1/12. carbon disulfide vasculopathy: a small vessel disease.We present the clinical manifestations of 4 male patients with acute stroke-like symptoms and polyneuropathy after long-term exposure to carbon disulfide (CS2) in a viscose rayon plant. The ages of onset of polyneuropathy ranged from 42 to 45 years with a duration of CS2 exposure between 6 and 21 years. The ages of onset of stroke were from 42 to 48 years. The risk factors for stroke including heart disease and diabetes were denied, except for smoking in 4, hyperlipidemia in 2 and hypertension in 1. At the initial visit in 1992, only 2 patients developed sudden onset of hemiparesis suggesting a lacunar stroke before the diagnosis of CS2 intoxication. brain computed tomography (CT) scans showed low-density lesions in the basal ganglia in 2 patients, cortical atrophy in 1 and normal in 1. brain magnetic resonance image (MRI) study disclosed multiple lesions in the corona radiata and basal ganglia on T(2)-weighted images in 3 patients and cortical atrophy in 1. After the diagnosis, they left their jobs for a CS2-free environment, and improvement of the working conditions was noted. During 5 years follow-up period, another 2 patients also developed an acute episode of stroke with hemiparesis. brain CT and/or MRI follow-up studies in these 2 patients revealed new lesions in the basal ganglia and corona radiata. Intriguingly, a patient with previous stroke also developed new lesions in the bilateral thalami and brainstem. Carotid Doppler scan, transcranial Doppler scan and/or cerebral angiography did not show any prominent stenosis or occlusion in the major intracranial large arteries. We conclude that encephalopathy may occur in patients after long-term CS2 exposure, probably due to impaired cerebral perfusion. The lesions tend to occur in the basal ganglia, corona radiata and even brainstem, particularly involving the small-sized vessels. In addition, the cerebral lesions may progress even after cessation of CS2 exposure. Therefore, we suggest that CS2 exposure may be a risk factor for stroke.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/12. Pure alexia and right hemiachromatopsia in posterior dementia.A 66 year old, right handed woman presented with pure alexia and right hemiachromatopsia (PARH) in the context of a posterior dementia. PARH was accompanied by prosopagnosia, 2-D object agnosia, and environmental agnosia. visual fields were normal to confrontation testing. The pathological anatomy of PARH involves circumscribed damage to the lingual and fusiform gyri and paraventricular white matter of the left occipital cortex, two contiguous cortical regions functionally specialised for processing colour and word form information, respectively.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/12. Preserved recognition of familiar personal names in global aphasia.Recognition of proper and common nouns was compared in four patients diagnosed with global aphasia secondary to ischemic left-hemisphere infarction. For proper noun recognition, subjects matched the spoken or written name of a famous person to a photograph, and for common nouns, subjects were tested on standardized and special word recognition tests. As expected, common noun recognition was severely compromised in the aphasic patients. In contrast, familiar personal names, despite their greater length and complexity, were recognized equally well by aphasic and normal control subjects. The right hemisphere may mediate the ability to recognize personally familiar names, as it may be specialized for establishing personally relevant environmental stimuli.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/12. Visuospatial dysgnosia.Spatial dysgnosia may occur in patients with various forms of brain disease, including tumors, vascular accidents, Alzheimer's disease, multiple sclerosis, and developmental aberrations. patients with lesion in the nondominant hemisphere, particularly at the junction of the occipito-temporoparietal regions, may manifest predominantly visuospatial dysgnosia--a loss of the sense of "whereness" in the relation of himself to his environment and in the relation of objects to each other. Visuospatial disturbances caused by lesions in the dominant hemisphere may be masked by other gnostic symptoms. patients with more extensive lesions, especially those involving similar areas in both hemispheres, may also exhibit other cognitive disturbances associated with vision.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/12. Pure topographical disorientation: a definition and anatomical basis.Four patients showing the syndrome of "topographical disorientation" are reported. patients became unable to find their way, especially in unfamiliar surroundings, following a single lesion in the territory of the right posterior cerebral artery, as evidenced on CT-scan. Associated disturbances included: left hemianopia, mild face recognition problems, and various degree of impairment in face-learning and visual maze-learning tasks. language, visuo-perceptive and constructional abilities, object and picture recognition were intact. memory tests only showed a mild, generally non-significant, impairment of visual memory. As inferred from the lesion located in the 4 patients, this syndrome seems to be strongly related to damage to the right parahippocampal gyrus, a structure that thus appears crucial for specifically storing and/or retrieving visual information necessary to achieve orientation in the locomotor environment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/12. Interdisciplinary roles in stroke care.Care of the stroke patient presents a complex challenge to the interdisciplinary stroke team. The physical therapist, occupational therapist, and clinical social worker are important members of that team, each of whom contributes specialized knowledge and interventions in behalf of the patient. The physical therapist focuses on prevention of joint and tissue injury and retraining of lost motor skills. The occupational therapist considers the total patient in his or her environment and assists the patient in regaining or improving function in all areas of daily living. The clinical social worker concentrates on psychosocial assessment and intervention with the patient and family, aiding them in the adjustment process and planning for discharge. The nurse, in addition to playing a unique role in the delivery of nursing care to the stroke patient, is in a position to serve as coordinator of the interdisciplinary team. The nurse can facilitate the work of the physical and occupational therapists and the social worker by providing them with timely referrals, valuable assessment information and insights, and reinforcement of therapeutic activity while the patient is on the nursing unit. The keys to making the interdisciplinary team work for the maximal benefit of the patient are threefold: mutual respect and understanding among team members; ongoing coordination of efforts; and open communication between all team members, the patient, and the family. These elements are interrelated and essential if the interdisciplinary team is to be successful at meeting its ultimate goal: expert care of the total patient to achieve maximal independence.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/12. The social environment and neurological disease.This chapter has reviewed some of the methodological and theoretical issues in research linking the social environment to medical illnesses. The second part of the chapter has focused on three specific neurological entities to examine evidence for a possible association between neurological illness and life stress. There is some suggestion that certain vulnerable epileptic patients can experience convulsions in response to acute emotional upheaval or certain types of cognitive challenges. More commonly, it is probable that social stress and emotional tension can produce lowering of seizure threshold by increasing levels of fatigue and disrupting sleep. The latter factor, in particular, is known to lower seizure threshold. In the case of stroke, several dramatic cases of intracranial hemorrhage have been related to disastrous life circumstances. A general association between life stress and stroke has yet to be established. The case for a link between life events and onset of exacerbation of multiple sclerosis seems stronger. Events which produce emotional upset seem capable of worsening symptoms in patients with existing disease, and several studies have reported unusual life stresses in the period preceding onset of symptoms in this disorder.- - - - - - - - - - ranking = 5keywords = environment (Clic here for more details about this article) |
8/12. Cerebral accident subsequent to G-force loading: a case report.A case review of a CVA in a 57-year-old general officer due to positive G-force loading is presented, which is apparently the first such documented episode recorded in the literature. This case reflects the concern about high G-force loading seen in newer high-performance aircraft and has significance in the assignment of older individuals to high G-force environments.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/12. Adaptation to a stroke: the experience of one couple.OBJECTIVE. Treatment of stroke, as described in the occupational therapy literature, focuses primarily on the person's physical problems, and less on the way in which the family and environment influence adaptation. This article examines family and environmental influences on adaptation to stroke. METHOD. The content of five interviews conducted over 2 years with a woman who experienced a stroke and her husband was analyzed with ethnographic research methods. RESULTS. The analysis revealed that a stroke cannot be understood as an individual phenomenon, because the life course of both this woman and her husband were profoundly affected by it. The man's roles as family member, caregiver, home maintainer, and hobbyist required change after his wife's stroke. The woman's experience of her changed body, dependence, and altered homemaking role were influenced not only by her husband's attitudes but also by societal values. CONCLUSION. The findings suggest that clinicians and researchers must pay greater attention to those living with the person who experienced a stroke and to the ways in which the person's social, cultural, and economic environments influence adaptation to disability.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
10/12. The psychophysical power law and unilateral spatial neglect.The relationship between objective measures and subjective experiences of sensory stimuli is described by a power law, psi = K phi beta, in which psi represents the psychological value and phi the physical value. The constant (K) and the exponent (beta) are empirically derived. This relationship is often assumed to correspond to properties of peripheral receptor sensory transduction. patients with left-sided spatial neglect tend to bisect lines to the right of the objective midline. Line bisection bias was used as the dependent variable in how a patient with neglect and five normal subjects bisected lines of varying lengths. Analyzing these data as a power function accounted for over 99% of the variance in five different experimental conditions. The normal exponent matched the value expected from traditional psychophysical experiments of line length estimation, whereas the patient's exponent was diminished. The patient's data provide evidence for central nervous system participation in computations underlying psychophysical relationships. The notion that attentional and perceptual processes are closely linked was supported by the influence of attentional cuing on the power functions obtained in normal subjects. The descriptive precision of the power function uncovered qualitative variability in how normal subjects allocate attention across different spatial reference frames and demonstrated that this patient had a quantitative defect in directing attention across an allosteric reference frame, but a qualitative defect in directing attention across a viewer/environment reference frame.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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