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)

We describe a 65-year-old right-handed (on the Edinburgh Inventory Test) woman who developed left hemiplegia and language disturbances after right hemisphere lesion. She showed global aphasia and left spatial neglect. To our knowledge, this is the first case of so called "crossed aphasia" in which the integrity of the left hemisphere is assessed by Magnetic Resonance Imaging (MRI). The association of aphasia and neglect is briefly discussed.
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PMID:A case of "crossed aphasia" in which the integrity of the left hemisphere is assessed by MRI. 233 26

Five right-handed patients with subcortical aphasia that involved the left hemisphere subcortical lesion sites were subjected to CT scans. Given their etiology, two cases were infarctions and the other three were hemorrhages. Two of the patients presented an involvement of the anterior limb of the internal capsule and of the basal ganglia and an anterior superior white-matter lesion extension. In both cases slow scanty dysarthric speech was noted; one had markedly impaired auditory comprehension, and the others were only partially impaired. The third patient presented an involvement of the posterior limb of the internal capsule and of the thalamus and a posterior paraventricular white-matter lesion extension. He had poor auditory comprehension, echolalia, and fluent speech. The last two patients presented an involvement of the internal capsule, the basal ganglia, and the thalamus and an anterior posterior paraventricular white-matter lesion extension. The latter two showed poor auditory comprehension with nonfluent and scanty spontaneous speech. The speech sounds were nonsensical monosyllabic words with a pattern similar to that of global aphasia. All patients had lasting right hemiplegia.
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PMID:Three variant forms of subcortical aphasia in Chinese stroke patients. 247 23

Treatment with recombinant tissue plasminogen activator (rt-PA) has been applied in acute cardioembolic stroke to reopen the occluded vessel and improve the patient's neurologic deficit. However, the effect of this therapy on intracardiac thrombus has not been documented previously. A forty-five-year-old man with dilated cardiomyopathy developed acute cardioembolic stroke with disturbance of consciousness, right hemianopia, right hemiplegia, and global aphasia. Cerebral angiography demonstrated occlusion of the left middle cerebral artery trunk. Intravenous administration of 30 megaunits (MU) of recombinant tissue plasminogen activator was commenced two hours after the ictus and completed within sixty minutes. Cerebral angiography was repeated just after this treatment and demonstrated a new occlusion of the left intracranial internal carotid artery along with occlusion of a branch of the left external artery. The authors subsequently performed two-dimensional echocardiography and found a mobile thrombus in the left ventricle. In patients with intracardiac mobile thrombi, recombinant tissue plasminogen activator seems to accelerate breakup or detachment of the thrombi and subsequent recurrent embolization. Therefore, it seems better to pay attention to the presence of mobile intracardiac thrombus before commencing intravenous infusion of rt-PA.
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PMID:Recurrent embolization during intravenous administration of tissue plasminogen activator in acute cardioembolic stroke. A case report. 820 76

Cerebral embolism poses one of the most perplexing problems in cerebrovascular disease; fat emboli and marantic air emboli occur occasionally. However, the most common cause for a cerebral embolism is degenerative changes in the central arteries. The authors report the case of a 75-year-old female suffering from ischemic cerebrovascular disease of the left dominant hemisphere during a revision arthroplasty of the right hip (cementless Austin Moore hemiarthroplasty to a cemented Charnley total hip replacement); a cement gun was used to introduce the cement; both the induction of anesthesia and the surgical procedure were uneventful. The patient awoke slowly, and when awake she showed a combination of contralateral hemiplegia, and right hemianesthesia with global aphasia; the CT scan showed an ischemic lesion in the territory of the middle cerebral artery; during the following two weeks the patient showed complete recovery from the clinical syndrome. This complication must be recognized by every orthopedic surgeon, and a high clinical index of suspicion remains essential to early diagnosis.
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PMID:Cerebral embolism during revision arthroplasty of the hip. 857 70

Neurosyphilis often develops brain infarction. Recently, the authors experienced a case of brain infarction caused by syphilitic aneurysm on the thoracic aorta, and its clinical significance is reported. A seventy-eight-year-old woman with strongly positive serologic tests for syphilis suddenly developed global aphasia and right hemiplegia. Brain computed tomography (CT) showed a large brain infarction in the left middle cerebral artery territory. A huge aneurysm of the ascending aorta eroded the sternum and the second and third ribs. The left common carotid artery was completely compressed by the aneurysm, and blood flow was not demonstrated on enhanced CT. A cerebrospinal fluid examination revealed normal cell counts, and the titer of a syphilis test was very low. She did not have any arrhythmia, ischemic heart disease, or valvular heart disease as an embolic source. Brain infarction may be developed by pressure of an aortic aneurysm on the left common carotid artery. They recommend consideration of syphilis as an etiology of brain infarction when luetic patients are seen in old age.
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PMID:Brain infarction caused by syphilitic aortic aneurysm. A case report. 881 Jun 59

Large supratentorial infarctions play an important role in early mortality and severe disability from stroke. However, data concerning these types of infarction are scarce. Using data from the Lausanne Stroke Registry, we studied patients with a CT-proven infarction of the middle cerebral artery (MCA) territory that covered at least two of three MCA subterritories (deep, superficial anterior [superior] and posterior [inferior] territory). We compared these patients with patients presenting more limited infarction in the MCA territory. Our study group of large MCA (laMCA) infarction contained 208 patients, corresponding to 7.6% of all ischemic infarctions in the Lausanne Stroke Registry. Seventy-two patients had complete infarction in the whole MCA territory (coMCA). Internal carotid artery (ICA) occlusion (41%) and ICA dissection (12%) were more common than in limited superficial MCA (lsMCA) infarct and anterior circulation infarct (p < 0.001). Among the patients without ICA occlusion, atrial fibrillation (33%; p < 0.002) and cardiogenic embolism in general (54%; p < 0.001) were more frequent in laMCA than in lsMCA infarct. Severe neurologic deficit (hemiplegia and hemisensory loss in the face, arm and leg, hemianopia, global aphasia, reduced consciousness) was more common than in other types of infarct. A combination of these symptoms had a positive predictive value for laMCA infarction of 0.73 (sensitivity for left side laMCA infarcts, 0.56). Mortality (17%) and severe disability (50%) were higher with laMCA than for other infarcts (p < 0.001). Sixteen of the 35 deaths could be attributed to brain edema. Reduced consciousness, hemianopia, and coMCA infarction were independent predictors of death or severe disability; for death only, coma was an independent predictor. Patients who died because of brain edema were younger than patients whose death was due to other causes (mean age, 57 versus 73 years; p < 0.001); they also died sooner (mean time of death after stroke, 5 versus 37 days; p < 0.001). Furthermore, patients who developed coma on the day of admission were more likely to die because of brain death (p < 0.001). Large middle cerebral artery infarction is associated with cardiogenic embolism, ICA occlusion, and ICA dissection. It is a major predictor of death and severe disability, although a lower frequency of malignant brain infarction was found than previously reported.
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PMID:Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. 981 7

A 55 year-old, right-handed, hypertensive woman with global aphasia, due to a spontaneous hemorrhage in the right putamen extending to the periventricular white matter was examined thirteen days after the acute onset of stroke. She had left hemiplegia and inability to speak. She displayed no spontaneous speech output and was capable only of occasional undifferentiated grunts in conversation. Other language modalities such as auditory and reading comprehension, naming, repetition and writing were severely impaired. Her aphasia was classified as global aphasia. Forty-five days after the onset of stroke, rapid recovery from the aphasia with mild deficits in speaking, naming, and repetition was detected. This case is a good example of crossed aphasia, favouring the importance of deep structures of the right hemisphere in this type of aphasia. Rapid recovery is an important feature.
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PMID:Subcortical crossed aphasia. 968 82

A neurologist witnessed the in-hospital onset of an ischemic stroke in a 71-year-old right-handed male who suddenly developed global aphasia and right hemiplegia. Diffusion-weighted magnetic resonance imaging (DWI) 39 minutes after the ictus demonstrated high signals in the left internal carotid artery territory. T1- and T2-weighted images failed to detect this change. Magnetic resonance angiography showed occlusions in branches of the left anterior and middle cerebral arteries and an atheromatous stenotic lesion in the ipsilateral proximal internal carotid artery. The patient was treated with intravenous heparin and low molecular dextran solution. Repeated magnetic resonance imagings identified an infarction slightly smaller than the abnormality demonstrated by the initial DWI. DWI detects hyperacute ischemic injury within 1 hour of symptom onset in human ischemic stroke.
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PMID:Diffusion-weighted magnetic resonance imaging: detection of ischemic injury 39 minutes after onset in a stroke patient. 1036 Jul 73

Cerebral venous thrombosis (CVT) is a disease with multiple known etiologies that present with a remarkably wide spectrum of clinical signs and symptoms. We present a case of a 34-year-old man with a history of meningeal symptoms for 1 week after receiving a lumbar injection for lower back pain. He subsequently developed dense right hemiplegia and global aphasia. Head magnetic resonance imaging revealed superior sagittal sinus thrombosis. The patient was started on intravenous heparin but deteriorated neurologically. Urokinase infusion directly into the superior sagittal sinus was performed, with striking functional and neurologic improvement. Lupus anticoagulant was positive. We also present the case of a 24-year-old pregnant woman who developed an acute onset of meningeal symptoms and resultant left hemiparesis. Head magnetic resonance angiography revealed thrombosis of right transverse and sigmoid sinuses. Protein S deficiency was found. She was started on intravenous heparin, then enoxaparin, with improvement in symptoms. These cases demonstrate that CVT can be a cause of stroke in young patients with hypercoagability disorders, and a heightened awareness of CVT will promote optimal medical care and functional outcomes. Excellent functional recovery is likely with early recognition and treatment of the underlying etiology, as well as successful lysis of the clot.
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PMID:Cerebral venous thrombosis in young adults: 2 Case reports. 1134 48

A 63-year-old male presented with sudden onset of right hemiplegia and global aphasia. On admission he was stuporous. Computed tomography (CT) revealed no abnormalities except for right intraventricular meningioma found incidentally. Emergency angiography confirmed complete occlusion of the left internal carotid artery (ICA) and left M1 trunk whereas the left ICA bifurcation remained patent. The ipsilateral ICA was permanently occluded with two detachable balloons to prevent thrombus migration into the distal ICA and middle cerebral artery (MCA), followed by thrombolysis of the clot in the ipsilateral M1 through the contralateral ICA with urokinase (total dose 420,000 U) under systemic heparinization. Partial recanalization of the ipsilateral MCA was accomplished. The time interval from onset to recanalization was about 3 hours. Postoperative CT showed no hemorrhagic transformation. Slight right paresis and mild motor aphasia persisted 2 months later and he was transferred to a rehabilitation facility. Thrombolysis of the MCA embolism can be performed through the contralateral ICA in the presence of ipsilateral ICA occlusion.
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PMID:Middle cerebral artery thrombolysis through the contralateral internal carotid artery--case report. 1534 15


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