1/49. Lack of t-PA use for acute ischemic stroke in a community hospital: high incidence of exclusion criteria.thrombolytic therapy with t-PA for acute ischemic stroke may provide benefit in long-term outcome. This retrospective study was undertaken to evaluate appropriateness of the national institute of neurological disorders and stroke (NINDS) protocol in the emergency department (ED). All patients with appropriate international classification of diseases, 9th revision (ICD-9) codes indicating stroke who presented to our 387-bed trauma-I community hospital during 1997 were included in the study. Of the nearly 35,000 patients screened, 201 patients satisfied our inclusion criteria. Mean age was 73.5 /- 13.3 years. Men were evaluated and transported to computed tomography more rapidly and older patients more slowly. Nonwhites were more likely to arrive via emergency medical services (EMS). Average time from EMS arrival at scene to ED arrival was 22.7 minutes, and from ED arrival to triage was 8.4 minutes. The most common reason for exclusion from t-PA administration was delayed presentation (n = 188); this is the most serious barrier to use of t-PA for acute ischemic stroke. Extensive public education may combat this.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/49. A transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas. Technical note.The authors advocate the use of a transparent sheath for guiding an endoscope, a simple and unique tool for endoscopic surgery, and describe preliminary results of its application in the evacuation of hypertensive intracerebral hematomas. This sheath is a 10-cm-long tube made of clear acrylic plastic, which greatly improves visualization of the surgical field through a 2.7-mm nonangled endoscope inserted within. Between April 1997 and December 1998, the authors performed endoscopic evacuation of intracerebral hematomas by using this sheath inserted into the patients' heads through a burr hole. In nine consecutive cases in which the hematoma was larger than 40 ml in volume, nearly complete evacuation (86-100%) of the lesion was achieved without complication. Excellent visualization of the border between the brain parenchyma and the hematoma facilitated accurate intraoperative orientation, and also allowed easy identification of the bleeding point. Thus, this combination of sheath and endoscope achieves both minimal invasiveness and the maximum extent of hematoma removal with secure hemostasis. This tool will reduce the inherent disadvantage of endoscopic procedures and may expand their application in other areas of neurosurgical management.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/49. Recovery from Duret hemorrhage: a rare complication after craniotomy--case report.A 44-year-old female presented with Duret hemorrhage due to transtentorial herniation by extradural hematoma as a complication after craniotomy for treatment of spontaneous middle cranial fossa cerebrospinal fluid leakage through the oval window. Brain computed tomography revealed linear hemorrhage in the midbrain and the rostral pons. She awoke after 2 weeks in a coma, despite showing ocular bobbing and bilateral intranuclear ophthalmoplegia. She was discharged from the hospital with minimal neurological defects. Duret hemorrhage is usually fatal, but this case shows that early surgical decompression is the most important factor to avoid the worst sequelae.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/49. Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases.OBJECT: In this study the authors performed a retrospective analysis of five cases in which the patients (three women and two men) were treated for intracranial dural arteriovenous fistulas (AVFs) associated with cerebellar hemorrhage. On the basis of their findings, the authors evaluated the characteristics of this unusual symptom. methods: The dural AVFs were located in the right cavernous sinus in one patient, the left transverse-sigmoid sinus in three patients, and the right superior petrosal sinus (SPS) in one patient. All patients presented with severe headache and/or loss of consciousness. Computerized tomography scans revealed a small cerebellar hemorrhage near the fourth ventricle and hydrocephalus in four cases, and a massive hemispheric cerebellar hemorrhage in the remaining case. The four patients with small hemorrhages underwent ventriculostomy and endovascular treatment; all recovered. The patient suffering from a massive hemorrhage because of a dural AVF in the SPS was treated by suboccipital craniectomy, hematoma evacuation, and removal of the vascular anomaly. This patient remains in a persistent vegetative state. In four cases, results of angiography demonstrated retrograde leptomeningeal venous drainage through the SPS to the anastomotic lateral mesencephalic vein (ALMV) and/or to the vein of the lateral recess of the fourth ventricle (VLR4V). Retrograde leptomeningeal venous drainage to the ALMV and/or VLR4V was responsible for cerebellar hemorrhage in these cases. CONCLUSIONS: Thus, it is important to consider dural AVF in cases in which there is even a small hemorrhage near the fourth ventricle accompanied by intraventricular perforation and a decreased level of consciousness.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
5/49. Treatment of ballism and pseudobulbar affect with sertraline.BACKGROUND: The pathogenesis of ballism is uncertain and may involve more than one mechanism; treatment is not always efficacious. OBJECTIVE: To provide evidence of a nondopaminergic mechanism and the potential for a prompt and nearly complete response to a serotonergic agent. methods: Report of 2 separate trials of sertraline hydrochloride in a single patient. RESULTS: Complete remission of symptoms within 48 hours of each drug trial. CONCLUSION: sertraline may offer an alternative with a better adverse effect profile than dopamine receptor blockers in the treatment of patients with ballism.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/49. Anterior transpetrosal approach for pontine cavernous angioma--case report.A 58-year-old male patient presented with headache and unsteady gait. magnetic resonance imaging revealed hemorrhage from a pontine cavernous angioma. The patient experienced stepwise aggravation of symptoms due to repeated hemorrhages. We decided to surgically remove the pontine cavernous angioma through an anterior transpetrosal approach, since the angioma and hematoma were located near the ventrolateral surface of the pons. The brain stem was incised at a site caudal to the trigeminal nerve and the hematoma and angioma were totally removed. No additional neurological deficits were observed following surgery. brain stem cavernous angiomas are usually removed via a trans-fourth ventricle or lateral suboccipital approach. However, these approaches may not be appropriate if the angioma is located ventrally to the pons. We propose that the anterior transpetrosal approach is the method of choice for ventrally located pontine cavernous angioma.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/49. Expectation-based attentional modulation of visual extinction in spatial neglect.Visual extinction, the failure of patients with unilateral focal brain damage to report the contralesional of two simultaneously presented stimuli, may be modulated by characteristics of the display such as similarity, collinearity, or connectedness. Since these factors affect the perceptual configuration of stimuli, the modulation of extinction is believed to reflect low-level perceptual grouping. In the present study, patient AG did not show any modulation of contralesional detection when the ipsilesional and contralesional stimulus grouped by colour, by form, or both (Experiment 1). In contrast, identification of the contralesional stimulus was facilitated when the stimuli grouped (Experiment 2), suggesting a modulation of extinction by specific task demands. Experiment 3 used a cueing procedure to demonstrate modulation of extinction by expectation biases. Prior to stimulus presentation, AG was cued to attend to a particular feature (e.g. colour). After stimulus exposure he was prompted to identify the expected feature on valid trials and the unexpected feature on invalid trials. AG showed a significant validity effect for contralesional stimuli i.e. he identified the expected feature (e.g. colour) significantly better than the unexpected feature (e.g. form). These results suggest that competition for selection between visual stimuli may not only be influenced by perceptual characteristics of the display, but also by high-level factors such as the response criterion or expectation biases.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/49. Medial pontine hemorrhagic stroke.BACKGROUND AND PURPOSE: This case report documents a rare opportunity to observe the motor function of an individual for nearly 6 months following a primary pontine hemorrhage in the medial pontine tegmentum of the brain stem. The purpose of this report is to illustrate how knowledge of the location of the hemorrhage, in conjunction with knowledge of brain-stem structure-function relationships, informs physical therapist examination and intervention. CASE DESCRIPTION: RM, a right-handed 81-year-old man with hypertension, had a hemorrhagic brain-stem stroke that severely compromised control of posture and whole-limb movements. Some residual ability to use the right hand and fingers remained, provided the trunk and right upper arm were stabilized. RM had undiminished intellectual abilities and unaltered memory because of sparing of cerebral cortices. RM's cognitive abilities, however, were obscured by severe impairments in interpersonal communication because of extensive damage to cranial nerve structures. Computed tomographic scans verified that the hematoma crossed the midline and was confined to the medial pontine tegmentum. DISCUSSION: We interpret motor deficits resulting from stoke in the medial pontine tegmentum in terms of damage to brain-stem descending motor systems and ascending somatosensory systems. Recognition of cognitive and residual motor abilities following brain-stem stroke can aid in the development of rehabilitation strategies.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/49. Pure imagery hemi-neglect of far space.patients with hemispatial neglect restricted to near (within reaching distance) or to far space (beyond reaching distance) have been described. This constitutes a double-dissociation considered by current neurocognitive thinking as compelling evidence for separate networks. However, a similar double-dissociation exists with respect to perceived as opposed to imagined space. If the organization of represented space was similar to that of perceived space, it should contain a far/near dissociation as well. This paper describes a patient with pure representational neglect restricted to far space.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
10/49. Late-onset meningitis in sick, very-low-birth-weight infants. Clinical and sonographic observations.OBJECTIVES--To determine the clinical and sonographic features of late-onset meningitis (after 7 days of life) in sick, very-low-birth-weight infants. DESIGN--Retrospective study of a patient series. SETTING--Neonatal intensive care nursery at Parkland Memorial Hospital in Dallas, Tex. PARTICIPANTS--Ten preterm infants with birth weights of more than 1750 g who developed late-onset meningitis during a 42-month study period. INTERVENTIONS--None. RESULTS--Ten preterm infants developed meningitis at a mean ( /- SD) postnatal age of 20 /- 14 days. Eight of the infants survived. Initial clinical signs were nonspecific, eg, apnea and bradycardia (eight infants), abdominal distention (five infants), hyponatremia (serum sodium level, < 130 mmol/L), and a decrease in urine output with an increase in weight (three infants). Specific neurologic signs occurred in three infants (seizures [n = 2] and third-nerve palsy [n = 1]). Sonographic abnormalities noted in seven (70%) of the 10 infants included progressive ventriculomegaly (n = 6), thalamic echodensities (n = 3), ventriculitis (n = 4), and cystic leukomalacia (n = 1). The progressive ventriculomegaly developed from 1 to 2 weeks after diagnosis; permanent shunting was required in all six infants. The thalamic echodensities were linear or punctate and developed from 1 to 2 weeks after diagnosis in two infants. CONCLUSIONS--The data indicate the need for a high index of suspicion of meningitis in very-low-birth-weight infants suspected of having sepsis because of the nonspecific clinical presentation of meningitis. Because both progressive ventriculomegaly and thalamic echodensities are late and frequent findings, serial sonograms are essential for careful monitoring of sequelae of disease.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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