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)

A rationale is presented for extra-anatomic carotid cross-over bypass to maintain or restore blood flow to the internal carotid artery distal to sites of disruption and ligation of a common carotid artery. Anatomic evidence indicates that the attachment of the carotid sheath to the hyoid bone is a barrier to spread of infection cephalad to that level. A patient with infected and disrupted right common carotid artery associated with an esophageal fistula was treated by double ligation of the artery. Contralateral hemiplegia 48 hours later forced consideration of cerebral revascularization. Left carotid angiography demonstrated patent cerebral vessels on the right, with retrograde filling of the right internal carotid artery to the bifurcation. These findings were interpreted as consistent with technical feasibility of external carotid to external carotid cross-over vein bypass in a suprahyoid location, avoiding reconstruction in an infected area and resulting in prompt recovery of function.
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PMID:Carotid cross-over bypass. Cerebral revascularization after ligation of common carotid artery. 59 57

Twenty-three children with 4 clinical subtypes of cerebral palsy were studied using 2-deoxy-2(18F)fluoro-D-glucose (FDG) and positron emission tomography (PET). Subtypes included spastic quadriparesis (N = 6), spastic diplegia (N = 4), infantile hemiplegia (N = 8), and choreoathetosis (N = 5). FDG-PET images were correlated with magnetic resonance imaging or computed tomography. Although the location of glucose metabolic abnormalities corresponded, in general, to abnormalities of brain structure demonstrated by structural imaging studies, the distribution of metabolic impairment almost invariably extended beyond the region of anatomic involvement. The following observations in specific subtypes of cerebral palsy were determined with FDG-PET: (1) In spastic diplegic patients, PET revealed focal areas of cortical hypometabolism in the absence of apparent structural abnormality; (2) A relatively normal pattern of cortical metabolism was observed in most patients with choreoathetoid cerebral palsy, despite marked hypometabolism in the thalamus and lenticular nuclei; and (3) In patients with infantile hemiplegia, FDG-PET disclosed symmetric cerebellar glucose metabolism with absence of crossed cerebellar hypometabolism (diaschisis). This finding is contrary to the typical persistence of crossed cerebellar diaschisis in adult patients with acquired cerebral lesions and suggests metabolic recovery due to developmental plasticity. The possibility that FDG-PET may be clinically useful in identifying the cerebral palsy patient with potential learning handicap and in the study of functional recovery or sparing following brain injury should be explored further.
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PMID:Regional cerebral glucose metabolism in clinical subtypes of cerebral palsy. 179 7

The goal of these experiments was to evaluate the effects of some drugs affecting noradrenergic (NE) synaptic transmission, commonly prescribed following stroke or traumatic brain injury, on functional recovery. Measurement of recovery from a transient hemiplegia produced by a traumatic unilateral focal contusion in sensorimotor cortex (SMCX) of rats was used to assess the effects of chronic haloperidol (HAL) treatment begun early (1 day) or late (18 days to recovered animals) after injury. Additionally, using the same model, the effects of a single administration of drugs with selective action at NE receptors were also evaluated early or late (30 days) after injury. These drugs were: phenoxybenzamine (PBZ), an alpha 1-NE antagonist; prazosin (PRAZ), an alpha 1-NE antagonist; yohimbine (YOH), an alpha 2-NE antagonist; propranolol (PROP), a beta 1- and 2-NE receptor antagonist; methoxymine (METHOX), an alpha 1-NE agonist; and clonidine (CLON), an alpha 2-NE agonist. The data indicate that drugs with antagonistic effects at alpha 1 NE receptors, including HAL and PRAZ but not PROP, administered early after SMCX contusion retard locomotor recovery. Beneficial effects of enhancing NE transmission by METHOX or YOH were not observed. In animals recovered from beam walk (BW) deficits, a single administration of PBZ or PRAZ (alpha 1 NE antagonists) or CLON (alpha 2 NE agonist) transiently reinstated hemiplegic symptoms. The nonspecific beta NE receptor antagonist PROP had no effect in recovered animals. A single dose of HAL had no effect in recovered animals, but a BW deficit transiently developed in some animals following chronic treatment. The data are discussed with reference to drug contraindications noted in clinical studies of recovery from poststroke aphasia and cognition in demented patients with degenerative brain disease.
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PMID:Norepinephrine and brain damage: alpha noradrenergic pharmacology alters functional recovery after cortical trauma. 216 17

Certain instances of neuronal degeneration secondary to brain damage might be functionally beneficial, and steps taken to protect against such degeneration may adversely affect behavioural outcome. After unilateral damage to the intrinsic neurons of the striatum, which includes GABAergic striatonigral projections, delayed trans-synaptic degeneration occurs in the ipsilateral substantia nigra pars reticulata (SNr). This degeneration was prevented by a 2-week regimen of muscimol delivered intraventricularly via osmotic minipumps. Muscimol is a direct-acting GABA agonist that presumably substituted for the absent GABA at the interface between the degenerating striatonigral GABAergic terminals and the GABAergic receptors located on SNr neurons. Sensorimotor asymmetry tests sensitive to unilateral striatal damage were carried out for 4 weeks to determine the functional consequences of the sparing of SNr neurons. Recovery of function was not improved. Instead, tactile extinction and hemiplegia were exaggerated in the contralateral forelimb. Other impairments were unaffected by the muscimol. The experiment was repeated using diazepam, rather than muscimol, to address the possibility that the disruptive effects of muscimol might reflect a more general disruptive influence on recovery processes. Diazepam, which has been shown in our lab to disrupt recovery of function after cortical lesions and to potentiate lesion-associated atrophy in remote subcortical structures, is an indirect-acting GABAergic agonist that requires GABA for its mechanism of action. Because GABAergic terminals at the SNr were destroyed, diazepam (as expected) failed to prevent SNr degeneration. Although diazepam presumably enhanced GABAergic synaptic activity in other brain regions, diazepam had no significant effect on postoperative behavioural function. Apparently, in the first experiment, the prevention of SNr degeneration per se was instrumental in the detrimental effects of muscimol. The rescued SNr neurons may have contributed to dysfunction because they lacked inhibitory GABAergic control. Transsynaptic degeneration secondary to brain damage was discussed as it might relate to release phenomena and their treatment by surgery or transmitter blocking agents in the clinical literature.
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PMID:Rescuing neurons from trans-synaptic degeneration after brain damage: helpful, harmful, or neutral in recovery of function? 216 18

Twenty-five femoral shaft fractures in twenty-three patients aged 10-16 years with open epiphyses and treated with flexible intramedullary nailing were studied retrospectively. Clinical and roentgenographic follow-up averaged 28 months. Hospitalization, which included patients with multiple injuries, averaged 11.7 days. Patients ambulated without assist devices as early as 2 weeks postoperatively (average of 7.7 weeks). All fractures healed with no leg length inequality--21 with anatomic alignment and full range of motion of the hip and knee. Three patients sustained intraoperative extension of the fracture resulting in healing with angular or rotatory malalignment. One patient with associated knee ligamentous injury had less than full knee flexion at follow-up. All patients had normal gait (except one patient with residual hemiplegia) and were able to participate in full activities including athletics. Early ambulation and functional recovery with low morbidity and cost suggest that this procedure should be considered for the treatment of femoral shaft fractures in this age group.
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PMID:Closed flexible intramedullary nailing of adolescent femoral shaft fractures. 266 81

Electromyographically triggered electric muscle stimulation (EMS) was evaluated in combination with conventional treatment in 69 consecutive postcerebrovascular accident outpatients whose onset of hemiplegia was four months to 14 years earlier. Six subjects initially exhibited no residual volitional activity in targeted muscles, and all patients had undergone conventional therapy with little or no functional recovery. Electromyographic (EMG) recordings and EMS directed to prime movers of impaired movements were accomplished by way of skin-surface electrodes. Prescribed treatment (patient compliance was frequently substandard) involved several months of four to five sessions per week, focusing on wrist extension and/or ankle dorsiflexion initially, and often other movements later. During 30 to 300 movement attempts per session, EMGs that exceeded a preset threshold triggered immediate stimulation to force movement completion. Over sessions, patients commonly realized substantially improved increases in voluntary EMG capabilities generally proportionate to the frequency of treatment sessions. Parallel improvements were also found for subjectively scaled functional measures of range-of-motion and ambulation. Motivation was important to success, but side and nature of stroke, age, and poststroke interval were not. Progress often far exceeded that of previous conventional therapy (each patient served as his/her own control). Regarding mechanisms, impaired proprioceptive feedback is considered central to stroke-disrupted sensorimotor control. EMG-triggered EMS is intended to improve brain relearning by reinstating proprioceptive feedback time-locked to each attempted movement. Clinical results were consistent with this theory; further assessment of the new EMG-triggered EMS modality intergrated into conventional treatment regimens seems warranted.
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PMID:Electromyographically triggered electric muscle stimulation for chronic hemiplegia. 349 65

Computerized tomography (CT) guided stereotactic evacuation of intracerebral hematomas is effective and little invasive treatment at subacute or chronic stage. Somatosensory evoked potentials (SEPs) of 23 patients with putaminal hemorrhage whose stereotactic evacuations were performed from day 4 to day 24 are studied about surgical result and CT findings. As for SEP, N20 which is thought to be generated in the thalamus or in the primary parietal area receiving direct projections from the thalamus is used for comparison with functional recovery. Among 12 patients whose N20s before the evacuation showed normal, 9 had good recovery of their hemiplegia. Motor recovery tended to begin quickly after the evacuation and the evacuation of hematomas were thought to make better result than conservative treatment. CT findings of 9 patients with good recovery revealed that the hematomas didn't invade to the internal capsule or invaded to the posterior part of the posterior limb alone. Among 3 patients whose N20s before the evacuation were not distinct and those after the evacuation were normal, 2 had good recovery of their hemiplegia. As those hematomas were relatively large but located laterally, the internal capsule was seem to be not invaded but only compressed. Among 8 patients whose N20s were not distinct both before and after the evacuation, 7 could not get the recovery of their hemiplegia. CT findings of them revealed that the hematomas were large or invaded toward the internal capsule and thalamus. From this study N20s of SEPs are thought to be useful to the decision of indication and the prediction of the functional prognosis about stereotactic evacuation of putaminal hemorrhage.
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PMID:[Evaluation of computerized tomography-guided stereotactic evacuation of putaminal hematomas by somatosensory evoked potentials]. 352 74

Unilateral ablation of cerebral cortical areas 4 and 6 of Brodmann in the macaque monkey results in a dense contralateral hemiplegia that recovers partially with time. During the phase of dense hemiplegia, the local cerebral metabolic rate for glucose (lCMRGlc) is decreased significantly in the caudate nucleus, putamen, globus pallidus, subthalamic nucleus, substantia nigra, and red nucleus of the hemisphere ipsilateral to the lesion. In the present study, lCMRGlc in the basal ganglia was studied during the phase of partial recovery of motor activity. lCMRGlc was partially restored, and the greatest degree of restoration occurred in structures with direct connections to the cerebral cortex (caudate nucleus, putamen, subthalamic nucleus, substantia nigra, and red nucleus). Restoration was least in structures that do not receive direct connections from the cerebral cortex (the internal and external segments of the globus pallidus). The findings support the hypothesis that corticofugal activity accounts for a substantial degree of functional recovery.
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PMID:Experimental hemiplegia in the monkey: basal ganglia glucose activity during recovery. 367 2

We investigated the participation of catecholaminergic mechanisms in the functional recovery from motor cortex lesions in young (9 months) and aged (26 months) rats. The animals were studied during the recovery period from an hemiplegic syndrome secondary to small motor cortex lesions potentiated by the localized, chronic (7 days) infusion of GABA into the lesion site. Acute administration of haloperidol (0.1 mg/kg IP) to these recovered animals induced a re-emergence of the contralateral motor syndrome in both groups. In the young group, the haloperidol-induced hemiplegia lasted one day whereas in the aged animals the deficit was significantly prolonged lasting three days. Apomorphine administration (0.5 mg/kg IP) prior to or immediately after haloperidol injection failed to prevent or reverse the reappearance of the motor deficit. Adult animals recovered from motor cortex aspirations performed 7 to 12 months prior were refractory to haloperidol effects. Amphetamine administration to young rats treated chronically with saline or GABA infusion into the somatomotor region also failed to alter the clinical evolution of the motor deficit. The evidence suggests that dopaminergic mechanisms are involved in the functional recovery from brain lesions and that these mechanisms are most susceptible to neuroleptic blockade during the early post-lesional period. The deleterious effects of dopaminergic blockade are heightened in aged populations. The use of dopaminergic antagonists in brain-lesioned subjects, and particularly in geriatric populations, is considered potentially harmful, particularly in the early stages of the recovery process.
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PMID:Recovery from GABA-mediated hemiplegia in young and aged rats: effects of catecholaminergic manipulations. 368 25

A novel model of hemiplegia in young and aged rats is described. Osmotic minipumps were used to deliver a chronic (7 days), localized application of gamma-aminobutyric acid (GABA) (100 micrograms/microliter/h), to the somatomotor cortex of unrestrained rats. This resulted in an easily quantifiable, contralateral and reversible motor syndrome in both young and aged animals. In the young group, the motor deficit cleared over 5-day period, while in the aged animals it persisted for at least a 2-week period. Control animals treated with saline-filled minipumps did not develop a long-lasting motor deficit. The GABA-induced facilitation of hemiplegia due to small motor cortex lesions and the age effects on behavioral recovery of function are discussed. Cortical inhibitory mechanisms may play a role in debilitating syndromes such as stroke or post-epileptic paralysis.
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PMID:gamma-Aminobutyric acid-induced potentiation of cortical hemiplegia. 394 81


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