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

An elderly lady developed an epidural hematoma following combined spinal-epidural anesthesia with a local anesthetic-opioid mixture for a vaginal hysterectomy. This occurred in association with the use of prophylactic subcutaneously administered unfractionated heparin. She had diabetes, hypertension and had previously undergone coronary artery bypass surgery and right carotid endarterectomy. Warfarin and aspirin were discontinued 2 weeks before the surgery. Postoperatively, an atypical presentation of backache, bilateral sensory loss and left lower limb monoplegia ensued. The initial clinical impression was of a cerebrovascular accident. Magnetic resonance imaging, however, revealed an extensive epidural hematoma that necessitated decompression laminectomy. Progression to paraparesis occurred but the patient gradually regained much of her functionality over the next 2 years.
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PMID:Postoperative epidural hematoma or cerebrovascular accident? A dilemma in differential diagnosis. 1194 75

Spinal cord dysfunction is a rare complication of Neisseria meningitidis (meningococcal) meningitis. We report a 17-year-old patient who had a 3-day history of fever, headache and vomiting, agitation, and unresponsiveness. Cerebrospinal fluid showed a marked polymorphonuclear pleocytosis. Latex particle agglutination was positive for meningococci. The patient was given intravenous antibiotics and intravenous dexamethasone. Over the next 4 days, he developed weakness of the lower extremities, with areflexia and extensor plantar responses. MRI revealed contiguous hyperintensities on T2-weighted images involving the thoracic spinal cord from T4 to T9 and 4 brain abscesses. Five months later, he recovered brain function, but the paraparesis remained. This case illustrates that myelopathy may complicate acute meningococcal meningitis, possibly due to a vasculitis, stroke, autoimmune myelopathy, or direct infection of the spinal cord. Patients with myelopathy associated with acute meningitis should receive spinal MRI. In addition, meningitis should be considered in patients presenting with acute myelopathy.
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PMID:Thoracic myelopathy complicating acute meningococcal meningitis: MRI findings. 1201 69

Little is known about long-term physical sequelae, cognitive functioning, and quality of life of children who have had a haemorrhagic stroke. Fifty-six patients (29 females, 27 males) under 16 years of age at time of the bleeding were studied. Mean age at time of bleeding was 7.7 years (range 1 month to 15.9 years). The primary site and cause of the bleeding at baseline were determined. Occurrences of death, re-bleedings, and seizures during follow-up were recorded. Patients who survived were invited for a follow-up examination including physical check-up, general screening of cognition, and an inventory of subjective health perception. Thirteen children died directly as a result of the haemorrhage; nine experienced a recurrent bleeding, which was fatal in three; six children developed epileptic seizures. At follow-up 36 of 56 patients were still alive. Mean follow-up time was 10.3 years (range 1.3 to 19.9 years) and mean age was 18.6 years (range 1.8 to 34.1 years). There was no patient lost to follow-up. Five patients declined to visit the hospital. In 15 out of 31 patients who could be examined, no physical impairment was observed, 11 had a hemiparesis of varying severity, and three had symptoms of cerebellar ataxia. One child had persisting tetraparesis and one persisting paraparesis. Signs of cognitive deficits were found in 15 patients. Of the children who survive haemorrhagic stroke, the physical and functional prognosis is relatively good, as almost all children were independent at follow-up. However, only a quarter of the surviving children had no physical or cognitive deficit after a mean follow-up period of 10 years. The majority had low self-esteem as well as emotional, behavioural, and health problems.
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PMID:Prognosis of haemorrhagic stroke in childhood: a long-term follow-up study. 1264 24

Hypothermic cardiopulmonary bypass, usually in combination with an interval of circulatory arrest, was used for the treatment of 211 patients with extensive thoracic or thoracoabdominal aortic disease during a 17-year interval. Profound hypothermia, distal perfusion, and intravenous methylprednisolone and thiopental were used for neuroprotection. No other technique or other adjunctive agents were used. The 30-day mortality rate was 7.1% (15 patients). It was 40% (8 of 20) for patients undergoing emergent operations for aortic rupture or acute dissection and 3.7% (7 of 191) for all other patients (P<0.001). Paraplegia occurred in 5 and paraparesis in 1 of the 205 operative survivors whose lower limb function could be assessed postoperatively (2.9%). Of the 121 survivors with thoracoabdominal aortic disease, paraplegia occurred in 1 of 38 patients with Crawford type I disease (2.6%), 2 of 49 with type II (4.1%), and 2 of 34 with type III (5.9%). Paralysis developed in 1 (1.7%) of the 58 patients who underwent aortic dissection. Renal dialysis was required in 6 (2.9%) of the 205 operative survivors, prolonged inotropic support (>48 hours) in 23 (11%), reoperation for bleeding in 10 (5%), mechanical ventilation (>48 hours) in 50 (24%), and tracheostomy in 21 (10%). Four (1.9%) patients sustained a stroke. Hypothermic cardiopulmonary bypass provides safe and substantial protection against paralysis, and renal, cardiac, and visceral organ system failure that equals or exceeds that of other currently used techniques but without the need for other adjuncts.
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PMID:Hypothermic cardiopulmonary bypass and circulatory arrest in the management of extensive thoracic and thoracoabdominal aortic aneurysms. 1471 Mar 74

Anterior spinal artery syndrome is characterised by acute flaccid quadriparesis or paraparesis, disturbance of pain and temperature sensation, and loss of sphincter control. Fibrocartilaginous embolism is a rarely recognised, but important cause of spinal cord infarction. Fibrocartilaginous embolisation usually occurs after minor trauma without major bony lesions, typically with an intervening symptom-free interval and progressive 'stroke-in-evolution' course. There is evidence that the embolus originates from the intervertebral disc, but the mechanism whereby disc fragments enter the spinal vessels is not well understood. We describe the evolution of MRI findings in a case of anterior spinal artery territory infarction thought to be secondary to fibrocartilaginous embolism.
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PMID:Anterior spinal cord infarction owing to possible fibrocartilaginous embolism. 1474 76

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

IML as one of the causes of cryptogenic stroke was nevieued in terms of the clinical features, diagnosis and treatment of IML. IML is a rare type of lymphoma which primarily proliferates inside blood vessels, caused mostly by B-cell type lymphocytes and rarely by T-cell type lymphocytes. IML has been difficult to be diagnosed antemortem because of nonspecific clinical and laboratory abnormalities, and has carried a poor prognosis. However, recent observations show that systemic chemotherapy may improve the outcome of IML in some patients, so that it is important to diagnose IML early and to initiate its treatment. We should consider the possibility of IML, if patients showed one or any combination of the following progressive four neurological features of undetermined etiology: 1) subacute multifocal cerebral infarcts, 2) paraparesis, 3) subacute encephalopathy, and 4) mononeuropathy to multiple mononeuropathy, particularly if patients showed an elevation of serum LDH and soluble interleukin-2R values, albuminocytologic dissociation in the cerebrospinal fluid, or any of the 3 abnormalities. If the possibility of IML is present, we should perform biopsies in involved areas such as skin, skeletal muscle and brain. Recent reports also show that polymerase chain reaction test of B-type lymphocytes in the peripheral blood is also helpful, involving the immunoglobulin heavy chain gene variable region. Early diagnosis and early treatment by vigorous chemotherapy such as biweekly CHOP therapy may improve the outcome of IML.
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PMID:[Intravascular malignant lymphomatosis (IML) as a cause of cryptogenic stroke]. 1743 13

We describe a patient with ascending tetraparesis following stroke. The patient presented initially with spastic paraparesis which acutely evolved to tetraparesis with abulia. Magnetic resonance imaging revealed acute infarctions in the bilateral medial frontal regions but not in the brainstem or spinal cord. Multiple infarctions in the anterior cerebral artery territory appeared to originate from artery to artery embolism. The present case provides distinct clinical features of anterior cerebral artery syndrome which mimic myelopathy or brainstem lesions.
J Stroke Cerebrovasc Dis
PMID:Anterior cerebral artery territory infarctions presenting with ascending tetraparesis. 1790 56

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

A 70-year old woman was admitted with an acute nontraumatic paraparesis. She enjoyed complete independence in all activities of daily living, although she had essential hypertension, dyslipidemia, mild depression and urinary frequency. In the past, the patient underwent a total right knee replacement and removal of right eye cataract. Neurological and radiological investigations excluded any cause for spinal cord compression. Enlarged thyroid gland which was seen on cervical MR scanning was left unnoticed. The diagnosis was made: a spinal stroke. After admission to the rehabilitation ward, full thyroid gland function investigations were conducted. Lower limbs weakness totally subsided when therapy was provided.
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PMID:[Transient paraparesis due to thyrotoxicosis]. 1893 52


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