چاپ صفحه |  صفحه نخست سامانه |  نویسندگان |  اطلاعات تفضیلی |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| نویسنده | نفر چندم مقاله |
|---|---|
| مازیار هاشمیلر | اول |
| الیار صادقی حکم آبادی | دوم |
| مسعود نیکانفر | سوم |
| داریوش سوادی اسکوئی | چهارم |
| شیدا شعفی | پنجم |
| سعید چارسوئی | ششم |
| عنوان | متن |
|---|---|
| کلمات کلیدی | stroke, cerebellar infarction, diagnosis |
| خلاصه مقاله | The misdiagnosis of cerebellar infarctions is important with regard to both treatment and prognosis. Many articles concentrate on infarcts that mimic peripheral vestibulopathies. However, the patients with cerebellar strokes are also misdiagnosed with migraines, toxic encephalopathies, and gastritis or gastroenteritis. The studies report three major pitfalls. The first pitfall involves the clinical evaluation. Half of the patients in a study were young and without vascular risk factors, which may have lessened clinical suspicion. Also, there was a failure to recognize the spectrum of presenting symptoms that should arouse suspicion for an acute cerebellar stroke, including headache, gait unsteadiness, vertigo, vomiting, and slurred speech. Vomiting in the absence of other gastrointestinal symptoms, especially diarrhea, should raise the possibility of a neurologic cause. Most patients had additional visual, sensory, or oculomotor symptoms often involving localized body parts that suggest a focal brain process. An incompletely performed or documented neurologic examination, especially examination of eye movements, coordination, and gait5 are often the culprit. The second pitfall concerns diagnostic testing. In particular, a normal CT scan does not exclude ischemic stroke in general and poorly visualizes the posterior fossa because of bony artifacts. The findings on CT scan are often normal in the acute stages of cerebellar infarction. An MR diffusion- weighted imaging sequence (DWI) is the most sensitive test for the detection of acute ischemic stroke. However, DWI does not always reveal an acute infarction, and its sensitivity is slightly lower in the posterior circulation. A common mechanism of cerebellar stroke in young patients is extracranial vertebral artery dissection. Failure to identify and treat these lesions may lead to further embolization and infarctions; survivors of cerebellar stroke have been shown to develop subsequent brain stem infarction. Cardioembolism is another important consideration. The third category of pitfalls is related to establishing a diagnosis. A failure to arrive at a specific diagnosis that completely explains the symptoms, signs, and imaging results is a common pitfall. Some patients may present with headache, and may be misdiagnosed with complicated migraine. Given the high prevalence of migraine in young adults, it is not surprising that clinicians make this error. Many of the misdiagnosed patients will have poor outcomes. Cerebellar stroke can progress from seemingly benign symptoms such as nausea, vomiting, dizziness, and headache to serious neurologic impairment due to additional infarcts, hydrocephalus, mass effect from edema formation, and brain stem compression. |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| ebook_2020_ P 13_88.pdf | 1400/06/03 | 4630188 | دانلود |
| certificate.jpeg | 1400/06/03 | 40086 | دانلود |
