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

Despite the acceptance of perseveration as a characteristic sign of disturbed CNS functioning, objective data relative to its nature and occurrence are noticeably lacking. Data obtained in this study, not unexpectedly, indicate that perseverative responses occur more often in brain-injured than in normal subjects. The brain-injured subject most likely to evidence perseveration appeared to be one who (1) had suffered a CVA (2) less than 6 months ago that (3) resulted in aphasia. Two types of perseveration, repetitious and continuous, were noted in the responses of the brain-injured with higher incidences of the repetitious type occurring. It was felt that the behavioral definitions used to differentiate between repetitious and continuous perseveration allowed for reliable judgments between observers.
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PMID:Perseveration in brain-injured adults. 100 54

Spontaneous drawings of 38 patients, diagnosed by the National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria as "probable Alzheimer's disease," and of 39 normal control subjects were analyzed by two independent observers using a standardized scoring system. Drawings of patients with Alzheimer's disease displayed fewer angles, impaired perspective and spatial relations, simplification, and overall impairment compared with those of the control subjects. This represents a combination of the deficits seen following right- and left-hemisphere lesions. Neglect, tremor, and perseveration were not prominent. Drawing impairment was relatively independent of language or memory impairment, but drawing performance was related to perceptual and executive dysfunction in the visuospatial domain. Deterioration was followed up for up to 3 years.
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PMID:On drawing impairment in Alzheimer's disease. 198 29

The study of 3 personal cases and 5 published cases of unilateral infarct limited to the territory of the tuberothalamic artery suggests that this syndrome should be differentiated from the other thalamic syndromes. The onset is usually sudden, with moderate contralateral weakness. Sensory changes may be present but remain mild. The patients are apathetic, show perseveration and may be disoriented. In left-sided infarcts, transcortical aphasia, verbal and visual memory impairment and sometimes acalculia are found. In right-sided infarcts, hemispatial neglect, visual memory impairment and disturbed visuospatial processing are common. A decreased level of consciousness, disturbed ocular movements, severe motor weakness and delayed abnormal movements do not occur. Involvement of the ventral lateral and dorsomedial nucleus with sparing of the intralaminar nuclei, posterolateral formation and upper midbrain may explain this picture. The fact that the tuberothalamic artery arises from the posterior communicating artery, which often receives its supply from the carotid system, further justifies considering unilateral tuberothalamic infarcts as a syndrome.
Stroke
PMID:The syndrome of unilateral tuberothalamic artery territory infarction. 242 53

Eleven of 134 patients with a right hemisphere stroke responded to stimuli directed at other patients as if the stimuli were directed at them. The stroke was severe in all 11 patients. Associated disturbances included hemineglect, anosognosia, motor impersistence, disorientation (sometimes with agitated confusion), and somatosensory delusions and allesthesia. This form of perseveration seems specific to acute right hemispheric stroke.
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PMID:Response-to-next-patient-stimulation: a right hemisphere syndrome. 339 72

Visual illusions and hallucinations may accompany a wide variety of disorders with many different aetiologies; therefore, they are non-specific phenomena. Lesions in the visual pathway may be associated with visual misperceptions. In these cases more exact information about the misperceptions--whether they are monocular or binocular, present in the whole visual field or a hemifield--may contribute to diagnostic accuracy and to a more comprehensive understanding of the patient and his state of mind. Illusions such as perseveration, monocular diplopia and polyopia, and dysmorphopsia may also occur in healthy individuals, but they are found most often in patients with epilepsy, migraine and stroke. These phenomena do not permit exact localization and definition of an aetiology, but lesions in the occipital and occipitotemporal regions near the visual pathway are involved in most cases. Hallucinations always represent a pathological form of perception. They are classified as unformed (photopsias) or formed (complex). Photopsias may be described in terms of colour, shape and brightness. Their wide variety makes it difficult, if not impossible, to arrive at an exact description of their aetiology, but it is possible to define their anatomical origin in some cases. Complex hallucinations suggest an occipitotemporal locus. Whether they appear in the whole visual field or in the hemifield may prove decisive in determining pathogenesis. A number of characteristics permit a rough classification of these phenomena. Complex hallucinations accompany physical illness and are susceptible to psychodynamic interpretation.
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PMID:Visual illusions and hallucinations. 813 1

A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.
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PMID:Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction. 1022 14

Differences in the pattern of neuropsychological dysfunction associated with Alzheimer's disease (AD) and vascular dementia (VaD) were examined using the Dementia Rating Scale (DRS). We examined three groups of patients: (1) Patients with AD; (2) patients with single stroke (CVA); and (3) patients with multiple cerebral infarctions (MI). Comparisons of cognitive dysfunction were conducted on patients that met the DRS criteria for dementia. Dementia groups were similar in age, education, and severity of dementia. Comparisons of the AD and two VaD groups across the specific DRS-scales (Attention, Conceptualization, Construction, Initiation/Perseveration, and Memory) indicated that patients with AD were more impaired on the DRS-Memory while the patients with VaD were more impaired on the DRS-Construction. Additionally, patients with VaD related to MI scored lower on the DRS-Initiation/Perseveration as compared to patients with AD, and patients with AD scored lower on the DRS-Conceptualization as compared to patients with VaD related to CVA. These results are indicative of qualitative differences in the pattern of cognitive deficits associated with the two types of dementia.
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PMID:Dementia rating scale performance: a comparison of vascular and Alzheimer's dementia. 1092 54

Acute language disorder is highly suggestive of cerebrovascular disease, but when accompanied by behavioral disturbance, particularly in elderly patients, it may express a different etiology. Six women aged 71 to 84 years presented with a mild behavioral disturbance followed by a language disorder that included fluent dysphasia, paraphasia, dysnomia, perseveration, and impaired understanding of complex orders. They fully recovered within 24 h. MR-imaging, including diffusion-weighted sequences in five of them, showed no acute lesions. EEG showed epileptogenic waveforms in three cases and slow waves in the other three, in a location that included the left temporal region. These findings disappeared in subsequent controls. All of these tests were performed during the acute episode or up to 72 h after onset. No patient has presented a new episode so far. The high sensitivity of new neuroimaging techniques forces the search for non-vascular etiologies in those patients in which no structural lesions that could account for the symptoms can be demonstrated. EEG can be useful in the diagnosis of some of these stroke mimics. Acute language disorders accompanied by disturbed behavior in the elderly may reflect a partial seizure of the temporal lobe.
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PMID:[Acute language disorder in elderly patients: ischemic or epileptic origin?]. 1174 26

The first weeks of aphasia are called the acute stage. The rapid change and possible fluctuation of language deficits at that stage as well as concurrent phenomena such as drive disturbances, apraxia, or perseveration pose particular requirements for aphasia diagnosis. Professional language diagnosis in a stroke unit is necessary for detailed description of the language deficits, differential diagnosis of concomitant cognitive or functional disturbances, and a description of the dynamics of the deficits to start with specific therapeutical interventions as soon as the patient's health status allows. There are three published German aphasia test batteries especially constructed for diagnosis of acute aphasia language deficits. They differ with respect to content and pragmatic aspects and offer a range of applications, including the diagnosis of aphasia, recommendations for therapy, and the use in scientific studies.
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PMID:[Diagnosis of aphasia on the stroke unit]. 1204 Sep 81

This is an appraisal of the varied clinical presentation and the neural substrate for akinetic mutism following stroke. The diagnosis is important as akinetic mutism is often misdiagnosed as depression, delirium and locked-in-syndrome. This is a descriptive study of eight selected patients with akinetic mutism following infarction/haemorrhage in different regions of the brain with characteristic syndromes. They involved the critical areas namely, the frontal (cingulate gyrus, supplementary motor area and dorso-lateral border zone), basal ganglia (caudate, putamen), the mesencephalon and thalamus. The disorders of speech and communication took different forms. The speech disorder included verbal inertia, hypophonia, perseveration, softened and at times slurred. The linguistic disturbances were fluent, non-fluent, anomia and transcortical (motor, mixed) aphasias. The findings were related to what is known about the neuroanatomic location of the lesions and the role of the frontal-subcortical circuitry in relation to behaviour. Akinetic mutism could be explained by damage to the frontal lobe and or interruption of the complex frontal subcortical circuits.
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PMID:Akinetic mutism following stroke. 1464 61


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