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)

Migraine headaches that occur in the 15- to 30-year-old age group are well documented. In patients in the stroke age bracket, however, who present with a history of neurologic deficit, transient ischemic attacks can be confused with migraine accompaniments. The typical patient is 50 years old, is without a past history of migraines, and complains of scintillating visual disturbances (20 percent), marching paresthesis (22 percent), or a myriad of neurologic deficits. In one series of 70 neurology patients aged over 55 years, 16 percent reported that they experience the new onset of scintillations. Once fully evaluated, the cause of unexplained marching paresthesias, dysphagia, or hemiplegia, once reserved for thrombotic or embolic phenomena, may be attributed to migraine accompaniments. In the face of a normal evaluation, neurologic deficit in the stroke age bracket may be attributed to migraine accompaniments. A case of a 47-year-old woman with sudden onset of left-sided paresthesia, dysarthria, and confusion is presented. The discussion includes a description of migraine pathophysiology and a review of concepts regarding accompaniments.
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PMID:Late-life migraine accompaniments: a case presentation and literature review. 358 61

Forty-one cervical paragangliomas that occurred in 40 patients born and living in Mexico City, Mexico, were studied. Tumors were most common in women (38/40); were unilateral (39/40), without a side preference; were of the nonhereditary type; and were not malignant. Tumor imaging with radionucleaide angiographic scanning was noninvasive, innocuous, and reliable for screening, whereas selective carotid angiography allowed for definitive diagnosis and clinical stratification of patients. Surgical resection was performed in 29 patients; in 23 cases, en bloc resection was accomplished without a vascular compromise, whereas in 4 patients, a portion of the external carotid artery had to be ligated and resected. Two other patients required a vascular graft to restore blood flow to the internal carotid. Seven patients had postoperative transient cranial nerve palsies, and one had an incomplete hemiplegia. Permanent nerve damage occurred in seven patients. It was concluded that high-altitude paragangliomas are hyperplastic growths that result from adaptation to hypoxia. They are rarely true neoplasm and, in general, are not associated with functional loss. In view of this and of the high morbidity rate associated with surgical removal, it was recommended that these patients be referred to research centers where efforts toward the elucidation of the etiology and pathophysiology of these tumors can be carried out. Surgery should be reserved for symptomatic cases or cases in which the diagnosis remains in doubt. The decision to operate must weigh the following factors: The tumor's benign nature, its slow growth rate, the technical difficulties associated with its resection, the high postoperative morbidity rate, and the general condition of the patient.
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PMID:High-altitude paragangliomas diagnostic and therapeutic considerations. 394 5

Postraumatic lesions of the carotid artery are very unusual in the general population and are especially rare in children due to the elasticity of their vessels. Because clinical expression of these lesions is mild, diagnosis can be delayed until the development of neurological signs, which are frequently irreversible. Neurological signs can be those of Horner's syndrome, drop attack, headache, vertigo, visual disorders, aphasia or transitory ischemic accidents. Carotid arterial lesion should be ruled out when the patient shows injuries in the soft tissue of the neck, when the neurological examination is incompatible with the findings of computed tomography (CT), when late neurological deficits develop or when the patient has Horner's syndrome. The patient reported herein presented partial motor seizures and hemiplegia 3 days after trauma. The most sensitive diagnostic test is angiography. Because this technique is aggressive, it is performed when suspicion is based on the results of Doppler sonography, CT or angiomagnetic resonance imaging. Treatment must be individualized. Standard therapy is anticoagulation but when this is contraindicated or the patient is asymptomatic anti-aggregating drugs are used. Thrombolytic treatment is reserved for the first few hours after injury. Surgical repair is the treatment of choice in patients with pseudoaneurysm. Because inaccessibility is one of the major difficulties in this type of surgery, intravascular stents can be a good therapeutic alternative in lesions unresponsive to medical treatment.
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PMID:[Postraumatic lesion of the carotid artery]. 1182 57

Venous thromboembolism (VTE) is a common complication after acute ischemic stroke. When screened by 125I fibrinogen scanning or venography, the incidence of deep-vein thrombosis (DVT) in stroke patients is comparable with that seen in patients undergoing hip or knee replacement. Most stroke patients have multiple risk factors for VTE, like advanced age, low Barthel Index severity score or hemiplegia. As pulmonary embolism is a major cause of death after acute stroke, the prevention of this complication is of crucial importance. Prospective trials have shown that both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are effective in reducing DVT and pulmonary embolism in stroke patients. Current guidelines recommend the use of these agents in stroke patients with risk factors for VTE. Some clinicians are concerned that the rate of intracranial bleeding associated with thromboprophylaxis may outweigh the benefit of prevention of VTE. Low-dose LMWH and UFH seem, however, safe in stroke patients. Higher doses clearly increase the risk of cerebral bleeding and should be avoided for prophylactic use. Both aspirin and mechanical prophylaxis are suboptimal to prevent VTE. Graduated compression stockings should be reserved to patients with a clear contraindication to antithrombotic agents.
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PMID:Prevention of venous thromboembolism after acute ischemic stroke. 1594 9