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Biomedical subjects

G Guidetti

Publications and source records attributed to G Guidetti.

At least 19 recordsLinked to original sources
PubMed2006

Clinical examination of labyrinthine-defective patients out of the vertigo attack: sensitivity and specificity of three low-cost methods.

Many reports have appeared in the medical literature concerning the clinical examination at the bedside of patients with vertigo and, even if few controversial opinions exist, the observation of one or more kinds of nystagmus is generally regarded as suggesting an organic aetiology. So far, the presence of nystagmus has been generally considered to be crucially important for clinicians who are daily asked to differentiate between an "organic" cause of vertigo (for example, a labyrinthine dysfunction) and a "non-organic" cause of vertigo, such as a panic disorder. Albeit, it should not be forgotten that the central nervous system is able to resolve the asymmetry of vestibulo-ocular reflexes, due to a peripheral vestibular failure, by means of compensatory mechanisms so that nystagmus is rapidly abolished after the acute attack of vertigo. In addition, visual fixation elicits sub-cortical inhibitory pathways to the vestibular nuclei so that spontaneous nystagmus is remarkably reduced by light. In order to more easily detect nystagmus, attempts have been made to minimize the interference of visual fixation by means of positive lenses (Frenzel's glasses) and light occluding masks with infrared cameras (videonystagmoscopy) which have in part replaced direct observation of the patient's eyes, albeit no systematic validation of the advantages has been reported yet. To investigate the usefulness of these 3 low-cost methods to detect nystagmus, 528 outpatients presenting peripheral vestibular hypofunction, diagnosed by a complete audiological and vestibular examination, including caloric tests, were enrolled in the present study, while 133 subjects with normal vestibular function acted as a control group. All patients and control subjects underwent a standardized clinical examination based on search for spontaneous, positioning and head-shaking nystagmus detected by direct observation of patient's eyes, Frenzel's glasses and videonystagmoscopy. Specificity of the three techniques were 35.6, 43.7 and 91.6, whilst sensitivity was 88.7, 88.7 and 84.2, respectively. Finally, discriminant analysis based on the presence/absence of at least one kind of nystagmus was computed for each technique and showed that videonystagmoscopy allowed the examiner to correctly classify both pathological and normal subjects more frequently (> 77% of cases) than the other two methods (about 50%). It is concluded that only videonystagmoscopy is an acceptable technique for screening a labyrinth defect in a population of outpatients with vertigo.

Adolescent↗
PubMed2005

Vasospasm of venous grafts in extra-intracranial by-pass. Report of two cases.

Two patients are described, the first with a giant aneurysm of the left carotid bifurcation previously treated by endovascular technique, the second with a bilateral intracavernous aneurysm: both were submitted to high-flow by-pass operation. The first patient was a 40 year-old woman who had presented subarachnoid hemorrhage 6 months before operation. She had been treated by means of a high-flow by-pass between the external carotid artery and the middle cerebral artery. Control angiograms performed 12 hours later showed a stenosis above the suture between the external carotid artery and the venous graft. Angioplasty was performed by endovascular route: new angiograms showed occlusion of the graft while dopplersonography demonstrated the presence of flow within the graft. Angiograms performed 1 week later showed marked vasospasm of the venous graft, of the internal carotid artery, the anterior cerebral artery and the middle cerebral artery. The evolution of spasm of the graft and of the intracranial arterial flow was monitored by dopplersonography and MR-angiography: the latter was performed 20 days after the last angiography and confirmed patency of the graft, while dopplersonography showed resolution of vasospasm. Finally, the aneurysm was embolized. The second patient was a 49 year-old woman with mild left palpebral ptosis and retro-orbital pain. She had already been submitted to high-flow by-pass operation 7 months earlier to treat a right intracavernous aneurysm; the left by-pass was necessary because the intracavernous aneurysm had become symptomatic. One week after surgery, spasm of the venous graft was documented by MR-angiography. In both cases, treatment consisted of calcium antagonists as well as hypertensive and hypervolemic medication, which was successful in treating vasospasm of the venous graft and its symptoms. Spasm of the venous graft, a well-known occurrence in cardiac revascularization, can also be observed in cerebral revascularization.

Adult↗
PubMed2005

[The role of clinical history in the evaluation of balance and spatial orientation disorders in the elderly].

Balance and spatial orientation complaints are very frequent in the elderly. The aetiology of these complaints may be related to specific peripheral or central vestibular disorders or to an extravestibular dizziness resulting from impairment or disease in multiple systems. A preliminary diagnostic orientation, permitting the patient to be referred to the most appropriate specialist (otologist, neurologist, consultant in internal medicine, psychiatrist, physical therapist) would be very useful. We examined 163 patients, referred for balance and spatial orientation complaints to the otoneurological outpatient services of 6 university hospital centres in the northern and central Italy, by a detailed questionnaire about characteristics, frequency, duration of any dizziness symptom and by a bedside vestibular examination. The questions were designed to determine whether the patients suffered from true vertigo, considered to be an expression of a vestibular disorder, or of an aspecific dizziness of multifactorial origin. Comparison of the conclusions of the vestibular examination and the diagnostic hypotheses deduced from the clinical history showed a high degree of concordance (Cohen Index 70.5%). To the patient, vertigo and dizziness are synonymous. By asking appropriate questions, a clearer picture should begin to emerge from the patient complaints so that distinction between psychogenic, nonvestibular and vestibular causes can be made. The importance of obtaining a good history cannot be overemphasized. A correct and rigorous approach by the general practitioner could be of great utility both for the health of the patient and for the efficiency of the national health service. The vestibular examination proved that about half the patients (80/163) suffered from vestibular disorders, mainly of peripheral origin (BPV, Menière's disease, vestibular neuritis).

Aged↗
PubMed2005

[The relationship between cognitive impairment, anxiety-depression symptoms and balance and spatial orientation complaints in the elderly].

Balance and spatial orientation complaints, generically defined as "dizziness", are frequent in the elderly. They can cause a greater or lesser degree of handicap, and be associated with a greater or lesser degree of cognitive impairment and anxiety-depression symptoms. We examined 163 patients, referred for these complaints to the otoneurological outpatient services of 6 university hospital centres of the northern and central Italy, performing a bedside vestibular examination. The test allowed to distinguish between subjects with specific vestibular disorders (mainly BVP, Menière's disease and vestibular neuritis) and subjects in who the vestibular examination was not significant, and whose dizziness probably resulted from impairment or disease in multiple systems. The evaluation of the degree of handicap, using the Dizziness Handicap Inventory, showed that in the former group the physical parameters were significantly impaired with respect of a group of 81 age matched healthy controls, whereas the functional and emotional parameters were not. The evaluation of the degree of anxiety-depression, using the Hospital Anxiety Depression Scale, showed that all elderly people with balance and spatial orientation complaints present a degree of anxiety, but not of depression, greater than the controls, irrespective of the vestibular or extravestibular origin of the symptoms. The evaluation of the cognitive level, using the Mini Mental Test, showed that it is similar to the cognitive level in the controls when, according to the results of the otoneurological examination, the balance and spatial orientation complaints are due to vestibular disorders, but it is impaired when these symptoms are related to a dizziness of multifactorial aetiology. The presence of comorbidities is also higher in these patients. It is likely that in the elderly balance and spatial orientation complaints not caused by specific vestibular disorders are due to a dizziness of multifactorial origin, both organic and psychic, that can be classified as a geriatric syndrome.

Aged↗
PubMed2004

Nicergoline in the treatment of dizziness in elderly patients. A review.

In elderly patients, dizziness occurs very frequently with significant effects on the patient's life. Its frequency increases with age, and may arise from a variety of causes. Chronic dysequilibrium in elderly patients is most probably related to disturbances within the central nervous system, due either to altered neuronal functions or to an underlying vascular disease. Nicergoline, a drug used in the treatment of cognitive disturbances in geriatric patients, improves dizziness in elderly demented and non-demented patients. In a double blind,placebo controlled trial the drug improved (i) the severity of symptoms, measured by the dizziness assessment rating scale (DARS), (ii) the overall clinical conditions revealed by global impression scale, and (iii) the perceived quality of life estimated by the dizziness handicap inventory (DHI). These results indicate a possible positive effect also on posturographic measures. Moreover, the improvement occurred at no expense of the established strategy of postural control suggesting that the effect is mediated by a substitute compensatory mechanism allowing the patient to preserve consolidated postural strategies. The results of previous open clinical studies in about 3000 patients are in agreement with those findings. Overall, severity of symptoms decreased by 68 % (57 % in the control study). Globally, the results indicate a beneficial effect of nicergoline on symptoms related to balance disorders of central origin. Animal studies show that the drug displays a broad spectrum of actions on cellular and molecular mechanisms. Moreover, animal research specifically aimed at vestibular pathophysiology has revealed that nicergoline improves vestibular compensation in models of vestibular lesion. Chronic treatment with nicergoline improved the time-course of behavioral recovery in old rats after hemi-labyrinthectomy and counteracted the regulation of cholinergic receptors observed after lesion in old rats. Nicergoline interacts at several levels by various mechanisms, from the molecular level to cognitive function, probably enhancing spontaneous plasticity phenomena underlying the central vestibular compensation. This effect is not dependent from the interaction with a single-transmitter-identified neural pathway, but from anatomical, functional and neurochemical synergistic adjustments in several brain areas.

Aged↗
PubMed2003

Combined effect of vestibular and craniomandibular disorders on postural behaviour.

A correlation has been reported in the dental literature between temporomandibular disorders and musculoskeletal abnormalities, however, the question whether they modify body postural sway remains controversial. In the present investigation, the Craniomandibular Index was used to evaluate the clinical extension of temporomandibular joint dysfunction and related problems in 40 patients with normal vestibular function and in 42 patients with peripheral vestibular disorders. Balance function was assessed by static posturography and body sway area was measured in two conditions: i) eye open, and g) eye closed. Data were compared to those of 40 healthy subjects. Postural control showed a significantly different behaviour between groups with an increase in average body sway in patients with craniomandibular disorders as opposed to controls (p < 0.005). Although the involvement of the stomatognathic apparatus was not quantitatively different in the two groups of patients, those also presenting a peripheral vestibular disorder exhibited greater average body sway than patients with only craniomandibular disorders (p < 0.005). The latter showed a greater average body sway than controls only in the trial with eyes closed (p < 0.05). The results demonstrated that craniomandibular alterations could produce moderate postural instability in patients with a normal vestibular function. Conversely, their association with peripheral vestibular disorders becomes a real challenge to the upright quiet stance probably due to a negative effect of somatosensory origin on the vestibulo-spinal reflex impairment.

Adult↗
PubMed2002

Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo.

The present study compares the efficacy and safety of betahistine dihydrochloride to that of a placebo in recurrent vertigo resulting from Meniere's disease (MD) or in paroxysmal positional vertigo (PPV) of probable vascular origin. The design was double-blind, multicentre and parallel-group randomised. Eleven Italian centres enrolled 144 patients: 75 of the patients were treated with betahistine (41 MD/34 PPV) and 69 with placebos (40 MD/29 PPV). The betahistine dosage was 16 mg twice per day for 3 months. Compared to the placebo, betahistine had a significant effect on the frequency, intensity and duration of vertigo attacks. Associated symptoms and the quality of life also were significantly improved by betahistine. Both the physician's judgement and the patient's opinion on the efficacy and acceptability of the treatment were in agreement as to the superiority of betahistine. The effective and safe profile of betahistine in the treatment of vertigo due to peripheral vestibular disorders was confirmed.

Administration, Oral↗
PubMed2002

Head shaking nystagmus in the follow-up of patients with vestibular diseases.

We examined 420 patients with vestibular diseases of different origin; 273 with peripheral vestibular disease and 147 with both peripheral and central vestibular disease. Recurrent vestibulopathy like Menière's disease, or benign paroxysmal positional vertigo, were not included. Patients were evaluated initially and 6 months after pharmacological and/or rehabilitation therapy. At the initial assessment, the head-shaking test was specific for the side of the lesion in both groups, even if spontaneous nystagmus was no longer present. Thus, head-shaking nystagmus is a physical sign that can be easily evoked and gives useful information about the presence of vestibulo-ocular reflex asymmetry. At the follow-up at 6 months, many changes in the head-shaking nystagmus were noted: in some cases it appeared, in some others it changed direction and more often it disappeared. There is actually no acceptable explanation for the disappearance of the head-shaking nystagmus, despite some evidence that vestibular compensation could play a role. It is definitely proved that sensitivity of the head-shaking test is really poor, especially in the course of time and, therefore, it should not be used alone in the follow-up of patients with vestibular disease.

Adult↗
PubMed2001

Psychological distress and disability in patients with vertigo.

OBJECTIVE: Vertigo is an extremely debilitating experience for the patient, especially during attacks; it is neither easy to identify nor control. The importance of psychosomatic factors has already been widely studied and discussed. In particular, it has been shown that stress factors are relevant in setting off episodes of dizziness, but there is no agreement if the presence of distress might influence the vestibular disability. METHODS: This study is concerned with evaluating the quality of life (QOL) in a group of 206 patients suffering from vertigo and 86 control patients, using the UCLA-Dizziness Questionnaire (UCLA-DQ) scale. The results were correlated with those achieved using the Hospital Anxiety and Depression Scale (HADS) psychometric test. RESULTS: What is clear is that, in patients suffering from vertigo as regards those who are not, there is a significant amount of anxiety and depression distress, especially in female subjects. There appears to be no relationship between psychological change and the various forms of clinical vertigo. In terms of the QOL parameter, what emerges is that, from a statistical point of view, fear of becoming dizzy is most closely correlated with the perception of disability. CONCLUSIONS: There is a also a need for psycho-education here in collaboration with the E.N.T. specialist so that the patient can learn to recognise his/her medical condition and be aware of the factors that primarily contribute to the deterioration of their QOL.

Adult↗
PubMed2001

Cerebral hemodynamics on MR perfusion images before and after bypass surgery in patients with giant intracranial aneurysms.

BACKGROUND AND PURPOSE: Preoperative assessment of the anatomy and dynamics of cerebral circulation for patients with giant intracranial aneurysm can improve both outcome prediction and therapeutic approach. The aim of our study was to use perfusion MR imaging to evaluate cerebral hemodynamics in such patients before and after extraintracranial high-flow bypass surgery. METHODS: Five patients with a giant aneurysm of the intracranial internal carotid artery underwent MR studies before, 1 week after, and 1 month after high-flow bypass surgery. We performed MR and digital subtraction angiography, and conventional and functional MR sequences (diffusion and perfusion). Surgery consisted of middle cerebral artery (MCA)-internal carotid artery bypass with saphenous vein grafts (n = 4) or MCA-external carotid artery bypass (n = 1). RESULTS: In four patients, MR perfusion study showed impaired hemodynamics in the vascular territory supplied by the MCA of the aneurysm side, characterized by significantly reduced mean cerebral blood flow (CBF), whereas mean transit time (MTT) and regional cerebral blood volume (rCBV) were either preserved, reduced, or increased. After surgery, angiography showed good canalization of the bypass graft. MR perfusion data obtained after surgery showed improved cerebral hemodynamics in all cases, with a return of CBF index (CBFi), MTT, and rCBV to nearly normal values. CONCLUSION: Increased MTT with increased or preserved rCBV can be interpreted as a compensatory vasodilatory response to reduced perfusion pressure, presumably from compression and disturbed flow in the giant aneurysmal sac. When maximal vasodilation has occurred, however, the brain can no longer compensate for diminished perfusion by vasodilation, and rCBV and CBFi diminish. Bypass surgery improves hemodynamics, increasing perfusion pressure and, thus, CBFi. Perfusion MR imaging can be used to evaluate cerebral hemodynamics in patients with intracranial giant aneurysm.

Adult↗
PubMed2001

Role of electrothrombosis in aneurysm treatment with Guglielmi detachable coils: an in vitro scanning electron microscopic study.

BACKGROUND AND PURPOSE: In the 1990s, the introduction of the Guglielmi detachable coil (GDC) system in clinical practice was followed by extensive clinical use of this endovascular device in the treatment of brain aneurysms. This technology is based on electrothrombosis and electrolytic detachment of platinum coils. Despite the extensive use of this treatment technique, the role of electrothrombosis has not been fully investigated and clarified. An in vitro electron microscopic study of human blood was performed to elucidate the role that electrothrombosis might play in triggering the biologic response of thrombosis of the aneurysmal sac. METHODS: Human blood from five patients was used to fill plastic containers in which GDCs had been deposited. These five patients had subarachnoid hemorrhage and were similar in age and clinical presentation. Electron microscopic studies were performed on GDCs that had been electrically charged and on GDCs that had not. RESULTS: All electron microscopic studies revealed that the electrically charged GDCs were covered by blood elements and fibrin adherent to the surface of the coil. Noncharged GDCs did not have deposits or adhesions of these blood constituents. CONCLUSION: These findings demonstrated that passage of electric current through the GDC induces attraction of blood constituents. This attraction may trigger a thrombotic reaction on the surface of the coil. The greater the time of current application, the more pronounced the cellular reaction and the deposition of fibrin and blood cells on the GDC.

Aneurysm↗
PubMed2000

Chronic melanocortin 4 receptor blockage causes obesity without influencing sexual behavior in male rats.

We investigated the effects of continuous intracerebroventricular infusion of a melanocortin 4 receptor antagonist HS014 (cyclic [AcCys11, D-Nal14, Cys18, Asp-NH2(22)]beta-MSH-(11-22)) over 12 days and a subsequent 12-day recovery period on food intake, body weight and copulatory behavior in male rats. The results show that the food intake increased immediately after the start of the infusion of HS014 (0.16 nmol/h) and progressively increased thereafter. No tachyphylaxis was observed. When the infusion of HS014 was terminated, the food-intake levels dropped. The body weights of the rats had increased by 17% by the end of the study, compared with controls. During the recovery period, the body weight decreased towards the levels of the control rats. These results indicate that overeating and the subsequent increases in body weight caused by blockage of the melanocortin 4 (MC4) receptor are reversible when the blockage is ended. We also tested the copulatory behavior of vigorous male rats in the presence of female rats in estrous. We registered mount latency, the number of mounts, the intromission latency, the number of intromissions, the ejaculation latency and the post-ejaculatory interval three times during the study and also after acute administration of HS014 and alpha-MSH. The sexual behavior of the male rats was not affected. These results indicate that the MC receptors, in particular the MC4 receptor, may not be a major mediator of effects on copulatory behavior in male rats.

Analysis of Variance↗
PubMed2000

Increased levels of clusterin (SGP-2) mRNA and protein accompany rat ventral prostate involution following finasteride treatment.

Finasteride is a well-known inhibitor of the prostatic enzyme 5 alpha-reductase type 2 which prevents conversion of testosterone into 5 alpha-dihydrotestosterone, the active intraprostatic androgen, which causes prostate involution through a combination of cell atrophy and cell death. The drug is widely used to improve symptoms of benign prostatic hyperplasia in man. Clusterin, a glycoprotein which is generally up-regulated under conditions inducing cell atrophy or organ involution, is produced at a high level in the regressing rat ventral prostate following androgen ablation. According to several authors, clusterin does not respond to finasteride treatment, suggesting a different action of testosterone and 5 alpha-dihydrotestosterone. We show here that, under our conditions, finasteride was capable of inducing production of both clusterin mRNA and protein in the rat ventral prostate. In fact, by using different and converging techniques, such as Northern hybridization, in situ hybridization histochemistry and immunohistochemistry, we were able to show a strong induction of the clusterin gene in the epithelial cell population of the gland. The response to finasteride, which was similar to that seen with castration, occurred with a delay of a few days. In situ and immunohistochemistry experiments indicated that both orchidectomy and finasteride administration resulted in increased transition of the epithelial cells from the columnar to the cuboidal (atrophic) shape, and this was accompanied by an increased intensity of the signal for clusterin. Thus, it appears that induction of clusterin is part of the molecular process leading to prostate involution caused by either orchidectomy or finasteride administration.

5-alpha Reductase Inhibitors↗
PubMed2000

[Head shaking test and low-frequency rotation-acceleration test: comparison of sensitivity and specificity].

In studying the vestibular-oculomotor reflex (VOR) in patients with equilibrium disorders, both active and passive methods are used and at different stimulation frequencies, particularly to evaluate vestibular compensation. The present study compares the sensitivity and specificity of the low-frequency pendular test and the HST in normal subjects and in subjects suffering from various vestibular pathologies but showing no signs of spontaneous nystagmus, even under optimal evaluation conditions (infrared videonystagmoscopy). These spontaneous nystagmus-free subjects underwent a routine study including: case history, infrared videonystagmoscopy (HST with 2 Hz stimulation) and ENG recording (saccadic movement, smooth pursuit, OKN, VOR, VOR-fix during pendular stimulation at 0.05 Hz and VOR after Fitzgerald-Hallpike heat stimulation). On the basis of the results the subjects were classified as follows: normal (N): case history free of any equilibrium disorders and all tests negative (122 cases; 8.1%); peripheral vestibular pathology (P): case history of equilibrium disorders and labyrinthine predominance (LP) in excess of 20% upon caloric testing (716 cases; 47.6%); central pathology (C): case history of equilibrium disorders and at least 3 pathological results from among the following tests: saccadic movement, smooth pursuit, OKN, VOR-fix (226 cases; 15.0%); mixed pathology (M): with both signs of P and C (440 cases; 29.3%). The pendular test showed signs of directional dominance (DP) higher than 10% (normal limit) in 7 cases of N (5.7%), 308 P (43.0%), 33 C (14.6%) and 162 M (36.8%). DP was higher than 10% in 55.2% of the P and M cases with onset less than 1 month before, in 42.8% of those with onset within the year and in 37.2% of those with onset more than a year before. A pathological response to the HST was observed (characterized by a series of at least 3 nystagmus shakes after a maximum latency of 15 seconds) in 0 N (0.0%), 378 P (52.8%), 4 C (1.8%) and 247 M (56.1%). The nystagmus seen was nearly always monophasic (92.5%), biphasic nystagmus was only seen in only a few cases (7.5%); moreover it was predominantly horizontal in nature (94.9%) while it was vertical in only a few of the C cases (5.1%). The HST proved pathological in 46.5% of those pathologies with onset less than 1 month before, in 55.8% of those with onset within the year and in 54.4% of those with onset more than a year before. In 213 of the cases presenting pathological response to the HST there was agreement between VOR DP at the pendular test and the direction of the nystagmus evoked by the HST: 138 P (74.6%), 0 C (0.0%), 75 M (68.2%): moreover there was no agreement in 83 cases. When the DP was lower than 10% at the pendular test, the HST proved pathological in 213 P (52.2%), 3 C (1.6%), 150 M (53.9%). Both tests gave negative results in 112 N (91.8%), 163 P (22.8%), 186 C (82.3%), 123 M (27.9%). In cases of peripheral vestibular deficit (P and M) the sensitivity of the rotoacceleration test was 40.7%, specificity 88.5%. The sensitivity of the HST was 54.1%, specificity 98.8%. The sensitivity of the association using both tests was 75.2%, specificity 85.7%.

Biophysical Phenomena↗
PubMed1999

Clusterin (SGP-2) gene expression is cell cycle dependent in normal human dermal fibroblasts.

In confluent human dermal fibroblasts brought to quiescence (G0) by serum starvation, the S phase peaked at 24 h after serum re-addiction and G2/M phase peaked at 36 h. This was confirmed by titration of h-gas1 mRNA (a marker of G0 phase) and histone H3 (a marker of S phase). Clusterin mRNA accumulation progressively increased in cells proceeding to confluence after seeding and to quiescence upon serum starvation, and peaked at around G0, in parallel with h-gas1 mRNA. At 6 h (roughly G1 phase) clusterin transcript formed a second peak, followed by a gradual decrease until 36 h. Correspondence of clusterin protein accumulation to its mRNA occurred solely with regard to the G0 peak but not to the second one. The possible meaning of the cell cycle related clusterin gene expression is discussed.

Blotting, Northern↗
PubMed1999

Long saphenous-vein grafts for extracranial and intracranial internal carotid aneurysms amenable neither to clipping nor to endovascular treatment.

BACKGROUND: In the treatment of patients with unclippable, uncoilable internal carotid artery aneurysms it may be necessary to use high-flow bypass grafts. The indications, surgical techniques and complications are discussed. METHODS: During a 12- year period, 20 saphenous vein grafts were performed in 20 patients. The 20 aneurysms were located in the prepetrous or intrapetrous internal carotid artery in 7 cases, the intracavernous in 9 and intracranial internal carotid artery in 4. All aneurysms were symptomatic. The vein graft was interposed between the internal carotid artery at the neck and the intrapetrous carotid, from the internal carotid artery at the neck to a branch of the middle cerebral artery, or from the external carotid artery and a branch of the middle cerebral artery, according to the collateral circulation assessed with a 30-minute the balloon test occlusion during electroencephalographic recording. RESULTS: Only one of the 20 grafts occluded. One patient died from a large postoperative cerebral infarction. One patient had cerebral ischemia with transient hemiparesis; and three patients had mixed aphasia that resolved completely within two weeks. Radiological follow-up monitoring was by magnetic resonance imaging, magnetic resonance angiography or digital angiography. Postoperative follow-up ranged from 1 to 12 years (mean 3.7 years). CONCLUSIONS: Our experience in this series suggests that the indications for cerebral revascularization should be widened, even to include patients with adequate collateral circulation, particularly those who have a long life expectancy.

Adult↗
PubMed1997

Visuomotor imagery and rehabilitation of neglect.

OBJECTIVE: To assess the effectiveness of visuomotor imagery training in the rehabilitation of unilateral neglect. DESIGN: Before-after trial. Behavioral analysis of single cases. SETTING: Neurologic rehabilitation unit of a university hospital. PATIENTS: Two patients with acquired brain injury who were suffering from severe and long-lasting unilateral neglect consequent to large lesions of cortical and subcortical right-brain. INTERVENTION: A behavioral training program consisting of visual and movement imagery exercises. Forty experimental sessions, each lasting 50 minutes, were delivered. MAIN OUTCOME MEASURES: Six neuropsychological tests evaluating unilateral neglect: seven "functional" tests assessing neglect behavior under daily life conditions; a questionnaire (filled out by the patients' relatives) concerning the patients' disability in the family context attributable to neglect. All the outcome measures were recorded at three different times: before, soon after, and 6 months after the end of the experimental training. RESULTS: The visuomotor "imagery training" ameliorated the deficit in performance related to neglect in both patients. All the outcome measures (neuropsychological and functional tests and the questionnaire) were positively influenced by the treatment. Moreover, the improvement was stable over a 6-month period, suggesting that the treatment had a long-term effect. CONCLUSIONS: The results show the possible effectiveness of a training method based on visuomotor imagery in diminishing impairment and functional disability associated with contralateral neglect.

Activities of Daily Living↗