摘要:

Several studies found a significant association between patent foramen ovale (PFO), interatrial septal aneurysm, and patients less than 60 years of age presenting with acute stroke and without any identified coexisting mechanism explaining the acute event. Paradoxical embolism from a venous source through a right-to-left shunt is usually incriminated, but the definite proof for paradoxical embolism is often lacking, with screening for deep-venous thrombosis leading to variable estimates. Despite these controversies, the possibility of paradoxical embolism in patients with cryptogenic stroke and PFO is commonly retained as the cause of the neurological deficit. Moreover, there are now definite studies documenting that these patients are at risk of recurrence. The aim of the present paper is to review the literature on the risks of stroke recurrence in patients with atrial septal defects, and to weigh the risks and benefits of the different therapeutic options currently available to prevent stroke recurrence. These options include chronic oral anticoagulant or anti-platelet therapy, and more invasive procedures such as surgical closure or transcatheter closure of the defect. Finally, using the principles of decision analysis, the authors suggest tentative practical therapeutic recommendations that might be helpful to clinicians in daily practice.

ISSN:0014-3022    

DOI:10.1159/000117442

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000190999

出版商:S. Karger AG    

年代:1915

数据来源: Karger

摘要:

We describe 14 patients (mean age 57 years) in whom stroke or TIA was the presenting manifestation of a haematologic disorder. Twelve patients had an ischaemic stroke and 2 a haemorrhagic stroke. This group represented 1.27% (14/1,099) of the total number of patients with first-ever stroke diagnosed from 1986 to 1992 at our institution, accounted for 1.32% (12/906) of all brain infarcts and 1.03% (2/193) of all haemorrhagic strokes, and was the most common aetiology (25%) of ischaemic stroke of unusual cause. Haematological disorders included essential thrombocythaemia (6), polycythaemia vera (1), smoker’s polycythaemia (1), thrombotic thrombocytopenic purpura (1), IgA lambda myeloma (1), acute lymphoblastic leukaemia (1), Waldenström’s macroglobulinaemia (1), chronic granulocytic leukaemia (1) and IgG lambda myeloma (1). Stroke subtypes included definitive cerebral infarct (10), TIA (2), parenchymal haemorrhage (1) and spontaneous subdural haematoma (1). Vascular territories in ischaemic stroke were the carotid in 7 patients, the ver-tebrobasilar in 1 and undetermined in 4. Mean follow-up was 40 months (range, 1-96 months). The mortality rate was 1

ISSN:0014-3022    

DOI:10.1159/000117444

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

We report a short-term double-blind, crossover study of CoQ10 in 8 patients with mitochondrial encephalomyopathies. Four patients had myoclonus epilepsy with ragged-red fibers syndrome, 3 had mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes syndrome, and 1 had chronic progressive external ophthalmoplegia with myopathy. A trend of effectiveness of CoQ10 in several parameters was noted. Fatigability of daily activities was alleviated. The endurance to muscle exercise was augmented. Global muscle strength scored by Medical Research Council scale was increased. The extent of elevation in serum lactate and pyruvate levels after exercise was decreased. However, only the global MRC index score had a statistical significance (p < 0.05). There were no side effects during therapy. The serum CoQ10 levels were significantly lower in patients than in normal controls before CoQ10 treatment and increased significantly after treatment.

ISSN:0014-3022    

DOI:10.1159/000117445

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Statistical probability mapping was used to quantify and localize EEG differences between 27 patients with Alzheimer’s disease (AD) and 25 age- and gen-er-matched controls. Differences in mean activity in four EEG frequency bands (delta, theta, alpha, beta) for wakefulness and for REM sleep were examined, t-statistic maps clearly highlighted common pattern anomalies in AD patients in the two states. More specifically, Alzheimer patients were more affected than control subjects in parieto-temporal and frontal regions. These differences were more prominent in REM sleep and consisted primarily in an increase in absolute delta and theta activities, and a decrease in absolute alpha and beta activities. Discriminant analysis, using a ratio of slow over fast frequencies, yielded a classification rate of 90.4% (sensitivity 81.5%, specificity 100%) for REM sleep. For wakefulness, the same measure allowed correct classification of 80.8% of the subjects (sensitivity 66.7%, specificity 96%

ISSN:0014-3022    

DOI:10.1159/000117446

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

To assess the bone health of patients with amyotrophic lateral sclerosis (ALS), we evaluated the bone density and serum biochemical indices of bone metabolism in 11 ALS patients. The serum concentration of 25-hydroxyvitamin D (25-OHD) was significantly lower in patients (14.0 ± 3.7 ng/ml) than in controls (25.2 ± 4.0 ng/ml), at deficient levels (< 10 ng/ml) in 2, and at insufficient levels (10-20 ng/ml) in 9 patients. Serum levels of parathyroid hormone (PTH) and ionized calcium were elevated in 8 and 6 patients, respectively. Dietary intake of vitamin D was below the recommended level (100 IU) in 10 patients, and 10 patients were in a sunlight-deprived state. The metacarpal bone density (MBD) and the metacarpal index (MCI) of the second metacarpal bone were measured by computed X-ray densitometry. Z scores of the MBD and the MCI were negative in 7 and 6 patients, respectively. The serum concentration of 25-OHD was positively correlated with the Z score of the MBD (p < 0.05, r = 0.727) and negatively with the PTH level (p < 0.05, r --0.410). The degree of dysfunction of hand grip also correlated with the Z score of the MBD (p < 0.05, r = 0.749). These data underscore the importance of hypovitaminosis D and compensatory hyperparathyroidism in the development of osteopenia in patients with AL

ISSN:0014-3022    

DOI:10.1159/000117447

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000191000

出版商:S. Karger AG    

年代:1915

数据来源: Karger

摘要:

We report a case with bilateral paramedian thalamic infarcts. The patient showed a dramatic personality change characterized by childish behavior and euphoria, which remained unchanged for 2 years after the onset. ‘Vorbeireden’ characterized by approximate answers was also observed. Anterograde amnesia had quite improved after 2 years, while retrograde amnesia for 1 year prior to the stroke onset and vertical gaze palsy remained unchanged. An MRI scan demonstrated bilateral medial thalamic and right midbrain infarcts without other lesions in the brain. A positron emission tomography study showed that cerebral metabolic rate for glucose was markedly decreased in both thalami and in the cerebellum, and only slightly decreased in the parietal and occipital cortical regions. Cerebral metabolic rates of glucose in the frontal and temporal cortices were within normal range. The paramedian thalamic lesions per se may be responsible for the patient’s personality change, ‘Vorbeireden’, an

ISSN:0014-3022    

DOI:10.1159/000117448

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The combination of levodopa and a dopamine agonist in the treatment of patients with Parkinson’s disease often reduces the severity of motor fluctuations. In patients with very severe motor fluctuations, monotherapy with continuous subcutaneous infusions of the dopamine agonist apomorphine may result in a marked reduction of hyperkinesia and on-off phenomena. We report 3 patients with Parkinson’s disease and motor fluctuations who received high doses of pergolide without levodopa resulting in a reduction of motor fluctuations. All patients received doses of pergolide exceeding the maximum recommended dose. One patient also required additional therapy with amantadine. These data show that in some patients oral treatment with high doses of a dopamine agonist may improve the severity of motor fluctuations and achieve a good control of parkinsonian signs without concomitant levodopa treatm

ISSN:0014-3022    

DOI:10.1159/000117449

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Muscle strength in neuropathic patients is usually evaluated clinically using manual muscle testing (MMT). Detection and grading of mild symmetrical muscle weakness using MMT is difficult partly because the examiner must take into consideration the normal variation in strength in relation to age, weight, height, and gender. In the present study assessment of the strength of ankle dorsal and plantar flexors and knee flexors and extensors with MMT and isokinetic dynamometry were compared in 108 patients, of whom 86 had diabetes mellitus and 22 had alcoholic liver cirrhosis. The isokinetic muscle strength of the patients was compared with the strength of 90 healthy control subjects, adjusted for the influence of age, weight, and height for both genders. MMT resulted in a significant underestimation of the frequency and severity of muscle weakness in both the ankle and the knee. In 28–41 % of the comparisons, MMT misclassified the strength performance with one category or more (>25%). Misclassifications were most frequent for the ankle plantar flexor

ISSN:0014-3022    

DOI:10.1159/000117450

出版商:S. Karger AG    

年代:1997

数据来源: Karger