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

A 10-year-old Turkish boy was admitted with mild right spastic hermiplegia. First, he experienced sudden numbness and weakness in the right extremities at the age of 2 years and was diagnosed with right hemiparesis. His parents were generally healthy and non-consanguineous. His mother suffered from deep vein thrombosis of the left lower extremity during pregnancy and had recurrent fetal loss. At the age of 10 years, a thrombophilia marker examination revealed that plasma-free protein S was 49.3% (normal range = 70-123%), and factor VIII level was found to be 470 IU/dL (normal = 150 IU/dL). The patient and his two siblings were found to be heterozygous for factor V Leiden mutation. His mother was also heterozygous for factor V Leiden mutation and had protein S deficiency. A combination of protein S deficiency, factor V Leiden mutation, and a high level of factor VIII was detected in our patient. After his first attack at the age of 2 years, in spite of no prophylaxis, he did not experience any other ischemic insult. To our knowledge, this is the first patient with these combinations of genetic defects and ischemic stroke to be reported in the literature.
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PMID:Combined genetic defects in a child with ischemic stroke: case report. 1226 33

Legal action has been taken in several US cities against Wyeth-Ayerst's Norplant, claiming that labels were deceptive regarding the potential side effects and the difficulties possible with removal. All the lawsuits claimed suffering caused by removals. 25 women in Miami, Florida, filed suit for $50,000 each in damages due to difficult removal. 8 women from Maryland joined 600 women filing in Chicago, who seek $20,000 to $50,000 for damages due to difficult removals and scarring. The group of plaintiffs also have asked for an injunction preventing the company from selling Norplant to doctors without proper training. Wyeth-Ayerst reported that it requested label changes before the lawsuits were filed. The label now states that removals and insertions are possible, without designating the time allocation required; prior labels indicated a 15-20 minute period. The new label includes possible side effects of emotional instability, heart attack, stroke, migraine, arm pain, numbness and tingling. One Maryland woman requested removal because the capsules had shifted and one had moved from her upper arm to under her armpit. Removal required 3 stages totaling 3 hours and ultrasound detection. Another women gained 20 pounds and had a sore arm. Norplant was first introduced in the US in 1991 after 20 years of experience with use worldwide. The contraceptive is effective for 5 years after insertion of 6 capsules, with slow releasing hormones. Planned Parenthood of Maryland administers Norplant at 7 clinics throughout the state, by practitioners at several clinics, and by the Baltimore City health department in school-based clinics. City clinics since 1991 have made 198 insertions and 14 removals, with no problems with removals. School-based clinics have inserted 45 implants and no removals. Bayview Clinic in Baltimore has made 2000 insertions and 250 removals, with few difficulties. The chief of obstetrics and gynecology at Bayview said that it takes about 6 times before removal is perfected by even a trained doctor. The Population Council, which developed Norplant and licensed it to Wyeth-Ayerst, still supports it as one of the most effective, reversible methods of birth control.
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PMID:Norplant removals spur suits. Some recipients report problems. 1231 99

The disinhibition hypothesis of post-stroke central pain (CPSP) suggests that 'the excessive response (dysesthesia/hyperalgesia/allodynia) is accompanied by a em leader loss of sensation' resulting from a lesion of a 'lateral nucleus' of thalamus or of 'cortico-thalamic paths' [Brain 34 (1911) 102]. One recent elaboration of this hypothesis proposes a submodality specific relationship, such that injury to a cool-signaling lateral thalamic pathway disinhibits a nociceptive medial thalamic pathway, thereby producing both burning, cold, ongoing pain and cold allodynia. The current study quantitatively evaluated the sensory loss and sensory abnormalities to discern submodality relationships between these sensory features of CPSP. The present results were statistically tested within individuals so that sensory loss and sensory abnormality are directly related by occurrence in the same individual. The results demonstrate that individuals with CPSP and normal tactile detection thresholds experience tactile allodynia significantly more often than those with tactile hypoesthesia. Most patients (11/13) exhibited hypoesthesia for the perception of cool stimuli, but few of these (2/11) showed cold allodynia. The most dramatic case of cold allodynia occurred in a patient who had a normal detection threshold for cold. Individuals with cold hypoesthesia, strictly contralateral to the cerebro-vascular accident (CVA or stroke), were often characterized by the presence of burning, cold, ongoing pain, and by the absence, not the presence, of cold allodynia. Overall, these results in CPSP suggest that tactile allodynia occurs in disturbances of thermal/pain pathways that spare the tactile-signaling pathways, and that cold hypoesthesia is neither necessary nor sufficient for cold allodynia.
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PMID:Allodynia in patients with post-stroke central pain (CPSP) studied by statistical quantitative sensory testing within individuals. 1515 97

A 30-year-old man was hospitalized with dysarthria and weakness of his right arm and leg. Three months previously, he had noticed numbness and weakness of his right shoulder, which spread to involve his left leg but which improved after 8 months. On admission, neurological examination revealed limb kinetic apraxia and constructive apraxia of the right hand, motor aphasia, dysarthria, and spastic quadriplegia. Sensory examination revealed hyperalgesia and dysesthesia in the right arm and left leg. Deep tendon reflexes were hyperactive in all four extremities. And he had bilateral Babinski signs. Laboratory examination revealed pH 7.38, PCO2 46.1 Torr, PO2 93.4 Torr, BE 1.7, and blood lactate, 9.0 mg/dl (normal 5-20 mg/dl). Cerebrospinal fluid lactate level was 20.0 mg/dl. pyruvate 1.34 mg/dl. and protein 83 mg/dl. Blood lactate and pyruvate values were markedly elevated after aerobic exercise. T2WI brain MRI showed scattered high signal lesions in the left precentral and postcentral gyrus, right paracentral lobes, both superior frontal gyri, and right superior temporal gyrus. Right biceps brachi biopsy showed almost complete cytochrome c oxidase (COX) deficiency. There were no ragged-red fibers. There was marked decrease of COX activity: 2.7 nmol/min/mg-mitochondrial protein (normal range: 33.0 +/- 16.1, n = 7) in the biopsied muscle. Open brain biopsy (after permission from the patient and his family) revealed gliosis and perivascular infiltration of lymphocytes and macrophages without vascular proliferation. There was no mitochondrial DNA mutations, deletion or duplication, including tRNA-Leu 3243, 8993, 3271, 9176, 3291, and tRNA-Lys 8344, 8356, and 8363. From these findings, a diagnosis of COX deficiency presenting as MELAS-like episodes was done. His mother also showed abnormality on aerobic exercise test, but she had no episode of stroke or neurological dysfunction. Six months later, his aphasia and apraxia of the right hand had resolved, and at discharge he was able to ambulate with a cane. Ten months later, he returned to his work. There has been no recurrence of neurologic symptoms over the next 3 years and 10 months. This patient appears to represent a rare case of adult onset COX deficiency presenting as MELAS-like episodes.
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PMID:[MELAS-like episodes in an adult case with cytochrome c oxidase deficiency]. 1523 72

Patients who experience a sudden ischemic stroke can benefit from administration of intravenous tissue plasminogen activator (tPA) to reduce the resulting disability, yet few arrive in time to be eligible for tPA administration. The purpose of this study was to determine (a) the stroke warning signs that most commonly result in the decision to seek hospital care, (b) who makes the decision to seek hospital care, (c) the most common mode of transportation to the hospital, (d) hospital arrival time in relation to the onset of the first warning sign, and (e) factors most associated with hospital arrival time for stroke survivors. Using a descriptive, cross-sectional design, data from a convenience sample of 50 stroke survivors and/or their companions (family, friends, or others seeking hospital care for the patient) were obtained by face-to-face interview during the patient's hospital stay using a structured interview guide developed by the investigator. The most common stroke warning sign resulting in the decision to seek medical care was sudden confusion and trouble speaking or understanding speech, followed by sudden numbness or weakness on one side of the body. Patients themselves were the most common initiators of care, followed by spouses, other relatives, and others. A majority of patients arrived by ambulance, followed by private car or taxi. Only 28.9% of patients arrived at the hospital within 3 hours of the first warning sign, with the mean arrival time for the group being 330.4 minutes (5.5 hours). Mode of transportation and perceived adequacy of income were the only significant factors associated with hospital arrival time, with no significant interaction effects. Patients arriving by private car or taxi and those perceiving their incomes as comfortable had the longest arrival times, suggesting public education efforts also should target people from higher socioeconomic groups. The nonsignificant associations between hospital arrival time, warning signs, and other demographic characteristics of initiators suggest there may be other unmeasured behavioral factors that play a more important role in reducing hospital arrival time for stroke patients. Further study of additional factors associated with early hospital arrival time is recommended to support educational efforts for early stroke treatment and prevention.
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PMID:Factors associated with hospital arrival time for stroke patients. 1523 13

Despite major advances in skull base surgery and microsurgical techniques, surgery for vestibular schwannoma (VS) carries a risk of complications. Some are inherent to general anesthesia and surgery of any type and include myocardial infarction, pneumonia, pulmonary embolism, and infection. Some are specific to neurosurgery in this area of the brain, and include hydrocephalus, cerebrospinal fluid leak, facial nerve paralysis, facial numbness, hearing loss, ataxia, dysphagia, and major stroke. Even in the hands of very experienced acoustic surgeons, these risks cannot be eliminated. Radiosurgery provides an outpatient, noninvasive alternative for the treatment of small acoustic schwannomas. Initially radiosurgery was undertaken in "high-risk" patients, including the elderly, those with severe medical comorbidities, and those in whom tumors recurred after surgery. Additionally, a high rate of cranial nerve morbidity was reported. With improvements in dosimetry planning and dose selection, however, authors practicing at radiosurgical centers now report very low complication rates, as well as high tumor control rates. In this report the authors specifically review the results of linear accelerator-based radiosurgery for VS and compare these outcomes with the best surgical alternatives.
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PMID:Linear accelerator-based radiosurgery for vestibular schwannoma. 1566 13

This study was designed to survey college students about their knowledge and use of Uwhangchungsimwon (UC), a Traditional Oriental herbal remedy for emergency and acute treatment of stroke, numbness, hypertension, epilepsy and arteriosclerosis. Students at three female nursing colleges in Korea completed a questionnaire containing 29 questions about the students' demographics, knowledge and use of UC, and the placebo effect. Of 608 respondents, 217 (36%) had taken UC. Eighty-three per cent reported that UC alleviated examination tension and 28% knew that it is used as an emergency drug for stroke. Forty-two per cent believed that UC has a "placebo effect" and 20% considered its effects were more than that of a placebo. Fifty-eight per cent of those using UC felt that it was effective in inducing psychological relaxation, 4% considered that it increased their energy levels, and 6% felt it was effective in "clearing the head"; 33% reported no effects. Users also reported adverse effects: 30% reported drowsiness, 17% reported a "heavy head" and 15% experienced indigestion. Most respondents (73%) obtained information about UC from family members and friends and 33% from newspapers or the media. These results confirm health practitioner should recognize that UC is used widely for purposes other than its intended purpose (i.e., to treat stroke and hypertension) and that such use can cause adverse effects. More systematic research is needed to increase the safety of consumers when using herbs and herbal supplements.
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PMID:Perceptions, knowledge and misuse of an oriental herbal drug: a survey of 608 Korean female nursing college students. 1600 37

Fibrocartilaginous embolism of the intervertebral disc represents an uncommon cause of spinal cord infarction. We present the case of a previously healthy 30-year old ballet dancer who noted acute severe neck pain shortly after an intensive training session and developed weakness and numbness of both arms, as well as difficulties in emptying the bladder and bowel. Her clinical presentation and neuroimaging studies including diffusion weighted imaging were consistent with a spinal cord infarction in the anterior spinal territory at the C3-C6 spinal cord level. Although no histological confirmation was obtained, lack of evidence of other plausible diagnoses in the setting of the patient's clinical presentation and neuroimaging findings made fibrocartilaginous embolism the most likely etiopathogenetic mechanism of spinal stroke.
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PMID:Spinal cord stroke in a ballet dancer. 1646 Jul 61

This is the case report of a 44-year-old woman presented with an acute stroke immediately after electroconvulsive therapy (ECT). The patient had no significant medical history other than chronic depression. She was taking sertraline, and she had had multiple previous ECT treatments without any complications. While being monitored in the recovery room within 10 minutes after the last ECT session, she was found to have sudden onset of left-sided flaccid hemiplegia and numbness along with slurred speech. On arrival to our hospital, she was found to have flaccid hemiplegia on the left side involving the face, arm, and leg (face and arm more than the leg involvement), severe dysarthria, and mild neglect syndrome (National Health Institute Stroke Scale of 14). Noncontrast computed tomography (CT) of the head showed no signs of early ischemia, and iodine contrast CT angiography revealed right middle cerebral artery (MCA) (distal M1 segment) clot. Patient received intravenous recombinant tissue plasminogen (rt-PA) at 2.5 hours after the onset of symptoms, and then a total of 3.0 mg of intra-arterial (IA) rt-PA. Angiography at the end of the procedure showed successful recanalization of the M1 segment and normal vessel caliber with adequate distal flow. After the procedure, the patient made rapid improvements in all of her initial symptoms during the first 24 hours. An extensive stroke workup failed to reveal any cause of the stroke, including usual stroke and hypercoagulable risk factors. This was an acute embolic stroke immediately following an ECT, and without the aggressive thrombolytic therapy, the patient's outcome would have been poor because there was an M1 segment clot with a major MCA syndrome with relatively high National Institute of Health Stroke Scale. The neurological side effect profile of ECT is reported to be minimal with most common symptoms being headache, disorientation, and memory complaints. There is no clear cause-and-effect relationship in this case, and the stroke after ECT is extremely rare. In such rare event of stroke while receiving ECT, there is an effective treatment available using both intravenous and IA thrombolysis as reported in this case.
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PMID:Acute embolic stroke after electroconvulsive therapy. 1663 11

We report a case of a young patient who had an ischemic stroke due to methylephedrine addiction. A 39-year-old man was admitted to our hospital because of right hemiplegia and persistent numbness. Brain diffusion-weighted magnetic resonance images demonstrated multiple hyperintensity spots in the deep and superficial borderzone area of the left hemisphere. The patient had no obvious diseases that might have caused ischemic stroke, including potential cardiac sources of embolism, vasculopathy of the cerebral artery, or abnormalities of blood coagulation. However, we found that the patient had started to abuse methylephedrine at the age of 20 years old, and we suspected that drug abuse might have caused his ischemic stroke. Although previous reports have associated ischemic stroke with ephedrine, no reports have related this condition to methylephedrine. However, our case suggests that methylephedrine abuse may cause ischemic stroke.
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PMID:[Ischemic stroke in a young patient with methylephedrine addiction: a case report]. 1676 95


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