Cerebellar cognitive affective syndrome in patient with cerebellar infarction

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

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Back-Table Modified Stent-Graft for Endovascular Repair of Ascending Aorta

Journal of Endovascular Therapy ◽

10.1177/15266028211028201 ◽

2021 ◽

pp. 152660282110282

Author(s):

Juan Shi ◽

Ligang Liu ◽

Xiang Wei ◽

Mingjia Ma

Keyword(s):

Endovascular Repair ◽

Survival Rates ◽

Ascending Aorta ◽

Cerebellar Infarction ◽

Type Ia ◽

Risk Patients ◽

Aorta Replacement ◽

Aortic Dissections ◽

Event Rates

Objectives To investigate the effectiveness of modified stent-grafts (SGs) for the management of ascending aortic pathologies. Materials and Methods From January 2015 to December 2019, 31 individuals were treated by ascending aortic endovascular repair with a back-table modified SG for acute (n=4) or chronic (n=1) type A aortic dissections, penetrating aortic ulcers (n=18), pseudoaneurysms (n=2), anastomotic fistula (n=1), and endoleaks after thoracic endovascular aortic repair (TEVAR) (n=5). The commercially available thoracic aortic SGs were modified with a fenestration or truncation technique on the back-table according to aortography during the operation. Results The 30-day mortality and aorta-related mortality rates were 12.9% and 6.5%, respectively. There were 2 strokes, 3 respiratory insufficiencies, and 6 endoleaks during hospitalization. During a mean follow-up of 28.8±16.6 months, the overall survival rates at 1 year and 3 years were both 80.6%. Free from adverse event rates at 1 year and 3 years were 88.9% and 84.7%, respectively. There were 2 deaths during follow-up: One patient died of cachexia 1 month after discharge, and the other patient died of acute myocardial infarction 3 months after discharge. One patient with a pseudoaneurysm underwent open ascending aorta replacement 3 months after discharge for a type Ia endoleak. Another patient suffered from cerebellar infarction 17 months after discharge. Conclusion The modified SG for endovascular repair of the ascending aorta is a practicable alternative and presents acceptable outcomes in high-risk patients.

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European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction

European Stroke Journal ◽

10.1177/23969873211014112 ◽

2021 ◽

pp. 239698732110141

Author(s):

H Bart van der Worp ◽

Jeannette Hofmeijer ◽

Eric Jüttler ◽

Avtar Lal ◽

Patrik Michel ◽

...

Keyword(s):

Brain Infarction ◽

Treatment Strategies ◽

Surgical Decompression ◽

Cerebellar Infarction ◽

High Quality ◽

Risk Of Death ◽

Grade Approach ◽

Quality Evidence ◽

Hemispheric Infarction

Space-occupying brain oedema is a potentially life-threatening complication in the first days after large hemispheric or cerebellar infarction. Several treatment strategies for this complication are available, but the size and quality of the scientific evidence on which these strategies are based vary considerably. The aim of this Guideline document is to assist physicians in their management decisions when treating patients with space-occupying hemispheric or cerebellar infarction. These Guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. A working group identified 13 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. An expert consensus statement was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high-quality evidence to recommend surgical decompression to reduce the risk of death and to increase the chance of a favourable outcome in adult patients aged up to and including 60 years with space-occupying hemispheric infarction who can be treated within 48 hours of stroke onset, and low-quality evidence to support this treatment in older patients. There is continued uncertainty about the benefit and risks of surgical decompression in patients with space-occupying hemispheric infarction if this is done after the first 48 hours. There is also continued uncertainty about the selection of patients with space-occupying cerebellar infarction for surgical decompression or drainage of cerebrospinal fluid. These Guidelines further provide details on the management of specific subgroups of patients with space-occupying hemispheric infarction, on the value of monitoring of intracranial pressure, and on the benefits and risks of medical treatment options. We encourage new high-quality studies assessing the risks and benefits of different treatment strategies for patients with space-occupying brain infarction.

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Intracranial Vertebral Endarterectomy

Neurosurgery ◽

10.1227/00006123-199003000-00014 ◽

1990 ◽

Vol 26 (3) ◽

pp. 465-471 ◽

Cited By ~ 22

Author(s):

James I. Ausman ◽

Fernando G. Diaz ◽

Balaji Sadasivan ◽

Manuel Dujovny

Keyword(s):

Vertebral Artery ◽

Medical Therapy ◽

Superficial Temporal Artery ◽

Posterior Inferior Cerebellar Artery ◽

Temporal Artery ◽

Superior Cerebellar Artery ◽

Focal Lesion ◽

Cerebellar Infarction ◽

Vertebrobasilar Insufficiency ◽

Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

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Hypertension Associated with Coarctation of the Aorta Revisited: Case-Based Update from Experience of Three Children

Case Reports in Pediatrics ◽

10.1155/2013/716438 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ali Baykan ◽

Mustafa Argun ◽

Abdullah Özyurt ◽

Özge Pamukçu ◽

Kazım Üzüm ◽

...

Keyword(s):

Physical Examination ◽

Coarctation Of The Aorta ◽

Secondary Hypertension ◽

Diagnostic Approach ◽

Systemic Hypertension ◽

Cerebellar Infarction ◽

Clinical Pictures ◽

Age Range ◽

Hypertension In Children ◽

Case Based

Coarctation of the aorta (CoA) can present with different clinical pictures depending on the severity of the narrowness in the coarcted aortic segment in an age range between newborn and adolescence. Sometimes, it can cause intracranial hemorrhage or infarction when diagnosis and treatment are delayed. The aim of this report is taking attention to CoA as a cause of systemic hypertension and is also emphasizing the differences of diagnostic approach for hypertension in children from adults. Two cases of hypertensive cerebral hemorrhage and one case of hypertensive cerebellar infarction associated with CoA are reported. These cases help us to pay attention to the possibility of CoA in adolescents with hypertensive stroke. We want to emphasize the importance of physical examination for evaluation of hypertension and to impress the diagnostic approach for secondary hypertension in children.

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Causes and Mechanisms of Cerebellar Infarction in Young Patients

Stroke ◽

10.1161/01.str.29.4.867 ◽

1998 ◽

Vol 29 (4) ◽

pp. 867-867 ◽

Cited By ~ 2

Author(s):

Michael I. Weintraub

Keyword(s):

Young Patients ◽

Cerebellar Infarction

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