Emboligenic Heart Disease Research Articles

Les causes des infarctus spléniques : une revue quasi systématique de la littérature

IntroductionSplenic infarction is a rare event in clinical practice, diagnosed by CT scan. There are many causes. They often determine the treatment given. However, there is no consensus on etiological investigations. MethodsWe present here an almost systematic review of the literature, based on data available on Pubmed from 1991 to 2022. Using the keywords “splenic infarct”, from 1893 references, 11 cohort studies and 867 clinical cases were included in this review. Articles written in languages using alphabets other than Latin were excluded. Results and conclusionsAnalysis of these various studies has enabled us to draw up a list that is intended to be as exhaustive as possible of the causes of splenic infarction. The most frequent are emboligenic heart disease, hematological malignancies, solid neoplasia and certain infections. The descriptions available in the literature were mainly based on isolated clinical cases, not always making it possible to establish a causal link with the disease described, especially as around 20% of reported cases of splenic infarction were asymptomatic and potentially of incidental discovery. Based on the findings of this literature review, we propose a protocol for the etiological assessment of splenic infarcts.

Digital necrosis in a chronic hemodialysis patient with multiple myeloma

Abstract Digital ulcer generally reflects the presence of focal ischemia related to a microangiopathy. Etiologies are dominated by connectivites in women and by diffuse arteriopathies such as Leo-Buerger disease in men, as well as emboligenic heart disease. This article describes the case of a 46-year-old chronic hemodialysis female patient with nephroangiosclerosis, who presented a progressive onset of intermittent cyanosis of the fingertips and toes. The symptomatology was worsened by the evolution toward necrosis at the amputation stage. Etiological workup was in favor of multiple myeloma, requiring the initiation of chemotherapy.

Stroke in Young Subjects at the Hospital of Mali

Introduction: Stroke is the second leading cause of death worldwide. In Mali, very few studies have been carried out on stroke in young subjects. Nowadays, stroke is increasingly seen in young subjects. Hence the need to identify risk factors in order to adopt appropriate preventive measures. Method: We carried out a retrospective descriptive study in the internal medicine department at the Hospital of Mali in Bamako from January 1 to December 31, 2022, in patients admitted for stroke confirmed by brain imaging (Scanner or Nuclear magnetic resonance imaging). Sociodemographic characteristics, medical history and biological parameters were recorded and analyzed to identify risk factors in patients aged 15-45 years. Results: A total of 44 patients out of a total of 446 hospitalized in the department were analyzed, of whom 31.8% (15/44) were young subjects. The majority (71.42%) had ischemic stroke compared with 14.28% with hemorrhagic stroke. The difference was statistically significant (p<0.001).Hypertension was the most frequent vascular risk factor compared with elderly subjects (p=0.045). Other risk factors such as obesity and smoking were also associated with young age with an Odd Ratio (OR) of 3.25 and 2.0 respectively; however, these associations were not statistically significant (p>0.05). The main causes of stroke in young subjects were atherosclerotic plaques and emboligenic heart disease. Undetermined causes accounted for 40.1%. Conclusion: Stroke prevention in young subjects involves screening for risk factors, especially hypertension. The vital prognosis depends on the cause of the stroke, but the functional prognosis remains better than that of the elderly.

Renal Infarction: Clinical and Evolutionary Aspects in the Nephrology Department Ibn Sina University Hospital of Rabat-Morocco

Introduction: Renal infraction is a rare medical-surgical emergency that should be evoked before any lumbar pain syndrome. We report in this work, two cases of renal infraction with their clinical evolution. Clinical observation: These patients, aged respectively 48 and 70 years, were hospitalized in our department concomitant for low back pain. Emboligenic heart disease was responsible for the renal infraction in both cases. Diagnostic certainty was established by a CT scan with injection of contrast medium. Renal function was normal in the young patient versus renal insufficiency at 20mg/l creatinine for a GFR estimated at 35ml/minute according to MDRD in the elderly patient. We had a clinical and biological improvement with a curative anticoagulant treatment relayed by a long term treatment with an anti vitamin K in both cases but the elderly man kept a sequential renal insufficiency. Conclusion: Acute renal infarction is a rare pathology which must be systematically evoked in front of a lumbar pain syndrome. Angioscan with injection of contrast medium allows to make the diagnosis. Heparinization at an effective dose is the mainstay of treatment in the case of unilateral involvement, or surgery if bilateral.

Ischemic Cerebrovascular Accidents in HIV Patients on Antiretroviral Therapy: Clinical, Paraclinical And Prognostic Aspects in The Neurology Department of The University Hospital Center of Conakry

Introduction: Ischemic stroke (Stroke) constitute, due to the demographic and epidemiological transition, a real challenge for developing countries and HIV infection, a real public health problem in these countries. The objective of our study was to describe aspects of clinical, paraclinical and prognostic ischemic stroke in people living with HIV (PLHIV) on antiretrovirals (ARVs). Material and methods: This was a prospective study of the descriptive type lasting 6 months from January 1, 2022 to June 31, 2022, relating to ischemic cerebrovascular accidents (DALYs) in HIV patients on ARVs.Were included patients admitted or hospitalized in the service for seropositive ischemic stroke under ARV for an average duration of 35.5 months. Patients recently put on ARVs and those with an obvious cause of DALY such as (diabetes, uncontrolled hypertension, emboligenic heart disease) were excluded. Results: During our study period, 336(94%) patients were listed. Among them, 20 have ischemic stroke associated with HIV on ARVs, i.e. 6%. This study showed that the average age of onset of ischemic stroke in PLHIV on ARV was 49 ± 11.6 years with a sex ratio F/M of 1.22. The risk factors were high blood pressure 13 (65%), diabetes 05 (25%), followed by alcohol 04 (20%). HIV type 1 was represented at 100%, then 16 (80%) of our patients were at WHO stage III with a CD4 count between 200 and 300 cells/µl09 (45%). The therapeutic line of ARVs was dominated by TDF+3TC+EFV at 14 (70%) followed by AZT+3TC+LPV/r at 04 (20%) and the average duration of patients on ARV was 35.5 months. The favorable evolution was marked 13 (65%), followed by a death in (10%) or 02. The location on the cerebral scanner was dominated by the sylvian artery in 12 (60%) of cases followed by the anterior cerebral artery (ACA) 06 (30%) and the posterior cerebral artery ( PCA) 02 (10%). Conclusion: Ischemic stroke in HIV patients on ARVs requires early management and regular monitoring

180 LONG TERM FOLLOW UP OF A NON-PROGRESSIVE LEFT MAIN CORONARY ARTERY FISTULA TO RIGHT ATRIUM

Abstract A 63 years old man, with multiple cardiovascular risk factor, presented at the emergency department with a transient ischemic attack during an hypertensive crisis. Electrocardiogram revealed a sinus rhythm and no sign of ischemia. No critical stenosis were detected at ultrasonography of the supra-aortic trunks. Brain CT showed an arachnoid cyst in right posterior cerebellar site. Transthoracic echocardiographic showed normal wall motion with a left ventricular ejection fraction of 66%. The transesophageal echocardiography, performed for searching possible emboligenic heart disease, revealed a fistulous aneurysmal formation arising from the left main coronary artery. Angio-CT confirmed a CAF between distal left main coronary artery and right atrium, with a retro-aortic serpiginous course and an ectasic vascular structure (above 8.35 mm), this pathological vessel also had an aneurismatic formation of maximum diameter of 1 cm. CT scan detected also a 50% soft eccentric plaque in mid circumflex coronary artery and a less than 50% soft eccentric plaque in the right coronary artery. An elective hospitalization was performed in order to better assess the CAF. Coronary angiography revealed no significant coronary atherosclerotic disease and confirmed the CAF with its convoluted course. No left to right shunt was found either in cardiac magnetic resonance (Qp/Qs close to 1) or in right heart catheterization. Maximal stress test with cycloergometer was negative for clinical and electrocardiographic inducible ischemia (120W). CAF is a rare vascular abnormality, occurring in only 0.002% of the general population. The majority of CAFs have a congenital origin, but occasionally they may be acquired after cardiac surgery or repeated myocardial biopsies in cardiac transplantation. The CAFs may increase in size over time, although this does not occur invariably, and complications include: myocardial ischemia (due to myocardial ‘steal’), thrombosis and embolism, heart failure, atrial fibrillation, rupture, endocarditis/endarteritis, arrhythmias and also spontaneous rupture of the CAF causing hemopericardium. Current treatment options for CAF include surgery or transcatheter closure. Considered the age of the patient, the absence of clinical symptoms and the absence of left to right shunt, a conservative strategy was chosen. The patient had strict follow up, with clinical and echocardiographic assessment every 6 months, and with annually CT scan and stress test. During these 9 years of follow up the CAF remained stable, and the patients clinically asymptomatic.

Stroke and Covid-19: The Experience of the Ziguinchor/Senegal Epidemic Treatment Center

Introduction: SARS-CoV-2 infection seems to have a brain tropism involving several pathophysiological mechanisms. The objective of our work was to study the epidemiological, clinical, paraclinical and evolutionary aspects of stroke patients following SARS-CoV-2 infection. Methodology: This was a retrospective descriptive and analytical study from 26 March 2020 to 30 September 2021, which took place at the Ziguinchor epidemic treatment center. All patients infected with SARS-CoV-2 confirmed by RT-PCR with clinical signs suggestive of stroke and confirmed by brain CT scan were included in our study. Patients with incomplete or unexploitable records were excluded. Results: Twenty-four patients were collected out of a total of 186 severe cases, a prevalence of 12.90%. All patients had an ischemic stroke. The mean age was 69 ± 6 years with extremes of 58 and 84 years. The sex ratio (M/F) was 1.2. Diabetes and hypertension were co-morbidities in 87.50% and 25% of cases respectively. Clinical signs were dominated by a hemi-corporal deficit (87.5%) and dyspnea (75%). All patients were on anticoagulation and corticosteroids. The evolution was favourable in 62.5% of patients against 37.5% of death. Conclusion: SARS-CoV-2 infection is responsible for numerous neurovascular complications and this risk increases with the presence of diabetes, arterial hypertension and emboligenic heart disease. Corticosteroid therapy and anticoagulation have allowed us to improve the prognosis of patients.

Ischemic Stroke; A Severe Complication In Patients Admitted To Resuscitation

Stroke is a real public health problem because of its incidence and morbimortality. Ischemic stroke (AVCI) accounts for 80% of strokes. It is the third leading cause of overall mortality in industrialized countries, after heart disease and cancer, and the leading cause of physical disability acquired. The objective of our study was to describe the clinical characteristics, and factors of Cardiovascular Risk (LRIF) and the factors associated with death in patients admitted for stroke (AVCI) and them in a resuscitation ward. Methods: Retrospective study over a 12-month period (between January 1, 2018 and January 1, 2019), conducted in the medical-surgical emergency room. Results: A total of 147 strokes: 110 AVCI (84%). The age of the patients included in the study ranged from 49 to 77 years. The average age was 66 years - 10.9 years, 75% of AVCI occurring after 65 years. Sex divided into 47 women (42.72%). And 63 men (57.28%). Ischemic strokes: The main vascular risk factors three risk factors: severe high blood pressure (0.007), diabetes (0.05) and emboligenic heart disease (0.017). Other risk factors found are tobacco (13.09%), obesity (10.7%), dyslipidemia (08.3%), alcohol (7.1%). 17, 8% of patients had a history of formed stroke or TIA (Table 1). The onset of neurological symptomatology was brutal in 70% (77 patients). The clinical examination at admission found consciousness disorders with a NIHSS score of 5 to 15 in 45.54% of cases (49 patients). 23 patients (20.9%) had a NIHSS score of 15 and 39 patients (35.45). Para clinical cardiac evaluation (ECG, Echocoeur) objective a complete arrhythmia by atrial fibrillation (AC/FA) in 11.4% of cases, left atrial hypertrophy in 40% of cases and left ventricular hypertrophy in 89% of cases. The length of hospitalization in resuscitation ranged from 1 to 46 days with an average of 13.4 days (-10.1). Among the 110 patients 22 died or (20%). Three risk factors associated with the poor prognosis: NIHSS SUP(p - 0.0001), anisocoria(p - 0.006) and long stay in reanimation(p - 0.013). Conclusion: Ischemic strokes have a major public health impact in terms of mortality or morbidity because of the physical and psychological consequences they can cause. The management of cardiovascular risk factors, the first of which is the HTA, keeps its interest with the peculiarity of diabetic balance and the cessation of tobacco in combination with a diet. Cardiovascular assessment (ACFA, HAG, HVG) plays an important role in stroke management. Primary and secondary stroke prevention requires the prevention of thromboembolic accidents (ACFA) Stroke remains a challenge.

Collateral Circulation in Spinal Cord Injury: A Comprehensive Review

AbstractSurgery is the most common cause of spinal cord ischemia; it is also caused by hemodynamic changes, which disrupt the blood flow. Direct ligation of the spinal arteries, especially the Adamkiewicz artery is involved as well. Other causes of spinal cord ischemia include arteriography procedures, thoracic surgery, epidural and rachianesthesia, foraminal infiltration, arterial dissection, systemic hypotension, emboligenic heart disease, thoracic disc herniation, and compression. Understanding the vascular anatomy of the spinal cord is essential to develop optimal strategies for preventing ischemic injuries to the spinal cord. During ischemia, a rich network of intra and paraspinal collaterals allow enough blood flow to compensate the intensity of spinal cord ischemia. In case of interruption of flow of a main artery, the collateral artery increases its flow to maintain perfusion to the tissues. Avoiding spinal cord ischemia by using collateral circulation is necessary to prevent the establishment of hypovolemia, hyperthermia and elevations in venous pressures. The objective of this narrative review is to present the current concepts of spinal collateral circulation and its role in the setting of ischemic events, affecting the vascular supply of the spinal cord.

Une ischémie digitale révélant un myélome multiple

Digital ulcers generally arise in a context of microangiopathy-related focal ischemia. In women, connective tissue diseases are the main etiology, while in men the cause is often diffuse arterial disease, e.g. Leo-Buerger disease, or emboligenic heart disease. A paraneoplastic origin of digital necrosis due to ischemia is rarely reported. A 75-year-old man presented with cyanosis of the fingertips and toes that had begun one month earlier. The physical examination found pulp ulcers on the fingers and toes of both hands and feet. Two weeks later, necrotic damage developed distally, with no other associated symptoms. Blood tests were suggestive of Kahler disease; immunodeficiency disorders tests were negative; the cyroglobulin test was positive. Multiple-drug chemotherapy was followed by clinical improvement. Distal necrotic damage is a frequent inaugural symptom in vascular disease. If the common causal mechanisms (iatrogenic, occupational, toxic, atheromatous, emboligenic heart disease, or systemic disease) have been ruled out, it is important to search for a blood disorder or cancer as the cause of distal necrotic damage.

Stroke in young adults: Incidence rate, risk factors, treatment and prognosis

ObjectivesTo analyse the incidence, risk factors, aetiology, treatment and clinical evolution of young patients with stroke. Patients and methodsRetrospective registry of patients aged 55 years or younger hospitalised in a stroke unit during 2014. We recorded the incidence rate for all strokes and analysed demographic data, risk factors, degree of stress, stroke type and aetiology, reperfusion treatments and clinical evolution. ResultsThe study included 110 patients, the majority of whom were men (60.9%, 1.6:1 ratio). The incidence rate was 13.3% (110 of 830 strokes). Most of the patients had cardiovascular risk factors. Smoking was the most common risk factor (56.4%), followed by arterial hypertension (50%), dyslipidaemia (42.7%), obesity (33%), diabetes (18.2%) and emboligenic heart disease (12.7%). Some 64.3% of the heart disease cases and 51.1% of the dyslipidaemia cases were discovered during hospitalisation. Some 57.2% of the patients experienced psychosocial stress in the stage prior to the stroke. Some 83.6% of the stroke cases were ischaemic, 12.7% were haemorrhagic and 3.6% were venous sinus thrombosis. Of the ischaemic stroke cases, 30.4% were cryptogenic, 23.9% were lacunar, 16.3% were from uncommon causes, 15.2% were atherothrombotic and 14.1% were cardioembolic. Some 78.6% of the cerebral haemorrhage cases were hypertensive. Some 23.3% of the ischaemic stroke cases underwent reperfusion treatments in the acute phase, achieving levels of functional independence at 3 months of 62.5%. ConclusionsThe majority of stroke events in patients 55 years of age or younger appear to be related to a high prevalence of classical cardiovascular risk factors and possibly to psychosocial stress.

Ictus en adultos jóvenes: incidencia, factores de riesgo, tratamiento y pronóstico

ObjectivesTo analyse the incidence, risk factors, aetiology, treatment and clinical evolution of young patients with stroke. Patients and methodsRetrospective registry of patients aged 55 years or younger hospitalised in a stroke unit during 2014. We recorded the incidence rate for all strokes and analysed demographic data, risk factors, degree of stress, stroke type and aetiology, reperfusion treatments and clinical evolution. ResultsThe study included 110 patients, the majority of whom were men (60.9%, 1.6:1 ratio). The incidence rate was 13.3% (110 of 830 strokes). Most of the patients had cardiovascular risk factors. Smoking was the most common risk factor (56.4%), followed by arterial hypertension (50%), dyslipidaemia (42.7%), obesity (33%), diabetes (18.2%) and emboligenic heart disease (12.7%). Some 64.3% of the heart disease cases and 51.1% of the dyslipidaemia cases were discovered during hospitalisation. Some 57.2% of the patients experienced psychosocial stress in the stage prior to the stroke. Some 83.6% of the stroke cases were ischaemic, 12.7% were haemorrhagic and 3.6% were venous sinus thrombosis. Of the ischaemic stroke cases, 30.4% were cryptogenic, 23.9% were lacunar, 16.3% were from uncommon causes, 15.2% were atherothrombotic and 14.1% were cardioembolic. Some 78.6% of the cerebral haemorrhage cases were hypertensive. Some 23.3% of the ischaemic stroke cases underwent reperfusion treatments in the acute phase, achieving levels of functional independence at 3 months of 62.5%. ConclusionsThe majority of stroke events in patients 55 years of age or younger appear to be related to a high prevalence of classical cardiovascular risk factors and possibly to psychosocial stress.

Dynamic Migration of a Mobile Plaque from the Brachiocephalic Artery Detected by Ultrasonography

Mini‐AbstractA 72‐year‐old woman with a history of radiation therapy on the right neck and thorax developed multiple brain embolism. Transthoracic ultrasonography demonstrated a mobile plaque attached to the beginning of the brachiocephalic artery. Over a week, we detected the plaque that had migrated to the beginning of the left external carotid artery without any neurological symptoms. Ultrasonography was very useful to observe the course of the mobile plaque.

Cardiac Papillary Fibroelastoma as a Cause of Embolic Stroke: Ultrasound and Histopathological Characteristics

Although a cardiac papillary fibroelastoma is a benign cardiac tumor, it can cause severe embolic complications. A 51-year-old man presented with an ischemic stroke in the right middle cerebral artery territory. Transesophageal echocardiography revealed a small mobile tumor on the mitral valve as the only detectable source of emboli to the brain. On histology, the tumor was diagnosed as a papillary fibroelastoma. In this paper, the detailed characteristics of the tumor on ultrasound and histopathology are documented. In patients with cryptogenic stroke, transesophageal echocardiography should be done to rule out such an unusual emboligenic heart disease.

Accident ischémique transitoire

Transient ischemic attacks (TIAs) involve the sudden and brief loss of cerebral or ocular function, due to ischemic causes, with complete recovery at the moment of examination. TIAs, too often trivialized, require specialized emergency management. The risk of cerebral infarction within 7 days after TIA can reach 35%. All transient neurological signs are not TIAs. The principal causes of TIAs are atherosclerosis, cerebral arteriolopathy, and emboligenic heart disease. Treatment by platelet aggregation inhibitors (aspirin 160-300 mg) should begin immediately and be adjusted according to test results.

Is 15 mm Size Criterion for Lacunar Infarction Still Valid? A Study on Strictly Subcortical Middle Cerebral Artery Territory Infarction Using Diffusion-Weighted MRI

Background and Purpose: The ‘lacunar hypothesis’ has been challenged, since small (diameter <15 mm) subcortical infarcts can be produced by middle cerebral artery disease (MCAD) or cardioembolism (CE), while a larger infarct can occur without evidence of MCAD or CE. We sought to assess whether the lacunar hypothesis based on size is still valid. Methods: We studied 118 patients who were admitted within 72 h after stroke onset and had acute deep subcortical MCA territory infarcts detected by diffusion-weighted MRI, and who had undergone angiography (mostly MR angiography). Stroke mechanisms were arbitrarily categorized regardless of lesion size: (1) MCAD when there was a corresponding MCA lesion; (2) internal carotid artery disease (ICAD) when there was a significant (>50%) ipsilateral ICAD; (3) CE when there was emboligenic heart disease without MCAD or ICAD, and (4) small vessel disease (SVD) when there was neither CE nor MCAD. SVD was further divided into definite SVD (dSVD, longest diameter <15 mm) or probable SVD (pSVD, longest diameter ≧15 mm). Results: Seventy-three patients (62%) had SVD, of which 38 (32%) had pSVD and 35 (30%) dSVD. Thirty-three patients (28%) had MCAD, five (4%) CE, and seven (6%) ICAD. The infarct diameter in MCAD was not larger than in SVD (p = 0.35), and there was no difference in clinical features or risk factors between MCAD and SVD, or between pSVD and dSVD. CE was distinguished from SVD by its larger size and cortical symptoms. Conclusions: There are no clinical and lesion-size differences between MCAD and SVD, suggesting that there seems to be no rationale for the 15 mm size criterion for lacunar or small-vessel infarction.

Estudio de los factores de riesgo en la amnesia global transitoria y su diferenciación del accidente isquémico transitorio

Transient global amnesia (TGA) is a clinical condition that has been described in many studies, but its pathophysiology is not fully understood. In recent years the theory of valvular insufficiency in the jugular vein has been added to the classical hypotheses that link it to migraine, to epilepsy and -the most widely accepted- to transient ischemic attacks (TIA), although the real origin of the condition has still not been determined. In a retrospective study we compared 131 patients diagnosed with TGA between 1993 and 2004 with 262 patients who were diagnosed as having TIA over the same period. Mean age was 65.94 years in TGA versus 71.11 years in the case of TIA. There was a higher rate of arterial hypertension among the patients with TGA and diabetes mellitus was more frequent among those with TIA (p<0.05 in both cases). Emboligenic heart disease was scarce among patients with TGA. The number of patients with a history of ischaemic heart disease and a history and the development of cerebrovascular diseases was greater among those with TIA than in cases of TGA (p<0.05). The TGA recurrence rate was 12%. The percentage of pathological findings in the CAT brain scan was higher in patients with TIA (p<0.05). There are no significant differences between patients with TGA and TIA as far as treatment on hospital discharge is concerned. TGA does not seem to be a symptom of an arteriosclerotic pathology nor does it appear to offer a higher risk of heart or cerebrovascular disease and, therefore, antiaggregating therapy would not be indicated in such cases.

Ictus y estenosis intracraneal: perfil clínico de una serie española de 134 pacientes

Intracranial stenoses (IS) are known to be a manifestation of atherosclerosis and a cause of cerebral ischemia, although very few clinical reports have appeared describing such patients in our milieu. The aim of this study was to describe the vascular risk factors, clinical presentation, radiological characteristics, aetiological role played in strokes and the vessels affected in a series of Spanish patients suffering from stroke and IS. We conducted a retrospective descriptive study of patients admitted to the Cerebrovascular Pathology Unit with strokes and IS between 1990 and 2001. Data collected included: age, sex, arterial hypertension (AHT), diabetes (Db), hypercholesterolemia (HC), smoking (Sm), ischemic or emboligenic heart disease, intermittent claudication, carotid atheromatosis, clinical presentation of stroke and earlier lesions in computerised axial tomography (CAT) scans of the brain. 132 patients; 187 stenotic vessels: 65.7% males, mean age 68.3 years. AHT 65%, Db 39%, HC 40%, Sm 43%, ischemic heart disease 22%, emboligenic heart disease 17%, intermittent claudication 13%. TIA 16%, LACI 33%; PACI 25%, TACI 4%, POCI 19%. Significant carotid atheromatosis 26.5%. Symptomatic IS 50%: mean age 63.3 years, 64% females. Arteries affected: vertebral (VA) 28%; middle cerebral (MCA) 27%; carotid siphon 21%; basilar (BA) 10% (65% symptomatic); anterior cerebral (ACA) 5% and posterior cerebral (CPA) 4%. Normal cranial CAT scan 24%, lacunar infarcts 42%, territorial 32%; leukoaraiosis 17%. Patients with stroke and IS display different clinical profiles according to their sex (males: a higher number of vascular risk factors and clinical involvement of other territories; females are more symptomatic, AHT and HC); they usually present clinically as lacunar syndromes, with a scarce amount of significant atheromatous carotid involvement, except IS of the VA, and IS of the BA are the most symptomatic.

Pure Sensory Syndromes in Thalamic Stroke

We studied 25 patients with an acute thalamic stroke (infarct or hemorrhage) on CT or MRI scan and sensory dysfunction, among the 3,628 patients with first-time stroke included in the Lausanne Stroke Registry. Twelve patients had a right-sided infarct, 11 a left-sided infarct, and 2 a left-sided thalamic hemorrhage. Sensory symptoms or signs were the only clinical abnormality. The presumed causes of stroke were small artery disease in 21 patients including both cases of hemorrhage, emboligenic heart disease in 2, while the etiology of ischemic stroke was undetermined in 2 patients. Nine patients had a loss of all modalities of sensation with faciobrachiocrural distribution, 5 patients suffered dissociated sensory loss with faciobrachiocrural distribution and 11 patients showed a dissociated involvement of sensation with a partial distribution pattern. The inferolateral region (thalamogeniculate arteries) was involved in all patients. Six patients complained of pain and/or dysesthesias during the stroke; 5 of them had involvement of the nucleus ventrocaudalis (in 3 with damage to the nucleus ventro-oralis intermedius, and in one to the pulvinar) and 1 patient had involvement of the nucleus ventro-oralis intermedius. Eighteen patients complained of paresthesias in the contralateral part of the body; 16 of them had involvement of the nucleus ventrocaudalis (in 4 with damage to the nucleus ventro-oralis intermedius, in 1 with damage to the nucleus ventro-oralis intermedius, and nucleus ventro-oralis externus, and in one with damage to the nucleus parvocellularis and pulvinar). Four patients developed delayed pain and/or dysesthesias; all of them had involvement of the nucleus ventrocaudalis (in 1 with damage to the nucleus parvocellularis and pulvinar). Time lag from stroke onset to developing pain ranged from 2 to 15 days (mean 10.5 days). One patient with dissociated involvement of sensation with a partial distribution pattern had paresthesias and dissociated hemisensory loss involving position sense without pain and temperature sensations. This patient had involvement of the posterolateral part of the nucleus ventrocaudalis. In conclusion, sensory dysfunction and delayed pain are more often found in thalamic lesions that involve the nucleus ventrocaudalis, and nucleus ventro-oralis intermedius. Restricted sensory abnormalities correlate with very small lesions located in critical areas within these nuclei.

Pontine infarction extending to the basal surface.

Etiology and symptomatology in pontine infarction extending to the basal surface are supposed to be different from those in deep pontine infarction of the lacunar type. The aim of this study was to compare the infarct size and location, vascular lesions, risk factors, and neurological deficits in three different types of acute pontine infarction. We studied isolated pontine infarction extending to the basal surface on brain imaging (group 1, n = 30), deep pontine infarction without extension to the basal surface (group 2, n = 23), and pontine infarction with simultaneous extrapontine infarct in the posterior circulatory system (group 3, n = 20). Clinical features, angiographic findings, and risk factors such as emboligenic heart disease, hypertension, and hypercholesterolemia were compared among the groups. The infarct area was 2.5 times greater in group 1 than in group 2. On angiogram, atherosclerotic stenosis of the basilar trunk was observed in 50% of the patients studied in group 1, in 0% in group 2, and in 78% in group 3. Emboligenic heart diseases were observed in 23%, 0%, and 30% in groups 1, 2, and 3, respectively. However, hypertension (60% to 65%), diabetes mellitus (35% to 45%), and hypercholesterolemia (13% to 17%) were equally distributed among the three groups. Classic lacunar syndromes were seen in 14 patients (47%) in group 1, in 20 patients (87%) in group 2, but in none of the patients in group 3. Patients belonging to group 1 showed a higher incidence of hemiparesis involving the face (37%), sensorimotor stroke (20%), and hemiparesis with confusion (17%) than those in group 2 (22%, 0%, and 4%, respectively) or in group 3 (0%, 5%, and 0%, respectively). Pontine infarction in group 1 may have several different causes, such as cardioembolism, artery-to-artery embolism, or atherosclerosis of the basilar artery affecting pontine branches. Severe neurological symptoms often result that differ from those seen in the deep pontine lacunar infarction in group 2.