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

Neurologic syndromes often complicate the management of infective endocarditis (IE). We retrospectively reviewed 166 episodes of native valve endocarditis to assess the occurrence and implications of nonfocal encephalopathy, meningitis, salient headache, back pain, and brain abscess. Neurologic complications occurred in 35% (58/166) of patients: 41% (54/133) of mitral or aortic valve IE and 12% (4/33) of tricuspid valve IE. Of 133 cases of mitral or aortic valve IE, encephalopathy occurred in 14%, meningitis in 5%, and salient headache in 3%. All neurologic complications occurred more often with Staphylococcus aureus infection (67%) than with viridans streptococci (22%), including encephalopathy (22% versus 7%), meningitis (17% versus 0%), stroke (39% versus 16%), and death (39% versus 9%). Encephalopathy was associated with virulent organisms, increased patient age, and uncontrolled infection. Clinical, radiologic, and neuropathologic data all suggest that infective microemboli are often etiologic in IE-related encephalopathy. There were no macroscopic brain abscesses clinically identified. Meningitis occurred only with virulent organisms. While many clinical aspects of IE have changed in recent years, the frequency and gravity of neurologic complications have not.
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PMID:Neurologic complications of infective endocarditis. 182 93

In a rehabilitation setting, pulmonary embolism is a relatively frequent and life-threatening complication. Deciding when a patient may be experiencing this condition is difficult, however, because of frequent deficits in patient communication skills (eg, aphasia and cognitive deficits) and the multisystem illnesses affecting many rehabilitation patients. We reviewed the charts of 30 rehabilitation patients transferred emergently during the years 1986 to 1988 with a diagnosis of pulmonary embolism, which was subsequently documented by ventilation-perfusion scanning. The average age of the 30 patients was 65; 63% were women and 20 (67%) had an admitting diagnosis of stroke. The most common new-onset clinical findings in the 24 hours before discharge were unusual facial skin color changes (pale, flushed, or cyanotic) (57%), chest or upper back pain (47%), tachycardia (heart rate more than 100 bpm) (40%), hypoxemia (arterial oxygen saturation less than or equal to 90%) (40%), and fever less than 101F (37%). In 63% of the patients, either anxiety, restlessness, diaphoresis, or dyspnea was also noted in the 24 hours before discharge. The data suggest that careful physician and nursing scrutiny may identify clinical signs characteristic of pulmonary embolism, and that the de novo appearance of these constellations of findings may help to select candidates for ventilation-perfusion scanning.
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PMID:Clinical findings associated with pulmonary embolism in a rehabilitation setting. 185 63

A case of successful surgical treatment of DeBakey IIIb dissecting aortic aneurysm with the true lumen obstruction of the thoracic descending aorta is presented. A 64-year-old male was admitted to our hospital with a complaint of severe chest and back pain. Immediately antihypertension therapy was carried out. But, after 14 days, acute renal failure was occurred by the true lumen obstruction of the thoracic descending aorta. On the 78 days after hospitalization, the flow reversal thromboexclusion by ascending aorta-abdominal aorta bypass and permanent aortic clamping was done. The reasons why this procedure was selected are as follows: 1) widely extended dissection, 2) renal failure, 3) poor pulmonary function, 4) left hemiparesis due to apoplexy. The post-operative course was excellent, paraplegia did not occur and renal function improved very well. The post-operative CT revealed thrombi formation within the thoracic descending aorta.
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PMID:[A case of successful surgical treatment of DeBakey IIIb dissecting aortic aneurysm with the true lumen obstruction of the thoracic descending aorta]. 226 89

The nervous system is frequently involved in patients with infective endocarditis. When a careful review of presenting complaints is undertaken, neurological symptoms have been found in as high as 29% of patients. Because these manifestations may be so protean in nature, for example, stroke or transient ischaemic attack (the most common), toxic encephalopathy, meningitis, brain abscess, visual loss, seizures, headache, backache, or acute mononeuropathy, the neurologist needs to consider infective endocarditis as a possible diagnosis in many patients. During the past two decades, infective endocarditis has occurred in an ever widening clinical setting. It may often be found in persons unknown to have predisposing cardiac disease. This is particularly true in certain subsets of the population, including the elderly, patients subjected to various invasive procedures leading to nosocomial infection, and drug abusers. New diagnostic studies, including refined bacteriological culture techniques, echocardiography, computed tomography, magnetic resonance imaging, and greater availability of skillful cerebral angiography, make earlier diagnosis of infective endocarditis possible. Despite this, patients with neurological complications continue to have an uncertain prognosis.
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PMID:Neurological manifestations of infective endocarditis. Review of clinical and therapeutic challenges. 267 68

Effective management of mechanical back pain in the athlete requires an understanding of the significance of the nature and the location of the pain and which injuries are related to the age or sport of the athlete. Muscle strains and interspinous ligament sprains occur at any age and in all sports. However, the adolescent may have an iliac crest apophysitis rather than a muscle strain, and the gymnast or diver may have interspinous process bursitis or a stress fracture of the pars interarticularis rather than a ligament sprain. Similarly, the swimmer with upper thoracic pain, training in the butterfly stroke, may have Scheuermann's kyphosis, while the weight lifter with upper lumbar pain may have Scheuermann's changes in the lumbar spine. Athletes of all ages with persistent midline lumbar pain may have a disk injury or chronic instability because of a fracture of the vertebral body or posterior elements. If the physician performs the pertinent physical tests described and obtains the appropriate radiographic studies listed, correct diagnosis of the most common causes of mechanical back pain in the athlete will be assured.
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PMID:Mechanical back pain in the athlete. 315 74

The ubiquitous nature of spinal ligamentous calcification in the paleontologic record provides additional support for the suggestion that DISH is a protective phenomenon rather than a musculoskeletal disease, and perhaps represents a normal variant. Clinical assessment of contemporary DISH suggests a protective mechanical effect, paradoxically associated with increased risk of hypertension and cerebrovascular accident. DISH should probably not be considered a satisfactory explanation for back pain, but the presence of spinal ligamentous calcification requires that the patient be assessed for hypertension and that aggressive therapy be instituted for any found.
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PMID:Diffuse idiopathic skeletal hyperostosis. 327 41

During a 40-month period, in 24 of 643 (4%) newly diagnosed patients with systemic cancer younger than 18 years of age (range: 3 months to 17 years) spinal cord disease developed. Patients with spinal cord disease included 21 children with metastatic spinal cord compression, two with treatment-related transverse myelopathies, and one with an anterior spinal artery stroke. Spinal cord disease occurred in 13 of 102 children (12%) with sarcomas, six of 82 (7%) with neuroblastomas, and four of 94 (4%) with lymphomas. Spinal cord compression occurred as the presenting sign of malignancy in six children (four with sarcomas and two with lymphomas). In the remaining 15 patients, cord compression occurred a median of 13 months after initial diagnosis, and in four patients it occurred at the time of first relapse. Symptoms of metastatic cord compression included back pain in 17 patients (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%), and sensory abnormalities in three (14%). Findings on plain radiographs of the spine were abnormal in only seven of 20 patients with cord compression, and myelography was needed to differentiate compression from other causes of spinal cord disease. Treatment included high-dose corticosteroids followed by operation (seven patients) or radiotherapy (14 patients). After treatment, nine of 15 nonambulatory patients became ambulatory, and five of 10 incontinent patients regained sphincter control. None of the patients with nonmetastatic spinal cord disease had a satisfactory outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Incidence, presentation, and outcome of spinal cord disease in children with systemic cancer. 374 77

Three patients with backache, aggravated by swimming the butterfly stroke, were subsequently diagnosed as having Scheuermann's kyphosis. These patients were treated with conventional methods. However, they were allowed additional time out of the brace to participate in swimming and were encouraged to do so, but they withheld from the butterfly. An average of 27% correction of curvature was seen with an average follow-up of 1.6 years. Symptoms subsided in all cases. We feel that the psychological and emotional well-being of the athlete can likewise be enhanced by continual participation without compromising the overall result.
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PMID:The adolescent "swimmer's back". 621 97

The complications associated with lumbar puncture (LP) were compared in 2 groups of 342 patients. The first group of patients was anticoagulated after the LP, and the second was not. The incidence of minor headache or back pain was similar in the 2 groups (Group 1--62%, Group 2--64%). The anticoagulated patients had a higher incidence of paraparesis (Group 1, 5 patients, Group 2, No patients; p less than .05) and severe back or lumbosacral radicular pain lasting more than 48 hours (Group 1, 18 patients, Group 2, 6 patients; p less than .025). Seven of the anticoagulated patients developed spinal hematomas (5 with paraparesis, 2 with severe back pain). Among the anticoagulated patients the risk of a major complication was increased by a traumatic LP (p less than .001), starting anticoagulation within one hour of the LP (p less than .001), or aspirin treatment at the time of the LP (p less than .001). This study suggests that if LP is done, delaying anticoagulation for at least one hour and avoiding concurrent aspirin therapy may decrease the risk of developing an extraparenchymal spinal hematoma.
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PMID:Complications of lumbar puncture followed by anticoagulation. 730 81

The model that will based any specialized attention in any healthy area depends the necessity of special and primary cares and the criteria of specialized practitioners on the type of patients what should be treated. We interview following a questionnaire on that question the neurologists of Valencian Community in order to know their opinion. The questionnaire includes 47 neurological topics and we ask the percentage of patients who should be evaluated as first visit and as follow-up visits. We used the formula proposed by Kurtzke in 1986 in order to calculate the neurological time. The response rate obtained was 30%. The whole neurological time was 4,600 hours per 100,000 inhabitants yearly, that means 6.9 neurologists-type per 100,000 inhabitants. These data suggest that Valencian neurologists agree a model of direct neurological care, including diagnosis and follow-up of all neurological topics. These data are similar to that obtained in interviews to primary physicians in different healthy areas in the Community and confirms the evolution of neurological care to a model similar to that in the United States. The topic that require more than 100 hours by year are: migraine (1,731) lumbar backache (685), stroke (306), seizures (248), Down's syndrome (175.5), alcoholism (150), zoster (122), severe cranial trauma (105) and dementia (103).
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PMID:[The model of neurological care needs in Valencian community. Commission of the analysis of the quality of SVN]. 855 2


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