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

Ischaemic cerebral strokes in children are relatively uncommon. With the exception of patients with moyamoya disease, there is no effective treatment for these lesions. One potential approach is encephalo-duro-arterio-synangiosis (EDAS). This is a safe neurosurgical procedure that promotes spontaneous transdural anastomosis that may provide additional blood flow to ischaemic regions. We present eight children with ischaemic strokes other than moyamoya disease, and discuss surgical attempts to treat this entity. The mean age of the eight children was 3.6 years (range: 13 months to 9 years). All children presented with acute childhood hemiplegia. Ischaemic stroke had occurred in association with a head injury in three children, but without an apparent cause in five. Five children underwent stable xenon-enhanced computed tomography to evaluate cerebral blood flow and all but one patient underwent EDAS. One child with no angiographic abnormalities recovered to a normal neurological state without surgery. Following surgery, another child also fully recovered, and the remaining six children recovered with only a slight hemiparesis. Revascularization was observed on a follow-up angiogram in three children. Our surgical experiences suggest that revascularization is influenced by haemodynamic demand and recanalization of the occluded artery. We favour the use of indirect anastomosis (EDAS) for selected patients and suggest that chronic ischaemia probably contributes to surgical success.
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PMID:Surgical approaches for treatment of ischaemic cerebral stroke other than moyamoya disease in children. 895 42

Ischaemic stroke has been observed more rarely among young people in comparison to old adults. The causes of ischaemic stroke among young adults are numerous. One of them is occlusion of internal carotid artery (ICA). The aetiology of the occlusion is different from arteriosclerotic disorders. Within the last few years the authors have paid much attention to the fact that spontaneous dissection is not such a rare cause of ICA occlusion. In many cases (60-70%) of dissection recanalization and benign outcome occur. Angiography has been considered as a gold standard in establishing the diagnosis. We described a young, 16-year-old patient with ischaemic stroke. The cause occlusion of ICA, probably was dissection. The diagnosis was made by angiography MR. In our patient follow-up angiography MR demonstrated recanalisation. The outcome of the stroke was benign and hemiplegia reversed.
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PMID:[Transient patency loss of the internal carotid artery in a young patient]. 1084 13

The authors describe a case of infective subacute endocarditis due to Streptococcus mitis in a 72 year-old woman with systemic complaints and joint symptoms, that had started 4 months before, diagnosed as a polymyalgia rheumatica, who suddenly presented with aphasia and hemiplegia. The delay in the diagnosis might be justified by the disregard of some details in the clinical history owe to the anxious/depressive personality of the patient. The devastating evolution of this case report illustrates that in patients with an inflammatory syndrome and cardiac murmur clinicians should be highly alert for the hypothesis of an infective subacute endocarditis. Ischemic stroke is a dramatic and rare presentation form of the disease. A detailed physical examination should be the first clinical approach to a patient with the diagnostic hypothesis of polymyalgia rheumatica.
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PMID:[Stroke as the dramatic presentation of infectious endocarditis: the importance of the clinical history]. 1733 46

Ischemic stroke following snake bite is rare. We report an 18-year male who developed right hemiplegia with expressive aphasia following a Russell's viper bite. T2-weighted magnetic resonance imaging revealed infarct in the left middle cerebral artery territory. The possible mechanisms for cerebral infarction in this scenario include disseminated intravascular coagulation, toxin induced vasculitis and endothelial damage.
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PMID:Acute ischemic infarct in the middle cerebral artery territory following a Russell's viper bite. 1977 May 52

Endothelins (ETs) are potent vasoconstrictor and may play a role in the pathophysiology of several cardiovascular diseases. Endothelin-mediated vasoconstriction may enhance ischemic neuronal damage. The study aimed to find out whether the plasma ET-1 levels may serve as marker of early ischemic stroke. Plasma ET-1 levels were tested in 20 patients with acute ischemic stroke, mean age 63.7 +/- 5.03 years, 12 men and 8 women, within 24 hours of stroke onset as compared to 10 sex- and age-matched control subjects; only the patients with normal CT-scan at admission were included in the study. Plasma ET-1 was measured by ELISA. The results were statistically analyzed by Student test and a p < 0.05 (95% CI) was considered statistically significant. ET-1 levels in patients with hemiplegia and normal CT-scan at admission were significantly higher as compared to control group (0.0910 +/- 0.0256 pg/mL vs. 0.0490 +/- 0.0185 pg/mL, p < 0.0001) (95% CI). Ischemic stroke is associated with acute and marked increased levels of ET-1 in plasma. This may reflect enhanced production by damaged endothelial cells within the infarcted lesion. ET-1 may be used as additional marker of cerebral ischemia in selected cases to distinguish between the onset of an ischemic stroke and other non-vascular diseases presenting similar symptoms.
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PMID:Study of endothelin-1 in acute ischemic stroke. 2152 61

Ischemic stroke secondary to aortic dissection is not uncommon. We present a patient with left hemiplegia secondary to Stanford type A aortic dissection extending to the supra-aortic vessels, which was precipitated by rifle butt recoil chest injury. The diagnosis of aortic dissection was delayed due to various factors. Finally, the patient underwent successful Bentall procedure with complete resolution of symptoms. This case emphasizes the need for caution in the use of firearms for recreation and to take precautions in preventing such incidents. In addition, this case illustrates the need for prompt cardiovascular physical examination in patients presenting with stroke.
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PMID:Ischemic stroke secondary to aortic dissection following rifle butt recoil chest injury: a case report. 2225 55

Ischemic stroke is the most common neurologic manifestation of cardiac myxoma. However, there has been no current guideline on the treatment of hyperacute ischemic stroke due to cardiac myxoma. We describe a patient with hyperacute stroke caused by cardiac myxoma who had a good outcome with rapid recanalization through mechanical thrombectomy. A 46-year-old man was admitted with acute symptoms of right side hemiplegia and global aphasia. Brain computed tomography (CT) angiography showed a T occlusion of the left internal carotid artery. Intravenous recombinant tissue plasminogen activator was administered. However, his clinical symptoms did not improve. Thus, we performed endovascular treatment and had a successful outcome. A pathologic examination of the retrieved clot revealed a tumor emboli from a cardiac myxoma. Transthoracic echocardiogram revealed a left atrial myxoma in which a large mass was attached to the posterior wall of the aorta. The patient's neurologic deficits recovered with the exception of left eye blindness. Reperfusion therapy with mechanical thrombectomy might be safe and effective for the rapid revascularization of large vessel occlusions in hyperacute ischemic stroke, from which the tumor thrombi can be retrieved.
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PMID:Effective mechanical thrombectomy in a patient with hyperacute ischemic stroke associated with cardiac myxoma. 2517 64

Aluminum phosphide (AlP) is a solid fumigant which is widely used for a suicide attempt in Iran. Although neurologic symptoms are commonly reported, cerebrovascular stenosis is rare in AlP poisoning. We described ischemic stroke as a delayed complication of AlP intoxication. A 30-year-old man was admitted because of sudden onset left side hemiplegia, 11 days after intentional ingestion of three rice tablets. Investigations revealed in situ thrombosis in right middle cerebral artery (MCA) while other causes of stroke in young adults were excluded. Ischemic stroke should be considered as a delayed complication of AlP intoxication even after the acute phase of intoxication.
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PMID:Ischemic stroke as a rare manifestation of aluminum phosphide poisoning: a case report. 2553 61

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease which is associated with an increased risk of cardio and cerebrovascular pathology. A 48-year old Caucasian female was admitted for diffuse arthralgias. She was diagnosed eight years before with seropositive RA and she received Methotrexate, Prednisone and anti-inflammatory drugs. A week after the admission the patient presented sudden onset of left hemiplegia. Cerebral CT scan was suggestive for acute infarction in the right middle cerebral artery area and an old sequelar infarction in the left posterior artery area. Laboratory tests revealed: erythrocyte sedimentation rate of 40 mm/hour, fibrinogen 656 mg/dL, C-reactive protein of 20 mg/dL, rheumatoid factor 66.83 U/mL, anti CCP3 IgG 213.54 U/mL, ANA 128.126 U/mL. Also, she had high LDL-cholesterol serum concentration (190 mg/dL). The ECG revealed sinus rhythm, QRS axis-45 degrees, antero-lateral ischemia. Ultrasound examination of cervico-cerebral arteries emphasized occlusion of the left internal carotid artery, large atheromas in both carotid and vertebral arteries. A treatment with anti-aggregant and statin was started, and the former treatment for RA was continued with a raised Prednisone dose. The outcome was favorable, the patient's motor deficit improved (3/5 BMRC at the upper limb and 4/5 at the inferior limb) and she was able to walk with a cane support. She also presented an alleviation in the laboratory test status. Ischemic stroke is a possible complication of RA, presenting as principal risk factor precocious atherosclerosis. A better control of inflammation by new anti-rheumatic treatments will protect the RA patients of deleterious effects of ischemic stroke.
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PMID:Rheumatoid arthritis and ischemic strokes in a young woman. Are these conditions interrelated? 2572 31

Painless aortic dissections in general are uncommon and are frequently misdiagnosed. Here we reported a rare case of acute ischemic stroke secondary to completely painless acute full-length dissection (DeBakey I) and provide a brief review of the literature. A 56-year-old man was referred to our department with right hemiplegia. Ischaemic stroke and thrombolytic treatment were considered initially. At the second examination, the patient was found to have decreased blood pressure, asymmetrical blood pressure/pulses between the bilateral limbs, and sudden loss of pulse in a lower extremity. Laboratory results revealed leucocytosis, elevated creatinine and CK without obvious cause. An aortic dissection was subsequently confirmed by contrast enhanced thoracic and abdominal CT scan. Our report provides some clues for the early diagnosis of painless aortic dissections.
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PMID:Unexpected cause of a right hemiplegia secondary to the painless full-length aortic dissection: a case report and literature review. 2593 76


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