Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aims of this prospective study were to investigate levels of anxiety and depression in patients with a solitary intracranial neoplasm before and after surgery, and to determine if relationships exist between high levels of anxiety or depression and the hemispheric location of the tumour, the tumour type or patient gender. Patients aged between 17 and 79 years with a solitary intracranial neoplasm completed the Hospital Anxiety and Depression Scale (HAD) before and after biopsy or resective tumour surgery. A control group of non-brain-damaged subjects also completed the HAD before and after lumbar spinal surgery. Of the 109 patients with a brain tumour 30 and 16% demonstrated the likely presence of anxiety and depression, respectively, according to HAD scoring criteria. A greater proportion of females with a left hemisphere tumour reported higher levels of emotional disturbance than any other group of patients; relationships between dysphasia and levels of anxiety or depression were not significant. Patients with a meningioma had higher levels of anxiety and depression as measured by the HAD than those with any other tumour types. Levels of both anxiety and depression were significantly lower after tumour surgery according to the HAD. There were no significant differences in HAD scores between (a) left and right hemispheric tumour groups, and (b) the tumour and control (n = 20) groups. This study has found that anxiety and depression as measured by the HAD are relatively uncommon in patients with an intracranial neoplasm, and that levels of mood disturbance do not differ significantly from those in patients undergoing lumbar spinal surgery. Levels of anxiety and depression become lower after surgery in patients with a brain tumour. Patterns of anxiety and depression in patients with a brain tumour appear to differ from those reported in stroke.
 ...
PMID:Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. 1049 84

The thalamus is a relay center for afferent sensory pathways that regulates and transmits peripheral stimulation to various representative areas of the cortex. Aphasia, neglect and anosognosia were also reported to occur after thalamic lesions, in the absence of cortical pathology. However, considerable controversy exists as to the pathogenetic mechanisms, and incidence of cognitive abnormalities following thalamic lesions. We present a series of sixteen consecutive stroke patients with thalamic stroke (n=12) or hemorrhage (n=4), admitted to a university based neurology department. Dysphasia was observed in seven of eight patients with left thalamic strokes (five in the territory of the tuberothalamic artery, two inferior-lateral thalamic lesions and one in the area supplied by the anterior choroidal artery). Neglect and anosognosia appeared in five of eight patients with right side thalamic insults (two each in the territories of the tuberothalamic and thalamogeniculate arteries and one in the area supplied by the posterior choroidal artery). These findings reconfirm those found in previous studies and suggest that the thalamus is part of an integral neuronal network concerned with cognitive functions.
 ...
PMID:Cognitive dysfunction following thalamic stroke: a study of 16 cases and review of the literature. 1062 Jun 56

We have used functional magnetic resonance imaging (fMRI) to characterize brain activations associated with two distinct language tasks performed by a 28-year-old woman after partial recovery from dysphasia due to a left frontal hemispheric ischemic stroke. MRI showed that her ischemic lesion extended posteriorly from the left inferior frontal to the perisylvian cortex. fMRI scans of both language tasks revealed substantial differences in activation pattern relative to controls. The nature of this difference was task-specific. During performance of a verbal semantic decision task, the patient, in contrast to controls, activated a network of brain areas that excluded the inferior frontal gyrus (in either hemisphere). A second task involving rhyme judgment was designed to place a heavier cognitive load on language production processes and activated the left inferior frontal gyrus (Broca's area) strongly in normal controls. During this task, the most prominent frontal activation in the patient occurred in the right homologue of Broca's area. Subsequent analysis of this data by methods able to deal with responses of changing amplitude revealed additional, less sustained recruitment by the patient of cortex adjacent to the infarct in the region inferior to Broca's area during rhyming. These results suggest that in addition to changes in cognitive strategy, recovery from dysphasia could be mediated by both the preservation of neuronal networks in and around the infarct and the use of homologous regions in the contralateral hemisphere.
 ...
PMID:Using fMRI to study recovery from acquired dysphasia. 1071 69

A 6-month follow-up of a single-blind, randomized, controlled trial in Southwest Stockholm was performed in order to evaluate the effect of early supported discharge and continued rehabilitation at home after stroke. Eighty-three stroke patients with moderate neurological impairments, continent, independent in feeding, and mental function within normal limits one week after onset were included in the study. The patients were allocated 1:1 to early supported discharge and continued rehabilitation at home by a specialized team, versus routine rehabilitation. Patient outcomes measured were motor capacity, dysphasia, activities of daily living, social activities, perceived dysfunction, mortality and reported falls. Data on length of stay in hospital; initial and recurrent during 6 months were compared. The 6-month follow-up of 78 patients showed no statistically significant differences in patient outcome. The results of multivariate logistic regression analysis suggest a positive effect of home rehabilitation on activities of daily living. At 3-6 months the frequency of significant improvements was higher in the intervention group. Death or dependency in activities of daily living was 24% in the intervention group compared with 44% in the control group. The mean initial hospitalization was 29 days in routine rehabilitation group versus 14 days in the home rehabilitation group. We conclude that for moderately disabled stroke patients with mental function within normal limits, early supported discharge and continued rehabilitation at home had no less a beneficial effect on patient outcome than routine rehabilitation, reduced initial hospitalization significantly and had no adverse effects on mortality and number of falls.
 ...
PMID:A randomized controlled trial of rehabilitation at home after stroke in Southwest Stockholm: outcome at six months. 1085 22

In measuring the progression of, or recovery from, a disease an individual's outcome may be assessed on a number of occasions. A model of the relationship between outcome and time since disease occurred which accounts for patient characteristics could be used to describe patterns of recovery, to predict outcome for a patient, or to evaluate health interventions. We use multilevel models to analyse such data, focusing on the choice of powers of time both for mean outcome and covariate effects. We give equations for predicted outcome and corresponding standard errors (i) based only on baseline characteristics, and (ii) by conditioning on previous outcomes for an individual. In a study of 331 stroke patients, outcome was measured approximately 0, 2,4,6 and 12 months after stroke. Patient characteristics included age, sex, and pre-stroke handicap, together with stroke-severity indicators (presence of limb deficit, dysphasia, dysarthria or incontinence). Of these, only the effects of age, dysphasia and presence of deficit varied with time. Conditioning on previous observations improved the accuracy of predictions. The outcome variable clearly had a skewed distribution, and the model residuals showed evidence of non-Normality. We discuss alternative models for non-Normal data, and show that, here, the standard (Normal errors) multilevel model gives equivalent parameter estimates and predictions to those obtained from alternative models.
 ...
PMID:Multilevel growth curve models with covariate effects: application to recovery after stroke. 1124 71

The authors' Survey of headache specialists highlights a number of controversial issues in migraine management including the following: acute treatment, focusing on use of triptans, and preventative medications; treatment of migraine with prolonged aura and basilar migraine; and the use of oral contraceptives in migraine. Interestingly, the prevalence of migraine among the headache specialists themselves is much higher than in the general population. Although triptans have revolutionized the acute treatment of migraine, treatment is still problematic for the sizable percentages of patients with an incomplete or no response and recurrence of headache. Triptans are generally very safe when the physician, aware of the potential for coronary artery vasoconstriction, appropriately screens patients before and during their use. Serotonin syndrome as a complication of triptan use is quite rare. Although there is no definite evidence of teratogenesis, triptans should not be taken during pregnancy unless the potential benefit justifies the potential risk to the fetus. Caution is also advised when using a triptan during breastfeeding. The United States Headache Consortium parameters, which consider indications for preventative treatment and propose general principles of management, are reviewed. Unfortunately, the experience of many migraineurs with preventative medications is less than satisfactory because of side effects or lack of efficacy. Treatment of both migraine with prolonged aura and basilar migraine is anecdotally based. Many headache specialists do not use beta blockers for prevention for those with prolonged aura and basilar migraines because of concerns over the potential limitation of compensatory vasodilatory capacitance. There are seven case reports in the literature of an association between stroke and the use of beta blockers in migraineurs. Prevention using divalproex sodium and verapamil is favored by many headache specialists. Triptans are contraindicated in the treatment of patients with hemiplegic or basilar migraine because of concern over the potential for cerebral vasoconstriction. The frequency of migraine is usually unchanged with the use of oral contraceptives although, occasionally, migraine may occur for the first time or increase in frequency. Studies have produced conflicting results as to whether low-dose estrogen oral contraception increases the risk of stroke. Migraine alone increases the risk of stroke, at least in women under the age of 45 years. Most women with migraine without aura and migraine with visual aura lasting less than 1 hour can safely use low-dose estrogen oral contraceptives when there are no other contraindications. Those with aura symptoms such as hemiparesis or dysphasia or prolonged focal neurologic symptoms and signs lasting more than 1 hour should avoid starting low-dose estrogen oral contraceptives and stop the medication if they are already taking it.
 ...
PMID:Topics in migraine management: a survey of headache specialists highlights some controversies. 1147 58

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.
 ...
PMID:[Acute language disorder in elderly patients: ischemic or epileptic origin?]. 1174 26

We present a patient (PW) with non-fluent progressive aphasia, characterized by severe word finding difficulties and frequent phonemic paraphasias in spontaneous speech. It has been suggested that such patients have insufficient access to phonological information for output and cannot construct the appropriate sequence of selected phonemes for articulation. Consistent with such a proposal, we found that PW was impaired on a variety of verbal tasks that demand access to phonological representations (reading, repetition, confrontational naming and rhyme judgement); she also demonstrated poor performance on syntactic and grammatical processing tasks. However, examination of PW's repetition performance also revealed that she made semantic paraphasias and that her performance was influenced by imageability and lexical status. Her auditory-verbal short-term memory was also severely compromised. These features are consistent with 'deep dysphasia', a disorder reported in patients suffering from stroke or cerebrovascular accident, and rarely reported in the context of non-fluent progressive aphasia. PW's pattern of performance is evaluated in terms of current models of both non-fluent progressive aphasia and deep dysphasia.
 ...
PMID:Deep dysphasic performance in non-fluent progressive aphasia: a case study. 1178 39

The aims of this study were to investigate the frequency of dysphagia among patients with acute stroke and compare non-dysphagic and dysphagic stroke patients regarding demographic aspects, performance in activities of daily living and type of neurological deficiency and to test a bedside screening tool to identify patients with dysphagia. The frequency of dysphagia was found to be 27%, or 40% if those patients who were unconscious, terminally ill or had a previous history of dysphagia were included. Overall stroke severity seemed to be an indicator for dysphagia, i.e. being significantly more drowsy, more dependent in activities of daily living, suffering more often from dysarthria, expressive dysphasia, taking antidepressive medication, staying significantly longer in hospital and being discharged to a higher level of formal care than non-dysphagic patients. The screening method proved to be useful, in that it detected 77% of those with dysphagia using a review of medical charts and continuous observations as a method to check the reliability of the bedside method. It is concluded that most patients with dysphagia can be identified through systematic interviews, observations and test swallows. These have to be repeated and included in nursing care assessment. Overall stroke severity is an indicator of dysphagia.
 ...
PMID:Nursing assessment of dysphagia among patients with stroke. 1203 25

Noonan syndrome is an autosomal-dominant inherited syndrome with variable expression of multiple malformations including cardiovascular and craniofacial anomalies. While cerebrovascular insults due to cardiogenic emboli, coagulation abnormalities or cerebrovascular malformations have been documented before, intracerebral occlusive artery disease is not well recognized as a cause of stroke in this syndrome. A 6-year-old girl with Noonan syndrome presented with repetitive transient ischemic attacks consisting of dysphasia and right-sided central facial and arm weakness. Neuroimaging showed acute ischemic lesions in the left putamen and caudate nucleus. Multiple intracranial stenoses were found during transcranial Doppler examination and MR angiography. Although hypertrophic cardiomyopathy was documented by transesophageal echocardiography, a cardioembolic origin of the ischemic attacks was unlikely in this case. The symptoms resolved and did not recur after antiplatelet and anticoagulant therapy was initiated. Stenoses of intracranial cerebral arteries should be considered among the causes of stroke in young patients with Noonan syndrome.
 ...
PMID:Cerebral occlusive artery disease in Noonan syndrome. 1218 19


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>