Cases reported "Hemiplegia"

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1/91. Localized scleroderma associated with progressing ischemic stroke.

    We present a 73 year-old Japanese woman with localized scleroderma involving the right side of the scalp accompanied by continuous tingling pain, who developed insidiously progressive left hemiparesis. In magnetic resonance imaging of the brain, an infarct first appeared in the watershed region of the right middle cerebral artery territory and subsequently extended to deep white matter accompanied by scattered hemorrhages. Focal stenosis in the M2 portion of the right middle cerebral artery was revealed on magnetic resonance angiography, and the distal vessels were only shown faintly. A biopsy specimen from the sclerotic scalp lesion showed obvious thickening of vessel walls and mild mononuclear cell infiltration. We believe that the progressing ischemic stroke was caused by hemodynamic disturbances from localized sclerotic obstruction of the middle cerebral artery, with an autoimmune pathogenesis.
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2/91. Application of a rheolytic thrombectomy device in the treatment of dural sinus thrombosis: a new technique.

    We present a novel application of a transvascular rheolytic thrombectomy system in the treatment of symptomatic dural sinus thrombosis in a 54-year-old woman with somnolence and left-sided weakness. The diagnosis of bilateral transverse and superior sagittal sinus thrombosis was made and the patient was treated with anticoagulant therapy. After an initial period of improvement, she became comatose and hemiplegic 8 days after presentation. After excluding intracerebral hemorrhage by MR imaging, we performed angiography and transfemoral venous thrombolysis with a hydrodynamic thrombectomy catheter, followed by intrasinus urokinase thrombolytic therapy over the course of 2 days. This technique resulted in dramatic sinus thrombolysis and near total neurologic recovery. Six months after treatment, the patient showed mild cognitive impairment and no focal neurologic deficit. Our preliminary experience suggests that this technique may play a significant role in the endovascular treatment of this potentially devastating disease.
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ranking = 823.95397790204
keywords = thrombosis
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3/91. Complex traumatic dissection of right vertebral and bilateral carotid arteries: a case report and literature review.

    A 27-year-old female motorcycle passenger was admitted with bruises and concussion after a motor-vehicle accident. After a lucid interval of several hours she became stuporous and progressed to an acute comatose state. Computed tomography demonstrated extensive cerebral ischaemia in the territory of the right middle cerebral artery. Angiography after transfer to the authors' hospital revealed dissections of both carotid arteries and of the right vertebral artery. The patient underwent surgical reconstruction of the left internal carotid artery with saphenous vein. The management of this patient is discussed and the literature reviewed.
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ranking = 0.5437331417102
keywords = vein
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4/91. Ipsilateral hemiparesis after putaminal hemorrhage due to uncrossed pyramidal tract.

    OBJECTIVE: Previous case reports supported the presence of the uncrossed pyramidal tract in exceptional patients. However, most of these case reports have not fully discussed involvement of the motor cortex controlling the ipsilateral limbs. DESIGN AND METHOD: The authors investigated a 62-year-old man who developed right hemiparesis after right putaminal hemorrhage by using MRI, transcranial magnetic stimulation, functional MRI (fMRI), and sensory evoked potentials. He had moderate weakness including the face, spasticity with brisk deep tendon reflexes and Babinski sign, and impaired vibration and position sense, all on the right side. RESULT: A MRI study showed hemorrhage in the right putamen and the wedge-shaped medulla. A fMRI study during a sequential finger opposition task showed activation in the motor cortex ipsilateral to the finger movements, but not on the contralateral side. Sensory evoked potentials showed cortical response ipsilateral to the side of stimulation. CONCLUSION: The pyramidal tract and the dorsal column-medial lemniscus pathway did not cross in the medulla in this patient. In view of the presence of the abnormal shape in the medulla and congenital scoliosis, a congenital factor might be responsible for the uncrossed pyramidal tract and dorsal column-medial lemniscus in this patient.
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5/91. neurologic manifestations of cerebral air embolism as a complication of central venous catheterization.

    OBJECTIVE, patients, AND methods: A severe case of cerebral air embolism after unintentional central venous catheter disconnection was the impetus for a systematic literature review (1975-1998) of the clinical features of 26 patients (including our patient) with cerebral air embolism resulting from central venous catheter complications. RESULTS: The jugular vein had been punctured in eight patients and the subclavian vein, in 12 patients. embolism occurred in four patients during insertion, in 14 patients during unintentional disconnection, and in eight patients after removal and other procedures. The total mortality rate was 23%. Two types of neurologic manifestations may be distinguished: group A (n = 14) presented with encephalopathic features leading to a high mortality rate (36%); and group B (n = 12) presented with focal cerebral lesions resulting in hemiparesis or hemianopia affecting mostly the right hemisphere, with a mortality rate as high as 8%. In 75% of patients, an early computed tomography indicated air bubbles, proving cerebral air embolism. Hyperbaric oxygen therapy was performed in only three patients (12%). A cardiac defect, such as a patent foramen ovale was considered the route of right to left shunting in 6 of 15 patients (40%). More often, a pulmonary shunt was assumed (9 of 15 patients; 60%). For the remainder, data were not available. CONCLUSION: When caring for critically ill patients needing central venous catheterization, nursing staff and physicians should be aware of this potentially lethal complication.
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ranking = 1.0874662834204
keywords = vein
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6/91. cerebrovascular disorders in children with the factor v Leiden mutation.

    Since 1995, at least 128 children with a cerebrovascular disorder, cerebral palsy, or both and the factor v Leiden mutation have been reported. The majority of these strokes were in the first year of life, many of them in the perinatal period. Two thirds had an additional exogenous risk factor for thrombosis, and 42% had another recognized endogenous prothrombotic risk factor in combination with the mutation. We review the association of the factor v Leiden mutation and a cerebrovascular disorder in children younger than 16 years of age and describe the clinical features of 8 children with cerebral palsy and the Leiden mutation. This mutation should be considered in the evaluation of children with a stroke or its sequelae, including infants with perinatal stroke.
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ranking = 137.32566298367
keywords = thrombosis
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7/91. Overlapping stents for treatment of a dissecting carotid artery aneurysm.

    PURPOSE: To report the increased efficacy of oversized, overlapping stents to treat an internal carotid artery (ICA) dissecting aneurysm. CASE REPORT: A 55-year-old woman presented with reduced consciousness, aphasia, and right-sided hemiplegia owing to an infarction of the left middle cerebral artery territory documented by computed tomography. Digital subtraction angiography disclosed an extracranial dissection of the left ICA with a pseudoaneurysm. Two self-expanding Wallstents were placed, bridging the dissected segment and overlapping at the level of the aneurysm neck. Immediate arteriography showed remarkably reduced filling of the pseudoaneurysm. Serial arteriograms performed 6 days and 9 and 20 months after stenting documented the disappearance of the pseudoaneurysm without appreciable intimal hyperplasia of the vessel w all. CONCLUSIONS: Reducing stent porosity by overlapping the devices causes significant hemodynamic changes inside the aneurysm sac, accelerating intra-aneurysmal thrombosis.
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ranking = 137.32566298367
keywords = thrombosis
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8/91. Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery: case report.

    OBJECTIVE AND IMPORTANCE: The presence of a residual arteriovenous malformation (AVM) on postoperative angiograms is typically an indication for prompt return to the operating room to complete resection, because of the risk of early hemorrhage. This approach, however, may involve risks of neurological deficits when the residual AVM is in eloquent cortex. We present a case of complete thrombosis of a residual AVM after surgery. This residual AVM tissue was located in eloquent cortex. Complete spontaneous thrombosis of residual AVMs after surgery has only rarely been reported. This phenomenon raises questions regarding the most appropriate management for residual AVMs in eloquent cortex. CLINICAL PRESENTATION: The patient was a 43-year-old, right-handed, male patient with an AVM centered in the left precentral gyrus. The patient presented with medically intractable seizures and progressive right hemiparesis. After AVM resection, angiography revealed a residual AVM with early venous drainage. Angiography performed 1 week later demonstrated a persisting AVM nidus without early venous drainage. Angiography performed 3 months later demonstrated complete thrombosis of the residual AVM. INTERVENTION: The patient has been monitored for more than 1 year, without additional symptoms or therapy. CONCLUSION: We continue to advocate prompt return to the operating room when postoperative angiography reveals a residual AVM with persistent shunting. When the residual AVM is in eloquent cortex and is small, with a single draining vein, however, observation of the patient (with strict blood pressure control) and repeat angiography after 1 week represent an alternative strategy that is supported by this case report. As this case demonstrates, it is possible for small residual AVMs to thrombose. This may avert the need for reoperation for residual AVMs in eloquent cortex, with the potential for neurological deficits.
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ranking = 961.82337402742
keywords = thrombosis, vein
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9/91. On pure motor hemiplegia (Fisher's syndrome).

    The authors described three cases of so-called "lacunar strokes" with pure motor hemiplegia. Clinical diagnosis in all three cases was middle cerebral artery thrombosis. In cases 1 and 2 small post-malacic lacunes were found in the basal part of the pons. In case 3 the lesion was located in the pyramidal tract within the pons and medulla. In all cases advanced arteriosclerotic changes were observed. "Lacunar stroke" can result from a lesion of both the pons and the medulla. The clinical syndrome may be engendered also by selective lesion of the pyramidal tract.
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ranking = 137.32566298367
keywords = thrombosis
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10/91. Epidural haematoma. A retrospective study of 100 patients.

    A retrospective study was made of 100 consecutive patients with an epidural haematoma in order to establish which clinically demonstrable factors had influenced the prognosis quoad vitam et sanationem. Operations were performed on 92 of these patients, 29 (32%) of whom died; 8 patients died without operation, and in 2 of these cases the diagnosis was not made during life. A lucid interval was observed in 57 patients; absence of a lucid interval in combination with a lowered sensory level indicated associated intradural lesions (cerebral contusion, acute subdural haematoma), with consequently a less good prognosis. The prognosis was also adversely affected by deeper coma, occurrence of extensor spasms, bilateral stiff pupils, bilateral pyramidal symptoms and an age over 50. Some 33% of the patients treated by operation showed marked symptoms of compression (extensor spasms and/or bilateral stiff pupils); although these symptoms are usually described as indicative of a hopeless prognosis, 40% of the patients in this catagory survived. Contrary to the data in the literature, the interval between accident and operation within the first 24 hours did not influence the mortality, which was 50%. All patients operated on more than 24 hours after the accident, survived. A cranial fracture was absent in 13 patients, 11 of whom were under 30; absence of a cranial fracture was prognostically favourable. A catamnestic study revealed that 7 of the 58 accessible survivors had residual neurological dysfunctions; all these patients were up and about. The residual morbidity after early operation (within 24 hours) was the same as that after later operation. The data obtained were compared with those on a number of series recently published in the literature.
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