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

We reported a 37-year-old man who presented complex partial status epilepticus as the initial symptom of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). He showed fluctuating consciousness disturbance, left homonymous hemianopsia, and paroxysmal conjugated eye deviation to the left. The lactic acid level was elevated in blood and CSF, and ragged-red fibers were observed in the biopsied muscle. MRI demonstrated T2-prolonged lesions in the right occipito-parieto-temporal lobes. Since a mutation of mitochondrial DNA (A3243G) was identified, he was diagnosed as having MELAS. On an ictal record, high amplitude, rhythmic sharp waves were observed at right parieto-temporo-occipital region. High amplitude slow waves were also observed on the right hemisphere, especially in the right frontal lobe. These ictal discharges gradually decreased at their amplitude and in frequency, and then ictal EEG turned to the interictal EEG. During an ictal period, conjugated eye deviation to the left side and consciousness loss were observed. These seizures were observed once every several minutes. During the interictal period, sharp waves and sharp-wave complexes were observed frequently at right parietal and posterior temporal lobes. The venous injection of diazepam (10 mg) normalized EEG quickly. When consciousness loss, especially fluctuating, was observed in the patients of MELAS, complex partial status epilepticus should be considered.
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PMID:[A case of MELAS presenting complex partial status epilepticus]. 1188 32

We evaluated consecutive stroke patients with an acute, unilateral lesion, in order to elucidate the anatomical correlates and the clinical course of sensory extinction phenomenon as well as its relation with unilateral spatial neglect (USN) and anosognosia for hemiplegia (AHP). Subjects consisted of 76 patients with right cerebral hemispheric lesions (RHL) and 43 with left cerebral hemispheric lesions (LHL). Twelve of 76 patients with RHL and 18 of 43 patients with LHL were excluded from this study, because of consciousness disturbance, aphasia, severe sensory disturbance, hemianopia, or severe dementia. All of the patients included in this study had an ischemic or hemorrhagic stroke, who admitted to our hospital within 24 hours after the onset of stroke. We repeatedly examined the patients to detect the presence of sensory extinction phenomenon, USN, and AHP from their acute to chronic stage. The incidence of extinction phenomenon in RHL was 33% (11/19 with cortical lesions and 10/45 with deep-seated lesions). When we excluded the patients with a lacunar stroke or TIA, 10 of 13 patients with subcortical lesions had sensory extinction phenomenon. Nineteen of 21 patients with RHL who showed sensory extinction phenomenon also accompanied USN, and twelve had associated AHP. The sensory extinction phenomenon disappeared within 20 days in 6 of 10 patients with subcortical lesions and 3 of 11 with cortical lesions. In contrast, three of 25 (12%) patients with LHL showed extinction phenomenon, the incidence being much rarer than the lesion in the right. Of these, two had USN and one had AHP together. All the deficits disappeared within 20 days after the onset of stroke in patients with LHL. Our studies may show that subcortical lesions present with extinction phenomenon more frequently than cortical lesions, although the phenomenon caused by the subcortical lesions of often disappear in a few weeks.
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PMID:[Sensory extinction phenomenon of double simultaneous stimulation: the analysis of consecutive stroke series with acute and unilateral lesions]. 1196 39

A 70-year-old male presented with progressive consciousness disturbance. He had a history of cerebrovascular accident in the left cerebral hemisphere. The initial diagnosis was newly developed extensive left cerebral hemispheric infarction based on computed tomography. However, magnetic resonance imaging and surgical findings were consistent with chronic subdural hematoma (CSDH). The preexisting neurological disease may have allowed such unexpected CSDH expansion.
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PMID:Huge chronic subdural hematoma mimicking cerebral infarction on computed tomography--case report. 1237 93

Stroke is the commonest neurological cause of morbidity and mortality. Changes in risk factors may influence stroke incidence. Definitive diagnosis of the type of stroke is necessary for management and it has a strong impact on stroke outcome. A total of eighty-five consecutive stroke patients irrespective of age and sex admitted during the period of August 2000 to June 2001 were studied. They were asked about occupation, area of habitat, smoking habit, family history of ischaemic heart disease and/or stroke, any febrile illness, recent history of productive cough, dysuria and diarrhoea. They were searched for hypertension, diabetes mellitus, ischaemic heart disease, valvular heart disease and dislipidaemia. In every patient complete blood count, urine examination, fasting blood glucose and serum lipids, ECG, x-ray chest were performed. CT scan of brain was performed in 68 cases. Male was found 81.18% of cases with age 62.54 +/- 13.08 (m +/- SD) years. Female were 18.82% of cases with age 58.81 +/- 12.77 (m +/- SD). 75.29% of patients were belongs to middle class family. 51.76% of patients came from rural area and 48.24% of patients came from urban area. 78.82% of patients were hypertensive. Infection was associated with 37.65% of cases. Hemiplegia was commonest presentation (88.24%). Though altered consciousness was found more in haemorrhagic stroke (54.84%) but it was not significantly. High from ischaemic cases (p > 0.10) Male suffer more from stroke. Hypertension is the commonest risk factor. Infection is a common association of stroke. Altered consciousness is not a reliable guide to differentiate between ischaemic and haemorrhagic stroke is hospitalized cases.
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PMID:Risk factors & clinical presentations--a study of eighty-five hospital admitted stroke cases. 1239 82

A 75-year-old woman with sarcoidosis developed sudden weakness of the left upper and lower limbs. Neurological examination revealed left-sided hemiplegia, hyperreflexia with pathological reflexes and hypesthesia. She was disoriented and euphoric. Diffusion-weighted brain MRI showed high intensity lesions in the right parietooccipital lobes. Electroencephalogram showed diffuse slowing of the background activity. Serum lysozyme increased to 18.4 mg/ml, CSF protein to 51 mg/dl. After admission, she presented psychotic manifestation followed by a progressive disturbance of consciousness. Epithelioid granulomas without caseous necrosis were present in the biopsied lymph node and specimens from the occipital cortex, indicating neurosarcoidosis. Necrosis was also present in the sampled brain tissue. The psychotic symptoms and consciousness disturbance rapidly ameliorated after the treatment with oral prednisolone, 40 mg/day. Neurosarcoidosis should be considered even in an elder case of sarcoidosis complicated with a stroke.
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PMID:[An elder case of neurosarcoidosis associated with brain infarction]. 1519 54

We report diffusion-weighted magnetic resonance imagings (DWI) at the acute stage of two patients with spectacular shrinking deficit (SSD) due to cardioembolic stroke. Patient 1 was a 74-year-old woman with atrial fibrillation (Af) who had been admitted for acute cholecystitis. She abruptly developed consciousness disturbance, global aphasia and right hemiparesis. Her neurological symptoms rapidly improved 30 minutes after onset, and completely disappeared in four hours. Patient 2 was a 84-year-old woman with Af who had been on medication of warfarin potassium for three years. She abruptly developed consciousness disturbance and left hemiplegia. Her neurological symptoms rapidly improved 90 minutes after onset, and almost completely disappeared in ten hours. Their conditions were consistent with SSD in acute cardioembolic stroke. DWI of Patient 1 taken 27 hours after onset showed hyperintense signal areas in the insular and temporal cortices of the left middle cerebral artery territory, and in the parietal cortex corresponding to the border zone between the territories of the left middle cerebral artery and posterior cerebral artery. DWI of Patient 2 taken 39 hours after onset showed hyperintense signal areas in the insular and frontal cortices of the right middle cerebral artery territory, and in the parietal cortex corresponding to the border zone between the territories of the right middle cerebral artery and posterior cerebral artery. They indicated multifocal ischemic injuries at the acute stage. The T2-weighted MRI of Patient 2 showed a slight hyperintense signal area only in the right parietal cortex, but the fluid-attenuated inversion recovery (FLAIR) in both patients showed no abnormal signals in the corresponding areas. To our knowledge, ischemic lesions in DWI of SSD at the acute stage after rapid recovery have not been reported previously. DWI is useful in SSD for detecting ischemic injuries of cardioembolic origin at the early stage.
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PMID:[Diffusion-weighted magnetic resonance imagings at the acute stage in two patients with spectacular shrinking deficit due to cardioembolic stroke]. 1661 36

We reported a rare case of cardioembolic stroke involving the territories of both the posterior cerebral artery (PCA) and the anterior choroidal artery. An 86-year-old man with atrial fibrillation was admitted to our hospital with consciousness disturbance and left hemiparesis. Diffusion-weighted imaging revealed high intensity lesions in the territories of the PCA and the anterior choroidal artery, leading us to make a diagnosis of cardioembolic stroke. Magnetic resonance angiography disclosed occlusion of the right internal carotid artery (ICA) and the right PCA. The P1 segment of the right PCA was absent, indicating that the right PCA had branched from the right ICA. Therefore, we believed that ICA occlusion caused the infarcts in the territories of both the PCA and the anterior choroidal artery. This is a rare stroke case involving the territories of both the PCA and the anterior choroidal artery.
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PMID:[A cardioembolic stroke case involving both the posterior cerebral artery and anterior choroidal artery territories]. 1758 8

A 64 year-old man was admitted to our hospital because of left leg weakness after a lot of alcohol drink. On admission, his blood pressure was 96/43 mmHg, and heart rate was 97 beats/min and regular. His laboratory data showed severe anemia, and Hb was 5.0 g/dl due to bleeding from gastric cancer. His clinical condition indicated pre-shock and we began to give him a blood transfusion immediately after admission. His neurological findings on admission were mild consciousness disturbance without aphasia, left unilateral spatial neglect, and mild monoparesis on left leg. Brain diffusion-weighted magnetic resonance images demonstrated the small hyper-intense lesions in the borderzone area between the anterior cerebral artery and the middle cerebral artery (MCA). MR angiography showed the occlusion of the right internal carotid artery (ICA) and the right MCA was fully supplied through anterior communicating artery from the left ICA. Transcranial Doppler (TCD) revealed the blunted waveform with low-resistance in the right MCA, but normal flow wave in the left MCA. We diagnosed him as having a hemodynamic brain infarction based on MRI and TCD findings. On day 5, severe anemia and pre-shock improved to Hb 8.2 g/dl and 148/78 mmHg, respectively. According to elevation of blood pressure, his neurological findings normalized. Follow-up TCD revealed that the abnormal waveform in the right MCA changed to normal. Finally we considered the stroke mechanism of this case as hemodynamic stroke based on TCD findings. Serial TCD examinations are useful to identify the hemodynamic mechanism of stroke in such case.
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PMID:[Case of hemodynamic brain infarction diagnosed by transcranial Doppler]. 1763 5

Approximately 10% of patients with transient ischemic attack (TIA) associate with atrial fibrillation (AF). The present study aimed to clarify clinical features of TIA patients with AF. The study group comprised 1084 patients with TIA who were registered in the Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC) registry between May 1999 to April 2000. Clinical characteristics and symptoms during ictus were analyzed to investigate factors associated with AF using multivariate logistic analysis. Subjects were categorized into an AF group (n = 186, 17%; median age, 72 years) and a non-AF group (n = 898, 83%; median age, 69 years). Multivariate logistic regression analysis identified 4 variables as independent factors associated with AF: (1) age > 59 years (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4-3.8), (2) consciousness disturbance (OR, 1.6; 95% CI, 1.1-2.4), (3) speech disturbance (OR, 1.7; 95% CI, 1.2-2.4), and (4) gait disturbance (OR, 1.6; 95% CI, 1.1-2.2). Using a simple index of 1 point for each factor of age > or = 60 years, consciousness disturbance, speech disturbance, and gait disturbance, 4.8% of patients without these factors displayed AF, compared with 12.4% of patients with 1 factor, 20.6% with 2 factors, and 29.7% with 3 or 4 risk factors. In all TIA patients, the frequency of association with AF was 17%. TIA patients with AF are likely to be older (> or = 60 years) and to have more frequent disturbance of consciousness, speech, or gait during the attack compared with those without AF. The pathogenesis of TIA may differ between TIA patients with and without AF.
J Stroke Cerebrovasc Dis
PMID:Clinical features of transient ischemic attack associated with atrial fibrillation: analysis of 1084 TIA patients. 1790 68

We report a 65-year-old male who suddenly developed consciousness disturbance and left hemiplegia, with tandem embolic occlusions of the right internal carotid artery (ICA) and the middle cerebral artery (MCA). Intra-arterial administration of recombinant tissue plasminogen activator (rtPA) through the right ICA was performed 2.75 hours after onset, but no recanalization of the right ICA was obtained. Then rtPA was administrated from the left ICA, and the right MCA was recanalized 3 hours after onset. Our findings indicate that administration of rtPA through the contralateral internal carotid system could be an effective strategy for patients with tandem occlusions of the ICA and MCA if an anterior communicating artery is patent.
J Stroke Cerebrovasc Dis
PMID:Intra-arterial fibrinolysis via the contralateral internal carotid artery for acute ischemic stroke. 1790 98


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