1/44. magnetic resonance angiography in vertebrobasilar ischemia. Preliminary experience.Forty-five patients were evaluated for vertebrobasilar ischemic disease by magnetic resonance imaging and magnetic resonance angiography (MRA). Ten also underwent intraarterial digital subtraction angiography. All were sorted into three groups based on results of the MRA and their clinical presentation. In the first group, vertebrobasilar ischemic disease could be reasonably excluded. In the second, such disease was nearly certain. In the third group, the vertebrobasilar system could not readily be assessed by the MRA alone and often required further studies. In 8 of 10 patients a strong correlation was found between MRA and intraarterial digital subtraction angiography. MRA provided valuable information for assessing vertebrobasilar disease and, in many instances, eliminated the need for invasive angiography.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/44. Pathological jealousy appearing after cerebrovascular infarction in a 25-year-old woman.OBJECTIVE: To report pathological jealousy (Othello syndrome) occurring in a young woman with a right hemisphere cerebrovascular infarction and to review diagnosis and possible organic mechanisms for the generation of this syndrome. CLINICAL PICTURE: A 20-year-old woman was admitted to hospital with a right hemisphere stroke associated with a history of severe migraine and the use of oral contraceptives. The patient made a good recovery with minimal neurological deficits but 5 years later developed the syndrome of morbid jealousy with depression and a near fatal overdose. TREATMENT AND OUTCOME: Morbid jealousy subsided, almost completely disappearing over a 6-week period of treatment with a selective serotonin re-uptake inhibitor (SSRI). CONCLUSIONS: case reports of the Othello syndrome and other content specific delusions following right hemisphere cerebrovascular infarction have appeared in geriatric psychiatry literature. The occurrence of a similar association in a young patient lends support to the suggestion of a causal relationship and has implications for diagnosis, clinical care and research.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/44. Near infrared spectroscopy and transcranial Doppler in monohemispheric stroke.We simultaneously performed near infrared spectroscopy (NIRS) and transcranial Doppler (TCD) to evaluate the effects of hypercapnia as well as of scalp ischemia on the blood flow at two different depth levels within the brain and of the scalp vessels. A decrease in the backscattered light intensity, meaning an increment of blood volume, was detected at the end of hypercapnia in all healthy subjects. This decrement was partly masked by ischemia in the cutaneous vessels. In 2 patients with a monohemispheric lesion in the middle cerebral artery (MCA) territory, an increase in NIRS response was found in the healthy hemisphere, while in the stroke side the CO2-induced changes were negligible. TCD data showed a similar increment of blood flow velocity to the hypercapnia in both hemispheres, with no differences between the affected and normal side in 1 patient, whereas in the second one, no increment was observed on the affected side, probably due to internal carotid artery stenosis. The two methods nicely integrate: TCD mainly tests subcortical changes in the MCA flow, while NIRS is exquisitely sensitive to cortical arterioles and capillary blood flow modifications.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/44. 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 = 1keywords = near (Clic here for more details about this article) |
5/44. Description of a new motor re-education programme for the paretic lower limb aimed at improving the mobility of stroke patients.OBJECTIVE: To describe and examine the feasibility of a new treatment approach for the paretic lower limb and to explore its effectiveness in one chronic hemiparetic stroke subject. DESIGN: Case report. The treatment was conducted three times per week over a period of six weeks. The mobility of the patient was assessed prior to the treatment, at the end of the treatment and at a six-week follow-up. SETTINGS: The study was carried out at the research centre of the Institut de readaptation de Montreal. The treating therapist was an experienced rehabilitation professional as was the assessor, who worked at a different rehabilitation centre. INTERVENTIONS: The motor re-education programme was based on the use of a static dynamometer that measures the linear external forces produced at the ankle level. A computer program provided the subject with constant feedback on the direction and intensity of the applied force. In each treatment session, the subject was asked to produce several submaximal efforts in 16 specific directions. Both the intensity and the number of repetitions were gradually increased. OUTCOME MEASURES: In addition to force production measurements, three clinical assessments of mobility were used: the Timed 'Up and Go', the comfortable gait speed and a 2-minute walk test. RESULTS: The maximal static linear forces produced by the subject increased through the treatment for all directions of effort, but differences were observed amongst directions. During the treatment programme, the subject improved his performance at the three clinical assessments. Even if some of the functional gain was lost at the follow-up, the mobility was still considerably improved as compared to baseline values. CONCLUSION: This study demonstrated the applicability of the treatment programme to a stroke subject. The results seem very promising and encourage further investigation in order to assess more rigorously the effectiveness of this new approach.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
6/44. Focal status epilepticus: clinical features and significance of different EEG patterns.PURPOSE: Focal status epilepticus is typically diagnosed by the observation of continuous jerking motor activity, but many other manifestations have been described. EEG evidence of focal status may take several forms, and their interpretation is controversial. We detailed the clinical spectrum of focal status in patients diagnosed by both clinical deficit and EEG criteria and contrasted clinical manifestations in patients with different EEG patterns. methods: patients were diagnosed with a neurologic deficit and discrete recurrent focal electrographic seizures or rapid, continuous focal epileptiform discharges on EEG. Clinical findings were determined by chart review. RESULTS: Of 41 patients with focal status, acute vascular disease was the cause in 21; 10 of 41 had exacerbations of prior epilepsy. A variety of clinical seizure types occurred, both before and after the EEG diagnosis, but the diagnosis was not expected in 28 patients before the EEG. Three had no obvious clinical seizures. Focal motor seizures and an abnormal mental status were the most common manifestations at the time of the EEG. With antiepileptic drugs, almost all had control of clinical seizures, and most improved in mental status. patients with rapid continuous focal epileptiform discharges were nearly identical in presentation, likelihood of diagnosis, subsequent seizures, response to medication, and outcome to those with discrete seizures on EEG. CONCLUSIONS: Focal status epilepticus may be seen with a wide variety of clinical seizure types or without obvious clinical seizures. The diagnosis is often delayed or missed and should be considered after strokes or clinical seizures when patients do not stabilize or improve as expected. The diagnosis should be made equally whether patients have discrete electrographic seizures or continuous rapid focal epileptiform discharges on the EEG, and the same response to medications and outcome should be anticipated for the two groups.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/44. Vascular compression of the medulla oblongata by the vertebral artery: report of two cases.OBJECTIVE AND IMPORTANCE: Compression of the medulla oblongata by a tortuous vertebral artery is rare. We report two patients with this lesion who were treated with vascular decompression of the vertebral artery. CLINICAL PRESENTATION: A 36-year-old man developed right hemiparesis with lower cranial nerve deficits, and a 47-year-old man developed left lower cranial nerve deficits and left cerebellar dysfunction. In both patients, magnetic resonance imaging revealed a tortuous vertebral artery compressing the medulla oblongata. INTERVENTION: In both patients, the compressed medulla oblongata was treated by detaching the vertebral artery from the medulla oblongata, shifting it, and anchoring it to the nearby dura mater. Postoperatively, both patients are asymptomatic and have returned to their previous jobs. CONCLUSION: Although compression of the medulla oblongata by a tortuous vertebral artery is rare, it can cause brainstem dysfunction. magnetic resonance imaging clearly revealed the vascular compression in these patients. Surgical treatment was effective. The symptoms related to a tortuous vertebral artery and some techniques for surgical treatment are discussed. awareness of this rare lesion is necessary to ensure appropriate treatment.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/44. Hindbrain stroke in children caused by extracranial vertebral artery trauma.Hindbrain transient ischemic attacks (TIAs) culminating in posterior circulation stroke are described in five children. Atlanto-axial subluxation and angiographical documentation of C1 to C2 level arterial pathology are documented in one patient. Four additional patients with nearly identical clinical presentations, posterior fossa TIAs, stroke and basilar angiographical pathology are reviewed. A mechanical traumatic etiology is suggested. Unexplained transient repeated brain stem and/or cerebellar sympotomatology may be due to extracranial vetebral artery stenosis or occlusion by atlanto-axial instability. After appropriate documentation, stabilization may prevent further TIAs or strokes.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/44. Presence of delayed myelination and macrocephaly in the sister of a patient with vacuolating leukoencephalopathy with subcortical cysts.Leukoencephalopathy with swelling and a discrepantly mild clinical course ("van der Knaap disease") is a recently identified syndrome. It is characterised by macrocephaly occurring during the first year of life, initially normal or nearly normal development, and slowly progressive ataxia and spasticity with initial preservation of intellectual functions. MRI shows diffuse abnormality in signal intensity, as well as swelling of the hemispheral white matter with subcortical cyst-like spaces in the fronto-parietal and anterior temporal areas. It is thought to have an autosomal recessive mode of inheritance, since many patients have consanguineous parents and more than one affected patient is often present within the same family. We report on two sibs: a 5-year old boy affected with "van der Knaap disease" and his macrocephalic sister whose first MRI (2 years 6 months) showed delayed myelination, which led us to suspect the same disease as her brother, however with subsequent normalisation at the second MRI (3 years 6 months).- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/44. Three cases of hyperperfusion syndrome identified by daily transcranial Doppler investigation after carotid surgery.BACKGROUND: cerebral hyperperfusion syndrome (HS), occurs in 0.5-1% of patients undergoing carotid endarterectomy (CEA), and may result in intracerebral haemorrhage and death. Aim: to diagnose HS by means of postoperative Transcranial Doppler (TCD). methods: between 1998 and 2001 nearly all 112 patients who underwent CEA were monitored for four days postoperatively by Transcranial Doppler. RESULTS: there were 3 patients with HS. All three showed TCD abnormalities hours before developing symptoms. One patient developed a full blown HS. Presumably, symptoms in the other two patients could be prevented by timely starting or restoring anti-hypertensive treatment. CONCLUSION: daily TCD investigation in all patients undergoing CEA seems an effective strategy for the presymptomatic detection of HS.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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