DOCSLIB.ORG

Cerebrovascular Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cerebrovascular Disease Cerebrovascular Disease a,b, a,b Louis R. Caplan, MD *, D. Eric Searls, MD , c Fong Kwong Sonny Hon, FRCP KEYWORDS Cerebrovascular disease Stroke Intracerebral hemorrhage Subarachnoid hemorrhage Transient ischemic attack AIMS AND QUERIES Effective management of patients who have cerebrovascular disease depends on ac- curate diagnosis. Outpatient ambulatory visits have advantages and disadvantages over inpatient encounters. The office allows more privacy, room, time, and relative freedom from distractions. Seeing the patient and significant others in their usual attire adds information not obtained from seeing the patient in the hospital. The inpatient setting allows for more rapid diagnostic testing, frequent nursing observation, and the possibility of deploying advanced pharmacologic and mechanical therapies for stroke. In ambulatory patients, the key questions are as follows: What is the diagnosis (what and where are the vascular and brain lesions)? How urgent is the problem? Should the patient be hospitalized? What tests should be ordered, and how soon? What treat- ment should be prescribed? What explanations and instructions should be given? These questions must be answered quickly, directly after the outpatient encounter. This article focuses on the first issues—making the diagnosis and planning the evalu- ation of a patient suspected of having cerebrovascular disease. Box 1 lists the data the clinician needs to know.1 Because cerebrovascular disease is so heterogeneous, management of individual patients depends on the type, loca- tion, and severity of the cerebrovascular disease and the presence, severity, and location of the resultant brain injury. Diagnosis and acquisition of data are accom- plished best by a question-driven approach. a Department of Neurology, Cerebrovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215-5400, USA b Cerebrovascular Division, Department of Neurology, Harvard University, School of Medicine, 127 Palmer, 330 Brookline Avenue, Boston, MA 02215, USA c Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 10 Tai Man Road, Hong Kong, China * Corresponding author. Cerebrovascular Division, Department of Neurology, Harvard University, School of Medicine, 127 Palmer, 330 Brookline Avenue, Boston, MA 02215. E-mail address: [email protected] (L.R. Caplan). Med Clin N Am 93 (2009) 353–369 doi:10.1016/j.mcna.2008.09.004 medical.theclinics.com 0025-7125/08/$ – see front matter ª 2009 Elsevier Inc. All rights reserved. 354 Caplan et al Box 1 Data needed to treat a patient with brain ischemia logically Stroke mechanism, ischemic or hemorrhagic, and their subtypes Nature, location, and severity of the causative cardiac-cerebrovascular-hematologic lesions Pathophysiology of the vascular lesion that caused the brain injury-hemorrhage, hypoperfusion, or embolism Nature and function of the key cellular and serologic blood components and any disorder of coagulation State of the brain, whether normal, infarcted, or injured but recoverable From Caplan LR, Hon FK. Clinical diagnosis of patients with cerebrovascular disease. Prim Care 2004;31(1):96; with permission. Does the Patient have Cerebrovascular Disease or a Mimic? Many conditions cause clinical findings that closely resemble cerebrovascular disor- ders. Table 1 lists the most frequent stroke mimics and whether they tend to produce general or focal neurologic symptoms and signs.1 Brain tumors occasionally cause sudden-onset symptoms. Seizures, migraine attacks, and faints sometime are difficult to separate from transient ischemic attacks (TIAs). Table 2 lists the differential diag- nostic features of these common stroke mimics.1 Hypoglycemia, severe hyperglyce- mia, severe hyponatremia, hypocalcemia, and other toxic and metabolic conditions occasionally can cause focal brain symptoms. Diagnosis is based on the presence of risk factors for vascular disease, the tempo of onset, the presence of concurrent conditions, and the clinical course of development of neurologic symptoms and signs. In many patients, recognition that the disorder is not cerebrovascular is based on the neuroimaging presence of another condition, such as a tumor, subdural hematoma, brain abscess, or hemorrhage. Stroke mimics are also diagnosed by blood and Table 1 Frequent stroke mimics and their tendency to produce general versus localized nervous system findings Conditions Focal Symptoms Nonfocal Symptoms Frequent disorders Seizures 11 11 Transient ischemic attacks 1111 Occasionally Migraine 1111 1111 Syncope — 1111 Less frequent disorders Vestibulopathy 11 11 Metabolic 1 111 Neoplasm 111 1 Multiple sclerosis 1111 — Psychiatric 11 11 Peripheral nerves and roots 1111 — From Caplan LR, Hon FK. Clinical diagnosis of patients with cerebrovascular disease. Prim Care 2004;31(1):96; with permission. Cerebrovascular Disease 355 Table 2 Differential diagnostic features Seizures TIAs Migraine Syncope Demographics Any age Older patients Younger age Any age Children are Stroke risk Women>men Often younger common factors present Women>men Men>women Central nervous Aura preceding Negative First positive Light-headed, system Positive symptoms: symptoms, dim vision, symptoms symptoms: numbness, then negative distant noises, limb jerking, weakness, symptoms in decreased head turning, aphasia, visual same modality alertness eye deviation, loss, ataxia Scintillating Transient loss of loss of All sensory scotomas and consciousness consciousness modalities paresthesias Negative affected most frequent symptoms: simultaneously Second sensory (weakness) modality is may develop involved after postictally the first clears Timing 20–180 sec Usually <1 h Usually 30 min to Usually a few Absence, atonic several h seconds seizures & Intermittent Sporadic attacks myoclonic daily, weekly, during years jerks briefer monthly, or yearly Associated Tongue biting, — Headache, Diaphoresis, symptoms incontinence, vomiting, pallor, nausea automatisms photophobia, Headache, phonophobia myalgias postictally Adapted from Caplan LR, Hon FK. Clinical diagnosis of patients with cerebrovascular disease. Prim Care 2004;31(1):97; with permission. cerebrospinal fluid testing that shows a toxic, metabolic, or infectious process and does not show brain infarction or hemorrhage. Does the Patient have Cerebrovascular Disease or a Seizure? Differentiating between strokes and seizures is important (although some stroke pa- tients have seizures at the onset of their stroke). Incorrect diagnosis can lead to the wrong management and can have severe, even life-threatening consequences for the patient. Table 2 lists common features of seizures.1 Once a seizure has concluded (the postictal period), it can be especially difficult to discern between the two condi- tions. During the postictal period, the patient may develop headache or muscle sore- ness. The patient may have focal weakness, such as a monoparesis or hemiparesis (otherwise known as a postictal paresis). This weakness can last from several hours to a day after the seizure’s termination. Postictal paresis can easily be mistaken for the effects of a stroke. Although diagnosing a seizure is based on the clinical picture, ancillary testing (electroencephalogram) can be helpful and may confirm the diagnosis. 356 Caplan et al If the Disorder is Cerebrovascular, is the Problem Hemorrhage or Ischemia? Differentiation into hemorrhagic and ischemic conditions is an important initial step. These two mechanisms are diametrically opposite. In intracranial hemorrhage, there is leakage or rupture of a blood vessel that results in blood in the brain tissue, ventri- cles, subarachnoid space, or epidural space, whereas in ischemia, blood cannot per- fuse brain tissue. The brain tissue is starved of vital nutrients and energy. For patients who have ischemic brains, the aim is to restore blood flow and thereby increase de- livery of oxygen and other nutrients. In hemorrhage patients, however, the aim is to stop the bleeding and prevent further hemorrhages. About 85% of strokes are ische- mic, and about 15% are hemorrhagic.2,3 Separation between bleeding and ischemia is based on the clinical history and examination, but corroboration is always necessary by brain imaging that shows either subarachnoid or intraparenchymatous blood, a brain infarct, or the absence of bleeding without infarction. In some patients, spinal puncture is necessary to document bleeding into the subarachnoid space because brain imaging in these patients sometimes does not show hemorrhage, especially if the hemorrhage was small or occurred days before imaging.4 The absence of bleeding and important nonvascular pathology on brain neuroimaging in patients with acute- onset focal brain symptoms is usually sufficient evidence that the problem is brain ischemia, especially when the patient has stroke risk factors and cardiac or cerebro- vascular lesions shown by vascular imaging and cardiac evaluation. What if the Problem is Hemorrhage? Is the Bleeding Subarachnoid or Intracerebral? Hemorrhagic conditions should be separated into subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH). These two subtypes of hemorrhage have different causes, different clinical findings, and different treatment strategies. About 5% of all strokes are due to SAH, and about 10% are due to ICH, depending on age, sex, ed- ucational and social status, and racial composition of patients studied.2,3 Subarachnoid bleeding usually occurs rapidly over several seconds. In some pa- tients,
Load more

Recommended publications
  • Pearls: Infectious Diseases
    Pearls: Infectious Diseases Karen L. Roos, M.D.1 ABSTRACT Neurologists have a great deal of knowledge of the classic signs of central nervous system infectious diseases. After years of taking care of patients with infectious diseases, several symptoms, signs, and cerebrospinal fluid abnormalities have been identified that are helpful time and time again in determining the etiological agent. These lessons, learned at the bedside, are reviewed in this article. KEYWORDS: Herpes simplex virus, Lyme disease, meningitis, viral encephalitis CLINICAL MANIFESTATIONS does not have an altered level of consciousness, sei- zures, or focal neurologic deficits. Although the ‘‘classic triad’’ of bacterial meningitis is The rash of a viral exanthema typically involves the fever, headache, and nuchal rigidity, vomiting is a face and chest first then spreads to the arms and legs. common early symptom. Suspect bacterial meningitis This can be an important clue in the patient with in the patient with fever, headache, lethargy, and headache, fever, and stiff neck that the meningitis is vomiting (without diarrhea). Patients may also com- due to echovirus or coxsackievirus. plain of photophobia. An altered level of conscious- Suspect tuberculous meningitis in the patient with ness that begins with lethargy and progresses to stupor either several weeks of headache, fever, and night during the emergency evaluation of the patient is sweats or a fulminant presentation with fever, altered characteristic of bacterial meningitis. mental status, and focal neurologic deficits. Fever (temperature 388C[100.48F]) is present in An Ixodes tick must be attached to the skin for at least 84% of adults with bacterial meningitis and in 80 to 24 hours to transmit infection with the spirochete 1–3 94% of children with bacterial meningitis.
    [Show full text]
  • Acquired Aphasia in Children
    13 Acquired Aphasia in Children DOROTHY M. ARAM Introduction Children versus Adults Language disruptions secondary to acquired central nervous system (CNS) lesions differ between children and adults in multiple respects. Chief among these differences are the developmental stage of language ac- quisition at the time of insult and the developmental stage of the CNS. In adult aphasia premorbid mastery of language is assumed, at least to the level of the aphasic's intellectual ability and educational opportunities. Acquired aphasia sustained in childhood, however, interferes with the de- velopmental process of language learning and disrupts those aspects of language already mastered. The investigator and clinician thus are faced with sorting which aspects of language have been lost or impaired from those yet to emerge, potentially in an altered manner. Complicating re- search and clinical practice in this area is the need to account continually for the developmental stage of that aspect of language under consideration for each child. In research, stage-appropriate language tasks must be se- lected, and comparison must be made to peers of comparable age and lan- guage stage. Also, appropriate controls common in adult studies, such as social class and gender, are critical. These requirements present no small challenge, as most studies involve a wide age range of children and ado- lescents. In clinical practice, the question is whether assessment tools used for developmental language disorders should be used or whether adult aphasia batteries should be adapted for children. The answer typically de- pends on the age of the child and the availability of age- and stage-appro- 451 ACQUIRED APHASIA, THIRD EDITION Copyright 1998 by Academic Press.
    [Show full text]
  • Synchronized Babinski and Chaddock Signs Preceded the MRI Findings in a Case of Repetitive Transient Ischemic Attack
    □ CASE REPORT □ Synchronized Babinski and Chaddock Signs Preceded the MRI Findings in a Case of Repetitive Transient Ischemic Attack Kosuke Matsuzono 1,2, Takao Yoshiki 1, Yosuke Wakutani 1, Yasuhiro Manabe 3, Toru Yamashita 2, Kentaro Deguchi 2, Yoshio Ikeda 2 and Koji Abe 2 Abstract We herein report a 53-year-old female with repeated transient ischemic attack (TIA) symptoms including 13 instances of right hemiparesis that decreased in duration over 4 days. Two separate examinations using diffusion weighted image (DWI) in magnetic resonance imaging (MRI) revealed normal findings, but we ob- served that both Babinski and Chaddock signs were completely synchronized with her right hemiparesis. We were only able to diagnose this case of early stage TIA using clinical signs. This diagnosis was confirmed 4 days after the onset by the presence of abnormalities on the MRI. DWI-MRI is generally useful when diag- nosing TIA, but a neurological examination may be more sensitive, especially in the early stages. Key words: Babinski sign, Chaddock sign, TIA, diffusion weighted image (Intern Med 52: 2127-2129, 2013) (DOI: 10.2169/internalmedicine.52.0190) Introduction Case Report Transient ischemic attack (TIA) is a clinical syndrome A 53-year-old woman suddenly developed right hemipare- that consists of sudden focal neurologic signs and a com- sis, and she was admitted to our hospital 30 minutes after plete recovery usually within 24 hours (1). Because TIA can the onset. She had smoked 10 cigarettes daily for 23 years, sometimes develop into a cerebral infarction, an early diag- and quit at 43 years of age.
    [Show full text]
  • Cognitive Performance Deficits and Dysgraphia in Alzheimer's Disease
    Send Orders for Reprints to [email protected] 6 Open Medicine Journal, 2015, 2, 6-16 Open Access Cognitive Performance Deficits and Dysgraphia in Alzheimer’s Disease Patients Emanuela Onofri1, Marco Mercuri1, MariaLucia Salesi1, Max Rapp Ricciardi2 and Trevor Archer*,2 1Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Italy 2Department of Psychology, University of Gothenburg, Gothenburg, Sweden Abstract: Introduction: Agraphia or dysgraphia, observed often in early AD, encompasses a progressive disorganization and degeneration of the various components of handwriting. Methods: Deficits in writing ability, dysgraphia, and the relationship with other measures of cognitive decline were studied in a group of 30 patients, originating from the Lazio region, Rome, Italy, presenting a moderate to relatively severe stage of Alzheimer’s disease (AD). Extent of dysgraphia and cognitive performance was compared with a matched group of healthy controls selected from the same region. Results: Several markedly strong relationships between dysgraphia and several measures of cognitive performance in AD patients were observed concomitant with consistent deficits by this patient sample in comparison with the matched group of healthy control subjects were obtained. Additionally, several measures of loss of functional integrity, MMSE, ADL and IADL, were found to be associated with both dysgraphia and impairments in cognitive performance. Conclusion: The present results are discussed from the notion of
    [Show full text]
  • Alexia Without Agraphia
    Neuroradiology(1992) 34:210-214 Neuro radiology Springer-Verlag 1992 Alexia without agraphia D. J. Quint I and J. L. Gilmore 2 1Division of Neuroradiology,Department of Radiology,University of MichiganHospitals, Ann Arbor, Michigan,USA 2Department of Neurology,University of Rochester, Rochester, New York, USA Received: September 16, 1991 Summary. Two new cases of alexia without agraphia are mentation and right visual complaints. She had suffered presented. Pertinent clinical findings, anatomy, pathophy- from extensive atherosclerotic peripheralvascular disease siology and differential diagnoses are reviewed. The im- involving both the systemic and cerebral vasculature, portance of carefully examining the inferior portion of the necessitating carotid endarterectomy. The patient denied left side of the splenium of the corpus callosum on CT any "strokes", but did suffer from complications of scle- and/or MR scans in patients who present with this clinical roderma including gastritis, esophagitis and Raynaud's syndrome is stressed. phenomenon and had also had a cervical sympathectomy. The patient did report a vague episode of "loss of con- Key words: Alexia - Agraphia - Disconnection syndrome sciousness" 4-5 months before admission. - Magnetic resonance imaging - Computed tomography General physical examination showed some edema of the legs. Neurologic examination revealed the patient to be oriented to person and place, but not to time. She could Alexia without agraphia or pure word blindness is con- sidered one of the classic disconnection syndromes. Pa- identify letters, but could not read. She could write her name and spell simple words forwards and backwards. Cra- tients retain the ability to write, but are unable to read nial nerve (II-XII) examination demonstrated a right ho- (even words that they have just written) and often have monymous hemianopia.
    [Show full text]
  • UCSD Moores Cancer Center Neuro-Oncology Program
    UCSD Moores Cancer Center Neuro-Oncology Program Recent Progress in Brain Tumors 6DQWRVK.HVDUL0'3K' 'LUHFWRU1HXUR2QFRORJ\ 3URIHVVRURI1HXURVFLHQFHV 0RRUHV&DQFHU&HQWHU 8QLYHUVLW\RI&DOLIRUQLD6DQ'LHJR “Brain Cancer for Life” Juvenile Pilocytic Astrocytoma Metastatic Brain Cancer Glioblastoma Multiforme Glioblastoma Multiforme Desmoplastic Infantile Ganglioglioma Desmoplastic Variant Astrocytoma Medulloblastoma Atypical Teratoid Rhabdoid Tumor Diffuse Intrinsic Pontine Glioma -Mutational analysis, microarray expression, epigenetic phenomenology -Age-specific biology of brain cancer -Is there an overlap? ? Neuroimmunology ? Stem cell hypothesis Courtesy of Dr. John Crawford Late Effects Long term effect of chemotherapy and radiation on neurocognition Risks of secondary malignancy secondary to chemotherapy and/or radiation Neurovascular long term effects: stroke, moya moya Courtesy of Dr. John Crawford Importance Increase in aging population with increased incidence of cancer Patients with cancer living longer and developing neurologic disorders due to nervous system relapse or toxicity from treatments Overview Introduction Clinical Presentation Primary Brain Tumors Metastatic Brain Tumors Leptomeningeal Metastases Primary CNS Lymphoma Paraneoplastic Syndromes Classification of Brain Tumors Tumors of Neuroepithelial Tissue Glial tumors (astrocytic, oligodendroglial, mixed) Neuronal and mixed neuronal-glial tumors Neuroblastic tumors Pineal parenchymal tumors Embryonal tumors Tumors of Peripheral Nerves Shwannoma Neurofibroma
    [Show full text]
  • Clinical Characteristics and Prognostic Factors in Childhood
    BALKAN MEDICAL JOURNAL 80 THE OFFICIAL JOURNAL OF TRAKYA UNIVERSITY FACULTY OF MEDICINE © Trakya University Faculty of Medicine Balkan Med J 2013; 30: 80-4 • DOI: 10.5152/balkanmedj.2012.092 Available at www.balkanmedicaljournal.org Original Article Clinical Characteristics and Prognostic Factors in Childhood Bacterial Meningitis: A Multicenter Study Özden Türel1, Canan Yıldırım2, Yüksel Yılmaz2, Sezer Külekçi3, Ferda Akdaş3, Mustafa Bakır1 1Department of Pediatrics, Section of Pediatric Infectious Diseases, Faculty of Medicine, Marmara University, İstanbul, Turkey 2Department of Pediatrics, Section of Pediatric Neurology, Faculty of Medicine, Marmara University, İstanbul, Turkey 3Department of Audiology, Faculty of Medicine, Marmara University, İstanbul, Turkey İstanbul, Turkey ABSTRACT Objective: To evaluate clinical features and sequela in children with acute bacterial meningitis (ABM). Study Design: Multicenter retrospective study. Material and Methods: Study includes retrospective chart review of children hospitalised with ABM at 11 hospitals in İstanbul during 2005. Follow up visits were conducted for neurologic examination, hearing evaluation and neurodevelopmental tests. Results: Two hundred and eighty three children were included in the study. Median age was 12 months and 68.6% of patients were male. Almost all patients had fever at presentation (97%). Patients younger than 6 months tended to present with feeding difficulties (84%), while patients older than 24 months were more likely to present with vomitting (93%) and meningeal signs (84%). Seizures were present in 65 (23%) patients. 26% of patients were determined to have at least one major sequela. The most common sequelae were speech or language problems (14.5%). 6 patients were severely disabled because of meningitis. Presence of focal neurologic signs at presentation and turbid cerebrospinal fluid appearance increased sequelae signifi- cantly.
    [Show full text]
  • Agraphia Classifications
    Agraphia Classifications © 2020 ARCHWAYS-APHASIA REHABILITATION SERVICES PLLC Central Agraphias Involve the language processing components of writing and result in difficulty with spelling. Include: • Surface Agraphia • Phonological Agraphia • Deep Agraphia • Global Agraphia • Semantic Agraphia • Graphemic Buffer Impairment Surface Agraphia • Impairment in lexical writing routes (Orthographic Output Lexicon will be impacted) • Phoneme-Grapheme Conversion preserved • Characteristic Features: • Regular words and nonwords written more accurately than irregular words • Over-reliance on sublexical spelling, creating a regualrisation effect • High-frequency words more accurate than low-frequency • Homophone confusion (e.g., SAIL’sale’) • Examples: • Regularisation/phonologically-plausible errors: ANSWER’anser’, OCEAN’oshen’ • Errors involving partial knowledge of irregular words: YACHT’yhaught’, SWORD’sward’ Phonological Agraphia • Impairment in sublexical spelling process • Phoneme-Grapheme Conversion AND/OR Auditory Phonological Analysis impacted • Characteristic Features: • Poor writing of nonwords to dictation • If real word writing impaired, high-imageability and high- frequency words more accurate than low-imageability and low-frequency words. Structurally similar and morphological errors may also be present, with content words being more accurate than functors • Examples: • Structurally similar errors: TOWER’towen’ • Morphological errors: WORKS’working’ • Functor substitutions: OVER’here’ Deep Agraphia • Impairment in semantic route
    [Show full text]
  • Parietal Dysgraphia: Characterization of Abnormal Writing Stroke Sequences, Character Formation and Character Recall
    Behavioural Neurology 18 (2007) 99–114 99 IOS Press Parietal dysgraphia: Characterization of abnormal writing stroke sequences, character formation and character recall Yasuhisa Sakuraia,b,∗, Yoshinobu Onumaa, Gaku Nakazawaa, Yoshikazu Ugawab, Toshimitsu Momosec, Shoji Tsujib and Toru Mannena aDepartment of Neurology, Mitsui Memorial Hospital, Tokyo, Japan bDepartment of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan cDepartment of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan Abstract. Objective: To characterize various dysgraphic symptoms in parietal agraphia. Method: We examined the writing impairments of four dysgraphia patients from parietal lobe lesions using a special writing test with 100 character kanji (Japanese morphograms) and their kana (Japanese phonetic writing) transcriptions, and related the test performance to a lesion site. Results: Patients 1 and 2 had postcentral gyrus lesions and showed character distortion and tactile agnosia, with patient 1 also having limb apraxia. Patients 3 and 4 had superior parietal lobule lesions and features characteristic of apraxic agraphia (grapheme deformity and a writing stroke sequence disorder) and character imagery deficits (impaired character recall). Agraphia with impaired character recall and abnormal grapheme formation were more pronounced in patient 4, in whom the lesion extended to the inferior parietal, superior occipital and precuneus gyri. Conclusion: The present findings and a review of the literature suggest that: (i) a postcentral gyrus lesion can yield graphemic distortion (somesthetic dysgraphia), (ii) abnormal grapheme formation and impaired character recall are associated with lesions surrounding the intraparietal sulcus, the symptom being more severe with the involvement of the inferior parietal, superior occipital and precuneus gyri, (iii) disordered writing stroke sequences are caused by a damaged anterior intraparietal area.
    [Show full text]
  • Journal of Neurological Disorders DOI: 10.4172/2329-6895.1000309 ISSN: 2329-6895
    olog eur ica N l D f i o s l o a r n d r e u r s o J Lee, et al., J Neurol Disord 2016, 4:7 Journal of Neurological Disorders DOI: 10.4172/2329-6895.1000309 ISSN: 2329-6895 Case Report Open Access Two Cases with Cerebral Infarction in the Left Middle Frontal Lobe Presented as Gerstmann's Syndrome Eun-Ju Lee, Hye-Young Shin, Young Noh, Ki-Hyung Park, Hyeon-Mi Park, Yeong-Bae Lee, Dong-Jin Shin, Young Hee Sung and Dong Hoon Shin* Department of Neurology, Gil Hospital, Gachon University Gil Medical Center, Incheon, South Korea *Corresponding author: Dong Hoon Shin, Department of Neurology, Gil Hospital, Gachon University Gil Medical Center, South Korea, Tel: +82-32-460-3346; Fax: +83-32-460-3344; E-mail: [email protected] Rec date: Oct 08, 2016, Acc date: Oct 18, 2016, Pub date: Oct 22, 2016 Copyright: © 2016 Lee, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Gerstmann's syndrome is a neuropsychological disorder characterized by four symptoms, namely, acalculia, finger agnosia, left-right disorientation, and agraphia suggesting the presence of a lesion in the inferior parietal lobule of the dominant hemisphere, especially at the angular gyrus. Several descriptions of Gerstmann's syndrome have been reported in associated with a lesion to the left frontal lobe, but none of these reports fulfilled the full tetrad of diagnostic criteria.
    [Show full text]
  • A Practical Review of Functional MRI Anatomy of the Language and Motor Systems
    REVIEW ARTICLE FUNCTIONAL A Practical Review of Functional MRI Anatomy of the Language and Motor Systems X V.B. Hill, X C.Z. Cankurtaran, X B.P. Liu, X T.A. Hijaz, X M. Naidich, X A.J. Nemeth, X J. Gastala, X C. Krumpelman, X E.N. McComb, and X A.W. Korutz ABSTRACT SUMMARY: Functional MR imaging is being performed with increasing frequency in the typical neuroradiology practice; however, many readers of these studies have only a limited knowledge of the functional anatomy of the brain. This text will delineate the locations, anatomic boundaries, and functions of the cortical regions of the brain most commonly encountered in clinical practice—specifically, the regions involved in movement and language. ABBREVIATIONS: FFA ϭ fusiform face area; IPL ϭ inferior parietal lobule; PPC ϭ posterior parietal cortex; SMA ϭ supplementary motor area; VOTC ϭ ventral occipitotemporal cortex his article serves as a review of the functional areas of the brain serving to analyze spatial position and the ventral stream working Tmost commonly mapped during presurgical fMRI studies, to identify what an object is. Influenced by the dorsal and ventral specifically targeting movement and language. We have compiled stream model of vision, Hickok and Poeppel2 hypothesized a sim- what we hope is a useful, easily portable, and concise resource that ilar framework for language. In this model, the ventral stream, or can be accessible to radiologists everywhere. We begin with a re- lexical-semantic system, is involved in sound-to-meaning map- view of the language-processing system. Then we describe the pings associated with language comprehension and semantic ac- gross anatomic boundaries, organization, and function of each cess.
    [Show full text]
  • Guideline for Concussion/Mild Traumatic Brain Injury & Persistent
    Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms Healthcare Professional Version Third Edition Adults (18+ years of age) SECTION 1: Diagnosis/Assessment of Concussion/mTBI The project team would like to acknowledge the Ontario Neurotrauma Foundation (ONF), who initiated and funded the development of the original guideline, as well as the current update. ONF is an applied health research organization with a focus on improving the quality of lives for people with an acquired brain injury or spinal cord injury, and on preventing neurotrauma injuries from occurring in the first place. ONF uses strategic research funding activity embedded within a knowledge mobilization and implementation framework to build capacity within systems of care. ONF works with numerous stakeholders and partners to achieve its objective of fostering, gathering and using research knowledge to improve care and quality of life for people who have sustained neurotrauma injuries, and to influence policy towards improved systems. The foundation receives its funding from the Ontario Government through the Ministry of Health and Long-Term Care. Please note, the project team independently managed the development and production of the guideline and, thus, editorial independence is retained. © Ontario Neurotrauma Foundation 2018 Ontario Neurotrauma Foundation 90 Eglinton East Toronto, ON, Canada M4P 2Y3 Tel.: 1 (416) 422-2228 Fax: 1 (416) 422-1240 Email: [email protected] www.onf.org Published May 2018 Cover Photo Credit: Puzzle Image: wallpaperwide.com The recommendations and resources found within the Guideline for Concussion/mTBI & Persistent Symptoms are intended to inform and instruct care providers and other stakeholders who deliver services to adults who have sustained or are suspected of having sustained a concussion/mTBI (mild traumatic brain injury).
    [Show full text]