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10 results

  • Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke

  • Jae-Sung Lim, Mi Sun Oh, Ju-Hun Lee, San Jung, Chulho Kim, Min Uk Jang, Sang-Hwa Lee, Yeo Jin Kim, Yerim Kim, Jaeseol Park, Yeonwook Kang, Kyung-Ho Yu, Byung-Chul Lee
  • Journal:
    International Psychogeriatrics / Volume 29 / Issue 5 / May 2017
    Published online by Cambridge University Press:
    25 January 2017, pp. 777-784
  • Background:

    The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke.

    Method:

    We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains.

    Results:

    Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65–15.05).

    Discussion:

    The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.

  • Clinical evaluation of acute phase nystagmus associated with cerebellar lesions

  • Y Ogawa, K Otsuka, A Hagiwara, T Inagaki, S Shimizu, N Nagai, U Konomi, S Itani, T Kondo, M Suzuki
  • Journal:
    The Journal of Laryngology & Otology / Volume 130 / Issue 6 / June 2016
    Published online by Cambridge University Press:
    18 April 2016, pp. 536-540
    Print publication:
    June 2016
  • Objectives:

    To determine the characteristics of acute phase nystagmus in patients with cerebellar lesions, and to identify a useful indicator for differentiating central lesions from peripheral lesions.

    Methods:

    Acute phase nystagmus and the appearance of neurological symptoms were retrospectively investigated in 11 patients with cerebellar stroke.

    Results:

    At the initial visit, there were no patients with vertical nystagmus, direction-changing gaze evoked nystagmus or pure rotatory nystagmus. There were four cases with no nystagmus and seven cases with horizontal nystagmus at the initial visit. There were no neurological symptoms, except for vertigo and hearing loss, in any cases at the initial visit. The direction and type of nystagmus changed with time, and neurological symptoms other than vertigo appeared subsequently to admission.

    Conclusion:

    It is important to observe the changes in nystagmus and other neurological findings for the differential diagnosis of central lesions.

  • Total palliative care for a patient with multiple cerebral infarctions that occurred repeatedly in association with gastric cancer (Trousseau's syndrome)

  • Katsuyuki Ukai, Akiko Okajima, Aya Yamauchi, Eiji Sasaki, Yohsuke Yamaguchi, Hiroyuki Kimura, Branko Aleksic, Norio Ozaki
  • Journal:
    Palliative & Supportive Care / Volume 11 / Issue 2 / April 2013
    Published online by Cambridge University Press:
    30 July 2012, pp. 169-172
  • Objective:

    Malignancy-related thromboembolism, also referred to as Trousseau's syndrome, can present as acute cerebral infarction, nonbacterial thrombotic endocarditis (NBTE), and migratory thrombophlebitis. Therefore, many physical, neurological, and psychological symptoms associated with Trousseau's syndrome may occur in the clinical course.

    Method:

    To illustrate this, we report a case of a male patient in his 50s with carcinomatous peritonitis caused by gastric cancer, with multiple cerebral infractions that developed during disease progression. The patient was admitted to our hospital for the treatment of side effects of chemotherapy, although he strongly hoped to go home as soon as possible. In addition to making social supports plans, we were required to perform intensive total palliative care, because of his physical pain, general fatigue, anorexia, abdominal and neck pain, and psychological issues (insomnia, delirium, depression, suicidal thoughts, self-mutilation, panic attacks, agoraphobia, fear of death, and feelings of hopelessness).

    Results:

    To the best of our knowledge, based on the literature search, this is the first reported case of Trousseau's syndrome described in the context of total palliative care, especially psychological care.

    Significance of results:

    We propose that neurological symptoms of Trousseau's syndrome cause these extensive mental disorders. Furthermore, because of the prognosis of Trousseau's syndrome, we should utilize our expertise fulfill the patient's wishes.

  • Chapter 51 - Intracranial arterial dissections

  • from Section 2 - Vascular topographic syndromes
  • Edited by Louis R. Caplan, Jan van Gijn
  • Book:
    Stroke Syndromes, 3ed
    Published online:
    05 August 2012
    Print publication:
    12 July 2012, pp 566-573

  • Summary

    A small number of syndromes that initially were correlated, more or less convincingly, with relevant lacunes observed at subsequent autopsy have come to be regarded as the classical lacunar syndromes (LACS), pure motor stroke (PMS), pure sensory stroke (PSS), homolateral ataxia and crural paresis (HACP), dysarthria-clumsy hand syndrome (DCHS), ataxic hemiparesis (AH), and sensorimotor stroke (SMS). The original cases of HACP were described as having weakness of the lower limb, particularly the ankle and toes, a Babinski sign, and striking dysmetria of the arm and leg on the same side. The classical LACS are clinical paradigms that should be fine-tuned by clinicians. They have been shown to be simple and reasonably valid markers for a numerically significant and pathophysiologically distinct subgroup of patients with cerebral infarction. Clinical and research utility of the classical LACS will have to be kept under review in the era of hyperacute stroke assessment and treatment.

  • Chapter 38 - Midbrain infarcts and hematomas

  • from Section 2 - Vascular topographic syndromes
  • Edited by Louis R. Caplan, Jan van Gijn
  • Book:
    Stroke Syndromes, 3ed
    Published online:
    05 August 2012
    Print publication:
    12 July 2012, pp 439-447

  • Summary

    The middle cerebral artery (MCA) and its branches are the most commonly affected brain vessels in cerebral infarction. Prior to the introduction of imaging in living patients, semiology was a prominent factor in neurological research and practice. Many syndromes reflected inspired guesses, confirmed or denied by autopsy data, such postmortem observations often having been obtained long after the acute clinical event. The orbitofrontal branch supplies the orbital portion of the middle and inferior frontal gyri and the inferior orbital part of the frontal lobe. Middle cerebral artery inferior (or posterior) division territory infarcts represent 14% of 2000 patients of the Lausanne Stroke Registry. The posterior parietal and angular arteries may arise individually from the superior or the inferior division. The centrum ovale (or centrum semiovale) of Vieussens comprises the central white matter of the cerebral hemispheres, including the most superficial part of the corona radiata and the long association bundles.

  • Chapter 100 - Auditory-induced epilepsy

  • from Section 4 - Provoked epilepsies
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 704-708

  • Summary

    Stroke is a killer and causes long-term disability. It is among the most frequent causes of death in adults and children across the globe. Risk factors include age, hypertension, and hypercholesterolemia. Hematologic disorders such as sickle-cell disease and coagulopathies put patients at risk for stroke. The initiating event for ischemic stroke is one of three pathophysiologic occurrences resulting in the interruption of oxygen and glucose delivery to brain cells. Presenting symptoms in children may include nausea, vomiting, headache, and seizures instead of, or in addition to, those described for adults. Electroencephalogram (EEG) and imaging studies are standard diagnostic tools for both cerebrovascular disease and epilepsy. Patients were treated with phenytoin, carbamazepine, or valproate and 75% of patients were reported to have seizures controlled, although that is not defined by the authors as seizure-free.

  • Defective comprehension of emotional faces and prosody as a result of right hemisphere stroke: Modality versus emotion-type specificity

  • MICHAL HARCIAREK, KENNETH M. HEILMAN, KRZYSZTOF JODZIO
  • Journal:
    Journal of the International Neuropsychological Society / Volume 12 / Issue 6 / November 2006
    Published online by Cambridge University Press:
    25 October 2006, pp. 774-781

  • Studies of patients with brain damage, as well as studies with normal subjects have revealed that the right hemisphere is important for recognizing emotions expressed by faces and prosody. It is unclear, however, if the knowledge needed to perform recognition of emotional stimuli is organized by modality or by the type of emotion. Thus, the purpose of this study is to assess these alternative a priori hypotheses. The participants of this study were 30 stroke patients with right hemisphere damage (RHD) and 31 normal controls (NC). Subjects were assessed with the Polish adaptation of the Right Hemisphere Language Battery of Bryan and the Facial Affect Recognition Test based on work of Ekman and Friesen. RHD participants were significantly impaired on both emotional tasks. Whereas on the visual-faces task the RHD subjects recognized happiness better than anger or sadness, the reverse dissociation was found in the auditory-prosody test. These results confirm prior studies demonstrating the role of the right hemisphere in understanding facial and prosodic emotional expressions. These results also suggest that the representations needed to recognize these emotional stimuli are organized by modality (prosodic-echoic and facial-eidetic) and that some modality specific features are more impaired than others. (JINS, 2006, 12, 774–781.)

  • Affective facial and lexical expression in aprosodic versus aphasic stroke patients

  • LEE X. BLONDER, KENNETH M. HEILMAN, TIMOTHY KETTERSON, JOHN ROSENBEK, ANASTASIA RAYMER, BRUCE CROSSON, LYNN MAHER, ROBERT GLUECKAUF, LESLIE GONZALEZ ROTHI
  • Journal:
    Journal of the International Neuropsychological Society / Volume 11 / Issue 6 / October 2005
    Published online by Cambridge University Press:
    21 October 2005, pp. 677-685

  • Past research has shown that lesions in the left cerebral hemisphere often result in aphasia, while lesions in the right hemisphere frequently impair the production of emotional prosody and facial expression. At least 3 processing deficits might account for these affective symptoms: (1) failure to understand the conditions that evoke emotional response; (2) inability to experience emotions; (3) disruption in the capacity to encode non-verbal signals. To better understand these disorders and their underlying mechanisms, we investigated spontaneous affective communication in right hemisphere damaged (RHD) stroke patients with aprosody and left hemisphere damaged (LHD) stroke patients with aphasia. Nine aprosodic RHD patients and 14 aphasic LHD patients participated in a videotaped interview within a larger treatment protocol. Two naïve raters viewed segments of videotape and rated facial expressivity. Verbal affect production was tabulated using specialized software. Results indicated that RHD patients smiled and laughed significantly less than LHD patients. In contrast, RHD patients produced a greater percentage of emotion words relative to total words than did LHD patients. These findings suggest that impairments in emotional prosodic production and facial expressivity associated with RHD are not induced by affective–conceptual deficits or an inability to experience emotions. Rather, they likely represent channel-specific nonverbal encoding abnormalities. (JINS, 2005, 11, 677–685.)