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PubMed1988

Nontraumatic frontal lobe hemorrhages: clinical-computed tomographic correlations.

Correlation of lesion location and appearance with clinical sequelae in 25 patients with CT-proven frontal lobe hematomas reveals 10 of 25 hematomas were located above the frontal horns of the lateral ventricles. Nine of the 10 patients were normotensive. All presented with contralateral motor and sensory deficits. Four of 25 hematomas were situated inferior to the frontal horns. All these patients were hypertensive, rapidly became comatose and exhibited hemiplegia, hemianesthesia and gaze preference contralateral to the hemiplegia. Five patients had frontal hematomas which extended inward from the interhemispheric fissure or caval-septal region. All were normotensive. All had anterior cerebral-anterior communicating artery aneurysms on angiography. Four patients had hematomas involving both the frontal and temporal region. All were normotensive with no known cause for hemorrhage. Two patients had bifrontal hematomas; one had butterfly appearance extending across the interhemispheric fissure and the other was midline but had no interhemispheric blood. Both were normotensive. One had an anterior cerebral-anterior communicating artery aneurysm.

Adult↗

PubMed1999

Effectiveness of sensory stimulation on tactile extinction.

Eleven brain-damaged patients with extinction were asked to report double tactile stimuli before, during, and after optokinetic stimulation and transcutaneous electrical stimulation of the posterior neck region. The goal of the study was to test whether tactile extinction is sensitive to these experimental manipulations in order to better understand the nature of the disorder. Both of these sensory stimulations are known to be effective in modulating only higher-order (cognitive) disorders of spatial coding, such as visual hemineglect, deficit of position sense, hemianesthesia, etc. When applied to the side contralateral to the cerebral lesion, both optokinetic and transcutaneous electrical stimulation significantly affected patients' performances, increasing the amount of detections of contralesional double stimuli. A tendency towards worse performance was observed when sensory stimulation was applied to the ipsilesional side. The reported effectiveness in reducing tactile extinction suggests that the deficit can not be fully ascribed to a peripheral sensory disorder and that it reflects damage to a higher-order cognitive function involved in contralesional space representation or in the deployment of attention to that side of space. The nature of the close relationship between extinction and hemineglect is also discussed from the point of view of extinction as a deficit of space coding.

Aged↗

PubMed2004

MRI of hyperacute stroke in the AChA territory.

The purpose of our study was to derive from the anatomical literature an easy-to-use map of the brain areas supplied by the anterior choroidal artery (AChA) and to assess the correspondence between damage within the putative AChA areas and clinical symptoms. A thorough review of the literature led to the recognition of 16 anatomical areas which could be delineated on routine diffusion-weighted MR images. A database of 138 consecutive ischemic stroke patients examined with MRI less than 6 h after symptoms onset was thereafter processed in a retrospective way. Patients presenting with at least one damaged AChA area were selected so as to assess the prevalence of AChA infarction and the clinical correlates of the condition. Fifteen patients (11%) had at least one damaged AChA area. Only two of them had "pure" AChA-restricted infarction. Contralateral hemiparesis and contralateral hemianesthesia were best predicted by lesions within the tail of the caudate nucleus with a sensitivity of 87% and 83%, respectively. Homonymous hemianopsia best correlated with lesions within the posterior limb of the internal capsule and within the retrolenticular part of the internal capsule, with a sensitivity of 100% and a specificity of 70% for both areas. We concluded that the clinical-radiological correlations did not match the neurophysiological standards, thereby highlighting the limitation of this study, which involved a cohort of acute stroke patients recruited from clinical practice and investigated the clinical impact of these brain lesions, even when documented with the most sensitive imaging modality.

Acute Disease↗

PubMed1983

Neural generators of N18 and P14 far-field somatosensory evoked potentials studied in patients with lesion of thalamus or thalamo-cortical radiations.

Somatosensory evoked potentials (SEPs) to electrical stimulation of the right or left median nerve were studied in 4 patients with hemianesthesia and a severe thalamic or suprathalamic vascular lesion on one side. The SEPs were recorded with a non-cephalic reference. The normal side of each patient served as his or her own control. The lesion consistently abolished the parietal N20-P27-P45 and the prerolandic P22-N30 SEP components. It did not significantly affect the P9-P11-P14 positive far fields, nor the widespread bilateral N18 SEP component. This allowed N18 features to be studied without interference from cortical components. It is proposed that N18 reflects several deeply located generators in brain stem and/or thalamus whereas N20 represents the earliest cortical response of the contralateral post-central receiving areas.

Brain Mapping↗

PubMedDate not supplied

Thalamic bleeding: clinico-computed tomographic correlations.

A series of 22 patients with thalamic bleeding with CT confirmation is reported. Sixteen patients had hypertension and 7 experienced headaches and vomiting. Twenty patients had hemiparesis, and 14 had hemianesthesia. More than half the cases had hematomas in the posterior thalamus. Twenty-one had hematomas less than 3 cm. No patient displayed the characteristic pupil signs. One patient died and mortality rate was 4.5% (died from respiratory arrest). None of the 7 patients who had ventricular rupture died, indicating that the prognosis of the patients may not be affected by the ventricular extension.

Adult↗

PubMed1976

Transient ischemic attacks: Pathophysiology and medical management.

There is substantial evidence to support the concept that most transient ischemic attacks (TIAs) are caused by microemboli that originate in areas of atherosclerosis in the blood vessels of the neck. TIA's are important risk factors in the development of stroke. The most common clinical features of TIAs caused by carotid insufficiency are hemianesthesia and hemiparesis; other symptoms in these cases include headache, dysphasia, and visual field distrubance. By far the most common clinical manifestation of vertebrobasilar insufficiency is vertigo.

Anti-Inflammatory Agents↗

PubMed2002

Feeling touches in someone else's hand.

Cerebral damage may induce a delusional belief so that patients claim that their limbs contralateral to the side of the lesion belong to someone else (somatoparaphrenia). This disorder, which is not due to a general delirium, is frequently accompanied by the inability to feel tactile sensations in the 'non-belonging' part of the body. We report the unique case of a patient with somatoparaphrenia in whom dense tactile imperception in the left hand dramatically recovered when she was instructed to report touches delivered to her niece's hand, rather than to her own hand. We suggest that, through this verbal instruction, the mismatch between the patient's belief about the ownership of her left hand and her ability to perceive touch on it was transiently recomposed. This is evidence that apparently elementary deficits, such as hemianesthesia, and selective delusional behavior, such as somatoparaphrenia, may both originate from an impairment of the body image.

Aged↗

PubMed1988

Amnesia following thalamic hemorrhage. Another stroke syndrome.

The clinical manifestations of thalamic hemorrhage frequently comprise hemiparesis, hemianesthesia, and oculomotor abnormalities. Since the advent of computed tomography, an amnestic syndrome following thalamic hemorrhage has been recognized, but the thalamic structures involved and the mechanism of amnesia have remained uncertain. We report a patient with sudden memory dysfunction following hemorrhage into the anterior nucleus of the left thalamus that was shown neuropathologically to disrupt the mamillothalamic fasciculus, one of the principal components of the limbic system. It is considered that the amnestic syndrome following thalamic (anterior nucleus) hemorrhage is due to interruption of the mamillothalamic fasciculus.

Amnesia↗

PubMed1995

Massive infarcts involving the territory of the anterior choroidal artery and cardioembolism.

BACKGROUND AND PURPOSE: At neuropathological examination, the territory of the anterior choroidal artery is frequently found to be involved in massive infarcts of the internal carotid artery territory. The aim of our study was to analyze the clinical spectrum, the course, and the mechanism of these massive infarcts compared with the rare infarcts involving only the anterior choroidal artery territory. METHODS: Retrospective clinical examination and pathological study were performed in 35 patients with cerebral infarcts affecting at least the territory of the anterior choroidal artery. RESULTS: In no patient had the involvement of the anterior choroidal territory infarcts been recognized clinically, nor had the triad of clinical signs (hemiplegia, hemianesthesia, and hemianopsia) classically seen in infarcts restricted to this territory been found alone. Impairment of consciousness, cognitive disorders, or oculomotor palsies had been found in addition to one or more signs of the triad. This was probably related to the involvement of other territories (94%), especially the middle cerebral artery territory (68%) and the posterior cerebral artery territory (20%). The concomitant involvement of several territories was due most frequently to an occlusion of the internal carotid artery, which was found at autopsy in 74% of the patients. These occlusions were often associated with cardioembolism (54%). In contrast, artery-to-artery embolism (17%) and small-artery disease (6%) were seldom found. Only two cases of infarcts restricted to the anterior choroidal artery territory were observed. CONCLUSIONS: The involvement of the territory of the anterior choroidal artery in massive infarcts was due mainly to a cardioembolic occlusion of the internal carotid artery.

Aged↗

PubMed2006

Neural correlates of modality-specific spatial extinction.

Sites of lesions responsible for visual, tactile, and/or motor extinction have not been clearly identified. We sought to determine the frequency of extinction in various modalities immediately after acute ischemic stroke, the rate of co-occurrence of extinction across modalities, and areas of infarct and/or hypoperfusion associated with each modality of extinction. A total of 148 patients with right supratentorial stroke were studied. In Study 1, 88 patients without hemiplegia, hemianesthesia, or visual field cuts were tested within 24 hours of onset for visual, tactile, and motor extinction, and underwent magnetic resonance diffusion and perfusion imaging. Associations between modality of extinction and areas of neural dysfunction (hypoperfusion/infarct) were identified. Of the 88 patients, 19 had only tactile extinction, 8 had only visual extinction, 12 had only motor extinction, 14 had extinction in two or more modalities, and 35 had no extinction. Tactile extinction was associated with neural dysfunction in the inferior parietal lobule; visual extinction was associated with dysfunction in the visual association cortex; and motor extinction was associated with neural dysfunction in the superior temporal gyrus. In Study 2, data from 60 patients who were excluded from Study 1 because of motor deficits were analyzed in the same way to determine whether frontal lesions contributed to visual or tactile extinction. Results again demonstrated that tactile extinction is associated with inferior parietal dysfunction, and visual extinction is associated with dysfunction of the visual association cortex. Potential accounts of the results, based on the "hemisphere rivalry" model of extinction and the limited attentional capacity model, are considered.

Aged↗

PubMed2005

Etomidate speech and memory test (eSAM): a new drug and improved intracarotid procedure.

BACKGROUND: The intracarotid amobarbital procedure (IAP) is an important part of comprehensive investigation of patients who are candidates for surgical treatment of epilepsy. Owing to repeated and lengthy shortages of amobarbital, causing delays in elective surgery, attempts have been made to find a suitable alternative anesthetic. The authors report their experience using etomidate, a widely used agent for the induction of anesthesia. METHODS: Sixteen consecutive patients requiring IAP to evaluate memory or to lateralize speech underwent the procedure using etomidate. Prior to the procedure a catheter was placed in the internal carotid artery and an angiogram was performed. EEG was recorded and read online by an electroencephalographer. An anesthetist injected the drug, administered by bolus followed by an infusion, which was maintained until each speech measure had been sampled and new memory items had been introduced. The infusion was then stopped and testing continued as in a standard IAP. RESULTS: In all cases (30 hemispheres) contralateral hemiplegia followed injection. EEG slow waves were observed in every injected hemisphere, with some contralateral slowing anteriorly in 18. Global aphasia with preserved attention and cooperation followed dominant-hemisphere injections. These phenomena remained during infusion, and upon its termination returned gradually to baseline over a period of about 4 minutes. CONCLUSIONS: Etomidate is a viable alternative to amobarbital, and its administration by bolus followed by infusion offers an improvement over the traditional intracarotid amobarbital procedure. Cognitive tests can be performed during an assured hemianesthesia of the injected hemisphere.

Adolescent↗

PubMed1986

Opticosensory ataxia and alien hand syndrome after posterior cerebral artery territory infarction.

A right-handed woman developed left homonymous hemianopia and left hemianesthesia from infarction due to right posterior cerebral artery occlusion. Ataxia of the left arm and leg was severe and was not improved by vision. The patient often interpreted spontaneous movements of the left arm as alien in origin. The ataxia may have been caused by a combination of sensory ataxia, resulting from right thalamic infarction, and crossed-optic ataxia, resulting from posterior disconnection of the hemispheres due to right temporo-occipital infarction. This opticosensory ataxia was associated with a new form of "alien hand" syndrome.

Aged↗

PubMed1993

Surgical treatment of thalamic arteriovenous malformations.

The microsurgical excision of arteriovenous malformations located in the thalamic region in eight patients is reported. Six were located in the posterior aspect of the thalamus and two were located in the anterior. Hemorrhage occurred in all of the cases. Hemiparesis, hemianesthesia, and consciousness disturbance were the most typical clinical features. The supine position with the anterior transcallosal approach was used for anterior dorsal lesions, and the sitting position with the posterior interhemispheric approach was used for posterior dorsal lesions. Total removal was confirmed by angiography in seven patients, and incomplete removal was noted in one patient. There was one death in this group of patients. Memory disturbance was the most common postoperative complication. This complication showed considerable improvement with time. Other complications included homonymous hemianopsia (three patients), hemisensory loss (six patients), and transient hemiparesis (one patient). All survivors (seven patients) were able to return to their occupation after surgery. The vascular input, the location of the malformation, and clinical history are the contributory factors concerning operability. With the modern neurosurgical and anesthesiological facilities, surgical removal of thalamic malformations in selected cases is advisable.

Adolescent↗

PubMed2004

Temporary balloon occlusion of the cavernous carotid artery for removal of an orbital and intracranial foreign body: case report.

OBJECTIVE AND IMPORTANCE: We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. CLINICAL PRESENTATION: A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. INTERVENTION: Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1-V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. CONCLUSION: Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.

Adult↗

PubMed1984

[Progressive facial hemiatrophy: report of a case].

The authors report a case of Parry-Romberg disease with predominantly facial left atrophy, seizures, amnesic aphasia, mental retardation, right hemiplegia and hemianesthesia, and cerebellar syndrome. The rarity of cerebellar atrophy (only one case thus far reported in the literature surveyed) is emphasized, as well as the correlation between the clinical abnormalities and the computerized axial tomography of the skull.

Adult↗

PubMed1998

Surgical techniques for arteriovenous malformations in functional areas: focus on the superior temporal gyrus.

Direct surgical intervention of arteriorvenous malformations (AVMs) in functional areas has been accepted as a standard mode of treatment. However, safe and successful intervention requires that such factors as exact location, size, vascular supply, and drainage be considered. Importantly, surgical techniques must be individualized to each patient, based on hemodynamic anatomy of the AVM. This paper discusses AVMs in the superior temporal lobe, which have a complex neuronal anatomy and circulatory system; the authors present 22 patients with AVMs of various sizes and describe the surgical techniques specific for the indicated location. Surgical procedures adhered to the following principles: 1) avoid brain tissue removal; 2) preserve microcirculation; 3) maintain circulation of the isolated major draining vein to access the AVM core; 4) compartmental isolation; and 5) preservation of functional area cortex covering the AVM. All patients underwent total resection except one, who had a subtotal resection. Neurological and occupational recovery was remarkable except for partial hemianesthesia in one patient; two patients are still in rehabilitation. This is the first description of a direct surgical approach to AVMs in the superior temporal gyrus, where management is challenging because the lesions may extend elsewhere, such as to Broca's and Wernicke's areas. The results suggest that the procedure is promising.

Adolescent↗

PubMed1987

Surgical treatment of arteriovenous malformations of the striatothalamocapsular region.

Sixteen patients with arteriovenous malformations (AVM's) located in the striatothalamocapsular region were treated microsurgically at the Hau Shan Hospital, Shanghai. These AVM's had a tendency to bleed intracerebrally and typically presented with hemiplegia, hemianesthesia, and hemianopsia. Angiographically the lesions were primarily located in the triangle of Reil. Postoperative outcome was not as good as that of AVM's in other locations, but the operation may have prevented the risk of further hemorrhage. This report details the operative technique used and the clinical course in this group of patients.

Adolescent↗

PubMed1989

Two cases of anterior choroidal artery territory infarction.

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequently observed in the thalamus, midbrain, temporal lobe, and lateral geniculate body (LGB) territories of the AChA. The most common clinical finding is hemiparesis. Hemianesthesia may be severe at onset but is usually transient. Homonymous hemianopia, upper-quadrant anopia, or upper- and lower-quadrant sector anopia can be present. Occasionally these patients are reported to have transient abnormalities of higher cortical function. The most common stroke mechanism is known to be small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients. Vasospasm due to ruptured aneurysm or intraoperative mechanical manipulation, and cardiac origin the AChA territory. The infarct lesion is usually recognized and diagnosed by computed tomography. The best treatment is still unknown.

Aged↗