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Biomedical subjects

J L Saver

Publications and source records attributed to J L Saver.

At least 55 records · Page 3Linked to original sources
PubMed1998

Multiple cerebral pseudoaneurysms and hemorrhages: the expanding spectrum of metastatic cerebral choriocarcinoma.

Cerebral metastases occur in 10-20% of patients with choriocarcinoma. Although single oncotic and pseudoaneurysms have been reported, multiple pseudoaneurysms and hemorrhages are rare. A 33-year-old woman developed 10 intracerebral hemorrhages over a 30-day period. Angiogram showed multiple focal areas of delayed contrast washout in distal vessels. Autopsy revealed intravascular choriocarcinoma without true aneurysm formation. A diagnosis of choriocarcinoma should be considered for women of childbearing age presenting with cerebrovascular syndromes, especially those found to have cerebral aneurysm pseudoaneurysm and/or hemorrhage.

Adult↗
PubMed1998

Homocysteine associated hypercoagulability and disseminated thrombosis--a case report.

The authors report the occurrence of vascular occlusion due to hyperhomocysteinemia without significant underlying atherosclerotic disease. This unique observation supports the potential of hyperhomocysteinemia to induce thrombosis and the independence of the thrombosis from hyperhomocysteinemia's associated atherosclerosis. The case demonstrates the clinical relevance of the effects of hyperhomocysteinemia on the coagulation cascade. A 42-year-old woman who lacked signs of classic homocystinuria developed disseminated thrombosis with a 24-hour urine homocysteine concentration of 384 mg, twelve times the upper limit of normal. Thrombosis was present in the aortic arch and its major branches and in the mesenteric arteries and veins. A fatal stroke resulted from the thrombosis. Autopsy revealed minimal atherosclerotic disease and no complicated plaques. This case demonstrates an expanded role of hyperhomocysteinemia in clinically significant vascular occlusion. Serum homocysteine concentration determination may be a factor in the evaluation of a hypercoagulable state. Hyperhomocysteinemia should be considered when evaluating arterial or venous thrombosis in a young person regardless of whether atherosclerosis or other signs of abnormal homocysteine metabolism are present.

Adult↗
PubMed1997

The neural substrates of religious experience.

Religious experience is brain-based, like all human experience. Clues to the neural substrates of religious-numinous experience may be gleaned from temporolimbic epilepsy, near-death experiences, and hallucinogen ingestion. These brain disorders and conditions may produce depersonalization, derealization, ecstasy, a sense of timelessness and spacelessness, and other experiences that foster religious-numinous interpretation. Religious delusions are an important subtype of delusional experience in schizophrenia, and mood-congruent religious delusions are a feature of mania and depression. The authors suggest a limbic marker hypothesis for religious-mystical experience. The temporolimbic system tags certain encounters with external or internal stimuli as depersonalized, derealized, crucially important, harmonious, and/or joyous, prompting comprehension of these experiences within a religious framework.

Epilepsy↗
PubMed1997

Pain after thalamic stroke: right diencephalic predominance and clinical features in 180 patients.

OBJECTIVE: To assess whether the thalamic pain syndrome of Dejerine-Roussy is produced preferentially by right diencephalic lesions and to elucidate its clinical features. BACKGROUND: Several experimental paradigms suggest that the right hemisphere is specialized for monitoring somatic states, including mediating pain. However, clinical studies of pain laterality have been inconclusive, possibly due to pathophysiologic diversity among analyzed patients. We collected reports of central pain laterality in a single, well-demarcated disorder, the Déjerine-Roussy syndrome. DESIGN/METHODS: Reports from English, French, and German literature were identified through Medline search and bibliography-guided retrieval. Inclusion criteria were (1) thalamic lesion documented by CT, MRI, or postmortem examination and (2) contralateral pain. Exclusion criteria were (1) tumoral/nonvascular etiology (to optimize anatomic localization), (2) symptoms consisting solely of evoked dysesthesia without spontaneous pain, or (3) sidedness of lesion not clearly indicated. Cases were analyzed for laterality as well as secondary anatomic and clinical variables. RESULTS: Literature search identified 274 cases. After exclusions, 180 remained. A total of 114 had a right-sided thalamic lesion, 66 left-sided (p < 0.001). Laterality predominance was greater among men than women. The frequency of other components of the Dejerine-Roussy syndrome--sensory impairment, hemiparesis, ataxia, and choreoathetosis--did not significantly differ between right and left groups. Pain onset was within the first week poststroke in 36%. Frequency of spontaneous pain was 14% after any thalamic stroke and 24% after geniculothalamic artery territory stroke. CONCLUSION: Right-sided lesions predominate among reported cases of the thalamic pain syndrome. This preferential involvement of the nondominant thalamus in pain processing is supportive evidence of a nondominant hemisphere specialization in monitoring somatic states.

Adolescent↗
PubMed1997

Delayed internal capsule infarctions following radiofrequency pallidotomy. Report of three cases.

The authors report on a series of patients with idiopathic Parkinson's disease (IPD) who underwent stereotactic radiofrequency (RF) pallidotomies, three of whom suffered delayed postoperative strokes. These three belonged to a group consisting of 42 patients with medically intractable IPD in whom 50 pallidotomies were performed. All three patients had significant previous vascular disease and were in a high-risk group for cerebral infarction. A postoperative magnetic resonance (MR) image was obtained immediately after the pallidotomy was performed to document the placement of the RF lesion and to rule out any hematoma. The delayed strokes occurred on postoperative Days 10, 51, and 117 in patients with previous vascular disease (Group 1, 11 patients). No strokes occurred in the group with the vascular disease risk factor (Group 2, 11 patients) or in the group with no risk factors for vascular disease (Group 3, 20 patients). This observation is statistically significant (p < 0.05). The T2-weighted MR images showed the lesions as high-intensity signals extending to the posterior limb of the internal capsule ipsilateral to the pallidotomy site. The poststroke T1-weighted images obtained in two patients showed persistent contrast enhancement of the RF lesion and no enhancement around the stroke lesion. Clinically and radiographically, these discrete new lesions represent delayed infarctions, suggesting that RF lesioning can induce delayed injury in adjacent tissue. Patients with previously identified vasculopathy may be at risk for delayed capsular infarction following RF pallidotomy.

Adult↗
PubMed1996

The size of subcortical ischemic infarction in patients with and without diabetes mellitus.

Diabetes mellitus is associated with a higher frequency and poorer outcome of ischemic stroke. Determinants of the poorer prognosis of stroke in patients with diabetes are not well defined. We investigated whether size of cerebral infarction differs in patients with and without diabetes mellitus. We compared ischemic lesions in 41 consecutive stroke patients with subcortical infarction-22 with and 19 without diabetes mellitus. The location and size of the ischemic infarct were derived from magnetic resonance images obtained on day 3 or 4 post stroke onset. Cross-sectional infarct area was determined by direct measurement from film. The age of patients was similar in both groups. Patients with diabetes had higher prevalence of arterial hypertension, and previous stroke, and higher admission triglyceride and glucose levels compared to patients without diabetes. We found no significant difference in the size of ischemic lesions in patients with and without diabetes mellitus (1.87 vs. 1.72 cm2, respectively). We conclude that among patients with subcortical ischemic stroke the size of infarction is not different between patients with and without diabetes mellitus.

Aged↗
PubMed1995

Cervical (C2) herpes zoster infection followed by pontine infarction.

This article reports a man who had herpes varicella zoster cervicalis with delayed stroke in the posterior circulation. Empiric treatment was acyclovir, methylprednisolone, and aspirin. Pontine infarction involving migration of the virus via cervicovascular innervation from C2 dorsal root ganglia to the vertebrobasilar circulation with attendant angiitis/angiopathy and thrombosis is proposed.

Basilar Artery↗
PubMed1995

Coping with an embarrassment of riches. How stroke centers may participate in multiple, concurrent clinical stroke trials.

BACKGROUND: The recent remarkable proliferation of multicenter clinical trials investigating novel treatments for acute ischemic stroke has created a new dilemma for stroke investigators. Promising agents and trials are many, competent clinical centers few. May a single clinical center, without scientific bias, participate in multiple, concurrent clinical trials recruiting overlapping populations of subjects with acute stroke? SUMMARY OF COMMENT: Many clinical stroke centers already participate in multiple overlapping trials. I delineate a variety of patient-allotment strategies that are presently used, although often not explicitly stated. Methods include assignment by time window, unique criteria, site, belief in agent efficacy, remuneration, and quota urgency. All have drawbacks, chiefly the introduction of bias into the selection of subjects for clinical trials, compromising the generalizability of trial findings to broader clinical populations. Several solutions are proposed that permit single centers to participate in multiple studies while minimizing or eliminating selection bias, including within-center use of a permuted-block enrollment strategy. The issue of trial allocation among multiple available studies has received insufficient attention from clinical trial designers, epidemiologists, and statisticians. Currently an inescapable problem for clinical stroke investigators, it arises in any clinical medical research field with rapid basic-to-clinical scientific advances. CONCLUSIONS: It is recommended that centers participating in multiple, concurrent clinical trials (1) use an articulated, formal method of patient allocation that is blinded or indifferent to clinical variables; (2) avoid assignment solely according to time since onset or unique patient criteria; and (3) avoid any influence of belief in agent efficacy on allocation.

Acute Disease↗
PubMed1995

Ischemic cerebrovascular disease and hormone therapy for infertility and transsexualism.

To highlight an emerging risk factor for stroke in the young, we report two patients who experienced ischemic cerebrovascular symptoms in unusual clinical settings of hormone therapy. Expanding indications for estrogenic therapy, including infertility and gender identity disorders, may constitute an emerging risk factor for ischemic stroke in young individuals.

Adult↗
PubMed1993

Asymmetric catalepsy after right hemisphere stroke.

We describe the appearance of left hemineglect and striking cataleptic posturing, more prominent in left-sided extremities, in a patient without psychiatric illness. Neuroimaging demonstrated a large posterior right hemisphere infarct involving the parietal, occipital, and temporal lobes, the insula, and caudate. Additional movement abnormalities that comprise the full catatonia syndrome were absent, including stereotypy, mannerisms, ambitendency, automatic obedience, mutism, negativism, and echopraxia. Catatonia has been reported to be produced by lesions of diverse etiology affecting the frontal lobe, limbic system, diencephalon, or basal ganglia. In these cases, catalepsy has been manifest only rarely, and motor signs that are present are generally bilateral. This case demonstrates that asymmetric catalepsy can be produced by right hemisphere stroke, and provides partial support for earlier clinical literature relating catalepsy and the parietal lobe.

Aged↗
PubMed1993

Unilateral amnesic stroke. Six new cases and a review of the literature.

BACKGROUND AND PURPOSE: Although persistent amnesia due to bilateral limbic system infarction is well described, reports of amnesic syndromes due to unilateral stroke have appeared infrequently and unsystematically. We report six new cases and review previously published reports to expand and consolidate knowledge regarding amnesic stroke. CASE DESCRIPTIONS: Six patients developed acute amnesia associated with unilateral stroke. Brain computed tomography or magnetic resonance imaging revealed lesions in limbic structures, which accounted for the memory deficit. Based on these as well as similar cases in the literature, we delineate three distinct syndromes of unilateral amnesic stroke involving the territories of the posterior cerebral, anterior choroidal, and thalamic penetrating arteries. Eighty-five percent of reported cases have involved the left hemisphere. CONCLUSIONS: Persistent as well as transient amnesia may be the sole or primary manifestation of unilateral hemispheric stroke. The vascular mechanisms of amnesic stroke are diverse. Patients presenting with acute amnesia possibly related to cerebral ischemia should be classified by documented or presumed lesion site as well as the involved vascular territory. Left amygdalohippocampal or diencephalic dysfunction may produce a particular vulnerability to global amnesia.

Adult↗