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)

Fibromuscular dysplasia (FMD) is well known owing to the characteristic angiographical finding of a "string of beads" appearance, but intracranial involvement with this disease is extremely rare. Moreover, to our knowledge, only seven cases that had repeated angiograms disclosed progression of FMD lesion in the literature. Such cases of intracranial FMD which showed progression in the follow-up angiography are reported. Case 1: A 8-year-old boy was referred to our hospital because of aphasia and right hemiplegia following right hemiconvulsion. Left carotid angiography on the 7th day from the onset revealed a "string of beads" appearance involving the left middle cerebral artery from M1 to M2 portion. He was treated with low molecular dextran, urokinase and steroid. After these drugs were administered, his speech was normalized. A repeat left angiogram performed two months later disclosed definite increase in the degree of stenosis associated with FMD. Perivascular sympathectomy around common and internal carotid artery and superior cervical ganglionectomy on the left side carried out on the 70th day from the onset. Postoperative left carotid angiogram showed improvement of the stenosis markedly, and the motor disturbance was improved gradually. Case 2: A 34-year-old woman presented with head dullness and disorientation suddenly. Left carotid angiogram on the third day from the onset showed a "string of beads" appearance from C1 to M1 portion. Follow-up angiography three days later revealed some progression of the stenosis. Furthermore a repeat left angiogram disclosed occlusion of left internal carotid artery at the C2 portion. Left STA-MCA bypass surgery was performed on the 61st day from the onset.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of intracranial fibromuscular dysplasia whose repeated angiography disclosed progression of the lesion]. 332 87

Recently percutaneous transluminal coronary recanalization therapy (PTCR) with urokinase infusion has became one of popular technique for coronary arterial occlusion. This paper reported clinical experience of intraarterial urokinase infusion therapy for acute or superacute stroke patients. The procedure was followed by angiographical study which revealed the major intracerebral arterial occlusion in three cases. Case 1: A 74-year-old female had sudden onset of clouding of consciousness with complete left hemiplegia. The patient was in our urological ward because of treatment for her right ureter tumor, as the patient was immediately subjected to angiographical study and complete occlusion of the trunk of the right middle cerebral artery was revealed four hours after onset. Successively 240,000 IU of urokinase solution was injected through the arterial catheter after angiographical study. This procedure repeated two times with 10 minute intervals. So total amount of 720,000 IU of urokinase was given by intraarterial injection. Immediately after the last urokinase injection the patient started to recover her consciousness and weakness. Simultaneous angiogram demonstrated partial recanalization of the proximal branches of the middle cerebral artery. The following day, she had complete recovery from her neurological deficits although she had transient hemorrhagic tendency. The final angiogram showed no existence of obstructed cerebral arteries as well as no low density areas in computed tomographic images. Case 2: A 73-year-old female, with the left internal carotid occlusion at the site of C1-2 portion, was instituted infusion therapy of similar procedure with total amount of 960,000 IU oi urokinase ten to twenty hours after onset. However, no rewarding was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intraarterial urokinase infusion therapy for the acute intracranial major artery occlusion]. 336 98

Magnetic resonance images of a case of superior sagittal sinus thrombosis before and after complete recanalization are presented. The patient was a 61-year-old man with two days history of intermittent right hemiconvulsion followed by post-ictal hemiplegia. Mild erythrocytosis was noted on admission. CT scans revealed left frontal hemorrhagic infarction with empty delta sign in the middle portion of the superior sagittal sinus. Left carotid angiogram showed occlusion of two frontal cortical veins and retrograde filling of these veins into the cavernous sinus. Lack of filling of the middle and anterior part of the superior sagittal sinus was noted. These studies led to the diagnosis of superior sagittal sinus thrombosis associated with hemorrhagic infarction. He was treated with intravenous infusion of low molecular dextran and venesection. Neither heparin, urokinase, hyperosmolar solutions nor steroids were used because of the presence of hemorrhagic infarction and of the lack of signs of increased intracranial pressure. He completely recovered neurologically and recanalization of the superior sagittal sinus was confirmed angiographically eight weeks after the onset. Magnetic resonance images were taken with a Siemens 1.5 T Magnetom scanner using spin-echo pulse sequences. A T 1-weighted mid-sagittal magnetic resonance image ten days after the onset showed hyperintensity in the middle part of the superior sagittal sinus which corresponded to the thrombus. Both T 1 and T 2 weighted coronal images revealed a small area of hypointensity indicating the existence of residual blood flow in the superior sagittal sinus in addition to the thrombus both in the sinus and in the cortical vein.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Sequential magnetic resonance images of a case of cerebral sinus thrombosis--imaging of the thrombosed sinus and its recanalization]. 340 6

Thrombosis of the basilar artery is not a rare disease, and the mortality is reported to be 60 to 80%. Present standard therapy with heparin infusions yields poor results. The high risk of intracerebral haemorrhage prohibits systemic fibrinolytic therapy. Due to these facts and good experience in our department with the use of local intracoronary lysis in acute myocardial infarction, the method of local thrombolysis was applied in a case of acute basilar artery thrombosis. Fibrinolytic therapy was started via an angiography catheter placed in the vertebral artery in a 28 year-old woman with hemiplegia and severe brain stem symptoms. The patient received 200,000 IU streptokinase within 2 hours and subsequently 300,000 IU urokinase within 10 hours. The vessel re-opened completely. The neurological symptoms decreased during the following weeks. Based on this experience and according to rare reports in the literature we believe local low-dose thrombolysis to be a causal therapy promising success for acute thrombosis of the basilar artery. This therapy can be carried out in every medical centre able to perform selective angiography and experienced in the administration of fibrinolytic drugs.
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PMID:[Regional lysis of acute basilar artery occlusion--case report]. 671 Sep 95

Operative stroke complicating carotid endarterectomy is traditionally treated by reexploration of the operative site to correct a potentially causative lesion; however, attempts are not made to diagnose or treat the intracranial arterial occlusion. A 65-year-old man had a right hemiplegia during a left carotid endarterectomy that was caused by premature reversal of heparin, which resulted in thrombosis of his left anterior cerebral artery. On reexploration, the patient was treated with a 1-hour infusion of 1 million U urokinase through an indwelling carotid shunt. A repeat arteriogram demonstrated patency of the left anterior cerebral artery, with complete clot dissolution and resolution of the right hemiplegia on awakening. Natural history studies of stroke and prospective, angiographically controlled clinical trials of intraarterial thrombolytic therapy for acute stroke support the use of intraoperative intraarterial infusion of urokinase as part of a therapeutic approach to patients who have an ischemic stroke during carotid endarterectomy.
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PMID:Intraoperative high-dose regional urokinase infusion for cerebrovascular occlusion after carotid endarterectomy. 897 54

A 42-year-old man with a high-grade left internal carotid artery (ICA) stenosis demonstrated on a duplex scan was referred to us. A cerebral arteriogram confirmed a greater than 90% left internal carotid stenosis, but with the unexpected finding of a moderate amount of thrombus in the proximal ICA. He underwent emergent left carotid endarterectomy, but during the operation, only a small amount of thrombus was identified as adherent to the atherosclerotic plaque. he awakened in the operating room with a dense right hemiplegia and aphasia. Immediate reexploration demonstrated a patent endarterectomy site, a distal thromboembolectomy was performed without extraction of thrombus, and urokinase (250,000 Units) was infused into the distal ICA. He reawakened with an unchanged right hemiplegia and aphasia. The patient then underwent an urgent postoperative carotid and cerebral arteriogram that demonstrated an embolus to the middle cerebral artery. he was treated with the superselective infusion of urokinase (500,000 Units), with almost complete resolution of the clot. Over the course of the next 48 hours, the patient made a nearly complete neurologic recovery, and he was discharged from the hospital with only a slight facial droop. At 2 months' follow-up he was completely neurologically healthy. To our knowledge this is the first reported case of urokinase administered in the immediate postoperative period in the angiography suite to treat a thromboembolus complicating a carotid endarterectomy.
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PMID:Immediate postoperative thrombolytic therapy: an aggressive strategy for neurologic salvage when cerebral thromboembolism complicates carotid endarterectomy. 1080 96

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 50-year-old female was admitted to our hospital with a chief complaint of disturbance of consciousness (DOC). Left-sided hemiparalysis was noted on examination and cerebral infarction was diagnosed with total occlusion of the right common carotid artery revealed by cerebral angiography. Pharmacological thrombolysis (urokinase 720,000 U) was performed. Dissection of the right common carotid artery was noted after successful thrombolytic therapy. Enhanced chest computed tomography (CT) showed the acute type A aortic dissection involving the cerebral artery. Ascending aortic replacement was performed 4 days after the thrombolytic therapy to avoid brain edema and hemorrhagic infarction during cardiopulmonary bypass. The postoperative course was uneventful. In the case of acute type A aortic dissection with DOC, proper indication and optimal timing of the operation may help to improve patient survival.
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PMID:[Surgical management of acute type A aortic dissection with a complaint of disturbance of consciousness; report of a case]. 1242 41

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

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


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