Reality
Rudi Coetzer in The Notebook of a New Clinical Neuropsychologist, 2017
The blue book on the desk is suffering increasing damage to its spine. Would Houdini have been able to untangle all of this? Everything? On the one hand it feels like there is just too much factual knowledge to learn. On the other hand, untangling all this knowledge to understand the individual patient, an intellectual demolition like no other. It feels similar to the individual limits of working memory of Digit Span – forwards, backward. With an infinite number of permutations to make your head spin, before the next day, making your heart ache. The cycle of learning before dismantling once again commences this evening. It would be good to have another look at what Kevin Walsh and Muriel Lezak have to say about stroke. Before leaving the unit this afternoon, I checked what I am doing tomorrow, to read up a bit in preparation. I am seeing a patient with a middle cerebral artery stroke in the morning. I’ve now seen a few of these, but like exercise, studying is not always about reading every new research paper. In the twentieth century we cannot possibly know everything in our own field. No, studying is about also mastering the simple stuff that works, in this case basic applied clinical knowledge. Revision and repetition is a good thing. Even though by now I now know pretty well what a middle cerebral artery stroke is, as well as the symptoms and signs associated with the condition. Tomorrow should be fine.
Arterial Thrombosis—Diagnosis and Management
E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson in Phospholipid-Binding Antibodies, 2020
However, by far the most common and devastating events are those causing cerebral infarction. In a recent review of 32 patients with cerebrovascular ischemia and lupus anticoagulant (LA) by Le vine and Welch,8 81% of patients presented with stroke and 19% with transient ischemic attacks (TIAs). These figures were similar in patients with SLE and those without. Patients were predominantly young women, (mean age 39; female:male ratio 2.5). Similar data have been reported by other authors.9-14 The majority of patients sustain a stroke in the region of the middle cerebral artery,15 although virtually any cerebrovascular syndrome can occur. These may include multiple infarcts leading to dementia,13,16,17 amaurosis fugax8,11 and vertebral artery syndromes including cerebellar infarcts.18
Neurorescue During Carotid Stenting: Catheter-Based Techniques and Patient Management
Peter A. Schneider, W. Todd Bohannon, Michael B. Silva in Carotid Interventions, 2004
Patients with a sudden major deficit and no angiographically identifiable embolus are a challenging group in which to decide upon a treatment course. The differential diagnostic possibilities of seizure or intracranial hemorrhage should be considered (see next section). A very small but well-placed embolus to a branch of the MCA or a shower of microemboli could also produce this clinical scenario. An aggressive approach would be to treat these patients with a regional thrombolytic infusion into the middle cerebral artery with the intention of dissipating the thrombus or platelet aggregates that may have showered into the smaller arterial branches of the brain. Minor deficits without angiographic evidence of emboli may be treated with supportive care alone or possibly IIb/IIIa inhibition.
Training flexible conceptual retrieval in post-stroke aphasia
Published in Neuropsychological Rehabilitation, 2022
Sara Stampacchia, Glyn P. Hallam, Hannah E. Thompson, Upasana Nathaniel, Lucilla Lanzoni, Jonathan Smallwood, Matthew A. Lambon Ralph, Elizabeth Jefferies
MRI scans were traced onto standardized templates (Damasio & Damasio, 1989) and lesion identification was manually performed (see Table 2 and Figure 1 for lesion overlay). All eleven patients had lesions affecting the left posterior LIFG; in eight cases this damage extended to mid-to-anterior LIFG. Parietal regions (supramarginal gyrus and/or angular gyrus) were also affected in 9 cases out of 11, and pMTG was affected in all but four cases. While there was some damage to ATL in 4 patients (SD, KQ, KA, VN), the ventral portion of ATL, which has been implicated in conceptual representation across modalities (Binney et al., 2012; Visser et al., 2012), was intact in all cases. This region is supplied by both the anterior temporal cortical artery of the middle cerebral artery and the anterior temporal branch of the distal posterior cerebral artery, reducing its vulnerability to stroke (Borden, 2006; Conn, 2008; Phan et al., 2005). The hippocampus and parahippocampal gyrus were intact in all patients.
Predictors of Cognitive and Academic Outcome following Childhood Subcortical Stroke
Published in Developmental Neuropsychology, 2018
Robyn Westmacott, Kyla P. McDonald, Samantha D. Roberts, Gabrielle deVeber, Daune MacGregor, Mahendranath Moharir, Nomazulu Dlamini, Tricia S. Williams
Presenting symptoms of childhood stroke involving the middle cerebral artery (MCA) territory are similar to those in adults and typically involve acute-onset focal deficits that correlate with the location of the lesion, such as hemiparesis (70–80%), speech and language difficulties (40%), imbalance (20%), and seizures (20%) (Amlie-Lefond, Sébire, & Fullerton, 2008; DeVeber et al., 2017; Hartman, Lunney, & Serena, 2009). Childhood stroke etiologies are varied, but the most common include: congenital heart disease, hemoglobinopathies (such as sickle cell disease), and vasculopathies (such as moyamoya disease, and transient cerebral arteriopathy related to infection; Amlie-Lefond et al., 2009; Askalan et al., 2001; DeVeber et al., 2017; Dlamini & Kirkham, 2009). Despite a much higher survival rate in children (90%) compared to adults (75%), significant neurological morbidity is reported in more than half of pediatric stroke survivors (Cárdenas et al., 2011; Mozaffarian et al., 2016). Recurrent stroke occurs in 5–15%, the development of seizure disorders occurs in 10–15%, and 60–70% have persistent neurological deficits, such as hemiparesis, spasticity, hemi-sensory loss, dystonia, and dysphasia (DeVeber et al., 2017; Fullerton et al., 2016).
Decompressive craniectomy in pediatric non-traumatic intracranial hypertension: a single center experience
Published in British Journal of Neurosurgery, 2020
Vijai Williams, Arun Bansal, Muralidharan Jayashree, Javed Ismail, Ashish Aggarwal, SK Gupta, Sunit Singhi, Pratibha Singhi, Arun Kumar Baranwal, Karthi Nallasamy
Our findings revealed that in children who underwent DC, anisocoria at admission was an independent predictor of poor outcome at 6 months’ post-discharge. This is similar to the observations seen in DC done for pediatric TBI26,51 and non-traumatic ICH.26 Low GCS at admission was another predictor of poor outcome following DC in nontraumatic ICH reported in an adult series54 and in a pediatric series.4 On the contrary, Guresir et al.26 and Thomale et al.55 showed good long-term functional outcome despite low GCS at admission. Sundseth et al. in their study identified middle cerebral artery infarct along with additional territory infarcts as a significant predictor of early in-hospital death.56
Related Knowledge Centers
- Anterior Cerebral Artery
- Cerebral Arteries
- Cerebral Cortex
- Insular Cortex
- Internal Carotid Artery
- Lateral Sulcus
- Posterior Communicating Artery
- Cerebrum
- Temporal Lobe
- Blood