Transcranial Doppler (TCD) ultrasonography typically visualizes the posterior cerebral arteries (PCAs) through the transtemporal window, while the basilar and vertebral arteries are assessed via the suboccipital approach. This report describes an unusual technical finding: visualization of PCA flow through the suboccipital window. During routine TCD in a patient with excellent acoustic access, two vascular structures arising from the distal basilar artery were identified at a depth of 92 mm, with flow characteristics consistent with PCAs. Favorable bone transmission and vascular alignment likely enabled this alternative insonation route. This observation suggests that, in exceptional anatomical conditions, suboccipital PCA assessment is feasible and may expand posterior circulation evaluation.
Imágenes en Neurología
Bilateral Globus Pallidus T1 Hyperintensity in Hepatic Cirrhosis. Hiperintensidades de Globos Pálidos en Cirrosis Hepática
Bilateral symmetric T1 hyperintensities in the globus pallidus on MRI are a hallmark of manganese deposition secondary to hepatic dysfunction, reflecting portosystemic shunting and subclinical hepatic encephalopathy. A 60-year-old man with history of diabetes mellitus type 2, and chronic liver disease, presented with troubling gait. The rest of the neurological examination was unremarkable.
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Técnica de Doble Stent Retriever para Trombectomía Mecánica en Ictus: Primera Experiencia en Ecuador. Double Stent Retriever Technique for Mechanical Thrombectomy in Acute Ischemic Stroke: First Experience in Ecuador
Endovascular treatment of acute ischemic stroke has become established as an effective and safe technique for reperfusion in selected cases. Although early studies did not demonstrate superiority over intravenous thrombolysis, the development of advanced devices, such as aspiration catheters and stent retrievers (SR), made it possible to show significantly improved outcomes.
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Paresia velopalatina unilateral aguda. Unilateral acute velopalatine paresis.
A 13-year-old male patient presented with acute symptoms of rhinolalia and nasal regurgitation. He reported no trauma, recent infections, or other relevant personal history. Examination revealed unilateral left-sided velopalatine hemiparesis (HPH), with hypomotility of the left soft palate and a right-sided deviation of the uvula (see Figure 1). He had no sensory or motor disturbances at other levels.
A cranial MRI was performed, which ruled out central nervous system disorders, including cranial nerves. A complete blood count and biochemical analysis were normal, and serologic tests (Borrelia, Mycoplasma, Chlamydia, VZV, HSV, parvovirus B19, EBV, CMV, toxoplasmosis, poliomyelitis, rubella, mumps) were negative.
Empirical corticosteroid treatment with prednisone was initiated for 5 days, followed by tapering. Follow-up revealed complete resolution of the symptoms (see Figure 2).
Given negative complementary studies and a favorable clinical course, the diagnosis is compatible with idiopathic PVH. This is a rare entity with sudden onset, mostly unilateral, transient, and benign. It occurs predominantly in boys aged 5–15 years. The typical triad consists of rhinolalia, nasal regurgitation, and uvular deviation. The diagnosis is based on exclusion, ruling out other causes such as surgery, tumors, or neuromuscular pathology. Recovery is usually complete.
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Parenchymal brain calcified cysticercus and progression of hippocampal atrophy. Cisticerco calcificado en el parénquima cerebral y progresión de atrofia de hipocampos.
A seizure-free 74-year-old woman had a single calcified cysticercus (Figure 1), and normal hippocampi (Figure 2, upper panel). Neuroimaging exams were practiced for a study aimed to assess the association between neurocysticercosis and hippocampal atrophy (HA).1 Seven years later, a control MRI showed bilateral HA (Figure 2, lower panel). The patient remained seizure-free during the observation period.
The association between calcified cysticercus and HA in seizure-free individuals has been recognized.2 It has been postulated that repetitive episodes of inflammation from antigens released to the brain parenchyma from calcifications are responsible for remote HA. However, HA progression in these patients has not been reported. This case underscores the need of early treatment with bisphosphonates to reverse the calcification process in the brain, reducing the risk of progressive HA.3
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External capsule infarct related to occlusion of the middle cerebral artery. Infarto en la cápsula externa relacionado con oclusión de la arteria cerebral media.
The external capsule is a band of longitudinal fibers (white matter) limited by two deep gray matter structures, the putamen medially and the claustrum laterally (Figure 1).
This structure is mainly composed of axons that connect different areas of the cerebral cortex with the tegmentum (corticotegmental fibers).
Ischemic strokes confined to the external capsule are extremely rare, representing 0.3% of patients enrolled in a large hospital-based ischemic stroke registry.
External capsule infarcts may be related to different pathogenic mechanisms, including large artery disease, cardiogenic brain embolism, sporadic cerebral small vessel disease, or to a combination of them.
In addition, external capsule infarcts have been typically reported in a hereditary form of cerebral small vessel disease known as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy).
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Multi-territorial posterior circulation ischemic stroke after cocaine intoxication. Infarto cerebral isquémico multi-territorial de circulación posterior luego de un episodio de intoxicación por cocaína.
A 35-year-old man presented to the emergency department with altered mental status and bilateral tonicclonic seizures. Due to a progressive decrease in consciousness, he was intubated for airway protection. The patient’s relatives reported that he had used cocaine, leading to an initial suspicion of acute cocaine intoxication. However, a head CT scan without contrast revealed a hyperdense basilar artery sign without other signs of infarction (figure 1).
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El chico con medio cerebro. Boy with nearly half-of-brain
A watery eye and an enlarged trigeminal nerve. Ojo acuoso y ensanchamiento del nervio trigémino
A 45-year-old man was evaluated one week after the acute onset of pain and numbness in the right side of the face. On examination, he had a right watery eye, which has been present for several weeks. The patient denied history of eye trauma or previous episodes of inflammatory or infected conditions affecting the lacrimal drainage complex.
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Enfermedad de Creutzfeldt-Jakob. Creutzfeldt-Jakob disease
Calambres musculares relacionados con uso de donepezilo. Donepezil-related muscular cramps
Temporal Squama Pneumatization: An Under-Recognized Limitation Of Transcranial Doppler. Pneumatización de las Escamas Temporales: Una Limitación Poco Reconocida Del Doppler Transcraneal
Transcranial Doppler (TCD) is a non-invasive procedure that is increasingly used for diagnostic and prognostic purposes in patients with an acute stroke. In addition, TCD enhances the effect of thrombolysis by exposing thrombi surfaces to circulating rTPA. However, insonation problems through acoustic windows limit the diagnostic efficiency of TCD.
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Encefalopatía Hipóxico-Isquémica Por Anfetaminas. Hypoxic-Ischemic Encephalopathy Due To Amphetamines
Infiltración dural metastásica. Metastatic dural infiltration.
Transient Global Amnesia Disclosing A Right Thalamic Dysembryoplasthic Neuroepithelial Tumor. Amnesia Global Transitoria Secundaria a un Tumor Neuroepitelial Disembrioplásico Localizado En El Tálamo Derecho
A 56-year-old, right-handed, previously healthy women, presented with transient global amnesia (TGA), characterized by the sudden onset of anterograde amnesia and confusion with a normal level of consciousness. During the episode, the patient recurrently asked what she was doing and what she had been told, but was able to recognize familiar faces. Mild-to-moderate right fronto-orbital headache was a companion symptom. The episode lasted about 10 hours.
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Malformación Arteriovenosa y Epilepsia. Arteriovenous Malformation And Epilepsy.
Insuficiencia Hepática Crónica y Lesiones Palidales Bilaterales. Chronic Liver Failure And Bilateral Pallidal Lesions.
A 66-year-old woman with history of cirrhosis of unknown etiology was evaluated one month after transient loss of consciousness followed by dystonic posturing, abnormal speech and shuffling gate.
She had been complaining of chronic fatigue, anorexia and weight loos for the past six months, and referred two episodes of non-traumatic nose bleeding in the past two weeks.
