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Peris-Subiza J, Vidal-Notari S, Cuadrado-Godia E, Ois A, Rodriguez-Campello A, Guisado-Alonso D. Teaching Video NeuroImage: The Digiti Quinti Sign as the Sole Objective Sign of Mild Hemiparesis. Neurology 2023; 101:e2340. [PMID: 37816649 PMCID: PMC10727213 DOI: 10.1212/wnl.0000000000207906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Affiliation(s)
- Julia Peris-Subiza
- From the Department of Neurology, Hospital del Mar Barcelona, Neurovascular Research Group, Hospital del Mar Research Institute Barcelona, Barcelona, Spain
| | - Sergio Vidal-Notari
- From the Department of Neurology, Hospital del Mar Barcelona, Neurovascular Research Group, Hospital del Mar Research Institute Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- From the Department of Neurology, Hospital del Mar Barcelona, Neurovascular Research Group, Hospital del Mar Research Institute Barcelona, Barcelona, Spain
| | - Angel Ois
- From the Department of Neurology, Hospital del Mar Barcelona, Neurovascular Research Group, Hospital del Mar Research Institute Barcelona, Barcelona, Spain
| | - Ana Rodriguez-Campello
- From the Department of Neurology, Hospital del Mar Barcelona, Neurovascular Research Group, Hospital del Mar Research Institute Barcelona, Barcelona, Spain
| | - Daniel Guisado-Alonso
- From the Department of Neurology, Hospital del Mar Barcelona, Neurovascular Research Group, Hospital del Mar Research Institute Barcelona, Barcelona, Spain.
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Ricciardi D, Lavorgna L, Cirillo G, Tedeschi G, Bonavita S. Unilateral polymicrogyria, hemispheric atrophy and spastic hemiparesis: rare etiologies for a common condition. Acta Neurol Belg 2021; 121:789-790. [PMID: 33151517 DOI: 10.1007/s13760-020-01537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dario Ricciardi
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy.
| | - Luigi Lavorgna
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy
| | - Giovanni Cirillo
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy.
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy.
| | - Gioacchino Tedeschi
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy
| | - Simona Bonavita
- I Division of Neurology and Neurophysiopathology, University of Campania "Luigi Vanvitelli", P.za Miraglia 2, 80138, Naples, Italy
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Tan YJ, Salkade P, Ho JXM, De Silva DA, Lo YL. Recurrent ipsilateral hemiparesis in a patient with both uncrossed corticospinal tracts and reorganization of cortical motor areas - An opportune visitation of the motor tracts. J Clin Neurosci 2021; 86:139-144. [PMID: 33775318 DOI: 10.1016/j.jocn.2021.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/06/2020] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
We report the case of a patient who experienced recurrent ipsilateral hemiparesis in the setting of predominantly-uncrossed corticospinal tracts, with concomitant neuronal reorganization of the cortical motor maps, and the presence of aberrant interhemispheric connections. Their presence was supported by our results from diffusion tensor imaging tractography, functional magnetic resonance imaging, and transcranial magnetic stimulation. To our knowledge, this has never been reported before, and provides valuable insights into the mechanisms behind post-stroke motor recovery.
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Affiliation(s)
- You-Jiang Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore.
| | - Parag Salkade
- Department of Radiology, Sengkang General Hospital, Singapore
| | | | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Yew-Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
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Steiner L, Homan S, Everts R, Federspiel A, Kamal S, Rodriguez JAD, Kornfeld S, Slavova N, Wiest R, Kaelin-Lang A, Steinlin M, Grunt S. Functional connectivity and upper limb function in patients after pediatric arterial ischemic stroke with contralateral corticospinal tract wiring. Sci Rep 2021; 11:5490. [PMID: 33750854 PMCID: PMC7943570 DOI: 10.1038/s41598-021-84671-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/17/2021] [Indexed: 12/29/2022] Open
Abstract
To develop individualized motor rehabilitation, knowledge of the relationship between neuroplastic reorganization and motor recovery after pediatric arterial ischemic stroke (AIS) is crucial. Thus, we investigated functional connectivity in patients after AIS with good motor outcome and in patients with hemiparesis compared with typically developing peers. We included 18 patients (n = 9 with hemiparesis, n = 9 with good motor outcome) with pediatric AIS in the chronic phase (≥ 2 years after diagnosis, diagnosed > 16 years) and 18 peers matched by age and gender. Participants underwent a standardized motor assessment, single-pulse transcranial magnetic stimulation to determine the type of corticospinal tract wiring, and resting-state functional magnetic resonance imaging to examine motor network connectivity. Corticospinal tract wiring was contralateral in all participants. Patients with hemiparesis had lower interhemispheric connectivity strength compared with patients with good clinical outcome and peers. Patients with good clinical outcome had higher intrahemispheric connectivity strength compared with peers. Further, higher intrahemispheric connectivity was related to better motor outcome in patients. Our findings suggest that better motor outcome after pediatric AIS is related to higher motor network connectivity strength. Thus, resting-state functional connectivity might be predictive for motor recovery after pediatric AIS.
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Affiliation(s)
- Leonie Steiner
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Freiburgstrasse 31, 3010, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Stephanie Homan
- Division of Systems Neuroscience, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Freiburgstrasse 31, 3010, Bern, Switzerland
| | - Andrea Federspiel
- Division of Systems Neuroscience, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
- Psychiatric Neuroimaging Unit, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Sandeep Kamal
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Freiburgstrasse 31, 3010, Bern, Switzerland
| | - Juan Antonio Delgado Rodriguez
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Freiburgstrasse 31, 3010, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Salome Kornfeld
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Freiburgstrasse 31, 3010, Bern, Switzerland
| | - Nedelina Slavova
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alain Kaelin-Lang
- Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Biomedical Neurosciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Freiburgstrasse 31, 3010, Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Freiburgstrasse 31, 3010, Bern, Switzerland
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5
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Kato D, Terae S. [Cervical Spinal Epidural Hematoma]. No Shinkei Geka 2021; 49:356-361. [PMID: 33762457 DOI: 10.11477/mf.1436204398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. She was suspected to have a spinal hematoma. A MRI scan revealed a spindle-shaped structure with a heterogeneous high signal on T2-weighted and a mild high signal on T1-weighted sagittal images, which led to the diagnosis of a spontaneous spinal epidural hematoma. The patient was treated with conservative therapy upon which her symptoms improved. She was discharged seven days after admission. Spontaneous cervical spinal epidural hematoma often causes neck pain followed by unilateral spinal cord compression symptoms(such as hemiparesis and paresthesia)and can be misdiagnosed as a stroke. In cases of hemiparesis with sudden-onset neck pain, cervical lesions should be considered in the differential diagnoses in addition to stroke.
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Affiliation(s)
- Daisuke Kato
- Department of Diagnostic Radiology, Sapporo City General Hospital
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Kosseifi CE, Seddiki K, Dumitriu D, Nassogne MC. Progressive hemiparesis reveals X-linked adrenoleukodystrophy in a 3.5-year-old boy. Acta Neurol Belg 2021; 121:261-263. [PMID: 32107715 DOI: 10.1007/s13760-020-01306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Charbel El Kosseifi
- Pediatric Neurology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10/1062, 1200, Brussels, Belgium
| | - Karima Seddiki
- MRI Unit, Radiology Department, Hôpital Central de L'Armée, Alger, Algeria
| | - Dana Dumitriu
- Pediatric Radiology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Cécile Nassogne
- Pediatric Neurology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10/1062, 1200, Brussels, Belgium.
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Zhu G, Zhang X, Tang X, Chen X, Gao XP. Examining and monitoring paretic muscle changes during stroke rehabilitation using surface electromyography: A pilot study. Math Biosci Eng 2019; 17:216-234. [PMID: 31731348 DOI: 10.3934/mbe.2020012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Complex neuromuscular changes have been reported to occur in paretic muscles following stroke, but whether and how they can recover under rehabilitation therapy remain unclear. A tracking analysis protocol needs to be designed involving multiple sessions of surface electromyography (sEMG) examinations during the rehabilitation procedure. Following such a protocol, this pilot study is aimed to monitor paretic muscle changes using three sEMG indicators namely clustering index (CI), root mean square (RMS) and medium frequency (MDF). Initially, a single sEMG examination was performed on the abductor pollicis brevis (APB) muscle on both sides of 23 subjects with stroke and one side of 18 healthy control subjects. With these data to establish CI diagnostic criterion, the paretic muscles of all subjects with stroke showed a very board CI distribution pattern from abnormally low values through normality to abnormally high values. Afterwards, 9 out of 23 subjects with stroke had their paretic muscles examined at least twice before and after the treatment. Almost all paretic muscles had an increase of the RMS, a change of the MDF approaching to the value of the contralateral muscle, and a change of the CI returning to its normal range after common rehabilitation treatments. Finally, 4 of the 9 subjects with stroke participated into repeated examinations of their paretic muscles. The combined use of three indicators helped to reveal specific neuromuscular processes contributing to recovery of paretic muscles, due to their complementary diagnostic powers. Furthermore, neuromuscular processes were found to vary across subjects in type, order and timing during rehabilitation. In conclusion, given the 4 cases following the tracking analysis protocol, this pilot study preliminarily demonstrates usability of three sEMG indicators as tools for examining and monitoring stroke rehabilitation procedure in terms of improvements of paretic muscle changes. All the revealed complex neuromuscular processes imply the necessity of applying sEMG examinations in monitoring rehabilitation procedure, with the potential of offering important guidelines for designing better and individualized protocols toward improved stroke rehabilitation.
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Affiliation(s)
- Ge Zhu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Xu Zhang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Xiao Tang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Xiang Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Xiao Ping Gao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
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Frenkel-Toledo S, Fridberg G, Ofir S, Bartur G, Lowenthal-Raz J, Granot O, Handelzalts S, Soroker N. Lesion location impact on functional recovery of the hemiparetic upper limb. PLoS One 2019; 14:e0219738. [PMID: 31323056 PMCID: PMC6641167 DOI: 10.1371/journal.pone.0219738] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/02/2019] [Indexed: 11/18/2022] Open
Abstract
The effect of stroke topography on the recovery of hemiparetic upper limb (HUL) function is unclear due to limitations in previous studies-examination of lesion effects only in one point of time, or grouping together patients with left and right hemispheric damage (LHD, RHD), or disregard to different lesion impact on proximal and distal operations. Here we used voxel-based lesion symptom mapping (VLSM) to investigate the impact of stroke topography on HUL function taking into consideration the effects of (a) assessment time (subacute, chronic phases), (b) side of damaged hemisphere (left, right), (c) HUL part (proximal, distal). HUL function was examined in 3 groups of patients-Subacute (n = 130), Chronic (n = 66), and Delta (n = 49; patients examined both in the subacute and chronic phases)-using the proximal and distal sub-divisions of the Fugl-Meyer (FM) and the Box and Blocks (B&B) tests. HUL function following LHD tended to be affected in the subacute phase mainly by damage to white matter tracts, the putamen and the insula. In the chronic phase, a similar pattern was shown for B&B performance, whereas FM performance was affected by damage only to the white matter tracts. HUL function following RHD was affected in both phases, mainly by damage to the basal ganglia, white matter tracts and the insula, along with a restricted effect of damage to other cortical structures. In the chronic phase HUL function following RHD was affected also by damage to the thalamus. In the small Delta groups the following trends were found: In LHD patients, delayed motor recovery, captured by the B&B test, was affected by damage to the sensory-motor cortex, white matter association fibers and parts of the perisilvian cortex. In the RHD patients of the Delta group, delayed motor recovery was affected by damage to white matter projection fibers. Proximal and distal HUL functions examined in LHD patients (both in the subacute and chronic phases) tended to be affected by similar structures-mainly white matter projection tracts. In RHD patients, a distinction between proximal and distal HUL functions was found in the subacute but not in the chronic phase, with proximal and distal HUL functions affected by similar subcortical and cortical structures, except for an additional impact of damage to the superior temporal cortex and the retro-lenticular internal capsule only on proximal HUL function. The current study suggests the existence of important differences between the functional neuroanatomy underlying motor recovery following left and right hemisphere damage. A trend for different lesion effects was shown for residual proximal and distal HUL motor control. The study corroborates earlier findings showing an effect of the time after stroke onset (subacute, chronic) on the results of VLSM analyses. Further studies with larger sample size are required for the validation of these results.
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Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel
| | - Gil Fridberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Ofir
- Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gadi Bartur
- Department of Physical Therapy, Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Justine Lowenthal-Raz
- Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Granot
- Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirley Handelzalts
- Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel
- Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Akazawa N, Harada K, Okawa N, Tamura K, Moriyama H. Low body mass index negatively affects muscle mass and intramuscular fat of chronic stroke survivors. PLoS One 2019; 14:e0211145. [PMID: 30657790 PMCID: PMC6338377 DOI: 10.1371/journal.pone.0211145] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/08/2019] [Indexed: 01/16/2023] Open
Abstract
Objective Relationship between secondary changes in skeletal muscle and body weight in chronic stroke survivors has not yet been carefully examined. The objective of this study was to clarify the relationships between muscle mass, intramuscular fat, and body weight in chronic stroke survivors. Methods Seventy-two chronic stroke survivors participated in this study. Transverse ultrasound images were acquired using B-mode ultrasound imaging. Quadriceps muscle mass and intramuscular fat were assessed based on muscle thickness and echo intensity, respectively. We used a stepwise multiple regression analysis to identify the factors that were independently associated with the body mass index. We entered quadriceps thickness and echo intensity of the paretic and non-paretic sides into another stepwise multiple regression model to avoid multicollinearity. Age, sex, type of stroke, time since stroke, thigh length, number of medications, and an updated Charlson comorbidity index were included as the independent variables. Results The quadriceps thickness and echo intensity of the paretic and non-paretic sides were significantly independently associated with the body mass index: quadriceps thickness of the paretic side, β = 0.52; quadriceps thickness of the non-paretic side, β = 0.55; quadriceps echo intensity of the paretic side, β = −0.35; quadriceps echo intensity of the non-paretic side, β = −0.27). Conclusions Our results suggest that low body mass index is associated with loss of muscle mass and increased intramuscular fat on both the paretic and non-paretic sides of chronic stroke survivors. Further studies examining whether appropriate weight management, along with targeted rehabilitation programs aimed at increasing muscle mass and decreasing intramuscular fat, achieves good outcomes in chronic stroke survivors are warranted.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
- * E-mail:
| | - Kazuhiro Harada
- Department of Physical Therapy, Faculty of Health, Medical Care, and Welfare, Kibi International University, Takahashi, Okayama, Japan
| | - Naomi Okawa
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Abstract
RATIONALE Recent studies have used diffusion tensor tractography (DTT) to demonstrate that central poststroke pain (CPSP) was related to spinothalamic tract (STT) injury in patients with stroke. However, few studies have been reported about delayed-onset CPSP due to degeneration of the STT following a stroke. PATIENT'S CONCERNS A 57-year-old female patient presented with right hemiparesis after stroke. Two weeks after onset, she did not report any pain. At approximately 6 months after onset, she reported pain in the right arm and leg, and the pain slowly intensified with the passage of time. At 14 months after onset, the characteristics and severity of her pain were assessed to be continuous pain without allodynia or hyperalgesia; tingling and cold-sensational pain in her right whole arm and leg (visual analog scale score: 5). DIAGNOSES The patient was diagnosed as the right hemiparesis due to spontaneous thalamic hemorrhage. INTERVENTIONS Clinical assessment and diffusion tensor imaging (DTI) were performed 2 weeks and 14 months after onset. OUTCOMES She suffered continuous pain in her right whole arm and leg (visual analog scale score: 5). On DTT of the 2-week postonset DTI scans, the configuration of the STT was well-preserved in both hemispheres. However, in contrast to those 2-week postonset results, the 14-month postonset DTT results showed partial tearing and thinning in the left STT. Regardless, both the 2-week and 14-month postonset DTT showed that the left STT passed through the vicinity of the thalamic lesion. LESSONS Diagnostic importance of performing a DTT-based evaluation of the STT in patients exhibiting delayed-onset CPSP following intracerebral hemorrhage.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation
| | - JongHoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation
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Calvo-Lobo C, Useros-Olmo AI, Almazán-Polo J, Martín-Sevilla M, Romero-Morales C, Sanz-Corbalán I, Rodríguez-Sanz D, López-López D. Quantitative Ultrasound Imaging Pixel Analysis of the Intrinsic Plantar Muscle Tissue between Hemiparesis and Contralateral Feet in Post-Stroke Patients. Int J Environ Res Public Health 2018; 15:ijerph15112519. [PMID: 30423860 PMCID: PMC6265729 DOI: 10.3390/ijerph15112519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022]
Abstract
Quantitative ultrasound imaging of the muscle tissue may be applied in the neurology field, due to B-mode grayscale pixels values could be used as potential biomarkers for disease progression and intervention effects in poststroke patients. Thus, the study aim was to compare and analyze the ultrasound imaging B-mode pixels differences between the intrinsic plantar muscles cross-sectional area (CSA) in hemiparetic and contralateral feet from poststroke patients by means of the Image J software. A case-control design and a convenience sampling method were used in order to recruit 22 feet from 11 poststroke patients. This total sample was divided into 11 hemiparetic feet and 11 contralateral feet. The Image J software was used in order to evaluate the interface distance, CSA as well as measure the pixels mean, standard deviation (SD) and count from all offline images in the flexor digitorum brevis, abductor hallucis (AbH), and flexor hallucis brevis muscles. Statistically significant differences (p = 0.003) were only shown for the pixels count in the AbH muscle. The rest of outcome measurements did not show any statistically significant difference (p > 0.05). Therefore, B-mode ultrasound imaging Image J software differences for the pixels count reduction were shown in the AbH muscle between hemiparetic and contralateral feet from poststroke patients. Further studies are necessary in order to apply our findings as potential biomarkers during the stroke disease course.
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Affiliation(s)
- Cesar Calvo-Lobo
- Nursing and Physical Therapy Department, Faculty of Health Sciences, Universidad de León, 24401 Ponferrada, Spain.
| | - Ana Isabel Useros-Olmo
- Departamento de Fisioterapia, Centro superior de estudios Universitarios La Salle, Motion in Brains Research Group, Universidad Autónoma de Madrid, 28023 Madrid, Spain.
- Unidad de Daño Cerebral, Hospital Beata Maria Ana, 28007 Madrid, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | | | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Irene Sanz-Corbalán
- School of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, 28040 Madrid, Spain.
| | - David Rodríguez-Sanz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
- School of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, 28040 Madrid, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
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Liu Y, Wu BY, Ma ZS, Xu JJ, Yang B, Li H, Duan RS. A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics. BMC Neurol 2018; 18:121. [PMID: 30131076 PMCID: PMC6102897 DOI: 10.1186/s12883-018-1130-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Segmental zoster paresis (SZP) of limbs, characterized by focal weakness of extremity, is recognized as a rare complication of herpes zoster (HZ). The following study analyzes the clinical characteristics and data from electromyography and MRI scans in patients with motor weakness after zoster infection. METHODS One thousand three hundred ninety-three patients from our database (Shandong Provincial Qianfoshan Hospital) suffering from HZ were retrospectively reviewed from June 2015 to July 2017. Patients who fulfilled the diagnostic criteria for SZP were included in the analysis. The clinical characteristics, as well as electromyography findings and MRI scans were analyzed. RESULTS SZP was present in 0.57% of patients with HZ (8/1393). The average age of symptom onset in 8 SZP patients was 69 years old (SD: 13, range 47-87). The severity of muscle weakness ranged from mild to severe. The electrophysiological testing revealed the characteristics of axonopathy. Radiculopathy (2/8), plexopathy (2/8), radiculoplexopathy (3/8) and combined radiculopathy and mononeuropathy (1/8) were also identified. MRI revealed hyperintensity of the affected spinal dorsal horns, nerve roots or peripheral nerves. CONCLUSIONS SZP is associated with obvious limb weakness, nerve axons lesions and localization to nerve roots, plexus or peripheral nerves.
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Affiliation(s)
- Ying Liu
- Department of Electromyography, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Bing-Yun Wu
- Department of Electromyography, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Zhen-Shen Ma
- Department of radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Juan-Juan Xu
- Department of Electromyography, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Bing Yang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Heng Li
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Rui-Sheng Duan
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
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Akazawa N, Harada K, Okawa N, Tamura K, Moriyama H. Muscle mass and intramuscular fat of the quadriceps are related to muscle strength in non-ambulatory chronic stroke survivors: A cross-sectional study. PLoS One 2018; 13:e0201789. [PMID: 30071100 PMCID: PMC6072321 DOI: 10.1371/journal.pone.0201789] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Improving muscle mass and intramuscular fat in the mid-thigh increases the muscle strength of the paretic and non-paretic limbs in ambulatory chronic stroke survivors. There is a remarkable decrease in muscle mass and muscle strength and an increase in intramuscular fat in the quadriceps of both limbs of non-ambulatory compared with ambulatory survivors. Therefore, given that paretic lower extremity function does not recover sufficiently in the chronic phase, it may be helpful to improve muscle mass and intramuscular fat to increase muscle strength in the quadriceps of non-ambulatory chronic stroke survivors. However, these relationships remain unclear. The purpose of this study was to clarify the relationships between muscle strength, muscle mass, and intramuscular fat of the quadriceps in non-ambulatory chronic stroke survivors. Methods Study design: A cross-sectional study. Participants: Fifty non-ambulatory chronic stroke survivors. Main outcome measures: Quadriceps muscle strength was measured using a handheld dynamometer. Transverse ultrasound images were acquired using B-mode ultrasound imaging. Muscle mass and intramuscular fat of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. Data analysis: Stepwise multiple regression analyses were used to identify the factors independently associated with the quadriceps muscle strength of the paretic and non-paretic limbs. To avoid multicollinearity, muscle thickness and echo intensity were entered into separate multiple regression models. Muscle thickness or echo intensity of the paretic or non-paretic limbs and other confounding factors were set as the independent variables. Results Muscle thickness was positively related and echo intensity was negatively related to the quadriceps muscle strength of the paretic and non-paretic limbs. Conclusions Muscle mass and intramuscular fat of the quadriceps are related to muscle strength in non-ambulatory chronic stroke survivors. Increasing muscle mass and decreasing intramuscular fat of the quadriceps of both limbs may improve muscle strength.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
- * E-mail:
| | - Kazuhiro Harada
- Department of Physical Therapy, Faculty of Health, Medical care, and Welfare, Kibi International University, Takahashi, Okayama, Japan
| | - Naomi Okawa
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Hou YR, Chiu YL, Chiang SL, Chen HY, Sung WH. Feasibility of a smartphone-based balance assessment system for subjects with chronic stroke. Comput Methods Programs Biomed 2018; 161:191-195. [PMID: 29852961 DOI: 10.1016/j.cmpb.2018.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Stroke is a cerebral artery disease that may lead to long-term disabilities or death. Patients that survive a stroke usually suffer balance impairments, which affect their performance in activities of daily living (ADLs) and quality of life (QoL). In recent years, smartphones have become very popular and have many capabilities. Smartphone built-in sensors have shown their ability and potential in balance performance assessment. However, the feasibility of smartphones on subjects with chronic strokes remains to be proved. Therefore, the purpose of this study is to evaluate the feasibility of a smartphone-based balance assessment system for subjects with chronic stroke. METHODS Ten subjects with chronic stroke and thirteen healthy adults were recruited in the study. The smartphone HTC 10 (HTC Corporation, Taiwan) was used to perform the balance assessment, and its built-in accelerometer and gyroscope were used to record data from the subjects. Six postures were tested for thirty seconds each: shoulder-width stance (SWS) with eyes opened (E/O) and eyes closed (E/C), feet-together stance (FTS) with E/O and E/C, and semi-tandem stance (STS) with E/O and E/C. The smartphone was fixed to the back of subjects at the second sacral spine (S2) level. The changes registered in the accelerometer and gyroscope data were used to represent the balance performance, in which higher values indicate more instability. Data was analyzed using the independent t-test with the software SPSS 20, and the statistical significance level was set to α < 0.05. RESULTS AND DISCUSSION Significant difference in the acceleration data was found among subjects with chronic stroke and healthy adults under four assessment postures: SWS with E/C (p = 0.048), FTS with E/O (p = 0.027), FTS with E/C (p = 0.000), and STS with E/C (p = 0.048). Furthermore, according to the gyroscope data, there were significant differences in how the two groups performed the postures. The results demonstrate that a smartphone with a built-in accelerometer and gyroscope can be used to classify balance performances between healthy adults and subjects with chronic stroke. CONCLUSION This study shows that smartphones are feasible to assess balance for subjects with chronic stroke.
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Affiliation(s)
- You-Ruei Hou
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Lan Chiu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Lin Chiang
- Tri-Service Hospital, Taipei, Taiwan; National Defense Medical Center, Taipei, Taiwan
| | - Hui-Ya Chen
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
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15
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Martirosyan M, Caliskan K, Kik C, Szili-Torok T. Left Diaphragmatic Hemiparesis: An Unexpected Complication of Transvenous Lead Extraction. JACC Clin Electrophysiol 2018; 3:1197-1199. [PMID: 29759507 DOI: 10.1016/j.jacep.2017.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Mihran Martirosyan
- Department of Clinical Electrophysiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Heart Failure/Heart Transplantation, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Clinical Electrophysiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.
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Goto H, Tanaka T, Suetsugi N, Kubotsu Y, Momozaki N, Mizuta T. [Non-cirrhotic Portal-systemic Encephalopathy with Total Aphasia and Right Hemiplegia Following Transient Right Hemiparesis: A Case Report]. Brain Nerve 2018; 70:155-159. [PMID: 29433117 DOI: 10.11477/mf.1416200968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 77-year-old right-handed woman without any liver diseases was admitted to our hospital because of transient right hemiparesis. She developed total aphasia with right hemiplegia on the third hospital day. We suspected that she had a cerebral infarction following a transient ischemic attack. However, brain diffusion-weighted images revealed no abnormal-intensity lesions, and cerebral angiography showed patent arteries. Additionally, her serum ammonia level was elevated. Theta waves without triphasic waves were detected by electroencephalogram. T1-weighted magnetic resonance brain images revealed high-intensity signals in the bilateral globus pallidus. Enhanced abdominal computed tomography showed a portal-systemic shunt from the splenic and inferior mesenteric veins into the left renal vein via the left ovarian vein. The administration of branched-chain amino acids and lactulose improved her clinical symptoms. We confirmed the diagnosis of non-cirrhotic portal-systemic encephalopathy (NCPSE), therefore balloon-occluded retrograde transvenous obliteration of the shunt vessel was performed. The recognition of NCPSE on the examination of a suspected stroke patient is important, as patients with NCPSE can present as stroke mimics. (Received June 26, 2017; Accepted August 22, 2017; Published February 1, 2018).
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Affiliation(s)
- Hirofumi Goto
- Department of Neurology, Imari Arita Kyoritsu Hospital
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Abstract
RATIONALE Although several studies have described the involvement pattern of myotonic dystrophy type 1 (DM1) using muscle MRI, most of these studies have limitations as cross-sectional studies. To the best of our knowledge, there have been no reports of longitudinal studies describing muscle involvement patterns in patients with DM1 via serial MRI. PATIENT CONCERNS Progressive weakness of both lower extremities. DIAGNOSIS Two patients with DM1. INTERVENTION The serial muscle MRI performed in the 2 patients with DM1. OUTCOMES The serial muscle MRI showed early involvement of proximal (tensor fascia latae) and truncal muscles (spine extensor muscles), and these longitudinal imaging may be helpful to reveal the pattern of muscle involvement in patients with DM1. LESSONS Since most previous studies on muscle involvement patterns in DM1 patients were cross-sectional studies, this case series of studying muscle involvement patterns through serial MRI in patients with DM1 may have significant clinical significance.
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Affiliation(s)
- Jin-Sung Park
- Department of Neurology, Kyungpook National University, School of Medicine
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
- Department of Phamacology, Kyungpook National University School of Medicine, Daegu, South Korea
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18
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Cikla U, Mukherjee D, Tumturk A, Baskaya MK. Overcoming End-to-End Vessel Mismatch During Superficial Temporal Artery-Radial Artery-M2 Interposition Grafting for Cerebral Ischemia: Tapering Technique. World Neurosurg 2017; 110:85. [PMID: 29122732 DOI: 10.1016/j.wneu.2017.10.162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/19/2022]
Abstract
Cerebral revascularization procedures, such as the external carotid-internal carotid bypass, have been used in the clinical management of cerebral ischemic states. Among the most commonly performed bypasses is the superficial temporal artery-middle cerebral artery (STA-MCA) bypass to restore cerebral blood flow. In cases of a foreshortened STA donor vessel, a radial artery (RA) graft is often used as an interposition graft between the STA and MCA. However, addressing the vessel size mismatch between the radial artery and donor can be problematic and challenging. We present the case of an 80-year-old male presenting with positional-onset expressive aphasia and right-sided hemiparesis. Computed tomography perfusion demonstrated a diffusion-perfusion mismatch in a left MCA distribution. Angiography showed a complete left internal cerebral artery occlusion and poor distal filling of the STA. We performed an external carotid artery-to-internal carotid artery bypass through interposing an RA graft to the STA proximally with an end-to-end anastomosis and to the MCA distally using an end-to-side anastomosis. The mismatch between 2 bypass vessel sizes was corrected by removing a small piece from the RA graft at 1 margin and suturing it to itself to reduce the size of the RA vessel diameter opening on the side used to sew to the STA. The patient did well clinically with improved right-sided strength, a patent graft, and no postoperative complications. Addressing vessel mismatch when using RA interposition grafts for bypass is challenging. Various operative approaches to address mismatch should be individualized on the basis of the particular vascular anatomy and needs of the case. Nevertheless, our method of cutting and suturing 1 side of the RA graft into a semiblind end to match donor vessel diameter may be of use to cerebrovascular surgeons in select cases.
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Affiliation(s)
- Ulas Cikla
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Debraj Mukherjee
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Abdulfettah Tumturk
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA.
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19
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Affiliation(s)
- Julia Myers
- Frenchay Brain Injury Rehabilitation Centre, Frenchay Park Road, Bristol, UK
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20
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Juković M, Petrović K, Till V. The question is whether hemiparesis is more common in unilateral than bilateral chronic subdural hematoma. Med Pregl 2014; 67:277-281. [PMID: 25546973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Chronic subdural hematoma is an intracranial hemorrhagic lesion that illustrates various expressions in clinical and radiological practice. The aim of this study was to emphasize the correlation between the brain site of chronic subdural hematoma and clinical symptoms/signs of disease. Furthermore, the study denotes the significance of hemiparesis occurrence in the patients with unilateral chronic subdural hematomas more than in those with bilateral ones, associated with time required to diagnose hematoma. MATERIAL AND METHODS A three-year study included 72 patients with chronic subdural hematoma. According to their clinical and neurological symptoms on hospital admission, all patients underwent non-contrast brain computed tomography scan, which confirmed the diagnosis. The radiological parameters, including the site of chronic subdural hematoma, a hematoma width and midline shift were recorded to give precise data about the correlation with neurological symptoms. A special focus was put on the lag time between the onset of symptoms and signs to diagnosis of chronic subdural hematoma. RESULTS The study proved that the patients with unilateral chronic subdural hematoma had more frequent occurrence of hemiparesis than the patients with bilateral chronic subdural hematoma. It took the left-sided chronic subdural hematomas less time (about 200 hours earlier) than the right-sided ones to present its symptoms although the average hematoma diameter value was almost the same. CONCLUSION The site and the form of intracranial lesion-chronic subdural hematoma could have a great influence on neurological and functional condition in a patient. Although the length of time required for making diagnosis as well as clinical symptoms greatly differ and the latter are not always so clear, physicians should maintain a high level of suspicion for this disease and thus contribute to prompt diagnosis and better clinical outcome of patients.
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Tiftik T, Kara M, Ozcan HN, Türkkan C, Ural FG, Ekiz T, Akkuş S, Ozçakar L. Doppler ultrasonographic evaluation of the radial and ulnar arteries in hemiparetic patients after stroke. J Clin Ultrasound 2014; 42:277-282. [PMID: 24436201 DOI: 10.1002/jcu.22127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND To evaluate blood flow of hand arteries (using Doppler ultrasonography) and sympathetic skin response (SSR) in patients with hemiparesis. METHODS Fifty-six stroke patients (30 M, 26 F) with unilateral hemiparesis (age 53.5 ± 10.8 years, mean disease duration 12.0 ± 19.1 months) were included. The patients' arm and hand motor functions were assessed according to Brunnstrom's stages. SSR was evaluated bilaterally from median nerves at the wrist level. Radial and ulnar artery blood flow was measured at the wrist in the neutral position. RESULTS Both radial and ulnar artery volume flow and end diastolic velocity, and radial artery diameter were smaller on the paretic side (all p < 0.0125). Radial artery resistance and pulsatility index were greater on the paretic side (both p < 0.0125). SSR amplitude was lower on the paretic side of patients with right-sided hemiparesis patients (p = 0.009). Hand Brunnstrom's stage was negatively correlated with nonparetic-paretic difference in radial artery volume flow and SSR amplitudes (all p < 0.025). CONCLUSIONS Hand blood flow was lower on the paretic side and was accompanied by a similar decrease in SSR amplitudes in patients with right-sided hemiparesis.
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Affiliation(s)
- Tülay Tiftik
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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22
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Talla R, Galea M, Lythgo N, Angeli T, Eser P. Contralateral comparison of bone geometry, BMD and muscle function in the lower leg and forearm after stroke. J Musculoskelet Neuronal Interact 2011; 11:306-313. [PMID: 22130139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the side-to-side differences of the upper and lower limbs in chronic stroke patients by means of peripheral quantitative computed tomography (pQCT). METHODS Twenty-three subjects (12 males and 11 females) who had previously suffered a stroke were recruited. Bone parameters and muscle cross-sectional areas were measured by pQCT in the forearm and the lower leg on the paretic and non-paretic side. Muscle function tests included hand grip dynamometry and sit-to-stand on force plates. RESULTS Relative side-to-side differences in bone parameters at the radius were twice to three times the relative differences at the tibia. At the forearm the muscle-bone relationship was stronger on the non-paretic than the paretic side, while at the lower leg the muscle-bone relationship was similar on both sides. CONCLUSIONS Side-to-side differences in bone parameters were much smaller than differences between individuals, and bone mass deficits on the paretic side were greater at the radius than at the tibia. Therapies to restore muscle force and function, which may also help to decrease the risk of falls, are recommended.
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Affiliation(s)
- R Talla
- Rehabilitation Sciences Research Centre, The University of Melbourne, Parkville, Victoria, Australia.
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Abstract
This report concerns a 41-year-old female patient with a huge meningioma which was preoperatively embolized with polyvinyl alcohol particles (PVA, 100-300 μm) via the left middle meningeal artery. Dangerous vascular anastomoses were not previously recognized in a superselective angiography. Aphasia and hemiparesis on the right side occurred immediately after the embolization. A cerebral infarct was seen in the region of the left pericallosal artery. The patient applied to the fact-finding board for medical liability and a neuroradiologic opinion was requested. The board came to the conclusion that no incorrect medical treatment had been carried out.
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Affiliation(s)
- H Becker
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Wilseder Weg 25, 30625 Hannover, Deutschland.
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Alpsan MH, Bebek N, Ciftci FD, Coban O, Bahar S, Tuncay R. Intracerebral hemorrhage associated with sildenafil use: a case report. J Neurol 2008; 255:932-3. [PMID: 18465112 DOI: 10.1007/s00415-008-0618-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 03/15/2007] [Accepted: 03/21/2007] [Indexed: 11/29/2022]
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Lim ECH, Pek CH, Seet RCS. Images in neuroscience. Slowly progressive hemiparesis. J Clin Neurosci 2007; 14:966-7, 1007-8. [PMID: 17977097 DOI: 10.1016/j.jocn.2006.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Erle C H Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Cánovas D, Perendreu J, Rovira A, Estela J. [Extravasation of contrast medium after carotid stent with brain infarction symptoms]. Neurologia 2007; 22:187-90. [PMID: 17364259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Angioplasty, with or without stent placement, as a carotid revascularisation technique, has become an alternative treatment for carotid stenosis, it being considered under certain circumstances the treatment of choice. The main concern about this technique is the distal embolisation during the procedure, while other, less frequent, complícations have also been described such as dissection, vasospasm or even arterial rupture. Some of the infrequent complications include the hyperperfusion syndrome, and, more exceptionally, cases of extravasation of the contrast medium. We present the case of a patient who was subjected to angioplasty and stent insertion due to carotid stenosis with signs of calcification who suffered a stroke-like disorder in her right medial brain artery as a consequence of the extravasation of contrast medium after the rupture of the angioplasty balloon, a situation which has never been described in the literature before.
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Affiliation(s)
- D Cánovas
- Servicio de Neurología, Hospital Parc Tauli, Sabadell (Barcelona), Spain.
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Cornish PB, Leaper CJ, Nelson G, Anstis F, McQuillan C, Stienstra R. Avoidance of phrenic nerve paresis during continuous supraclavicular regional anaesthesia*. Anaesthesia 2007; 62:354-8. [PMID: 17381571 DOI: 10.1111/j.1365-2044.2007.04988.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study sought to determine whether it is possible reliably to avoid phrenic nerve block using the bent needle technique for continuous supraclavicular brachial plexus anaesthesia. In a prospective study, 100 patients undergoing a variety of upper extremity surgical procedures were studied. Ultrasound examinations of the patients' diaphragms were performed after insertion of an anaesthetic block, and were repeated a day later with the analgesic block working. Three phrenic nerve blocks were detected in different patients. Factors were identified in all three cases that we think contributed to the phrenic nerve blocks. We think it is possible to provide continuous supraclavicular regional anaesthesia and analgesia for a wide range of upper extremity operations without phrenic nerve blockade.
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Vieira Santos A, Saraiva P. Spontaneous isolated non-haemorrhagic thrombosis in a child with development venous anomaly: case report and review of the literature. Childs Nerv Syst 2006; 22:1631-3. [PMID: 17072663 DOI: 10.1007/s00381-006-0159-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 11/03/2005] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The natural history of developmental venous anomalies (DVAs) is said to be relatively benign. CASE REPORT We herein report the clinical case of a 9-year-old female child with sudden right hemiparesis. An ischaemic infarct secondary to an isolated spontaneous thrombosis of a DVA was diagnosed by brain magnetic resonance imaging, further confirmed by digital subtraction angiography. CONCLUSION Considering the therapeutic options, early diagnosis is mandatory.
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Affiliation(s)
- A Vieira Santos
- Neuroradiology Department, Garcia de Orta Hospital, Almada, Portugal.
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Wu YW, Lindan CE, Henning LH, Yoshida CK, Fullerton HJ, Ferriero DM, Barkovich AJ, Croen LA. Neuroimaging abnormalities in infants with congenital hemiparesis. Pediatr Neurol 2006; 35:191-6. [PMID: 16939859 DOI: 10.1016/j.pediatrneurol.2006.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 03/07/2006] [Accepted: 03/07/2006] [Indexed: 11/15/2022]
Abstract
Clinical and neuroimaging characteristics of congenital hemiparesis were examined in a retrospective cohort study nested within 199,176 births within the Kaiser Permanente Medical Care Program, 1997-2002. Infants with a physician diagnosis of paresis or cerebral palsy were electronically identified, and charts were reviewed to confirm congenital hemiparesis. A neuroradiologist reviewed available head MRI and CT scans. Of 96 infants with congenital hemiparesis (population prevalence 4.8 per 10,000), 81% received either a head magnetic resonance imaging (n = 55) or head computed tomography only (n = 23). Perinatal arterial infarction was the most common (30%) neuroimaging finding in term infants. Infants with right-sided hemiparesis (relative risk 4.6, 95% confidence interval 1.4-14.4) or moderate to severe weakness (relative risk 4.4, 95% confidence interval 1.1-17.7) were more likely to have had a perinatal arterial infarction. Periventricular white matter lesions predominated in preterm infants (71%). Brain malformations observed in 14 (18%) patients included polymicrogyria, heterotopia, and schizencephaly. The 14 infants (18%) with a normal head imaging study were more likely to outgrow all signs of hemiparesis by age 3 than were infants with an abnormal brain image (29% vs 0%, P < 0.001). Neuroimaging studies provide useful diagnostic and prognostic information in infants with congenital hemiparesis.
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Affiliation(s)
- Yvonne W Wu
- Department of Neurology, University of California, San Francisco, California 94143-0137, USA.
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30
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De Silva DA, Pey HB, Wong MC, Chang HM, Chen CPLH. Deep vein thrombosis following ischemic stroke among Asians. Cerebrovasc Dis 2006; 22:245-50. [PMID: 16788297 DOI: 10.1159/000094011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 03/02/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep vein thrombosis (DVT) is perceived as uncommon among Asian stroke patients. However, there is a paucity of published data, and thus, we studied the frequency, characteristics and prognosis of DVT following ischemic stroke in Asian patients with lower limb paresis. METHODS Doppler ultrasound scans of the lower limbs were performed at days 7-10 and 25-30 after stroke onset. The functional status of patients was assessed at 6 months using the modified Rankin scale. RESULTS DVT was detected in 30% of patients at days 7-10 and in 45% of patients at days 25-30. Most thromboses were distal. There were significant associations of age and degree of weakness with the presence of DVT at days 25-30, but not at days 7-10. DVT in the first month after stroke was associated with poorer outcome at 6 months. CONCLUSIONS DVT following ischemic stroke among Asians is common and associated with poor functional outcome.
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Affiliation(s)
- Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore.
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31
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Khodapanahandeh F, Hadizadeh H. Neuroimaging in children with first afebrile seizures: to order or not to order? Arch Iran Med 2006; 9:156-8. [PMID: 16649360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Seizures are common in children and 5% of all medical attendances to accident and emergency departments are related to seizures. The role of emergent neuroimaging for those children with first afebrile seizure is, however, not well-defined. We reviewed medical charts of 125 children who were admitted with a new-onset afebrile seizure to the Pediatric Ward of Rasool Akram Hospital and underwent CT scan or MRI of the brain. Neuroimaging was performed for 95% (119/125) of these children over the first few hours of their arrival to the Emergency Department. In 90% (107/119) of them, the result was normal. There was a significant relationship between abnormal neuroimaging and focal seizure (P < 0.001), and with age under 2 years (P < 0.002). Therefore, it is recommended that CT scan or MRI to be performed in children with first afebrile seizure who present with focal seizures, abnormal neurologic findings, or age under 2 years.
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Könönen M, Kuikka JT, Husso-Saastamoinen M, Vanninen E, Vanninen R, Soimakallio S, Mervaala E, Sivenius J, Pitkänen K, Tarkka IM. Increased perfusion in motor areas after constraint-induced movement therapy in chronic stroke: a single-photon emission computerized tomography study. J Cereb Blood Flow Metab 2005; 25:1668-74. [PMID: 15931162 DOI: 10.1038/sj.jcbfm.9600158] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hemiparesis is the most common deficit after cerebral stroke. Constraint-induced movement therapy (CIMT) is a new neurorehabilitation method that emphasizes task-relevant repetitive training for the stroke hand. Twelve chronic stroke patients were studied with single-photon emission computerized tomography at rest before and after the two-week CIMT period. Increased perfusion was found in motor control related areas. The specific areas with an increase in perfusion in the affected hemisphere were in the precentral gyrus, premotor cortex (Brodmann's area 6 (BA6)), frontal cortex, and superior frontal gyrus (BA10). In the nonaffected hemisphere, perfusion was increased in the superior frontal gyrus (BA6) and cingulate gyrus (BA31). In the cerebellum increased perfusion was seen bilaterally. The brain areas with increased perfusion receive and integrate the information from different sensory systems and plan the movement execution. Regional cerebral perfusion decreased in the lingual gyrus (BA18) in the affected hemisphere. In the nonaffected frontal cortex, two areas with decreased perfusion were found in the middle frontal gyrus (BA8/10). Also, the fusiform gyrus (BA20) and inferior temporal gyrus (BA37) in the nonaffected hemisphere showed decreased perfusion. Intensive movement therapy appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of active reorganization processes after CIMT in the chronic state of stroke.
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Affiliation(s)
- Mervi Könönen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
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33
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Affiliation(s)
- Kathryn W Holmes
- Division of Pediatric Cardiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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Imaizumi M, Kitagawa K, Oku N, Hashikawa K, Takasawa M, Yoshikawa T, Osaki Y, Matsushita K, Matsumoto M, Hori M, Hatazawa J. Clinical significance of cerebrovascular reserve in acetazolamide challenge -comparison with acetazolamide challenge H2O-PET and Gas-PET. Ann Nucl Med 2005; 18:369-74. [PMID: 15462398 DOI: 10.1007/bf02984479] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The response of cerebral blood flow (CBF) to acetazolamide (ACZ) challenge is frequently determined in clinical settings to evaluate cerebrovascular reserve (CVR). A reduced CVR can indicate patients with occlusive cerebrovascular disease and compromised hemodynamics who may be at increased risk of cerebral ischemia. However, how precisely ACZ reflects cerebral hemodynamic impairment remains obscure. The present study aims to clarify the pathological significance of CVR in patients with occluded carotid arteries. METHODS We recruited seventeen patients with occlusive lesions in the internal carotid artery (ICA) or middle cerebral artery (MCA). We assessed these patients in terms of resting cerebral blood flow (CBF) and the CVR response to ACZ challenge using H20 positron emission tomography (PET). In addition, we evaluated hemodynamic parameters including oxygen extraction fraction (OEF) using Gas-PET. RESULTS We identified a significant negative correlation between the CVR and OEF or the cerebral blood volume (CBV)/CBF ratio, as a potential index of cerebral perfusion pressure. Although the CVR values were reduced in all regions with elevated OEF (Stage II), these values were highly variable regardless of the CBV/CBF ratios. The cut-off value of CVR alone could not detect Stage II, but when combined with resting CBF, misery perfusion accompanied by increased OEF was detected with high sensitivity (6/7) and specificity (61/62). CONCLUSION CVR could be applied as an index reflecting both autoregulatory capacity and OEF. The present study also supported the notion that SPECT with ACZ challenge can be clinically applied to detect misery perfusion.
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Affiliation(s)
- Masao Imaizumi
- Division of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Japan.
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35
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Cascino GD, Buchhalter JR, Sirven JI, So EL, Drazkowski JF, Zimmerman RS, Raffel C. Peri-ictal SPECT and surgical treatment for intractable epilepsy related to schizencephaly. Neurology 2004; 63:2426-8. [PMID: 15623720 DOI: 10.1212/01.wnl.0000147262.70507.76] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors evaluated four patients with schizencephaly who underwent subtraction ictal SPECT coregistered to MRI (SISCOM) prior to epilepsy surgery. Three patients had a SISCOM alteration that was concordant with the epileptic brain tissue. Two of these patients were rendered seizure-free and one individual experienced a significant reduction in seizures. The patient with an indeterminate SISCOM had an unfavorable outcome. SISCOM is useful in evaluating patients with schizencephaly for epilepsy surgery.
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Affiliation(s)
- G D Cascino
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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36
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Ivey FM, Gardner AW, Dobrovolny CL, Macko RF. Unilateral Impairment of Leg Blood Flow in Chronic Stroke Patients. Cerebrovasc Dis 2004; 18:283-9. [PMID: 15331874 DOI: 10.1159/000080353] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2003] [Accepted: 03/24/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies comparing paretic limb blood flow with the unaffected limb have been contradictory and have often omitted comparisons of peak reactive hyperemic flow. Our objective was to perform bilateral measurements of resting and reactive hyperemic blood flow in the lower legs of chronic (>6 months) stroke patients. A secondary purpose was to determine the extent to which any unilateral changes in limb blood flow were a function of decreases in lean tissue mass on the affected side. We hypothesized that the chronic hemiparesis accompanying ischemic stroke creates an altered metabolic environment in the tissues of the affected side that ultimately impairs vasomotor function. METHODS The study used a single-visit cross-sectional design. All tests were performed at the Baltimore VA Medical Center. Nineteen chronic hemiparetic stroke patients (15 male, 4 female) who had mild to moderate hemiparetic gait after ischemic stroke were recruited for observation. Bilateral measurements of resting and reactive hyperemic blood flow were made using venous occlusion strain gauge plethysmography. Paired t-tests were used for the between leg comparison. Regression analysis and analysis of covariance were utilized to determine the strength of the relationship between lower leg lean tissue mass and blood flow. RESULTS Resting and reactive hyperemic blood flows were significantly reduced in the paretic compared with the non-paretic limb (32 and 35%, respectively, p < 0.001). Lean tissue mass was also significantly lower in the affected limb (p < 0.01). However, neither resting nor reactive hyperemic blood flows were significantly correlated with lower leg lean tissue mass by dual energy X-ray absorptiometry. The difference in blood flow between limbs remained after covarying for lean tissue mass. CONCLUSION Hemiparesis causes impairments in vasomotor function under both resting and hyperemic conditions that are independent of the muscle atrophy on the affected side.
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Affiliation(s)
- Frederick M Ivey
- Department of Medicine, Division of Gerontology, University of Maryland School of Medicine, Baltimore VA Medical Center/GRECC, Baltimore, MD 21201, USA.
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Okabe R, Inaba M, Sakai S, Ishimura E, Moriguchi A, Shoji T, Nishizawa Y. Increased arterial stiffening and thickening in the paretic lower limb in patients with hemiparesis. Clin Sci (Lond) 2004; 106:613-8. [PMID: 14761247 DOI: 10.1042/cs20030387] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Revised: 01/26/2004] [Accepted: 02/05/2004] [Indexed: 11/17/2022]
Abstract
Atherosclerosis has two key components, thickening and stiffening of arterial wall. These parameters are quantified ultrasonographically by IMT (intima-media thickness) and PWV (pulse wave velocity). In the present study, we determined the FA IMT (IMT of the bilateral femoral artery) and PWV of femoral–ankle (PWV fa) and brachial–ankle (PWV ba) segments in order to examine whether the degree of atherosclerosis is different between paretic and non-paretic lower limbs in 24 patients with hemiparesis. The values of PWV fa, PWV ba and FA IMT were all significantly greater on the paretic than the non-paretic side. Furthermore, significant decreases in masses of muscle, bone and fat, determined by dual-energy X-ray absorptiometry, were observed in paretic lower limbs compared with the non-paretic side. PWV fa correlated significantly and negatively with muscle mass (r=-0.488, P=0.0004) and tended to correlate negatively with BMC (bone mineral content; r=-0.264, P=0.069) when statistical analyses were performed with the paretic and non-paretic sides together. Multiple regression analysis elucidated that the muscle mass was associated significantly with PWV fa and PWV ba, independent of age, duration after cerebrovascular accident, gender, bone and fat mass and FA IMT. The muscle mass was still associated with increased PWV fa and PWV ba when multivariate analysis was conducted independently in the paretic and non-paretic sides. In summary, our results indicated that arterial thickening and stiffening were greater on the paretic than the non-paretic side and suggested that a decrease of muscle mass might be associated with increased arterial stiffening in the paretic lower limb.
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Affiliation(s)
- Reiko Okabe
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Abstract
Secondary surgery following obstetric brachial plexus palsy is usually performed between two and six years of age, but also later when the patient presents later. Surgery consists of contracture releases and transpositions of muscles and tendons. Indication for surgery must be assessed and discussed individually. Only a real functional improvement in ADL is a success. We describe usual techniques according to topography and present an overview of our results. This knowledge should influence all decisions about reconstructive surgery in these children.
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Affiliation(s)
- J Bahm
- Bereich Plastische Wiederherstellungschirurgie am St. Franziskus Krankenhaus Aachen.
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39
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Affiliation(s)
- Denis J Gradinscak
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
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40
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Affiliation(s)
- Shelagh B Coutts
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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Wasay M. Iatrogenic neurology: a wire in the carotid artery. Arch Neurol 2003; 60:896-7. [PMID: 12810498 DOI: 10.1001/archneur.60.6.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi 74800, Pakistan.
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Muroi C, Yonekawa Y, Khan N, Pangalu A, Keller E. Metabolic changes after H(2) 15O-positron emission tomography with acetazolamide in a patient with moyamoya disease: case report and review of previous cases. J Neurosurg Anesthesiol 2003; 15:131-9. [PMID: 12657999 DOI: 10.1097/00008506-200304000-00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Perioperative ischemic complications not directly related to surgery require special attention in patients with moyamoya disease; positron emission tomography (H(2) 15O-PET) and single-photon emission computed tomography have been considered indispensable for evaluating pre- and postsurgical cerebral hemodynamics. The clinical records of 14 patients with moyamoya disease who underwent 26 extracranial-intracranial bypass operations were reviewed with special reference to perisurgical complications. One patient developed multiple postoperative ischemic infarctions and died of ischemic brain edema. The history of this patient with prolonged acidosis is analyzed, and the role of metabolic changes induced by H(2) 15O-PET with acetazolamide challenge is reviewed. Seven (77.8%) of nine patients operated on within 48 hours after H(2) 15O-PET with acetazolamide (group 1) developed metabolic acidosis, whereas only three (17.6%) of 17 patients operated on >48 hours (group 2) after the examination had intraoperative pH of <7.35. In group 1, the mean intraoperative pH was 7.328, which was significantly lower than the mean pH of 7.393 (P <.0001) in group 2. After H(2) 15O-PET with acetazolamide challenge, patients must be carefully observed concerning acidosis and volume state. We recommend at least 48 hours between examination and surgery for patients with moyamoya disease so that their conditions can stabilize. Furthermore, special care should be taken to avoid additional perioperative risk factors such as hypotension, hypocapnia, hypercapnia, and hypovolemia.
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Affiliation(s)
- Carl Muroi
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
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43
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Zelikovich EI. [Potentialities of temporal bone computed tomography in the study of the facial nerve and in the diagnosis of peripheral pareses of thr 7th pair of cranial nerves]. Vestn Rentgenol Radiol 2003:11-9. [PMID: 12920878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Computed tomography (CT) was used to examine 200 patients (400 temporal bones) aged 3 to 74 years who had no signs of facial nerve lesion and 28 patients who had clinical manifestations of peripheral paresis of the facial nerve of varying genesis. Multipositional CT of the temporal bone is the most informative mode of visualization of the fallopian canal which is embodied on tomographic scans in 100% of cases irrespective of the age of a patient. CT data indicate that the formation of the facial nerve canal brings to completion by the age of 6 years. The following causes of n. facialis paresis were identified: facial neuroma; sarcoma of the temporal bone sarcoma; dehiscence of the canal wall in otitis media acuta; destruction of the tympanic wall of the canal in otitis nedia chronica, fractures of the temporal bone, anomalies of the fallopian canal in temporal bone malformations; stenosis of the canal in fibrous dysplasia. The detected alterations of the n. facialis canal permits further policy of management of a patient to be defined.
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Affiliation(s)
- E I Zelikovich
- Moscow City Consulting and Diagnostic Center, H.F. Filatov Children's City Clinical Hospital No. 13, Moscow
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Abstract
BACKGROUND Cerebral ptosis is considered rare; it has been reported with unilateral, usually right hemispheric lesions. However, the frequency of cerebral ptosis in patients with strokes has not received systematic study. OBJECTIVE To determine the frequency of ptosis in patients with acute hemispheric stroke and to identify stroke features associated with ptosis. METHODS Eyelid function was studied in 64 consecutive patients with acute hemispheric stroke and 40 age-matched subjects with no known neurologic disease. All underwent comprehensive neuro-ophthalmologic and general neurologic examination within 48 hours of admission, including measurement of palpebral fissures, marginal reflex distance, and range of upper lid movement. Only patients who could cooperate with eyelid testing were included. Brain CT scans were obtained for all patients who had had strokes. RESULTS Twenty-four (37.5%) of the patients with strokes had neurogenic ptosis, which was bilateral in 10 and unilateral in 14. None of the control subjects had neurogenic ptosis. All patients with strokes with ptosis had a hemiparesis. Rightward gaze deviation and upgaze paresis were more common (p < 0.05) in the patients with ptosis compared with others who had had strokes. CT evidence of right-sided hemispheric cortical infarction was more common in patients with strokes with ptosis (p < 0.05). In five patients with large hemispheric infarction, complete bilateral or asymmetric ptosis was the first sign of imminent herniation, preceding pupillary dilation and ocular motor deficits. CONCLUSIONS Ptosis occurs frequently in patients with hemispheric strokes, especially in association with right hemispheric lesions. Complete bilateral ptosis is usually caused by large infarctions and may be a premonitory sign of an impending herniation.
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Kastenbauer S, Schulz-Schaeffer WJ, Tatsch K, Yousry TA, Kretzschmar HA, Pfister HW. Crossed cerebellar diaschisis: a clue to the mechanism of ataxic hemiparesis in Creutzfeldt-Jakob disease? J Neurol 2001; 248:1093-5. [PMID: 12013589 DOI: 10.1007/pl00007828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sagiuchi T, Ishii K, Asano Y, Aoki Y, Woodhams R, Yanaihara H, Kan S, Hayakawa K. Transient seizure activity demonstrated by Tc-99m HMPAO SPECT and diffusion-weighted MR imaging. Ann Nucl Med 2001; 15:267-70. [PMID: 11545200 DOI: 10.1007/bf02987844] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cerebral perfusion single photon emission computed tomography (SPECT) has been used to confirm the localization of the epileptic focus and the evaluation of seizure. Recently, diffusion-weighted MR imaging (DWI) has been recognized for evaluation of seizure activity. We describe a case of transient seizure activity demonstrated by Tc-99m HMPAO SPECT and DWI. This patient was a 61-year-old woman with a 10-month history of right middle cerebral artery (MCA) infarction who had a generalized seizure during MRI. DWI immediately after seizure showed transient hyperintensity in the right frontal gray matter and the white matter, and these apparent diffusion coefficients (ADC) were transiently decreased. This transient hyperintensity on DWI corresponded to transient hyperperfusion identifying the epileptic focus on interictal Tc-99m HMPAO SPECT. Transient sustained seizure activity might cause these changes on DWI and SPECT. It was considered that interictal Tc-99m HMPAO SPECT showed the delayed hyperperfusion caused by excitatory neuronal overaction and DWI showed cytotoxic edema seizure-induced by energy failure of the membrane-bound Na/K-ATPase pump.
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Affiliation(s)
- T Sagiuchi
- Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Giannoukas AD, Katsamouris A, Tsetis D, Papakonstantinou O, Plaitakis A, Gourtsoyiannis N. Misdiagnosed post-traumatic occlusion of the internal carotid artery in a young woman. Eur J Vasc Endovasc Surg 2000; 20:478-81. [PMID: 11112469 DOI: 10.1053/ejvs.2000.1206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A D Giannoukas
- Division of Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
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Morioka T, Nishio S, Sasaki M, Yoshida T, Kuwabara Y, Nagamatsu T, Fukui M. Functional imaging in schizencephaly using [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime (HMPAO-SPECT). Neurosurg Rev 1999; 22:99-101. [PMID: 10547006 DOI: 10.1007/s101430050039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We analyzed interictal [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FGD-PET) and single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime (HMPAO-SPECT) in a 23-year-old female with schizencephaly. She had epilepsy and mild left hemiparesis, but was otherwise developmentally normal. We found the glucose metabolism and perfusion of the wall of the schizencephalic cleft to be identical to those of normal cerebral cortex. The wall of the transcerebral clefts, which were observed to be lined by abnormally organized gray matter as a result of a migration disorder, demonstrated gray matter metabolic activity and perfusion. FDG-PET and HMPAO-SPECT were thus found to be a useful complement to magnetic resonance imaging for evaluating schizencephaly.
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Affiliation(s)
- T Morioka
- Department of Neurosurgery, Neurological Institute, Faculty of Medicine, Kyusyu University, Fukuoka, Japan.
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49
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Qasho R, Vangelista T, Rocchi G, Ferrante L, Delfini R. Abducens nerve paresis as first symptom of trigeminal neurinoma. Report of two cases and review of the literature. J Neurosurg Sci 1999; 43:223-8. [PMID: 10817392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Two cases of neurinoma of the Gasserian ganglion with abducens nerve paresis as the first symptom are described and 27 cases culled from the literature are reviewed. The anatomo-surgical and clinical-radiological features of this pathology were re-assessed in an attempt to identify the pathogenetic mechanism responsible for a trigeminal neurinoma manifesting with VI cranial nerve palsy.
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Affiliation(s)
- R Qasho
- Department of Neurological Sciences, University of Rome La Sapienza, Italy
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50
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Hadzagić-Catibusić F, Sulejmanpasić G, Cucić Z, Zubcević S, Buljina A, Uzicanin S. [Characteristics of computerized tomography of the brain in congenital hemiparesis]. Med Arh 1999; 53:27-30. [PMID: 10758757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Congenital hemiparesis is defined as an unilateral disorder of movement and posture, with clinical signs of spasticity with flexor hypertonicity, increased tendon reflexes and characteristic posturing. We have examined a group of 26 children with congenital hemiparesis (14 boys and 12 girls) with mean age of 3.5 years (range 6 months to 9 years). 24 had been born at term (% weeks gestation) and 2 were preterm (% completed weeks gestation). From the neuroimaging point of view, congenital hemiparesis form a rather heterogeneous group. CT scans revealed: porencephalic cyst (6), unilateral ventricular enlargement (2), cortical atrophy with unilateral ventricular enlargement (1), hypodense zones resulting from previous hemathermous (4), normal CT scans (6), and 7 cases have not had CT scans for technical reasons (war conditions). Congenital hemiparesis mainly affects term children with prenatal origin in majority of cases. Vascular occlusions (in utero stroke) originating from various pathophysiological factors, maternal or fetal, may result in congenital hemiparesis. Normal CT findings should be revised by using MRI, which provides direct evidence of white matter lesions.
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