Cases reported "Cerebral Hemorrhage"

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21/71. Spontaneous intracerebral hemorrhage related to methamphetamine abuse: autopsy findings and clinical correlation.

    A healthy 31-year-old male abstinent from drug abuse during his recent incarceration developed slurred speech, a severe headache, and left-sided hemiparesis prior to his eventual death 9.5 hours after inhalation of methamphetamine. On postmortem examination, inspection of the brain revealed bilateral subarachnoid hemorrhage, with a prominent intralobar hemorrhage centered within the right frontal cerebral hemisphere. No evidence of vasculitis, infarction, intraventricular hemorrhage, or ruptured aneurysm could be observed. While this is not the first report of a methamphetamine-related stroke, this report describes the autopsy findings of an intracerebral hemorrhage secondary to methamphetamine abuse on autopsy and compares the findings and antemortem history to previously reported methamphetamine cerebral vascular deaths.
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22/71. Auditory and electrophysiological patterns of a unilateral lesion of the lateral lemniscus.

    Auditory disorders resulting from focal brainstem lesions are rarely symptomatic. Isolated lesions of the inferior colliculus have previously been reported, whereas no detailed description of a localized involvement of the lateral lemniscus is yet available. We report a unilateral lesion of the lateral lemniscus by a bleeding in a cavernoma. Symptoms included strictly contralateral tinnitus and auditory impairment, with normal pure-tone and speech audiometry. Conversely, the dichotic listening test revealed an extinction of contralateral ear input. The brainstem auditory evoked potentials disclosed a reduced and delayed wave V only after contralateral ear stimulation, while the middle latency evoked potentials were normal. This observation shows that a unilateral lesion of the lateral lemniscus can produce auditory symptoms. The dysfunction of auditory pathways is associated with specific electrophysiological abnormalities that can be assessed by evoked potential recording.
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23/71. magnetoencephalography and positron emission tomography studies of a patient with auditory agnosia caused by bilateral lesions confined to the auditory radiations.

    The aim of this study was to investigate auditory cortex function in the context of auditory stimuli in a patient with auditory agnosia due to bilateral lesions confined to the auditory radiations. A male patient experienced mild left temporal hemiplegia because of right putaminal hemorrhage at the age of 43 years. Thereafter he recovered completely but hypertension persisted. When he was 53 years old, he suffered left putaminal hemorrhage and went into a coma. After recovering from the coma and right hemiplegia he could hear but could not discriminate speech sounds. brain CT and MRI demonstrated small bilateral lesions confined to the auditory radiations. magnetoencephalography demonstrated the disappearance of middle latency responses and auditory-evoked potential studies showed a very small Pa peak. In contrast, a positron emission tomography study demonstrated a marked increase in blood flow in the bilateral auditory cortex in response to both click and monosyllable stimuli. It is speculated that the auditory cortex receives functional projections from the cochlea via non-specific pathways in the cerebral hemispheres.
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24/71. Chronic expanding intracerebral hematoma treated by mini-invasive ultrasonography-guided needle aspiration.

    Chronic expanding intracerebral hematoma (CEIH) is a rare cerebrovascular disease that behaves as a slowly expanding lesion with a gradual onset of progressive neurological deficit or recurrent seizures. The etiology of the CEIH is still not clear. Even if about a half of these lesions are associated with vascular malformations, the remaining cases are post-traumatic, associated with coagulative disorders or are cryptogenic. Treatment of these lesions is controversary: while some neurosurgeons remove the hematoma with its capsule, others prefer to wait and observe it if the patient is neurologically stable. We discuss the opportunity of treating selected patients bearing a CEIH by means of ultrasonography(US)-guided aspiration in selected patients. A 42-year-old hepatopathic man with coagulation disorders was referred to us with a 2-month history of progressive right-sided weakness, speech disorders and difficulty in swallowing solid foods. Radiological findings supported a CEIH with a thin surrounding capsule. The patient underwent to US-guided aspiration of the lesion with a complete resolution of the hematoma, confirmed intraoperatively by real-time US-control and postoperatively by early and long term neuroradiological controls. US-guided aspiration is a low cost, not time consuming technique, that allows an intraoperative real-time control of the lesion and seems to be an effective alternative to open surgery in cases of CEIHs with a thin capsule.
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keywords = speech
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25/71. Crossed anomic aphasia: mild naming deficits following right brain damage in a dextral patient.

    A detailed case study is reported of crossed aphasia (CA) in a dextral patient, bearing upon such controversial issues as intrahemispheric localisation of language function and hemispheric reversal of nonverbal function. DA, a man aged 37, developed a mild naming problem due to right temporal lobe haematoma. Apart from a mild acquired stutter, his continuous speech was fluent and had a normal proportion of open to closed class lexical items. His naming deficit appears to originate in the 'blocking' or 'disconnection' of the phonological lexicon: he could usually give a functional definition of un-named items and retrieve them with the help of a phonemic cue. Lexical retrieval appears his only language deficit, as he had no comprehension or phonological discrimination deficits. DA showed no visuo-spatial or auditory-nonverbal deficits, suggesting the complete reversal of hemispheric specialisation.
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26/71. Semiquantitative regional cerebral blood flow evaluation using 123I-IMP SPECT in a case showing transient ischemic attack caused by putaminal hemorrhage.

    A 69-year-old woman presented a transient cerebral ischemic attack, showing left arm weakness and slurred speech which recovered within 4 h of onset, while computed tomography indicated a putaminal hemorrhage. The regional cerebral blood flow distribution, measured semiquantitatively by use of 123I amphetamine emission tomography, was disturbed, which persisted more than one month up to a maximum of 4.5 months from the onset of symptoms. This case illustrates a variety of putaminal hemorrhage of good functional and vital prognosis, and provides an example in which the regional cerebral blood flow disturbances might persist for more than one month up to 4.5 months after the occurrence of a transient ischemic attack caused by a putaminal hemorrhage.
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27/71. Oculopalatal myoclonus: report of a case.

    We report a patient who developed a delayed onset of oculopalatal myoclonus, characterized by synchronous oscillatory movements of the eyeballs, soft palate and the orbicularis oculi muscle, 5 months after a pontine hemorrhage. The involuntary oscillations did not affect the speech or swallowing but continued in sleep with decreased amplitudes. These oscillations also failed to respond to clonazepam therapy and the patient was unable to voluntarily suppress them for several minutes. A temporary association in synchronous titubation of the head was also observed. A characteristic vertical ocular oscillation was demonstrated in an oculogram. This is in accordance with the midline form of oculopalatal myoclonus.
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28/71. Dichotic listening in an aphasic male patient after a subcortical hemorrhage in the left fronto-parietal region.

    Dichotic listening (DL) performance to consonant-vowel (CV) syllables is reported in an aphasic right-handed male patient. The patient suffered initially from a complete expressive aphasia after an intracerebral hemorrhage caused by the rupture of an arteriovenous malformation (AVM) underlying Broca's area. The patient was tested three times with DL; one week after the hemorrhage, five weeks after, and after at about 6 months. At the first test he could not speak, but understood well. At the second test he uttered one-syllable words, and could answer "yes" and "no" to questions. At the third test he could speak whole sentences, although slow and "stutter-like." Dichotic listening performance showed an almost perfect match with speech recovery. At the first test he showed a left ear advantage which changed to no ear advantage at the second test, and to a right ear advantage at the third test. The overall performance was markedly reduced at the first test, but improved at the following test. It is concluded that dichotic listening may be a valid complement to traditional language assessment procedures after unilateral brain lesions.
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keywords = speech
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29/71. Disruption of semantic influence on writing following a left prefrontal lesion.

    We report a patient with impaired spontaneous writing, written naming, and homophone spelling, consistent with a disruption of semantic influence on writing. However, writing to dictation by both the phonological and lexical spelling systems was intact. In addition, general semantic abilities were spared, as indicated by preserved auditory and reading comprehension. We propose that our patient could not incorporate meaning into writing because of a disruption of both direct and indirect connections between semantics and the orthographic output lexicon. The writing dysfunction was accompanied by a similar impairment of speech output, suggesting that it was part of a more general disturbance of semantic influence on language production following left prefrontal damage.
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keywords = speech
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30/71. Three variant forms of subcortical aphasia in Chinese stroke patients.

    Five right-handed patients with subcortical aphasia that involved the left hemisphere subcortical lesion sites were subjected to CT scans. Given their etiology, two cases were infarctions and the other three were hemorrhages. Two of the patients presented an involvement of the anterior limb of the internal capsule and of the basal ganglia and an anterior superior white-matter lesion extension. In both cases slow scanty dysarthric speech was noted; one had markedly impaired auditory comprehension, and the others were only partially impaired. The third patient presented an involvement of the posterior limb of the internal capsule and of the thalamus and a posterior paraventricular white-matter lesion extension. He had poor auditory comprehension, echolalia, and fluent speech. The last two patients presented an involvement of the internal capsule, the basal ganglia, and the thalamus and an anterior posterior paraventricular white-matter lesion extension. The latter two showed poor auditory comprehension with nonfluent and scanty spontaneous speech. The speech sounds were nonsensical monosyllabic words with a pattern similar to that of global aphasia. All patients had lasting right hemiplegia.
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