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

Isolated vertigo is usually a distressing though benign clinical entity. Recently, however, it has been recognized that in a subset of patients isolated vertigo may be a harbinger of vertebrobasilar stroke. Recognition of this "at risk" subgroup may be difficult. Brainstem auditory evoked potentials (BAEPs) are usually normal in patients with vertigo from labyrinthine disease. We describe a patient with isolated vertigo, in whom BAEPs were abnormal, and who subsequently developed an anterior inferior cerebellar artery territory infarct. BAEP testing might lead to early recognition of those patients at risk for catastrophic stroke, and prompt appropriate investigation and treatment to prevent this outcome.
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PMID:When is isolated vertigo a harbinger of stroke? 786 29

In a 28-month-period 100 consecutive carotid operations were performed on 91 patients under locoregional anaesthesia. The indications were 37 TIAs, 16 recovered strokes, 12 cases presenting with amaurosis fugax, eight with vertigo and 27 patients with severe but still asymptomatic stenosis. In 20 cases a shunt had to be used. Twice a transient neurological syndrome developed, two strokes occurred. One stroke patient died in the postoperative course. Carotid surgery under locoregional anaesthesia seems to be a safe method with advantages for the patient and the surgeon.
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PMID:Carotid surgery under locoregional anaesthesia. Description of technique and results of our first 100 consecutive operations. 797 70

We report the clinical findings and stroke mechanisms of 63 patients with cerebellar infarcts. We divided the intracranial vertebrobasilar circulation into the proximal territory (P), fed by the intracranial vertebral arteries and their branches; the middle territory (M), fed by the proximal and middle basilar artery and its branches; and the distal territory (D), fed by the rostral basilar artery and its branches. Cerebellar infarcts were classified by vascular territories P, M, D, P&D, and middle-plus (P&M, M&D, and P&M&D). Patients with P infarcts (11 patients) frequently had vertigo, gait instability, limb ataxia, and headache, whereas patients with D infarcts (15 patients) most often had limb ataxia, gait instability, and dysarthria. Patients with P&D infarcts (17 patients) had signs and symptoms of both groups combined. Infarcts in which the middle territory was involved, either alone (three patients) or combined with other territories (17 patients) were dominated by brainstem signs and symptoms. The predominant stroke mechanisms in the P, D, and P&D groups were embolic due to intra-arterial or cardiac embolism. When the M territory was involved, either alone or with P, D, or P&D territories, stroke mechanisms were more varied, and there was often large-artery occlusion with hemodynamic ischemia.
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PMID:Cerebellar infarcts in the New England Medical Center Posterior Circulation Stroke Registry. 805 34

The frequency of cerebellar infarctions over two and a half years was 2.7% of the 1300 hospitalized patients over that period. Sixteen patients with cerebellar infarctions were studied by using clinical manifestations and magnetic resonance imaging (MRI). Ages ranged from 41-87 (mean 63.5) years; 13 were men and 3, women. Risk factors included: hypertension (50%), diabetes (44%), prior stroke (44%), cardiac disease (38%), and hyperlipidemia (19%). Common symptoms and signs were dizziness/vertigo (75%), unsteadiness (69%), dysarthria (69%), and nausea/vomiting (50%). Infarcts mainly involved the posterior inferior cerebellar artery (PICA) territory and tended to be associated with brainstem infarcts in 14 of the 16 patients. Most cerebellar infarctions had a benign course, especially the small ones. No mortality was noted in this series. The short-term outcome of the cerebellar infarctions seemed to depend on the size of the infarcts and the sites of the artery occlusion. It was concluded that diagnosis of cerebellar infarctions requires a high index of clinical suspicion, especially when patients present with a sudden onset of ataxia, dizziness/vertigo, nausea/vomiting and dysarthria; and that MRI is a useful tool for the detailed study of cerebellar infarctions and can elucidate associated brainstem infarcts.
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PMID:A clinical and MRI study of cerebellar infarctions. 829 26

We report a 57-year-old man who developed Wallenberg syndrome and vertebral artery dissection, probably as a complication of neck rotation during golf exercise. He noticed pain in the neck during golf exercise. About 16 hours later, he developed numbness in the right hand, cold sweat, vertigo, hiccup, double vision and ataxia in gait. Neurological examination on the 22nd day revealed a right Wallenberg syndrome. The right vertebral angiogram showed a marked stenosis of the vertebral artery at the portion across the dura, and a dissecting aneurysm in the portion from its entrance into the posterior fossa through the exit of the right posterior inferior cerebellar artery. Quick rotation and/or extension of the neck and head during golf exercise probably caused the vertebral artery dissection, resulting in Wallenberg syndrome. More attention should be paid to relatively trivial trauma as the cause of stroke, especially in the victims of younger ages.
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PMID:[Wallenberg syndrome and vertebral artery dissection probably due to trivial trauma during golf exercise]. 833 99

The natural history of coronary artery disease (CAD) is often complicated by cerebrovascular accidents. The real incidence of atherosclerotic lesions of carotid arteries in coronary patients is not well established. In order to detect a high-risk group for stroke development, 184 patients affected by CAD, either partially symptomatic or asymptomatic for carotid artery stenosis, underwent Echo-Doppler ultrasonography (duplex scanning) of supra-aortic branches. Significant carotid stenosis (> 50%) was demonstrated in 51 subjects (27.7%); 21 subjects (41.2%) were partially symptomatic (dizziness, vertigo, lipothymia, etc), and 30 subjects (58.8%) were completely asymptomatic. The authors' data suggest that carotid disease can develop concurrently with coronary disease in a significant proportion of patients, even though completely asymptomatic. In order to obtain optimal long-term results, both coronary and carotid artery disease require appropriate evaluation and either medical or surgical management. For these reasons they recommend duplex scanning as a routine screening procedure in patients affected by CAD.
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PMID:Incidence of carotid artery atherosclerosis in patients with coronary artery disease. 842 83

We studied 34 consecutive patients with non-mass-producing cerebellar infarcts using a standard protocol of investigations including magnetic resonance imaging (MRI). We analyzed the topography of infarcts to determine the involved arterial territories and we correlated the findings with neurological dysfunction and potential causes of stroke. Sixteen patients had an infarct in the territory of the posterior inferior cerebellar artery (PICA); 2, in the territory of the anterior inferior cerebellar artery (AICA); 13, in the territory of the superior cerebellar artery (SCA); and 8 had junctional infarcts between the territories of the medial and lateral branches of the PICA or PICA/SCA territories. PICA or medial PICA territory infarcts were manifested by acute vertigo and truncal ataxia, while the patients with lateral PICA territory infarcts presented with unsteadiness, limb ataxia and dysmetria without dysarthria. Patients with infarcts in the AICA territory were characterized by limb and trunk ataxia associated with signs of lateropontine involvement. Patients with SCA territory infarcts presented with dysarthria, unsteadiness and/or vertigo, limb ataxia, and dysmetria. Cardiac embolism was the main cause of large infarcts in the territories of the PICA (8/16) or SCA (4/7). Multiple small infarcts were associated with vertebrobasilar atherosclerosis (8/12). These clinical-MRI correlations allow better definition of the topographic and etiological spectrum of cerebellar infarction, which was previously based on pathological studies in subjects with severe infarction.
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PMID:The clinical and topographic spectrum of cerebellar infarcts: a clinical-magnetic resonance imaging correlation study. 849 23

To determine the utility of magnetic resonance imaging (MRI) of the brain in diagnosing active neuropsychiatric disease in systemic lupus erythematosus (NP-SLE), a prospective study of 51 hospitalized systemic lupus erythematosus (SLE) patients during 64 separate episodes of suspected NP-SLE was initiated. In addition to standard hematology, chemistry, and serological tests, the workup included MRI in all patients. A computed tomographic scan of the brain was obtained in patients enrolled in the first year of the study. Of the 64 neuropsychiatric episodes, 42 were attributable to NP-SLE and 22 were attributed to causes other than SLE. Neuropsychiatric complaints unrelated to lupus included depression (n = 6), seizures (n = 5), headache (n = 3), altered mental status (n = 2), aseptic meningitis (n = 2), cardiovascular accident (n = 2), transient ischemic attack (n = 1), and vertigo (n = 1). The MRI was abnormal in 34 of 64 (53%) episodes. MRI abnormalities were more common in patients with focal neurological deficits (19/26) than in those without focal findings (15/38; P = .008) and in patients with nephritis (19/24) than in those without renal disease (15/40; P = .002). MRI abnormalities were as frequent in NP-SLE (25/42) as in cases with non-NP-SLE-related causes (9/22). Periventricular increased signal (PIS) was a frequent MRI finding (10/64). Enlargement of the prepontine cistern, an MRI finding not previously described in NP-SLE, was seen (14/64). Both findings were associated with the presence of hypertension and lupus nephritis. PIS similar to that seen in our patients has been described in otherwise healthy elderly individuals with risk factors for stroke, suggesting that vascular abnormalities may be important in the etiology of these lesions. In conclusion, abnormalities in brain MRI occur frequently in NP-SLE, especially in patients with focal neurological deficits. However, the presence of similar MRI abnormalities in SLE patients with neuropsychiatric symptoms and findings with non-SLE-related causes limits the specificity of the MRI for diagnosing NP-SLE.
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PMID:Magnetic resonance imaging of the brain in neuropsychiatric systemic lupus erythematosus. 851 97

Neuro-otological and posturography findings in 15 patients with visually induced vertiginous symptoms (visual vertigo) are reported. Thirteen patients were considered to have a peripheral vestibular disorder; seven had abnormal caloric or rotational test results. Two patients had CNS disorder--a cerebellar degeneration and a brainstem stroke. Posturography testing showed that five patients showed abnormally large body sway induced by full field visual motion stimulation. This group included the two patients with CNS disease and four with strabismic symptoms (diplopia, squint surgery, and ocular muscle weakness). It is concluded that visual vertigo is a heterogeneous syndrome with peripheral or central aetiologies and may occur if patients with balance disorders show high visual field dependence. In patients with visual vertigo, the presence of additional CNS or strabismic symptoms may cause inappropriate postural reactions in environments with conflicting or disorienting visual stimuli, probably by reducing the ability to resolve the sensory conflict.
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PMID:Visual vertigo syndrome: clinical and posturography findings. 853 Sep 28

Records of 108 patients with lupus erythematosus beginning in childhood (1953-1990) were reviewed; 25 had recorded neurologic findings. This is the largest group of childhood lupus erythematosus patients with neurologic disease that has been reported. The average age of children at the time of diagnosis of lupus was 154 months. There were 22 girls and 3 boys in the group. All patients met at least four of the 1982 American Rheumatism Association criteria for the classification of systemic lupus erythematosus. Average age at onset of neurologic difficulties was 168 months. In 4 patients, the neurologic symptoms preceded the diagnosis: 1 month (spastic diplegia), 1 month (bilateral weakness and spasticity), 24 months (chorea), and 26 months (chorea), respectively. Four patients had neurologic symptoms coincident with the diagnosis of lupus erythematosus. In those patients whose symptoms followed the diagnosis of lupus erythematosus, the average elapsed time until symptoms appeared was 33 months; the single lowest and highest outliers were discounted. Most frequent findings were headache (16/25) and behavioral aberrations (10/25). All behavioral manifestations were depression except in 1 patient. Other prevalent findings included hemichorea or chorea (7/25), cerebrovascular accident with hemiplegia or diplegia (7/25), seizures (5/25), visual loss (3/25), and cranial neuropathy (2/25). Vertigo and myelopathy occurred in 1 patient each. All patients were treated primarily with corticosteroids and azathioprine; in the presence of active disease, the drug dosages were increased with significant improvement in neurologic symptoms. Resolution usually occurred from days to months; most improved in a few days to a few weeks; 3-4 months was the longest period until symptoms subsided.
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PMID:Neurologic characteristics of childhood lupus erythematosus. 855 56


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