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

A 55-year-old man having hemiplegia after the sudden onset of a stroke was referred for rehabilitation. Cerebral angiography had demonstrated occlusion of the left middle cerebral artery and steroid therapy had been started. Attempted tapering of the steroid therapy on admission for rehabilitation resulted in the patient having severe headaches and confusion. Blink reflex evaluation, somatosensory cerebral evoked potential determinations and visual evoked responses were all consistent with a widespread process involving the parietal lobe of the patient's left cerebral hemisphere. Computerized axial tomography indicated an abnormality consistent with a space-occupying lesion. Craniotomy revealed the presence of a glioblastoma multiforme in the left cerebral hemisphere. Electrodiagnostic evaluation was entirely consistent with the operative finding of widespread involvement of the patient's left parietal lobe. Stroke patients whose conditions deteriorate over time must be serially evaluated in order to determine possible other causes of their symptoms.
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PMID:Glioblastoma multiforme presenting as stroke: an electrophysiological and clinicopathological case report. 22 22

Brain hemorrhage from an intracranial tumor was encountered in 7 males and 6 females during a 4-year period. In 5 patients, hemorrhage was responsible for the first signs of a previously unsuspected neoplasm. The intracranial lesion was demonstrated by computed tomography (CT scanning) in each patient. Characteristic CT scan findings included: a neoplastic core (high or low density); small, multifocal clots usually at the margin of the tumor; and, surrounding, often extensive, edema. Enhancement of the tumor tissue with intravenous injection of 60% Hypaque was observed in the 8 patients so studied. The regions which were enhanced had a peripheral distribution corresponding to the site of hemorrhage. Microscopic examination demonstrated 7 glioblastoma multiforme, 1 oligodendroglioma, 4 metastatic carcinomas (including 1 each of bronchogenic carcinoma, melanoma, hypernephroma, and adrenal carcinoma), and 1 hemangiopericytoma. High-grade malignancy and extensive, abnormal vascularity appeared to be predisposing factors.
Stroke
PMID:Brain hemorrhage from intracranial tumor. 46 14

Ten patients with symptomatic peritumoral hemorrhage were analyzed. The neoplasms included glioblastoma multiforme (9 cases) and oligodendroglioma (1 case). Two presented with stroke syndromes and initial CT showed an intracerebral nonenhancing hematoma. There was clinical improvement with CT evidence of resolution of the hematoma; however clinical deterioration occurred within 4-6 weeks and CT findings were consistent with an enhancing neoplasm. Eight patients had the sudden onset of neurological symptoms. The neurological deficit subsequently stabilized (2 cases) or worsened (6 cases). Initial CT showed evidence of an intracerebral hemorrhage on the noncontrast scan with evidence of heterogeneous ring enhancement on the post-contrast CT scan.
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PMID:Hemorrhagic primary intracranial neoplasms: clinical-computed tomographic correlations. 301 55

Several months after onset of typical stroke syndromes, two patients were found to harbor a glioblastoma multiforme in the area of infarction. Arteriographic and late CT studies suggested that one neoplasm caused parenchymal compressive occlusion of a sylvian branch mimicking embolism and the other entwined the origin of the middle cerebral artery in the leptomeninges simulating atherothrombosis.
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PMID:Stroke associated with glioblastoma. 384 81

Seven autopsy cases of shoulder-hand syndrome following hemiplegia were studied with regard to cerebral localization. One of them showed an isolated brain lesion in the premotor area due to a metastasis from malignant melanoma. Four other cases with cerebral infarction and one with glioblastoma multiforme showed massive brain lesions involving the frontal and parietal lobe cortex in the area supplied by the middle cerebral artery. The seventh case showed a hemorrhagic cerebral lesion in the lentiform nucleus. The most common overlap area in 6 of the 7 cases was located in the premotor region including the anterior part of the motor region. The shoulder-hand syndrome following hemiplegia always develops on the side contralateral to the brain lesion which might cause a unilateral longstanding autonomic dysfunction. As corroborated in a review of the relevant literature, a lesion in the premotor area appears chiefly responsible for the primary mechanism of the shoulder-hand syndrome in post-stroke hemiplegia.
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PMID:Posthemiplegic shoulder-hand syndrome, with special reference to related cerebral localization. 615 86

The contributions of Arthur Elvidge (1899-1985), Wilder Penfield's first neurosurgical recruit, to the development of neurosurgery have been relatively neglected, although his work in brain tumors extended the previous work of Percival Bailey and Harvey Cushing. He published rigorous correlations of clinical and histological information and formulated a revised, modern nosology for neuroepithelial tumors, including a modern histological definition of glioblastoma multiforme. Well ahead of his time, he believed that glioblastoma was not strictly localized and was the first to comment that the tumor frequently showed "satellitosis." He was the first neurosurgeon in North America to use angiography as a radiographic aid in the diagnosis of cerebrovascular disease. Having studied with Egas Moniz, he was the first to detail the use of angiographic examinations specifically for demonstrating cerebrovascular disorders, believing that it would make possible routine surgery of the intracranial blood vessels. Seeking to visualize all phases of angiography, he was the impetus behind the design of one of the first semi-automatic film changers. Elvidge and Egas Moniz made the first observations on thrombosis of the carotid vessels independently of each other. Elvidge elucidated the significance of embolic stroke and commented on the ischemic sequelae of subarachnoid hemorrhage. Besides his contributions to neurosurgery, he codiscovered the mode of transmission of poliomyelitis. Elvidge's soft-spoken manner, his dry wit and candor, mastery of the understatement, love of exotic travel, and consummate dedication to neurosurgery made him a favorite of patients, neurosurgery residents, nurses, and other hospital staff. His accomplishments and example as teacher and physician have become part of neurosurgery's growing legacy.
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PMID:Arthur Roland Elvidge (1899-1985): contributions to the diagnosis of brain tumors and cerebrovascular disease. 942 95

Elevated levels of extracellular glutamate ([Glu]o) cause uncontrolled Ca2+ increases in most neurons and are believed to mediate excitotoxic brain injury following stroke and other nervous system insults. In the normal brain, [Glu]o is tightly controlled by uptake into astrocytes. Because the vast majority of primary brain tumors (gliomas) are derived from astrocytes, we investigated glutamate uptake in glioma cells surgically isolated from glioma patients (glioblastoma multiforme) and in seven established human glioma cell lines, including STTG-1, D-54 MG, D-65 MG, U-373 MG, U-138 MG, U-251 MG, and CH-235 MG. All glioma cells studied showed impaired glutamate uptake, with a Vmax < 10% that of normal astrocytes. Moreover, rather than removing glutamate from the extracellular fluid, glioma cells release large amounts of glutamate, resulting in elevations of [Glu]o in excess of 100 microM within hours in a space that is 1000-fold larger than the cellular volume. Exposure of cultured hippocampal neurons to glioma-conditioned medium elicited sustained [Ca2+]i elevations that were followed by widespread neuronal death. Similarly, coculturing of hippocampal neurons and glioma cells, either with or without direct contact, resulted in neuronal death. Glioma-induced neuronal death could be completely prevented by treating neurons with the N-methyl-D-aspartate receptor antagonists MK-801/D(-)-2-amino-5-phosphonopentanoic acid or by depletion of glutamate from the medium. Interestingly, several phenylglycine derivatives including the metabotropic glutamate receptor agonist/antagonist (S)-4-carboxyphenylglycine (S-4CPG) potently and selectively inhibited glutamate release from glioma cells and prevented neurotoxicity. These data suggest that growing glioma tumors may actively kill surrounding neuronal cells through the release of glutamate. This glutamate release may also be responsible in part for tumor-associated seizures that occur frequently in conjunction with glioma. These data also suggest that neurotoxic release of glutamate by gliomas may be prevented by phenylglycine derivatives, which may thus be useful as an adjuvant treatment for brain tumors.
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PMID:Glioma cells release excitotoxic concentrations of glutamate. 1048 87

The purpose of this study was to examine for gender-related differences in activities of daily living (ADL) and lifestyle of elderly persons living at home, and to support our hypothesis that the gender-related difference in lifestyle of stroke patients derives from their lifestyle prior to the stroke. Participants were randomly sampled elderly persons living at home. Questionnaire sheets including subject profile, Self-Rating Barthel Index (disability index), and Self-Rating Frenchay Activities Index (activity index) were mailed and collected, and the data were analyzed with the t-test and General Linear Model (factorial model with interaction). A total of 752 subjects were recruited, and their average age was 67.1 years. No significant gender-related differences were evident in the disability index including self-care and mobility domains (t-test, P > 0.05). In contrast gender-related differences in the activity index were significant (t-test, P < 0.05) for three factors; gender, age group, and living conditions, and in a covariate disability index (GLM, P < 0.05). Because randomly selected elderly persons in this study exhibited a prominent gender-related difference in lifestyle, we believe the lifestyle difference in stroke patients that we have previously described derives primarily from their premorbid attitude to daily life.
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PMID:Gender-related differences in scores of the Barthel Index and Frenchay activities index in randomly sampled elderly persons living at home in Japan. 1052 3

Discriminating brain tumor from stroke in patients presenting with acute focal neurologic signs and symptoms is crucial to avoid improper treatment, or delay correct treatment of the brain tumor patient. Data from the era before computed tomography (CT) suggests that 3% of patients with brain tumors are initially thought to have had a stroke. Our goal was to see if this has improved in the CT era. We reviewed hospital charts of all patients admitted to the Johns Hopkins Hospital with a brain tumor during a one year period. Eleven (4.9%) of the 224 patients discharged with a diagnosis of brain tumor were initially thought to have had a stroke. Seven had primary brain tumors and 4 had metastatic tumors. Patients who were originally misdiagnosed were significantly older (p = 0.01) and more likely to have a Glioblastoma Multiforme (p = 0.04) than those correctly diagnosed. Eighty-two percent of those misdiagnosed had no prior history of cancer compared to 59% of patients correctly diagnosed. Distinguishing the acute presentation of brain tumor and stroke remains an important diagnostic consideration. Physicians should recognize that while CT is frequently employed for acute neurologic deficits to exclude intracranial hemorrhage, CT may not be sufficient to exclude brain tumor. A prospective study is needed to confirm these findings.
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PMID:Brain tumor masquerading as stroke. 1058 68

Sometimes, the clinical presentation of a brain tumour mimics that of stroke or vice versa, as exemplified in the following three patients. In a 73-year-old patient the initial clinical picture was compatible with a brachial plexus lesion, as the weakness in his right hand appeared to have a traumatic, and not a central nervous system related, cause. When he experienced a focal seizure, the CT scan of the brain revealed a lesion in the motor cortex. This was presumed to be an infarction due to the lack of mass effect and the absence of contrast enhancement. Shortly afterwards the patient deteriorated and a follow-up scan revealed a large contrast-enhancing lesion. During surgery this proved to be a glioblastoma multiforme. A 76-year-old man was suffering from a progressive neurological deficit. An MRI scan of the brain revealed a contrast-enhancing lesion and a chest X-ray revealed an asymptomatic lung tumour; the diagnosis 'brain metastasis' was made. The surgeon removed the lung tumour, which proved to be a carcinoma. Later, when the patient was referred to the neurosurgeon for extirpation of the presumed brain metastasis, the MRI scan revealed that the lesion had decreased in size and no longer exhibited contrast enhancement. The metastasis proved to be an infarction. A 53-year-old man presented with sudden loss of consciousness due to a haemorrhage in the occipital lobe. An angiogram did not reveal a vascular malformation and during surgery no abnormal tissue was seen. The patient almost made a complete recovery. However, several months later he developed an elevated intracranial pressure due to a large occipital high-grade glioma, which had caused the original haemorrhage.
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PMID:[Brain tumor or stroke?]. 1137 93


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