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

Nine cases have been presented in detail to illustrate some of the varied causes of sudden neurological deficit in childhood: arteriovenous malformation, cryptic hamartoma, berry aneurysm, mycotic aneurysm, intraspinal arteriovenous malformation, brain tumor, migraine, arteritis, and multiple sclerosis. The Boston Children's Hospital experience with aneurysms and intracranial arteriovenous malformation has been summarized. It is noteworthy that a cutaneous hemangioma overlay one cranial and one intraspinal arteriovenous malformation. One small but deep cerebral arteriovenous malformation apparently destroyed itself after its second hemorrhage. Not only have multiple sclerosis and a brain tumor mimicked a vascular lesion, but a series of vascular accidents was misdiagnosed first as multiple sclerosis then as a thalamic tumor. The many possible causes of childhood strokes has been thoroughly cataloged in the Report of the Joint Committee for Stroke Facilities in 1973 (11). Children may be more susceptible to strokes because of congenital abnormalities such as congenital heart disease, hemophilia, and sickle cell anemia, or by diseases which more commonly occur in this age group, such as leukemia. The likelihood of brain abscess in cyanotic congenital heart disease is stressed. Arteriographic studies in our series have been safe; however, there have been reports of probable worsening of symptoms in children with multiple cerebral occlusive lesions in the presence of homocystinuria.
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PMID:Strokes in children. 98 45

A 24 hour ambulatory EEG study performed in a population of 300 non epileptic outpatients with an anxious and depressive pathology revealed a high prevalence of abnormalities in subjects referred with panic disorder. Two groups of 150 medication-free patients each have been selected on the base of DSM-III-R = one with panic attacks (PA), the other with depressive patients without paroxystic anxiety (DS). The results showed respectively = in the PA group 63.2% abnormal, 19.7% normal and 17.1% dubious records. In the DS group = 74.5% normal, 18.3% abnormal and 7.2% dubious records. Epileptiform abnormalities were 4 times more frequent in the PA group (80%) than in the DS group (20%). Two nycthemeral peaks were found (5-8 pm and 3 hours after awakening). MRI has permitted the discovery of abnormal cerebral images in 3 patients of the PA group (cyst of the insula, temporal and parietal cryptic angiomas, sequelae of a parietal vasculo-cerebral stroke) frequency appearing to be clearly superior to the one resulting from recent epidemiologic data. The subclinical character of 2/3 of these abnormalities refers beyond epilepsy to their signification in the field of emotive and intellectual disturbances. The paradoxal efficiency of tricyclic drugs in panic disorder, sets the problem of their eventual antiepileptic action at low doses. If recent data on standard EEG in panic disorder is available, we did not find any similar study to ours in order to confront our results.
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PMID:[Panic attacks and 24-hour ambulatory EEG monitoring]. 134 26

Primary intracerebral hemorrhages are often dramatic and lethal. Therapeutic possibilities are limited. Multivariate studies show that patient age, hematoma volume, ventricular extension of the hemorrhage, and level of consciousness are the decisive prognostic parameters. This overview shows that the etiological spectrum is larger than suggested by the classic paradigm of "either hypertensive or cryptic angioma". The variability of clinical presentation can be put into a systematic order by means of clinical neurological examination and imaging techniques. Experiences with 62 consecutive cases from the Klosterneuburg Stroke Data-Bank are reported.
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PMID:[Clinical aspects and diagnosis of cerebral hemorrhage]. 158 79

Five cases of brain-stem hematoma are described. The cause of these hematomas was identified as "cryptic angioma" (1 cavernous angioma, 1 telangiectasia, 3 arteriovenous malformations). So, they are so-called "secondary hematoma", as opposed to brain-stem hematoma in relation with hypertension. Such secondary hematomas are reported in the literature: 37 operated on cases and 22 untreated cases were found. The clinical picture does not seem to be typical. The presentation appears to be either with the acute onset of a stroke, or with a subacute onset including relapsing symptoms. A progressive deterioration suggesting a pontine glioma or mimicking demyelination is not rare. The CT scanner appearance is often characteristic showing a high density area in the brain-stem which enhanced after injection of contrast medium with an aspect of "halo". Angiography is usually negative. The natural history of brain-stem hematoma due to rupture of a cryptic angioma is not well documented, but it seems that prognosis is very poor. So, the authors insist on surgical evacuation which is effective and safe allowing the diagnosis of brain-stem hematoma and in some cases the identification of the malformation.
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PMID:[Secondary hematoma of the brain stem. Apropos of 5 cases]. 376 36

Thirty-two patients with lobar hematoma were encountered during a period of six and a half years. Of these patients, 13 had arterial hypertension, 7 had other etiologies, and the remaining 12 were without apparent etiology. In 5 of these patients, cryptic angiomas were suspected from angiograms and CT scans. In one young patient, there was a later recurrence of hemorrhage that resulted in death. Our experience in this series and a review of the literature have led us to conclude that, in young normotensive patients with lobar hematoma, surgical intervention may be a reasonable consideration so that evacuation of the hematoma may be accomplished and a detailed search for small angiomatous malformations may be carried out with a view to preventing recurrences.
Stroke
PMID:Lobar intracerebral hemorrhage: etiology and a long-term follow-up study of 32 patients. 394 83

We had a case of patient with pure sensory stroke which was caused by the rapture of a cryptic angioma located on the mesencephalon. The patient was a 41-year-old woman. She visited our clinic with sudden onset of numbness in the left hand, arm, trunk, leg, and face, and of hyposmia of the left side on arising. CT scans revealed a small hematoma with calcification located on the right dorsal mesencephalon, which diminished in size correlating with her recovery of the sensation. Her symptoms were considered to be caused by this hematoma which destroyed only the trigeminothalamic and the spinothalamic tracts excluding the superior colliculi, oculomotor nucleus, and the medial leminiscus. By angiography we failed to demonstrate a cause of the hemorrhage, but the presence of a cryptic angioma was suggested, because the post angiographic CT scan exhibited enhancement of the lesion. Her olfactory sensation was also restored accompanied with the recovery of the superficial sensation, therefore the hyposmia seemed to be due to the damage of the trigeminothalamic tract.
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PMID:[Pure sensory stroke due to midbrain hemorrhage--case report]. 400 74

We prospectively analyzed the effect of surgical procedures in epilepsy patients, except for those with mesial temporal lobe epilepsy. Twenty patients with a mean age of 26 years (range 3 to 58 years, 10 male and 10 female) underwent the surgical procedures. These patients were divided into 3 groups according to MRI findings, as follows; group A (localized type): localized lesions such as angiomas or benign tumors, group B (widespread type): widespread lesions such as regional encephalitis or stroke, visible on anatomical neuroimaging, and group C (cryptic type): no lesion visible on anatomical neuroimaging. Following surgery, 11 (85%) of the 13 patients in group A were seizure-free, one showed worthwhile improvement, and one, whose lesion was not removed totally, was unchanged. In group B, two patients (50%) were seizure-free and 2 (50%) showed worthwhile improvement. All the patients in group C showed worthwhile improvement. Lesionectomy, cortical excision, multiple subpial transection (MST) or a combination of these procedures were effective in groups A and B. Patients in group C had a chance to obtain worthwhile improvement by corpus callosotomy or cortical excision. Intracranial EEG recording provides useful information for epilepsy surgery in intractable cases.
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PMID:[Effect of epilepsy surgery based on magnetic resonance imaging (MRI) classification]. 1064 90

Neuroserpin, a recently identified inhibitor of tissue-type plasminogen activator (tPA), is primarily localized to neurons within the central nervous system, where it is thought to regulate tPA activity. In the present study neuroserpin expression and its potential therapeutic benefits were examined in a rat model of stroke. Neuroserpin expression increased in neurons surrounding the ischemic core (ischemic penumbra) within 6 hours of occlusion of the middle cerebral artery and remained elevated during the first week after the ischemic insult. Injection of neuroserpin directly into the brain immediately after infarct reduced stroke volume by 64% at 72 hours compared with control animals. In untreated animals both tPA and urokinase-type plasminogen activator (uPA) activity was significantly increased within the region of infarct by 6 hours after reperfusion. Activity of tPA then decreased to control levels by 72 hours, whereas uPA activity continued to rise and was dramatically increased by 72 hours. Both tPA and uPA activity were significantly reduced in neuroserpin-treated animals. Immunohistochemical staining of basement membrane laminin with a monoclonal antibody directed toward a cryptic epitope suggested that proteolysis of the basement membrane occurred as early as 10 minutes after reperfusion and that intracerebral administration of neuroserpin significantly reduced this proteolysis. Neuroserpin also decreased apoptotic cell counts in the ischemic penumbra by more than 50%. Thus, neuroserpin may be a naturally occurring neuroprotective proteinase inhibitor, whose therapeutic administration decreases stroke volume most likely by inhibiting proteinase activity and subsequent apoptosis associated with focal cerebral ischemia/reperfusion. (Blood. 2000;96:569-576)
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PMID:Neuroserpin reduces cerebral infarct volume and protects neurons from ischemia-induced apoptosis. 1088 20

Foraging by mammals is a complex suite of behaviors that can entail high energetic costs associated with supporting basal metabolism, locomotion and the digestion of prey. To determine the contribution of these various costs in a free-ranging marine mammal, we measured the post-dive oxygen consumption of adult Weddell seals (N=9) performing foraging and non-foraging dives from an isolated ice hole in McMurdo Sound, Antarctica. Dives were classified according to behavior as monitored by an attached video-data logging system (recording activity, time, depth, velocity and stroking). We found that recovery oxygen consumption showed a biphasic relationship with dive duration that corresponded to the onset of plasma lactate accumulation at approximately 23 min. Locomotor costs for diving Weddell seals increased linearly with the number of strokes taken according to the relationship: locomotor cost = -3.78+0.04 x stroke number (r(2)=0.74, N=90 dives), where locomotor cost is in ml O(2) kg(-1). Foraging dives in which seals ingested Pleuragramma antarcticum resulted in a 44.7% increase in recovery oxygen consumption compared to non-foraging dives, which we attributed to the digestion and warming of prey. The results show that the energy expended in digestion for a free-ranging marine mammal are additive to locomotor and basal costs. By accounting for each of these costs and monitoring stroking mechanics, it is possible to estimate the aerobic cost of diving in free-ranging seals where cryptic behavior and remote locations prevent direct energetic measurements.
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PMID:The cost of foraging by a marine predator, the Weddell seal Leptonychotes weddellii: pricing by the stroke. 1476 56

We retrospectively evaluate the presence of cryptic fibromuscular dysplasia (FMD) (i.e. not macroscopically visible and not associated to FMD in larger arteries) in the small meningeal vessels in a comprehensive series of patients. Such a study has not been performed before to our knowledge. The meningeal tissue has been systematically examined in a series of 100 consecutive autopsies. The immunohistochemical study was performed in one case with leptomeningeal FMD. In the whole series only one case had FMD in the small leptomeningeal arteries. The histological variant was intimal fibroplasia, a rare variant of FMD. Immunohistochemistry was necessary to confirm this peculiar change of the vascular wall. Cryptic fibromuscular dysplasia in the meninges is a very rare finding in our series of autopsied patients--1% of cases, in concordance with the literature data. The clinical associations of this lesion are difficult to be related to this lesion. A cryptic presence of FMD must be suspected in some cases with stroke.
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PMID:Cryptic fibromuscular dysplasia in the meningeal vessels. An autopsy study. 1628 84


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