Transient total locked-in syndrome due to vertebral and basilar artery dissection

A 52-year-old woman suddenly presented with right conjugate eye deviation, anarthria and quadriplegia, and appeared to be in a deep coma. MRI revealed a new infarct in the left cerebellar hemisphere and stenosis in the distal portion of the basilar artery caused by arterial dissection. Her deficits improved within 6 hours of onset. Moreover, on day 1, she described that she had been alert and her vision, hearing and somatic sensation had been preserved during the illness. Total locked-in syndrome should be considered while assessing patients with total immobility who are unable to communicate.

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Spontaneous Catheter Separation from the Implanted Venous Port and Its Migration to the Venous Heart: Clinical Case

Oncopediatrics ◽

10.15690/onco.v5i2.1915 ◽

2018 ◽

Vol 5 (2) ◽

pp. 127-132 ◽

Cited By ~ 2

Author(s):

Lyudmila V. Olkhova ◽

Vladimir E. Popov

Keyword(s):

Clinical Case ◽

Care Delivery ◽

Venous Access ◽

Cerebellar Hemisphere ◽

Clinical State ◽

Venous Port ◽

Silicone Catheter ◽

Oncological Diseases ◽

Left Cerebellar Hemisphere ◽

Port Systems

Background. Currently, vascular access is one of the most important aspects in specific and accompanying treatment of cancer patients regardless of their age and sex. Partially implanted venous catheters previously described by Hickman were widely applied all over the world. The introduction of completely implanted venous port-systems revolutionized health care delivery and improved the quality of life in patients with oncological diseases. A fully implanted venous port consists of a silicone catheter which distal tip is connected to a port tank implanted subcutaneously. Such a design allows providing safe and multiple adequate vascular accesses regardless of the patient’s clinical state.Case Report. We present a clinical case of a 10-year-old patient diagnosed with medulloblastoma of the cerebellopontine angle and the left cerebellar hemisphere. The case described spontaneous detachment of an implanted venous port catheter and its migration to the venous heart in a patient who underwent chemotherapy by venous access provided through implantation of the venous port.Conclusion. Our clinical case demonstrated a rare and potentially extremely dangerous noninfectious complication associated with the use of venous port-systems. Implanted systems require washing 1–2 times per month with heparinized solutions or solutions containing taurolidine when they are not used. Periodic chest radiographs can reveal integrity alterations of the system. Any implanted system should be removed when it is not used, or it should be monitored on a regular basis.

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Utility of indocyanine green in the detection of radiologically silent hemangioblastomas: case report

Journal of Neurosurgery ◽

10.3171/2020.8.jns202176 ◽

2021 ◽

pp. 1-7

Author(s):

Alice Senta Ryba ◽

Juan Sales-Llopis ◽

Stefan Wolfsberger ◽

Aki Laakso ◽

Roy Thomas Daniel ◽

...

Keyword(s):

Indocyanine Green ◽

Histological Analysis ◽

Complete Resection ◽

Fluorescent Imaging ◽

Cerebellar Hemisphere ◽

Potential Applications ◽

Left Cerebellar Hemisphere ◽

Future Treatments ◽

Cerebellar Mass ◽

Suboccipital Approach

Hemangioblastomas (HBs) are rare, benign, hypervascularized tumors. Fluorescent imaging with indocyanine green (ICG) can visualize tumor angioarchitecture. The authors report a case of multiple HBs involving two radiologically silent lesions only detected intraoperatively by ICG fluorescence. A 26-year-old woman presented with a cystic cerebellar mass on the tentorial surface of the left cerebellar hemisphere on MRI. A left paramedian suboccipital approach was performed to remove the mural nodule with the aid of ICG injection. The first injection, applied just prior to removing the nodule, highlighted the tumor and vessels. After resection, two new lesions, invisible on the preoperative MRI, surprisingly enhanced on fluorescent imaging 35 minutes after the ICG bolus. Both silent lesions were removed. Histological analysis of all three lesions revealed they were positive for HB. The main goal of this report is to hypothesize possible explanations about the mechanism that led to the behavior of the two silent lesions. Intraoperative ICG videoangiography was useful to understand the 3D angioarchitecture and HB flow patterns to perform a safe and complete resection in this case. Understanding the HB ultrastructure and pathophysiological mechanisms, in conjunction with the properties of ICG, may expand potential applications for their diagnosis and future treatments.

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Endovascular Treatment of Basilar Artery Thrombosis Secondary to Bilateral Vertebral Artery Dissection with Symptom Onset Following Cervical Spine Manipulation Therapy

American Journal of Case Reports ◽

10.12659/ajcr.895273 ◽

2015 ◽

Vol 16 ◽

pp. 868-871 ◽

Cited By ~ 4

Author(s):

Ronni Mikkelsen ◽

Rikke Beese Dalby ◽

Niels Hjort ◽

Claus Ziegler Simonsen ◽

Sanja Karabegovic

Keyword(s):

Cervical Spine ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Basilar Artery ◽

Symptom Onset ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Basilar Artery Thrombosis ◽

Artery Thrombosis ◽

Cervical Spine Manipulation

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Dominant SCN2A Mutation Causes Familial Episodic Ataxia and Impairment of Speech Development

Neuropediatrics ◽

10.1055/s-0038-1668141 ◽

2018 ◽

Vol 49 (06) ◽

pp. 379-384 ◽

Cited By ~ 7

Author(s):

Kerstin Becker ◽

Peter Herkenrath ◽

Christoph Düchting ◽

Friederike Körber ◽

Pablo Landgraf ◽

...

Keyword(s):

Autosomal Dominant ◽

Index Patient ◽

Speech Development ◽

Episodic Ataxia ◽

Cerebellar Hemisphere ◽

First Episode ◽

Whole Exome ◽

Neurologic Disorders ◽

Left Cerebellar Hemisphere ◽

Impaired Speech

AbstractMutations in SCN2A are associated with a heterogeneous clinical spectrum including epilepsy and autism. Here, we have identified a peculiar phenotype associated with vaccination related exacerbations of ataxia. We report the first family with three individuals affected by SCN2A-associated episodic ataxia (EA) with impaired speech development. The index patient manifested his first episode of subacute cerebellar ataxia at the age of 12 months, 3 weeks after vaccinations for measles, mumps, rubella, and varicella. Cranial magnetic resonance imaging showed a lesion of the left cerebellar hemisphere, which was first considered as a potential cause of the ataxia. The patient fully recovered within 3 weeks, but developed three very similar episodes of transient ataxia within the following 24 months. Whole exome sequencing of the index patient revealed a heterozygous autosomal-dominant mutation in SCN2A (NM_021007, c.4949T > C; p.L1650P), which was confirmed in the likewise affected mother, and was then also identified in the younger brother who developed the first episode of ataxia. We hereby extend the recently described spectrum of SCN2A-associated neurologic disorders, emphasizing that SCN2A mutations should also be considered in familial cases of EA. Coincidental imaging findings or other associated events such as immunizations should not protract genetic investigations.

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Microvascular decompression for trigeminal neuralgia caused by trigeminocerebellar artery

Neurosurgical Focus: Video ◽

10.3171/2020.7.focvid2017 ◽

2020 ◽

Vol 3 (2) ◽

pp. V4

Author(s):

Norio Ichimasu ◽

Nobuyuki Nakajima ◽

Ken Matsushima ◽

Michihiro Kohno ◽

Yutaka Takusagawa

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Basilar Artery ◽

Microvascular Decompression ◽

Nerve Root ◽

Cerebellar Hemisphere ◽

Link Type ◽

Trigeminal Nerve Root ◽

Close Relationship

In this operative video, the authors demonstrate the case of a 53-year-old woman who presented with typical right trigeminal neuralgia by a trigeminocerebellar artery (TCA). The TCA was first defined by Marinković as a unique branch of the basilar artery supplying both the trigeminal nerve root and the cerebellar hemisphere. As a result of the close relationship between this vessel and the nerve root, the TCA might compress the nerve root, thereby causing trigeminal neuralgia. However, few cases of trigeminal neuralgia caused by TCA have been reported. This video shows the microvascular decompression for trigeminal neuralgia by the TCA.The video can be found here: https://youtu.be/UnGsCQRK6aY

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Abstract WP64: Perfusion Imaging Can Identify Basilar Occlusion Patients With a Favorable Response to Thrombectomy

Stroke ◽

10.1161/str.51.suppl_1.wp64 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Carlo W Cereda ◽

Jeremy Heit ◽

Giovanni Bianco ◽

Marco Pileggi ◽

Abid Qureshi ◽

...

Keyword(s):

Multivariate Analysis ◽

Basilar Artery ◽

Perfusion Imaging ◽

Univariate Analysis ◽

Brain Regions ◽

Artery Occlusion ◽

Posterior Circulation ◽

Favorable Outcome ◽

Cerebellar Hemisphere ◽

Basilar Artery Occlusion

Introduction: Perfusion imaging can identify patients who respond favorably to endovascular therapy (EVT) in the anterior circulation; no data are available for the posterior circulation. We evaluated perfusion patterns, assessed with RAPID software, in a consecutive cohort of patients with basilar artery occlusion treated with EVT and assessed the association between reperfusion and favorable clinical outcome based on the perfusion profile. Hypothesis: We hypothesized that patients with limited regions of severe hypoperfusion (Tmax > 10s) would have a favorable response (mRS 0-2) to reperfusion (mTICI 2b-3) while patients with multiple critical brain regions severely hypoperfused would have poor outcome (mRS 4-6) despite reperfusion. Methods: From a multicenter cohort of perfusion imaging in posterior circulation stroke, we included patients with basilar artery occlusion and EVT. We pre-specified a Critical Area Perfusion Score (CAPS, 0 - 8 points) to identify severe hypoperfusion (Tmax >10s) in the following regions: inferior and/or superior cerebellar hemisphere (1-4 points), pons (2 points), midbrain/thalamus (2 points). We compared the outcome between reperfusers and non reperfusers based on the CAP score with univariate and multivariate analysis. Results: 38 patients met the inclusion criteria. Mean age was 63±17, 34% female, NIHSS 17±11. In patients who reperfused (n=30, 79%) 63% had favorable outcome, while no patient without reperfusion survived, p=0.003 OR=29 (95%CI 1.5-547). Ninety percent (19/21) of reperfused patients with CAPS ≤2 had a favorable outcome, while none of the 9 with reperfusion and a score >2 survived, p<0.001, OR=148 (95%CI 6.5-3,333). In univariate analysis, favorable outcome was associated with NIHSS OR=0.87 (95% CI 0.80-0.96), p=0.003, and mismatch volume OR=0.98 (95% CI 0.97-0.997) p=0.013. In the multivariate analysis, only CAPS was an independent predictor of favorable outcome. Conclusions: Patients with limited regions of severe hypoperfusion (Tmax > 10s) had a robust response to basilar artery EVT, however, all patients with multiple critical brain regions severely hypoperfused died despite successful reperfusion. Perfusion imaging profiles may help identify optimal patients for basilar EVT.

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