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Approach to “Visual Loss”
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aastha Takkar Kapila, Monika Singla, Vivek Lal
TBVL may be seen in transient ischemic attacks involving the posterior circulation. These symptoms usually accompany vertebrobasilar insufficiency and are warning signs of impending stroke. Depending upon the site of hypoperfusion patient may present with homonymous hemianopia or complete blindness. Unlike migrainous auras, these are not associated with positive visual symptoms and do not evolve over time.2 Outcome is grim because of their strategic vascular character.
Cerebral
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
This common and vague symptom can mean different things to different people. It is treated here as being a sense of light-headedness without the illusion of movement characteristic of vertigo. This is a useful distinction in practice as the causes of true vertigo are different – see p. 101. Dizziness tends to be a heartsink symptom as it is so common, has so many diagnostic possibilities, is so often linked with anxiety and other symptoms – and very often the exact cause remains obscure.Note: We no longer list the diagnosis ‘vertebrobasilar insufficiency’ as this is an ill-defined term which is falling out of use.
Paper 7 Answers
Published in Hayley Dawson, Anna Trigell, EMQs for the nMRCGP® Applied Knowledge Test, 2018
Vasovagal attacks may mimic epilepsy, as tonic-clonic movements may occur, especially if the patient remains upright. Vertebrobasilar insufficiency is also known as brainstem ischaemia, and classically occurs on extension or rotation of the neck. In Question 48, it could be argued that this is iatrogenic, but the patient has been treated for hypertension for many years, and it is more likely that due to the ageing process his autonomic nervous system is unable to compensate adequately for postural changes.
Dynamic observation on collateral circulation construction of patient with vertebral artery restenosis after stenting: case report
Published in International Journal of Neuroscience, 2021
Yan-Wei Yin, Qian-Qian Sun, Da-Wei Chen, Fa-Guo Zhao, Jin Shi
Collateral circulation system has major impact on the outcome of conservatively treated patients, and poor collateral circulation is related to worse outcome of larger infarcts in ischemic cerebrovascular disease. It is widely accepted that collateral circulation system can be divided into primary or secondary pathways [4]. Primary collateral pathway is the circle of Willis, whereas the ophthalmic artery and leptomeningeal vessels constitute secondary collateral pathways [4]. Furthermore, when the above common collateral circulations doesn't work, the third collateral pathway, neovascularization, will play their important role [5, 6]. Although it takes a long time to finish the third collateral circulation, the role is not negligible. Here, we report a patient who suffered from vertebrobasilar insufficiency and review the clinic and radiologic features of this entity. For two years we observe the whole process of the collateral circulation construction of this patient by digital subtraction angiography (DSA).
Prospective memory impairment in patients with white matter lesions
Published in International Journal of Neuroscience, 2019
Ju Qiu, Huai-Dong Cheng, Ting Dong, Li Xiang, Min Wang, Lan Xia, Kai Wang
Forty-two patients with WML (M = 25, F = 17) and 40 normal controls (M = 19, F = 21) took part in this study. The 42 patients with WML were all in-hospital patients in the Department of Neurology of The Second Affiliated Hospital of Anhui Medical University from July 2013 to March 2015. All the patients presented with vertigo or dizziness as the chief complaint, given the diagnosis of vertebrobasilar insufficiency (VBI) [18]. All subjects were underwent brain MRI scans. The images of WML were corresponded to diagnosis standard of LA [19] (as shown in Figures 1–3). According to the grading methods of Fazekas et al. [20], severity of WML can be divided into four levels: level 0: deep white matter around lateral ventricle without high signal; level I: different signal cap shaped lateral ventricle or pencil line, deep brain white matter high signal in dot; level II: high signal connection into a circular ring around lateral ventricle, deep brain white matter signal to fusion; level III: the high signal around the ventricle is irregular, extending the deep white matter of the person, and the white matter of the brain is fused in large shapes. According to the severity, the ventricle and deep white matter can be divided into three groups: mild (0,I), moderate (II), severe (III).
Bow hunter’s syndrome after cervical laminoplasty in a patient with rheumatoid arthritis with bony ankylosis in the cervical spine: a case report
Published in Modern Rheumatology Case Reports, 2020
Sho Dohzono, Ryuichi Sasaoka, Kiyohito Takamatsu, Hiroaki Nakamura
A 59-year-old female presented with sudden incomplete left hemiplegia, and was delivered to another hospital by emergency transport. During the night before the onset of symptoms, the patient had slept with her head rotated to the right, and subsequently woke up with left hemiplegia. She had no history of head rotation causing symptoms of vertebrobasilar insufficiency such as dizziness, vertigo, syncope, dysarthria, nausea and dysphagia. In the 15 months before presentation, the patient had undergone cervical laminectomy at C3 and laminoplasty from C4 to C7. She had been diagnosed with RA 36 years earlier, and had been treated with prednisolone, salazosulfapyridine, leflunomide and golimumab (Steinbrocker stage IV, functional class IV).