Cases reported "Cerebrovascular Disorders"

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1/201. stroke and seizures as the presenting signs of pediatric hiv infection.

    The authors report two pediatric patients with definite human immunodeficiency virus infection whose initial presentation was stroke and seizure. The first patient was a 3-year-old female who developed acute hemiparesis as the first manifestation. The other, a 2-month-old infant, had focal seizures secondary to cerebral infarction. Investigations revealed ischemic infarction of the thalamus, hypothalamus, and internal capsule in the first patient and cerebral cortex in the second. Further investigations failed to demonstrate any other causes of these cerebral infarctions. Opportunistic infection of the central nervous system was not documented. The authors emphasize that cerebrovascular accident may be the initial presentation in human immunodeficiency virus infection in children. Human immunodeficiency virus infection must be included in the differential diagnosis, and testing for the disease is mandatory in the investigation of stroke in any child who is at risk of having this infection.
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ranking = 1
keywords = cortex
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2/201. Spatz-Lindenberg disease: a rare cause of vascular dementia.

    BACKGROUND: Isolated cerebral thromboangiitis obliterans (Spatz-Lindenberg disease) is not well recognized as a cause of vascular dementia. CASE DESCRIPTION: A 58-year-old woman presented with dementia and pyramidal signs. neuroimaging showed multiple areas of white matter change. brain biopsy showed intimal thickening of the walls of leptomeningeal and intraparenchymal arteries, almost to complete occlusion, with an intact internal elastic lamina and media and without inflammation or infiltration. The cortex showed only moderate gliosis. CONCLUSIONS: Spatz-Lindenberg disease should be considered in the differential diagnosis of vascular dementia. Additional studies of its pathogenesis are required to determine appropriate treatment.
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keywords = cortex
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3/201. Selective horizontal dysmetropsia following prestriate lesion.

    We describe a patient (P.S.) who, following a right prestriate lesion, reported that objects in the left visual field appeared distorted and smaller than those on the right. Other aspects of visual processing were remarkably unaffected. We carried out a series of size comparison tests using simple or complex stimuli and requiring different types of behavioural responses. We found that P.S. significantly underestimated the size of stimuli presented in her left visual field. When comparison tasks involved stimuli placed along the vertical axis or in the right visual field, P.S. performed well. The vertical and horizontal components of size distortion were found to be differentially affected. We conclude that size processing may be dissociated from other aspects of visual processing, such as form or colour processing, and depends critically on part of the occipital, prestriate areas (Brodmann areas 18-19).
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ranking = 0.76020178362674
keywords = visual
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4/201. Memories are made of this: the effects of time on stored visual knowledge in a case of visual agnosia.

    We report the effects of the passage of time on the longterm visual knowledge for objects in a patient with visual agnosia (H.J.A.). The naming of real objects was found to have improved, although this was not associated with any change in H.J.A.'s basic perceptual abilities which were stable over a 16-year period. The improvement in object naming was attributed to better use of non-contour-based visual information (such as surface detail and depth cues). In addition, we demonstrate a deterioration in H.J.A.'s long-term memory for the visual properties of objects, and argue that this has occurred as a result of his having impaired perceptual input. The deterioration was only apparent in drawing from memory and in the verbal descriptions of items; with forced-choice testing, H.J.A. operated at ceiling; we propose that current tests of visual imagery may not be sufficiently sensitive to detect subtle impairments of visual memory. Our findings can be taken to indicate that perceptual and memorial processes are not functionally independent, but are linked in an interactive manner.
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ranking = 2.1285649941549
keywords = visual
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5/201. Does vestibular stimulation activate thalamocortical mechanisms that reintegrate impaired cortical regions?

    Caloric stimulation induced a transient reversal of multimodal hemispatial cognitive deficits in an 81-year-old woman with an acute left cerebral hemisphere stroke. The patient had unawareness of her right hand (asomatognosia), right-sided visual unawareness (hemineglect), aphasia and right-sided weakness (hemiplegia) prior to the stimulation. Transient improvements in impaired sensory, motor, linguistic and cognitive function developed within 30 s following application of the caloric stimulus and onset of horizontal nystagmus. The effect persisted for 3 min and ceased completely after 5 min. While several recent reports have described the capacity of caloric stimulation to transiently improve or reverse a wide range of attentional, cognitive and motor impairments, most examples are in right-hemisphere-damaged patients with long-standing brain injury. Typically, patients have been tested several months or years after the onset of the deficit. A possible mechanism for the temporary reintegration of multiple cognitive functions in this patient is discussed.
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ranking = 0.15204035672535
keywords = visual
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6/201. The bare bones of object recognition: implications from a case of object recognition impairment.

    Three experiments were designed to investigate the performance of a patient (RK) who could name objects when presented in conventional views but showed catastrophic failures in identification from unconventional views. The aim of all three experiments was to assess the properties of the central representations that allow recognition of objects presented in conventional but not unconventional views. All three experiments showed that RK had problems in object identification not apparent from his naming performance. In the first experiment, RK was found to be extremely impaired at recognising the parts of objects even though he could name the whole object. In the second experiment, alterations in colour, shape and parts of objects were undetected in stimuli that he could name. In the third experiment, RK showed considerable difficulty with mirror-images and inversion tasks. The explanation for RK's impaired object recognition could not be attributed to defects to his early visual processing. We argue that RK's recognition is achieved through abstract (object-centred) representations that are global rather than local, and quite independent of their spatial framework. These abstract representations we take to be the essential bare bones for object recognition.
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ranking = 0.15204035672535
keywords = visual
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7/201. Somatosensory extinction for meaningful objects in a patient with right hemispheric stroke.

    Implicit, high level processing of extinguished objects has often been described in the visual modality. In the tactile domain, however, research on this topic is meagre and it is still uncertain whether processing of tactually presented stimuli can be affected by the same attentional disorders as visual stimuli. In this paper we describe a patient, ENM, with visual neglect and light touch extinction who, in a naming task of objects presented in the tactile modality, simultaneously to both hands, showed extinction for left hand objects. He was, nevertheless, able to make above chance Same/Different judgements on the two stimuli. We also tested two neurologically intact subjects who performed the test wearing a ski-glove on the left hand to impair the recognition of left hand objects. In these subjects, Same/Different judgements were at chance level when recognition rate was as low as that found in patient ENM. This happened when either the objects, although sharing the same name were different in shape (conditions Same-Different) or when the two objects were different with respect to the category name but were actually physically similar (conditions Different-Similar). However, when the objects were either identical or completely different, i.e., in a condition where judgement could be based simply on the physical analysis of the object shape (condition Same Identical and Different Dissimilar), their Same/Different judgements were above chance, despite the tactual deficit. Our conclusion was that patient ENM showed implicit recognition of left hand objects, at least in the Same Different and in the Different-Similar conditions, whereas, in the same conditions, normal subjects with an artificial sensory impairment did not. Our results also show that Same/Different judgements may be, in some conditions, less demanding than naming tasks, as suggested by Farah et al. Furthermore, patient ENM performed the test both with uncrossed and crossed hands. We found that extinction always affected the hand contralateral to the brain damage, although there was a tendency for a decrement of the ipsilesional hand performance in the crossed condition. We discuss these findings with reference to the most recent theories on the existence of a body centered spatial frame of reference.
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ranking = 0.45612107017605
keywords = visual
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8/201. Neurogenic ST depression in stroke.

    BACKGROUND: stroke is occasionally associated with ECG repolarization changes including ST depression. Recent evidence suggests a neurogenic contribution to these abnormalities in stroke patients. Animal studies implicate the insular cortex in cardiovascular control. We describe a patient with a left insular infarct and without cardiac or coronary artery disease, who developed ST depression indicating a neurogenic etiology. CASE DESCRIPTION: A 48 year-old female, with no risk factors for stroke, developed sudden expressive aphasia. MRI brain showed an infarct in the left insular cortex. Twenty-four hour Holter monitoring on the third day revealed transient ST depression more than 1.5 mm, which was not reproducible on subsequent monitoring. Transesophageal echo-cardiography (TEE) was normal. She had no cardiac symptoms and serial ECGs, cardiac enzymes (CKMB) and adenosine thallium scan were normal. To-date, there had been no cardiac events like congestive heart failure or myocardial ischemia. CONCLUSION: These findings suggest neurogenic ST depression is related to the left insular infarct in view of the normal adenosine thallium scan, non-reproducibility and evanescence of the ST segment changes and lack of associated cardiac symptoms. When neurogenic ST depression is combined with underlying coronary artery disease, it may adversely influence cardiac outcome after stroke.
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ranking = 2
keywords = cortex
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9/201. Painful supernumerary phantom arm following motor cortex stimulation for central poststroke pain. Case report.

    In this report, the authors describe a case in which the patient began to experience a supernumerary phantom arm after she received motor cortex stimulation for central pain. The patient had a history of right thalamocapsular stroke. It is speculated that the motor cortex activation triggered a response in the patient's parietal lobe, precipitating perception of the phantom limb. To the authors' knowledge this is the first reported case of its kind.
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ranking = 6
keywords = cortex
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10/201. Aicardi-Goutieres syndrome: a genetic microangiopathy?

    Aicardi-Goutieres syndrome (AGS) (McKusick 225750) is an autosomal recessive disease with onset in the 1st year of life, resulting in progressive microcephaly, calcification of cerebral white matter, thalamus and basal ganglia, generalized cerebral demyelination and a chronic low-grade CSF lymphocytosis, without evidence of infection. We report the autopsy of a patient who died with this disorder at the age of 17 years. Findings were severe microencephaly, diffuse but inhomogeneous cerebral white matter loss with associated astrocytosis, calcific deposits in the white matter, thalami and basal ganglia. neocortex and cerebellar cortex were affected by wedge-shaped microinfarctions. Small vessels showed calcification in the media, adventitia and perivascular spaces. These findings are similar to some previous publications that in retrospect may have been AGS, but this is the first reported cerebral microangiopathy in which the diagnosis AGS was made during lifetime. This report provides evidence that microangiopathy plays a significant role in the pathogenesis of AGS.
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ranking = 2
keywords = cortex
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