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

A 73-year-old man was admitted with gait disturbance and dysarthria. He showed right-side cerebellar ataxia. Computed tomography of brain showed left thalamic bleeding. Nine months later, he was admitted again because of seizure and consciousness disturbance. He had a history of diabetes mellitus and gout for five years, but no hypertension. On physical examination the lungs and heart were normal. On neurological examination, he showed stupor,pupils and eye position were normal. He showed right hemiparesis and urinary incontinence. The deep tendon reflexes were (+) at the upper limbs and (2+) at the right knee and ankle. Blood pressure was 162/88 mmHg and glucose was 275 mg/dl. Other laboratory data were normal. Brain CT showed hemorrhage of the left frontal lobe. The cystatin C level in cerebrospinal fluid was 68 ng/ml. Therefore we suspected cystatin C deposit amyloid angiopathy. In this case, thalamic hemorrhage was initially thought to be amyloid angiopathy. In cases of cerebral hemorrhage in the elderly without hypertension, we must be considered amyloid angiopathy.
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PMID:[A case of recurrent cerebral hemorrhage considered to be cerebral amyloid angiopathy by cerebrospinal fluid examination]. 143 57

A consecutive series of 94 patients with chronic subdural hematomas (CSDHs) was studied on compensation against intracranial pressure and tolerance, and plasticity from compression of CSDHs, comparing between 47 cases of the aged group over 70 years of age and 47 cases of the younger group under 69 years of age. Better compensation from compression of CSDHs in the aged group was demonstrated from the fact those of long duration from impact to onset of symptoms, few cases with signs of chronic intracranial hypertension and volume of hematoma over 100 ml. But, when CSDHs progressed over 100 ml in size, this compensation mechanism and also tolerance against increased intracranial pressure were deprived. Disturbance of consciousness and anisocoria were shown much more in the aged group on admission. Patients in the aged group demonstrated reduced brain reexpansion and poor clinical recovery during 3 months after surgery. CT performed on 3 months after surgery demonstrated persisting subdural fluid in 63% of cases in the aged group comparing with 8% of those in the younger group. There was significant difference about morbidity between two groups. These study suggests that the plasticity and elastance in the aged brain reduce because of brain atrophy and impairment of cerebral blood flow, then brain reexpansion and clinical improvement may participate in delay regardless of release from compression of CSDHs. It may be urged that the critical age maintaining the plasticity of the brain in cases with SDHs in 75 years of age.
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PMID:[Tolerance and plasticity against the intracranial pressure in cases of chronic subdural hematoma in the aged brain]. 359

Stroke was the leading cause of death in Taiwan for 19 years (1963-1981). About 60% of the hospitalized patients dying of stroke suffered from cerebral hemorrhage (CH). This fact denotes an important role of CH in causing fatal stroke. The widely use of computed tomography (CT) in Taiwan in the past decade enables clear differentiation between CH and cerebral infarction (CI). In Taiwan, the ratio of CH: CI is 1:1.5, which is 3.5 times higher than that of the Western countries. CH is most prevalent between aged 55 and 65 years; the male to female ratio after adjusted to that of general population is around 1.1:1. Hypertension is the most important risk factor (86.7%) and spontaneous CH is, therefore, often referred to as "hypertensive CH". CH has a predilection to occur in the putamen (41%), thalamus (23%), putaminothalamus (9.7%), subcortical white mater (9.3%), brainstem (6.5%), and cerebellum (5.9%). Motor dysfunction (80%) is the most frequent clinical manifestation, followed by disturbance of consciousness (50%), and language problems (31.1%). In addition to motor and consciousness disturbance, vomiting (30.8%) and headache (27%) are among important initial presentations, especially for cerebellar and intraventricular hemorrhage. For patients with stable condition after CH, medical treatment is the mainstay of therapy. If condition deteriorates during medical treatment, surgical intervention may be considered for patients with cerebellar, lobar, or putaminal hemorrhage. In Taiwan, 11.6% of patients with CH receive surgical treatment. The mortality rate one month after CH was 53.7% before the CT era; it has decreased to 23.3% in recent years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cerebral hemorrhage in Taiwan]. 791 73

Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) were originally described as separate disease entities. Recently, HUS and TTP have been considered a single disease, because of the identical microangiopathic lesion. In the present study, we investigated the clinical and histological characteristics of HUS/TTP. Eleven patients with a definite diagnosis of HUS/TTP were found from a cohort of adult patients who were admitted to Kitasato University Hospital in the past two decades. Their clinical and histological characteristics were retrospectively analyzed. All of the 11 patients with HUS/TTP were sporadic and non-diarrheal cases with a mean age of 49 years +/- 10. Preceding episodes of flu-like syndrome and the administration of mitomycin C were observed in 3 and 5 patients, respectively. On admission, two of 10 patients with renal dysfunction required dialysis treatment, while none developed nephrotic syndrome. Six patients showed CNS manifestation, such as consciousness disturbance and convulsion. Three patients with severe hypertension did not show consciousness disturbance. As for the final outcome, 6 patients recovered and the remaining 5 died. Two died after 60 hospital days. In the histopathological investigation, renal biopsy specimen showed narrowing of the capillary loops in the glomeruli due to swelling of the endothelial cells, double contour of the glomerular basement membrane, or mesangial cell necrosis and sclerosis. In the autopsy specimen, internal organ infarction with fibrin thrombi in small arteries was observed in multiple organs, such as brain, kidneys, hearts, lungs, jejunum, liver, pancreas, adrenal glands and pituitary gland. A circumferential myocardial infarction with hyaline thrombi in the medial layer of myocardium was characteristic of HUS/TTP. In conclusion, microangiopathic lesions with infarction spread widely throughout various organs in HUS/TTP. Involvement of internal organs, not to mention kidneys and brain, is lethal and their prognosis remains poor.
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PMID:[Clinical characteristics of hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) in adult]. 808 74

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

A 48-year-old woman complained of fever, headache and nausea in October, 1994. Because polymerase chain reaction (PCR) was positive for mycobacterium tuberculosis in her cerebrospinal fluid, she was administered anti-tuberculous drugs. Steroid hormone was also administered for her symptoms of intracranial hypertension. However, multiple intracerebral masses appeared on CT and MRI 2 months later, and have increased in number and size. Cessation of the steroid hormone was impossible as her intracranial hypertension had been deteriorated. She was transferred to our clinic on October 23, 1995. On neurological examination she was drowsy and showed papilledema, weakness of bilateral lower extremities, left cerebellar sign, and bilateral Babinski's reflexes. Enhanced CT and MRI revealed multi-locular lesions in the right fronto-temporal, left temporal and left cerebellar regions. On November 7, 1995 she was operated on. Right fronto-temporal and left cerebellar masses were partially removed. Pathological examination and PCR of the surgical specimens demonstrated tuberculoma. Postoperatively, her consciousness disturbance improved and the residual tuberculomas decreased in size under the influence of anti-tuberculous drugs and cessation of the use of steroid hormone. Recently, tuberculosis is common neither in Japan nor in Western countries. Intracerebral tuberculoma is also very rare. The tuberculosis in our patient with multiple intracerebral tuberculomas resistant to antituberculous drugs was thought to have been induced by decreased resistance to the infection due to the administration of the steroid hormone.
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PMID:[A case of intracerebral tuberculoma resistant to therapy]. 882 34

We report three patients with dural arteriovenous malformation (DAVM) in the posterior fossa presenting the venous ischemia and the pathophysiology and the clinical characteristics of DAVM presenting the venous ischemia are discussed. Associated with occlusive changes in the venous sinuses, DAVM in the posterior fossa develops the venous hypertension of the straight sinus and the venous ischemia of cerebral white matter and basal ganglia. The venous ischemia presents progressive symptoms consisting of dementia with or without the ensuing consciousness disturbance. Multiple parenchymal lesions and abnormally dilated and tortuous veins are the characteristic findings in MRI/CT.
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PMID:[Dural arteriovenous malformation presenting venous ischemia]. 931 Oct 2

We studied seizures that occur during the acute phase of aseptic and bacterial meningitis in childhood. Of the 108 children with aseptic meningitis, five had seizures (4.7%). Four patients developed them within 24 hours of the onset of the initial symptom (fever in 3 cases), and three had repeated seizures on the first day. One case had SIADH complication, but another neurologic abnormalities were not observed. On the 18 children with bacterial meningitis, three cases (16.7%) had seizure, which occurred on the second day of illness. Disturbance of consciousness and cerebral hypertension were observed in 2 cases each, and abnormal cerebral CT findings in all the three. The NSE level in the cerebrospinal fluid was elevated in 2 cases. Thus, seizures occurring in the acute phase of aseptic meningitis may reflect transient cerebral functional abnormality accompanying fever or SIADH, whereas those in bacterial meningitis may result from neural tissue damage due to encephalopathy or angitis. In aseptic and bacterial meningitis, the presence of seizures in the acute phase was not correlated with the neurological outcome.
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PMID:[Seizures in the acute phase of aseptic and bacterial meningitis]. 984 13

An 86-year-old woman with a 13-year history of hypertension was admitted because of consciousness disturbance, hypotension, tachycardia, and cyanosis at her extremities. Enhanced computed tomography showed a thrombus in the truncus pulmonalis and right pulmonary artery, and also showed a left renal mass and a right renal cyst. Under a diagnosis of pulmonary embolism we started anticoagulant therapy, but the patient died five days after admission. At autopsy, a saddle-like thrombus was found in the truncus pulmonalis and bilateral trunks of pulmonary arteries. Microscopic examination showed smooth muscle cells in the thrombus. We could not find any other thrombus in the inferior vena cava, intrapelvic veins, nor in veins of lower extremities by milking. We also found tumors in both kidneys. Microscopically all tumors were diagnosed as angiomyolipoma. There were many fibrin thrombi in the sinuses of the tumors but there was no evidence of malignancy. We finally diagnosed pulmonary embolism due to renal angiomyolipoma because there was no other thrombus origin and microscopically the same smooth muscle cells were found both in the renal tumor and the pulmonary thrombus. There is only one case report concerning pulmonary embolism due to renal angiomyolipoma which happened during operative treatment. The treatment method of renal angiomyolipoma is determined by tumor size and symptoms, and usually intensive treatment is not performed in cases without symptoms. Our patient had no symptoms until the onset of severe complication of pulmonary embolism, suggesting that radical treatment is necessary for renal angiomyolipoma with a thrombus even when there are no symptoms.
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PMID:[An autopsy case of pulmonary embolism due to renal angiomyolipoma in an elderly woman]. 1051 15

We reported a rare case, which was successfully treated by PTA, of right common carotid artery dissection propagated from acute aortic dissection (AAD) type A. A 45-year-old male with a past history of hypertension and an artificial graft replacement of the abdominal aorta due to AAD type B, 7 years ago, was brought into our hospital by ambulance 30 minutes after an attack of fainting and left hemiparesis. On admission, the patient complained not of chest pain or left hemiparesis, but nausea. At that time his consciousness level was JCS 1. During examinations, he had the same attack twice and his consciousness level deteriorated to JCS 2. Brain MRI showed no abnormality, but cervical MRA did not visualize the right carotid artery and thoracic CT depicted acute aortic dissection including branches of the aorta. Emergent angiography disclosed that the dissecting 99% stenosis of the right common carotid artery had developed from AAD type A with poor collateral blood flow. PTA was carried out 8 times and reduced the residual stenosis to about 50% with shortened circulation time. The patient's consciousness disturbance improved. After the replacement of the whole aortic arch in an artificial graft, the residual stenosis disappeared. The patient recovered without neurological deficit but right frontal silent embolic infarction caused by the artificial graft replacement was detected. AAD is a catastrophic illness and sometimes accompanied by devastating ischemic cerebral disease (ICD) because of propagation of dissecting to extracranial vessels. This is the first report that shows the efficacy of PTA for treatment of ICD associated with AAD.
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PMID:[Common carotid artery dissection propagated from acute aortic dissection: a case successfully treated by PTA]. 1112 87


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