Infarctions of the brainstem and cerebellum: a correlation of computed tomography and angiography.

Hinshaw, David B.; Thompson, Jeffrey P.; Hasso, Anton N.; Casselman, E S

doi:10.1148/radiology.137.1.7422831

Cited by 56 publications

(13 citation statements)

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“…A male preponderance has been suggested for CI [1]in elderly, but the sexes were equally distributed in our study. In accordance with others [3, 17, 18, 21, 22], the PICA and SCA territory were almost equally often involved and AICA territory infarcts infrequently. Nonterritorial or junctional infarcts have frequently been reported in elderly populations [20, 22], but occurred sporadically in this study.…”

Section: Discussionsupporting

confidence: 90%

“…However, in patients above 45 years studied by the same research group the differences were less pronounced and among infratentorial structures, the cerebellum (47%) was almost as often affected as the brainstem (59%) [15]. In other studies consisting mainly of elderly patients, the proportion of CI among patients with ischemic stroke ranges from 0.6 to 2.8% [16, 17, 18, 19], but a center with special interest in CI recently reported a proportion of 10.4% CI [20]. …”

Section: Discussionmentioning

confidence: 99%

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Clinical Features and Prognosis in Young Adults with Infratentorial Infarcts

Malm

Kristensen²,

Carlberg³

et al. 1999

Cerebrovasc Dis

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Background and Purpose: Many comprehensive descriptions of the clinical spectrum of infratentorial infarcts in elderly patients and with a retrospective design have been published. The aim of this study was to describe the clinical characteristics and prognosis in young patients with isolated infratentorial infarcts. Methods: In a prospective series of 105 patients aged 18–44 years with cerebral infarction 24 had a brainstem or cerebellar infarction. The patient selection was validated in a population-based epidemiological survey. The patients were assessed acutely and at 4 and 12 months after onset. Extensive evaluation included CT and MRI scans, angiography, ultrasonic duplex scanning, transesophageal echocardiography and a chemistry panel including hematologic testing. The modified Rankin scale and NIH stroke scale were used for assessment of disability and neurological dysfunction. Results: Eighteen patients had a cerebellar infarct (posterior inferior cerebellar artery territory in 9 patients, superior cerebellar artery in 6, anterior inferior cerebellar artery in 2, nonterritorial in 1). Two patients had lateral medullary infarcts and 2 isolated pontine infarcts. In 2 patients MRI was normal despite repeated investigations. Hearing loss and tinnitus were the only explicit symptoms for superior cerebellar artery infarcts, but it was otherwise impossible to classify each case to a vascular territory according to clinical characteristics. The age-specific incidence of isolated cerebellar infarction was 1.8/100,000/year. The presumed causes were arterial dissection in 8 patients, idiopathic in 7, cardioembolic in 5, oral contraceptive use in 3 and protein S deficiency in 1 patient. One patient died during the acute phase and another developed a locked-in syndrome. At follow-up, 1 patient had a transitory ischemic attack and 1 a silent cerebral infarction. Twenty-two patients had a favorable outcome according to the modified Rankin scale (grade 0–2) and the NIH scale. Conclusions: Cerebellar infarctions are frequent among young stroke patients in northern Sweden. Arterial dissection is the prevailing stroke mechanism in infratentorial infarcts. The prognosis is favorable regarding motor impairment but cognitive deficits may prevent return to work.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Clinical Features and Prognosis in Young Adults with Infratentorial Infarcts

Malm

Kristensen²,

Carlberg³

et al. 1999

Cerebrovasc Dis

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“…The frequency of cerebellar infarcts has been estimated to be 0.7% in neuroradiological studies [25,26] and 1.5-4.2% in autopsy series [27,28]. Most of these patients have a pure cerebellar syndrome with a benign course of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…31,32], Greenberg et al [6] reported successful treatm ent of cerebellar in farction with sole ventriculostomy in 2 patients. In a large retrospective CT study, H inshaw et al [25] recommended medical therapy to be sufficient for the majority of patients presenting with posterior fossa infarcts. How ever, most of their cases did not show severe spaceoccupying posterior fossa mass lesions.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Strategies in Space-Occupying Cerebellar Infarction Based on Clinical, Neuroradiological and Neurophysiological Data

Rieke¹,

Krieger²,

Adams³

et al. 1993

Cerebrovasc Dis

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This study presents 42 patients with cerebellar infarctions; 27 patients were studied retrospectively, 15 patients were studied prospectively according to a fixed protocol. Rating of the clinical status using an adapted classification schema according to Heros with additional neuroimaging and neurophysiological data was found to be a reliable tool to estimate the severity of the disease. Evoked potential studies are useful and reliable to monitor the clinical course and to estimate the severity of the disease (i.e. BAEP) or predict outcome (i.e. SSEP). Treatment should be determined by the severity of the disease, i.e. awake and drowsy patients can be treated either medically or with ventriculostomy, if hydrocephalus occurs. In comatose patients decompressive surgery is significantly superior to ventriculostomy (p < 0.05). The analysis of the preliminary data suggests surgical decompression of the posterior fossa as the optimum therapeutic regimen in obtunded patients presenting with occlusive hydrocephalus and signs of brainstem compression. An open multicenter trial in Austria and Germany is in progress to confirm the results of this pilot study.

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“…EVD has been favored in many reports 5,10-14 and craniectomy has been performed in some reports. [15][16][17][18][19][20][21][22] Recently, it has been reported that EVD is done as the first step, and then craniectomy with or without resection is added in the case of there being no recovery of the neurologic condition after EVD. 1,[3][4][5][6][7] This opinion seems to be reasonable.…”

Section: Discussionmentioning

confidence: 99%