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Sample records for inferior cerebellar artery

  1. [Aneurysm of the anterior inferior cerebellar artery: case report].

    PubMed

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  2. Sudden deafness as an initial presenting symptom of posterior inferior cerebellar artery infarction: two case reports.

    PubMed

    Lee, E J; Yoon, Y J

    2014-11-01

    This paper reports on two patients with posterior inferior cerebellar artery infarction whose only presenting complaint was acute unilateral hearing loss. In the two cases reported, sudden hearing loss was an initial symptom, with no other neurological signs. Infarction in the territory of the posterior inferior cerebellar artery was diagnosed using brain magnetic resolution imaging. The patients had some degree of hearing improvement 3 or 4 days after initial treatment. In this article, new cases of posterior inferior cerebellar artery infarction presenting as sudden deafness, without prominent neurological signs, are described. Otologists should be aware that hearing loss can sometimes appear as a warning sign of impending posterior inferior cerebellar artery infarction.

  3. Anterior and posterior inferior cerebellar artery infarction with sudden deafness and vertigo.

    PubMed

    Murakami, Takenobu; Nakayasu, Hiroyuki; Doi, Mitsuru; Fukada, Yasuyo; Hayashi, Miwa; Suzuki, Takeo; Takeuchi, Yuichi; Nakashima, Kenji

    2006-12-01

    We report a patient with anterior and posterior inferior cerebellar artery infarction, which manifested as profound deafness, transient vertigo, and minimal cerebellar signs. We suspect that ischaemia of the left internal auditory artery, which originates from the anterior inferior cerebellar artery, caused the deafness and transient vertigo. A small lesion in the middle cerebellar peduncle in the anterior inferior cerebellar artery territory and no lesion in the dentate nucleus in the posterior inferior cerebellar artery territory are thought to explain the minimal cerebellar signs despite the relatively large size of the infarction. Thus a relatively large infarction of the vertebral-basilar territory can manifest as sudden deafness with vertigo. Neuroimaging, including magnetic resonance imaging, is strongly recommended for patients with sudden deafness and vertigo to exclude infarction of the vertebral-basilar artery territory.

  4. Acute bilateral cerebellar infarction in the territory of the medial branches of posterior inferior cerebellar arteries.

    PubMed

    Gurer, G; Sahin, G; Cekirge, S; Tan, E; Saribas, O

    2001-10-01

    The most frequent type of cerebellar infarcts involved the posterior inferior cerebellar artery (PICA) and superior cerebellar artery territories but bilateral involvement of lateral or medial branches of PICA is extremely rare. In this report, we present a 55-year-old male who admitted to hospital with vomiting, nausea and dizziness. On examination left-sided hemiparesia and ataxic gait were detected. Infarct on bilateral medial branch of PICA artery territories was found out with cranial magnetic resonance imaging (MRI) technique and 99% stenosis of the left vertebral artery was found out with digital subtraction arteriography. The patient was put on heparin treatment. After 3 weeks, his complaints and symptoms had disappeared except for mild gait ataxia.

  5. Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: Case report and review of literature

    PubMed Central

    Akhtar, Saad; Azeem, Abdul; Jiwani, Amyna; Javed, Gohar

    2016-01-01

    Introduction There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20–24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature. Presentation of case We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically. Discussion Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below. Conclusion The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty. PMID:27017276

  6. Ruptured partially thrombosed anterior inferior cerebellar artery aneurysms: two case reports and review of literature

    PubMed Central

    Kanamori, Fumiaki; Kawabata, Teppei; Muraoka, Shinsuke; Kojima, Takao; Watanabe, Tadashi; Hatano, Norikazu; Seki, Yukio

    2016-01-01

    ABSTRACT Aneurysms arising from the distal anterior inferior cerebellar artery (AICA) are very rare. When the parent artery is an AICA−posterior inferior cerebellar artery (PICA) variant, occlusion of the artery, even distal to the meatal loop, leads to a significant area of cerebellar infarction. We report two cases of ruptured partially thrombosed distal AICA aneurysms. In both cases, the parent artery was an AICA−PICA variant. The aneurysms were clipped in one case and trapped following occipital artery (OA)−AICA anastomosis in another case. It is important to keep the OA as a donor artery for revascularization in the treatment of the AICA−PICA variant aneurysms, especially when the absence of intra-aneurysmal thrombus is not comfirmed preoperatively. PMID:28008208

  7. Retrograde Stent Placement for Coil Embolization of a Wide-Necked Posterior Inferior Cerebellar Artery Aneurysm

    PubMed Central

    Roh, Hong Gee; Choi, Jin Woo; Cho, Joon; Moon, Won-Jin; Solander, Sten

    2012-01-01

    Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization. PMID:22778576

  8. Anterior spinal and bulbar artery supply to the posterior inferior cerebellar artery revealed by a ruptured aneurysm: case report.

    PubMed

    Gabrieli, Joseph; Sourour, Nader-Antoine; Chauvet, Dorian; Di Maria, Federico; Chiras, Jacques; Clarençon, Frédéric

    2017-02-01

    The posterior inferior cerebellar artery (PICA) is a vessel located between the intra- and extracranial circulation. The artery is characterized by a complex embryological development and numerous anatomical variants. The authors present a case of the PICA supplied by both a hypertrophic anterior spinal artery and a hypoplastic bulbar artery. This unusual arrangement somehow completes the list of previously published variants, and the spontaneous rupture of a related aneurysm confirmed the fragility of this network. The authors discuss anatomical and treatment considerations.

  9. [Extracranial aneurysm of the posterior inferior cerebellar artery. A case report].

    PubMed

    Alliez, B; Du Lac, P; Trabulsi, R

    1990-01-01

    A case is presented of an aneurysm arising in an extracranial loop of the left posterior inferior cerebellar artery (P.I.C.A.). Two similar cases can be found in a review of the literature. It is essential to obtain clear visualization of both P.I.C.A.s. in the evaluation of patients with subarachnoid hemorrhage. Surgical treatment of this aneurysm, located distal to the lateral medullary segment, involves a midline approach with retraction or subpial resection of the tonsillar tip.

  10. Ruptured aneurysm at the cortical segment of the posterior inferior cerebellar artery.

    PubMed

    Matsushita, Yoko; Kawabata, Shinji; Kamo, Masatsugu; Yamada, Makoto; Matsukawa, Masanori; Taniguchi, Hirokatsu; Kuroiwa, Toshihiko

    2006-08-01

    We report a rare case of a ruptured aneurysm at the cortical segment of the posterior inferior cerebellar artery (PICA) with a branching complex that was feeding the bilateral cerebellar hemispheres. A 70-year-old woman suddenly sustained a severe headache and vomiting. CT scan revealed diffuse subarachnoid haemorrhage with fourth and lateral ventricular haemorrhage, which suggested typical aneurysmal bleeding in the posterior circulation. No aneurysm was detected on the initial angiogram. This angiogram also showed no significant evidence of other lesions that could be the origin of the bleeding. A third angiogram was performed 15 days from the ictus and revealed a distal PICA saccular aneurysm. The aneurysm was located at the cortical segment, and the artery was branching to both of the cerebellar hemispheres. This could be more clearly visualised during the ensuing operation, and neck clipping was performed. The patient recovered without neurological deterioration. Subarachnoid haemorrhage with blood in the fourth ventricle may indicate a ruptured aneurysm on the distal segment of the PICA with a branching variation, feeding the contra-lateral hemisphere, which is rarely located in this position.

  11. Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms*

    PubMed Central

    de Abreu Junior, Luiz; Kuniyoshi, Cristina Hiromi; Wolosker, Angela Borri; Borri, Maria Lúcia; Antunes, Augusto; Ota, Vanessa Kiyomi Arashiro; Uchida, Daniela

    2016-01-01

    Objective To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms. Materials and Methods We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant. Results The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom. Conclusion Vascular loops do not appear to be associated with otoneurological manifestations. PMID:27818543

  12. Gravity-dependent nystagmus and inner-ear dysfunction suggest anterior and posterior inferior cerebellar artery infarct.

    PubMed

    Shaikh, Aasef G; Miller, Benjamin R; Sundararajan, Sophia; Katirji, Bashar

    2014-04-01

    Cerebellar lesions may present with gravity-dependent nystagmus, where the direction and velocity of the drifts change with alterations in head position. Two patients had acute onset of hearing loss, vertigo, oscillopsia, nausea, and vomiting. Examination revealed gravity-dependent nystagmus, unilateral hypoactive vestibulo-ocular reflex (VOR), and hearing loss ipsilateral to the VOR hypofunction. Traditionally, the hypoactive VOR and hearing loss suggest inner-ear dysfunction. Vertigo, nausea, vomiting, and nystagmus may suggest peripheral or central vestibulopathy. The gravity-dependent modulation of nystagmus, however, localizes to the posterior cerebellar vermis. Magnetic resonance imaging in our patients revealed acute cerebellar infarct affecting posterior cerebellar vermis, in the vascular distribution of the posterior inferior cerebellar artery (PICA). This lesion explains the gravity-dependent nystagmus, nausea, and vomiting. Acute onset of unilateral hearing loss and VOR hypofunction could be the manifestation of inner-ear ischemic injury secondary to the anterior inferior cerebellar artery (AICA) compromise. In cases of combined AICA and PICA infarction, the symptoms of peripheral vestibulopathy might masquerade the central vestibular syndrome and harbor a cerebellar stroke. However, the gravity-dependent nystagmus allows prompt identification of acute cerebellar infarct. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Laceration of the posterior inferior cerebellar artery by suboccipital puncture of the cisterna magna: case report.

    PubMed

    Portela, Luiz Antonio Pezzi; Souza, Valéria; Pahl, Félix Hendrick; Cardoso, Alberto Cappel; Vellutini, Eduardo de Arnaldo Silva; Mutarelli, Eduardo Genaro; Machado, Luis dos Ramos; Livramento, José Antonio

    2004-09-01

    We report the case of a 27 year old man who presented to the emergency room of a hospital with headache, vomiting and an episode of loss of conciousness. A cranial CT scan was normal and the patient discharged. Ten hours later he came to the emergency room of our hospital with the same complaints. A technically difficult cisternal puncture in an anxious patient who moved during the needle introduction was done. The CSF sample showed 1600 intact red blood cells without other alterations. His headache worsened and after 6 hours he became drowsy, numb and exhibited decerebration signs. A new CT scan showed diffuse subarachnoid and intraventricular blood. An emergency angiogram demonstrated laceration of a left posterior-inferior cerebellar artery in its retrobulbar loop with a pseudoaneurysm. He was successfully treated by surgical clipping without injury. Sixteen days later he was discharged with a normal neurological exam.

  14. Spontaneous healing and complete disappearance of a ruptured posterior inferior cerebellar artery dissecting aneurysm.

    PubMed

    Su, Tsung-Ming; Cheng, Ching-Hsiao; Chen, Wu-Fu; Hsu, Shih-Wei

    2014-05-01

    A 7-month-old baby presented with a 4-day history of drowsiness and vomiting after a falling accident. Magnetic resonance imaging demonstrated diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and variable stages of subdural hematoma in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was noted in the right craniocervical junction. Ophthalmological examination revealed bilateral retinal petechial hemorrhages. Conventional cerebral angiography revealed a dissecting aneurysm in the right posterior inferior cerebellar artery (PICA). Endovascular embolization was suggested, but the family refused. After conservative treatment, follow-up MRI revealed that the PICA aneurysm had remodeled and ultimately disappeared completely at the 10th month. This case illustrates the relatively plastic nature of intracranial aneurysms in pediatric patients. More studies are necessary to clarify the natural history of spontaneously thrombosed aneurysms to assist in their overall management.

  15. Spectrum of the posterior inferior cerebellar artery territory infarcts. Clinical-diffusion-weighted imaging correlates.

    PubMed

    Kumral, Emre; Kisabay, Ayşin; Ataç, Ceyla; Calli, Cem; Yunten, Nilgun

    2005-01-01

    The clinical, etiological and stroke mechanisms are defined well before but the detailed clinical and etiologic mechanisms regarding to all clinical spectrum of posterior inferior cerebellar artery (PICA) infarcts were not systematically studied by diffusion-weighted imaging (DWI). Seventy-four patients with PICA territory ischemic lesion proved by DWI with decreased apparent diffusion coefficient and FLAIR (fluid attenuation inversion recovery) included in our Registry, corresponding to 2% of 3,650 patients with ischemic stroke, were studied. The presence of steno-occlusive lesions in the posterior circulation were sought by magnetic resonance angiography, and reviewed with a three-dimensional rotating cineangiographic method. We found six subgroups of PICA territory infarcts according clinico-topographical relationship: (1) 9 patients with lesion in the territory lateral branch of PICA; (2) 23 patients with an infarct in the territory of medial branch of PICA; (3) 9 patients with a lesion involving both medial and lateral branches of the PICA; (4) 9 patients with cortical infarcts at the boundary zones either between medial and lateral branches of the PICA or between PICA and m/l superior cerebellar artery (SCA); (5) 10 patients with a lesion at the deep boundary zones either between medial and lateral PICA, or between PICA and medial/lateral SCA; (6)14 patients with concomitant multiple lesions in the PICA and in other vertebrobasilar artery territories. The main cause of PICA infarcts was extracranial large-artery disease in 30 patients (41%) patients, cardioembolism and in situ branch disease in 15 patients (20%) each. Multiple PICA territory lesions on DWI were not uncommon and could be caused by multiple emboli originating from break-up of atherosclerotic plaque in the subclavian/innominate-vertebral arterial system. DWI findings of single or multiple small lesions could account for some cases with transient and subtle cerebellar symptoms which have been

  16. [Dissecting aneurysm of the posterior inferior cerebellar artery--a case report].

    PubMed

    Ueki, K; Teraoka, A; Yoshida, S; Hori, T

    1987-11-01

    The authors present a case of dissecting aneurysm of the right posterior inferior cerebellar artery (PICA) in a 47-year-old female, who suffered from mild subarachnoid hemorrhage. Right vertebral angiogram showed typical "pearl and string" sign of the PICA, but we could not fully understand the condition until a surgical exposure revealed a purple sausage-like dissecting aneurysm of the PICA. The aneurysm was wrapped with muscle pieces. Postoperatively she developed Wallenberg's syndrome, but it subsided gradually. No specific disorder concerning the mural dissection was found in this patient, except for a history of mild hypertension. This case is unusual because it affected not an arterial trunk but a small branch and we could find only one other case reported in the literature. Other formerly reported cases were of arterial trunks. The intracranial dissecting aneurysm has been known as a rare cause of cerebral infarct in children and adolescents. Infants are also affected and referred to as "infantile hemiplegia". It mainly affects one of the trunk arteries and cause a severe ischemic stroke, and surgically treatable case is rare. But as the typical angiographic findings are commonly known the number of the reported cases is increasing at an accelerating rate, and some of them are being noted to need surgical treatment because they cause subarachnoid hemorrhage. We here emphasize that not only trunk arteries but also small branch arteries can develop mural dissection, leading to subarachnoid hemorrhage. Dissecting aneurysm of a smaller artery would be milder in symptom, and would give more chance for surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. [Dissecting aneurysm of the posterior inferior cerebellar artery--studied by serial angiography].

    PubMed

    Yamashita, Y; Hayashi, S; Saitho, H; Teramoto, A

    2001-11-01

    We report the case of a 34-year-old male with cerebellar hemorrhagic infarction caused by a dissecting aneurysm of the left posterior inferior cerebellar artery (PICA). The patient suffered from a headache and vomiting for two days and was transferred to our hospital with sudden deterioration of consciousness. On admission, he was semicomatose. A CT scan revealed hemorrhagic infarction in the left cerebellum and upward herniation. The emergency operation for posterior fossa decompression was performed. Postoperatively, his consciousness level improved promptly and he had no neurological deficits except for slight gait disturbance. The first vertebral angiography was performed on Day 27. It showed a sausage-like dissecting aneurysm of the left distal PICA. We planned conservative therapy with careful observation because of there being no indication for an operation. Serial angiography was performed and demonstrated the regression of the dissecting aneurysm on Day 258. Dissecting aneurysms of the distal PICA are rare and their natural history is not well understood. Conservative therapy for vertebrobasilar dissecting aneurysms has often been reported. We suggest that conservative therapy with serial angiography is the treatment of choice especially for ischemic-type dissecting aneurysms. We review 17 cases of dissecting aneurysm of the distal PICA in this study.

  18. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

    SciTech Connect

    Fang, Yi-Bin Zhao, Kai-Jun Wu, Yi-Na Zhou, Yu Li, Qiang Yang, Peng-Fei Huang, Qing-Hai Zhao, Wen-Yuan Xu, Yi Liu, Jian-Min

    2015-06-15

    PurposeThe treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.MethodsA retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.ResultsThe immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).ConclusionsOur preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.

  19. Intracranial Aneurysms Associated with a Double Origin of the Posterior Inferior Cerebellar Artery

    PubMed Central

    Padovani Trivelato, F.; Salles Rezende, M.T.; Brito Santos, R.; Hilton Vieira Madeira, T.; Cardoso Campos, R.; Cordeiro Ulhûa, A.

    2011-01-01

    Summary The posterior inferior cerebellar artery (PICA) frequently has a variable course and target territory. However, double origin PICA is a rare finding. Its significance is uncertain, but it has been associated with intracranial aneurysms localized at the PICA proper or at a distant site. The presence of this variation imposes specific challenges. We describe two cases of double origin PICA, one of them associated with an ipsilateral PICA aneurysm. The role of this finding was critically reviewed. A literature search identified 23 cases of double origin PICA, including both cases reported in this paper. Intracranial aneurysms were strongly associated with double origin PICA (71% in 21 detailed cases of double origin PICA). The current patient harboring a PICA aneurysm was successfully treated by endovascular trapping. In the setting of double origin PICA aneurysms, this variation beneficially affects the treatment choice once the two limbs enable the safe sacrifice of the channel involved, with preservation of blood flow through the other channel. PMID:22005699

  20. Therapeutic Progress in Treating Vertebral Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery

    PubMed Central

    Shi, Lei; Xu, Kan; Sun, Xiaofeng; Yu, Jinlu

    2016-01-01

    Among the variations of vertebral artery dissecting aneurysms (VDAs), VDAs involving the posterior inferior cerebellar artery (PICA), especially ruptured and high-risk unruptured aneurysms, are the most difficult to treat. Because the PICA is an important structure, serious symptoms may occur after its occlusion. Retained PICAs are prone to re-bleeding because VDAs are difficult to completely occlude. There is therefore confusion regarding the appropriate treatment for VDAs involving the PICA. Here, we used the PubMed database to review recent research concerning VDAs that involve the PICA, and we found that treatments for VDAs involving the PICA include (i) endovascular treatment involving the reconstruction of blood vessels and blood flow, (ii) occluding the aneurysm using an internal coil trapping or an assisted bypass, (iii) inducing reversed blood flow by occluding the proximal VDA or forming an assisted bypass, or (iv) the reconstruction of blood flow via a craniotomy. Although the above methods effectively treat VDAs involving the PICA, each method is associated with both a high degree of risk and specific advantages and disadvantages. The core problem when treating VDAs involving the PICA is to retain the PICA while occluding the aneurysm. Therefore, the method is generally selected on a case-by-case basis according to the characteristics of the aneurysm. In this study, we summarize the various current methods that are used to treat VDAs involving the PICA and provide schematic diagrams as our conclusion. Because there is no special field of research concerning VDAs involving the PICA, these cases are hidden within many multiple-cases studies. Therefore, this study does not review all relevant documents and may have some limitations. Thus, we have focused on the mainstream treatments for VDAs that involve the PICA. PMID:27429591

  1. Vertebral artery occlusion with vertebral artery-to-posterior inferior cerebellar artery stenting for preservation of the PICA in treating ruptured vertebral artery dissection.

    PubMed

    Chung, Joonho; Kim, Bum-soo; Lee, Dongwoo; Kim, Tae-Hyun; Shin, Yong Sam

    2010-09-01

    We report a patient with a right vertebral artery (VA) dissecting aneurysm who was treated by placing an Enterprise stent (Cordis Neurovascular, Miami Lakes, FL) from the proximal VA to the posterior inferior cerebellar artery (PICA) in order to save the patency of the PICA. A 47-year-old man was admitted with a ruptured right VA dissecting aneurysm that involved the origin of the PICA. A 4.5 x 37-mm Enterprise stent was then placed through the proximal VA to the PICA. The dissected segment of the VA was completely occluded by coil embolization. The 1-year follow-up angiography showed that the dissected segment was completely occluded and the diameter of the PICA was slightly increased, and the PICA's patency was good.

  2. Lesion patterns and etiology of ischemia in the anterior inferior cerebellar artery territory involvement: a clinical - diffusion weighted - MRI study.

    PubMed

    Kumral, E; Kisabay, A; Ataç, C

    2006-04-01

    The topography and mechanism of stroke in the anterior inferior cerebellar artery (AICA) territory are delineated before, but the detailed clinical spectrum of lesions involving AICA territory was not studied by diffusion weighted imaging (DWI). We reviewed 1350 patients with posterior circulation ischemic stroke in our registry. We included patients if the diagnosis of AICA territory involvement was confirmed, and DWI, and magnetic resonance angiography were obtained in the 3 days of symptoms onset. The potential feeding arteries of the AICA territory were evaluated on magnetic resonance imaging (MRI) using a three-dimensional rotating cineoangiographic method. There were 23 consecutive patients with lesion involving AICA territory, six with isolated lesion in the AICA territory, six with posterior inferior cerebellar artery, 11 with multiple posterior circulation infarcts (MPCIs). The clinical feature of isolated AICA infarct was vertigo, tinnitus, dysmetria, ataxia, facial weakness, facial sensory deficits, lateral gaze palsy, and sensory-motor deficits in patients with pontine involvement. Patients with largest lesion extending to the anterior and inferolateral cerebellum showed mixed symptomatology of the lateral medullary (Wallenberg's syndrome) and AICA territory involvement. Patients with MPCIs presented various clinical pictures with consciousness disturbances and diverse clinical signs because of involvement of different anatomical structures. Large-artery atherosclerotic disease in the vertebrobasilar system was the main cause of stroke in 12 (52%) patients, cardioembolism (CE) in one (4%), and coexisting large-artery disease and a source of CE in four (17%). The main cause of stroke was atheromatous vertebrobasilar artery disease either in the distal vertebral or proximal basilar artery. The outcome was usually good except those with multiple lesions. The new MRI techniques and clinical correlations allow better definition of the diverse topographical

  3. Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion

    PubMed Central

    Marutani, Akiko; Nakagawa, Ichiro; Park, Hun Soo; Tamura, Kentaro; Motoyama, Yasushi; Nakase, Hiroyuki

    2016-01-01

    Background: A distal posterior inferior cerebellar artery (PICA) de novo aneurysm at the cortical segment after atherosclerotic basilar artery occlusion is extremely rare. Here, we report the case of a ruptured distal PICA de novo aneurysm 8 years after basilar artery occlusion. Case Description: A 75-year-old man experienced sudden disturbance of consciousness; computed tomography demonstrated cerebellar and subarachnoid hemorrhage due to a ruptured distal PICA aneurysm. Neck clipping of the aneurysm prevented re-rupture initially, and superficial temporal artery-superior cerebellar artery (STA-SCA) bypass was performed 3 months after admission. Postoperative angiography confirmed patency of the bypass, and the patient was discharged without any new neurological deficits. Conclusion: This report describes a case of de novo development of a saccular distal PICA aneurysm after atherosclerotic basilar artery occlusion. We believe that increased hemodynamic stress at the PICA might have contributed to the occurrence and rupture of the aneurysm. STA-SCA bypass, introduced in the territory of the cerebellar hemisphere, reduces hemodynamic stress, which would prevent the occurrence of de novo aneurysm and recurrent bleeding. PMID:28144485

  4. Aneurysm of the distal anterior inferior cerebellar artery at the medial branch: a case report and review of the literature.

    PubMed

    Mizushima, H; Kobayashi, N; Yoshiharu, S; Kazuo, H; Dohi, K; Sasaki, K; Matsumoto, K

    1999-08-01

    Distal aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Most have been located at the cerebellopontine angle. Only three cases, including ours, located in the medial branch of the AICA have been reported in the literature. A 55-year-old female presented with epilepsy that she experienced for the first time. Computed tomography and magnetic resonance imaging revealed no abnormality. Digital subtraction angiography (DSA) disclosed a rare aneurysm at the medial branch of the distal anterior inferior cerebellar artery. In the blood workup on her admission, a mild inflammatory sign was found, and bacterial aneurysm was suggested as the presumptive differential diagnosis. Repeated DSA was performed 3 months after admission, but the aneurysm did not disappear. She then underwent a suboccipital craniotomy in the prone position. The aneurysm was clipped and partially resected for the pathological examination. Histologic examination revealed a true aneurysm. She was discharged without neurological deficit. In this report, we summarize the previous cases and discuss the location and clinical manifestations of aneurysms of the AICA through a review of the literature.

  5. Ruptured vertebral artery-posterior inferior cerebellar artery aneurysm associated with facial nerve paresis successfully treated with interlocking detachable coils--case report.

    PubMed

    Kurokawa, R; Saito, R; Nakamura, Y; Kagami, H; Ichikizaki, K

    1999-11-01

    An 81-year-old female presented with severe headache. Computed tomography revealed subarachnoid hemorrhage. She developed right facial nerve paresis on the next day. Angiography revealed a right vertebral artery-posterior inferior cerebellar artery aneurysm. The aneurysm was successfully occluded with interlocking detachable coils (IDCs) on the 7th day. Magnetic resonance (MR) imaging 1 month after IDC placement showed partially thrombosed aneurysm near the internal acoustic meatus. Ten months after the ictus, MR imaging revealed marked resolution of the intra-aneurysmal thrombus and reduction of the aneurysm size. Her facial nerve function gradually recovered during this period. Her facial nerve paresis was probably caused by acute stretching of the facial nerve by the ruptured aneurysm that was in direct contact with the nerve. Intra-aneurysmal thrombosis using coils can reduce aneurysm size and alleviate cranial nerve symptoms.

  6. [Compression of the inferior cerebellar artery-induced compression of the medulla oblongata in Arnold-Chiari malformation as a cause of essential hypertension].

    PubMed

    Makhmudov, U V; Salalykin, V I; Shimanskiĭ, V N; Taniashin, S V; Sidorkin, D V

    2001-01-01

    Cerebrovascular abnormalities (primarily looping of cerebellar arteries) are almost without exception concurrent with the Arnold-Chiari syndrome and hydrocephalus. Persistent essential hypertension may be a manifestation of pathological vessel-brain contact. Customary microvascular decompression may lead to blood pressure stabilization in the postoperative period for a long time. The paper presents a clinical case of a 52-year female patient with the Arnold-Chiari syndrome who underwent microvascular decompression of the left posterior inferior cerebellar artery at the level of the medulla oblongata. Surgical treatment regressed preoperative cerebellar, bulbar, and truncal symptoms, lowered blood pressure from 190/100 to 120/80 mm Hg, and stabilized it at this level.

  7. [A dissecting aneurysm of the posterior inferior cerebellar artery was reduced spontaneously during conservative therapy: case report].

    PubMed

    Wakamoto, Hirooki; Orii, Maaya; Miyazaki, Hiromichi; Ishiyama, Naomi

    2002-04-01

    We report here a case of a patient with a dissecting aneurysm of the anterior medullary segment of the posterior inferior cerebellar artery (PICA) which presented with Wallenberg's syndrome. A 32-year-male presented with an unusual case of Wallenberg's syndrome due to a dissecting aneurysm of the PICA manifesting as a sensation of heaviness in the occipital region and vertigo. The occipital symptoms persisted and vertigo and vomiting developed after 6 days. Numbness developed on the left side of the patient's face, and hyperalgesia on the right side of the body. The diagnosis of Wallenberg's syndrome was based on the above findings. MRI revealed infarction of the lateral aspect of the medulla oblongata and MR angiography revealed dilatation in the proximal portion of the left PICA. Digital subtraction angiography revealed that the left vertebral artery was essentially normal, but there was a spindle-shaped dilatation in the proximal portion of the left PICA. We carried out conservative therapy at the patient's request and 3D-CTA revealed that the dissecting aneurysm was markedly reduced in size seven months after the onset. Dissecting aneurysms of the intracranial posterior circulation have been shown to be less uncommon than previously thought. However, those involving the PICA without involvement of the vertebral artery at all are extremely rare. The natural history of the dissecting PICA aneurysm was unknown, and the indication for surgical treatment of such aneurysms remains controversial. Management options are conservative treatment, open surgical treatment including wrapping, trapping, and resection with reconstruction, but almost all of the patients underwent radical treatment to prevent rupture of the aneurysm. However we had no knowledge of the risk of rupture of a PICA dissecting aneurysm presenting with ischemic symptoms. We have reviewed the well-documented 15 cases of dissecting aneurysms of the PICA reported in the literature and we discuss the

  8. Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach.

    PubMed

    Chwajol, Markus; Hage, Ziad A; Amin-Hanjani, Sepideh; Charbel, Fady T

    2013-01-01

    Extracranial aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with only 22 reported cases in the English literature. For saccular extracranial distal PICA aneurysms not amenable to coiling, a surgically placed clip is not protected by the cranium postoperatively, and can be subject to movement in the mobile cervical region. Furthermore, fusiform or complex aneurysms cannot be clipped primarily. Resection and primary reanastomosis is a useful surgical approach not previously described for these extracranial lesions. We report three cases of extracranially located distal PICA aneurysms successfully treated with this surgical strategy at our center. One patient harboring a broad necked saccular aneurysm originally underwent successful primary clipping of the aneurysm but sustained a second subarachnoid hemorrhage (SAH) on postoperative day 25 due to clip dislodgement from vigorous neck movement. The other two patients were found to have fusiform and complex aneurysms, respectively. All three patients were ultimately treated with resection and end-to-end PICA anastomosis, which successfully obliterated their aneurysms. Resection and primary reanastomosis of extracranial distal PICA aneurysms averts the risk of clip dislodgement due to neck movement and/or compression by soft tissues in the upper cervical region. It is a safe and efficacious technique, which we propose as the preferred management strategy for these rare vascular lesions.

  9. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    PubMed

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  10. Ruptured Distal Posterior Inferior Cerebellar Artery (PICA) Aneurysms Associated with Cerebellar Arterial Venous Malformations (AVMs): A Case Series and Review of the Literature Demonstrating the Need for Angiographic Evaluation and Feasibility of Endovascular Treatment.

    PubMed

    Case, David; Kumpe, David; Cava, Luis; Neumann, Robert; White, Andrew; Roark, Christopher; Seinfeld, Joshua

    2017-01-01

    The characteristics, diagnosis, and preferred management strategies for distal posterior inferior cerebellar artery (PICA) aneurysms associated with cerebellar arteriovenous malformation (AVMs) are poorly understood. We present a case series with attention to aneurysm angioarchitecture, diagnostic imaging, treatment approaches, and a thorough review of the literature. With this information, we demonstrate a specific anatomical pattern for these aneurysms, an underreported need for conventional digital subtraction angiography (DSA) during evaluation, along with the utility of endovascular treatment with liquid embolic agents. Neurosurgical patients from 2005 to 2016 were reviewed to identify PICA aneurysms along with distal PICA aneurysms. Details of their presentation, imaging studies, associated AVMs and treatment were recorded. A thorough literature search of previous case series and case reports of distal PICA aneurysms with and without associated small cerebellar AVMs was performed with PubMed and Google Scholar. Thirty-four patients with PICA aneurysms were identified at our institution, 12 of which were in a distal segment. All 12 of these patients underwent DSA as a part of their evaluation. Of the 12 patients with distal PICA aneurysms, 9 presented with subarachnoid hemorrhage and intraventricular hemorrhage. Five of these patients had a small occult cerebellar AVM. All nine patients presenting with a ruptured distal PICA aneurysm had a Fischer grade 4 subarachnoid hemorrhage. Of the five patients with a small occult cerebellar AVM, the AVM nidus was missed on computed tomography angiogram (CTA) interpretation but easily visualized with DSA. CTA followed by DSA with concurrent endovascular treatment was performed in 9 of the 12 patients with distal PICA aneurysms. Two of the 12 patients were treated with microsurgical clip ligation, and one mycotic aneurysm was identified and treated with antibiotics. Parent vessel sacrifice was used distal to the aneurysm

  11. Development of anterior inferior cerebellar artery pseudoaneurysm after gamma knife surgery for vestibular schwannoma. A case report and review of the literature.

    PubMed

    Sunderland, Geraint; Hassan, Faizul; Bhatnagar, Priya; Mitchell, Patrick; Jayakrishnan, Vijayam; Forster, David; Mendelow, Alexander David

    2014-08-01

    Gamma knife surgery (GKS) is a well-established modality for controlling the progression of vestibular schwannomas. Adverse effects of this treatment are extremely rare but include cyst formation and malignant transformation. We report a case of anterior inferior cerebellar artery (AICA) pseudoaneurysm development rupture presenting as a poor WFNS grade subarachnoid haemorrhage. This is only the fourth case of aneurysm development (AICA aneurysm) following GKS reported but due to its serious nature we believe this potential complication warrants awareness in those offering this treatment.

  12. Superior and anterior inferior cerebellar arteries and their relationship with cerebello-pontine angle cranial nerves revisited in the light of cranial cephalometric indexes: a cadaveric study.

    PubMed

    Habibi, Zohreh; Meybodi, Ali Tayebi; Maleki, Farid; Tabatabai, Seyed

    2011-01-01

    The aim was to clarify the anatomical features of the superior and anterior inferior cerebellar arteries in relation to the trigeminal nerve and acoustic-facial complex and to the bony structures of the skull in a sample of male Iranian cadavers. Bilateral dissections, calvariectomy, and brain evacuation were performed on 31 adult human fresh brains and skull bases to assess the neurovascular associations, and skull base morphometry. Equations were defined to estimate posterior fossa volume and the relationships between bony and neurovascular elements. Eight SCAs were duplicated from origin. There were 9 cases of SCA-trigeminal contacts, which were at the root entry zone in 7. Mean distance from the origin of AICA to the vertebrobasilar junction was 11.80 mm, while 79% of AICAs originated from the lower half of the BA. This was significantly associated with "posterior fossa funneling" and "basilar narrowing" indexes. In most cases AICA crossed the acoustic-facial complex and coursed between neural bundles (48.3%). The AICA reached or entered the internal acoustic canal in 22.6% of cases and was medial to porous in 77.4%. We documented anatomical variations of the superior and anterior inferior cerebellar arteries along with some cephalometric equations with relevant neurovascular anatomy in Iranian cadavers.

  13. Compression of the medulla oblongata and acute respiratory failure caused by rupture of a thrombosed large aneurysm of the anterior inferior cerebellar artery.

    PubMed

    Oyama, Hirofumi; Kito, Akira; Maki, Hideki; Hattori, Kenichi; Tanahashi, Kuniaki

    2010-01-01

    A 65-year-old female presented with an extremely rare case of a ruptured thrombosed large aneurysm of the anterior inferior cerebellar artery (AICA) in which a local hematoma compressed the medulla oblongata and caused acute respiratory failure. She first presented with dizziness, general fatigue, and nausea 2 months before admission. She was hospitalized for intense general fatigue, nausea, and occipitalgia. Computed tomography and T(1)-weighted magnetic resonance imaging showed a heterogeneous lesion around the right cerebello-medullary cistern. Angiography revealed a fusiform aneurysm of the right AICA. Asphyxia occurred 4 days after admission and the patient underwent an emergency operation. No subarachnoid hematoma was present, but a hematoma around the ruptured portion markedly compressed the medulla oblongata. The medulla oblongata was adequately decompressed after subtotal removal of the aneurysm. The patient's respiratory status and consciousness level recovered after the operation.

  14. Treatment of a partially thrombosed giant aneurysm of the vertebral artery by aneurysm trapping and direct vertebral artery-posterior inferior cerebellar artery end-to-end anastomosis: technical case report.

    PubMed

    Benes, Ludwig; Kappus, Christoph; Sure, Ulrich; Bertalanffy, Helmut

    2006-07-01

    The purpose of this article is to focus for the first time on the operative management of a direct vertebral artery (VA)-posterior inferior cerebellar artery (PICA) end-to-end anastomosis in a partially thrombosed giant VA-PICA-complex aneurysm and to underline its usefulness as an additional treatment option. The operative technique of a direct VA-PICA end-to-end anatomosis is described in detail. The VA was entering the large aneurysm sack. Distally, the PICA originated from the aneurysm sack-VA-complex. The donor and recipient vessel were cut close to the aneurysm. Whereas the VA was cut in a straight manner, the PICA was cut at an oblique 45-degree angle to enlarge the vascular end diameter. Vessel ends were flushed with heparinized saline and sutured. The thrombotic material inside the aneurysm sack was removed and the distal VA clipped, leaving the anterior spinal artery and brainstem perforators free. The patient regained consciousness without additional morbidity. Magnetic resonance imaging scans revealed a completely decompressed brainstem without infarction. The postoperative angiograms demonstrated a good filling of the anastomosed PICA. Despite the caliber mistmatch of these two vessels the direct VA-PICA end-to-end anastomosis provides an accurate alternative in addition to other anastomoses and bypass techniques, when donor and recipient vessels are suitable and medullary perforators do not have to be disrupted.

  15. Partial wrap-clipping of the entrance of the pseudolumen of a fusiform aneurysm in the posterior inferior cerebellar artery: a technical note.

    PubMed

    Motoyama, Yasushi; Takamura, Yoshiaki; Yamada, Shuichi; Park, Young-Su; Nakase, Hiroyuki

    2017-05-01

    Fusiform aneurysms in the posterior inferior cerebellar artery (PICA) are rare and challenging to treat. Surgical treatment options for a fusiform aneurysm in the PICA include trapping with/without bypass and wrap-clipping, when elimination of the pathological wall from the systemic circulation and prevention of perforator injury are important. In addition, lower cranial nerve impairment due to surgical manipulation should also be avoided. A fusiform-shaped aneurysm was found in a proximal part of the PICA by magnetic resonance angiography undertaken for evaluation of repeated vertigo in a 36-year-old man. The patient underwent direct surgery via a lateral suboccipital transcondylar fossa approach. The entrance of the pseudolumen was the only part to be wrapped and obstructed by clip application, through the corridor between the acoustic and glossopharyngeal nerves to avoid lower cranial nerve injury. Indocyanine green (ICG) videoangiography demonstrated obliteration of pseudolumen and patency of peripheral PICA and perforator contributing to the medulla oblongata. The postoperative course was uneventful without periprocedural complications, including dysphagia and hoarseness. Partial wrap-clipping technique for obstruction of the entrance into a pseudolumen is one of alternatives for dissecting fusiform-shaped aneurysm in the PICA. ICG videoangiography was helpful to confirm the obliteration of the pseudolumen and patency of parent vessel and perforators.

  16. Glucose utilization in the inferior cerebellar vermis and ocular myoclonus.

    PubMed

    Yakushiji, Y; Otsubo, R; Hayashi, T; Fukuchi, K; Yamada, N; Hasegawa, Y; Minematsu, K

    2006-07-11

    In a patient with symptomatic ocular myoclonus, the authors observed the regional cerebral metabolic rate of glucose use (rCMRGlu) before and after successful treatment with clonazepam. Even after the symptoms resolved, the rCMRGlu in the hypertrophic olive increased persistently, whereas that in the inferior cerebellar vermis contralateral to the hypertrophic olive decreased. The inferior cerebellar vermis, belonging to the vestibulocerebellar system, may be associated with the generation of symptomatic ocular myoclonus.

  17. Inferior Olivary TMEM16B Mediates Cerebellar Motor Learning.

    PubMed

    Zhang, Yang; Zhang, Zhushan; Xiao, Shaohua; Tien, Jason; Le, Son; Le, Trieu; Jan, Lily Y; Yang, Huanghe

    2017-08-30

    Ca(2+)-activated ion channels shape membrane excitability and Ca(2+) dynamics in response to cytoplasmic Ca(2+) elevation. Compared to the Ca(2+)-activated K(+) channels, known as BK and SK channels, the physiological importance of Ca(2+)-activated Cl(-) channels (CaCCs) in neurons has been largely overlooked. Here we report that CaCCs coexist with BK and SK channels in inferior olivary (IO) neurons that send climbing fibers to innervate cerebellar Purkinje cells for the control of motor learning and timing. Ca(2+) influx through the dendritic high-threshold voltage-gated Ca(2+) channels activates CaCCs, which contribute to membrane repolarization of IO neurons. Loss of TMEM16B expression resulted in the absence of CaCCs in IO neurons, leading to markedly diminished action potential firing of IO neurons in TMEM16B knockout mice. Moreover, these mutant mice exhibited severe cerebellar motor learning deficits. Our findings thus advance the understanding of the neurophysiology of CaCCs and the ionic basis of IO neuron excitability. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Congenital rubella with agenesis of the inferior cerebellar vermis and total anomalous pulmonary venous drainage.

    PubMed

    Cluver, C; Meyer, R; Odendaal, H; Geerts, L

    2013-08-01

    Congenital rubella infection has been associated with a number of abnormalities including cardiac, central nervous system and placental complications. We present a case with multiple fetal abnormalities detected on prenatal ultrasound, and confirmed postnatally, that included a single umbilical artery, severe tricuspid regurgitation, micrognathia and agenesis of the inferior cerebellar vermis. Postnatal echocardiography additionally revealed unobstructed total anomalous pulmonary venous drainage (TAPVD) into the coronary sinus. Placental examination showed signs of placentitis, and polymerase chain reaction on neonatal serum was positive for rubella. Following a multidisciplinary team review, it was decided to provide only supportive care, and the infant died at 6 months of age owing to a respiratory tract infection. To our knowledge, TAPVD and agenesis of the inferior cerebellar vermis have not been reported previously in association with congenital rubella infection. This case illustrates how congenital infection may present in atypical ways and stresses the importance of considering congenital infection in the differential diagnosis of fetal anomalies when multiple features are present.

  19. Inferior pancreaticoduodenal artery aneurysm associated with common hepatic artery occlusion.

    PubMed

    Bracale, G; Porcellini, M; Bernardo, B; Selvetella, L; Renda, A

    1996-12-01

    A unique case of true inferior pancreaticoduodenal artery aneurysm (IPDA) associated with occlusion of common hepatic artery is reported. Radiological and MRI findings are described. Because of high risk of visceral ischemia that contraindicated a percutaneous transluminal embolization, a successful tangential resection of aneurysm was performed.

  20. A case of cerebellar infarction caused by vertebral artery injury from a stab wound to the neck.

    PubMed

    Park, Jung Je; Shim, Hyun Seok; Jeong, Jae Ho; Whang, Soo Hyun; Kim, Jin Pyeong; Jeon, Sea Young; Kwon, Oh Jin

    2007-09-01

    Vertebral artery injuries are the least common arterial injuries because of the deep location of the vessel in a bony canal. Injury of this vessel has not been associated with neurological deficits, and it is thought that many of these injuries are not recognized. The incidence of vertebral artery injury occurring after a penetration wound to the neck varies from 1.0% in gunshot wounds to 7.4% in stab wounds. However, even with vertebral artery injury in penetration wounds of the neck the association with cerebellar infarction is a rare occurrence. We describe a case of cerebellar infarction caused by vertebral artery injury from a stab wound that severed the vessel between the transverse processes of C3 and C4 with a hypoplastic contralateral vertebral artery. The patient ultimately suffered infarction of the cerebellum due to the lack of preservation of the posterior inferior cerebellar artery blood flow. Management is discussed and the medical literature is reviewed.

  1. [Surgery of AVM of the inferior medullary velum by the uvulotonsillar approach--advantage of moving of the cerebellar tonsil: technical case report].

    PubMed

    Shigeno, Taku; Kumai, Junichiro; Endo, Masaru; Hotta, Shinji

    2002-01-01

    An incidentally found arteriovenous malformation (AVM) of the inferior medullary velum behind the medulla was removed by the lateral approach to the fourth ventricle originally described by Seeger in 1980. A wide posterior fossa craniotomy was performed to move the cerebellar tonsil laterally with C-1 laminectomy. The tela chroidea and inferior medullary velum, the two main sheets of tissue that form the lower half of the roof of the fourth ventricle can be exposed by gently displacing the tonsils laterally without splitting the vermis. Both the cerebellomedullary and uvulotonsillar spaces were exposed. Because the lateral cerebellomedullary cistern was also exposed, the moving of the cerebellar tonsil in a lateral direction was easy to do without injuring the cerebellar tissues. The nidus was located mainly in the extrapial plane that received feeding arteries from the posterior inferior cerebellar artery. The nidus was removed in a dry field without bleeding. This report is the first report of surgical removal of unruptured AVM of the inferior medullary velum through the so-called telovelar or transcerebellomedullary fissure approach. We propose to call this approach the uvulotonsillar approach to emphasize the dissecting plane between the uvula and the tonsil.

  2. Clipping of ipsilateral posterior communicating and superior cerebellar artery aneurysms.

    PubMed

    Welch, Babu G

    2015-01-01

    The case is a 55-year-old female who presented with dizziness as the chief complaint. She has a family history of two relatives with subarachnoid hemorrhage. Digital subtraction angiography revealed the presence of a left-sided posterior communicating artery aneurysm and an ipsilateral superior cerebellar artery (SCA) aneurysm. Due to the smaller nature of the SCA, a decision was made to proceed with surgical clipping of both lesions through a pterional approach. A narrated video with illustrations depicts the intraoperative management of these lesions with postoperative angiography results. The video can be found here: http://youtu.be/HCHToSsXv-4 .

  3. Spontaneous Recanalization of Superior Mesenteric Artery Occlusion Following Angioplasty and Stenting of Inferior Mesenteric Artery

    SciTech Connect

    Akpinar, Erhan Cil, Barbaros E.; Arat, Anil; Baykal, Atac; Karaman, Kerem; Balkanci, Ferhun

    2006-02-15

    An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with a progressively worsening diffuse abdominal pain. Computed tomography scan of the abdomen and angiography revealed occlusion of the origin and proximal portion of superior mesenteric artery. Aortography also showed severe origin stenosis of inferior mesenteric artery and that the distal part of the superior mesenteric artery was supplied by a prominent marginal artery of Drummond. Patient was effectively treated with percutaneous transluminal angioplasty and stenting of the inferior mesenteric artery. Follow-up imaging studies demonstrated patency of the stent and spontaneous recanalization of superior mesenteric artery occlusion.

  4. Anatomical study on the "perforator-free zone": reconsidering the proximal superior cerebellar artery and basilar artery perforators.

    PubMed

    Garcia-Gonzalez, Ulises; Cavalcanti, Daniel D; Agrawal, Abhishek; Spetzler, Robert F; Preul, Mark C

    2012-03-01

    The proximal superior cerebellar artery (pSCA) is often considered a perforator-free area. Precise anatomical knowledge of this region clarifies the pathophysiology underlying posterior fossa ischemic syndromes and helps avoid treatment-related complications. To anatomically evaluate perforating branches arising from the pSCA and the upper basilar artery (BA). Forty-four SCAs from 20 cadaveric heads were examined to determine patterns of the pSCA; its morphometry for medial and lateral branches; and frequency, number, diameter, distribution, and vascular territory of perforators arising from the pSCA and rostral BA. SCA arose as a single trunk in 36 sides (90%): mean diameter at origin was 1.38 mm; mean length was 14.4 ± 7.9 mm. Ninety-nine pSCA perforator branches were present in 82% of specimens (mean, 2.3 ± 1.6; range, 0-7 perforators/side). Of these, 59% were direct, belonging to the interpeduncular group in 85% of cases; 28% were short circumflex, belonging to lateral and medial pontine group; and 13% were long circumflex, reaching the medullary perforation zone (basal cerebellar group). Median distance to the first perforator was 2.0 mm (range, 0.1-15 mm). There were 132 perforator branches in the last centimeter of the BA. The pSCA should not be regarded as a perforator-free area. Although the pSCA territories likely overlap with the posterior cerebral artery, BA, and anterior inferior cerebellar artery, the pSCA segment cannot be surgically manipulated with impunity.

  5. Infantile intracranial aneurysm of the superior cerebellar artery.

    PubMed

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-03-03

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes.

  6. Infantile intracranial aneurysm of the superior cerebellar artery.

    PubMed

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-02-29

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes. 2016 BMJ Publishing Group Ltd.

  7. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics

    PubMed Central

    Sommer, Wieland H; Bollwein, Christine; Thierfelder, Kolja M; Baumann, Alena; Janssen, Hendrik; Ertl-Wagner, Birgit; Reiser, Maximilian F; Plate, Annika; Straube, Andreas

    2015-01-01

    We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis. PMID:26661242

  8. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics.

    PubMed

    Sommer, Wieland H; Bollwein, Christine; Thierfelder, Kolja M; Baumann, Alena; Janssen, Hendrik; Ertl-Wagner, Birgit; Reiser, Maximilian F; Plate, Annika; Straube, Andreas; von Baumgarten, Louisa

    2016-04-01

    We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis. © The Author(s) 2015.

  9. Inferior epigastric artery: Surface anatomy, prevention and management of injury.

    PubMed

    Wong, Clare; Merkur, Harry

    2016-04-01

    The anatomical position of the inferior epigastric artery (IEA) subjects it to risk of injury during abdominal procedures that are close to the artery, such as laparoscopic trocar insertion, insertion of intra-abdominal drains, Tenckhoff(®) catheter (peritoneal dialysis catheter) and paracentesis. This article aims to raise the awareness of the anatomical variations of the course of the IEA in relation to abdominal landmarks in order to define a safer zone for laparoscopic ancillary trocar placement. Methods of managing the IEA injury as well as techniques to minimise the risk of injury to the IEA are reviewed and discussed.

  10. A Case of the Inferior Mesenteric Artery Arising from the Superior Mesenteric Artery in a Korean Woman

    PubMed Central

    Yoo, Seung Jin; Ku, Min Jung; Cho, Sa Sun

    2011-01-01

    Anatomical variations of the inferior mesenteric artery are extremely uncommon, since the inferior mesenteric artery is regularly diverged at the level of the third lumbar vertebra. We found a rare case in which the inferior mesenteric artery arose from the superior mesenteric artery. The findings were made during a routine dissection of the cadaver of an 82-yr-old Korean woman. This is the tenth report on this anomaly, the second female and the first Korean. The superior mesenteric artery normally arising from abdominal aorta sent the inferior mesenteric artery as the second branch. The longitudinal anastomosis vessels between the superior mesenteric artery and inferior mesenteric artery survived to form the common mesenteric artery. This anatomical variation concerning the common mesenteric artery is of clinical importance, performing procedures containing the superior mesenteric artery. PMID:22022194

  11. Cerebellar inhibitory output shapes the temporal dynamics of its somatosensory inferior olivary input.

    PubMed

    Hogri, Roni; Segalis, Eyal; Mintz, Matti

    2014-08-01

    The cerebellum is necessary and sufficient for the acquisition and execution of adaptively timed conditioned motor responses following repeated paired presentations of a conditioned stimulus and an unconditioned stimulus. The underlying plasticity depends on the convergence of conditioned and unconditioned stimuli signals relayed to the cerebellum by the pontine nucleus and the inferior olive (IO), respectively. Adaptive timing of conditioned responses relies on the correctly predicted onset of the unconditioned stimulus, usually a noxious somatosensory stimulus. We addressed two questions: First, does the IO relay information regarding the duration of somatosensory stimuli to the cerebellum? Multiple-unit recordings from the IO of anesthetized rats that received periorbital airpuffs of various durations revealed that sustained somatosensory stimuli are invariably transformed into phasic IO outputs. The phasic response was followed by a post-peak depression in IO activity as compared to baseline, providing the cerebellum with a highly synchronous signal, time-locked to the stimulus' onset. Second, we sought to examine the involvement of olivocerebellar interactions in this signal transformation. Cerebello-olivary inhibition was interrupted using temporary pharmacological inactivation of cerebellar output nuclei, resulting in more sustained (i.e., less synchronous) IO responses to sustained somatosensory stimuli, in which the post-peak depression was substituted with elevated activity as compared to baseline. We discuss the possible roles of olivocerebellar negative-feedback loops and baseline cerebello-olivary inhibition levels in shaping the temporal dynamics of the IO's response to somatosensory stimuli and the consequences of this shaping for cerebellar plasticity and its ability to adapt to varying contexts.

  12. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps.

    PubMed

    Spiegel, Aldona J; Eldor, Liron

    2010-08-01

    In this study, partial breast reconstruction was undertaken after breast conservation therapy using mini abdominal free flaps on both an immediate and delayed basis.Patient demographics, oncologic status, reconstructive data, and complications were collected from medical records.Twelve patients (age range 39-60) were included in this study with a mean follow-up time of 5 years. Ten mini superficial inferior epigastric artery flaps and 2 mini deep inferior epigastric perforator flaps were used (7 immediate and 5 delayed reconstructions). No flap lost, 1 minor abdominal wound dehiscence, and no local or distant recurrences were noted. Good to excellent results were reported by 91% of the women.In properly selected patients with high motivation toward breast conservation, tailored abdominal mini-free flaps can safely and satisfactorily be implemented for the reconstruction of partial mastectomy defects. Patients should be comprehensively educated on the potential future implications of using the abdominal donor site for partial breast reconstruction.

  13. Aberrant origin of the inferior thyroid artery from the common carotid artery: a rare anatomical variation

    PubMed Central

    Ngo Nyeki, Adèle-Rose; Peloni, Giuseppe; Karenovics, Wolfram; Triponez, Frédéric

    2016-01-01

    We describe the case of a rare anatomical variant of the inferior thyroid artery (ITA) taking its origin directly from the common carotid artery (CCA) instead of the thyrocervical trunk (TCT). This anatomical feature exposes to risks of perioperative bleeding and nerve injuries when it is unrecognized by the surgeons. Knowledge of its existence may be helpful to reduce risks for the patient. PMID:28149813

  14. Use of the inferior epigastric artery to revascularize a lower pole renal artery in renal transplant.

    PubMed

    Young, J S; Rohr, M S

    1995-02-01

    The increasing use of living-related donors has increased the incidence wherein the transplant surgeon is required to use special vascular surgical techniques to transplant kidneys with anomalous arterial anatomy. One of the most commonly encountered arterial anomalies is the presence of a lower pole renal artery. In many cases, this artery can be anastomosed to the main renal artery, and the main renal artery can then be anastomosed into the recipient vessel. However, there are cases where the lower pole renal artery is too distant from the main renal artery to allow an anastomosis to be performed. The lower pole renal artery of the graft must be revascularized to avoid ischemic injury to the ureter. Thus, alternate methods for the revascularization of this vessel must be found. We describe the use of the recipient inferior epigastric artery as an arterial supply for the donor lower pole artery. In our case report, this method provided excellent flow to the lower kidney and was documented by later studies.

  15. [Conservative management of a ruptured inferior pancreaticoduodenal artery aneurysm associated with celiac artery occlusion].

    PubMed

    Kidogawa, Hideo; Okamoto, Kohji; Yamayoshi, Takatomo; Noguchi, Junya

    2013-10-01

    A 45-year-old female presented at our hospital with a one-day history of upper abdominal pain. Abdominal computed tomography (CT) revealed that the root of the celiac artery was obstructed and that a large hematoma was present in the retroperitoneum. The patient was diagnosed with retroperitoneal hemorrhage associated with the rupture of an inferior pancreaticoduodenal artery aneurysm, which was caused by increased blood flow in the pancreaticoduodenal arterial arcade. Because the patient's general condition was stable, she was managed conservatively and discharged on achieving remission after a month. Follow-up CT revealed spontaneous resolution of the celiac artery obstruction and aneurysm. The celiac artery obstruction in this case was assumed to be caused by segmental arterial mediolysis.

  16. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation.

    PubMed

    El-Sherbiny, M; Abou-Elela, A; Morsy, A; Salah, M; Foda, A

    2008-01-01

    This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning +/- MRA in some patients. In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.

  17. Unilateral Breast Reconstruction Using Bilateral Inferior Gluteal Artery Perforator Flaps

    PubMed Central

    Muto, Mayu; Ogawa, Marina; Shibuya, Mai; Yasumura, Kazunori; Kobayashi, Shinji; Ishikawa, Takashi; Maegawa, Jiro

    2015-01-01

    Background: For reconstructing moderate-to-high projection breasts in nulliparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity. Methods: We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon. Results: Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps). Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative. PMID:25878925

  18. A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state.

    PubMed

    Troisi, Nicola; Esposito, Giovanni; Cefalì, Pietro; Setti, Marco

    2011-07-01

    Inferior mesenteric artery aneurysms are very rare and they are among the rarest of visceral artery aneurysms. Sometimes, the distribution of the blood flow due to chronic atherosclerotic occlusion of some arteries can establish an increased flow into a particular supplying district (high flow state). A high flow state in a stenotic inferior mesenteric artery in compensation for a mesenteric occlusive disease can produce a rare form of aneurysm. We report the case of an atherosclerotic inferior mesenteric aneurysm secondary to high flow state (association with occlusion of the celiac trunk and severe stenosis of the superior mesenteric artery), treated by open surgical approach.

  19. Chemoembolization for hepatocellular carcinoma via the inferior pancreaticoduodenal artery in patients with celiac artery stenosis.

    PubMed

    Okazaki, M; Higashihara, H; Ono, H; Koganemaru, F; Fujimitsu, R; Mizuma, Y; Nakamura, T; Sato, S; Kimura, S; Kodama, S

    1993-01-01

    Twenty-one patients with hepatocellular carcinoma (HCC) accompanied by extensive celiac artery stenosis or obstruction were treated by chemoembolization via the inferior pancreaticoduodenal artery (IPDA). The tip of the catheter was placed in the arteries in front of the confluence with the proper hepatic artery in 12 patients (group A: the proximal portion of the IPDA in 10, and common hepatic artery in 2), and in the proper hepatic artery or branches of it (group B) in 9 using a coaxial catheter system. Transient hyperamylasemia was observed in 10 of the 12 patients in group A and in 3 of the 9 patients in group B after chemoembolization. Splenic infarction developed in 8 patients in group A and in none in group B. Intrapancreatic fluid collection was present in 2 patients in group A following chemoembolization. No fatal complications were encountered. The 1-, 2-, and 3-year survival rates of the 10 patients in group A treated by only chemoembolization were 90, 57, and 23%, respectively (mean survival 780 days). The 1- and 2-year survival rates of 9 patients in group B were 85.8 and 85.8% (mean 879 days), respectively. Considering the severity of complications and the survival rates in groups A and B, chemoembolization by superselective catheterization into the hepatic artery via the IPDA is the treatment of choice. However, chemoembolization from the arteries in front of the confluence with the proper hepatic artery seems to be acceptable in cases of hypervascular HCC which fail to be superselectively catheterized.

  20. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

    PubMed Central

    Bergman, Taylor J.; Saporito, Rachael C.; Hope, Thomas

    2016-01-01

    Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male. PMID:28203181

  1. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation.

    PubMed

    Bergman, Taylor J; Saporito, Rachael C; Hope, Thomas

    2016-01-01

    Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  2. Successful transcatheter arterial embolization of an inferior pancreaticoduodenal artery aneurysm associated with celiac axis stenosis.

    PubMed

    Kobayashi, Toshihiko; Uenoyama, Shoichi; Isogai, Satoshi

    2004-05-01

    A case of inferior pancreaticoduodenal artery (IPDA) aneurysm associated with celiac axis stenosis was successfully treated using only transcatheter arterial embolization (TAE). A 57-year-old woman was urgently referred to our hospital with sudden abdominal pain; computed tomography revealed retroperitoneal hematoma due to bleeding from an aneurysm around the superior mesenteric artery (SMA). Selective angiography into the SMA showed an aneurysm derived from the IPDA posterior branch; the IPDA anterior branch was intact and contrast medium flowed into the common hepatic artery territory through the pancreatic arcade because of celiac axis stenosis. We subsequently performed TAE on the lesion. Arteriography after TAE showed that the aneurysm had disappeared and that the IPDA anterior branch was intact. She had no aneurysm recurrence for about two years after the treatment. We believe that TAE is effective even for a PDA aneurysm with celiac axis stenosis or occlusion. However, it is important to perform embolization precisely and over a long period.

  3. Embolization of Inferior Mesenteric Artery for Intractable Intrapelvic and Vaginal Bleeding After Hysterectomy.

    PubMed

    Kim, Cho Hee; Lee, Shin Jae; Jeon, Gyeong Sik; Kang, Suk Ho; Kim, Hyeon Chul

    Branches of the internal iliac artery or ovarian artery are the typical sources of pelvic hemorrhage. The inferior mesenteric artery has been rarely reported as the origin of pelvic bleeding. We present 2 cases of intractable intrapelvic and vaginal bleeding after hysterectomy. One patient underwent a hysterectomy because of uncontrolled postpartum hemorrhage and another underwent a vaginal hysterectomy to treat vaginal prolapse. Both patients were subjected to angiography to control continuous vaginal bleeding after hysterectomy. The angiography revealed that the bleeding originated from the inferior mesenteric artery. Selective embolization of the inferior mesenteric artery successfully controlled the intractable intrapelvic and vaginal bleeding without complications. The inferior mesenteric artery is a potential source of intractable intrapelvic and vaginal bleeding for patients with a lower genital tract injury. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Traumatic Inferior Gluteal Artery Pseudoaneurysm and Arteriovenous Fistula Managed with Emergency Transcatheter Embolization

    SciTech Connect

    Keeling, A. N.; Naughton, P. A.; Leahy, A. L.; Lee, M. J.

    2008-07-15

    We present a case of blunt trauma to the buttock resulting in an inferior gluteal artery pseudoaneurysm and arteriovenous fistula. The characteristic diagnostic features on CT angiography and digital subtraction angiography (DSA), along with the emergency percutaneous management of this traumatic vascular injury, are described. A review of the literature demonstrates inferior gluteal artery pseudoaneurysm is a rare condition, while successful treatment with glue embolization is previously unreported.

  5. Pseudoaneurysm of the Inferior Epigastric Artery Successfully Treated by Ultrasound-guided Compression

    SciTech Connect

    Takase, Kei Kazama, Takuro; Abe, Kayoko; Chiba, Yoshihiro; Saito, Haruo; Takahashi, Shoki

    2004-09-15

    An 82-year-old woman underwent right hemicolectomy by median laparotomy. Two weeks later, a pulsatile mass was found at the left side of the surgical wound, which was diagnosed as pseudoaneurysm of the inferior epigastric artery by color Doppler US and CT. The pseudoaneurysm was successfully treated by US-guided compression of the neck of the aneurysm for 30 minutes. US-guided compression should be considered the treatment of choice for postsurgical pseudoaneurysm of the inferior epigastric artery.

  6. Cerebellar and cerebral autoregulation in migraine.

    PubMed

    Reinhard, Matthias; Schork, Joscha; Allignol, Arthur; Weiller, Cornelius; Kaube, Holger

    2012-04-01

    Silent ischemic brain lesions frequently occur in migraine with aura and are most often located in cerebellar border zones. This may imply an impairment of cerebellar blood flow autoregulation. This study investigated the characteristics of interictal cerebellar autoregulation in migraine with and without aura. Thirty-four patients (n=17, migraine without aura; n=17, migraine with aura) and 35 age- and sex-matched controls were studied. Triple simultaneous transcranial Doppler monitoring of one posterior inferior cerebellar artery, right posterior cerebral artery, and left middle cerebral artery was performed. Autoregulation dynamics were assessed from spontaneous blood pressure fluctuations (correlation coefficient index Dx) and from respiratory-induced 0.1-Hz blood pressure oscillations (phase and gain). Compared with controls, the autoregulatory index Dx was higher (indicating less autoregulation) in the posterior inferior cerebellar artery (P=0.0062) and middle cerebral artery (P=0.0078) in migraine with aura, but not in migraine without aura. Phase and gain did not significantly differ between migraine patients and controls. No significant associations of autoregulation with clinical factors were found, including frequency of migraine attacks and orthostatic intolerance. This first-time analysis of cerebellar autoregulation in migraine did not show a specific cerebellar dysautoregulation in the interictal period. More static autoregulatory properties (index Dx) are, however, impaired in persons with migraine with aura both in the cerebellar and anterior circulation. The cerebellar predilection of ischemic lesions in migraine with aura might be a combination of altered autoregulation and additional factors, such as the end artery cerebellar angioarchitecture.

  7. Acute Traumatic Renal Artery to Inferior Vena Cava Fistula Treated with a Covered Stent

    SciTech Connect

    Tam, J.; Kossman, T.; Lyon, S.

    2006-12-15

    A 34-year-old man presented within hours of suffering a penetrating stab wound and was diagnosed with a right renal artery to inferior vena cava fistula. Initial attempts at excluding the fistula with a balloon were unsuccessful. He was subsequently treated with a covered stent inserted into the right renal artery which successfully excluded the fistula.

  8. Acute Anterior Myocardial Infarction Accompanied by Acute Inferior Myocardial Infarction: A Very Rare Coronary Artery Anomaly.

    PubMed

    Alsancak, Y; Sezenöz, B; Duran, M; Unlu, S; Turkoglu, S; Yalcın, R

    2015-01-01

    Coronary artery anomalies are rare and mostly silent in clinical practice. First manifestation of this congenital abnormality can be devastating as syncope, acute coronary syndrome, and sudden cardiac death. Herein we report a case with coronary artery anomaly complicated with ST segment myocardial infarction in both inferior and anterior walls simultaneously diagnosed during primary percutaneous coronary intervention.

  9. Trigeminal Neuralgia Completely Relieved After Stent-Assisted Coiling of a Superior Cerebellar Artery Aneurysm.

    PubMed

    Di Stefano, Giulia; Limbucci, Nicola; Cruccu, Giorgio; Renieri, Leonardo; Truini, Andrea; Mangiafico, Salvatore

    2017-05-01

    Although secondary trigeminal neuralgia is usually due to tumors or multiple sclerosis, other major neurologic diseases, such as aneurysms, should be taken into account when the history or the symptoms suggest a secondary origin. A 67-year-old lady presented with a 6-month history of trigeminal neuralgia involving exclusively the right ophthalmic division. A dedicated 3-dimensional-magnetic resonance imaging-magnetic resonance angiography study documented rare contact with a wide-necked aneurysm of the superior cerebellar artery, which distorted the trigeminal root. The patient underwent an endovascular treatment by stent-assisted coiling with the complete disappearance of neuralgic pain attacks within 24 hours. The complete relief from the neuralgic paroxysms immediately after endovascular stent-assisted occlusion of a superior cerebellar artery aneurysm demonstrates the crucial role of a pulsating stimulus on the demyelinated nerve fibers in evoking the ectopically generated discharges. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Embolization in a Patient with Ruptured Anterior Inferior Pancreaticoduodenal Arterial Aneurysm with Median Arcuate Ligament Syndrome

    SciTech Connect

    Ogino, Hiroyuki; Sato, Yozo; Banno, Tatsuo; Arakawa, Toshinao; Hara, Masaki

    2002-08-15

    In median arcuate ligament syndrome, the root of the celiac artery is compressed and narrowed by the median arcuate ligament of the diaphragm during expiration, causing abdominal angina.Aneurysm may be formed in arteries of the pancreas and duodenum due toa chronic increase in blood flow from the superior mesenteric artery into the celiac arterial region. We report a patient saved by embolization with coils of ruptured aneurysm that developed with markedly dilated anterior inferior pancreaticoduodenal artery due to median arcuate ligament syndrome.

  11. Aberrant Left Inferior Bronchial Artery Originating from the Left Gastric Artery in a Patient with Acute Massive Hemoptysis

    SciTech Connect

    Jiang, Sen Sun, Xi-Wen Yu, Dong Jie, Bing

    2013-10-15

    Massive hemoptysis is a life-threatening condition, and the major source of bleeding in this condition is the bronchial circulation. Bronchial artery embolization is a safe and effective treatment for controlling hemoptysis. However, the sites of origin of the bronchial arteries (BAs) have numerous anatomical variations, which can result in a technical challenge to identify a bleeding artery. We present a rare case of a left inferior BA that originated from the left gastric artery in a patient with recurrent massive hemoptysis caused by bronchiectasis. The aberrant BA was embolized, and hemoptysis has been controlled for 8 months.

  12. Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging

    PubMed Central

    Kang, Koung Mi; Sohn, Chul-Ho

    2017-01-01

    Background and purpose Arterial spin-labeling (ASL) was recently introduced as a noninvasive method to evaluate cerebral hemodynamics. The purposes of this study were to assess the ability of ASL imaging to detect crossed cerebellar diaschisis (CCD) in patients with their first unilateral supratentorial hyperacute stroke and to identify imaging or clinical factors significantly associated with CCD. Materials and methods We reviewed 204 consecutive patients who underwent MRI less than 8 hours after the onset of stroke symptoms. The inclusion criteria were supratentorial abnormality in diffusion-weighted images in the absence of a cerebellar or brain stem lesion, bilateral supratentorial infarction, subacute or chronic infarction, and MR angiography showing vertebrobasilar system disease. For qualitative analysis, asymmetric cerebellar hypoperfusion in ASL images was categorized into 3 grades. Quantitative analysis was performed to calculate the asymmetric index (AI). The patients’ demographic and clinical features and outcomes were recorded. Univariate and multivariate analyses were also performed. Results A total of 32 patients met the inclusion criteria, and 24 (75%) presented CCD. Univariate analyses revealed more frequent arterial occlusions, higher diffusion-weighted imaging (DWI) lesion volumes and higher initial NIHSS and mRS scores in the CCD-positive group compared with the CCD-negative group (all p < .05). The presence of arterial occlusion and the initial mRS scores were related with the AI (all p < .05). Multivariate analyses revealed that arterial occlusion and the initial mRS scores were significantly associated with CCD and AI. Conclusion ASL imaging could detect CCD in 75% of patients with hyperacute infarction. We found that CCD was more prevalent in patients with arterial occlusion, larger ischemic brain volumes, and higher initial NIHSS and mRS scores. In particular, vessel occlusion and initial mRS score appeared to be significantly related

  13. Arterial supply to the bleeding diverticulum in the ascending duodenum treated by transcatheter arterial embolization- a duodenal artery branched from the inferior pancreaticoduodenal artery.

    PubMed

    Sanda, Hiroki H; Kawai, Nobuyuki N; Sato, Morio M; Tanaka, Fumihiro F; Nakata, Kouhei K; Minamiguchi, Hiroki H; Nakai, Motoki M; Sonomura, Tetsuo T

    2014-01-01

    We present a case of endoscopically unmanageable hemorrhagic diverticulum in the ascending duodenum. The ventral and dorsal walls of the ascending duodenum were supplied from the first jejunal artery (1JA) and inferior pancreaticoduodenal artery (IPDA), respectively. The hemorrhage mainly occurred from IPDA. The abruptly branching of IPDA from superior mesenteric artery enabled successful catheterization of the IPDA with an angled microcatheter. Hemostasis was obtained by embolization using n-butyl cyanoacrylate. Gastroendoscopy depicted a duodenal hemi-circumferential ulcer. No symptoms related to hemorrhage were found at the last follow-up at 12 months.

  14. Traumatic Inferior Gluteal Artery Aneurysm Managed with Emergency Transcatheter Thrombin Injection

    SciTech Connect

    Juszkat, Robert; Zielinski, Maciej; Wykretowicz, Mateusz; Piekarek, Alina; Majewski, Waclaw

    2010-06-15

    Pseudoaneurysms of the inferior gluteal artery (IGA) are rare and are often caused by trauma. Treatment options vary and include surgery, ultrasound-guided percutaneous thrombin injection, and endovascular procedures such as stent-graft placement, coil embolization, and glue injection. We report a 70-year-old male who presented to the hospital after a road accident with a posttraumatic pseudoaneurysm that was treated by endovascular thrombin embolization. To the best of our knowledge, this is the first reported case of inferior gluteal artery false aneurysm treated by this method.

  15. Bilateral Pedicled Superficial Inferior Epigastric Artery Flap in the Treatment of Hidradenitis Suppurativa

    PubMed Central

    Hoang, Don; Saber, Sepideh; Patel, Ketan; Carey, Joseph

    2016-01-01

    Summary: The authors present a new technique in surgically treating hidradenitis suppurativa (HS), a debilitating skin condition. In HS, surgical treatment is often the best option because of the high recurrence rates despite extensive medical treatment. A commonly successful surgical method is using skin flaps after excision of the affected area. A superficial inferior epigastric artery flap is demonstrated here as a new alternative approach to treating a case of extensive HS of the groin. By using the pedicled superficial inferior epigastric artery flap for groin reconstruction, inguinal HS can be widely excised and reconstructed with minimal donor-site morbidity and a good aesthetic outcome. PMID:27622101

  16. Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture.

    PubMed

    Muratsu, Hirotsugu; Doita, Minoru; Yanagi, Toshihide; Sekiguchi, Kenji; Nishida, Kotaro; Tomioka, Masao; Kurosaka, Masahiro

    2005-06-01

    Neurologic deficit secondary to a Jefferson fracture is rare, as the fracture fragments tend to spread outward. To the authors' knowledge, only five cases of vertebral artery injury associated with C1 fracture have been reported. A 75-year-old man with diffuse spinal hyperostosis hit the top of his head and sustained a Jefferson fracture. The patient presented with vertigo and slurred speech. Magnetic resonance (MR) imaging demonstrated cerebellar infarction, and MR angiography (MRA) showed bilateral vertebral artery occlusion associated with a Jefferson fracture. The patient was placed in a halo vest for a total of 11 weeks and treated with anticoagulant therapy. Vertigo gradually improved, and the patient was able to walk with a cane. Previously slurred speech was completely resolved. This case demonstrates that a Jefferson fracture can cause vertebral artery occlusion, resulting in cerebellar infarction. The clinician should be aware of the possibility and implications of vertebral artery injuries, especially if a fracture involving the foramen transversarium with displacement is documented or if there is a neurologic deficit above the level of injury. Advances in noninvasive imaging such as MRA will facilitate accurate evaluation of these potentially life-threatening vascular injuries.

  17. Inferior Mesenteric Artery Aneurysm Complicated With Occluded Celiac and Superior Mesenteric Artery After Replacement of Thoracoabdominal Aorta for Chronic Dissected Thoracoabdominal Aortic Aneurysm.

    PubMed

    Igarashi, Takashi; Yamamoto, Akihiro; Fujimiya, Tsuyoshi; Takase, Shinya; Satokawa, Hirono; Yokoyama, Hitoshi

    2017-10-01

    We report a case of inferior mesenteric artery aneurysm (IMAA) after the replacement of the thoracoabdominal aorta for a chronic dissected thoracoabdominal aortic aneurysm in which the celiac artery and superior mesenteric artery were occluded. We performed the resection of the IMAA and the revascularization of the superior mesenteric artery, inferior mesenteric artery, and meandering artery. The patient's postoperative course was uneventful, without bowel ischemia. From the findings of intraoperative flow measurement of the visceral arteries, revascularization of the superior mesenteric artery was judged to be appropriate in this situation. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Recent Advances in Cerebellar Ischemic Stroke Syndromes Causing Vertigo and Hearing Loss.

    PubMed

    Kim, Hyun-Ah; Yi, Hyon-Ah; Lee, Hyung

    2016-12-01

    Cerebellar ischemic stroke is one of the common causes of vascular vertigo. It usually accompanies other neurological symptoms or signs, but a small infarct in the cerebellum can present with vertigo without other localizing symptoms. Approximately 11 % of the patients with isolated cerebellar infarction simulated acute peripheral vestibulopathy, and most patients had an infarct in the territory of the medial branch of the posterior inferior cerebellar artery (PICA). A head impulse test can differentiate acute isolated vertigo associated with PICA territory cerebellar infarction from more benign disorders involving the inner ear. Acute hearing loss (AHL) of a vascular cause is mostly associated with cerebellar infarction in the territory of the anterior inferior cerebellar artery (AICA), but PICA territory cerebellar infarction rarely causes AHL. To date, at least eight subgroups of AICA territory infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the AICA). Audiovestibular loss from cerebellar infarction has a good long-term outcome than previously thought. Approximately half of patients with superior cerebellar artery territory (SCA) cerebellar infarction experienced true vertigo, suggesting that the vertigo and nystagmus in the SCA territory cerebellar infarctions are more common than previously thought. In this article, recent findings on clinical features of vertigo and hearing loss from cerebellar ischemic stroke syndrome are summarized.

  19. [Experience of coronary artery bypass grafting with inferior epigastric artery (IEA) and pathological examination of the IEA].

    PubMed

    Hayashi, S; Kawaue, Y

    1995-01-01

    From January to March 1994, coronary artery bypass grafting (CABG) using the inferior epigastric artery (IEA) were performed in 10 patients. The stumps of the IEAs were examined pathologically. 1. Intimal thickening of the IEA was scarcely noted. 2. Internal elastic lamina of the IEA showed good development equivalent to the internal thoracic artery (ITA). 3. Tunica media of the IEA was poor in elastic fibers and rich in smooth muscle cells compared with the ITA. 4. The thickness of intima + media was 150-360 microns, suggesting its low risk of ischemic necrosis in case of free grafting. These results suggested the IEA to be a good graft material applicable for CABG.

  20. [Clinical outcome of the coronary arterial bypass graft with inferior epigastric artery as a composite graft].

    PubMed

    Ayabe, T; Fukushima, Y; Yoshioka, M; Onizuka, T

    2003-08-01

    Based on a good long-patency of the internal thoracic arteries (ITA) in coronary arterial bypass graft (CABG), the postoperative early patency of the inferior epigastric artery (IEA) was evaluated by means of the proximal anastomosed types as a composite graft. Among patients performed with CABG during October in 1998 to June, 2000, 39 cases with the IEA composite graft were studied for this clinical outcome (31 males and 8 females, the averaged age was 66.4 +/- 8.0 year old). The preoperative diagnosis were done as acute myocardial infarction (4), old myocardial infarction with angina pectoris (8), effort angina (12), and unstable angina (15). The coronary disease was left main trunk disease (8), 3 vessels (22), and 2 vessels (9). The operation was performed with cold blood-cardioplegia (20 degrees C, blood-GIK liquor used) on cardiopulmonary bypass with a single atrial and aortic cannulation. The averaged extracorporeal circulation time and the aortic clamping one were done for 169 and 131 min, respectively. The bypass number was double (n = 5), triple (n = 10), quadruple (n = 16), and quintuple (n = 8). Total bypass number was 150 (the averaged bypass number was 3.7 +/- 0.9), and total anastomosal number was 145. The postoperative early-patency of IEA was 94.9% (37/39). The proximal sites of IEA were anastomozed to ITA with I-shaped end-to-end (n = 15), to ITA with Y-shaped end-to-side (n = 5), and to SVG with Y-shaped end-to-side (n = 19). Compared with the postoperative early-patency of I-shaped anastomosis to ITA and that of Y-shaped one to ITA or SVG, there was no significance among these cases (100%, 15/15 versus 91.7%, 22/24, p = 0.6738), however, that of Y-shaped one to ITA was significantly better than that of Y-shaped one to SVG (60%, 3/5 versus 100%, 19/19, p = 0.0488). It should be available for spreading of the anastomotic objective vessels that the IEA as a composite graft was used with the proximal site anastomozed to ITA by I-shaped end-to-end and

  1. Disappearance of myocardial bridging of the left anterior descending coronary artery after inferior myocardial infarction.

    PubMed

    Yıldız, Bekir Serhat; Esin, Fatma; Alihanoğlu, Yusuf Izzettin; Kılıç, Ismail Doğu; Evrengül, Harun

    2014-06-01

    Myocardial bridging (MB) is defined as the intramural course of a major epicardial coronary artery, and is mostly confined to the left ventricle and the left anterior descending coronary artery (LAD). MB is a common congenital abnormality of a coronary artery, and is usually thought to be a benign anatomical variant. Although rare, previous studies have reported that patients with MB may suffer from myocardial ischemia, myocardial infarction (MI), arrhythmias, and even sudden death. Therefore, the diagnosis and treatment of MB are both important. Since MB is congenital, its disappearance is unlikely. We here report a very rare case of disappearance of MB after inferior MI.

  2. Lumbar artery pseudoaneurysm caused by a Gunther Tulip inferior vena cava filter.

    PubMed

    Skeik, Nedaa; McEachen, James C; Stockland, Andrew H; Wennberg, Paul W; Shepherd, Roger F J; Shields, Raymond C; Andrews, James C

    2011-11-01

    Inferior vena cava (IVC) filters are widely used to decrease the risk of pulmonary embolism in patients with contraindications to anticoagulation. Complications include local hematoma, access site deep venous thrombosis (DVT), filter migration and embolization, leg penetration through the IVC wall, IVC occlusion, and filter fracture with embolization. Other rare complications include leg penetration into adjacent organs including duodenum and ureter. Lumbar artery pseudoaneurysms are rare and may be spontaneous, iatrogenic, or traumatic. To date, there have been 3 case reports of lumbar artery pseudoaneurysms caused by IVC filters. We present an additional case of a lumbar artery pseudoaneurysm caused by a Gunther Tulip IVC filter treated successfully with selective embolization.

  3. Origin of a common trunk for the inferior phrenic arteries from the right renal artery: a new anatomic vascular variant with clinical implications.

    PubMed

    Topaz, On; Topaz, Allyne; Polkampally, Pritam R; Damiano, Thomas; King, Christopher A

    2010-01-01

    The inferior phrenic arteries constitute a pair of important vessels, supplying multiple organs including the diaphragm, adrenal glands, esophagus, stomach, liver, inferior vena cava, and retroperitoneum. The vast majority (80-90%) of inferior phrenic arteries originate as separate vessels with near equal frequency from either the abdominal aorta or the celiac trunk. Infrequently, the right and left inferior phrenic arteries can arise in the form of a common trunk from the aorta or from the celiac trunk. We herein present three patients with a new anatomic vascular variant: a common trunk of the inferior phrenic arteries arising from the right renal artery. In one case, the left inferior phrenic branch of the common trunk provided collaterals connecting with a supra-diaphragmatic branch of the left internal mammary artery and in another with the lateral wall of the pericardium. Angiographic identification of a common trunk for the inferior phrenic arteries arising from the right renal artery is important for proper diagnosis and clinical management. The presence of this unique vascular variant can impact revascularization of the renal arteries.

  4. Inferior Phrenic Arteries and Their Branches, Their Anatomy and Possible Clinical Importance: An Experimental Cadaver Study

    PubMed Central

    Gürses, İlke Ali; Gayretli, Özcan; Kale, Ayşin; Öztürk, Adnan; Usta, Ahmet; Şahinoğlu, Kayıhan

    2015-01-01

    Background: Transcatheter arterial chemoembolization is a common treatment for patients with inoperable hepatocellular carcinoma. If the carcinoma is advanced or the main arterial supply, the hepatic artery, is occluded, extrahepatic collateral arteries may develop. Both, right and left inferior phrenic arteries (RIPA and LIPA) are the most frequent and important among these collaterals. However, the topographic anatomy of these arteries has not been described in detail in anatomy textbooks, atlases and most previous reports. Aims: To investigate the anatomy and branching patterns of RIPA and LIPA on cadavers and compare our results with the literature. Study Design: Descriptive study. Methods: We bilaterally dissected 24 male and 2 female cadavers aged between 49 and 88 years for this study. Results: The RIPA and LIPA originated as a common trunk in 5 cadavers. The RIPA originated from the abdominal aorta in 13 sides, the renal artery in 2 sides, the coeliac trunk in 1 side and the left gastric artery in 1 side. The LIPA originated from the abdominal aorta in 9 sides and the coeliac trunk in 6 sides. In 6 cadavers, the ascending and posterior branches of the LIPA had different sources of origin. Conclusion: As both the RIPA and LIPA represent the half of all extrahepatic arterial collaterals to hepatocellular carcinomas, their anatomy gains importance not only for anatomists but interventional radiologists as well. PMID:26167344

  5. The Anterior Branch of the Left Inferior Phrenic Artery Arising from the Right Inferior Phrenic Artery: An Angiographic and CT Study

    SciTech Connect

    Hieda, Masashi Toyota, Naoyuki; Kakizawa, Hideaki; Ishikawa, Masaki; Horiguchi, Jun; Ito, Katsuhide

    2009-03-15

    The purpose of this study was to retrospectively analyze the frequency and anatomical pattern of the anterior branch of the left inferior phrenic artery (LIPA) arising from the right inferior phrenic artery (RIPA). Angiography of the RIPA for patients (n = 140) with hepatic malignancy was retrospectively reviewed. The frequency at which the anterior branch of the LIPA arose from the RIPA was 14.3% (20 of 140 patients [pts]). Among the three branches that may arise from the RIPA in these cases (the anterior branch of the LIPA and the anterior and posterior branches of the RIPA), the anterior branch of the LIPA was the first branch of the RIPA in 9 of 20 pts (45%), and the posterior branch of the RIPA in 11 of 20 pts (55%). The anterior branch of the LIPA ran along the ventral side of the esophagus or stomach and supplied the esophagogastric region and dome of the left diaphragm in all cases. In conclusion, the anterior branch of the LIPA arises from the RIPA at a comparatively high frequency. In embolization of the RIPA, to effectively treat and avoid possible complications, interventionalists should be aware of this potential variant anatomy.

  6. Multiple aneurysms of the inferior pancreaticoduodenal artery: a rare complication of acute pancreatitis.

    PubMed

    Klonaris, Chris; Psathas, Emmanouil; Katsargyris, Athanasios; Lioudaki, Stella; Chatziioannou, Achilleas; Karatzas, Theodore

    2013-01-01

    Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed.

  7. Multiple Aneurysms of the Inferior Pancreaticoduodenal Artery: A Rare Complication of Acute Pancreatitis

    PubMed Central

    Klonaris, Chris; Katsargyris, Athanasios; Lioudaki, Stella; Chatziioannou, Achilleas; Karatzas, Theodore

    2013-01-01

    Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed. PMID:23509663

  8. Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery

    PubMed Central

    Lamo-Espinosa, J. M.; Llombart Blanco, R.; Valentí, J. R.

    2012-01-01

    We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries. PMID:22957293

  9. FoxP2 expression in the cerebellum and inferior olive: development of the transverse stripe-shaped expression pattern in the mouse cerebellar cortex.

    PubMed

    Fujita, Hirofumi; Sugihara, Izumi

    2012-02-15

    Many molecules are expressed heterogeneously in subpopulations of cerebellar Purkinje cells (PCs) and inferior olive (IO) neurons during development or in adulthood. These expression patterns are often organized in longitudinal stripes in the cerebellar cortex, which may be related to functional compartmentalization. FoxP2, a transcription factor, is expressed in PCs and IO neurons, but the details of its expression pattern remain unclear. Here we examined FoxP2 expression patterns systematically by immunostaining serial sections of the hindbrain from embryonic day 14.5 to adulthood in mice. FoxP2 was highly expressed in virtually all PCs at and before postnatal day 6 (P6), except for those in the flocculus and small parts of the nodulus (vermal lobule X), where FoxP2 expression was moderate or absent. After P6, FoxP2 expression gradually diminished in PCs in some areas. In adults, FoxP2 was expressed, less intensely than in earlier stages, in subsets of PCs that were mostly arranged transversely along the folial apices. In contrast, FoxP2 was expressed intensely in most IO neurons during development and in adulthood. FoxP2 was also expressed in a small population of neurons in the cerebellar nuclei. FoxP2 expression in adult rats and chicks was generally comparable to that in adult mice, suggesting evolutionary conservation of the expression pattern. Thus, the FoxP2 expression pattern reflects new transverse compartmentalization in the adult cerebellar cortex, although its functional significance remains unclear.

  10. Postpartum dissecting aneurysm of the superior cerebellar artery--case report.

    PubMed

    Ikeda, K; Shoin, K; Taguchi, H; Yamano, J; Kawahara, R

    1999-11-01

    A 37-year-old female with toxemia of pregnancy suffered sudden headache and loss of consciousness on the day following a cesarean delivery. Computed tomography revealed subarachnoid hemorrhage (SAH). Vertebral angiography revealed a fusiform dilatation near the origin of the right superior cerebellar artery (SCA) with distal luminal narrowing. She underwent surgery within 24 hours of the ictus. A SAH clot was carefully removed from the prepontine cistern, and subadventitial discoloration was seen in the wall of the right SCA just distal to the aneurysmal protuberance (rupture site). The dissecting aneurysm was treated with body clipping by directly clipping the rupture site and with additional wrapping of the proximal SCA, including the aneurysmal protuberance and discolored site. The postoperative clinical course was uneventful. Postoperative angiography revealed complete obliteration of the aneurysm and patency of the SCA. Therapeutic intervention should be considered for patients with ruptured dissecting aneurysm who present with recurrent SAH.

  11. Acute cervical artery dissection after a dental procedure due to a second inferior molar infection

    PubMed Central

    Delgado, Montserrat G; Riesco, Nuria; Murias, Eduardo; Calleja, Sergio

    2015-01-01

    Periodontal infections might represent one of the causative factors for cervical artery dissection. We present a case of a 49-year-old woman admitted due to headache. The patient had been suffering from a right second inferior molar infection with a cervical phlegmon for 1 week prior to admission. On 2 October 2014, the patient went to the dentist and a molar extraction was performed in the morning. In the afternoon, the patient began to experience right hemifacial pain that progressed towards an intense and bilateral headache. Neurological status at the time of admission revealed right miosis, ptosis and conjuntival hyperaemia. A CT angiography showed a right internal carotid artery dissection provoking a high-degree stenosis. The relationship between periodontal infection and vascular disease has been previously presented. Microbial agents may directly, and inflammatory and immunological host response indirectly, influence inflammatory changes in cervical arteries favouring dissections with minor traumas. PMID:26038385

  12. Acute cervical artery dissection after a dental procedure due to a second inferior molar infection.

    PubMed

    Delgado, Montserrat G; Riesco, Nuria; Murias, Eduardo; Calleja, Sergio

    2015-06-02

    Periodontal infections might represent one of the causative factors for cervical artery dissection. We present a case of a 49-year-old woman admitted due to headache. The patient had been suffering from a right second inferior molar infection with a cervical phlegmon for 1 week prior to admission. On 2 October 2014, the patient went to the dentist and a molar extraction was performed in the morning. In the afternoon, the patient began to experience right hemifacial pain that progressed towards an intense and bilateral headache. Neurological status at the time of admission revealed right miosis, ptosis and conjuntival hyperaemia. A CT angiography showed a right internal carotid artery dissection provoking a high-degree stenosis. The relationship between periodontal infection and vascular disease has been previously presented. Microbial agents may directly, and inflammatory and immunological host response indirectly, influence inflammatory changes in cervical arteries favouring dissections with minor traumas. 2015 BMJ Publishing Group Ltd.

  13. Successful Treatment of Acute on Chronic Mesenteric Ischaemia by Common Iliac to Inferior Mesenteric Artery Bypass

    PubMed Central

    Coakley, D. N.; Shaikh, F. M.; Kavanagh, E. G.

    2015-01-01

    Chronic mesenteric ischaemia is a rare and potentially fatal condition most commonly due to atherosclerotic stenosis or occlusion of two or more mesenteric arteries. Multivessel revascularisation of both primary mesenteric vessels, the celiac artery and superior mesenteric artery (SMA), is the current mainstay of treatment; however, in a certain cohort of patients, revascularisation one or both vessels may not be possible. Arteries may be technically unreconstructable or the patient may be surgically unfit for the prolonged aortic cross clamping times required. Here we present a case involving a 72-year-old woman with acute on chronic mesenteric ischaemia. She was a high risk surgical patient with severe unreconstructable stenotic disease of the SMA and celiac arteries. She was successfully treated with single vessel revascularisation of the inferior mesenteric artery (IMA) via a common iliac to IMA reversed vein bypass. At two-year follow-up, the graft remains patent and the patient continues to be symptom-free and is maintaining her weight. PMID:26421207

  14. Potential for iatrogenic coil embolization of the caudal cerebellar artery during treatment of internal carotid artery bifurcation in two horses with guttural pouch mycosis.

    PubMed

    Bonilla, Alvaro G; Scansen, Brian A; Hurcombe, Samuel D; Mudge, Margaret C

    2015-12-15

    2 horses were examined for chronic nasal discharge secondary to unilateral guttural pouch mycosis. Initial endoscopic examination of both horses confirmed the presence of a fungal plaque on the dorsomedial aspect of the medial compartment of the guttural pouch (auditory tube diverticulum) involving the internal carotid artery (ICA). No signs of hemorrhage or neurologic deficits were present at admission. Transarterial stainless steel coil embolization of the affected ICA was performed under general anesthesia, with fluoroscopic guidance. During treatment, an aberrant branch of the ICA, or a proposed bifid ICA, that anastomosed with the caudal cerebellar artery was identified. Occlusion of the distal (noncardiac) side of the aberrant branch was performed in both horses because of potential mycotic involvement at that level. Following treatment, resolution of the mycotic infection was observed in both horses; however, 1 horse developed neurologic signs compatible with unilateral caudal cerebellar artery ischemia on recovery from anesthesia; these signs resolved over the following 2 months. Findings highlighted variability of the anatomy of the ICA in 2 horses that was identified during treatment for guttural pouch mycosis and identified caudal cerebellar artery infarction as a potential complication of treatment. Because of the size and pathway of both arterial branches, we suggest that the term bifurcation of the ICA is more appropriate than aberrant branching, as has been previously described in the literature. The information in this report may be of value to clinicians performing procedures involving the vasculature of the head and neck in horses.

  15. Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

    PubMed Central

    Malik, Ali Osama; Abela, Oliver; Devabhaktuni, Subodh; Malik, Arhama Aftab; Allenback, Gayle; Ahsan, Chowdhury H; Malhotra, Sanjay; Diep, Jimmy

    2017-01-01

    AIM To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with non-dominant right coronary artery anatomy. METHODS This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain. Only patients who underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included. Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed. Patients with prior history of coronary artery disease (CAD) including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded. True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography, in the same territory as identified on SPECT MPI. Coronary artery dominance was determined on coronary angiography. Patients were divided into group 1 and group 2. Group 1 included patients with non-dominant right coronary artery (RCA) (left dominant and codominant). Group 2 included patients with dominant RCA anatomy. Demographics, baseline characteristics and positive predictive value (PPV) were analyzed for the two groups. RESULTS The mean age of the study cohort was 57.6 years. Sixty-one point seven percent of the patients were males. The prevalence of self-reported diabetes mellitus, hypertension and dyslipidemia was 36%, 71.9% and 53.9% respectively. A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men. For inferior wall ischemia on SPECT MPI, patients in study group 2 had a significantly higher PPV, 32/42 (76.1%), compared to patients in group 1, in which only 3 out of the 29 patients (10.3%) had true positive results (P value < 0.001 Z test). The difference remained statistically significant even when only patients

  16. Significance of inferior wall ischemia in non-dominant right coronary artery anatomy.

    PubMed

    Malik, Ali Osama; Abela, Oliver; Devabhaktuni, Subodh; Malik, Arhama Aftab; Allenback, Gayle; Ahsan, Chowdhury H; Malhotra, Sanjay; Diep, Jimmy

    2017-03-26

    To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with non-dominant right coronary artery anatomy. This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain. Only patients who underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included. Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed. Patients with prior history of coronary artery disease (CAD) including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded. True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography, in the same territory as identified on SPECT MPI. Coronary artery dominance was determined on coronary angiography. Patients were divided into group 1 and group 2. Group 1 included patients with non-dominant right coronary artery (RCA) (left dominant and codominant). Group 2 included patients with dominant RCA anatomy. Demographics, baseline characteristics and positive predictive value (PPV) were analyzed for the two groups. The mean age of the study cohort was 57.6 years. Sixty-one point seven percent of the patients were males. The prevalence of self-reported diabetes mellitus, hypertension and dyslipidemia was 36%, 71.9% and 53.9% respectively. A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men. For inferior wall ischemia on SPECT MPI, patients in study group 2 had a significantly higher PPV, 32/42 (76.1%), compared to patients in group 1, in which only 3 out of the 29 patients (10.3%) had true positive results (P value < 0.001 Z test). The difference remained statistically significant even when only patients with left dominant

  17. Crossed cerebellar diaschisis after stroke identified noninvasively with cerebral blood flow-weighted arterial spin labeling MRI

    PubMed Central

    Strother, Megan K.; Buckingham, Cari; Faraco, Carlos C.; Arteaga, Daniel; Lu, Pengcheng; Xu, Yaomin; Donahue, Manus J.

    2015-01-01

    Background and Purpose Crossed cerebellar diaschisis (CCD) is most commonly investigated using hemodynamic PET and SPECT imaging. However, noninvasive MRI offers advantages of improved spatial resolution, allowing hemodynamic changes to be compared directly with structural findings and without concerns related to ionizing radiation exposure. The aim of this study was to evaluate relationships between CCD identified from cerebral blood flow (CBF)-weighted arterial spin labeling (ASL) MRI with cerebrovascular reactivity (CVR)-weighted blood oxygenation level dependent (BOLD) MRI, Wallerian degeneration, clinical motor impairment, and corticospinal tract involvement. Methods Subjects (n=74) enrolled in an ongoing observational stroke trial underwent CBF-weighted ASL and hypercapnic CVR-weighted BOLD MRI. Hemispheric asymmetry indices for basal cerebellar CBF, cerebellar CVR, and cerebral peduncular area were compared between subjects with unilateral supratentorial infarcts (n=18) and control subjects without infarcts (n=16). CCD required (1) supratentorial infarct and (2) asymmetric cerebellar CBF (>95% confidence interval relative to controls). Results In CCD subjects (n=9), CVR (p=0.04) and cerebral peduncular area (p < 0.01) were significantly asymmetric compared to controls. Compared to infarct subjects not meeting CCD criteria (n=9), CCD subjects had no difference in corticospinal tract location for infarct (p=1.0) or motor impairment (p=0.08). Conclusions CCD correlated with cerebellar CVR asymmetry and Wallerian degeneration. These findings suggest that noninvasive MRI may be a useful alternative to PET or SPECT to study structural correlates and clinical consequences of CCD following supratentorial stroke. PMID:26724658

  18. Intra-arterial CT angiography visualization of arterial supply to inferior vena cava tumor thrombus prior to radioembolization of hepatocellular carcinoma.

    PubMed

    Roche, Glen; Teo, Terence K B; Tan, Andrew E H; Irani, Farah G

    2012-01-01

    Unresectable hepatocellular carcinoma has a high frequency of vascular invasion and arterial parasitization. Trans-arterial radioembolization using yttrium-90 (Y90) microspheres is a possible treatment option. Paramount to its success is the meticulous angiographic interrogation of tumor feeding arteries and extra-hepatic supply. We describe a patient with tumor invasion of the inferior vena cava with arterial supply from the right inferior phrenic artery, which was exquisitely visualized using intra-arterial computed tomographic angiography (IACTA) during the planning technetium-99m macro aggregated albumin phase. This technique was useful in planning which artery to administer Y90 microspheres into for maximal brachytherapy. Although patient outcome was poor due to significant arterio-portal shunting, we believe that IACTA is a useful adjunct to conventional digital subtraction angiography in planning radioembolization therapy.

  19. Fast convergence of learning requires plasticity between inferior olive and deep cerebellar nuclei in a manipulation task: a closed-loop robotic simulation

    PubMed Central

    Luque, Niceto R.; Garrido, Jesús A.; Carrillo, Richard R.; D'Angelo, Egidio; Ros, Eduardo

    2014-01-01

    The cerebellum is known to play a critical role in learning relevant patterns of activity for adaptive motor control, but the underlying network mechanisms are only partly understood. The classical long-term synaptic plasticity between parallel fibers (PFs) and Purkinje cells (PCs), which is driven by the inferior olive (IO), can only account for limited aspects of learning. Recently, the role of additional forms of plasticity in the granular layer, molecular layer and deep cerebellar nuclei (DCN) has been considered. In particular, learning at DCN synapses allows for generalization, but convergence to a stable state requires hundreds of repetitions. In this paper we have explored the putative role of the IO-DCN connection by endowing it with adaptable weights and exploring its implications in a closed-loop robotic manipulation task. Our results show that IO-DCN plasticity accelerates convergence of learning by up to two orders of magnitude without conflicting with the generalization properties conferred by DCN plasticity. Thus, this model suggests that multiple distributed learning mechanisms provide a key for explaining the complex properties of procedural learning and open up new experimental questions for synaptic plasticity in the cerebellar network. PMID:25177290

  20. Pseudoaneurysm of the inferior epigastric artery: a rare complication of laparoscopic ventral hernia repair.

    PubMed

    Nichols-Totten, Kysha; Pollema, Travis; Moncure, Michael

    2012-02-01

    Pseudoaneurysm of the inferior epigastric artery (IEA) is a recognized complication of surgery; however, it is a very rare clinical occurrence. The anatomic position of the IEA subjects patients to possible IEA injury during abdominal wall procedures that are close to the artery, such as insertions of drains, Tenckhoff catheters, laparoscopic trocars, or paracentesis. Treatment options include open surgery, percutaneous coil embolization, embolization with N-butyl cyanoacrylate, sonographic-guided thrombin injection, or sonographic-guided compression. We report the first case of a pseudoaneurysm arising from the IEA after a laparoscopic ventral hernia repair. To our knowledge, 17 IEA pseudoaneurysms have been reported, only 3 of which were spontaneous. The pseudoaneurysm in our patient was successfully treated by percutaneous injection of thrombin by interventional radiology.

  1. Identification of inferior pancreaticoduodenal artery during pancreaticoduodenectomy using augmented reality-based navigation system.

    PubMed

    Onda, Shinji; Okamoto, Tomoyoshi; Kanehira, Masaru; Suzuki, Fumitake; Ito, Ryusuke; Fujioka, Shuichi; Suzuki, Naoki; Hattori, Asaki; Yanaga, Katsuhiko

    2014-04-01

    In pancreaticoduodenectomy (PD), early ligation of the inferior pancreaticoduodenal artery (IPDA) before efferent veins has been advocated to decrease blood loss by congestion of the pancreatic head to be resected. In this study, we herein report the utility of early identification of the IPDA using an augmented reality (AR)-based navigation system (NS). Seven nonconsecutive patients underwent PD using AR-based NS. After paired-point matching registration, the reconstructed image obtained by preoperative computed tomography (CT) was fused with a real-time operative field image and displayed on 3D monitors. The vascular reconstructed images, including the superior mesenteric artery, jejunal artery, and IPDA were visualized to facilitate image-guided surgical procedures. We compared operating time and intraoperative blood loss of six patients who successfully underwent identification of IPDA using AR-based NS (group A) with nine patients who underwent early ligation of IPDA without using AR (group B) and 18 patients who underwent a conventional PD (group C). The IPDA or the jejunal artery was rapidly identified and ligated in six patients. The mean operating time and intraoperative blood loss in group A was 415 min and 901 ml, respectively. There was no significant difference in operating time and intraoperative blood loss among the groups. The AR-based NS provided precise anatomical information, which allowed the surgeons to rapidly identify and perform early ligation of IPDA in PD. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  2. MDCT Anatomic Assessment of Right Inferior Phrenic Artery Origin Related to Potential Supply to Hepatocellular Carcinoma and its Embolization

    SciTech Connect

    Basile, Antonio Tsetis, Dimitrios; Montineri, Arturo; Puleo, Stefano; Massa Saluzzo, Cesare; Runza, Giuseppe; Coppolino, Francesco; Ettorre, Giovanni Carlo; Patti, Maria Teresa

    2008-03-15

    Purpose. To prospectively assess the anatomic variation of the right inferior phrenic artery (RIPA) origin with multidetector computed tomography (MDCT) scans in relation to the technical and angiographic findings during transcatheter arterial embolization of hepatocellular carcinoma (HCC). Methods. Two hundred patients with hepatocellular carcinomas were examined with 16-section CT during the arterial phase. The anatomy of the inferior phrenic arteries was recorded, with particular reference to their origin. All patients with subcapsular HCC located at segments VII and VIII underwent arteriography of the RIPA with subsequent embolization if neoplastic supply was detected. Results. The RIPA origin was detected in all cases (sensitivity 100%), while the left inferior phrenic artery origin was detected in 187 cases (sensitivity 93.5%). RIPAs originated from the aorta (49%), celiac trunk (41%), right renal artery (5.5%), left gastric artery (4%), and proper hepatic artery (0.5%), with 13 types of combinations with the left IPA. Twenty-nine patients showed subcapsular HCCs in segments VII and VIII and all but one underwent RIPA selective angiography, followed by embolization in 7 cases. Conclusion. MDCT assesses well the anatomy of RIPAs, which is fundamental for planning subsequent cannulation and embolization of extrahepatic RIPA supply to HCC.

  3. [EFFECTIVENESS OF DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR FLAP FOR REPAIR OF PERINEAL AND PERIANAL CICATRICIAL CONTRACTURE].

    PubMed

    Du, Liping; You, Xiaobo; Tang, Kuangyun; Fu, Rong

    2015-08-01

    To discuss the effectiveness of deep inferior epigastric artery perforator flap to repair perineal and perianal cicatricial contracture. Between March 2007 and December 2013, 23 patients with perineal and perianal cicatricial contracture were treated with deep inferior epigastric artery perforator flap. There were 15 males and 8 females, aged from 21 to 62 years (mean, 42 years). Burn depth was III degree. The burning scars involved in the fascia, even deeper, which was rated as peripheral type (mild stenosis of the anal region and perianal cicatricial contracture) in 13 cases and as central type (severe stenosis of the anal region and anal canal with shift or defect of external genitalia) in 10 cases. All patients had limited hip abduction and squatting. Repair operation was performed at 3 months to 2 years (mean, 6 months) after wound healing. The size of soft tissue defects ranged from 10 cmx6 cm to 28 cm x 13 cm after scar excision and release. The size of flaps ranged from 12 cmx7 cm to 30 cmx15 cm. The donor site was sutured directly in 16 cases and repaired by autograft of skin in 7 cases. The flap had distal necrosis, distal cyanosis, and spotted necrosis in 1 case, 2 cases, and 1 case respectively, which were cured after symptomatic treatment; the other flaps survived and wound healed primarily. Twenty-one patients were followed up 6 months to 2 years (mean, 1 year). Nineteen patients had good appearance of the perinea and position of external genitalia, normal function of defecation function; stenosis of the anal region was relived, and the flaps had good texture and elasticity. Linear scar contracture was observed at the edge of flap in 2 cases, and the appearance of the perineum was restored after Z plasty. The hip abduction reached 30-40°. No abdominal hernia was found at donor site. Deep inferior epigastric artery perforator flap has stable blood supply and flexible design, which is similar to the perianal and perineal tissues. The good effectiveness

  4. Compression of the Inferior Vena Cava by the Right Iliac Artery: A Rare Variant of May-Thurner Syndrome

    SciTech Connect

    Fretz, V.; Binkert, C. A.

    2010-10-15

    May-Thurner syndrome is known as compression of the left common iliac vein by the right common iliac artery. We describe a case of an atypical compression of the inferior vena cava by the right common iliac artery secondary to a high aortic bifurcation. Despite an extensive collateral network, there was a significant venous gradient between the iliac veins and the inferior vena cava above the compression. After stenting the venous pressure gradient disappeared. Follow-up 4 months later revealed a good clinical response with a patent stent.

  5. Monitoring microcirculatory changes in the deep inferior epigastric artery perforator flap with laser Doppler perfusion imaging.

    PubMed

    Tindholdt, Tyge Tind; Saidian, Said; Pripp, Are Hugo; Tønseth, Kim Alexander

    2011-08-01

    Microcirculatory changes were monitored in 20 deep inferior epigastric artery perforator (DIEAP) flaps during unilateral breast reconstruction until the seventh postoperative day using laser Doppler perfusion imaging. Measurements were recorded according to the zonal classification by Scheflan and Dinner. The cutaneous territory zone IV was discarded during insetting due to marginal circulation. The highest perfusion levels were found the first postoperative day for both zones I and III. Postoperative perfusion values were significantly higher for these zones compared with zone II. Immediately after revascularization, zone I was significantly better perfused than both II and III. However, the perfusion in zone III stabilized at the level of zone I in the postoperative phase. Evaluating microcirculatory changes in the DIEAP flap with laser Doppler perfusion imaging showed that zones I and III have higher perfusion levels than zone II in the postoperative phase.

  6. Microvascular anatomy of the cerebellar parafloccular perforating space.

    PubMed

    Sosa, Pablo; Dujovny, Manuel; Onyekachi, Ibe; Sockwell, Noressia; Cremaschi, Fabián; Savastano, Luis E

    2016-02-01

    The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle-namely, the paraflocculus or parafloccular perforating space-has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle. Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized. A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported. The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the

  7. The inferior medial genicular artery and its vascularization of the pes anserinus superficialis: A cadaveric study.

    PubMed

    Hirtler, Lena; Ederer, Manuel; Faber, Mike; Weninger, Patrick

    2016-01-01

    A common method for reconstruction of the anterior cruciate ligament (ACL) is it's replacement by a free avascular graft, using the gracilis and/or semitendinosus tendons. These grafts pass a vulnerable phase in the ligamentization-process during the 1(st) year after reconstruction. The aims of this study were first to evaluate the vascularization of the pes anserinus superficialis (PAS) by the inferior medial genicular artery (IMGA) and second to develop a pedunculated surgical technique for ACL reconstruction, to preserve a maximal amount of natural vascularization of the tendons inserting at the PAS. First, the vascularization of the PAS was assessed in 12 fresh-frozen lower extremities. The IMGA was identified at its origin at the popliteal artery and perfused with a methylene blue solution. Second, a pedunculated ACL reconstruction was performed in 5 fresh-frozen lower extremities under maintenance of the distal tendon insertion at PAS. The PAS is a highly vascularized structure. Vessels originate from the IMGA, running along the three tendons of the PAS in the paratendinous tissue. Histologically intratendinous vessels exist; however, perfusion of the inserting tendons through intratendinous vessels was not proven macroscopically. The pedunculated grafts could be positioned and fixed successfully into the bone tunnels in all knees. Although intratendinous vascularization of the tendons of the PAS via the IMGA was not proven, this study indicates a new possibility of ACL reconstruction. The described operation technique can be conducive to shorten the vulnerable phase of the graft-ligamentization after ACL reconstruction.

  8. Surface anatomy of the inferior epigastric artery in relation to laparoscopic injury.

    PubMed

    Epstein, J; Arora, A; Ellis, H

    2004-07-01

    The inferior epigastric artery (IEA) is at risk of injury in laparoscopic surgery. Current descriptions of the course of the IEA do not provide surface landmarks useful to the surgeon. This study aimed to define surface relations and propose guidelines for safer trocar placement. The posterior surfaces of the anterior abdominal walls of 30 preserved cadavers were dissected. The surface anatomy of 60 IEAs and their branches were defined. At the level of the anterior superior iliac spine (ASIS), the IEA is 38% +/- 18% (95% confidence interval [CI]) from the midline to the ASIS. At the mid-inguinal point the relation is 40% +/- 17% and at the umbilicus 40% +/- 22%. The pattern of branches is highly variable. Although giving guidelines for trocar insertion can be treacherous, we found the following to be of value: 1) the midline is avascular; 2) the main stem of the IEA will be avoided if trocars are inserted more than two-thirds of the distance along a horizontal line between the midline and the ASIS; and 3) IEA branches are least frequently found in the lowest part of the abdomen lateral to the artery.

  9. Robotic Low Ligation of the Inferior Mesenteric Artery for Rectal Cancer Using the Firefly Technique.

    PubMed

    Bae, Sung Uk; Min, Byung Soh; Kim, Nam Kyu

    2015-07-01

    By integrating intraoperative near infrared fluorescence imaging into a robotic system, surgeons can identify the vascular anatomy in real-time with the technical advantages of robotics that is useful for meticulous lymphovascular dissection. Herein, we report our initial experience of robotic low ligation of the inferior mesenteric artery (IMA) with real-time identification of the vascular system for rectal cancer using the Firefly technique. The study group included 11 patients who underwent a robotic total mesorectal excision with preservation of the left colic artery for rectal cancer using the Firefly technique between July 2013 and December 2013. The procedures included five low anterior resections and six ultra-low anterior resections with loop ileostomy. The median total operation time was 327 min (226-490). The low ligation time was 10 min (6-20), and the time interval between indocyanine green injection and division of the sigmoid artery was 5 min (2-8). The estimated blood loss was 200 mL (100-500). The median time to soft diet was 4 days (4-5), and the median length of stay was 7 days (5-9). Three patients developed postoperative complications; one patients developed anal stricture, one developed ileus, and one developed non-complicated intraabdominal fluid collection. The median total number of lymph nodes harvested was 17 (9-29). Robotic low ligation of the IMA with real-time identification of the vascular system for rectal cancer using the Firefly technique is safe and feasible. This technique can allow for precise lymph node dissection along the IMA and facilitate the identification of the left colic branch of the IMA.

  10. [Study of cerebellar infarction with isolated vertigo].

    PubMed

    Utsumi, Ai; Enomoto, Hiroyuki; Yamamoto, Kaoru; Kimura, Yu; Koizuka, Izumi; Tsukuda, Mamoru

    2010-07-01

    Isolated vertigo is generally attributed to labyrinthine disease, but may also signal otherwise asymptomatic cerebellar infarction. Of 309 subjects admitted between April 2004 and March 2009 for the single symptom of acute vertigo initially thought to be labyrinthine, four were found to have cerebellar infarction of the posterior inferior cerebellar artery area (PICA). All were over 60 years old and had risk factors including hypertension, diabetes mellitus, arrhythmia, and/or hyperlipidemia. Two had trunk ataxia, with magnetic resonance imaging (MRI) showing infarction within a few days. The other two could walk without apparent trunk ataxia, however, it took 4 to 7 days to find the infarction, mainly through neurological, neurootological, and MRI findings. Neurologically, astasia, dysbasia or trunk ataxia were important signs. Neurootologically, nystagmus and electronystagmographic testing involving eye tracking, saccade, and optokinetic patttens were useful.

  11. Crossed cerebellar diaschisis detected by arterial spin-labeled perfusion magnetic resonance imaging in subacute ischemic stroke.

    PubMed

    Chen, Shuai; Guan, Min; Lian, Hao-Jun; Ma, Li-Jia; Shang, Jun-Kui; He, Shuang; Ma, Ming-Ming; Zhang, Mi-Lan; Li, Zi-Yuan; Wang, Mei-Yun; Shi, Da-Peng; Zhang, Jie-Wen

    2014-10-01

    Crossed cerebellar diaschisis (CCD) was a common radiological phenomenon manifested as reduced blood flow and metabolism in the cerebellar hemisphere contralateral to a supratentorial cerebral lesion. The hypoperfusion and hypometabolism in the contralateral cerebellum in CCD was traditionally detected by positron emission tomography (PET) and single-photon emission computed tomography (SPECT). The present prospective study aimed to assess the detection of CCD in subacute stage ischemic stroke by arterial spin-labeling (ASL) perfusion technique with a 3.0-T magnetic resonance imaging (MRI) scanner. ASL images were obtained from 46 patients with supratentorial ischemic stroke at subacute stage. Regional cerebral blood flow values in the cerebellar hemispheres were measured on a region of interest basis. Twenty-four of 46 (52%) patients showed CCD phenomenon by ASL-MRI method, which was in line with the PET/SPECT series. Infarctions in basal ganglia areas are prone to cause CCD. With advantages in easy acquisition and no radiation, ASL-MRI seems to be an ideal tool for the detection and follow-up of CCD. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. The inferior medial genicular artery and its vascularization of the pes anserinus superficialis: A cadaveric study

    PubMed Central

    Hirtler, Lena; Ederer, Manuel; Faber, Mike; Weninger, Patrick

    2016-01-01

    Background: A common method for reconstruction of the anterior cruciate ligament (ACL) is it's replacement by a free avascular graft, using the gracilis and/or semitendinosus tendons. These grafts pass a vulnerable phase in the ligamentization-process during the 1st year after reconstruction. The aims of this study were first to evaluate the vascularization of the pes anserinus superficialis (PAS) by the inferior medial genicular artery (IMGA) and second to develop a pedunculated surgical technique for ACL reconstruction, to preserve a maximal amount of natural vascularization of the tendons inserting at the PAS. Materials and Methods: First, the vascularization of the PAS was assessed in 12 fresh-frozen lower extremities. The IMGA was identified at its origin at the popliteal artery and perfused with a methylene blue solution. Second, a pedunculated ACL reconstruction was performed in 5 fresh-frozen lower extremities under maintenance of the distal tendon insertion at PAS. Results: The PAS is a highly vascularized structure. Vessels originate from the IMGA, running along the three tendons of the PAS in the paratendinous tissue. Histologically intratendinous vessels exist; however, perfusion of the inserting tendons through intratendinous vessels was not proven macroscopically. The pedunculated grafts could be positioned and fixed successfully into the bone tunnels in all knees. Conclusion: Although intratendinous vascularization of the tendons of the PAS via the IMGA was not proven, this study indicates a new possibility of ACL reconstruction. The described operation technique can be conducive to shorten the vulnerable phase of the graft-ligamentization after ACL reconstruction. PMID:27904225

  13. Inferior Cerebellar Hypoplasia Resembling a Dandy-Walker-Like Malformation in Purebred Eurasier Dogs with Familial Non-Progressive Ataxia: A Retrospective and Prospective Clinical Cohort Study

    PubMed Central

    Bernardino, Filipa; Rentmeister, Kai; Schmidt, Martin J.; Bruehschwein, Andreas; Matiasek, Kaspar; Matiasek, Lara A.; Lauda, Alexander; Schoon, Heinz A.; Fischer, Andrea

    2015-01-01

    Cerebellar malformations can be inherited or caused by insults during cerebellar development. To date, only sporadic cases of cerebellar malformations have been reported in dogs, and the genetic background has remained obscure. Therefore, this study`s objective was to describe the clinical characteristics, imaging features and pedigree data of a familial cerebellar hypoplasia in purebred Eurasier dogs. A uniform cerebellar malformation characterized by consistent absence of the caudal portions of the cerebellar vermis and, to a lesser degree, the caudal portions of the cerebellar hemispheres in association with large retrocerebellar fluid accumulations was recognized in 14 closely related Eurasier dogs. Hydrocephalus was an additional feature in some dogs. All dogs displayed non-progressive ataxia, which had already been noted when the dogs were 5 – 6 weeks old. The severity of the ataxia varied between dogs, from mild truncal sway, subtle dysmetric gait, dysequilibrium and pelvic limb ataxia to severe cerebellar ataxia in puppies and episodic falling or rolling. Follow-up examinations in adult dogs showed improvement of the cerebellar ataxia and a still absent menace response. Epileptic seizures occurred in some dogs. The association of partial vermis agenesis with an enlarged fourth ventricle and an enlarged caudal (posterior) fossa resembled a Dandy-Walker-like malformation in some dogs. Pedigree analyses were consistent with autosomal recessive inheritance. PMID:25668516

  14. Right coronary artery dissection and aneurysm presented as acute inferior myocardial infarction from an automobile airbag trauma.

    PubMed

    Zeng, Chunlai; Hu, Wuming; Zhu, Ning; Zhao, Xuyong; Xu, Jian; Ye, Shiyong; Xiang, Yijia; Lv, Linchun

    2015-10-01

    Coronary artery dissection and aneurysm culminating in acute myocardial infarction are rare after blunt chest trauma. We are reporting a case of a previously healthy 52-year-old man who presented with right inferior lobe contusion, pleural effusion, right interlobar fissure effusion, bone fracture of right fourth rib, and acute inferior wall myocardial infarction and who experienced blunt trauma in his right chest wall by an airbag deployment in a car accident. Coronary angiography showed an aneurysm in the middle of right coronary artery with 70% afferent narrowing just distal to the aneurysm with no visible atherosclerotic lesion. A 4.0×20 mm TEXUS Liberté stent in the lesion was deployed, and a good coronary flow was obtained without residual stenosis and the aneurysm vanished.

  15. [Case of cerebellar and spinal cord infarction presenting with acute brachial diplegia due to right vertebral artery occlusion].

    PubMed

    Fujii, Takayuki; Santa, Yo; Akutagawa, Noriko; Nagano, Sukehisa; Yoshimura, Takeo

    2012-01-01

    A 73-year-old man was admitted for evaluation of sudden onset of dizziness, bilateral shoulder pain, and brachial diplegia. Neurological examination revealed severe bilateral weakness of the triceps brachii, wrist flexor, and wrist extensor muscles. There was no paresis of the lower limbs. His gait was ataxic. Pinprick and temperature sensations were diminished at the bilateral C6-C8 dermatomes. Vibration and position senses were intact. An MRI of the head revealed a right cerebellar infarction and occlusion of the right vertebral artery. An MRI of the cervical spine on T₂ weighted imaging (T₂WI) showed cord compression at the C3/4-C5/6 level secondary to spondylotic degeneration without any intramedullary signal changes of the cord. On the following day, however, high-signal lesions on T₂WI appeared in the C5-C6 spinal cord, suggesting cord infarction. Unilateral vertebral artery occlusion does not usually result in cervical cord infarction because of anastomosis of arteries. Because of the long-term mechanical compression in our case, it was likely that cervical cord ischemia was present before the onset of symptoms. On the basis of chronic cord compression, our case suggests that occlusion of a unilateral vertebral artery could cause cervical cord infarction.

  16. Renal Artery Stump to Inferior Vena Cava Fistula: Unusual Clinical Presentation and Transcatheter Embolization with the Amplatzer Vascular Plug

    SciTech Connect

    Taneja, Manish; Lath, Narayan Soo, Tan Bien; Hiong, Tay Kiang; Htoo, Maung Myint; Richard, Lo; Fui, Alexander Chung Yaw

    2008-07-15

    Fistulous communication between the renal artery stump and inferior vena cava following nephrectomy is rare. We describe the case of a 52-year-old man with a fistula detected on investigation for hemolytic anemia in the postoperative period. The patient had had a nephrectomy performed 2 weeks prior to presentation for blunt abdominal trauma. The fistula was successfully occluded percutaneously using an Amplatzer vascular plug. The patient recovered completely and was discharged 2 weeks later.

  17. Variations in the Origin of Inferior Phrenic Arteries and Their Relationship to Celiac Axis Variations on CT Angiography

    PubMed Central

    Aslaner, Ramazan; Sahin, Hilal; Toka, Onur

    2017-01-01

    Objective Knowing the origin of the inferior phrenic artery (IPA) is important prior to surgical interventions and interventional radiological procedures related to IPA. We aimed to identify variations in the origin of IPA and to investigate the relationship between the origin of IPA and celiac axis variations using computed tomography angiography (CTA). Materials and Methods The CTA images of 1000 patients (737 male and 263 female, the mean age 60, range 18–94 years) were reviewed in an analysis of IPA and celiac axis variations. The origin of IPA was divided into two groups, those originating as a common trunk and those originating independently without a truncus. The relationship between the origin of IPA and celiac axis variation was analyzed using Pearson's chi-square test. Results Both IPAs originated from a common trunk in 295 (29.5%) patients. From which the majority of the common trunk originated from the aorta. Contrastingly, the inferior phrenic arteries originated from different origins in 705 (70.5%) patients. The majority of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) originated independently from the celiac axis. Variation in the celiac axis were detected in 110 (11%) patients. The origin of IPA was found to be significantly different in the presence of celiac axis variation. Conclusion The majority of IPA originated from the aorta in patients with a common IPA trunk, while the majority of RIPA and LIPA originating from the celiac axis in patients without a common IPA trunk. Thus, the origin of IPA may widely differ in the presence of celiac axis variation. PMID:28246513

  18. Variations in the Origin of Inferior Phrenic Arteries and Their Relationship to Celiac Axis Variations on CT Angiography.

    PubMed

    Aslaner, Ramazan; Pekcevik, Yeliz; Sahin, Hilal; Toka, Onur

    2017-01-01

    Knowing the origin of the inferior phrenic artery (IPA) is important prior to surgical interventions and interventional radiological procedures related to IPA. We aimed to identify variations in the origin of IPA and to investigate the relationship between the origin of IPA and celiac axis variations using computed tomography angiography (CTA). The CTA images of 1000 patients (737 male and 263 female, the mean age 60, range 18-94 years) were reviewed in an analysis of IPA and celiac axis variations. The origin of IPA was divided into two groups, those originating as a common trunk and those originating independently without a truncus. The relationship between the origin of IPA and celiac axis variation was analyzed using Pearson's chi-square test. Both IPAs originated from a common trunk in 295 (29.5%) patients. From which the majority of the common trunk originated from the aorta. Contrastingly, the inferior phrenic arteries originated from different origins in 705 (70.5%) patients. The majority of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) originated independently from the celiac axis. Variation in the celiac axis were detected in 110 (11%) patients. The origin of IPA was found to be significantly different in the presence of celiac axis variation. The majority of IPA originated from the aorta in patients with a common IPA trunk, while the majority of RIPA and LIPA originating from the celiac axis in patients without a common IPA trunk. Thus, the origin of IPA may widely differ in the presence of celiac axis variation.

  19. [Injection of methylene blue into inferior mesenteric artery improves lymph node harvest in rectal cancer after neoadjuvant chemotherapy].

    PubMed

    Liu, Jianpei; Huang, Pinjie; Huang, Jianglong; Chen, Tufeng; Wei, Hongbo

    2015-06-09

    To confirm the feasibility of improving lymph node harvest by injecting methylene blue into inferior mesenteric artery in rectal cancer after neoadjuvant therapy. Forty two ex vivo specimens were collected from rectal cancer patients with neoadjuvant therapy and radical operation at our hospital. Traditional method with palpation and injection of methylene blue into inferior mesenteric artery were employed. The data of lymph node harvest were analyzed by paired t and chi-square tests. The average number of detected lymph node in traditional method and methylene blue groups were 6.1 ± 4.3 and 15.2 ± 6.4 respectively (P<0.001). The proportions of lymph nodes <5 mm were 14.1% and 46.7% in traditional method and methylene blue groups respectively (P<0.001). And the injection of methylene blue added 13 extra metastatic lymph nodes and caused a shift to node-positive stage (P=0.89). Neoadjuvant therapy decrease lymph node retrieval in rectal cancer. Injecting methylene blue into inferior mesenteric artery improves lymph node harvest especially for small nodes and helps to acquire more metastatic nodes for accurate pathological staging.

  20. Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging

    PubMed Central

    Liu, Bo; Li, Zhiwei; Xie, Peng

    2014-01-01

    Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic resonance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treatment only. The intervention group received vertebral artery orifice angioplasty and stenting + identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects. PMID:25657727

  1. Transcatheter Arterial Chemoembolization for Advanced Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrial Tumors

    SciTech Connect

    Chern, M. C. Chuang, V. P. Cheng, T. Lin, Z. H. Lin, Y. M.

    2008-07-15

    Advanced hepatocelluar carcinoma (HCC) with invasion of venous systems usually indicates not only a poor prognosis but also a contraindication for transcatheter arterial chemoembolization (TACE). This study evaluated the feasibility of TACE for advanced HCC with inferior vena cava (IVC) and right atrium (RA) tumors and, also, to search for the ideal embolization particle size. Twenty-six patients who had HCC invasion into the IVC included five patients with coexistent RA tumors that were treated with TACE. The chemoembolization method was cisplatin, doxorubicin, and mitomycin C mixed with Lipiodol and Ivalon. The selection of Ivalon particles was divided into two groups based on their size: (A) >180 {mu}m, N = 9; and (B) 47-180 {mu}m, N = 17. The overall response rate was 53.8% (14/26). Based on the response to TACE, the median survival period of the entire group was 4.2 months (range, 1.5 to 76.7 months). The median survival period of the 14 responders was 13.5 months (1.5-76.7 months), and that of the 12 nonresponders, 3.3 months (2.1 to 24.3 months) (p < 0.002). Comparing the two Ivalon particle sizes, the response rate was 12.5% (1/9 patients) for group A and 76.5% for group B (13/17 patients) (p < 0.02). No serious complication was observed post-chemoembolization. In conclusion, TACE is a safe and effective treatment for advanced HCC with IVC and RA tumors, and small Ivalon particles (47-180 {mu}m) are superior to large ones (>180 {mu}m).

  2. Resection of Colorectal Cancer With Versus Without Preservation of Inferior Mesenteric Artery.

    PubMed

    Mihara, Yoshiaki; Kochi, Mitsugu; Fujii, Masashi; Kanamori, Noriaki; Funada, Tomoya; Teshima, Youichi; Jinno, Daijo; Takayama, Tadatoshi

    2017-08-01

    To assess the clinical significance of preservation of the inferior mesenteric artery (IMA) in comparison with IMA ligation in surgery for sigmoid colon or rectal (colorectal) cancer. Consecutive patients (n=862) with colorectal cancer who underwent intended surgical resection of the main tumor between 1986 and 2011 were retrospectively analyzed. The patients were divided into 2 groups: IMA preserved (n=745) and IMA ligated (n=117). No significant difference was observed in incidence of advanced stage III or IV disease between the 2 groups (P=0.56 and 0.51, respectively), whereas a longer operation time (287 [95 to 700] vs. 215 [60 to 900] min, respectively; P<0.001) and greater amount of intraoperative bleeding (595 [15 to 4530] vs. 235 [1 to 11565] mL, respectively; P<0.001) were observed in the IMA-ligated group. The overall incidence of surgery-related complications was higher in the IMA-ligated group than in the IMA-preserved group (53.0% vs. 38.5%, respectively; P=0.003). Urinary dysfunction and abdominal abscess were significantly more frequent in the IMA-ligated group (11.1% vs. 4.0%, P=0.001; and 6.8% vs. 2.6%, P=0.01, respectively), and postoperative hospitalization was longer (11 to 140, median 28 vs. 5 to 153, median 19 d, respectively; P<0.001). No significant difference was found in overall survival rate between the 2 groups. For colorectal cancer resection, IMA preservation may be no change to IMA ligation as to patient' survival, with small risk of operative morbidity.

  3. Low-rise scar deep inferior epigastric artery perforator flap for breast reconstruction.

    PubMed

    Akita, Shinsuke; Mitsukawa, Nobuyuki; Tokumoto, Hideki; Kuriyama, Motone; Kubota, Yoshitaka; Kira, Tomoe; Sasahara, Yoshitaro; Sakakibara, Masahiro; Nagashima, Takeshi; Satoh, Kaneshige

    2015-09-01

    To achieve an unnoticeable postoperative scar in patients with little abdominal skin laxity for breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap, we devised a new design called the low-rise scar DIEP flap; the skin paddle of this flap is located lower with a smaller vertical width, and more adipose tissue is elevated to obtain enough volume. The purpose of this report is to evaluate the utility of the low-rise scar DIEP flap compared with that of the conventionally designed flap. Twelve patients who underwent low-rise scar DIEP flaps (study group) and 11 patients who underwent conventionally-designed DIEP flaps (control group) were included in the present study. The distance from the umbilicus to horizontal scar was divided by the patient's height. The length of the scar was divided by the abdominal circumference. These ratios were compared between groups. All flaps survived completely and no recipient site complication was observed, except for one case in the control group with small-range fat necrosis. No donor site complication was observed in either group. The distance ratio was significantly larger in study group (<0.01, 0.049 ± 0.004, and 0.028 ± 0.005, respectively). The length ratio was significantly smaller in the study group <0.01, 0.42 ± 0.02 and 0.36 ± 0.02, respectively). The weight of the flap used for reconstruction was 338.8 ± 127.7 g in the study group and 320.5 ± 63.0 g in the control group A low-rise scar DIEP flap leaves a lower and shorter postoperative scar. © 2015 Wiley Periodicals, Inc.

  4. Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: a paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia.

    PubMed

    Lotun, Kapildeo; Shetty, Ranjith; Topaz, On

    2012-11-01

    Symptomatic chronic mesenteric ischemia results from intestinal hypoperfusion and is classically thought to result from involvement of two or more mesenteric arteries. The celiac artery and superior mesenteric artery are most frequently implicated in this disease process, and their involvement usually results in symptoms of small intestinal ischemia. Symptomatic chronic mesenteric ischemia resulting predominantly from inferior mesenteric artery involvement has largely been overlooked but does gives rise to its own, unique clinical presentation with symptoms resulting from large intestinal ischemia. We present four patients with atherosclerotic inferior mesenteric artery stenosis with symptomatic chronic mesenteric ischemia that have unique clinical presentations consistent with large intestinal ischemia that resolved following percutaneous endovascular treatment of the inferior mesenteric artery stenosis. These cases represent a novel approach to the diagnosis and management of this disease process and may warrant a further subclassification of chronic mesenteric ischemia into chronic small intestinal ischemia and chronic large intestinal ischemia.

  5. Pituitary adenylate cyclase activating polypeptide (PACAP) dilates cerebellar arteries through activation of large-conductance Ca(2+)-activated (BK) and ATP-sensitive (K ATP) K (+) channels.

    PubMed

    Koide, Masayo; Syed, Arsalan U; Braas, Karen M; May, Victor; Wellman, George C

    2014-11-01

    Pituitary adenylate cyclase activating polypeptide (PACAP) is a potent vasodilator of numerous vascular beds, including cerebral arteries. Although PACAP-induced cerebral artery dilation is suggested to be cyclic AMP (cAMP)-dependent, the downstream intracellular signaling pathways are still not fully understood. In this study, we examined the role of smooth muscle K(+) channels and hypothesized that PACAP-mediated increases in cAMP levels and protein kinase A (PKA) activity result in the coordinate activation of ATP-sensitive K(+) (KATP) and large-conductance Ca(2+)-activated K(+) (BK) channels for cerebral artery dilation. Using patch-clamp electrophysiology, we observed that PACAP enhanced whole-cell KATP channel activity and transient BK channel currents in freshly isolated rat cerebellar artery myocytes. The increased frequency of transient BK currents following PACAP treatment is indicative of increased intracellular Ca(2+) release events termed Ca(2+) sparks. Consistent with the electrophysiology data, the PACAP-induced vasodilations of cannulated cerebellar artery preparations were attenuated by approximately 50 % in the presence of glibenclamide (a KATP channel blocker) or paxilline (a BK channel blocker). Further, in the presence of both blockers, PACAP failed to cause vasodilation. In conclusion, our results indicate that PACAP causes cerebellar artery dilation through two mechanisms: (1) KATP channel activation and (2) enhanced BK channel activity, likely through increased Ca(2+) spark frequency.

  6. Study of the course of inferior epigastric artery with reference to laparoscopic portal

    PubMed Central

    Rao, Manvikar Purushottam; Swamy, Vatsala; Arole, Vasanti; Mishra, Paramatma

    2013-01-01

    INTRODUCTION: Laparoscopy has been in vogue for more than 2 decades. Making portals in the anterior abdominal wall for introducing laparoscopic instruments is done with trocar and cannula which is a blind procedure. Stab incision and trocar insertion, though safe, at times can lead to injury of blood vessels of anterior abdominal wall more so the inferior epigastric artery (IEA). Trauma to abdominal wall vessels is 0.2%-2% of laparoscopic procedures and said to be 3 per 1000 cases. Injury to IEA is one of the commonest complications seen. Purpose of the present study was to observe the course of IEA in 50 formalin preserved cadavers, by dissection. MATERIALS AND METHODS: In 50 formalin fixed cadavers, IEA was exposed by opening the rectus sheath. Rectus was divided and IEA was exposed. Five reference points A, B, C, D, and E were defined. A was at pubic symphysis, while E at umbilicus. B, C, and D were marked at the distance of 3.5, 7, and 10.5 cm, respectively from pubic symphysis. Distances of the IEA from these midline points were measured with the help of sliding vernier calipers. RESULTS: Significant observation was variations in the length of IEA. It was seen to end at a lower level than normal (three cases on right and four on left side) by piercing rectus. In 14, cadavers artery did not reach up to umbilicus on both sides. Nearest point of entry of IEA in to rectus sheath at the level of pubic symphysis was 1.2 cm on left and 3.2 cm on right side. Farthest point from point A was 6.8 cm on right and 6.9 cm on left side. Width of strip of abdominal wall which was likely to have IEA beneath was up to 4 cm till level C and beyond which it widened up to 5cm on left side and 6 cm on right at umbilicus. DISCUSSION: Present study did reveal notable variations in length and termination of IEA. No uniformity in entry of IEA in to the rectus sheath was observed. Findings did concur with earlier observations but the strip of skin of arterial zone was not equidistant

  7. The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip.

    PubMed

    Grose, A W; Gardner, M J; Sussmann, P S; Helfet, D L; Lorich, D G

    2008-10-01

    The inferior gluteal artery is described in standard anatomy textbooks as contributing to the blood supply of the hip through an anastomosis with the medial femoral circumflex artery. The site(s) of the anastomosis has not been described previously. We undertook an injection study to define the anastomotic connections between these two arteries and to determine whether the inferior gluteal artery could supply the lateral epiphyseal arteries alone. From eight fresh-frozen cadaver pelvic specimens we were able to inject the vessels in 14 hips with latex moulding compound through either the medial femoral circumflex artery or the inferior gluteal artery. Injected vessels around the hip were then carefully exposed and documented photographically. In seven of the eight specimens a clear anastomosis was shown between the two arteries adjacent to the tendon of obturator externus. The terminal vessel arising from this anastomosis was noted to pass directly beneath the posterior capsule of the hip before ascending the superior aspect of the femoral neck and terminating in the lateral epiphyseal vessels. At no point was the terminal vessel found between the capsule and the conjoined tendon. The medial femoral circumflex artery receives a direct supply from the inferior gluteal artery immediately before passing beneath the capsule of the hip. Detailed knowledge of this anatomy may help to explain the development of avascular necrosis after hip trauma, as well as to allow additional safe surgical exposure of the femoral neck and head.

  8. A comparison of the superficial inferior epigastric artery flap and deep inferior epigastric perforator flap in postmastectomy reconstruction: A cost-effectiveness analysis.

    PubMed

    Thoma, Achilleas; Jansen, Leigh; Sprague, Sheila; P Stat, Eric Duku

    2008-01-01

    To perform a cost-effectiveness analysis comparing the superficial inferior epigastric artery (SIEA) and deep inferior epigastric perforator (DIEP) flaps in postmastectomy reconstruction. A decision analytic model with seven clinically important health outcomes (health states) was used, incorporating the Ontario Ministry of Health's perspective. Direct medical costs were estimated from a university-based hospital. The utilities of each health state converted into quality-adjusted life years (QALYs) were obtained from previously published data. Health state probabilities were computed from a systematic literature review. Analyses yielded SIEA and DIEP expected costs and QALYs allowing calculation of the incremental cost-utility ratio (ICUR). One-way sensitivity analyses were conducted under five plausible scenarios, assessing result robustness. Five SIEA and 27 DIEP studies were identified. The baseline SIEA expected cost was slightly higher than that for the DIEP ($16,107 versus $16,095), with slightly higher QALYs (33.14 years versus 32.98 years), giving an ICUR of $77/QALY. Taking into account conversions from SIEA to DIEP, the ICUR increased to $4,480/QALY. Sensitivity analysis gave ICURs ranging from $2,614/QALY to 'dominant', all consistent with the adoption of the SIEA over the DIEP. The best available evidence suggests the SIEA is a cost-effective procedure. However, given the high SIEA to DIEP conversion rates and small marginal differences in cost and effectiveness, the ICUR may be sensitive to minor changes in costs or QALYs. The 'truth' can only be obtained from a randomized, controlled trial comparing both techniques side by side, simultaneously capturing the costs of the competing interventions.

  9. Celiac Artery Stenting in the Treatment of Intestinal Ischemia Due to the Sacrifice of the Dominant Inferior Mesenteric Artery During Endovascular Aortic Repair.

    PubMed

    Su, Zijie; Pan, Tianyue; Lian, Weishuai; Guo, Daqiao; Dong, Zhihui; Fu, Weiguo

    2016-08-01

    A 42-year-old man had intestinal ischemia 7 weeks after endovascular abdominal aortic aneurysm repair due to sacrifice of the inferior mesenteric artery, which had compensated for the intestinal blood supply because of the total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). He was diagnosed in the active phase of Takayasu arteritis, and an emergency endovascular treatment was performed. After the SMA failed to be recanalized, a stent was successfully placed into the CA; this choice was made based on the preexisting collaterals between them. The symptoms were relieved shortly after the operation. The Kirk arcade, the Barkow arcade, and the enlarged pancreaticoduodenal arcade were visualized on the follow-up computed tomography angiography. Based on this case, a short review of celiomesenteric and intermesenteric collateral circulations is presented.

  10. Vertebral artery section for treating arterial compression of the medulla oblongata. Case report.

    PubMed

    Hongo, K; Kobayashi, S; Hokama, M; Sugita, K

    1993-07-01

    A case of a 30-year-old man who showed progressive pyramidal tract signs caused by compression of the left vertebral artery is presented. Initial decompression of the vertebral artery by placing a piece of sponge between the artery and medulla had no long-term effect. The left vertebral artery distal to the origin of the posterior inferior cerebellar artery was then sectioned, decompressing the medulla oblongata. The patient's symptoms improved postoperatively. This is the first reported case of brain-stem compression by an elongated vertebral artery treated by sectioning of the artery.

  11. Arterial supply to the thyroid gland and the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in human fetal cadavers.

    PubMed

    Ozgüner, G; Sulak, O

    2014-11-01

    The aim of this study was to identify the arterial supply to the thyroid gland and the relationship between the inferior thyroid artery (ITA) and the recurrent laryngeal nerve (RLN) in fetal cadavers using anatomical dissection. The anterior necks of 200 fetuses were dissected. The origins of the superior thyroid artery (STA) and the ITA and location of the ITA in relation to the entrance of the thyroid lobe were examined. The relationship between the ITA and the RLN was determined. The origins of the STA were classified as: external carotid artery, common carotid artery (CCA), and the thyrolingual trunk. The origins of the ITA were the thyrocervical trunk and the CCA. The ITA was absent on the left side in two cases. The relationship of the RLN to the ITA fell into seven different types. Type 1: the RLN lay posterior to the artery; right (42.5%), left (65%). Type 2: the RLN lay anterior to the artery; right (40.5%), left (22.5%). Type 3: the RLN lay parallel to the artery; right (11.5%), left (7%). Type 4: the RLN lay between the two branches of the artery; right (1%), left (3.5%). Type 5: The extralaryngeal branch of the RLN was detected before it crossed the ITA; right (4.5%), left (0%). Type 6: the ITA lay between the two branches of the RLN; right (0%), left (0.5%). Type 7: the branches of the RLN lay among the branches of the ITA; right (0%), left (0.5%). The results from this study would be useful in future thyroid surgeries. © 2014 Wiley Periodicals, Inc.

  12. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery - A retrospective observational study.

    PubMed

    Ke, Jia; Cai, Jiawei; Wen, Xiaofeng; Wu, Xianrui; He, Zhen; Zou, Yifeng; Qiu, Jianping; He, Xiaowen; He, Xiaosheng; Lian, Lei; Wu, Xiaojian; Zhou, Zhiyang; Lan, Ping

    2017-05-01

    To demonstrate the clinical applicability of 3-dimensional CT angiography (3D-CTA) in evaluating the anatomic variations of inferior mesenteric artery (IMA) and left colic artery (LCA), to help make pre-operative strategies of rectal cancer surgery. 188 patients with abdominal and pelvic contrast-enhanced CT scan were retrospectively enrolled and 3D-CTA was reconstructed. The origin and branching patterns of IMA, tracking patterns of LCA, intersectional patterns among IMA, LCA and inferior mesenteric vein (IMV) were examined, and their associations with clinical features were analyzed. The origin of IMA was located 42.1 ± 7.7 mm above iliac artery bifurcation, 64.4% within the area of the 3rd lumbar vertebra. 47.3% of LCA arose independently from IMA, 27.1% arose at the root of sigmoid artery (SA), 20.7% shared a common trunk with SA while 4.8% of LCA was absent. As for track of LCA before anastomosis with marginal artery, 53.2% went straight upward while medial to the inner border of left kidney (Type A), 27.1% traveled diagonally across left kidney (Type B) and14.9% went infero-laterally to the lower border of left kidney (Type C). Short IMA trunk was independently associated with type A LCA and lower site of IMA origin. At the horizontal level of IMA origin, 29% of the LCA went distant from IMV, while 71% (21% medial, 50% lateral) were mutually close, and the close type was independently associated with type A LCA. Preoperative understanding of the vascular variations and the mutual relationship among LCA, IMA and IMV could be obtained by 3D-CTA, which would further help surgeons to set detailed plans for laparoscopic rectal cancer surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  13. Combined Use of an Occlusion Balloon Catheter and a Microcatheter for Embolization of the Unselectable Right Inferior Phrenic Artery Supplying Hepatocellular Carcinoma

    SciTech Connect

    Miyayama, Shiro Matsui, Osamu; Taki, Keiichi; Minami, Tetsuya; Ito, Chiharu; Shinmura, Rieko; Takamatsu, Shigeyuki; Kobayashi, Miki; Notsumata, Kazuo

    2004-11-15

    We report the combined use of an occlusion balloon catheter and a microcatheter for transcatheter arterial embolization (TAE) of hepatocellular carcinoma (HCC) fed by the unselectable right inferior phrenic artery (IPA). In one case, HCC was fed by the reconstructed right IPA via a small branch arising from the proximate portion of the celiac artery. In another, the tumor was fed by the right IPA that had been previously embolized with coils. TAE was successfully performed through a microcatheter placed in the celiac artery immediately proximal to the occluding balloon catheter of the celiac trunk and coil embolization of the left gastric artery.

  14. A Novel Strategy to Supercharge a Deep Inferior Epigastric Artery Perforator Flap after Port-a-Cath Removal

    PubMed Central

    Teven, Chad M.; Ooi, Adrian S.H.; Chang, David W.

    2016-01-01

    Summary: Autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap has become increasingly popular because of its unique advantages. However, compared with some other forms of abdominal-based autologous reconstruction, DIEP flaps are associated with an increased risk of venous congestion. Many techniques—or lifeboats—have been introduced to diagnose and treat this potentially devastating complication. In this case report, we describe a novel strategy to augment venous drainage when venous congestion is encountered. A patient presented requesting autologous reconstruction and removal of a venous access catheter that had been used for chemotherapy administration. We performed left delayed breast reconstruction using a single-perforator DIEP flap from the right hemiabdomen. The superficial inferior epigastric vein to this flap was preserved. After removal of the Port-a-Cath from the left chest, we anastomosed the superficial inferior epigastric vein to the fibrous capsular sheath that had formed around the indwelling catheter to allow additional venous drainage. Flow through this conduit was confirmed using Doppler ultrasound. There were no flap-related complications, and the patient was discharged in good condition. Further research is warranted to characterize the indications and limitations of this novel lifeboat.

  15. [Pancreatoduodenectomy for invasive carcinoma of the head of the pancreas with ligation of the inferior pancreaticoduodenal artery performed first].

    PubMed

    Horiguchi, Akihiko; Ishihara, Shin; Ito, Masahiro; Asano, Yukio; Yamamoto, Toshiyuki; Miyakawa, Shuichi

    2011-05-01

    The ideal surgical procedure for treating pancreatic cancer achieves radical excision in a minimally invasive manner and allows rapid transition to adjuvant chemotherapy. If the afferent artery to the pancreatic head is not ligated until the latter half of the surgery, congestion of the pancreaticoduodenal vein may occur, leading to phleborrhagia and increased intraoperative hemorrhage. Ligation of the afferent artery, i.e., the inferior pancreaticoduodenal artery (IPDA), in the first half of the surgery may prevent the occurrence of hemorrhage due to congestion. Early ligation of the IPDA is also useful in ensuring the success of radical dissection of the plexus around the superior mesenteric artery or the no. 14 lymph node. We have been performing pancreaticoduodenectomies with antecedent IPDA ligation since 2005 and have found that the percentage of R0 versus R1 and R2 has increased compared with that when standard pancreaticoduodenectomies were performed. Preemptive ligation of the IPDA early in pancreaticoduodenectomy for invasive pancreatic cancer is a useful method for reducing blood loss and achieving R0 resection in a thorough yet efficient manner.

  16. Innovative Procedure for Inferior Mesenteric Artery Embolization Using the Amplatzer Vascular Plug 4 during Endovascular Aneurysm Repair.

    PubMed

    Morikage, Noriyasu; Samura, Makoto; Takeuchi, Yuriko; Tanaka, Yuya; Ueda, Koshiro; Harada, Takasuke; Yamashita, Osamu; Suehiro, Kotaro; Hamano, Kimikazu

    2017-05-10

    The aim of this study is to present an easy and quick technique for embolization of the inferior mesenteric artery (IMA) during endovascular aneurysm repair (EVAR). We performed IMA embolization using a conventional EVAR device alone with the femoral artery approach during EVAR, which has not been reported previously. First, a 16F or 18F DrySeal Sheath is inserted from the femoral artery into the site around the IMA. Second, cannulation is performed in the IMA with an angiography catheter having a 0.038-inch inner lumen that is used for gate cannulation during EVAR. Third, IMA embolization is performed using the Amplatzer Vascular Plug 4 (AVP4). The use of the DrySeal Sheath facilitates cannulation of the IMA, and its combination with a stent-graft balloon allows the AVP4 to be placed at the root of the IMA without deviation of the catheter. The success rate of the procedure was 90.9% (30/33 cases). The median procedure time was 11.6 min. No complications due to IMA embolization were noted. This procedure enables safe and quick placement of the AVP4 in the IMA using the catheter insertion approach from the femoral artery, which has been conventionally regarded as difficult. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Traumatic Neuroma at the Inferior Mesenteric Artery Stump after Rectal Cancer Surgery: A Case Report and Literature Review.

    PubMed

    Jeon, Sung Mi; Lee, Jae Young; Byeon, Sun Ju

    2016-11-25

    Traumatic neuroma results from regeneration attempts of the proximal end of an injured or severed nerve, resulting in a non-neoplastic nodular lesion. The lower extremity after amputation is the most common site, followed by the head and neck. Traumatic neuromas occurring in the abdomen, however, are rare. In the abdominal region, traumatic neuromas occur in the cystic duct stump and the common bile ducts as well as around the celiac trunk. This study reports a case of a 59-year-old man who presented with a traumatic neuroma arising at the stump of the inferior mesenteric artery after rectal cancer surgery. Traumatic neuromas at the stump of the inferior mesenteric artery have not been previously reported. The lesion exhibited atypical imaging features, including a well-enhanced nodule, a significant interval growth in size and a mild increase in 18F-fluo-rodeoxyglucose uptake, resembling lymph node metastasis. This case report will help physicians understand the sites of occurrence and imaging features of traumatic neuromas in the abdomen.

  18. Endovascular embolization for the management of inferior alveolar artery bleeding after a third molar extraction: A case report.

    PubMed

    Bianchi, Bernardo; Varazzani, Anea; Ferri, Anea; Menozzi, Roberto; Sesenna, Enrico

    2016-03-01

    Removal of third molars is a common surgical procedure with low complication rates. Localized alveolar osteitis, infection, bleeding, and paresthesia are the four most common postoperative complications of third molar extraction reported in the literature. Postoperative severe hemorrhages are rare and are usually related to inferior alveolar artery damage. Although most bleeding is usually managed effectively by local compression or packing of the socket, even life-threatening complications may occur. Endovascular embolization has been rarely reported as treatment for such a complication and represents an ideal solution, with a low complication rate and excellent control of bleeding. The authors report a case of potentially life-threatening hemorrhage continuing 4 days after extraction of the mandibular right third molar, resulting in significant anemia (Hb 6.6 g/dL) and treated successfully with endovascular embolization of the inferior alveolar artery. The authors consider it important for general practitioners to know this treatment and how to manage this rare complication in the correct way, saving time if satisfactory hemostasis cannot be reached with common procedures.

  19. Orexin-neuromodulated cerebellar circuit controls redistribution of arterial blood flows for defense behavior in rabbits

    PubMed Central

    Nisimaru, Naoko; Mittal, Chetan; Shirai, Yoshinori; Sooksawate, Thongchai; Anandaraj, Prabu; Hashikawa, Tsutomu; Nagao, Soichi; Arata, Akiko; Sakurai, Takeshi; Yamamoto, Miyuki; Ito, Masao

    2013-01-01

    We investigated a unique microzone of the cerebellum located in folium-p (fp) of rabbit flocculus. In fp, Purkinje cells were potently excited by stimulation of the hypothalamus or mesencephalic periaqueductal gray, which induced defense reactions. Using multiple neuroscience techniques, we determined that this excitation was mediated via beaded axons of orexinergic hypothalamic neurons passing collaterals through the mesencephalic periaqueductal gray. Axonal tracing studies using DiI and biotinylated dextran amine evidenced the projection of fp Purkinje cells to the ventrolateral corner of the ipsilateral parabrachial nucleus (PBN). Because, in defense reactions, arterial blood flow has been known to redistribute from visceral organs to active muscles, we hypothesized that, via PBN, fp adaptively controls arterial blood flow redistribution under orexin-mediated neuromodulation that could occur in defense behavior. This hypothesis was supported by our finding that climbing fiber signals to fp Purkinje cells were elicited by stimulation of the aortic nerve, a high arterial blood pressure, or a high potassium concentration in muscles, all implying errors in the control of arterial blood flow. We further examined the arterial blood flow redistribution elicited by electric foot shock stimuli in awake, behaving rabbits. We found that systemic administration of an orexin antagonist attenuated the redistribution and that lesioning of fp caused an imbalance in the redistribution between active muscles and visceral organs. Lesioning of fp also diminished foot shock-induced increases in the mean arterial blood pressure. These results collectively support the hypothesis that the fp microcomplex adaptively controls defense reactions under orexin-mediated neuromodulation. PMID:23912185

  20. Embolic stroke in the territory of a cerebellar arteriovenous malformation--case report.

    PubMed

    Komiyama, M; Nakajima, H; Nishikawa, M; Yasui, T

    1998-07-01

    A 63-year-old male presented with an embolic stroke in the right medial inferior cerebellum. Angiography at 2 and 8 months after the stroke revealed arteriovenous shunts from the vermian branch of the right posterior inferior cerebellar artery of the right inferior vermian vein. The shunts mimicked the arteriovenous shunts of post-recanalization in acute ischemic stroke, but were finally diagnosed as a pre-existing congenital arteriovenous malformation based on their persistence. Arteriovenous shunts that persists more than 2 weeks after ictus should be differentiated from the post-recanalization arteriovenous shunts of ischemic stroke, as the different etiology may affect the ultimate prognosis and course of treatment.

  1. Congenital subclavian steal syndrome with multiple cerebellar infarctions caused by an atypical circumflex retroesophageal right aortic arch with atretic aberrant left subclavian artery.

    PubMed

    Mamopoulos, Apostolos T; Luther, Bernd

    2014-09-01

    A right-sided aortic arch is a rare anomaly with an incidence of 0.1% worldwide and is usually associated with a mirror image of all supra-aortic branches or an aberrant left subclavian artery. The latter is often associated with a Kommerell diverticulum, although it can rarely be hypoplastic or atretic and lead to congenital subclavian steal. In most patients, the situation is well-tolerated. In this report, we present a case of subclavian steal syndrome with multiple cerebellar infarcts in a patient with an atypical right-sided aortic arch and an atretic aberrant left subclavian artery arising from a left-sided descending thoracic aorta.

  2. [Influences of inferior mesenteric artery types and Riolan artery arcade absence on the incidence of anastomotic leakage after laparoscopic resection of rectal cancer].

    PubMed

    Huang, Jun; Zhou, Jiaming; Wan, Yingjie; Lin, Yanghao; Deng, Yanhong; Zhou, Zhiyang; Qiu, Jianping; Wang, Jianping; Huang, Meijin

    2016-10-25

    To evaluate the influences of inferior mesenteric artery (IMA) types and Riolan artery arcade absence on the incidence of anastomotic leakage(AL) after laparoscopic resection of rectal cancer. Clinical data of 116 local advanced rectal cancer patients who underwent laparoscopic resection in The Sixth Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2014 were analyzed retrospectively. IMA and Riolan artery arcade were examined by preoperative computed tomography angiography (CTA) reconstruction. The influences of IMA type, Riolan artery arcade absence and ligation site (high or low) on AL were analyzed by Logistic regression. The proportion of IMA types(I(-IIII() was 57.8%(67/116), 10.3%(12/116), 31.0%(36/116) and 0.9%(1/116), respectively. Riolan artery arcade absence was found in 60.3%(70/116). Eight (6.9%) patients suffered from AL. IMA type III( had significantly higher AL incidence as compared to other IMA types [19.4%(7/36) vs. 1.2%(1/80), P=0.001]. Meanwhile, patients with Riolan artery arcade absence also had significantly higher AL incidence[11.4%(8/70) vs. 0.0%(0/46), P=0.030]. However, the difference in AL incidence between high and Low IMA ligation was not statistically significant [8.0%(7/87) vs. 3.4%(1/29), P=0.531]. Seven of these 8 AL patients were found in IMA type III( with Riolan artery arcade absence and high ligation. Multivariate analysis showed that IMA type III( (P=0.001) and Riolan artery arcade absence (P=0.002) were independent risk factors of AL. IMA type III( with Riolan artery arcade absence increases AL incidence significantly in laparoscopic resection of rectal cancer. IMA type and Riolan aretry arcade absence or not contribute to the selection of IMA ligation site in the operation. For the colorectal cancer patients with IMA type III( and Riolan artery arcade absence, selective low IMA ligation with root lymph node dissection should be recommended.

  3. Inferior pancreaticoduodenal artery aneurysm treated with coil packing and stent placement

    PubMed Central

    Ikoma, Akira; Nakai, Motoki; Sato, Morio; Kawai, Nobuyuki; Tanaka, Takami; Sanda, Hiroki; Nakata, Kouhei; Minamiguchi, Hiroki; Sonomura, Tetsuo

    2012-01-01

    Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery (SMA) stenosis were previously described and both were treated surgically. However, for interventional treatment, securing a sufficient blood supply to the SMA should be a priority of treatment. We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin. The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis; however, the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique, leading to stent placement. Thereafter, coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia. At the last follow-up computed tomography 8 mo later, no recurrence of the aneurysm was confirmed. The pull-through technique was useful for angioplasty for tight SMA stenosis in this case. PMID:22937218

  4. Inferior Pancreaticoduodenal Artery Aneurysms Associated with Occlusive Lesions of the Celiac Axis: Diagnosis, Treatment Options, Outcomes, and Review of the Literature

    SciTech Connect

    Flood, Karen Nicholson, Anthony A.

    2013-06-15

    Purpose. To describe the presentation, treatment, and outcomes for 14 patients with aneurysms of the inferior pancreaticoduodenal arteries associated with occlusive lesions of the celiac axis, and to review the literature for similar cases. Methods, Over a period of 12 years, 14 patients (10 women and 4 men) ranging in age from 26 to 50 (mean 46) years were demonstrated to have aneurysms of the inferior pancreaticoduodenal artery origin associated with stenosis or occlusion of the celiac axis. All patients were treated by a combination of surgery and interventional radiology. Results. Outcome data collected between 3 months and 4 years (mean 2 years) demonstrated that all aneurysms remained excluded, and all 14 patients were well. The 49 case reports in the literature confirm the findings of this cohort. Conclusion. In inferior pancreaticoduodenal artery aneurysm resulting from celiac occlusive disease, endovascular treatment is best achieved by stenting the celiac axis and/or embolizing the aneurysm when necessary.

  5. Retrograde microvascular augmentation (turbocharging) of a single-pedicle TRAM flap through a deep inferior epigastric arterial and venous loop.

    PubMed

    Semple, J L

    1994-01-01

    Modern trends in breast reconstruction with the TRAM flap have promoted adequate blood supply to the flap while minimizing the donor-site defect in the anterior abdominal wall. Preservation of the rectus abdominis muscle (both unipedicled and bipedicled), supercharging, delayed, and free-flap techniques all have promoted these principles. A new technique is presented utilizing the single pedicle with a transmidline retrograde microvascular loop anastomosis of the deep inferior epigastric artery and vein. The turbocharging allows increased blood flow to the remote areas of the flap as well as augmented venous outflow. In addition, the abdominal-wall donor site is similar to that of a single pedicle. This technique is ideal for reconstruction where the entire flap is required, a lower abdominal scar is present, or the recipient vessels for the free flap are absent or damaged.

  6. Failure of Fixation Suppression of Spontaneous Nystagmus in Cerebellar Infarction: Frequency, Pattern, and a Possible Structure.

    PubMed

    Kim, Hyun-Ah; Yi, Hyon-Ah; Lee, Hyung

    2016-04-01

    To investigate the frequency and pattern of failure of the fixation suppression (FFS) of spontaneous nystagmus (SN) in unilateral cerebellar infarction, and to identify the structure responsible for FFS, 29 patients with acute, mainly unilateral, isolated cerebellar infarction who had SN with a predominantly horizontal component were enrolled in this study. The ocular fixation index (OFI) was defined as the mean slow phase velocity (SPV) of the horizontal component of SN with fixation divided by the mean SPV of the horizontal component of SN without fixation. The OFI from age- and sex-matched patients with vestibular neuritis was calculated and used as the control data. The FFS of SN was only found in less than half (41 %, 12/29) of the patients. Approximately 65 % (n = 7) of the patients with isolated anterior inferior cerebellar artery territory cerebellar infarction showed FFS, whereas only a quarter (n = 3) of the patients with isolated posterior inferior cerebellar artery (PICA) territory cerebellar infarction showed FFS. The proportion of gaze-evoked nystagmus (6/12 [50 %] vs. 2/17 [12 %], p = 0.04) and deficient gain of ipsilesional pursuit (10/12 [83 %] vs. 6/17 [35 %], p = 0.05) was more frequent in the FFS group than in the group without FFS. Lesion subtraction analysis in isolated PICA territory cerebellar infarction revealed that the nodulus was commonly damaged in patients with FFS, compared to that of patients without FFS. Our study shows that FFS of SN due to acute cerebellar infarction is less common than previously thought and the nodulus may be an important structure for the suppression of SN in humans.

  7. Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column: a case report.

    PubMed

    Mimata, Yoshikuni; Murakami, Hideki; Sato, Kotaro; Suzuki, Yoshiaki

    2014-01-01

    Vertebral artery injury can be a complication of cervical spine injury. Although most cases are asymptomatic, the rare case progresses to severe neurological impairment and fatal outcomes. We experienced a case of bilateral cerebellar and brain stem infarction with fatal outcome resulting from vertebral artery injury associated with cervical spine trauma. A 69-year-old male was admitted to our hospital because of tetraplegia after falling down the stairs and hitting his head on the floor. Marked bony damage of the cervical spine was not apparent on radiographs and CT scans, so the injury was initially considered to be a cervical cord injury without bony damage. However, an intensity change in the intervertebral disc at C5/C6, and a ventral epidural hematoma were observed on MRI. A CT angiogram of the neck showed the right vertebral artery was completely occluded at the C4 level of the spine. Forty-eight hours after injury, the patient lapsed into drowsy consciousness. The cranial CT scan showed a massive low-density area in the bilateral cerebellar hemispheres and brain stem. Anticoagulation was initiated after a diagnosis of the right vertebral artery injury, but the patient developed bilateral cerebellar and brain stem infarction. The patient's brain herniation progressed and the patient died 52 h after injury. We considered that not only anticoagulation but also treatment for thrombosis would have been needed to prevent cranial embolism. We fully realize that early and appropriate treatment are essential to improve the treatment results, and constructing a medical system with a team of orthopedists, radiologists, and neurosurgeons is also very important.

  8. Three-dimensional reconstruction of the vascular arrangement including the inferior mesenteric artery and left colic artery in laparoscope-assisted colorectal surgery.

    PubMed

    Miyamoto, Ryoichi; Nagai, Kentaro; Kemmochi, Akira; Inagawa, Satoshi; Yamamoto, Masayoshi

    2016-10-01

    We performed three-dimensional (3D) reconstruction to investigate the vascular anatomy, including the inferior mesenteric artery (IMA), left colic artery (LCA), and inferior mesenteric vein (IMV), for laparoscope-assisted left-side colorectal surgery. Furthermore, we also examined the distances from the root of the IMA to the bifurcation of the LCA and to the IMV using 3D imaging. We retrospectively analyzed 46 patients who underwent laparoscope-assisted left-side colorectal surgery via 3D surgical reconstruction at Tsukuba Medical Center Hospital. The branching patterns among the IMA, LCA, and sigmoidal colic artery (SCA) in colon cancer could be classified into three groups (types A, B, and C): type A, in which both arteries (LCA and SCA) branch off from the same point of the IMA; type B, in which the common trunk of the LCA and SCA branches off from the IMA; and type C, in which the LCA and SCA branch off separately from the IMA. The shortest length from the root of the IMA to bifurcation of the LCA and SCA branches (D mm) or to the IMV (d mm) was measured by 3D imaging. The mean D mm and d mm for all cases were 39.4 ± 11.2 and 27.9 ± 9.21 mm, respectively. The D mm from the IMA root to the LCA or SCA branch in types A, B, and C was 37.8 ± 9.21, 40.5 ± 12.7, and 38.6 ± 10.2 mm, respectively. Similarly, the d mm from the IMA root to the IMV in types A, B, and C was 30.2 ± 11.3, 29.9 ± 7.27, and 25.2 ± 10.3 mm, respectively. The present 3D reconstruction technique was useful for determining the 3D vascular anatomical pattern including the relative positions of the IMA, SCA, and IMV during laparoscope-assisted left-side colorectal surgery.

  9. Diminution and reversal of eye movements induced by local stimulation of rabbit cerebellar flocculus after partial destruction of the inferior olive.

    PubMed

    Dufossé, M; Ito, M; Miyashita, Y

    1978-09-15

    After the dorsal cap and adjacent ventrolateral outgrowth regions of the inferior olive had been chronically destroyed in the rabbits, the eye movements evoked by local stimulation of the flocculus were reduced in amplitude and reversed in direction, indicating that the inhibition by flocculus Purkinje cells of vestibulo-ocular relay neurons could no longer be actuated by the stimulation.

  10. Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study

    PubMed Central

    Stawicki, Stanislaw P.; Papadimos, Thomas J.; Bahner, David P.; Evans, David C.; Jones, Christian

    2016-01-01

    Introduction: As pulmonary artery catheter (PAC) use declines, search continues for reliable and readily accessible minimally invasive hemodynamic monitoring alternatives. Although the correlation between inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVP) has been described previously, little information exists regarding the relationship between IVC-CI and pulmonary artery pressures (PAPs). The goal of this study is to bridge this important knowledge gap. We hypothesized that there would be an inverse correlation between IVC-CI and PAPs. Methods: A post hoc analysis of prospectively collected hemodynamic data was performed, examining correlations between IVC-CI and PAPs in a convenience sample of adult Surgical Intensive Care Unit patients. Concurrent measurements of IVC-CI and pulmonary arterial systolic (PAS), pulmonary arterial diastolic (PAD), and pulmonary arterial mean (PAM) pressures were performed. IVC-CI was calculated as ([IVCmax − IVCmin]/IVCmax) × 100%. Vena cava measurements were obtained by ultrasound–credentialed providers. For the purpose of correlative analysis, PAP measurements (PAS, PAD, and PAM) were grouped by terciles while the IVC-CI spectrum was divided into thirds (<33, 33–65, ≥66). Results: Data from 34 patients (12 women, 22 men, with median age of 59.5 years) were analyzed. Median Acute Physiologic Assessment and Chronic Health Evaluation II score was 9. A total of 76 measurement pairs were recorded, with 57% (43/76) obtained in mechanically ventilated patients. Correlations between IVC-CI and PAS (rs = −0.334), PAD (rs = −0.305), and PAM (rs = −0.329) were poor. Correlations were higher between CVP and PAS (R2 = 0.61), PAD (R2 = 0.68), and PAM (R2 = 0.70). High IVC-CI values (≥66%) consistently correlated with measurements in the lowest PAP ranges. Across all PAP groups (PAS, PAD, and PAM), there were no differences between the mean measurement values for the lower and middle IVC

  11. The Usefulness of the TOAST Classification and Prognostic Significance of Pyramidal Symptoms During the Acute Phase of Cerebellar Ischemic Stroke.

    PubMed

    Dziadkowiak, Edyta; Chojdak-Łukasiewicz, Justyna; Guziński, Maciej; Noga, Leszek; Paradowski, Bogusław

    2016-04-01

    Cerebellar stroke is a rare condition with very nonspecific clinical features. The symptoms in the acute phase could imitate acute peripheral vestibular disorders or a brainstem lesion. The aim of this study was to assess the usefulness of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification in cerebellar stroke and the impact of clinical features on the prognosis. We retrospectively analyzed 107 patients with diagnosed ischemic cerebellar infarction. We studied the clinical features and compared them based on the location of the ischemic lesion and its distribution in the posterior interior cerebellar artery (PICA), superior cerebellar artery (SCA), and anterior inferior cerebellar artery (AICA) territories. According to the TOAST classification, stroke was more prevalent in atrial fibrillation (26/107) and when the lesion was in the PICA territory (39/107). Pyramidal signs occurred in 29/107 of patients and were more prevalent when the lesion was distributed in more than two vascular regions (p = 0.00640). Mortality was higher among patients with ischemic lesion caused by cardiac sources (p = 0.00094) and with pyramidal signs (p = 0.00640). The TOAST classification is less useful in assessing supratentorial ischemic infarcts. Cardioembolic etiology, location of the ischemic lesion, and pyramidal signs support a negative prognosis.

  12. Extreme fenestration of the right vertebral artery: magnetic resonance angiographic demonstration.

    PubMed

    Uchino, A; Sawada, A; Takase, Y; Kudo, S

    2002-12-01

    The authors describe an extreme fenestration of the right vertebral artery. This anomaly was found incidentally in a female patient undergoing MR imaging and MR angiography evaluation for severe dizziness and headache. Magnetic resonance angiography showed that the right posterior inferior cerebellar artery originated possibly extracranially and anastomosed with the terminal portion of the right vertebral artery, indicating the presence of an extremely large fenestration. This, to our knowledge, is the first report of MR angiographic demonstration of this variation.

  13. "High or low Inferior Mesenteric Artery ligation in Laparoscopic low Anterior Resection: study protocol for a randomized controlled trial" (HIGHLOW trial).

    PubMed

    Mari, Giulio; Maggioni, Dario; Costanzi, Andrea; Miranda, Angelo; Rigamonti, Luca; Crippa, Jacopo; Magistro, Carmelo; Di Lernia, Stefano; Forgione, Antonello; Carnevali, Pietro; Nichelatti, Michele; Carzaniga, Pierluigi; Valenti, Francesco; Rovagnati, Marco; Berselli, Mattia; Cocozza, Eugenio; Livraghi, Lorenzo; Origi, Matteo; Scandroglio, Ildo; Roscio, Francesco; De Luca, Antonio; Ferrari, Giovanni; Pugliese, Raffaele

    2015-01-27

    The position of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision can affect genito-urinary function, bowel function, oncological outcomes, and the incidence of anastomotic leakage. Ligation to the inferior mesenteric artery at the origin or preservation of the left colic artery are both widely performed in rectal surgery. The aim of this study is to compare the incidence of genito-urinary dysfunction, anastomotic leak and oncological outcomes in laparoscopic anterior rectal resection with total mesorectal excision with high or low ligation of the inferior mesenteric artery in a controlled randomized trial. The HIGHLOW study is a multicenter randomized controlled trial in which patients are randomly assigned to high or low inferior mesenteric artery ligation during laparoscopic anterior rectal resection with total mesorectal excision for rectal cancer. Inclusion criteria are middle or low rectal cancer (0 to 12 cm from the anal verge), an American Society of Anesthesiologists score of I, II, or III, and a body mass index lower than 30. The primary end-point measure is the incidence of post-operative genito-urinary dysfunction. The secondary end-point measure is the incidence of anastomotic leakage in the two groups. A total of 200 patients (100 per arm) will reliably have 84.45 power in estimating a 20% difference in the incidence of genito-urinary dysfunctions. With a group size of 100 patients per arm it is possible to find a significant difference (α = 0.05, β = 0.1555). Allowing for an estimated dropout rate of 5%, the required sample size is 212 patients. The HIGHLOW trial is a randomized multicenter controlled trial that will provide evidence on the merits of the level of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision in terms of better preserved post-operative genito-urinary function. ClinicalTrials.gov Identifier: NCT02153801 Protocol Registration Receipt 29/5/2014.

  14. Sitting on a gold mine: optimal autologous reconstruction of a significant cosmetic contour defect of the buttock using a deep inferior epigastric artery perforator free flap.

    PubMed

    Thomas, A; Branford, O A; Floyd, D

    2012-06-01

    The options for reconstruction of soft tissue defects of the buttock include custom prosthetic implants and autologous tissue transfer: fat transfer, local flaps, pedicled flaps and free flaps. Optimal reconstruction involves replacement of like-with-like tissue, sufficient padding and adequate contouring. We report a case of a female patient presenting with a significant cosmetic contour defect of her left buttock following previous excision of a malignant fibrous histiocytoma. The patient had autologous buttock reconstruction using a deep inferior epigastric artery perforator free flap with an excellent result. To our knowledge a deep inferior epigastric artery perforator free flap has not previously been described to reconstruct the buttock. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Combined Use of an Anterolateral Thigh Flap and Superficial Inferior Epigastric Artery Flap for Reconstruction of an Extensive Abdominal Wall Defect

    PubMed Central

    Kagaya, Yu; Arikawa, Masaki; Kobayashi, Eisuke

    2016-01-01

    Summary: Reconstruction of large abdominal wall defects is challenging. We herein report the successful reconstruction of an extensive abdominal wall defect using a novel combination of flaps after sarcoma resection. A 74-year-old man presented with a dedifferentiated liposarcoma on his abdominal wall. He underwent excision of the tumor, which resulted in an extensive abdominal wall defect. The defect was reconstructed with a pedicled anterolateral thigh flap with an iliotibial tract and a pedicled superficial inferior epigastric artery flap. No skin graft was necessary. The wounds healed successfully, and no herniation occurred. The combination of an anterolateral thigh flap and a superficial inferior epigastric artery flap is a versatile option for reconstruction of extensive abdominal wall defects. PMID:27975026

  16. ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction.

    PubMed

    Kanei, Yumiko; Sharma, Jyoti; Diwan, Ravi; Sklash, Ron; Vales, Lori L; Fox, John T; Schweitzer, Paul

    2010-01-01

    ST-segment depression in lead aVR in acute inferior wall ST-segment elevation myocardial infarction (STEMI) has recently been suggested as a predictor of left circumflex (LCx) artery involvement. The purpose of this study is to evaluate the clinical significance of aVR depression during inferior wall STEMI. This study included 106 consecutive patients who presented with inferior wall STEMI and underwent urgent coronary angiogram. Clinical and angiographic findings were compared between patients with and without aVR depression > or = 0.1 mV. The sensitivity and specificity of aVR depression as a predictor of LCx infarction were 53% and 86%, respectively. In patients with right coronary artery infarction, aVR depression was associated with increased cardiac enzymes and the involvement of a large posterolateral branch, which may explain the larger infarction. ST-segment depression in lead aVR in inferior wall STEMI predicts LCx infarction or larger RCA infarction involving a large posterolateral branch. 2010 Elsevier Inc. All rights reserved.

  17. Combination of blood flow asymmetry in the cerebral and cerebellar hemispheres on brain perfusion SPECT predicts 5-year outcome in patients with symptomatic unilateral major cerebral artery occlusion.

    PubMed

    Nomura, Jun-ichi; Ogasawara, Kuniaki; Saito, Hideo; Terasaki, Kazunori; Matsumoto, Yoshiyasu; Takahashi, Yoshihiro; Ogasawara, Yasushi; Saura, Hiroaki; Yoshida, Koji; Sato, Yuiko; Kubo, Yoshitaka; Ogawa, Akira

    2014-03-01

    Misery perfusion increases the risk of stroke recurrence in patients with symptomatic major cerebral artery occlusion. The ratio of brain perfusion contralateral-to-affected asymmetry in the cerebellar hemisphere to brain perfusion affected-to-contralateral asymmetry in the cerebral hemisphere (CblPR/CbrPR) indicates affected-to-contralateral asymmetry of oxygen extraction fraction (OEF) in the cerebral hemisphere. The purpose of the present study was to determine whether the CblPR/CbrPR on brain perfusion single-photon emission computed tomography (SPECT) predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the middle cerebral artery (MCA) or internal carotid artery (ICA). Brain perfusion was assessed using N-isopropyl-p-[123I]-iodoamphetamine (123I-IMP) SPECT in 70 patients. A region of interest (ROI) was manually placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres, and the CblPR/CbrPR was calculated. All patients were prospectively followed for 5 years. The primary end points were stroke recurrence or death. A total of 17 patients exhibited the primary end points, 11 of whom experienced subsequent ipsilateral strokes. Multivariate analysis revealed that only high CblPR/CbrPR was significantly associated with the development of the primary end point or subsequent ipsilateral strokes (95% confidential limits [CIs], 1.130-3.145; P  =  0.0114 or 95% CIs, 2.558-5.140; P  =  0.0045, respectively). The CblPR/CbrPR provided 65% (11/17) or 91% (10/11) sensitivity and 88% (47/53) or 88% (52/59) specificity in predicting the primary end point or subsequent ipsilateral strokes, respectively. The CblPR/CbrPR on brain perfusion SPECT predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the MCA or ICA.

  18. Preoperative Inferior Mesenteric Artery Embolization: A Valid Method to Reduce the Rate of Type II Endoleak after EVAR?

    PubMed

    Manunga, Jesse M; Cragg, Andrew; Garberich, Ross; Urbach, Jonathan A; Skeik, Needa; Alexander, Jason; Titus, Jessica; Stephenson, Elliot; Alden, Peter; Sullivan, Timothy M

    2017-02-01

    Type II endoleak is the most commonly encountered endoleak after endovascular abdominal aortic aneurysm repair (EVAR). Some have advocated preoperative inferior mesenteric artery (IMA) embolization as a valid method for reducing the incidence of this endoleak, but controversies exist. We sought to demonstrate the impact of IMA embolization using a meta-analysis of currently available studies combined with our own experience. We conducted an institutional review board-approved, retrospective analysis of all patients undergoing IMA embolization before EVAR between the years 2010 and 2015 and used as a control a similar group of patients with patent IMA. We divided patients from our own experience and 5 other studies into 2 groups: those who did not undergo IMA embolization (control) before EVAR and those who did. Rates of type II endoleaks, aneurysm sac regression, and secondary interventions were analyzed. A total of 620 patients from 6 studies were analyzed, including 258 patients who underwent an attempted IMA embolization before EVAR with a cumulative success rate of 99.2% (range, 93.8% to 100%). There was 1 fatality associated with IMA embolization. A meta-analysis showed that preoperative IMA embolization protected against type II endoleaks compared to the control group (odds ratio [OR], 0.31 [0.17-0.57]; P < 0.001, I(2) = 43%). Furthermore, the rate of secondary intervention was significantly lower in the treatment group (OR, 0.12 [0.004-0.36]; P < 0.001, I(2) = 0%). After IMA embolization, type II endoleak resulted from patent lumbar arteries in all 62 patients with persistent endoleak. Preoperative embolization of the IMA protects against the development of type II endoleaks and secondary interventions and may potentially lead to a rapid aneurysm sac regression. The procedure can be performed with a high technical success rate and minimal complications and should be considered in patients with IMA >3 mm before EVAR. A randomized trial, however, is

  19. Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall

    PubMed Central

    Joy, Praisy; Prithishkumar, Ivan James; Isaac, Bina

    2017-01-01

    INTRODUCTION: Injury to the inferior epigastric artery (IEA) has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures. MATERIALS AND METHODS: Sixty IEAs of 30 adult cadavers (male = 19; female = 11) were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS) and umbilicus. RESULTS: The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32%) of the distance between the midline and the sagittal plane through ASIS at all levels. CONCLUSION: To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD)] away from the midline (or) slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains. PMID:27251822

  20. Spatial organization of visual messages of the rabbit's cerebellar flocculus. I. Typology of inferior olive neurons of the dorsal cap of Kooy.

    PubMed

    Leonard, C S; Simpson, J I; Graf, W

    1988-12-01

    1. Single-unit responses to large-field visual stimuli were recorded extracellularly from neurons in the dorsal cap of Kooy of the inferior olive in anesthetized, paralyzed rabbits. The visually modulated neurons in the dorsal cap responded optimally to slow rotation of random dot stimuli, which were produced using handheld patterns or a planetarium projector. 2. Neurons had either monocular or binocular receptive fields. For binocular receptive field neurons, monocular stimulation of one eye, called the dominant eye, elicited greater modulation than did stimulation of the other eye. Rotation about a particular axis, called the preferred axis, produced both maximal excitation and inhibition. On the basis of differences in preferred axis orientation and in eye dominance, three neuron classes called Vertical Axis, Anterior (45 degrees) Axis, and Posterior (135 degrees) Axis were distinguished. 3. Vertical Axis neurons were modulated exclusively from the eye contralateral to the inferior olive recording site. This cell type responded strongly to large-field visual stimuli rotating about the vertical axis. Excitation resulted from movement in the temporal to nasal direction, and inhibition occurred during movement in the nasal to temporal direction. 4. Two subclasses of Anterior (45 degrees) Axis neurons were distinguished according to whether the receptive field was monocular or binocular. For both subclasses, the dominant eye was ipsilateral. The receptive field organization of the dominant eye was bipartite as described in the previous paper (51) for neurons in the midbrain visual tegmental relay zone. Anterior (45 degrees) Axis neurons were maximally excited when the stimulus pattern moved upward and posterior above the horizon in the anterior quadrant of the ipsilateral visual field, from 0 degrees (nose) to approximately 45 degrees azimuth. From 45 to 180 degrees azimuth (occiput) and above the horizon, these neurons were excited by downward and posterior

  1. Atypical cerebral and cerebellar language organisation: a case study.

    PubMed

    van Dun, Kim; De Witte, Elke; Van Daele, Wendy; Van Hecke, Wim; Manto, Mario; Mariën, Peter

    2015-01-01

    In the majority of right-handed subjects, language processing is subserved by a close interplay between the left cerebral hemisphere and right cerebellum. Within this network, the dominant fronto-insular region and the contralateral posterior cerebellum are crucially implicated in oral language production. We report atypical anatomoclinical findings in a right-handed patient with an extensive right cerebellar infarction and an older left fronto-insular stroke. Standardised neurolinguistic and neurocognitive test batteries were performed. In addition, fMRI, DTI, and SPECT results are reported. In this patient, disruption of the cerebellocerebral language network due to vascular damage in the left fronto-insular region and right posterior inferior cerebellar artery (PICA) territory did not induce any speech or language deficits. By contrast, executive and behavioural disturbances were found after the right cerebellar stroke. Evidence from fMRI and DTI suggests atypical bilateral language representation (Laterality Index = +0,11). At the cerebellar level, fMRI showed more activated voxels in the left than in the right hemisphere (Laterality Index = +0,66). We hypothesise congenital bilateral language representation in this patient which might be more advantageous than a typically lateralised distribution of linguistic functions to compensate acute damage to critical language regions. The more activated left cerebellum possibly compensated the functional loss in the right cerebellum after acute damage due to bilateral organisation of language function. However, more research is needed to confirm this hypothesis.

  2. Diagnostic accuracy of supine and prone thallium-201 stress myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in inferior wall of left ventricle.

    PubMed

    Katayama, Takuji; Ogata, Nobuhiko; Tsuruya, Yoshio

    2008-05-01

    Prone thallium-201 ((201)Tl) myocardial perfusion single-photon emission computed tomography (SPECT) reduces false-positive rates when evaluating inferior wall abnormalities by minimizing diaphragmatic attenuation. The present study investigates the diagnostic validity of prone (201)Tl stress myocardial perfusion SPECT for detecting coronary artery disease in the inferior wall of the left ventricle in Japanese patients. Of the 104 consecutive patients who underwent (201)Tl stress myocardial perfusion SPECT to diagnose coronary artery disease, we evaluated 46 who underwent image acquisition in both the supine and prone positions, and coronary angiography within 3 months thereafter. Images were acquired in the routine supine position immediately following (201)Tl (111 MBq) injection and 4 h following early acquisition. Images were acquired in the prone position only during the early phase following supine acquisition. We evaluated the SPECT images of the inferior half segments of the left ventricle using a five-point defect scoring system. According to the coronary angiographic findings, we investigated the diagnostic accuracy of stress-rest supine, stress supine, stress prone, and combined supine-prone images. Reduced uptake in the stress supine image of the combined images was considered as attenuation when uptake was normal in the prone image. The sensitivity of the stress-rest supine, stress supine, stress prone, and stress-combined supine-prone images was 77%, 86%, 55%, and 55%, and the specificity was 71%, 54%, 79%, and 83%, respectively. Diagnostic accuracy was the highest in stress-rest supine images. Prone images tended to improve the specificity of detecting coronary artery disease in the inferior wall, but not diagnostic accuracy compared with stress-rest supine images because of decreased sensitivity.

  3. Stable fracture of the pubic rami: a rare cause of life-threatening bleeding from the inferior epigastric artery managed with transcatheter embolization.

    PubMed

    Loffroy, Romaric; Yeguiayan, Jean-Michel; Guiu, Boris; Cercueil, Jean-Pierre; Krausé, Denis

    2008-07-01

    Extraperitoneal bleeding from the inferior epigastric artery (IEA) and its branches is a rare complication of blunt pelvic trauma; however, it can result in life-threatening hemorrhage, even in cases of minimally displaced fractures of the pelvic ring. We report the case of a patient who had posttraumatic pelvic hematoma and cardiovascular collapse caused by avulsion of the right pubic branch of the IEA related to undisplaced fractures of the pubic rami. CT scanning followed by angiography showed leakage of contrast from the IEA. Transcatheter arterial embolization was performed to successfully control the hemorrhage. There have been very few previous reports of IEA injury related to stable fractures of the pubic rami successfully treated by transcatheter arterial embolization.

  4. Inferior mesenteric artery lymph node metastasis in rectal cancer treated with neoadjuvant chemoradiotherapy: Incidence, prediction and prognostic impact.

    PubMed

    Sun, Y; Chi, P; Lin, H; Lu, X; Huang, Y; Xu, Z; Huang, S; Wang, X

    2017-01-01

    To assess the effect of neoadjuvant chemoradiotherapy (nCRT) on inferior mesenteric artery (IMA) nodal metastasis and identify predictors for IMA nodal metastasis in locally advanced rectal cancer (LARC) after nCRT. Propensity score matching of 1167 patients with LARC was performed. Clinicopathological predictors and survival rates were analyzed using univariate and multivariate analyses. Compared to surgery alone, nCRT reduced the incidence of IMA nodal metastasis (before matching, 4.8% vs 9.1%, p = 0.004; after matching, 4.3% vs 10.1%, p = 0.002). Logistic regression analysis revealed that poorly differentiated (OR = 5.955, p < 0.001), tumors located above the peritoneal reflection (OR = 3.513, p = 0.005), and preoperative CEA levels ≧10 ng/ml (OR = 4.774, p = 0.005) were associated with IMA nodal metastasis. Time intervals to surgery ≧6 weeks were associated with fewer IMA nodal metastasis (OR = 0.274, p = 0.009).Over a median 40-month follow-up, the 3-year overall survival and disease-free survival rates were 63.0% and 43.1% in IMA-positive patients, respectively, which were significantly lower than the corresponding 89.0% and 82.4% rates in IMA-negative patients. Cox regression analysis revealed that IMA nodal metastasis was independently associated with unfavorable 3-year DFS. nCRT reduced the incidence of IMA node metastasis. Tumors located above the peritoneal reflection, poorly differentiated, and higher preoperative CEA levels were associated with IMA nodal metastasis after nCRT. IMA lymph node dissection is beneficial to certain patients with IMA nodal metastases, and the oncologic benefit may be improved if IMA nodal metastasis can be predicted. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  5. [Cerebellar hypoplasias].

    PubMed

    Safronova, Marta Maia; Barbot, Clara; Resende Pereira, Jorge

    2010-01-01

    Cerebellar hypoplasias are cerebellar malformations with small but completely formed cerebellum. They can be divided in focal and in diffuse or generalized. It is sometimes difficult to make distinction between cerebellar atrophy (progressive condition) and hipoplasia (not progressive condition). Focal hypoplasias are restricted to one cerebellar hemisphere or to the vermis. Diffuse hypoplasias refer to both cerebellar hemispheres and vermis. If there is associated IVth ventricle enlargement, hypoplasias occur in the context of Dandy-Walker complex, a continuum of posterior fossa cystic anomalies. A revision of cerebellar hypoplasias and associated pathology is done, illustrated with 22 cases tha include focal and diffuse cerebellar hypoplasias, Dandy-Walker malformations and its variant, persistent Blake's pouch cyst, megacisterna magna, PEHO síndrome (progressive encephalopathy with oedema, hipsarrhythmia and optic atrophy), Joubert syndrome, congenital disorder of glycosylation type Ia, pontocerebellar hipoplasias Barth type I and II, diffuse subcortical heterotopia. The imaging finding of structural cerebellar anomalies frequently leads to diagnostic incertainty as the anomalies are mostly unspecific, implying an extenuating analytical and genetic workup. Their knowledge and classification may be useful to decide the patient adjusted laboratorial workup.

  6. The microvascular anatomy of superior and inferior gluteal artery perforator (SGAP and IGAP) flaps: a fresh cadaveric study and clinical implications.

    PubMed

    Georgantopoulou, Anthi; Papadodima, Stavroula; Vlachodimitropoulos, Dimitrios; Goutas, Nikolaos; Spiliopoulou, Chara; Papadopoulos, Othon

    2014-12-01

    Our study aimed to highlight anatomical similarities, differences, and variations in the microvascular anatomy between superior and inferior gluteal artery perforator (SGAP and IGAP) flaps. Thirty gluteal flaps (15 SGAP and 15 IGAP) were studied on 22 adult fresh cadavers. We recorded the number and location of perforators, the characteristics of the main perforator (course, length, and diameter at the level of division at the greater sciatic foramen), and the anatomical variations of the submuscular venous plexus. The mean number of perforators was similar in both flaps (n = 7). We found a statistically significant difference in the total length of the vascular pedicle between SGAP (mean = 9.80 cm) and IGAP (mean = 13.36 cm) flaps, which correlated strongly with the difference in the intramuscular length (mean difference = 3.40 cm) of the perforator. There was no statistically significant difference in the diameter of the superior and inferior gluteal vessels at the point of pedicle division. The complex submuscular venous plexus, which is typically found on SGAP flaps deep to the sacral fascia, was never encountered on IGAP flaps. Perforators originating from the inferior gluteal artery were found on the lower half of five superior gluteal flaps. These were dominant perforators in two cases. We also report a rare anatomical communication between superior and inferior gluteal vessels deep to the piriformis muscle and a case of atheromatous disease of the inferior gluteal artery. Our findings are highly relevant to clinical practice and contribute to the understanding of the vascular anatomy of SGAP and IGAP flaps and the successful use of these challenging flaps. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full

  7. Cerebellar ataxias.

    PubMed

    Manto, Mario; Marmolino, Daniele

    2009-08-01

    The term 'cerebellar ataxias' encompasses the various cerebellar disorders encountered during daily practice. Patients exhibit a cerebellar syndrome and can also present with pigmentary retinopathy, extrapyramidal movement disorders, pyramidal signs, cortical symptoms (seizures, cognitive impairment/behavioural symptoms), and peripheral neuropathy. The clinical diagnosis of subtypes of ataxias is complicated by the salient overlap of the phenotypes between genetic subtypes. The identification of the causative mutations of many hereditary ataxias and the development of relevant animal models bring hope for effective therapies in neurodegenerative ataxias. We describe the current classification of cerebellar ataxias and underline the recent discoveries in molecular pathogenesis. Cerebellar disorders can be divided into sporadic forms and inherited diseases. Inherited ataxias include autosomal recessive cerebellar ataxias, autosomal dominant cerebellar ataxias/spinocerebellar ataxia) and episodic ataxias, and X-linked ataxias. From a motor control point of view, the leading theories of ataxia are based on neural representations or 'internal models' to emulate fundamental natural processes such as body motion. Recent molecular advances have direct implications for research and daily practice. We provide a framework for the diagnosis of ataxias. For the first time, the therapeutic agents under investigation are targeted to deleterious pathways.

  8. Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study.

    PubMed

    Zuhur, Sayid Shafi; Ozel, Alper; Velet, Selvinaz; Buğdacı, Mehmet Sait; Cil, Esra; Altuntas, Yüksel

    2012-01-01

    To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

  9. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial.

    PubMed

    Mäkikallio, Timo; Holm, Niels R; Lindsay, Mitchell; Spence, Mark S; Erglis, Andrejs; Menown, Ian B A; Trovik, Thor; Eskola, Markku; Romppanen, Hannu; Kellerth, Thomas; Ravkilde, Jan; Jensen, Lisette O; Kalinauskas, Gintaras; Linder, Rikard B A; Pentikainen, Markku; Hervold, Anders; Banning, Adrian; Zaman, Azfar; Cotton, Jamen; Eriksen, Erlend; Margus, Sulev; Sørensen, Henrik T; Nielsen, Per H; Niemelä, Matti; Kervinen, Kari; Lassen, Jens F; Maeng, Michael; Oldroyd, Keith; Berg, Geoff; Walsh, Simon J; Hanratty, Colm G; Kumsars, Indulis; Stradins, Peteris; Steigen, Terje K; Fröbert, Ole; Graham, Alastair N J; Endresen, Petter C; Corbascio, Matthias; Kajander, Olli; Trivedi, Uday; Hartikainen, Juha; Anttila, Vesa; Hildick-Smith, David; Thuesen, Leif; Christiansen, Evald H

    2016-12-03

    Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease. In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1·35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651. Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 1·48 (95% CI 1·11-1·96), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0·0066). As-treated estimates were 28% versus 19% (1·55, 1·18-2·04, p=0·0015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (1·07, 0·67-1·72, p=0·77) for all-cause mortality, 7% versus 2% (2·88, 1·40-5·90, p=0·0040) for non-procedural myocardial infarction, 16

  10. Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction: imaging correlations.

    PubMed

    Huh, Young Eun; Kim, Ji Soo

    2011-12-01

    Horizontal head-shaking may induce nystagmus in peripheral as well as central vestibular lesions. While the patterns and mechanism of head-shaking nystagmus are well established in peripheral vestibulopathy, they require further exploration in central vestibular disorders. To define the characteristics and mechanism of head-shaking nystagmus in central vestibulopathies, we investigated spontaneous nystagmus and head-shaking nystagmus in 72 patients with isolated cerebellar infarction. Spontaneous nystagmus was observed in 28 (39%) patients, and was mostly ipsilesional when observed in unilateral infarction (15/18, 83%). Head-shaking nystagmus developed in 37 (51%) patients, and the horizontal component of head-shaking nystagmus was uniformly ipsilesional when induced in patients with unilateral infarction. Perverted head-shaking nystagmus occurred in 23 (23/37, 62%) patients and was mostly downbeat (22/23, 96%). Lesion subtraction analyses revealed that damage to the uvula, nodulus and inferior tonsil was mostly responsible for generation of head-shaking nystagmus in patients with unilateral posterior inferior cerebellar artery infarction. Ipsilesional head-shaking nystagmus in patients with unilateral cerebellar infarction may be explained by unilateral disruption of uvulonodular inhibition over the velocity storage. Perverted (downbeat) head-shaking nystagmus may be ascribed to impaired control over the spatial orientation of the angular vestibulo-ocular reflex due to uvulonodular lesions or a build-up of vertical vestibular asymmetry favouring upward bias due to lesions involving the inferior tonsil.

  11. Cerebellar Degeneration

    MedlinePlus

    ... is a process in which neurons in the cerebellum - the area of the brain that controls coordination ... body, can cause neurons to die in the cerebellum. Neurological diseases that feature cerebellar degeneration include: ischemic ...

  12. Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial.

    PubMed

    Masoni, Luigi; Mari, Francesco Saverio; Nigri, Giuseppe; Favi, Francesco; Gasparrini, Marcello; Dall'Oglio, Anna; Pindozzi, Fioralba; Pancaldi, Alessandra; Brescia, Antonio

    2013-01-01

    Defecatory disorders are very common complications after left hemicolectomy and anterior rectal resection. These disorders seem related primarily to colonic denervation after the resection. To evaluate the real benefits of inferior mesenteric artery (IMA) preservation via laparoscopic left hemicolectomy performed for diverticular disease in terms of reduced colonic denervation and improved postoperative intestinal functions, a randomized, single-blinded (patients) controlled clinical trial was conducted. From January 2004 to January 2010, patients with symptomatic diverticular disease and a surgical indication were enrolled in the study and randomly assigned to two treatment groups. The first group underwent laparoscopic left hemicolectomy, which preserved the IMA by sectioning the sigmoid arteries one by one near the colonic wall, In the second group, the IMA was sectioned immediately below the origin of left colic artery. Defecation disorders were assessed by anorectal manometry and by three questionnaires to evaluate constipation, incontinence, and quality of life 6 months after the intervention. A total of 107 patients were included in the study. The 54 patients with preserved IMA showed a statistically lower incidence of defecation disorders such as fragmented evacuations, alternating bowel function, constipation, and minor incontinence, as well as less lifestyle alteration than the 53 patients with the IMA sectioned just below the left colic artery. This study confirmed that preservation of the IMA should be recommended to reduce the incidence of defecatory disorders after left hemicolectomy for benign disease.

  13. Motion perception without Nystagmus--a novel manifestation of cerebellar stroke.

    PubMed

    Shaikh, Aasef G

    2014-01-01

    The motion perception and the vestibulo-ocular reflex (VOR) each serve distinct functions. The VOR keeps the gaze steady on the target of interest, whereas vestibular perception serves a number of tasks, including awareness of self-motion and orientation in space. VOR and motion perception might abide the same neurophysiological principles, but their distinct anatomical correlates were proposed. In patients with cerebellar stroke in distribution of medial division of posterior inferior cerebellar artery, we asked whether specific location of the focal lesion in vestibulocerebellum could cause impaired perception of motion but normal eye movements. Thirteen patients were studied, 5 consistently perceived spinning of surrounding environment (vertigo), but the eye movements were normal. This group was called "disease model." Remaining 8 patients were also symptomatic for vertigo, but they had spontaneous nystagmus. The latter group was called "disease control." Magnetic resonance imaging in both groups consistently revealed focal cerebellar infarct affecting posterior cerebellar vermis (lobule IX). In the "disease model" group, only part of lobule IX was affected. In the disease control group, however, complete lobule IX was involved. This study discovered a novel presentation of cerebellar stroke where only motion perception was affected, but there was an absence of objective neurologic signs. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Side predilections of offending arteries in hemifacial spasm.

    PubMed

    Chung, Moonyoung; Han, Inbo; Chung, Sang-Sup; Huh, Ryoong

    2016-07-01

    The side predilections of various offending arteries in hemifacial spasm (HFS) have not been well studied. The relationship between clinical and radiological features of HFS and offending arteries were investigated in the present study. A retrospective analysis of 370 patients who underwent microvascular decompression for HFS was performed. The patients were divided into four groups based on the offending arteries, namely anterior inferior cerebellar artery (AICA), posterior inferior cerebellar artery (PICA), vertebral artery, and multiple offending arteries. Affected side, age at onset, presence of hypertension, and sigmoid sinus area and dominance were compared between groups. The mean age of patients with a left HFS was significantly greater than that of patients with a right HFS (P=0.009). The AICA affected primarily the right side and PICA and multiple offending arteries the left side (P<0.001). Side of sigmoid sinus dominance was significantly different among groups (P<0.001). The offending arteries in HFS may be related to these differences. AICA was associated with right-sided symptoms, younger age at onset, and presence of left dominant sigmoid sinus, while PICA was associated with left-sided symptoms, older age at onset, and smaller right sigmoid sinus area.

  15. In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap

    NASA Astrophysics Data System (ADS)

    Saint-Cyr, Michel; Lakhiani, Chrisovalantis; Cheng, Angela; Mangum, Michael; Liang, Jinyang; Teotia, Sumeet; Livingston, Edward H.; Zuzak, Karel J.

    2013-03-01

    The selection of well-vascularized tissue during DIEP flap harvest remains controversial. While several studies have elucidated cross-midline perfusion, further characterization of perfusion to the ipsilateral hemiabdomen is necessary for minimizing rates of fat necrosis or partial fat necrosis in bilateral DIEP flaps. Eighteen patients (29 flaps) underwent DIEP flap harvest using a prospectively designed protocol. Perforators were marked and imaged with a novel system for quantitatively measuring tissue oxygenation, the Digital Light Hyperspectral Imager. Images were then analyzed to determine if perforator selection influenced ipsilateral flap perfusion. Flaps based on a single lateral row perforator (SLRP) were found to have a higher level of hemoglobin oxygenation in Zone I (mean %HbO2 = 76.1) compared to single medial row perforator (SMRP) flaps (%HbO2 = 71.6). Perfusion of Zone III relative to Zone I was similar between SLRP and SMRP flaps (97.4% vs. 97.9%, respectively). These differences were not statistically significant (p>0.05). Perfusion to the lateral edge of the flap was slightly greater for SLRP flaps compared SMRP flaps (92.1% vs. 89.5%, respectively). SMRP flaps had superior perfusion travelling inferiorly compared to SLRP flaps (88.8% vs. 83.9%, respectively). Overall, it was observed that flaps were better perfused in the lateral direction than inferiorly. Significant differences in perfusion gradients directed inferiorly or laterally were observed, and perforator selection influenced perfusion in the most distal or inferior aspects of the flap. This suggests broader clinical implications for flap design that merit further investigation.

  16. In vivo comparison of free coronary grafts using the inferior epigastric (IEA), the gastroepiploic (GEA) and the internal thoracic artery (ITA).

    PubMed

    Cremer, J; Liesmann, T; Wimmer-Greinecker, G; Abraham, C; Mügge, A; Haverich, A

    1994-01-01

    The validity of alternative arterial conduits for myocardial revascularization in comparison to internal thoracic artery (ITA) has not been sufficiently defined. Evaluation of the functional in vivo vascular properties of the different conduits may be appropriate to give a perspective on long-term graft qualities. The intraoperative function of single free grafts to the left anterior descending artery (LAD) was compared in inferior epigastric (IEA, n = 13), internal thoracic (ITA, n = 12) and gastroepiploic artery (GEA, n = 12) conduits. Graft flows were measured at four points of time, 1) in situ free flow after distal dissection (IEA: 42.2 ml/min, ITA: 68.8 ml/min, GEA: 61.1 ml/min), 2) free flow following proximal grafting to the aorta (IEA: 48.1 ml/min, ITA: 63.7 ml/min, GEA: 84.2 ml/min), 3) selective graft flow after distal attachment to the LAD (IEA: 52.6 ml/min, ITA: 77.5 ml/min, GEA: 102.8 ml/min), and 4) selective LAD graft flow following paraverine (Pap) stimulation (IEA: 98.4 ml/min, ITA: 128.0 ml/min, GEA: 142.9 ml/min). Endothelium-dependent and -independent relaxation was evaluated by examination of the intraluminal graft pressures at mechanically controlled constant flow rates. Following stimulation with substance P (SP), the change of intraluminal pressure (dp) was similar in IEA (dp: -20.0 mmHg) and GEA grafts (dp: -21.1 mmHg). Only ITA conduits were less reactive to SP (-9.7 mmHg). The response to acetylcholine (ACh) could only be assessed in ITA (dp: -16.0 mmHg) and IEA (dp: -10.7 mmHg) grafts. Gastroepiploic arteries did not react on ACh stimulation (dp: +0.4 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Resolution of inferior venous baffle leak and total venous occlusion using a bare stent and the gore(®) excluder( ®) aortic extension in transposition of the great arteries after mustard procedure.

    PubMed

    Ross, Michael M; Schamberger, Marcus S; Hoyer, Mark H

    2016-01-01

    We present a patient with a history of Mustard repair for transposition of the great arteries. The patient presented with complete inferior venous baffle obstruction and a large baffle leak after several years of cyanosis. Complete relief of the obstruction and exclusion of the baffle leak were accomplished with the use of a combination of bare metal stenting and the Gore(®) Excluder(®) aortic extender. To our knowledge, this represents the first reported use of the Gore(®) Excluder(®) aortic extender in the setting of inferior venous baffle leak and associated total inferior vena cava obstruction. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  18. Minimally Invasive Extracorporeal Circulation Circuit Is Not Inferior to Off-Pump Coronary Artery Bypass Grafting: Meta-Analysis Using the Bayesian Method.

    PubMed

    Winkler, Bernhard; Heinisch, Paul P; Gahl, Brigitta; Aghlmandi, Soheila; Jenni, Hans Jörg; Carrel, Thierry P

    2017-01-01

    The pathophysiologic side effects of cardiopulmonary bypass have already been identified. Minimally invasive extracorporeal circulation technologies (MiECT) and off-pump coronary artery bypass graft surgery (OPCABG) aim to reduce these problems. This meta-analysis provides a comparison of MiECT and OPCABG in randomized and observational studies. A fully probabilistic, Bayesian approach of primary and secondary endpoints was conducted. MiECT does not give inferior results when compared with OPCABG. However, there is a trend to borderline significantly higher blood loss in this group in randomized controlled trials. The question whether MiECT is equivalent to OPCABG can be answered with the affirmative, but long-term follow-up data are needed to detect any advantage over time. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. [Cerebellar cognitive affective syndrome secondary to a cerebellar tumour].

    PubMed

    Domínguez-Carral, J; Carreras-Sáez, I; García-Peñas, J J; Fournier-Del Castillo, C; Villalobos-Reales, J

    2015-01-01

    Cerebellar cognitive affective syndrome is characterized by disturbances of executive function, impaired spatial cognition, linguistic difficulties, and personality change. The case of an 11 year old boy is presented, with behavior problems, learning difficulties and social interaction problems. In the physical examination he had poor visual contact, immature behavior, reduced expressive language and global motor disability with gait dyspraxia, with no defined cerebellar motor signs. In the neuropsychological evaluation he has a full scale overall intellectual quotient of 84, with signs of cerebellar cognitive affective syndrome. A tumour affecting inferior cerebellar vermis was observed in the magnetic resonance imaging, which had not significantly grown during 5 years of follow up. The cerebellum participates in controlling cognitive and affective functions. Cerebellar pathology must be considered in the differential diagnosis of children with cognitive or learning disorder with associated behavioral and emotional components. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  20. Management of the accessory or replaced right hepatic artery (A/R RHA) during multiorgan retrieval when the inferior pancreaticoduodenal artery shares a common origin with A/R RHA.

    PubMed

    Huang, Y; Li, J; Qi, H

    2013-01-01

    The accessory or replaced right hepatic artery (A/R RHA), which arises from the superior mesenteric artery (SMA), represents a challenge to the surgeon during combined procurement of liver and whole pancreas allografts. We have herein described an angiographic investigation of this aberrant artery among 553 patients who underwent angiography of both the celiac axis and SMA trunks to measure the diameters of the arteries to be anastomosed as well as to clarify the locational relationship between the inferior pancreaticoduodenal artery (IPDA) and A/R RHA. Sixty-nine (12.5%) of 553 patients had an unambiguous site of the A/R RHA. In 6 patients the IPDA was not visible. We separated the remaining 63 patients into 2 groups: group A whose A/R RHA shared a common origin with IPDA, and group B whose A/R RHA had a noncommon origin with IPDA. Fifteen (23.8%) of these 63 patients had a common origin of IPDA and A/R RHA. The results showed that the diameters of A/R RHA and gastroduodenal artery (GDA) were matched in both groups whether or not the IPDA shared a common origin with A/R RHA. The similar vascular diameters between A/R RHA and GDA in these 2 groups simplified the anastomosis, but management of the A/R RHA with different locational relationships between the IPDA and A/R RHA remains a problem. We recommend a safe method to be applied to all donors with an A/R RHA regardless of the origin of the IPDA.

  1. Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion

    PubMed Central

    Giacomini, Craig; Brooke Jeffrey, R.; Willmann, Juergen K.; Olcott, Eric

    2013-01-01

    Abstract Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four pathways of extrapancreatic perineural spread have been described that conveniently follow small defined arterial pathways. Small field of view three-dimensional (3D) volume-rendered multidetector computed tomography (MDCT) images allow visualization of small peripancreatic vessels and thus perineural invasion that may be associated with them. One such vessel, the posterior inferior pancreaticoduodenal artery (PIPDA), serves as a surrogate for extrapancreatic perineural spread by pancreatic adenocarcinoma arising in the uncinate process. This pictorial review presents the normal and variant anatomy of the PIPDA with 3D volume-rendered MDCT imaging, and emphasizes its role as a vascular landmark for the diagnosis of extrapancreatic perineural invasion from uncinate adenocarcinomas. Familiarity with the anatomy of PIPDA will allow accurate detection of extrapancreatic perineural spread by pancreatic adenocarcinoma involving the uncinate process, and may potentially have important staging implications as neoadjuvant therapy improves. PMID:24434918

  2. Impaired modulation of the otolithic function in acute unilateral cerebellar infarction.

    PubMed

    Choi, Seo Young; Lee, Seung-Han; Kim, Hyo Jung; Kim, Ji-Soo

    2014-06-01

    To define the cerebellar contribution in modulating the otolithic signals, we investigated the otolithic function in 27 patients with acute unilateral cerebellar infarctions in the territory of the posterior inferior cerebellar artery (PICA, n = 17, 63%), combined PICA and superior cerebellar artery (SCA) (n = 7, 30%), SCA (n = 2, 7%), and anterior inferior cerebellar artery (n = 1, 4%) from 2010 to 2012. The patients had evaluation of the ocular tilt reaction [head tilt, ocular torsion (OT), and skew deviation], tilt of the subjective visual vertical (SVV), cervical vestibular evoked myogenic potentials (VEMPs) in response to air conducted tone bursts, and ocular VEMPs induced by tapping the head at AFz. The evaluation was completed within 2 weeks after symptom onset. Patients often showed OT or SVV tilt (15/27, 55.6%) that was either ipsi- (n = 6) or contraversive (n = 9). Overall, there were no differences in the amplitudes and latencies of cervical and ocular VEMPs between the ipsi- and contralesional sides. However, individual analyses revealed frequent abnormalities of cervical (11/27, 41%) and/or ocular (9/27, 33%) VEMPs. While 11 (73%) of the 15 patients with the OTR/SVV tilt showed abnormalities of cervical (n = 9) and/or ocular (n = 7) VEMP responses, only three (25%) of the 12 patients without the OTR/SVV tilt had abnormal cervical (n = 2) and/or ocular (n = 2) VEMPs (73% vs. 25%, Fisher's exact test, p = 0.021). The concordance rate in the results of cervical and ocular VEMPs was marginally significant (19/27, 70%, p = 0.052, binominal). Unilateral cerebellar lesions may generate otolithic imbalances, as evidenced by the OTR/SVV tilt and asymmetric ocular or cervical VEMP responses, but without directionality according to the lesion side. Patients with the OTR/SVV tilt had abnormal VEMPs more often than those without.

  3. Cerebellar Ataxia.

    PubMed

    Perlman

    2000-05-01

    There is nothing more discouraging than for a patient to be given a specific diagnosis, then to be told that there is nothing that can be done. Physicians are equally disheartened to see exponential progress being made in the understanding of the pathophysiology of a complex disorder but few direct benefits resulting for their patients. Over the past 5 years, molecular genetic research has completely revolutionized the way in which the progressive cerebellar ataxias are classified and diagnosed, but it has yet to produce effective gene-based, neuroprotective, or neurorestorative therapies. The treatment of cerebellar ataxia remains primarily a neurorehabilitation challenge, employing physical, occupational, speech, and swallowing therapy; adaptive equipment; driver safety training; and nutritional counseling. Modest additional gains are seen with the use of medications that can improve imbalance, incoordination, or dysarthria (amantadine, buspirone, acetazolamide); cerebellar tremor (clonazepam, propranolol); and cerebellar or central vestibular nystagmus (gabapentin, baclofen, clonazepam). Many of the progressive cerebellar syndromes have associated features involving other neurologic systems (eg, spasticity, dystonia or rigidity, resting or rubral tremor, chorea, motor unit weakness or fatigue, autonomic dysfunction, peripheral or posterior column sensory loss, neuropathic pain or cramping, double vision, vision and hearing loss, dementia, and bowel, bladder, and sexual dysfunction), which can impede the treatment of the ataxic symptoms or can worsen with the use of certain drugs. Treatment of the associated features themselves may in turn worsen the ataxia either directly (as side effects of medication) or indirectly (eg, relaxation of lower limb spasticity that was acting as a stabilizer for an ataxic gait). Secondary complications of progressive ataxia can include deconditioning or immobility, weight loss or gain, skin breakdown, recurrent pulmonary and

  4. Altered cerebellar feedback projections in Asperger syndrome.

    PubMed

    Catani, Marco; Jones, Derek K; Daly, Eileen; Embiricos, Nitzia; Deeley, Quinton; Pugliese, Luca; Curran, Sarah; Robertson, Dene; Murphy, Declan G M

    2008-07-15

    It has been proposed that the biological basis of autism spectrum disorder includes cerebellar 'disconnection'. However, direct in vivo evidence in support of this is lacking. Here, the microstructural integrity of cerebellar white matter in adults with Asperger syndrome was studied using diffusion tensor magnetic resonance tractography. Fifteen adults with Asperger syndrome and 16 age-IQ-gender-matched healthy controls underwent diffusion tensor magnetic resonance imaging. For each subject, tract-specific measurements of mean diffusivity and fractional anisotropy were made within the inferior, middle, superior cerebellar peduncles and short intracerebellar fibres. No group differences were observed in mean diffusivity. However, people with Asperger syndrome had significantly lower fractional anisotropy in the short intracerebellar fibres (p<0.001) and right superior cerebellar (output) peduncle (p<0.001) compared to controls; but no difference in the input tracts. Severity of social impairment, as measured by the Autistic Diagnostic Interview, was negatively correlated with diffusion anisotropy in the fibres of the left superior cerebellar peduncle. These findings suggest a vulnerability of specific cerebellar neural pathways in people with Asperger syndrome. The localised abnormalities in the main cerebellar outflow pathway may prevent the cerebral cortex from receiving those cerebellar feedback inputs necessary for a successful adaptive social behaviour.

  5. Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note.

    PubMed

    Kubota, Hisashi; Tanikawa, Rokuya; Katsuno, Makoto; Noda, Kosumo; Ota, Nakao; Miyata, Shiro; Yabuuchi, Tomonari; Izumi, Naoto; Bulsara, Ketan R; Hashimoto, Masaaki

    2013-08-01

    Symptomatic fusiform intracranial vertebral artery aneurysms pose a formidable treatment challenge when not amenable to endovascular treatment. In this paper, we illustrate the microsurgical management of such an aneurysm. To prevent neurological deterioration, anatomical reconstruction preserving all vessels including posterior inferior cerebellar artery and perforators is essential. In this case illustration, the occipital artery was used as a donor to a perforator originating from the aneurysmal segment. This bypass was performed in an end-to-side fashion. Subsequently, the aneurysmal component of the vertebral artery was resected and an end-to-side (V4 to V3) bypass was performed using a radial artery graft. The patient achieved complete resection of the aneurysm preserving normal anatomy of the posterior circulation without any ischemic complications. Complex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy.

  6. Total arterial off-pump coronary artery bypass grafting was not associated with inferior outcomes for diabetic when compared with non-diabetic patients.

    PubMed

    Suzuki, Tomoaki; Asai, Tohru; Kinoshita, Takeshi

    2015-12-01

    Diabetes mellitus is a strong risk factor that worsens the clinical outcome of patients undergoing coronary artery bypass grafting (CABG). With the development of the off-pump CABG technique, there is a current trend in revascularization strategies towards in situ all-arterial grafting. We were interested in whether total arterial off-pump CABG could improve the outcome for diabetic patients. From January 2002 to December 2013, a total of 1064 patients underwent off-pump CABG at our institution, with total arterial reconstruction carried out in 775 cases. Of the 775 patients, 436 had diabetes (DM) and 339 did not (nDM). After propensity score matching, 301 cases from each group were successfully matched. All procedures were performed via the off-pump technique without conversion to on-pump. Four patients in the DM group and 1 in the nDM group died in hospital. Multivariate analysis revealed that chronic pulmonary disease [odds ratio (OR) 7.04, P = 0.036] and low (<40%) ejection fraction (OR 11.3, P = 0.009) are independent risk factors for hospital death, and advanced age for deep sternal infection (OR 1.07, P = 0.04). Follow-up was completed in 97.7% of the patients to a maximum of 11.9 years. The rate of 10-year freedom from all-cause mortality was 84.2% in the DM and 74.3% in the nDM group (P = 0.45). The corresponding rates for major adverse cardiac event were 93.3 and 86.9% (P = 0.09). Multivariate Cox regression analysis revealed chronic renal failure, older age, cerebrovascular accident, low ejection fraction and urgency as significant predictors of late death. Diabetes was not associated with any long- or short-term outcome. Total arterial off-pump CABG using skeletonization technique can provide similar clinical outcome for diabetic patients in the long as well as in the short term as that for non-diabetic patients. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights

  7. The Influence of a Pfannenstiel Scar on Venous Anatomy of the Lower Abdominal Wall and Implications for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction.

    PubMed

    Kim, So Young; Lee, Kyeong-Tae; Mun, Goo-Hyun

    2017-03-01

    A Pfannenstiel incision involves the obstruction of superficial venous pathways and functional diversion of flow through alternative pathways and adjacent vessels. This study investigated the effect of a prior Pfannenstiel incision on venous anatomy of the lower abdominal wall; specifically, the superficial inferior epigastric vein (SIEV), using computed tomographic angiography. A case-control study was performed of 50 patients with Pfannenstiel scars and 50 age-matched, body mass index-matched control patients without Pfannenstiel scars. The authors compared the number of direct/indirect and total communications between the SIEV and deep inferior epigastric artery perforator (DIEP) venae comitantes, midline crossover, and other SIEV-related anatomical changes by using computed tomographic angiography. Flap-related clinical outcomes and donor-site-related complications were also assessed. The median number of direct and total communications between the SIEV and DIEP venae comitantes in the study group was greater than in the control group. The percentage of SIEVs having more than two branching patterns per hemiabdomen was significantly higher in the study group than in the control group. The study group also showed a significantly lower rate of fat necrosis compared with the control group (p = 0.03). The rate of donor-site seroma was significantly higher in the study group. This study suggests that the presence of a Pfannenstiel scar may promote the development of direct and total communications between the SIEV and DIEP venae comitantes and branching within the SIEV in the lower abdominal wall, which may facilitate venous drainage of adipose tissue in DIEP flap breast reconstruction. Risk, II.

  8. Effect of edaravone on acute brainstem-cerebellar infarction with vertigo and sudden hearing loss.

    PubMed

    Inoue, Yuta; Yabe, Takao; Okada, Kazunari; Nakamura, Yuka

    2014-06-01

    We report 2 cases with acute brainstem and brainstem-cerebellar infarction showed improvement of their signs and symptoms after administration of edaravone. Case 1, a 74-year-old woman who experienced sudden vertigo, also had dysarthria and left hemiplegia. Magnetic resonance imaging (MRI) showed an abnormal region in the right ventrolateral medulla oblongata. The patient's vertigo and hemiplegia improved completely after treatment. Case 2, a 50-year-old man who experienced sudden vertigo and sensorineural hearing loss (SNHL), developed dysarthria after admission. MRI revealed acute infarction in the right cerebellar hemisphere. Magnetic resonance angiography revealed dissection of the basilar artery and occlusion of the right anterior inferior cerebellar artery. The patient's vertigo and hearing remarkably improved. We have described 2 patients whose early symptoms were vertigo and sudden SNHL, but who were later shown to have ischemic lesions of the central nervous system. Edaravone is neuroprotective drug with free radical-scavenging actions. Free radicals in the ear are responsible for ischemic damage. Edaravone, a free radical scavenger, may be useful in the treatment of vertigo and SNHL. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. Telemedicine-supported transition of stable coronary artery disease patients from tertiary to primary health care facilities: protocol for a randomized non-inferiority trial.

    PubMed

    Batista, Joanna d'Arc Lyra; Furtado, Mariana Vargas; Katz, Natan; Agostinho, Milena Rodrigues; Neto, Brasil Silva; Harzheim, Erno; Polanczyk, Carisi Anne

    2016-07-07

    Many Brazilian patients with complex diseases who are treated in tertiary referral clinics have been stable for long periods. The main needs of these patients involve monitoring of risk factors and review of drug prescriptions, which could be satisfactorily done in primary care facilities. The goal of this protocol is to evaluate the safety and effectiveness of telemedicine services to support the transition of patients with stable chronic coronary artery disease from the tertiary to the primary level of care. We designed a randomized non-inferiority protocol that will include 280 patients with stable coronary artery disease (for at least 12 months). Patients will be selected from the Ischemic Heart Disease Clinic in a tertiary care hospital in southern Brazil. Enrolled participants will be randomized into one of two groups: 12 months of follow-up at the same clinic; or 12 months of follow-up at a primary care facility with clinical support from a telemedicine platform including a toll-free line for physicians (intervention group). In the intervention group, decisions to refer patients to tertiary care during follow-up will be made jointly by primary physicians and medical teleconsultants. The groups will be compared in terms of the primary outcome-maintenance of baseline functional class 1 or 2 after 12 months. Secondary outcomes include control of risk factors and instability of the disease. We intend to determine the effectiveness of using telemedicine to qualify the transition of patients with chronic coronary disease from the tertiary to the primary level of care. This should facilitate the access of patients to the healthcare system, since care will be provided closer to their homes, and provide more opportunities for treatment of severe cases at tertiary care hospitals that are often overcrowded. ClinicalTrials.gov # NCT02489565 - trial registration date May 13, 2015.

  10. Cerebellar blood flow in methylmercury poisoning (Minamata disease).

    PubMed

    Itoh, K; Korogi, Y; Tomiguchi, S; Takahashi, M; Okajima, T; Sato, H

    2001-04-01

    We looked at regional cerebellar blood flow in patients with Minamata disease (MD) using technetium-99m ethyl cysteinate dimer (99m-Tc-ECD). We carried out single-photon emission computed tomography (SPECT) on 15 patients with MD (eight men, seven women, aged 51-78 years, mean 70.5 years) and 11 control subjects (eight men, three women, aged 62-80 years, mean 72.5 years). Regional blood flow was measured in the superior, middle, and inferior portions of the cerebellar hemispheres, and the frontal, temporal and occipital cerebral lobes. The degree of cerebellar atrophy was assessed on MRI. There were significant differences in regional blood flow in all parts of the cerebellum between patients and control, but no significant decrease was observed in the cerebrum. Blood flow was lower in the inferior cerebellum than in the other parts. Even in patients without cerebellar atrophy, flow was significantly decreased regional blood flow in the inferior part.

  11. Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature

    PubMed Central

    Nair, Prakash; Panikar, Dilip; Nair, Anup Parameshwaran; Sundar, Shyam; Ayiramuthu, Parasuraman; Thomas, Anoop

    2015-01-01

    Objective: This is a retrospective study from January 2002 to December 2012 analyzing the results of microsurgical clipping for aneurysms arising from the superior cerebellar artery (SCA). Materials and Methods: All patients with SCA were evaluated with computerized tomography angiography and/or digital subtraction angiography (DSA) prior to surgery. All patients in our series underwent microsurgical clipping and postoperative DSA to assess the extent of aneurysm occlusion. The Glasgow outcome scale (GOS) and the modified Rankin's scale (mRS) were used to grade their postoperative neurological status at discharge and 6 months, respectively. Results: Fourteen patients had SCA aneurysms (ruptured-9, unruptured-5). There were 10 females and 4 males with the mean age of 47.2 years (median - 46 years, range = 24–66 years). Subarachnoid hemorrhage (SAH) was seen in 11 patients. The mean duration of symptoms was 2.5 days (range = 1–7 days). The WFNS score at presentation was as follows: Grade 1 in 10 cases, II in 2 cases, III in 1 case and IV in 1 case. In the 9 cases with ruptured SCA aneurysm, average size of the ruptured aneurysms was 7.3 mm (range = 2.5–27 mm, median = 4.9 mm). The subtemporal approach was used in the first 7 cases. The extradural temporopolar (EDTP) approach was used in the last 5 cases. Complications include vasospasm (n = 6), third nerve palsy (n = 5) and hydrocephalus (n = 3). Two patients died following surgery. At mean follow-up 33.8 months (median - 25 months, range = 19–96 months), no patient had a rebleed. At discharge 9 (64%), had a GOS of 4 or 5 and 3 (21%) had a GOS of 3. At 6 months follow-up, 10/14 (71%) patients had mRS of 0–2, and 2 (14%) had mRS of 5. Conclusions: Aneurysms of the SCA are uncommon and tend to rupture even when the aneurysm size is small (<7 mm). They commonly present with SAH. The EDTP approach avoids complication caused by temporal lobe retraction and injury to the vein of Labbe. PMID:25767580

  12. Nipple reconstruction with banked costal cartilage after vertical-type skin-sparing mastectomy and deep inferior epigastric artery perforator flap.

    PubMed

    Mori, Hiroki; Uemura, Noriko; Okazaki, Mutsumi

    2015-01-01

    We recently used skin-sparing mastectomy (SSM), the deep inferior epigastric artery perforator (DIEP) flap, and delayed nipple reconstruction with banked costal cartilage. Eight patients who underwent these reconstructions between 2008 and 2010 were reviewed. SSM was performed by vertical-type incision. We transferred the DIEP flap using an internal thoracic vessel and banked costal cartilage into an abdominal wound. Three to 6 months later, we removed the cartilage and cut it into a cylindrical shape. We fixed the cartilage on the dermal base of a modified C-V flap. No flap necrosis or exposure of cartilage was seen and the scar was acceptable in all cases. At a mean follow-up of 12.6 months, 59% of the nipple projection was maintained in comparison to immediately postoperatively. Our new concept is the combination of SSM, DIEP, and banked cartilage, and furthermore putting the cartilage on a dermal base. With support from the dermis, a large, complicated cartilage form is unnecessary.

  13. CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization.

    PubMed

    Fukuda, Tetsuya; Matsuda, Hitoshi; Sanda, Yoshihiro; Morita, Yoshiaki; Minatoya, Kenji; Kobayashi, Junjiro; Naito, Hiroaki

    2014-01-01

    To identify the computed tomography (CT) findings of persistent type II endoleak from the inferior mesenteric artery (IMA) which indicate the need for preoperative IMA embolization. Included were 120 patients (96 males, 49-93 years old, mean: 77.7) who underwent endovascular aortic aneurysm repair (EVAR) between June 2007 and October 2010. The relationship between persistent type II endoleak and CT findings of IMA orifice was examined. CT showed no type II endoleak from IMA in 106 patients (89%; Group N), and transient type II endoleak from IMA in 10 patients (8.3%; Group T). CT showed persistent type II endoleak from IMA in 4 patients (3.3%; Group P) and three of them underwent reintervention. Univariate Cox-Mantel test analysis indicated that stenosis (p = 0.0003) and thrombus (p = 0.043) in IMA orifice were significant factors for persistent type II endoleak. The ratios of patients with proximal IMA more than 2.5 mm diameter in Groups N, Y, and P were 26/106 (24%), 5/10 (50%) and 4/4 (100%), respectively. Indicators for embolization of IMA prior to EVAR for the prevention of type II endoleak appear to be: (1) more than 2.5 mm in diameter and (2) no stenosis due to calcification or mural thrombus in IMA orifice.

  14. CT Findings of Risk Factors for Persistent Type II Endoleak from Inferior Mesenteric Artery to Determine Indicators of Preoperative IMA Embolization

    PubMed Central

    Matsuda, Hitoshi; Sanda, Yoshihiro; Morita, Yoshiaki; Minatoya, Kenji; Kobayashi, Junjiro; Naito, Hiroaki

    2014-01-01

    Purpose: To identify the computed tomography (CT) findings of persistent type II endoleak from the inferior mesenteric artery (IMA) which indicate the need for preoperative IMA embolization. Materials and Methods: Included were 120 patients (96 males, 49–93 years old, mean: 77.7) who underwent endovascular aortic aneurysm repair (EVAR) between June 2007 and October 2010. The relationship between persistent type II endoleak and CT findings of IMA orifice was examined. Results: CT showed no type II endoleak from IMA in 106 patients (89%; Group N), and transient type II endoleak from IMA in 10 patients (8.3%; Group T). CT showed persistent type II endoleak from IMA in 4 patients (3.3%; Group P) and three of them underwent reintervention. Univariate Cox-Mantel test analysis indicated that stenosis (p = 0.0003) and thrombus (p = 0.043) in IMA orifice were significant factors for persistent type II endoleak. The ratios of patients with proximal IMA more than 2.5 mm diameter in Groups N, Y, and P were 26/106 (24%), 5/10 (50%) and 4/4 (100%), respectively. Conclusion: Indicators for embolization of IMA prior to EVAR for the prevention of type II endoleak appear to be: (1) more than 2.5 mm in diameter and (2) no stenosis due to calcification or mural thrombus in IMA orifice. PMID:25298829

  15. Transanal natural orifice transluminal endoscopic surgery total mesorectal excision in animal models: endoscopic inferior mesenteric artery dissection made easier by a retroperitoneal approach.

    PubMed

    Park, Sun Jin; Sohn, Dae Kyung; Chang, Tae Young; Jung, Yunho; Kim, Hyung Jin; Kim, Young Ill; Chun, Ho-Kyung

    2014-07-01

    We report the performance of natural orifice transluminal endoscopic surgery (NOTES) low anterior resection in animals using transanal total mesorectal excision (TME) with laparoscopic assistance and endoscopic inferior mesenteric artery (IMA) dissection. Four pigs weighing 45 kg each, and one dog weighing 25 kg, underwent surgery via a transanal approach. The rectum was occluded transanally using a purse-string suture, approximately 3-4 cm from the anal verge. The rectal mucosa was incised circumferentially just distal to the purse-string. A SILS or GelPOINT port was inserted transanally. Transanal TME was assisted by laparoscopy and proceeded up to the peritoneal reflection. More proximal dissection, including IMA dissection, was performed along the retroperitoneal avascular plane by endoscopy alone and facilitated by CO2 insufflation. The IMA was clipped and divided endoscopically. The mobilized rectosigmoid were exteriorized transanally and transected. A colorectal anastomosis was performed using a circular stapler with a single stapling technique. Endoscopic dissection of the IMA was successful in all five animals. The mean operation time was 125 minutes (range, 90-170 minutes). There were no intraoperative complications or hemodynamic instability. The mean length of the resected specimen was 14.4 cm (range, 12-16 cm). A NOTES retroperitoneal approach to the IMA with CO2 insufflation and intact peritoneal covering overcame the difficulties of retraction and exposure of endoscopic dissection in animals.

  16. [Part of the vertebral artery in patients with sudden deafness].

    PubMed

    Song, Yisa; Lv, Fengquan; Cai, Huixiau; Wu, Hao

    2013-08-01

    To explore the characteristics of vertebral artery system in the patients with sudden deafness by using digital subtraction angiography (DSA). Thirty-four cases of sudden deafness with vertebrobasilar artery ischemia confirmed by the color doppler ultrasound were undergone DSA in both side. The characteristics of vertebral artery, basal artery and before-cerebellum artery were analysis before specific therapy. There is no related complication were occurred among 34 cases. Side vertebral artery was blocked in 2 cases, atherosclerosis was found in 5 cases. The right cerebellar artery anterior and the left cerebellar artery posterior were found filling defect or minor change in 29.4% (10/34) and 35.3% (12/34) of the patients, respectively. The right and the left arteria auditiva interna were found filling defect or minor change in 64.7% (22/34) and 73.5% (25/34) of the patients, respectively. After specific therapy, 8 cases were cured, the hearing of 9 cases were markedly improved, the hearing of 12 cases were improved efficient and 5 patients have no hearing improvement, the total effective rate was 85.3%. The arteria auditiva interna and inferior anterior arteria cerebelli caused inner ear ischemia were found in the patients with sudden deafness. The using of vasodilator may have satisfactory and positive curative effect in the therapy of sudden deafness.

  17. Crossed Cerebellar Diaschisis

    PubMed Central

    Han, Shuguang; Wang, Xiaopeng; Xu, Kai; Hu, Chunfeng

    2016-01-01

    Abstract Crossed cerebellar diaschisis (CCD) describes a depression of oxidative metabolism glucose and blood flow in the cerebellum secondary to a supratentorial lesion in the contralateral cerebral hemisphere. PET/MR has the potential to become a powerful tool for demonstrating and imaging intracranial lesions .We herein report 3 cases of CCD imaging using a tri-modality PET/CT–MR set-up for investigating the value of adding MRI rather than CT to PET in clinical routine. We describe 3 patients with CCD and neurological symptoms in conjunction with abnormal cerebral fluorodeoxyglucose (FDG) positron emission tomography/computed tomography-magnetic resonance imaging (PET/CT–MR) manifestations including arterial spin-labeling (ASL) and T2-weighted images. In all, 18FDG-PET/CT detected positive FDG uptake in supratentorial lesions, and hypometabolism with atrophy in the contralateral cerebellum. More than that, hybrid PET/MRI provided a more accurate anatomic localization and ASL indicated disruption of the cortico-ponto-cerebellar pathway. Using pathology or long-term clinical follow-up to confirm the PET and ASL findings, the supratentorial lesions of the 3 patients were respectively diagnosed with cerebral infarction, recurrent glioma, and metastasis. The reports emphasize the significance of multimodality radiological examinations. Multimodality imaging contributes to proper diagnosis, management, and follow-up of supratentorial lesions with CCD. PMID:26765477

  18. Clinical and radiologic features and their relationships with neurofunctional scores in patients with acute cerebellar infarct

    PubMed Central

    Kozak, Hasan Hüseyin; Uca, Ali Ulvi; Poyraz, Necdet; Anliaçık, Süleyman Ömer; Tokgöz, Osman Serhat

    2016-01-01

    Background: Cerebellar infarct is a rare condition with very nonspecific clinical features. The aim of this study was to assess the full spectrum of the clinical characteristics, neuroimaging findings and neurofunctional analyses of cerebellar infarction, and the relationship between them. Materials and Methods: Data were collected from 59 patients admitted to our department during an 8-year period. We retrospectively analyzed the relationship between demographic characteristics, clinical symptomatology, etiological factors, functional condition, vascular distribution, frequency of subcortical white matter lesions (WMLs), and concomitant lesion outside the cerebellum in patients with acute cerebellar infarct (ACI) at time of admission. Results: The mean age in our series was 65.2 years, with most being male (57.6%). The posterior inferior cerebellar (PICA) artery was the most commonly affected territory at 62.7%. There was concomitant lesion outside the cerebellum in 45.7%. The main etiology in PICA was cardioembolism. While mean National Institutes of Health Stroke Scale on admission was 2.08 ± 1.67 in study group, modified Rankin Scale (mRS) on admission was detected to be mRS1 (n: 44, 74.5%) and mRS2 (n: 12, 20.3%) most frequently. Fourteen (35%) patients were detected to be in Fazekas stage 0; 11 (27.5%) patients in Fazekas stage 1; 6 (15%) patients in Fazekas stage 2; and 9 (22.5%) patients in Fazekas stage 3. Conclusion: Cerebellar infarct is very heterogeneous. The other cerebral area infarcts which accompany ACI negatively affect neurologic functional scores. Although it is difficult to detect the relationship between WMLs and neurologic functional severity, timely detection of risk factors and their modulation may be associated with prevention and treatability of WMLs, and this may be one of the important points for prevention of stroke-related disability. PMID:27293332

  19. A probabilistic atlas of the cerebellar white matter.

    PubMed

    van Baarsen, K M; Kleinnijenhuis, M; Jbabdi, S; Sotiropoulos, S N; Grotenhuis, J A; van Cappellen van Walsum, A M

    2016-01-01

    Imaging of the cerebellar cortex, deep cerebellar nuclei and their connectivity are gaining attraction, due to the important role the cerebellum plays in cognition and motor control. Atlases of the cerebellar cortex and nuclei are used to locate regions of interest in clinical and neuroscience studies. However, the white matter that connects these relay stations is of at least similar functional importance. Damage to these cerebellar white matter tracts may lead to serious language, cognitive and emotional disturbances, although the pathophysiological mechanism behind it is still debated. Differences in white matter integrity between patients and controls might shed light on structure-function correlations. A probabilistic parcellation atlas of the cerebellar white matter would help these studies by facilitating automatic segmentation of the cerebellar peduncles, the localization of lesions and the comparison of white matter integrity between patients and controls. In this work a digital three-dimensional probabilistic atlas of the cerebellar white matter is presented, based on high quality 3T, 1.25mm resolution diffusion MRI data from 90 subjects participating in the Human Connectome Project. The white matter tracts were estimated using probabilistic tractography. Results over 90 subjects were symmetrical and trajectories of superior, middle and inferior cerebellar peduncles resembled the anatomy as known from anatomical studies. This atlas will contribute to a better understanding of cerebellar white matter architecture. It may eventually aid in defining structure-function correlations in patients with cerebellar disorders.

  20. Perfusion-Related Complications are Similar for DIEP and MS FTRAM Flaps Harvested on Medial or Lateral Deep Inferior Epigastric Artery Branch Perforators for Breast Reconstruction

    PubMed Central

    Garvey, Patrick B.; Salavati, Seroos; Feng, Lei; Butler, Charles E.

    2011-01-01

    Background Anatomic studies suggest the deep inferior epigastric artery (DIEA) medial branch perfuses more tissue across the midline than the lateral branch. We hypothesized that unilateral DIEP and MS FTRAM flaps based on medial branch perforators would have fewer perfusion-related complications. Methods We evaluated 2043 consecutive free flap breast reconstructions and included unilateral reconstructions where DIEP or MS FTRAM flaps were definitively harvested from a single DIEA branch. We grouped flaps by tissue volume, i.e., Hemiflaps, Cross-Midline Flaps, and Total Flaps. Primary outcome measures were fat necrosis and partial flap necrosis. Logistic regression was used to evaluate the association between patient and reconstruction characteristics and perfusion outcomes. Results We included 228 patients: 120 (52.6%) medial and 108 (47.4%) lateral branch flaps. Mean follow-up was 33.2 months. Cross-Midline Flaps (79.8%) were most common, followed by Hemiflaps (15.4%) and Total Flaps (4.8%). Overall fat necrosis and partial flap necrosis rates were 10.5% and 3.1%, respectively. Medial and lateral branch flaps had similar rates of fat necrosis (8.3% vs. 13.0%, respectively; p=0.26) and partial flap necrosis (3.3% vs. 2.8%, respectively; p=1.0). DIEP and MS FTRAM flaps had no difference in the incidence of fat necrosis (10.2% vs. 11.3%; p=0.81) or partial necrosis (3.2% vs. 2.8%; p=1.0). Medial and lateral branch flap perfusion-related complications were also similar among the flap volume classifications. Conclusions We suggest that surgeons base their decisions regarding DIEA branch harvest on the clinical assessment of perforator perfusion quality rather than relying on the theoretic benefit of medial branch perforator harvest. PMID:22094755

  1. The cerebellar serotoninergic system and its possible involvement in cerebellar ataxia.

    PubMed

    Trouillas, P

    1993-05-01

    A review concerning the characteristics of the cerebellar serotoninergic system is presented. In rat, cat and oppossum, the perikarya of origin are located in the brain stem raphe nuclei and in other brainstem structures. The projections to the cerebellar layers and deep nuclei include synaptic connections, but also non synaptic terminals, especially in a diffuse cortical plexus. Serotoninergic receptors have been described: 5-HT1B in the molecular layer and 5-HT2 in the inferior olive. Serotonin exerts neurophysiological effects on several target cells, directly or indirectly, presynaptically or postsynaptically. A modulatory effect on Purkinje cells is well documented. In thiamine deprived animals, a specific serotoninergic cerebellar syndrome includes a selective degeneration of the serotoninergic cerebellar system, an increase of the 5-HIAA cerebellar values and an exaggerated serotoninergic turnover. In human heredoataxias (Friedreich's ataxia and cerebellar cortical atrophy), serotoninergic disturbances have been observed in the CSF, including low 5-HIAA values and an increased serotoninergic turnover. Therapeutic results have been obtained with L-5-HTP, a precursor of serotonin, in several conditions presenting cerebellar ataxia. L-5-HTP resistance of olivopontocerebellar atrophies may be explained by the destruction of serotonin-sensitive target cells, especially Purkinje cells.

  2. Differential olivo-cerebellar cortical control of rebound activity in the cerebellar nuclei

    PubMed Central

    Hoebeek, Freek E.; Witter, Laurens; Ruigrok, Tom J. H.; De Zeeuw, Chris I.

    2010-01-01

    The output of the cerebellar cortex is controlled by two main inputs, (i.e., the climbing fiber and mossy fiber-parallel fiber pathway) and activations of these inputs elicit characteristic effects in its Purkinje cells: that is, the so-called complex spikes and simple spikes. Target neurons of the Purkinje cells in the cerebellar nuclei show rebound firing, which has been implicated in the processing and storage of motor coordination signals. Yet, it is not known to what extent these rebound phenomena depend on different modes of Purkinje cell activation. Using extracellular as well as patch-clamp recordings, we show here in both anesthetized and awake rodents that simple and complex spike-like train stimuli to the cerebellar cortex, as well as direct activation of the inferior olive, all result in rebound increases of the firing frequencies of cerebellar nuclei neurons for up to 250 ms, whereas single-pulse stimuli to the cerebellar cortex predominantly elicit well-timed spiking activity without changing the firing frequency of cerebellar nuclei neurons. We conclude that the rebound phenomenon offers a rich and powerful mechanism for cerebellar nuclei neurons, which should allow them to differentially process the climbing fiber and mossy fiber inputs in a physiologically operating cerebellum. PMID:20395550

  3. Cerebellar infarction presenting as inner ear decompression sickness following scuba diving: a case report.

    PubMed

    Gempp, E; Louge, P; Soulier, B; Alla, P

    2014-11-01

    Inner ear decompression sickness following scuba diving is not uncommon and the characteristic features of this disorder are acute peripheral vestibular syndrome, sometimes associated with cochlear signs, requiring urgent hyperbaric oxygen therapy. Cerebellar infarction can also mimic isolated peripheral vestibulopathy. The authors report the case of a 47-year-old man in good general health admitted with acute left vestibular dysfunction suggestive of inner ear decompression sickness 6 hours after scuba diving. Normal videonystagmography and delayed onset of occipital headache finally led to brain MRI that confirmed the presence of recent ischaemic infarction in the territory of the medial branch of the posterior inferior cerebellar artery. Complementary investigations revealed the presence of a patent foramen ovale with atrial septal aneurysm. No underlying atherosclerotic disease or clotting abnormalities were observed. Cerebellar infarction can present clinically with features of inner ear decompression sickness following scuba diving. An underlying air embolism mechanism cannot be excluded, particularly in patients with a large right-to-left circulatory shunt and no other cardiovascular risk factors. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. Surgical anatomy of the arteries of the posterior fossa.

    PubMed

    Shrontz, C; Dujovny, M; Ausman, J I; Diaz, F G; Pearce, J E; Berman, S K; Hirsch, E; Mirchandani, H G

    1986-10-01

    The development of revascularization for vertebrobasilar ischemic events has created a need to identify the best sites at which to perform bypass procedures. Since the occlusive process may selectively affect various levels of the vertebrobasilar tree, sites in different vessels must be used to reestablish flow distal to the area of occlusion. Twenty-seven unfixed human brains were obtained 4 to 8 hours post mortem, and the vertebrobasilar system was injected with polyester resin. Under a surgical microscope the outer diameter, length, and site of origin of major branches were recorded for the following arteries: vertebral, basilar, posterior inferior cerebellar (PICA), anterior inferior cerebellar (AICA), superior cerebellar (SCA), and posterior cerebral (PCA). The ideal sites for an anastomosis were identified as the pretonsillar segment of the PICA, the second portion of the AICA, the perimesencephalic segment of the SCA, and the perimesencephalic part of the PCA. Based on the anatomical observations reported here, these were the best sites because of their outer diameter, degree of mobility, least number of branches, and frequency of occurrence. Use of two of these arteries, however, may pose potential problems: although the PCA has an ideal outer diameter, it also has numerous branches to the brain stem in its most accessible site in the perimesencephalic area; and the PICA is not consistently present, being found in only 75% of the 27 specimens studied.

  5. Pediatric cerebellar infarction caused by atlantoaxial subluxation--case report.

    PubMed

    Miyata, I; Imaoka, T; Masaoka, T; Nishiura, T; Ishimitsu, H

    1994-04-01

    An 11-year-old girl developed cerebellar infarction presenting as a posterior fossa mass lesion after stretching and flexing her neck. Cerebral angiography demonstrated irregular narrowing of the right vertebral artery at the C2 level and x-rays of the upper cervical spine showed atlantoaxial subluxation with os odontoideum. She underwent surgical decompression with removal of infarcted tissue. The cerebellar infarction probably resulted from occlusion of the vertebral artery, followed by brain swelling due to recanalization.

  6. Olivary degeneration after cerebellar or brain stem haemorrhage: MRI.

    PubMed

    Uchino, A; Hasuo, K; Uchida, K; Matsumoto, S; Tsukamoto, Y; Ohno, M; Masuda, K

    1993-01-01

    Magnetic resonance (MR) images of seven patients with olivary degeneration caused by cerebellar or brain stem haemorrhages were reviewed. In four patients with cerebellar haemorrhage, old haematomas were identified as being located in the dentate nucleus; the contralateral inferior olivary nuclei were hyperintense on proton-density- and T2-weighted images. In two patients with pontine haemorrhages, the old haematomas were in the tegmentum and the ipsilateral inferior olivary nuclei, which were hyperintense. In one case of midbrain haemorrhage, the inferior olivary nuclei were hyperintense bilaterally. The briefest interval from the ictus to MRI was 2 months. Hypertrophic olivary nuclei were observed only at least 4 months after the ictus. Olivary degeneration after cerebellar or brain stem haemorrhage should not be confused with ischaemic, neoplastic, or other primary pathological conditions of the medulla.

  7. Distinct critical cerebellar subregions for components of verbal working memory

    PubMed Central

    Cooper, Freya E.; Grube, Manon; Von Kriegstein, Katharina; Kumar, Sukhbinder; English, Philip; Kelly, Thomas P.; Chinnery, Patrick F.; Griffiths, Timothy D.

    2014-01-01

    A role for the cerebellum in cognition has been proposed based on studies suggesting a profile of cognitive deficits due to cerebellar stroke. Such studies are limited in the determination of the detailed organisation of cerebellar subregions that are critical for different aspects of cognition. In this study we examined the correlation between cognitive performance and cerebellar integrity in a specific degeneration of the cerebellar cortex: Spinocerebellar Ataxia type 6 (SCA6). The results demonstrate a critical relationship between verbal working memory and grey matter density in superior (bilateral lobules VI and crus I of lobule VII) and inferior (bilateral lobules VIIIa and VIIIb, and right lobule IX) parts of the cerebellum. We demonstrate that distinct cerebellar regions subserve different components of the prevalent psychological model for verbal working memory based on a phonological loop. The work confirms the involvement of the cerebellum in verbal working memory and defines specific subsystems for this within the cerebellum. PMID:22133495

  8. Anatomy and approaches along the cerebellar-brainstem fissures.

    PubMed

    Matsushima, Ken; Yagmurlu, Kaan; Kohno, Michihiro; Rhoton, Albert L

    2016-01-01

    OBJECT Fissure dissection is routinely used in the supratentorial region to access deeply situated pathology while minimizing division of neural tissue. Use of fissure dissection is also practical in the posterior fossa. In this study, the microsurgical anatomy of the 3 cerebellar-brainstem fissures (cerebellomesencephalic, cerebellopontine, and cerebellomedullary) and the various procedures exposing these fissures in brainstem surgery were examined. METHODS Seven cadaveric heads were examined with a microsurgical technique and 3 with fiber dissection to clarify the anatomy of the cerebellar-brainstem and adjacent cerebellar fissures, in which the major vessels and neural structures are located. Several approaches directed along the cerebellar surfaces and fissures, including the supracerebellar infratentorial, occipital transtentorial, retrosigmoid, and midline suboccipital approaches, were examined. The 3 heads examined using fiber dissection defined the anatomy of the cerebellar peduncles coursing in the depths of these fissures. RESULTS Dissections directed along the cerebellar-brainstem and cerebellar fissures provided access to the posterior and posterolateral midbrain and upper pons, lateral pons, floor and lateral wall of the fourth ventricle, and dorsal and lateral medulla. CONCLUSIONS Opening the cerebellar-brainstem and adjacent cerebellar fissures provided access to the brainstem surface hidden by the cerebellum, while minimizing division of neural tissue. Most of the major cerebellar arteries, veins, and vital neural structures are located in or near these fissures and can be accessed through them.

  9. Modality specificity in the cerebro-cerebellar neurocircuitry during working memory.

    PubMed

    Ng, H B Tommy; Kao, K-L Cathy; Chan, Y C; Chew, Effie; Chuang, K H; Chen, S H Annabel

    2016-05-15

    Previous studies have suggested cerebro-cerebellar circuitry in working memory. The present fMRI study aims to distinguish differential cerebro-cerebellar activation patterns in verbal and visual working memory, and employs a quantitative analysis to deterimine lateralization of the activation patterns observed. Consistent with Chen and Desmond (2005a,b) predictions, verbal working memory activated a cerebro-cerebellar circuitry that comprised left-lateralized language-related brain regions including the inferior frontal and posterior parietal areas, and subcortically, right-lateralized superior (lobule VI) and inferior cerebellar (lobule VIIIA/VIIB) areas. In contrast, a distributed network of bilateral inferior frontal and inferior temporal areas, and bilateral superior (lobule VI) and inferior (lobule VIIB) cerebellar areas, was recruited during visual working memory. Results of the study verified that a distinct cross cerebro-cerebellar circuitry underlies verbal working memory. However, a neural circuitry involving specialized brain areas in bilateral neocortical and bilateral cerebellar hemispheres subserving visual working memory is observed. Findings are discussed in the light of current models of working memory and data from related neuroimaging studies. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Segmental Arterial Mediolysis Involving Both Vertebral and Middle Colic Arteries Leading to Subarachnoid and Intraperitoneal Hemorrhage.

    PubMed

    Shinoda, Narihide; Hirai, Osamu; Mikami, Kazuyuki; Bando, Toshiaki; Shimo, Daisuke; Kuroyama, Takahiro; Matsumoto, Masato; Itoh, Tomoo; Kuramoto, Yoji; Ueno, Yasushi

    2016-04-01

    Segmental arterial mediolysis (SAM) is not yet well known in the neurosurgical field, even though it has become an increasingly recognized pathology in arterial dissection. A case of SAM presented as subarachnoid hemorrhage (SAH) due to a dissecting aneurysm of the left intracranial vertebral artery (VA), which extended from the proximal VA union to the distal portion of the left posterior inferior cerebellar artery. The lesion was successfully embolized by an endovascular technique. However, subsequent intraperitoneal hemorrhage due to rupture of a fusiform aneurysm of the middle colic artery prompted surgical treatments. The features of the extirpated visceral vascular lesion were compatible with the diagnosis of SAM based on histopathologic examinations. It is very important that SAM is recognized as a systemic disease that affects the central nervous system, visceral arteries, and coronary arteries. The possibility of SAM should always be considered, particularly in patients with ruptured VA dissection-which is nowadays treated by endovascular techniques-since concomitantly involved visceral arteries may cause unexpected hemorrhagic complications other than SAH. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Cerebellar white matter pathways are associated with reading skills in children and adolescents.

    PubMed

    Travis, Katherine E; Leitner, Yael; Feldman, Heidi M; Ben-Shachar, Michal

    2015-04-01

    Reading is a critical life skill in the modern world. The neural basis of reading incorporates a distributed network of cortical areas and their white matter connections. The cerebellum has also been implicated in reading and reading disabilities. However, little is known about the contribution of cerebellar white matter pathways to major component skills of reading. We used diffusion magnetic resonance imaging (dMRI) with tractography to identify the cerebellar peduncles in a group of 9- to 17-year-old children and adolescents born full term (FT, n = 19) or preterm (PT, n = 26). In this cohort, no significant differences were found between fractional anisotropy (FA) measures of the peduncles in the PT and FT groups. FA of the cerebellar peduncles correlated significantly with measures of decoding and reading comprehension in the combined sample of FT and PT subjects. Correlations were negative in the superior and inferior cerebellar peduncles and positive in the middle cerebellar peduncle. Additional analyses revealed that FT and PT groups demonstrated similar patterns of reading associations within the left superior cerebellar peduncle, middle cerebellar peduncle, and left inferior cerebellar peduncle. Partial correlation analyses showed that distinct sub-skills of reading were associated with FA in segments of different cerebellar peduncles. Overall, the present findings are the first to document associations of microstructure of the cerebellar peduncles and the component skills of reading.

  12. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms

    PubMed Central

    Hamasaki, Osamu; Ikawa, Fusao; Hidaka, Toshikazu; Kurokawa, Yasuharu; Yonezawa, Ushio

    2014-01-01

    Summary We evaluated the outcomes of endovascular or surgical treatment of ruptured vertebral artery dissecting aneurysms (VADAs), and investigated the relations between treatment complications and the development and location of the posterior inferior cerebellar artery (PICA). We treated 14 patients (12 men, two women; mean age, 56.2 years) with ruptured VADAs between March 1999 and June 2012 at our hospital. Six and eight patients had Hunt and Hess grades 1-3 and 4-5, respectively. Twelve patients underwent internal endovascular trapping, one underwent proximal endovascular occlusion alone, and one underwent proximal endovascular occlusion in the acute stage and occipital artery (OA)-PICA anastomosis and surgical trapping in the chronic stage. The types of VADA based on their location relative to the ipsilateral PICA were distal, PICA-involved, and non-PICA in nine, two, and three patients, respectively. The types of PICA based on their development and location were bilateral anterior inferior cerebellar artery (AICA)-PICA, ipsilateral AICA-PICA, extradural, and intradural type in one, two, two, and nine patients, respectively. Two patients with high anatomical risk developed medullary infarction, but their midterm outcomes were better than in previous reports. The modified Rankin scale indicated grades 0-2, 3-5, and 6 in eight, three, and three patients, respectively. A good outcome is often obtained in the treatment of ruptured VADA using internal endovascular trapping, except in the PICA-involved type, even with high-grade subarachnoid hemorrhage. Treatment of the PICA-involved type is controversial. The anatomical location and development of PICA may be predicted by complications with postoperative medullary infarction. PMID:24976093

  13. Liver hydatid cyst leading to bilateral pulmonary artery embolism and bilateral multiple pulmonar echinococcosis via inferior vena cava: report of a case.

    PubMed

    Bayaroğullari, Hanifi; Davran, Ramazan; Cavuş, Yeliz; Yetim, Tülin Durgun; Evirgen, Ömer

    2013-01-01

    Hydatid disease (HD) is a worldwide parasitic disease. Echinococcosis may involve many organs but affect most commonly liver and lungs. The location of echinococcal cysts inside pulmonary artery is extremely rare. Radiologic findings range from purely cystic lesions to a completely solid appearance. Hydatid cysts (HC) can be solitary or multiple and varies size. Pulmonary artery embolism of HC can be symptomatic or asymptomatic. When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Controlateral cavernous syndrome, brainstem congestion and posterior fossa venous thrombosis with cerebellar hematoma related to a ruptured intracavernous carotid artery aneurysm.

    PubMed

    Aldea, Sorin; Guedin, Pierre; Roccatagliata, Luca; Boulin, Anne; Auliac, Stéphanie; Dupuy, Michel; Cerf, Charles; Gaillard, Stéphan; Rodesch, Georges

    2011-06-01

    Intracavernous carotid artery aneurysms (ICCAs) are rarely associated with life-threatening complications. We describe a 55-year-old woman who, after the rupture of an intracavernous carotid artery aneurysm, presented with a contralateral cavernous sinus syndrome and severe posterior fossa and spinal cord symptoms. Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a "locked-in" state. The patient fully recovered with anticoagulation therapy. Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications related to venous thrombosis.

  15. Improvement of sudden bilateral hearing loss after vertebral artery stenting

    PubMed Central

    Kim, Ji Hwa; Roh, Kyung Jin; Suh, Sang Hyun; Lee, Kyung-Yul

    2015-01-01

    Bilateral deafness is a rare but possible symptom of vertebrobasilar ischemia. We report a case of sudden bilateral sensorineural hearing loss caused by bilateral vertebral artery (VA) occlusion which dramatically improved after stenting. A 54-year-old man was admitted with sudden onset of bilateral deafness, vertigo, and drowsy mental status. Brain diffusion-weighted MRI showed acute infarction involving both the posterior inferior cerebellar artery and left posterior cerebral artery territory. Cerebral angiography showed bilateral distal VA occlusion, and emergency intracranial stenting was performed in the left VA. After reperfusion therapy his symptoms gradually improved, including hearing impairment. Endovascular stenting may be helpful in a patient with sudden deafness caused by bilateral VA occlusion. PMID:25697296

  16. Distribution of cerebello-olivary degeneration in idiopathic late cortical cerebellar atrophy: clinicopathological study of four autopsy cases.

    PubMed

    Ota, Satoru; Tsuchiya, Kuniaki; Anno, Midori; Niizato, Kazuhiro; Akiyama, Haruhiko

    2008-02-01

    Late cortical cerebellar atrophy (LCCA) is a neurodegenerative disease which presents with slowly progressive cerebellar ataxia as a prominent symptom and is characterized neuropathologically by a limited main lesion to the cerebellar cortex and inferior olivary nucleus. To elucidate the features of lesions in the cerebellar cortex and inferior olivary nucleus, four autopsy cases suffering from idiopathic LCCA without other cortical cerebellar atrophies, such as alcoholic cerebellar degeneration, phenytoin intoxication, or hereditary cerebellar atrophy including spinocerebellar ataxia type 6, were examined. All affected patients had identical distinct features of cerebellar cortical lesions. In all four cases, the most obvious pathological finding throughout the cerebellum was loss of Purkinje cells, but the rarefaction of granular cell layers was observed only where loss of Purkinje cells was very severe, and thinning of the molecular layer was seen only where the rarefaction of granular cell layers was moderate to severe. Two patients presented with vermis dominant cerebellar cortical lesions, but the other two patients showed hemispheric dominant pathological changes. Neuronal loss of the inferior olivary nucleus was observed in the three autopsy cases. Two of the three cases had a prominent lesion in the dorsal part of the inferior olive and the cerebellar cortical lesion disclosed the vermis dominance, but the other patient, showing prominent neuronal loss in the ventral olivary nucleus, had a cerebellar hemisphere dominant lesion. The patient without neuronal loss in the inferior olivary nucleus had suffered from a shorter period of disease than the others and the rarefaction of granular cell layers and narrowing of the molecular layer of the cerebellar cortex were mild. Therefore, it is obvious that there are two types of cerebellar cortex lesions in idiopathic LCCA; one is vermis dominant and the other is cerebellar hemispheric dominant. The lesion of the

  17. Early degeneration of the cerebellar cortex, particularly the granular cells.

    PubMed

    Bugiani, O; Berio, A; Di Stefano, A; Mangiante, G; Mancardi, G L; Leonardi, A

    1978-12-07

    An 8 month old infant, who died of severe gastroenteritis, presented a degeneration of the cerebellar cortex involving cells arising from the outer granular layer as well as Purkinje and Golgi II cells. Residual Purkinje cells showed vacuolar change of the cell body and dendritic abnormalities. Related lesions were atrophy of the inferior olives and degeneration of the mossy fibers.

  18. Subarachnoid small vein occlusion due to inflammatory fibrosis-a possible mechanism for cerebellar infarction in cryptococcal meningoencephalitis: a case report.

    PubMed

    Shimoda, Yoshiteru; Ohtomo, Satoru; Arai, Hiroaki; Ohtoh, Takashi; Tominaga, Teiji

    2017-08-09

    Cryptococcal meningoencephalitis (CM) causes cerebral infarction, typically, lacunar infarction in the basal ganglia. However, massive cerebral infarction leading to death is rare and its pathophysiology is unclear. We report a case of CM causing massive cerebellar infarction, which led to cerebral herniation and death. A 56-year-old man who suffered from dizziness and gait disturbance for one month was admitted to our hospital and subsequently diagnosed with a cerebellar infarction. He had a past medical history of hepatitis type B virus infection and hepatic failure. Although the findings on magnetic resonance imaging (MRI) imitated an arterial infarction of the posterior inferior cerebellar artery, an accompanying irregular peripheral edema was observed. The ischemic lesion progressed, subsequently exerting a mass effect and leading to impaired consciousness. External and internal decompression surgeries were performed. Cryptococcus neoformans was confirmed in the surgical specimen, and the patient was diagnosed with CM. In addition, venule congestion in the parenchyma was observed with extensive fibrosis and compressed veins in the subarachnoid space. The patient died 26 days after admission. Autopsy revealed that pathological changes were localized in the cerebellum. C. neoformans can induce extensive fibrosis of the subarachnoid space, which may compress small veins mechanically inducing venule congestion and massive cerebral infarction. In such cases, the clinical course can be severe and even rapidly fatal. An atypical pattern of infarction on MRI should alert clinicians to the possibility of C. neoformans infection.

  19. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes.

    PubMed

    Yang, Xiao-Sheng; Li, Shi-Ting; Zhong, Jun; Zhu, Jin; Du, Quan; Zhou, Qiu-Meng; Jiao, Wei; Guan, Hong-Xin

    2012-05-01

    Due to its anatomical features, the vertebrobasilar artery complex (VBA) seldom contributes to the neurovascular conflict in patient with trigeminal neuralgia (TN). However, once it offends the trigeminal root, this large artery is really difficult to manipulate during microvascular decompression (MVD) surgery. Therefore, the surgical strategy for such cases needs to be detailed in order to obtain a satisfactory outcome. From 2009 through 2011, 475 consecutive TN patients underwent MVDs in our department. Among them, ten were found in which an ipsilateral deviating ectatic vertebrobasilar artery complex (VBA) offended the trigeminal nerve. Those cases were focused on in this study and each operation was analyzed retrospectively. During the operation, the vertebral artery was regarded as the direct culprit in six (60 %) patients, while the basilar artery in four (40 %). As companions, some smaller vessels were also observed to be close to the nerve, including the superior cerebellar artery (SCA) in five, veins in two and anterior inferior cerebellar artery (AICA) in two. The neurovascular conflict was discovered in the cisternal segment of the trigeminal root in eight, while in the root entry zone (REZ) in two. In six out of the ten cases, the affected nerves were demonstrated to be squeezed towards the tentorium by the ectatic VBA. Postoperatively, the symptom of pain totally disappeared immediately in eight (80 %) patients, while it was relieved apparently in two (20 %). During the follow-up period of 3-30 months, no recurrence or complication was found, except for one patient who had numbness of the face. With a proper strategy, MVD is probably the most effective therapy for the TN cases caused by ectatic vertebrobasilar artery complex. The substance of the surgery is to withdraw the proximal vertebral artery caudally via a lateroinferior cerebellar approach.

  20. Asterixis as a Presentation of Cerebellar Ischemic Stroke

    PubMed Central

    Siniscalchi, Antonio; Gallelli, Luca; Di Benedetto, Olindo; De Sarro, Giovambattista

    2012-01-01

    Asterixis is not yet considered a common neurological sign of cerebellum infarction, and the pathogenic mechanism for asterixis remains elusive. We report a 58-year-old male with moderate hypertension who presented to our emergency department for acute headache in both cervical and occipital regions of the left side. About 2 hours later the patient developed ipsilateral asterixis in the upper left limb; 3 days later the asterixis disappeared. Magnetic resonance imaging of the brain disclosed cerebellar infarctions at the left superior cerebellar artery. In conclusion, we observed that a transitory asterixis associated with ipsilateral headache can be an initial clinical manifestation of ipsilateral cerebellar infarctions in the superior cerebellar artery area. PMID:23359270

  1. Abnormal cerebellar morphometry in abstinent adolescent marijuana users

    PubMed Central

    Medina, Krista Lisdahl; Nagel, Bonnie J.; Tapert, Susan F.

    2010-01-01

    Background Functional neuroimaging data from adults have, in general, found frontocerebellar dysfunction associated with acute and chronic marijuana (MJ) use (Loeber & Yurgelun-Todd, 1999). One structural neuroimaging study found reduced cerebellar vermis volume in young adult MJ users with a history of heavy polysubstance use (Aasly et al., 1993). The goal of this study was to characterize cerebellar volume in adolescent chronic MJ users following one month of monitored abstinence. Method Participants were MJ users (n=16) and controls (n=16) aged 16-18 years. Extensive exclusionary criteria included history of psychiatric or neurologic disorders. Drug use history, neuropsychological data, and structural brain scans were collected after 28 days of monitored abstinence. Trained research staff defined cerebellar volumes (including three cerebellar vermis lobes and both cerebellar hemispheres) on high-resolution T1-weighted magnetic resonance images. Results Adolescent MJ users demonstrated significantly larger inferior posterior (lobules VIII-X) vermis volume (p<.009) than controls, above and beyond effects of lifetime alcohol and other drug use, gender, and intracranial volume. Larger vermis volumes were associated with poorer executive functioning (p’s<.05). Conclusions Following one month of abstinence, adolescent MJ users had significantly larger posterior cerebellar vermis volumes than non-using controls. These greater volumes are suggested to be pathological based on linkage to poorer executive functioning. Longitudinal studies are needed to examine typical cerebellar development during adolescence and the influence of marijuana use. PMID:20413277

  2. Bioglue-Coated Teflon Sling Technique in Microvascular Decompression for Hemifacial Spasm Involving the Vertebral Artery

    PubMed Central

    Lee, Seong Ho; Park, Jae Sung

    2016-01-01

    Objective Microvascular decompression (MVD) for hemifacial spasm (HFS) involving the vertebral artery (VA) can be technically challenging. We investigated the therapeutic effects of a bioglue-coated Teflon sling technique on the VA during MVD in 42 cases. Methods A bioglue-coated Teflon sling was crafted by the surgeon and applied to patients in whom neurovascular compression was caused by the VA. The radiologic data, intra-operative findings with detailed introduction of the procedure, and the clinical outcomes of each patient were reviewed and analyzed. Results The 42 patients included in the analysis consisted of 22 females and 20 males, with an average follow-up duration of 76 months (range 24–132 months). Intraoperative investigation revealed that an artery other than the VA was responsible for the neurovascular compression in all cases : posterior inferior cerebellar artery (PICA) in 23 patients (54.7%) and anterior inferior cerebellar artery (AICA) in 11 patients (26.2%). All patients became symptom-free after MVD. Neither recurrence nor postoperative neurological deficit was noted during the 2-year follow-up, except in one patient who developed permanent deafness. Cerebrospinal fluid (CSF) leak occurred in three patients, and one required dural repair. Conclusion Transposition of the VA using a bioglue-coated Teflon sling is a safe and effective surgical technique for HFS involving the VA. A future prospective study to compare clinical outcomes between groups with and without use of this novel technique is required. PMID:27651870

  3. Cerebellar Dysfunction in a Patient with HIV.

    PubMed

    Gonzalez-Ibarra, Fernando; Abdul, Waheed; Eivaz-Mohammadi, Sahar; Foscue, Christopher; Gongireddy, Srinivas; Syed, Amer

    2014-01-01

    A 50-year-old AIDS patient with a CD4 T-cell count of 114/mm(3) was admitted with cerebellar symptoms of left CN XI weakness, wide-based gait with left-sided dysmetria, abnormal heel-knee-shin test, and dysdiadochokinesia. MRI showed region of hyperintensity in the left inferior cerebellar hemisphere involving the cortex and underlying white matter. Serological tests for HSV1, HSV2, and syphilis were negative. Her CSF contained high protein content and a WBC of 71/mm(3), predominantly lymphocytes. The CSF was also negative for cryptococcal antigen and VDRL. CSF culture did not grow microbes. CSF PCR assay was negative for HSV1 and HSV2 but was positive for JC virus (1,276 copies). The most likely diagnosis is granule cell neuronopathy (GCN), which can only be definitively confirmed with biopsy and immunohistochemistry.

  4. Iatrogenic postoperative cerebellar cyst.

    PubMed

    Sharif, Robin; Moscovici, Samuel; Wygoda, Marc; Eliahou, Ruth; Spektor, Sergey

    2016-12-01

    Cerebellar cyst is a known but uncommon entity. It is congenital in most cases, or may develop after brain parenchyma injuries or interventions. To our knowledge, de novo cerebellar cyst after extra-axial tumor excision, has not been described in the literature. We present the first reported case of a de novo cerebellar cyst developing in a 70-year-old woman following retrosigmoid craniotomy for vestibular schwannoma excision, and discuss the possible causes. Following cyst fenestration, there was no clinical or radiological evidence of a residual cyst. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction.

    PubMed

    Zhu, Wei; Wang, Ya-Fang; Dong, Xiao-Feng; Feng, Hong-Xuan; Zhao, He-Qing; Liu, Chun-Feng

    2016-09-01

    Vertebral artery dominance (VAD), which is a common congenital variation of vertebral artery, may be associated with an increased risk of cerebral posterior circulation infarction (PCI). The aims of this study were to investigate the correlation of VAD with incidence and laterality of PCI, and oblige the correlation of VAD and basilar artery (BA) curvature. Incidence of separate territory infarction in posterior circulation and incidence of BA curvature were compared between 78 VAD patients and 68 controls. VA dominance, laterality of BA curvature and separate territory infarction, and their directional relationships were observed in VAD group. The incidence of BA curvature in VAD group was significantly higher than that in controls (P = 0.000). 89.7 % (35/39) of patients had an opposite directional relationship between dominant VA and BA curvature. The total incidence of PCI in VAD group was significantly higher than that in controls (P = 0.001). The incidences of posterior inferior cerebellar artery (PICA) and BA territory infarction were both significantly higher than those in controls [11.5 % (9/78) vs. 1.5 % (1/68), P = 0.016; 20.5 % (16/78) vs. 7.4 % (5/68), P = 0.024]. No differences were found in superior cerebellar artery and posterior cerebral artery territory infarction between two groups. 77.8 % (7/9) of PICA infarction were on the opposite side of dominant VA. 75.0 % (12/16) of BA infarction were on the side of dominant VA. The incidence of PCI in BA curvature patients was significantly higher than that in BA straight patients. The incidence of BA curvature is higher in VAD patients, and BA usually bends to the opposite side of dominant VA. The incidence of PCI is higher in VAD patients, especially in PICA infarction and BA infarction patients.

  6. Acute cerebellar ataxia

    MedlinePlus

    ... movement due to disease or injury to the cerebellum in the brain. ... of acute cerebellar ataxia include: Abscess of the cerebellum Alcohol, medications, and insecticides Bleeding into the cerebellum ...

  7. In and out of the loop: external and internal modulation of the olivo-cerebellar loop.

    PubMed

    Libster, Avraham M; Yarom, Yosef

    2013-01-01

    Cerebellar anatomy is known for its crystal like structure, where neurons and connections are precisely and repeatedly organized with minor variations across the Cerebellar Cortex. The olivo-cerebellar loop, denoting the connections between the Cerebellar cortex, Inferior Olive and Cerebellar Nuclei (CN), is also modularly organized to form what is known as the cerebellar module. In contrast to the relatively organized and static anatomy, the cerebellum is innervated by a wide variety of neuromodulator carrying axons that are heterogeneously distributed along the olivo-cerebellar loop, providing heterogeneity to the static structure. In this manuscript we review modulatory processes in the olivo-cerebellar loop. We start by discussing the relationship between neuromodulators and the animal behavioral states. This is followed with an overview of the cerebellar neuromodulatory signals and a short discussion of why and when the cerebellar activity should be modulated. We then devote a section for three types of neurons where we briefly review its properties and propose possible neuromodulation scenarios.

  8. [Autosomal recessive cerebellar ataxias].

    PubMed

    Tranchant, Christine; Anheim, Mathieu

    2009-12-01

    Friedreich ataxia is the most frequent recessive cerebral ataxia d should always be researched first. Ataxia with isolated vitamin E deficiency and abetalipoproteinemia have a specific treatment. Associated neurological signs such polyneuroapthy, ophtalmologic or oculomotor signs, pyramidal signs, and cerebellar MRI can lead to the etiological diagnosis. Biological tests should be: vitamin E, cholesterol, alpha-fetoprotein levels, acanthocytes, than phytanic acid, cholestanol, lysosomal enzymes. Numerous autosomal recessive cerebellar ataxia remain without etiology.

  9. Cerebellar Development and Disease

    PubMed Central

    Gleeson, Joseph G.

    2008-01-01

    Recent Advances The molecular control of cell type specification within the developing cerebellum as well as the genetic causes of the most common human developmental cerebellar disorders have long remained mysterious. Recent genetic lineage and loss-of-function data from mice have revealed unique and non-overlapping anatomical origins for GABAergic neurons from ventricular zone precursors and glutamatergic cell from rhombic lip precursors, mirroring distinct origins for these neurotransmitter-specific cell types in the cerebral cortex. Mouse studies elucidating the role of Ptf1a as a cerebellar ventricular zone GABerigic fate switch were actually preceded by the recognition that PTF1A mutations in humans cause cerebellar agenesis, a birth defect of the human cerebellum. Indeed, several genes for congenital human cerebellar malformations have recently been identified, including genes causing Joubert syndrome, Dandy-Walker malformation and Ponto-cerebellar hypoplasia. These studies have pointed to surprisingly complex roles for transcriptional regulation, mitochondrial function and neuronal cilia in patterning, homeostasis and cell proliferation during cerebellar development. Together mouse and human studies are synergistically advancing our understanding of the developmental mechanisms that generate the uniquely complex mature cerebellum. PMID:18513948

  10. Os odontoideum with cerebellar infarction: a case report.

    PubMed

    Sasaki, H; Itoh, T; Takei, H; Hayashi, M

    2000-05-01

    A case report. To report the case of a child with os odontoideum associated with cerebellar infarction and to discuss the correlation between atlantoaxial instability with os odontoideum and vertebrobasilar artery insufficiency. Knowledge of the influence of atlantoaxial instability on vertebrobasilar artery insufficiency remains limited despite the publication of several reports. A 5-year-old boy with ataxic gait disturbance was hospitalized in the pediatric ward. Magnetic resonance imaging revealed multiple cerebellar infarctions, and cerebral angiogram showed occlusions of several branches of the basilar artery and a winding of the left vertebral artery. Stress lateral radiographs of the cervical spine showed atlantoaxial instability with os odontoideum. Posterior C1-C2 transarticular screw fixation with iliac bone graft was applied to obtain firm stability and fusion. There was no damage to the vertebral arteries or spinal nerves in the perioperative period. Solid union of the grafted bone and rigid stability of the atlantoaxial joint were seen on lateral flexion-extension radiographs 1 year after the operation. There has been no sign of recurrent arterial insufficiency, and the patient has been free from cerebellar dysfunction to date. Atlantoaxial instability may cause insufficiency of the vertebral artery as well as spinal cord injury. More attention should be paid to the possible relation between atlantoaxial instability and vertebrobasilar artery insufficiency.

  11. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

    PubMed

    Wijdicks, Eelco F M; Sheth, Kevin N; Carter, Bob S; Greer, David M; Kasner, Scott E; Kimberly, W Taylor; Schwab, Stefan; Smith, Eric E; Tamargo, Rafael J; Wintermark, Max

    2014-04-01

    There are uncertainties surrounding the optimal management of patients with brain swelling after an ischemic stroke. Guidelines are needed on how to manage this major complication, how to provide the best comprehensive neurological and medical care, and how to best inform families facing complex decisions on surgical intervention in deteriorating patients. This scientific statement addresses the early approach to the patient with a swollen ischemic stroke in a cerebral or cerebellar hemisphere. The writing group used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. The panel reviewed the most relevant articles on adults through computerized searches of the medical literature using MEDLINE, EMBASE, and Web of Science through March 2013. The evidence is organized within the context of the American Heart Association framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive American Heart Association internal peer review. Clinical criteria are available for hemispheric (involving the entire middle cerebral artery territory or more) and cerebellar (involving the posterior inferior cerebellar artery or superior cerebellar artery) swelling caused by ischemic infarction. Clinical signs that signify deterioration in swollen supratentorial hemispheric ischemic stroke include new or further impairment of consciousness, cerebral ptosis, and changes in pupillary size. In swollen cerebellar infarction, a decrease in level of consciousness occurs as a result of brainstem compression and therefore may

  12. Vertebral artery dissection after a chiropractor neck manipulation

    PubMed Central

    Jones, Jeremy; Nugent, Kenneth

    2015-01-01

    The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. Magnetic resonance angiography revealed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke. PMID:25552813

  13. Vertebral artery dissection after a chiropractor neck manipulation.

    PubMed

    Jones, Jeremy; Jones, Catherine; Nugent, Kenneth

    2015-01-01

    The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. Magnetic resonance angiography revealed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke.

  14. A simple bracing technique to correct kinking of arterial branches to avoid ischemic sequelae during neurovascular surgery

    PubMed Central

    Motoyama, Yasushi; Tanaka, Yoshitaka; Gurung, Pritam; Nakagawa, Ichiro; Park, Young-Soo; Nakase, Hiroyuki

    2016-01-01

    Background: During microscopic procedures for neurovascular disease, we sometimes encounter kinking of arterial branches resulting in ischemic sequelae. A simple and useful technique that involves inserting a small, ball-like prosthesis made of oxidized cellulose or shredded Teflon with fibrin glue that corrects the arterial branch kinking and avoids subsequent compromise is reported. Methods: Between January and December 2014, three patients developed arterial kinking during microscopic procedures, including two in the caudal loop of the posterior inferior cerebellar artery during microvascular decompression for glossopharyngeal neuralgia and one in a branch of the middle cerebral artery (MCA) during clipping for an unruptured MCA aneurysm. Blood flow insufficiency was confirmed by microvascular Doppler ultrasonography (MDU) and indocyanine green (ICG) videoangiography. The prosthesis, which was made of shredded Teflon in two cases and oxidized cellulose in one case, was inserted into the crotch of the kinked arteries to correct the kinking of the arteries and restore the proper vascular shape and normal blood flow. Results: The small, ball-shaped prosthesis corrected the kinked arteries and maintained the proper shape, which was confirmed by ICG videoangiography and MDU during the operation and three-dimensional computerized tomography angiography postoperatively. Postoperatively, the patients did not manifest any ischemic sequelae related to the kinked arteries. Conclusion: The insertion of prostheses with fibrin glue into the crotch of a kinked artery for repair is considered a simple and useful method for correcting a kinked artery that avoids ischemic sequelae. PMID:26862447

  15. Selective Developmental Increase in the Climbing Fiber Input to the Cerebellar Interpositus Nucleus in Rats

    PubMed Central

    Nicholson, Daniel A.; Freeman, John H.

    2008-01-01

    Previous studies have demonstrated that learning-related cerebellar plasticity and stimulus-elicited neuronal activity emerge ontogenetically in parallel with delay eyeblink conditioning in rats. The present study examined cerebellar interpositus field potentials and multiunit neuronal activity evoked by microstimulation of the inferior olive in Postnatal Day 17 and 24 rats. The slope and amplitude of the excitatory postsynaptic potential and the number of evoked multiunit spikes increased with age, whereas the inhibitory postsynaptic potential caused by Purkinje cell input remained stable. These results are consistent with the notion that the postsynaptic depolarization of cerebellar interpositus neurons caused by cerebellar afferents (e.g., the climbing fibers of the inferior olive) is a critical factor contributing to the ontogeny of delay eyeblink conditioning in rats. PMID:15506893

  16. Trigeminal Neuralgia Attributable to Intraneural Trigeminocerebellar Artery: Case Report and Review of the Literature.

    PubMed

    Jito, Junya; Nozaki, Kazuhiko

    2016-04-01

    The trigeminocerebellar artery (TCA) is a branch of the basilar artery supplying both the trigeminal nerve root and the cerebellar hemisphere. Despite its proximity to the trigeminal nerve, only a few cases of trigeminal neuralgia (TN) caused by TCA compression of the trigeminal nerve have been reported. Moreover, TN caused by blood vessel penetration of the trigeminal nerve is very rare. We present a case of an 82-year-old female patient with typical episodes of TN. The radiologic studies showed that the offending artery was a unique branch of the basilar artery originating at a higher level than that of the usual anterior inferior cerebellar artery. During microvascular decompression surgery we were able to identify the offending vessel supplying the trigeminal nerve root and traveling between the sensory and motor root of the trigeminal nerve as an intraneural TCA. To shift the TCA away from the root entry zone, we dissected the epineurium of trigeminal nerve parallel to its axis and anchored the proximal portion of the TCA to the petrous dura. The patient's pain was completely gone immediately after the operation, with no neurologic deficits reported. The TCA is a potential offending vessel in TN because of trigeminal nerve compression, and the longitudinal dissection of the trigeminal nerve to make space between the vessel and the nerve roots may be an effective procedure to relieve TN caused by pressing intraneural vessels. Copyright © 2016. Published by Elsevier Inc.

  17. Cerebellar learning mechanisms

    PubMed Central

    Freeman, John H.

    2014-01-01

    The mechanisms underlying cerebellar learning are reviewed with an emphasis on old arguments and new perspectives on eyeblink conditioning. Eyeblink conditioning has been used for decades a model system for elucidating cerebellar learning mechanisms. The standard model of the mechanisms underlying eyeblink conditioning is that there two synaptic plasticity processes within the cerebellum that are necessary for acquisition of the conditioned response: 1) long-term depression (LTD) at parallel fiber-Purkinje cell synapses and 2) long-term potentiation (LTP) at mossy fiber-interpositus nucleus synapses. Additional Purkinje cell plasticity mechanisms may also contribute to eyeblink conditioning including LTP, excitability, and entrainment of deep nucleus activity. Recent analyses of the sensory input pathways necessary for eyeblink conditioning indicate that the cerebellum regulates its inputs to facilitate learning and maintain plasticity. Cerebellar learning during eyeblink conditioning is therefore a dynamic interactive process which maximizes responding to significant stimuli and suppresses responding to irrelevant or redundant stimuli. PMID:25289586

  18. Embolization of Ruptured Aneurysm Arising From Basilar Artery Fenestration Using Hydrocoils

    PubMed Central

    Chuan Zhi, Duan

    2015-01-01

    Aneurysms arising from the basilar artery fenestration are considered among the rare cerebrovascular diseases. Here, we report on a 44-year-old gentleman who presented with the sudden onset of severe headache complicated by several episodes of vomiting and an altered level of consciousness. A subarachnoid hemorrhage in the interpeduncle and ambient cisterns was detected by computed tomography of the head. During left vertebral arteriography, a basilar fenestration with a ruptured aneurysm just above the proximal end of vertebrobasilar junction was identified. The aneurysm was successfully occluded by means of endovascular treatment using Hydrosoft coils. In the 15-month follow-up angiography, 100% occlusion without recurrence and recanalization was observed. Bilateral anterior inferior cerebellar arteries and both channels of the basilar artery fenestration were entirely filled in follow-up angiograms. PMID:26488001

  19. 3D morphometric analysis of human fetal cerebellar development.

    PubMed

    Scott, Julia A; Hamzelou, Kia S; Rajagopalan, Vidya; Habas, Piotr A; Kim, Kio; Barkovich, A James; Glenn, Orit A; Studholme, Colin

    2012-09-01

    To date, growth of the human fetal cerebellum has been estimated primarily from linear measurements from ultrasound and 2D magnetic resonance imaging (MRI). In this study, we use 3D analytical methods to develop normative growth trajectories for the cerebellum in utero. We measured cerebellar volume, linear dimensions, and local surface curvature from 3D reconstructed MRI of the human fetal brain (N = 46). We found that cerebellar volume increased approximately 7-fold from 20 to 31 gestational weeks. The better fit of the exponential curve (R (2) = 0.96) compared to the linear curve (R (2) = 0.92) indicated acceleration in growth. Within-subject cerebellar and cerebral volumes were highly correlated (R (2) = 0.94), though the cerebellar percentage of total brain volume increased from approximately 2.4% to 3.7% (R (2) = 0.63). Right and left hemispheric volumes did not significantly differ. Transcerebellar diameter, vermal height, and vermal anterior to posterior diameter increased significantly at constant rates. From the local curvature analysis, we found that expansion along the inferior and superior aspects of the hemispheres resulted in decreased convexity, which is likely due to the physical constraints of the dura surrounding the cerebellum and the adjacent brainstem. The paired decrease in convexity along the inferior vermis and increased convexity of the medial hemisphere represents development of the paravermian fissure, which becomes more visible during this period. In this 3D morphometric analysis of the human fetal cerebellum, we have shown that cerebellar growth is accelerating at a greater pace than the cerebrum and described how cerebellar growth impacts the shape of the structure.

  20. 3D Morphometric Analysis of Human Fetal Cerebellar Development

    PubMed Central

    Hamzelou, Kia S.; Rajagopalan, Vidya; Habas, Piotr A.; Kim, Kio; Barkovich, A. James; Glenn, Orit A.; Studholme, Colin

    2012-01-01

    To date, growth of the human fetal cerebellum has been estimated primarily from linear measurements from ultrasound and 2D magnetic resonance imaging (MRI). In this study, we use 3D analytical methods to develop normative growth trajectories for the cerebellum in utero. We measured cerebellar volume, linear dimensions, and local surface curvature from 3D reconstructed MRI of the human fetal brain (N = 46). We found that cerebellar volume increased approximately 7-fold from 20 to 31 gestational weeks. The better fit of the exponential curve (R2 = 0.96) compared to the linear curve (R2 = 0.92) indicated acceleration in growth. Within-subject cerebellar and cerebral volumes were highly correlated (R2 = 0.94), though the cerebellar percentage of total brain volume increased from approximately 2.4% to 3.7% (R2 = 0.63). Right and left hemispheric volumes did not significantly differ. Transcerebellar diameter, vermal height, and vermal anterior to posterior diameter increased significantly at constant rates. From the local curvature analysis, we found that expansion along the inferior and superior aspects of the hemispheres resulted in decreased convexity, which is likely due to the physical constraints of the dura surrounding the cerebellum and the adjacent brainstem. The paired decrease in convexity along the inferior vermis and increased convexity of the medial hemisphere represents development of the paravermian fissure, which becomes more visible during this period. In this 3D morphometric analysis of the human fetal cerebellum, we have shown that cerebellar growth is accelerating at a greater pace than the cerebrum and described how cerebellar growth impacts the shape of the structure. PMID:22198870

  1. Modality specific cerebro-cerebellar activations in verbal working memory: an fMRI study.

    PubMed

    Kirschen, Matthew P; Chen, S H Annabel; Desmond, John E

    2010-01-01

    Verbal working memory (VWM) engages frontal and temporal/parietal circuits subserving the phonological loop, as well as, superior and inferior cerebellar regions which have projections from these neocortical areas. Different cerebro-cerebellar circuits may be engaged for integrating aurally- and visually-presented information for VWM. The present fMRI study investigated load (2, 4, or 6 letters) and modality (auditory and visual) dependent cerebro-cerebellar VWM activation using a Sternberg task. FMRI revealed modality-independent activations in left frontal (BA 6/9/44), insular, cingulate (BA 32), and bilateral inferior parietal/supramarginal (BA 40) regions, as well as in bilateral superior (HVI) and right inferior (HVIII) cerebellar regions. Visual presentation evoked prominent activations in right superior (HVI/CrusI) cerebellum, bilateral occipital (BA19) and left parietal (BA7/40) cortex while auditory presentation showed robust activations predominantly in bilateral temporal regions (BA21/22). In the cerebellum, we noted a visual to auditory emphasis of function progressing from superior to inferior and from lateral to medial regions. These results extend our previous findings of fMRI activation in cerebro-cerebellar networks during VWM, and demonstrate both modality dependent commonalities and differences in activations with increasing memory load.

  2. Modality Specific Cerebro-Cerebellar Activations in Verbal Working Memory: An fMRI Study

    PubMed Central

    Kirschen, Matthew P.; Chen, S. H. Annabel; Desmond, John E.

    2010-01-01

    Verbal working memory (VWM) engages frontal and temporal/parietal circuits subserving the phonological loop, as well as, superior and inferior cerebellar regions which have projections from these neocortical areas. Different cerebro-cerebellar circuits may be engaged for integrating aurally- and visually-presented information for VWM. The present fMRI study investigated load (2, 4, or 6 letters) and modality (auditory and visual) dependent cerebro-cerebellar VWM activation using a Sternberg task. FMRI revealed modality-independent activations in left frontal (BA 6/9/44), insular, cingulate (BA 32), and bilateral inferior parietal/supramarginal (BA 40) regions, as well as in bilateral superior (HVI) and right inferior (HVIII) cerebellar regions. Visual presentation evoked prominent activations in right superior (HVI/CrusI) cerebellum, bilateral occipital (BA19) and left parietal (BA7/40) cortex while auditory presentation showed robust activations predominately in bilateral temporal regions (BA21/22). In the cerebellum, we noted a visual to auditory emphasis of function progressing from superior to inferior and from lateral to medial regions. These results extend our previous findings of fMRI activation in cerebro-cerebellar networks during VWM, and demonstrate both modality dependent commonalities and differences in activations with increasing memory load. PMID:20714061

  3. Strong-Meter and Weak-Meter Rhythm Identification in Spina Bifida Meningomyelocele and Volumetric Parcellation of Rhythm-Relevant Cerebellar Regions

    PubMed Central

    Dennis, Maureen; Hopyan, Talar; Juranek, Jenifer; Cirino, Paul T.; Hasan, Khader M.; Fletcher, Jack

    2011-01-01

    Children with spina bifida meningomyelocele (SBM) are impaired relative to controls in terms of discriminating strong-meter and weak-meter rhythms, so congenital cerebellar dysmorphologies that affect rhythmic movements also disrupt rhythm perception. Cerebellar parcellations in children with SBM showed an abnormal configuration of volume fractions in cerebellar regions important for rhythm function: a smaller inferior-posterior lobe, and larger anterior and superior-posterior lobes. PMID:19673758

  4. Very thin strut biodegradable polymer everolimus-eluting and sirolimus-eluting stents versus durable polymer zotarolimus-eluting stents in allcomers with coronary artery disease (BIO-RESORT): a three-arm, randomised, non-inferiority trial.

    PubMed

    von Birgelen, Clemens; Kok, Marlies M; van der Heijden, Liefke C; Danse, Peter W; Schotborgh, Carl E; Scholte, Martijn; Gin, R Melvyn Tjon Joe; Somi, Samer; van Houwelingen, K G; Stoel, M G; de Man, Frits H A F; Louwerenburg, J Hans W; Hartmann, Marc; Zocca, Paolo; Linssen, Gerard C M; van der Palen, Job; Doggen, Carine J M; Löwik, Marije M

    2016-11-26

    In patients with coronary artery disease, treated with durable polymer-coated drug-eluting stents, the life-long presence of the polymer might delay arterial healing. Novel very thin strut biodegradable polymer stents, which leave only a bare metal stent after polymer resorption, might improve long-term outcome. We investigated in allcomers the safety and efficacy of three stents eluting either everolimus, sirolimus, or zotarolimus, often clinically used but never compared, of which the biodegradable polymer everolimus-eluting stent was never before assessed in allcomers. The large-scale, investigator-initiated, multicentre, assessor and patient blinded, three-arm, randomised, BIO-RESORT non-inferiority trial was done at four clinical sites in the Netherlands. All-comer patients were aged 18 years or older, capable of providing informed consent, and required a percutaneous coronary intervention with drug-eluting stent implantation according to clinical guidelines or the operators' judgment. Exclusion criteria were: participation in another randomised drug or device study before reaching the primary endpoint of that study; planned surgery necessitating interruption of dual antiplatelet therapy within the first 6 months; known intolerance to components of the investigational product or medication required; uncertainty about the adherence to follow-up procedures or an assumed life expectancy of less than 1 year; or known pregnancy. Web-based computer-generated allocation sequences randomly assigned patients (1:1:1) to treatment with very thin strut biodegradable polymer everolimus-eluting or sirolimus-eluting stents (which differ substantially in type, amount, distribution, and resorption speed of their respective coating), or thin strut durable polymer zotarolimus-eluting stents. The primary endpoint was a composite of safety (cardiac death or target vessel-related myocardial infarction) and efficacy (target vessel revascularisation) at 12 months of follow up with a

  5. Consensus Paper: Neuroimmune Mechanisms of Cerebellar Ataxias.

    PubMed

    Mitoma, Hiroshi; Adhikari, Keya; Aeschlimann, Daniel; Chattopadhyay, Partha; Hadjivassiliou, Marios; Hampe, Christiane S; Honnorat, Jérôme; Joubert, Bastien; Kakei, Shinji; Lee, Jongho; Manto, Mario; Matsunaga, Akiko; Mizusawa, Hidehiro; Nanri, Kazunori; Shanmugarajah, Priya; Yoneda, Makoto; Yuki, Nobuhiro

    2016-04-01

    In the last few years, a lot of publications suggested that disabling cerebellar ataxias may develop through immune-mediated mechanisms. In this consensus paper, we discuss the clinical features of the main described immune-mediated cerebellar ataxias and address their presumed pathogenesis. Immune-mediated cerebellar ataxias include cerebellar ataxia associated with anti-GAD antibodies, the cerebellar type of Hashimoto's encephalopathy, primary autoimmune cerebellar ataxia, gluten ataxia, Miller Fisher syndrome, ataxia associated with systemic lupus erythematosus, and paraneoplastic cerebellar degeneration. Humoral mechanisms, cell-mediated immunity, inflammation, and vascular injuries contribute to the cerebellar deficits in immune-mediated cerebellar ataxias.

  6. Neuropharmacologic characterization of strychnine seizure potentiation in the inferior olive lesioned rat

    SciTech Connect

    Anderson, M.C.

    1988-01-01

    Cerebellar stimulation is associated with anticonvulsant activity in several animal models. There are two afferent inputs to cerebellar Purkinje cells: (1) parallel fibers, which relay mossy fiber input, from brainstem, spinal cord, cerebral cortex and cerebellum, and (2) climbing fibers, arising from the inferior olive. Both climbing and parallel fibers release excitatory amino acid neurotransmitters, which stimulate Purkinje cells and cause GABA release in the deep cerebellar nuclei. Climbing fibers also exert tonic inhibition over Purkinje cell activity by producing an absolute refractory period following stimulation, rendering Purkinje cells unresponsive to parallel fibers. Climbing fiber deafferentation by bilateral inferior olive lesions produced a specific decrease in threshold for strychnine-seizures in the rat. Inferior olive lesions produced no change in threshold to seizures induced by picrotoxin, bicuculline or pentylenetetrazole. Inferior olive lesions also produced abnormal motor behavior including, myoclonus, backward locomotion and hyperextension, which was significantly aggravated by strychnine, brucine, picrotoxin, bicuculline and pentylenetetrazole. Inferior olive lesions produced a significant increase in quisqualate sensitive ({sup 3}H)AMPA ((Rs)-alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid) binding to cerebellar membranes. AMPA is a glutamate analog with high affinity for quisqualate sensitive receptors.

  7. Hepatic arterial infusion chemotherapy using 5-fluorouracil and systemic interferon-α for advanced hepatocellular carcinoma in combination with or without three-dimensional conformal radiotherapy to venous tumor thrombosis in hepatic vein or inferior vena cava.

    PubMed

    Murakami, Eisuke; Aikata, Hiroshi; Miyaki, Daisuke; Nagaoki, Yuko; Katamura, Yoshio; Kawaoka, Tomokazu; Takaki, Shintaro; Hiramatsu, Akira; Waki, Koji; Takahashi, Shoichi; Kimura, Tomoki; Kenjo, Masahiro; Nagata, Yasushi; Ishikawa, Masaki; Kakizawa, Hideaki; Awai, Kazuo; Chayama, Kazuaki

    2012-05-01

      We investigated the efficacy of hepatic arterial infusion chemotherapy (HAIC) using 5-fluorouracil (5-FU) and systemic interferon (IFN)-α (HAIC-5-FU/IFN) for advanced hepatocellular carcinoma (HCC) with venous tumor thrombosis (VTT) in the hepatic vein trunk (Vv2) or inferior vena cava (Vv3).   Thirty-three patients with HCC/Vv2/3 underwent HAIC with 5-FU (500 mg/body weight/day, into hepatic artery on days 1-5 on the first and second weeks) and IFN-α (recombinant IFN-α-2b 3 000 000 U or natural IFN-α 5 000 000 U, intramuscularly on days 1, 3 and 5 of each week). Three-dimensional conformal radiotherapy (3D-CRT) was used in combination with HAIC-5-FU/IFN in 14 of 33 patients to reduce VTT.   The median survival time (MST) was 7.9 months, and 1- and 2-year survival rates were 30% and 20%, respectively. Evaluation of intrahepatic response after two cycles of HAIC-5-FU/IFN showed complete response (CR) in three (9%) and partial response (PR) in seven (21%), with an objective response rate of 30%. Multivariate analysis identified reduction of VTT (P = 0.0006), size of largest tumor (P = 0.013) and intrahepatic response CR/PR (P = 0.030) as determinants of survival. CR/PR correlated significantly with tumor liver occupying rate (P = 0.016) and hepatitis C virus Ab (P = 0.010). Reduction of VTT correlated significantly with radiotherapy (P = 0.021) and platelet count (P = 0.015). Radiotherapy-related reduction in VTT significantly improved survival of 16 patients with Vv3 and non-CR/PR response of HAIC-5-FU/IFN (P = 0.028).   As for advanced HCC with VTT of Vv2/3, HAIC-5-FU/IFN responsive patients could obtain favorable survival. Despite ineffective HAIC-5-FU/IFN, the combination with effective radiotherapy to VTT might improve patients' prognosis. © 2011 The Japan Society of Hepatology.

  8. Cerebellar and afferent ataxias.

    PubMed

    Pandolfo, Massimo; Manto, Mario

    2013-10-01

    Ataxia is the predominant manifestation of many acquired and inherited neurologic disorders affecting the cerebellum, its connections, and the afferent proprioceptive pathways. This article reviews the phenomenology and etiologies of cerebellar and afferent ataxias and provides indications for a rational approach to diagnosis and management. The pathophysiology of ataxia is being progressively understood and linked to the functional organization of the cerebellum. The impact of cerebellar diseases on different neurologic functions has been better defined and shown not to be limited to loss of motor coordination. The role of autoimmunity is increasingly recognized as a cause of sporadic cases of ataxia. Large collaborative studies of long duration are providing crucial information on the clinical spectrum and natural history of both sporadic ataxias (such as the cerebellar form of multiple system atrophy) and inherited ataxias. New dominant and recessive ataxia genes have been identified. On the therapeutic front, progress mostly concerns the development of treatments for Friedreich ataxia. Ataxia is the clinical manifestation of a wide range of disorders. In addition to accurate clinical assessment, MRI plays a major role in the diagnostic workup, allowing us to distinguish degenerative conditions from those due to other types of structural damage to the cerebellar or proprioceptive systems. Diagnostic algorithms based on clinical features, imaging, and neurophysiologic and biochemical parameters can be used to guide genetic testing for hereditary ataxias, the diagnosis of which is likely to be greatly improved by the introduction of new-generation DNA-sequencing approaches. Some rare forms of ataxia can be treated, so their diagnosis should not be missed. Proven symptomatic treatments for ataxia are still lacking, but intensive physical therapy appears to be helpful.

  9. Fatal remote cerebellar hemorrhage after supratentorial unruptured aneurysm surgery in patient with previous cerebellar infarction

    PubMed Central

    Koh, Eun-Jeong; Park, Jung-Soo

    2017-01-01

    Abstract Rationale: Remote cerebellar hemorrhage (RCH) is a rare complication of supratentorial and spinal surgeries, seldom requiring intervention but occasionally causing significant morbidity or even mortality. Although a number of theories have been proposed, the exact pathophysiology of RCH remains incompletely understood. Patient concerns: We present a 62-year-old patient with RCH encountered following surgical clipping of an unruptured middle cerebral artery bifurcation aneurysm in a patient with previous cerebellar infarction. Lessons: It is extremely rare, but sometimes, RCH can be life-threatening. It is necessary to check the patient's general condition, underlying diseases and medical history. And controlled drainage of the CSF seems to be most important. Arachnoidplasty may be a consideration and the position of the drain string might have to be carefully determined. PMID:28121936

  10. Genetics Home Reference: lissencephaly with cerebellar hypoplasia

    MedlinePlus

    ... Conditions lissencephaly with cerebellar hypoplasia lissencephaly with cerebellar hypoplasia Enable Javascript to view the expand/collapse boxes. ... Open All Close All Description Lissencephaly with cerebellar hypoplasia (LCH) affects brain development, resulting in the brain ...

  11. Fibromuscular dysplasia of the vertebral artery presenting with lateral medullary syndrome: a case report.

    PubMed

    Chen, Yuan-Liang; Hsu, Yaw-Don; Lee, Jiunn-Tay

    2004-12-01

    We have recently encountered a rare case of fibromuscular dysplasia (FMD) of the vertebral artery (VA) presenting as lateral medullary syndrome. A 39-year-old male was admitted to our hospital due to vertigo, dysarthria and numbness of the left face and the right limbs. A magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of brain revealed lateral medullary infarction in the territory of the left posterior inferior cerebellar artery (PICA). The angiography of the VA revealed tubular stenosis of the left extracranial VA and a focal vascular kinking as well as web in the right extracranial VA, confirming the diagnosis of FMD. We present this rare case to emphasize that FMD could be one of the risk factors causing lateral medullary syndrome in young people.

  12. Cerebellar agenesis revisited.

    PubMed

    Boyd, C A R

    2010-03-01

    New clinical and employment information, together with over-looked previously published information, on a patient (H.C.) is reviewed. H.C., who died at the age of 76 in 1939, was found, by chance during anatomical dissection, to lack a cerebellum. This synthesis challenges an unusual and interesting account of cerebellar agenesis published in Brain in 1994 by Glickstein (see also Glickstein, 2006), in which the allegedly 'bogus' oral history of this individual's motor skills was held to have led to 'medical myth making'. Part of the burden of the 1994 paper was to show that 'cerebellar agenesis is always associated with profound motor deficits'. Glickstein therefore focussed on an apparent 'exception' to this conclusion, concerning the brain of a single case, H.C., who died 70 years ago, who 'had given rise to an oral tradition alleging that normal movement is possible despite total cerebellar agenesis'. Glickstein (1994) concludes 'despite an oral tradition to the contrary there is absolutely no evidence about the motor capacities of this man during his life'. Rather remarkably, an extensive history of this individual has become available, its significance becoming noted only this year; this complements and adds to a previous brief history published on H.C. (and not mentioned in the 1994 paper; see below). The new evidence includes the death certificate stating the man's occupation to have been 'manual labourer' with all the implications relevant to his supposed incapacity. The written historical record thus confronts the alleged 'myth'. It is interesting to note how medical records on an undoubtedly very ordinary citizen were recorded in London in the 1930s (before the NHS was set up in 1949) and how they could be made accessible to clinical colleagues in east London in the middle of World War II blitz bombing of the capital.

  13. Neurotransplantation therapy and cerebellar reserve.

    PubMed

    Cendelin, Jan; Mitoma, Hiroshi; Manto, Mario

    2017-08-10

    Neurotransplantation has been recently the focus of interest as a promising therapy to substitute lost cerebellar neurons and improve cerebellar ataxias. However, since cell differentiation and synaptic formation are required to obtain a functional circuitry, highly integrated reproduction of cerebellar anatomy is not a simple process. Rather than a genuine replacement, recent studies have shown that grafted cells rescue surviving cells from neurodegeneration by exerting trophic effects, supporting mitochondrial function, modulating neuroinflammation, stimulating endogenous regenerative processes, and facilitating cerebellar compensatory properties thanks to neural plasticity. On the other hand, accumulating clinical evidence suggests that the self-recovery capacity is still preserved even if the cerebellum is affected by a diffuse and progressive pathology. We put forward the period with intact recovery capacity as "restorable stage" and the notion of reversal capacity as "cerebellar reserve". The concept of cerebellar reserve is particularly relevant, both theoretically and practically, to target recovery of cerebellar deficits by neurotransplantation. Reinforcing the cerebellar reserve and prolonging the restorable stage can be envisioned as future endpoints of neurotransplantation. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  14. Changes in cerebro-cerebellar interaction during response inhibition after performance improvement.

    PubMed

    Hirose, Satoshi; Jimura, Koji; Kunimatsu, Akira; Abe, Osamu; Ohtomo, Kuni; Miyashita, Yasushi; Konishi, Seiki

    2014-10-01

    It has been demonstrated that motor learning is supported by the cerebellum and the cerebro-cerebellar interaction. Response inhibition involves motor responses and the higher-order inhibition that controls the motor responses. In this functional MRI study, we measured the cerebro-cerebellar interaction during response inhibition in two separate days of task performance, and detected the changes in the interaction following performance improvement. Behaviorally, performance improved in the second day, compared to the first day. The psycho-physiological interaction (PPI) analysis revealed the interaction decrease from the right inferior frontal cortex (rIFC) to the cerebellum (lobule VII or VI). It was also revealed that the interaction increased from the same cerebellar region to the primary motor area. These results suggest the involvement of the cerebellum in response inhibition, and raise the possibility that the performance improvement was supported by the changes in the cerebro-cerebellar interaction. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Childhood Cerebellar Ataxia

    PubMed Central

    Fogel, Brent L.

    2012-01-01

    Childhood presentations of ataxia, an impairment of balance and coordination caused by damage to or dysfunction of the cerebellum, can often be challenging to diagnose. Presentations tend to be clinically heterogeneous but key considerations may vary based on the child's age at onset, the course of illness, and subtle differences in phenotype. Systematic investigation is recommended for efficient diagnosis. In this review, we outline common etiologies and describe a comprehensive approach to the evaluation of both acquired and genetic cerebellar ataxia in children. PMID:22764177

  16. A case of cerebellar psychopathology.

    PubMed

    Rosinski, Amy; Goldman, Mona; Cameron, Oliver

    2010-01-01

    Pathology of the cerebellum has traditionally been associated with motor symptoms, vertigo, and nystagmus. Patients with cerebellar disorders do not usually receive psychiatric evaluations. The authors seek to alert clinicians to the association between cerebellar disease and psychiatric symptoms. The authors describe a patient with uncommon psychiatric morbidity associated with cerebellar dysfunction, and provide a brief review of previous research on this phenomenon. Neurology consultants suggested that physical exam findings and behavioral changes could be accounted for by cerebellar cognitive affective syndrome. This syndrome involves dysfunction of the cerebellum, including classic cerebellar findings, in addition to cognitive difficulties and affective/personality changes. The suspected etiology was post-infectious cerebellitis from Epstein-Barr virus infection.

  17. Toxic agents causing cerebellar ataxias.

    PubMed

    Manto, Mario

    2012-01-01

    The cerebellum is particularly vulnerable to intoxication and poisoning, especially so the cerebellar cortex and Purkinje neurons. In humans, the most common cause of a toxic lesion to the cerebellar circuitry is alcohol related, but the cerebellum is also a main target of drug exposure (such as anticonvulsants, antineoplastics, lithium salts, calcineurin inhibitors), drug abuse and addiction (such as cocaine, heroin, phencyclidine), and environmental toxins (such as mercury, lead, manganese, toluene/benzene derivatives). Although data for the prevalence and incidence of cerebellar lesions related to intoxication and poisoning are still unknown in many cases, clinicians should keep in mind the list of agents that may cause cerebellar deficits, since toxin-induced cerebellar ataxias are not rare in daily practice. Moreover, the patient's status may require immediate therapies when the intoxication is life-threatening. 2012 Elsevier B.V. All rights reserved.

  18. Translational Approach to Behavioral Learning: Lessons from Cerebellar Plasticity

    PubMed Central

    Cheron, Guy; Dan, Bernard; Márquez-Ruiz, Javier

    2013-01-01

    The role of cerebellar plasticity has been increasingly recognized in learning. The privileged relationship between the cerebellum and the inferior olive offers an ideal circuit for attempting to integrate the numerous evidences of neuronal plasticity into a translational perspective. The high learning capacity of the Purkinje cells specifically controlled by the climbing fiber represents a major element within the feed-forward and feedback loops of the cerebellar cortex. Reciprocally connected with the basal ganglia and multimodal cerebral domains, this cerebellar network may realize fundamental functions in a wide range of behaviors. This review will outline the current understanding of three main experimental paradigms largely used for revealing cerebellar functions in behavioral learning: (1) the vestibuloocular reflex and smooth pursuit control, (2) the eyeblink conditioning, and (3) the sensory envelope plasticity. For each of these experimental conditions, we have critically revisited the chain of causalities linking together neural circuits, neural signals, and plasticity mechanisms, giving preference to behaving or alert animal physiology. Namely, recent experimental approaches mixing neural units and local field potentials recordings have demonstrated a spike timing dependent plasticity by which the cerebellum remains at a strategic crossroad for deciphering fundamental and translational mechanisms from cellular to network levels. PMID:24319600

  19. Mechanisms of synchronous activity in cerebellar Purkinje cells

    PubMed Central

    Wise, Andrew K; Cerminara, Nadia L; Marple-Horvat, Dilwyn E; Apps, Richard

    2010-01-01

    Complex spike synchrony is thought to be a key feature of how inferior olive climbing fibre afferents make their vital contribution to cerebellar function. However, little is known about whether the other major cerebellar input, the mossy fibres (which generate simple spikes within Purkinje cells, PCs), exhibit a similar synchrony in impulse timing. We have used a multi-microelectrode system to record simultaneously from two or more PCs in the posterior lobe of the ketamine/xylazine-anaesthetized rat to examine the relationship between complex spike and simple spike synchrony in PC pairs located mainly in the A2 and C1 zones in crus II and the paramedian lobule. PC pairs displaying correlations in the occurrence of their complex spikes (coupled PCs) were usually located in the same zone and were also more likely to exhibit correlations in the timing of their spontaneous simple spikes and associated pauses in activity. In coupled PCs, synchrony in both complex spike and simple spike activity was enhanced and the relative timing in the occurrence of complex spikes could be altered by peripheral stimulation. We conclude that the functional coupling between PC pairs in their complex spike and simple spike activity can be significantly modified by sensory inputs, and that mechanisms besides electrotonic coupling are involved in generating PC synchrony. Synchronous activity in multiple PCs converging onto the same cerebellar nuclear cells is likely to have a significant impact on cerebellar output that could form important timing signals to orchestrate coordinated movements. PMID:20442262

  20. Cerebellar Zonal Patterning Relies on Purkinje Cell Neurotransmission

    PubMed Central

    White, Joshua J.; Arancillo, Marife; Stay, Trace L.; George-Jones, Nicholas A.; Levy, Sabrina L.; Heck, Detlef H.

    2014-01-01

    Cerebellar circuits are patterned into an array of topographic parasagittal domains called zones. The proper connectivity of zones is critical for motor coordination and motor learning, and in several neurological diseases cerebellar circuits degenerate in zonal patterns. Despite recent advances in understanding zone function, we still have a limited understanding of how zones are formed. Here, we focused our attention on Purkinje cells to gain a better understanding of their specific role in establishing zonal circuits. We used conditional mouse genetics to test the hypothesis that Purkinje cell neurotransmission is essential for refining prefunctional developmental zones into sharp functional zones. Our results show that inhibitory synaptic transmission in Purkinje cells is necessary for the precise patterning of Purkinje cell zones and the topographic targeting of mossy fiber afferents. As expected, blocking Purkinje cell neurotransmission caused ataxia. Using in vivo electrophysiology, we demonstrate that loss of Purkinje cell communication altered the firing rate and pattern of their target cerebellar nuclear neurons. Analysis of Purkinje cell complex spike firing revealed that feedback in the cerebellar nuclei to inferior olive to Purkinje cell loop is obstructed. Loss of Purkinje neurotransmission also caused ectopic zonal expression of tyrosine hydroxylase, which is only expressed in adult Purkinje cells when calcium is dysregulated and if excitability is altered. Our results suggest that Purkinje cell inhibitory neurotransmission establishes the functional circuitry of the cerebellum by patterning the molecular zones, fine-tuning afferent circuitry, and shaping neuronal activity. PMID:24920627

  1. Chiropractic Response to a Spontaneous Vertebral Artery Dissection

    PubMed Central

    Tarola, Gary; Phillips, Reed B.

    2015-01-01

    Objective The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes. Clinical Features A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category. Intervention and Outcome The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately. Conclusion Recognition and rapid response by the chiropractic physician provided the optimum outcome for

  2. Cerebellar white matter pathways are associated with reading skills in children and adolescents

    PubMed Central

    Travis, Katherine E; Leitner, Yael; Feldman, Heidi M.; Ben-Shachar, Michal

    2015-01-01

    Reading is a critical life skill in the modern world. The neural basis of reading incorporates a distributed network of cortical areas and their white matter connections. The cerebellum has also been implicated in reading and reading disabilities. However, little is known about the contribution of cerebellar white matter pathways to major component skills of reading. We used diffusion magnetic resonance imaging (dMRI) with tractography to identify the cerebellar peduncles in a group of 9–17 year old children and adolescents born full term (n=19) or preterm (n=26). In this cohort, no significant differences were found between fractional anisotropy (FA) measures of the peduncles in the preterm and full term groups. FA of the cerebellar peduncles correlated significantly with measures of decoding and reading comprehension in the combined sample of full term and preterm subjects. Correlations were negative in the superior and inferior cerebellar peduncles and positive in the middle cerebellar peduncle. Additional analyses revealed that full term and preterm groups demonstrated similar patterns of reading associations within the left SCP, MCP and left ICP. Partial correlation analyses showed that distinct sub-skills of reading were associated with FA in segments of different cerebellar peduncles. Overall, the present findings are the first to document associations of microstructure of the cerebellar peduncles and the component skills of reading. PMID:25504986

  3. Microsurgical Anatomy of the Labyrinthine Artery and Clinical Relevance.

    PubMed

    Haidara, Aderehime; Peltier, Johann; Zunon-Kipre, Yvan; N'da, Hermann Adonis; Drogba, Landry; Gars, Daniel Le

    2015-01-01

    To describe the origin, the course, and relationships of the labyrinthine artery (LA). Thanks to a colored silicone mix preparation, ten cranial bases were examined using x3 to x40 magnification under surgical microscope. The LA often arose from the meatal loop of the anterior inferior cerebellar artery (AICA) (90%), or basilar artery (10%). The loop was extra-meatal of the internal auditory meatus (IAM) in 30%, at the opening of the internal auditory meatus in 20%, or intra-meatal in 35%. The AICA coursed in closed relationship to the VII and VIII cranial nerves. It coursed between VII and VIII cranial nerve roots in 85%, or passed over the ventral side of both VII and VIII cranial nerve. The average diameter of the LA was 0.2 +/- 0.05 mm. LA was single trunk in 60%, and bi-arterial in 40%. The implication of these anatomic findings for cerebello-pontine angle tumors surgery and neurovascular pathology such as infarction, aneurysm of the LA or the AICA are reviewed and discussed.

  4. Is the parvocellular red nucleus involved in cerebellar motor learning?

    PubMed

    Reid, E K; Norris, S A; Taylor, J A; Hathaway, E N; Smith, A J; Yttri, E A; Thach, W T

    2009-01-01

    The anatomical connections of the parvocellular red nucleus (RNp) have led to the suggestion that it might participate along with the cerebellum in modifying old and developing new programs for the control of complex, compound, coordinated movements of multiple body parts. RNp projects to and excites the inferior olivary nuclear neurons, which send climbing fibers to excite neurons in contralateral cerebellar cortex and nuclei. RNp receives excitatory inputs from ipsilateral cerebral cortex (onto distal dendrites) and from contralateral cerebellar nuclei (onto proximal dendrites). We here further develop a hypothesis as to mechanism, and offer preliminary evidence from RNp inactivation studies in awake, trained macaques during modification of their gaze-reach calibration while wearing wedge prism spectacles.

  5. Head impulse gain and saccade analysis in pontine-cerebellar stroke and vestibular neuritis

    PubMed Central

    Todd, Michael; Halmagyi, Gabor M.; Aw, Swee

    2014-01-01

    Objective: We sought to quantify and compare angular vestibulo-ocular reflex (aVOR) gain and compensatory saccade properties elicited by the head impulse test (HIT) in pontine-cerebellar stroke (PCS) and vestibular neuritis (VN). Methods: Horizontal HIT was recorded ≤7 days from vertigo onset with dual-search coils in 33 PCS involving the anterior inferior, posterior inferior, and superior cerebellar arteries (13 AICA, 17 PICA, 3 SCA) confirmed by MRI and 20 VN. We determined the aVOR gain and asymmetry, and compensatory overt saccade properties including amplitude asymmetry and cumulative amplitude (ipsilesional trials [I]; contralesional trials [C]). Results: The aVOR gain (normal: 0.96; asymmetry = 2%) was bilaterally reduced, greater in AICA (I = 0.39, C = 0.57; asymmetry = 20%) than in PICA/SCA strokes (I = 0.75, C = 0.74; asymmetry = 7%), in contrast to the unilateral deficit in VN (I = 0.22, C = 0.76; asymmetry = 54%). Cumulative amplitude (normal: 1.1°) was smaller in AICA (I = 4.2°, C = 3.0°) and PICA/SCA strokes (I = 2.1°, C = 3.0°) compared with VN (I = 8.5°, C = 1.3°). Amplitude asymmetry in AICA and PICA/SCA strokes was comparable, but favored the contralesional side in PICA/SCA strokes and the ipsilesional side in VN. Saccade asymmetry <61% was found in 97% of PCS and none of VN. Gain asymmetry <40% was found in 94% of PCS and 10% of VN. Conclusion: HIT gains and compensatory saccades differ between PCS and VN. VN was characterized by unilateral gain deficits with asymmetric large saccades, AICA stroke by more symmetric bilateral gain reduction with smaller saccades, and PICA stroke by contralesional gain bias with the smallest saccades. Saccade and gain asymmetry should be investigated further in future diagnostic accuracy studies. Classification of evidence: This study provides Class II evidence that aVOR testing accurately distinguishes patients with PCS from VN (sensitivity 94%–97%, specificity 90%–100%). PMID:25253747

  6. Arterial anatomy of the lower lip: a cadaveric study.

    PubMed

    Edizer, Mete; Mağden, Orhan; Tayfur, Volkan; Kiray, Amaç; Ergür, Ipek; Atabey, Atay

    2003-06-01

    The aim of the study was to investigate the arterial anatomy of the lower lip. The location, course, length, and diameter of the inferior labial artery and the sublabial artery were revealed by bilateral meticulous anatomic dissections in 14 adult male preserved cadaver heads. Another cadaver head was used for silicone rubber injection to fill the regional arterial tree. The inferior labial artery was the main artery of the lower lip and in all cases branched off the facial artery. The mean length of the inferior labial artery was found to be 52.3 mm (range, 16 to 98 mm). The mean distance of the origin of the inferior labial artery from the labial commissura was 23.9 mm. The mean external diameter of the inferior labial artery at the origin was 1.2 mm. The sublabial artery was present in 10 (71 percent) of the cadavers. Mean measurements of this artery were 1 mm for diameter, 23.4 mm for length, and 27.6 mm for distance from the labial commissura. The sublabial artery may originate from the facial artery or the inferior labial artery. This study found that this region does not have a constant arterial distribution, the inferior labial artery and the sublabial artery (if it exists) can be in different locations unilaterally or bilaterally, and the diameter and the length may vary.

  7. Basilar impression as a possible cause of cerebellar stroke: case report.

    PubMed

    Roje-Bedeković, Marina; Vargek-Solter, Vesna; Bedek, Darko; Demarin, Vida

    2011-12-01

    A case is reported of a 72-year-old woman who presented with severe vertigo, vomit, and mild neck and occipital pain. She had a medical history of hypertension, angina pectoris, cholelithiasis, gastric ulcer, pyelonephritis and periodical mild dizziness. Neuroimaging revealed right vertebral artery occlusion, right cerebellar stroke and basilar impression. The therapeutic approach chosen in our patient was conservative, with non-steroid anti-inflammatory drugs and neck collar. Although our patient's prior risk factors for stroke supported a diagnosis of vertebrobasilar stroke, it is possible that the vertebral artery occlusion was the result of changes in the atlantoaxial anatomy and that cerebellar infarction was secondary to craniocervical anomaly. Although the presence of vertebral artery occlusion, cerebellar stroke and basilar impression in our patient may have been coincidental, we suggest that patients with basilar impression and craniocervical anomalies in general may be at an increased risk of vertebrobasilar vascular disease and vertebrobasilar stroke.

  8. Autosomal recessive cerebellar ataxias

    PubMed Central

    Palau, Francesc; Espinós, Carmen

    2006-01-01

    Autosomal recessive cerebellar ataxias (ARCA) are a heterogeneous group of rare neurological disorders involving both central and peripheral nervous system, and in some case other systems and organs, and characterized by degeneration or abnormal development of cerebellum and spinal cord, autosomal recessive inheritance and, in most cases, early onset occurring before the age of 20 years. This group encompasses a large number of rare diseases, the most frequent in Caucasian population being Friedreich ataxia (estimated prevalence 2–4/100,000), ataxia-telangiectasia (1–2.5/100,000) and early onset cerebellar ataxia with retained tendon reflexes (1/100,000). Other forms ARCA are much less common. Based on clinicogenetic criteria, five main types ARCA can be distinguished: congenital ataxias (developmental disorder), ataxias associated with metabolic disorders, ataxias with a DNA repair defect, degenerative ataxias, and ataxia associated with other features. These diseases are due to mutations in specific genes, some of which have been identified, such as frataxin in Friedreich ataxia, α-tocopherol transfer protein in ataxia with vitamin E deficiency (AVED), aprataxin in ataxia with oculomotor apraxia (AOA1), and senataxin in ataxia with oculomotor apraxia (AOA2). Clinical diagnosis is confirmed by ancillary tests such as neuroimaging (magnetic resonance imaging, scanning), electrophysiological examination, and mutation analysis when the causative gene is identified. Correct clinical and genetic diagnosis is important for appropriate genetic counseling and prognosis and, in some instances, pharmacological treatment. Due to autosomal recessive inheritance, previous familial history of affected individuals is unlikely. For most ARCA there is no specific drug treatment except for coenzyme Q10 deficiency and abetalipoproteinemia. PMID:17112370

  9. Storage of a naturally acquired conditioned response is impaired in patients with cerebellar degeneration.

    PubMed

    Thieme, Andreas; Thürling, Markus; Galuba, Julia; Burciu, Roxana G; Göricke, Sophia; Beck, Andreas; Aurich, Volker; Wondzinski, Elke; Siebler, Mario; Gerwig, Marcus; Bracha, Vlastislav; Timmann, Dagmar

    2013-07-01

    Previous findings suggested that the human cerebellum is involved in the acquisition but not the long-term storage of motor associations. The finding of preserved retention in cerebellar patients was fundamentally different from animal studies which show that both acquisition and retention depends on the integrity of the cerebellum. The present study investigated whether retention had been preserved because critical regions of the cerebellum were spared. Visual threat eye-blink responses, that is, the anticipatory closure of the eyes to visual threats, have previously been found to be naturally acquired conditioned responses. Because acquisition is known to take place in very early childhood, visual threat eye-blink responses can be used to test retention in patients with adult onset cerebellar disease. Visual threat eye-blink responses were tested in 19 adult patients with cerebellar degeneration, 27 adult patients with focal cerebellar lesions due to stroke, 24 age-matched control subjects, and 31 younger control subjects. High-resolution structural magnetic resonance images were acquired in patients to perform lesion-symptom mapping. Voxel-based morphometry was performed in patients with cerebellar degeneration, and voxel-based lesion-symptom mapping in patients with focal disease. Visual threat eye-blink responses were found to be significantly reduced in patients with cerebellar degeneration. Visual threat eye-blink responses were also reduced in patients with focal disease, but to a lesser extent. Visual threat eye-blink responses declined with age. In patients with cerebellar degeneration the degree of cerebellar atrophy was positively correlated with the reduction of conditioned responses. Voxel-based morphometry showed that two main regions within the superior and inferior parts of the posterior cerebellar cortex contributed to expression of visual threat eye-blink responses bilaterally. Involvement of the more inferior parts of the posterior lobe was

  10. Functional Relations of Cerebellar Modules of the Cat

    PubMed Central

    Pong, Milton; Gibson, Alan R.

    2010-01-01

    The cerebellum consists of parasagittal zones that define fundamental modules of neural processing. Each zone receives input from a distinct subdivision of the inferior olive (IO)—activity in one olivary subdivision will affect activity in one cerebellar module. To define functions of the cerebellar modules, we inactivated specific olivary subdivisions in six male cats with a glutamate receptor blocker. Olivary inactivation eliminates Purkinje cell complex spikes, which results in a high rate of Purkinje cell simple spike discharge. The increased simple spike discharge inhibits output from connected regions of the cerebellar nuclei. After inactivation, behavior was evaluated during a reach-to-grasp task and during locomotion. Inactivation of each subdivision produced unique behavioral deficits. Performance of the reach-to-grasp task was affected by inactivation of the rostral dorsal accessory olive (rDAO) and the rostral medial accessory olive (rMAO) and, possibly, the principal olive. rDAO inactivation produced paw drag during locomotion and a deficit in grasping the handle during the reach-to-grasp task. rMAO inactivation caused the cats to reach under the handle and produced severe limb drag during locomotion. Inactivation of the dorsal medial cell column, cell group β, or caudal medial accessory olive produced little deficit in the reach-to-grasp task, but each produced a different deficit during locomotion. In all cases, the cats appeared to have intact sensation, good spatial awareness, and no change of affect. Normal cerebellar function requires low rates of IO discharge, and each cerebellar module has a specific and unique function in sensory–motor integration. PMID:20631170

  11. Functional relations of cerebellar modules of the cat.

    PubMed

    Horn, Kris M; Pong, Milton; Gibson, Alan R

    2010-07-14

    The cerebellum consists of parasagittal zones that define fundamental modules of neural processing. Each zone receives input from a distinct subdivision of the inferior olive (IO)-activity in one olivary subdivision will affect activity in one cerebellar module. To define functions of the cerebellar modules, we inactivated specific olivary subdivisions in six male cats with a glutamate receptor blocker. Olivary inactivation eliminates Purkinje cell complex spikes, which results in a high rate of Purkinje cell simple spike discharge. The increased simple spike discharge inhibits output from connected regions of the cerebellar nuclei. After inactivation, behavior was evaluated during a reach-to-grasp task and during locomotion. Inactivation of each subdivision produced unique behavioral deficits. Performance of the reach-to-grasp task was affected by inactivation of the rostral dorsal accessory olive (rDAO) and the rostral medial accessory olive (rMAO) and, possibly, the principal olive. rDAO inactivation produced paw drag during locomotion and a deficit in grasping the handle during the reach-to-grasp task. rMAO inactivation caused the cats to reach under the handle and produced severe limb drag during locomotion. Inactivation of the dorsal medial cell column, cell group beta, or caudal medial accessory olive produced little deficit in the reach-to-grasp task, but each produced a different deficit during locomotion. In all cases, the cats appeared to have intact sensation, good spatial awareness, and no change of affect. Normal cerebellar function requires low rates of IO discharge, and each cerebellar module has a specific and unique function in sensory-motor integration.

  12. Central Hypoventilation Syndrome Complicated with Lateral Medullary Infarction after Endovascular Treatment of the Vertebral Artery Dissecting Aneurysm: A Case Report.

    PubMed

    Tanaka, Katsuhiro; Kanamaru, Hideki; Morikawa, Atsunori; Kawaguchi, Kenji

    2016-10-01

    Lateral medullary infarction rarely leads to central hypoventilation syndrome (CHS). CHS is a life-threatening disorder characterized by hypoventilation during sleep. We report the first case of CHS as a complication of lateral medullary infarction after endovascular treatment. A 65-year-old man presented twice with severe headache. Computed tomography revealed subarachnoid hemorrhage and cerebral angiography showed a right vertebral dissecting aneurysm involving the posterior inferior cerebellar artery. After emergent endovascular patent artery occlusion, he developed Wallenberg syndrome and experienced apnea and a conscious disturbance episode due to CHS on postoperative days 6 and 16. Intensive respiratory care including intubation, tracheostomy, mechanical ventilation, and rehabilitation prevented subsequent recurrence of apnea and the CHS resolved completely. CHS after unilateral medullary infarction involving respiratory centers tends to occur in the acute and subacute phase and may be lethal without careful respiratory management.

  13. Speech prosody in cerebellar ataxia

    NASA Astrophysics Data System (ADS)

    Casper, Maureen

    The present study sought an acoustic signature for the speech disturbance recognized in cerebellar degeneration. Magnetic resonance imaging was used for a radiological rating of cerebellar involvement in six cerebellar ataxic dysarthric speakers. Acoustic measures of the [pap] syllables in contrastive prosodic conditions and of normal vs. brain-damaged patients were used to further our understanding both of the speech degeneration that accompanies cerebellar pathology and of speech motor control and movement in general. Pair-wise comparisons of the prosodic conditions within the normal group showed statistically significant differences for four prosodic contrasts. For three of the four contrasts analyzed, the normal speakers showed both longer durations and higher formant and fundamental frequency values in the more prominent first condition of the contrast. The acoustic measures of the normal prosodic contrast values were then used as a model to measure the degree of speech deterioration for individual cerebellar subjects. This estimate of speech deterioration as determined by individual differences between cerebellar and normal subjects' acoustic values of the four prosodic contrasts was used in correlation analyses with MRI ratings. Moderate correlations between speech deterioration and cerebellar atrophy were found in the measures of syllable duration and f0. A strong negative correlation was found for F1. Moreover, the normal model presented by these acoustic data allows for a description of the flexibility of task- oriented behavior in normal speech motor control. These data challenge spatio-temporal theory which explains movement as an artifact of time wherein longer durations predict more extreme movements and give further evidence for gestural internal dynamics of movement in which time emerges from articulatory events rather than dictating those events. This model provides a sensitive index of cerebellar pathology with quantitative acoustic

  14. Redistribution of crossed cerebellar diaschisis

    SciTech Connect

    Kim, S.M.; Park, C.H.; Intenzo, C.M.; Bell, R.

    1989-04-01

    Crossed cerebellar diaschisis refers to a functional decrease in blood flow to the cerebellar hemisphere contralateral to the infarcted or ischemic cerebral hemisphere. This phenomenon can be depicted using PET as well as using SPECT. This condition, seen on early I-123 IMP brain scans, can show redistribution on the three hour delayed scan, presumably due to normal non-specific amine receptor sites of the affected cerebellum. One such case is reported.

  15. Inferior vestibular neuritis.

    PubMed

    Kim, Ji-Soo; Kim, Hyo Jung

    2012-08-01

    Vestibular neuritis (VN) mostly involves the superior portion of the vestibular nerve and labyrinth. This study aimed to describe the clinical features of VN involving the inferior vestibular labyrinth and its afferents only. Of the 703 patients with a diagnosis of VN or labyrinthitis at Seoul National University Bundang Hospital from 2004 to 2010, we retrospectively recruited 9 patients (6 women, age range 15-75) with a diagnosis of isolated inferior VN. Diagnosis of isolated inferior VN was based on torsional downbeating spontaneous nystagmus, abnormal head-impulse test (HIT) for the posterior semicircular canal (PC), and abnormal cervical vestibular-evoked myogenic potentials (VEMP) in the presence of normally functioning horizontal and anterior semicircular canals, as determined by normal HIT and bithermal caloric tests. All patients presented with acute vertigo with nausea, vomiting, and imbalance. Three patients also had tinnitus and hearing loss in the involved side. The rotation axis of torsional downbeating spontaneous nystagmus was best aligned with that of the involved PC. HIT was also positive only for the involved PC. Cervical VEMP was abnormal in seven patients, and ocular VEMP was normal in all four patients tested. Ocular torsion and subjective visual vertical tests were mostly within the normal range. Since isolated inferior VN lacks the typical findings of much more prevalent superior VN, it may be mistaken for a central vestibular disorder. Recognition of this rare disorder may help avoid unnecessary workups in patients with acute vestibulopathy.

  16. Inferiority is compex

    NASA Astrophysics Data System (ADS)

    Wade, Jess

    2017-07-01

    In Inferior: How Science Got Women Wrong and the New Research That's Rewriting the Story, author Angela Saini puts forward the idea that bad science has been used to endorse the cultural prejudice that women are both biologically and psychologically second rate to men.

  17. Cerebellar Transcranial Direct Current Stimulation (ctDCS): A Novel Approach to Understanding Cerebellar Function in Health and Disease.

    PubMed

    Grimaldi, Giuliana; Argyropoulos, Georgios P; Bastian, Amy; Cortes, Mar; Davis, Nicholas J; Edwards, Dylan J; Ferrucci, Roberta; Fregni, Felipe; Galea, Joseph M; Hamada, Masahi; Manto, Mario; Miall, R Chris; Morales-Quezada, Leon; Pope, Paul A; Priori, Alberto; Rothwell, John; Tomlinson, S Paul; Celnik, Pablo

    2016-02-01

    The cerebellum is critical for both motor and cognitive control. Dysfunction of the cerebellum is a component of multiple neurological disorders. In recent years, interventions have been developed that aim to excite or inhibit the activity and function of the human cerebellum. Transcranial direct current stimulation of the cerebellum (ctDCS) promises to be a powerful tool for the modulation of cerebellar excitability. This technique has gained popularity in recent years as it can be used to investigate human cerebellar function, is easily delivered, is well tolerated, and has not shown serious adverse effects. Importantly, the ability of ctDCS to modify behavior makes it an interesting approach with a potential therapeutic role for neurological patients. Through both electrical and non-electrical effects (vascular, metabolic) ctDCS is thought to modify the activity of the cerebellum and alter the output from cerebellar nuclei. Physiological studies have shown a polarity-specific effect on the modulation of cerebellar-motor cortex connectivity, likely via cerebellar-thalamocortical pathways. Modeling studies that have assessed commonly used electrode montages have shown that the ctDCS-generated electric field reaches the human cerebellum with little diffusion to neighboring structures. The posterior and inferior parts of the cerebellum (i.e., lobules VI-VIII) seem particularly susceptible to modulation by ctDCS. Numerous studies have shown to date that ctDCS can modulate motor learning, and affect cognitive and emotional processes. Importantly, this intervention has a good safety profile; similar to when applied over cerebral areas. Thus, investigations have begun exploring ctDCS as a viable intervention for patients with neurological conditions.

  18. Nitrergic nerves derived from the pterygopalatine ganglion innervate arteries irrigating the cerebrum but not the cerebellum and brain stem in monkeys.

    PubMed

    Ayajiki, Kazuhide; Kobuchi, Shuhei; Tawa, Masashi; Okamura, Tomio

    2012-01-01

    The functional roles of the nitrergic nerves innervating the monkey cerebral artery were evaluated in a tension-response study examining isolated arteries in vitro and cerebral angiography in vivo. Nicotine produced relaxation of arteries by stimulation of nerve terminals innervating isolated monkey arteries irrigating the cerebrum, cerebellum and brain stem. Relaxation of arteries induced by nicotine was abolished by treatment with N(G)-nitro-L-arginine, a nitric oxide synthase inhibitor, and was restored by addition of L-arginine. Cerebral angiography showed that electrical stimulation of the unilateral greater petrosal nerve, which connects to the pterygopalatine ganglion via the parasympathetic ganglion synapse, produced vasodilatation of the anterior, middle and posterior cerebral arteries in the stimulated side. However, stimulation failed to produce vasodilatation of the superior and anterior-inferior cerebellar arteries and the basilar artery in anesthetized monkeys. Therefore, nitrergic nerves derived from the pterygopalatine ganglion appear to regulate cerebral vasomotor function. In contrast, circulation in the cerebellum and brain stem might be regulated by nitrergic nerves originating not from the pterygopalatine ganglion, but rather from an unknown ganglion (or ganglia).

  19. The effects of inferior olive lesion on strychnine seizure

    SciTech Connect

    Anderson, M.C.; Chung, E.Y.; Van Woert, M.H. )

    1990-10-01

    Bilateral inferior olive lesions, produced by systemic administration of the neurotoxin 3-acetylpyridine (3AP) produce a proconvulsant state specific for strychnine-induced seizures and myoclonus. We have proposed that these phenomena are mediated through increased excitation of cerebellar Purkinje cells, through activation of glutamate receptors, in response to climbing fiber deafferentation. An increase in quisqualic acid (QA)-displaceable ({sup 3}H)AMPA ((RS)-alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid) binding in cerebella from inferior olive-lesioned rats was observed, but no difference in ({sup 3}H)AMPA binding displaced by glutamate, kainic acid (KA) or glutamate diethylester (GDEE) was seen. The excitatory amino acid antagonists GDEE and MK-801 ((+)-5-methyl-10,11-dihydro-5H-dibenzo(a,d)cyclo-hepten-5,10 imine) were tested as anticonvulsants for strychnine-induced seizures in 3AP inferior olive-lesioned and control rats. Neither drug effected seizures in control rats, however, both GDEE and MK-801 produced a leftward shift in the strychnine-seizure dose-response curve in 3AP inferior olive-lesioned rats. GDEE also inhibited strychnine-induced myoclonus in the lesioned group, while MK-801 had no effect on myoclonus. The decreased threshold for strychnine-induced seizures and myoclonus in the 3AP-inferior olive-lesioned rats may be due to an increase in glutamate receptors as suggested by the ({sup 3}H)AMPA binding data.

  20. Cerebellar BOLD signal during the acquisition of a new lexicon predicts its early consolidation.

    PubMed

    Lesage, Elise; Nailer, Emma L; Miall, R Chris

    2016-10-01

    Cerebellar contributions to language are presently poorly understood, but it has been argued that the cerebellar role in motor learning can be extended to learning in cognitive and linguistic domains. Here, we used fMRI to investigate whether the cerebellum is recruited in mapping novel words onto existing semantic concepts. On separate days, participants performed a Basque vocabulary learning task and a control English synonym task in the MRI scanner. Learning-related BOLD activity was found in left inferior frontal gyrus, bilateral insula, pre-SMA, left superior parietal cortex, right caudate, the right cerebellar vermis and right cerebellar Crus II. The extent to which the cerebellar regions, but not the cerebral areas, were recruited during learning correlated positively with participants' off-line improvement in performance after the learning task. These data provide evidence for a cerebellar role in lexical learning, and suggest that the right cerebellum may contribute toward consolidation of lexico-semantic associations in the language network. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Suprarenal inferior vena cava filter placement prior to transcatheter arterial embolization (TAE) of a renal cell carcinoma with large renal vein tumor thrombus: Prevention of pulmonary tumor emboli after TAE

    SciTech Connect

    Hirota, Shozo; Matsumoto, Shinnichi; Ichikawa, Satoshi; Tomita, Masaru; Koshino, Tukasa; Sako, Masao; Kono, Michio

    1997-03-15

    To prevent embolization of necrotic renal vein tumor after transcatheter embolization of a left renal cell carcinoma, we placed a suprarenal Bird's nest inferior vena cava filter. The patient tolerated the procedure well and had extensive tumor infarction including the tumor thrombus on 6-month follow-up computed tomography.

  2. Homolateral ataxia and crural paresis: a crossed cerebral-cerebellar diaschisis.

    PubMed Central

    Giroud, M; Creisson, E; Fayolle, H; Gras, P; Vion, P; Brunotte, F; Dumas, R

    1994-01-01

    A patient developed weakness of the right leg and homolateral ataxia of the arm, caused by a subcortical infarct in the area supplied by the anterior cerebral artery in the left paracentral region, demonstrated by CT and MRI. Cerebral blood flow studied by technetium-labelled hexamethyl-propylene-amine oxime using single photon emission computed tomography showed decreased blood flow in the left lateral frontal cortex and in the right cerebellar hemisphere ("crossed cerebral-cerebellar diaschisis"). The homolateral ataxia of the arm may be caused by decreased function of the right cerebellar hemisphere, because of a lesion of the corticopontine-cerebellar tracts, whereas crural hemiparesis is caused by a lesion of the upper part of the corona radiata. Images PMID:8126511

  3. Vertebrobasilar junction fenestration associated with dissecting aneurysm of intracranial vertebral artery.

    PubMed

    Zhang, Q J; Kobayashi, S; Gibo, H; Hongo, K

    1994-06-01

    Vertebrobasilar junction fenestration is considered to be a subtype of fenestration of the proximal basilar artery, which has been described only in autopsy cases. The fenestration associated with a dissecting vertebral aneurysm is extremely rare. A 47-year-old man presented with subarachnoid hemorrhage. The four-vessel angiogram showed a fusiform dilatation with an intimal flap of the left vertebral artery distal to the origin of the posterior inferior cerebellar artery and a fenestration at the vertebrobasilar junction, in which a small limb of the fenestration arising from the distal portion of the left vertebral artery bridged the proximal basilar trunk, while another limb had a large diameter showing the same diameter as the basilar artery. The dissecting aneurysm was treated with body clipping by directly clipping the ruptured portion of the aneurysm via a suboccipital approach in an early operation 48 hours after the ictus. The patient had a good recovery and returned to his work. He is well at a 5-year follow-up. The relevant angiographic features of the vertebrobasilar junction fenestration and the surgical treatment of such associated aneurysms are discussed.

  4. Ischemia as a potential etiologic factor in idiopathic unilateral sudden sensorineural hearing loss: Analysis of posterior circulation arteries.

    PubMed

    Kim, Chulho; Sohn, Jong-Hee; Jang, Min Uk; Hong, Sung-Kwang; Lee, Joong-Seob; Kim, Hyung-Jong; Choi, Hui-Chul; Lee, Jun Ho

    2016-01-01

    The association between idiopathic sudden sensorineural hearing loss (ISSNHL) and the radiologic characteristics of the vertebrobasilar artery is unclear. We hypothesized that the degree and direction of vertebrobasilar artery curvature in the posterior circulation contribute to the occurrence of ISSNHL. We consecutively enrolled patients diagnosed with unilateral ISSNHL in two tertiary hospitals. Magnetic resonance images were performed in all patients to exclude specific causes of ISSNHL, such as vestibular schwannoma, chronic mastoiditis, and anterior inferior cerebellar artery infarct. We measured the following parameters of posterior circulation: vertebral and basilar artery diameter, the degree of basilar artery curvature (modified smoker criteria), and vertebral artery dominance. Pure tone audiometries were performed at admission and again 1 week and 3 months later. A total of 121 ISSNHL patients (mean age, 46.0 ± 17.3 years; 48.8% male) were included in these analyses. The proportion of patients with the left side hearing loss was larger than the proportion with the right side hearing loss (left, 57.9%; right, 42.1%). The majority of patients were characterized by a left dominant vertebral artery and right-sided basilar artery curvature. The direction of the basilar artery curvature was significantly associated with hearing loss lateralization (p = 0.036). Age and sex matched multivariable analyses revealed the absence of diabetes and right-sided basilar artery curvature as significant predictors for left sided hearing loss. There was no statistical difference between atherosclerotic cardiovascular risk score (high versus low) and hearing outcomes at 3 months. In ISSNHL, the laterality of hearing loss was inversely associated with the direction of basilar artery curvature. Our results, therefore, indicate the importance of vascular assessment when evaluating ISSNHL.

  5. Endovascular Treatment of Huge Dissecting Aneurysms Involving the Basilar Artery

    PubMed Central

    Yang, X.; Mu, S.; Lv, M.; Li, L.; Wu, Z.

    2007-01-01

    Summary Dissecting aneurysms involving the basilar artery (BA) are lesions with significant morbidity and mortality. Their management is controversial and often difficult. There is no generally approved strategy. Two cases of huge dissections involving the BA presented with subarachnoid hemorrhage in one case and mass effect in both cases. The dissection of case 1 involved the upper two thirds of the BA distal to the anterior inferior cerebellar arteries (AICA). Another dissection of case 2 involved the bilateral vertebral arteries (VA) distal to bilateral PICA and extended to upper third of the BA. After making a basket with coils inside the pseudoaneursym, proximal dissection was totally occluded in case 1. Dissection on the bilateral VA distal to the bilateral PICA and proximal BA was occluded in case 2 with a small residual dissection on the left VA. Case 1 had an excellent recovery with a durable image and clinical result. But recanalization and regrowth occurred in case 2, which might have originated from the residual dissection on the left VA, induced acute mass effect and sudden coma six weeks after the initial treatment. The residual and regrown dissection had to be occluded in a second intervention. The patient died two days later. BA occlusion is safe and efficient for dissections involving the BA as in our case and the literature. Proximal occlusion might be enough for huge and long lesions like ours. It seems that completely dense packing of proximal dissection is the key point to prevent recanalization. PMID:20566106

  6. Spontaneous vertebral artery dissection with multiple supratentorial and infratentorial acute infarcts in the posterior circulation Case report.

    PubMed

    I, Cristea; C, Popa

    2016-01-01

    The article represents a case of a young patient with atypical clinical and paraclinical presentation of vertebral artery dissection by multiple cerebral infarcts, localized at the supratentorial and infratentorial levels in the posterior circulation. A case of a 21-year-old man, without a history of trauma in the cervical area or at the cranial level, without recent chiropractic maneuvers or practicing a sport, which required rapid, extreme, rotational movements of the neck, was examined. He presented to the emergency room with nausea, numbness of the left limbs, dysarthria, and incoordination of walking, with multiple objective signs at the neurological examination, which revealed right vertebral artery subacute dissection after the paraclinical investigations. The case was particular due to the atypical debut symptomatology, through the installation of the clinical picture in stages, during 4 hours and by multiple infarcts through the artery-to-artery embolic mechanism in the posterior cerebral territory. Abbreviations: PICA = posterior inferior cerebellar artery, CT = computed tomography, MRI = magnetic resonance imaging, angio MRI = mangnetic resonance angiography, FLAIR = fluid attenuated inversion recovery, FS = fat suppression, ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, T1/ T2 = T1/ T2 weighted image-basic pulse sequences in MRI, VA = vertebral artery, 3D-TOF = 3D Time of Flight.

  7. Spontaneous vertebral artery dissection with multiple supratentorial and infratentorial acute infarcts in the posterior circulation Case report

    PubMed Central

    Cristea, I; Popa, C

    2016-01-01

    The article represents a case of a young patient with atypical clinical and paraclinical presentation of vertebral artery dissection by multiple cerebral infarcts, localized at the supratentorial and infratentorial levels in the posterior circulation. A case of a 21-year-old man, without a history of trauma in the cervical area or at the cranial level, without recent chiropractic maneuvers or practicing a sport, which required rapid, extreme, rotational movements of the neck, was examined. He presented to the emergency room with nausea, numbness of the left limbs, dysarthria, and incoordination of walking, with multiple objective signs at the neurological examination, which revealed right vertebral artery subacute dissection after the paraclinical investigations. The case was particular due to the atypical debut symptomatology, through the installation of the clinical picture in stages, during 4 hours and by multiple infarcts through the artery-to-artery embolic mechanism in the posterior cerebral territory. Abbreviations: PICA = posterior inferior cerebellar artery, CT = computed tomography, MRI = magnetic resonance imaging, angio MRI = mangnetic resonance angiography, FLAIR = fluid attenuated inversion recovery, FS = fat suppression, ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, T1/ T2 = T1/ T2 weighted image-basic pulse sequences in MRI, VA = vertebral artery, 3D-TOF = 3D Time of Flight PMID:27974938

  8. Progressive limb ataxia following inferior olive lesions

    PubMed Central

    Horn, K M; Deep, A; Gibson, A R

    2013-01-01

    Cerebellar climbing fibres originate in the inferior olive (IO). Temporary IO inactivation produces movement deficits. Does permanent inactivation produce similar deficits and, if so, do they recover? The excitotoxin, kainic acid, was injected into the rostral IO of three cats. Behaviour was measured during reaching and locomotion. Two cats were injected during the reaching task. Within minutes, grasping became difficult and the trajectories of the reaches showed higher arcing than normally seen. During locomotion, both cats showed head and trunk deviation to the injected side, walking paths curved to the injected side, and the paws were lifted higher than normal. Limbs contralateral to the injections became rigid. Within 1 day, posture had normalized, locomotion was unsteady and high lifting of the paws had reversed to a tendency to drag the dorsum of the paws. Passive body movement produced vestibular signs. Over a few days, locomotion normalized and vestibular signs disappeared. Reach trajectories were normal but grasping deficits persisted. Over the first week, the amplitude of limb lift during reaching and locomotion began to increase. The increase continued over time and, after several months, limb movements became severely ataxic. The effects followed the somatotopy of the rostral IO: a loss of cells in medial rostral IO only affected the forelimb, whereas a loss of cells in medial and lateral IO affected both forelimb and hindlimb. Deficits produced by IO lesions involve multiple mechanisms; some recover rapidly, some appear stable, and some worsen over time. The nature of the progressive deficit suggests a gradual loss of Purkinje cell inhibition on cerebellar nuclear cells. PMID:23027819

  9. Flavoprotein imaging in the cerebellar cortex in vivo: cellular and metabolic basis and insights into cerebellar function

    NASA Astrophysics Data System (ADS)

    Gao, Wangcai; Chen, Gang; Ebner, Timothy J.

    2009-02-01

    Flavoprotein autofluorescence is an activity dependent intrinsic signal. Flavoproteins are involved in the electron transport chain and change their fluorescence according to the cellular redox state. We have been using flavoprotein autofluorescence in the cerebellum to examine properties of cerebellar circuits. Studies have also focused on understanding the cellular and metabolic origins of this intrinsic optical signal. Parallel fiber stimulation evokes a beamlike response intersected by bands of decreased fluorescence. The beam response is biphasic, with an early fluorescence increase (light phase) followed by a slower decrease (dark phase). We show this signal originates from flavoproteins as determined by its wavelength selectivity and sensitivity to blockers of the electron transport chain. Selectively blocking glutamate receptors abolished the on-beam light phase with the dark phase remaining intact. This demonstrates that the light phase is due to postsynaptic neuronal activation and suggests the dark phase is primarily due to glial activation. The bands of reduced fluorescence intersecting the beam are primarily neuronal in origin, mediated by GABAergic transmission, and due to the inhibitory action of molecular layer interneurons on Purkinje cells and the interneurons themselves. This parasagittally organized molecular layer inhibition differentially modulates the spatial pattern of cerebellar cortical activity. Flavoprotein imaging also reveals the functional architectures underlying the responses to inferior olive and peripheral whisker pad stimulation. Therefore, flavoprotein autofluorescence imaging is providing new insights into cerebellar cortical function and neurometabolic coupling.

  10. Alcohol Withdrawal and Cerebellar Mitochondria.

    PubMed

    Jung, Marianna E

    2015-08-01

    Cerebellar disorders trigger the symptoms of movement problems, imbalance, incoordination, and frequent fall. Cerebellar disorders are shown in various CNS illnesses including a drinking disorder called alcoholism. Alcoholism is manifested as an inability to control drinking in spite of adverse consequences. Human and animal studies have shown that cerebellar symptoms persist even after complete abstinence from drinking. In particular, the abrupt termination (ethanol withdrawal) of long-term excessive ethanol consumption has shown to provoke a variety of neuronal and mitochondrial damage to the cerebellum. Upon ethanol withdrawal, excitatory neurotransmitter molecules such as glutamate are overly released in brain areas including cerebellum. This is particularly relevant to the cerebellar neuronal network as glutamate signals are projected to Purkinje neurons through granular cells that are the most populated neuronal type in CNS. This excitatory neuronal signal may be elevated by ethanol withdrawal stress, which promotes an increase in intracellular Ca(2+) level and a decrease in a Ca(2+)-binding protein, both of which result in the excessive entry of Ca(2+) to the mitochondria. Subsequently, mitochondria undergo a prolonged opening of mitochondrial permeability transition pore and the overproduction of harmful free radicals, impeding adenosine triphosphate (ATP)-generating function. This in turn provokes the leakage of mitochondrial molecule cytochrome c to the cytosol, which triggers a cascade of adverse cytosol reactions. Upstream to this pathway, cerebellum under the condition of ethanol withdrawal has shown aberrant gene modifications through altered DNA methylation, histone acetylation, or microRNA expression. Interplay between these events and molecules may result in functional damage to cerebellar mitochondria and consequent neuronal degeneration, thereby contributing to motoric deficit. Mitochondria-targeting research may help develop a powerful new

  11. Posttraumatic Cerebellar Infarction after Repeated Sport-related Minor Head Injuries in a Young Adult: A Case Report

    PubMed Central

    MATSUMOTO, Hiroaki; YOSHIDA, Yasuhisa

    2015-01-01

    A healthy 23-year-old man suffered helmet-to-helmet collisions with an opponent during American football game twice within 3 days. He then experienced continuous vomiting and dizziness. Magnetic resonance imaging revealed acute infarction in the right cerebellar hemisphere, and magnetic resonance angiography revealed transient stenosis of the right superior cerebellar artery. Although minor head injury is not usually accompanied by complications, posttraumatic ischemic stroke has been reported on rare occasions. We report a case of cerebellar infarction after repeated sports-related minor head injuries in a young adult and discuss the etiology. PMID:25746313

  12. Decreased cerebellar blood flow in postinfectious acute cerebellar ataxia

    PubMed Central

    Nagamitsu, S.; Matsuishi, T.; Ishibashi, M.; Yamashita, Y.; Nishimi, T.; Ichikawa, K.; Yamanishi, K.; Kato, H.

    1999-01-01

    OBJECTIVE—The aim of the present study was to evaluate the regional cerebral blood flow (rCBF) in patients with postinfectious acute cerebellar ataxia using single photon emission computed tomography (SPECT).
METHODS—Five children with postinfectious acute cerebellar ataxia and five control subjects were examined. The distribution of rCBF was measured by SPECT imaging after intravenous administration of 123I-IMP (111 MBq). The rCBF ratio—defined as the ratio of rCBF in the region of interest (ROI) to that in the occipital cortex—was calculated for each cortical and subcortical ROI. The mean rCBF ratio of each region was then compared between the ataxic and control subjects. These patients and all control subjects were also evaluated using MRI.
RESULTS—The rCBF ratio was significantly lower in the cerebellum of the ataxic patients than in the cerebellum of the control subjects (p<0.05). No abnormal cerebellar morphology and no abnormal signal intensities were found on MRI.
CONCLUSION—123I-IMP SPECT clearly demonstrated the decreased rCBF in the cerebellum of all patients with postinfectious acute cerebellar ataxia.

 PMID:10369834

  13. Laceration of the inferior vena cava of angiographic demonstration

    SciTech Connect

    Sclafani, S.J.A.; Gordon, D.H.; Mitchell, W.

    1983-08-01

    Laceration of the inferior vena cava (IVC) often presents as an acute surgical emergency requiring immediate operative intervention. We show that when the patient's clinical condition permits, angiography may delineate the site of caval laceration and active hemorrhage, and identify associated arterial injuries. Contrast extravasation from the IVC also is reported for the first time.

  14. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    PubMed Central

    Prasad, G. Raghavendra; Billa, Srikar; Bhandari, Pavaneel; Hussain, Aijaz

    2013-01-01

    Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI) bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric – inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up. PMID:23798814

  15. Inferior vena cava filters.

    PubMed

    Duffett, L; Carrier, M

    2017-01-01

    Use of inferior vena cava (IVC) filters has increased dramatically in recent decades, despite a lack of evidence that their use has impacted venous thromboembolism (VTE)-related mortality. This increased use appears to be primarily driven by the insertion of retrievable filters for prophylactic indications. A growing body of evidence, however, suggests that IVC filters are frequently associated with clinically important adverse events, prompting a closer look at their role. We sought to narratively review the current evidence on the efficacy and safety of IVC filter placements. Inferior vena cava filters remain the only treatment option for patients with an acute (within 2-4 weeks) proximal deep vein thrombosis (DVT) or pulmonary embolism and an absolute contraindication to anticoagulation. In such patients, anticoagulation should be resumed and IVC filters removed as soon as the contraindication has passed. For all other indications, there is insufficient evidence to support the use of IVC filters and high-quality trials are required. In patients where an IVC filter remains, regular follow-up to reassess removal and screen for filter-related complications should occur. © 2016 International Society on Thrombosis and Haemostasis.

  16. Clinical findings of intracranial vertebral artery disease using magnetic resonance angiography.

    PubMed

    Liu, Lu-Han; Chen, Clayton Chi-Chang; Chang, Ming-Hong

    2004-09-01

    The vertebral artery lesion has a variety of clinical characteristics. We sought to clarify the clinical patterns and the location of the intracranial vertebral artery (ICVA) diseases according to analyses of images obtained using magnetic resonance angiography (MRA). We studied vascular lesions, risk factors, symptoms, signs, and outcomes in 35 patients with ICVA disease (3 had bilateral occlusion; 9, unilateral occlusion; 6, bilateral stenosis; and 17, unilateral stenosis). The most common site of unilateral and bilateral lesions was the distal ICVA after the origin of posterior inferior cerebellar artery (PICA). We found accompanying basilar artery disease in 28.6% of patients with unilateral and bilateral ICVA disease. The majority of the ICVA lesions were associated with internal carotid arteries disease (48.8%). The common vascular risk factors were hypertension (71%), diabetes mellitus (34%), hyperlipidemia (31%), smoking (29%), and coronary artery disease (23%). Eighteen patients (51.4%) had transient ischemic attacks (TIAs) only, 10 patients (28.6%) had TIAs before stroke, and 5 patients (14.3%) had strokes without TIAs. Most patients (80%) with TIAs, with or without stroke, had multiple episodes. Vertigo or dizziness, ataxia, limbs weakness and abnormal gait were the common symptoms and signs. At 6 months follow-up, 66.7% patients had no symptoms or only slight symptoms that caused no disability. Our data showed (1) the usual location of ICVA disease (occlusion or severe stenosis) was distal to PICA, especially near the vertebrobasilar junction; (2) the risk factors were hypertension, diabetes mellitus, hyperlipidemia, smoking, and coronary artery disease; (3) patients with ICVA disease had a high frequency of accompanying internal carotid, middle cerebral, or basilar artery disease; (4) vertigo or dizziness, and ataxia were the common symptoms and signs; (5) TIA was the most common clinical pattern; (6) the outcome was favorable, except in cases with

  17. Speech Prosody in Cerebellar Ataxia

    ERIC Educational Resources Information Center

    Casper, Maureen A.; Raphael, Lawrence J.; Harris, Katherine S.; Geibel, Jennifer M.

    2007-01-01

    Persons with cerebellar ataxia exhibit changes in physical coordination and speech and voice production. Previously, these alterations of speech and voice production were described primarily via perceptual coordinates. In this study, the spatial-temporal properties of syllable production were examined in 12 speakers, six of whom were healthy…

  18. Linking oscillations in cerebellar circuits

    PubMed Central

    Courtemanche, Richard; Robinson, Jennifer C.; Aponte, Daniel I.

    2013-01-01

    In many neuroscience fields, the study of local and global rhythmicity has been receiving increasing attention. These network influences could directly impact on how neuronal groups interact together, organizing for different contexts. The cerebellar cortex harbors a variety of such local circuit rhythms, from the rhythms in the cerebellar cortex per se, or those dictated from important afferents. We present here certain cerebellar oscillatory phenomena that have been recorded in rodents and primates. Those take place in a range of frequencies: from the more known oscillations in the 4–25 Hz band, such as the olivocerebellar oscillatory activity and the granule cell layer oscillations, to the more recently reported slow (<1 Hz oscillations), and the fast (>150 Hz) activity in the Purkinje cell layer. Many of these oscillations appear spontaneously in the circuits, and are modulated by behavioral imperatives. We review here how those oscillations are recorded, some of their modulatory mechanisms, and also identify some of the cerebellar nodes where they could interact. A particular emphasis has been placed on how these oscillations could be modulated by movement and certain neuropathological manifestations. Many of those oscillations could have a definite impact on the way information is processed in the cerebellum and how it interacts with other structures in a variety of contexts. PMID:23908606

  19. Orthostatic tremor: a cerebellar pathology?

    PubMed

    Gallea, Cécile; Popa, Traian; García-Lorenzo, Daniel; Valabregue, Romain; Legrand, André-Pierre; Apartis, Emmanuelle; Marais, Lea; Degos, Bertrand; Hubsch, Cecile; Fernández-Vidal, Sara; Bardinet, Eric; Roze, Emmanuel; Lehéricy, Stéphane; Meunier, Sabine; Vidailhet, Marie

    2016-08-01

    SEE MUTHURAMAN ET AL DOI101093/AWW164 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Primary orthostatic tremor is characterized by high frequency tremor affecting the legs and trunk during the standing position. Cerebellar defects were suggested in orthostatic tremor without direct evidence. We aimed to characterize the anatomo-functional defects of the cerebellar motor pathways in orthostatic tremor. We used multimodal neuroimaging to compare 17 patients with orthostatic tremor and 17 age- and gender-matched healthy volunteers. Nine of the patients with orthostatic tremor underwent repetitive transcranial stimulation applied over the cerebellum during five consecutive days. We quantified the duration of standing position and tremor severity through electromyographic recordings. Compared to healthy volunteers, grey matter volume in patients with orthostatic tremor was (i) increased in the cerebellar vermis and correlated positively with the duration of the standing position; and (ii) increased in the supplementary motor area and decreased in the lateral cerebellum, which both correlated with the disease duration. Functional connectivity between the lateral cerebellum and the supplementary motor area was abnormally increased in patients with orthostatic tremor, and correlated positively with tremor severity. After repetitive transcranial stimulation, tremor severity and functional connectivity between the lateral cerebellum and the supplementary motor area were reduced. We provide an explanation for orthostatic tremor pathophysiology, and demonstrate the functional relevance of cerebello-thalamo-cortical connections in tremor related to cerebellar defects.

  20. Speech Prosody in Cerebellar Ataxia

    ERIC Educational Resources Information Center

    Casper, Maureen A.; Raphael, Lawrence J.; Harris, Katherine S.; Geibel, Jennifer M.

    2007-01-01

    Persons with cerebellar ataxia exhibit changes in physical coordination and speech and voice production. Previously, these alterations of speech and voice production were described primarily via perceptual coordinates. In this study, the spatial-temporal properties of syllable production were examined in 12 speakers, six of whom were healthy…

  1. The compartmental restriction of cerebellar interneurons

    PubMed Central

    Consalez, G. Giacomo; Hawkes, Richard

    2013-01-01

    The Purkinje cells (PC's) of the cerebellar cortex are subdivided into multiple different molecular phenotypes that form an elaborate array of parasagittal stripes. This array serves as a scaffold around which afferent topography is organized. The ways in which cerebellar interneurons may be restricted by this scaffolding are less well-understood. This review begins with a brief survey of cerebellar topography. Next, it reviews the development of stripes in the cerebellum with a particular emphasis on the embryological origins of cerebellar interneurons. These data serve as a foundation to discuss the hypothesis that cerebellar compartment boundaries also restrict cerebellar interneurons, both excitatory [granule cells, unipolar brush cells (UBCs)] and inhibitory (e.g., Golgi cells, basket cells). Finally, it is proposed that the same PC scaffold that restricts afferent terminal fields to stripes may also act to organize cerebellar interneurons. PMID:23346049

  2. Cerebellar Contribution to Social Cognition.

    PubMed

    Hoche, Franziska; Guell, Xavier; Sherman, Janet C; Vangel, Mark G; Schmahmann, Jeremy D

    2016-12-01

    Emotion attribution (EA) from faces is key to social cognition, and deficits in perception of emotions from faces underlie neuropsychiatric disorders in which cerebellar pathology is reported. Here, we test the hypothesis that the cerebellum contributes to social cognition through EA from faces. We examined 57 patients with cerebellar disorders and 57 healthy controls. Thirty-one patients had complex cerebrocerebellar disease (complex cerebrocerebellar disease group (CD)); 26 had disease isolated to cerebellum (isolated cerebellar disease group (ID)). EA was measured with the Reading the Mind in the Eyes test (RMET), and informants were administered a novel questionnaire, the Cerebellar Neuropsychiatric Rating Scale (CNRS). EA was impaired in all patients (CD p < 0.001, ID p < 0.001). When analyzed for valence categories, both CD and ID missed more positive and negative stimuli. Positive targets produced the highest deficit (CD p < 0.001, ID p = 0.004). EA impairments correlated with CNRS measures of deficient social skills (p < 0.05) and autism spectrum behaviors (p < 0.005). Patients had difficulties with emotion regulation (CD p < 0.001, ID p < 0.001), autism spectrum behaviors (CD p < 0.049, ID p < 0.001), and psychosis spectrum symptoms (CD p < 0.021, ID p < 0.002). ID informants endorsed deficient social skills (CD p < 0.746, ID p < 0.003) and impaired attention regulation (CD p < 0.144, ID p < 0.001). Within the psychosis spectrum domain, CD patients were worse than controls for lack of empathy (CD p = 0.05; ID p = 0.49). Thus, patients with cerebellar damage were impaired on an EA task associated with deficient social skills and autism spectrum behaviors and experienced psychosocial difficulties on the CNRS. This has relevance for ataxias, the cerebellar cognitive affective/Schmahmann syndrome, and neuropsychiatric disorders with cerebellar pathology.

  3. Diffusion Tensor Tractography of the Cerebellar Peduncles in Prematurely Born 7-Year-Old Children.

    PubMed

    Shany, Eilon; Inder, Terrie E; Goshen, Sharon; Lee, Iris; Neil, Jeffrey J; Smyser, Christopher D; Doyle, Lex W; Anderson, Peter J; Shimony, Joshua S

    2017-04-01

    The objective of this study was to correlate neurodevelopmental outcome of preterm-born children and their perinatal clinical and imaging characteristics with diffusion magnetic resonance imaging (MRI) measures of the three cerebellar peduncles at age 7. Included in this prospective longitudinal study were 140 preterm-born children (<30 weeks gestation) who underwent neurodevelopmental assessment (IQ, motor, language, working memory) and diffusion-weighted imaging (DWI) at age 7 years. White matter tracts in the superior, middle, and inferior cerebellar peduncles were delineated using regions of interest drawn on T2-weighted images and fractional anisotropy (FA) maps. Diffusion measures (mean diffusivity (MD) and FA) and tract volumes were calculated. Linear regression was used to assess relationships with outcome. The severity of white matter injury in the neonatal period was associated with lower FA in the right superior cerebellar peduncle (SCP) and lower tract volumes of both SCPs and middle cerebellar peduncles (MCPs). In the MCP, higher IQ was associated with lower MD in the whole group and higher FA in right-handed children. In the SCP, lower motor scores were associated with higher MD and higher language scores were associated with higher FA. These associations remained significant in multivariable models. This study adds to the body of literature detailing the importance of cerebellar involvement in cognitive function related to reciprocal connections with supratentorial structures.

  4. Integration of Purkinje cell inhibition by cerebellar nucleo-olivary neurons.

    PubMed

    Najac, Marion; Raman, Indira M

    2015-01-14

    Neurons in the cerebellar cortex, cerebellar nuclei, and inferior olive (IO) form a trisynaptic loop critical for motor learning. IO neurons excite Purkinje cells via climbing fibers and depress their parallel fiber inputs. Purkinje cells inhibit diverse cells in the cerebellar nuclei, including small GABAergic nucleo-olivary neurons that project to the IO. To investigate how these neurons integrate synaptic signals from Purkinje cells, we retrogradely labeled nucleo-olivary cells in the contralateral interpositus and lateral nuclei with cholera toxin subunit B-Alexa Fluor 488 and recorded their electrophysiological properties in cerebellar slices from weanling mice. Nucleo-olivary cells fired action potentials over a relatively narrow dynamic range (maximal rate, ∼ 70 spikes/s), unlike large cells that project to premotor areas (maximal rate, ∼ 400 spikes/s). GABA(A) receptor-mediated IPSCs evoked by electrical or optogenetic stimulation of Purkinje cells were more than 10-fold slower in nucleo-olivary cells (decay time, ∼ 25 ms) than in large cells (∼ 2 ms), and repetitive stimulation at 20-150 Hz evoked greatly summating IPSCs. Nucleo-olivary firing rates varied inversely with IPSP frequency, and the timing of Purkinje IPSPs and nucleo-olivary spikes was uncorrelated. These attributes contrast with large cells, whose brief IPSCs and rapid firing rates can permit well timed postinhibitory spiking. Thus, the intrinsic and synaptic properties of these two projection neurons from the cerebellar nuclei tailor them for differential integration and transmission of their Purkinje cell input.

  5. Development of cerebellar connectivity in human fetal brains revealed by high angular resolution diffusion tractography.

    PubMed

    Takahashi, Emi; Hayashi, Emiko; Schmahmann, Jeremy D; Grant, P Ellen

    2014-08-01

    High angular resolution diffusion imaging (HARDI) tractography has provided insights into major white matter pathways and cortical development in the human fetal cerebrum. Our objective in this study was to further apply HARDI tracography to the developing human cerebellum ranging from fetal to adult stages, to outline in broad strokes the 3-dimensional development of white matter and local gray matter organization in the cerebellum. We imaged intact fixed fetal cerebellum specimens at 17 gestational weeks (W), 21W, 31W, 36W, and 38W along with an adult cerebellum for comparison. At the earliest gestational age studied (17W), coherent pathways that formed the superior, middle, and inferior cerebellar peduncles were already detected, but pathways between deep cerebellar nuclei and the cortex were not observed until after 38W. At 36-38W, we identified emerging regional specification of the middle cerebellar peduncle. In the cerebellar cortex, we observed disappearance of radial organization in the sagittal orientation during the studied developmental stages similar to our previous observations in developing cerebral cortex. In contrast, in the axial orientation, cerebellar cortical pathways emerged first sparsely (31W) and then with increased prominence at 36-38W with pathways detected both in the radial and tangential directions to the cortical surface. The cerebellar vermis first contained only pathways tangential to the long axes of folia (17-21W), but pathways parallel to the long axes of folia emerged between 21 and 31W. Our results show the potential for HARDI tractography to image developing human cerebellar connectivity.

  6. Impaired Motor Learning in a Disorder of the Inferior Olive: Is the Cerebellum Confused?

    PubMed

    Shaikh, Aasef G; Wong, Aaron L; Optican, Lance M; Zee, David S

    2017-02-01

    An attractive hypothesis about how the brain learns to keep its motor commands accurate is centered on the idea that the cerebellar cortex associates error signals carried by climbing fibers with simultaneous activity in parallel fibers. Motor learning can be impaired if the error signals are not transmitted, are incorrect, or are misinterpreted by the cerebellar cortex. Learning might also be impaired if the brain is overwhelmed with a sustained barrage of meaningless information unrelated to simultaneously appearing error signals about incorrect performance. We test this concept in subjects with syndrome of oculopalatal tremor (OPT), a rare disease with spontaneous, irregular, roughly pendular oscillations of the eyes thought to reflect an abnormal, synchronous, spontaneous discharge to the cerebellum from the degenerating neurons in the inferior olive. We examined motor learning during a short-term, saccade adaptation paradigm in patients with OPT and found a unique pattern of disturbed adaptation, quite different from the abnormal adaption when the cerebellum is involved directly. Both fast (seconds) and slow (minutes) timescales of learning were impaired. We suggest that the spontaneous, continuous, synchronous output from the inferior olive prevents the cerebellum from receiving the error signals it needs for appropriate motor learning. The important message from this study is that impaired motor adaptation and resultant dysmetria is not the exclusive feature of cerebellar disorders, but it also highlights disorders of the inferior olive and its connections to the cerebellum.

  7. Arterial hypertension with brachydactyly in a 15-year-old boy.

    PubMed

    Litwin, Mieczysław; Jurkiewicz, Elzbieta; Nowak, Katarzyna; Kościesza, Andrzej; Grenda, Ryszard; Malczyk, Katarzyna; Kościesza, Iwona

    2003-08-01

    Autosomal dominant brachydactyly with hypertension is the only form of monogenic hypertension which is not sodium dependent. The disease is characterized by brachydactyly type E, short stature, arterial hypertension and aberrant loop of posterior inferior cerebellar artery (PICA) causing neurovascular conflict. So far the syndrome was described in one family in Turkey and two in Canada. We report a case of a 15-year-old boy who was admitted because of arterial hypertension 160/100 mmHg. He complained also of attacks of bilateral numbness of hands with deterioration of visual field. Examination revealed short stature (156 cm) and bone deformities of hands and feet consistent with brachydactyly type E. Ophthalmoscopy showed mild narrowing of retinal arteries. Serum electrolytes, blood gases, and renal function were normal. Renin activity and aldosterone concentrations were raised, and 24-h urinary excretion of catecholamines and urinary steroid profile were in normal range. Renal Doppler ultrasound was normal, but renal scintigraphy suggested vascular changes in the left kidney. Echocardiographic examination, besides mild left ventricular hypertrophy, was normal. Magnetic resonance angiography (angio-MR) revealed bilateral abnormal PICA loops and neurovascular conflict. Spiral angiotomography of renal arteries revealed narrow additional left renal artery. Both nonconsanguineous parents and younger brother were healthy, with normal height, without bone deformities, and had normal intracranial vessels. Amlodipine and metoprolol were given, and blood pressure lowered to 143/87. Adding rilmenidine gave no effect and enalapril was then added. It led to further improvement in blood pressure control. To our knowledge, this is the first pediatric description of a sporadic form of autosomal dominant brachydactyly with hypertension with abnormalities of brain and renal arteries.

  8. Cochlear implantation following cerebellar surgery.

    PubMed

    Saeed, Shahad; Mawman, Deborah; Green, Kevin

    2011-08-01

    Cochlear implantation in patients with known central nervous system conditions can result in wide-ranging outcomes. The aim of this study is to report two cases of cochlear implantation outcomes in patients with acquired cerebellar ataxia following cerebellar surgery. The first is a female implanted with the Nucleus 24 implant in September 2000 and the second is a male implanted with a MED-EL Sonata Flexsoft electro-acoustic stimulation in July 2009. Programming these patients resulted in significant non-auditory stimulation which resulted in less than optimum map fittings. The patients did not gain any open set speech perception benefit although both of them gained an awareness of sound with the device. However, patient 2 elected to become a non-user because of the limited benefit.

  9. A rare case report of subscapular artery.

    PubMed

    Khaki, Amir Afshin; Shoja, M A Mohagjel; Khaki, Arash

    2011-01-01

    Axillary artery is one of the most important arteries of the upper limb, which is a continua- tion of the subclavian artery. It begins at the lateral border of the first rib and ends at the inferior border of the teres major where it becomes the brachial artery. Axillary artery has six important branches included: 1) Superior thoracic artery 2) Thoracoacromial artery 3) Lateral thoracic artery 4) Subscapular artery 5) Posterior circumflex humeral artery 6) Anterior circumflex humeral artery. Subscapular artery arises from the third part of axillary artery normally and then divides into cir- cumflex scapular artery that extremely enters the triangular space. The other branch of subscapular artery, the thoracodorsal artery, accompanies thracodorsal nerve to lateral border of scapula and supplies and innervates that region. In this case the subscapular artery was absent in both sides and instead of that the circumflex scapular artery was directly derived from axillary artery and the thoracodorsal artery is separated from circumflex scapular artery as a thin and short branch, too. It seemed that the lateral thoracic artery, which was thicker than its normal condition, supplied the muscles of the lateral part of scapula and the thoracodorsal muscle. Other branches of the axillary artery demonstrated without any abnormally. Since axillary artery has the highest rate of rapture and damage coming after the popliteal artery, knowing the variations is important and essential for surgeons, radiologist and anatomist.

  10. Nonsurgical cerebellar mutism (anarthria) in two children.

    PubMed

    Mewasingh, Leena D; Kadhim, Hazim; Christophe, Catherine; Christiaens, Florence J; Dan, Bernard

    2003-01-01

    Cerebellar mutism (anarthria) is a well-described complication of posterior fossa tumor resection. It is accompanied by a characteristic behavior including irritability and autistic features. This syndrome is typically reversible within days to months. Underlying pathophysiology is unknown. We describe two children who presented with a similar clinical finding after nonsurgical cerebellar involvement, hemolytic-uremic syndrome in one and cerebellitis in the other. Postmortem pathologic findings in the first patient indicated cerebellar ischemic necrosis. Single-photon emission computed tomography in the second patient revealed diffuse cerebellar hypoperfusion with no supratentorial abnormalities, refuting a phenomenon of diaschisis between cerebellar and frontal connections. These findings confirm that this clinical syndrome may occur in a nonsurgical, nontraumatic context. They are consistent with recent integrative hypotheses explaining cerebellar anarthria.

  11. Postnatal Migration of Cerebellar Interneurons

    PubMed Central

    Galas, Ludovic; Bénard, Magalie; Lebon, Alexis; Komuro, Yutaro; Schapman, Damien; Vaudry, Hubert; Vaudry, David; Komuro, Hitoshi

    2017-01-01

    Due to its continuing development after birth, the cerebellum represents a unique model for studying the postnatal orchestration of interneuron migration. The combination of fluorescent labeling and ex/in vivo imaging revealed a cellular highway network within cerebellar cortical layers (the external granular layer, the molecular layer, the Purkinje cell layer, and the internal granular layer). During the first two postnatal weeks, saltatory movements, transient stop phases, cell-cell interaction/contact, and degradation of the extracellular matrix mark out the route of cerebellar interneurons, notably granule cells and basket/stellate cells, to their final location. In addition, cortical-layer specific regulatory factors such as neuropeptides (pituitary adenylate cyclase-activating polypeptide (PACAP), somatostatin) or proteins (tissue-type plasminogen activator (tPA), insulin growth factor-1 (IGF-1)) have been shown to inhibit or stimulate the migratory process of interneurons. These factors show further complexity because somatostatin, PACAP, or tPA have opposite or no effect on interneuron migration depending on which layer or cell type they act upon. External factors originating from environmental conditions (light stimuli, pollutants), nutrients or drug of abuse (alcohol) also alter normal cell migration, leading to cerebellar disorders. PMID:28587295

  12. Cerebellar mutism syndrome and its relation to cerebellar cognitive and affective function: Review of the literature

    PubMed Central

    Yildiz, Ozlem; Kabatas, Serdar; Yilmaz, Cem; Altinors, Nur; Agaoglu, Belma

    2010-01-01

    Tumors of the cerebellum and brainstem account for half of all brain tumors in children. The realization that cerebellar lesions produce clinically relevant intellectual disability makes it important to determine whether neuropsychological abnormalities occur in long-term survivors of pediatric cerebellar tumors. Little is known about the neurobehavioral sequale resulting specifically from the resection of these tumors in this population. We therefore reviewed neuropsychological findings associated with postoperative cerebellar mutism syndrome and discuss the further implications for cerebellar cognitive function. PMID:20436742

  13. Ovarian arteries with bilateral unusual courses.

    PubMed

    Sulak, Osman; Albay, Soner; Tagil, Suleyman M; Malas, Mehmet A

    2005-09-01

    Bilateral unusual coursed ovarian arteries were found in a 45-year-old female cadaver. The ovarian arteries arose from the abdominal aorta at a level inferior to the corpus of L1 vertebra bilaterally. The right ovarian artery was coursing behind the inferior vena cava. The left one was coursing between the left renal artery and vein upward to the level of the inferior part of the body of Th12 vertebra. At the level of Th12 vertebra, it turned caudally and proceeded downward between the anterior-inferior and posterior segmental renal veins. On both sides, ovarian arteries were on their normal routes below the L2 vertebra accompanying the ovarian veins. The variation determined by this study would reduce possible complications of nephrectomy operations that urologists, gynecologists and other related surgeons may encounter.

  14. Duplicated middle cerebral artery.

    PubMed

    Perez, Jesus; Machado, Calixto; Scherle, Claudio; Hierro, Daniel

    2009-01-01

    Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion.

  15. Different subregional metabolism patterns in patients with cerebellar ataxia by 18F-fluorodeoxyglucose positron emission tomography.

    PubMed

    Oh, Minyoung; Kim, Jae Seung; Oh, Jungsu S; Lee, Chong Sik; Chung, Sun Ju

    2017-01-01

    We evaluated cerebellar subregional metabolic alterations in patients with cerebellar ataxia, a representative disease involving the spinocerebellum. We retrospectively analyzed 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) images in 44 patients with multiple system atrophy of the cerebellar type (MSA-C), 9 patients with spinocerebellar ataxia (SCA) type 2, and 14 patients with SCA type 6 and compared with 15 patients with crossed cerebellar diaschisis (CCD) and 89 normal controls. Cerebellar subregional metabolism was assessed using 13 cerebellar subregions (bilateral anterior lobes [ANT], superior/mid/inferior posterior lobes [SUPP/MIDP/INFP], dentate nucleus [DN], anterior vermis [ANTV], and superior/inferior posterior vermis [SUPV/INFV]) to determine FDG uptake ratios. MSA-C and SCA type 2 showed severely decreased metabolic ratios in all cerebellar subregions compared to normal controls (ANT, 0.58 ± 0.08 and 0.50 ± 0.06 vs. 0.82 ± 0.07, respectively, p < 0.001). SCA type 6 showed lower metabolic ratios in almost all cerebellar subregions (ANT, 0.57 ± 0.06, p < 0.001) except INFV. Anterior-posterior lobe ratio measurements revealed that SCA type 2 (Right, 0.81 ± 0.05 vs. 0.88 ± 0.04, p < 0.001; Left, 0.83 ± 0.05 vs. 0.88 ± 0.04, p = 0.003) and SCA type 6 (Right, 0.72 ± 0.05 vs. 0.88 ± 0.04, p < 0.001; Left, 0.72 ± 0.05 vs. 0.88 ± 0.04, p < 0.001) showed preferential hypometabolism in the anterior lobe compared to normal controls, which was not observed in CCD and MSA-C. Asymmetric indices were higher in CCD and MSA-C than in normal controls (p < 0.001), whereas such differences were not found in SCA types 2 and 6. In summary, quantitative analysis of cerebellar subregional metabolism ratios revealed preferential involvement of the anterior lobe, corresponding to the spinocerebellum, in patients with cerebellar ataxia, whereas patients with CCD and MSA-C exhibited more asymmetric hypometabolism in the posterior lobe.

  16. Different subregional metabolism patterns in patients with cerebellar ataxia by 18F-fluorodeoxyglucose positron emission tomography

    PubMed Central

    Kim, Jae Seung; Oh, Jungsu S.; Lee, Chong Sik; Chung, Sun Ju

    2017-01-01

    We evaluated cerebellar subregional metabolic alterations in patients with cerebellar ataxia, a representative disease involving the spinocerebellum. We retrospectively analyzed 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) images in 44 patients with multiple system atrophy of the cerebellar type (MSA-C), 9 patients with spinocerebellar ataxia (SCA) type 2, and 14 patients with SCA type 6 and compared with 15 patients with crossed cerebellar diaschisis (CCD) and 89 normal controls. Cerebellar subregional metabolism was assessed using 13 cerebellar subregions (bilateral anterior lobes [ANT], superior/mid/inferior posterior lobes [SUPP/MIDP/INFP], dentate nucleus [DN], anterior vermis [ANTV], and superior/inferior posterior vermis [SUPV/INFV]) to determine FDG uptake ratios. MSA-C and SCA type 2 showed severely decreased metabolic ratios in all cerebellar subregions compared to normal controls (ANT, 0.58 ± 0.08 and 0.50 ± 0.06 vs. 0.82 ± 0.07, respectively, p < 0.001). SCA type 6 showed lower metabolic ratios in almost all cerebellar subregions (ANT, 0.57 ± 0.06, p < 0.001) except INFV. Anterior-posterior lobe ratio measurements revealed that SCA type 2 (Right, 0.81 ± 0.05 vs. 0.88 ± 0.04, p < 0.001; Left, 0.83 ± 0.05 vs. 0.88 ± 0.04, p = 0.003) and SCA type 6 (Right, 0.72 ± 0.05 vs. 0.88 ± 0.04, p < 0.001; Left, 0.72 ± 0.05 vs. 0.88 ± 0.04, p < 0.001) showed preferential hypometabolism in the anterior lobe compared to normal controls, which was not observed in CCD and MSA-C. Asymmetric indices were higher in CCD and MSA-C than in normal controls (p < 0.001), whereas such differences were not found in SCA types 2 and 6. In summary, quantitative analysis of cerebellar subregional metabolism ratios revealed preferential involvement of the anterior lobe, corresponding to the spinocerebellum, in patients with cerebellar ataxia, whereas patients with CCD and MSA-C exhibited more asymmetric hypometabolism in the posterior lobe. PMID:28319124

  17. Development of the cerebellar afferent system in the shark Scyliorhinus canicula: insights into the basal organization of precerebellar nuclei in gnathostomes.

    PubMed

    Pose-Méndez, Sol; Candal, Eva; Adrio, Fátima; Rodríguez-Moldes, Isabel

    2014-01-01

    The cerebellum is recognized as an evolutionary innovation of jawed vertebrates, whose most primitive group is represented by the chondrichthyans, or cartilaginous fishes. A comprehensive knowledge of cerebellar connections in these fishes might shed light on the basal organization of the cerebellar system. Although the organization of the precerebellar system is known in adults, developmental studies are essential for understanding the origin and evolution of precerebellar nuclei. In the present work we performed a developmental study of cerebellar connections in embryos and juveniles of an advanced shark species, Scyliorhinus canicula, by application of tract tracing in combination with immunohistochemical techniques. Main precerebellar cell populations were located in the diencephalon (pretectum and thalamus), mesencephalon (reticular formation and nucleus ruber), rhombencephalon (cerebellar nucleus, reticular formation, and inferior olive), and spinal cord (ventral horn). The order of arrival of cerebellar afferent projections throughout development revealed a common pattern with other jawed vertebrates, which was helpful for comparison of stages of cerebellar development. The neurochemical study of the inferior olive and other precerebellar nuclei revealed many shared features with other gnathostomes. Furthermore, because many precerebellar nuclei originate from rhombic lips, the first analysis of neuronal migrations from these lips was performed with markers of neuroblasts. The shared features of development and organization of precerebellar connections observed between sharks and amniotes suggest that their basic pattern was established early in gnathostome evolution.

  18. Anatomical correlates of dyslexia: frontal and cerebellar findings.

    PubMed

    Eckert, Mark A; Leonard, Christiana M; Richards, Todd L; Aylward, Elizabeth H; Thomson, Jennifer; Berninger, Virginia W

    2003-02-01

    In this study, we examined the neuroanatomy of dyslexic (14 males, four females) and control (19 males, 13 females) children in grades 4-6 from a family genetics study. The dyslexics had specific deficits in word reading relative to the population mean and verbal IQ, but did not have primary language or motor deficits. Measurements of the posterior temporal lobe, inferior frontal gyrus, cerebellum and whole brain were collected from MRI scans. The dyslexics exhibited significantly smaller right anterior lobes of the cerebellum, pars triangularis bilaterally, and brain volume. Measures of the right cerebellar anterior lobe and the left and right pars triangularis correctly classified 72% of the dyslexic subjects (94% of whom had a rapid automatic naming deficit) and 88% of the controls. The cerebellar anterior lobe and pars triangularis made significant contributions to the classification of subjects after controlling for brain volume. Correlational analyses showed that these neuroanatomical measurements were also significantly correlated with reading, spelling and language measures related to dyslexia. Age was not related to any anatomical variable. Results for the dyslexic children from the family genetics study are discussed with reference to dyslexic adults from a prior study, who were ascertained on the basis of a discrepancy between phonological coding and reading comprehension. The volume of the right anterior lobe of the cerebellum distinguished dyslexic from control participants in both studies. The cerebellum is one of the most consistent locations for structural differences between dyslexic and control participants in imaging studies. This study may be the first to show that anomalies in a cerebellar-frontal circuit are associated with rapid automatic naming and the double-deficit subtype of dyslexia.

  19. Cerebellar Transcranial Direct Current Stimulation (ctDCS)

    PubMed Central

    Grimaldi, Giuliana; Argyropoulos, Georgios P.; Bastian, Amy; Cortes, Mar; Davis, Nicholas J.; Edwards, Dylan J.; Ferrucci, Roberta; Fregni, Felipe; Galea, Joseph M.; Hamada, Masahi; Manto, Mario; Miall, R. Chris; Morales-Quezada, Leon; Pope, Paul A.; Priori, Alberto; Rothwell, John; Tomlinson, S. Paul; Celnik, Pablo

    2016-01-01

    The cerebellum is critical for both motor and cognitive control. Dysfunction of the cerebellum is a component of multiple neurological disorders. In recent years, interventions have been developed that aim to excite or inhibit the activity and function of the human cerebellum. Transcranial direct current stimulation of the cerebellum (ctDCS) promises to be a powerful tool for the modulation of cerebellar excitability. This technique has gained popularity in recent years as it can be used to investigate human cerebellar function, is easily delivered, is well tolerated, and has not shown serious adverse effects. Importantly, the ability of ctDCS to modify behavior makes it an interesting approach with a potential therapeutic role for neurological patients. Through both electrical and non-electrical effects (vascular, metabolic) ctDCS is thought to modify the activity of the cerebellum and alter the output from cerebellar nuclei. Physiological studies have shown a polarity-specific effect on the modulation of cerebellar–motor cortex connectivity, likely via cerebellar–thalamocortical pathways. Modeling studies that have assessed commonly used electrode montages have shown that the ctDCS-generated electric field reaches the human cerebellum with little diffusion to neighboring structures. The posterior and inferior parts of the cerebellum (i.e., lobules VI-VIII) seem particularly susceptible to modulation by ctDCS. Numerous studies have shown to date that ctDCS can modulate motor learning, and affect cognitive and emotional processes. Importantly, this intervention has a good safety profile; similar to when applied over cerebral areas. Thus, investigations have begun exploring ctDCS as a viable intervention for patients with neurological conditions. PMID:25406224

  20. Cerebellar Infarction Presenting with Acute Vestibular Syndrome in Two U.S. Air Force Pilots.

    PubMed

    Hesselbrock, Roger R

    2017-09-01

    Cerebellar infarction is an uncommon but serious cause of isolated acute vestibular symptoms, particularly in young, healthy individuals, and can easily be overlooked. We present two cases of cerebellar infarction in U.S. Air Force pilots, one of which occurred during flight. A 41-yr-old man developed acute vertigo, disequilibrium, nausea, and headache, with progressive slow symptomatic improvement, and presented to medical attention 4 d after symptom onset. Brain magnetic resonance imaging showed right inferomedial cerebellar infarction. Echocardiography discovered patent foramen ovale and atrial septal aneurysm. A 40-yr-old man developed severe vertigo, nausea, and vomiting during initial aircraft descent. Head computed tomography scan was performed acutely and was normal. Initial assessment was benign paroxysmal positional vertigo. Brain magnetic resonance imaging 1 mo after symptom onset showed a small right inferior cerebellar infarction. Patent foramen ovale and bilateral atrial enlargement were seen on echocardiography. Both pilots made full neurological recoveries and were eventually returned to flight status. Central causes of isolated acute vestibular symptoms are uncommon and are often not considered in otherwise healthy individuals. Cerebellar infarction is one of these uncommon but increasingly recognized causes of acute vestibular symptoms. As evaluation and management of central causes are much different from peripheral conditions, prompt localization confirmation is paramount. Accurate evidence-based bedside screening methods are available for rapid localization. Awareness of the possibility of central etiologies and careful clinical evaluation with application of bedside screening methods in patients with acute vestibular symptoms will reduce the number of inaccurate diagnoses.Hesselbrock RR. Cerebellar infarction presenting with acute vestibular syndrome in two U.S. Air Force pilots. Aerosp Med Hum Perform. 2017; 88(9):880-883.

  1. MR imaging evaluation of inferior olivary nuclei: comparison of postoperative subjects with and without posterior fossa syndrome.

    PubMed

    Patay, Z; Enterkin, J; Harreld, J H; Yuan, Y; Löbel, U; Rumboldt, Z; Khan, R; Boop, F

    2014-04-01

    Posterior fossa syndrome is a severe postoperative complication occurring in up to 29% of children undergoing posterior fossa tumor resection; it is most likely caused by bilateral damage to the proximal efferent cerebellar pathways, whose fibers contribute to the Guillain-Mollaret triangle. When the triangle is disrupted, hypertrophic olivary degeneration develops. We hypothesized that MR imaging patterns of inferior olivary nucleus changes reflect patterns of damage to the proximal efferent cerebellar pathways and show association with clinical findings, in particular the presence or absence of posterior fossa syndrome. We performed blinded, randomized longitudinal MR imaging analyses of the inferior olivary nuclei of 12 children with and 12 without posterior fossa syndrome after surgery for midline intraventricular tumor in the posterior fossa. The Fisher exact test was performed to investigate the association between posterior fossa syndrome and hypertrophic olivary degeneration on MR imaging. The sensitivity and specificity of MR imaging findings of bilateral hypertrophic olivary degeneration for posterior fossa syndrome were measured. Of the 12 patients with posterior fossa syndrome, 9 had bilateral inferior olivary nucleus abnormalities. The 12 patients without posterior fossa syndrome had either unilateral or no inferior olivary nucleus abnormalities. The association of posterior fossa syndrome and hypertrophic olivary degeneration was statistically significant (P < .0001). Hypertrophic olivary degeneration may be a surrogate imaging indicator for damage to the contralateral proximal efferent cerebellar pathway. In the appropriate clinical setting, bilateral hypertrophic olivary degeneration may be a sensitive and specific indicator of posterior fossa syndrome.

  2. Acute inferior myocardial infarction due to cannabis smoking in a young man.

    PubMed

    Kocabay, Gonenc; Yildiz, Mustafa; Duran, Nilufer Eksi; Ozkan, Mehmet

    2009-09-01

    Cannabis smoking, which has euphoric effects, is consistently increasing in Europe. Smoking cannabis is a rare trigger of acute myocardial infarction (MI) by inducing coronary artery spasm. Some cases who have thrombus formation in acute coronary artery and no serious atherosclerotic lesions have been reported in the literature. These cases had involved the left coronary artery. Although some cases were reported with MI after cannabis smoking, only two case reports with inferior MI after cannabis smoking were reported in the literature. The present report is of a young male patient who was affected by acute inferior MI half an hour after cannabis smoking.

  3. The cerebellum, cerebellar disorders, and cerebellar research--two centuries of discoveries.

    PubMed

    Manto, Mario

    2008-01-01

    Research on the cerebellum is evolving rapidly. The exquisiteness of the cerebellar circuitry with a unique geometric arrangement has fascinated researchers from numerous disciplines. The painstaking works of pioneers of these last two centuries, such as Rolando, Flourens, Luciani, Babinski, Holmes, Cajal, Larsell, or Eccles, still exert a strong influence in the way we approach cerebellar functions. Advances in genetic studies, detailed molecular and cellular analyses, profusion of brain imaging techniques, emergence of behavioral assessments, and reshaping of models of cerebellar function are generating an immense amount of knowledge. Simultaneously, a better definition of cerebellar disorders encountered in the clinic is emerging. The essentials of a trans-disciplinary blending are expanding. The analysis of the literature published these last two decades indicates that the gaps between domains of research are vanishing. The launch of the society for research on the cerebellum (SRC) illustrates how cerebellar research is burgeoning. This special issue gathers the contributions of the inaugural conference of the SRC dedicated to the mechanisms of cerebellar function. Contributions were brought together around five themes: (1) cerebellar development, death, and regeneration; (2) cerebellar circuitry: processing and function; (3) mechanisms of cerebellar plasticity and learning; (4) cerebellar function: timing, prediction, and/or coordination?; (5) anatomical and disease perspectives on cerebellar function.

  4. How I Do It: Medial Flap Inferior Turbinoplasty.

    PubMed

    Barham, Henry P; Knisely, Anna; Harvey, Richard J; Sacks, Raymond

    2015-01-01

    Techniques for inferior turbinate reduction vary from complete turbinectomy to limited cauterization. Surgical methods differ on the degree of tissue reduction and reliance on surgical tissue removal versus tissue ablation. The technique and surgical steps of our preferred method of turbinate reduction are presented. Critical steps include proper design of the medial flap and removal of turbinate bone and lateral mucosa to allow lateral positioning of the medial flap. Bipolar cautery of the inferior turbinate artery branches allows complete haemostasis and undermining of the head allows proper debulking of the anterior aspect of the turbinate and widening of the nasal valve area. The medial flap inferior turbinoplasty provides consistent, robust results. Long-term relief of obstructive symptoms without additional risk of complication is expected with this procedure.

  5. Learning of Sensory Sequences in Cerebellar Patients

    ERIC Educational Resources Information Center

    Frings, Markus; Boenisch, Raoul; Gerwig, Marcus; Diener, Hans-Christoph; Timmann, Dagmar

    2004-01-01

    A possible role of the cerebellum in detecting and recognizing event sequences has been proposed. The present study sought to determine whether patients with cerebellar lesions are impaired in the acquisition and discrimination of sequences of sensory stimuli of different modalities. A group of 26 cerebellar patients and 26 controls matched for…

  6. Acute cerebellar ataxia and infectious mononucleosis.

    PubMed Central

    Wadhwa, N. K.; Ghose, R. R.

    1983-01-01

    A 28-year-old man, who presented with acute cerebellar ataxia, was found to have haematological features of infectious mononucleosis. There was serological evidence of recent infection with Epstein-Barr virus. It is speculated that cerebellar dysfunction results from virus-induced inflammatory changes within the central nervous system. PMID:6312442

  7. Familial cerebellar ataxia and diabetes insipidus.

    PubMed Central

    Robinson, I C; O'Malley, B P; Young, I D

    1988-01-01

    Two sisters are reported who both developed partial cranial diabetes insipidus in their 4th decade, followed by progressive cerebellar ataxia. This appears to be the first report of cerebellar ataxia and diabetes insipidus occurring together as a genetic entity. PMID:3221226

  8. Learning of Sensory Sequences in Cerebellar Patients

    ERIC Educational Resources Information Center

    Frings, Markus; Boenisch, Raoul; Gerwig, Marcus; Diener, Hans-Christoph; Timmann, Dagmar

    2004-01-01

    A possible role of the cerebellum in detecting and recognizing event sequences has been proposed. The present study sought to determine whether patients with cerebellar lesions are impaired in the acquisition and discrimination of sequences of sensory stimuli of different modalities. A group of 26 cerebellar patients and 26 controls matched for…

  9. Consensus Paper: Management of Degenerative Cerebellar Disorders

    PubMed Central

    Ilg, W.; Bastian, A. J.; Boesch, S.; Burciu, R. G.; Celnik, P.; Claaßen, J.; Feil, K.; Kalla, R.; Miyai, I.; Nachbauer, W.; Schöls, L.; Strupp, M.; Synofzik, M.; Teufel, J.

    2015-01-01

    Treatment of motor symptoms of degenerative cerebellar ataxia remains difficult. Yet there are recent developments that are likely to lead to significant improvements in the future. Most desirable would be a causative treatment of the underlying cerebellar disease. This is currently available only for a very small subset of cerebellar ataxias with known metabolic dysfunction. However, increasing knowledge of the pathophysiology of hereditary ataxia should lead to an increasing number of medically sensible drug trials. In this paper, data from recent drug trials in patients with recessive and dominant cerebellar ataxias will be summarized. There is consensus that up to date, no medication has been proven effective. Aminopyridines and acetazolamide are the only exception, which are beneficial in patients with episodic ataxia type 2. Aminopyridines are also effective in a subset of patients presenting with downbeat nystagmus. As such, all authors agreed that the mainstays of treatment of degenerative cerebellar ataxia are currently physiotherapy, occupational therapy, and speech therapy. For many years, well-controlled rehabilitation studies in patients with cerebellar ataxia were lacking. Data of recently published studies show that coordinative training improves motor function in both adult and juvenile patients with cerebellar degeneration. Given the well-known contribution of the cerebellum to motor learning, possible mechanisms underlying improvement will be outlined. There is consensus that evidence-based guidelines for the physiotherapy of degenerative cerebellar ataxia need to be developed. Future developments in physiotherapeutical interventions will be discussed including application of non-invasive brain stimulation. PMID:24222635

  10. Metronidazole-Induced Cerebellar Toxicity

    PubMed Central

    Agarwal, Amit; Kanekar, Sangam; Sabat, Shyam; Thamburaj, Krishnamurthy

    2016-01-01

    Metronidazole is a very common antibacterial and antiprotozoal with wide usage across the globe, including the least developed countries. It is generally well-tolerated with a low incidence of serious side-effects. Neurological toxicity is fairly common with this drug, however majority of these are peripheral neuropathy with very few cases of central nervous toxicity reported. We report the imaging findings in two patients with cerebellar dysfunction after Metronidazole usage. Signal changes in the dentate and red nucleus were seen on magnetic resonance imaging in these patients. Most of the cases reported in literature reported similar findings, suggesting high predilection for the dentate nucleus in metronidazole induced encephalopathy. PMID:27127600

  11. Cellular and molecular basis of cerebellar development

    PubMed Central

    Martinez, Salvador; Andreu, Abraham; Mecklenburg, Nora; Echevarria, Diego

    2013-01-01

    Historically, the molecular and cellular mechanisms of cerebellar development were investigated through structural descriptions and studying spontaneous mutations in animal models and humans. Advances in experimental embryology, genetic engineering, and neuroimaging techniques render today the possibility to approach the analysis of molecular mechanisms underlying histogenesis and morphogenesis of the cerebellum by experimental designs. Several genes and molecules were identified to be involved in the cerebellar plate regionalization, specification, and differentiation of cerebellar neurons, as well as the establishment of cellular migratory routes and the subsequent neuronal connectivity. Indeed, pattern formation of the cerebellum requires the adequate orchestration of both key morphogenetic signals, arising from distinct brain regions, and local expression of specific transcription factors. Thus, the present review wants to revisit and discuss these morphogenetic and molecular mechanisms taking place during cerebellar development in order to understand causal processes regulating cerebellar cytoarchitecture, its highly topographically ordered circuitry and its role in brain function. PMID:23805080

  12. Cerebellar Stroke-manifesting as Mania

    PubMed Central

    Jagadesan, Venkatesan; Thiruvengadam, Kannapiran R.; Muralidharan, Rengarajalu

    2014-01-01

    Secondary mania resulting from cerebral Cortex are described commonly. But secondary mania produced by cerebellar lesions are relatively uncommon. This case report describes a patient who developed cerebellar stoke and manic features simultaneously. 28 years old male developed giddiness and projectile vomiting. Then he would lie down for about an hour only to find that he could not walk. He became quarrelsome. His Psycho motor activities and speech were increased. He was euphoric and was expressing grandiose ideas. Bender Gestalt Test showed signs of organicity. Score in Young mania relating scale was 32; productivity was low in Rorschach. Neurological examination revealed left cerebellar signs like ataxia and slurring of speech. Computed tomography of brain showed left cerebellar infarct. Relationship between Psychiatric manifestations and cerebellar lesion are discussed. PMID:25035567

  13. Inferior ST-Elevation Myocardial Infarction Associated with Takotsubo Cardiomyopathy

    PubMed Central

    Koeth, Oliver; Zeymer, Uwe; Schiele, Rudolf; Zahn, Ralf

    2010-01-01

    Takotsubo cardiomyopathy (TCM) is usually characterized by transient left ventricular apical ballooning. Due to the clinical symptoms which include chest pain, electrocardiographic changes, and elevated myocardial markers, Takotsubo cardiomyopathy is frequently mimicking ST-elevation myocardial infarction in the absence of a significant coronary artery disease. Otherwise an acute occlusion of the left anterior descending coronary artery can produce a typical Takotsubo contraction pattern. ST-elevation myocardial infarction (STEMI) is frequently associated with emotional stress, but to date no cases of STEMI triggering TCM have been reported. We describe a case of a female patient with inferior ST-elevation myocardial infarction complicated by TCM. PMID:20811565

  14. Diffusion Tensor Imaging Demonstrates Brainstem and Cerebellar Abnormalities in Congenital Central Hypoventilation Syndrome

    PubMed Central

    Kumar, Rajesh; Macey, Paul M.; Woo, Mary A.; Alger, Jeffry R.; Harper, Ronald M.

    2008-01-01

    Congenital central hypoventilation syndrome (CCHS) patients show reduced breathing drive during sleep, decreased hypoxic and hypercapnic ventilatory responses, and autonomic and affective deficits, suggesting both brainstem and forebrain injuries. Forebrain damage was previously described in CCHS, but methodological limitations precluded detection of brainstem injury, a concern because genetic mutations in CCHS target brainstem autonomic nuclei. To assess brainstem and cerebellar areas, we used diffusion tensor imaging-based measures, namely axial diffusivity, reflecting water diffusion parallel to fibers, and sensitive to axonal injury, and radial diffusivity, measuring diffusion perpendicular to fibers, and indicative of myelin injury. Diffusion tensor imaging was performed in 12 CCHS and 26 controls, and axial and radial diffusivity maps were compared between groups using analysis of covariance (covariates; age and gender). Increased axial diffusivity in CCHS appeared within the lateral medulla and clusters with injury extended from the dorsal midbrain through the periaqueductal gray, raphé, and superior cerebellar decussation, ventrally to the basal-pons. Cerebellar cortex and deep nuclei, and the superior and inferior cerebellar peduncles showed increased radial diffusivity. Midbrain, pontine, and lateral medullary structures, and the cerebellum and its fiber systems are injured in CCHS, likely contributing to the characteristics found in the syndrome. PMID:18458651

  15. Neuroprotective Role of Liver Growth Factor “LGF” in an Experimental Model of Cerebellar Ataxia

    PubMed Central

    Calatrava-Ferreras, Lucía; Gonzalo-Gobernado, Rafael; Reimers, Diana; Herranz, Antonio S.; Jiménez-Escrig, Adriano; Díaz-Gil, Juan José; Casarejos, María José; Montero-Vega, María Teresa; Bazán, Eulalia

    2014-01-01

    Cerebellar ataxias (CA) comprise a heterogeneous group of neurodegenerative diseases characterized by a lack of motor coordination. They are caused by disturbances in the cerebellum and its associated circuitries, so the major therapeutic goal is to correct cerebellar dysfunction. Neurotrophic factors enhance the survival and differentiation of selected types of neurons. Liver growth factor (LGF) is a hepatic mitogen that shows biological activity in neuroregenerative therapies. We investigate the potential therapeutic activity of LGF in the 3-acetylpiridine (3-AP) rat model of CA. This model of CA consists in the lesion of the inferior olive-induced by 3-AP (40 mg/kg). Ataxic rats were treated with 5 µg/rat LGF or vehicle during 3 weeks, analyzing: (a) motor coordination by using the rota-rod test; and (b) the immunohistochemical and biochemical evolution of several parameters related with the olivo-cerebellar function. Motor coordination improved in 3-AP-lesioned rats that received LGF treatment. LGF up-regulated NeuN and Bcl-2 protein levels in the brainstem, and increased calbindin expression and the number of neurons receiving calbindin-positive projections in the cerebellum. LGF also reduced extracellular glutamate and GABA concentrations and microglia activation in the cerebellum. In view of these results, we propose LGF as a potential therapeutic agent in cerebellar ataxias. PMID:25338046

  16. A cerebellar model for predictive motor control tested in a brain-based device.

    PubMed

    McKinstry, Jeffrey L; Edelman, Gerald M; Krichmar, Jeffrey L

    2006-02-28

    The cerebellum is known to be critical for accurate adaptive control and motor learning. We propose here a mechanism by which the cerebellum may replace reflex control with predictive control. This mechanism is embedded in a learning rule (the delayed eligibility trace rule) in which synapses onto a Purkinje cell or onto a cell in the deep cerebellar nuclei become eligible for plasticity only after a fixed delay from the onset of suprathreshold presynaptic activity. To investigate the proposal that the cerebellum is a general-purpose predictive controller guided by a delayed eligibility trace rule, a computer model based on the anatomy and dynamics of the cerebellum was constructed. It contained components simulating cerebellar cortex and deep cerebellar nuclei, and it received input from a middle temporal visual area and the inferior olive. The model was incorporated in a real-world brain-based device (BBD) built on a Segway robotic platform that learned to traverse curved paths. The BBD learned which visual motion cues predicted impending collisions and used this experience to avoid path boundaries. During learning, the BBD adapted its velocity and turning rate to successfully traverse various curved paths. By examining neuronal activity and synaptic changes during this behavior, we found that the cerebellar circuit selectively responded to motion cues in specific receptive fields of simulated middle temporal visual areas. The system described here prompts several hypotheses about the relationship between perception and motor control and may be useful in the development of general-purpose motor learning systems for machines.

  17. Cerebellar contributions to episodic memory encoding as revealed by fMRI.

    PubMed

    Fliessbach, Klaus; Trautner, Peter; Quesada, Carlos M; Elger, Christian E; Weber, Bernd

    2007-04-15

    Event-related functional Magnetic Resonance Imaging (fMRI) allows for the comparison of hemodynamic responses evoked by items that are remembered in a subsequent memory task vs. items that are forgotten. In this way, brain regions that assumingly contribute to successful memory encoding have been identified, including the left inferior prefrontal cortex (LIPC) and the medial temporal lobe. Although a cerebellar involvement in verbal working memory is well-established, a contribution of the cerebellum to episodic long-term encoding has only sporadically been described, and mechanisms underlying cerebellar memory effects are unclear. We conducted a typical incidental verbal memory fMRI experiment with three different encoding tasks varying the depth of semantic processing. Slice positioning allowed for the coverage of the entire cerebellum. We observed a significant subsequent memory effect within the superior and posterior right cerebellar hemisphere that was task independent. Additionally, we found a different area within the superior right cerebellum displaying a memory effect specifically for semantically processed words and a bilateral cerebellar activation specifically associated with encoding success only for a non-semantic task. Our results suggest that besides its known role in verbal working memory, the cerebellum contributes to episodic long-term encoding and should therefore be considered in future fMRI studies dealing with episodic memory.

  18. Cerebro-cerebellar Resting-State Functional Connectivity in Children and Adolescents with Autism Spectrum Disorder.

    PubMed

    Khan, Amanda J; Nair, Aarti; Keown, Christopher L; Datko, Michael C; Lincoln, Alan J; Müller, Ralph-Axel

    2015-11-01

    The cerebellum plays important roles in sensori-motor and supramodal cognitive functions. Cellular, volumetric, and functional abnormalities of the cerebellum have been found in autism spectrum disorders (ASD), but no comprehensive investigation of cerebro-cerebellar connectivity in ASD is available. We used resting-state functional connectivity magnetic resonance imaging in 56 children and adolescents (28 subjects with ASD, 28 typically developing subjects) 8-17 years old. Partial and total correlation analyses were performed for unilateral regions of interest (ROIs), distinguished in two broad domains as sensori-motor (premotor/primary motor, somatosensory, superior temporal, and occipital) and supramodal (prefrontal, posterior parietal, and inferior and middle temporal). There were three main findings: 1) Total correlation analyses showed predominant cerebro-cerebellar functional overconnectivity in the ASD group; 2) partial correlation analyses that emphasized domain specificity (sensori-motor vs. supramodal) indicated a pattern of robustly increased connectivity in the ASD group (compared with the typically developing group) for sensori-motor ROIs but predominantly reduced connectivity for supramodal ROIs; and 3) this atypical pattern of connectivity was supported by significantly increased noncanonical connections (between sensori-motor cerebral and supramodal cerebellar ROIs and vice versa) in the ASD group. Our findings indicate that sensori-motor intrinsic functional connectivity is atypically increased in ASD, at the expense of connectivity supporting cerebellar participation in supramodal cognition. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  19. Is there a cerebellar compensatory effort in first-episode, treatment-naive major depressive disorder at rest?

    PubMed

    Guo, Wenbin; Liu, Feng; Liu, Jianrong; Yu, Liuyu; Zhang, Zhikun; Zhang, Jian; Chen, Huafu; Xiao, Changqing

    2013-10-01

    This study was undertaken to explore whether there is a cerebellar compensatory response in patients with first-episode, treatment-naive major depressive disorder (MDD). The cerebellar compensatory response is defined as a cerebellar hyperactivity which would be inversely correlated with both the activation of the functionally connected cerebral regions and the depression severity. Resting-state functional magnetic resonance imaging (fMRI) data of 24 patients with MDD and 24 healthy subjects were analyzed with the fractional amplitude of low-frequency fluctuations (fALFF) and functional connectivity (FC) methods. The structural images were processed with the voxel-based morphometry (VBM) method. Compared to healthy controls, depressed patients had significantly increased fALFF in the left Crus I and the left cerebellar lobule VI. FC analysis of these two seeded regions found that depressed patients had increased FC between the left Crus I and the right hippocampus, but had decreased FC between the left Crus I and the left inferior parietal lobule (IPL), and between the left cerebellar lobule VI and bilateral inferior temporal gyrus. No correlation was observed between the abnormal fALFF of the seeds and their connected regions and the depression severity or the executive function. The VBM results did not show significant reduction in gray or white matter volume in any above-mentioned region. Our findings suggest that increased cerebellar activity at resting state may be a disease state phenomenon but not a compensatory response to the dysfunction of the default mode network (DMN) in MDD. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. An unusual origin of supernumerary renal arteries: case report.

    PubMed

    Asala, S A; Masumbuko-Kahamba, N; Bidmos, M A

    2001-12-01

    Patent left and right supernumerary inferior polar renal arteries were found in a dissection room cadaver. Both arteries originated from the left common iliac artery. This is an unusual form of origin of these arteries in the presence of an apparently normal ascent and position of the two kidneys.

  1. Active integration of glutamatergic input to the inferior olive generates bidirectional postsynaptic potentials

    PubMed Central

    Garden, Derek L. F.; Rinaldi, Arianna

    2016-01-01

    Key points We establish experimental preparations for optogenetic investigation of glutamatergic input to the inferior olive.Neurones in the principal olivary nucleus receive monosynaptic extra‐somatic glutamatergic input from the neocortex.Glutamatergic inputs to neurones in the inferior olive generate bidirectional postsynaptic potentials (PSPs), with a fast excitatory component followed by a slower inhibitory component.Small conductance calcium‐activated potassium (SK) channels are required for the slow inhibitory component of glutamatergic PSPs and oppose temporal summation of inputs at intervals ≤ 20 ms.Active integration of synaptic input within the inferior olive may play a central role in control of olivo‐cerebellar climbing fibre signals. Abstract The inferior olive plays a critical role in motor coordination and learning by integrating diverse afferent signals to generate climbing fibre inputs to the cerebellar cortex. While it is well established that climbing fibre signals are important for motor coordination, the mechanisms by which neurones in the inferior olive integrate synaptic inputs and the roles of particular ion channels are unclear. Here, we test the hypothesis that neurones in the inferior olive actively integrate glutamatergic synaptic inputs. We demonstrate that optogenetically activated long‐range synaptic inputs to the inferior olive, including projections from the motor cortex, generate rapid excitatory potentials followed by slower inhibitory potentials. Synaptic projections from the motor cortex preferentially target the principal olivary nucleus. We show that inhibitory and excitatory components of the bidirectional synaptic potentials are dependent upon AMPA (GluA) receptors, are GABAA independent, and originate from the same presynaptic axons. Consistent with models that predict active integration of synaptic inputs by inferior olive neurones, we find that the inhibitory component is reduced by blocking large conductance

  2. Active integration of glutamatergic input to the inferior olive generates bidirectional postsynaptic potentials.

    PubMed

    Garden, Derek L F; Rinaldi, Arianna; Nolan, Matthew F

    2017-02-15

    We establish experimental preparations for optogenetic investigation of glutamatergic input to the inferior olive. Neurones in the principal olivary nucleus receive monosynaptic extra-somatic glutamatergic input from the neocortex. Glutamatergic inputs to neurones in the inferior olive generate bidirectional postsynaptic potentials (PSPs), with a fast excitatory component followed by a slower inhibitory component. Small conductance calcium-activated potassium (SK) channels are required for the slow inhibitory component of glutamatergic PSPs and oppose temporal summation of inputs at intervals ≤ 20 ms. Active integration of synaptic input within the inferior olive may play a central role in control of olivo-cerebellar climbing fibre signals. The inferior olive plays a critical role in motor coordination and learning by integrating diverse afferent signals to generate climbing fibre inputs to the cerebellar cortex. While it is well established that climbing fibre signals are important for motor coordination, the mechanisms by which neurones in the inferior olive integrate synaptic inputs and the roles of particular ion channels are unclear. Here, we test the hypothesis that neurones in the inferior olive actively integrate glutamatergic synaptic inputs. We demonstrate that optogenetically activated long-range synaptic inputs to the inferior olive, including projections from the motor cortex, generate rapid excitatory potentials followed by slower inhibitory potentials. Synaptic projections from the motor cortex preferentially target the principal olivary nucleus. We show that inhibitory and excitatory components of the bidirectional synaptic potentials are dependent upon AMPA (GluA) receptors, are GABAA independent, and originate from the same presynaptic axons. Consistent with models that predict active integration of synaptic inputs by inferior olive neurones, we find that the inhibitory component is reduced by blocking large conductance calcium

  3. White matter integrity of cerebellar-cortical tracts in reading impaired children: A probabilistic tractography study

    PubMed Central

    Fernandez, Vindia G.; Juranek, Jenifer; Romanowska-Pawliczek, Anna; Stuebing, Karla; Williams, Victoria J.; Fletcher, Jack M.

    2016-01-01

    Little is known about the white matter integrity of cerebellar-cortical pathways in individuals with dyslexia. Building on previous findings of decreased volume in the anterior lobe of the cerebellum, we utilized novel cerebellar segmentation procedures and probabilistic tractography to examine tracts that connect the anterior lobe of the cerebellum and cortical regions typically associated with reading: the temporoparietal (TP), occipitotemporal (OT), and inferior frontal (IF) regions. The sample included 29 reading impaired children and 27 typical readers. We found greater fractional anisotropy (FA) for the poor readers in tracts connecting the cerebellum with TP and IF regions relative to typical readers. In the OT region, FA was greater for the older poor readers, but smaller for the younger ones. This study provides evidence for discrete, regionally-bound functions of the cerebellum and suggests that projections from the anterior cerebellum appear to have a regulatory effect on cortical pathways important for reading. PMID:26307492

  4. Atypical Activations of Fronto-Cerebellar Regions During Forethought in Parents of Children With ADHD.

    PubMed

    Rapin, Lucile; Poissant, Hélène; Mendrek, Adrianna

    2017-10-01

    Although several studies suggest heritability of ADHD, only a few investigations of possible associations between people at risk and neural abnormalities in ADHD exist. In this study, we tested whether parents of children with ADHD would show atypical patterns of cerebral activations during forethought, a feature of working memory. Using Functional Magnetic Resonance Imaging (fMRI), we compared 12 parents of children with ADHD and 9 parents of control children during a forethought task. Parents of children with ADHD exhibited significantly increased neural activations in the posterior lobes of the cerebellum and in the left inferior frontal gyrus, relative to parents of control children. These findings are consistent with previous reports in children and suggest the fronto-cerebellar circuit's abnormalities during forethought in parents of children with ADHD. Future studies of people at risk of ADHD are needed to fully understand the extent of the fronto-cerebellar heritability.

  5. [Memory transfer in cerebellar motor learning].

    PubMed

    Nagao, Soichi

    2012-01-01

    Most of our motor skills are acquired through learning. Experiments of gain adaptation of ocular reflexes have consistently suggested that the memory of adaptation is initially formed in the cerebellar cortex, and is transferred to the cerebellar (vestibular) nuclei for consolidation to long-term memory after repetitions of training. We have recently developed a new system to evaluate the motor learning in human subjects using prism adaptation of hand reaching movement, by referring to the prism adaptation of dart throwing of Martin et al. (1996). In our system, the subject views the small target presented in the touch-panel screen, and touches it with his/her finger without direct visual feedback. After 15-30 trials of touching wearing prisms, an adaptation occurs in healthy subjects: they became able to touch the target correctly. Meanwhile, such an adaptation was impaired in patients of cerebellar disease. We have proposed a model of human prism adaptation that the memory of adaptation is initially encoded in the cerebellar cortex, and is later transferred to the cerebellar nuclei after repetitions of training. The memory in the cerebellar cortex may be formed and extinguished independently of the memory maintained in the cerebellar nuclei, and these two memories work cooperatively.

  6. Cerebellar Motor Function in Spina Bifida Meningomyelocele

    PubMed Central

    Dennis, Maureen; Salman, Michael S.; Juranek, Jenifer; Fletcher, Jack M.

    2010-01-01

    Spina bifida meningomyelocele (SBM), a congenital neurodevelopmental disorder, involves dysmorphology of the cerebellum, and its most obvious manifestations are motor deficits. This paper reviews cerebellar neuropathology and motor function across several motor systems well studied in SBM in relation to current models of cerebellar motor and timing function. Children and adults with SBM have widespread motor deficits in trunk, upper limbs, eyes, and speech articulators that are broadly congruent with those observed in adults with cerebellar lesions. The structure and function of the cerebellum are correlated with a range of motor functions. While motor learning is generally preserved in SBM, those motor functions requiring predictive signals and precise calibration of the temporal features of movement are impaired, resulting in deficits in smooth movement coordination as well as in the classical cerebellar triad of dysmetria, ataxia, and dysarthria. That motor function in individuals with SBM is disordered in a manner phenotypically similar to that in adult cerebellar lesions, and appears to involve similar deficits in predictive cerebellar motor control, suggests that age-based cerebellar motor plasticity is limited in individuals with this neurodevelopmental disorder. PMID:20652468

  7. Topography of cerebellar deficits in humans.

    PubMed

    Grimaldi, Giuliana; Manto, Mario

    2012-06-01

    The cerebellum is a key-piece for information processing and is involved in numerous motor and nonmotor activities, thanks to the anatomical characteristics of the circuitry, the enormous computational capabilities and the high connectivity to other brain areas. Despite its uniform cytoarchitecture, cerebellar circuitry is segregated into functional zones. This functional parcellation is driven by the connectivity and the anatomo-functional heterogeneity of the numerous extra-cerebellar structures linked to the cerebellum, principally brain cortices, precerebellar nuclei and spinal cord. Major insights into cerebellar functions have been gained with a detailed analysis of the cerebellar outputs, with the evidence that fundamental aspects of cerebrocerebellar operations are the closed-loop circuit and the predictions of future states. Cerebellar diseases result in disturbances of accuracy of movements and lack of coordination. The cerebellar syndrome includes combinations of oculomotor disturbances, dysarthria and other speech deficits, ataxia of limbs, ataxia of stance and gait, as well as often more subtle cognitive/behavioral impairments. Our understanding of the corresponding anatomo-functional maps for the human cerebellum is continuously improving. We summarize the topography of the clinical deficits observed in cerebellar patients and the growing evidence of a regional subdivision into motor, sensory, sensorimotor, cognitive and affective domains. The recently described topographic dichotomy motor versus nonmotor cerebellum based upon anatomical, functional and neuropsychological studies is also discussed.

  8. Factors involved in the antinatriuretic effects of acute constriction of the thoracic and abdominal inferior vena cava.

    NASA Technical Reports Server (NTRS)

    Schrier, R. W.; Humphreys, M. H.

    1971-01-01

    Study of the antinatriuretic effect of acute thoracic inferior vena cava (TIVC) constriction in the absence of alterations in renal perfusion pressure. A comparison is made of the effects of equivalent degrees of TIVC and abdominal inferior vena cava constriction on arterial pressure, renal hemodynamics, and electrolyte excretion.

  9. Memory trace of motor learning shifts transsynaptically from cerebellar cortex to nuclei for consolidation.

    PubMed

    Shutoh, F; Ohki, M; Kitazawa, H; Itohara, S; Nagao, S

    2006-05-12

    Adaptation of ocular reflexes is a prototype of motor learning. While the cerebellum is acknowledged as the critical site for motor learning, the functional differences between the cerebellar cortex and nuclei in motor memory formation are not precisely known. Two different views are proposed: one that the memory is formed within the cerebellar flocculus, and the other that the memory is formed within vestibular nuclei. Here we developed a new paradigm of long-term adaptation of mouse horizontal optokinetic response eye movements and examined the location of its memory trace. We also tested the role of flocculus and inferior olive in long-term adaptation by chronic lesion experiments. Reversible bilateral flocculus shutdown with local application of 0.5 microl-5% lidocaine extinguished the memory trace of day-long adaptation, while it very little affected the memory trace of week-long adaptation. The responsiveness of vestibular nuclei after week-long adaptation was examined by measuring the extracellular field responses to the electrical stimulation of vestibular nerve under trichloroacetaldehyde anesthesia. The amplitudes and slopes of evoked monosynaptic field response (N1) of week-long adapted mice were enhanced around the medial vestibular nucleus compared with those of control mice. Chronic flocculus or inferior olive lesions abolished both day and week-long adaptations. These results suggest that the functional memory trace of short-term adaptation is formed initially within the cerebellar cortex, and later transferred to vestibular nuclei to be consolidated to a long-term memory. Both day and week-long adaptations were markedly depressed when neural nitric oxide was pharmacologically blocked locally and when neuronal nitric oxide synthase was ablated by gene knockout, suggesting that cerebellar long-term depression underlies both acquisition and consolidation of motor memory.

  10. Simulation of the Inferior Mirage

    NASA Astrophysics Data System (ADS)

    Branca, Mario

    2010-09-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior" mirage.2 The most common example of an inferior mirage is when, on a hot day, a stretch of dry road off in the distance appears to be wet (see Fig. 1). Many lab activities have been described that simulate the formation of superior mirages. In these demonstrations light beams curve downward as they pass through a nonuni-form fluid.3-6 Much less common are laboratory demonstrations of upward-curving light rays of the kind responsible for inferior mirages. This paper describes a simple version of such a demonstration.

  11. Sonic hedgehog patterning during cerebellar development.

    PubMed

    De Luca, Annarita; Cerrato, Valentina; Fucà, Elisa; Parmigiani, Elena; Buffo, Annalisa; Leto, Ketty

    2016-01-01

    The morphogenic factor sonic hedgehog (Shh) actively orchestrates many aspects of cerebellar development and maturation. During embryogenesis, Shh signaling is active in the ventricular germinal zone (VZ) and represents an essential signal for proliferation of VZ-derived progenitors. Later, Shh secreted by Purkinje cells sustains the amplification of postnatal neurogenic niches: the external granular layer and the prospective white matter, where excitatory granule cells and inhibitory interneurons are produced, respectively. Moreover, Shh signaling affects Bergmann glial differentiation and promotes cerebellar foliation during development. Here we review the most relevant functions of Shh during cerebellar ontogenesis, underlying its role in physiological and pathological conditions.

  12. Cerebellar cortex development in the weaver condition presents regional and age-dependent abnormalities without differences in Purkinje cells neurogenesis.

    PubMed

    Martí, Joaquín; Santa-Cruz, María C; Hervás, José P; Bayer, Shirley A; Villegas, Sandra

    2016-01-01

    Ataxias are neurological disorders associated with the degeneration of Purkinje cells (PCs). Homozygous weaver mice (wv/wv) have been proposed as a model for hereditary cerebellar ataxia because they present motor abnormalities and PC loss. To ascertain the physiopathology of the weaver condition, the development of the cerebellar cortex lobes was examined at postnatal day (P): P8, P20 and P90. Three approaches were used: 1) quantitative determination of several cerebellar features; 2) qualitative evaluation of the developmental changes occurring in the cortical lobes; and 3) autoradiographic analyses of PC generation and placement. Our results revealed a reduction in the size of the wv/wv cerebellum as a whole, confirming previous results. However, as distinguished from these reports, we observed that quantified parameters contribute differently to the abnormal growth of the wv/wv cerebellar lobes. Qualitative analysis showed anomalies in wv/wv cerebellar cytoarchitecture, depending on the age and lobe analyzed. Such abnormalities included the presence of the external granular layer after P20 and, at P90, ectopic cells located in the molecular layer following several placement patterns. Finally, we obtained autoradiographic evidence that wild-type and wv/wv PCs presented similar neurogenetic timetables, as reported. However, the innovative character of this current work lies in the fact that the neurogenetic gradients of wv/wv PCs were not modified from P8 to P90. A tendency for the accumulation of late-formed PCs in the anterior and posterior lobes was found, whereas early-generated PCs were concentrated in the central and inferior lobes. These data suggested that wv/wv PCs may migrate properly to their final destinations. The extrapolation of our results to patients affected with cerebellar ataxias suggests that all cerebellar cortex lobes are affected with several age-dependent alterations in cytoarchitectonics. We also propose that PC loss may be regionally

  13. Cortical Amyloid Beta in Cognitively Normal Elderly Adults is Associated with Decreased Network Efficiency within the Cerebro-Cerebellar System

    PubMed Central

    Steininger, Stefanie C.; Liu, Xinyang; Gietl, Anton; Wyss, Michael; Schreiner, Simon; Gruber, Esmeralda; Treyer, Valerie; Kälin, Andrea; Leh, Sandra; Buck, Alfred; Nitsch, Roger M.; Prüssmann, Klaas P.; Hock, Christoph; Unschuld, Paul G.

    2014-01-01

    Background: Deposition of cortical amyloid beta (Aβ) is a correlate of aging and a risk factor for Alzheimer disease (AD). While several higher order cognitive processes involve functional interactions between cortex and cerebellum, this study aims to investigate effects of cortical Aβ deposition on coupling within the cerebro-cerebellar system. Methods: We included 15 healthy elderly subjects with normal cognitive performance as assessed by neuropsychological testing. Cortical Aβ was quantified using (11)carbon-labeled Pittsburgh compound B positron-emission-tomography late frame signals. Volumes of brain structures were assessed by applying an automated parcelation algorithm to three dimensional magnetization-prepared rapid gradient-echo T1-weighted images. Basal functional network activity within the cerebro-cerebellar system was assessed using blood-oxygen-level dependent resting state functional magnetic resonance imaging at the high field strength of 7 T for measuring coupling between cerebellar seeds and cerebral gray matter. A bivariate regression approach was applied for identification of brain regions with significant effects of individual cortical Aβ load on coupling. Results: Consistent with earlier reports, a significant degree of positive and negative coupling could be observed between cerebellar seeds and cerebral voxels. Significant positive effects of cortical Aβ load on cerebro-cerebellar coupling resulted for cerebral brain regions located in inferior temporal lobe, prefrontal cortex, hippocampus, parahippocampal gyrus, and thalamus. Conclusion: Our findings indicate that brain amyloidosis in cognitively normal elderly subjects is associated with decreased network efficiency within the cerebro-cerebellar system. While the identified cerebral regions are consistent with established patterns of increased sensitivity for Aβ-associated neurodegeneration, additional studies are needed to elucidate the relationship between dysfunction of the

  14. Cortical Amyloid Beta in Cognitively Normal Elderly Adults is Associated with Decreased Network Efficiency within the Cerebro-Cerebellar System.

    PubMed

    Steininger, Stefanie C; Liu, Xinyang; Gietl, Anton; Wyss, Michael; Schreiner, Simon; Gruber, Esmeralda; Treyer, Valerie; Kälin, Andrea; Leh, Sandra; Buck, Alfred; Nitsch, Roger M; Prüssmann, Klaas P; Hock, Christoph; Unschuld, Paul G

    2014-01-01

    Deposition of cortical amyloid beta (Aβ) is a correlate of aging and a risk factor for Alzheimer disease (AD). While several higher order cognitive processes involve functional interactions between cortex and cerebellum, this study aims to investigate effects of cortical Aβ deposition on coupling within the cerebro-cerebellar system. We included 15 healthy elderly subjects with normal cognitive performance as assessed by neuropsychological testing. Cortical Aβ was quantified using (11)carbon-labeled Pittsburgh compound B positron-emission-tomography late frame signals. Volumes of brain structures were assessed by applying an automated parcelation algorithm to three dimensional magnetization-prepared rapid gradient-echo T1-weighted images. Basal functional network activity within the cerebro-cerebellar system was assessed using blood-oxygen-level dependent resting state functional magnetic resonance imaging at the high field strength of 7 T for measuring coupling between cerebellar seeds and cerebral gray matter. A bivariate regression approach was applied for identification of brain regions with significant effects of individual cortical Aβ load on coupling. Consistent with earlier reports, a significant degree of positive and negative coupling could be observed between cerebellar seeds and cerebral voxels. Significant positive effects of cortical Aβ load on cerebro-cerebellar coupling resulted for cerebral brain regions located in inferior temporal lobe, prefrontal cortex, hippocampus, parahippocampal gyrus, and thalamus. Our findings indicate that brain amyloidosis in cognitively normal elderly subjects is associated with decreased network efficiency within the cerebro-cerebellar system. While the identified cerebral regions are consistent with established patterns of increased sensitivity for Aβ-associated neurodegeneration, additional studies are needed to elucidate the relationship between dysfunction of the cerebro-cerebellar system and risk for AD.

  15. Cystic cerebellar astrocytomas in childhood.

    PubMed

    Griffin, T W; Beaufait, D; Blasko, J C

    1979-07-01

    Thirty-nine patients with low grade cystic cerebellar astrocytomas were treated at the University of Washington and Children's Orthopedic Hospital in Seattle, Washington, between 1955 and 1977; 29 were treated with partial or complete resection alone, and 10 received radiation therapy after various types of surgical procedures. With a mean follow-up time of 7 years, the survival rate for patients who had complete resections of their primary disease was 100%. The relapse-free survival rate was 82%. The relapse-free survival rate for patients treated primarily with partial resection alone was 36%. Postoperative irradiation after partial resection for both primary and recurrent disease resulted in a relapse-free survival rate of 83%. If complete tumor excision is not possible, postoperative radiation therapy is recommended following partial resection.

  16. Inferior angle of the scapula as a vascularized bone graft: an anatomic study.

    PubMed

    Sundine, M J; Sharobaro, V I; Ljubic, I; Acland, R D; Tobin, G R

    2000-04-01

    In reconstructing patients with massive midface losses, the authors required a vascularized bone graft that could be used to reconstruct the palate and orbital floor, provide vertical maxillary support, and provide soft tissue. The inferior angle of the scapula appears to be a promising source of vascularized bone stock, and until now, there has been no clear description of its vascular anatomy. The purpose of this study was to define the vascular anatomy of the inferior angle of the scapula. Thirteen fresh cadavers were studied. The subscapular artery was injected with Microfil (Flow Tec, Carver, MA) at its origin. Two branches of the subscapular artery were found to converge on the angle of the scapula: the descending osseous branch of the circumflex scapular, and the transverse branch of the thoracodorsal. The descending osseous branch of the circumflex scapular artery supplied the inferior angle of the scapula in 100 percent of cases. The transverse branch of the thoracodorsal artery supplied it in 76 percent of cases. The descending osseous branch of the circumflex scapular artery is the principal artery supplying the inferior angle of the scapula.

  17. [A case of brainstem and cerebellar infarctions related to basilar impression].

    PubMed

    Kasai, Takashi; Yoshikawa, Kenji; Tachibana, Shunji; Taniguchi, Takuya; Nakagawa, Masanori

    2004-03-01

    We report a 30-year-old man presenting with medial longitudinal fasciculus (MLF) syndrome after an afternoon nap. Magnetic resonance imaging revealed a right medial pontine tegmental infarction and right cerebellar infarctions. This patient was complicated with basilar impression detected on cervical X-ray and MRI. Three-dimensional CT angiography disclosed that the odontoid process migrated into the posterior fossa, thrusting the bilateral vertebral arteries postero-laterally. The mechanical stress on the bilateral vertebral arteries may have caused infarctions in the territories of the posterior circulation of this patient with basilar impression.

  18. Simultaneous occurrence of internal capsule infarct and cerebellar haemorrhage in a patient with hemiplegia.

    PubMed

    Pande, Nikhil; Vivek, Ganapathiraman; Hande, Manjunath; Acharya, Vasudeva

    2014-01-09

    A 68-year-old woman with hypertension with no history of cerebrovascular events presented with a left-sided hemiplegia which had developed acutely 2 days ago. She was not on maintenance therapy with antiplatelets or anticoagulants. A CT scan showed acute ischaemic infarction of the right internal capsule and cerebellar haemorrhage. Cardiac evaluation was normal. Doppler ultrasonography of the extracranial carotid and vertebral arteries showed diffuse arteriosclerotic changes, but did not reveal any haemodynamic occlusion. The simultaneous development of dual strokes was considered to be an extension of the same arteriosclerotic process to the intracranial carotid and basilar arteries.

  19. A dynamical system view of cerebellar function

    NASA Astrophysics Data System (ADS)

    Keeler, James D.

    1990-06-01

    First some previous theories of cerebellar function are reviewed, and deficiencies in how they map onto the neurophysiological structure are pointed out. I hypothesize that the cerebellar cortex builds an internal model, or prediction, of the dynamics of the animal. A class of algorithms for doing prediction based on local reconstruction of attractors are described, and it is shown how this class maps very well onto the structure of the cerebellar cortex. I hypothesize that the climbing fibers multiplex between different trajectories corresponding to different modes of operation. Then the vestibulo-ocular reflex is examined, and experiments to test the proposed model are suggested. The purpose of the presentation here is twofold: (1) To enlighten physiologists to the mathematics of a class of prediction algorithms that map well onto cerebellar architecture. (2) To enlighten dynamical system theorists to the physiological and anatomical details of the cerebellum.

  20. [Bilateral cerebellar hematoma after supratentorial glioma surgery].

    PubMed

    Czepko, Ryszard; Kwinta, Borys; Uhl, Henryka; Urbanik, Andrzej; Libionka, Witold; Pietraszko, Wojciech

    2004-01-01

    We present a case of bilateral hematoma in cerebellar hemispheres in a 30-year-old man after surgical treatment of extensive left frontal glioma. 16 hours after surgery the patient lost consciousness. An immediate CT revealed hematoma in both cerebellar hemispheres. The hematoma was subsequently removed via bilateral suboccipital craniectomy. After the operation the clinical status of the patient gradually improved - he was discharged in a good general condition. In the presented case the hematoma developed presumably as a consequence of extensive cerebrospinal fluid (CSF) loss (670 ml) via postoperative wound drainage. The resulting cerebellar displacement caused strain of the draining veins, affecting blood outflow, and causing parenchymal hemorrhage. In order to prevent the complication, massive CSF loss during and after operation should be avoided. Careful monitoring of the patient's condition in the postoperative period, even if the general status is good, is important because only an immediate intervention may prevent the development of irreversible consequences of cerebellar hematoma formation.

  1. [Morphine in the inferior cerebellar cisterna for oncologic pain in the ORL area].

    PubMed

    De Cicco, M; Fracasso, A; Magri, D; Barzan, L; Testa, V

    1990-11-01

    The study aimed to assess whether the infusion of microdoses of morphine in the cisterna magna, close to the sensitive nuclei of the cranial nerves (V-VII-IX-X) involved in painful syndromes of the head and neck, is able to control severe oncological pain in this region which does not respond to traditional pain killing treatment or neurolesive practices. Cisternal catheters were inserted in eight patients with cancer of the head and neck. The intensity of pain was assessed using VAS and the quality of analgesia obtained using cisternal morphine was judged to be: excellent, good, inadequate or null. Treatment lasted a mean of 121 days. Good or excellent analgesia was achieved in 7 patients using a mean daily dose of 1.5 mg morphine during the initial stage and 4.8 mg during the final stage; in one patient with a large component of "deafferent pain", good pain relief was obtained by associating cisternal morphine with chlorimipramin per os. The side-effects observed were almost always short-term and easily resolved. Morphine treatment was begun in the hospital and in all cases continued at home. This efficacious pain killing method should be given adequate attention in the global strategies used to treat oncological pain in the head and neck region.

  2. Arnold-Chiari malformation type 1 complicated by sudden onset anterior spinal artery thrombosis, tetraparesis and respiratory arrest.

    PubMed

    Wani, Abdul Majid; Zayyani, Najah R; Al Miamini, Wail; Khoujah, Amer M; Alharbi, Zeyad; Diari, Mohd S

    2011-04-15

    Chiari in 1891 described a constellation of anomalies at the base of the brain inherited congenitally, the characteristic of which are (1) extension of a tongue of cerebellar tissue posterior to the medulla and cord that extends into the cervical spinal canal; (2) caudal displacement of the medulla and the inferior part of the fourth ventricle into the cervical canal; and (3) a frequent but not invariable association with syringomyelia or a spinal developmental abnormality. Chiari recognized four types of abnormalities. Presently, the term has come to be restricted to Chiari's types I and II, that is, to cerebellomedullary descent without and with a meningomyelocele, respectively. The association of Arnold-Chairi malformation and high cervical cord infarction is unusual. The most common syndrome, anterior spinal artery syndrome (ASAS), is caused by interruption of blood flow to the anterior spinal artery, producing ischaemia in the anterior two-thirds of the cord, with resulting neurologic deficits. Causes of ASAS include aortic disease, postsurgical, sepsis, hypotension and thromboembolic disorders. The authors present an interesting case of cervical cord infarction due to anterior spinal artery thrombosis in a patient of type 1 Arnold-Chiari malformation without any of the above predisposing factors.

  3. Synchrony and neural coding in cerebellar circuits

    PubMed Central

    Person, Abigail L.; Raman, Indira M.

    2012-01-01

    The cerebellum regulates complex movements and is also implicated in cognitive tasks, and cerebellar dysfunction is consequently associated not only with movement disorders, but also with conditions like autism and dyslexia. How information is encoded by specific cerebellar firing patterns remains debated, however. A central question is how the cerebellar cortex transmits its integrated output to the cerebellar nuclei via GABAergic synapses from Purkinje neurons. Possible answers come from accumulating evidence that subsets of Purkinje cells synchronize their firing during behaviors that require the cerebellum. Consistent with models predicting that coherent activity of inhibitory networks has the capacity to dictate firing patterns of target neurons, recent experimental work supports the idea that inhibitory synchrony may regulate the response of cerebellar nuclear cells to Purkinje inputs, owing to the interplay between unusually fast inhibitory synaptic responses and high rates of intrinsic activity. Data from multiple laboratories lead to a working hypothesis that synchronous inhibitory input from Purkinje cells can set the timing and rate of action potentials produced by cerebellar nuclear cells, thereby relaying information out of the cerebellum. If so, then changing spatiotemporal patterns of Purkinje activity would allow different subsets of inhibitory neurons to control cerebellar output at different times. Here we explore the evidence for and against the idea that a synchrony code defines, at least in part, the input–output function between the cerebellar cortex and nuclei. We consider the literature on the existence of simple spike synchrony, convergence of Purkinje neurons onto nuclear neurons, and intrinsic properties of nuclear neurons that contribute to responses to inhibition. Finally, we discuss factors that may disrupt or modulate a synchrony code and describe the potential contributions of inhibitory synchrony to other motor circuits. PMID

  4. A novel approach for treating cerebellar ataxias.

    PubMed

    Manto, Mario; Ben Taib, Nordeyn Oulad

    2008-01-01

    The terminology of cerebellar ataxias encompasses a variety of sporadic and inherited debilitating diseases. Patients exhibit disabling deficits such as dysmetria, kinetic tremor and ataxia of stance/gait. We are currently lacking effective treatments in degenerative cerebellar ataxias. Animal models of cerebellar disorders and studies in ataxic patients have demonstrated that the excitability of the sensorimotor cortex is severely depressed in case of cerebellar lesion. These reduced levels of excitability are associated with learning deficits. Recent experimental data show that transcranial direct current stimulation (tDCS) of the premotor cortex and low-frequency repetitive stimulation of the motor cortex (LFRSM1) restore the excitability of the motor cortex in hemicerebellectomized rats, reinstating the ability of the motor cortex to adapt to sustained peripheral stimulation. The hypothesis is based on the possibility that the combination of tDCS and contralateral LFRSM1 can improve human cerebellar ataxias. The proposed treatment consists of delivering trains of tDCS either in conjunction or in alternance with contralateral LFRSM1, in addition to application of peripheral nerve stimulation to sensitize the sensorimotor cortex. This hypothesis is to be tested in a procedure made of 3 steps in patients exhibiting a sporadic or inherited cerebellar disorder. First, patients are assessed clinically using validated scales of cerebellar ataxias and performing accepted quantified tests. Second, trains of tDCS and LFRSM1 are delivered, using a sham procedure in a cross-over design. Trains of peripheral stimulation are applied at peripheral nerves. Third, patients are re-assessed clinically and with quantified tests. Although grafting of stem cells and gene therapy are being developed, they will not be available soon. A successful treatment of combined neurostimulation would lead to a new and readily available approach in the management of cerebellar ataxias. This new

  5. Consensus Paper: Radiological Biomarkers of Cerebellar Diseases

    PubMed Central

    Baldarçara, Leonardo; Currie, Stuart; Hadjivassiliou, M.; Hoggard, Nigel; Jack, Allison; Jackowski, Andrea P.; Mascalchi, Mario; Parazzini, Cecilia; Reetz, Kathrin; Righini, Andrea; Schulz, Jörg B.; Vella, Alessandra; Webb, Sara Jane; Habas, Christophe

    2016-01-01

    Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine. PMID:25382714

  6. Molecular mechanisms governing competitive synaptic wiring in cerebellar Purkinje cells.

    PubMed

    Watanabe, Masahiko

    2008-03-01

    Cerebellar Purkinje cells (PCs) play a principal role in motor coordination and motor learning. To fulfill these functions, PCs receive and integrate two types of excitatory inputs, climbing fiber (CF) and parallel fiber (PF). CFs are projection axons from the inferior olive, and convey error signals to PCs. On the other hand, PFs are T-shaped axons of cerebellar granule cells, and convey sensory and motor information carried through the pontocerebellar and spinocerebellar mossy fiber pathways. The most remarkable feature of PC circuits is the highly territorial innervation by these two excitatory afferents. A single climbing CF powerfully and exclusively innervates proximal PC dendrites, whereas hundreds of thousands of PFs innervate distal PC dendrites. Recent studies using gene-manipulated mice have been elucidating that the PC circuitry is formed and maintained by molecular mechanisms that fuel homosynaptic competition among CFs and heterosynaptic competition between CFs and PFs. GluRdelta2 (a PC-specific glutamate receptor) and precerebellin or Cbln1 (a granule cell-derived secretory protein) cooperatively work for selective strengthening of PF-PC synapses, and prevent excessive distal extension of CFs that eventually causes multiple innervation at distal dendrites. In contrast, P/Q-type Ca2+ channels, which mediate Ca2+ influx upon CF activity, selectively strengthen the innervation by a single main CF, and expel PFs and other CFs from proximal dendrites that it innervates. Therefore, we now understand that owing to these mechanisms, territorial innervation by CFs and PFs is properly structured and mono-innervation by CFs is established. Several key issues for future study are also discussed.

  7. Transcatheter Arterial Embolization for Large Pancreaticoduodenal Artery Aneurysm with Mechanically Detachable Coils

    SciTech Connect

    Shibata, Toshiya Fujimoto, Yukinori; Jin, Myeong Jun; Hiraoka, Masahiro

    2004-03-15

    Large aneurysms (5.5 and 3.6 cm in diameter) arising from the inferior pancreaticoduodenal artery located just near the main superior mesenteric artery were incidentally diagnosed in two patients. Transcatheter arterial embolization, packing mechanically detachable coils and microcoils into the aneurysms, was performed while the inflated balloon catheter was placed near the neck of the aneurysms. The procedures were successfully performed and no aneurysmal rupture or bowel ischemia was noted during follow-up. Balloon-assisted transcatheter arterial embolization with mechanically detachable coils seems to be an effective and safe treatment for large inferior pancreaticoduodenal aneurysms.

  8. Training-induced improvements in postural control are accompanied by alterations in cerebellar white matter in brain injured patients.

    PubMed

    Drijkoningen, David; Caeyenberghs, Karen; Leunissen, Inge; Vander Linden, Catharine; Leemans, Alexander; Sunaert, Stefan; Duysens, Jacques; Swinnen, Stephan P

    2015-01-01

    We investigated whether balance control in young TBI patients can be promoted by an 8-week balance training program and whether this is associated with neuroplastic alterations in brain structure. The cerebellum and cerebellar peduncles were selected as regions of interest because of their importance in postural control as well as their vulnerability to brain injury. Young patients with moderate to severe TBI and typically developing (TD) subjects participated in balance training using PC-based portable balancers with storage of training data and real-time visual feedback. An additional control group of TD subjects did not attend balance training. Mean diffusivity and fractional anisotropy were determined with diffusion MRI scans and were acquired before, during (4 weeks) and at completion of training (8 weeks) together with balance assessments on the EquiTest® System (NeuroCom) which included the Sensory Organization Test, Rhythmic Weight Shift and Limits of Stability protocols. Following training, TBI patients showed significant improvements on all EquiTest protocols, as well as a significant increase in mean diffusivity in the inferior cerebellar peduncle. Moreover, in both training groups, diffusion metrics in the cerebellum and/or cerebellar peduncles at baseline were predictive of the amount of performance increase after training. Finally, amount of training-induced improvement on the Rhythmic Weight Shift test in TBI patients was positively correlated with amount of change in fractional anisotropy in the inferior cerebellar peduncle. This suggests that training-induced plastic changes in balance control are associated with alterations in the cerebellar white matter microstructure in TBI patients.

  9. New insights into olivo-cerebellar circuits for learning from a small training sample.

    PubMed

    Tokuda, Isao T; Hoang, Huu; Kawato, Mitsuo

    2017-08-19

    Artificial intelligence such as deep neural networks exhibited remarkable performance in simulated video games and 'Go'. In contrast, most humanoid robots in the DARPA Robotics Challenge fell down to ground. The dramatic contrast in performance is mainly due to differences in the amount of training data, which is huge and small, respectively. Animals are not allowed with millions of the failed trials, which lead to injury and death. Humans fall only several thousand times before they balance and walk. We hypothesize that a unique closed-loop neural circuit formed by the Purkinje cells, the cerebellar deep nucleus and the inferior olive in and around the cerebellum and the highest density of gap junctions, which regulate synchronous activities of the inferior olive nucleus, are computational machinery for learning from a small sample. We discuss recent experimental and computational advances associated with this hypothesis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Role of Muscarinic Acetylcholine Receptor-2 in the Cerebellar Cortex in Cardiovascular Modulation in Anaesthetized Rats.

    PubMed

    Zhang, Changzheng; Sun, Tingzhe; Zhou, Peiling; Zhu, Qingfeng; Zhang, Liefeng

    2016-04-01

    Our previous investigations have demonstrated that microinjection of acetylcholine (ACh) or muscarinic ACh receptor activation in the cerebellar cortex induces a systemic blood pressure depressor response. This study aimed to determine the role of muscarinic ACh receptor-2 (M2 receptor) in the cerebellar cortex in cardiovascular function regulation in rats. A nonselective muscarinic receptor agonist (oxotremorine M, OXO; 30 mM), a selective M2 receptor agonist (arecaidine but-2-ynyl ester tosylate, ABET; 3, 10, and 30 mM), 30 mM OXO mixed with a selective M2 receptor antagonist (methoctramine hydrate, MCT; 0.3, 1, and 3 mM), and normal saline (0.9 % NaCl) were separately microinjected (0.5 µl/5 s) into the cerebellar cortex (lobule VI) of anaesthetized rats. We measured the mean arterial pressure (MAP), maximum change in MAP, and reactive time (RT; the duration required for the blood pressure to return to basal levels), heart rate (HR) and the maximum change in HR during the RT in response to drug activation. The results demonstrated that ABET dose-dependently decreased MAP and HR, increased the maximum change in MAP and the maximum change in HR, and prolonged the RT. Furthermore, MCT dose-dependently blocked the OXO-mediated cardiovascular depressor response. This study provides the first evidence that M2 receptors in the cerebellar cortex are involved in cardiovascular regulation, the activation of which evokes significant depressor and bradycardic responses.

  11. Cerebellar Exposure to Cell-Free Hemoglobin Following Preterm Intraventricular Hemorrhage: Causal in Cerebellar Damage?

    PubMed

    Agyemang, Alex Adusei; Sveinsdóttir, Kristbjörg; Vallius, Suvi; Sveinsdóttir, Snjolaug; Bruschettini, Matteo; Romantsik, Olga; Hellström, Ann; Smith, Lois E H; Ohlsson, Lennart; Holmqvist, Bo; Gram, Magnus; Ley, David

    2017-06-10

    Decreased cerebellar volume is associated with intraventricular hemorrhage (IVH) in very preterm infants and may be a principal component in neurodevelopmental impairment. Cerebellar deposition of blood products from the subarachnoid space has been suggested as a causal mechanism in cerebellar underdevelopment following IVH. Using the preterm rabbit pup IVH model, we evaluated the effects of IVH induced at E29 (3 days prior to term) on cerebellar development at term-equivalent postnatal day 0 (P0), term-equivalent postnatal day 2 (P2), and term-equivalent postnatal day 5 (P5). Furthermore, the presence of cell-free hemoglobin (Hb) in cerebellar tissue was characterized, and cell-free Hb was evaluated as a causal factor in the development of cerebellar damage following preterm IVH. IVH was associated with a decreased proliferative (Ki67-positive) portion of the external granular layer (EGL), delayed Purkinje cell maturation, and activated microglia in the cerebellar white matter. In pups with IVH, immunolabeling of the cerebellum at P0 demonstrated a widespread presence of cell-free Hb, primarily distributed in the white matter and the molecular layer. Intraventricular injection of the Hb scavenger haptoglobin (Hp) resulted in a corresponding distribution of immunolabeled Hp in the cerebellum and a partial reversal of the damaging effects observed following IVH. The results suggest that cell-free Hb is causally involved in cerebellar damage following IVH and that blocking cell-free Hb may have protective effects.

  12. Changes in the cerebellar and cerebro-cerebellar circuit in type 2 diabetes.

    PubMed

    Fang, Peng; An, Jie; Tan, Xin; Zeng, Ling-Li; Shen, Hui; Qiu, Shijun; Hu, Dewen

    2017-04-01

    Currently, 422 million adults suffer from diabetes worldwide, leading to tremendous disabilities and a great burden to families and society. Functional and structural MRIs have demonstrated that patients with type 2 diabetes mellitus (T2DM) exhibit abnormalities in brain regions in the cerebral cortex. However, the changes of cerebellar anatomical connections in diabetic patients remains unclear. In the current study, diffusion tensor imaging deterministic tractography and statistical analysis were employed to investigate abnormal cerebellar anatomical connections in diabetic patients. This is the first study to investigate the altered cerebellar anatomical connectivity in T2DM patients. Decreased anatomical connections were found in the cerebellar and cerebro-cerebellar circuits of T2DM patients, providing valuable new insights into the potential neuro-pathophysiology of diabetes-related motor and cognitive deficits. Copyright © 2017. Published by Elsevier Inc.

  13. Simulation of the Inferior Mirage

    ERIC Educational Resources Information Center

    Branca, Mario

    2010-01-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior"…

  14. Simulation of the Inferior Mirage

    ERIC Educational Resources Information Center

    Branca, Mario

    2010-01-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior"…

  15. Tubulin-related cerebellar dysplasia: definition of a distinct pattern of cerebellar malformation.

    PubMed

    Romaniello, Romina; Arrigoni, Filippo; Panzeri, Elena; Poretti, Andrea; Micalizzi, Alessia; Citterio, Andrea; Bedeschi, Maria Francesca; Berardinelli, Angela; Cusmai, Raffaella; D'Arrigo, Stefano; Ferraris, Alessandro; Hackenberg, Annette; Kuechler, Alma; Mancardi, Margherita; Nuovo, Sara; Oehl-Jaschkowitz, Barbara; Rossi, Andrea; Signorini, Sabrina; Tüttelmann, Frank; Wahl, Dagmar; Hehr, Ute; Boltshauser, Eugen; Bassi, Maria Teresa; Valente, Enza Maria; Borgatti, Renato

    2017-07-04

    To determine the neuroimaging pattern of cerebellar dysplasia (CD) and other posterior fossa morphological anomalies associated with mutations in tubulin genes and to perform clinical and genetic correlations. Twenty-eight patients harbouring 23 heterozygous pathogenic variants (ten novel) in tubulin genes TUBA1A (n = 10), TUBB2B (n = 8) or TUBB3 (n = 5) were studied by a brain MRI scan performed either on a 1.5 T (n = 10) or 3 T (n = 18) MR scanner with focus on the posterior fossa. Cerebellar anomalies were detected in 24/28 patients (86%). CD was recognised in 19/28 (68%) including cortical cerebellar dysplasia (CCD) in 18/28, either involving only the cerebellar hemispheres (12/28) or associated with vermis dysplasia (6/28). CCD was located only in the right hemisphere in 13/18 (72%), including four TUBB2B-, four TUBB3- and five TUBA1A-mutated patients, while in the other five TUBA1A cases it was located only in the left hemisphere or in both hemispheres. The postero-superior region of the cerebellar hemispheres was most frequently affected. The cerebellar involvement in tubulinopathies shows specific features that may be labelled as 'tubulin-related CD'. This pattern is unique and differs from other genetic causes of cerebellar dysplasia. • Cortical cerebellar dysplasia without cysts is suggestive of tubulin-related disorder. • Cerebellar dysplasia in tubulinopathies shows specific features labelled as 'tubulin-related CD'. • Focal and unilateral involvement of cerebellar hemispheres has important implications for counselling.

  16. Pheochromocytoma with inferior vena cava thrombosis: An unusual association.

    PubMed

    Kota, Sunil K; Kota, Siva K; Jammula, Sruti; Meher, Lalit K; Modi, Kirtikumar D

    2012-04-01

    Pheochromocytomas have been described in association with vascular abnormalities like renal artery stenosis. A 48-year-old man was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and hypertension. For last several days, he was having a dull aching abdominal pain. Abdominal computed tomography (CT) revealed the presence of a left adrenal pheochromocytoma. An inferior vena cava (IVC) venogram via the right jugular vein demonstrated occlusion of the IVC inferior to the right atrium. Surgical removal of pheochromocytoma was done, followed by anticoagulant treatment for IVC thrombosis, initially with subcutaneous low molecular weight heparin, and then with oral warfarin, resulting in restoration of patency. To the best of our knowledge, the occurrence of pheochromocytoma in IVC thrombosis has not been reported so far from India. Possible mechanisms of such an involvement are discussed.

  17. Cerebellar Atrophy in Adult Survivors of Childhood Cerebellar Tumor.

    PubMed

    Ailion, Alyssa S; King, Tricia Z; Wang, Liya; Fox, Michelle E; Mao, Hui; Morris, Robin M; Crosson, Bruce

    2016-05-01

    The cerebellum (CB) is known for its role in supporting processing speed (PS) and cognitive efficiencies. The CB often sustains damage from treatment and resection in pediatric patients with posterior fossa tumors. Limited research suggests that CB atrophy may be associated with the radiation treatment experienced during childhood. The purpose of the study was to measure cerebellar atrophy to determine its neurobehavioral correlates. Brain magnetic resonance images were collected from 25 adult survivors of CB tumors and age- and gender-matched controls (M age= 24 years (SD=5), 52% female). Average age at diagnosis was 9 years (SD=5) and average time since diagnosis was 15 years (SD=5). PS was measured by the Symbol Digit Modality Test. To quantify atrophy, an objective formula was developed based on prior literature, in which Atrophy=[(CB White+CB Gray Volume)/Intracranial Vault (ICV)]controls-[(CB White+CB Gray+Lesion Size Volume)/ICV]survivors. Regression analyses found that the interaction term (age at diagnosis*radiation) predicts CB atrophy; regression equations included the Neurological Predictor Scale, lesion size, atrophy, and the interaction term and accounted for 33% of the variance in oral PS and 48% of the variance in written PS. Both interactions suggest that individuals with smaller CB lesion size but a greater degree of CB atrophy had slower PS, whereas individuals with a larger CB lesion size and less CB atrophy were less affected. The results of the current study suggest that young age at diagnosis and radiation is associated with CB atrophy, which interacts with lesion size to impact both written and oral PS.

  18. Inability to Process Negative Emotions in Cerebellar Damage: a Functional Transcranial Doppler Sonographic Study.

    PubMed

    Lupo, Michela; Troisi, Elio; Chiricozzi, Francesca R; Clausi, Silvia; Molinari, Marco; Leggio, Maria

    2015-12-01

    Recent studies have implicated the cerebellum as part of a circuitry that is necessary to modulate higher order and behaviorally relevant information in emotional domains. However, little is known about the relationship between the cerebellum and emotional processing. This study examined cerebellar function specifically in the processing of negative emotions. Transcranial Doppler ultrasonography was performed to detect selective changes in middle cerebral artery flow velocity during emotional stimulation in patients affected by focal or degenerative cerebellar lesions and in matched healthy subjects. Changes in flow velocity during non-emotional (motor and cognitive tasks) and emotional (relaxing and negative stimuli) conditions were recorded. In the present study, we found that during negative emotional task, the hemodynamic pattern of the cerebellar patients was significantly different to that of controls. Indeed, whereas relaxing stimuli did not elicit an increase in mean flow velocity in any group, negative stimuli increased the mean flow velocity in the right compared with left middle cerebral artery only in the control group. The patterns by which mean flow velocity increased during the motor and cognitive tasks were similar within patients and controls. These findings support that the cerebellum is part of a network that gives meaning to external stimuli, and this particular involvement in processing negative emotional stimuli corroborates earlier phylogenetic hypotheses, for which the cerebellum is part of an older circuit in which negative emotions are crucial for survival and prepare the organism for rapid defense.

  19. Responses evoked in the cerebellar cortex by stimulation of the caudate nucleus in the cat

    PubMed Central

    Fox, Mary; Williams, T. D.

    1968-01-01

    1. Responses evoked in the cerebellar cortex following stimulation of caudate nucleus are described. 2. The evoked responses recorded from the surface of the cerebellar cortex were found to be of two types, one with a short (4-6 msec) latency and one with a longer (12-17 msec) latency. 3. The short latency response was maximal in the lobulus simplex, the longer latency response was maximal in paramedian lobule. 4. Following lesions in the inferior olive the longer latency response was absent. 5. Recordings from within the cerebellar cortex showed that the short latency response was uniformly distributed throughout the grey matter, the longer latency response was maximal in the region of the Purkinje cell bodies. 6. It was concluded that the short latency response was due to activation via the mossy fibres and the longer latency response to activation via the climbing fibres. 7. It was found that responses could be evoked in the cerebellum following stimulation of only the latero-ventral part of the caudate nucleus; stimulation of the rest of the nucleus caused no response in the cerebellum. This division of the caudate nucleus into two parts is similar to the subdivision of the caudate nucleus made by other workers using different criteria. PMID:5698279

  20. Specific cerebellar regions are related to force amplitude and rate of force development.

    PubMed

    Spraker, M B; Corcos, D M; Kurani, A S; Prodoehl, J; Swinnen, S P; Vaillancourt, D E

    2012-01-16

    The human cerebellum has been implicated in the control of a wide variety of motor control parameters, such as force amplitude, movement extent, and movement velocity. These parameters often covary in both movement and isometric force production tasks, so it is difficult to resolve whether specific regions of the cerebellum relate to specific parameters. In order to address this issue, the current study used two experiments and SUIT normalization to determine whether BOLD activation in the cerebellum scales with the amplitude or rate of change of isometric force production or both. In the first experiment, subjects produced isometric pinch-grip force over a range of force amplitudes without any constraints on the rate of force development. In the second experiment, subjects varied the rate of force production, but the target force amplitude remained constant. The data demonstrate that BOLD activation in separate sub-areas of cerebellar regions lobule VI and Crus I/II scales with both force amplitude and force rate. In addition, BOLD activation in cerebellar lobule V and vermis VI was specific to force amplitude, whereas BOLD activation in lobule VIIb was specific to force rate. Overall, cerebellar activity related to force amplitude was located superior and medial, whereas activity related to force rate was inferior and lateral. These findings suggest that specific circuitry in the cerebellum may be dedicated to specific motor control parameters such as force amplitude and force rate.

  1. Reduced fractional anisotropy in early-stage cerebellar variant of multiple system atrophy.

    PubMed

    Oishi, Kenichi; Konishi, Junya; Mori, Susumu; Ishihara, Hiroyuki; Kawamitsu, Hideaki; Fujii, Masahiko; Kanda, Fumio

    2009-04-01

    In patients with the cerebellar variant of multiple system atrophy (MSA-C), reduced fractional anisotropy (FA) has been reported in several brain areas. However, since previous studies have employed predetermined regions of interest (ROI), the brain areas showing the earliest alterations in FA are unknown. The sensitivity of detecting early-stage MSA-C and the time course of the FA reduction are also unknown. The purpose was to address these issues to determine the diagnostic value of FA for early diagnosis. Twenty-one patients with MSA-C were investigated. Voxel-based FA analysis and morphometry were used to detect the differences between early-stage MSA-C and normal controls. An ROI-based FA analysis was also used to clarify the temporal profile. From the early-stage, MSA-C patients exhibited reduced FA and white matter atrophy in the middle cerebellar peduncle, the inferior cerebellar peduncle, and the ventral pons. The FA of these areas decreased rapidly during the first few years after onset, after which a rather gradual reduction occurred. The receiver operating characteristics analysis revealed a high sensitivity and specificity for discriminating early MSA-C from normal controls. FA measurement could potentially be used to make an early diagnosis and monitor progression in MSA-C patients.

  2. Metabolic anatomy of paraneoplastic cerebellar degeneration

    SciTech Connect

    Anderson, N.E.; Posner, J.B.; Sidtis, J.J.; Moeller, J.R.; Strother, S.C.; Dhawan, V.; Rottenberg, D.A.

    1988-06-01

    Eleven patients with acquired cerebellar degeneration (10 of whom had paraneoplastic cerebellar degeneration (PCD)) were evaluated using neuropsychological tests and /sup 18/F-fluorodeoxyglucose/positron emission tomography to (1) quantify motor, cognitive, and metabolic abnormalities; (2) determine if characteristic alterations in the regional cerebral metabolic rate for glucose (rCMRGlc) are associated with PCD; and (3) correlate behavioral and metabolic measures of disease severity. Eighteen volunteer subjects served as normal controls. Although some PCD neuropsychological test scores were abnormal, these results could not, in general, be dissociated from the effects of dysarthria and ataxia. rCMRGlc was reduced in patients with PCD (versus normal control subjects) in all regions except the brainstem. Analysis of patient and control rCMRGlc data using a mathematical model of regional metabolic interactions revealed two metabolic pattern descriptors, SSF1 and SSF2, which distinguished patients with PCD from normal control subjects; SSF2, which described a metabolic coupling between cerebellum, cuneus, and posterior temporal, lateral frontal, and paracentral cortex, correlated with quantitative indices of cerebellar dysfunction. Our inability to document substantial intellectual impairment in 7 of 10 patients with PCD contrasts with the 50% incidence of dementia in PCD reported by previous investigators. Widespread reductions in PCD rCMRGlc may result from the loss of cerebellar efferents to thalamus and forebrain structures, a reverse cerebellar diaschisis.

  3. Regionalization of the isthmic and cerebellar primordia.

    PubMed

    Narboux-Nême, Nicolas; Louvi, Angeliki; Alexandre, Paula; Wassef, Marion

    2005-01-01

    The complex migrations of neurons born in the dorsal neural tube of the isthmic and rhombomere l (rl) domains complicate the delineation of the cerebellar primordium. We show that Purkinje cells (P) are likely generated over a wide territory before gathering in the future cerebellar primordium under the developing external granular layer. Later expansion of the cerebellum over a restricted ependymal domain could rely on mutual interations between P cells and granule cell progenitors (GCP). P are attracted by GCP and in turn stimulate their proliferation, increasing the surface of the developing cortex. At later stages, regionalization of the developing and adult cerebellar cortex can be detected through regional variations in the distribution of several P cell markers. Whether and how the developmental and adult P subtypes are related is still unknown and it is unclear if they delineate the same sets of cerebellar subdivisions. We provide evidence that the early P regionalization is involved in intrinsic patterning of the cerebellar primordium, in particular it relate to the organization of the corticonuclear connection. We propose that the early P regionalization provides a scaffold to the mature P regionalization but that the development of functional afferent connections induces a period of P plasticity during which the early regional identity of P could be remodeled.

  4. Atypical Presentation of a Pediatric Cerebellar Ganglioglioma.

    PubMed

    Bram, Richard; Seidman, Roberta J; Chesler, David

    2017-09-20

    Gangliogliomas (GGs) are rare central nervous system tumors occurring primarily in the supratentorial compartment with infratentorial instances most often involving the brain stem. Infratentorial GGs typically present with signs and symptoms of increased intracranial pressure (ICP), cranial nerve deficits, or focal cerebellar findings; rarely, these tumors have been associated with focal seizures. In this report, we describe an atypical presentation of a cerebellar GG in a 20-month-old male who initially presented with syncope and emesis in the absence of electrographic evidence of seizures, radiographic evidence of hydrocephalus, or elevated ICP. The epidemiology, radiographic, and pathological findings as well as the treatment of these tumors are also discussed. After gross total resection, the patient experienced full resolution of all his preoperative symptoms without the development of new neurological deficits. Unlike their supratentorial counterparts, infratentorial GGs do not commonly present with seizures although rare reports exist in the literature of seizures attributed to cerebellar GG. Moreover, cerebellar GGs may produce nonspecific symptoms in the absence of concrete diagnostic findings. Such a presentation should prompt further neurological evaluation. Most cases of isolated cerebellar GG can be successfully treated with surgical resection and carry a favorable prognosis. © 2017 S. Karger AG, Basel.

  5. Epidemiology of Cerebellar Diseases and Therapeutic Approaches.

    PubMed

    Salman, Michael S

    2017-09-22

    Diseases involving the cerebellum occur relatively commonly in children and adults around the globe. Many factors influence their epidemiology including geography, ethnicity, consanguinity, and the methodology used to ascertain patients. In addition, reliable epidemiological data rely heavily on accurate disease classification. Continuous advances in genetic research and neuroimaging modalities have resulted in improved understanding of cerebellar diseases and have led to several revisions in their classification. Recent global epidemiological studies on ataxia reported an estimated overall prevalence rate of 26/100,000 in children, a prevalence rate of dominant hereditary cerebellar ataxia of 2.7/100,000, and a prevalence rate of recessive hereditary cerebellar ataxia of 3.3/100,000. The management of cerebellar diseases is multidisciplinary and multimodal. General supportive and symptomatic therapies should be initiated. Genetic counseling should be offered, where appropriate. Few drugs, specific motor rehabilitation programs, and noninvasive cerebellar stimulation for the treatment of ataxia have been developed and seem to show early promise, but more studies are needed to replicate and fine-tune their benefits further. Some disease-specific treatments are available. For example, acetazolamide or 4-aminopyridine for patients with episodic ataxia type 2 and vitamin E for patients with ataxia caused by vitamin E deficiency.

  6. Cerebellar modules operate at different frequencies

    PubMed Central

    Zhou, Haibo; Lin, Zhanmin; Voges, Kai; Ju, Chiheng; Gao, Zhenyu; Bosman, Laurens WJ; Ruigrok, Tom JH; Hoebeek, Freek E

    2014-01-01

    Due to the uniform cyto-architecture of the cerebellar cortex, its overall physiological characteristics have traditionally been considered to be homogeneous. In this study, we show in awake mice at rest that spiking activity of Purkinje cells, the sole output cells of the cerebellar cortex, differs between cerebellar modules and correlates with their expression of the glycolytic enzyme aldolase C or zebrin. Simple spike and complex spike frequencies were significantly higher in Purkinje cells located in zebrin-negative than zebrin-positive modules. The difference in simple spike frequency persisted when the synaptic input to, but not intrinsic activity of, Purkinje cells was manipulated. Blocking TRPC3, the effector channel of a cascade of proteins that have zebrin-like distribution patterns, attenuated the simple spike frequency difference. Our results indicate that zebrin-discriminated cerebellar modules operate at different frequencies, which depend on activation of TRPC3, and that this property is relevant for all cerebellar functions. DOI: http://dx.doi.org/10.7554/eLife.02536.001 PMID:24843004

  7. Cerebellar research: two centuries of discoveries.

    PubMed

    Manto, Mario; Haines, Duane

    2012-06-01

    Numerous laboratories currently focus their activities on cerebellar research. The cerebellum is attractive due to its sophisticated circuitry, high degree of modifiability combined with unique operational mechanisms, and the growing awareness of its multiple roles. Works of pioneers of these last two centuries, such as Rolando, Flourens, Magendie, Luciani, Lugaro, Babinski, Holmes, Cajal, Larsell, Eccles, Voogd, Llinas, or Ito, still exert a strong influence in the way we investigate cerebellar functions. The amount of knowledge is exploding, thanks to advances in genetics, molecular and cellular analyses, profusion of brain imaging techniques, novel behavioral assessments, and reshaping of models of cerebellar function. More than ever, strong and consistent intellectual efforts are required to generate homogeneous research outcomes that might exert a significant influence in the forthcoming domains of research. Because research is often based on the results of our predecessors, The Cerebellum has launched a section called Cerebellar Classics. Papers selected represent key steps for the discovery of some of the secrets of the cerebellar circuitry. These seminal contributions offer a portal to the past to modern scholars.

  8. Neurodevelopmental malformations of the cerebellar vermis in genetically engineered rats

    EPA Science Inventory

    The cerebellar vermis is particularly vulnerable to neurodevelopmental malformations in humans and rodents. Sprague-Dawley, and Long-Evans rats exhibit spontaneous cerebellar malformations consisting of heterotopic neurons and glia in the molecular layer of the vermis. Malformati...

  9. Secondary orthostatic tremor in the setting of cerebellar degeneration.

    PubMed

    Sarva, Harini; Severt, William Lawrence; Jacoby, Nuri; Pullman, Seth L; Saunders-Pullman, Rachel

    2016-05-01

    Orthostatic tremor (OT) and cerebellar ataxia are uncommon and difficult to treat. We present two patients with OT and cerebellar degeneration, one of whom had spinocerebellar ataxia type 2 and a good treatment response.

  10. Neurodevelopmental malformations of the cerebellar vermis in genetically engineered rats

    EPA Science Inventory

    The cerebellar vermis is particularly vulnerable to neurodevelopmental malformations in humans and rodents. Sprague-Dawley, and Long-Evans rats exhibit spontaneous cerebellar malformations consisting of heterotopic neurons and glia in the molecular layer of the vermis. Malformati...

  11. Landmark based shape analysis for cerebellar ataxia classification and cerebellar atrophy pattern visualization

    NASA Astrophysics Data System (ADS)

    Yang, Zhen; Abulnaga, S. Mazdak; Carass, Aaron; Kansal, Kalyani; Jedynak, Bruno M.; Onyike, Chiadi; Ying, Sarah H.; Prince, Jerry L.

    2016-03-01

    Cerebellar dysfunction can lead to a wide range of movement disorders. Studying the cerebellar atrophy pattern associated with different cerebellar disease types can potentially help in diagnosis, prognosis, and treatment planning. In this paper, we present a landmark based shape analysis pipeline to classify healthy control and different ataxia types and to visualize the characteristic cerebellar atrophy patterns associated with different types. A highly informative feature representation of the cerebellar structure is constructed by extracting dense homologous landmarks on the boundary surfaces of cerebellar sub-structures. A diagnosis group classifier based on this representation is built using partial least square dimension reduction and regularized linear discriminant analysis. The characteristic atrophy pattern for an ataxia type is visualized by sampling along the discriminant direction between healthy controls and the ataxia type. Experimental results show that the proposed method can successfully classify healthy controls and different ataxia types. The visualized cerebellar atrophy patterns were consistent with the regional volume decreases observed in previous studies, but the proposed method provides intuitive and detailed understanding about changes of overall size and shape of the cerebellum, as well as that of individual lobules.

  12. Landmark Based Shape Analysis for Cerebellar Ataxia Classification and Cerebellar Atrophy Pattern Visualization

    PubMed Central

    Yang, Zhen; Abulnaga, S. Mazdak; Carass, Aaron; Kansal, Kalyani; Jedynak, Bruno M.; Onyike, Chiadi; Ying, Sarah H.; Prince, Jerry L.

    2016-01-01

    Cerebellar dysfunction can lead to a wide range of movement disorders. Studying the cerebellar atrophy pattern associated with different cerebellar disease types can potentially help in diagnosis, prognosis, and treatment planning. In this paper, we present a landmark based shape analysis pipeline to classify healthy control and different ataxia types and to visualize the characteristic cerebellar atrophy patterns associated with different types. A highly informative feature representation of the cerebellar structure is constructed by extracting dense homologous landmarks on the boundary surfaces of cerebellar sub-structures. A diagnosis group classifier based on this representation is built using partial least square dimension reduction and regularized linear discriminant analysis. The characteristic atrophy pattern for an ataxia type is visualized by sampling along the discriminant direction between healthy controls and the ataxia type. Experimental results show that the proposed method can successfully classify healthy controls and different ataxia types. The visualized cerebellar atrophy patterns were consistent with the regional volume decreases observed in previous studies, but the proposed method provides intuitive and detailed understanding about changes of overall size and shape of the cerebellum, as well as that of individual lobules. PMID:27303111

  13. Cerebellar contribution to feedforward control of locomotion

    PubMed Central

    Pisotta, Iolanda; Molinari, Marco

    2014-01-01

    The cerebellum is an important contributor to feedforward control mechanisms of the central nervous system, and sequencing—the process that allows spatial and temporal relationships between events to be recognized—has been implicated as the fundamental cerebellar mode of operation. By adopting such a mode and because cerebellar activity patterns are sensitive to a variety of sensorimotor-related tasks, the cerebellum is believed to support motor and cognitive functions that are encoded in the frontal and parietal lobes of the cerebral cortex. In this model, the cerebellum is hypothesized to make predictions about the consequences of a motor or cognitive command that originates from the cortex to prepare the entire system to cope with ongoing changes. In this framework, cerebellar predictive mechanisms for locomotion are addressed, focusing on sensorial and motoric sequencing. The hypothesis that sequence recognition is the mechanism by which the cerebellum functions in gait control is presented and discussed. PMID:25009490

  14. Cerebellar contribution to feedforward control of locomotion.

    PubMed

    Pisotta, Iolanda; Molinari, Marco

    2014-01-01

    The cerebellum is an important contributor to feedforward control mechanisms of the central nervous system, and sequencing-the process that allows spatial and temporal relationships between events to be recognized-has been implicated as the fundamental cerebellar mode of operation. By adopting such a mode and because cerebellar activity patterns are sensitive to a variety of sensorimotor-related tasks, the cerebellum is believed to support motor and cognitive functions that are encoded in the frontal and parietal lobes of the cerebral cortex. In this model, the cerebellum is hypothesized to make predictions about the consequences of a motor or cognitive command that originates from the cortex to prepare the entire system to cope with ongoing changes. In this framework, cerebellar predictive mechanisms for locomotion are addressed, focusing on sensorial and motoric sequencing. The hypothesis that sequence recognition is the mechanism by which the cerebellum functions in gait control is presented and discussed.

  15. 21 CFR 882.5820 - Implanted cerebellar stimulator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted cerebellar stimulator. 882.5820 Section... (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5820 Implanted cerebellar stimulator. (a) Identification. An implanted cerebellar stimulator is a device used to stimulate...

  16. 21 CFR 882.5820 - Implanted cerebellar stimulator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Implanted cerebellar stimulator. 882.5820 Section... (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5820 Implanted cerebellar stimulator. (a) Identification. An implanted cerebellar stimulator is a device used to stimulate...

  17. Unilateral cerebellar hypoplasia with different clinical features.

    PubMed

    Benbir, Gulcin; Kara, Simay; Yalcinkaya, Beyza Citci; Karhkaya, Geysu; Tuysuz, Beyhan; Kocer, Naci; Yalcinkaya, Cengiz

    2011-03-01

    Unilateral cerebellar hypoplasia (UCH) is a rare pathological condition characterized by the loss of volume in cerebellar hemispheres ranging from mild asymptomatic to severe symptomatic cases. As the designation of UCH remains problematic, the underlying etiopathogenesis also lacks explanation. We investigated the patients admitted to Departments of Child Neurology, Neurology, and Genetics between the years 1992 and 2010 and detected 12 patients with unilateral cerebellar volume loss, with the exclusion of all other cerebellar pathologies. The ages of patients ranged between 6 months to 55 years. Five patients had a delay in developmental milestones, and one of these was diagnosed with neurofibromatosis type 1. Two patients had epileptic seizures, one patient had peripheral facial paralysis as a component of Moebius syndrome, and four patients were incidentally diagnosed during etiological work-up for headache. The clinical outcomes of patients varied from healthy subjects to marked developmental impairment. Radiologically, five patients had severe disproportionate UCH, six had moderate disproportionate, and one had mild proportionate UCH. Cerebellar peduncles were affected in all, and vermis was partly hypoplastic in eight patients. Brainstem was involved in four patients, and seven patients showed involvement of white matter and/or corpus callosum. Imaging features supported that patients with severe disproportionate UCH also displayed additional cerebral and commissural changes, which were related to ischemic or vascular injuries, implying a prenatally acquired disruption. In the presence of such a wide spectrum of clinical and radiological features, a prenatally acquired lesion and, thus, a disruption seem to be more explanatory rather than a primary developmental process or malformation in the etiopathogenesis of unilateral cerebellar hypoplasia.

  18. Cerebellar hypoperfusion in infantile neuroaxonal dystrophy.

    PubMed

    Kóbor, Jeno; Javaid, Ahmad; Omojola, Matthew F

    2005-02-01

    An identical abnormal pattern was detected by means of (99m)Tc-hexamethyl-propyleneamine-oxime single-photon emission computed tomography in two siblings with infantile neuroaxonal dystrophy. The markedly decreased cerebellar perfusion, along with the early motor symptoms, characteristic magnetic resonance imaging and pathologic findings, points to a preferential cerebellar involvement in this disease. A relative increase in the perfusion to the basal ganglia correlated with the magnetic resonance imaging abnormalities, highly resembling that of Hallervorden-Spatz disease in one of the males, at this site.

  19. Coronary Arteries

    MedlinePlus

    ... and animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

  20. Reduced motor competence in children with obesity is associated with structural differences in the cerebellar peduncles.

    PubMed

    Augustijn, Mireille J C M; Deconinck, Frederik J A; D'Hondt, Eva; Van Acker, Lore; De Guchtenaere, Ann; Lenoir, Matthieu; Caeyenberghs, Karen

    2017-08-22

    Previous studies have suggested that neurological factors partly explain the reduced motor competence found in many children with obesity. Accordingly, the aim of this study was to compare motor competence and white matter organization of important pathways for motor control (cerebellar peduncles) in children with and without obesity. Nineteen children with obesity and 25 children with a healthy weight, aged 7-11 years old, were included. Anthropometric measurements were taken and the level of motor competence was assessed using the Movement Assessment Battery for Children (2nd Edition). Children's brain was scanned using diffusion weighted imaging preceded by a standard anatomical scan. Fractional anisotropy and mean diffusivity were extracted from the cerebellar peduncles. Obese children's level of motor competence was significantly lower than that in healthy weight peers (p < 0.05). Additionally, significant group differences (p < 0.05) were found for values of fractional anisotropy, but not for mean diffusivity. Further analyses revealed that lower values of fractional anisotropy in the inferior (p = 0.040) and superior (p = 0.007) cerebellar peduncles were present in children with obesity compared to children with a healthy weight. After controlling for multiple comparisons (p < 0.0167), only significant differences in the superior cerebellar peduncle remained significant. Our results showed that childhood obesity is accompanied by reduced motor competence and alterations in white matter organization. This suggests that the motor difficulties of children with obesity are not solely due to carrying excess weight, which may have implications for prevention and intervention programs.

  1. Autosomal-Recessive Congenital Cerebellar Ataxia Is Caused by Mutations in Metabotropic Glutamate Receptor 1

    PubMed Central

    Guergueltcheva, Velina; Azmanov, Dimitar N.; Angelicheva, Dora; Smith, Katherine R.; Chamova, Teodora; Florez, Laura; Bynevelt, Michael; Nguyen, Thai; Cherninkova, Sylvia; Bojinova, Veneta; Kaprelyan, Ara; Angelova, Lyudmila; Morar, Bharti; Chandler, David; Kaneva, Radka; Bahlo, Melanie; Tournev, Ivailo; Kalaydjieva, Luba

    2012-01-01

    Autosomal-recessive congenital cerebellar ataxia was identified in Roma patients originating from a small subisolate with a known strong founder effect. Patients presented with global developmental delay, moderate to severe stance and gait ataxia, dysarthria, mild dysdiadochokinesia, dysmetria and tremors, intellectual deficit, and mild pyramidal signs. Brain imaging revealed progressive generalized cerebellar atrophy, and inferior vermian hypoplasia and/or a constitutionally small brain were observed in some patients. Exome sequencing, used for linkage analysis on extracted SNP genotypes and for mutation detection, identified two novel (i.e., not found in any database) variants located 7 bp apart within a unique 6q24 linkage region. Both mutations cosegregated with the disease in five affected families, in which all ten patients were homozygous. The mutated gene, GRM1, encodes metabotropic glutamate receptor mGluR1, which is highly expressed in cerebellar Purkinje cells and plays an important role in cerebellar development and synaptic plasticity. The two mutations affect a gene region critical for alternative splicing and the generation of receptor isoforms; they are a 3 bp exon 8 deletion and an intron 8 splicing mutation (c.2652_2654del and c.2660+2T>G, respectively [RefSeq accession number NM_000838.3]). The functional impact of the deletion is unclear and is overshadowed by the splicing defect. Although ataxia lymphoblastoid cell lines expressed GRM1 at levels comparable to those of control cells, the aberrant transcripts skipped exon 8 or ended in intron 8 and encoded various species of nonfunctional receptors either lacking the transmembrane domain and containing abnormal intracellular tails or completely missing the tail. The study implicates mGluR1 in human hereditary ataxia. It also illustrates the potential of the Roma founder populations for mutation identification by exome sequencing. PMID:22901947

  2. Sensory neuropathy as part of the cerebellar ataxia neuropathy vestibular areflexia syndrome

    PubMed Central

    Waterston, J.A.; Halmagyi, G.M.; Mossman, S.; Chancellor, A.M.; McLean, C.A.; Storey, E.

    2011-01-01

    Objective: The syndrome of cerebellar ataxia with bilateral vestibulopathy was delineated in 2004. Sensory neuropathy was mentioned in 3 of the 4 patients described. We aimed to characterize and estimate the frequency of neuropathy in this condition, and determine its typical MRI features. Methods: Retrospective review of 18 subjects (including 4 from the original description) who met the criteria for bilateral vestibulopathy with cerebellar ataxia. Results: The reported age at onset range was 39–71 years, and symptom duration was 3–38 years. The syndrome was identified in one sibling pair, suggesting that this may be a late-onset recessive disorder, although the other 16 cases were apparently sporadic. All 18 had sensory neuropathy with absent sensory nerve action potentials, although this was not apparent clinically in 2, and the presence of neuropathy was not a selection criterion. In 5, the loss of pinprick sensation was virtually global, mimicking a neuronopathy. However, findings in the other 11 with clinically manifest neuropathy suggested a length-dependent neuropathy. MRI scans showed cerebellar atrophy in 16, involving anterior and dorsal vermis, and hemispheric crus I, while 2 were normal. The inferior vermis and brainstem were spared. Conclusions: Sensory neuropathy is an integral component of this syndrome. It may result in severe sensory loss, which contributes significantly to the disability. The MRI changes are nonspecific, but, coupled with loss of sensory nerve action potentials, may aid diagnosis. We propose a new name for the condition: cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS). Neurology® 2011;76:1903–1910 PMID:21624989

  3. A cerebellar model for predictive motor control tested in a brain-based device

    PubMed Central

    McKinstry, Jeffrey L.; Edelman, Gerald M.; Krichmar, Jeffrey L.

    2006-01-01

    The cerebellum is known to be critical for accurate adaptive control and motor learning. We propose here a mechanism by which the cerebellum may replace reflex control with predictive control. This mechanism is embedded in a learning rule (the delayed eligibility trace rule) in which synapses onto a Purkinje cell or onto a cell in the deep cerebellar nuclei become eligible for plasticity only after a fixed delay from the onset of suprathreshold presynaptic activity. To investigate the proposal that the cerebellum is a general-purpose predictive controller guided by a delayed eligibility trace rule, a computer model based on the anatomy and dynamics of the cerebellum was constructed. It contained components simulating cerebellar cortex and deep cerebellar nuclei, and it received input from a middle temporal visual area and the inferior olive. The model was incorporated in a real-world brain-based device (BBD) built on a Segway robotic platform that learned to traverse curved paths. The BBD learned which visual motion cues predicted impending collisions and used this experience to avoid path boundaries. During learning, the BBD adapted its velocity and turning rate to successfully traverse various curved paths. By examining neuronal activity and synaptic changes during this behavior, we found that the cerebellar circuit selectively responded to motion cues in specific receptive fields of simulated middle temporal visual areas. The system described here prompts several hypotheses about the relationship between perception and motor control and may be useful in the development of general-purpose motor learning systems for machines. PMID:16488974

  4. [A Case of Left Vertebral Artery Aneurysm Showing Evoked Potentials on Bilateral Electrode by the Left Vagus Nerve Stimulation to Electromyographic Tracheal Tube].

    PubMed

    Kadoya, Tatsuo; Uehara, Hirofumi; Yamamoto, Toshinori; Shiraishi, Munehiro; Kinoshita, Yuki; Joyashiki, Takeshi; Enokida, Kengo

    2016-02-01

    Previously, we reported a case of brainstem cavernous hemangioma showing false positive responses to electromyographic tracheal tube (EMG tube). We concluded that the cause was spontaneous respiration accompanied by vocal cord movement. We report a case of left vertebral artery aneurysm showing evoked potentials on bilateral electrodes by the left vagus nerve stimulation to EMG tube. An 82-year-old woman underwent clipping of a left unruptured vertebral artery-posterior inferior cerebellar artery aneurysm. General anesthesia was induced with remifentanil, propofol and suxamethonium, and was maintained with oxygen, air, remifentanil and propofol. We monitored somatosensory evoked potentials, motor evoked potentials, and electromyogram of the vocal cord. When the manipulation reached brainstem and the instrument touched the left vagus nerve, evoked potentials appeared on bilateral electrodes. EMG tube is equipped with two electrodes on both sides. We concluded that the left vagus nerve stimulation generated evoked potentials of the left laryngeal muscles, and they were simultaneously detected as potential difference between two electrodes on both sides. EMG tube is used to identify the vagus nerve. However, it is necessary to bear in mind that each vagus nerve stimulation inevitably generates evoked potentials on bilateral electrodes.

  5. The Cerebellar Mutism Syndrome and Its Relation to Cerebellar Cognitive Function and the Cerebellar Cognitive Affective Disorder

    ERIC Educational Resources Information Center

    Wells, Elizabeth M.; Walsh, Karin S.; Khademian, Zarir P.; Keating, Robert F.; Packer, Roger J.

    2008-01-01

    The postoperative cerebellar mutism syndrome (CMS), consisting of diminished speech output, hypotonia, ataxia, and emotional lability, occurs after surgery in up to 25% of patients with medulloblastoma and occasionally after removal of other posterior fossa tumors. Although the mutism is transient, speech rarely normalizes and the syndrome is…

  6. The Cerebellar Mutism Syndrome and Its Relation to Cerebellar Cognitive Function and the Cerebellar Cognitive Affective Disorder

    ERIC Educational Resources Information Center

    Wells, Elizabeth M.; Walsh, Karin S.; Khademian, Zarir P.; Keating, Robert F.; Packer, Roger J.

    2008-01-01

    The postoperative cerebellar mutism syndrome (CMS), consisting of diminished speech output, hypotonia, ataxia, and emotional lability, occurs after surgery in up to 25% of patients with medulloblastoma and occasionally after removal of other posterior fossa tumors. Although the mutism is transient, speech rarely normalizes and the syndrome is…

  7. INTERDEPENDENT SUPERIORITY AND INFERIORITY FEELINGS

    PubMed Central

    Ingham, Harrington V.

    1949-01-01

    It is postulated that in neurotic persons who have unrealistic feelings of superiority and inferiority the two are interdependent. This is a departure from the concept of previous observers that either one or the other is primary and its opposite is overcompensation. The author postulates considerable parallelism, with equal importance for each. He submits that the neurotic person forms two logic-resistant compartments for the two opposed self-estimates and that treatment which makes inroads of logic upon one compartment, simultaneously does so upon the other. Two examples are briefly reported. The neurotic benefits sought in exaggeration of capability are the same as those sought in insistence upon inferiority: Presumption of superiority at once bids for approbation and delivers the subject from the need to prove himself worthy of it in dreaded competition; exaggeration of incapability baits sympathy and makes competition unnecessary because failure is conceded. Some of the characteristics of abnormal self-estimates that distinguish them from normal are: Preoccupation with self, resistance to logical explanation of personality problems, inconsistency in reasons for beliefs in adequacy on the one hand and inadequacy on the other, unreality, rationalization of faults, and difficulty and vacillation in the selection of adequate goals. PMID:15390573

  8. Homozygous Deletion of the Very Low Density Lipoprotein Receptor Gene Causes Autosomal Recessive Cerebellar Hypoplasia with Cerebral Gyral Simplification

    PubMed Central

    Boycott, Kym M.; Flavelle, Shauna; Bureau, Alexandre; Glass, Hannah C.; Fujiwara, T. Mary; Wirrell, Elaine; Davey, Krista; Chudley, Albert E.; Scott, James N.; McLeod, D. Ross; Parboosingh, Jillian S.

    2005-01-01

    An autosomal recessive syndrome of nonprogressive cerebellar ataxia and mental retardation is associated with inferior cerebellar hypoplasia and mild cerebral gyral simplification in the Hutterite population. An identity-by-descent mapping approach using eight patients from three interrelated Hutterite families localized the gene for this syndrome to chromosome region 9p24. Haplotype analysis identified familial and ancestral recombination events and refined the minimal region to a 2-Mb interval between markers D9S129 and D9S1871. A 199-kb homozygous deletion encompassing the entire very low density lipoprotein receptor (VLDLR) gene was present in all affected individuals. VLDLR is part of the reelin signaling pathway, which guides neuroblast migration in the cerebral cortex and cerebellum. To our knowledge, this syndrome represents the first human lipoprotein receptor malformation syndrome and the second human disease associated with a reelin pathway defect. PMID:16080122

  9. Cerebellar mutism syndrome: cause and rehabilitation.

    PubMed

    Catsman-Berrevoets, Coriene E

    2017-04-01

    Mutism of cerebellar origin may occur in the context of various causes but is most frequent in children after resection of a large midline cerebellar tumour. In this review, the endeavour to reach a consensus on name and definition of postoperative mutism of cerebellar origin and associated symptoms is highlighted. In addition, progress in understanding of cause and risk factors for the syndrome is discussed as well as the rehabilitation issues. Consensus on the term cerebellar mutism syndrome (CMS) has been reached. The exact pathogenesis of CMS remains unclear. Recently, attention was drawn to the hypothesis that thermal injury might be an important mechanism in the pathogenesis of CMS. Diffusion tensor imaging tractography was found to visualize the damage to relevant pathways that are associated with persistent impairments after recovery of CMS. There is still no established treatment for CMS to date. By reaching a consensus on terminology and description of CMS, a firm basis has been created for future research. The pathogenesis of CMS seems multifactorial and important risk factors have been found. However, CMS cannot be effectively prevented yet and no established or specific treatment is available, apart from very general rehabilitation and cognitive interventions.

  10. Improving Cerebellar Segmentation with Statistical Fusion.

    PubMed

    Plassard, Andrew J; Yang, Zhen; Prince, Jerry L; Claassen, Daniel O; Landman, Bennett A

    2016-02-27

    The cerebellum is a somatotopically organized central component of the central nervous system well known to be involved with motor coordination and increasingly recognized roles in cognition and planning. Recent work in multi-atlas labeling has created methods that offer the potential for fully automated 3-D parcellation of the cerebellar lobules and vermis (which are organizationally equivalent to cortical gray matter areas). This work explores the trade offs of using different statistical fusion techniques and post hoc optimizations in two datasets with distinct imaging protocols. We offer a novel fusion technique by extending the ideas of the Selective and Iterative Method for Performance Level Estimation (SIMPLE) to a patch-based performance model. We demonstrate the effectiveness of our algorithm, Non-Local SIMPLE, for segmentation of a mixed population of healthy subjects and patients with severe cerebellar anatomy. Under the first imaging protocol, we show that Non-Local SIMPLE outperforms previous gold-standard segmentation techniques. In the second imaging protocol, we show that Non-Local SIMPLE outperforms previous gold standard techniques but is outperformed by a non-locally weighted vote with the deeper population of atlases available. This work advances the state of the art in open source cerebellar segmentation algorithms and offers the opportunity for routinely including cerebellar segmentation in magnetic resonance imaging studies that acquire whole brain T1-weighted volumes with approximately 1 mm isotropic resolution.

  11. Myoclonus epilepsy with cerebellar Lafora bodies

    PubMed Central

    Scelsi, R.; Mazzella, G. L.; Lombardi, M.

    1976-01-01

    A case is reported of an 18 year old man with progressive myoclonus epilepsy. Histopathological examination revealed the presence of numerous Lafora bodies in the cerebellar granular layer, without other significant changes in the central nervous system or in other organs. Images PMID:932752

  12. Active force perception depends on cerebellar function.

    PubMed

    Bhanpuri, Nasir H; Okamura, Allison M; Bastian, Amy J

    2012-03-01

    Damage to the cerebellum causes characteristic movement abnormalities but is thought to have minimal impact on somatosensory perception. Traditional clinical assessments of patients with cerebellar lesions reveal no perceptual deficits despite the fact that the cerebellum receives substantial somatosensory information. Given that abnormalities have been reported in predicting the visual consequences of movement, we suspect that the cerebellum broadly participates in perception when motor output is required (i.e., active perception). Thus we hypothesize that cerebellar integrity is essential for somatosensory perception that requires motor activity, but not passive somatosensory perception. We compared the perceptual acuity of human cerebellar patients to that of healthy control subjects in several different somatosensory perception tasks with minimal visual information. We found that patients were worse at active force and stiffness discrimination but similar to control subjects with regard to passive cutaneous force detection, passive proprioceptive detection, and passive proprioceptive discrimination. Furthermore, the severity of movement symptoms as assessed by a clinical exam was positively correlated with impairment of active force perception. Notably, within the context of these perceptual tasks, control subjects and cerebellar patients displayed similar movement characteristics, and hence differing movement strategies are unlikely to underlie the differences in perception. Our results are consistent with the hypothesis that the cerebellum is vital to sensory prediction of self-generated movement and suggest a general role for the cerebellum in multiple forms of active perception.

  13. Improving cerebellar segmentation with statistical fusion

    NASA Astrophysics Data System (ADS)

    Plassard, Andrew J.; Yang, Zhen; Prince, Jerry L.; Claassen, Daniel O.; Landman, Bennett A.

    2016-03-01

    The cerebellum is a somatotopically organized central component of the central nervous system well known to be involved with motor coordination and increasingly recognized roles in cognition and planning. Recent work in multiatlas labeling has created methods that offer the potential for fully automated 3-D parcellation of the cerebellar lobules and vermis (which are organizationally equivalent to cortical gray matter areas). This work explores the trade offs of using different statistical fusion techniques and post hoc optimizations in two datasets with distinct imaging protocols. We offer a novel fusion technique by extending the ideas of the Selective and Iterative Method for Performance Level Estimation (SIMPLE) to a patch-based performance model. We demonstrate the effectiveness of our algorithm, Non- Local SIMPLE, for segmentation of a mixed population of healthy subjects and patients with severe cerebellar anatomy. Under the first imaging protocol, we show that Non-Local SIMPLE outperforms previous gold-standard segmentation techniques. In the second imaging protocol, we show that Non-Local SIMPLE outperforms previous gold standard techniques but is outperformed by a non-locally weighted vote with the deeper population of atlases available. This work advances the state of the art in open source cerebellar segmentation algorithms and offers the opportunity for routinely including cerebellar segmentation in magnetic resonance imaging studies that acquire whole brain T1-weighted volumes with approximately 1 mm isotropic resolution.

  14. Improving Cerebellar Segmentation with Statistical Fusion

    PubMed Central

    Plassard, Andrew J.; Yang, Zhen; Prince, Jerry L.; Claassen, Daniel O.; Landman, Bennett A.

    2016-01-01

    The cerebellum is a somatotopically organized central component of the central nervous system well known to be involved with motor coordination and increasingly recognized roles in cognition and planning. Recent work in multi-atlas labeling has created methods that offer the potential for fully automated 3-D parcellation of the cerebellar lobules and vermis (which are organizationally equivalent to cortical gray matter areas). This work explores the trade offs of using different statistical fusion techniques and post hoc optimizations in two datasets with distinct imaging protocols. We offer a novel fusion technique by extending the ideas of the Selective and Iterative Method for Performance Level Estimation (SIMPLE) to a patch-based performance model. We demonstrate the effectiveness of our algorithm, Non-Local SIMPLE, for segmentation of a mixed population of healthy subjects and patients with severe cerebellar anatomy. Under the first imaging protocol, we show that Non-Local SIMPLE outperforms previous gold-standard segmentation techniques. In the second imaging protocol, we show that Non-Local SIMPLE outperforms previous gold standard techniques but is outperformed by a non-locally weighted vote with the deeper population of atlases available. This work advances the state of the art in open source cerebellar segmentation algorithms and offers the opportunity for routinely including cerebellar segmentation in magnetic resonance imaging studies that acquire whole brain T1-weighted volumes with approximately 1 mm isotropic resolution. PMID:27127334

  15. Inverse Stochastic Resonance in Cerebellar Purkinje Cells

    PubMed Central

    Häusser, Michael; Gutkin, Boris S.; Roth, Arnd

    2016-01-01

    Purkinje neurons play an important role in cerebellar computation since their axons are the only projection from the cerebellar cortex to deeper cerebellar structures. They have complex internal dynamics, which allow them to fire spontaneously, display bistability, and also to be involved in network phenomena such as high frequency oscillations and travelling waves. Purkinje cells exhibit type II excitability, which can be revealed by a discontinuity in their f-I curves. We show that this excitability mechanism allows Purkinje cells to be efficiently inhibited by noise of a particular variance, a phenomenon known as inverse stochastic resonance (ISR). While ISR has been described in theoretical models of single neurons, here we provide the first experimental evidence for this effect. We find that an adaptive exponential integrate-and-fire model fitted to the basic Purkinje cell characteristics using a modified dynamic IV method displays ISR and bistability between the resting state and a repetitive activity limit cycle. ISR allows the Purkinje cell to operate in different functional regimes: the all-or-none toggle or the linear filter mode, depending on the variance of the synaptic input. We propose that synaptic noise allows Purkinje cells to quickly switch between these functional regimes. Using mutual information analysis, we demonstrate that ISR can lead to a locally optimal information transfer between the input and output spike train of the Purkinje cell. These results provide the first experimental evidence for ISR and suggest a functional role for ISR in cerebellar information processing. PMID:27541958

  16. Vergence Deficits in Patients with Cerebellar Lesions

    ERIC Educational Resources Information Center

    Sander, T.; Sprenger, A.; Neumann, G.; Machner, B.; Gottschalk, S.; Rambold, H.; Helmchen, C.

    2009-01-01

    The cerebellum is part of the cortico-ponto-cerebellar circuit for conjugate eye movements. Recent animal data suggest an additional role of the cerebellum for the control of binocular alignment and disconjugate, i.e. vergence eye movements. The latter is separated into two different components: fast vergence (to step targets) and slow vergence…

  17. Vergence Deficits in Patients with Cerebellar Lesions

    ERIC Educational Resources Information Center

    Sander, T.; Sprenger, A.; Neumann, G.; Machner, B.; Gottschalk, S.; Rambold, H.; Helmchen, C.

    2009-01-01

    The cerebellum is part of the cortico-ponto-cerebellar circuit for conjugate eye movements. Recent animal data suggest an additional role of the cerebellum for the control of binocular alignment and disconjugate, i.e. vergence eye movements. The latter is separated into two different components: fast vergence (to step targets) and slow vergence…

  18. Cerebellar Hypoplasia and Dysmorphia in Neurofibromatosis Type 1.

    PubMed

    Toelle, Sandra P; Poretti, Andrea; Weber, Peter; Seute, Tatjana; Bromberg, Jacoline E C; Scheer, Ianina; Boltshauser, Eugen

    2015-12-01

    Unidentified bright objects (UBO) and tumors are well-known cerebellar abnormalities in neurofibromatosis type 1 (NF1). Literature reports on malformative cerebellar anomalies in neurofibromatosis type 1 (NF1), however, are scant. We retrospectively studied the clinical and neuroimaging findings of 5 patients with NF1 (4 females, age 6 to 29 years at last follow-up) and cerebellar anomalies. Cerebellar symptoms on neurological examination were mild or even not evident whereas learning disabilities were more or less pronounced in four patients. Two patients had cerebellar hypoplasia (diffusely enlarged cerebellar interfoliar spaces) and three cerebellar dysmorphias involving mainly one cerebellar hemisphere. In NF1, malformative cerebellar anomalies are rare (estimated prevalence of about 1%), but most likely underestimated and easily overlooked, because physicians tend to focus on more prevalent, obvious, and well-known findings such as optic pathway gliomas, other tumors, and UBO. This kind of cerebellar anomaly in NF1 has most likely a malformative origin, but the exact pathogenesis is unknown. The individual clinical significance is difficult to determine. We suggest that cerebellar anomalies should be systematically evaluated in neuroimaging studies of NF1 patients.

  19. Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome.

    PubMed

    Desai, Jay; Mitchell, Wendy G

    2012-11-01

    Acute cerebellar ataxia and acute cerebellitis represent a process characterized by parainfectious, postinfectious, or postvaccination cerebellar inflammation. There is considerable overlap between these entities. The mildest cases of acute cerebellar ataxia represent a benign condition that is characterized by acute truncal and gait ataxia, variably with appendicular ataxia, nystagmus, dysarthria, and hypotonia. It occurs mostly in young children, presents abruptly, and recovers over weeks. Neuroimaging is normal. Severe cases of cerebellitis represent the other end of the spectrum, presenting with acute cerebellar signs often overshadowed by alteration of consciousness, focal neurological deficits, raised intracranial pressure, hydrocephalus, and even herniation. Neuroimaging is abnormal and the prognosis is less favorable than in acute cerebellar ataxia. Acute disseminated encephalomyelitis may be confused with acute cerebellitis when the clinical findings are predominantly cerebellar, but lesions on neuroimaging are usually widespread. Paraneoplastic opsoclonus-myoclonus syndrome is often initially misdiagnosed as acute cerebellar ataxia, but has very specific features, course, and etiopathogensis.

  20. Cerebellar contribution to mental rotation: a cTBS study.

    PubMed

    Picazio, Silvia; Oliveri, Massimiliano; Koch, Giacomo; Caltagirone, Carlo; Petrosini, Laura

    2013-12-01

    A cerebellar role in spatial information processing has been advanced even in the absence of physical manipulation, as occurring in mental rotation. The present study was aimed at investigating the specific involvement of left and right cerebellar hemispheres in two tasks of mental rotation. We used continuous theta burst stimulation to downregulate cerebellar hemisphere excitability in healthy adult subjects performing two mental rotation tasks: an Embodied Mental Rotation (EMR) task, entailing an egocentric strategy, and an Abstract Mental Rotation (AMR) task entailing an allocentric strategy. Following downregulation of left cerebellar hemisphere, reaction times were slower in comparison to sham stimulation in both EMR and AMR tasks. Conversely, identical reaction times were obtained in both tasks following right cerebellar hemisphere and sham stimulations. No effect of cerebellar stimulation side was found on response accuracy. The present findings document a specialization of the left cerebellar hemisphere in mental rotation regardless of the kind of stimulus to be rotated.

  1. Duplication of the inferior vena cava: anatomy, embryology and classification proposal.

    PubMed

    Natsis, Konstantinos; Apostolidis, Stylianos; Noussios, George; Papathanasiou, Efthymia; Kyriazidou, Aggela; Vyzas, Vasilios

    2010-03-01

    A case of a duplicated inferior vena cava (IVC) along with other anatomical vessel variations in a 72-year-old male cadaver is presented. The anomalous vessels involved, besides the IVC, were the left testicular vein and artery, the left suprarenal artery and a superior accessory left renal artery. Based on the gross appearance of the preaortic anastomotic trunk between the left and right IVC as well as on the underlying embryological features, a classification is proposed: incomplete bilateral duplication of the IVC and complete bilateral duplication of the IVC. The latter can be further divided into three types: major, minor and asymmetric.

  2. Self-referential phase reset based on inferior olive oscillator dynamics

    PubMed Central

    Kazantsev, V. B.; Nekorkin, V. I.; Makarenko, V. I.; Llinás, R.

    2004-01-01

    The olivo-cerebellar network is a key neuronal circuit that provides high-level motor control in the vertebrate CNS. Functionally, its network dynamics is organized around the oscillatory membrane potential properties of inferior olive (IO) neurons and their electrotonic connectivity. Because IO action potentials are generated at the peaks of the quasisinusoidal membrane potential oscillations, their temporal firing properties are defined by the IO rhythmicity. Excitatory inputs to these neurons can produce oscillatory phase shifts without modifying the amplitude or frequency of the oscillations, allowing well defined time-shift modulation of action potential generation. Moreover, the resulting phase is defined only by the amplitude and duration of the reset stimulus and is independent of the original oscillatory phase when the stimulus was delivered. This reset property, henceforth referred to as selfreferential phase reset, results in the generation of organized clusters of electrically coupled cells that oscillate in phase and are controlled by inhibitory feedback loops through the cerebellar nuclei and the cerebellar cortex. These clusters provide a dynamical representation of arbitrary motor intention patterns that are further mapped to the motor execution system. Being supplied with sensory inputs, the olivo-cerebellar network is capable of rearranging the clusters during the process of movement execution. Accordingly, the phase of the IO oscillators can be rapidly reset to a desired phase independently of the history of phase evolution. The goal of this article is to show how this selfreferential phase reset may be implemented into a motor control system by using a biologically based mathematical model. PMID:15604140

  3. Cerebellar atrophy without cerebellar cortex hyperintensity in infantile neuroaxonal dystrophy (INAD) due to PLA2G6 mutation.

    PubMed

    Biancheri, Roberta; Rossi, Andrea; Alpigiani, Giannina; Filocamo, Mirella; Gandolfo, Carlo; Lorini, Renata; Minetti, Carlo

    2007-05-01

    Infantile neuroaxonal dystrophy (INAD) is a rare neurodegenerative disorder characterized by infantile onset and rapid progression of psychomotor regression and hypotonia evolving into spasticity. The neuroradiologic hallmark of the disease is represented by cerebellar atrophy and signal hyperintensity in the cerebellar cortex on MR T2-weighted images. We report a 2-year-old boy with psychomotor regression and hypotonia carrying a homozygous 5' splice site mutation in PLA2G6 gene, whose brain MRI revealed cerebellar atrophy with normal cerebellar cortex signal intensity. The absence of the signal hyperintensity of the cerebellar cortex does not rule out the diagnosis of INAD.

  4. Improved segmentation of cerebellar structures in children

    PubMed Central

    Narayanan, Priya Lakshmi; Boonazier, Natalie; Warton, Christopher; Molteno, Christopher D; Joseph, Jesuchristopher; Jacobson, Joseph L; Jacobson, Sandra W; Zöllei, Lilla; Meintjes, Ernesta M

    2016-01-01

    Background Consistent localization of cerebellar cortex in a standard coordinate system is important for functional studies and detection of anatomical alterations in studies of morphometry. To date, no pediatric cerebellar atlas is available. New method The probabilistic Cape Town Pediatric Cerebellar Atlas (CAPCA18) was constructed in the age-appropriate National Institute of Health Pediatric Database asymmetric template space using manual tracings of 16 cerebellar compartments in 18 healthy children (9–13 years) from Cape Town, South Africa. The individual atlases of the training subjects were also used to implement multi atlas label fusion using multi atlas majority voting (MAMV) and multi atlas generative model (MAGM) approaches. Segmentation accuracy in 14 test subjects was compared for each method to ‘gold standard’ manual tracings. Results Spatial overlap between manual tracings and CAPCA18 automated segmentation was 73% or higher for all lobules in both hemispheres, except VIIb and X. Automated segmentation using MAGM yielded the best segmentation accuracy over all lobules (mean Dice Similarity Coefficient 0.76; range 0.55–0.91). Comparison with existing methods In all lobules, spatial overlap of CAPCA18 segmentations with manual tracings was similar or higher than those obtained with SUIT (spatially unbiased infra-tentorial template), providing additional evidence of the benefits of an age appropriate atlas. MAGM segmentation accuracy was comparable to values reported recently by Park et al. (2014) in adults (across all lobules mean DSC = 0.73, range 0.40–0.89). Conclusions CAPCA18 and the associated multi atlases of the training subjects yield improved segmentation of cerebellar structures in children. PMID:26743973

  5. Improved segmentation of cerebellar structures in children.

    PubMed

    Narayanan, Priya Lakshmi; Warton, Christopher; Rosella Boonzaier, Natalie; Molteno, Christopher D; Joseph, Jesuchristopher; Jacobson, Joseph L; Jacobson, Sandra W; Zöllei, Lilla; Meintjes, Ernesta M

    2016-03-15

    Consistent localization of cerebellar cortex in a standard coordinate system is important for functional studies and detection of anatomical alterations in studies of morphometry. To date, no pediatric cerebellar atlas is available. The probabilistic Cape Town Pediatric Cerebellar Atlas (CAPCA18) was constructed in the age-appropriate National Institute of Health Pediatric Database asymmetric template space using manual tracings of 16 cerebellar compartments in 18 healthy children (9-13 years) from Cape Town, South Africa. The individual atlases of the training subjects were also used to implement multi atlas label fusion using multi atlas majority voting (MAMV) and multi atlas generative model (MAGM) approaches. Segmentation accuracy in 14 test subjects was compared for each method to 'gold standard' manual tracings. Spatial overlap between manual tracings and CAPCA18 automated segmentation was 73% or higher for all lobules in both hemispheres, except VIIb and X. Automated segmentation using MAGM yielded the best segmentation accuracy over all lobules (mean Dice Similarity Coefficient 0.76; range 0.55-0.91; mean Hausdorff distance 0.9 mm; range 0.8-2.7 mm). In all lobules, spatial overlap of CAPCA18 segmentations with manual tracings was similar or higher than those obtained with SUIT (spatially unbiased infra-tentorial template), providing additional evidence of the benefits of an age appropriate atlas. MAGM segmentation accuracy was comparable to values reported recently by Park et al. (Neuroimage 2014;95(1):217) in adults (across all lobules mean DSC=0.73, range 0.40-0.89). CAPCA18 and the associated multi-subject atlases of the training subjects yield improved segmentation of cerebellar structures in children. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Hybrid Coronary Artery Revascularization for Takayasu Arteritis with Major Visceral Collateral Circulation from the Left Internal Thoracic Artery

    PubMed Central

    Sim, Hyung Tae; Kim, Jeong-Won; Yoo, Jae Suk; Cho, Kwang Ree

    2017-01-01

    Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation. PMID:28382269

  7. Can secondary degeneration accelerate the formation of neurofibrillary tangles? A case of hemispheric infarction showing asymmetric degeneration of the substantia nigra, red nuclei, inferior olivary nuclei and dentate nuclei with concomitant changes of progressive supranuclear palsy.

    PubMed

    Matsumoto, R; Oda, M; Arai, N; Shin, T; Hayashi, M

    1999-02-01

    A case of hemispheric infarction involving the territory of the right middle cerebral artery and the thalamus showed conspicuous asymmetric degeneration in the substantia nigra, red nuclei, inferior olivary nuclei and dentate nuclei with concomitant changes of progressive supranuclear palsy (PSP). The right substantia nigra and red nucleus showed loss of neurons and proliferation of astrocytes. The right olivary nucleus was hypertrophic, while the neuronal loss and astrocytosis in the dentate nucleus were predominant on the contralateral side. Modified Gallyas-Braak staining revealed the extensive distribution of neurofibrillary tangles (NFTs), threads and intraglial argyrophilic structures in the globus pallidus, subthalamic nuclei, cerebral cortex and dentate nuclei, as well as in the affected brain stem nuclei, with a distinct predominance on the affected side. In this case, the one-sided predominance of the extended degeneration in these brain stem and cerebellar areas is considered, in addition to the PSP changes, to be due to secondary retrograde degeneration via the nigrostriatal and dentato-rubro-thalamic pathways following the hemispheric infarction, and to also be the result of disruption of the dentato-olivary fiber connections. In addition, because of the predominant distribution of NFTs on the more degenerated side, it is surmised that the formation of NFTs may be accelerated by secondary degeneration.

  8. Shape recognition and inferior temporal neurons.

    PubMed Central

    Schwartz, E L; Desimone, R; Albright, T D; Gross, C G

    1983-01-01

    Inferior temporal cortex plays an important role in shape recognition. To study the shape selectivity of single inferior temporal neurons, we recorded their responses to a set of shapes systematically varying in boundary curvature. Many inferior temporal neurons were selective for stimuli of specific boundary curvature and maintained this selectivity over changes in stimulus size or position. The method of describing boundary curvature was that of Fourier descriptors. PMID:6577453

  9. Segmentation of the Cerebellar Peduncles Using a Random Forest Classifier and a Multi-object Geometric Deformable Model: Application to Spinocerebellar Ataxia Type 6.

    PubMed

    Ye, Chuyang; Yang, Zhen; Ying, Sarah H; Prince, Jerry L

    2015-07-01

    The cerebellar peduncles, comprising the superior cerebellar peduncles (SCPs), the middle cerebellar peduncle (MCP), and the inferior cerebellar peduncles (ICPs), are white matter tracts that connect the cerebellum to other parts of the central nervous system. Methods for automatic segmentation and quantification of the cerebellar peduncles are needed for objectively and efficiently studying their structure and function. Diffusion tensor imaging (DTI) provides key information to support this goal, but it remains challenging because the tensors change dramatically in the decussation of the SCPs (dSCP), the region where the SCPs cross. This paper presents an automatic method for segmenting the cerebellar peduncles, including the dSCP. The method uses volumetric segmentation concepts based on extracted DTI features. The dSCP and noncrossing portions of the peduncles are modeled as separate objects, and are initially classified using a random forest classifier together with the DTI features. To obtain geometrically correct results, a multi-object geometric deformable model is used to refine the random forest classification. The method was evaluated using a leave-one-out cross-validation on five control subjects and four patients with spinocerebellar ataxia type 6 (SCA6). It was then used to evaluate group differences in the peduncles in a population of 32 controls and 11 SCA6 patients. In the SCA6 group, we have observed significant decreases in the volumes of the dSCP and the ICPs and significant increases in the mean diffusivity in the noncrossing SCPs, the MCP, and the ICPs. These results are consistent with a degeneration of the cerebellar peduncles in SCA6 patients.

  10. Cerebellar lobule atrophy and disability in progressive MS.

    PubMed

    Cocozza, Sirio; Petracca, Maria; Mormina, Enricomaria; Buyukturkoglu, Korhan; Podranski, Kornelius; Heinig, Monika M; Pontillo, Giuseppe; Russo, Camilla; Tedeschi, Enrico; Russo, Cinzia Valeria; Costabile, Teresa; Lanzillo, Roberta; Harel, Asaff; Klineova, Sylvia; Miller, Aaron; Brunetti, Arturo; Morra, Vincenzo Brescia; Lublin, Fred; Inglese, Matilde

    2017-08-26

    To investigate global and lobular cerebellar volumetries in patients with progressive multiple sclerosis (MS), testing the contribution of cerebellar lobular atrophy to both motor and cognitive performances. Eighty-two patients with progressive MS and 46 healthy controls (HC) were enrolled in this cross-sectional study. Clinical evaluation included motor and cognitive testing: Expanded Disability Status Scale, cerebellar Functional System score, Timed 25-Foot Walk Test, 9-Hole Peg Test (9-HPT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT) and California Verbal Learning Test II (CVLT). Cerebellar volumes were automatically obtained using the Spatially Unbiased Infratentorial Toolbox. A hierarchical multiple linear regression analysis was performed to assess the relationship between MRI variables of supratentorial and cerebellar damage (grey matter fraction, T2 lesion volume, metrics of cerebellar atrophy and cerebellar lesion volume) and motor/cognitive scores. Patients with MS exhibited lower cerebellar volumes compared with HC. Regression analysis showed that cerebellar metrics accounted for extra variance in both motor and cognitive performances, with cerebellar lesion volume, cerebellar Lobules VI, Crus I and VIIIa atrophy being independent predictors of 9-HPT, SDMT, BVMT and CVLT performances. Atrophy of specific cerebellar lobules explains different aspects of motor and cognitive disability in patients with progressive MS. Investigation of cerebellar involvement provides further insight into the pathophysiological basis of clinical disability in progressive MS. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Inferior vena caval masses identified by echocardiography

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Asher, C. R.; Xu, Y.; Huang, V.; Griffin, B. P.; Stewart, W. J.; Novick, A. C.; Thomas, J. D.

    1999-01-01

    The most common cause of an inferior vena caval mass is renal cell carcinoma that extends through the lumen, occurring in 47 of 62 patients (85%). Detection of an inferior vena caval mass affects the surgical approach requiring cardiopulmonary bypass for resection when the mass extends to the heart.

  12. Inferior vena caval masses identified by echocardiography

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Asher, C. R.; Xu, Y.; Huang, V.; Griffin, B. P.; Stewart, W. J.; Novick, A. C.; Thomas, J. D.

    1999-01-01

    The most common cause of an inferior vena caval mass is renal cell carcinoma that extends through the lumen, occurring in 47 of 62 patients (85%). Detection of an inferior vena caval mass affects the surgical approach requiring cardiopulmonary bypass for resection when the mass extends to the heart.

  13. Structural cerebellar correlates of cognitive and motor dysfunctions in cerebellar degeneration.

    PubMed

    Kansal, Kalyani; Yang, Zhen; Fishman, Ann M; Sair, Haris I; Ying, Sarah H; Jedynak, Bruno M; Prince, Jerry L; Onyike, Chiadi U

    2017-03-01

    See King et al. (doi:10.1093/aww348) for a scientific commentary on this article.Detailed mapping of clinical dysfunctions to the cerebellar lobules in disease populations is necessary to establish the functional significance of lobules implicated in cognitive and motor functions in normal subjects. This study constitutes the first quantitative examination of the lobular correlates of a broad range of cognitive and motor phenomena in cerebellar disease. We analysed cross-sectional data from 72 cases with cerebellar disease and 36 controls without cerebellar disease. Cerebellar lobule volumes were derived from a graph-cut based segmentation algorithm. Sparse partial least squares, a variable selection approach, was used to identify lobules associated with motor function, language, executive function, memory, verbal learning, perceptual organization and visuomotor coordination. Motor dysfunctions were chiefly associated with the anterior lobe and posterior lobule HVI. Confrontation naming, noun fluency, recognition, and perceptual organization did not have cerebellar associations. Verb and phonemic fluency, working memory, cognitive flexibility, immediate and delayed recall, verbal learning, and visuomotor coordination were variably associated with HVI, Crus I, Crus II, HVII B and/or HIX. Immediate and delayed recall also showed associations with the anterior lobe. These findings provide preliminary anatomical evidence for a functional topography of the cerebellum first defined in task-based functional magnetic resonance imaging studies of normal subjects and support the hypotheses that (i) cerebellar efferents target frontal lobe neurons involved in forming action representations and new search strategies; (ii) there is greater involvement of the cerebellum when immediate recall tasks involve more complex verbal stimuli (e.g. longer words versus digits); and (iii) it is involved in spontaneous retrieval of long-term memory. More generally, they provide an anatomical

  14. Spinocerebellar ataxia type 4 (SCA4): Initial pathoanatomical study reveals widespread cerebellar and brainstem degeneration.

    PubMed

    Hellenbroich, Y; Gierga, K; Reusche, E; Schwinger, E; Deller, T; de Vos, R A I; Zühlke, C; Rüb, U

    2006-07-01

    Spinocerebellar ataxia type 4 (SCA4), also known as 'hereditary ataxia with sensory neuropathy', represents a very rare, progressive and untreatable form of an autosomal dominant inherited cerebellar ataxia (ADCA). Due to a lack of autopsy cases, no neuropathological or clinicopathological studies had yet been performed in SCA4. In the present study, the first available cerebellar and brainstem tissue of a clinically diagnosed and genetically-confirmed German SCA4 patient was pathoanatomically studied using serial thick sections. During this systematic postmortem investigation, along with an obvious demyelinization of cerebellar and brainstem fiber tracts we observed widespread cerebellar and brainstem neurodegeneration with marked neuronal loss in the substantia nigra and ventral tegmental area, central raphe and pontine nuclei, all auditory brainstem nuclei, in the abducens, principal trigeminal, spinal trigeminal, facial, superior vestibular, medial vestibular, interstitial vestibular, dorsal motor vagal, hypoglossal, and prepositus hypoglossal nuclei, as well as in the nucleus raphe interpositus, all dorsal column nuclei, and in the principal and medial subnuclei of the inferior olive. Severe neuronal loss was seen in the Purkinje cell layer of the cerebellum, in the cerebellar fastigial nucleus, in the red, trochlear, lateral vestibular, and lateral reticular nuclei, the reticulotegmental nucleus of the pons, and the nucleus of Roller. In addition, immunocytochemical analysis using the anti-polyglutamine antibody 1C2 failed to detect any polyglutamine-related immunoreactivity in the central nervous regions of this SCA4 patient studied. In view of the known functional role of affected nuclei and related fiber tracts, the present findings not only offer explanations for the well-known disease symptoms of SCA4 patients (i.e. ataxic symptoms, dysarthria and somatosensory deficits), but for the first time help to explain why diplopia, gaze-evoked nystagmus

  15. Bilateral inferior petrosal sinus sampling

    PubMed Central

    Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo

    2016-01-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  16. Bilateral inferior petrosal sinus sampling.

    PubMed

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

  17. A toolbox to visually explore cerebellar shape changes in cerebellar disease and dysfunction

    NASA Astrophysics Data System (ADS)

    Abulnaga, S. Mazdak; Yang, Zhen; Carass, Aaron; Kansal, Kalyani; Jedynak, Bruno M.; Onyike, Chiadi U.; Ying, Sarah H.; Prince, Jerry L.

    2016-03-01

    The cerebellum plays an important role in motor control and is also involved in cognitive processes. Cerebellar function is specialized by location, although the exact topographic functional relationship is not fully understood. The spinocerebellar ataxias are a group of neurodegenerative diseases that cause regional atrophy in the cerebellum, yielding distinct motor and cognitive problems. The ability to study the region-specific atrophy patterns can provide insight into the problem of relating cerebellar function to location. In an effort to study these structural change patterns, we developed a toolbox in MATLAB to provide researchers a unique way to visually explore the correlation between cerebellar lobule shape changes and function loss, with a rich set of visualization and analysis modules. In this paper, we outline the functions and highlight the utility of the toolbox. The toolbox takes as input landmark shape representations of subjects' cerebellar substructures. A principal component analysis is used for dimension reduction. Following this, a linear discriminant analysis and a regression analysis can be performed to find the discriminant direction associated with a specific disease type, or the regression line of a specific functional measure can be generated. The characteristic structural change pattern of a disease type or of a functional score is visualized by sampling points on the discriminant or regression line. The sampled points are used to reconstruct synthetic cerebellar lobule shapes. We showed a few case studies highlighting the utility of the toolbox and we compare the analysis results with the literature.

  18. A neural model of cerebellar learning for arm movement control: cortico-spino-cerebellar dynamics.

    PubMed

    Contreras-Vidal, J L; Grossberg, S; Bullock, D

    1997-01-01

    A neural network model of opponent cerebellar learning for arm movement control is proposed. The model illustrates how a central pattern generator in cortex and basal ganglia, a neuromuscular force controller in spinal cord, and an adaptive cerebellum cooperate to reduce motor variability during multijoint arm movements using mono- and bi-articular muscles. Cerebellar learning modifies velocity commands to produce phasic antagonist bursts at interpositus nucleus cells whose feed-forward action overcomes inherent limitations of spinal feedback control of tracking. Excitation of alpha motoneuron pools, combined with inhibition of their Renshaw cells by the cerebellum, facilitate movement initiation and optimal execution. Transcerebellar pathways are opened by learning through long-term depression (LTD) of parallel fiber-Purkinje cell synapses in response to conjunctive stimulation of parallel fibers and climbing fiber discharges that signal muscle stretch errors. The cerebellar circuitry also learns to control opponent muscles pairs, allowing cocontraction and reciprocal inhibition of muscles. Learning is stable, exhibits load compensation properties, and generalizes better across movement speeds if motoneuron pools obey the size principle. The intermittency of climbing fiber discharges maintains stable learning. Long-term potentiation (LTP) in response to uncorrelated parallel fiber signals enables previously weakened synapses to recover. Loss of climbing fibers, in the presence of LTP, can erode normal opponent signal processing. Simulated lesions of the cerebellar network reproduce symptoms of cerebellar disease, including sluggish movement onsets, poor execution of multijoint plans, and abnormally prolonged endpoint oscillations.

  19. Crossed Cerebellar Atrophy of the Lateral Cerebellar Nucleus in an Endothelin-1-Induced, Rodent Model of Ischemic Stroke

    PubMed Central

    Chan, Hugh H.; Cooperrider, Jessica L.; Park, Hyun-Joo; Wathen, Connor A.; Gale, John T.; Baker, Kenneth B.; Machado, Andre G.

    2017-01-01

    Crossed cerebellar diaschisis (CCD) is a functional deficit of the cerebellar hemisphere resulting from loss of afferent input consequent to a lesion of the contralateral cerebral hemisphere. It is manifested as a reduction of metabolism and blood flow and, depending on severity and duration, it can result in atrophy, a phenomenon known as crossed cerebellar atrophy (CCA). While CCA has been well-demonstrated in humans, it remains poorly characterized in animal models of stroke. In this study we evaluated the effects of cerebral cortical ischemia on contralateral cerebellar anatomy using an established rodent model of chronic stroke. The effects of cortical ischemia on the cerebellar hemispheres, vermis and deep nuclei were characterized. Intracortical microinjections of endothelin-1 (ET-1) were delivered to the motor cortex of Long Evans rats to induce ischemic stroke, with animals sacrificed 6 weeks later. Naive animals served as controls. Cerebral sections and cerebellar sections including the deep nuclei were prepared for analysis with Nissl staining. Cortical ischemia was associated with significant thickness reduction of the molecular layer at the Crus 1 and parafloccular lobule (PFL), but not in fourth cerebellar lobule (4Cb), as compared to the ipsilesional cerebellar hemisphere. A significant reduction in volume and cell density of the lateral cerebellar nucleus (LCN), the rodent correlate of the dentate nucleus, was also noted. The results highlight the relevance of corticopontocerebellar (CPC) projections for cerebellar metabolism and function, including its direct projections to the LCN. PMID:28261086

  20. Prognostic significance of resting anterior thallium-201 defects in patients with inferior myocardial infarction

    SciTech Connect

    Gibson, R.S.; Taylor, G.J.; Watson, D.D.; Berger, B.C.; Crampton, R.S.; Martin, R.P.; Beller, G.A.

    1980-11-01

    To determine whether Tl-201 scintigraphy performed at rest during the late hospital phase of inferior myocardial infarction can predict subsequent coronary events, 25 patients with historical, enzymatic, and electrocardiographic criteria of transmural inferior infarction underwent serial imaging with computer quantification 7 to 35 days after admission. All 25 patients had inferior defects, and 13 (52%) also had anterior defects implying stenosis of the left anterior descending coronary artery. The patients were divided into those with inferior and anterior perfusion defects (Group 1) and those with inferior defects alone (Group 2). In Group 1, three patients had persistent defects in the anterior wall and ten had initial defects with redistribution. New or recurrent coronary events - which included new onset or progression of angina pectoris, sudden death, reinfarction, and congestive heart failure - were recorded over an average 7.2 months of followup (range 3 to 9 mo) for all patients. Ten of 13 (77%) patients in Group 1 had 17 coronary events and four of 12 (33%) patients in Group 2 had six coronary events (p < 0.02). Nine patients in Group 1 and three in Group 2 developed angina (p < 0.03). The apparently increased prevalence in Group 1 of sudden death (8% against 0%), reinfarction (8% against 0%), and congestive heart failure (46% against 25%) was not statistically significant. Thus resting T1-201 scintigraphy with computer quantification is a highly sensitive method to detect inferior myocardial infarction even in the late hospital phase. Moreover, it appears to identify those patients with inferior infarction at high risk for subsequent coronary events, presumably due to stenosis of the left anterior descending coronary artery.

  1. Traumatic Hemorrhage within a Cerebellar Dermoid Cyst

    PubMed Central

    Luan, Yongxin; Wang, Haifeng; Zhong, Yanping; Bian, Xinchao; Luo, Yinan; Ge, Pengfei

    2012-01-01

    Intracranial dermoid cysts with hemorrhage are fairly rare. Herein, we reported a 28-year-old female patient with a cerebellar dermoid cyst, which was found accidently on neuro-imaging after head trauma. MR scanning revealed that the lesion was located within the cerebellar vermis and was measured 3.5cm×3.9cm×3.0cm, with hyper-intensity on T1WI and hypo-intensity on T2WI. However, on CT imaging, it showed hyper-dense signals. It was removed completely via midline sub-occipital approach under surgical microscope. Histological examination proved it was a dermoid cyst with internal hemorrhage. In combination with literature review, we discussed the factors that might be responsible for the hemorrhage within dermoid cysts. PMID:22211083

  2. Traumatic hemorrhage within a cerebellar dermoid cyst.

    PubMed

    Luan, Yongxin; Wang, Haifeng; Zhong, Yanping; Bian, Xinchao; Luo, Yinan; Ge, Pengfei

    2012-01-01

    Intracranial dermoid cysts with hemorrhage are fairly rare. Herein, we reported a 28-year-old female patient with a cerebellar dermoid cyst, which was found accidently on neuro-imaging after head trauma. MR scanning revealed that the lesion was located within the cerebellar vermis and was measured 3.5cm×3.9cm×3.0cm, with hyper-intensity on T1WI and hypo-intensity on T2WI. However, on CT imaging, it showed hyper-dense signals. It was removed completely via midline sub-occipital approach under surgical microscope. Histological examination proved it was a dermoid cyst with internal hemorrhage. In combination with literature review, we discussed the factors that might be responsible for the hemorrhage within dermoid cysts.

  3. Marijuana alters the human cerebellar clock.

    PubMed

    O'Leary, Daniel S; Block, Robert I; Turner, Beth M; Koeppel, Julie; Magnotta, Vincent A; Ponto, Laura Boles; Watkins, G Leonard; Hichwa, Richard D; Andreasen, Nancy C

    2003-06-11

    The effects of marijuana on brain perfusion and internal timing were assessed using [15O] water PET in occasional and chronic users. Twelve volunteers who smoked marijuana recreationally about once weekly, and 12 volunteers who smoked daily for a number of years performed a self-paced counting task during PET imaging, before and after smoking marijuana and placebo cigarettes. Smoking marijuana increased rCBF in the ventral forebrain and cerebellar cortex in both groups, but resulted in significantly less frontal lobe activation in chronic users. Counting rate increased after smoking marijuana in both groups, as did a behavioral measure of self-paced tapping, and both increases correlated with rCBF in the cerebellum. Smoking marijuana appears to accelerate a cerebellar clock altering self-paced behaviors.

  4. Cerebellar degeneration following neuroleptic malignant syndrome.

    PubMed Central

    Lal, V.; Sardana, V.; Thussu, A.; Sawhney, I. M.; Prabhakar, S.

    1997-01-01

    A 55-year-old woman with a history of bipolar affective disorder developed hyperpyrexia, rigidity and depressed consciousness (neuroleptic malignant syndrome) after commencing neuroleptic therapy. On regaining consciousness, she was mute and had signs suggesting pancerebellar involvement. Hyperpyrexia, which is a cardinal feature of neuroleptic malignant syndrome, may have caused cerebellar damage. Neuroleptic malignant syndrome needs both early recognition and prompt treatment to obviate devastating complications. PMID:9519191

  5. Cerebellar secretin modulates eyeblink classical conditioning

    PubMed Central

    Fuchs, Jason R.; Robinson, Gain M.; Dean, Aaron M.; Schoenberg, Heidi E.; Williams, Michael R.; Morielli, Anthony D.

    2014-01-01

    We have previously shown that intracerebellar infusion of the neuropeptide secretin enhances the acquisition phase of eyeblink conditioning (EBC). Here, we sought to test whether endogenous secretin also regulates EBC and to test whether the effect of exogenous and endogenous secretin is specific to acquisition. In Experiment 1, rats received intracerebellar infusions of the secretin receptor antagonist 5-27 secretin or vehicle into the lobulus simplex of cerebellar cortex immediately prior to sessions 1–3 of acquisition. Antagonist-infused rats showed a reduction in the percentage of eyeblink CRs compared with vehicle-infused rats. In Experiment 2, rats received intracerebellar infusions of secretin or vehicle immediately prior to sessions 1–2 of extinction. Secretin did not significantly affect extinction performance. In Experiment 3, rats received intracerebellar infusions of 5-27 secretin or vehicle immediately prior to sessions 1–2 of extinction. The secretin antagonist did not significantly affect extinction performance. Together, our current and previous results indicate that both exogenous and endogenous cerebellar secretin modulate acquisition, but not extinction, of EBC. We have previously shown that (1) secretin reduces surface expression of the voltage-gated potassium channel α-subunit Kv1.2 in cerebellar cortex and (2) intracerebellar infusions of a Kv1.2 blocker enhance EBC acquisition, much like secretin. Kv1.2 is almost exclusively expressed in cerebellar cortex at basket cell–Purkinje cell pinceaus and Purkinje cell dendrites; we propose that EBC-induced secretin release from PCs modulates EBC acquisition by reducing surface expression of Kv1.2 at one or both of these sites. PMID:25403455

  6. Morphometry and Variability of the Brain Arterial Circle in Chinchilla (Chinchilla laniger, Molina).

    PubMed

    Kuchinka, Jacek

    2017-02-09

    Arterial circles of brains from 70 adult chinchillas were filled with synthetic latex. The arterial circle of the brain is formed as the result of vertebral arteries being merged into the basilar artery. Caudally, both vertebral arteries gave rise to the ventral spinal artery. The ventral spinal artery splits into tiny cerebellar vessels, the pontine and cochlear branches. Distally, the basilar artery ramified into two terminal branches that formed the arterial circle of brain, rostrally open in most cases (75%). The observed variability of the arterial circle of brain of chinchillas pertained to all elements of that circle. The greatest variability within the vessels of the circle of Willis in chinchillas was observed in 22 cases (31.4%) of internal ophthalmic arteries. In chinchillas, a trend toward slight variability within the arteries comprising the arterial circle of the brain was observed in 44 animals. This accounted for 62.8% of all cases. Only in three cases was the arterial circle of brain clearly symmetrical. At the same time, 23 animals (32.8%) revealed features of significant vascular variability within the brain base region. These consisted of disturbed geometry of the entire arterial circle, different levels of ramifications into individual arteries, as well as the number and diameter of arteries. No internal carotid arteries were observed in chinchillas apart from one atypical case in which the carotid artery extended unilaterally into the basilar artery. These investigations indicate on the significant variability of arterial circle in rodents. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc.

  7. Phonemic vowel length contrasts in cerebellar disorders.

    PubMed

    Ackermann, H; Gräber, S; Hertrich, I; Daum, I

    1999-04-01

    Apraxia of speech and Broca's aphasia both affect voice onset time (VOT) whereas phonemic vowel length distinctions seem to be preserved. Assuming a close cooperation of anterior perisylvian language zones and the cerebellum with respect to speech timing, a similar profile of segment durations must be expected in ataxic dysarthria. In order to test this hypothesis, patients with cerebellar atrophy or cerebellar ischemia were asked to produce sentence utterances including either one of the German lexial items "Rate" (/ra:t(h)e/, 'installment'), "Ratte" (/rat(h)e/, 'rat'), "Gram" (/gra:m/, 'grief'), "Gramm" (/gram/, 'gramm'), "Taten" (/t(h)atn/, 'actions'), or "Daten" (/datn/, 'data'). At the acoustic signal, the duration of the target vowels /a/ and /a:/ as well as the VOT of the word-initial alveolar stops /d/ and /t/ were determined. In addition, a master tape comprising the target words from patients and controls in randomized order was played to three listeners for perceptual evaluation. In accordance with a previous study, first, the cerebellar subjects presented with a reduced categorical separation of the VOT of voiced and unvoiced stop consonants. Second, vowel length distinctions were only compromised in case of the minimal pair "Gram"/"Gramm." In contrast to "Rate"/"Ratte", production of the former lexical items requires coordination of several orofacial structures. Disruption of vowel length contrasts would, thus, depend upon the complexity of the underlying articulatory pattern. Copyright 1999 Academic Press.

  8. Pulmonary Artery Intimal Sarcoma: A Case Report.

    PubMed

    Kriz, Joseph P; Munfakh, Nabil A; King, Gregory S; Carden, Juan O

    2016-01-01

    Pulmonary artery intimal sarcomas are rare and lethal malignant tumors that typically affect larger vessels: the aorta, inferior vena cava, and pulmonary arteries. Since symptoms and imaging of pulmonary arterial intimal sarcomas mimic pulmonary thromboembolism, the differential diagnosis of a patient presenting with chest pain, dyspnea, and filling defect within the pulmonary arteries should include intimal sarcoma. Often right ventricular failure is observed due to pulmonary hypertension caused by the obstructive effect of the tumor and concomitant chronic thromboembolism. We report the case of a 72-year-old African-American male with arterial intimal sarcoma of the left and right pulmonary artery with extension through the right artery into the bronchus and right lung.

  9. Pulmonary Artery Intimal Sarcoma: A Case Report

    PubMed Central

    Kriz, Joseph P.; Munfakh, Nabil A.; King, Gregory S.; Carden, Juan O.

    2016-01-01

    Pulmonary artery intimal sarcomas are rare and lethal malignant tumors that typically affect larger vessels: the aorta, inferior vena cava, and pulmonary arteries. Since symptoms and imaging of pulmonary arterial intimal sarcomas mimic pulmonary thromboembolism, the differential diagnosis of a patient presenting with chest pain, dyspnea, and filling defect within the pulmonary arteries should include intimal sarcoma. Often right ventricular failure is observed due to pulmonary hypertension caused by the obstructive effect of the tumor and concomitant chronic thromboembolism. We report the case of a 72-year-old African-American male with arterial intimal sarcoma of the left and right pulmonary artery with extension through the right artery into the bronchus and right lung. PMID:27239183

  10. Cerebro-cerebellar circuits in autism spectrum disorder

    PubMed Central

    D'Mello, Anila M.; Stoodley, Catherine J.

    2015-01-01

    The cerebellum is one of the most consistent sites of abnormality in autism spectrum disorder (ASD) and cerebellar damage is associated with an increased risk of ASD symptoms, suggesting that cerebellar dysfunction may play a crucial role in the etiology of ASD. The cerebellum forms multiple closed-loop circuits with cerebral cortical regions that underpin movement, language, and social processing. Through these circuits, cerebellar dysfunction could impact the core ASD symptoms of social and communication deficits and repetitive and stereotyped behaviors. The emerging topography of sensorimotor, cognitive, and affective subregions in the cerebellum provides a new framework for interpreting the significance of regional cerebellar findings in ASD and their relationship to broader cerebro-cerebellar circuits. Further, recent research supports the idea that the integrity of cerebro-cerebellar loops might be important for early cortical development; disruptions in specific cerebro-cerebellar loops in ASD might impede the specialization of cortical regions involved in motor control, language, and social interaction, leading to impairments in these domains. Consistent with this concept, structural, and functional differences in sensorimotor regions of the cerebellum and sensorimotor cerebro-cerebellar circuits are associated with deficits in motor control and increased repetitive and stereotyped behaviors in ASD. Further, communication and social impairments are associated with atypical activation and structure in cerebro-cerebellar loops underpinning language and social cognition. Finally, there is converging evidence from structural, functional, and connectivity neuroimaging studies that cerebellar right Crus I/II abnormalities are related to more severe ASD impairments in all domains. We propose that cerebellar abnormalities may disrupt optimization of both structure and function in specific cerebro-cerebellar circuits in ASD. PMID:26594140

  11. Autism and cerebellar dysfunction: Evidence from animal models.

    PubMed

    Tsai, Peter T

    2016-10-01

    Autism is a prevalent neurodevelopmental disorder whose origins are not well understood. Cerebellar involvement has been implicated in the pathogenesis of autism spectrum disorders with increasing evidence from both clinical studies and animal models supporting an important role for cerebellar dysfunction in autism spectrum disorders. This article discusses the various cerebellar contributions to autism spectrum disorders. Both clinical and preclinical studies are discussed and future research directions highlighted.

  12. Cerebro-cerebellar circuits in autism spectrum disorder.

    PubMed

    D'Mello, Anila M; Stoodley, Catherine J

    2015-01-01

    The cerebellum is one of the most consistent sites of abnormality in autism spectrum disorder (ASD) and cerebellar damage is associated with an increased risk of ASD symptoms, suggesting that cerebellar dysfunction may play a crucial role in the etiology of ASD. The cerebellum forms multiple closed-loop circuits with cerebral cortical regions that underpin movement, language, and social processing. Through these circuits, cerebellar dysfunction could impact the core ASD symptoms of social and communication deficits and repetitive and stereotyped behaviors. The emerging topography of sensorimotor, cognitive, and affective subregions in the cerebellum provides a new framework for interpreting the significance of regional cerebellar findings in ASD and their relationship to broader cerebro-cerebellar circuits. Further, recent research supports the idea that the integrity of cerebro-cerebellar loops might be important for early cortical development; disruptions in specific cerebro-cerebellar loops in ASD might impede the specialization of cortical regions involved in motor control, language, and social interaction, leading to impairments in these domains. Consistent with this concept, structural, and functional differences in sensorimotor regions of the cerebellum and sensorimotor cerebro-cerebellar circuits are associated with deficits in motor control and increased repetitive and stereotyped behaviors in ASD. Further, communication and social impairments are associated with atypical activation and structure in cerebro-cerebellar loops underpinning language and social cognition. Finally, there is converging evidence from structural, functional, and connectivity neuroimaging studies that cerebellar right Crus I/II abnormalities are related to more severe ASD impairments in all domains. We propose that cerebellar abnormalities may disrupt optimization of both structure and function in specific cerebro-cerebellar circuits in ASD.

  13. Cerebellar vascular hamartoma in a British Shorthair cat.

    PubMed

    Stalin, Catherine E; Granger, Nicolas; Jeffery, Nick D

    2008-04-01

    Cerebellar vascular hamartoma was diagnosed in a 16-month-old cat following magnetic resonance imaging and incisional biopsy. The clinical features were consistent with the cerebellar site of the lesion accompanied by signs attributable to cerebellar herniation through the foramen magnum and increased intra-cranial pressure. A lesion of this type represents a previously unreported differential diagnosis for central nervous system lesions in young cats.

  14. Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery: An Unusual Case Report.

    PubMed

    Sen, Halil Murat; Guven, Mustafa; Aras, Adem Bozkurt; Cosar, Murat

    2017-05-01

    Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has not been described. We describe the case of a 65-year old female who lost cerebrospinal fluid after inadvertent opening of the dura during surgery. Computerized tomography performed when the patient became unable to speak revealed a bilateral cerebellar hemorrhage.

  15. Precordial ST segment depression during acute inferior myocardial infarction: early thallium-201 scintigraphic evidence of adjacent posterolateral or inferoseptal involvement

    SciTech Connect

    Lew, A.S.; Weiss, A.T.; Shah, P.K.; Maddahi, J.; Peter, T.; Ganz, W.; Swan, H.J.; Berman, D.S.

    1985-02-01

    To investigate the myocardial perfusion correlates of precordial ST segment depression during acute inferior myocardial infarction, a rest thallium-201 scintigram and a closely timed 12 lead electrocardiogram were obtained within 6 hours of the onset of infarction in 44 patients admitted with their first acute inferior myocardial infarction. Thirty-six patients demonstrated precordial ST segment depression (group 1) and eight did not (group 2). A perfusion defect involving the inferior wall was present in all 44 patients. Additional perfusion defects of the adjacent posterolateral wall (n . 20), the ventricular septum (n . 9) or both (n . 6) were present in 35 of 36 patients from group 1 compared with only 1 of 8 patients from group 2 (p less than 0.001). There was no significant difference in the frequency of multivessel coronary artery disease or disease of the left anterior descending artery between group 1 and group 2 or between patients with and those without a thallium-201 perfusion defect involving the ventricular septum. Thus, precordial ST segment depression during an acute inferior myocardial infarction is associated with thallium-201 scintigraphic evidence of more extensive involvement of the adjacent posterolateral or inferoseptal myocardial segments, which probably reflects the extent and pattern of distribution of the artery of infarction, rather than the presence of coexistent multivessel coronary artery disease or disease of the left anterior descending artery.

  16. Pitch discrimination in cerebellar patients: evidence for a sensory deficit.

    PubMed

    Parsons, Lawrence M; Petacchi, Augusto; Schmahmann, Jeremy D; Bower, James M

    2009-12-15

    In the last two decades, a growing body of research showing cerebellar involvement in an increasing number of nonmotor tasks and systems has prompted an expansion of speculations concerning the function of the cerebellum. Here, we tested the predictions of a hypothesis positing cerebellar involvement in sensory data acquisition. Specifically, we examined the effect of global cerebellar degeneration on primary auditory sensory function by means of a pitch discrimination task. The just noticeable difference in pitch between two tones was measured in 15 healthy controls and in 15 high functioning patients afflicted with varying degrees of global cerebellar degeneration caused by hereditary, idiopathic, paraneoplastic, or postinfectious pancerebellitis. Participants also performed an auditory detection task assessing sustained attention, a test of verbal auditory working memory, and an audiometric test. Patient pitch discrimination thresholds were on average five and a half times those of controls and were proportional to the degree of cerebellar ataxia assessed independently. Patients and controls showed normal hearing thresholds and similar performance in control tasks in sustained attention and verbal auditory working memory. These results suggest there is an effect of cerebellar degeneration on primary auditory function. The findings are consistent with other recent demonstrations of cerebellar-related sensory impairments, and with robust cerebellar auditorily evoked activity, confirmed by quantitative meta-analysis, across a range of functional neuroimaging studies dissociated from attention, motor, affective, and cognitive variables. The data are interpreted in the context of a sensory hypothesis of cerebellar function.

  17. Immune activation during cerebellar dysfunction following Plasmodium falciparum malaria.

    PubMed

    de Silva, H J; Hoang, P; Dalton, H; de Silva, N R; Jewell, D P; Peiris, J B

    1992-01-01

    Evidence for immune activation was investigated in 12 patients with a rare syndrome of self-limiting, delayed onset cerebellar dysfunction following an attack of falciparum malaria which occurred 18-26 d previously. Concentrations of tumour necrosis factor, interleukin 6 and interleukin 2 were all significantly higher in serum samples of patients during cerebellar ataxia than in recovery sera and in the sera of 8 patients who did not develop delayed cerebellar dysfunction following an attack of falciparum malaria. Cytokine concentrations in the cerebrospinal fluid were also significantly higher in ataxic patients than in controls. These findings suggest that immunological mechanisms may play a role in delayed cerebellar dysfunction following falciparum malaria.

  18. Decreased cerebellar-cerebral connectivity contributes to complex task performance

    PubMed Central

    Knops, André

    2016-01-01

    The cerebellum's role in nonmotor processes is now well accepted, but cerebellar interaction with cerebral targets is not well understood. Complex cognitive tasks activate cerebellar, parietal, and frontal regions, but the effective connectivity between these regions has never been tested. To this end, we used psycho-physiological interactions (PPI) analysis to test connectivity changes of cerebellar and parietal seed regions in complex (2-digit by 1-digit multiplication, e.g., 12 × 3) vs. simple (1-digit by 1-digit multiplication, e.g., 4 × 3) task conditions (“complex − simple”). For cerebellar seed regions (lobule VI, hemisphere and vermis), we found significantly decreased cerebellar-parietal, cerebellar-cingulate, and cerebellar-frontal connectivity in complex multiplication. For parietal seed regions (PFcm, PFop, PFm) we found significantly increased parietal-parietal and parietal-frontal connectivity in complex multiplication. These results suggest that decreased cerebellar-cerebral connectivity contributes to complex task performance. Interestingly, BOLD activity contrasts revealed partially overlapping parietal areas of increased BOLD activity but decreased cerebellar-parietal PPI connectivity. PMID:27334957

  19. [Ruptured pseudoaneurysm of the renal artery associated with segmental arterial mediolysis].

    PubMed

    Mizutani, Kosuke; Kikuchii, Mina; Kondo, Hiroshi; Moriyama, Yoji; Tsuchiya, Tomohiro; Masahiro, Nakano; Hidetoshi, Ehara; Deguchii, Takashi; Shinoda, Ikuo

    2008-07-01

    We present a 71-year-old woman with spontaneous perinephric hematoma due to a rupture of pseudoaneurysm of the right renal artery on the fourth day after radical cystectomy and bilateral ureterocutaneostomy for bladder cancer. This patient received steroid therapy for chronic rheumatoid arthritis for several years. The digital subtraction angiography of the right renal artery showed two pseudoaneurysms in the anterior inferior segmental branch and the posterior inferior segmental branch. Transarterial coil embolization of the right renal artery proximally and distally to the two aneurysms was performed without complications. Moreover, the additional angiography showed typical string-of-beads appearance and small aneurysms in abdominal visceral arteries, suggesting segmental arterial mediolysis (SAM) as a possible etiology. Differential diagnoses of SAM are discussed.

  20. Inferior alveolar nerve block: Alternative technique

    PubMed Central

    Thangavelu, K.; Kannan, R.; Kumar, N. Senthil

    2012-01-01

    Background: Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. Aim and Objective: The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. Materials and Methods: This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. Conclusion: This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages. PMID:25885503

  1. A cerebellar neural network model for adaptative control of saccades implemented with MATLAB.

    PubMed

    Rodriguez Campos, Francisco A; Enderle, John

    2003-01-01

    This paper describes the implementation of a neural network for the adaptative control of the saccadic system. The model shows the cerebellum plays an important role in the adaptive control of the saccadic gain. Using only eye position input through the granule cells, the cerebellum projects this signal to the other cerebellar structures and then to motor neurons responsible for the saccade. The generation of an adjustment signal occurs in the inferior olive as a result of the error sensory signal created by the open loop saccade system from propioceptive position inputs from the last eye movement generated by the network until the movement towards the target is completed. In addition, a memory component has been defined in the error system to achieve the adaptation. This neural network involves only the horizontal saccade component modeled with Matrix Laboratory language (MATLAB), in conjunction with the Simulink tool.

  2. Implications of Functional Anatomy on Information Processing in the Deep Cerebellar Nuclei

    PubMed Central

    Baumel, Yuval; Jacobson, Gilad A.; Cohen, Dana

    2009-01-01

    The cerebellum has been implicated as a major player in producing temporal acuity. Theories of cerebellar timing typically emphasize the role of the cerebellar cortex while overlooking the role of the deep cerebellar nuclei (DCN) that provide the sole output of the cerebellum. Here we review anatomical and electrophysiological studies to shed light on the DCN's ability to support temporal pattern generation in the cerebellum. Specifically, we examine data on the structure of the DCN, the biophysical properties of DCN neurons and properties of the afferent systems to evaluate their contribution to DCN firing patterns. In addition, we manipulate one of the afferent structures, the inferior olive (IO), using systemic harmaline injection to test for a network effect on activity of single DCN neurons in freely moving animals. Harmaline induces a rhythmic firing pattern of short bursts on a quiescent background at about 8 Hz. Other neurons become quiescent for long periods (seconds to minutes). The observed patterns indicate that the major effect harmaline exerts on the DCN is carried indirectly by the inhibitory Purkinje cells (PCs) activated by the IO, rather than by direct olivary excitation. Moreover, we suggest that the DCN response profile is determined primarily by the number of concurrently active PCs, their firing rate and the level of synchrony occurring in their transitions between continuous firing and quiescence. We argue that DCN neurons faithfully transfer temporal patterns resulting from strong correlations in PCs state transitions, while largely ignoring the timing of simple spikes from individual PCs. Future research should aim at quantifying the contribution of PC state transitions to DCN activity, and the interplay between the different afferent systems that drive DCN activity. PMID:19949453

  3. Importance of the perforating arteries in the proximal part of the PICA for surgical approaches to the brain stem and fourth ventricle--an anatomical study.

    PubMed

    Kayaci, Selim; Caglar, Yusuf Sukru; Bas, Orhan; Ozveren, Mehmet Faik

    2013-10-01

    The purpose of this study is to examine the perforating arteries (PAs) in the proximal part of the posterior inferior cerebellar artery (PICA) for surgical approaches to the brain stem and fourth ventricle, and to stress their importance in microsurgical procedures. Twenty-six adult cadaver obtained from routine autopsies were used. During the examination, the PAs and the segmental structure of the proximal part of the PICAs and their relation to the neighbouring anatomical structures were demonstrated. We classified the PICAs into 4 types on the basis of the distance of the middle point of the width of the caudal loop to the midline, and their presence or absence as Group A (symmetrical, anterior medullary type: 26.9%), Group B (lateral medullary type: 15.4%), Group C (asymmetrical type: 38.5%), and Group D (unilateral type: 19.2%). The number of the PAs in the tonsillomedullary segment and the caudal loop was higher than those originating from the other segments. Approaches to the medial or lateral of the PICA should be made in a way that protects the PAs (avoiding retraction of the PICA). Otherwise the PAs will be damaged and as a result brain stem ischaemia may occur, which can have serious clinical outcomes. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Morphological aspect of the thyroid ima artery in human fetuses.

    PubMed

    Vasović, Ljiljana; Arsić, Stojanka; Vlajković, Slobodan; Zdravković, Dejan

    2004-01-01

    Some morphological characteristics of the variable thyroid ima artery were investigated on the injected fetal arteries and explained on their 106 static images. Thyroid ima artery of different origin was proven in 18 (16.9%) cases. With respect to the vascular sources of the investigated artery, the branching of the brachiocephalic trunk and right common carotid artery was found in 72.1% of the cases. At the same time, the thyroid ima and superior or inferior thyroid arteries were obvious in all cases, as well as the presence of single or multiple variations and abnormalities of neighbouring arteries in 38.8% of the cases. No major anatomical difference was noted between the fetal form of the variable thyroid artery reported in this paper and the postnatal form reviewed from the literature. Thyroid ima artery probably represents an example of the arterial self-differentiation and induced differentiation of the unilateral vascular trunk.

  5. Cerebellar supervised learning revisited: biophysical modeling and degrees-of-freedom control.

    PubMed

    Kawato, Mitsuo; Kuroda, Shinya; Schweighofer, Nicolas

    2011-10-01

    The biophysical models of spike-timing-dependent plasticity have explored dynamics with molecular basis for such computational concepts as coincidence detection, synaptic eligibility trace, and Hebbian learning. They overall support different learning algorithms in different brain areas, especially supervised learning in the cerebellum. Because a single spine is physically very small, chemical reactions at it are essentially stochastic, and thus sensitivity-longevity dilemma exists in the synaptic memory. Here, the cascade of excitable and bistable dynamics is proposed to overcome this difficulty. All kinds of learning algorithms in different brain regions confront with difficult generalization problems. For resolution of this issue, the control of the degrees-of-freedom can be realized by changing synchronicity of neural firing. Especially, for cerebellar supervised learning, the triangle closed-loop circuit consisting of Purkinje cells, the inferior olive nucleus, and the cerebellar nucleus is proposed as a circuit to optimally control synchronous firing and degrees-of-freedom in learning. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Altered Cerebellar Circuitry following Thoracic Spinal Cord Injury in Adult Rats

    PubMed Central

    2016-01-01

    Cerebellar function is critical for coordinating movement and motor learning. However, events occurring in the cerebellum following spinal cord injury (SCI) have not been investigated in detail. We provide evidence of SCI-induced cerebellar synaptic changes involving a loss of granule cell parallel fiber input to distal regions of the Purkinje cell dendritic tree. This is accompanied by an apparent increase in synaptic contacts to Purkinje cell proximal dendrites, presumably from climbing fibers originating in the inferior olive. We also observed an early stage injury-induced decrease in the levels of cerebellin-1, a synaptic organizing molecule that is critical for establishing and maintaining parallel fiber-Purkinje cell synaptic integrity. Interestingly, this transsynaptic reorganizational pattern is consistent with that reported during development and in certain transgenic mouse models. To our knowledge, such a reorganizational event has not been described in response to SCI in adult rats. Regardless, the novel results of this study are important for understanding SCI-induced synaptic changes in the cerebellum, which may prove critical for strategies focusing on promoting functional recovery. PMID:27504204

  7. Role of the olivo-cerebellar complex in motor learning and control

    PubMed Central

    Schweighofer, Nicolas; Lang, Eric J.; Kawato, Mitsuo

    2013-01-01

    How is the cerebellum capable of efficient motor learning and control despite very low firing of the inferior olive (IO) inputs, which are postulated to carry errors needed for learning and contribute to on-line motor control? IO neurons form the largest electrically coupled network in the adult human brain. Here, we discuss how intermediate coupling strengths can lead to chaotic resonance and increase information transmission of the error signal despite the very low IO firing rate. This increased information transmission can then lead to more efficient learning than with weak or strong coupling. In addition, we argue that a dynamic modulation of IO electrical coupling via the Purkinje cell-deep cerebellar neurons – IO triangle could speed up learning and improve on-line control. Initially strong coupling would allow transmission of large errors to multiple functionally related Purkinje cells, resulting in fast but coarse learning as well as significant effects on deep cerebellar nucleus and on-line motor control. In the late phase of learning decreased coupling would allow desynchronized IO firing, allowing high-fidelity transmission of error, resulting in slower but fine learning, and little on-line motor control effects. PMID:23754983

  8. Increased cerebellar-default-mode-network connectivity in drug-naive major depressive disorder at rest.

    PubMed

    Guo, Wenbin; Liu, Feng; Liu, Jianrong; Yu, Miaoyu; Zhang, Zhikun; Liu, Guiying; Xiao, Changqing; Zhao, Jingping

    2015-03-01

    The default-mode network (DMN) has been implicated in the neurobiology of major depressive disorder (MDD), and the cerebellum is suggested to be involved in high-order cognitive network such as the DMN. However, the specific contribution of the cerebellum to the DMN alterations remains equivocal. This study was conducted to examine the cerebellar-DMN connectivity in drug-naive MDD directly by using the cerebellum Crus I as seeds.Forty-four drug-naive MDD patients and 44 healthy controls participated in the resting-state scan. Functional connectivity (FC) was applied to analyze the images.Significantly increased FCs were observed between the right Crus I and the right inferior frontal cortex (orbital part)/superior temporal pole, bilateral MPFC (orbital part), and left middle temporal gyrus in the patients compared with the controls. There was a significantly positive correlation between the z values of the right Crus I-bilateral MPFC (orbital part) connectivity and the scores of Automatic Thoughts Questionnaire in the patients (r = 0.329, P = 0.029).The findings reveal that depressed patients have increased cerebellar-DMN connectivity with clinical significance, and thus highlight the contribution of the cerebellum to the DMN alterations in neurobiology of MDD.

  9. [Inferior vestibular neuritis: diagnosis using VEMP].

    PubMed

    Walther, L E; Repik, I

    2012-02-01

    Vestibular evoked myogenic potentials (VEMP) are a new method to establish the functional status of the otolith organs. The sacculocollic reflex of the cervical VEMP to air conduction (AC) reflects predominantly saccular function due to saccular afferents to the inferior vestibular nerve. We describe a case of inferior vestibular neuritis as a rare differential diagnosis of vestibular neuritis. Clinical signs were a normal caloric response, unilaterally absent AC cVEMPs and bilaterally preserved ocular VEMPs (AC oVEMPs).

  10. Robotic inferior vena cava surgery.

    PubMed

    Davila, Victor J; Velazco, Cristine S; Stone, William M; Fowl, Richard J; Abdul-Muhsin, Haidar M; Castle, Erik P; Money, Samuel R

    2017-03-01

    Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy. All patients undergoing robotic surgery that included cavotomy and repair from 2011 to 2014 were retrospectively reviewed. Data were obtained detailing preoperative demographics, operative details, and postoperative morbidity and mortality. Ten patients (6 men) underwent robotic vena caval procedures at our institution. Seven patients underwent robotic nephrectomy with removal of IVC tumor thrombus and retroperitoneal lymph node dissection. Three patients underwent robotic explantation of an IVCF after multiple endovascular attempts at removal had failed. The patients with renal cell carcinoma were a mean age of was 65.4 years (range, 55-74 years). Six patients had right-sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5 cm (range, 1-8 cm). All patients underwent robotic radical nephrectomy, with caval tumor thrombus removal and retroperitoneal lymph node dissection. The average operative time for patients undergoing surgery for renal cell carcinoma was 273 minutes (range, 137-382 minutes). Average intraoperative blood loss was 428 mL (range, 150-1200 mL). The patients with IVCF removal were a mean age of 33 years (range, 24-41 years). Average time from IVCF placement until robotic removal was 35.5 months (range, 4.3-57.3 months). Before robotic IVCF removal, a minimum of two endovascular retrievals were attempted. Average operative time

  11. Cerebellar vermis proteome of chronic alcoholic individuals.

    PubMed

    Alexander-Kaufman, Kimberley; Harper, Clive; Wilce, Peter; Matsumoto, Izuru

    2007-08-01

    Cerebellar changes are commonly associated with alcoholism and chronic alcohol consumption can produce profound impairments in motor functioning and various aspects of cognition. Although the mechanisms underlying alcohol-induced changes in the cerebellar vermis are poorly understood, observations in the alcoholic vermis are thought to be consequential to common alcohol-related factors, particularly thiamine deficiency. In the present study, we used a proteomics-based approach to compare protein expression profiles of the cerebellar vermis from human alcoholic individuals (both neurologically uncomplicated and alcoholic individuals complicated with liver cirrhosis) and healthy control brains. This article complements our recent stu