Assuntos
Infartos do Tronco Encefálico/diagnóstico , Frutas/intoxicação , Síndromes Neurotóxicas/diagnóstico , Infartos do Tronco Encefálico/etiologia , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Diagnóstico Diferencial , Escala de Coma de Glasgow , Humanos , Hipertensão/complicações , Hipertensão/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Doenças Renais Policísticas/complicações , Doenças Renais Policísticas/terapia , Diálise Renal , Estado Epiléptico/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Hemimedullary syndrome is very rare and combines the clinical features of lateral and medial medullary infarctions. In patients with hemimedullary syndrome, the presence of ipsilateral, rather than contralateral hemiplegia, is rare. OBJECTIVE: To describe a patient with an infarction in the right hemimedulla with an ipsilateral motor deficit due to dissection of the right vertebral artery (VA) and to assess whether the ipsilateral hemiplegia may be the result of a specific stroke mechanism. METHODS: We reviewed the reports of hemimedullary syndrome in the literature and compared the characteristics of patients with dissection of the VA with those with VA atherosclerotic disease. RESULTS: In our patient, magnetic resonance angiography showed dissection of the right VA to be the cause of the stroke. In a review of the literature (including our case), hemiplegia was ipsilateral to the infarction in four of the five patients with VA dissection, but contralateral in all six patients with atherosclerotic disease of the VA (p=0.01). In all five cases of VA dissection, the right hemimedulla was involved, while, in the six cases of atherosclerotic disease, the left side of the medulla oblongata was affected in five instances and the right side in one (p=0.01). CONCLUSION: Dissection of the VA may provoke a hemimedullary lesion at a lower level than atherosclerosis, thus affecting medullary-penetrating branches that irrigate the medulla immediately below the pyramidal decussation. Hemimedullary syndrome accompanied by ipsilateral motor deficit should raise suspicion of dissection of the VA.
Assuntos
Infartos do Tronco Encefálico/etiologia , Infartos do Tronco Encefálico/patologia , Hemiplegia/etiologia , Bulbo/irrigação sanguínea , Dissecação da Artéria Vertebral/diagnóstico , Adulto , Humanos , Angiografia por Ressonância Magnética , Masculino , Bulbo/patologia , Síndrome , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/patologiaRESUMO
INTRODUCTION: Blood stream penetrates through the lacerations of the arterial layers determining dissecting aneurysms. Each intramural clot localization determines different clinical form. OBJECTIVE: We present the clinical observations carried out in two patients with vertebrobasilar dissecting aneurysms and we review the state of the art of this process to remark the early identification of these unusual lesions. CASE REPORTS: Two cases of vertebrobasilar dissecting aneurysms were described. They were young patients that debuted, one as posteroinferior artery brain steam infarction and the other one as a subarachnoid hemorrhage caused by a right posterior cerebral artery dissecting aneurysms. Lesions were confirmed by helicoidal cerebral angiotomographic and angiograms. This patient was operated on and we clipped the posterior communicating that irrigated dissecting segment. We carry out an anatomical and hemodynamic analysis of that lesion. Both patients had a satisfactory clinical evolution. CONCLUSIONS: Dissecting intramural hematomas of the vertebrobasilar territory are frequent cause of young people ictus. It has been suggested that the ictus may happen after minor head trauma and pain, main symptom, always precedes neurological dysfunction signs. Hemorrhagic presentation has a high incidence of rebleeding and elevated mortality. It always requires, as soon as possible, direct microsurgical treatment or endovascular methods (coils). Most useful microsurgical procedure, until today, is parent artery clipping. This technique has a low index of isquemic and neural postoperative damage.