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Journal articles on the topic 'Aphasia Cerebrovascular disease'
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Hinckley, Jacqueline. "Clinical Decision-Making for Stroke and Aphasia in the Older Adult." Perspectives on Gerontology 14, no. 1 (2009): 4–11. http://dx.doi.org/10.1044/gero14.1.4.
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Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.
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Koh, Ji-yoo, Ah-hyu Son, and Hyeon-su Shin. "Review of Clinical Research about the Treatment of Aphasia after Cerebrovascular Disease." Journal of Internal Korean Medicine 39, no. 6 (2018): 1105–15. http://dx.doi.org/10.22246/jikm.2018.39.6.1105.
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Ramasubbu, Rajamannar, and Sidney H. Kennedy. "Factors Complicating the Diagnosis of Depression in Cerebrovascular Disease, Part Ii — Neurological Deficits and Various Assessment Methods*." Canadian Journal of Psychiatry 39, no. 10 (1994): 601–7. http://dx.doi.org/10.1177/070674379403901004.
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Neurological deficits associated with cerebrovascular disease such as aphasia, dementia, anosognosia and aprosodia may impair the ability to express or experience depressive symptoms. Identification of depression in the absence of verbal report on subjective mood state is a difficult task. The value of various diagnostic methods including depressive rating scales, standard psychiatric interviews and biological variables in the diagnosis of depression in cerebrovascular disease is considered. This review concludes by focusing on the deficiencies of existing approaches in the diagnostic assessment of depression in patients with severe communication and comprehension deficits and emphasizes the importance of devising a standard diagnostic method with less reliance on verbal responses.
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Spanou, Ioanna, Maria-Eleftheria Evangelopoulos, Georgios Velonakis, et al. "Moyamoya Disease May Mimic Multiple Sclerosis?" Case Reports in Neurological Medicine 2019 (May 2, 2019): 1–4. http://dx.doi.org/10.1155/2019/1276950.
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Introduction. A wide range of medical conditions may mimic multiple sclerosis. Among them, cerebrovascular diseases, including moyamoya disease, need to be excluded since they share common clinical features and radiographic findings with multiple sclerosis. Case Report. A 44-year-old woman experienced transient numbness of her right sided face and arm and was referred to our unit due to small brain lesions in magnetic resonance imaging, with a possible diagnosis of multiple sclerosis. Neurological examination was unremarkable except for plantar reflexes and jerky deep tendon reflexes. Brain magnetic resonance angiography revealed findings typically seen in moyamoya disease, confirmed with digital subtraction angiography. Antiplatelet therapy started, but few days later, she developed suddenly global aphasia and right hemiparesis (National Institutes of Health Stroke Scale/NIHSS 6). Brain magnetic resonance imaging revealed acute infarct in the distribution of the left middle cerebral artery. At her discharge, she was significantly improved (NIHSS 3). Conclusion. Diagnosis of multiple sclerosis is often challenging. In particular, in young patients with transient neurological symptoms and atypical white matter lesions in magnetic resonance imaging, cerebrovascular disorders such as moyamoya disease should be considered in the differential diagnosis. Detailed clinical and neuroimaging evaluation are mandatory for the correct diagnosis.
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VITTURI, Bruno Kusznir, and Rubens José GAGLIARDI. "Post-stroke aphasia in famous writers: when Neurology left geniuses speechless." Arquivos de Neuro-Psiquiatria 79, no. 3 (2021): 251–53. http://dx.doi.org/10.1590/0004-282x-anp-2020-0282.
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ABSTRACT Aphasia is a frequent and devastating stroke complication that does not spare even great writers. In these cases, not only one of the highest cognitive functions is suddenly lost but also the act of bringing beauty into the world. Herein, we discuss the case of three writers who had to abandon their art compulsorily due to a cerebrovascular disease: Charles Baudelaire, Ralph Waldo Emerson, and Stendhal. They were magnificent writers, united by excellence in literature and an inevitable destiny that restricted their art to just a few words. They are also examples of the proximity of Neurology to Art, History, and Literature.
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Schmugge, Markus, Hannes Frischknecht, Yasuhiro Yonekawa, Ralf W. Baumgartner, Eugen Boltshauser, and James Humbert. "Stroke in hemoglobin (SD) sickle cell disease with moyamoya: successful hydroxyurea treatment after cerebrovascular bypass surgery." Blood 97, no. 7 (2001): 2165–67. http://dx.doi.org/10.1182/blood.v97.7.2165.
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Abstract An 11-year-old boy with hemoglobin sickle disease (HbSD), bilateral stenosis of the intracranial carotid arteries, and moyamoya syndrome had recurrent ischemic strokes with aphasia and right hemiparesis. His parents (Jehovah's Witnesses) refused blood transfusions. After bilateral extracranial–intracranial (EC-IC) bypass surgery, hydroxyurea treatment increased hemoglobin F (HbF) levels to more than 30%. During a follow-up of 28 months, flow velocities in the basal cerebral arteries remained stable, neurologic sequelae regressed, and ischemic events did not recur. This is the first report of successful hydroxyurea treatment after bypass surgery for intracranial cerebral artery obstruction with moyamoya syndrome in sickle cell disease. The patient's religious background contributed to an ethically challenging therapeutic task.
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Villain, Nicolas, and Bruno Dubois. "Alzheimer's Disease Including Focal Presentations." Seminars in Neurology 39, no. 02 (2019): 213–26. http://dx.doi.org/10.1055/s-0039-1681041.
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AbstractAlzheimer's disease (AD) is the commonest neurodegenerative disease and the most frequent cause of dementia. It affects 30 million people worldwide. Current research criteria focus on biomarkers' status for amyloid and tau using positron emission tomography and cerebrospinal fluid analysis, independent of clinical status. Current epidemiological data, which mostly rely on biomarker-undetermined AD cases, have highlighted ApoE4 and age as the main risk factors. Rare autosomal dominant mutations also account for a small fraction of early-onset AD. The main clinical phenotype at presentation is the amnestic phenotype targeting episodic memory. This is followed by rarer phenotypes such as posterior cortical atrophy, logopenic variant of primary progressive aphasia, frontal variant AD, corticobasal syndrome, and other even rarer presentations mimicking language variants of frontotemporal dementia. Main differential diagnoses include hippocampal sclerosis with TDP-43, primary age-related tauopathy, argyrophilic grain disease, frontotemporal lobar degeneration, Lewy body disease, chronic traumatic encephalopathy as well as nondegenerative disorders such as cerebrovascular disease, chronic alcohol consumption, limbic encephalitis, medial temporal lobe epilepsy, and others. Co-occurrence of AD pathology with other neurodegenerative and vascular diseases is common and increases with age. This presents a challenge in current clinical practice due to a lack of reliable biomarkers for non-AD neurodegenerative diseases.
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Bhavsar, Minal Dhairya, and Vinal Charpot. "Takayasu Arteritis - A Case Study." International Journal of Health Sciences and Research 11, no. 6 (2021): 362–66. http://dx.doi.org/10.52403/ijhsr.20210654.
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Takayasu arteritis (TA) is a chronic inflammatory disease of unknown etiology. The mechanism of this disease is not exactly defined. The inflammatory process is generally (but not exclusively) initiated in the second or third decade of life through the actions of non-specific inflammatory cells. As the disease progresses, fibrotic stenosis occurs in aorta and its main branches. The consequence of this inflammatory process can be stenosis, thrombosis, dilatation or aneurysm formation in aorta and/ or its branches. In Asia, its incidence (2.69 in a million per year) has been reported to be 100 times higher than in Europe and North America. Because of the delay in diagnosing the disease, patients often experience claudication, absence of pulses, hypertension, myocardial infarction (MI), and cerebrovascular accidents (CVAs). Accurate and early diagnosis of TA can reduce the economic, social, and psychological burdens. We present clinical, laboratory and imaging findings of a 15 years old girl with TA, who initially presented with clinical manifestations of stroke in form of weakness in Lt Side upper and lower limb and aphasia. The rarity of the disease and especially such a presentation can cause considerable delay in the diagnosis and treatment. Key words: Takayasu arteritis, Cerebrovascular accident, Infarction, physical therapy.
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Santos, Jolina Pamela, Zaher Hamadeh, and Naheed Ansari. "Cerebrovascular Accident Secondary to Paradoxical Embolism Following Arteriovenous Graft Thrombectomy." Case Reports in Nephrology 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/183730.
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Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF) or arteriovenous graft (AVG). Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD), atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT) scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure.
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Kulesh, A. A., N. L. Starikova, V. E. Drobakha, L. Yu Brokhin, and A. S. Chubarov. "The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL): a description of three patients." Neurology, Neuropsychiatry, Psychosomatics 12, no. 4 (2020): 65–72. http://dx.doi.org/10.14412/2074-2711-2020-4-65-72.
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Three clinical cases of the syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) are first described in Russian literature. The patients were young (aged 30–35 years), had symptoms characteristic of the prodromal period of infections. In all the patients, the disease started with intense headache, followed by focal neurological symptoms: aphasia and hemihypesthesia in all cases and confusion with psychomotor agitation in two cases. All the three patients showed spontaneous recovery within 2–3 days. Perfusion computed tomography, magnetic resonance imaging, and electroencephalography are compared in one of the cases. The differential diagnosis of HaNDL with acute cerebrovascular accident, herpetic encephalitis, epilepsy, and migraine is discussed.
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PIOVESAN, ELCIO JULIATO, ROSANA HERMINIA SCOLA, LINEU CESAR WERNECK, et al. "Neurofibromatosis, stroke and basilar impression: case report." Arquivos de Neuro-Psiquiatria 57, no. 2B (1999): 484–88. http://dx.doi.org/10.1590/s0004-282x1999000300022.
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Neurofibromatosis type 1 (NF1) can virtually affect any organ, presenting most frequently with "cafe au lait" spots and neurofibromas. Vasculopathy is a known complication of NF1, but cerebrovascular disease is rare. We report the case of a 51-year-old man admitted to the hospital with a history of stroke four months before admission. On physical examination, he presented various "cafe au lait" spots and cutaneous neurofibromas. Neurologic examination demonstrated right-sided facial paralysis, right-sided hemiplegia, and aphasia. Computed tomography scan of head showed hypodense areas in the basal ganglia and centrum semiovale. Radiographs of cranium and cervical spine showed basilar impression. Angiography revealed complete occlusion of both vertebral and left internal carotid arteries, and partial stenosis of the right internal carotid artery. A large network of collateral vessels was present (moyamoya syndrome). It is an uncommon case of occlusive cerebrovascular disease associated with NF1, since most cases described in the literature are in young people, and tend to spare the posterior cerebral circulation. Basilar impression associated with this case may be considered a pure coincidence, but rare cases of basilar impression and NF1 have been described.
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Jellinger, Kurt A. "Pathobiological Subtypes of Alzheimer Disease." Dementia and Geriatric Cognitive Disorders 49, no. 4 (2020): 321–33. http://dx.doi.org/10.1159/000508625.
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Alzheimer disease (AD), the most common form of dementia, is a heterogenous disorder with various pathobiological subtypes. In addition to the 4 major subtypes based on the distribution of tau pathology and brain atrophy (typical, limbic predominant, hippocampal sparing, and minimal atrophy [MA]), several other clinical variants showing distinct regional patterns of tau burden have been identified: nonamnestic, corticobasal syndromal, primary progressive aphasia, posterior cortical atrophy, behavioral/dysexecutive, and mild dementia variants. Among the subtypes, differences were found in age at onset, sex distribution, cognitive status, disease duration, APOE genotype, and biomarker levels. The patterns of key network destructions parallel the tau and atrophy patterns of the AD subgroups essentially. Interruption of key networks, in particular the default-mode network that is responsible for cognitive decline, is consistent in heterogenous AD groups. AD pathology is often associated with co-pathologies: cerebrovascular lesions, Lewy pathology, and TDP-43 proteinopathies. These mixed pathologies essentially influence the clinical picture of AD and may accelerate disease progression. Unraveling the heterogeneity among the AD spectrum entities is important for opening a window to pathogenic mechanisms affecting the brain and enabling precision medicine approaches as a basis for developing preventive and ultimately successful disease-modifying therapies for AD.
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Bollipo, Johny Prasad, and Pasupuleti Bhimeswara Rao. "Color doppler assessment of extra cranial carotid arteries in carotid artery disease with correlation of risk factors in predicting cerebro vascular accident in patients with carotid atheromatous disease." International Journal of Advances in Medicine 5, no. 6 (2018): 1402. http://dx.doi.org/10.18203/2349-3933.ijam20184718.
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Background: Stroke is a clinical syndrome, which describes a sudden neurological deficit of presumed vascular origin. The risk factors for stroke are diabetes mellitus, smoking, alcohol and hypertension. Colour doppler ultrasound is one of the important tool for the evaluation of exracranial insufficiency of the carotid arteries. This study was performed to assess the carotid arteries with the help of color doppler in carotid artery disease.Methods: Of the 100 patients who had come to our department during the study period with symptoms of cerebrovascular disease such as transient episodes of neurological dysfunction, sudden weakness or numbness, hemiparesis, focal neurological deficits, sudden loss of consciousness, altered sensorium, aphasia, slurring of speech, diminution or loss of vision were included into the study. CT scan of brain and color doppler evaluation for the extracranial carotid arteries was done for all the patients to assess the atheromatous disease of extracranial carotid arteries and comparison with brain changes in cerebrovascular disease patients.Results: Of the 100 patients included into the study, 51% were males and 49% were females. 59% of the patients were above 61 years of age, 24% of them were between 51-60 years and 12% were between 41-50 years. 82% of the patients had the presence of atherosclerotic plaque while 18% had increased intima-media thickness without the plaque. Among the patients with atherosclerotic plaque, 63.4% had diabetes and 68.3% had hypertension. <50% stenosis was seen among 45.1% of the patients while 36.6% had between 50-70%. Near total occlusion was seen in 6.1% of the patients.Conclusions: The color Doppler sonography is a useful tool in evaluation of extra cranial course of carotid vessels. It is a non-invasive, cheap, faster modality without any side effects. Therefore, it could be used in predicting CVA in patients with carotid atheromatous disease.
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Carr, Kristin, and Onyema Ogbuagu. "Late neurosyphilis and VZV meningoencephalitis coinfection." BMJ Case Reports 14, no. 6 (2021): e240412. http://dx.doi.org/10.1136/bcr-2020-240412.
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The incidence of syphilis has increasing recently, largely attributable to improved screening that may result in the diagnosis of chronic untreated infections. These patients can develop severe or subtle neurologic symptoms that can be missed and, therefore, detected accidentally while a patient is evaluated for other mimicking neurological infections. A 58-year-old man with diabetes presented with 2 days of aphasia, headache, chills and confusion. He had an MRI brain with evidence of a prior cerebrovascular accident. Subsequently, he developed a fever and thoracic dermatomal rash consistent with herpes zoster. A lumbar puncture was performed, and cerebrospinal fluid analysis revealed a lymphocytic pleocytosis, a reactive Venereal Disease Research Laboratory test and positive varicella-zoster virus (VZV) PCR. He was suspected to have both late neurosyphilis and acute meningoencephalitis from VZV. This paper will discuss how to approach the diagnosis of late neurosyphilis and possible associations with herpesvirus central nervous system infections.
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Rahme, Ralph, Tejaswi D. Sudhakar, Marjan Alimi, Timothy G. White, Rafael A. Ortiz, and David J. Langer. "Cerebral Hyperperfusion Syndrome by the Numbers: Transient Focal Neurological Deficit, Imaging-Proven Focal Hyperperfusion, and High Graft Flow Rate Following Superficial Temporal Artery-Middle Cerebral Artery bypass in a Patient With Symptomatic Carotid Occlusion—Case Report." Operative Neurosurgery 15, no. 6 (2018): E94—E99. http://dx.doi.org/10.1093/ons/opy010.
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Abstract BACKGROUND AND IMPORTANCE Cerebral hyperperfusion syndrome (CHS) is a well-known complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass for ischemic cerebrovascular disease. While this argues against “low flow” in the bypass construct, flow rates in the graft have not been previously quantified in the setting of CHS. CLINICAL PRESENTATION A 58-yr-old man presented with recurrent left hemispheric ischemic strokes and fluctuating right hemiparesis and aphasia. Vascular imaging revealed left cervical internal carotid artery occlusion and perfusion imaging confirmed left hemispheric hypoperfusion. After failing to respond to maximal medical therapy, the patient underwent single-barrel STA-MCA bypass. Postoperatively, his symptoms resolved and blood pressure (BP) was strictly controlled within normal range. However, 2 d later, he developed severe expressive aphasia. CTA demonstrated a patent bypass graft and SPECT showed focal hyperperfusion in Broca's speech area. Seizure activity was ruled out. A high graft flow rate of 52 mL/min was documented by quantitative magnetic resonance angiography (MRA). Thus, the diagnosis of CHS was made and managed with strict BP control. The patient exhibited complete recovery of speech over a period of days and was discharged home. Repeat SPECT at 4 mo showed resolution of hyperperfusion and quantitative MRA demonstrated reduction of graft flow rate to 34 mL/min. CONCLUSION This is the first case of perfusion imaging-proven CHS after STA-MCA bypass, where high graft flow rates are objectively documented. Our observations constitute irrefutable evidence challenging the classic belief that the STA-MCA bypass is a low-flow construct.
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Obukhova, A. V., N. N. Koberskaya, and D. A. Artemev. "Motor-speech disorders in a patient with a vertebrobasilar stroke affected by coronavirus infection (clinical observation)." Meditsinskiy sovet = Medical Council, no. 10 (August 12, 2021): 154–62. http://dx.doi.org/10.21518/2079-701x-2021-10-154-162.
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Amidst the growing coronavirus infection (COVID-19) pandemic, there is increasing evidence of the development of neurological complications of this disease and, especially, acute cerebrovascular accidents, and what is more, an increase in incidence rates of strokes is noted in the patients under the age of 50, who did not have risk factors for cerebrovascular diseases. The article examines several potential mechanisms that determine the relationships between ischemic stroke and COVID-19. A clinical case of the development of ischemic stroke in the vertebrobasilar system affected by the coronavirus infection is presented. The causal relationship between coronavirus infection and vascular catastrophe is discussed. In the described case, COVID-19 contributed to the decompensation of the patient’s associated risk factors. A feature of the described case is the delayed development of a rare motor disorder in the form of Holmes tremor and combined speech disorders (dysarthria and aftereffects of motor aphasia) in the patient. Holmes tremor is an unusual type of tremor characterized by a combination of rest, postural, and action tremors that predominantly affects the proximal limbs. This symptom is named after the British neurologist Gordon Holmes, who described a series of cases of an unusual variant of tremulous hyperkinesis in 1904. The article discusses the pathogenesis issues of the development of this condition and provides clinical criteria for Holmes tremor. This is a rather rare symptom, there are no data on large studies of this disorder in the literature, and it is mainly described in small series of clinical cases. The efficacy of Akatinol Memantine in the treatment of post-stroke speech disorders is discussed, and the rationale for prescribing this drug in the management of patients with post-stroke speech disorders is presented.
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Turan, Tanya N., Sami Al Kasab, Alison Smock, et al. "Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial." Cerebrovascular Diseases 47, no. 1-2 (2019): 24–31. http://dx.doi.org/10.1159/000497245.
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Background: Cerebrovascular disease is an important cause of cognitive impairment. The aim of this study is to report the relationship between cognitive function and risk factors at baseline and during follow-up in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial. Methods: Subjects in the SAMMPRIS trial were included in this study. In order to have an assessment of cognitive function independent of stroke, patients with a stroke as a qualifying event whose deficits included aphasia or neglect were excluded from these analyses as were those with a cerebrovascular event during follow-up. The Montreal Cognitive Assessment (MoCA) score was used to assess cognitive impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA < 26. A multivariate analysis was performed to determine what risk factors were independent predictors of cognitive function at baseline, 12 months and closeout. Among patients randomized to aggressive medical management only, the percentage of patients with cognitive impairment was compared between patients in versus out of target for each risk factor at 12 months and closeout. Results: Of the 451 patients in SAMMPRIS, 371 patients met the inclusion criteria. MoCA < 26 was present in 55% at baseline. Older age and physical inactivity were associated with cognitive impairment at baseline. Older age, non-white race, lower baseline body mass index, and baseline cognitive impairment were associated with cognitive impairment at 12 months. In the aggressive medical management group, at 12 months, physical inactivity during follow-up was the strongest risk factor associated with cognitive impairment. Conclusion: Cognitive impairment is common in patients with severe symptomatic intracranial atherosclerosis. Physical inactivity at baseline and during follow-up is a strong predictor of cognitive impairment.
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Khludenev, George, Akshay Reddy, Sinan Akosman, and Michael J. Whalen. "An Unusual Location for a Nonurachal Bladder Adenocarcinoma." Case Reports in Urology 2021 (September 23, 2021): 1–6. http://dx.doi.org/10.1155/2021/5827120.
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Malignant bladder neoplasms represent a significant disease burden not only for urologists but also the broader medical community. While the majority of bladder tumors are urothelial in origin, up to two percent are found to be adenocarcinomas. Among bladder adenocarcinomas, roughly one-tenth are urachal and are frequently located at the dome of the bladder where urachal remnants can often be found. We describe a case of bladder adenocarcinoma that presented at the dome of the bladder but ultimately exhibited a nonurachal histology. A 65-year-old male with a history of myocardial infarction and cerebrovascular accident with residual right-sided hemiparesis and aphasia was referred to our clinic for evaluation of a bladder mass discovered in the setting of painless gross hematuria. Diagnostic cystoscopy demonstrated a large mass at the dome of the bladder, and subsequent transurethral resection revealed stage T1 mucinous adenocarcinoma arising in a villous adenomatous lesion without the presence of muscle in the specimen. The patient underwent a robotic-assisted laparoscopic partial cystectomy with extended bilateral pelvic lymph node dissection. Postoperatively, the patient experienced short-lived paralytic ileus and was discharged on postoperative day 5. Follow-up surveillance imaging at 6 months with CT chest, abdomen, and pelvis, repeat office cystoscopy, and negative tumor markers postoperatively indicated no evidence of disease recurrence. Characterization of bladder adenocarcinomas into urachal and nonurachal subtypes is critical in differentiating the operative management and oncologic outcomes of the respective neoplasms. However, given the paucity of literature describing treatment approaches to bladder adenocarcinoma in general, existing methods have largely mirrored genetically similar neoplasms, including ovarian and colon adenocarcinomas. Although there is still much to be understood regarding the potential mechanisms of carcinogenesis of nonurachal adenocarcinomas, further investigation may pave the way for a more standardized treatment paradigm and provide insight into the potential utility of modern immunotherapies.
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Elie, Emmauela, Gisela Aguila Puentes, Susan Ireland, and Sheba Kumbhani. "A-60 Case of Moyamoya Syndrome in Haitian Female without Known Risk Factors." Archives of Clinical Neuropsychology 36, no. 6 (2021): 1102. http://dx.doi.org/10.1093/arclin/acab062.78.
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Abstract Objective Moyamoya is a rare, progressive cerebrovascular disorder characterized by carotid artery stenosis or occlusion. Tiny “moyamoya” blood vessels open at the brain base to compensate, often resulting in large vessel ischemic strokes or from hemorrhage of moyamoya vessels. Peak incidence in adults is 30 to 50 years old and 30% progress bilaterally. 54 year-old right-handed Black Haitian female with 13 years of education presented with new stroke, now diagnosed with bilateral moyamoya syndrome. Premorbid history includes hypertension, Type II Diabetes Mellitus, patent foramen ovale, and malignant phyllodes breast tumor treated by resection and local radiation. Presents with no traditional risk factors for moyamoya (e.g., brain radiation, sickle cell disease, neurofibromatosis). Method Five years previously patient experienced multi-focal embolic MCA strokes from left internal carotid occlusion attributed to hypercoagulability of malignancy, returning to previous activities except driving. Present perfusion CT showed complete occlusion of bilateral cavernous carotid arteries. Diagnostic angiogram showed collateral system via PCA-MCA pial-pial collaterals in parieto-occipital-temporal regions, and leptomeningeal collaterals to ACA territory. She underwent bilateral STA-MCA direct bypass. Results Acute neuropsychological testing conducted in Haitian Creole by native-speaking trainee showed expressive aphasia, orientation to person and situation, ability to follow 1-step commands, moderately impaired naming of familiar objects, reduced sustained attention. Also left hemiparesis, right gaze preference, and left homonymous hemianopsia. Conclusions The present case study delineates development of secondary moyamoya in a Black Haitian woman without known risk factors, resulting in significant cognitive-linguistic deficits consistent with brain findings. Limitations include lack of validated measures in Haitian Creole.
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Georgieva, Dobrinka, Dobrinka Kalpachka, and Rossen Kalpachki. "Stroke and aphasia rehabilitation: A comparison of international guidelines." Logopedia Silesiana, no. 9 (December 29, 2020): 1–15. http://dx.doi.org/10.31261/logopediasilesiana.2020.09.19.
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Cerebrovascular diseases are the leading cause of morbidity and mortality worldwide. Unfortunately, Bulgaria leads most countries in its incidence of stroke. Furthermore, a substantial number of Bulgarian patients post-stroke present with persisting communication disorders, especially aphasia. The main purpose of the present study is to conduct an evidence-based theoretical review of leading international guidelines for treatment and rehabilitation of adult stroke patients. In particular, this theoretical overview compares the current Bulgarian guidelines with those developed by the United States of America, Europe, Australia, Canada, the United Kingdom, and New Zealand. The Bulgarian guidelines for the prevention, diagnosis, and treatment of cerebrovascular diseases strongly recommends pharmacological treatment, which is commensurate with international standards. Nationally, a range of different language tests are currently used in post-stroke aphasia.
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liboshi, Kiyoko, Takeshi Igakura, and Hirofumi Hamada. "PACE approach for patients of chronic aphasia due to patients in cerebrovascular diseases." Higher Brain Function Research 12, no. 3 (1992): 255–63. http://dx.doi.org/10.2496/apr.12.255.
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Naqvi, Imama, Emi Hitomi, and Richard Leigh. "Sustained Opening of the Blood-Brain Barrier with Progressive Accumulation of White Matter Hyperintensities Following Ischemic Stroke." Brain Sciences 9, no. 1 (2019): 16. http://dx.doi.org/10.3390/brainsci9010016.
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Objective: To report a patient in whom an acute ischemic stroke precipitated chronic blood-brain barrier (BBB) disruption and expansion of vascular white matter hyperintensities (WMH) into regions of normal appearing white matter (NAWM) during the following year. Background: WMH are a common finding in patients with vascular risk factors such as a history of stroke. The pathophysiology of WMH is not fully understood; however, there is growing evidence to suggest that the development of WMH may be preceded by the BBB disruption in the NAWM. Methods: We studied a patient enrolled in the National Institutes of Health Natural History of Stroke Study who was scanned with magnetic resonance imaging (MRI) after presenting to the emergency room with an acute stroke. After a treatment with IV tPA, she underwent further MRI scanning at 2 h, 24 h, 5 days, 30 days, 90 days, 6 months, and 1-year post stroke. BBB permeability images were generated from the perfusion weighted imaging (PWI) source images. MRIs from each time point were co-registered to track changes in BBB disruption and WMH over time. Results: An 84-year-old woman presented after acute onset right hemiparesis, right-sided numbness and aphasia with an initial NIHSS of 13. MRI showed diffusion restriction in the left frontal lobe and decreased blood flow on perfusion imaging. Fluid attenuated inversion recovery (FLAIR) imaging showed bilateral confluent WMH involving the deep white matter and periventricular regions. She was treated with IV tPA without complication and her NIHSS improved initially to 3 and ultimately to 0. Permeability maps identified multiple regions of chronic BBB disruption remote from the acute stroke, predominantly spanning the junction of WMH and NAWM. The severity of BBB disruption was greatest at 24 h after the stroke but persisted on subsequent MRI scans. Progression of WMH into NAWM over the year of observation was detected bilaterally but was most dramatic in the regions adjacent to the initial stroke. Conclusions: WMH-associated BBB disruption may be exacerbated by an acute stroke, even in the contralateral hemisphere, and can persist for months after the initial event. Transformation of NAWM to WMH may be evident in areas of BBB disruption within a year after the stroke. Further studies are needed to investigate the relationship between chronic BBB disruption and progressive WMH in patients with a history of cerebrovascular disease and the potential for acute stroke to trigger or exacerbate the process leading to the development of WMH.
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Chen, Y. K., E. Lee, G. S. Ungvari, et al. "Atrophy of left dorsolateral prefrontal cortex is associated with poor performance in verbal fluency in elderly poststroke women." European Psychiatry 26, S2 (2011): 1180. http://dx.doi.org/10.1016/s0924-9338(11)72885-1.
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IntroductionPrefrontal cortex and sex difference are involved in verbal fluency network described in normal participants. Stroke patients often have prefrontal cortex atrophy.ObjectivesTo investigate whether atrophy in subdivisions of prefrontal cortex and sex difference contribute to verbal fluency in non-aphasic stroke patients.AimTo understand the relationship between the atrophy of left dorsolateral prefrontal cortex and verbal performance in elderly poststroke women.Methods30 elderly (age> = 60 years old) women with non-aphasic ischemic stroke and 30 age-controlled stroke men recruited. Automatic segmentation methods were used to assess the volume of both sides of the whole prefrontal cortex, anterior cingulate cortex, orbital frontal cortex and dorsalateral prefrontal cortex (DLPFC), as well as white matter lesions (WMLs) volume. Mini-mental state examination (MMSE) and semantic verbal fluency test (VFT, category: foods and animals) were administered at 3 and 15 months after the index stroke.ResultsThe mean (s.d) age was 73.3 ± 7.2 in women and 72.1 ± 6.9 in men. Men had higher education years, less diabetes and higher MMSE scores (p < 0.05). At 3 months after stroke, volume of the left DLPFC was significantly correlated with VFT score in women rather than men, even after controlled by age, education years, neurological deficit, diabetes, WMLs volume and infarct location (partial r = 0.477, p = 0.018). At 15 months, this correlation remained significant (partial r = 0.548, p = 0.006) in women.ConclusionSex difference may be present in the neuropsychological mechanism of verbal fluency impairment in patients with cerebrovascular disease.
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Mesulam, M. Marsel, Benjamin M. Rader, Jaiashre Sridhar, et al. "Word comprehension in temporal cortex and Wernicke area." Neurology 92, no. 3 (2018): e224-e233. http://dx.doi.org/10.1212/wnl.0000000000006788.
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ObjectiveTo explore atrophy–deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary progressive aphasia (PPA).MethodsCortical thickness in regions within and outside the classical Wernicke area, measured by FreeSurfer, was correlated with repetition and single word comprehension scores in 73 right-handed patients at mild to moderate stages of PPA.ResultsAtrophy in the Wernicke area was correlated with repetition (r = 0.42, p = 0.001) but not single word comprehension (r = −0.072, p = 0.553). Correlations with word comprehension were confined to more anterior parts of the temporal lobe, especially its anterior third (r = 0.60, p < 0.001). A single case with postmortem autopsy illustrated preservation of word comprehension but not repetition 6 months prior to death despite nearly 50% loss of cortical volume and severe neurofibrillary degeneration in core components of the Wernicke area.ConclusionsTemporoparietal cortices containing the Wernicke area are critical for language repetition. Contrary to the formulations of classic aphasiology, their role in word and sentence comprehension is ancillary rather than critical. Thus, the Wernicke area is not sufficient to sustain word comprehension if the anterior temporal lobe is damaged. Traditional models of the role of the Wernicke area in comprehension are based almost entirely on patients with cerebrovascular lesions. Such lesions also cause deep white matter destruction and acute network diaschisis, whereas progressive neurodegenerative diseases associated with PPA do not. Conceptualizations of the Wernicke area that appear to conflict, therefore, can be reconciled by considering the hodologic and physiologic differences of the underlying lesions.
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Čustović, Mirsada. "Monitoring in the treatment of patients with aneurysmal and nonaneurysmal subarachnoid haemorrhage in terms of nursing care and therapy." Croatian nursing journal 3, no. 1 (2019): 5–23. http://dx.doi.org/10.24141/2/3/1/1.
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Cerebrovascular diseases together with cardiovascular and malignant diseases are the most common diseases in the developed world, regardless of the gender. They are at the third place as the cause of mortality and first as the cause of disability. Subarachnoid haemorrhage is a condition of discharging blood from cerebral arteries into the subarachnoid space within the brain. Subarachnoid haemorrhage (SAH) has a number of etiological features, but when it comes to spontaneous subarachnoid haemorrhage, in 80% of the cases it is caused by the rupture of an intracranial aneurysm. Subarachnoid haemorrhage (SAH) can be spontaneous and traumatic (post-traumatic). Also, it could be primary (direct bleeding into the subarachnoid space) or secondary (parenchymal bleeding to the subarachnoid space of the brain). Cerebral aneurysms are a local expansion in the blood vessel wall usually at the bifurcation of the artery. If cerebral artery ruptures and blood enters the subarachnoid space, the patient can have a very strong headache at the back and front part of the head. Short term memory can be affected as well. The initial assessment of patients should include: an overview of the quantitative state of mind, pupil size and reaction to light, motor and sensory function, the presence of headaches, dysfunction of cranial nerve (ptosis of the eyelids, difficulty moving eyes in all directions) blurred vision, aphasia, other neurological deficits). Several serious complications often arise after a successful operative treatment of the subarachnoid haemorrhage and aneurysm. One such complication is cerebral vasospasm, and is present in 50 to 70% of the patients. Late complications include recurrent bleeding, brain edema, chronic hydrocephalus and as most important - brain infarction. The incidence of subarachnoid haemorrhage ranges from 10-15/100 000 inhabitants. About 20% of the patients with spontaneous subarachnoid haemorrhage are younger than 45 years, while patients older than 70 years have a less positive prognosis of survival. Spontaneous subarachnoid haemorrhage is a disease of the middle age (55-60 years) with a relatively high mortality and morbidity. The prevalence of patients with an intracranial aneurysm is unknown, but it is assumed to be of higher incidence than subarachnoid haemorrhage. Approximately 10-15% of the patients die before they reach the physician, 10% die within the first few days, while the mortality rate in patients with all forms of subarachnoid haemorrhage is up to 45%. Morbidity is significant, considering that 66% of the patients never return to their earlier work, nor they have the same quality of life. Most patients with subarachnoid haemorrhage are subjected to a microneurosurgical treatment. In monitoring the patients and depending on the complications, but also in all situations, the role of nurses is primarily reflected in monitoring vital parameters and states of consciousness, and recognizing the signs and symptoms of neurological deterioration of the patient. Hypothesis. Patients with proper postoperative nursing care, monitoring and rehabilitation, with aneurysmal and nonaneurysmal subarachnoid haemorrhage, have fewer complications such as neurological deficits, pressure ulcers, nosocomial infections, changes in the values of the vital parameters and biohumoral status. Research Objectives. To show the total number of operated patients with confirmed subarachnoid haemorrhage at the Department of Neurosurgery, University of Sarajevo Clinical Centre during the period from 1 January 2013 to 31 December 2014. To show the ways in which the patients were monitored from admission to discharge from the Department. To show the stages of the patients’ progress along with the outcome of the treatment strategy. To show quality indicators (ventilator-associated pneumonia, nosocomial infections, pressure ulcers) in the test sample. Research Method. The research was a retrospective study. A descriptive analytical method was used which compared the data from the patient medical histories that included physicians and nurses’ notes for patients that were operated on at the Department of Neurosurgery, University of Sarajevo Clinical Centre. The sample included patients of both genders with a confirmed diagnosis of subarachnoid haemorrhage (aneurysma cerebri, haemorrhagia subarachnoidalis spontanea) who were operated on at the Department of Neurosurgery, University of Sarajevo Clinical Centre, in the period from 1 January 2013 to 31 December 2014. Of the 142 respondents, 93 or 65.5% were hospitalized for aneurysmal surgery and a control group of 49 of them, or 34.5%, were operated on for nonaneurysmal subarachnoid haemorrhage. There were 50.7% of men (n=72), and 49.3% of women (n=70). The participants in the study were of the average age of 54 years or 45-63.2 years. The study did not include the education and occupation of the participants. Criteria for inclusion into the study: Patients with a confirmed diagnosis of subarachnoid haemorrhage; patients operated on during the abovestated period; people older than 18 years. Criteria for exclusion from the study: Patients who were in the abovestated period diagnosed with the same illness and have not undergone surgery, but underwent conservative neuroradiological treatment (embolization). Results. Of the 142 respondents in the sample, 65.5% were hospitalized for aneurysmal surgery and 34.5% of the patients were operated for nonaneurysmal subarachnoid haemorrhage. The respondents were on average 54 years old. Men were on average 53 years and women 55 years old. Aneurysmal subarachnoid haemorrhage was more frequent among women (65.6%). The respondents with nonaneurysmal subarachnoid haemorrhage were older, 61 (43-62) years. Only 2% of the patients after aneurysm surgery were not under non-invasive monitoring, while the percentage of those with surgical treatment of nonaneurysmal subarachnoid haemorrhage was significantly higher at 24.5%. There was a fatal outcome in a total of 30 (32.6%) patients operated on for an aneurysm while the percentage of those who were operated on due to nonaneurysmal haemorraghe was lower and amounted to 4 (8.2%). Surviving patients, those with an aneurysm, on average stayed in hospital for 18 (12-24) days. Of the total number of patients operated for an aneurysm - 44 (47.3%) were independently mobile after surgery, 9 (9.7%) had limited mobility, 8 (8.6%) had very limited mobility and 32 (34.4%) were immobile. Most participants operated for subarachnoid haemorrhage were independently mobile after surgery 32 (65.3%), 10 (20.4%) had limited mobility, 3 (6.1%) had very limited mobility and only 4 (8.2%) were immobile. Of the entire sample with aneurysmal haemorrhage, ventilator-associated pneumonia was found in 9 patients (9.7%) who were operated for an aneurysm and in 2 patients (4.1%) after SAH surgery.
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Hoffmann, Michael. "Higher Cortical Function Deficits After Stroke: An Analysis of 1,000 Patients from a Dedicated Cognitive Stroke Registry." Neurorehabilitation and Neural Repair 15, no. 2 (2001): 113–27. http://dx.doi.org/10.1177/154596830101500205.
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Objective: Despite spectacular success of animal model neuroprotective therapy in stroke, these agents have been uniformly unsuccessful in humans. One possible ex planation is the crudity of cerebral measurement by insensitive of stroke scales com prising scant or absent higher cortical-function parameters and the heterogeneity of stroke syndromes and etiology. We sought to determine the frequency and extent of cognitive disorders after stroke and their relation to stroke risk factors, syndromes, le sion site, and etiology. Methods: We used hospital-based consecutive stroke cases. A tiered, hierarchic, cerebrovascular investigative protocol and a battery of predefined, validated bedside higher cortical function deficit (HCFD) tests with comparison to neuropsychological. Quantification according to the World Health Organization lev els of disease model was achieved by a clinical neurologic deficit scale, etiologic scale, and disability scale. Results: Stroke deficit, disability and etiology: In patients evaluated (n = 1,000), the admission Canadian Neurological Scale deficit grading was mild, 11.5-9.5 (n = 696); moderate, 9.5-5.5 (n = 204); and severe, 5.0-0 (n = 86); with correlation to Rankin scale of independent (n = 467), mild disability (n = 345) and severe disability (n = 174) with moderate agreement (kappa = 0.54) between the two measurements. The etiologic subtypes included large-vessel atherothrombosis (n = 264), small-vessel atherothrombosis (n = 262), cardioembolic (n = 122), other (dis section, vasculitis, prothrombotic states; n = 253), and unknown (n = 99). Cognitive Data: 1. One or more higher cortical function abnormalities was detected in 607 (63.5%) of 955 nondrowsy patients. The most numerous categories were aphasias (25.2%), apraxias (14.5%), amnesias (11.6%), and frontal network syndromes (9.2%), with the other categories less frequent (3%). Cognitive impairment occurred without elementary neurologic deficits (motor, sensory, or visual impairment) in 137 (22.5%) of 608. The cardloembolic, other, and unknown stroke mechanistic groups differed sig nificantly from the other groups in terms of HCFD (p = 0.01) frequency. HCFD did not differ between younger (younger than 49 years) and older patients (p = 0.194). 3. Univariate and multivariate analyses of risk factors and likelihood of developing an HCFD revealed increasing age, black race, being overweight, and recent infection to be independent variables (p = 0.05). 4. In 76 patients, neuropsychological testing was performed and comparison with the HCFD test revealed a sensitivity of 80.2% (CI, 72-88%) and specificity of 100%. Conclusions: 1. Cognitive impairment is pres ent in the majority of all types of stroke. 2. Cognitive impairment may be the sole pres entation of stroke, unaccompanied by long-tract signs. 3. Stroke etiologic subtype dif fered significantly among the subgroups, but in comparison of young versus older patients, no significant differences in HCFD frequency were recorded. 4. Risk factors for developing cognitive impairment in the indigenous stroke population included increasing age, black race, overweight body habitus, and recent infection. Key Words: Stroke—Cognitive deficit—Higher cortical function.
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Watanabe, Hiroyuki, Manabu Ikeda, and Etsuro Mori. "Logopenic progressive aphasia with neologisms: a case report." BMC Neurology 19, no. 1 (2019). http://dx.doi.org/10.1186/s12883-019-1524-y.
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Abstract Background Neologisms are commonly encountered in patients with acute cerebrovascular diseases, particularly in those with Wernicke’s aphasia. However, few studies have investigated primary progressive aphasia with neologisms in neurodegenerative disease. Case presentation We describe the case of a 74-year-old, right-handed man who developed logopenic progressive aphasia (LPA) with neologisms. He was assessed with neuropsychological tests, magnetic resonance imaging, and single-photon emission computed tomography. Neologisms accounted for a relatively large portion of the paraphasic errors in the naming tests performed during the neuropsychological assessment. He had all the diagnostic features of LPA. Notably, the unique feature of this patient was the presentation of neologisms, which are seldom observed in typical LPA. Conclusions Neologisms are considered rare symptoms in patients with early-stage LPA. Our findings in this case report provide new insights into the spectrum of clinical features in LPA.
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Knopman, David. "Clinical Aspects of Non-Alzheimer Disease Dementias." DeckerMed Family Medicine, March 11, 2017. http://dx.doi.org/10.2310/fm.1336.
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There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment
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Knopman, David. "Clinical Aspects of Non-Alzheimer Disease Dementias." DeckerMed Neurology, March 11, 2017. http://dx.doi.org/10.2310/neuro.1336.
Full textAbstract:
There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment
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Knopman, David. "Clinical Aspects of Non-Alzheimer Disease Dementias." DeckerMed Medicine, March 11, 2017. http://dx.doi.org/10.2310/im.1336.
Full textAbstract:
There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment
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Knopman, David. "Clinical Aspects of Non-Alzheimer Disease Dementias." DeckerMed Psychiatry, March 11, 2017. http://dx.doi.org/10.2310/psych.1336.
Full textAbstract:
There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment
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Purnomo, Andrew M., Lidwina S. Sengkey, and Christina A. Damopolii. "Angka kejadian afasia pada stroke di Instalasi Rehabilitasi Medik RSUP Prof. Dr. R. D. Kandou Manado tahun 2015." e-CliniC 4, no. 2 (2016). http://dx.doi.org/10.35790/ecl.4.2.2016.14346.
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Abstract: Aphasia is a general term used to define a set of language disorder that occurs after brain damage commonly in the left hemisphere. The most underlying etiology of aphasia is cerebrovascular disease, stroke. Aphasia is present in 21-38% of patients with acute stroke and its impact is associated with short-term and long-term morbidity, high mortality rates, and limitations of the patients socialization. So as to raise awareness of disability caused by stroke, especially aphasia, it is necessary to know the incidence of aphasia in stroke patients in the Medical Rehabilitation Installation of Prof. Dr. R. D. Kandou Manado Hospital in 2015. This was retrospective descriptive study with a cross sectional design using data from medical records. Of the 455 stroke patients, 60 (13,2%) were aphasic. The youngest age of aphasic patients was 30 years old and the oldest one was 85 years old. The incidence of aphasia was more common in the age above 60 years (40%), non hemorrhagic stroke (60%), and in patients with right hemiparesis (78,3%). However, there were 6 (10%) aphasic patients with left hemiparesis. Conclusion: In the Medical Rehabilitation Installation of Prof. Dr. R. D. Kandou Manado Hospital in 2015, the incidence of aphasia was 13.2%. There was an increasing incidence of aphasia in each decade over the age of 30 years. No significant differences between the genders and types of stroke. Aphasia was also f ound in patients with left hemiparesis which signified the involvement of the right hemisphere.Keywords: aphasia, stroke, medical rehabilitation Abstrak: Afasia adalah istilah umum yang digunakan untuk mendefinisikan sekumpulan gangguan berbahasa yang terjadi setelah adanya kerusakan otak, yang sering mengenai hemisfer sebelah kiri. Etiologi yang paling banyak mendasari afasia ialah penyakit serebrovaskular, yaitu stroke. Afasia terdapat pada 21-38% pasien stroke akut dan dampaknya dikaitkan dengan morbiditas jangka pendek dan jangka panjang, tingginya angka mortalitas, dan keterbatasan pasien dalam sosialisasi. Penelitian ini bertujuan untuk mengetahui angka kejadian afasia pada stroke di Instalasi Rehabilitasi Medik RSUP Prof. Dr. R. D Kandou Manado tahun 2015. Jenis penelitian ialah deskriptif retrospektif dengan desain potong lintang menggunakan data dari rekam medik. Hasil penelitian memperlihatkan dari 455 pasien stroke, 60 (13,2%) diantaranya mengalami afasia. Usia paling muda pasien dengan afasia ialah 30 tahun dan usia paling tua ialah 85 tahun. Angka kejadian afasia lebih banyak terjadi pada usia di atas 60 tahun (40%), stroke non hemoragik (60%), dan pasien dengan hemiparesis dekstra (78,3%). Terdapat 6 (10%) pasien afasia dengan hemiparesis sinistra. Simpulan:Angka kejadian afasia pada tahun 2015 ialah 13,2%. Adanya peningkatan angka kejadian afasia pada tiap dekade usia di atas 30 tahun. Tidak ada perbedaan bermakna antara jenis kelamin dan jenis stroke. Pasien dengan hemiparesis sinistra juga mengalami afasia yang menandakan keterlibatan hemisfer dekstra. Kata kunci: afasia, stroke, rehabilitasi medik
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Nacional, K., R. Lorilla, and K. E. Bagaoisan. "P1263 Acute cerebrovascular infarct in a young adult with double septal defect and double outlet ventricle." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (2020). http://dx.doi.org/10.1093/ehjci/jez319.715.
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Abstract Introduction Double outlet right ventricle is a rare cause of acute cerebrovascular disease among young adults. Case. We report a case of a 21 year old male who presented with aphasia and left sided weakness. This was associated with cyanosis, easy fatigablity, recurrent epistaxis and loss of consciousness since childhood. On admission, patient’s vital sign was stable at 100/60, 90 bpm regular, 20 cycles per minute afebrile 80% oxygen saturation on room air. Patient is conscious, aphasic but follows simple commands. He had central cyanosis, clubbing of the upper and lower extremities, adynamic precordium, single s2, right ventricular heave, grade 3/6 systolic ejection murmur at the 2nd left intercoastal space parasternal line, 4/6 holosystolic murmur at the 4th intercoastal space parasternal line, and clear breath sounds. Neurologic examination revealed a 0/5 motor response on both left upper and lower extremity. Cranial MRI showed acute ischemic infarcts at the right frontal centrum semiovale and left cerebral hemisphere. During his admission, cardiac work up was done to investigate cardioembolic cause of the acute cerebrovascular disease. Transesophageal echocardiogram revealed congenital heart disease situs solitus with atrioventricular discordance; double outlet right ventricle, pulmonic valve stenosis, interatrial septal aneurysm with atrial septal defect and persistent left superior vena cava syndrome. During his hospital course, patient was started on aspirin, citicholine and atorvastatin for his cerebrovascular disease which was noted to improve after 2 days. Patient was also referred to the thoracovascular surgery team for comanagement who did modified Blalock Tausig shunting. Patient was referred to cardiac rehabilitation post procedure. His vital signs remained to be stable, his oxygen saturation increased to 90% at room air, and his functional capacity improved. Patient was discharged stable. Discussion Double outlet right ventricle is a rare complex congenital heart disease characterized by a conotruncal malseptation from which more than or equal to 50% of each great artery arises from the morphologic right ventricle. Associated defects like atrial septal defect and persistent left superior vena cava were reported in some literature. Cerebrovascular infarcts in complex cyanotic congenital heart disease might be secondary to polycythemia and/or paradoxical emboli bypassing the interatrial defect. Prompt prophylaxis such as periodic phlebotomy and/or anticoagulation in patients high risk for deep vein thrombosis must be evaluated for each patient.
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"Posters Sessions." Archives of Clinical Neuropsychology 35, no. 6 (2020): 773. http://dx.doi.org/10.1093/arclin/acaa069.02.
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Abstract Aging and Dementia: Alzheimer Aging and Dementia: Healthy Aging and Cognition Aging and Dementia: Other Development and Pediatric: Attention Deficit (Hyperactivity) Disorder Development and Pediatric: Learning Disability Developmental and Pediatric: Other Diversity Neurological and Neuropsychiatric Disorders: Cerebrovascular Disease Neurological and Neuropsychiatric Disorders: Other Neurological and Neuropsychiatric Disorders: Psychiatric Illness Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Neurological and Neuropsychiatric Disorders: Treatment and Rehabilitation Neuropsychological Domains: Attention Neuropsychological Domains: Executive Functions Neuropsychological Domains: Language and Aphasia Neuropsychological Domains: Memory and Amnesia Neuropsychological Domains: Other Professional Issues: Effort and Motivation Professional Issues: Ethics Professional Issues: Forensic Practice Professional Issues: Test Development and Methods
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"NEUROLOGICAL DISEASE AS COMPLICATIONS OF COVID-19: A LITERATURE REVIEW." Health and Society, 2021. http://dx.doi.org/10.51249/hes01.03.2021.351.
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Neurological complications are very relevant in the current pandemic scenario. The virus has the Spike protein, which binds to the Angiotensin-Converting Enzyme 2 receptor (ACE2), receptor present in the body, triggering the infection. This enzyme is present in abundance in the respiratory epithelium, which explains the predominance of respiratory symptoms; however it is still found in neurons and glial cells, making the Central Nervous System (CNS), a possible target of the pathogen. The objective is to highlight the main neurological complications resulting from infection by the coronavirus agent of acute respiratory syndrome (SARS-CoV-2). Thus, we conducted a literature search based on the descriptors “Covid 19”, “Neurological disease” and “Complications”, with publication period between 2020 and 2021 on the MEDLINE, PubMed, Latin American and Caribbean Literature in Science Sciences platforms (LILACS), UpToDate and World Health Organization. The most persistent neurological complications found were: aphasia, dysgeusia, cerebrovascular diseases and encephalopathies. The neurological manifestations arising from COVID-19 are a reality and very complex , so further studies are needed to further evaluation and analysis of the consequences caused by this virus infection.
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Sutagatti, Kavita B., Pradeep L. Grampurohit, Vinayak B. Angadi, and Ashwini Patil. "AYURVEDIC MANAGEMENT OF PAKSHAGHATA (CEREBROVASCULAR ACCIDENT) A CASE STUDY." INDIAN JOURNAL OF APPLIED RESEARCH, August 1, 2021, 55–56. http://dx.doi.org/10.36106/ijar/0613141.
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Stroke represents the third most common cause of death in developed nations and is one of the leading causes of death and disability in India. Stroke is dened as the rapid onset of focal neurological decit resulting from cerebral vasculature and its contents. This disease has posed a great problem to the medical eld as far as its treatment is concerned. There is a wealth of information available on the cause, prevention, risk, and treatment of stroke. Even then much, less is known about the treatment of the stroke, there is no any satisfactory and widely acceptable measure for the stroke. The present article deals with the diagnosed case of hemorrhagic stroke presenting with right sided hemiplegia, Right basal ganglia bleed with epsilateral minimal midline shift. The Ayurvedic diagnosis of vama pakshaghata and managed with Virechana Karma (Detoxication therapy), Manjishtadi khseera basti (Administration of a medicated colloidal solution through rectum), Pratimarsha Nasya (Instillation of medicated oil through nasal route). Assessment was made before and after the treatment using National Institute of Health Score Scale (NIH-SS). Maximum improvement was noticed in the symptoms of aphasia and dysarthria. There was also improvement in the left upper and lower extremity functions. At the end of the treatment patient could walk without support. Panchakarma play a pivotal role in the management of stroke/ Pakshaghata. The recuperation was assuring and worth documenting.
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Gegenava, M., T. Gegenava, and T. Huizinga. "P1473 Detection of cardiac sources of cerebrovascular events in patient with systemic lupus erythematosus with neuropsychiatric manifestations." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (2020). http://dx.doi.org/10.1093/ehjci/jez319.899.
Full textAbstract:
Abstract Introduction Systemic lupus erythematosus (SLE) is an idiopathic connective tissue disease, characterized with multiorgan involvement. Central nervous system (CNS) involvement is one of the most frequent manifestation of SLE and is termed as neuropsychiatric SLE (NPSLE) Prevalence of NPSLE varies between 12% and 95% among SLE patients. cerebrovascular accidents (CVA) and/or transient ischemic attack (TIA) represents one of the most frequent neuropsychiatric manifestation in SLE patients. Cerebral embolism may have cardioembolic source. Purpose: we described one case of SLE patient with NPSLE diagnosis and concomitant nonsignificant size of ASD II and tried to find its possible association with cerebrovascular accident. Method: We performed retrospective analysis of SLE (NPSLE) patient who had undergone echocardiographic and brain MRI evaluation. Case-Results: A 63 years old women was diagnosed with SLE in 1996 based on positive ANF, positive anti-cardiolipin IGg , arthritis, discoid lupus, positive coombs test and neurological manifestations (hemiplegia and aphasia). Echocardiographic evaluation showed pericarditis and nonsignificant ASD II (&lt;3mm). Ischemic changes were observed on Brain MRI study. Two years later in 1998 brain MRI showed a white matter defect (suspected vascular nature). Patient received 6 standard course of treatment with Cyclophosphamide ,Prednisone (from 60 mg gradually decreased to 10 mg) and oral anticoagulation drugs. After 9 years from the first diagnosis of SLE patient achieved complete remission, but soon in 2006 patient developed TIA and in 2013 developed lacunar infarct. Cardiac source of embolism was excluded according to performed analysis. In addition myocardial infarction was excluded based on Single-photon emission computed tomography (SPECT) perfusion scan. Since then patient remained under the observation of multidisciplinary team. Conclusion: We demonstrated one case of SLE patient with life threating neurological manifestations developed several times. Transthoracic echocardiographic examination showed small ASD II which was not considered as source of embolism, but we believe that in SLE patients with PFO/ASD, even though the size of defect is not large, cerebrovascular accidents may develop due to underlying inflammatory mechanism predisposing possible thromboembolism and early diagnosis, follow-up and management can be paramount to avoid future complications.
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Ikeda, Masaki, Sayaka Kodaira, Hiroo Kasahara, et al. "Cerebral Microbleeds, Cerebrospinal Fluid, and Neuroimaging Markers in Clinical Subtypes of Alzheimer's Disease." Frontiers in Neurology 12 (April 6, 2021). http://dx.doi.org/10.3389/fneur.2021.543866.
Full textAbstract:
Lobar cerebral microbleeds (CMBs) in Alzheimer's disease (AD) are associated with cerebral amyloid angiopathy (CAA) due to vascular amyloid beta (Aβ) deposits. However, the relationship between lobar CMBs and clinical subtypes of AD remains unknown. Here, we enrolled patients with early- and late-onset amnestic dominant AD, logopenic variant of primary progressive aphasia (lvPPA) and posterior cortical atrophy (PCA) who were compatible with the AD criteria. We then examined the levels of cerebrospinal fluid (CSF) biomarkers [Aβ1-42, Aβ1-40, Aβ1-38, phosphorylated tau 181 (P-Tau), total tau (T-Tau), neurofilament light chain (NFL), and chitinase 3-like 1 protein (YKL-40)], analyzed the number and localization of CMBs, and measured the cerebral blood flow (CBF) volume by 99mTc-ethyl cysteinate dimer single photon emission computerized tomography (99mTc ECD-SPECT), as well as the mean cortical standard uptake value ratio by 11C-labeled Pittsburgh Compound B-positron emission tomography (11C PiB-PET). Lobar CMBs in lvPPA were distributed in the temporal, frontal, and parietal lobes with the left side predominance, while the CBF volume in lvPPA significantly decreased in the left temporal area, where the number of lobar CMBs and the CBF volumes showed a significant inversely correlation. The CSF levels of NFL in lvPPA were significantly higher compared to the other AD subtypes and non-demented subjects. The numbers of lobar CMBs significantly increased the CSF levels of NFL in the total AD patients, additionally, among AD subtypes, the CSF levels of NFL in lvPPA predominantly were higher by increasing number of lobar CMBs. On the other hand, the CSF levels of Aβ1-38, Aβ1-40, Aβ1-42, P-Tau, and T-Tau were lower by increasing number of lobar CMBs in the total AD patients. These findings may suggest that aberrant brain hypoperfusion in lvPPA was derived from the brain atrophy due to neurodegeneration, and possibly may involve the aberrant microcirculation causing by lobar CMBs and cerebrovascular injuries, with the left side dominance, consequently leading to a clinical phenotype of logopenic variant.
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Dai, Yongqiang, Yi Zhong, Banghao Jian, et al. "Bridging Therapy for Acute Stroke as the Initial Manifestation of Takayasu Arteritis: A Case Report and Review of Literature." Frontiers in Immunology 12 (April 30, 2021). http://dx.doi.org/10.3389/fimmu.2021.630619.
Full textAbstract:
Takayasu arteritis (TA) is a chronic inflammatory disease involving the aorta and its principal branches. Acute ischaemic stroke (AIS) as the initial manifestation of TA is uncommon. There is little evidence on the efficacy of bridging therapy for AIS induced by TA. A 23-year-old Chinese woman with a suspected stroke presented to our hospital with sudden onset of right-sided weakness, right facial palsy, and aphasia that occurred 1 hour ago. After physical and ancillary examinations, recombinant tissue plasminogen activator was administered to the patient, which led to partial recovery. Her neurological function deteriorated with a large salvageable ischaemic penumbra on computed tomography perfusion. Cerebrovascular angiography showed multiple stenoses in the brachiocephalic trunk, the beginning of the right common carotid artery (CCA), and the bilateral subclavian arteries, as well as occlusion of the left CCA and its branches. Mechanical thrombectomy of the left middle cerebral artery was performed immediately. Percutaneous transluminal balloon angioplasty of the left CCA followed by stent implantation of the proximal left CCA was then performed. A diagnosis of TA was made based on the findings. The patient’s neurological deficit fully recovered with immunosuppressants at the 3 month-follow-up. We report a rare case of a patient with TA initially presenting with AIS treated with bridging therapy with full recovery of neurological function. Bridging therapy should be taken into consideration for AIS in patients with TA. Further study is needed in this regard.