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

People with severe arm impairment have limited technologies available for retraining their arms, and, if they also have difficulty walking, they often cannot effectively use a manual wheelchair because they cannot grasp and push the pushrim. We are using Lever-Actuated Resonance Assistance (LARA) to solve these problems. A LARA-based device can attach to a manual wheelchair and allow it to be used by people with severe arm weakness in a stationary exercise mode, or for self-powered overground ambulation. LARA uses a lever drive and arm support to appropriately position the arm and to reduce the dexterity required to operate the wheelchair. It also uses mechanical resonance implemented with elastic bands to provide assistance for both stationary exercise and overground ambulation. We first review here pilot results in which we used the LARA method to provide arm therapy to individuals with chronic stroke in stationary exercise mode. We then describe a novel motion-based user interface that allows individuals to control a video game with LARA while operating a wheelchair in resonance. Finally, for overground ambulation mode, we show in simulation that the mechanical resonance provided by LARA theoretically allows people with severe arm weakness to propel themselves with reduced effort and obtain speeds previously unattainable.
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PMID:Lever-actuated resonance assistance (LARA): a wheelchair-based method for upper extremity therapy and overground ambulation for people with severe arm impairment. 2418 19

iPAM (intelligent Pneumatic Arm Movement) is a dual robot system for providing assistive upper-limb exercise to people with arm weakness as a result of stroke. This paper highlights refinements made to the system in the development of iPAM MkII. The rationale of an on-going random control trial using the iPAM MkII is also presented.
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PMID:Development of the iPAM MkII system and description of a randomized control trial with acute stroke patients. 2418 26

Ischemic stroke due to congenital cardiopulmonary vasculature anomalies is rare in adults. We report a 54-year-old man with a stroke due to a unique right-to-left shunt who underwent successful endovascular treatment. This patient developed acute onset of right arm weakness with facial droop and aphasia which improved after intravenous thrombolysis. An MRI showed acute cerebral ischemia in the left middle cerebral artery and left posterior cerebral artery distribution. The patient developed recurrent stroke symptoms during agitated saline injection while undergoing a transthoracic echocardiogram which showed right-to-left shunting. Chest CT scan and conventional angiography revealed near occlusion of the superior vena cava. Head and upper limb venous return drained via a large left vertical vein into an anomalous left pulmonary vein into the left atrium. He underwent endovascular surgery to relieve the superior vena cava obstruction and to occlude the source of right-to-left shunt. While rare, congenital cardiopulmonary vascular anomalies may result in ischemic stroke in adults. CT angiography may be necessary to evaluate cardiopulmonary vasculature when right-to-left shunting is discovered on echocardiography in the setting of ischemic stroke. With large right-to-left shunts, agitated saline should be avoided.
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PMID:Successful endovascular repair of an unusual right-to-left shunt presenting with cerebral ischemia. 2447 38

Cerebrovascular events are very common in sickle cell disease (SCD), and multiple mechanisms are probably involved in their pathophysiology. We report a 30-year-old woman who presented a large volume silent stroke followed 2 months later by a second large volume stroke that manifested only with transient arm weakness. In the acute phase, magnetic resonance angiography revealed a segmental stenosis of the 2 different large intracranial vessels supplying the stroke territories. Partial regression of vascular stenosis was revealed by a follow-up magnetic resonance imaging. Present case suggests that stenosis of large intracranial vessels, possibly related to vascular injury promoted by the endothelial adhesion of reticulocytes and inflammatory elements, is involved in large volume brain infarcts in SCD.
J Stroke Cerebrovasc Dis
PMID:Recurrent large volume silent strokes in sickle cell disease. 2523 21

Asterixis as limb-shaking transient ischemic attack (TIA) is rare and poorly understood. Bilateral asymmetrical asterixis as limb-shaking TIA has not been reported in carotid stenosis. A 69-year-old gentleman presented with a TIA episode (dysarthria, right-arm weakness, and numbness). Bilateral asterixis was observed and was more severe on the right side. No prior infarcts were noted in the thalamus. Liver function was normal. A computerized tomography angiogram revealed 85%stenosis of the right internal carotid artery (ICA) and 65% stenosis of the left ICA. Three days after left ICA endarterectomy, the patient had complete disappearance of bilateral asterixis, with the right side showing initial improvement. The bilateral asterixis observed is proposed to be secondary to hemodynamic impairment and hypoperfusion of certain brain territory with resolution on revascularization.
J Stroke Cerebrovasc Dis 2015 Jan
PMID:Bilateral asymmetrical asterixis as limb-shaking transient ischemic attack in bilateral carotid stenosis. 2544 Mar 34

OBJECT Moyamoya can cause cerebral ischemia and stroke in Down syndrome (DS) patients. In this study, the authors defined a surgically treated population of patients with DS and moyamoya and compared their clinical presentation, response to surgical treatment, and long-term prognosis with those of the general population of patients with moyamoya but without DS. METHODS This study was a retrospective review of a consecutive operative series of moyamoya patients with DS treated at Boston Children's Hospital from 1985 through 2012. RESULTS Thirty-two patients, average age 9.7 years (range 1.8-29.3 years), underwent surgery for moyamoya in association with DS. The majority presented with ischemic symptoms (87% stroke, 42% transient ischemic attacks). Twenty-four patients (75%) had congenital heart disease. Nineteen patients (59%) had bilateral moyamoya on presentation, and 13 presented with unilateral disease, of which 2 progressed to surgery on the opposite side at a later date. Patients were followed for a median of 7.5 years (1-20.2 years) after surgery, with no patients lost to follow-up. Follow-up arteriography demonstrated Matsushima Grade A collaterals in 29 of 39 (74%) hemispheres, Grade B in 5 (13%), and Grade C in 5 (13%). Complications included postoperative strokes in 2 patients, which occurred within 48 hours of surgery in both; one of these patients had arm weakness and the other confusion (both had recovered completely at follow-up). Seizures occurred in 5 patients perioperatively, including one who had a new seizure disorder related to hypocalcemia. CONCLUSIONS Moyamoya disease is a cause of stroke in patients with DS. Both the incidence of preoperative stroke (87% vs 67%) and the average age at diagnosis for children under age 21 (8.4 vs 6.5 years) were greater in patients with DS and moyamoya than in the general moyamoya surgical population, suggesting a possible delay in reaching a correct diagnosis of the cause of cerebral ischemia in the DS patient population. Pial synangiosis provided long-term protection from stroke in all patients treated.
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PMID:Down syndrome and moyamoya: clinical presentation and surgical management. 2583 90

This study evaluates whether the International Classification of Functioning, Disability, and Health (ICF) framework provides a useful basis to ensure that key user needs are identified in the development of a home-based arm rehabilitation system for stroke patients. Using a qualitative approach, nine people with residual arm weakness after stroke and six healthcare professionals with expertise in stroke rehabilitation were enrolled in the user-centered design process. They were asked, through semi-structured interviews, to define the needs and specification for a potential home-based rehabilitation device to facilitate self-managed arm exercise. The topic list for the interviews was derived by brainstorming ideas within the clinical and engineering multidisciplinary research team based on previous experience and existing literature in user-centered design. Meaningful concepts were extracted from questions and responses of these interviews. These concepts obtained were matched to the categories within the ICF comprehensive core set for stroke using ICF linking rules. Most of the concepts extracted from the interviews matched to the existing ICF Core Set categories. Person factors like gender, age, interest, compliance, motivation, choice, and convenience that might determine device usability are yet to be categorized within the ICF comprehensive core set. The results suggest that the categories of the comprehensive ICF Core Set for stroke provide a useful basis for structuring interviews to identify most users needs. However some personal factors (related to end users and healthcare professionals) need to be considered in addition to the ICF categories.
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PMID:Investigating the International Classification of Functioning, Disability, and Health (ICF) Framework to Capture User Needs in the Concept Stage of Rehabilitation Technology Development. 2613 97

Reperfusion brain edema occurs infrequently after carotid endarterectomy and has been reported only ipsilateral to the side of surgery. We report a 51-year-old woman who presented with transient right arm weakness followed by left hemiparesis. Angiography showed occlusion of the left internal carotid artery, 90% stenosis of the right internal carotid artery, filling of the left anterior cerebral artery from the right carotid circulation only, and filling of the left middle cerebral artery branches by pial collaterals from the left anterior cerebral and posterior cerebral arteries. The patient had a right carotid endarterectomy and 1 day postoperatively developed a severe headache but had no new focal neurologic findings. Computed tomography showed effacement of sulci and scattered areas of high attenuation in the left parietal lobe, consistent with cerebral edema and petechial hemorrhage or vascular engorgement. Magnetic resonance imaging 2 days later did not show a lesion in the left hemisphere, suggesting resolution of the edema. This report suggests that reperfusion brain edema can occur contralateral to carotid endarterectomy.
J Stroke Cerebrovasc Dis 1994
PMID:Contralateral reperfusion injury after carotid endarterectomy. 2648 36

We studied 15 consecutive patients with acute brachial monoparesis due to stroke. There were 12 men and 3 women aged 45-78 years (mean, 61). Stroke workup included brain imaging, carotid duplex, echocardiography, and blood tests. In nine patients, the arm weakness was mainly distal, and in six it was equal distally and proximally. Tendon reflexes in the affected arm compared to the contralateral arm were symmetrical in 10, increased in 3, and decreased in 2 patients. In 14 patients, brain imaging showed a stroke in the middle cerebral artery branch territory superficially corresponding to the symptoms; and magnetic resonance imaging was negative in 1. Fourteen strokes were ischemic, and 1 was hemorrhagic. Of the 14 patients with ischemic stroke, 6 had > 50% ipsilateral extracranial cartoid artery stenosis, 4 had a serious source of cardiac emboli, and in 4 the cause of stroke was not identified. Our findings suggest that sudden brachial monoparesis should be considered a middle cerebral artery branch territory nonlacunar stroke syndrome. The etiologies of stroke causing pure brachial monoparesis are varied and include carotid artery disease, cardiac embolism, and intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 1995
PMID:Stroke causing pure brachial monoparesis. 2648 89

A 64-year-old man developed right arm weakness and dysarthria, and was admitted to our hospital. Diffusion-weighted magnetic resonance imaging of the brain showed a high intensity area in the frontal lobe. T2*-weighted images showed multiple spotty low intensity lesions in bilateral cerebral hemispheres, mimicking cerebral microbleeds. Cerebral angiography showed multiple aneurysms in the anterior, middle, posterior cerebral arteries and cerebellar arteries. Transthoracic echocardiography revealed a floating structure in the left atrial chamber, indicating cardiac myxoma. We diagnosed cardioembolic ischemic stroke due to left atrial myxoma. Cardiac surgery for excision of a left atrial myxoma was performed on the 3rd hospital day. Multiple aneurysms should be taken into account for differential diagnosis in patients with cardiac myxoma and with atypical spotty low intensity on T2*-weighted images.
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PMID:[A case of cerebral embolism due to cardiac myxoma presenting with multiple cerebral microaneurysms detected on first MRI scans]. 2679 85


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