Cases reported "Cerebral Infarction"

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1/411. Cerebral polyopia with extrastriate quadrantanopia: report of a case with magnetic resonance documentation of V2/V3 cortical infarction.

    This is a case report of the occurrence of cerebral diplopia with right-side superior homonymous quadrantanopia in a young woman after chiropractic neck manipulation. magnetic resonance imaging confirmed an infarct in the left inferior V2/V3 (extrastriate) cortex. The characteristics of the diplopia are illustrated with the patient's drawings, and persisting abnormalities in perception are described in the area of the initial field defect after static (computed) visual field testing yielded normal results.
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keywords = visual
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2/411. Plasticity of language-related brain function during recovery from stroke.

    BACKGROUND AND PURPOSE: This study was undertaken to correlate functional recovery from aphasia after acute stroke with the temporal evolution of the anatomic, physiological, and functional changes as measured by MRI. methods: blood oxygenation level-dependent contrast and echo-planar MRI were used to map language comprehension in 6 normal adults and in 2 adult patients during recovery from acute stroke presenting with aphasia. perfusion, diffusion, sodium, and conventional anatomic MRI were used to follow physiological and structural changes. RESULTS: The normal activation pattern for language comprehension showed activation predominately in left-sided Wernicke's and Broca's areas, with laterality ratios of 0.8 and 0.3, respectively. Recovery of the patient confirmed as having a completed stroke affecting Broca's area occurred rapidly with a shift of activation to the homologous region in the right hemisphere within 3 days, with continued rightward lateralization over 6 months. In the second patient, in whom mapping was performed fortuitously before stroke, recovery of a Wernicke's aphasia showed a similar increasing rightward shift in activation recruitment over 9 months after the event. CONCLUSIONS: Recovery of aphasia in adults can occur rapidly and is concomitant with an activation pattern that changes from left to a homologous right hemispheric pattern. Such recovery occurs even when the stroke evolves to completion. Such plasticity must be considered when evaluating stroke interventions based on behavioral and neurological measurements.
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3/411. Spatial characteristics of cerebral polyopia: a case study.

    A 41-year-old woman showed bilateral monocular polyopia and an incomplete, right-sided homonymous hemianopia following bilateral cerebral strokes confirmed by neuroimaging. She was tested with briefly-presented visual stimuli to determine whether her polyopic images varied with visual field position of stimuli which evoked them. Stimuli close to her scotoma elicited polyopic images at shorter latency and higher probability than did stimuli more distant from it. RS could maintain stable fixation on small stimuli, suggesting that eye movements were not responsible for her polyopia. We discuss the possibility that cerebral polyopia is due to recoding of visual receptive fields in primary visual cortex and that bilateral occipital lesions are a causative factor in the genesis of the disorder.
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4/411. Vertebrobasilar artery territory infarction as an initial manifestation of systemic lupus erythematosus.

    cerebral infarction is a well-documented complication of systemic lupus erythematosus (SLE), that usually occurs several years after the diagnosis of SLE. To our knowledge, however, strokes associated with vertebrobasilar artery involvement were not reported to present as an initial manifestation of SLE. We report two patients, who presented with vertebrobasilar territory infarction as an initial manifestation of SLE. Patient 1 was a 16-year-old girl, who developed dysarthria and ataxia. MRI showed multiple infarcts in the pons, cerebellum and thalamus. Four-vessel cerebral angiography showed multifocal stenoses in the vertebral and basilar arteries with beaded appearance. Patient 2 was a 26-year-old woman, who developed headache associated with dysarthria, dizziness and ataxia. MRI showed multiple infarcts in the cerebellum, medulla, pons, midbrain and thalamus. cerebral angiography revealed occlusion of both vertebral arteries at the first cervical vertebral level with non-visualization of the basilar artery. Both patients were diagnosed as having SLE supported by laboratory results. Although rare, posterior circulation stroke can present as an initial manifestation of SLE, which may be attributed to vasculitis or dissection in the vertebral/basilar artery.
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5/411. Contributions of prefrontal cortex to recognition memory: electrophysiological and behavioral evidence.

    To clarify the involvement of prefrontal cortex in episodic memory, behavioral and event-related potential (ERP) measures of recognition were examined in patients with dorsolateral prefrontal lesions. In controls, recognition accuracy and the ERP old-new effect declined with increasing retention intervals. Although frontal patients showed a higher false-alarm rate to new words, their hit rate to old words and ERP old-new effect were intact, suggesting that recognition processes were not fundamentally altered by prefrontal damage. The opposite behavioral pattern was observed in patients with hippocampal lesions: a normal false-alarm rate and a precipitous decline in hit rate at long lags. The intact ERP effect and the change in response bias during recognition suggest that frontal patients exhibited a deficit in strategic processing or postretrieval monitoring, in contrast to the more purely mnemonic deficit shown by hippocampal patients.
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6/411. Incongruous homonymous hemianopic scotoma.

    We report a patient presenting with incongruous homonymous hemianopic scotoma due to infarction in the territory of the lateral posterior choroidal artery. Imaging studies showed that the patient had a fresh infarct in the lateral geniculate body causing this unusual visual field defect.
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7/411. When the left brain is not right the right brain may be left: report of personal experience of occipital hemianopia.

    OBJECTIVES: To make a personal report of a hemianopia due to an occipital infarct, sustained by a professor of neurology. methods: Verbatim observation of neurological phenomena recorded during the acute illness. RESULTS: Hemianopia, visual hallucinations, and non-occipital deficits without extraoccipital lesions on MRI, are described and discussed. CONCLUSIONS: Hemianopia, due to an occipital infarct, without alexia, is not a disability which precludes a normal professional career. Neurorehabilitation has not been necessary.
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keywords = visual
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8/411. Pointing and grasping in unilateral visual neglect: effect of on-line visual feedback in grasping.

    Three experiments are reported examining judgements of the centre of a stick in a patient with unilateral neglect after right hemisphere damage. Replicating previous data [35, 37], judgements showed more evidence of neglect when pointing rather than when a grasp response was used (Experiment 1), particularly when pointing preceded grasp (Experiment 2). Neglect also increased for longer sticks and when sticks fell in the patient's left hemispace; the effects of stick length and hemispace were additive with those of response (point vs grasp). Experiment 3 showed that the advantage for grasp over pointing responses occurred only when performance was guided by on-line visual feedback, and it emerged only during the end part of the reach trajectory. The results are discussed in relation to the role of visual feedback in movement control.
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keywords = visual
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9/411. Second harmonic imaging In acute middle cerebral artery infarction. Preliminary results.

    BACKGROUND: Second harmonic imaging (SHI) is a new ultrasound technique that is able to detect microbubbles in the tissue vascular space. The aim of this pilot study was to prove that this technique may detect focal abnormalities of cerebral echo-contrast enhancement in acute hemispheric stroke. CASE DESCRIPTIONS: Two male patients (aged 72 and 64 years) were included who presented with acute onset of severe hemiparesis and no established demarcation of the ischemic area in CT scans. After bolus application of galactose-based microbubbles, axial SHI examinations in a diencephalic plane of sections were performed using the transtemporal approach. Ultrasound investigations were recorded and evaluated offline. In both individuals demarcated focal abnormalities of cerebral contrast enhancement were detectable: in patient 1 the region of the lentiform nucleus and the adjacent parts of the temporoparietal lobe was affected, and in patient 2 a large region including the lentiform nucleus and cortical white matter was involved for at least 24 hours. Follow-up CT scans demonstrated a striatocapsular infarct in patient 1 and complete MCA infarction in patient 2, correlating with the presumed ischemic area in acute ultrasound examinations. The patient with complete MCA infarction showed missing contrast enhancement in the entire hemisphere of the affected side in follow-up SHI examinations. He died of malignant space-occupying brain edema. In the patient with the striatocapsular infarction, reappearance of echo-contrast enhancement in the ischemic area was assessable after 1 week. CONCLUSIONS: SHI may identify focal abnormalities of cerebral echo-contrast enhancement in acute hemispheric stroke. Furthermore, this technique helps to determine size, localization, and prognosis of the ischemic region and could be useful for bedside assessment of echo-contrast agent distribution related to brain tissue perfusion.
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10/411. Mechanisms of spatial attention revealed by hemispatial neglect.

    We report performance by a patient, NG, with hemispatial neglect after nondominant stroke, in detecting briefly (200 msec) presented visual targets. NG's detection of targets (gaps in circles) was determined by the location of the target in the space in which stimuli appeared. Gaps on the neglected side of a circle at fixation were rarely detected when circles of uniform size were always presented at fixation. The same targets in the same location were detected far more often in blocks that also included targets presented on each side of the central circle, or in blocks that included larger target stimuli. In these blocks, the window of space in which stimuli appeared was larger, such that the target fell closer to the center of this "window". These results indicate that the spatial extent of attention, and of hemispatial neglect, can be modified on the the basis of expectations and task requirements.
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