1/12. rehabilitation for balance and ambulation in a patient with attention impairment due to intracranial hemorrhage.BACKGROUND AND PURPOSE: The purpose of this case report is to describe physical therapy to improve the balance and ambulation of a 16-year-old patient with attention impairment following intracranial hemorrhage. CASE DESCRIPTION: The patient initially had frequent losses of balance, especially in distracting environments, due in part to decreased attention. He was managed with a balance and ambulation training program that incorporated the principles of cognitive rehabilitation for attention impairments. OUTCOMES: Following 11 weeks of outpatient therapy, the patient returned to independent ambulation at school without losses of balance. DISCUSSION: research is needed to determine the interaction between balance and attention in patients with brain injury and effective treatment for patients with decreased balance related to attention impairments.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/12. Use of a static adjustable ankle-foot orthosis following tibial nerve block to reduce plantar-flexion contracture in an individual with brain injury.BACKGROUND AND PURPOSE: ankle plantar-flexion contractures are a common complication of brain injuries and can lead to secondary limitations in mobility. CASE DESCRIPTION: The patient was a 44-year-old woman with left hemiplegia following a right frontal arteriovenous malformation resection. She had a left ankle plantar-flexion contracture of -31 degrees from neutral. After a tibial nerve block, an adjustable ankle-foot orthosis was applied 23 hours a day for 27 days. Adjustments of the orthosis were made as the contracture was reduced. The patient received physical therapy during the 27-day period for functional mobility activities and stretching the plantar flexors outside of the orthosis. OUTCOMES: The patient's dorsiflexion passive range of motion increased from -31 degrees to 10 degrees. DISCUSSION: The application of an adjustable ankle-foot orthosis following a tibial nerve block, as an addition to a physical therapy regimen of stretching and mobility training, may reduce plantar-flexion contractures in patients with brain injury.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
3/12. An adolescent male with an arteriovenous malformation presenting with reproducible seizures.The patient who presents with new onset seizure is a difficult but common problem in emergency medicine. It is more difficult to make a specific etiologic diagnosis when the seizure patient is without fever, focal neurological deficit, prior medical history, electrolyte or acid-base imbalance. Such a patient with new onset seizures presented to our emergency department. The seizures were induced by a specific right arm position. The patient's initial evaluation included a normal physical examination, screening chemistries, and an unenhanced computed tomography (CT scan) of the head. Subsequent contrast-enhanced head CT scan and eventual magnetic resonance imaging (MRI) of the brain revealed a large arteriovenous malformation (AVM). The differential diagnosis of seizures is long and involved, but a majority of these diagnoses can be ruled in or out by simple and inexpensive screening examinations. Occasionally, more involved studies are indicated than the routine electroencephalogram (EEG) and CT scan. CT scan with contrast, angiography, and magnetic resonance imaging (MRI) may be required to elucidate the cause of the seizure. Of these, angiography and MRI are the most sensitive for AVM, but contrast CT scan is the most readily available with acceptable sensitivity and is therefore potentially more beneficial.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/12. Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report.headache as a chief complaint is rare in the paediatric emergency room. Actually, very seldom cases secondary to life threatening conditions as non-traumatic subarachnoid haemorrhage have been reported. A child with severe headache and nuchal rigidity and no other abnormalities on the physical examination is reported. magnetic resonance angiography and cerebral angiography disclosed a ventricular arteriovenous malformation in the choroid plexus, supplied by the anterior choroidal artery, classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2). The differences in the clinical presentations of the central nervous system arteriovenous malformation between children and adults are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/12. Two teenagers with syncope.We report the cases of 2 teenagers with syncope and headaches who were subsequently found, on head computed tomography examinations, to have central nervous system etiologies (arteriovenous malformation and arachnoid cyst) of their syncope. These cases highlight the importance of a focused history and physical examination when evaluating patients who present with syncope.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/12. Coexistence of multiple arteriovenous malformations and an anomalous aortic arch.An unusual case of multiple congenital arteriovenous malformations (AVM) coexistent with an anomalous aortic arch is described. Our patient had been asymptomatic, with physical findings limited to a low grade systolic murmur, until the onset of acute subarachnoid hemorrhage. Arteriography was technically difficult and failed to demonstrate the origin of his hemorrhage or the configuration of his aortic arch. However, an AVM within the neck muscles was visualized. magnetic resonance imaging of his chest revealed a right-sided, retroesophageal aortic arch with an anomalous pattern of branching. The intracranial AVM and the course of the great vessels was clearly revealed at autopsy. A possible embryologic mechanism underlying the origin and distribution of the arch vasculature is discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/12. Value of the ring-enhancing sign in differentiating intracerebral hematomas and brain abscesses.Computerized tomography (CT) is a sensitive method for detecting intracerebral pathology. Ring enhancement on contrast CT scan is a classic finding for intracerebral abscesses. Two cases are described in which clinical and physical findings were not suggestive of brain abscess; however, CT scan disclosed ring-enhancing lesions. Both patients were found to have vascular abnormalities without evidence of infection. The diagnostic dilemmas and specificity of ring enhancement on contrast CT scan are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/12. Ruptured arteriovenous anomaly in a former woman astronaut candidate.A case is reported of a former woman astronaut candidate who withstood the rigors of the preliminary physical examinations for this position. Some years later, she sustained a subarachnoid hemorrhage from an arteriovenous malformation in the right parieto-occipital area, which was successfully excised. Postoperatively, she had a marked visual deficit, from which she completely recovered within 3 months. The development of psychomotor seizures 5 months later was due to probable scarring in the right parieto-occipital region of the cerebral cortex, the interpretive area for orientation of body image in space, which had been supplied by the clipped right anterior and posterior cerebral arteries feeding the arteriovenous anomaly. These seizures have been well controlled on anticonvulsants. A lesion in the temporoparieto-occipital region due to a hemorrhage from a ruptured arteriovenous anomaly, resulting in the disabling symptoms of disorientation or loss of body image due to impairment of the interpretive cortex, could be devastating to the pilot and a mission. This case raises the question of an automatic use of the CT brain scan in screening potential space candidates, and even the consideration of a percutaneous femoral four-vessel arteriogram in all, or possibly selected, candidates. Most neurosurgeons and neuroradiologists probably would consider the risks of the latter procedure too great to justify its use for fear of permanent complications to the space candidate.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/12. Angiographically cryptic cerebrovascular malformations.Three cases of angiographically cryptic cerebrovascular malformations are presented and a review of the cases in the English literature is tabulated. The typical patient is a 30- to 40-year-old woman with a history of seizures and headache. There is no antecedent history suggesting hemorrhage. On nonenhanced computerized tomographic scans, these lesions are denser than normal brain. They enhance with contrast administration. The angiogram demonstrates an avascular mass. The history, physical findings, and radiographic studies suggest brain tumor. An accurate diagnosis requires operation and pathological examination of the lesion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/12. Obstructive hydrocephalus at the anterior third ventricle caused by dilated veins from an arteriovenous malformation.A dilated thalamostriate--internal cerebral vein complex, draining a right frontoparietal arteriovenous malformation, caused a physical block at the foremen of Monroe and was the cause of obstructive hydrocephalus. It represents a new mechanism of obstructive hydrocephalus formation in patients with arteriovenous malformations, which has not been previously reported. There was no history of subarachnoid hemorrhage. Embolization, followed by resection, was successfully carried out. This case was reported because of its unusual nature and to discuss potential problems to be avoided in dealing with intraventricular arteriovenous malformations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
| | Next -> |