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9 - Less common stroke syndromes

from Section III - Diagnostics and syndromes

Published online by Cambridge University Press:  05 May 2010

By
Wilfried Lang
Edited by
Michael Brainin  and
Wolf-Dieter Heiss
Michael Brainin
Affiliation:
Zentrum für Klinische Neurowissenschaften, Donnau-Universität, Krems, Austria
Wolf-Dieter Heiss
Affiliation:
Universität zu Köln
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Summary

Introduction

This chapter deals with focal brain ischemia, either TIA or ischemic stroke. Causes, mechanisms and clinical syndromes of brain hemorrhage are described elsewhere. This chapter is divided into three parts. The first part focuses on an uncommon mechanism of focal brain ischemia, which is low flow. Most TIA and ischemic strokes are caused by embolism or in situ artery occlusion. Hemodynamic causes of focal brain ischemia are less common. Secondly, uncommon clinical presentations of focal brain ischemia are described. In the third part, uncommon causes of TIA and ischemic stroke are presented together with associated clinical syndromes.

Uncommon mechanism of stroke: low flow

Ischemic strokes and transient ischemic attacks caused by low cerebral flow – anterior circulation

Most ischemic strokes and transient ischemic attacks are caused by embolic and acute, in situ (usually thrombotic) occlusion of an artery in the brain. However, in some patients severe stenosis or occlusion of carotid or vertebral arteries may cause a critical reduction of blood flow, particularly when collateral circulation is compromised because the circle of Willis is incomplete or diseased. Mechanisms to compensate for the reduction of blood flow are vasodilatation by autoregulation and an increase of the oxygen extraction fraction. If the vascular bed is maximally dilated the supplied brain is particularly vulnerable to any fall in perfusion pressure. Under these circumstances a small drop in systemic blood pressure may cause transient or permanent focal ischemia.

Type
Chapter
Information
Textbook of Stroke Medicine , pp. 135 - 153
Publisher: Cambridge University Press
Print publication year: 2009

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References

Warlow, C, Gijn, J, Dennis, M, Wardlaw, J, Bamford, J, Hankey, G, et al. Stroke, 3rd ed. Oxford: Blackwell; 2008.CrossRefGoogle Scholar
Ringelstein, ER, Stögbauer, F. Border zone infarcts. In: Bogousslavsky, J, Caplan, L, eds. Stroke Syndromes, 2nd ed. Cambridge: Cambridge University Press; 2001: 564–83.CrossRefGoogle Scholar
Choi, KD, Shin, HY, Kim, JS, Kim, SH, Kwon, OK, Koo, JW, et al. Rotational vertebral artery syndrome: oculographic analysis of nystagmus. Neurology 2005; 65:1287–90.CrossRefGoogle ScholarPubMed
Kuether, TA, Nesbit, GM, Clark, GM, Barnell, SL. Rotational vertebral artery occlusion: a mechanism of vertebrobasilar insufficiency. Neurosurgery 1997; 41:427–32.CrossRefGoogle ScholarPubMed
Caplan, LR, Wityk, RJ, Glass, TA, Tapia, J, Pazdera, L, Chang, HM, et al. New England Medical Center Posterior Circulation registry. Ann Neurol 2004; 56:389–98.CrossRefGoogle ScholarPubMed
Gerstner, E, Liberato, B, Wright, CB. Bi-hemispheric anterior cerebral artery with drop attack and limb shaking TIAs. Neurology 2005; 65:174.CrossRefGoogle ScholarPubMed
Hennerici, M, Klemm, C, Rautenberg, W. The subclavian steal phenomenon: a common vascular disorder with rare neurological deficits. Neurology 1988; 38:669–73.CrossRefGoogle Scholar
Caplan, LR. Posterior Circulation Disease. Clinical Findings, Diagnosis, and Management. Boston: Blackwell; 1996.Google Scholar
Dashe, JF. Hyperviscosity and stroke. In: Bogousslavsky, J, Caplan, L, eds. Uncommon Causes of StrokeCambridge: Cambridge University Press; 2001: 100–10.Google Scholar
Donnan, GA, O'Malley, HM, Quang, L, Hurley, S, Bladin, PF. In: Donnan, GA, Norrving, B, Bamford, J, Bogousslavsky, J, eds. Subcortical Stroke, 2nd ed. Oxford: Oxford University Press; 2002: 175–84.Google Scholar
Caplan, LR. “Top of the basilar” syndrome. Neurology 1980; 30:72–9.CrossRefGoogle ScholarPubMed
Fisher, CM. The posterior cerebral artery syndrome. Can J Neurol Sci 1986; 13:232–9.CrossRefGoogle ScholarPubMed
Dunne, JW, Leedman, PJ, Edis, RH. Inobvious stroke: a cause of delirium and dementia. Austr N Z J Med 1986: 16:771–8.CrossRefGoogle ScholarPubMed
Bogousslavsky, J, Maeder, P, Regli, F, Meuli, R. Pure midbrain infarction: clinical syndromes, MRI, and etiologic patterns. Neurology 1994; 44:2032–40.CrossRefGoogle ScholarPubMed
Thömke, F, Tettenborn, B, Hopf, HC. Third nerve palsy as the sole manifestation of midbrain ischemia. Neuro-ophthalmology 1995; 15:327–35.CrossRefGoogle Scholar
Thömke, F. Brainstem diseases causing isolated ocular nerve palsies. Neuro-ophthalmology 2002; 28:53–67.CrossRefGoogle Scholar
Lang, W, Cheyne, D, Kristeva, R, Beisteiner, R, Lindinger, G, Deecke, L. Three-dimensional localization of SMA activity preceding voluntary movement – A study of electric and magnetic fields in a patient with infarction of the right supplementary motor area. Ex Brain Res 1991; 87:688–95.Google Scholar
Gheka, J, Bogousslavsky, J. Abnormal movements. In: Bogousslavsky, J, Caplan, L, eds. Stroke Syndromes, 2nd ed. Cambridge: Cambridge University Press; 2001: 162–82.CrossRefGoogle Scholar
Prabhakaran, S. Neurologic complications of endocarditis. Continuum 2008; 14:53–74.Google Scholar
Jones, HR, Siekert, RG. Neurological manifestations of infective endocarditis. Review of clinical and therapeutic challenges. Brain 1989; 112:1295–315.CrossRefGoogle ScholarPubMed
Anderson, DJ, Goldstein, LB, Wilkinson, WE, et al. Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis. Neurology 2003; 61:1341–6.CrossRefGoogle ScholarPubMed
Hart, RG, Foster, JW, Luther, MF, Kanter, MC. Stroke in infective endocarditis. Stroke 1990; 21:695–700.CrossRefGoogle ScholarPubMed
Hart, RG, Kagan-Hallett, K, Joerns, SE. Mechanisms of intracranial hemorrhage in infective endocarditis. Stroke 1987; 18:1048–56.CrossRefGoogle ScholarPubMed
Biller, J, Challa, VR, Toole, JF, Howard, VJ. Nonbacterial thrombotic endocarditis. A neurological perspective of clinicopathological correlations of 99 patients. Arch Neurol 1982; 39:95–8.CrossRefGoogle Scholar
Rogers, LR, Cho, ES, Kempin, S, Posner, JB. Cerebral infarction from non-bacterial thrombotic endocarditis. Clinical and pathological study including the effects of anticoagulation. Am J Med 1987; 83:746–56.CrossRefGoogle ScholarPubMed
Lopez, JA, Ros, RS, Fishbein, MC, Siegel, RJ. Nonbacterial thrombotic endocarditis: a review. Am Heart J 1987; 113:773–84.CrossRefGoogle ScholarPubMed
Singhal, AB, Topcuoglu, MA, Buonanno, FS. Acute ischemic stroke patterns in infective and nonbacterial thrombotic endocarditis: a diffusion-weighted magnetic resonance imaging study. Stroke 2002; 33:1267–73.CrossRefGoogle ScholarPubMed
Nagel, MA, Cohrs, RJ, Mahalingam, R, et al. The varizella zoster virus vasculopathies – clinical, CSF, imaging, and virologic features. Neurology 2008; 70:853–60.CrossRefGoogle Scholar
Schmutzhard, E. Entzündliche Erkrankungen des Nervensystems. Stuttgart: Thieme; 2000.Google Scholar
Joutel, A, Corpechot, C, Ducros, A, et al. Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia. Nature 1996; 383:707–10.CrossRefGoogle ScholarPubMed
Boom, , Lesnik Oberstein, S, Ferrari, M, Haan, M. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: MR imaging findings at different ages – 3rd–6th decades. Radiology 2003; 229:683–90.CrossRefGoogle ScholarPubMed
Rolfs, A, Böttcher, T, Zschiesche, M, et al. Prevalence of Fabry disease in patients with cryptogenic stroke: a prospective study. Lancet 2005; 366:1794–6.CrossRefGoogle ScholarPubMed
Takanashi, J, Barkovich, A, Dillon, W, Sherr, E, Hart, K, Packman, S. T1 hyperintensity in the pulvinar: a key imaging feature for diagnosis of Fabry disease. Am J Neuroradiol 2003; 24:916–21.Google ScholarPubMed
Mizrachi, I, Gomez-Hassan, D, Blaivas, M, Trobe, J. Pitfalls in the diagnosis of mitochondrial encephalopathy with lactic acidosis and stroke-like episodes. J Neuroophthalmol 2006; 26:38–43.CrossRefGoogle Scholar
Iizuka, T, Sakai, F, Kan, S, Suzuki, N. Slowly progressive spread of the stroke-like lesions in MELAS. Neurology 2003; 61:1238–44.CrossRefGoogle ScholarPubMed
Möller, H, Kurlemann, G, Pützler, M, Wiedermann, D, Hilbich, T, Fiedler, B. Magnetic resonance spectroscopy in patients with MELAS. J Neurol Sci 2005; 229–230:131–9.CrossRefGoogle ScholarPubMed
Bogousslavsky, J, Despland, PA, Regli, F. Spontaneous carotid dissection with acute stroke. Arch Neurol 1987; 44:137–40.CrossRefGoogle ScholarPubMed
Bogousslavsky, J, Pierre, P. Ischemic stroke in patients under age 45. Neurol Clin 1992; 10:113.CrossRefGoogle ScholarPubMed
Schievink, WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001; 344:898.CrossRefGoogle ScholarPubMed
Zweifler, RM, Silverboard, GS. Arterial dissections. In: Mohr, JP, Choi, DW, Grotta, JC, et al., eds. Stroke: Pathophysiology, Diagnosis, and Management, 4th ed. New York: Churchill Livingstone; 2004: 549–73.CrossRefGoogle Scholar
Friedman, AH, Drake, CG. Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 1984; 60:325.CrossRefGoogle ScholarPubMed
Saver, JL, Easton, JD. Dissections and trauma of cervicocerebral arteries. In: Barnett, HJM, Mohr, JP, Stein, BM, et al., eds. Stroke: Pathophysiology, Diagnosis and Management, 3rd ed. New York: Churchill Livingstone; 1998: 769.Google Scholar
Baumgartner, RW, Arnold, M, Baumgartner, I, et al. Carotid dissection with and without events: local symptoms and cerebral artery findings. Neurology 2001; 57:827.CrossRefGoogle ScholarPubMed
Takeuchi, K, Shimizu, K. Hypoplasia of the bilateral internal carotid arteries. No To Shinkei 1957; 9:37.Google Scholar
Adams, HP. Moya-moya. In: Bogousslavsky, J, Caplan, J, eds. Uncommon Causes of Stroke. Cambridge: Cambridge University Press; 2001: 241.Google Scholar

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