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1.
Eur J Neurol ; 20(11): 1431-9, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23837733

ABSTRACT

BACKGROUND AND PURPOSE: Risk factors for IS in young adults differ between genders and evolve with age, but data on the age- and gender-specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15 European stroke centers. METHODS: Stroke etiology was reported in detail for 3331 patients aged 15-49 years with first-ever IS according to Trial of Org in Acute Stroke Treatment (TOAST) criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-vessel occlusion (SVO), other determined etiology, or undetermined etiology. CE was categorized into low- and high-risk sources. Other determined group was divided into dissection and other non-dissection causes. Comparisons were done using logistic regression, adjusting for age, gender, and center heterogeneity. RESULTS: Etiology remained undetermined in 39.6%. Other determined etiology was found in 21.6%, CE in 17.3%, SVO in 12.2%, and LAA in 9.3%. Other determined etiology was more common in females and younger patients, with cervical artery dissection being the single most common etiology (12.8%). CE was more common in younger patients. Within CE, the most frequent high-risk sources were atrial fibrillation/flutter (15.1%) and cardiomyopathy (11.5%). LAA, high-risk sources of CE, and SVO were more common in males. LAA and SVO showed an increasing frequency with age. No significant etiologic distribution differences were found amongst southern, central, or northern Europe. CONCLUSIONS: The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.


Subject(s)
Brain Ischemia/etiology , Stroke/etiology , Adolescent , Adult , Brain Ischemia/epidemiology , Europe/epidemiology , Female , Humans , Male , Middle Aged , Stroke/epidemiology , Young Adult
2.
Scott Med J ; 54(1): 4-6, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19291926

ABSTRACT

BACKGROUND AND AIMS: To evaluate the effect of local corticosteroid injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of carpal tunnel syndrome (CTS), 32 patients were included in this study. METHODS: A prospective, randomised clinical trial, assessing functional findings by Functional Status Scale (FSS), (JTT) Jebsen Taylor Test and electrophysiologic examinations, analysed on initial visit and at the third month after treatment. Group A was treated with betamethasone injection and group B with NSAIDs, both with concomitant use of wrist splints. RESULTS: The mean age of the patients was 40.8 +/- 11.2 (range 21-64) years. There was a significant improvement in FSS in groups A and B at the third month. In JTT, 'writing', 'picking up small common objects' and 'picking up large heavy objects' activities were improved in group A; 'writing' and 'stacking checkers' activities were improved in group B. Statistically significant improvement was observed in peak sensory conduction velocity and distal motor latency in groups A and B. Mixed nerve conduction velocity and compound sensory action potential were improved in group A. CONCLUSIONS: The results showed that neither of the groups demonstrated superior results. We conclude that local steroid injection and NSAIDs with concomitant use of wrist splints may offer patients with CTS variable and effective treatment options for the management of functional scores and nerve conduction parameters.


Subject(s)
Anti-Inflammatory Agents/administration & dosage , Betamethasone/administration & dosage , Carpal Tunnel Syndrome/drug therapy , Glucocorticoids/administration & dosage , Action Potentials , Adult , Cohort Studies , Female , Humans , Injections, Intra-Articular , Middle Aged , Neural Conduction , Recovery of Function , Splints , Treatment Outcome
3.
J Neurol ; 256(7): 1134-42, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19280104

ABSTRACT

Cerebral venous thrombosis (CVT) is caused by various etiologies. In Mediterranean and Middle Eastern countries, Behçet's disease (BD) is one of the leading causes of CVT. We aimed to evaluate any differences in CVT patients with and without BD. All registered patients with CVT were evaluated retrospectively. Clinical, neuroradiological findings and follow-up data were compared between patients with BD and patients with other etiologies. There were 36 patients with CVT and BD, and 32 patients with CVT related to other etiological causes. BD patients were younger (median age at onset 26 vs. 39 years; P < 0.001), and there was a male preponderance (28 males, 8 females) as compared to the non-BD group (10 males, 22 females; P < 0.001). Onset was frequently acute in the non-BD group, and it was subacute or chronic in the BD group. Hemi/quadriparesis, aphasia and seizures were significantly more common (P < 0.001) in the non-BD group. In the BD group 94% of the patients presented with symptoms of isolated intracranial hypertension (P < 0.001). Venous infarcts were observed in 63% of the patients with other causes and in 6% of the patients with BD (P < 0.001). At admission 97% of the patients in the BD group and 41% of the patients in the non-BD group had a modified Rankin score of 0-2. Outcome was good in all of the patients with BD and in 91% of patients with other causes. Clinical recurrences were seen in six patients with BD and in one patient without BD. CVT associated with BD has a subacute onset, mostly presents with signs of isolated intracranial hypertension and venous infarction rarely develops; these features distinguish CVT due to BD from those with other causes.


Subject(s)
Behcet Syndrome/epidemiology , Behcet Syndrome/physiopathology , Cerebral Veins/physiopathology , Venous Thrombosis/epidemiology , Venous Thrombosis/physiopathology , Adolescent , Adult , Aged , Aphasia/epidemiology , Aphasia/physiopathology , Child , Comorbidity , Disability Evaluation , Female , Humans , Intracranial Hypertension/epidemiology , Intracranial Hypertension/physiopathology , Male , Middle Aged , Paresis/epidemiology , Paresis/physiopathology , Retrospective Studies , Severity of Illness Index , Young Adult
5.
J Neurol ; 250(11): 1363-9, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14648154

ABSTRACT

INTRODUCTION: Few studies have tested the hypothesis of whether the beneficial effect of Stroke Units (SUs) can be reproduced in routine clinical practice and whether SU are also superior to neurological wards [NWs]. We aimed to compare the outcomes of patients of a newly implemented SU to the outcomes of patients hospitalized in a NW. METHODS: We made a before-after comparison of 352 SUs and 352 NWs patients after adjusting for case-mixes by the multivariate method. Subgroup analyses were also performed to evaluate which patient groups benefit the most. In-hospital case-fatality, proportion of independent patients at discharge, length of hospital stay (LOHS), medical complication rate were the main outcome measures. RESULTS: Adjusted in-hospital case fatality was significantly reduced in the SUs (OR: 0.44, 95 % CI: 0.26-0.76; p = 0.003). The proportion of independent patients at discharge and patients having medical complications was not different. Length of hospital stay was shorter in SU patients (13.76 days vs. 16.72 days, p = 0.003). Treatment in the SUs decreased case fatality in many subgroups [men, elderly, early admitted, severe stroke, co-morbidity present and ischemic stroke groups]. DISCUSSION: The results of randomized trials in favor of SUs can be reproduced in routine clinical practice. The benefit of SU care seems to be more apparent with advancing age and increasing stroke severity. Stroke Unit seems to be a better alternative to an experienced NW.


Subject(s)
Activities of Daily Living , Hospital Units , Outcome Assessment, Health Care , Stroke/mortality , Aged , Female , Humans , Length of Stay/statistics & numerical data , Male , Neurology/standards , Regression Analysis , Stroke/therapy , Treatment Outcome
6.
Cerebrovasc Dis ; 12(4): 346-8, 2001.
Article in English | MEDLINE | ID: mdl-11721107

ABSTRACT

Deep hemispheric or brainstem small infarcts can lead to atypical lacunar syndromes. Unilateral internuclear ophthalmoplegia (INO) and cerebellar ataxia has not been reported previously. A 57-year-old hypertensive female presented with bilateral appendicular and left truncal cerebellar ataxia and right INO. Cranial MRI showed a right paramedian infarct of lacunar size located in the tegmentum of caudal mesencephalon. At this level the involvement of medial longitudinal fascicle (MLF) led to right INO and the lesion of brachium conjunctivum caused the bilateral cerebellar ataxia. Ipsilateral involvement of both cerebellofugal fibers, before and after decussation, was responsible for bilateral cerebellar ataxia.


Subject(s)
Brain Infarction/complications , Cerebellar Ataxia/etiology , Cerebellar Ataxia/pathology , Ocular Motility Disorders/etiology , Ocular Motility Disorders/pathology , Brain Infarction/pathology , Female , Humans , Magnetic Resonance Imaging , Mesencephalon/pathology , Middle Aged
7.
J Neuroimaging ; 11(4): 425-31, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11677884

ABSTRACT

The authors describe 2 cases of posterior fosa venous infarction. A 56-year-old woman with essential thrombocytemia presented with fluctuating complaints of headache, nausea, vomiting, left-sided numbness-weakness, and dizziness and became progressively stuporous. Cranial magnetic resonance imaging (MRI) showed bilateral parasagittal fronto-parietal and left cerebellar contrast-enhancing hemorrhagic lesions. On magnetic resonance venography, the left transverse and sigmoid sinuses were occluded. The second patient, a 39-year-old woman, presented with acute onset of diplopia, numbness of the tongue, vertigo, and right-sided weakness following a gestational age stillbirth. MRI revealed lesions in the right half of midbrain and pons and in the superior part of the right cerebellar hemisphere. Digital subtraction angiography showed right transverse and sigmoid sinus occlusion. The authors suggest that one should investigate the possibility of venous infarction in the presence of posterior fossa lesions that are often hemorrhagic and are not within any arterial territory distribution but respect a known venous drainage pattern. Recognition of the observed clinical and neuroimaging features can lead to earlier diagnosis and, potentially, more effective management.


Subject(s)
Brain Stem Infarctions/diagnosis , Cerebellar Diseases/diagnosis , Cerebral Infarction/diagnosis , Diagnostic Imaging , Adult , Brain Stem/blood supply , Brain Stem Infarctions/etiology , Cerebellar Diseases/etiology , Cerebellum/blood supply , Cerebral Infarction/etiology , Contrast Media , Diagnosis, Differential , Female , Humans , Middle Aged
8.
Eur J Neurol ; 8(6): 719-22, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11784360

ABSTRACT

INTRODUCTION: Behçet's disease (BD) is a multisystemic, recurrent, inflammatory disorder. Neurological involvement is well-known but cerebral vasculitis and ischaemic stroke are unusual. CASE DESCRIPTION: A 43-year-old male patient presented with acute left hemiparesis, he had recurrent oral aphthae and scrotal ulcerations. Two episodes of transient brainstem ischaemia and an episode of right hemiparesis were reported in the past 2 years. Cranial magnetic resonance (MR) imaging showed a right striatocapsular infarction and multiple segmental stenosis, fusiform enlargement and beading of the arteries of the polygone of Willis were seen on angiography. Cerebro-spinal fluid (CSF) examination disclosed lymphocytic pleocytosis. Skin pathergy test was positive. A diagnosis of BD with cerebral vasculitis was made and immunosuppressive therapy was started. Some improvement of the arterial lesions on MR angiography and normalization of CSF were observed after 1 year of treatment. DISCUSSION: Low grade chronic meningo-encephalitis is the core neuropathological process in neuro-Behçet's disease. Nevertheless BD is a systemic disease known to cause vasculitis and can exceptionally lead to cerebral vasculitis and brain infarction. While BD is usually not part of the differential diagnosis of cerebral vasculitis, it should be borne in mind especially in endemic areas of the disease and in patients from these areas.


Subject(s)
Behcet Syndrome/complications , Brain Ischemia/etiology , Stroke/etiology , Vasculitis, Central Nervous System/etiology , Adult , Brain Ischemia/diagnosis , Cerebral Angiography , Humans , Male , Stroke/diagnosis , Vasculitis, Central Nervous System/diagnosis
9.
Seizure ; 6(6): 487-93, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9530947

ABSTRACT

Congenital bilateral perisylvian syndrome (CBPS) is a recently described, neuronal migration disorder, characterized by pseudobulbar palsy, epilepsy and mental retardation and bilateral perisylvian dysplasia. A 15-year-old boy was diagnosed with CBPS according to the typical clinical, and magnetic resonance imaging (MRI) features. The patient was suffering from atypical absence seizures, repeating daily in spite of antiepileptic drug therapy, since age 7 years. He had also experienced rare generalized tonic-clonic seizures and complex partial seizures. Neurological examination showed severe restriction of tongue movements, severe dysarthria, dysphagia, facial diplegia, mild pyramidal signs and moderate mental retardation. A computed tomographic (CT) scan demonstrated bilateral perisylvian enlargement. The diagnosis was corrected with MRI after six years. Frequent irregular generalized spike and wave abnormalities and focal sharp and slow waves over the posterior regions of both hemispheres were shown by electroencephalograms (EEG). The patient was treated with Na-Valproate, carbamazepine and lamotrigine but did now show any significant change in seizure frequency in the eight-year follow-up period. Intractable seizures, mental retardation and particularly congenital pseudobulbar palsy suggest this congenital entity. Those patients who exhibit these typically clinical features, must have MRI.


Subject(s)
Brain Damage, Chronic/congenital , Cerebral Aqueduct/abnormalities , Dominance, Cerebral/physiology , Electroencephalography , Epilepsy/congenital , Paralysis/congenital , Adolescent , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/physiopathology , Cerebral Aqueduct/physiopathology , Epilepsy/diagnosis , Epilepsy/physiopathology , Epilepsy, Complex Partial/congenital , Epilepsy, Complex Partial/diagnosis , Epilepsy, Complex Partial/physiopathology , Epilepsy, Tonic-Clonic/congenital , Epilepsy, Tonic-Clonic/diagnosis , Epilepsy, Tonic-Clonic/physiopathology , Evoked Potentials/physiology , Follow-Up Studies , Humans , Intellectual Disability/diagnosis , Intellectual Disability/physiopathology , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Paralysis/diagnosis , Paralysis/physiopathology , Syndrome , Tomography, X-Ray Computed
10.
Neuroradiology ; 38(7): 636-40, 1996 Oct.
Article in English | MEDLINE | ID: mdl-8912318

ABSTRACT

Subacute sclerosing panencephalitis (SSPE) is a progressive, slow virus infection of the brain, caused by the measles virus, attacking children and young adults. We investigated 15 patients with SSPE by MRI, with 5 normal and 10 pathological results. In the early period, lesions were in the grey matter and subcortical white matter. They were asymmetrical and had a predilection for the posterior parts of the hemispheres. Later, high-signal changes in deep white matter and severe cerebral atrophy were observed. Parenchymal lesions significantly correlated with the duration of disease. A significant relationship between MRI findings and clinical stage was observed in the 1st year of the disease.


Subject(s)
Magnetic Resonance Imaging , Subacute Sclerosing Panencephalitis/diagnosis , Adolescent , Adult , Brain/pathology , Cerebral Cortex/pathology , Cerebral Ventricles/pathology , Child , Diagnosis, Differential , Dominance, Cerebral/physiology , Female , Follow-Up Studies , Humans , Male
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