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

Caplan, L.R.; Chung, Chanjin; Wityk, RJ; Ta, Glass; Tapia, Jorge; Pazdera, Ladislav; Chang, Hyo Won; Dashe, JF; Chaves, CJ; Vemmos, Kostas; Leary, Megan; DeWitt, L. D.; Pessin,

doi:10.3988/jcn.2005.1.1.14

Cited by 109 publications

(100 citation statements)

References 90 publications

(113 reference statements)

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“…2,10,11 Embolic stroke originating from the heart is another potential etiology that should be considered, particularly in patients with arrhythmias, cardiac dysfunction, or valvular disease. 12 …”

Section: Discussionmentioning

confidence: 99%

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Day

Swartz

Chenkin

et al. 2014

CJEM

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Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla. However, variability in the presentation of this syndrome is the rule, as illustrated in this case presentation and literature review. We propose an approach to diagnosis and management of the lateral medullary syndrome and illustrate the need to integrate clinical information with an understanding of brainstem anatomy with the goal of determining which patients require urgent neuroimaging and acute stroke therapies. The importance of recognition of this condition in the emergency department is underscored by the association between lateral medullary infarction and vertebral artery dissection. With optimal therapy, the prognosis for recovery from lateral medullary syndrome is good. RÉ SUMÉLes patients qui souffrent du syndrome bulbaire laté ral pré sentent gé né ralement des troubles hé misensoriels croisé s, un syndrome de Claude Bernard-Horner homolaté ral et des signes cé ré belleux, manifestations qui ré sultent toutes d'un infarctus du bulbe laté ral. Toutefois, le tableau clinique habituel du syndrome est variable, comme en té moignent un exposé de cas et l'examen de la documentation. Nous ferons donc é tat de l'approche diagnostique et de la prise en charge du syndrome bulbaire laté ral, et soulignerons la né cessité de rassembler tous les renseignements d'ordre clinique et de les mettre en relation avec l'anatomie du tronc cé ré bral afin de distinguer les patients devant subir d'urgence des examens en neuro-imagerie et des traitements pour un accident vasculaire cé ré bral. L'association entre l'infarctus du bulbe laté ral et la dissection de l'artè re verté brale fait ressortir l'importance de reconnaître cette premiè re affection au service des urgences. Moyennant le meilleur traitement possible, le syndrome bulbaire laté ral porte un pronostic favorable quant au ré tablissement.

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Section: Discussionmentioning

confidence: 99%

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Day

Swartz

Chenkin

et al. 2014

CJEM

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“…Taburculuk sonrası takipte hiçbir hastada baş dönmesi görülmemesi buna kanıt olarak gösterilebilir. Büyük serilerde [8,9] vertebrobaziler yetmezliğin yanı sıra asemptomatik hastalar veya hemisferik semptomlu hastalar sırasıyla %30 ve %3 gibi oranlarda bildirilmekteyse de serimizde tüm hastaların özellikle vertebrobaziler yetmezlik semptomuyla ameliyat olmasını, bu bölge ile ilgili cerrahi deneyim ve yaklaşımın sınırlı olması ile açıklamak mümkündür. Başarılı sonuçlar ve artan cerrahi deneyim ile ameliyat öncesi şikâyet oranlarında değişiklik beklenebilir.…”

Section: Discussionunclassified

“…Başarılı sonuçlar ve artan cerrahi deneyim ile ameliyat öncesi şikâyet oranlarında değişiklik beklenebilir. Caplan ve ark., [9] 1988-1996 yıl-ları arasında posterior dolaşım ile ilişkili nörolojik olay gelişen 407 hastayı inceledikleri çalışmalarında, bu böl-gede gelişen olaylar ile ilgili değerli bulgular bildirmiş-lerdir. Buna göre, bu bölgede gelişen inmelerin %59'u önceden bir GİA görülmeden gelişmektedir.…”

Section: Discussionunclassified

“…[4] En sık etkilenen bölge distal posterior dolaşım bölgesi olup (rostral beyin sapı, superior serebellum, oksipital ve temporal loblar), bu bölgeyi etkileyen infarktlar proksimal ve orta kısım-lara göre yaklaşık iki kat daha sıktır. [9] Kardiyak kaynak embolinin en sık nedeni olup hastaların %35'inde KAH tespit edilmiştir. Ayrıntılı kardiyak değerlendirmede hastaların %64'ünde kardiyak anomaliler saptanmıştır (KAH, aritmi, kapak hastalığı, kardiyomiyopati, kalp yetmezliği, vb.).…”

Section: Discussionunclassified

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Posterior cerebral circulation re-visited: vertebral artery surgery

Mert¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada kliniğimizde vertebral arter darlığı nedeniyle ameliyata alınan hastaların ameliyat ve orta dönem takip sonuçları sunuldu.Ça lış mapla nı:Eylül 2012 -Nisan 2015 tarihleri arasında vertebral arter darlığı nedeniyle ameliyat edilen toplam 13 hastanın (8 erkek, 5 kadın; ort. yaş 62.3±5.0 yıl; dağılım 54-70 yıl) verileri hastane kayıtları kullanılarak geriye dönük incelendi. Hastaların demografik özellikleri, eşlik eden hastalıklar, sigara kullanımı ve ejeksiyon fraksiyon değerleri, uygulanan işlemler, kalp damar cerrahisi yoğun bakım ünitesinde ve hastanede kalış süreleri ve mortalite oranları kaydedildi. Bul gu lar:Hiçbir hastada mortalite gözlenmedi. Altı hastada (%46.2) minör morbidite görüldü. İki hastada ses kısıklığı ve birer hastada lenfatik akıntı, aynı taraf dudak asimetrisi, aynı taraf kol ağrısı ve kanama revizyonu gelişti. Ortalama yoğun bakım ve hastanede kalış süresi, sırasıyla 1.2±0.6 (1-3) ve 3.7±1.3 (3-7) gün idi. Takip süresi ortalama 14.7±8.8 (1.7-30.2) ay (toplam 15.9 hasta/yıl) idi. Takip süresince hiçbir hastada serebrovasküler olay izlenmedi. İki hastada (%14.4) kısa süreli semptomlar görüldü (baş dönmesi ve aynı taraf kolda yanma hissi). Bir hastada (%7.7) restenoz görüldü. Restenozsuz sağkalım süresi ortalama 11.3±10.3 (0.4-30.2) ay (toplam 11.3 hasta/yıl) idi. Bir yıllık ortalama vertebral arter açıklık oranı %83.3±15.2 idi.So nuç: Vertebral arter cerrahisi uzun zamandır ihmal edilen bir alanda başarılı sonuçlar veren bir cerrahi yöntemdir. Yüksek açıklık ve sağkalım oranları ile cerrahi tedavi vertebral arter darlığı olan hastalarda göz önünde bulundurulmalıdır.Anah tarsöz cük ler: Posterior serebral dolaşım; cerrahi; vertebral arter. ABSTRACTBackground:In this study, we present the surgical outcomes of vertebral artery stenosis with and mid-term follow-up results.

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“…21 Artery-to-artery embolism from the stump of the occluded V1 segment seems to be involved more often in large arterial embolic stroke than in hemodynamic stroke. 22 The prevalence of the so-called "VA stump syndrome" is 1.4% in patients with posterior circulation stroke, the rate of recurrence of ischemic stroke is 25%, and it shows unfavorable outcomes in 25% of patients with posterior circulation stroke. 23 A low-flow state in the stump might cause thrombus formation that can lead to distal embolism.…”

Section: Discussionmentioning

confidence: 99%

Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke

Park

Lee

Shim

et al. 2013

American Journal of Neuroradiology

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SUMMARY:Vertebral artery recanalization in symptomatic stenosis/occlusion remains controversial, as no definite evidence exists regarding this topic. There are only a few reports regarding the feasibility and safety of recanalization in the first segment of the vertebral artery with atherosclerotic vertebral ostial occlusion. We report our experience treating first segment occlusion in 8 patients and present a balloon protection technique used to reduce the thromboembolic burden during the stent placement procedure. The outcome at 3 months showed an mRS Յ2 except for a patient with a poor initial status with basilar artery occlusion. Revascularization of a rather long first segment occlusion is technically feasible and can be safely performed by use of embolic protection methods. A therosclerotic lesions of the vertebral artery (VA) origin are a potential cause of posterior circulation ischemia, which has approximately a 20% to 50% risk for vertebrobasilar TIA or stroke. ABBREVIATIONS:1 The VA ostium is known to be the most common site for atherosclerosis of the posterior circulation. 2 Patients with symptomatic severe (Ͼ 70%) ostial VA stenosis face an 11% annual risk for recurrent stroke or TIA while receiving medical treatment. 3Early understanding of the stroke mechanism of VA ostial lesions was focused on their hemodynamic nature, which commonly presents with TIA including dizziness.4 After a few case series that described an embolic infarct originating from vertebral ostial occlusive disease, 5 artery-to-artery embolism was also considered as an important cause of the stroke mechanism in lesions in the first segment of the VA (V1). 6 A large series of patients revealed that half of the artery-to-artery embolic strokes in the posterior circulation were the result of VA ostial lesions. 7 The presence of a clot in the vertebral ostial plaque provides the causeand-effect relationship between vertebral arterial ostial lesions and posterior circulation stroke. 8 Even a large ulcer in the vertebral arterial ostium has been described as adding to the possibility of the vertebral arterial ostium as a source of emboli. 9The optimal treatment of patients with symptomatic severe ostial VA stenosis is still unclear.3 The only randomized trial comparing endovascular with medical treatment is the Carotid and VA Transluminal Angioplasty Study. 10 This study did not show a separate result for the small number of its patients (nϭ16) with VA stenosis, though it failed to demonstrate the benefit of angioplasty of carotid and vertebral stenosis. Although several articles have dealt with revascularization of vertebral ostial lesions, they mostly have described revascularization of vertebral arterial stenosis.11 To our knowledge, only a few case reports have demonstrated anecdotal evidence of revascularization for vertebral ostial occlusion. 12 Therefore, we present the revascularization procedure and the outcome of vertebral ostial occlusion in strokes related to artery-to-artery embolism. MATERIALS AND METHODS Case SeriesEight...

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

Cited by 109 publications

References 90 publications

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Posterior cerebral circulation re-visited: vertebral artery surgery

Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke

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