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

Neurologic manifestations, afflicting up to 70% of SLE patients, include psychosis, seizures, chorea, neuropathies, and stroke. MRI is useful in evaluation of lupus patients and several reports have documented cerebral atrophy or focal hyperintensities. We report an unusual MRI appearance in a 56-year-old woman with SLE, diagnosed on the basis of pleuritis, lymphopenia, anti-DNA antibodies, and neurologic involvement. She reported recent onset of Raynaud's phenomenon and generalized macular rash. She presented after two months of gradual deterioration with memory loss, flattened affect, dysphagia, dysarthria, anomia, and somnolence, without focal neurologic signs. Investigations included elevated ESR, reduced complement, normal CSF without oligoclonal bands, negative viral serology, normal hormone and vitamin levels, normal renal and hepatic function. Neuropsychologic testing showed widespread impairment (WAIS-R: FSIQ-63; WMS-69; DRS-98; RCPM-14; WAB AQ-78.8). CT was normal but MRI showed strikingly symmetric, confluent hyperintensities extensively involving cerebral and cerebellar white matter on T1 and T2 weighted scans. Basal ganglia and subependymal and subcortical white matter were spared. Treated with prednisone, the patient made a gradual, but incomplete, recovery. These MRI findings may reflect widespread vasculopathy or direct immunologic brain insult with or without immunologic blood-brain barrier disruption.
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PMID:Dementia with leukoencephalopathy in systemic lupus erythematosus. 191 71

We describe an otherwise healthy 2-year-old patient with Williams syndrome who had a stroke as a result of intracranial multivessel focal and segmental stenotic disease. The diagnosis of Williams syndrome was confirmed by elastin gene deletion testing. Combined magnetic resonance imaging and magnetic resonance angiography, and transcranial Doppler flow studies, were used in diagnosing and monitoring the course of the disease.
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PMID:Ischemic stroke and intracranial multifocal cerebral arteriopathy in Williams syndrome. 777 2

We report on a patient with Williams syndrome who suffered a cerebrovascular accident. Clinical evaluation demonstrated the presence of carotid and cerebral arterial stenoses. We believe these lesions led to acute cerebrovascular ischemia and a non-hemorrhagic cerebral infarction. It is possible the stenoses were exacerbated by a vasculitis. The stenoses were identified by both invasive and noninvasive imaging studies. These studies may have a role in the evaluation of persons with Williams syndrome.
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PMID:Cerebrovascular stenoses with cerebral infarction in a child with Williams syndrome. 807 44

The deleterious effects of left hemisphere brain damage on language and verbal memory functions are well documented. However, limited attention has been paid to the effects of right hemisphere cerebrovascular accident (CVA) on these critical functions. Twenty-five right-handed, right hemisphere, stroke patients (RHS) were administered the California Verbal Learning Test (CVLT) and selected verbal, nonverbal, and orientation memory subtests of the Wechsler Memory Scale-Revised (WMS-R). An aphasia screening was also performed. The RHS patients performed significantly below the norm on all CVLT indices, whereas no differences were found between the RHS group and the WMS-R normative population for the story memory subtests. Study findings indicate that right hemisphere damage does affect performance of certain verbal memory tasks. Implications for inpatient treatment, post-acute care, and research with survivors of right hemisphere CVA are discussed.
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PMID:Indices of verbal learning and memory deficits after right hemisphere stroke. 850 54

The Wechsler Memory Scale-Revised (WMS-R) malingering indices proposed by Mittenberg, Azrin, Millsaps, and Heilbronner [Psychol Assess 5 (1993) 34.] were partially cross-validated in a sample of 200 nonlitigants. Nine diagnostic categories were examined, including participants with traumatic brain injury (TBI), brain tumor, stroke/vascular, senile dementia of the Alzheimer's type (SDAT), epilepsy, depression/anxiety, medical problems, and no diagnosis. Results showed that the discriminant function using WMS-R subtests misclassified only 6.5% of the sample as malingering, with significantly higher misclassification rates of SDAT and stroke/vascular groups. The General Memory Index-Attention/Concentration Index (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering when a difference score of greater than 25 points was used as the cutoff criterion. No diagnostic group was significantly more likely to be misclassified. Results support the utility of the GMI-ACI difference score, as well as the WMS-R subtest discriminant function score, in detecting malingering.
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PMID:Partial cross-validation of the Wechsler Memory Scale-Revised (WMS-R) General Memory-Attention/Concentration Malingering Index in a nonlitigating sample. 1459 79

The Wechsler Memory Scale-III (WMS-III) Rarely Missed Index (RMI) was developed by Killgore and DellaPietra (1999b, 2000b, 2001) to detect malingering. Its development was based on item-response biases in the Logical Memory Delayed Recognition (LMDR) items of the WMS-III (Killgore & DellaPietra, 1999a, 2000a). We completed replication studies using undergraduates, analog malingerers, and patients. In Experiment 1, 100 undergraduates naive to the WMS-III Logical Memory stories were administered the LMDR, and item-response biases were explored. In Experiment 2, 49 undergraduates feigned brain injury on cognitive and symptom validity tests. Data were also extracted from 83 traumatic brain injury (TBI), dementia, psychiatric/pain, stroke, and other patient files. Neither the previously reported item-response biases nor the diagnostic utility of the RMI in identifying simulated malingerers were replicated.
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PMID:Inability of the Rarely Missed Index to identify simulated malingering under more realistic assessment conditions. 1785 85

A 55-year-old woman sustained an acute amnesia that lasted for 8 days. The results of a cerebral magnetic resonance imaging scan and an electroencephalogram were normal. A Wechsler Memory Scale-Revised (WMS-R) test performed 6 days after the event showed global impairment in every domain, except for attention/concentration. A single photon emission computed tomography (SPECT) scan taken 8 days after the event showed hypoperfusion in the left temporal and frontal areas. The results of a follow-up SPECT scan on the 40th day after the episode were normal. A second WMS-R test showed some improvement on the 40th day after the event and considerable improvement on the 176th day. The clinical feature of the patient meets the criteria of transient global amnesia (TGA), except for her protracted course. It was not amnesic stroke, however, because of its reversibility and because there were no accompanying neurological signs. This case raises some implications of the pathogenesis of TGA and the clinical applicability of research criteria.
J Stroke Cerebrovasc Dis
PMID:Prolonged reversible amnesia: a case report. 1789 3

The present study aimed to develop a Chinese equivalence version of the Letter-Number (LN) Span Test and to explore the preliminary construct and discriminative validity of the developed version among a group of healthy Chinese volunteers and patients with stroke. A group of 165 (73 men and 92 women) healthy participants were recruited for the validation study, most of them were undergraduates or postgraduates. Moreover, a comparison was made between nine patients with stroke and the healthy controls. For the healthy sample, the Chinese version correlated significantly with the English version in total number of correct span (r = .6, p < .00001) and the longest span (r = .5, p < .00005). The Chinese version of LN Span Test was also found to be significantly associated with memory-loaded tests but not other tests. A series of ANCOVAs controlling for age, education, and IQ indicated that stroke patients performed significantly worse than the healthy controls in LN Span total number of correct responses (p < .04), immediate recall (p < .0005), and delayed recall (p < .0005) of WMS-R, SART total number of correct response (p < .0005), PASAT dyads correct response (p < .01). The preliminary findings suggest that the Chinese version of the LN Span Test shows impressive preliminary validity among a group of healthy volunteers and an impressive clinical discriminative validity among a group of stroke cases.
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PMID:The development of a Chinese equivalence version of letter-number span test. 1824 21

A 15-year-old girl was admitted because of an acute onset of facial palsy and right hemiparesis. The patient had a history of moderate mental retardation and developmental delay. On admission, her vital signs were stable, except for high blood pressure. Magnetic resonance imaging demonstrated an infarct involving the left internal capsule and putamen. Because of the patient's young age, an extensive stroke survey was performed. Williams-Beuren syndrome was finally confirmed by fluorescent in situ hybridization. Compared with the previously reported cases, no evidence of cerebral arterial stenosis or cardiac abnormalities was found by noninvasive imaging techniques. Because Williams-Beuren syndrome is a complex, multiple congenital anomaly syndrome with prominent cardiovascular features, regular assessment and antihypertensive treatment are necessary to minimize the lifelong cardiovascular risk in patients with this syndrome.
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PMID:Ischemic stroke in Williams-Beuren syndrome: a case report. 1950 39

Williams syndrome is caused by the deletion of 26 to 28 genes, including elastin, on human chromosome 7. Elastin insufficiency leads to the cardiovascular hallmarks of this condition, namely focal stenosis and hypertension. Extrapolation from the Eln(+/-) mouse suggests that affected people may also have stiff vasculature, a risk factor for stroke, myocardial infarction, and cardiac death. NCF1, one of the variably deleted Williams genes, is a component of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex and is involved in the generation of oxidative stress, making it an interesting candidate modifier for vascular stiffness. Using a case-control design, vascular stiffness was evaluated by pulse wave velocity in 77 Williams cases and matched controls. Cases had stiffer conducting vessels than controls (P<0.001), with increased stiffness observed in even the youngest children with Williams syndrome. Pulse wave velocity increased with age at comparable rates in cases and controls, and although the degree of vascular stiffness varied, it was seen in both hypertensive and normotensive Williams participants. Use of antihypertensive medication and extension of the Williams deletion to include NCF1 were associated with protection from vascular stiffness. These findings demonstrate that vascular stiffness is a primary vascular phenotype in Williams syndrome and that treatment with antihypertensives or agents inhibiting oxidative stress may be important in managing patients with this condition, potentially even those who are not overtly hypertensive.
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PMID:Williams syndrome predisposes to vascular stiffness modified by antihypertensive use and copy number changes in NCF1. 2412 71


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