Primary medullary haemorrhage with intractable hiccup.
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Adult↗
Biomedical subjects
E Kumral
Publications and source records attributed to E Kumral.
Acute multiple infarction involving the anterior circulation.
OBJECTIVE: To evaluate the frequency and clinical, topographic, and etiologic patterns of acute multiple infarction involving the anterior circulation. DESIGN: Data analysis from a prospective acute stroke registry in a community-based primary care center. RESULTS: Among 751 patients with first ischemic stroke in the anterior circulation over a 4-year period, 40 patients (5%) had acute multiple infarcts involving the anterior circulation. On computed tomography and magnetic resonance imaging with gadolinium enhancement, there were four topographic patterns of infarction: (1) superficial infarcts (11 patients [28%]); (2) superficial and deep infarcts (12 patients [30%]); (3) deep infarcts (three patients [8%]); and (4) infarcts involving the anterior and the posterior circulation (14 patients [35%]). Both cerebral hemispheres were involved in one fourth of the cases. A specific clinical picture was found in up to 20% of the patients. This included global aphasia with left hemianopia, hemisensory loss or hemiparesis (in right-handed patients), transcortical mixed aphasia with hemianopia, and acute pure cognitive impairment ("dementia"). Large-artery disease was found in 13 patients (33%); a cardiac source of embolism was found in 11 patients (28%); and both were found in three patients (8%). Bilateral infarcts were related to cardioembolism (four patients) and bilateral large-artery disease (three patients). One month after stroke, one fourth of the patients were independent, one third had some disability, and 40% were either dead or completely dependent. CONCLUSIONS: Acute multiple infarcts involving the anterior circulation may be bilateral more frequently than is currently thought, and they are often associated with posterior circulation infarcts. They mainly involve the pial hemispheral territories, commonly being caused by cardioembolism or bilateral carotid atheroma. They may be associated with a specific neurologic-neuropsychological dysfunction pattern in up to one fifth of the patients, allowing diagnosis before brain imaging.
Adult↗
Stroke subtypes and hypertension. Primary hemorrhage vs infarction, large- vs small-artery disease.
BACKGROUND: Hypertension is the major risk factor for stroke associated with small-artery disease and large-artery disease, but the factors behind the development of a particular stroke subtype in individual patients are not known. METHODS: We determined risk factors potentially predictive of stroke subtype in 822 of 2760 patients consecutively admitted to a primary care stroke center with (1) first-ever stroke, (2) hypertension (blood pressure >160/90 mm Hg at least twice before the stroke), and (3) no cardioembolic source. We used logistic regression analysis to delineate factors associated with ischemic (brain infarct) vs hemorrhagic (primary hemorrhage) stroke and with large- vs small-artery disease. A scoring system was elaborated on the basis of the estimated regression coefficients. Observed proportions and calculated risks were determined. RESULTS: Age greater than 67 years, cigarette smoking, hypercholesterolemia, and a family history of stroke or ischemic heart disease were independent predictors of ischemic vs hemorrhagic stroke. In women, diabetes mellitus was an additional risk factor for ischemic vs hemorrhagic stroke. Only one of 144 patients with primary hemorrhage had an ipsilateral carotid stenosis. In men with brain infarct, cigarette smoking, cardiac ischemia, and a family history of stroke or ischemic heart disease were significantly and independently associated with large- vs small-artery disease. In women with brain infarct, smoking was the only predictive factor for large- vs small-artery disease. CONCLUSION: In patients with stroke and hypertension, associated risk factors influence the subtype of stroke (hemorrhage vs brain ischemia, large- vs small-artery disease).
Adolescent↗
Visually evoked hyperpathia due to thalamic hemorrhage: a variant of Déjerine-Roussy syndrome.
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Aged↗
[Thrombolytic therapy in ischemic cerebrovascular accidents].
Thrombolysis together with neuroprotective agents the two most important recent advances in the treatment of acute ischemic stroke. This update summarizes the recent randomized clinical trials and emphasizes the question of risk versus benefit of this potentially useful but dangerous treatment.
Anistreplase↗
Acute hemiconcern: a right anterior parietotemporal syndrome.
Three patients developed a striking visual and motor behaviour in the acute phase of a stroke involving the territory of the right anterior parietal artery (postcentral gyrus, parts or upper and middle temporal gyri, anterior part of inferior parietal gyrus, and supramarginal gyrus). The patients concentrated on the left side of their bodies, looking at it for long periods and relentlessly rubbing, touching, pinching, pressing, lifting, and manipulating parts of the left arm, trunk, and leg with their right hand or foot. They all had severe loss of elementary sensation on the left (touch, pain, temperature, vibration, position). The behaviour was not associated with overinterest in the left hemispace apart from their own bodies. It lasted no more than a few days, disappearing when left sided sensation improved. The findings suggest an association between sensory dysfunction and this "acute hemiconcern". None of 13 patients with a mirror infarct in the left hemisphere and none of 38 patients with acute hemisensory loss due to thalamic capsular or brainstem stroke showed hemiconcern behaviour. This behaviour may result from a feeling of strangeness critically associated with hemisensory loss without hemispatial neglect, due to involvement of the right anterior parietotemporal region.
Aged↗
Headache at stroke onset: the Lausanne Stroke Registry.
Within 12 hours of stroke onset 2506 patients with first ever stroke admitted to the Lausanne Stroke Registry were questioned about headache. Eighteen per cent of the patients reported headache, 14% with anterior circulation stroke and 29% with posterior circulation stroke (p < 0.001). Headache was reported by 16% of the patients with infarct and 36% of those with haemorrhage (p < 0.001). The prevalence of headache was 9% with lacunar infarct, 15% with middle cerebral artery territory infarct, 37% with infratentorial haemorrhage, and 36% with supratentorial haemorrhage. The most common topography of pain was frontal (41%), followed by diffuse headache (27%; p < 0.001). Diffuse (41%) or occipital (30%) headache was particularly frequent with posterior circulation stroke, whereas frontal headache was associated with anterior circulation stroke (51%; p < 0.001). Headache in stroke may be explained in part by involvement of blood vessels (acute distention or distortion) and mechanical (stretch of haemorrhage) stimulation of intracranial nociceptive afferents. Stroke due to dissection was strongly associated with headache (p < 0.001), whereas embolic (cardiac, artery to artery) stroke was more common without headache (p < 0.001), emphasising the role of extracranial v intracranial arteries in the genesis of headache at stroke onset. Moreover, dual trigeminal-vascular and cervical-vascular system involvement in causing headache may explain the lack of correspondence with the "rules of referral" in up to 38% of the cases.
Adolescent↗
Thalamic hemorrhage. A prospective study of 100 patients.
BACKGROUND AND PURPOSE: The clinical features of thalamic hemorrhage in terms of localization are of great interest in many studies. To better understand the relationship between the localization of thalamic hemorrhage and clinical features. we evaluated the characteristics of patients with four different topographic types of thalamic hemorrhage. METHODS: We prospectively studied 100 patients with thalamic hemorrhage who were admitted consecutively to our primary care unit. We divided them into two groups according to large (> 2 cm in diameter and/or > 4 mL in volume) and small thalamic hemorrhage. Four topographic subgroups (large and small) were compared to identify clinical syndromes associated with distinct lesion locations. RESULTS: All patients with posterolateral thalamic hemorrhage had severe sensorimotor deficit. Neuropsychological disturbances in patients with posterolateral thalamic hemorrhage were prominent, with primarily transcortical aphasia in those with left-sided lesions and hemineglect and anosognosia in those with right-sided lesions. Several variants of vertical gaze dysfunction, skew ocular deviation, gaze preference toward the site of the lesion, and miotic pupils were frequent in posterolateral thalamic hemorrhage, particularly in the large type. Patients with small and large anterolateral thalamic hemorrhage were characterized by severe motor and sensory deficits; language and oculomotor disturbances were also observed, although less frequently than in posterolateral hemorrhage. Sensorimotor deficits were observed in patients with medial thalamic hemorrhage (moderate in small hemorrhages and severe in large hemorrhages because of involvement of the adjacent internal capsule). Language disturbances in patients with left-sided lesions and neglect in patients with right-sided lesions were seen only in large medial thalamic hemorrhage. Dorsal thalamic hemorrhage was rare and characterized by mild and transient sensorimotor disturbances. Among patients with dorsal thalamic hemorrhages, only those with large lesions had oculomotor and neuropsychological disturbances. CONCLUSIONS: We concluded that despite clinical similarity among the four types of thalamic hemorrhage, there was some discrepancy in the clinical features of small and large thalamic hemorrhages. The most important predictors of death were initial consciousness, nuchal rigidity, maximum size, volume and ventricular extension of hemorrhage, and occurrence of hydrocephalus.
Adolescent↗
[Callosal infarction after bilateral occlusion of the internal carotid arteries with hemineglect syndrome and astasia-abasia].
We report a patient who had a callosal infarct, showed by Computer Tomography and Magnetic Resonance Imaging, without injury to the adjacent hemispheres. Angiography revealed an occlusion of both internal carotid arteries. Besides interhemispheric disconnection with unilateral left agraphia, left tactile anomia, left ideomotor apraxia and left ear auditivoverbal extinction, the patient showed signs of left hemineglect and astasia-abasia, both persistent.
Arterial Occlusive Diseases↗
The Ege Stroke Registry: a hospital-based study in the Aegean region, Izmir, Turkey. Analysis of 2,000 stroke patients.
We present the profile of risk factors, etiologic and clinical data of 2,000 consecutive patients with first-ever-in-a-lifetime stroke (cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage), admitted to the Ege University Hospital between January 1, 1991, and September 31, 1995. This hospital-based registry is the first systematic epidemiologic report on the stroke profile of Turkish people The Ege University Stroke Unit is the only tertiary medical care facility which is organized for patients with different stroke subtypes in Izmir, Turkey. A prospective hospital-based registry using systematic computer coding of data of all stroke patients has been used since January 1991. All patients were evaluated by clinical examination, CT and/or MRI, color duplex and specific cardiac investigations. They were followed up for at least 6 months. The mean age was 62.3 +/- 12 years, and 44.4% were females. Ischemic stroke was found in 77%, primary intracerebral hemorrhage in 19% and subarachnoid hemorrhage in 4%. The major risk factor of ischemic stroke was hypertension (63%), followed by hypercholesterolemia (37%), diabetes mellitus (35%), ischemic heart disease (23%), atrial fibrillation (20%) and smoking (17%). The main cause of primary intracerebral hemorrhage was hypertension (88%), and the principal localization was the thalamus (38%), followed by putamen (28%), lobar(16%), pons(6%), cerebellar(4%), primary intraventricular hemorrhage (4%) and multiple hemorrhages (2%). The over- all 30-day case-fatality rate was 19.7% and the higher mortality rate was found in patients with primary intracerebral hemorrhage (29%) than in those with ischemic stroke (17%). The Ege Stroke Registry allows to estimate the stroke-related problems in patients admitted to a stroke unit and to evaluate the risk factors, etiology and clinical manifestations of stroke in Turkey.
Adolescent↗
Cerebral hemorrhage with transient signs.
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Aged↗