Cases reported "Cerebral Infarction"

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1/36. Bilateral infarction in the territory of the anterior cerebral arteries.

    An elderly hypertensive man had extensive bilateral infarction in the distribution of the anterior cerebral arteries. The circle of willis was fully formed, but occlusion of the dominant anterior cerebral artery, aggravated and perhaps caused by postlaparotomy hypotension, produced the dramatic lesions, causing akinetic mutism. This stroke pattern occurs in various settings and does not require an anomalous azygous unilateral supply to both anterior cerebral arteries.
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ranking = 1
keywords = akinetic mutism, akinetic, mutism
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2/36. Transient mutism resolving into cerebellar speech after brain stem infarction following a traumatic injury of the vertebral artery in a child.

    A 3.7-year-old girl presented with an anterior neck injury followed by progressive subcutaneous emphysema and loss of consciousness. After resuscitation, a laceration on the first tracheal cartilage was closed surgically. As she was extubated one week later, she was found to have right hemiplegia and muteness. MRI showed a T2-bright lesion on the tegmentum of the left midbrain down to the upper pons. Right vertebral angiography disclosed an intimal flap with stenosis at the C3 vertebral level presumably caused by a fracture of the right C3 transverse process later confirmed in a cervical 3D-CT scan. Her muteness lasted for 10 days, after which she began to utter some comprehensible words in a dysarthric fashion. Her neurological deficits showed improvement within 3 months of her admission. Transient mutism after brain stem infarction has not been reported previously. We discuss the anatomical bases for this unusual reversible disorder in the light of previous observations and conclude that bilateral damage to the dentatothalamocortical fibers at the decussation of the superior cerebellar peduncle may have been responsible for her transient mutism.
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ranking = 0.55445676940608
keywords = mutism
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3/36. akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction.

    A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.
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ranking = 2.3696378462707
keywords = akinetic mutism, akinetic, mutism
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4/36. A case of mutism subsequent to cocaine abuse.

    The authors report a case of mutism that was ultimately found to be associated with chronic cocaine use in an adult woman. Brain dysfunction was confirmed by SPECT scan, which revealed reduced cerebral blood perfusion and areas of infarction, presumably consequent to the cocaine addiction. This is the first reported case of such an association.
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ranking = 0.4620473078384
keywords = mutism
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5/36. Bilateral caudate infarct--a case report.

    Caudate strokes comprise only a small proportion of all subtypes of strokes. Bilateral caudate infarcts are even rarer and only a few cases have been reported in the literature. We report an 86-year-old woman with bilateral caudate infarcts. She had no past medical history of note. She presented with headache for several days and drowsiness on day of admission. Clinical examination revealed abulia, inability to comprehend or verbalize (acute mutism), right-sided neglect and right-sided hemiparesis. Computed tomographic (CT) scan brain revealed decreased attenuation in both heads of both caudate nuclei with extension across the anterior limb of both internal capsules to involve the lentiform nuclei. echocardiography showed aortic valve sclerosis, mild mitral and aortic regurgitation and normal left ventricular function. Carotid ultrasound revealed mild stenosis of proximal right internal carotid and left distal common carotid and adjacent proximal internal carotid arteries. She showed initial improvement in the first week, but subsequently had a progressive downward course despite rehabilitation and died 44 days after her stroke. A patient with bilateral caudate infarcts is likely to have poor prognosis for rehabilitation and survival.
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ranking = 0.09240946156768
keywords = mutism
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6/36. Phonological agraphia following a focal anterior insulo-opercular infarction.

    Following a unique infarction, restricted to the left anterior insula and the adjacent part of the intrasylvian frontal opercular cortex, an 83-year-old right-handed patient acutely developed a severe speech disorder that evolved into mere mutism within a few hours. After rapid recovery from mutism, oral language was characterized by severe apraxia of speech. In-depth language investigations further disclosed an isolated, highly selective disturbance of the spelling system (phonological agraphia) which resolved rapidly. One year after onset of neurological symptoms, the apraxia of speech had almost completely receded. The anatomoclinical findings in this first representative of pure and nearly isolated phonological agraphia complement previous neuroanatomical and neurolinguistic accounts of phonological agraphia. The data not only seem to enrich current insights in the anatomical locus for phonological agraphia, they also seem to contribute to a further delineation of the insular role in phonologically mediated aphasic manifestations.
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ranking = 0.18481892313536
keywords = mutism
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7/36. BIPLEDs in akinetic mutism caused by bilateral anterior cerebral artery infarction.

    INTRODUCTION: akinetic mutism is described as a result of many disorders. Bilateral infarction of the anterior cerebral artery (ACA) territory is reported rarely, however, often leading to akinetic mutism. CASE REPORT: We report a 70 year-old man with akinetic mutism due to bilateral ACA infarction. electroencephalography, 24h after admission, showed bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) in the frontal region and diffuse theta and polymorphic delta activity. DISCUSSION: Postanoxic encephalopathy, central nervous system infection and chronic seizure disorders are the major causes of BIPLEDs. However, BIPLEDs may occur in bilateral ACA territory infarction.
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ranking = 6.0924094615677
keywords = akinetic mutism, akinetic, mutism
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8/36. 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.
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ranking = 4.0924094615677
keywords = akinetic mutism, akinetic, mutism
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9/36. Parkinsonism following striatal infarcts: incidence in a prospective stroke unit cohort.

    A number of case reports have highlighted the occurrence of parkinsonism following strategic infarcts affecting the basal ganglia but the prevalence of parkinsonism after striatal infarcts (SI) has not been assessed. Therefore, we evaluated the clinical features and prevalence of parkinsonism in a large series of patients admitted to the stroke-Unit of the Department of neurology Innsbruck. Cerebral scans were retrospectively screened for SI, defined as a lesion larger than 1.5 cm involving the basal ganglia and the internal capsule. Out of 622 patients, 27 met the criteria for SI (4.3%) and 11 patients were available for follow-up. All patients presented contralateral motor weakness. Bilateral akinetic-rigid parkinsonism was found in only one patient whose [(123)I]beta-CIT-SPECT showed a decrease of the ligand uptake following the limits of the vascular lesion. overall, parkinsonism does not appear to be a frequent consequence of striatal infarcts. Multiple lacunar subcortical infarcts interrupting thalamocortical drive may be more critical for the development of vascular parkinsonism.
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ranking = 0.39393721193848
keywords = akinetic
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10/36. Crossed aphasia in early childhood.

    A four-year-old child was admitted to hospital with an infarct of the right middle cerebral artery involving the frontoparietal area. His symptoms included left hemiplegia and aphasia. After two weeks, he had hemiparesis, word-finding and naming problems and enuresis. A year later he demonstrated elective mutism at school, had attention and short-term memory impairments, occasional enuresis and an average IQ. He was shy and withdrawn; this is interesting, since depression is usually associated with left-hemispheric lesions. It is suggested that an early period of mutism should be included among the criteria for the study of crossed aphasia in children, as this is a common occurrence in such cases. Even after recovery of speech, impairments in attention and academic skills may persist.
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ranking = 0.18481892313536
keywords = mutism
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