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)

Reversible osmotic blood-brain barrier (BBB) modification was used in 38 patients with glioblastoma to enhance the delivery of chemotherapeutic agents. The patients ranged in age from 14 to 70 years (mean, 43), and all had prior surgery and radiation; 5 had also received systemic chemotherapy. Karnofsky Performance Status (KPS) scores ranged from 60 to 100% (mean, 79) on admission to the treatment program. Barrier modification was achieved by intracarotid or intravertebral artery infusion of mannitol, and a chemotherapy regimen of methotrexate, cytoxan, and procarbazine was given in conjunction with barrier modification. The 38 glioblastoma patients were compared to two control groups of patients with glioblastoma; these encompassed 14 patients treated with surgery and radiation and 8 treated with surgery, radiation, and systemic chemotherapy. Survival analysis using the Cox Proportional Hazards Regression Model (corrected for age, sex, presence or absence of necrosis, and functional status) showed that patients receiving chemotherapy with BBB modification had a statistically significant (P = 0.0006) longer expected survival (17.5 months) than the control groups (12.8 and 11.4 months, respectively). Presently 16 patients of the barrier-enhanced treatment group are alive at 5 to 42 months from diagnosis (median, 20) with KPS scores ranging from 40 to 90% (median, 65). The neurological complications seen included a stroke-like syndrome in 3 patients (1 with decreased motor movement in the hand, 1 with marked hemiparesis, and 1 with hemiplegia), transient exacerbation of preexisting neurological deficits lasting 2 to 3 days, and a 15% incidence of seizures during or within 24 hours of the BBB modification. In 2 of the 38 patients, radiographic documentation of central nervous system tumor regression concurrent with the development of new tumor nodule(s) in portions of the brain distant from the region of osmotic BBB opening was seen. These studies indicate that chemotherapeutic drug delivery to tumors (as well as surrounding brain) can be augmented by osmotic BBB modification and that such therapy can result in a prolongation of survival.
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PMID:Therapeutic efficacy of multiagent chemotherapy with drug delivery enhancement by blood-brain barrier modification in glioblastoma. 309 67

A 12-year-old girl presented with weakness, diplopia, and lethargy after a prodrome of gastroenteritis. Laboratory studies were compatible with a diagnosis of hemolytic uremic syndrome. She developed seizures that were controlled by diphenylhydantoin and valium. In spite of peritoneal dialysis and fresh frozen plasma infusions, she progressed to a left hemiplegia associated with a brain scan finding of decreased blood flow in the right middle cerebral artery perfusion area. A 5 liter whole blood exchange transfusion did not improve the neurological status or low platelet count. Daily plasma exchanges with fresh frozen plasma replacement resulted in normal platelet count within 48 hours and was followed by progressive improvement in neurological status. Platelet agglutinating factor decreased to control levels. A repeat brain scan was normal.
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PMID:Reversal of central nervous system involvement in hemolytic uremic syndrome by use of plasma exchanges. 311 70

Higier first reported on "Paroxysmal appearing palsy of epileptic origin". This syndrome has only rarely been described under a variety of names such as: "focal inhibitory seizures, unilateral atonic seizures, hemiparetic seizures, ictal hemiparesis". The case report we present regards a 34-year-old woman who complained of sudden loss of tone accompanied by a left-sided hemiplegia lasting for several minutes. Treatment with carbamazepine was successful in reducing the attacks as might be expected in partial seizures. An inhibitory discharge may be causative of this syndrome in agreement with Higier's original theory.
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PMID:Paroxysmal appearing palsy of epileptic origin. 314 5

Early outcome results for 10 cases of modified hemispherectomy are presented. All patients had a history of infantile hemiplegia and intractable epilepsy. Pre- and postoperative measures for seizures and motor and cognitive and behavioural functioning are described. Early results are encouraging with no mortality and a low rate of complications. There was a complete cessation of seizures in seven patients and a considerable reduction in seizure frequency in two. Motor functioning was largely unaffected. Behaviour problems tended to improve at the cessation of seizures. IQ scores did not deteriorate as a consequence of operation and some patients showed considerable gains in IQ with the passage of time. Details of cognitive functioning are described.
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PMID:Modified hemispherectomy for epilepsy: early results in 10 cases. 278 9

The success of surgery for seizure focus resection depends on postoperative reduction or disappearance in number of seizures, improvement in psychosocial functioning, and low morbidity and mortality. Permanent neurologic sequelae are most often not discussed in this context. Deficits more than a superior quadrantanopsia are not expected after temporal lobectomy. Four cases of ischemic stroke after seizure focus resection, each distant from the site of tissue removal, are reported. These are the first such radiologically documented reports of "manipulation hemiplegia." The permanent neurologic deficits are not attributed to resected tissue or edema.
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PMID:Infarction after surgery for focal epilepsy: manipulation hemiplegia revisited. 362 10

We report on symptoms, clinical course and prognostic factors of eight children (6 girls and 2 boys) with Sturge-Weber syndrome. The period of observation was 1 to 17 years (mean 8.8 years). All patients had the classical symptoms with facial port-wine stain nevus and intracranial calcifications. In two cases a bilateral distribution of the nevus was found. All patients but one had epileptic seizures which were followed by Todd's palsies in five. Four children additionally suffered from hydrophthalmia. Another patient had an angiomatosis of the retina and cataract. Neurological findings were normal in three patients, minimal signs were found in three, one patient had a spastic hemiplegia and another one hypotone tetraplegia. The mental development was normal in three patients, however severe dyscalculia occurred in one of them. Five patients were mentally retarded, three of them severely. The prognosis was the worse the earlier the cerebral seizures appeared.
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PMID:[Clinical aspects and course of Sturge-Weber syndrome in childhood]. 372 61

Nineteen patients with large cortical or deep seated cerebral arteriovenous malformation (AVM) were treated with intraoperative embolization using bucrylate (isobutyl-2-cyanoacrylate, IBC). In three cases of medium-sized AVM, the procedure was followed by a total excision of the lesion during the same operation. The results were excellent. In one case a hematoma and brain swelling following embolization necessitated total removal immediately afterwards. In eight patients embolization was carried out in two or three stages, to achieve a gradual obliteration of the shunt and to diminish the risk of postoperative brain swelling. Nevertheless, in three of these patients, postoperative hemiplegia was seen, which, however, improved considerably over a 1-2 year period. Complete occlusion of the shunt was obtained in only two patients. Seven patients underwent single-stage embolization, which resulted in partial obliteration of the AVM in six of them. In two of these, this treatment had been proposed for the accompanying symptoms of seizures and ischemic attacks. In all but one case the epileptic seizures decreased or disappeared completely after embolization. One patient suffered intracerebral bleeding three months after partial obliteration. Mortality was zero. It is argued that an alteration of the cerebral circulation with subsequent hyperemia is the most important sequela of rapid obliteration of large AVMs. Some details concerning the structure of cerebral AVMs are discussed.
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PMID:Intraoperative embolization of cerebral arteriovenous malformations. 373 6

18 cases of cerebral Arterio-Venous malformations (AVM) are reported, treated by direct intra-operative embolisation. A 50% mixture of Butyl-2-Cyanoacrylate and Mono-Iodo-Stearate of Ethyl was used. The clinical history of the patients was a long history of seizures in 8 cases a sub-arachnoid or intra-cerebral hemorrhage in 9 cases, and a transient motor deficit in 1 case. The AVM site was supra-tentorial in 16 cases, and infra-tentorial in 2 cases. The AVM size was large with numerous feeders in 13 cases, and limited with a few feeders in 5 cases. Technically, after catheterisation of a cortical feeder, an intra-operative angiogram was performed (except for the first 6 cases) then the polymerizing mixture was pushed inside the feeder (from 1 cc to 3 cc routinely, depending of the AVM size; exceptionally 7 cc and 11 cc were used). In the immediate postoperative course, 1 patient died (case with the 11 cc embolization), 3 patients had a serious postoperative hemorrhage, 4 patients presented with a transient postoperative deficit, and in 10 patients the postoperative course was uneventful. The long term results are: 1 postoperative death, 1 death after recurrence of intra-cerebral hemorrhage (3 years postoperatively), 1 hemiplegia, 15 patients without long lasting complication. The embolization was performed as unique treatment in 14 cases, and was followed with the AVM removal in 4 cases (immediately in 1 case, delayed in 1 case, late after recurrence of intra-cerebral hemorrhage in 2 cases, respectively after 3 years and 2 years).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Peroperative embolization of cerebral arteriovenous malformations with butylcyanoacrylate (18 cases)]. 388 82

Despite important advances in the treatment of epilepsy over the past several decades, many patients remain uncontrolled. Partial complex (psychomotor) seizures are the largest problem, with less than two thirds of patients successfully managed despite optimal medication use. In these situations, various surgical procedures may be helpful, depending on the type of epilepsy, its cerebral location of origin, and the neurologic status of the particular patient. Intensive investigation including EEG and audiovisual monitoring are utilized to evaluate the medically refractory epileptic. In some instances, specialized recordings from epidural, subdural or intracerebral locations are needed to try to pinpoint onset of focal seizure. When this is possible, and the epileptogenic area is resectable, cortical excision may provide cure or marked reduction of seizures in 60 to 90 per cent of properly selected patients with minimal morbidity. The most common operation is temporal lobectomy; this procedure itself is undergoing modifications as more is learned about the usual locations of seizure foci and the functions of this tissue. Resections in other cortical areas may be more difficult but are possible. When a single focus is not identified or is not resectable, other procedures may be used. Results in seizure control with chronic cerebellar stimulation have been variable. The results of stereotaxic lesions in various locations are difficult to evaluate with the single exception of field H of Forel, which in many reports has been effective for grand mal seizures. Generalized seizures, particularly in patients with infantile hemiplegia or frontal lobe epilepsy, are well controlled with corpus callosotomy. Surgery for epilepsy is currently practiced at several centers in this country and abroad. There is great need for more such centers and more education about this treatment as estimates indicate 100,000 patients in the United States at this time could benefit from such procedures.
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PMID:Surgery for epilepsy. 392 30

A 34-year-old homosexual male developed cryptococcal meningitis as the initial manifestation of Acquired Immune Deficiency Syndrome (AIDS). With antifungal therapy he improved. Six weeks later he developed focal motor seizures and progressive hemiplegia. Computer assisted tomography revealed multiple, ring-enhancing, low density lesions. The patient expired and at necropsy he was found to have multiple toxoplasma brain abscesses as well as chronic cryptococcal meningitis. This case demonstrates that in a patient with AIDS with pre-existing central nervous system infection who develops new neurological symptoms the possibility of a second and potentially treatable infection must be considered and its diagnosis pursued vigorously.
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PMID:Cryptococcal meningitis and cerebral toxoplasmosis in a patient with acquired immune deficiency syndrome. 395 46


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