Stroke; a journal of cerebral circulation
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Case Reports
Sensory changes in the ipsilateral extremity. A clinical variant of lateral medullary infarction.
Classically, patients with unilateral lateral medullary infarction exhibit sensory abnormalities over the ipsilateral face and contralateral hemibody. As a variant, bilateral or contralateral facial sensory changes can be seen. However, sensory changes in the ipsilateral extremities are extremely rare. ⋯ Although rare, impaired ipsilateral deep sensation is encountered in patients with lateral medullary infarction syndrome.
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Comment Letter Comparative Study
Prognostic value of transcranial magnetic stimulation in acute stroke.
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With advanced imaging techniques, infarctions occurring in the medulla are now more easily identified. To date, however, only approximately 30 cases of medial medullary infarction syndrome (MMS) have been reported, and the clinical and radiological characteristics of MMS remain to be studied. ⋯ Our data illustrate that MMS is most often manifested as benign hemisensorimotor stroke frequently associated with tingling sensation and impaired deep sensation. This benign form of MMS should be much more common than MMS with poor prognosis and may have been frequently misdiagnosed as capsular or pontine stroke before the era of MRI.
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Stroke is largely a preventable disease. However, there are little data available concerning the use of stroke prevention diagnostic and treatment modalities by practicing physicians. These data are critical for the rational allocation of resources and targeting of educational efforts. The purposes of this national survey were to gather information about physicians' stroke prevention practice patterns and their attitudes and beliefs regarding secondary and tertiary stroke prevention strategies. ⋯ Although all routine and most specialized services for secondary and tertiary stroke prevention are readily available to most physicians, variation in availability exists. The use of international normalized ratios for monitoring warfarin therapy has not yet become universal. Physician knowledge of carotid endarterectomy complication rates is generally lacking. Depending on their causes, these problems may be addressed through targeted physician education efforts and systematic changes in the way in which services are provided.
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Hypervolemic hemodilution therapy is effective for treating neurological deficits due to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). We monitored various hemorheological and hemodynamic parameters to assess the effects of hypervolemic hemodilution therapy in SAH patients with cerebral vasospasm. ⋯ Patients with SAH develop hypovolemia, hemodynamic depression, and increased red blood cell aggregability. Hypervolemic hemodilution therapy decreases hematocrit level and red cell aggregability while increasing cardiac output. Improvement of hemorheological and hemodynamic parameters by this therapy can reverse neurological deterioration due to cerebral vasospasm.