Evaluation of functional outcomes of vertebrobasilar infarction depending on the aff ected intracranial vascular territory of the posterior circulation

The aim of the work is to examine the features of recovery of lost neurological functions and the quali ty of life of patients with acute vertebrobasilar infarction, to evaluate and compare the short-term and long-term outcome of a stroke depending on the aff ected intracranial anatomical areas of the posterior circulation basin. 120 patients with acute vertebrobasilar infarction were examined, among them 22 (18.3 %) patients had a cerebral infarction, 38 (31.7 %) — pontine infarction, 13 (10.8 %) — midbrain infarction, 22 (18.3 %) — thalamic infarction and 25 (20.8 %) patients — cerebellar infarction. Strokes were distributed into three intracranial anatomical territories of the posterior circular basin: proximal, medial, distal. The diagnosis was established on the basis of data from the neurological clinic and magnetic resonance imaging in standard and DV modes. Clinical and neurological comparisons and a comparative statistical analysis of the functional outcomes of infarctions on the 21st and 90th day of a prospective observation. Despite the fact that there is no clear functional boundary between the proximal, medial and distal intracranial anatomical territories of the posterior circulation basin, which once again confi rms their functional unity, the potential for resuming lost neurological functions, a short-term and long-term outcome after infarction of diff erent anatomical and topographic areas of posterior circulation basin do not always match. Statistical analysis pointed that the short-term and long-term functional outcome after a infarction in diff erent intracranial vascular territories of the posterior circulation basin had certain features of the evolution of functional and neurological recovery. In particular, cerebellar infarctions had a signifi cantly better functional outcome compared to infarctions of the medulla oblongata in the short and long term perspective and midbrain infarctions — on the 90th day of the prospective observation (p <0.05). Paired comparisons of functional consequences between cere bellar, pontine and thalamic infarction did not reveal a statistically signifi cant (p > 0.05) correlation between factorial and eff ective signs during short-term and longterm follow-up.

Abstract TP260: Causes of Delayed Diagnosis of Vertebrobasilar Stroke Patients After Arrival at Emergency Room

Introduction: Dizziness is a main symptom caused by ischemic insult to vertebrobasilar vessels as well as peripheral vertigo. So, proper diagnosis and management is often delayed in the vertebrobasilar ischemic patients. The present study was to evaluate factors related with the delayed diagnosis among vertebrobasilar infarction patients suffered from dizziness as initial main symptom. Methods: We reviewed clinical and radiologic data of 166 patients, who suffered from dizziness and/or vertigo as initial symptom and diagnosed finally as acute infarction on cerebellum and/or brainstem. First, we classified patients by incorrect triage as peripheral vertigo for the patients by first triage doctor of emergency room. Then, we evaluated time intervals from arrival at emergency room to first examination by a neurologist, to first brain image, and to final diagnosis as ischemic stroke of each group of patients. Type of initial symptoms including dizziness only or dizziness plus focal neurologic deficits were also compared between the groups. Finally, factors related with the incorrect triage of the included patients were analyzed using multivariate analysis. Results: The time from ER arrival to examination by a neurologist (221.0±158.7 vs. 56.0±76.8 min, p <0.001), to first image (232.4±182.1 vs. 58.2±77.0 min, p <0.001), and to final diagnosis (367.2±179.7 vs. 151.3±94.1 min, p <0.001) were significantly delayed in incorrect triage group. More patients in incorrect triage group showed dizziness only at presenting ER (52% vs. 13%, p <0.001). Among the focal neurologic signs defined by neurologists in incorrect triage group, Tandem abnormality was most frequently observed (29%). On multiple regression analysis, presence of chronic kidney disease (Odd ratio (OR) 15.7, 95% CI 1.4-175.6, p =0.026), isolated dizziness symptom (OR 13.5, 95% CI 3.3-55.3, p <0.001). Conclusions: In the present study, presence of chronic kidney disease and initial presenting symptom were the main cause of delaying diagnosis of vertebrobasilar infarction patients in ER. Additionally, Tandem gait should be performed for the dizzy patients to avoid delaying diagnosis of ischemic stroke.

Precise Localization of Dysfunctional Areas in Vertebrobasilar Infarction by FDGand 0-15-H20-PET Using Standardized Image Analysis and Image Registration to 3-D MR

SummaryThe advantages of standardized multimodal image analysis are demonstrated in a case of symptomatic tremor after basilar thrombosis. Functionally and structurally lesioned areas were mapped in Talairach space using 3-D MRI, cerebral FDG-PET and 0-15-H20-PET. Structural lesions were found in the left midbrain, thalamus, putamen and cerebellar areas. Voxel-based statistics in comparison to a normal data base revealed hypometabolism in the left thalamus, left red nucleus, left cerebellar hemisphere including dentate nucleus and in the left inferior olivary nucleus. The 0-15-H20-PET investigation revealed metabolic uncoupling along the rubroolivocerebellar loop. Given the delicate anatomy of the structures involved, image registration and standardized image analysis techniques are essential for a synoptic multimodality analysis of morphological and functional pathology and should generally be used for cerebral PET investigations.

Pediatric Cerebellar Infarction

Infarction in the vertebrobasilar system is uncommon in children. Cerebellar infarction presenting as a posterior fossa mass lesion is distinctly rare. We recently treated a 13-year-old boy with such a lesion as a complication of basilar artery migraine. A review of the literature on vertebrobasilar infarction in children is presented and the therapeutic alternatives in cerebellar infarction are discussed.