1/101. Multiple cerebral infarctions associated with ovarian hyperstimulation syndrome.A 26-year-old woman on human menopausal gonadotrophin-human chorionic gonadotrophin therapy for sterility showed multiple cerebral infarctions associated with ovarian hyperstimulation syndrome. A hypercoagulable state (hemoconcentration, increased plasma levels of D-dimer and thrombin-antithrombin III complex, and decreased protein s activity) was associated with her thromboembolic events. cerebral infarction associated with mild neurologic deficits may be overlooked in patients with ovarian hyperstimulation syndrome.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/101. 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 = 1keywords = complex (Clic here for more details about this article) |
3/101. A combined pattern of movement disorders resulting from posterolateral thalamic lesions of a vascular nature: a syndrome with clinico-radiologic correlation.We report a series of seven patients in whom a combined pattern of complex movement disorders restricted to one upper extremity emerged as a result of posterolateral thalamic lesions of vascular origin. This disorder was mainly characterized by choreiform and dystonic movements associated with variable, rhythmic, alternating movements of low frequency (myorhythmia). All cases showed, on computed tomography scan and/or magnetic resonance imaging, focal lesions involving the posterolateral quadrant of the thalamus. review of similar cases reported with identical clinico-radiologic features allows us to conclude that it is possible to establish an accurate anatomoclinical correlation based on the clinical phenomenology, even before imaging studies are performed, in these cases. The opposite is not entirely possible, however, because lesions in the same quadrant of the thalamus are often associated with different patterns of abnormal movements or present without abnormal movements.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/101. Forced hyperphasia and environmental dependency syndrome.A distinctive, language related fragment of the environmental dependency syndrome is described: compulsive, involuntary, environmentally dependent speaking. Because this syndrome represents the observe of aphasia, it is named forced hyperphasia. An 84 year old woman with acute left frontal infarction was admitted to hospital with gait disturbance, forced grasp reflex, and striking imitation behaviour. After 2 weeks her imitation behaviour disappeared, but an equally striking new behaviour emerged. In the presence of others she would call out the names of objects in the room, and also call out the actions and gestures of people in the room, even though she was not asked to do so, and even though she was asked to stop. For example, if the doctor scratched his nose, she said, "The doctor is scratching his nose." brain CT, MRI, and SPECT showed cerebral atrophy and a left superior frontal subcortical infarct. It is suggested that "forced hyperphasia" is a clinical fragment of the environmental dependency syndrome and that her compulsive, impulsive, involuntary release of spoken language resulted from the release of frontal inhibition of the complex reflex linking environmental cues to the set of motor, limbic, spatial, and linguistic associations underlying spoken language.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/101. brain activation during reading in deep dyslexia: an MEG study.Magnetoencephalographic (MEG) changes in cortical activity were studied in a chronic Finnish-speaking deep dyslexic patient during single-word and sentence reading. It has been hypothesized that in deep dyslexia, written word recognition and its lexical-semantic analysis are subserved by the intact right hemisphere. However, in our patient, as well as in most nonimpaired readers, lexical-semantic processing as measured by sentence-final semantic-incongruency detection was related to the left superior-temporal cortex activation. Activations around this same cortical area could be identified in single-word reading as well. Another factor relevant to deep dyslexic reading, the morphological complexity of the presented words, was also studied. The effect of morphology was observed only during the preparation for oral output. By performing repeated recordings 1 year apart, we were able to document significant variability in both the spontaneous activity and the evoked responses in the lesioned left hemisphere even though at the behavioural level, the patient's performance was stable. The observed variability emphasizes the importance of estimating consistency of brain activity both within and between measurements in brain-damaged individuals.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
6/101. Expressive language disorder after infarction of left lentiform nucleus.A 53 year old bilingual woman presented with apraxia of speech and writing in English and German after ischaemic infarction of the left posterior lentiform nucleus. Detailed language assessment revealed impairments of articulation, verbal fluency, auditory repetition, interpretation of complex semantic relationships, formulation of definitions and verbal short-term memory. The case illustrates the role of the basal ganglia in speech planning, word retrieval and verbal short-term memory.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/101. Restricted dissociated sensory loss in a patient with a lateral medullary syndrome: A clinical-MRI study.BACKGROUND: Various sensory syndromes in lateral medullary infarctions are described. A small variation in the location of a lesion may lead to very different clinical features, owing to the complex anatomy of the medulla oblongata. MRI may identify the location and extent of the ischemic lesions, allowing a clear clinical-anatomical correlation. CASE DESCRIPTION: We describe a man with an ischemic lesion in the right portion of the lower medulla that presented a contralateral impairment of spinothalamic sensory modalities and an ipsilateral impairment of lemniscal modalities with a restricted distribution (left forearm and hand, right hand and fingers, respectively). The restricted and dissociated sensory abnormalities represent the only permanent neurological consequence of that lesion. CONCLUSIONS: The atypical sensory syndrome may be explained by the involvement of the medial portion of spinothalamic tract and the lateral portion of archiform fibers at the level of the lemniscal decussation.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/101. myocardial stunning secondary to aneurysmal subarachnoid hemorrhage.BACKGROUND: Although subarachnoid hemorrhage (SAH) is often associated with electrocardiographic abnormalities, profound effects on cardiac performance are rare. CASE DESCRIPTION: A 57-year-old woman who developed loss of consciousness, respiratory distress, severe hypotension, and left ventricular hypokinesis with minimal coronary artery disease is described. Despite normal appearance of the coronary arteries on angiography, left ventricle function was so severely depressed that she required intra-aortic balloon pump support for 24 hours. Mental status changes prompted a head computed tomographic (CT) scan, which showed severe SAH and an intraventricular hemorrhage (IVH). cerebral angiography demonstrated a basilar apex aneurysm. An echocardiogram done on hospital day 6 was normal. A left frontal ventriculostomy catheter was placed. This was later changed to a lumbar subarachnoid (SA) drain. The patient underwent an orbito-zygomatic craniotomy and aneurysm clipping. Although several serious medical problems occurred during her hospitalization, at follow-up, her sole neurological impairment was a minimal and resolving oculomotor paresis. CONCLUSION: This patient's respiratory failure and severe hypotension were initially thought to be due to a chemical pneumonitis or a cardiomyopathy. However, her symptoms ultimately proved to be secondary to a ruptured basilar apex aneurysm. The complex relationship of SAH to myocardial stunning, as illustrated by this patient, is discussed.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/101. pseudoxanthoma elasticum diagnosed 25 years after the onset of cardiovascular disease.A 63-year-old man who had experienced cerebral infarction and myocardial infarction at an early age, and repeatedly underwent coronary angioplasty was admitted to our hospital for cardiac evaluation. A coronary angiography showed complex multi-vessel disease with significant stenosis in all major vessels and coronary-artery bypass grafts. A funduscopic examination to evaluate hypertensive and diabetic changes revealed angioid streaks. Therefore, a skin biopsy was performed despite the absence of characteristic skin lesions. Histopathologic examinations revealed calcification and fragmentation of elastic fibers. Therefore, he was finally diagnosed as having pseudoxanthoma elasticum 25 years after the onset of cardiovascular disease.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
10/101. Chronic akinetic mutism after mesencephalic-diencephalic infarction: remediated with dopaminergic medications.OBJECTIVE: akinetic mutism (AKM) is an uncommon disorder with a complex neuropathology. There is no generally accepted treatment, and it is not known if late treatments are effective. The relationship between AKM and abulia is uncertain. methods: The effects of dopaminergic treatment of a patient with chronic AKM after discrete bilateral infarctions of the mesencephalic ventral tegmental area and the lateral hypothalamus were studied with motor measures, the Functional Independence Measure (FIM), and neuropsychological tests. RESULTS: Treatment with a combination of carbidopa/levodopa and pergolide produced prompt amelioration of AKM with dramatic and rapid improvement in FIM. An apathetic, amotivational state persisted despite resolution of akinesia and normal frontal executive functions. CONCLUSIONS: AKM may respond to dopaminergic treatment even after months of severe akinesia. The mechanism of abulia is more complex than simply a partial dopaminergic deficiency state and may persist even when AKM is treated and frontal cognitive functions are normal.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
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