagnosed with CN 3/4/6 palsies were extracted to constitute the control group (cases and controls = 1:4). All subjects were followed until death, loss due to follow-up or completion of the study. Cox proportional hazard regression model stratified by matched pairs was used to estimate the hazards ratio (HR) of ischemic stroke. Results: A total of 657 patients with isolated CN 3/4/6 palsies (61.1% male, mean age 54.8 years) were identified. Compared with control group, the patients with isolated CN 3/4/6 palsies exhibited an increased risk of ischemic stroke (CN3: adjusted HR 3.69 (95% CI 2.20-6.19); CN4: 2.71 (95% CI 1.11-6.64); CN6: 2.15 (95% CI 1.31-3.52)). The association between CN 3/4/6 palsies and ischemic stroke was detected in both separate subgroup and sensitivity analyses. Conclusions: The patients with CN 3/4/6 palsies exhibited an increased risk of developing ischemic stroke. Therefore, isolated ocular motor nerves palsies appear to represent an unrecognized risk factor for ischemic stroke, and these require further confirmation and exploration.

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“…

We read with interest the review on cerebrovascular brainstem diseases with isolated cranial nerve palsies by Thömke et al [1]. They proposed to classify brainstem infarctions into three main categories: (1) classic ischemic brainstem syndromes with cranial nerve lesions and contralateral signs of the long tracts; (2) lacunar brainstem syndromes with isolated signs of the long tracts, and (3) cranial nerve brainstem syndromes whereby patients present with isolated cranial nerve palsy.

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mentioning

confidence: 99%

“…They proposed to classify brainstem infarctions into three main categories: (1) classic ischemic brainstem syndromes with cranial nerve lesions and contralateral signs of the long tracts; (2) lacunar brainstem syndromes with isolated signs of the long tracts, and (3) cranial nerve brainstem syndromes whereby patients present with isolated cranial nerve palsy. The authors reported that the case of brainstem vascular disorder with isolated 3rd nerve lesion is rare and that there have been only 36 cases documented in the literature.…”

mentioning

confidence: 99%