2261/2677. A case of pontine lacunar infarction with ulcerative colitis. We present the case of a young man who experienced a sudden onset of pure motor hemiplegia in association with ulcerative colitis. Based on a review of earlier reports, ulcerative colitis was suspected to be the background disease leading to cerebral infarction. A cerebral infarction of the lacunar type in the right ventromedial aspect of the upper pons was seen on magnetic resonance images. These images detected small lesions in the brain stem, and were used to follow-up their transitions. ( info) |
| A 37 year-old man with an ischaemic stroke after the nasal use of amphetamine and caffeine is reported. Transient arterial hypertension due to these agents may have been the mediator of the stroke. Mitral annular calcification was the only other abnormality found, and was thought not to play an important role in this patient. There was no evidence of a primary or secondary hypercoagulable state. stroke due to nasal use of these agents appears not to have been previously reported (medline literature search 1983-1993). ( info) |
2263/2677. New onset rapid cycling bipolar disorder in an 87 year old woman. New onset rapid cycling bipolar disorder is rare in late life. The authors report the case of an 87 year old woman who first developed this disorder at age 82 and was successfully treated with valproate and L-thyroxine. The contribution of aging, hypothyroidism and stroke to the etiology of this woman's disorder is discussed. The pharmacological management of rapid cycling bipolar disorder in the elderly is also reviewed. ( info) |
| cerebral infarction in the setting of vasospasm due to subarachnoid hemorrhage (SAH) is a known complication of aneurysmal rupture. Computed tomography (CT) has been instrumental in making this diagnosis; however, focal hypodense lesions on CT scan do not always represent infarcted tissue. Two patients are presented here who had CT hypodense lesions in regions of cerebral vasospasm following subarachnoid hemorrhage. ( info) |
2265/2677. Thalamo-frontal psychosis. A 43-year-old man presented with an 18-month history of acute-onset cyclical behavioural change affecting mood, appetite, sleep, and energy levels. This had followed an initial episode of transient drowsiness which lasted 24 hours. On examination, there was some evidence of visual memory and frontal lobe deficits. A brain CT scan showed bilateral thalamic infarcts and a brain SPECT scan showed bilateral hypoperfusion of the frontal lobes. To our knowledge, this is the first reported case of thalamic infarction associated with acute-onset cyclical affective psychosis with clinical and neurophysiological features of frontal lobe syndrome. The case also highlights the possible role of thalamo-frontal circuits in the pathogenesis of the kleine-levin syndrome. ( info) |
2266/2677. Focal inhibitory seizures as the presenting sign of ischemic cerebrovascular disease. Recurrent episodes of transient neurological dysfunction occurring in a patient with evidence of recent multiple lacunar infarctions were at first diagnosed as transient ischemic attacks (TIAs), but later proved to be due to focal inhibitory seizures. The differential diagnosis between TIAs and partial epileptic seizures in patients with ischemic cerebrovascular disease may sometimes be difficult in the presence of uncommon clinical manifestations. ( info) |
2267/2677. Postpartum cerebral infarction associated with aspirin withdrawal in the antiphospholipid antibody syndrome. We observed 2 cases of antiphospholipid syndrome complicated with hemiparesis appearing after delivery. During pregnancy, both women were systematically treated with aspirin (100 mg/day) in addition to prednisone in the second case. cerebral infarction appeared a few hours after delivery and 8 days after discontinuation of aspirin. The close temporal relationship between discontinuation of aspirin and stroke occurring in early postpartum period suggests a causal link. If aspirin must be stopped for obstetrical reasons, we think that efficient anticoagulation should be started even if the presence of the antiphospholipid antibodies has been priorly asymptomatic. ( info) |
2268/2677. Wasp sting-associated cerebral infarction: a role for cerebrovascular sympathetic innervation. A 38-year-old man, stung repeatedly by wasps on the left face and neck, had his left internal carotid artery occluded 2 days later. A mechanism for ischemic stroke involving the sympathetic innervation of cerebral vasculature is suggested. ( info) |
2269/2677. Severe diffuse intracranial vasospasm as a cause of extensive migrainous cerebral infarction. We report on a 47-year-old white female with a long history of recurrent episodes of migraine with aura, who progressed to develop a continuous intractable headache during the course of which cortical blindness and quadriparesis occurred due to extensive and bilateral hemispheric cerebral infarction. Severe diffuse intracranial major arterial vasospasm was demonstrated by arteriogram. All studies were negative for CNS vasculitis, including cerebral biopsy. The arterial spasm reversed itself, but the patient did not improve. smoking was the only additional risk factor. Vasospasm is an important cause to be considered in migrainous infarctions. The use of vasoconstrictor agents such as DHE in patients with migraine with prolonged aura has to be carefully re-evaluated. ( info) |
2270/2677. Recovery of brain function following ischemia. Experimental evidence conveys clear suggestions that early reperfusion following at least focal cerebral ischemia in the primate is accompanied by a return of function demonstrably suspended during the ischemic period. Complete and permanent arrest of the cerebral circulation has been known within seconds to lead to depression of brain electrical activity, and within minutes to gross disruption of the normal energy metabolism with failure of ionic homeostatic mechanisms. There is irreversible cell change and death within 5 to 10 minutes. Very much more protracted periods of ischemia have been shown more recently to be associated with potential viability of neuronal function, and in clinical neurosurgery we have known for years that patients with established cerebral vascular occlusion and a dense neurological deficit may show quite evident improvement over months or years. In these protracted recoveries, the potential for re-learning in nervous circuits may play a part, but in more acute circumstances, for example in the progressive recovery from vasospasm, re-learning is clearly not a factor, and this demonstrates quite evidently that neurons at one moment apparently non-functioning, can again within a few minutes recover function even after hours of apparent suppression. The experimental evidence is fairly well known. In this symposium and elsewhere we have presented a model of experimental occlusion of the middle cerebral artery in primates demonstrating irreversible recovery of electrical function after some 20 minutes of middle cerebral artery occlusion, and reversible recovery of ionic homeostasis after periods of up to an hour.(ABSTRACT TRUNCATED AT 250 WORDS) ( info) |