Case of gustatory disturbance caused by pontine infarction]

We reported a 72-year-old man presented with gustatory disturbance. He lost bitter, salty, sour and sweet sensation on the left half of the tongue. No other neurologic signs were observed. Brain MRI showed the cerebral infarction in the left middle cerebellar peduncle. The lesion was suspected of affecting the gustatory tract running from the nucleus solitalius to the pontine taste area in the upper pons. The gustatory tract is generally recognized to be located medially from the medial lemniscus and the reticular formation. Our case suggests that the tract would be located laterally from the medial lemniscus and the reticular formation.     

脑梗死伴中心性浆液性脉络膜视网膜病变(附1例报告)

目的 探讨腑梗死伴中心性浆液性脉络膜视网膜病变（CSCP）的临床特点。方法 同顾性分析1例脑梗死伴CSCP患者的临床资料。结果 本例为中年男性患者,无高血压、糖尿病、高脂血症以及相关血管炎的病史,表现头晕、行走不稳和视物障碍等,头颅MRI显示小脑半球梗死,荧光眼底血管造影提示右眼CSCP,经改善微血管循环、神经营养等治疗好转。结论 对无脑卒中危险因素的脑梗死伴视物障碍的患者,要考虑CSCP的可能。     

中青年脑梗塞患者的临床与病理

目的 探讨中，青年人脑梗塞的病因。方法 将连续尸检确诊的脑梗塞病例中≤４５岁患者的脑标本常规处理，以动脉为重点行肉眼及光镜下观察，并分析有关临床资料。结果 ７２例患者中≤４５岁者７例，其中男６例，女１例，其中高血压，风湿性心脏病各２例，嗜烟，嗜酒中４例，病前１日酗酒１例。便塞灶相关动脉闭塞处管壁５例发现粥样斑块，３例发现炎症（１例与粥样斑并存）。５例粥样斑块血栓形成均位于基底动脉，４例病后２日内死     

Patient with innominate artery steal accompanied with cerebral infarction]

A 49-year-old man suddenly suffered left hemiplegia, and was brought to our hospital by ambulance at the beginning of August, 2006. He had a history of hypertension, and had received replacement of a synthetic graft in the ascending aorta and aortic arch with innominate artery for dissecting aneurysm in the aorta 2 years before. On diffusion-weighted magnetic resonance images obtained after admission, cerebral infarction was detected at the right corona radiata, and MR angiography (MRA) showed obstruction of the right middle cerebral artery. He was given intravenous tissue-plasminogen activator (t-PA) a few hours after arrival, and his hemiplegia was improved on the following day. At 11 days after onset, recanalization of the right middle cerebral artery was seen by MRA. On Doppler ultrasonographic examination, obstruction and thrombus in the innominate artery were observed. Retrograde flow of the right vertebral artery was demonstrated by both pulse-Doppler ultrasonography and velocity-coded color MRA. This patient is a rare example of innominate artery steal and ischemic cerebrovascular disease with obstruction of the innominate artery. Cerebral infarction in this patient might have developed via artery-to-artery embolism, with the thrombus in the innominate artery, rather than through a hemodynamic mechanism with innominate artery steal.     

Cerebral infarction in a boy with subdural abscess]

A 13-year-old boy was reported with a subdural abscess in the left anterior cranial fossa and an infarction in the lesion supplied by the left middle cerebral artery. Cranial computed tomography revealed a gradual increase of a low density area with surrounding capsule formation, and later another low density area which indicated in occlusion of the left middle cerebral artery. Cerebral angiography disclosed a stenosis at the trifurcated portion of the left internal carotid artery near the abscess. These findings suggested the occurrence of infarction due to angiitis of the internal carotid artery.     

Clinical study of central taste disorders and discussion of the central gustatory pathway

The aim of this work is to examine the clinical findings of patients with taste disorders due to central lesions and also to study the central gustatory pathway in humans. We conducted a retrospective review of 13 patients with central taste disorders that visited Nihon University Itabashi Hospital. An additional 25 cases with central taste disorders previously reported in the literature were assessed in the study. We examined 38 patients with taste disorders due to central lesions. The sites of the central lesions and their frequencies, the laterality of taste disorders relative to the central lesions, and prognosis of taste disorders were studied. We identified the following taste-related regions in the central nervous system: the medulla, pons, midbrain, thalamus, internal capsule, putamen, corona radiata, and cerebral cortex. As for the laterality of the taste disorders, we observed more ipsilateral cases for lesions located from the medulla to the pons. We observed ipsilateral, contralateral, and bilateral cases for lesions located above the midbrain, but bilateral cases were more frequently detected. Taste disorders of 80% of the patients improved by 24 weeks. The prognoses of central taste disorders appeared to be good. We identified eight central regions supposed to be relate to taste disorders. From the laterality of the taste disorders relative to the central lesions, it was suggested that the central gustatory pathway ascends ipsilaterally from the medulla to the pons, branches at the upper pons, and then ascends bilaterally from the midbrain to the cerebral cortex.     

Cerebral infarction, placoid epitheliopathy and sarcoidosis]

We report a case of cerebral infarction in the basal territory of the left middle cerebral artery, associated with acute posterior multifocal placoid pigment epitheliopathy, most probably due to sarcoidosis. Neurological symptoms resolved spontaneously without sequelae. We discuss the relationship between acute posterior multifocal placoid pigment epitheliopathy, sarcoidosis and cerebral granulomatous angiitis.     

Cerebral infarction presenting pure motor monoparesis: diagnosis by diffusion-weighted MR imaging]

We studied 10 patients with acute ischemic cerebrovascular disorders presenting paralysis confined to one limb, unaccompanied by sensory signs(pure motor monoparesis, PMM) on diffusion-weighted MR imaging(DWI). DWI revealed fresh ischemic lesions in all patients, except for 2 cases of transient ischemic attack. On DWI, acute infarction in multiple lesions was identified, and small superficial lesions were clearly described. Superficial lesions were seen in 4 patients, and deep lesions were also seen in 4 patients. DWI is useful for lesion analysis in cerebral infarction with PMM.     

Cerebral infarction and migraine: clinical and radiologic correlations

Cerebral infarction was documented by arteriography and serial computed cranial tomography (CT) in four young adults (ages 16 to 32 years) with migraine. In one case, posterior cerebral artery occlusion produced a deep parietotemporal infarct. The other three cases all had frontotemporal infarcts (one hemorrhagic) in the territory of the middle cerebral artery, without major arterial occlusion. Two infarcts produced lasting neurologic deficits; one was associated with mild, transitory symptoms, and one was asymtomatic. Laboratory investigations in two cases revealed no hematologic or cardiovascular predisposition to cerebrovascular disease. Cerebral infarction, as revealed by CT, may be more prevalent in "complicated" migraine than is generally appreciated. Such lesions may or may not develop in chronologic and anatomic relationship to the headache, and may involve either large or small arteries. The prognosis for functional recovery, based on this limited sample, seems favorable.     

Cerebral processing of gustatory stimuli in patients with taste loss

Aim was to investigate differences in the central-nervous processing of gustatory stimuli between normogeusic subjects and patients with taste disorders. Twelve subjects with normal gustatory function and eight patients suffering from hypo- to ageusia underwent one fMRI run each in a 1.5 T scanner where they received liquid gustatory stimuli. fMRI analyses were performed by means of SPM2. Across all participants clusters of activated voxels were mainly found in orbitofrontal and insular regions of interest. Even those patients who did not perceive any stimuli showed some activation of gustatory centers. Group comparisons revealed higher activation of the insular and orbitofrontal cortices in patients compared to the group of healthy subjects. While further studies are needed, this finding may be interpreted in terms of enhanced neuronal recruitment due to functional impairment in patients with gustatory loss. It may ultimately prove useful in terms of the prognostic evaluation of individual patients.     

Cerebral blood flow variations in CNS lupus

We studied the patterns of cerebral blood flow (CBF), over time, in patients with systemic lupus erythematosus and varying neurologic manifestations including headache, stroke, psychosis, and encephalopathy. For 20 paired xenon-133 CBF measurements, CBF was normal during CNS remissions, regardless of the symptoms. CBF was significantly depressed during CNS exacerbations. The magnitude of change in CBF varied with the neurologic syndrome. CBF was least affected in patients with nonspecific symptoms such as headache or malaise, whereas patients with encephalopathy or psychosis exhibited the greatest reductions in CBF. In 1 patient with affective psychosis, without clinical or CT evidence of cerebral ischemia, serial SPECT studies showed resolution of multifocal cerebral perfusion defects which paralleled clinical recovery.     

Astasia in a patient with unilateral thalamic infarction: clinical and MRI study]

We report a 82-year-old woman who developed difficulty in standing and sitting in the morning. She had no other complaints and stayed in the bed. The next day, she was admitted to the hospital and neurological examination revealed that she was alert, with no other motor or sensory abnormalities. Finger to nose test, and knee to heel test were normal. No dysdiadochokinesia was seen. Astasia was the only observed abnormal finding. MRI showed a small infarction (14 x 8mm) in the posterolateral portion of the left thalamus (VPL-LP nucleus). During the following 15 days, her imbalance has gradually improved and then disappeared. We diagnosed the patient as astasia occurring from a small unilateral infarction in the thalamus. It is thought that thalamic astasia is caused by the disruption of afferent pathway from the vestibulocerebellum; however, this case is based on just clinical and MRI study, so physiological and pathological studies will be necessary in the future.     

老年人的无症状脑梗塞

回顾性研究３７２例人老年人无症状性脑梗塞（ＳＩ）的患病率、与脑卒中危险因素的关系及其临床意义，并与非老年人对照结果显示老年人的ＳＩ患病率为２２．０％（８２／３７２），其中无脑卒中史组为２１．７％，首次２卒中且为２２．５％，各年龄组的ＳＩ患病率类似。有Ｓ 较无ＳＩ组高血压和糖尿病患病率高，有ＳＩ组的冠状动脉供 足及脑白蛋异常、血管周围间隙增宽的检出率较无ＳＩ组高。非人ＳＩ患病率为１１．６％，较老年     

Paradoxical embolism with Chiari network, subsequently being accompanied by probable incomplete infarction: a case report]

We presented a patient of paradoxical embolism with Chiari network, subsequently being accompanied by probable incomplete infarction. This 21-year-old man suffered from consciousness disorder, aphasia and right hemiparesis, and hospitalized in November 6, 1999. Magnetic resonance imaging showed mixed intensity on T1 and T2-weighted images in part of the areas of the left anterior and middle cerebral arteries. Cerebral angiography revealed the early venous fillings and the capillary blushs. These findings implicated stroke in young adult. Still more transcranial color-flow imaging showed high intensity transient signals with "Chirp" sounds on the left middle cerebral artery. Transesophageal echocardiography detected Chiari network. Chiari network was thought the course of cerebral infarction. Over again 123I-IMP single-photon emission CT findings revealed the marked reduction of his cerebral blood flow comprehensively in the left hemispherium. It was suggested that the recanalization after the paradoxical cerebral embolism had caused incomplete infarction.     

中青年脑梗死68例临床分析

脑梗死多见于老年人，但近年来中青年（16-45岁）患者逐渐增多且有年轻化趋势，深人探讨中青年脑梗死的致病因素及临床表现对其防治有重要意义。本文回顾性分析了我院自1998年1月到2004年12月问收治的中青年脑梗死患者68例，现报告如下。     

临床路径管理对脑出血患者卒中相关性肺炎的干预作用

目的观察临床路径管理对脑出血患者卒中相关性肺炎(SAP)发生与预后的影响。方法根据本院特点制定脑出血临床路径,收集200例发病在3 d内的脑出血患者,最终入组180例,采用非同期队列研究来比较未实施临床路径组70例(对照组)与实施临床路径组110例(路径组)脑出血患者SAP发生率和改良Rankin评分(mRS)。结果 SAP总体发病率为16.11%,对照组发病率为25.71%,路径组SAP发病率为10.00%;实施临床路径后脑出血患者SAP有明显降低(P0.05),但3个月时评分路径组明显降低(P<0.05)。结论脑出血发病后通过实施临床路径...