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Vascular Territories (vascular + territory)
Selected AbstractsPseudomigraine With Lymphocytic Pleocytosis: A Calcium Channelopathy?HEADACHE, Issue 8 2003Clinical Description of 10 Cases, Genetic Analysis of the Familial Hemiplegic Migraine Gene CACNA1A Objective.,To report the clinical findings of 10 patients diagnosed with pseudomigraine with lymphocytic pleocytosis and the results of mutational analysis of the CACNA1A gene in 8 of these patients. Background.,Pseudomigraine with lymphocytic pleocytosis, also referred to as headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL), is characterized by episodic transient neurologic dysfunction associated with moderate to severe headache and cerebrospinal fluid lymphocytic pleocytosis. Episodes are recurrent and the condition is self-limiting. The etiology of this sporadic condition remains unknown, but the episodic nature and its ability to be triggered by angiography is somewhat reminiscent of the phenotypic features of familial hemiplegic migraine, a condition caused by mutations in the CACNA1A gene. Design/Methods.,Utilizing retrospective chart review, we describe the clinical features of pseudomigraine with lymphocytic pleocytosis in 10 patients. Whole blood was taken from 8 patients (2 were lost to follow-up) and used for DNA testing. The CACNA1A gene was screened for mutations using heteroduplex analysis and direct DNA sequencing. Results.,Clinical features of pseudomigraine with lymphocytic pleocytosis included transient episodes of weakness, sensory and visual symptoms, aphasia, and confusion lasting minutes up to 4 hours. Sensory symptoms, typically affecting the face and arm, were the most common presentation. Localization of symptoms did not conform to vascular territories. Headache was typically throbbing and most often bilateral. Genetic analysis did not identify any mutations in the CACNA1A gene. Conclusions.,Similarities between familial hemiplegic migraine and pseudomigraine with lymphocytic pleocytosis include recurrent headache with reversible neurologic deficit, cerebrospinal fluid lymphocytic pleocytosis, and triggers such as angiography. Even so, heteroduplex analysis and DNA sequencing failed to identify any sporadic mutations or shared polymorphisms in the exons or the intron/exon boundaries of the CACNA1A gene. These results do not support a role of the CACNA1A gene in the etiology of pseudomigraine with lymphocytic pleocytosis. [source] Delirium due to Brain Microembolism: Diagnostic Value of Diffusion-Weighted MRIJOURNAL OF NEUROIMAGING, Issue 2 2007Pablo Irimia MD ABSTRACT Delirum is a common complication in hospitalized patients and it is characterized by acute disturbances of consciousness, attention, cognition, and perception. Despite the frequency with which it is observed, ischemic stroke is generally considered as an unusual cause of delirium. A subtype of brain embolism is characterized by multiple small emboli in different vascular territories, a condition known as "brain microembolism." Given the high contrast of acute ischemic lesions in diffusion weighted imaging (DWI) this technique is particularly helpful to detect these small infarctions. We present here a patient with pulmonary metastases who was treated with bronchial artery embolization and who subsequently developed delirium due to brain microembolism. The embolic material crossed through pulmonary arteriovenous fistulas, producing multiple areas of cerebral ischemia. The ischemic lesions could be visualized only on DWI, and they affected the periventricular region, caudate nucleus, thalamus, and cerebellum. [source] The spectrum of vascular involvement in giant-cell arteritis: clinical consequences of detrimental vascular remodelling at different sitesAPMIS, Issue 2009MARIA C. CID Although repeatedly reported in the literature, the extracranial involvement by giant-cell arteritis has been considered anecdotal until recent years. The emergence of new or improved imaging techniques along with a closer follow-up of these patients and their increase in life expectancy are beginning to underline that the clinical impact of extracranial involvement by GCA may be more relevant than previously thought. This review focuses on the extent of vascular involvement in GCA as reported by pathology and imaging studies as well as the clinical consequences of imperfect vascular remodelling in various vascular territories. [source] The arterial anatomy of the Achilles tendon: Anatomical study and clinical implicationsCLINICAL ANATOMY, Issue 3 2009Tony M. Chen Abstract The Achilles tendon is the most frequently ruptured tendon in the lower limb and accounts for almost 20% of all large tendon injuries. Despite numerous published studies describing its blood supply, there has been no uniformity in describing its topography. The current study comprises a detailed anatomical study of both the intrinsic and extrinsic arterial supply of the Achilles tendon, providing the detail sought from studies calling for improved planning of surgical procedures where damage to the vascularity of the Achilles tendon is likely. A dissection, microdissection, histological, and angiographic study was undertaken on 20 cadaveric lower limbs from 16 fresh and four embalmed cadavers. The Achilles tendon is supplied by two arteries, the posterior tibial and peroneal arteries. Three vascular territories were identified, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. The midsection of the Achilles tendon was markedly more hypovascular that the rest of the tendon. The Achilles tendon is at highest risk of rupture and surgical complications at its midsection. Individuals with particularly poor supply of the midsection may be at increased risk of tendon rupture, and approaches to the tendon operatively should consider the route of supply by the peroneal artery to this susceptible part of the tendon. Clin. Anat. 22:377,385, 2009. © 2009 Wiley-Liss, Inc. [source] Recurrent artery of Heubner infarction in infancyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2000Steven P Miller MDCM Classically, acquired occlusion of the recurrent artery of Heubner (RAH) results in hemiparesis with faciobrachial predominance. Infarction in the territory of the RAH represents a specific stroke syndrome not yet described in infancy with a range of motor and functional manifestations. An infant is described with apparent congenital infarction of the recurrent artery of Heubner. The child had prominent involvement of the contralateral upper extremity with athetosis. Neuroimaging changes were evident in the vascular territory classically attributed to the RAH. The clinician should suspect congenital RAH infarction in those infants with congenital upper-extremity athetosis. [source] Symptomatic stenosis of the vertebrobasilar arteries: results of extra- and intracranial stent-PTAEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2009T. Seifert Background and purpose:, About half of all transient ischaemic attacks (TIAs) or strokes in the posterior circulation are caused by the arterial stenosis. The purposes of this study were to determine the safety of stent-assisted percutaneous transluminal angioplasty (stent-PTA) and its efficacy for the prevention of recurrent stroke in patients with symptomatic artery stenosis in the extra- and intracranial posterior circulation. Methods:, Forty-six patients with a previous stroke or TIA who received balloon-mounted coronary stents for vertebral artery origin stenosis (VAOS; 29 patients) or self-expanding nitinol stents for vertebrobasilar intracranial stenosis (VBIS; 17 patients) were followed-up for a mean of 24.1 (VAOS) and 12.7 (VBIS) months. Results:, When all cause morbidity/mortality within 30 days from stent-PTA and stroke or death from stroke in the treated vascular territory during the first 12 months of follow-up are combined, the incidence of periprocedural complications and disease progression for the first year is 10.3% in VAOS patients and 17.6% in the VBIS group. Vessel restenosis ,50% was found in 52.0% of VAOS and in 32.1% of VBIS patients who completed 6 months follow-up. Conclusions:, We observed a higher periprocedural complication rate for patients with VBIS and a higher rate of restenosis in VAOS patients after stent-PTA for symptomatic artery stenosis. [source] A Method for the Automated Assessment of Temporal Characteristics of Functional Hemispheric Lateralization by Transcranial Doppler SonographyJOURNAL OF NEUROIMAGING, Issue 3 2004M. Deppe ABSTRACT Background and Purpose. Transcranial Doppler sonography (TCD) can guide and complement investigations based on functional magnetic resonance and positron emission tomography imaging by providing continuous information on cerebral perfusion changes correlated to cerebral activation. So far, however, the role of functional TCD has been limited by a lack of sensitivity.Methods. Here, the authors present an outline of a method that increases the potential of TCD to detect perfusion changes within a vascular territory. Sensitivity on the order of 1% can be achieved by transformation of Doppler envelope curves, which accounts for systemic quasi-periodic and irregular spontaneous blood flow modulations and artificial disturbances related to the recording. A statistical technique is introduced that allows the automatic detection of time periods of significant hemispheric lateralization in evoked flow studies. Furthermore, an index of laterality is defined quantifying the extent of hemispheric dominance during stimulus processing.Results and Discussion. The analysis technique described in this article has been successfully employed in recent examinations on vision, motor activation, language, language recovery, and other cognitive tasks. Conclusion. The novel functional TCD technique permits valid and reproducible assessments of the temporal characteristics of functional hemispheric lateralization. [source] Susceptibility Contrast and Arterial Spin Labeled Perfusion MRI in Cerebrovascular DiseaseJOURNAL OF NEUROIMAGING, Issue 1 2003Ronald L. Wolf MD ABSTRACT Purpose. To directly compare dynamic susceptibility contrast (DSC) and continuous arterial spin labeled (CASL) magnetic resonance (MR) perfusion techniques in patients with known cerebrovascular disease, with the goals of identifying possible pitfalls in interpretation and determining potential for a complementary role in this setting. Methods. DSC and CASL MR perfusion studies were performed and compared in 11 patients with acute and/or chronic cerebrovascular disease. Using an automated segmentation technique, Pearson correlation coefficients were generated for CASL perfusion measurements compared to DSC perfusion maps (time-to-peak [TTP], relative cerebral blood volume [rCBV], cerebral blood flow [rCBF], and mean transit time [MTT]) by hemisphere and vascular territory. Results. TTP maps obtained using DSC perfusion MR correlated best both subjectively and objectively with CASL perfusion MRmeasurements when all patients studied were considered. If patients with a major transit delay were excluded, DSC rCBF correlated best with CASL CBF measurements. Conclusion. There may be a complementary role for CASL and DSC perfusion MR methods in cerebrovascular disease, especially in the setting of a marked transit delay. [source] | ||||||||||