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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 4 male patients (age range 50-73 years) with unilateral motor hemineglect as a sequelae of circumscribed cerebral infarction, depressions of the regional cerebral glucose metabolism (rCMRGlu) were mapped to identify the metabolically affected cerebral structures. Motor neglect was defined according to Castaigne by lack of spontaneous and pain-induced motor activity on one side of the body in the absence of paresis, pyramidal signs, and sensory loss. The depressions of the rCMRGlu as determined by positron emission tomography (PET) were found to exceed the areas of structural damage but to be restricted to the affected cerebral hemisphere. Significant mean rCMRGlu depressions followed a focal pattern involving the premotor, prefrontal, parietal and cingulate cortex, as well as the thalamus. In correspondence to the lack of significant mean rCMRGlu depressions in primary sensorimotor cortex, basal ganglia, and cerebellum the cortico-spinal pathway was spared as indicated by preserved magnetic evoked motor potentials. Our data provide evidence suggesting that motor hemineglect is a disturbance in a cerebral network of higher order cortical areas subserving motor activity in the presence of an intact motor cortical output system.
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PMID:Cerebral network underlying unilateral motor neglect: evidence from positron emission tomography. 796 85

We report a 70-year-old man who had a sudden onset of right hemiparesis and mutism. The lower extremity was more involved than the upper one. He had a long history of diabetes and chronic renal failure for which hemodialysis was necessary. On August 30, 1990, he had an sudden onset of right hemiparesis and mutism. Neurological examination revealed awake but mute in no acute distress. He could only respond to very simple commands such as opening his mouth or protruding his tongue. He did not appear to understand more difficult questions. In addition, he could not answer verbally. He was totally mute. Cranial nerves appeared intact except for slight right central facial paresis and severe diabetic retinopathy. He had complete paralysis of his right leg and a moderate weakness in his right upper extremity. Deep reflexes were diminished in both upper extremities and absent in the lower limbs. Frotal signs such as grasp and snout reflexes were present. Cranial CT scans revealed an ill-defined low density area in the left parasagittal subcortical area and a part of the anterior cerebral artery territory. The supplementary motor area appeared at least in part to be involved. He was treated with glycerol and other supportive cares, however, his clinical course was complicated by pneumonia, heart failure, septicemia, and he expired two months after his stroke. The patient was discussed in a neurological CPC, and the chief discussant arrived at a conclusion that he had an artery-to-artery embolism at the internal carotid bifurcation resulting in the cerebral infarction mainly in the territory of the anterior cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A 70-year-old man with right hemiparesis and mutism]. 836 54

The early diagnosis of the motor functional outcome of the upper and lower limbs in patient with cerebrovascular disease is important in establishing a treatment plan. The purpose of this study was to establish a method to evaluate the severity of low density areas on CT scans in patients with hemiparesis caused by cerebral infarction. The subjects were 186 patients who were admitted on the day of onset, showed a low density area on CT images within 5 days of onset. Of these patients, 111 had cerebral infarction, and the other 75 had reversible ischemic neurological deficit (RIND). On CT images, the low density area in the slice of corpus calosum splenium (S-1) and that of ventricular body (S-2) was measured, and its relationship with motor functional results at the time of discharge was evaluated. The motor functional level was evaluated using Brunnstrom's stage. The findings are as follows: 1) Discriminant analysis was performed using an explanatory variable of 1 and an error rates of 5% or less. The severity of the low density area could be classified into 4 major types in S-1: I-IV; and into 3 subtypes in S-2: a, b, c. The 186 patients were topographically classified using the major types and subtypes. 2) The 75 patients with type I a, b, c and II a motor function recovered within 3 weeks (RIND). Of 16 patients with type II b, 10 recovered after rehabilitation for 3 weeks or more, but the other 6 showed remaining of motor impairment in the upper limbs. Of 29 patients with type II c, 5 recovered, but the other 15 showed remaining of motor impairment in the upper limbs. 3) Of patients with type III, none recovered completely. All patients with III c had hemiparesis. 4) In 3 patients with type IV b, Stage 1.2 paresis remained in the upper limbs and Stage 4.3 in the lower limbs. Of 38 patients with type IV c, 23 showed remaining of Stage 1.2 paresis in both upper and lower limbs, and the other 10 showed Stage 1.2 paresis in the upper limbs. 5) The severity classification of the low density area on CT images was closely related to the motor functional outcome of the upper and lower limbs. Therefore, this classification is useful for determining the treatment method early after onset.
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PMID:[Location of lesion on CT and motor functional outcome of the upper and lower limbs in patients with cerebral infarction]. 888 32

We report about a patient who underwent double valve replacement with two Starr-Edwards prostheses in aortic and mitral position 30 years ago. Under anticoagulation medication he survived 28 years without any valve-related events. In the 29th year he sustained a cerebral infarction from which he recovered, having only a residual left arm paresis. His NYHA functional class today is II-III. Chest X-ray shows a mildly enlarged configuration of the heart, echocardiography reveals no irregularities of the implanted prostheses. We conclude, that the Starr-Edwards valve presents an outstanding standard concerning durability in mechanical valve replacement.
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PMID:Thirty years survival after double valve replacement with Starr-Edwards prostheses in aortic and mitral position. 908 Jan 75

Spontaneous dissection of the internal carotid artery is rarely submitted to surgery. We report a case successfully operated on with complete restoration of the cerebral blood flow. A 43-year-old male was admitted to our hospital 10 days after an episode of amaurosis fugax of the left eye, left sided headache and paresis of the right arm of a few hours duration. A diagnosis of dissection of the left internal carotid artery was made by duplex and triplex ultrasound examination and was confirmed by cerebral arteriography in contrast to magnetic resonance angiography which was misleading. Due to the slow arterial flow from the right to the left cerebral hemisphere through only the posterior communicating arteries we envisaged the possibility of a cerebral infarction if the dissection were to be extended. For this reason a surgical procedure was performed by excising the dissected segment and inserting a venous graft for the re-establishment of the arterial flow. Surgical treatment of spontaneous internal carotid dissection should be considered very carefully when the clinical and laboratory findings suggest the possibility of an impending stroke.
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PMID:Surgical treatment of spontaneous internal carotid dissection. 975 2

A 66-year-old right-handed man with acquired stuttering was reported. He complained of paresis in his left leg and speech dysfluency. He was not aphasic in terms of comprehension and writing. His speech dysfluency was mainly characterized by initial syllable repetitions. He has apraxia with his left hand, but has neither agraphia with his left hand nor crossed optic ataxia. MRI showed cerebral infarction in the truncus of the corpus callosum, and angiography revealed occlusion of the right anterior cerebral artery. 99mTc HM-PAO SPECT showed decreased blood flow in the right frontal lobe. Within six months of its onset, the patient's speech dysfluency had diminished. As the causative lesion for acquired stuttering, we proposed a hemispheric lesion in addition to a callosal lesion.
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PMID:[Acquired stuttering associated with callosal infarction: a case report]. 1002 89

Massive cerebral infarction is often accompanied by early death secondary to transtentorial herniation. Decompressive hemicraniectomy has been suggested as a lifesaving procedure. We report the case of a 61 year old man who had an acute infarction in the distribution area of the right middle cerebral artery. Initially, he was awake and suffered from total left-sided hemiparalysis. Over the next two days, his level of consciousness deteriorated to a Glasgow Coma Scale score of 5. Intracranial pressure (ICP) monitoring was then established. Three days later, the ICP increased from 20 to 40 mm Hg. We performed a right-sided decompressive hemicraniectomy, and the ICP was normalized immediately. Ten months after surgery the patient was at home and functioning with minimal assistance. He had moderate paresis of the left leg and was able to walk, but his left arm was paralytic. The presented case confirms that decompressive hemicraniectomy may prevent death and allow survival without severe disability in patients with massive cerebral infarction.
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PMID:[Decompression craniectomy--life-saving treatment in acute cerebral infarction]. 1066 83

Two rare cases of dissections which involve the anterior cerebral artery (ACA) are reported. A 58-year-old woman presented with a ruptured dissecting aneurysm manifesting as sudden onset of severe headache and consciousness disturbance followed by aphasia, right hemiparesis, paresis of the left lower extremity, and choreoathetotic movements of the upper arms and face. Computed tomography and angiography revealed subarachnoid hemorrhage due to a dissecting aneurysm at the left A1 segment. The dissecting aneurysm was trapped surgically on the day of onset. Her neurological deficits disappeared within a month. A 39-year-old woman experienced continuous dull headache from the day before onset, and then suffered right hemiparesis. Magnetic resonance (MR) imaging revealed cerebral infarction at the left globus pallidus. Angiography and MR imaging revealed a dissecting aneurysm at the left A1 segment and occlusion of the left Heubner's artery. She received conservative treatment and her neurological findings were improved. Dissections or dissecting aneurysms involving the ACA can be classified into three types: Extension of a dissection to the ACA from the internal carotid artery, dissection at the A1 segment, and dissection at the A2-A4 segments. These types of dissection have distinct uniform clinical features.
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PMID:Dissecting aneurysms at the A1 segment of the anterior cerebral artery--two case reports. 1139 8

We describe a case presenting with facial and hypoglossal nerve paresis due to cortical cerebral infarction. A 54-year-old man visited our hospital complaining of sudden episode of dysarthria and facial paresis. Neurological findings revealed tongue deviation to the left and left facial paresis with forehead wrinkling while neither limb paralysis nor sensory impairment was observed. Head CT performed on day 3 after onset revealed a cortical infarction in the right prefrontal gyrus. Symptoms gradually improved with medical management. This patient had isolated facial and hypoglossal nerve paresis without other neurological symptoms. Patients with mild paresis of cranial nerves should be diagnosed carefully, because their paresis could be supranuclear type.
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PMID:[A case of cortical infarction showing unilateral facial and hypoglossal paresis]. 1555 71

We document the presentation profiles, treatment strategies, and clinical outcomes in a relatively large cohort of pediatric patients with intracardiac thrombi (ICT). We performed a retrospective review of patients diagnosed with ICT by echocardiography at a tertiary pediatric hospital during a 10-year period. These patients received medical therapy or thrombectomy. We provided echocardiographic descriptions of the ICT-size, chamber location, and mobility/morphology. The outcome measures were ICT (persistence, resolution, or embolization), effectiveness of therapy, and patient morbidity and mortality. There were 40 ICT diagnosed in 31 patients (22 males and 9 females). Mean age at diagnosis was 8.8 years (range, 15 days to 18 years). Overall mortality was 12/31 patients (39%); only one death was attributed to ICT embolization. Embolic events occurred in 4/31 patients (13%). The most common initial therapies included heparin infusion (n = 15), warfarin (n = 7), and aspirin (n = 7). The ICT resolved with medical therapy alone in 19/30 patients (63%). One patient required surgical thrombectomy. The cohort was divided into group 1 (dilated cardiomyopathy), group 2 (status post Fontan operation), and group 3 (other diagnoses). In group 1 (n = 11), there were 8 deaths. Embolization occurred in 2/5 large ICT, resulting in cerebral infarction and death (n = 1) and renal infarction (n = 1). The most common ICT location was the left ventricle (n = 10). Severe ventricular systolic dysfunction was present in 10/11 patients (91%). In group 2 (n = 9), there was 1 death. Embolization occurred in 1/7 large ICT, resulting in seizures and temporary paresis. All ICT were located in the Fontan pathway. Severe ventricular systolic dysfunction was present in 2/9 patients (22%). In group 3 (n = 11), there were 3 deaths. Embolization occurred in 1/9 small ICT, resulting in coronary emboli. ICT are most commonly diagnosed in pediatric patients with dilated cardiomyopathy or patients status post Fontan operation. The majority of ICT resolve with medical therapy. Larger ICT tend to embolize more frequently, and the morbidity secondary to embolization is significant. Rarely is mortality due to ICT embolization. The prognosis is poor for patients with left ventricular ICT or ICT in the presence of ventricular systolic dysfunction.
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PMID:Intracardiac thrombi in pediatric patients: presentation profiles and clinical outcomes. 1740 82


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