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https://www.readbyqxmd.com/read/29457651/progressive-recruitment-of-contralesional-cortico-reticulospinal-pathways-drives-motor-impairment-post-stroke
#1
Jacob G McPherson, Albert Chen, Michael D Ellis, Jun Yao, C J Heckman, Julius P A Dewald
KEY POINTS: Activation of the shoulder abductor muscles in the arm opposite a unilateral brain injury causes involuntary increases in elbow, wrist and finger flexion in the same arm, a phenomenon referred to as the flexion synergy. It has been proposed that flexion synergy expression is related to reduced output from ipsilesional motor cortex and corticospinal pathways. In this human subjects study, we provide evidence that the magnitude of flexion synergy expression is instead related to a progressive, task-dependent recruitment of contralesional cortex...
February 19, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29333567/predictors-for-intracranial-hemorrhage-following-intravenous-thrombolysis-in-posterior-circulation-stroke
#2
Dorňák Tomáš, Král Michal, Sedláčková Zuzana, Šaňák Daniel, Čecháková Eva, Divišová Petra, Zapletalová Jana, Kaňovský Petr
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90...
January 15, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29281159/non-alcoholic-fatty-liver-disease-is-associated-with-stroke-severity-and-progression-of-brainstem-infarctions
#3
Haiyan Li, Biao Hu, Wei Lei, Li Zhou, Lei Zhang, Yinyao Lin, Bing Qin, Yongqiang Dai, Zhengqi Lu
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is closely correlated to visceral obesity, dyslipidaemia, insulin resistance, and type 2 diabetes mellitus (T2DM). We sought to assess the association between a specific stroke subgroup, brainstem infarctions (BSIs), and NAFLD. Furthermore, we evaluated whether NAFLD is an independent risk factor in patients with BSIs. METHODS: NAFLD was assessed in 306 radiologically confirmed BSIs patients via liver ultrasound...
December 27, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29274051/stroke-and-craniectomy
#4
Eelco F M Wijdicks
Neurosurgical involvement in the care of major stroke complications has yielded striking results in the subtentorial region but equivocal outcomes in the supratentorial compartment. Most neurosurgeons want to see some degree of deterioration before proceeding; thus, timing will be debated. Viewpoints have changed over the years regarding surgical or medical intervention, but in many patients the procedure has not produced a definitive change in outcome other than preventing death from terminal brainstem shift...
December 22, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29249993/unexpected-improvement-of-hand-motor-function-with-a-left-temporoparietal-low-frequency-repetitive-transcranial-magnetic-stimulation-regime-suppressing-auditory-hallucinations-in-a-brainstem-chronic-stroke-patient
#5
Fanny Thomas, Noomane Bouaziz, Julià L Amengual, Palmyre Schenin-King Andrianisaina, Christian Gaudeau-Bosma, Virginie Moulier, Antoni Valero-Cabré, Dominique Januel
We here report paradoxical hand function recovery in a 61-year-old male tetra-paretic chronic patient following a stroke of the brainstem (with highly degraded right and abolished left-hand finger flexion/extension disabling him to manipulate objects) who experienced insidious auditory hallucinations (AHs) 4 years after such event. Symptomatic treatment for AHs was provided with periodical double sessions of low-frequency repetitive transcranial magnetic stimulation (rTMS) (daily 1 Hz, 2 × 1,200 pulses interleaved by 1 h interval) delivered to the left temporoparietal junction across two periods of 5 and 3 weeks, respectively...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29246600/prediction-of-conscious-awareness-recovery-after-severe-acute-ischemic-stroke
#6
Yajuan Hu, Changqing Wang, Xiaoxiang Yan, Hong Fu, Kai Wang
BACKGROUND: Ischemic stroke that is sufficiently severe to cause loss of consciousness has a high rate of morbidity and mortality. Many individuals who suffer from these disorders never recover conscious awareness. In this study, we aimed to identify an accurate and simple bedside method to predict awareness recovery after severe acute ischemic stroke. METHODS: Between 2013 and 2017, all consecutive patients with consciousness disorders after acute ischemic stroke were recruited to the study...
December 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29234822/-acute-vestibular-syndrome-clinical-examination-outperforms-mri-in-the-detection-of-central-lesions
#7
REVIEW
F Thömke
A significant number of patients who seek medical treatment in an emergency department because of vertigo or dizziness, suffer from acute vestibular syndrome. This is characterized by sustained vertigo, horizontal or horizontal rotatory jerk nystagmus, and unsteady stance and gait. In the acute situation it is crucial to differentiate patients with a peripheral vestibular disorder from those with a central disease. A number of recent studies have shown that a structured clinical examination enables a reliable differential diagnosis of central or peripheral disorders...
December 12, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/29231792/patient-selection-for-mechanical-thrombectomy-in-posterior-circulation-emergent-large-vessel-occlusion
#8
Scott Raymond, Natalia Sana Rost, Pamela Whitney Schaefer, Thabele Leslie-Mazwi, Joshua A Hirsch, Ramon Gilberto Gonzalez, James Rabinov
Triage of posterior circulation stroke from emergent large-vessel occlusion (pc-ELVO) is challenging owing to the stuttering clinical course and potential for rapid decline. Growing clinical data support the use of mechanical thrombectomy in pc-ELVO, but there are limited data addressing the clinical and imaging criteria for patient selection. We present our triage algorithm used to select patients for endovascular therapy (EVT) in the setting of pc-ELVOS. We use a consecutive retrospective database from 2004 to 2016 to describe the practice patterns and prognostic factors for pc-ELVO patients treated using both medical and EVT...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29226021/holmes-tremor-secondary-to-a-stabbing-lesion-in-the-midbrain
#9
Rubens Gisbert Cury, Egberto Reis Barbosa, Christian Freitas, Luis Filipe de Souza Godoy, Wellingson Silva Paiva
Background: The development of Holmes tremor (HT) after a direct lesion of the midbrain has rarely been reported in the literature, although several etiologies have been linked with HT, such as stroke, brainstem tumors, multiple sclerosis, head trauma, or infections. Phenomenology Shown: A 31-year-old male, having been stabbed in the right eye, presented with a rest and action tremor in the left upper limb associated with left hemiparesis with corresponding post-contrast volumetric magnetic resonance imaging T1 with sagittal oblique reformation showing the knife trajectory reaching the right midbrain...
2017: Tremor and Other Hyperkinetic Movements
https://www.readbyqxmd.com/read/29213030/acute-bilateral-ophthalmoplegia-due-to-vertebrobasilar-dolichoectasia-a-report-of-two-cases
#10
Haifa Alabri, Whitfield D Lewis, Sunil Manjila, Ayham M Alkhachroum, Michael A De Georgia
BACKGROUND Vertebrobasilar dolichoectasia (VBD) is a complex progressive arterial disease characterized by dilation, elongation, and tortuosity of the vertebral and basilar arteries, and may be congenital or acquired. VBD may lead to progressive compression of the brainstem, cranial nerve abnormalities, and intracranial hemorrhage, but may also be associated with arterial thrombosis, with ischemic stroke as the most common clinical outcome. CASE REPORT Two cases of VBD are presented, both with acute bilateral ophthalmoplegia and cranial nerve palsies, and vertebrobasilar arterial thrombosis that resulted in ischemic stroke...
December 7, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/29209479/a-brief-psychotic-episode-with-depressive-symptoms-in-silent-right-frontal-lobe-infarct
#11
Salziyan Badrin, Noraini Mohamad, Nor Akma Yunus, Maryam Mohd Zulkifli
Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature...
November 2017: Korean Journal of Family Medicine
https://www.readbyqxmd.com/read/29208342/pediatric-stroke-related-to-lyme-neuroborreliosis-data-from-the-swiss-neuropaediatric-stroke-registry-and-literature-review
#12
O Monteventi, M Steinlin, M Regényi, E Roulet-Perez, P Weber, J Fluss
BACKGROUND: Cerebrovascular complications of Lyme neuroborreliosis (LNB) are poorly documented in the paediatric population. METHODS: We performed a retrospective analysis from prospectively registered cases of acute ischemic stroke (AIS) from the Swiss NeuroPaediatric Stroke Registry (SNPSR) from 2000 to 2015. Only cases with serologically confirmed LNB were included. In addition, a literature review on paediatric stroke cases secondary to Lyme neuroborreliosis in the same time frame was performed...
November 24, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/29187935/-haemorrhagic-stroke-of-the-brainstem-secondary-to-postpartum-eclampsia-about-a-case-and-literature-review
#13
REVIEW
Khadija Ennaqui, Assia Makayssi, Houssine Boufettal, Naima Samouh
Strokes are rare but severe accidents during pregnancy and post-partum period. They are responsible for high mortality and morbidity rates. Pre-eclampsia, eclampsia, and strokes are significantly related. Endothelial dysfunction, alteration of brain self-regulation and severe hypertension are, probably, the cause of many strokes in pregnant women and during postpartum period. We report a case of hemorrhagic stroke of the brainstem in a nonmonitored 21-year old patient at 38 weeks pregnant admitted with severe preeclampsia complicated by eclampsia and then by haemorrhagic stroke of the brainstem on the second post-operative day after cesarean section performed due to suspicion of retroplacental haematoma arisen since her admission...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/29162502/vagus-nerve-magnetic-modulation-facilitates-dysphagia-recovery-in-patients-with-stroke-involving-the-brainstem-a-proof-of-concept-study
#14
Wang-Sheng Lin, Chen-Liang Chou, Miao-Hsiang Chang, Yuh-Mei Chung, Fu-Gong Lin, Po-Yi Tsai
BACKGROUND & AIMS: Stroke involving the brainstem (SBS) causes severe oropharyngeal dysphagia (OD). Research on the therapeutic efficacy of vagus nerve modulation (VNM) by using repetitive transcranial magnetic stimulation (rTMS) in SBS patients with OD has been limited thus far. We aimed to assess the effect of VNM by using rTMS in improving swallowing function after SBS. METHOD: We conducted a sham-controlled, double-blinded, parallel pilot study in 28 SBS patients with OD randomly allocated to a real rTMS group (n = 13; TMSreal) or a sham group (n = 15; TMSsham)...
November 7, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/29155435/periventricular-white-matter-hyperintensities-and-functional-decline
#15
Mandip S Dhamoon, Ying-Kuen Cheung, Ahmet Bagci, Noam Alperin, Ralph L Sacco, Mitchell S V Elkind, Clinton B Wright
BACKGROUND/OBJECTIVES: We previously showed that global brain white matter hyperintensity volume (WMHV) was associated with accelerated long-term functional decline. The objective of the current study was to determine whether WMHV in particular brain regions is more predictive of functional decline. DESIGN: Prospective population-based study. SETTING: Northern Manhattan magnetic resonance imaging (MRI) study. PARTICIPANTS: Individuals free of stroke at baseline (N = 1,195; mean age 71 ± 9; n = 460 (39%) male)...
November 20, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29137102/lateral-medullary-infarction-with-similar-features-of-brown-sequard-syndrome-caused-by-vertebrobasilar-dysplasia-and-klippel-feil-syndrome-a-case-report
#16
Jingzhe Han, Duanhua Cao, Guomei Ma, Tingting Wang, Ye Ji, Zhilei Kang
RATIONALE: Patients with Klippel-Feil syndrome (KFS) are always anomaly associated with vertebrobasilar dysplasia. That may present commonly as infarction of brainstem, medulla, and cerebellum. In this article, we reported a rare case of lateral medullary infarction (LMI) with similar features of Brown Sequard syndrome caused by vertebrobasilar dysplasia and KFS, and the 2 rare conditions that are causally related. The case is being reported because of its unusual and rare presentation...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29128343/post-stroke-depression-mechanisms-and-pharmacological-treatment
#17
REVIEW
Roberto Federico Villa, Federica Ferrari, Antonio Moretti
Depression, the most frequent psychiatric disorder following ischaemic stroke, negatively affects survivals' functional outcome, response to rehabilitation and quality of life. Approximately, one-third of them are affected by post-stroke depression (PSD), making it a serious social and public health problem and anti-depressant preventive and curative therapies worth investigating. However, a two-way association between depression and stroke has been also established: stroke increases the risk of PSD, but depression is an independent risk factor for stroke...
November 9, 2017: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29095902/rehabilitative-skilled-forelimb-training-enhances-axonal-remodeling-in-the-corticospinal-pathway-but-not-the-brainstem-spinal-pathways-after-photothrombotic-stroke-in-the-primary-motor-cortex
#18
Naohiko Okabe, Naoyuki Himi, Emi Maruyama-Nakamura, Norito Hayashi, Kazuhiko Narita, Osamu Miyamoto
Task-specific rehabilitative training is commonly used for chronic stroke patients. Axonal remodeling is believed to be one mechanism underlying rehabilitation-induced functional recovery, and significant roles of the corticospinal pathway have previously been demonstrated. Brainstem-spinal pathways, as well as the corticospinal tract, have been suggested to contribute to skilled motor function and functional recovery after brain injury. However, whether axonal remodeling in the brainstem-spinal pathways is a critical component for rehabilitation-induced functional recovery is not known...
2017: PloS One
https://www.readbyqxmd.com/read/29081427/clinical-and-video-head-impulse-test-in-the-diagnosis-of-posterior-circulation-stroke-presenting-as-acute-vestibular-syndrome-in%C3%A2-the-emergency-department
#19
Ayse Guler, Funda Karbek Akarca, Cenk Eraslan, Ceyda Tarhan, Cem Bilgen, Tayfun Kirazli, Nese Celebisoy
INTRODUCTION: Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. METHODS: Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. An emergency specialist and a neurologist performed HIT. vHIT was conducted by an neuro-otology research fellow...
2017: Journal of Vestibular Research: Equilibrium & Orientation
https://www.readbyqxmd.com/read/29059697/stimulation-of-the-mesencephalic-locomotor-region-for-gait-recovery-after-stroke
#20
Felix Fluri, Uwe Malzahn, György A Homola, Michael K Schuhmann, Christoph Kleinschnitz, Jens Volkmann
OBJECTIVE: One-third of all stroke survivors are unable to walk, even after intensive physiotherapy. Thus, other concepts to restore walking are needed. Because electrical stimulation of the mesencephalic locomotor region (MLR) is known to elicit gait movements, this area might be a promising target for restorative neurostimulation in stroke patients with gait disability. The present study aims to delineate the effect of high-frequency stimulation of the MLR (MLR-HFS) on gait impairment in a rodent stroke model...
November 2017: Annals of Neurology
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