1/8. An unusual cause of transient ischemic attacks: case report.A 42-year-old black man, a physician, presented with a three week history of intermittent right arm and leg numbness and weakness, lasting about five minutes. This was not associated with headache, visual changes, seizures, aphasia or loss of consciousness. There was no history of head trauma, migraines, or previous attacks. Positive findings on physical examination were confined to a blood pressure of 182/80; evidence of hypertensive retinopathy; normal carotid pulses without bruits; and a Grade II/VI systolic ejection murmur with normal sinus rhythm. Initial hematocrit was 25.7%; white blood cell count 14,000 cu/mm with a normal differential; platelet count 532,000 cu/mm. An electrocardiogram showed left ventricular hypertrophy. Duplex scan demonstrated normal carotid bifurcations bilaterally, and arteriogram revealed no carotid or intracranial pathology. Hemoglobin electrophoresis revealed sickle cell disease of the SS type. He was treated with transfusion therapy and has remained asymptomatic at 40 months. Approximately 20% of children with the SS type sickle cell disease will have cerebrovascular symptoms caused by small intracranial artery occlusion due to sludging of the abnormal hemoglobin. This unusual cause of transient ischemic attacks can occur in older patients of African-American ancestry and must be recognized to enable early and effective therapy with exchange transfusion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Interaction of neuropsychological and psychological factors in two cases of "space phobia".Recent theories of psychological disorders are beginning to break down the traditional dichotomy between mental and physical processes. The present paper reports on two cases of space phobia in which this is especially apparent. Neuropsychological assessment indicated subtle disturbance in visuospatial functioning. The emotional response to this dysfunction appeared, however, to be somewhat excessive given the subtlety of the deficit. This is seen as a psychological reaction to a neuropsychological dysfunction.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. May focal epileptic seizures be considered a marker of TIAs?Late-onset focal epileptic seizures occurred in 8 patients with ischemic cerebro-vascular disease (ICVD) and were associated with TIAs in 6 of them. history, physical, laboratory, ancillary examinations and follow-up revealed no other disease which might be responsible for the seizures. Moreover, time of onset and appropriate signs of ICVD suggested that transient cerebral ischemia was the most likely cause of seizures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Vascular syndromes.patients with suspected transient ischemic attacks are frequently seen in the Emergency Department. Accurate diagnosis is crucial but often very difficult because signs and symptoms often will have resolved when the patient is seen. This article reviews the details of the history and physical examination that may help to establish a correct diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Dilated episcleral arteries--a significant physical finding in assessment of patients with cerebrovascular insufficiency.Dilated episcleral vessels associated with ipsilateral internal carotid artery occlusions have been previously reported though not widely appreciated. These ocular changes have been presumed to be manifestations of ocular ischemia. The authors have recently encountered this sign in seven patients and in none was there evidence of ocular ischemia. In addition to an ipsilateral internal carotid artery occlusion, arteriograms demonstrated that the major source of blood supply to the homolateral cerebral hemisphere was by retrograde flow through markedly enlarged ophthalmic arteries filled in retrograde fashion from dilated external carotid collateral channels in the orbit. This association of dilated episcleral arteries as a sign of increased orbital blood flow and the major source of collateral blood supply to the homolateral cerebral hemisphere has not been previously reported. We reemphasize the importance of a careful examination of the episcleral vessels in patients suspected of having internal carotid artery occlusions.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
6/8. Blunt carotid artery trauma: report of two cases and review of the literature.Blunt carotid artery trauma is uncommon but has been associated with severe, permanent neurologic deficits in 42% and mortality in 30% of 96 patients previously reported in the English literature. Since neurologic symptoms characteristically develop only after a latent interval and since physical evidence of significant cervical trauma often is absent, diagnosis of nonpenetrating carotid injuries with the use of arteriography usually is delayed until the appearance of obvious, frequently irreversible neurologic complications. Carotid injuries should be suspected in patients who develop monoplegia or hemiplegia following blunt craniocervical trauma, particularly if computerized tomography excludes the presence of intracranial hemorrhage. The cumulative results of a collected series of 96 patients suggest that early surgical correction of blunt carotid injuries is appropriate for patients with transient episodes of cerebral ischemia, strokes in evolution, or mild completed neurologic deficits.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Cardiac papillary fibroelastoma: a treatable cause of transient ischemic attack and ischemic stroke detected by transesophageal echocardiography.Transesophageal echocardiography (TEE) is used frequently in patients with cerebrovascular ischemia. On TEE, a typical appearance of a cardiac fibroelastoma is that of a pedunculated, mobile mass attached to a leaflet of a valve. Surgical excision of the lesion may lead to resolution of the symptoms and prevent further cerebrovascular ischemic events; valve replacement is seldom necessary. Herein we describe three patients with cerebral or ocular ischemia in whom histologic study confirmed a cardiac papillary fibroelastoma after initial detection by TEE. Cardiac papillary fibroelastomas should be considered in the differential diagnosis of transient ischemic attack and stroke, even in cases of recurrent events in the same vascular distribution. Although the use of echocardiography in the evaluation of stroke and transient ischemic attack is controversial, TEE must be considered in patients in whom the cause of cerebrovascular ischemia is unclear after noninvasive neurovascular studies or transthoracic echocardiography, even if the patient's cardiac history and the findings on physical examination are normal.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Mitral-annulus calcification and cerebral or retinal ischaemia.Radiological and echocardiographic evidence of extensive mitral-annulus calcification was present in 8 patients (aged 64 to 78) from a series of 151 consecutive patients presenting with symptoms of retinal or cerebral ischaemia but in none of 188 controls matched for age and sex. The mitral-annulus calcification syndrome appears to be significantly associated with cerebral emboli, particularly in the elderly. echocardiography is a valuable noninvasive means of making the diagnosis and distinguishing the condition from others with similar physical signs.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |