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

Two aged women suddenly suffered from severe cervical and back pain followed by ipsilateral hemiparesis sparing the face. One woman had taken anticoagulant for prosthetic mitral valve and another had taken antiplatelet for prevention of recurrent brain infarction. On admission, MRI did not document any definite lesions in the brain, and revealed epidural hematoma compressing the cervical spinal cord for both patients. We promptly stopped their anticoagulants and antiplatelets use, because the agents seemed to be the leading cause of hematoma. In addition, we performed emergent laminectomy and evacuation of hematoma for the former patient. These cases suggest dual warnings against recently prevalent antithrombotic therapy for patients with histories of thromboembolic accidents. First, we should be careful about spinal epidural hematoma as a hemorrhagic complication of antithrombotic therapy. Second, we should not misdiagnose spinal epidural hematoma as ischemic stroke nor select hyperacute thrombolytic therapy. Cervical pain and hemiparesis sparing face are important signs for distinction of spinal epidural hematoma from stroke.
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PMID:[Acute cervical spinal epidural hematoma during antithrombotic therapy: dual warnings against antithrombotic therapy]. 1293 38

It remains unclear whether or not the infarcted brain caused by aortic dissection should be reperfused when an emergency operation is needed for aortic arch dissection. A 64-year-old woman presented with severe back pain and syncope with a sudden left hemiplegia. CT scan demonstrated an aortic dissection of the entire aorta, obstruction of the right common carotid artery by extended aortic dissection, cerebral infarction of the right middle cerebral artery territory, brain edema and pericardial effusion. Though she was unable to communicate with us, she underwent an emergent aortic arch replacement and ligature of the right common carotid artery nine hours after the onset of stroke, when massive cerebral infarction was established. She survived the operation and regained full consciousness. When brain infarction was established by extended aortic dissection in emergent aortic surgery, concomitant ligature of the responsible artery to the brain infarction may be allowed for avoiding cerebral damage leading to brain death.
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PMID:Acute aortic dissection with new massive cerebral infarction - a successful repair with ligature of the right common carotid artery. 1500 5

A 70-yr-old man was referred for bone mineral density because of a history of vertebral and hip fracture. His past history included prednisone-treated rheumatoid arthritis and stroke resulting in hemiparesis and expressive aphasia. He had received injections for back pain at another hospital. The overall spine T-score was +3.40 with L3 at +10.92. The overall hip T-score was -1.09 with the femoral neck at -1.75 and Ward's triangle at -2.94. Radiographs of the spine revealed increased densities of L2-4. The patient's wife provided information the aphasic patient could not. The back injections were part of a vertebroplasty for stabilization. The patient had such great pain relief that he ambulated too soon, fell, and suffered a right hip fracture. Injection of polymethylmethyacrylate is a new addition to the treatment of spinal osteoporosis. The case demonstrates the importance of acquiring a complete medical history.
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PMID:Increased bone mineral density in a man with known compression fractures. 1530 99

We investigated whether serum and cerebrospinal fluid (CSF) antibodies to the light subunit of the NF protein (NF-L), a main component of the axonal cytoskeleton, may serve as biological markers for axonal pathology and/or disease progression in multiple sclerosis (MS). IgG to NF-L was measured in sera and CSF of MS patients, patients with inflammatory demyelinating diseases of the PNS, with acute inflammatory neurological diseases (including bacterial and viral meningitis), with neurodegenerative diseases, with acute noninflammatory neurological diseases (including stroke, headache and backache) and healthy controls by enzyme-linked immunosorbent assay. We found that serum anti-NF-L IgG antibodies were significantly elevated in MS patients with primary progressive disease course and we provide evidence for an intrathecal production of these antibodies. Our findings support the use of serum antibodies to NF-L as a marker for axonal destruction.
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PMID:Increased frequencies of serum antibodies to neurofilament light in patients with primary chronic progressive multiple sclerosis. 1558 81

As part of its planning process, the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, periodically evaluates how well it applies its criteria for setting research priorities. For its most recent evaluation, NCCAM compared funding levels in fiscal years 2000 and 2003 for 18 diseases with a substantial public health burden including Alzheimer's disease, arthritis, back pain, cancer, diabetes, coronary heart disease, HIV/AIDS, migraine, and stroke, with 7 measures of disease burden: 1) prevalence, 2) mortality, 3) years of life lost (YLL), 4) years lost to disability (YLD), 5) disability-adjusted life years (DALY's), 6) direct costs of illness (COI), and 7) total COI. There is an increasing relationship between NCCAM research funding and disease burden over the 4-year study period that reflects funding of specific research initiatives. The strength of the individual correlations varied among measures, with the strongest correlations seen with total COI and the weakest seen with mortality. When applied with its other criteria, measures of disease burden aid identification and matching of NCCAM priorities with levels of support.
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PMID:Identifying and pursuing research priorities at the National Center for Complementary and Alternative Medicine. 1605 86

Although left heart bypass and hypothermia are often used in the performance of type I and type II thoracoabdominal aneurysms (TAAs), most of these more distal aneurysms are done utilizing the clamp and sew technique. Renal failure occurs between 8.6% to 39% in recent series of patients following surgery for type III and IV TAAs. The purpose of this study was to determine whether the use of hypothermic circulatory arrest in these cases would serve to protect renal function. All patients were operated on using hypothermic circulatory arrest. The kidneys were perfused with cold blood during the procedures, and renal artery bypasses were aggressively used (when stenoses greater than 50% were observed). The series describes 33 consecutive patients with type III and IV TAAs who were operated on utilizing hypothermic circulatory arrest with a core temperature of 15 degrees centigrade. All visceral and renal arteries were individually perfused; 20 patients had bypass grafts of their renal artery stenoses. Although six patients had renal failure preoperatively, only one developed postoperative renal failure. This was the patient who was operated on as an emergency for severe abdominal pain, back pain, and acidosis who was also the only hospital death. Of the remaining five patients with elevated creatinines preoperatively, four had postoperative decrease of the serum creatinine. One patient developed paraparesis and one developed a stroke. The median length of stay was 8 days. Consideration should be given to the use of hypothermic circulatory arrest in type III and IV TAAs for the preservation of renal function and improved overall results.
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PMID:Preservation of renal function utilizing hypothermic circulatory arrest in the treatment of distal thoracoabdominal aneurysms (types III and IV). 1734 63

The present literature review on functional assessment in physiotherapy was carried out for the following reasons: 1) to identify the functional instruments used in the field of physiotherapy that were supported by published evidence of their psychometric qualities; 2) to investigate how these instruments relate to the International Classification of Functioning, Disability and Health (ICF); and 3) to investigate the use of functional instruments in the financing of physiotherapy. A search of Medline from 1990 to December 2005, in the domains of functional evaluation, psychometric qualities, functional classification, and health policy in relation to physiotherapy resulted in a list of 1,567 studies. Two reviewers examined the resulting references on the basis of their title and abstract, in order to select the studies that presented data on the psychometric qualities of functional evaluation tests, leading to a final selection of 44 such studies. A selection of functional tests was identified in four major diagnostic groups treated in community physiotherapy: musculoskeletal disorders (including lower back pain), stroke, the elderly, and traumatic brain injuries. The functional tests authors identified essentially cover the body and activities dimension of the ICF. The selected tests could be used as a basis for the standardisation of functional evaluation of the major diagnostic groups treated in community physiotherapy. This means that standards are available for reporting and following the evolution of patients both longitudinally and transversally. Nevertheless, in the current literature review no attempt at using functional outcomes as a rationale for financing physiotherapy could be found to date.
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PMID:Functional assessment in physiotherapy. A literature review. 1808 77

A 56-year-old woman with chronic nonvalvular atrial fibrillation presented with cardiac arrest during magnetic resonance imaging for back pain evaluation. Brain magnetic resonance imaging performed after cardiopulmonary resuscitation revealed multiple embolic lesions. Transesophageal echocardiography showed a large free floating thrombus ball and multiple mural thrombi in the left atrium. In light of the high-risk situation, an emergency operation was performed despite the occurrence of a fresh stroke within the previous 24 hours. The surgery was successful and the postoperative course was uneventful. The patient has been doing well since the operation on outpatient follow-up for 8 months.
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PMID:Giant left atrial ball thrombus in a patient with chronic nonvalvular atrial fibrillation. 1815 33

Apical hypertrophic cardiomyopathy (AHC) is associated with neurological abnormalities such as transient ischemic attack, stroke, limb-girdle muscular dystrophy, or eosinophilic myositis in single cases. The association of AHC and metabolic myopathy has not been reported. In an 84-year-old woman with long-standing gait disturbance, dementia, Parkinson syndrome, ptosis, ophthalmoparesis, tetraparesis, polyneuropathy, lactacidosis, polyarthralgia, dorsalgia, and osteoporosis, cardiac examination for long-standing anginal chest pain and palpitations, revealed supraventricular and monomorphic ventricular ectopic beats, hypertrophic signs, ST-depression and negative T waves on electrocardiogram (ECG), diastolic dysfunction with impaired relaxation, and AHC on transthoracic echocardiography. AHC was confirmed by cardiac magnetic resonance imaging, which additionally showed a small left ventricular apical aneurysm with a wall-thickness of only 3 mm. The patient was suspected to additionally have a multisystem disease, most likely due to impaired oxidative metabolism. This case shows that AHC may take a mild course and be associated with a number of extracardiac abnormalities.
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PMID:Apical hypertrophic cardiomyopathy in encephalomyopathy. 1816 25

A 49-year-old woman with an acute ischemic stroke was treated by the intravenous administration of tissue plasminogen activator within 2 h of symptom onset. She complained of severe upper thoracic back pain the following day. Progressive paraparesis was detected on the third admission day. Spinal MRI demonstrated an acute anterior subdural hematoma from the C7 to T2 level. An urgent laminectomy was performed. Neurologists must be aware of the possibility that neck or back pain after thrombolysis for ischemic stroke may be the first presenting symptom of spinal hematoma.
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PMID:Spinal subdural hematoma following tissue plasminogen activator treatment for acute ischemic stroke. 1863 96


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