Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiac myxoma is a source of emboli to the vascular tree, especially to the central nervous system. Although it is rare, its early recognition is particularly important because of its unique clinical features of subsequently leading to intracerebral or subarachnoid hemorrhage, even brain metastases, and its potential for surgical cure. Missing the diagnosis may lead to devastating results, including stroke, even sudden death. A 40-year-old male with no other conventional vascular risk factors such as hypertension, diabetes or hyperlipidemia presented with right hemiplegia, global aphasia, vomiting, and fever. Infarction over the left middle cerebral artery was disclosed on magnetic resonance imaging study, and echocardiogram showed a huge mass, about 5cm in size, on the mitral valve which was histopathologically proved to be a cardiac myxoma. He also presented with multiple emboli to the kidneys and the left eye. There is uncertainty about the role of anticoagulation. The treatment of choice remains surgical excision of the cardiac myxoma which may lead to normalization of serum interleukin-6 levels and resolution of constitutional symptoms, and the intracranial aneurysms may regress and resolve.
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PMID:Young stroke, cardiac myxoma, and multiple emboli: a case report and literature review. 1699 1

A 52-year-old man fell from standing and a computed tomography (CT) scan revealed traumatic intracerebral haematoma and subarachnoid haemorrhage in the temporal cortex. He was treated without surgery and discharged. On day 30 after the accident, he had no neurological deficit. On day 37 he complained of headache and urinary incontinence, and on day 39 he was hospitalized due to progressive neurological deterioration (reduced conciousness, dilated pupils, and left hemiplegia). A CT scan revealed a diffuse low-density in the right cerebral hemisphere with marked midline shift. Emergency decompressive craniectomy and right temporal lobectomy were performed. Angiography after surgery revealed moderate vasospasm in the right middle and anterior cerebral arteries. The patient remained severely disabled. Delayed onset neurological deterioration can be caused by brain oedema and vasospasm after traumatic brain injury, despite an intervening period of improvement.
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PMID:Delayed onset massive oedema and deterioration in traumatic brain injury. 1716 Dec 92

This study investigated nonspecific behaviors as early indications of vasospasm following subarachnoid hemorrhage. Although symptoms of vasospasm (e.g., lowered level of consciousness, focal deficits such as hemiplegia or aphasia), are well recognized, the significance of early appearance of nonspecific symptoms such as restlessness, unusual behaviors, and impulsive behavior has not been investigated in detail. The study design included descriptive quantitative elements and a small qualitative component. Nonspecific behaviors were recorded, and the prevalence of those behaviors in individuals developing vasospasm was noted. Of 60 participants, 31 developed vasospasm; 24 of the 31 initially presented with nonspecific behaviors (p < .0001). Early detection of cerebral vasospasm allows prompt intervention and treatment, with the goal of preventing further ischemia or infarction.
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PMID:Nonspecific behaviors as early indications of cerebral vasospasm. 1723 10

The objective of this study was to review available data on negligence claims for neurological disease treated by National Health Service (NHS) clinicians in England and Wales. The study design was a retrospective review of the NHS Litigation Authority (NHSLA) database, which holds data on negligence claims against NHS clinicians from 1995 to 2005. This database was searched to retrieve abstracts of claims concerning neurological disease treated by clinicians of all specialties. Abstracts were systematically reviewed to extract the following information: specialty of clinician, pathology involved, misadventure, patient injury and value of claim. A complete data set was available for 559 cases. The chi-squared test was used to investigate differences in negligence claims between neurologists/neurosurgeons and non-specialists. The specialty most frequently cited was neurosurgery (241) followed by neurology (172). Non-neurologists and non-neurosurgeons were the defendant in 146 cases, predominantly general physicians (42), orthopaedic surgeons (39) and emergency physicians (33). The most common pathologies were intervertebral disc disease (27%), CNS tumours (21%), CNS infection (11%) and subarachnoid haemorrhage (9%). The most frequent misadventure was diagnostic error (44%). In 47% of cases major permanent injury (e.g. blindness, hemiplegia) resulted from the misadventure. The patient died in 17% of cases. The total cost for all closed claims was 37 million pounds (2% of expenditure on claims for medical and surgical specialites over 1995 to 2005). This is the first systematic study of negligence claims for the treatment of neurological disorders in the UK. The prominence of diagnostic error highlights the need for early assessment by neurologists and prompt use of neuroimaging during the acute phase.
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PMID:Neurological negligence claims in the NHS from 1995 to 2005. 1738 87

The objective of the study was to analyze the quality of life six months after stroke in survivors under sixty years of age, to determine which life activities was the most affected, as well as to correlate the neurological insufficiency and the quality of life. It monitored 200 stroke survivors under sixty years of age treated at the Department of Neurology, University Clinical Centre Tuzla. Average age was 51,83 years (+/-7,02). The ischemic stroke was diagnosed in 77,5% stroke survivors, cerebral hemorrhage in 15%, and subarachnoid hemorrhage in 7,5%. Five stroke survivors suffered hemiplegia (2,5%), 24 (12%) experienced moderate consequences and 143 (71,5%) had mild consequences. No neurological deficit had 28 (14%) stroke survivors. Six months after the onset of disease all stroke survivors have been followed-up and evaluated about quality of life by filling in a modified questionnaire: Questionnaire on Quality of Life after Stroke (2). The questionnaire contained 20 questions covering four fields of life: Working Ability, Home Activity, Family Relations and Leisure Activities. Six months after the onset of stroke a worse quality of life in comparison to the period before the disease was noted in 172 (86%) stroke survivors, the unchanged in 19 (9,5%) and better in 9 (4,5%). The most affected is the field "Leisure Activities", followed by "Family Relations", "Home Activity", and the least affected is "Work Ability". The neurological deficit significantly correlates to the "Home Activities" and "Leisure Activities".
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PMID:Quality of life in stroke survivors under the sixty years of age. 1784 52

A 34-year-old woman with a previous history of severe headache ("thunderclap") was admitted with a diagnosis of aneurysmal subarachnoid hemorrhage (SAH). The patient developed symptomatic vasospasm on day 5 that resolved rapidly after having increased arterial blood pressure. She experienced also short-lasting excruciating headache. On day 12, while velocities had normalised, as revealed by transcranial Doppler (TCD), for more than 48 h, she developed aphasia and right hemiplegia associated with diffuse segmental vasospasm on the left middle cerebral artery. Intra-arterial infusion of vasodilatory agents was required. Recurrence of symptomatic vasospasm was noted on day 25, with a great number of territories involved as shown in the cerebral angiogram. A second intra-arterial treatment was needed. The patient complained of multiple episodes of extremely severe headache ("thunderclap"), with also transient dysarthria and hemiparesia on day 30. She was discharged on day 38 after full recovery. The clinical and TCD/radiological findings were consistent with a reversible cerebral vasoconstriction syndrome overlapping SAH related symptomatic vasospasm.
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PMID:Possible overlap between reversible cerebral vasoconstriction syndrome and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. 1938 33

Cerebral amyloid angiopathy (CAA) is predominantly recognized in elderly people and repeatedly causes a huge subcortical hemorrhage. Some cases of CAA can cause secondary subarachnoid hemorrhage (SAH), but cases in which it causes primary SAH is very rare. We describe a valuable reference case of a 75-year-old man in whom a restricted SAH recurred in the cortical sulcus following a huge subcortical hemorrhage. He presented with an unknown restricted SAH in the left frontal sulcus twice before neck clipping for a right IC-PC unruptured aneurysm. Postoperative computed tomography (CT) revealed a recurrent SAH in the left frontal lobe, and it spread gradually. T2(*) weighted imaging (T2(*)WI) revealed subarachnoid hemosiderosis and superficial cortical hemosiderosis in the frontal and parietal lobe. On the 21st postoperative day, he suddenly presented right hemiplegia and a huge subcortical hemorrhage was observed in the left frontal lobe on CT. Emergent removal of the hematoma was performed, but the patient had become bedridden. Pathological diagnosis of CAA was made. A recurrent restricted SAH in the frontal sulcus might have been a warning sign of a huge subcortical hemorrhage. In the aging society, a radiological prediction of CAA is very important. Although it is generally thought to be very difficult, T2(*)WI may be useful for predicting CAA. When we plan surgery for elderly people, we must always take CAA into consideration.
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PMID:[A case of cerebral amyloid angiopathy in which a restricted subarachnoid hemorrhage recurred in the cortical sulcus following a subcortical hemorrhage]. 2054 29

Aim to investigate the changes of cerebral microcirculation after subarachnoid hemorrhage (SAH) and its association with cerebral vasospasm (CVS) after SAH. CTP was performed in 85 patients with SAH and 35 controls. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were recorded for final analysis. CTP parameters were compared between (1) SAH group and control group, (2) CVS group and non-CVS group (nCVS), (3) symptomatic CVS (sCVS) group and asymptomatic CVS (asCVS) group. Compared to control group, there were significant differences in CBF and MTT of SAH patients (P<0.05). Among SAH patients, the CBF and MTT (a decreased CBF and a prolonged MTT) of CVS patients were significantly different from those of non-CVS patients (P<0.05). In 46 CVS patients, sCVS group presented significantly lower CBF and more prolonged MTT than asCVS patients (P<0.05). Seven cases with MTT between 6.31 and 12.72 s showed delayed ischemic neurological deficit (DIND), two of whom had hemiplegia, and one died. Our findings suggest that CTP examination contributes to uncover the changes of cerebral microcirculation after SAH, and the changes of cerebral microcirculation are associated with CVS post SAH.
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PMID:Clinical study of changes of cerebral microcirculation in cerebral vasospasm after SAH. 2111 44

A 53-year-old man abruptly developed headache and unconsciousness. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage, intraventricular hemorrhage, and multiple tortuous vascular structures on the brain stem and upper cervical spinal cord. Four-vessel angiography displayed intradural ventral arteriovenous fistula, supplied by the left vertebral and occipital arteries. Drainage was via both sigmoid sinus and cervical venous plexus. He had been treated with transarterial coil embolization of the left vertebral artery. Subsequently, he suffered from left hemiplegia and cognitive problem. Brain magnetic resonance (MR) and MR angiography performed 4 weeks later revealed multiple infarctions on the left cerebellum, left upper cervical spinal cord, and both medial thalamus, as well as occlusion of the left vertebral artery with reduction in varix size. After rehabilitative management, his muscle strength and cognitive function improved. We report a very rare case of dural arteriovenous fistula on the brain stem and upper cervical spinal cord.
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PMID:Dural arteriovenous fistula on the brain stem and upper cervical spinal cord - a case report -. 2250 99

Previous reports of outcome after endovascular treatment of posterior cerebral artery (PCA) aneurysms have been limited. This study aimed to describe the clinical outcome and angiographic results obtained in the endovascular therapy of PCA aneurysm over a six year period. Endovascular treatment strategies were determined. A retrospective analysis was performed on 18 patients with PCA aneurysms evaluated at Beijing Tiantan Hospital between December 2000 and December 2006. Nine patients presented with subarachnoid hemorrhage (SAH): one of these patients had additional seizure and hemiparesis, one had additional memory loss and oculomotor palsy and one had additional vitreous hemorrhage. One patient had an intracerebral hematoma causing hemipalsy. Nine patients demonstrated unruptured PCA aneurysms. Ten aneurysms were = or >15 mm and the other eight were <15 mm. Ten aneurysms were saccular, four were fusiform and four were giant serpentine. Eighteen aneurysms were successfully treated with one patient deceased and one with a permanent deficit, 11 with selective occlusion of the aneurysm with platinum coils, one with NBCA and five with simultaneous occlusion of the aneurysm and parent PCA with detachable coils. One patient underwent complete spontaneous thrombosis after angiography. One patient had recanalization one year after coiling and one patient (patient 13) had persistent homonymous hemianopsia and mild hemipalsy. Five patients had parent vessels were occluded with intact visual field. Clinical presentation of PCA aneurysms varied with SAH, oculomotor palsy, heminumbness, hemiparalysis, memory loss, seizure or a combination. Various aneurysms of the posterior cerebral artery can be managed effectively with endovascular treatment.
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PMID:Endovascular treatment of posterior cerebral artery aneurysms. 2425 62


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