1/224. Transient paralytic attacks of obscure nature: the question of non-convulsive seizure paralysis.Eleven patients with transient paralytic attacks of obscure nature are described. paralysis could involve face or leg alone, face and hand, or face, arm and leg. The duration varied from two minutes to one day. Four patients had brain tumors, six probably had brain infarcts, and one a degenerative process. The differential diagnosis included TIAs, migraine accompaniments, and seizures. In the absence of good evidence for the first two, the cases are discussed from the standpoint of possibly representing nonconvulsive seizure paralysis (ictal paralysis, inhibitory seizure paralysis or somatic inhibitory seizure). Because of the difficulty in defining seizures as well as TIAs and migraine in their atypical variations, a firm conclusion concerning the mechanisms of the spells was not attained. Two cases of the hypertensive amaurosis-seizure syndrome have been added as further examples of ictal deficits.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
2/224. ego-syntonic alien hand syndrome after right posterior cerebral artery stroke.The alien hand syndrome classically consists of involuntary movements accompanied by a feeling of foreignness and personification of the affected limb. Autocriticism, in which patients criticize and express astonished frustration with the behavior of the autonomous limb, is a commonly noted feature. Most cases of alien hand are associated with lesions of the supplementary motor areas of the frontal lobes, the corpus callosum, or both. The authors report on a 79-year-old man who sustained a right posterior cerebral artery distribution infarction and developed alien hand syndrome in the absence of callosal involvement. Also unique is that the patient perceived the alien hand as acceptable and positive, not hostile and repugnant. This case suggests not only that the neuroanatomic regions responsible for alien hand syndrome may require re-examination, but also that its definition may need expansion.- - - - - - - - - - ranking = 35109.769044259keywords = alien hand syndrome, hand syndrome, alien hand, alien, hand (Clic here for more details about this article) |
3/224. stroke-associated stuttering.OBJECTIVE: To present patients with stuttering speech in association with stroke. DESIGN: Case series with follow-up for 5 years, or until the stuttering resolved. SETTING: University and community hospital neurology wards, and ambulatory neurology clinics. patients: Four patients who developed stuttering speech in association with an acute ischemic stroke. A 68-year-old man acutely developed stuttering with a large left middle cerebral artery distribution stroke. A 59-year-old man who had stuttered as a child began to stutter 2 months after a left temporal lobe infarction, as nonfluent aphasia was improving. Another childhood stutterer, a 59-year-old originally left-handed man developed severe but transient stuttering with a right parietal infarction. A 55-year-old man with a left occipital infarction had a right hemianopia and an acquired stutter, for which he was anosognosic. CONCLUSION: The clinical presentation of stroke-associated stuttering is variable, as are the locations of the implicated infarctions.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
4/224. Monoparesis of the right hand following a localised infarct in the left "precentral knob".A patient with acute weakness of the righ arm showed a focal lesion on MRI in the left 'precentral knob', not visible on CT.- - - - - - - - - - ranking = 4keywords = hand (Clic here for more details about this article) |
5/224. Crossed apraxia: implications for handedness.Liepmann posited that right hand preference relates to left hemisphere dominance for learned skilled movements. Limb apraxia, impairment of skilled movement, typically occurs in individuals with left hemisphere (LH) lesions. The occurrence of apraxia in right-handed individuals following right-hemisphere lesions appears to refute Liepmann's hypothesis. We studied the apraxia of a right-handed man, RF, following a right frontal lesion to determine whether his apraxia paralleled the apraxia seen following LH lesions. Results of behavioral testing indicated that, like individuals with apraxia following left frontal lesions, RF was better at gesture recognition than gesture production which was significantly impaired across tasks. Kinematic motion analyses of movement linearity, planarity, and the coupling of temporospatial aspects of movements substantiated the parallel impairments in RF and patients with LH apraxia. The impairment seen in our patient with crossed apraxia provides evidence for the fractionation of systems underlying hand preference and skilled movement.- - - - - - - - - - ranking = 8keywords = hand (Clic here for more details about this article) |
6/224. 'Fou rire prodromique' as the heralding symptom of lenticular infarction, caused by dissection of the internal carotid artery in a 12-year-old boy.A 12-year-old, right-handed boy experienced a pathological fit of laughter before a sudden right hemiplegia. magnetic resonance imaging showed a left basal ganglia infarction, induced by a left internal carotid dissection. Arteriography revealed an underlying fibromuscular dysplasia. This case study demonstrates that cerebral artery dissection can occur in children and that a basal ganglia infarction may be preceded by pathological laughter called 'fou rire prodromique'. The clinical and anatomical relationship of this paroxysmal event are discussed.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
7/224. Tactile morphagnosia secondary to spatial deficits.A 73-year old man showed visual and tactile agnosia following bilateral haemorrhagic stroke. Tactile agnosia was present in both hands, as shown by his impaired recognition of objects, geometrical shapes, letters and nonsense shapes. Basic somatosensory functions and the appreciation of substance qualities (hylognosis) were preserved. The patient's inability to identify the stimulus shape (morphagnosia) was associated with a striking impairment in detecting the orientation of a line or a rod in two- and three-dimensional space. This spatial deficit was thought to underlie morphagnosia, since in the tactile modality form recognition is built upon the integration of the successive changes of orientation in space made by the hand as it explores the stimulus. Indirect support for this hypothesis was provided by the location of the lesions, which could not account for the severe impairment of both hands. Only those located in the right hemisphere encroached upon the posterior parietal cortex, which is the region assumed to be specialised in shape recognition. The left hemisphere damage spared the corresponding area and could not, therefore, be held responsible for the right hand tactile agnosia. We submit that tactile agnosia can result from the disruption of two discrete mechanisms and has different features. It may arise from a parietal lesion damaging the high level processing of somatosensory information that culminates in the structured description of the object. In this case, tactile recognition is impaired in the hand contralateral to the side of the lesion. Alternatively, it may be caused by a profound derangement of spatial skills, particularly those involved in detecting the orientation in space of lines, segments and complex patterns. This deficit results in morphagnosia, which affects both hands to the same degree.- - - - - - - - - - ranking = 6keywords = hand (Clic here for more details about this article) |
8/224. Somatotopic gradients in the distributed organization of the human primary motor cortex hand area: evidence from small infarcts.Nine cases of relatively selective hand weakness produced by stroke were analyzed to examine the degree to which representations of different fingers are segregated in the human primary motor cortex (M1). In five cases, all the digits were involved uniformly; in four cases the radial versus ulnar digits of the hand were involved differentially. No patient showed discrete involvement of a single digit, nor did any patient have greatest weakness in the index, middle or ring finger. These findings provide little evidence that each digit is represented in a separate cortical territory, but rather suggest that broadly overlapping gradients - with the radial digits somewhat more heavily represented laterally and the ulnar digits somewhat more heavily represented medially - are superimposed on an underlying organization in which control of each finger is distributed widely throughout the human M1 hand area.- - - - - - - - - - ranking = 7keywords = hand (Clic here for more details about this article) |
9/224. Is there a syndrome of tuberothalamic artery infarction? A case report and critical review.Short-term post-acute neuropsychological, neurological, and neuroradiological test results and a 16-month follow-up of a 65-year-old patient with a right hemisphere ischemic lesion in the tuberothalamic area of vascular supply are reported. During a 6-week period of examinations the originally left- but trained right-handed patient exhibited fluctuating neuropsychological disorders including aphasia, visuo-perceptive and visuoconstructive disorders, and memory and attention deficits. In the follow-up examination the patient exhibited no aphasia and significant improvements in most neuropsychological tasks. Based on three-dimensional reconstruction of MRI, lesion topography and involvement of thalamic nuclei were established. We discuss the neuropsychological and neurological symptoms of the present case against the background of the 'syndrome of unilateral tuberothalamic artery territory infarction' proposed by Bogousslavsky and coworkers (1986) and the neuropsychological literature on unilateral ischemic anterior/anterolateral thalamic infarction.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
10/224. Post-stroke mania late in life involving the left hemisphere.OBJECTIVE: Although post-stroke depression is well recognised, post-stroke mania has rarely been reported and researched. Most reported cases have involved lesions of the non-dominant hemisphere. We report a case of late-onset mania following stroke with a lesion in the dominant hemisphere. CLINICAL PICTURE: A 78-year-old, right-handed man developed sudden cognitive deficits and manic symptoms. Investigations revealed lesions in the dominant hemisphere. TREATMENT: Pharmacological intervention was complicated by side effects. OUTCOME: His symptoms resolved gradually over 2 months and he was back to normal in 4 months. CONCLUSIONS: We would encourage further study in the area of post-stroke mania and especially in relation to the site of the lesion in the brain.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
| | Next -> |