Chronic post-hypoxic myoclonus, also known as Lance-Adams syndrome (LAS), is a rare complication of successful cardiopulmanry resuscitation often accompanied by action myoclonus and cerebellar ataxia. It is seen in patients who have undergone a cardiorespiratory arrest, regained consciousness afterwards, and then developed myoclonus days or weeks after the event. Worldwide, 122 cases have been reported in the literature so far, including 1 case of Chinese. Here we report 2 Chinese LAS patients with detailed neuroimagings. Cranial single photon emission computed tomography (SPECT) of patient 1, a 52-year-old woman, showed a mild hypoperfusion in her left temporal lobe, whereas patient 2, a 54-year-old woman, manifested a mild bilateral decrease of glucose metabolism in the frontal lobes and a mild to moderate decrease of the N-acetyl aspartate (NAA) peak in the bilateral hippocampi by cranial [(18)F]-fluorodeoxyglucose positron emission tomographic (PET) scan and cranial magnetic resonance spectroscopy (MRS), respectively. We also review the literature on the neuroimaging, pathogenesis, and treatment of LAS.
Cardiopulmonary Resuscitation ; adverse effects ; Cerebellar Ataxia ; diagnosis ; etiology ; Female ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; etiology ; Middle Aged ; Myoclonus ; diagnosis ; etiology ; Syndrome

Coronary Artery Disease/complications* ; Death, Sudden, Cardiac/etiology* ; Humans ; Myocardial Ischemia/diagnosis*

No abstract available.
Adult ; Brain Ischemia/diagnosis/*etiology ; Cerebral Angiography ; Fatal Outcome ; Female ; Humans ; Hyperventilation/complications ; Moyamoya Disease/*complications/diagnosis/therapy ; Risk Factors ; Stroke/diagnosis/*etiology ; Thyroid Crisis/*complications/diagnosis/therapy

Protein C is an important physiological anticoagulant factor. Protein C deficiency has been linked to venous thrombosis at unusual sites, including the cerebral and mesenteric veins. Hereditary protein C deficiency is inherited primarily as an autosomal dominant trait with incomplete penetrance. Protein C and S deficiencies are known to increase the risk of venous thrombosis and pulmonary thromboembolism. Testing for protein C levels and function is necessary for the detection of both type I and type II protein C deficiency. In this article, we report a case of pulmonary embolism and mesentery ischemia due to type 1 protein C deficiency.
Colonoscopy ; Humans ; Ischemia/*diagnosis/etiology ; Magnetic Resonance Angiography ; Male ; Mesenteric Veins ; Middle Aged ; Protein C Deficiency/*complications/genetics ; Pulmonary Embolism/*diagnosis/etiology/radiography ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinical and imaging characteristics of acute hypoxic-ischemic brain injury (HIBI) due to perinatal sentinel events in neonates.

METHODSForty-six neonates with acute HIBI who were admitted between January 2004 and May 2013, and who had a history of major cardiopulmonary resuscitation, were enrolled in the study. They were classified into full-term and preterm infants to analyze the clinical and imaging characteristics.

RESULTSAmong full-term infants, the incidence rates of white matter injury, cortical injury, basal ganglia /thalamic injury, and brain stem injury were 95%, 90%, 75%, and 65%, respectively; among preterm infants, the incidence rates of white matter injury, cortical injury, basal ganglia/thalamic injury, and brain stem injury were 73%, 23%, 19%, and 15%, respectively. Compared with full-term infants, preterm infants had a significantly lower incidence of gray matter injury in the cortex, basal ganglia/thalamus, and brain stem (P<0.05). About 46% of all subjects had multiple organ dysfunction. The 20 full-term infants with HIBI had typical clinical manifestations; 19 (95%) of them had moderate or severe neonatal encephalopathy, with mixed lesions on magnetic resonance imaging (MRI), and moderate or severe basal ganglia/thalamic injury was found in 68% of these patients. Multiple organ dysfunction, various abnormal neurological manifestations, and arterial blood pH less than 7.1 were closely related to moderate or severe brain injury.

CONCLUSIONSWhite matter injury is the most common type of HIBI. Gray matter injury can be found in preterm infants, but the incidence is lower than that in full-term infants. Moderate or severe neonatal encephalopathy is mainly manifested as basal ganglia/thalamic injury on MRI. Evaluation of multiple organ dysfunction and abnormal neurological manifestations and early blood gas analysis are very important for the diagnosis of neonatal HIBI.

Acute Disease ; Brain ; pathology ; Female ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; etiology ; pathology ; Infant, Newborn ; Magnetic Resonance Imaging ; Male

OBJECTIVETo understand the clinical characteristics of hypoxic-ischemic encephalopathy (HIE) in full-term infants and to explore the value of magnetic resonance imaging (MRI) for the early prediction of HIE prognosis.

METHODSThe medical data, including histories, clinical manifestations, MRI findings and follow-up outcomes, of 348 full-term infants with HIE between January 2001 and December 2005 were retrospectively reviewed.

RESULTSHIE patients (348 cases) accounted for 8.25% of in-patients (4220 cases) over the five years. The etiology of HIE mainly attributed to birth asphyxia (76.2%), consisting of mild asphyxia (59.2%) and severe asphyxia (40.8%). A poor outcome was confirmed in 10.1% of these patients, including 27.3% in severe HIE, 10.0% in moderate HIE and 1.5% in mild HIE cases. All of patients whose MRI showed diffusion intraparenchymal hemorrhages and cerebral infarctions had poor outcomes. Fourteen (87.5%) out of the 16 cases with basal ganglia and thalamic or internal capsule injury and 9 (81.8%) out of the 11 cases with cytotoxic brain edema diagnosed by diffusion weighted imaging had poor outcomes.

CONCLUSIONSHIE is one of common diseases in newborn infants. The etiology of neonatal HIE mainly attributed to birth asphyxia, mild asphyxia accounting for a greater proportion. MRI findings can be helpful for the early prediction of HIE prognosis.

Brain ; pathology ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; etiology ; pathology ; Infant, Newborn ; Magnetic Resonance Imaging ; methods ; Prognosis ; Retrospective Studies

To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.
Aged ; *Arthroplasty, Replacement, Knee ; Choroid/*blood supply ; Coloring Agents/diagnostic use ; Female ; Fluorescein Angiography ; Humans ; Indocyanine Green/diagnostic use ; Ischemia/diagnosis/*etiology ; Pain Measurement ; *Pain, Postoperative ; Retinal Detachment/diagnosis/*etiology ; Serum ; Vision Disorders/etiology

OBJECTIVE: To analyze two groups of patients with migrainous vertigo (MV )and vertigo resulting from posterior circulation ischemia (PCIV) and investigate the differential diagnosis between them. METHOD: There were 60 patients with MV and 64 patients with PCIV. Clinical tests include high risk factors of posterior circulation ischemia (PCI), cerebral MRI, ocular motion and high stimulating rate ABR. RESULT: Among 64 patients with PCIV, 29 had abnormal blood pressure and 14 had abnormal blood fat and/or pathoglycemia; 37 had abnormality in cervical vascular ultrasound; 14 suffered from amaurosis or dizziness upon fast getting up. Twenty two had abnormal high stimulating rate ABR and 4 had cerebral lacunar infarction in MRI. As for 60 patients with MV, 45 suffered from motion sickness; 20 were sensitive to motion; 32 had photophobia and (or) phonophobia; 45 had migraine; 16 had abnormal ocular motion function; 3 had abnormal cerebral MRI and 40 had abnormal results in high stimulating rate ABR. The percentage of abnormal high stimulating rate ABR in MV and PCIV were 53% (22/42) and 67% (40/60) respectively. CONCLUSION The mean age of MV is younger than that of PCIV. Female is more prone to MV than male (2.75 : 1. 00); the sex difference in PCIV is lesser (1.46 : 1.00). Motion sickness, motion sensitivity, photophobia and (or) phonophobia are principal differential highlights to MV. The major characteristics of PCIV include abnormal blood pressure, abnormal blood fat, pathoglycemia and arteriosclerosis. Vestibular function tests could not serve as a differential point; Cerebral MRI might be helpful to differential diagnosis. The results of high stimulating rate ABR is not a differential point between PCIV and MV, but it might play a role in differentiating other kinds of vertigo.
Adolescent ; Adult ; Age Factors ; Aged ; Child ; Diagnosis, Differential ; Female ; Humans ; Ischemia ; complications ; Male ; Middle Aged ; Migraine Disorders ; complications ; Sex Factors ; Vertigo ; diagnosis ; etiology ; Young Adult

OBJECTIVECerebral infarction (CI) is one of severe diseases of central nervous system in neonates, and some infants with CI could have poor prognosis in the long term. This study aimed to analyze the clinical data and prognosis of all neonatal cases with cerebral infarction in recent years and to help future clinical work.

METHODTotally 58 neonatal cases with CI admitted to NICU of the hospital from January 1999 to December 2010 were included in this study. We analyzed all clinical data and prognosis by retrospective analysis.

RESULTSFifty-two term babies and six preterm babies were included. There were altogether 51 cases with asphyxia and 7 with hemorrhagic cerebral infarction. Perinatal hypoxia-ischemia was the most common high-risk factor and it accounted for 46.6%. Seizure was the most frequent initial symptom and the most common clinical manifestation (accounted for 77.6%), and it was followed by intermittent cyanosis, apnea and lethargy. Cerebral CT scan and magnetic resonance imaging were major methods to help to make the diagnosis and they also had close relation with prognosis. Diffusion weighted imaging was very helpful to diagnose infarction in early stage. Left middle cerebral artery was the most common artery to be involved. Supportive therapy and symptomatic treatment were the main methods in the acute stage of neonatal cerebral infarction. Those babies with poor prognosis mostly had large infarction involving cerebral hemisphere, thalamus and basal ganglia.

CONCLUSIONSNeonatal cerebral infarction was a severe brain injury affecting long tern nervous system prognosis. Perinatal hypoxia was the most common high-risk factor and seizure was the most frequent initial symptom. Diffusion weighted imaging was valuable to diagnose infarction in early stage. Most of infants with poor prognosis had large infarction involving hemisphere, thalamus and basal ganglia. Early diagnosis with brain imaging would be helpful for rehabilitation therapy and improving prognosis.

Brain ; diagnostic imaging ; pathology ; Cerebral Infarction ; diagnosis ; etiology ; pathology ; therapy ; Cerebral Palsy ; etiology ; Humans ; Hypoxia-Ischemia, Brain ; complications ; Incidence ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Prognosis ; Radiography ; Retrospective Studies ; Risk Factors ; Seizures ; etiology ; Ultrasonography, Doppler, Color

No abstract available.
Adult ; Arteriovenous Shunt, Surgical/*adverse effects ; Female ; Humans ; Ischemia/diagnosis/*etiology/surgery ; Ligation ; Peripheral Nervous System Diseases/diagnosis/*etiology/surgery ; *Renal Dialysis ; Reoperation ; Treatment Outcome ; Upper Extremity/*blood supply