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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Six cases of apparent and four cases of histopathologically confirmed vasculitis of the central nervous system (CNS), including one case of histopathologically documented vasculitis with encephalitis associated with coccidioidal meningitis (CM), are presented. Vasculitic complications included changes in mental status as well as stroke-like findings of aphasia, hemianopsia, and hemiparesis. Seven patients died. Vasculitic complications were unanticipated and often abrupt in onset, and delayed therapeutic intervention was characteristic. The diagnosis of vasculitis/encephalitis due to Coccidioides immitis infection must be based on clinical judgment, since serum antibody titers, cerebrospinal fluid findings, and initial radiological studies are not always helpful. Institution of both intravenous and intracisternal administration of amphotericin B and possibly concomitant intravenous administration of dexamethasone may be warranted in situations in which the association of C. immitis with CNS vasculitis or encephalitis appears likely before serologic or cultural confirmation of C. immitis infection involving the CNS is available.
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PMID:Vasculitic and encephalitic complications associated with Coccidioides immitis infection of the central nervous system in humans: report of 10 cases and review. 156 59

We studied the effects of the localisation and size of ischemic brain infarcts and the influence of potential covariates (gender, age, time since infarction, physical handicap, cognitive impairment, aphasia, cortical atrophy and ventricular size) on 'post-stroke depression'. During an 18-months period all patients who underwent a CT-scan at the Central Institute of Mental Health and who had a single unilateral ischemic hemisphere infarct were initially included. Patients with severe aphasia or cognitive impairment who could not communicate well enough for the administration of depression rating scales were excluded. This led to a selection bias towards larger infarct sizes in the right hemisphere. In order to overcome this potentially critical selection artefact all patients with infarct sizes over 23 cm2 and/or with 'mini Mental State Scores' under 20 were excluded. The data from the remaining 30 patients (mean age 68 years; 15 male; 13 left hemisphere infarcts were used for the analysis. Their scores on the Hamilton depression rating scale, the Zung self rating depression scale and the von Zerssen clinical self-rating depression scale correlated significantly with one another (r greater than 0.73; p less than 0.001). Backward stepwise regression analysis carried out on the covariates mentioned above demonstrated a significant relationship only between cognitive impairment or cortical atrophy and a higher depression score.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Depressive disorders after cerebral infarct. Relations to infarct site, brain atrophy and cognitive deficits]. 157 74

A patient is reported who was treated successfully for a left thalamic abscess that resulted in subcortical aphasia. A SPECT scan showed large areas of hypoperfusion in the cortex of the left hemisphere. At follow up after seven months there was marked improvement in the language disorder and the cortical hypoperfusion. It is suggested that aphasia in patients with subcortical lesions results from secondary cortical dysfunctions. The evidence is confined to patients with stroke lesions. The possible implications of this case on current theories of pathophysiological mechanisms, in particular the ischaemic penumbra theory and the cortical diaschisis theory, are briefly discussed. Cortical diaschisis may be the appropriate explanation in this patient.
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PMID:Subcortical aphasia from a thalamic abscess. 158 20

The role that stroke patients have played in the history of behavioral neurology was illustrated by describing some contributions made by Broca, Dejerine, Wilbrand, Liepman, and Geschwind. The recent work on the anatomic basis of recovery or lack of recovery in aphasia was discussed and the network of structures important in attention were reviewed. The study of stroke patients with amnestic syndromes (particularly those with basal forebrain and diencephalic lesions) was discussed as well. Starting with Liepman's classic contribution, and then looking at more recent studies, the left hemisphere's role in limb praxis was analyzed. The different syndromes that result when the superior and inferior visual association cortices are damaged were described and illustrated. A summary of neurobehavioral syndromes related to stroke that may present to the psychiatrist because the patient does not have an hemiparesis was given. The relationship of stroke to dementia and depression was reviewed.
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PMID:Behavioral neurology and stroke. 160 33

Between May, 1974, and March, 1991, 104 patients with moyamoya disease, all under 16 years old at the time of first surgery, underwent superficial temporal-to-middle cerebral artery anastomosis and/or encephalomyosynangiosis. The mean follow-up period was 9.6 years (range 4.8 to 16.0 years). Hemiplegia was the most frequent symptom before the first operation. Transient ischemic attacks (TIA's) were noted in 57 patients and minor stroke with hemiplegia in 44. The most frequent type of cortical dysfunction was aphasia (21 cases). Postoperatively, the incidence of TIA's and/or completed stroke with motor weakness of the extremities was markedly decreased, but visual disturbance progressed and major or minor stroke with visual disturbance was found in two cases. In patients under the age of 3 years, a major stroke prior to surgery resulted in a poor outcome in 36% of cases. Preoperative major stroke in patients between the ages of 3 and 7 years was less frequent, and poor outcomes were seen in 17% of this group. There were no major preoperative strokes in patients with surgery after the age of 7 years, and no poor outcomes were recorded in this group. A major preoperative stroke prior to surgery had adverse impact on the ultimate patient intelligence quotient (IQ) following surgery. All patients operated on after the age of 7 years had a normal or borderline IQ at follow-up examination.
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PMID:Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. 160 76

Neocortical contributions to emotional processing are discussed. First, parameters critical to the neuropsychological study of emotion are examined: interhemispheric (right, left) and intrahemispheric (anterior, posterior) factors, processing mode (expression, perception), and communication channel (facial, prosodic, lexical). Second, neuropsychological theories of emotion are described: right-hemisphere and valence hypotheses. Third, experimental studies of right-brain-damaged, left-brain-damaged, and normal adults are reviewed, on the basis of mode and channel, with a focus on stroke. Findings support right cerebral hemispheric dominance for emotion, regardless of valence and channel, and are more consistent for perception than expression. When lesion site is a factor, posterior sites are important for perception and anterior ones for expression. Finally, clinical implications are suggested for aphasia rehabilitation and for assessment of affect in neurological disorders.
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PMID:Interhemispheric and intrahemispheric control of emotion: a focus on unilateral brain damage. 161 88

In a comparative study of the performance of patients with Alzheimer's disease (AD), aphasia resulting from stroke, and normal elders on a variety of neuropsychological tasks, 3 aphasic patients performed similarly to AD patients in the delayed recall of verbal material. The memory deficit of these aphasic patients raised the question of incipient dementia because memory impairment is the hallmark characteristic of AD. However, when the performance profiles of the aphasic patients on all four memory measures administered in the study were compared to those of AD patients, differences made the presence of dementia unlikely. Nonetheless, the possibility remained that a deficit in delayed free recall might be the primordial symptom of dementia. Therefore, the four memory tasks were readministered to the 3 aphasic patients 2 years later, and intergroup performance comparisons again were made. The performance profiles of the aphasic patients obtained 2 years later were superior to and distinct from the AD patients, confirming the absence of dementia at Test Time 1.
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PMID:Delayed recall deficits in aphasic stroke patients: evidence of Alzheimer's dementia? 169 4

The Panjabi adaptation of the Aphasia Screening Test (AST) has been used with a small group of stroke patients and the preliminary results are reported. All the patients are described and their test results plotted. Observations are made about the test procedure, with recommendations for its further use.
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PMID:Preliminary results from using the Panjabi adaptation of the Aphasia Screening Test. 169 45

According to our clinical observations from various aspects of stroke patients, such as the total incidence of aphasia, the incidence of aphasia after left brain damage of the dextrals, the aphasia that occurs in patients without hemiplegia, and the types of aphasia, a much higher incidence of crossed aphasia is seen among the stroke patients of the Han (the largest ethnic group in China) as compared with the Uighur-Kazaks (U-K) in China and the Occidentals documented in the literature. Motor aphasia is most common and pure sensory or posterior aphasia is rarely seen in Han patients. The distinct features of the Chinese language is a possible explanation for this difference. We suspect that language function of the Han is not localized in the left brain but in the right or both hemispheres. There is no definite Wernicke's area in the left brain of the Chinese people and the neural pathway of the language function in the brain of the Chinese people is not similar to people who speak phonetic languages. Consequently the universal applicability of the theories of cerebral laterality of the language function and dominant hemisphere established by Dax and Broca are questioned in this paper.
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PMID:Crossed aphasia in Chinese: a clinical survey. 170 10

The purpose of the present study was to establish the relationship between persisting aphasia and the extent of overall disability in the long-term outcome following left hemisphere ischaemic stroke. 55 right-handed patients who had sustained an initial left-sided cerebral infarction, verified by CT scan, were investigated after a mean observation period of six years. 39 patients were categorized as being non-aphasic, and 16 as being aphasic (3 Global, 6 Broca's, 1 conduction, 1 transcortical motor and 5 anomic aphasics) at the end of the follow-up period. Regarding motor and sensory functions, a correlation between the presence of aphasia and the severity of deficits could be established at the end of the follow-up period. With respect to activities of daily living, a significantly larger number of aphasic stroke victims had to rely on help by others. Furthermore, the persistence of aphasia also negatively influenced the subsequent occupational capacity. With regard to social participation and leisure activities, a significant reduction was found in aphasic long-term stroke survivors as compared to non-aphasics. Concerning quality of life, both groups reported a marked decline at the end of the observation period; the presence of aphasia had an additional negative effect. However, as regards the long-term non-verbal cognitive impairment, statistical analysis revealed no significant differences between both groups. In addition, aphasic stroke survivors did not demonstrate a higher incidence of depressive states than those without language deficit. On the basis of our results it is concluded that the presence of aphasia in left-hemispheric ischaemic stroke survivors indicates a more severe stroke, resulting in greater physical disability and social handicap in the long-term outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Depression, nonverbal intellectual impairment and quality of life following left-brain ischemic insult--results of a catamnestic study]. 171 23


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