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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Periventricular arteriovenous malformations (AVMs) have often been deemed inoperable because of their location in critical structures. Furthermore, the excision of large lesions may be complicated by the potential for serious brain swelling and hemorrhage due to "autoregulation breakthrough." Nonetheless, the unfavorable natural history of the untreated disease in a symptomatic young patient has induced us to approach these lesions using staged microsurgical excision combined with elective barbiturate coma for maximal cerebral protection. Between 1979 and 1983, six patients (four female, aged 12 to 60 years, and 2 male, aged 14 and 29) who harbored large AVMs in the basal ganglia, thalamic, and hypothalamic areas presented with subarachnoid hemorrhage (2 cases), progressive neural deficits (3 cases), and intractable headache (1 case). Nineteen staged operations were performed for the complete excision of these lesions. Among the first three patients, there was one death due to "autoregulation breakthrough" hemorrhage into the lateral ventricle during the excision of a lesion approached through the sylvian fissure using standard anesthesia techniques. This led to the adoption of the transventricular surgical approach and elective barbiturate coma to facilitate exposure of the lesion and to protect the adjacent vital structures from potential ischemia. Three patients were treated in this fashion uneventfully. Of the five successfully treated patients, two have returned to their preoperative status and one has completely recovered from global hemispheric ischemia and hemiplegia. The hemiparesis in one patient worsened as a result of postoperative hypertensive intraventricular hemorrhage, and one patient developed mild dysphasia and hemiparesis. This experience suggests that this approach offers a valid therapeutic regimen for the treatment of this disease. During the same period, three patients--one man (age 23) and two women (aged 29 and 22)--harboring four intraventricular AVMs presented with intraventricular hemorrhage. After the acute effects of chemical ventriculitis and hydrocephalus were overcome with cerebrospinal fluid diversion, all four lesions were excised microsurgically using the transtemporal approach. One patient demonstrated significant and progressive improvement of her preoperative memory deficit. The remaining two patients have both returned to their preoperative employment.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Microsurgical excision of paraventricular arteriovenous malformations. 398 6

Clinical signs of cerebrovascular accidents during oral contraception in 27 patients and autopsy findings in 2 patients are reported. Hemiparesis or hemiplegia was the most common symptom (10 cases); others include migraine, vision disorders, loss of consciousness, subarachnoid hemorrhage, and (fatally) sinus thrombosis and occlusions of the medial artery. Autopsy findings included fresh thromboses, infarctions in the gyrus hippocampi and the gyrus fusiformis, and massive enlargement of the right hemisphere (1 case). The mechanism of thrombus formation and predisposing risk factors are discussed.
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PMID:[Clinical and morphological aspects of cerebrovascular accidents under oral contraception (author's transl)]. 413 Aug 58

Transfemoral and intraoperative embolization of arteriovenous malformations (AVMs) of the brain with isobutyl-2 cyanoacrylate may achieve complete and permanent occlusion of the AVMs. The preembolization superselective angiogram is an important source of information to decrease potential technical or clinical complications while seeking that goal. The information obtained from the angiogram of each individual feeder may be classified as anatomical, dynamic, and functional. This angiogram is performed either through a calibrated-leak balloon glued to a Silastic tubing, which is capable of negotiating cortical arterial curves, or through a short catheter directly placed into a feeder at surgery. In 64 patients, 175 preembolization superselective angiograms were obtained. Of those, 105 were obtained using the transfemoral technique, and 70 were obtained by direct catheterization after a craniotomy. Complications occurred in eight patients with only one permanent injury. Transient neurologic deficit occurred in five patients. One patient developed a permanent left monoplegia and one patient a subarachnoid hemorrhage without permanent neurologic deficit. In one patient, a delayed intracerebral hemorrhage produced a right hemiplegia and aphasia. The patient fully recovered in 6 months.
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PMID:Preembolization superselective angiography: role in the treatment of brain arteriovenous malformations with isobutyl-2 cyanoacrylate. 643 78

The authors report a case of giant aneurysm in which extravasation of contrast medium was demonstrated during cerebral angiography and confirmed by computed tomography. A 33-year-old man suddenly lost consciousness and vomited frequently. Three hours later, he was admitted to our hospital in semicomatose state with left hemiplegia. Within two hours after admission, plain CT scan, enhanced CT scan, left carotid angiography and post-angiographic CT scan were performed. CT scan showed marked subarachnoid hemorrhage, left temporal intracerebral hematoma and oval mass which was remarkably enhanced in the left Sylvian fissure. First left carotid angiogram demonstrated a giant aneurysm of the middle cerebral artery which was measured 4.5 cm in maximum diameter. Second left carotid angiogram demonstrated an extravasation of contrast medium around the aneurysm. The patient immediately underwent CT scan, which showed enlargement of intracerebral hematoma and intraventricular high density area as added lesion. By regulation of window level, the presence of contrast medium due to intra-angiographic rupture of the aneurysm was confirmed. The patient expired fifteen hours after admission. At autopsy, the thrombus in the aneurysmal sac was hardly present and the wall of the sac was made mainly of collagen fibers. From the following two points this case was very interesting. However this aneurysm was very large, the thrombus in the aneurysmal sac was hardly present. Extravasation of contrast medium was clearly demonstrated during cerebral angiography with confirmation by computed tomography in the giant aneurysm.
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PMID:[Extravasation of contrast media demonstrated during cerebral angiography in the giant aneurysm of the brain]. 663 13

A case of aneurysm at the junction of the vertebrospinal and anterior spinal arteries at the level of C-1 is presented. There was severe intracranial subarachnoid hemorrhage with subsequent right hemiplegia and 6th nerve palsies. Angiograms showed an anomalous arrangement of the arteries, but no arteriovenous malformation was seen. The lesion was repaired via a posterior approach. Anatomical and technical considerations of this approach are discussed. A review of the pertinent literature is presented.
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PMID:Ruptured anterior spinal artery aneurysm: repair via a posterior approach. 709 15

A 24-year-old woman developed subarachnoid hemorrhage from an aneurysm at the bifurcation of the right internal carotid artery. Following successful clipping of the aneurysm she developed a left hemiplegia associated with focal cerebral vasospasm, which markedly improved when systemic blood pressure was raised with intravenous dopamine infusion. Regional cerebral blood flow and oxygen utilization were significantly depressed in both cerebral hemispheres, while blood volume was significantly elevated only on the side with vasospasm. Oxygen extraction was significantly elevated in both hemispheres, indicating a generalized impairment in oxygen delivery to the brain.
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PMID:Cerebral hemodynamics and metabolism in postoperative cerebral vasospasm and treatment with hypertensive therapy. 727 Dec 44

A 50-year-old woman with an 18-year history of systemic lupus erythematosus (SLE) died after an exacerbation of the illness, characterized by deteriorating mentation and right hemiplegia. Necropsy revealed massive spinal subarachnoid hemorrhage resulting from aneurysmal dilation and rupture of the posterior spinal artery, which was involved by vasculitis. The left parietal lobe and internal capsule contained recent infarcts. To our knowledge, this is the first reported case of SLE with spinal subarachnoid hemorrhage revealed by necropsy.
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PMID:Subarachnoid spinal hemorrhage in a case of systemic lupus erythematosus. 735 25

A consecutive series of 78 patients underwent surgery for 106 aneurysms between 1972 and 1978; this group included 14 patients with subarachnoid hemorrhage who had multiple, unruptured, incidental aneurysms (20 additional aneurysms). These aneurysms were operated on with no mortality. In 15 other patients, who underwent angiography for various nonhemorrhagic disorders, a total of 18 asymptomatic aneurysms were found. These were also operated on with no mortality. Three of the 29 patients had postoperative hemiplegia, which persists in only one. The author recommends that all aneurysms should be considered for operation when diagnosed, if the patient's clinical condition is stable.
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PMID:Surgical treatment of asymptomatic and incidental intracranial aneurysms. 741 Dec 4

A patient with cerebral vasospasm following subarachnoid hemorrhage (SAH) was investigated by serial measurement of cerebral blood flow (CBF) using the xenon-133 emission tomography method. The CBF was measured before and after acetazolamide injection. On Day 2 after SAH, there was early local hyperperfusion in the middle cerebral artery (MCA) territory, ipsilateral to the left posterior communicating artery aneurysm. The regional CBF of this arterial territory decreased slightly after acetazolamide injection, probably because of vasoplegia and the "steal" phenomenon, and thus surgery was delayed. A right hemiplegia with aphasia and disturbed consciousness occurred 4 days later (on Day 6 after SAH) due to arterial vasospasm, despite treatment with a calcium-channel blocker. The initial hyperemia of the left MCA territory was followed by ischemia. The vasodilation induced by acetazolamide administration was significantly subnormal until Day 13, at which time CBF and vasoreactivity amplitude returned to normal and the patient's clinical condition improved. Surgery on Day 14 and outcome were without complication. It is concluded that serial CBF measurements plus acetazolamide injection are useful for monitoring the development of cerebral vasospasm to determine the most appropriate time for aneurysm surgery.
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PMID:Abnormal cerebral vasodilation in aneurysmal subarachnoid hemorrhage: use of serial 133Xe cerebral blood flow measurement plus acetazolamide to assess cerebral vasospasm. 841 Feb 15

Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon-computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon-CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.
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PMID:Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage. Case report. 861 66


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