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

Emotional lability or emotionalism is a relatively common phenomenon and frequently occurs following vascular or traumatic brain injury. It is distressing and embarrassing to sufferers and their families, and often interferes with rehabilitation. At present there is no satisfactory or reliable treatment for this condition. We describe an open trial using fluoxetine, a newer antidepressant with a specific serotonergic action, in the treatment of emotional lability due to brain injury. Six consecutive cases of emotional lability attending a rehabilitation unit were studied (five cases of cerebrovascular accident and one of traumatic brain injury). Response to treatment was measured using a modification of the scale described by Lawson and MacLeod [1]. All showed a marked improvement within one week of commencing fluoxetine and the drug was well tolerated with no reported side-effects. The speed of onset and degree of improvement suggest that fluoxetine may be a useful agent in the treatment of emotional lability due to brain injury. Our observations indicate that further investigation of the role of fluoxetine in the treatment of emotional lability is warranted.
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PMID:Fluoxetine as a treatment for emotional lability after brain injury. 163 65

Neuropsychiatric disorders following stroke are common, and pathologic involvement of specific regions or functional systems results in behavioral syndromes similar to idiopathic psychiatric syndromes. Depression occurs in up to half of all stroke patients and is most frequently associated with left anterior cortical and subcortical infarctions. Mood changes interfere with cognitive, functional and social recovery. Treatment with heterocyclic antidepressants, stimulants, and electroconvulsive therapy is efficacious in most patients. Mania, delusions, hallucinations, personality alterations, obsessive-compulsive disorder, and changes in sexual behavior are less common but have also been described in post-stroke patients. Each behavioral syndrome is associated with a specific pattern of brain involvement. Investigation of these phenomena contributes to understanding the cerebral basis of psychiatric disorders.
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PMID:Neuropsychiatric aspects of stroke. 206 51

The aims of this study were (i) to determine the frequency of emotional lability following first ever stroke, and (ii) to identify factors associated with this condition. Sixty-six consecutive inpatients with first ever stroke were surveyed two months post stroke for the presence of emotional lability. Demographic, clinical, psychiatric and stroke lesion characteristics were also assessed. Emotional lability was present in 12 of the 66 patients (prevalence: 18%). Emotional lability occurred independently of post stroke depression. Single lesions located in anterior regions of the cerebral hemispheres had four times the odds of emotional lability than lesions located anywhere else (p < 0.05). Emotional lability is a common emotional-behavioural syndrome following stroke and is probably a separate condition from post stroke depression. The aetiology of this condition is possibly related to the consequences of injury to anterior regions of the cerebral hemispheres.
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PMID:Emotional lability after stroke. 813 84

The authors describe 9 patients with bipolar affective disorder associated with cerebrovascular lesions. Eight had negative family histories of affective disorders and late age at onset (after age 40) of manic-depressive symptoms. Only one, with positive family history of affective disorders, developed mood swings before age 40. Clinical subtypes of bipolar disorder and patterns of affective cycling in these stroke patients resembled those previously reported in functional bipolar disorder. Five patients had concurrent hyperkinetic movement disorders, and one depressed patient presented with unilateral left-sided parkinsonism that disappeared during a manic switch. In most patients, bipolar affective disorder was associated with right hemisphere lesions that involved subcortical and midline structures. Findings suggest that damage to frontal-basal ganglia-thalamocortical circuits by subcortical vascular lesions may simultaneously provoke disorders of movement and mood regulation.
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PMID:Poststroke bipolar affective disorder: clinical subtypes, concurrent movement disorders, and anatomical correlates. 908 51

Pathologic laughter which usually occurs after bilateral or diffuse cerebral lesions was rarely reported in patients with unilateral stroke. I describe clinical and radiological findings of 13 patients presenting pathologic laughter due to unilateral stroke. Their laughter was excessive, unmotivated, uncontrollable and most often occurred during conversation especially at the initiation of speaking. There usually was a latent period between the onset of stroke and occurrence of the pathologic laughter. The degree and duration of the pathologic laughter varied, but its severity tended to diminish during the follow up. Some of them also had emotional instability evidenced by easy weeping. Imaging studies showed that 12 patients had infarcts and one had a haemorrhage. The lesions were located in the lenticulocapsular area in 8, pontine base in 3, thalamocapsular area in 1, and cerebral cortical-subcortical area in one. The lenticulocapsular stroke usually involved the upper part of the basal ganglia and a genu or an anterior portion of the posterior limb of the internal capsule/corona radiata. In conclusion, unilateral, usually subcortical, strokes can produce pathologic laughter. Although the neuroradiological data presented here generally support the motor release hypothesis, the delayed onset symptoms suggest that more complex mechanisms may be involved.
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PMID:Pathologic laughter after unilateral stroke. 912

Different pharmacological properties of almitrine-raubasine show that this combination may be a good therapy for the treatment of age-related cerebral disorders and functional rehabilitation after stroke. Many clinical studies have been carried out in France and in the rest of Europe, confirming the value of this compound in such situations. Without discussing the complexity of clinical trials in both the areas of cognitive disorders and stroke, we shall present two studies demonstrating the beneficial effects of almitrine-raubasine against cognitive impairments. The first is a double-blind controlled study versus placebo with a 3-month follow-up period involving patients (aged between 60 and 85) with memory loss, lack of concentration, impaired mental altertness, and emotional instability. The second is a controlled multicenter study of 155 outpatients (age 70-85) presenting with cognitive decline (assessed by MMSE, SCAG). In both these studies, almitrine-raubasine significantly improved symptomatology and was superior to placebo, especially in the vascular cases. This confirms the validity of previous studies and justifies the indication of these compounds in the treatment of age-related cognitive disorders. Other studies also demonstrated the beneficial effect of this compound on neurosensory vascular disorders, with specific studies carried out on chorioretinal dysfunctions (visual symptomatology) and in vestibular disorders (vertigo associated with electronystagmographic modifications). The appropriate and usual dosage (2 tablets per day) and the good tolerance of the compound have been confirmed in a French multicentric study in 5,361 outpatients.
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PMID:Clinical efficacy of almitrine-raubasine. An overview. 951 74

Legal action has been taken in several US cities against Wyeth-Ayerst's Norplant, claiming that labels were deceptive regarding the potential side effects and the difficulties possible with removal. All the lawsuits claimed suffering caused by removals. 25 women in Miami, Florida, filed suit for $50,000 each in damages due to difficult removal. 8 women from Maryland joined 600 women filing in Chicago, who seek $20,000 to $50,000 for damages due to difficult removals and scarring. The group of plaintiffs also have asked for an injunction preventing the company from selling Norplant to doctors without proper training. Wyeth-Ayerst reported that it requested label changes before the lawsuits were filed. The label now states that removals and insertions are possible, without designating the time allocation required; prior labels indicated a 15-20 minute period. The new label includes possible side effects of emotional instability, heart attack, stroke, migraine, arm pain, numbness and tingling. One Maryland woman requested removal because the capsules had shifted and one had moved from her upper arm to under her armpit. Removal required 3 stages totaling 3 hours and ultrasound detection. Another women gained 20 pounds and had a sore arm. Norplant was first introduced in the US in 1991 after 20 years of experience with use worldwide. The contraceptive is effective for 5 years after insertion of 6 capsules, with slow releasing hormones. Planned Parenthood of Maryland administers Norplant at 7 clinics throughout the state, by practitioners at several clinics, and by the Baltimore City health department in school-based clinics. City clinics since 1991 have made 198 insertions and 14 removals, with no problems with removals. School-based clinics have inserted 45 implants and no removals. Bayview Clinic in Baltimore has made 2000 insertions and 250 removals, with few difficulties. The chief of obstetrics and gynecology at Bayview said that it takes about 6 times before removal is perfected by even a trained doctor. The Population Council, which developed Norplant and licensed it to Wyeth-Ayerst, still supports it as one of the most effective, reversible methods of birth control.
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PMID:Norplant removals spur suits. Some recipients report problems. 1231 99

The purpose of this study was to identify the major problems and associated feelings experienced by family caregivers of stroke survivors during the first month after returning home. Safety, difficulty in managing activities of daily living, and cognitive, behavioral and emotional changes of stroke survivors (for example, mood swings, lack of motivation, forgetfulness and memory loss, depression and calling the caregiver often) were the three most common problems experienced by caregivers during the first month. Other problems were loss of caregiver independence, confinement, tiredness and inadequate time to do caregiving tasks as well as managing stroke survivor physical symptoms, for example, pain, not eating and skin problems. The first month of caregiving is very dynamic and distressful for caregivers of stroke survivors and telephone contacts appear to be beneficial in assisting caregivers to cope with the caregiving process.
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PMID:Caregiving problems and feelings experienced by family caregivers of stroke survivors the first month after discharge. 1516 7

Although classical psychopathological studies have shown the presence of an independent diagnostic category, 'atypical psychosis', most psychotic patients are currently classified into two major diagnostic categories, schizophrenia and bipolar disorder, by the Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria. 'Atypical psychosis' is characterized by acute confusion without systematic delusion, emotional instability, and psychomotor excitement or stupor. Such clinical features resemble those seen in organic mental syndrome, and differential diagnosis is often difficult. Because patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) sometimes show organic mental disorder, 'atypical psychosis' may be caused by mutations of mitochondrial DNA (mtDNA) in some patients. In the present study whole mtDNA was sequenced for seven patients with various psychotic disorders, who could be categorized as 'atypical psychosis'. None of them had known mtDNA mutations pathogenic for mitochondrial encephalopathy. Two of seven patients belonged to a subhaplogroup F1b1a with low frequency. These results did not support the hypothesis that clinical presentation of some patients with 'atypical psychosis' is a reflection of subclinical mitochondrial encephalopathy. However, the subhaplogroup F1b1a may be a good target for association study of 'atypical psychosis'.
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PMID:Mitochondrial DNA sequence analysis of patients with 'atypical psychosis'. 1604 57

Sleep-related breathing disorders encompass a range of disorders in which abnormal ventilation occurs during sleep as a result of partial or complete obstruction of the upper airway, altered respiratory drive, abnormal chest wall movement, or respiratory muscle function. The most common of these is obstructive sleep apnea (OSA), occurring in both adults and children, and causing significant cognitive and daytime dysfunction and reduced quality of life. OSA patients experience repetitive brief cessation of breathing throughout the night, which causes intermittent hypoxemia (reductions in hemoglobin oxygen levels) and fragmented sleep patterns. These nocturnal events result in excessive daytime sleepiness, and changes in mood and cognition. Chronic excessive sleepiness during the day is a common symptom of sleep-related breathing disorders, which is assessed in sleep clinics both subjectively (questionnaire) and objectively (sleep latency tests). Mood changes are often reported by patients, including irritability, fatigue, depression, and anxiety. A wide range of cognitive deficits have been identified in untreated OSA patients, from attentional and vigilance, to memory and executive functions, and more complex tasks such as simulated driving. These changes are reflected in patient reports of difficulty in concentrating, increased forgetfulness, an inability to make decisions, and falling asleep at the wheel of a motor vehicle. These cognitive changes can also have significant downstream effects on daily functioning. Moderate to severe cases of the disorder are at a higher risk of having a motor vehicle accident, and may also have difficulties at work or school. A number of comorbidities may also influence the cognitive changes in OSA patients, including hypertension, diabetes, and stroke. These diseases can cause changes to neural vasculature and result in neural damage, leading to cognitive impairments. Examination of OSA patients using neuroimaging techniques such as structural magnetic resonance imaging and proton magnetic resonance spectroscopy has observed significant changes to brain structure and metabolism. The downstream effects of neural, cognitive, and daytime functional impairments can be significant if left untreated. A better understanding of the cognitive effects of these disorders, and development of more effective assessment tools for diagnosis, will aid early intervention and improve quality of life of the patient.
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PMID:Cognition and daytime functioning in sleep-related breathing disorders. 2153 Dec 44


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