Cases reported "Cerebral Hemorrhage"

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1/17. anthrax meningitis. Report of two cases with autopsies.

    The authors report two cases of occupation-related anthrax meningitis; one was direct contamination from a diseased animal; the second was due to handling of bone powder imported from india. The pathological pattern of involvement of the meninges and brain is described and discussed.
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2/17. Hyperacute cerebral enhancement: the earliest predictor of hemorrhage by MR imaging?

    A test to detect very early hemorrhage in acute cerebral infarct could offer a substantial increase in the safety and success of advanced stroke therapies, particularly when the use of thrombolytic therapies is contemplated. Currently, computed tomography is the standard test for the detection of cerebral hemorrhage but is not a valid predictor of potential areas of hemorrhagic transformation. A technique to evaluate the risk of hemorrhagic transformation in infarcted cerebral tissue has been conducted with contrast-enhanced magnetic resonance imaging in various animal stroke models. Knight demonstrated gadolinium-DTPA enhancement in the territory of occluded vessels immediately in rats after reperfusion. gadolinium enhancement was thought to predict areas of hemorrhagic transformation. Yenari and associates demonstrated in rabbit models that contrast-enhanced T1-weighted scans can reveal regions of blood-brain barrier disruption, characterized as hemorrhagic transformation in ischemic tissue. The authors report a clinical example in which hyperacute contrast-enhanced magnetic resonance imaging was the first indication of hemorrhagic transformation within 24 hours of onset of an acute cerebral infarct.
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3/17. Cardiac arrhythmias in acute central nervous system disease. Successful management with stellate ganglion block.

    Cardiac rhythm disturbances and ECG wave-form abnormalities have been described with CNS disease or injury in experimental animals and in man. Unilateral sympathetic stimulation has been shown to produce similar changes in ventricular repolarization and reduce the fibrillation threshold. A patient with a ruptured congenital aneurysm of the basilar artery developed an accelerating ventricular tachycardia associated with an episode of active intracranial bleeding. The rhythm disturbance proved refractory to all modalities of chemotherapy, including lidocaine, phenytoin, atropine, procainamide, digoxin, and propranolol. The ECG showed a repolarization abnormality similar to that described with left stellate ganglion stimulation. Left stellate ganglion block was carried out with 15 ml of 1% lidocaine. An effect on the tachyarrhythmia was noted in five minutes. By 15 minutes, the rhythm disturbance was abolished. The repolarization abnormalities improved over a period of hours. Successful management with left stellate ganglion block suggests that this form of therapy may have clinical application in arrhythmias associated with CNS disease.
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4/17. A deficit in discriminating gaze direction in a case with right superior temporal gyrus lesion.

    The superior temporal sulcus (STS) region is well recognized as being heavily involved in detecting and discriminating gaze. Lesions confined to this area are quite rare in humans, and so the research has mainly depended on animal studies and functional neuroimaging in normal human subjects. We report one such rare case, a 54-year-old Japanese female with a possible congenital s anomaly who, after a cerebral hemorrhage, demonstrated a lesion almost completely confined to the entire right superior temporal gyrus (STG). In the subacute phase, the patient showed evidence of left hemispatial neglect, from which she gradually recovered. In the chronic phase, she showed a puzzling difficulty in obtaining eye-contact. We have conducted, in conjunction with conventional neuropsychological evaluations, experimental assessment of her ability in gaze cognition. Her performance on neuropsychological testing demonstrated no compromise in intellect, memory, or language skills, and a close-to-full recovery from neglect. On gaze cognition experiments, she was repeatedly shown to perceive left gaze as straight, and to a lesser degree, straight gaze as right. We suggest that the function of the STG in detecting gaze, together with the directional information it receives from earlier visual areas, may be associated, when damaged, with this deficit in detecting contra-directional gaze. We have demonstrated for the first time that a single circumscribed lesion to the STG results in both gaze processing deficit and concurrent aberrant gaze behavior of the victim herself, implicating a mechanism within the STG as an interface between gaze of others and gaze of self.
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5/17. Brain hemorrhages in cocaine-exposed human fetuses.

    Autopsies of 4 fetuses exposed to maternal cocaine are reported. Brain examination revealed hemorrhages in 3 of the fetuses involving the germinal matrix. The hemorrhages resembled subependymal germinal matrix hemorrhages seen as postnatal complications in premature infants with idiopathic respiratory distress syndrome. One of the placentas had sonographic evidence of abruption which could not be confirmed pathologically. The findings are discussed in light of reports of neurobehavioral deficits and other congenital anomalies in children and animals exposed to cocaine in utero. Speculations about the pathophysiologic events leading to these findings are made.
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6/17. oligohydramnios sequence and renal tubular malformation associated with maternal enalapril use.

    We present the case of a child who died of pulmonary hypoplasia as a result of the oligohydramnios sequence. The mother was taking enalapril, as well as propranolol and hydrochlorothiazide, for treatment of hypertension associated with systemic lupus erythematosus. autopsy examination revealed severe renal tubular malformation. Correlation of animal data with previous case reports of neonatal anuria in association with maternal angiotensin converting enzyme inhibitors suggests that these agents may have a deleterious effect on fetal renal development and general well-being.
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7/17. Synaptic reorganization within the human central nervous system following injury.

    Behavioral recovery following brain injury in humans is well recognized; however, the anatomical basis for such recovery has not been demonstrated. Two cases are presented that show reorganization of synaptic connections (plasticity) in the dentate gyrus of human brain following uncal herniation. The neurohistological appearance of these cases is very similar to a well-described animal model of anatomical, physiological, and behavioral recovery following experimental surgical injury.
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8/17. Brainstem death.

    A patient with the clinical picture of brain death resulting from brainstem hemorrhage and subsequent infarction is presented. The EEG showed activity similar to what has been described in the cerveau isole animal preparations. Cortical evoked potentials were unobtainable from auditory or somatosensory stimulation, but of unusually high amplitude to flash stimuli. The point is made that a diagnosis of brain death cannot be made on clinical grounds alone when a patient is on life support systems, and the differences between cerebral death, brainstem death and brain death are discussed.
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9/17. Auditory brain-stem potentials with unilateral pontine hemorrhage.

    Although there have been extensive anatomical and physiological studies in animals, the actual neural sources, or even the laterality, of some components of auditory brain-stem evoked potentials in humans are uncertain. We studied these responses in a 56-year-old patient who had a clearly demarcated pontine hemorrhage on the right side. The patient was somnolent, with dense left hemiplegia and signs of involvement of right cranial nerves V, VI, and VII. Stimulation of the left ear (ie, contralateral to the lesion) evoked a normal series of waves with clearly resolved positive components peaking at 2.0, 3.3, 4.8 (wave IV), and 6.0 ms (wave V). Stimulation of the right ear (ie, ipsilateral to the lesion) evoked only waves I, III, and IV. These results suggest that a pathway ipsilateral to the stimulated ear is necessary and sufficient for generation of auditory wave V and that wave IV is generated in bilateral pathways.
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10/17. Thalamic neglect.

    Three patients with right thalamic hemorrhage showed contralateral neglect and limb akinesia. They also had anosognosia, visuospatial disorders, and emotional flattening. In animals, neglect can be induced by lesions along a cortico-limbic-reticular loop including the intralaminar thalamic nuclei. We propose that an activation defect is responsible not only for the neglect and akinesia, but also for the visuospatial and emotional defects usually associated with right-hemisphere cortical dysfunction.
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