Putaminal Hemorrhage
Putamen
Cerebral Hemorrhage
Hematoma
Tomography, X-Ray Computed
Neuroendoscopy
Multiple System Atrophy
Subarachnoid Hemorrhage
Chorea
MRI features of intracerebral hemorrhage within 2 hours from symptom onset. (1/12)
BACKGROUND AND PURPOSE: MRI has been increasingly used in the evaluation of acute stroke patients. However, MRI must be able to detect early hemorrhage to be the only imaging screen used before treatment such as thrombolysis. Susceptibility-weighted imaging, an echo-planar T2* sequence, can show intracerebral hemorrhage (ICH) in patients imaged between 2.5 and 5 hours from symptom onset. It is unknown whether MRI can detect ICH earlier than 2.5 hours. We describe 5 patients with ICH who had MRI between 23 and 120 minutes from symptom onset and propose diagnostic patterns of evolution of hyperacute ICH on MRI. METHODS: As part of our acute imaging protocol, all patients with acute stroke within 24 hours from symptom onset were imaged with a set of sequences that included susceptibility-weighted imaging, diffusion- and perfusion-weighted imaging, T1- and T2-weighted imaging, fluid-attenuated inversion recovery (FLAIR), and MR angiography using echo-planar techniques. Five patients with ICH had MRI between 23 and 120 minutes from the onset of symptoms. RESULTS: ICH was identified in all patients. Distinctive patterns of hyperacute ICH and absence of signs of ischemic stroke were the hallmark features of this diagnosis. The hyperacute hematoma appears to be composed of 3 distinct areas: (1) center: isointense to hyperintense heterogeneous signal on susceptibility-weighted and T2-weighted imaging; (2) periphery: hypointense (susceptibility effect) on susceptibility-weighted and T2-weighted imaging; and (3) rim: hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, representing vasogenic edema encasing the hematoma. CONCLUSIONS: MRI is able to detect hyperacute ICH and show a pattern of evolution of the hematoma within 2 hours from the onset of symptoms. (+info)Hydrocephalus is a determinant of early mortality in putaminal hemorrhage. (2/12)
BACKGROUND AND PURPOSE: Previous studies have shown that the volume of intracerebral hemorrhage and Glasgow Coma Score (GCS) on admission are powerful predictors of 30-day mortality. However, the significance of hydrocephalus associated with deep cerebral hemorrhage has not been studied extensively. The purpose of this study was to determine the prognostic indicators of 30-day mortality in patients with deep cerebral hemorrhage. METHODS: We studied 100 consecutive patients with deep cerebral hemorrhage between 1994 and 1998. Deep cerebral hemorrhage was divided into 2 groups: putaminal hemorrhage (lateral group) and thalamic and caudate hemorrhage (medial group). Univariate and multivariate logistic regression analyses were performed to determine independent prognostic indicators of 30-day mortality. RESULTS: Hydrocephalus was present in 40 of the 100 patients. The 30-day mortality was 29%, and hydrocephalus was present in 76% of those who died. Multivariate analyses showed 2 independent prognostic indicators of 30-day mortality for putaminal hemorrhage: GCS +info)Simultaneous occurrence of subarachnoid hemorrhage due to ruptured aneurysm and remote hypertensive intracerebral hemorrhage: case report. (3/12)
Simultaneous occurrence of aneurysmal subarachnoid hemorrhage (SAH) and hypertensive intracerebral hemorrhage (ICH) is very rare and only two cases have been previously reported in the literatures. We present a case of 68-yr-old man with a history of untreated hypertension, who suffered from sudden onset of headache followed by right hemiparesis. Computed tomographic (CT) scan revealed SAH in the basal cistern and remote ICH at the left putamen. Cerebral angiography showed a saccular aneurysm at the anterior communicating artery. No other vascular anomaly could be found at left putaminal area. Nine days after the ictal attack of SAH, the neck of aneurysm was clipped via the left frontotemporal craniotomy. Because of the ICH at the left frontal lobe and intraventricular hematoma on postoperative CT, we performed hematoma removal and external ventricular drainage 3 hours after the first operation. Postoperative neurological status had been improved to be drowsy and he was discharged in a severely disabled state 4 weeks after surgery. We suggest that the rupture of aneurysm possibly caused a rapid increase in blood pressure and subsequently resulted in hypertensive ICH. (+info)Bilateral putaminal hemorrhage with cerebral edema in hyperglycemic hyperosmolar syndrome. (4/12)
Bilateral putaminal hemorrhages rarely occur simultaneously in hypertensive patients. The association of intracerebral hemorrhage with cerebral edema (CE) has been rarely reported in diabetic patients. We present a patient with bilateral putaminal hemorrhage (BPH) and CE during the course of hyperglycemic hyperosmolar syndrome (HHS). A 40-year-old man with a history of diabetes mellitus and chronic alcoholism was admitted with acute impaired mentality. His blood pressure was within the normal range on admission. Laboratory results revealed hyperglycemia and severe metabolic acidosis without ketonuria. After aggressive treatment, plasma sugar fell to 217 mg/dl, but brain CT showed BPH and diffuse CE. Our case demonstrated that HHS should be considered as a cause of BPH with CE. Initial brain imaging study may be recommended for patients with diabetic coma. (+info)Deterioration of pre-existing hemiparesis brought about by subsequent ipsilateral lacunar infarction. (5/12)
Mechanisms of post-stroke recovery are still poorly understood. Recent evidence suggests that cortical reorganisation in the unaffected hemisphere plays an important role. A 59 year old man developed a small lacunar infarct in the left corona radiata, which then caused marked deterioration in a pre-existing left hemiparesis that had resulted from an earlier right putaminal haemorrhage. Functional magnetic resonance imaging showed that the paretic left hand grip activated the ipsilateral left motor areas, but not the right hemispheric motor areas. This suggests that partial recovery of the left hemiparesis had been brought about by cortical reorganisation of the left hemisphere and intensification of the uncrossed corticospinal tract. The subsequent small infarct may have damaged the uncrossed tract, thereby causing the pre-existing hemiparesis to deteriorate even further. (+info)Witzelsucht after right putaminal hemorrhage: a case report. (6/12)
Witzelsucht is a tendency to tell inappropriate and poor jokes. It usually occurs after a focal lesion involving orbitofrontal cortical or paramedian thalamic regions, especially on the right side. Here we report a 56-year-old man developing witzelsucht and hypersexuality after a right putaminal hemorrhage. The hematoma extended to the sublenticular part of posterior internal capsule and mesencephalon. The hemorrhage might have disconnected the fibers in the ascending reticular systems, and the fibers between paramedian thalamus and orbitofrontal cortex, and thus could be responsible for the patient's rare clinical manifestations. (+info)CT and MR imaging findings in methanol intoxication. (7/12)
We present the CT and MR imaging findings in acute methanol intoxication in a 35-year-old man who was admitted to the emergency department with weakness, blurred vision, mild bilateral areactive mydriasis, and a progressive decrease in the level of consciousness. CT and MR imaging showed bilateral putaminal hemorrhagic necrosis and subcortical white matter lesions with peripheral contrast enhancement. There was only partial improvement in patient's Glasgow Coma Scale score during follow-up. (+info)Perimesencephalic non-aneurysmal subarachnoid hemorrhage caused by cavernous sinus thrombosis: case report. (8/12)
A 37-year-old man presented with perimesencephalic non-aneurysmal subarachnoid hemorrhage associated with cavernous sinus thrombosis. Anticoagulant therapy was administered to treat the cavernous sinus thrombosis, but provoked severe intracranial hemorrhage, severely disabling the patient. Perimesencephalic non-aneurysmal subarachnoid hemorrhage is a benign clinical entity with generally good prognosis, but the association with cavernous sinus thrombosis requires careful investigation prior to treatment. (+info)A putaminal hemorrhage is a type of intracranial hemorrhage, which is defined as bleeding within the brain. Specifically, it refers to bleeding that occurs in the putamen, which is a region located deep within the forebrain and is part of the basal ganglia.
Putaminal hemorrhages are often caused by hypertension (high blood pressure) or rupture of small aneurysms (weakened areas in the walls of blood vessels). Symptoms can vary depending on the severity and location of the bleed, but may include sudden onset of headache, altered consciousness, weakness or paralysis on one side of the body, difficulty speaking or understanding speech, and visual disturbances.
Diagnosis is typically made using imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI). Treatment may involve supportive care, medications to control blood pressure and prevent seizures, and surgical intervention in some cases. The prognosis for putaminal hemorrhage depends on various factors, including the patient's age, overall health status, and the severity of the bleed.
The putamen is a round, egg-shaped structure that is a part of the basal ganglia, located in the forebrain. It is situated laterally to the globus pallidus and medially to the internal capsule. The putamen plays a crucial role in regulating movement and is involved in various functions such as learning, motivation, and habit formation.
It receives input from the cerebral cortex via the corticostriatal pathway and sends output to the globus pallidus and substantia nigra pars reticulata, which are also part of the basal ganglia circuitry. The putamen is heavily innervated by dopaminergic neurons from the substantia nigra pars compacta, and degeneration of these neurons in Parkinson's disease leads to a significant reduction in dopamine levels in the putamen, resulting in motor dysfunction.
A cerebral hemorrhage, also known as an intracranial hemorrhage or intracerebral hemorrhage, is a type of stroke that results from bleeding within the brain tissue. It occurs when a weakened blood vessel bursts and causes localized bleeding in the brain. This bleeding can increase pressure in the skull, damage nearby brain cells, and release toxic substances that further harm brain tissues.
Cerebral hemorrhages are often caused by chronic conditions like hypertension (high blood pressure) or cerebral amyloid angiopathy, which weakens the walls of blood vessels over time. Other potential causes include trauma, aneurysms, arteriovenous malformations, illicit drug use, and brain tumors. Symptoms may include sudden headache, weakness, numbness, difficulty speaking or understanding speech, vision problems, loss of balance, and altered level of consciousness. Immediate medical attention is required to diagnose and manage cerebral hemorrhage through imaging techniques, supportive care, and possible surgical interventions.
A ventriculostomy is a medical procedure in which an opening is made into one of the cerebral ventricles, the fluid-filled spaces within the brain, to relieve pressure or to obtain cerebrospinal fluid (CSF) for diagnostic testing. This is typically performed using a catheter known as an external ventricular drain (EVD). The EVD is inserted through a burr hole in the skull and into the ventricle, allowing CSF to drain out and be measured or tested. Ventriculostomy may be necessary in the management of various conditions that can cause increased intracranial pressure, such as hydrocephalus, brain tumors, or traumatic brain injuries.
A hematoma is defined as a localized accumulation of blood in a tissue, organ, or body space caused by a break in the wall of a blood vessel. This can result from various causes such as trauma, surgery, or certain medical conditions that affect coagulation. The severity and size of a hematoma may vary depending on the location and extent of the bleeding. Symptoms can include swelling, pain, bruising, and decreased mobility in the affected area. Treatment options depend on the size and location of the hematoma but may include observation, compression, ice, elevation, or in some cases, surgical intervention.
X-ray computed tomography (CT or CAT scan) is a medical imaging method that uses computer-processed combinations of many X-ray images taken from different angles to produce cross-sectional (tomographic) images (virtual "slices") of the body. These cross-sectional images can then be used to display detailed internal views of organs, bones, and soft tissues in the body.
The term "computed tomography" is used instead of "CT scan" or "CAT scan" because the machines take a series of X-ray measurements from different angles around the body and then use a computer to process these data to create detailed images of internal structures within the body.
CT scanning is a noninvasive, painless medical test that helps physicians diagnose and treat medical conditions. CT imaging provides detailed information about many types of tissue including lung, bone, soft tissue and blood vessels. CT examinations can be performed on every part of the body for a variety of reasons including diagnosis, surgical planning, and monitoring of therapeutic responses.
In computed tomography (CT), an X-ray source and detector rotate around the patient, measuring the X-ray attenuation at many different angles. A computer uses this data to construct a cross-sectional image by the process of reconstruction. This technique is called "tomography". The term "computed" refers to the use of a computer to reconstruct the images.
CT has become an important tool in medical imaging and diagnosis, allowing radiologists and other physicians to view detailed internal images of the body. It can help identify many different medical conditions including cancer, heart disease, lung nodules, liver tumors, and internal injuries from trauma. CT is also commonly used for guiding biopsies and other minimally invasive procedures.
In summary, X-ray computed tomography (CT or CAT scan) is a medical imaging technique that uses computer-processed combinations of many X-ray images taken from different angles to produce cross-sectional images of the body. It provides detailed internal views of organs, bones, and soft tissues in the body, allowing physicians to diagnose and treat medical conditions.
Hemorrhage is defined in the medical context as an excessive loss of blood from the circulatory system, which can occur due to various reasons such as injury, surgery, or underlying health conditions that affect blood clotting or the integrity of blood vessels. The bleeding may be internal, external, visible, or concealed, and it can vary in severity from minor to life-threatening, depending on the location and extent of the bleeding. Hemorrhage is a serious medical emergency that requires immediate attention and treatment to prevent further blood loss, organ damage, and potential death.
Neuroendoscopy is a minimally invasive surgical technique that involves the use of an endoscope to access and treat various conditions within the brain and spinal column. An endoscope is a long, flexible tube with a light and camera at its tip, which allows surgeons to view and operate on internal structures through small incisions or natural openings in the body.
In neuroendoscopy, the surgeon uses the endoscope to navigate through the brain's ventricular system (fluid-filled spaces) or other narrow spaces within the skull or spine to diagnose and treat conditions such as hydrocephalus, brain tumors, arachnoid cysts, and intraventricular hemorrhage.
The benefits of neuroendoscopy include reduced trauma to surrounding tissues, shorter hospital stays, faster recovery times, and improved outcomes compared to traditional open surgical approaches. However, neuroendoscopic procedures require specialized training and expertise due to the complexity of the anatomy involved.
Multiple System Atrophy (MSA) is a rare, progressive neurodegenerative disorder that affects multiple systems in the body. It is characterized by a combination of symptoms including Parkinsonism (such as stiffness, slowness of movement, and tremors), cerebellar ataxia (lack of muscle coordination), autonomic dysfunction (problems with the autonomic nervous system which controls involuntary actions like heart rate, blood pressure, sweating, and digestion), and pyramidal signs (abnormalities in the corticospinal tracts that control voluntary movements).
The disorder is caused by the degeneration of nerve cells in various parts of the brain and spinal cord, leading to a loss of function in these areas. The exact cause of MSA is unknown, but it is thought to involve a combination of genetic and environmental factors. There is currently no cure for MSA, and treatment is focused on managing symptoms and improving quality of life.
A subarachnoid hemorrhage is a type of stroke that results from bleeding into the space surrounding the brain, specifically within the subarachnoid space which contains cerebrospinal fluid (CSF). This space is located between the arachnoid membrane and the pia mater, two of the three layers that make up the meninges, the protective covering of the brain and spinal cord.
The bleeding typically originates from a ruptured aneurysm, a weakened area in the wall of a cerebral artery, or less commonly from arteriovenous malformations (AVMs) or head trauma. The sudden influx of blood into the CSF-filled space can cause increased intracranial pressure, irritation to the brain, and vasospasms, leading to further ischemia and potential additional neurological damage.
Symptoms of a subarachnoid hemorrhage may include sudden onset of severe headache (often described as "the worst headache of my life"), neck stiffness, altered mental status, nausea, vomiting, photophobia, and focal neurological deficits. Rapid diagnosis and treatment are crucial to prevent further complications and improve the chances of recovery.
Chorea is a medical term that describes an involuntary movement disorder characterized by brief, irregular, and abrupt jerky movements. These movements often occur randomly and can affect any part of the body. Chorea can also cause difficulty with coordination and balance, and can sometimes be accompanied by muscle weakness or rigidity.
The term "chorea" comes from the Greek word "χορεία" (khoréia), which means "dance," reflecting the graceful, dance-like movements that are characteristic of this condition. Chorea can occur as a symptom of various underlying medical conditions, including neurological disorders such as Huntington's disease, Sydenham's chorea, and cerebral palsy, as well as metabolic disorders, infections, and certain medications.
Treatment for chorea depends on the underlying cause of the condition and may include medications to help control the involuntary movements, physical therapy to improve coordination and balance, and lifestyle modifications to reduce the risk of injury from falls or other accidents. In some cases, surgery may be recommended as a last resort for severe or refractory chorea.