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

Functional hemispherectomy, indicated for the control of pharmacologically refractory seizures, has been used at the Montreal Neurological Hospital since 1974. We have used this technique in 18 children suffering from intractable seizures secondary to conditions such as infantile hemiplegia, chronic encephalitis, head trauma, cerebrovascular accident, brain dysplasia and Sturge-Weber angiomatosis. None has developed superficial cerebral hemosiderosis often seen following the classical anatomical hemispherectomy. Eighty-two per cent (82%) of patients have been seizure-free since hospital discharge while another 11.5% have had at least 80% reduction in their seizure frequency. Most patients have shown an improvement in their intellectual capacity and sociability.
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PMID:Functional hemispherectomy in children. 847 13

We reviewed the medical records of 60 consecutive patients (28 men and 32 women; aged from 13 to 63 years) with the diagnosis of dissection of the internal carotid artery (ICA), and with available clinical and neurosonological follow-up. Ten cases occurred after trauma and 50 cases were spontaneous. Angiographic evidence of fibromuscular dysplasia of the ICA was found in 23% of the cases. Unilateral headaches or neck pain associated with focal cerebral ischemic symptoms or oculosympathetic palsy were the most common findings. Less frequent symptoms such as isolated cranial nerve palsies and pulsating bruits were also observed. Follow-up ranged from 3 to 144 months (mean, 37.5 months). A favourable outcome occurred in 73.7% of the cases with a follow-up of 6 months or more, and seemed to depend on the severity of the ischemic cerebral deficit associated with the ICA dissection. 68% (41/60 cases) of our patients developed stroke and 18% (11/60 cases) experienced a transient ischemic attack, which occurred as the initial manifestation of the ICA dissection in 28.8% (15/52 cases) of the cases, and with a delay (more than 24 hours) in the other cases. Evidence of embolization in the cerebral arteries was found in 36% of the cases with stroke (15/41 cases). Anticoagulant therapy, given in 34 of our patients, seems to be justified by the fact that a considerable risk exists for cerebral emboli in association with ICA dissections; no serious neurological complications were observed in our series as a result of this anticoagulant therapy. Doppler sonography follow-up diagnosed a recanalization in 67.8% of the stenotic or occlusive dissections, most of them being completed within the first 6 months (92%). Recurrence of ICA dissection is exceptional but occurred in one of our 60 cases, 2.5 years after the first event.
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PMID:Dissection of the internal carotid artery: aetiology, symptomatology, clinical and neurosonological follow-up, and treatment in 60 consecutive cases. 855 96

Foix-Chavany-Marie Syndrome or anterior opercular syndrome constitutes the cortical form of pseudobulbar palsy. Its most common etiology is stroke in the region of either operculum. Clinically it can be characterized by severe dysarthria and facio-pharyngo-glosso-masticatory dysplasia with automatic-voluntary dissociation. An inversion of this classical dissociation can be seen in patients with emotional paralysis in the face, in whom asymmetry of emotional expression but conservation of voluntary movement can be seen. The lesional topography of this inverse dissociation corresponds to the supplementary motor area. both processes support the existence of an anatomical base which is different for emotional movements and voluntary types. We describe the clinical case of a 65 year old woman with a history of breast cancer who presented a subacute and progressive clinical picture of dysphagia and severe dysarthria. Upon neurological examination slight velo-palato-pharyngea was noticed; most relevant was paralysis of the facial muscles for either emotional or automatic movements while voluntary innervation was maintained. Neuroradiological studies show the presence of brain metastasis located in both Roland opercula. Although the neuroanatomic bases for automatic-voluntary dissociation remain unclear, our case lends weight to the evidence that impulses for voluntary and emotional movements originate in different cortical areas or else take a different route through the brain. We have been unable to find any cases of biopercular lesion with inverse dissociation described in the literature we reviewed.
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PMID:[Biopercular lesion with inverse dissociation]. 855 92

Elongation, coiling and/or kinking of the interal carotid artery occur in 10-25% of the population. While coiling of the internal carotid artery is ascribed to embryological causes, elongation and kinking are due to atherosclerosis or fibromuscular dysplasia. Seventy-seven patients with carotid kinking were examined using different diagnostic imaging methods. Of these, 64 underwent surgery because of cerebrovascular symptoms that ranged from local disturbances, vertigo, diplopia and cerebrovascular insufficiency producing ischemic attacks or infarction. The treatment of choice was surgical correction of the carotid kinking in symptomatic cases and, if indicated, endarterectomy of atherosclerotic lesions of the internal carotid artery to prevent ischemic stroke. Because of the anatomical position of the interal carotid artery kink there is a potential risk of complications in head and neck surgery. For this reason, the presence of carotid kinking should be excluded preoperatively by means of non-invasive diagnostic imaging, such as afforded by ultrasonic testing. The merits of the different diagnostic imaging methods to diagnose internal carotid artery disease were compared and discussed.
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PMID:[Current aspects in diagnosis and therapy of carotid artery kinking]. 865 48

Spontaneous dissection of the vertebral artery (VA) is an infrequent cause of vertebral-basilar ischaemia in children and young adults, being responsible for 4% of cases of ischaemic infarct in this age group. The distinction between spontaneous dissection and traumatic dissection helps to clarify its vascular tendency, not brought on by laceration of the vessel wall secondary to traumatism. It appears clinically with neck pain and/or headache, followed by a clinical picture of ischaemia in the vertebral-basilar area. Diagnosis is based on clinical suspicion and identification of the angiographic signs of dissection prognosis is favourable with good recuperation in 88% of cases and low recurrence risk. We present a series of seven patients with ischaemic stroke of the brainstem brought about by spontaneous VA dissection. We studied the patients using computerized tomography (CT) scan, magnetic resonance (MR) and brain angiography. The group comprised six men and one woman aged from 9 to 44 years. In one case localization was intracranial, in five there was earlier arterial pathology (hypoplasia or dysplasia) and in the remaining case dissection was bilateral. After a long-term follow-up of between one and seven years, not one of our patients showed any recurrence of ischaemic signs. We would suggest that spontaneous VA dissection should be considered in differential diagnosis in clinical pictures of vertebral-basilar ischaemia in children and young adults since most probably its frequency is greater than that currently supposed. The discussed data would support underlying arterial pathology as a tendency factor.
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PMID:[Spontaneous dissection of the vertebral artery]. 871 81

Cerebral infarction before the age of 45 years accounts for 4-6% of all strokes. The etiology remains unexplained in a significant proportion of patients even after extensive investigations. The reported risk factors of this age group are cardiopathies, hypertension, smoking, hypercholesterolemia, reduction of anticoagulant proteins, hypercoagulable states, antiphospholipid antibodies primary syndrome, antiphospholipid antibodies secondary syndrome, some hemoglobinopathies, hyperviscosity syndromes, vasculitis, collagen vascular diseases, fibromuscular dysplasia, arterial dissections, migraine, myopathy encephalopathy lactic acidosis stroke like episodes, homocystinuria, familial amyloid angiopathy, microangiopathy with retinopathy encephalopathy and deafness, systemic lupus erythematosus, use of cocaine, traumas or manipulations of neck, AIDS. From 1/1/94 to 04/30/95 we observed 19 patients with cerebral infarctions and 9 patients with transitory ischemic attacks in young people. The aim of our study was to apply a diagnostic protocol by sequential tests of first level and second level. According to this protocol we found that the more common risk factors were ischemic cardiopathy, hypertension, smoking and hypercholesterolemia. Moreover we observed other independent risk factors, although less frequent, like the antiphospholipid antibodies, neurolupus, AIDS, deficit of protein S.
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PMID:[The application of a new diagnostic protocol for stroke in the young]. 876 46

Long-term outcome was studied in 233 patients who had undergone renal artery revascularization (51 with balloon angioplasty, 182 with surgery) between 1976 and 1992. Patients (excluding renal transplants) were treated for renal vascular hypertension without or with renal insufficiency (serum creatinine > 1.6 mg/dl. All patients still alive (n = 188) were contacted to determine current blood pressure, medications, serum creatinine, and subsequent significant medical events. In patients who had died the cause of death was determined and renal function status at the time of death noted from medical records. Some follow-up information was obtained on all 233 patients; follow-up serum creatinine data were obtained in 193 (82.8%) patients. Some 24 patients (10.3%) became dialysis-dependent. Using a multiple logistic regression analysis only, preoperative creatinine maintained significance (P < 0.001) for increased dialysis risk. There was no statistically significant association of dialysis for type of revascularization (percutaneous transluminal angioplasty, autogenous artery, saphenous vein, endarterectomy or synthetic material), simultaneous or previous aortic or other vascular surgery (carotid endarterectomy, femoropopliteal bypass, etc.), pathology (atherosclerosis or fibromuscular dysplasia), number of renal arteries stenosed or treated, length of follow-up, age, coronary artery disease, congestive heart failure, stroke, chronic lung disease or type II diabetes. It is concluded that, in patients with renal artery stenosis, the timing of renal artery revascularization relative to the level of renal function is the most important determinant for long-term renal salvage.
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PMID:Late renal function in patients undergoing renal revascularization for control of hypertension and/or renal preservation. 890 17

A 5-year-old girl presenting with acute middle cerebral artery stroke was diagnosed as having intracranial fibromuscular dysplasia by angiographic findings of focal changes in the proximal right middle cerebral artery and pathological dilatation of the right internal carotid artery at the base of the skull, as well as dissection of at least one of the middle cerebral artery branches and nonfilling of two or perhaps three remaining middle cerebral artery segmental branches. Her clinical condition improved after management of the increased intracranial pressure. She did not receive any medication after discharge and had virtually no residual sequelae. Our case documents an unusual location and age of onset of a patient with fibromuscular dysplasia.
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PMID:Intracranial fibromuscular dysplasia in a 5-year-old child. 896 89

A migranous cerebral infarct (ICM) has the appearance of an ischaemic cerebral lesion which occurs during a migraine crisis and is shown by neuroimaging techniques to be in the corresponding vascular area. Four young patients are described. They fulfilled the clinical and neuroimaging criteria for compatibility with ICM and the protocol for the aetiological study of stroke was normal. Angiography ruled out other causes of ischaemia (dissection, fibromuscular dysplasia, etc.) and showed segmental images of 'vasculitis appearance' similar to these described in Call's syndrome, in 'benign intracranial angiopathy' and in other intracranial vasculopathies or criteria of 'reversible segmental cerebral vasoconstriction'. The pathogenic significance, as with migraine, is still unknown.
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PMID:[Segmental arteriographic anomalies in migranous cerebral infarct]. 914 42

We report on a young man with fibromuscular dysplasia involving the basilar artery detected at autopsy. He presented with sudden onset of stroke, and the lesion was complicated by thrombosis and dissection of the vessel wall. The organizing thrombotic lesion of the basilar artery was responsible for the ventral pontine infarct that resulted in "locked-in syndrome."
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PMID:Fibromuscular dysplasia with dissection of basilar artery presenting as "locked-in-syndrome". 919 74


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