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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We investigated the clinical profile, etiological factors, neuropsychological features and radiological characteristics of 17 cases of striatocapsular infarction (SCI). SCI was defined as the following CT criteria: the area of infarction included the internal capsule and striatum, the maximum diameter of the lesion exceeded 2.0 cm without cortical involvement. There were 9 men and 8 women with mean age of 58 years. Five patients had lesions mainly involving the caudate head (anterior type) and the other 12 had lesions mainly involving the putamen (lateral type), 6 with left side lesion and 6 with right side lesion. Motor weakness was observed in all patients, and the upper extremities were preferentially involved, while in 9 patients face, upper and lower extremities were simultaneously involved. Etiological investigation revealed that 8 patients were cardioembolic stroke, 2 were artery-to-artery embolism and 2 were MCA stem occlusive disease, while the remaining 5 were undetermined. When compared with patients with lacunar infarction (LI), patients with SCI had significantly more frequent cardioembolic sources (47% vs 17%, p < 0.05) and less frequent hypertension (41% vs 80%, p < 0.01). In acute phase, neuropsychological abnormalities were found in 15 patients. Anterior type patients had psychiatric symptoms such as abulia, depression and agitation, while left lateral type patients had aphasia and right lateral type patients had hemispatial neglect or anosognosia. These symptoms gradually improved, although in most patients subtle abnormalities lasted over chronic phase. In 11 out of 13 patients who underwent SPECT using 99mTc-HMPAO, blood flow was decreased in overlying cerebral cortex besides the infarcted area.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical investigation of striatocapsular infarction]. 833 92

Among 251 patients examined 3 months after the onset of acute ischemic stroke, we diagnosed dementia in 66 (26.3%) by using modified DSM-III-R criteria based on neuropsychological, neurological, functional, and psychiatric examinations. We used a logistic regression model to derive odds ratios (ORs) for clinical factors independently related to dementia in this cross-sectional sample. Dementia was significantly associated with age, education, and race. A history of prior stroke (OR = 2.7) and diabetes mellitus (OR = 2.6) was also independently related to dementia, but hypertension and cardiac disease were not. Stroke features associated with dementia included lacunar infarction compared with all other subtypes combined (OR = 2.7) and hemispheric laterality in relation to brainstem or cerebellar location. There was a predominance of dementia in patients with left-sided lesions (OR = 4.7), an effect not explained by aphasia. Dementia was especially common with infarctions in the left posterior cerebral and anterior cerebral artery territories. A major dominant hemispheral syndrome (reflecting size and laterality) was also independently associated with dementia (OR = 3.9). We suggest that dementia after ischemic stroke is a result of multiple independent factors, including both small subcortical and large cortical infarcts especially involving the left medial frontal and temporal regions, with additional contributions by demographic and vascular risk factors.
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PMID:Clinical determinants of dementia related to stroke. 849 36

A 61-year old man with a history of arterial hypertension suffered a left HZO, and was treated with acyclovir. Three weeks later he suddenly developed moderate left hemiparesis particularly of the leg, severe paresis of the right leg, aphasia and somnolence. Treated with IV acyclovir and high-dose corticosteroids deterioration of the right hemiparesis was apparent. Serological and CSF-studies showed acute varicella-zoster virus infection with intrathecal antibody synthesis (antibody specificity index 2.7). On the third day CT scan revealed infarctions in the territory of both anterior cerebral arteries, at the fifth day additionally left striatocapsular infarction. Selective carotid arteriogram showed bilateral occlusions of anterior cerebral arteries in their proximal segment. With a mean delay of seven weeks granulomatous vasculitis is a rare complication of HZO, leading commonly to ischemic infarctions in the region of the middle cerebral artery. Trigeminovascular connections are the probable pathway of virus-transmission from the trigeminal nerve to ipsilateral branches of the circle of Willis. Because of the presumed pathogenesis immediate therapy with high-dose corticosteroids and acyclovir is justified.
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PMID:[Granulomatous vasculitis of the CNS as a complication of herpes zoster ophthalmicus]. 852 86

The postoperative hyperperfusion syndrome describes an abrupt increase in blood flow with loss of autoregulation in surgically reperfused brain. Reports described a spectrum of findings, including severe headache, transient ischemia, seizures, and intracerebral hemorrhage. Hypertension is common after carotid artery surgery and often plays a role in the pathophysiology. We now report five patients with severe white matter edema after carotid surgery, a finding not previously included in the hyperperfusion syndrome. Five to 8 days after carotid surgery and after hospital discharge, each patient developed hypertension, headache, hemiparesis, seizures, and aphasia or neglect due to severe white matter edema ipsilateral to the carotid surgery. One patient had a small hemorrhage within the edematous area. Hypertension was severe in four patients and moderate in one. The carotid artery was patent by ultrasound or angiography in each patient after surgery. Transcranial Doppler showed increased velocities ipsilateral to surgery in two patients and bilaterally in one. Computed tomographic abnormalities and neurologic signs resolved within 3 weeks in four of the five patients treated with antihypertensives and anticonvulsants. The fifth patient died from herniation secondary to massive edema. Brain edema with focal neurologic signs should be included as a serious but potentially reversible component of the postoperative hyperperfusion syndrome.
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PMID:Brain edema after carotid surgery. 904 Jul 62

A 78-year-old man with a history of total gastrectomy, myocardial infarction and hypertension was admitted to our hospital because of frequent transient attacks of consciousness disturbance, aphasia and right hemiparesis after meals. His attacks occurred one to three times a day, 30 to 60 minutes after meals and lasted 120 to 180 minutes. At the time of the attacks his blood pressure decreased, but his pulse rate did not change. Cerebral angiography demonstrated atherosclerotic occlusion of the left internal carotid artery. There was no myocardial uptake of 123I-metaiodobenzylguanidine (MIBG). These results suggest that our patient had an autonomic dysfunction. Duplex carotid ultrasonography revealed that the blood flow velocity fell about 30% at the time of the attacks. His autonomic dysfunction and major artery occlusion may have produced a hemodynamic TIA following postprandial hypotension.
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PMID:[A case of transient ischemic attacks preceded by postprandial hypotension]. 856 48

In a retrospective analysis 385 patients with a histologically defined cranial meningioma were studied to analyze the impact of characteristic factors on morbidity and mortality after modern cranial meningioma surgery. Mortality was 4.2% one month and 7.3% six months after operation. 15.6% of the patients stayed more than one month in the hospital (defined as criteria of operative morbidity). Age, poor preoperative clinical condition (ASA score), intra- and postoperative bleeding and CSF disturbances were significantly associated with a subsequent decrease of quality of life. First symptoms like intracranial hypertension, seizures, aphasia and hemiparesis were correlated with an increase of postoperative Karnowsky index. Postoperative quality of life decreased in patients with optic and other cranial nerve disturbances significantly. Tumour size, location (exception: medial sphenoid wing) and histological diagnosis did not influence surgical outcome. This information may be useful in management decisions regarding asymptomatic meningiomas in elderly and high risk patients.
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PMID:Factors influencing morbidity and mortality after cranial meningioma surgery--a multivariate analysis. 873 7

Differential diagnosis of dementing diseases is very important to rule in the so-called treatable dementia. The new DSM-IV criteria for dementia include memory disturbances and one or more of aphasia, apraxia, or frontal lobe dysfunctions as essentials. Alzheimer disease requires, in addition, slowly progressive course and ruling out other brain or systemic diseases. Vascular dementia requires focal neurological or neuroimaging signs. Other diseases which cause dementia include chronic subdural hematoma, infection and brain tumor. CT or MRI can readily diagnose them if suspected and they may be treated. Systemic diseases associated with treatable dementia include electrolyte disturbances, hypothyroidism, vitamin deficiency, alcohol or drug intoxication, syphilis and HIV infection. Prevention of dementia seems to be the future problem as we could prevent cerebrovascular diseases by treating hypertension.
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PMID:[Clinical aspects of dementia]. 875 26

Medical treatment of stroke is dependent on a narrow therapeutic time window. We prospectively analyzed the influence of demographic, medical, and pathophysiologic factors on admission delay in 1,197 unselected, acute stroke patients. Twenty five percent were admitted within 3 1/2 hours, 35% within 6 hours, 50% within 14 hours, and 68% within 24 hours after stroke onset. Living alone (odds ratio [OR] 1.75, 95% CI 1.3 to 2.3) and retired working status (OR 1.61, 95% CI 1.01 to 2.54) delayed admission. A well-working social network thus seems important to early admission. The milder the stroke, the higher was the risk of delayed admission (OR 1.25 per 10 points decrease in stroke severity [Scandinavian Neurological Stroke Scale score on admission], 95% CI 1.14 to 1.36). A history of TIA increased the relative chance of early admission by odds 1.64 (95% CI 1.06 to 2.54). Other factors such as age, sex, diabetes, hypertension, ischemic heart disease, other comorbidity, previous stroke, headache, aphasia, apraxia, anosognosia, neglect, lowered consciousness, mental status (Mini-Mental State Examination) and type of stroke (hemorrhage/infarct) had no independent influence on admission time. Admission was markedly delayed in most patients. This represents a major barrier to medical treatment. Patients with the most severe strokes are admitted early, but patients with milder symptoms should also be encouraged to seek immediate admission. The observation that a history of TIA reduced admission time indicates that an increase in public awareness and knowledge may reduce delay and save precious time.
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PMID:Factors delaying hospital admission in acute stroke: the Copenhagen Stroke Study. 875 8

We reported 6 cases of excellent motor recovery after a large infarction in the middle cerebral artery territory including the cortex. All patients were men (aged 67 to 80); 4 had left hemiplegia and 2 had right hemiplegia. They had abrupt onset of focal neurologic symptoms and signs, suggesting embolic stroke. The consciousness level, according to the Japan coma scale, was grade II in 4 patients and normal in the other 2. Atrial fibrillation was present in 4 patients and premature atrial and ventricular contractions were seen in 1 each. Hypertension was present in 3 patients and diabetes mellitus in 1. The motor plegia gradually improved after 1 to 3 days and almost completely disappeared at 12 days after onset. All patients were eventually able to walk alone without any aids. However, aphasia persisted in 2 patients with left hemispheric damage and left unilateral spatial neglect in 3 patients with right hemispheric damage. A cerebral blood flow analysis by single photon emission computed tomography, using [123I] isopropyliodoamphetamine or technetium 99m hexamethylpropylenamine oxime, demonstrated increased blood flow in the frontal lobe cortex surrounding the infarcted region in 5 patients. These patients showed good recovery from motor deficit, even though, motor symptoms did not begin to improve until 1 to 3 days after onset of stroke. We suggest that there is a subgroup of stroke patients, whose severe motor deficit starts to improve even 3 days after onset of a large infarction in the middle cerebral artery territory including the cerebral cortex.
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PMID:[Analysis of patients with excellent motor recovery after large infarction in the middle cerebral artery territory including the cortex]. 886 42

There is presented a case a 42 year old woman, who was admitted to the Department of Internal Diseases, the Institute of Dentistry, Medical Academy in Warsaw, with suspected bacterial endocarditis. Two episodes which indicate a lesion in the central nervous system (as right side hemiparesis and mixed aphasia) in the patients with valvular heart disease, were the basis of this suspicion. Bacterial endocarditis was not confirmed during hospitalisation. Diagnosis of Sneddon's syndrome was established based on skin lesion of livedo reticulatis type with typical picture in skin biopsy and on the lesions in the central nervous system confirmed by MRI. Moreover the patients had arterial hypertension and Raynaud's syndrome. We presented the diagnostic difficulties of Sneddon's syndrome, a course of the disease, the factors, which affect its prognosis and attempts to treat this syndrome based on this case.
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PMID:[Sneddon syndrome]. 900 25


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