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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 59-year-old man was admitted to our hospital with the history of epileptick attack of six years' duration. The seizure was associated with Jacksonian march starting in the right hand and then generalized. Todd's paresis of the right arm followed occasionally to the seizure. He was admitted to neurosurgical unit of other hospital in 1968 and 1971, but on each occasion no tumor or vascular abnormality was detected by extensive examiniations such as brain angiography, pneumoencephalography or brain scanning. He continued his hob as an engineer with anticonvulsant. He once lived in Manchuria in 1930s and had history of pulmonary tuberculosis. He was suffering from diabetes mellitus and chronic otitis media. Recentry he developed headache, forgetfulness, speech disturbance and right hemiparesis and was admitted to our department through psychiatric unit. On examination he was fully conscious but showed typical Gerstmann's syndrome and conduction aphasia. He also revealed bilateral choked disc, right hemiparesis, right hemihypesthesia and right homonymous hemianopsia. The cerebral angiograms and peneumoencephalogram suggested a left parietal cystic tumor. Brain scan with technetium 99m was negative. The spinal fluid was clear but showed slight pleocytosis (99/3/ml). Leucocyte count in the peripheral blood was 6600 per cubic meter with eosinophils of 3%. On craniotomy, small white patches were scattered at the subarachnoidal space suggesting of history of some meningitis. In the left parietooccipital region at Brodmann's area 19, a greyish yellow transparent cystic tumor was found in the subarachnoidal space which was confirmed to be one of the multilocular grape-like cystic tumors extending from area 19, gyrus angularis towards the arcuate fasciculus without continuity with the left lateral ventricle. Microscopic examination showed the racemosal type of cysticercus but no scolex was found. The fluid of the cysts was similar to the spinal fluid. He is totally symptome-free after five months' lapse from the operation except for sporadic spikes on the electroencephalogram. Although some neurosurgeons are against direct operation of the cerebral cysticercosis, we are sure it is possible to cure these patients suffering from chronic cysticercosis with tumor-like symptoms i.e. the tumor type of Stepien. But it is essential not to rupture the cysts during the operative procedure to avoid dissemination of worms which might lead to acute severe cerebral edema. Besides, echinococcus cysts harbouring many worms are often hardly differenciated macroscopically from the cysts of cysticercosis.
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PMID:[A case of brain cysticerosis]. 98 76

A 73-year-old man was admitted with gait disturbance and dysarthria. He showed right-side cerebellar ataxia. Computed tomography of brain showed left thalamic bleeding. Nine months later, he was admitted again because of seizure and consciousness disturbance. He had a history of diabetes mellitus and gout for five years, but no hypertension. On physical examination the lungs and heart were normal. On neurological examination, he showed stupor,pupils and eye position were normal. He showed right hemiparesis and urinary incontinence. The deep tendon reflexes were (+) at the upper limbs and (2+) at the right knee and ankle. Blood pressure was 162/88 mmHg and glucose was 275 mg/dl. Other laboratory data were normal. Brain CT showed hemorrhage of the left frontal lobe. The cystatin C level in cerebrospinal fluid was 68 ng/ml. Therefore we suspected cystatin C deposit amyloid angiopathy. In this case, thalamic hemorrhage was initially thought to be amyloid angiopathy. In cases of cerebral hemorrhage in the elderly without hypertension, we must be considered amyloid angiopathy.
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PMID:[A case of recurrent cerebral hemorrhage considered to be cerebral amyloid angiopathy by cerebrospinal fluid examination]. 143 57

Three elderly patients with partial motor seizures triggered by movement of posture of an extremity are presented. They had a history of diabetes mellitus. Two of them had nonketotic hyperglycemia. Hemiparesis was present in the three patients, which resolved in two. In the other patient, hemiparesis resulted from a previous stroke. All patients had transitory parietal syndrome. During seizures, EEG showed discharges in the parieto-occipital area in two cases and in the mid-temporal area in one. Seizures were resistant to conventional anticonvulsant therapy, and ceased only after treatment of metabolic disturbances. A search for reflex seizures and hyperglycemia should be carried out routinely in the elderly with repeated spontaneous focal motor seizures. This may be important for treatment and prognosis.
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PMID:[Partial motor seizures induced by movement in diabetic patients]. 184 94

Lacunar stroke was diagnosed in 337 (26%) of the 1,273 patients with cerebral infarction among the 1,805 total in the Stroke Data Bank. We analyzed the 316 patients with classic lacunar syndromes. Among these, 181 (57%) had pure motor hemiparesis, 63 (20%) sensorimotor syndrome, 33 (10%) ataxic hemiparesis, 21 (7%) pure sensory syndrome, and 18 (6%) dysarthria-clumsy hand syndrome. No striking differences were found among the risk factors for the lacunar subtypes, but differences were found between lacunar stroke as a group and other types of infarcts. Compared to 113 patients with large-vessel atherosclerotic infarction, those with lacunar stroke had fewer previous transient ischemic attacks and strokes. Compared to 246 with cardioembolic infarction, patients with lacunar stroke more frequently had hypertension and diabetes and less frequently had cardiac disease. We found a lesion in 35% of the lacunar stroke patients' computed tomograms, with most lesions located in the internal capsule and corona radiata. The mean infarct volume was greater in patients with pure motor hemiparesis or sensorimotor syndrome than in those with the other lacunar stroke subtypes. In patients with pure motor hemiparesis and infarcts in the posterior limb of the internal capsule, there was a correlation between lesion volume and hemiparesis severity except for the few whose infarct involved the lowest portion of the internal capsule; in these patients severe deficits occurred regardless of lesion volume. Taken together, the computed tomographic correlations with the syndromes of hemiparesis showed only slight support for the classical view of a homunculus in the internal capsule.
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PMID:Clinical-computed tomographic correlations of lacunar infarction in the Stroke Data Bank. 200 81

Seventy-nine children with the Haemolytic Uraemic Syndrome were referred to our unit between 1972 and 1988. The typical summer peak incidence was seen. A diarrhoeal prodrome occurred in 71 (90%). Fifty-nine (75%) required dialysis and 74 (94%) blood transfusion. Extra-renal disease was documented: neurological 32 (40%); abdominal 11 (14%); diabetes mellitus one case. Fifty-one (61%) had acute hypertension. The acute mortality rate was 9%. Children with neurological features had greater biochemical disturbances and longer duration of dialysis. Fifty-nine children were followed for a mean 47.4 months. Forty-four (75%) are healthy. Nine (15%) have renal impairment, two have proteinuria, one hypertension and one has a residual hemiparesis. There were two late deaths. Presence of acute neurological features increased risk of early death or survival with sequelae. Prolonged dialysis was significantly associated with poorer outcome. However, there were no reliable early indicators of poor prognosis.
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PMID:Haemolytic uraemic syndrome: 17 years' experience in a Scottish paediatric renal unit. 203 Nov 74

We studied clinical characteristics and coexisting causes of stroke in 305 patients admitted to a population-based primary care center with an initial ischemic stroke and a potential cardiac source of embolism (PCSE). Using systematic standardized cardiac, arterial, and cerebral investigations and the logistics of the prospective Lausanne Stroke Registry, we found that nonprogressive onset, hemianopia without hemiparesis or hemisensory disturbances, Wernicke's aphasia, ideomotor apraxia, involvement of specific territories (posterior division of middle cerebral artery, anterior cerebral artery, cerebellum, multiple territories), and a hemorrhagic component were associated with the presence of a PCSE, as compared with 1,006 initial ischemic stroke patients without PCSE. Although age and sex did not differ, the frequency of hypertension, diabetes, cigarette smoking, elevated blood cholesterol, and deep hemispheric or brainstem infarcts was higher in the patients without a PCSE. Nearly one-fourth of the patients with a PCSE had a coexisting potential arterial cause of stroke (large artery greater than or equal to 50% stenosis or small-vessel disease). In the majority of patients with a PCSE (76.7%), cardioembolism was the most likely cause of stroke, although a direct source of embolism was uncommon (4.3%) and intracranial embolic occlusions were present in less than one-half of the patients who were angiographed.
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PMID:Cardiac sources of embolism and cerebral infarction--clinical consequences and vascular concomitants: the Lausanne Stroke Registry. 204 30

The Solitary thalamic abscess appears to be uncommon, 17 cases have been reported since 1973. We successfully treated a case of thalamic abscess associated with diabetes mellitus by sterotactic aspiration with external drainage. A 55 years old man presented right hemiparesis. A computed tomographic (CT) scan revealed solitary thalamic low density lesion with ringed contrast enhancement. We started the administration of antibiotics, but on the 9th day he became drowsy and his eyes were deviated downward and inward. CT scan on the 10th day showed the edema had been spread to the tectum. We aspirated purulent fluid material with confidence by sterotactic operation. We considered the mid brain tectum to be responsible for the downward and medial deviation of the eyes, because it appeared only when the edema and abscess were spread to that area, and disappeared after aspiration of the abscess with subsidence of the edema.
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PMID:[A case of solitary thalamic abscess treated by sterotactic aspiration]. 222 66

From a total number of 227 patients with lacunar infarcts of the brain assisted during a period of 7 consecutive years, 18 (8%) had an age equal or below 45 years. This group of patients represent 1.1% of strokes and 1.6 of the ischemic cerebral infarcts treated in a Neurology Service during the study period. Eleven patients (64%) were male. The most relevant cerebrovascular risk factors are: arterial hypertension (55%), cardiopathy (26%), and diabetes mellitus (11%). The most common syndrome was pure motor hemiparesis (61%), pure sensitive syndrome (22%), and atypical lacunar syndrome (17%). Computerized axial tomography of the brain was positive in 44.5% of cases. The mean systolic arterial pressure during the first 24 hours of the illness was significantly lower (p less than 0.03) in the young patients. Our results indicate that lacunar cerebral infarcts in young patients: a) are uncommon, and b) constitute a group with some differential clinical characteristics and with a better immediate prognosis with respect to the remaining patients with lacunar infarcts.
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PMID:[Cerebral infarctions of the lacunar type in young adults]. 226 Nov 90

61 of 1,590 (3.8%) patients with cerebrovascular disease showed suprabulbar palsy of the pure form (42 patients; 2 had autopsy) and striate form (19 patients; 3 had autopsy). 25 patients with the pallidopyramidal syndrome were included since the clinical picture bordered on the striate form. The pure variety was characterized by dysarthria, dysphagia and automatic voluntary dissociation of facial movements. Half of the patients also had hemiparesis, primitive reflexes and short-step gait. In the striate form, the main signs were dysarthria, dysphagia, automatic voluntary dissociation, rigidity and hypokinesia. Brisk tendon reflexes, primitive reflexes, short-step gait and mental deterioration were also present in half of the patients. The pure variety was caused by multiple infarcts and/or lacunae (85.7%), while the striate form had vascular lesions by computed tomography in only 36.8% of the cases. Histological findings, showing lipohyalinosis of the arterial wall leading to stenosis and occlusion of the lumen and tissue rarefaction and disintegration, support the assumption that microinfarctions, sometimes found only by histopathological examination, are the leading pathogenetic factor in this form. Hypertension, cardiopathy, smoking habit, dyslipemia and diabetes are the most frequent risk factors in both forms.
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PMID:Pseudobulbar palsy: a clinical computed tomography study. 229 26

We describe an analysis of 227 patients with lacunar infarcts; 177 were inpatients and the remaining 50 were outpatients. The group comprised 11% of all inpatients with cerebrovascular pathology and 16% of all consecutive inpatients with brain infarcts studied at the Department of Neurology of the Hospital de la Santa Creu i Sant Pau. The main risk factors identified in these patients were arterial hypertension in 164 (72%), diabetes mellitus in 64 (28%), and heart disease in 58 (26%). The most common clinical syndromes were pure motor hemiparesis in 125 (55%), pure hemisensory stroke in 42 (18%), the sensorimotor deficit syndrome in 34 (15%), ataxic hemiparesis in seven (3%), and the dysarthria-clumsy hand syndrome in four (2%); atypical syndromes were observed in 15 patients (7%). Lacunes were demonstrated by computed tomography in 100 patients (44%) and by magnetic resonance imaging in 35 (78%) of the 45 patients in which it was applied. Magnetic resonance imaging was significantly better (p less than 0.001) than computed tomography for imaging lacunes, especially those located in either the pons (p less than 0.005) or the internal capsule (p less than 0.001). After the acute phase, mild or no neurologic disability was detected in 178 patients (78.4%), moderate disability persisted in 48 patients (21.1%), and severe disability was recorded in one case (0.4%). Lacunar infarcts are a clearly defined entity with characteristic clinical features and an excellent short-term prognosis. Magnetic resonance imaging is the current method of choice for demonstrating these small brain lesions.
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PMID:Clinical study of 227 patients with lacunar infarcts. 234 85


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