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

While emotional outcome is a critical factor influencing early evolution and late prognosis after stroke, few relevant studies have been performed on this subject. However, mood changes, modified judgment, and emotional reactions may also dramatically alter recruitment into clinical trials; for instance, up to one third of patients with acute stroke may have altered time perception, inappropriate self-evaluation of their condition, and attentional or memory dysfunction, with a subsequent increase in referral-to-hospital delays. In addition, the value of the "informed" consenting process may be questionable in the setting of urgent randomization into an acute stroke clinical trial. Data from ongoing studies suggest that behavior and emotional reactions in acute stroke patients may be classified into a few broad categories, with considerable overlap. Correlations between mood changes and the type, location, and severity of stroke may provide useful information for improving patient management, including the prediction of functional evolution and late prognosis. While depressive reactions have been widely studied in the recovery-rehabilitation phase after stroke, significant depression is uncommon shortly after stroke. On the other hand, related, though different, emotional behavioral changes may be more frequent; these have often been confused with depression and include catastrophic reaction, emotionalism, and athymhormia. Late depression is the most common mood alteration during the first year after stroke and has specific characteristics that differentiate it from classic endogenous and reactive depression, thus emphasizing the critical role of brain damage in the pathogenesis of poststroke depression. Early recognition and management of mood disorders after stroke are critical for the functional improvement of individual patients. However, little is known about specific indications for different antidepressant drugs in poststroke depression and related disorders. Ongoing research has identified a "new" emotional-behavioral disorder, poststroke fatigue, which is clearly distinct from depression in most instances. It is especially disabling and frustrating in that it typically involves patients with total or near-total neurological recovery, who should have been able to go back to their previous activities but who become severely disabled because of early and persisting exhaustion. Preliminary neuropsychological and MR and PET imaging studies suggest that disruption of subtle mechanisms underlying attention, in the absence of significant cognitive and mood alterations, may be responsible. Research projects are now being launched to better delineate poststroke fatigue and its management.
Stroke 2003 Apr
PMID:William Feinberg lecture 2002: emotions, mood, and behavior after stroke. 1264 23

Attention-deficit/hyperactivity disorder (AD/HD) is a common pediatric behavioral disorder associated, in part, with male preponderance and reduced regional cerebral blood flow (rCBF). However, mechanism(s) underlying male preponderance and reduced rCBF in AD/HD are unclear. The present study profiles the expression of angiogenic and hormonal factors likely to underlie these symptoms using a recently characterized AD/HD animal model, juvenile male stroke-prone spontaneously hypertensive rats (SHRSP). Because vascular endothelial growth factor (VEGF) signaling cascade and gonadal steroids are key regulators of angiogenesis and gender-based behavior, respectively, we profiled their patterns of expression in the frontal cortex of SHRSP to elucidate their roles in the genesis of AD/HD male preponderance and rCBF. Interestingly, levels of VEGF, VEGF receptors (KDR, Flt-1), endothelial nitric oxide synthase, phosphorylated Akt (pAkt), estrogen receptor-alpha, aromatase, and capillary density in sham-operated SHRSP were remarkably down-regulated, whereas androgen receptor levels were up-regulated, compared with age-matched genetic control, Wistar-Kyoto rats. Castration, estrogen, and androgen receptor antagonist (flutamide) counteracted these effects. Dihydrotestosterone, but not testosterone, reversed the beneficiary effects of castration. Estrogen receptor-beta levels remained unchanged in all groups examined. We postulate that changes in androgen metabolism that tend to up-regulate local dihydrotestosterone concentration and diminish estrogen synthesis, in the frontal cortex of juvenile male SHRSP, may lower levels and/or activity of VEGF and its signaling cascade and, subsequently, reduce rCBF. These findings could, in part, help explain the pathogenesis of reduced rCBF and male preponderance in AD/HD.
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PMID:Gonadal hormones and frontocortical expression of vascular endothelial growth factor in male stroke-prone, spontaneously hypertensive rats, a model for attention-deficit/hyperactivity disorder. 1517 44

Attention-deficit/hyperactivity disorder (AD/HD) is a common pediatric behavioral disorder associated with male preponderance and reduction of regional cerebral blood flow (rCBF). However, lack of an appropriate animal model exhibiting appropriate AD/HD symptoms stands in the way of studying mechanism(s) underlying reduced rCBF and male preponderance. Our group has been investigating the suitability of juvenile male stroke-prone spontaneously hypertensive rats (SHRSP), a substrain of the commonly used AD/HD animal model SHR, as a model for AD/HD because, unlike SHR, SHRSP displays cognitive impairment and male preponderance. Our more recent studies revealed alterations in the synthesis of sex steroid hormones and angiogenic factors in the frontal cortex of male SHRSP compared to the genetic control WKY. Based on these observations, the present study utilizes laser-Doppler flowmetry, histochemistry, enzyme immunoassay, immunoblotting, and real-time PCR to characterize and compare the patterns of regional cerebral blood flow and synthesis of angiogenic molecules [basic fibroblast growth factor; nitric oxide synthase isoforms (endothelial, neuronal and inducible); vascular endothelial growth factor (VEGF) and its signaling molecules (VEGF receptors, phosphorylated Akt, endothelial nitric oxide synthase eNOS] between male SHRSP and SHR. Overall, consistent with our previous data showing alteration in VEGF/Akt/NO signaling, there was a marked reduction in the profile of rCBF (35%) and angiogenic factors of SHRSP, compared to age-matched genetic control Wistar-Kyoto rats (WKY) and SHR. We conclude that, unlike SHR, the profiles of rCBF and angiogenic factors in SHRSP are altered in juvenile male. Thus, SHRSP appears to be a more suitable animal model for studying changes in rCBF in AD/HD.
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PMID:Characterization of regional cerebral blood flow and expression of angiogenic growth factors in the frontal cortex of juvenile male SHRSP and SHR. 1557 67

We characterize the clinical features of Parkinson's syndrome on Guadeloupe and describe possible environmental causes. Consecutive patients who were referred to the University Hospital at Pointe a Pitre with parkinsonism from September 1996 to May 2002 were included. All cases were examined in a standardized manner by a neurologist with a special interest in movement disorders and independently by 3 external movement disorders specialists, using standard operational clinical diagnostic criteria. The subjects were 265 patients with Parkinson's syndrome living on Guadeloupe, four fifths of whom had been referred by primary care physicians and one fifth by neurologists. The levodopa response was assessed after a minimum period of 1 month of continuous treatment. All patients had brain computed tomography or brain magnetic resonance imaging scans and detailed neuropsychological examinations. Of 265 patients, only 66 were classified as Parkinson's disease, whereas 58 fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) and Society for Progressive Supranuclear Palsy (SPSP) criteria for progressive supranuclear palsy, 100 had unclassifiable parkinsonism, characterized by dopa-unresponsiveness, marked axial rigidity, relative symmetry of parkinsonian features, early dysarthria, and frontolimbic cognitive impairment. Within this group, early postural instability, dysarthria, a frontal behavior disorder, cortical or subcortical atrophy, pyramidal signs, axial rigidity, and family history of neurodegenerative disorders were associated with poorer prognosis. A very large number of unclassifiable cases of atypical parkinsonism that do not fulfill operational criteria for Parkinson's disease or other defined motor neurodegenerations has been observed on Guadeloupe. Most patients closely resemble descriptions of bodig from Guam. In both geographic isolates, an environmental cause has been discussed. Annonaceae fruits and herbal teas are consumed on both islands. These plants contain several neurotoxins, particularly acetogenins, which induce dopaminergic neuron loss in animals. Neuronal death involves cholinergic and dopaminergic cells of the substantia nigra and GABAergic neurons of the striatum, associated with microglial proliferation. The development of atypical parkinsonism in Guadeloupe and probably elsewhere, could result from synergistic toxicity, but acetogenins are probably the most potent neurotoxin, acting as mitochondrial complex I inhibitor.
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PMID:Atypical unclassifiable parkinsonism on Guadeloupe: an environmental toxic hypothesis. 1609

Previous study has indicated that chronic treatment with lithium protects brain against ischemic injury by reducing apoptotic death. To investigate whether lithium improves the behavioral disorder induced by transient global cerebral ischemia, we examined the effects of lithium treatment on the performance of rats in a set of behavioral tests, i.e. beam balance, elevated plus maze (EPM), open field and Morris water maze. Our results showed that lithium attenuated the worse general 'well-being' and the worse performance in beam balance, and hyperactivity in EPM and open field, including increased open arm entries, time spent in the open arms, squares crossed, rearing and grooming over 7 days after 15min ischemia, which were induced by four-vessel occlusion in Sprague-Dawley rats. Moreover, lithium improved the injured spatial learning and memory ability in Morris water maze at post-ischemic days 8 and 9. Histological analysis displayed that it decreased obviously cell death in hippocampal CA1 region. Our study further confirmed the protective role of lithium in the ischemia-reperfusion injury and suggested that lithium might be a helpful therapeutic approach to the treatment of stroke combining with other neuroprotective agents.
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PMID:Lithium improves the behavioral disorder in rats subjected to transient global cerebral ischemia. 1721 Jan 90

Rapid eye movement (REM) sleep behavior disorder (RBD), which is characterized by dream-enacted, sometimes violent and aggressive, behaviors was firstly reported by Schenck and his colleagues in 1986; thereafter, it was incorporated as parasomnia in the International Classification of Sleep Disorders 1st edition (ICSD-1). The polysomnographical hallmarks of RBD include intermittent/sustained loss of the skeletal muscle atonia of REM sleep (REM sleep without atonia [RWA]); further, this finding has been mandatory in the diagnostic criterion (requiring polysomnographic [PSG] monitoring) in the ICSD-2 in 2005. The animal equivalent of RBD was previously described by Jouvet's and Morrison's groups, dated back to 1965, when Jouvet's group firstly created experimentally lesioned cats (in the bilateral pontine tegmentum areas) presenting with "oneiric behaviors". In 1970s Hishikawa's group had also described peculiar sleep state in alcoholics and other subjects of drug withdrawal with rapid eye movements and tonically increased chin muscle activity (reffered to as "Stage 1-REM with tonic EMG" [Stage 1-REM]). It was difficult to determine from the polysomnographical features whether Stage 1-REM was REM sleep or not, as this state did not preserve proper cyclic appearance of REM sleep. They also reported Stage 1-REM in patients with Shy-Drager syndrome in 1981. The latter finding of Hishikawa's group, together with RBD observed in multiple system atrophy (MSA) reported by other groups, could be best explained by the experimental cat model because of its presumed extensive brainstem pathology. However, neurophysiology of withdrawal states has not been well understood; therefore, Stage 1-REM should be reappraised from new perspectives. After 1990, more extensive studies on RBD revealed that about half of RBD cases were associated with neurological disorders, especially neurodegenerative diseases pathologically known as syncleiopathies (Parkinson disease [PD], dementia with Lewy bodies, and MSA). In addition, it has been shown that a substantial number of idiopathic RBD (iRBD) patients eventually developed Parkinsonian diseases. In accordance with accumulative data indicating that various non-parkinsonian features can precede the onset of motor symptoms of PD (or pathologically Lewy body diseases), a search of early PD markers in patients with iRBD has been performed. The results of the studies support the hypothesis of RBD as an early sign of a neurodegenerative disorder. More recently, it was reported that RBD is frequently symptomatic of narcolepsy, although the pathophysiological mechanism of this state was still unknown. RBD in stroke patients have been anecdotal; however, under such conditions, specific lesion studies can be possible, as data in the experimental RBD rats have been accumulated during these few years. In conclusion, RBD is observed in a wide range of neurological disorders, and the causative mechanism of RWA and behavioral manifestations may not only be attributable to brainstem lesions. RBD is not a homogeneous clinical entity, and further refinement of its diagnostic classification is warranted to avoid diagnostic confusion.
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PMID:[Historical overview of REM sleep behavior disorder in relation to its pathophysiology]. 1951 16

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a rare autosomal dominant genetic disease characterized with recurrent stroke, migrainous headache, cognitive deficits, and psychiatric symptoms associated with mutations in the NOTCH 3 gene on chromosome 19. Here, we report a case of CADASIL who presented with migrainous headache, behavioral disorder, and familial history of stroke and the diagnosis was established by the findings of head magnetic resonance images revealing characteristic white matter lesions and a mutation in the NOTCH 3 gene.
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PMID:A case report about CADASlL: mutation in the NOTCH 3 receptor. 2032 94

Neurologists treat many people with unrecognized sleep disorders. This review recommends that new and established patients routinely complete standard sleep questionnaires as an aid to clinical history. Because there is high prevalence of treatable primary sleep disorders among neurologic patients, routine diagnostic sleep testing is indicated for patients with stroke, neuromuscular disease, dementia, REM behavioral disorder, atypical or treatment-refractory insomnia, and chronic and unexplained fatigue or sleepiness. As local and national regulatory momentum favors increasing care coordination and integration, neurologists should develop a clinical pathway to diagnose and treat sleep disorders within the practice or through a collegial expert network.
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PMID:Treating sleep disorders in neurology practice. 2309 27

Sleep and sleep-related problems play a role in a large number of human disorders and affect every field of medicine. It is estimated that 50 to 70 million Americans suffer from a chronic sleep disorder, which hinders their daily life, affects their health, and confers a significant economic burden to society. The negative public health consequences of sleep disorders are enormous and could have long-term effects, including increased risk of hypertension, diabetes, obesity, heart attack, stroke and in some cases death. Polysomnographic modalities can monitor sleep cycles to identify disrupted sleep patterns, adjust the treatments, increase therapeutic options and enhance the quality of life of recording the electroencephalogram (EEG), electromyogram (EMG) and electrocardiogram (ECG). Although the skills acquired by medical facilitators are quite extensive, it is just as important for them to have access to an assortment of technologies and to further improve their monitoring and treatment capabilities. Computer-aided analysis is one advantageous technique that could provide quantitative indices for sleep disorder screening. Evolving evidence suggests that Parkinson's disease may be associated with rapid eye movement sleep behavior disorder (RBD). With this article, we are reviewing studies that are related to EMG signal analysis for detection of neuromuscular diseases that result from sleep movement disorders. As well, the article describes the recent progress in analysis of EMG signals using temporal analysis, frequency-domain analysis, time-frequency, and sparse representations, followed by the comparison of the recent research.
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PMID:A Review of Sleep Disorder Diagnosis by Electromyogram Signal Analysis. 2635 Oct 20

Unilateral spatial neglect (USN) is one of the most dramatic behavioral disturbances in patients with cerebral lesions. USN occurs more frequently following right parietal lesions. Patients with USN may neglect targets on the side opposite a brain lesion; and always look toward the contralateral side. This behavioral disorder impedes functional recovery. A number of approaches to patients with USN have been reported. This article discusses the manifestations, pathophysiology, and assessment of USN; and includes a review of the references to the rehabilitation approach to the USN patients.
Top Stroke Rehabil 1999
PMID:Rehabilitation Approach to Patients with Unilateral Spatial Neglect. 2836 2


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