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

The effectiveness of monitoring somatosensory evoked potentials (SEPs) intraoperatively to detect brain damage early remains controversial. To assess the diagnostic accuracy of this modality, a study was conducted between 1991 and 1994, recording SEPs in 287 consecutive patients undergoing cardiac and aortic surgery using cardiopulmonary bypass (CPB) with moderate hypothermia or deep hypothermic circulatory arrest. From P1 to N2 of the SEPs occurring within 50 ms latency in response to electrical stimulation of the median nerve were recorded over the contralateral postcentral cortex at 5-min intervals using a Neuropack-2 (Nihon Koden, Tokyo, Japan). Normal SEPs were recovered in 247 patients postoperatively; however, 2 of these patients had suffered a cerebral infarction and 1, a transient stroke intraoperatively, demonstrating a false-negative incidence of 1.2%. On the other hand, three different types of abnormal SEPs were recorded postoperatively. P1 and N1 absence, probably caused by a subcortical lesion, was observed in 4 patients; P2 and N2 absence, probably caused by a cortical lesion, was observed in 8 patients; and a flat SEP, representing diffuse damage, was observed in 2 patients. Among these 14 patients with abnormal SEPs, 7 showed no neurologic disturbance at all, demonstrating a false-positive incidence of 50%. Thus, we concluded that when normal SEPs are recovered during weaning from CPB, the incidence of brain damage could be predicted at below 5%. Conversely, when abnormal SEPs are demonstrated, the incidence of brain dysfunction impeding a return to active life is estimated to be about 70%.
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PMID:Continuous monitoring of short-latency somatosensory evoked potentials during cardiac and aortic surgery. 872 17

Carotid body paragangliomas are rare, and are generally benign tumours that grow slowly. Extirpation of carotid body paragangliomas is well documented as the best curative treatment, but can be accompanied by complications such as peroperative bleeding, stroke and injury to cranial nerves. Accurate preoperative diagnosis and evaluation are important, and preoperative carotide angiography is essential to confirm the diagnosis. In this case report, a patient with large carotid body paraganglioma underwent preoperative selective embolization of the major afferent arteries. The vascularity of the paraganglioma was reduced substantially, and complete extirpation was accomplished without complications. Blood loss was negligible and the postoperative course was uneventful. The patient had no cranial nerve or cerebral dysfunction after operation. In cases with angiographically distinct feeding arteries, in addition to satisfactory cerebral perfusion, preoperative selective embolization can be an important supplementary treatment.
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PMID:[Combined embolization and surgery of paragangliomas of the glomus caroticum. Report of a case and review of literature]. 892 6

Evidence for impaired psychological functions mediated by the left hemisphere in sober alcoholics is inconsistent. We predicted that sober alcoholics have deficits in immediate and delayed memory similar to deficits found in left hemisphere damaged patients. Four prose stories were administered to 24 alcoholics and 24 nonalcoholic peers and were scored according to Webster et al's criteria for essential and detail propositions. These investigators found that right hemisphere stroke patients performed significantly worse than controls on recall of detail propositions, but left hemisphere damaged stroke patients performed worse on recall of both detail and essential propositions. Similar to their left hemisphere group, our alcoholics were impaired on both proposition types supporting the hypothesis of a residual mild generalized brain dysfunction state in sober alcoholics.
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PMID:Assessment of prose recall performance in chronic alcoholics: recall of essential versus detail propositions. 907 51

Japanese patients with brain dysfunction (21 with severe traumatic brain injury [TBI], 21 with right, and 21 with left cerebral vascular accidents [CVA]) were asked to make behavioral ratings regarding their competencies in several areas. Relatives of patients and physical therapists who treated them also rated each patient's behavioral competency. Japanese patients with TBI overestimated their behavioral competencies compared with therapists ratings, but not relatives' ratings. Japanese patients with TBI overstimated self-care skills but not their ability to interact in socioemotional situations. Patients who had right and left CVA did not differ in their mean ratings of behavioral competency. Among all patient groups, there was no correlation between self-reported competencies and performance on a neuropsychological test. Family ratings of patients' behavioral competencies correlated with the patients' neuropsychological test performance. Post hoc analyses of patients with TBI suggest that speed of finger tapping related to an impaired self-awareness. Whereas cultural factors may influence self-reports of behavioral competency, patients across cultures with brain dysfunction seem to have reduced insight into their actual level of neuropsychological functioning.
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PMID:A cross-cultural study on impaired self-awareness in Japanese patients with brain dysfunction. 915 May 15

Seventeen patients with severe cardiomyopathy underwent neuropsychological evaluation prior to and at least 1 year after successful heart transplantation. Study candidates were screened, and individuals with a history of stroke, cardiac arrest, or medical and neurological conditions which might affect brain function were excluded. Pre-transplant testing revealed normal intelligence and normal attentional, language, and executive abilities but impaired recent memory. Following heart transplant, memory functioning improved significantly, reaching normal levels. Other cognitive abilities remained unchanged. Results suggest that cardiomyopathy is associated with mesial temporal dysfunction, possibly attributable to inadequate or reduced cerebral blood flow and related hypometabolism. This cerebral dysfunction is potentially reversible following successful transplantation, which restores cardiac output and cerebrovascular perfusion.
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PMID:Memory improvement following cardiac transplantation. 940 99

We describe the use of a mathematical/statistical method (i.e., Rasch analysis) to elucidate biological patterns of disability present in the functional ability of persons undergoing medical rehabilitation. Two measures chosen for illustration are the FIM Instrument for inpatients and the Body Movement and Control (BMC) measure for outpatients. In order to meet the assumptions necessary for application of linear statistics to clinical measurement studies, Rasch analysis was used to transform ordinal scales into linear measures. Another unique feature of Rasch analysis is that it allows evaluation of the difficulty of items and the abilities of persons being tested, separately, on the same metric. Also, the difficulty represented by each item may be arranged along a hierarchy from easy to hard. The hierarchies of functional ability items are dependent upon the specific patterns of disability related to underlying pathophysiology. For inpatients, initial analyses of the 18 items of the FIM Instrument demonstrated separate hierarchies for the 13 motor items and for the 5 cognition items. Subsequent analyses demonstrated five distinct patterns for the 13 motor items of: brain dysfunction, orthopedic conditions, pain conditions, ambulatory spinal cord dysfunction, and wheelchair users with spinal cord dysfunction. Two patterns were identified for cognition: stroke with right body hemiparesis and all others. For outpatients, the BMC measure of physical functioning is used to demonstrate that pathophysiologic conditions are expected to affect the hierarchial pattern of items differently. This was noted to be the case for persons with lower body dysfunction, low back pain, and neck pain/upper limb dysfunction. Based upon the item responses, sitting, reaching and standing appear to represent items most useful for discriminating between the three conditions in terms of the functional consequences. Rasch analysis, among other advantages, enables investigation of the subtle relationships among items and is a useful method to evaluate underlying biological patterns of disability. A clinician, using a map that shows the expected relationships between item scores, may observe that a particular patient matches or does not match the expected pattern. Such insights may help the clinician in monitoring the responses of the patient to treatment efforts.
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PMID:Biologic patterns of disability. 1127 19

Stroke is the major cause of adult brain dysfunction. In an experimental approach to evaluate the possible beneficial effects of administration of neurotrophic factors in stroke, we have used a model of distal middle cerebral artery (MCA) occlusion in adult rats. In this model, we found: (1) a permanent reduction of brain-derived neurotrophic factor (BDNF) and its full-length receptor, TrkB, in the infarcted core; (2) a transient increase in BDNF immunoreactivity in the internal region of the border of the infarct (penumbra area) at 12 h after MCA occlusion; (3) increased truncated TrkB immunoreactivity in astrocytes surrounding the area of the infarction; and (4) increased full-length TrkB immunoreactivity in scattered neurons, distant from the infarct, in ipsilateral and contralateral cortices at 24 and 48 h after MCA occlusion. We next studied the regulation of TrkB expression by BDNF, after ischemia, and its neuroprotective effects in vivo. In control non-ischemic rats, grafting of mock- or BDNF-transfected fibroblasts (F3A-MT or F3N-BDNF cell lines, respectively) in the medial part of the somatosensory cortex increased truncated TrkB immunoreactivity in neighboring astrocytes. Grafting alone also increased full-length TrkB in the vicinity of the mock graft (at 24 and 48 h) and the BDNF-grafted graft (at 4 days). Interestingly, ischemic animals grafted with the mock-transfected cell line did not show any further regulation of TrkB receptors. However, ischemic animals grafted with the BDNF cell line showed an up-regulation of full-length TrkB expression in neurons located in the internal border of the infarct. Analysis of nuclear DNA fragmentation in situ, combined with microtubule-associated protein 2 immunohistochemistry, revealed that most cells dying in the borders of the infarct (penumbra area) at 48 h following MCA occlusion were neurons. No differences in the infarct size were found between MCA occluded, mock-transfected MCA-occluded, and BDNF-transfected MCA-occluded rats. Moreover, cell death was similar in nongrafted and mock-grafted rats subjected to MCA occlusion. However, the number of cells with nuclear DNA breaks was significantly reduced in the penumbra area close to the BDNF graft in ischemic rats. Thus, our results show that BDNF specifically up-regulates its full-length TrkB receptor in cortical neurons of the penumbra area and prevents their death in an in vivo model of focal ischemia.
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PMID:Brain-derived neurotrophic factor reduces cortical cell death by ischemia after middle cerebral artery occlusion in the rat. 1130 22

The brain mediates and integrates all cognitive activities, emotional experiences and finally behaviours. Stroke is undoubtedly a privileged disease for human behavioural studies, because of its high incidence. Recent advances in high-resolution magnetic resonance imaging techniques and functional neuroimaging allow both the precise localization of lesions and on-line visualization of the activity of cerebral areas and networks. Nevertheless, the neuropsychiatry of stroke remains uncertain in its relationship with brain dysfunction. Clinical studies on registry populations, single case studies, and functional neuroimaging data provide interesting findings, but differences in methods and great individual intervariability still prevent a complete understanding of emotional perception and behavioural responses in stroke. We adopted an anatomical-functional model as an operational framework in order to systematize the recent literature on emotional, behavioural and mood changes after stroke. The dysfunction of the areas subserving fundamental and executive functions induces behavioural and affective changes (such as depression, anxiety, apathy) that reflect the dysfunction of the whole system. Conversely, lesions in the system of instrumental functions induce signature syndromes (aphasia, anosognosia). At any delay from stroke, the diagnosis and treatment of mood and behavioural changes are a priority for clinicians and healthcare professionals to improve the quality of life of patients.
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PMID:Emotions, behaviours and mood changes in stroke. 1179 52

There is evidence that object-location memory consists of three separate processes, that is, positional memory, binding of objects to locations, and a possible integration mechanism. A group of 26 patients with lesions following ischaemic stroke was studied to find evidence for selective impairments in these three processes using displays with pictures of everyday objects on different locations. Moreover, object-recognition memory and visuospatial construction was assessed. The Corsi Block-Tapping Task and Oxford Stylus Maze Test were included as standard spatial-memory tests. The results showed that of these 26 patients, 8 patients had selective impairments in the aforementioned object-location memory task conditions (both after immediate and delayed testing). These data further support the existence of separate cognitive processes within memory for object locations that can be selectively affected by cerebral dysfunction.
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PMID:Selective impairments in spatial memory after ischaemic stroke. 1193 30

Aniracetam is a pyrrolidinone-type cognition enhancer that has been clinically used in the treatment of behavioral and psychological symptoms of dementia following stroke and in Alzheimer's disease. New discoveries in the behavioral pharmacology, biochemistry and pharmacokinetics of aniracetam provided new indications for this drug in the treatment of various CNS disorders or disease states. This article reviews these new findings and describes the effects of aniracetam in various rodent models of mental function impairment or cerebral dysfunction. Also, several metabolites of aniracetam have been reported to affect learning and memory in animals. It is, therefore, conceivable that major metabolites of aniracetam contribute to its pharmacological effects. The animal models, used in pharmacological evaluation of aniracetam included models of hypoattention, hypovigilance-arousal, impulsiveness, hyperactivity, fear and anxiety, depression, impaired rapid-eye movement sleep, disturbed temporal regulation, behavioral performance, and bladder hyperactivity. These are models of clinical disorders or symptoms that may include personality disorders, anxiety, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, autism, negative symptoms of schizophrenia, and sleep disorders. At present, there is no convincing evidence that promising effects of aniracetam in the animal models will guarantee its clinical efficacy. It is conceivable, however, that clinical trials will demonstrate beneficial effects of aniracetam in the above listed disease states. New findings regarding the mechanism of action of aniracetam, its central target sites, and its effects on signal transduction are also discussed in this review article.
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PMID:Aniracetam: its novel therapeutic potential in cerebral dysfunctional disorders based on recent pharmacological discoveries. 1207 May 27


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