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 report a 65-year-old male who suddenly developed consciousness disturbance and left hemiplegia, with tandem embolic occlusions of the right internal carotid artery (ICA) and the middle cerebral artery (MCA). Intra-arterial administration of recombinant tissue plasminogen activator (rtPA) through the right ICA was performed 2.75 hours after onset, but no recanalization of the right ICA was obtained. Then rtPA was administrated from the left ICA, and the right MCA was recanalized 3 hours after onset. Our findings indicate that administration of rtPA through the contralateral internal carotid system could be an effective strategy for patients with tandem occlusions of the ICA and MCA if an anterior communicating artery is patent.
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PMID:Intra-arterial fibrinolysis via the contralateral internal carotid artery for acute ischemic stroke. 1790 98

A 47-year-old man presented with sudden consciousness disturbance and left hemiplegia caused by intracerebral hemorrhage. Initial computed tomography (CT) showed a massive subcortical right temporoparietal lobe hematoma and signs of impending uncal herniation. However, he became alert and his hemiplegia improved considerably in the course of 2 hours, so conservative treatment was preferred over surgical intervention. Follow-up CT acquired on the next day revealed dramatic diminution of the intracerebral hemorrhage. Small intracerebral hemorrhages occasionally produce transient symptoms with or without disappearance of the hematoma, but the present patient had a large hematoma that decreased in size within a short time with rapid improvement of the symptoms attributed to the hematoma. The mechanism underlying the diminution of the hematoma may be related to redistribution by cerebrospinal fluid flow.
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PMID:Rapid spontaneous resolution of neurological signs and cerebral herniation caused by intracerebral hemorrhage -case report-. 2050 94

A 76-year-old man was admitted to our hospital because of progressive dyspnea, fever, and consciousness disturbance. Empyema was diagnosed by chest image findings and laboratory findings of pleural effusion and serum. The patient was first given an antimicrobial agent, and chest drainage was performed. Although his general condition improved, his systemic inflammation and chest radiograph findings did not. Then, thoracoscopy under local anesthesia was considered. However, surgery was almost impossible, because he was hemiparetic, with mild conscious disturbance following cerebral hemorrhage. We decided to insert another drain into the thoracic cavity and continued to perform irrigation with saline in addition to the systemic administration of antibiotics for 3 weeks. His general condition gradually improved. Although the volume of drained fluid from the thoracic cavity decreased, the empyema lesions did not completely disappear. We then performed irrigation with saline and urokinase for 3 days, from the 40th hospital day. Irrigation drainage using saline was more effective than previously, before urokinase administration; his symptoms and empyema lesions markedly improved without antibiotics treatment. He was discharged on the 95th hospital day. For the treatment of chronic emypema, surgery using recently developed thoracoscopic techniques should be considered first, but may not be appropriate for frail elderly with severe systemic complications. Conventional intrathoracic irrigation using saline containing urokinase may be a treatment of choice for intractable empyema in frail older patients with hemiplegia caused by cerebral infarction.
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PMID:[Successful treatment of thoracic drainage using urokinase for empyema in an elderly man]. 2130 Nov 64

A 61-year-old man suddenly developed transient left hemiplegia and consciousness disturbance. Computed tomography showed acute Stanford type A aortic dissection. Dissection affected the entire right common carotid artery, and its false lumen extremely compressed the true lumen. The right common carotid artery, along with the right femoral and the left axillary arteries, was used as an inflow of cardiopulmonary bypass during emergency surgery. The ascending aorta that included a large intimal tear was replaced. However, systemic reperfusion either through the femoral artery or through a side branch of vascular prosthesis failed to restore the right cerebral blood flow due to persistent true lumen obstruction by the expanded false lumen in the innominate artery. Therefore, ascending aorta-right carotid artery bypass using that side branch was performed immediately. Though temporary cerebral malperfusion could cause dismal outcome, direct carotid artery cannulation played a key role in this successfully-treated patient.
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PMID:[Persistent cerebral malperfusion following central aortic repair for acute aortic dissection involving the right carotid artery; efficacy of direct carotid artery cannulation]. 2338 60

Our objective is to present a case of fatal multiple systemic emboli after intravenous thrombolysis for cardioembolic stroke. A 64-year-old woman with atrial fibrillation was admitted for evaluation of sudden consciousness disturbance, right hemiplegia, and aphasia. Diffusion-weighted imaging showed no early ischemic changes of the brain, and magnetic resonance angiography (MRA) showed occlusion of the left middle cerebral artery (MCA). One hour after initiation of 0.6 mg/kg of intravenous alteplase, the MCA was partially recanalized. Her symptoms disappeared the following day. We began intravenous heparin for secondary prevention of cardioembolic stroke. However, on the third day (52 hours after thrombolysis), she suddenly developed a coma and left hemiplegia. MRA showed acute occlusion of the right internal carotid artery (ICA). She developed acute kidney injury and sudden shock and then died of fatal cardiorespiratory arrest on the fourth day. Autopsy revealed occlusion of the mitral valve orifice by a spherical fresh red thrombus that led from the left atrial appendage. Acute embolic infarcts were identified in the spleen and right kidney, the latter secondary to occlusion of the right renal artery with fresh red thrombus. Intravenous thrombolysis and subsequent anticoagulation therapy may destabilize pre-existing intracardiac thrombus, potentially leading to recurrent stroke, multiple systemic embolisms, and the fatal "hole-in-one" effect.
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PMID:Fatal multiple systemic emboli after intravenous thrombolysis for cardioembolic stroke. 2354 21

Traumatic acute subdural hematoma (ASDH) is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4). Computed tomography (CT) demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.
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PMID:Endoscopic surgery for traumatic acute subdural hematoma. 2465 65

Introduction. Familial hemiplegic migraine (FHM) is a rare disorder characterized by migraine attacks with motor weakness during the aura phase. Mutations in CACNA1A, ATP1A2, SCN1A, and PRRT2 genes have been described. Methods. To describe a mutation in ATP1A2 gene in a FHM case with especially severe and prolonged symptomatology. Results. 22-year-old woman was admitted due to migraine-type headache and sudden onset of right-sided weakness and aphasia; she had similar episodes in her childhood. Her mother was diagnosed with hemiplegic migraine without genetic confirmation. She presented with fever, decreased consciousness, left gaze preference, mixed aphasia, right facial palsy, right hemiplegia, and left crural paresis. Computed tomography (CT) showed no lesion and CT perfusion study evidenced oligohemia in left hemisphere. A normal brain magnetic resonance (MR) was obtained. Impaired consciousness and dysphasia began to improve three days after admission and mild dysphasia and right hemiparesis lasted for 10 days. No recurrences were reported during a follow-up of two years. We identified a variant in heterozygous state in ATP1A2 gene (p.Thr364Met), pathogenic according to different prediction algorithms (SIFT, PolyPhen2, MutationTaster, and Condel). Conclusion. Prolonged and severe attacks with diffuse hypoperfusion in a FHM seemed to be specially related to ATP1A2 mutations, and p.T364M should be considered.
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PMID:Familial Hemiplegic Migraine with Severe Attacks: A New Report with ATP1A2 Mutation. 2781 13

Ischemic stroke following acute myocardial infarction is a rare but a serious complication. Because the pathophysiology of stroke is dynamic, it is often hard to identify the cause of stroke. Here, we present the case of a 75-year-old man with ischemic stroke following angina pectoris caused by severe anemia and localized peritonitis due to gastrointestinal stromal tumor of small intestine. On admission, he showed consciousness disturbance, fever, and left hemiplegia. The electrocardiogram on admission showed ST-segment depression in V2 to V6 which was normalized 4 hours later. The ultrasound cardiogram showed the mild hypokinesis in the apical portion of left ventricle which was also normalized later. The magnetic resonance imaging and angiography showed ischemic stroke in watershed area between right anterior and middle cerebral arteries area and stenosis of distal portion of right middle cerebral artery. The computed tomography of abdomen showed a mass of small intestine. We decided to perform curative surgery after transfusion and successfully resected the mass of the small intestine, which was revealed to be a gastrointestinal stromal tumor (GIST). This is a successfully treated case of GIST in which the complicated pathophysiology of watershed cerebral infarction following angina pectoris might be clearly revealed.
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PMID:A Successfully Treated Case of Gastrointestinal Stromal Tumor Causing Severe Anemia and Localized Peritonitis Showing Angina Pectoris Resulting in Watershed Cerebral Infarction. 2891 18

A 67-year-old woman was admitted to our hospital due to an acute onset of consciousness disturbance, aphasia and left hemiplegia. Computed tomography revealed multiple systemic infarctions, including brain, kidney and spleen. Transesophageal echocardiography revealed vegetations attached to the mitral valve leaflets, which was suspected to be the embolic source. Repeated blood cultures were negative, and advanced lung cancer was incidentally revealed by computed tomography. She was then diagnosed with nonbacterial thrombotic endocarditis (NBTE) based on the overall clinical picture. Subsequently, extensive systemic embolization repeatedly occurred, and she eventually died 25 days after admission. The autopsy proved NBTE and advanced-stage lung adenocarcinoma.
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PMID:Nonbacterial Thrombotic Endocarditis Concomitant with Repeated Systemic Embolization That Received Palliative Care Based on the Antemortem Diagnosis. 3010 43

We had a case of Emery-Dreifuss muscular dystrophy (EDMD) in an 18-year-old woman who underwent endovascular therapy for a cardioembolic stroke. At 5 years old, she showed a high creatine kinase level and atrial fibrillation on electrocardiography in our hospital. Finally, she was diagnosed as having EDMD by genetic screening that revealed mutations in the LMNA gene (c.810+1G>T). Before this event, she received no medications. At 18 years old, she was admitted to our hospital>8 hours after the onset of sudden consciousness disturbance. Neurological examination on admission revealed consciousness disturbance and right hemiplegia. Magnetic resonance imaging revealed a cerebral infarction in the left insular cortex and putamen with left internal carotid artery occlusion. We performed endovascular therapy and completely recanalized her left internal carotid artery. Thereafter, her neurological symptoms improved. She was subsequently transferred to a rehabilitation hospital. EDMD is a rare genetic muscular disease that mainly presents with contractures, weakness, and cardiac conduction abnormalities. Although patients with EDMD are young with low CHADS₂ score, they have a disease-specific cardiovascular pathogenesis caused by a fatal risk factor. Therefore, we consider anticoagulant therapy necessary to prevent thrombotic events, even if the CHADS₂ score is low, in patients with EDMD.
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PMID:A Young Patient with Emery-Dreifuss Muscular Dystrophy Treated with Endovascular Therapy for Cardioembolic Stroke: A Case Report. 3019 44


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