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

A 64 y/o man experienced during 2 weeks TIA's or TIA's like episodes, once or twice a day, with or without contralateral pain in the head. CT Scans showed peculiar enhanced areas appended to the superior sagittal sinus. Angiography was refused. Twenty-seven months later during mild exertion a left frontal hematoma developed. Among frontal symptoms and signs laconism, abulia and a striking whispering were prominent. Angiography showed a dural arteriovenous fistula draining into cortical veins on the inner aspect of the left hemisphere. The fistula was successfully operated.
Stroke
PMID:A cerebrovascular accident with unusual features. 665 69

The mechanisms of dementia resulting from small deep infarctions are incompletely understood. The thesis underlying the concept of "multi-infarct dementia" is that multiple lesions have a synergistic effect on mental functions, resulting in dementia irrespective of specific location or volume. In this report, we summarize our experience with six patients reported previously along with additional patients examined subsequently, whose clinical features and brain imaging findings allow an alternative formulation for dementia resulting from lacunar stroke. The six initial patients presented with an abrupt change in behavior after acute infarction involving the inferior genu of the internal capsule documented by computed tomography (CT) and magnetic resonance imaging (MRI). The acute syndrome featured fluctuating alertness, inattention, memory loss, apathy, abulia, and psychomotor retardation suggesting frontal lobe dysfunction. Contralateral hemiparesis and dysarthria were generally mild, except when the infarct extended into the posterior limb. Neuropsychological testing in five patients with left-sided infarcts revealed severe verbal memory loss. Additional cognitive deficits consistent with dementia were evident in four patients. A right-sided infarct caused transient impairment in visuospatial memory. Functional brain imaging in three patients using 133xenon regional cerebral blood flow (rCBF) and single photon emission computed tomography (SPECT) showed focal reduction in hemispheric perfusion most prominent in the ipsilateral inferior and medial frontal cortex. Perfusion was also defective in the medial and laterial temporal cortex. Important pathways of the limbic system traverse the inferior capsule in the region of the genu. Corticothalamic and thalamocortical fibers form the thalamic peduncles which detach from the internal capsule and enter the thalamus at its rostral and caudal poles and along its dorsal surface. The anterior thalamic peduncle, conveys reciprocal connections between the dorsomedial nucleus and the cingulate gyrus, as well as the prefrontal and orbitofrontal cortex. The inferior thalamic peduncle carries fibers which connect the thalamus with orbitofrontal, insular, and temporal cortex, as well as the amygdala via the ansa peduncularis to the ventral amygdalofugal pathway. Thus, damage to one or both white-matter tracts may occur with infarctions in the region of the inferior genu, causing striking frontal behavioral effects and memory loss in our patients associated with functional deactivation of the ipsilateral frontal and temporal cortex.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Strategic infarcts in vascular dementia. A clinical and brain imaging experience. 776 29

A patient with polycythaemia rubra vera is described, presenting primarily with symptoms attributed to depression. While in the ward she developed a stroke, confirmed on CT scan of the head. Venesection alone produced marked improvement in her neurological and psychiatric symptoms. The clinical picture corresponds most accurately to the neurological syndrome of abulia, which is an important differential diagnosis of depression with psychomotor retardation. The pathophysiology of impaired cerebral blood flow causing neuropsychiatric symptoms in polycythaemia is discussed.
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PMID:Polycythaemia rubra vera presenting with depression: recognising the syndrome abulia. 777 54

We investigated the clinical profile, etiological factors, neuropsychological features and radiological characteristics of 17 cases of striatocapsular infarction (SCI). SCI was defined as the following CT criteria: the area of infarction included the internal capsule and striatum, the maximum diameter of the lesion exceeded 2.0 cm without cortical involvement. There were 9 men and 8 women with mean age of 58 years. Five patients had lesions mainly involving the caudate head (anterior type) and the other 12 had lesions mainly involving the putamen (lateral type), 6 with left side lesion and 6 with right side lesion. Motor weakness was observed in all patients, and the upper extremities were preferentially involved, while in 9 patients face, upper and lower extremities were simultaneously involved. Etiological investigation revealed that 8 patients were cardioembolic stroke, 2 were artery-to-artery embolism and 2 were MCA stem occlusive disease, while the remaining 5 were undetermined. When compared with patients with lacunar infarction (LI), patients with SCI had significantly more frequent cardioembolic sources (47% vs 17%, p < 0.05) and less frequent hypertension (41% vs 80%, p < 0.01). In acute phase, neuropsychological abnormalities were found in 15 patients. Anterior type patients had psychiatric symptoms such as abulia, depression and agitation, while left lateral type patients had aphasia and right lateral type patients had hemispatial neglect or anosognosia. These symptoms gradually improved, although in most patients subtle abnormalities lasted over chronic phase. In 11 out of 13 patients who underwent SPECT using 99mTc-HMPAO, blood flow was decreased in overlying cerebral cortex besides the infarcted area.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical investigation of striatocapsular infarction]. 833 92

There are two basic approaches to cognitive training: (1) impairment training and (2) task specific training. Impairment training addresses impairments common to a number of tasks and attempts to offer a general benefit to all of the tasks at once. Task specific training focuses on the impairments that arise in a single task and attempts to improve performance on that task. Impairment training of spatial disorders following right hemisphere stroke has shown some success when curricula are properly designed. The success, however, is quite limited because of normal cognitive constraints and those occurring after brain damage. Task specific training in conjunction with the combined application of various cognitive principles appears more promising, but as yet, only a few studies exist. The neurologic factors are likely to be the same factors that influence recovery. The factors that influence trainability are lesion topography (size and location of the focus plus premorbid atrophy), lesion chronicity, and the presence of additional cognitive impairments (anosognosia, confusion, and abulia). Other interventions that may be beneficial, even for training resistant patients, include behavior modification, cognitive prostheses, and drugs.
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PMID:Elements of cognitive rehabilitation after right hemisphere stroke. 844 73

Caudate strokes comprise only a small proportion of all subtypes of strokes. Bilateral caudate infarcts are even rarer and only a few cases have been reported in the literature. We report an 86-year-old woman with bilateral caudate infarcts. She had no past medical history of note. She presented with headache for several days and drowsiness on day of admission. Clinical examination revealed abulia, inability to comprehend or verbalize (acute mutism), right-sided neglect and right-sided hemiparesis. Computed tomographic (CT) scan brain revealed decreased attenuation in both heads of both caudate nuclei with extension across the anterior limb of both internal capsules to involve the lentiform nuclei. Echocardiography showed aortic valve sclerosis, mild mitral and aortic regurgitation and normal left ventricular function. Carotid ultrasound revealed mild stenosis of proximal right internal carotid and left distal common carotid and adjacent proximal internal carotid arteries. She showed initial improvement in the first week, but subsequently had a progressive downward course despite rehabilitation and died 44 days after her stroke. A patient with bilateral caudate infarcts is likely to have poor prognosis for rehabilitation and survival.
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PMID:Bilateral caudate infarct--a case report. 1056 73

Cognitive syndromes are common clinical manifestations of hyperacute stroke and may be the single or dominant presenting features. They are related to acute dysfunction of complex integrated distributed functional networks serving different cognitive domains. The most common cortical syndromes include nonfluent or fluent aphasia, neglect, collor agnosia, pure alexia and Balint's syndrome. Disturbances of declarative memory are common following posterior cerebral artery and thalamic strokes. Abulia can follow thalamic, caudate and capsular lesions. Intraventricular and subarachnoid haemorrhages can cause preeminent neuropsychological changes. Disorientation is present in about 40% of acute stroke patients and delirium complicates the course of 25% of acute strokes. Some hyperacute cognitive stroke syndromes are useful indicators of later disability. Cognitive syndromes may pose special difficulties to neurology residents, unless formal teaching in neuropsychology and psychiatry is included in their training programs.
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PMID:Hyperacute cognitive stroke syndromes. 1169 19

Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome.
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PMID:Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis. 1564 27

Abulia, akinetic mutism, and other conditions causing reduced activity and slowness are a continuum of severity of behavior. Unilateral lesions usually cause transient symptoms. This article describes a patient with prolonged abulia lasting 12 weeks after aspontaneous left putaminal hemorrhage. He developed seizures that could be a contributing factor. The pathophysiologic mechanisms are discussed.
J Stroke Cerebrovasc Dis
PMID:Prolonged abulia following putaminal hemorrhage. 1790 6

We describe a patient with ascending tetraparesis following stroke. The patient presented initially with spastic paraparesis which acutely evolved to tetraparesis with abulia. Magnetic resonance imaging revealed acute infarctions in the bilateral medial frontal regions but not in the brainstem or spinal cord. Multiple infarctions in the anterior cerebral artery territory appeared to originate from artery to artery embolism. The present case provides distinct clinical features of anterior cerebral artery syndrome which mimic myelopathy or brainstem lesions.
J Stroke Cerebrovasc Dis
PMID:Anterior cerebral artery territory infarctions presenting with ascending tetraparesis. 1790 56


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