SciCombinator

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Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

29

Frequencies of cognitive impairment and dementia have not been assessed in spontaneous intracerebral hemorrhage (ICH). The objective of this study was to determine the frequencies and patterns of cognitive impairment and dementia in a cross-sectional study of consecutive patients hospitalized in a single university medical center.

Concepts: Hospital, Cross-sectional study, Cerebral hemorrhage, Cross-sectional analysis

28

We report a patient who presented with callosal disconnection syndrome (CDS) and fiber disconnection on diffusion tensor tractography (DTT) after an infarct of the corpus callosum (CC). A 72-year-old woman presented with manifestations of CDS, including frontal alien hand syndrome (AHS), left agraphia, right hemiparesis, right somatosensory deficit, left neglect, and impaired visual recognition. DTT was performed for the evaluation of CC fibers, followed by comparison with DTT findings of normal subjects. DTT of the normal subject revealed bilateral extension of CC fibers to the frontal, parietal, and occipitotemporal cortices. By contrast, CC fibers of the patient revealed extensive disruption, with the exception of CC fibers passing through the anterior genu and the posterior splenium. The extensive disruption of CC fibers appears to explain the patient’s various CDS symptoms. In brief, DTT could be useful for detection of CC lesions in patients with CDS.

Concepts: Patient, Cerebrum, Corpus callosum, Splenium, Neurological disorders, Agenesis of the corpus callosum, Alien hand syndrome, Genu of the corpus callosum

28

BACKGROUND: Cerebellar infarction is easily misdiagnosed or underdiagnosed. In this study, we investigated factors leading to misdiagnosis of cerebellar infarction in patients with acute ischemic stroke. METHODS: Data on neurological and radiological findings from 114 consecutive patients with acute cerebellar infarction were analyzed. We investigated factors associated with misdiagnosis from the data on clinical findings. RESULTS: Thirty-two (28%) patients were misdiagnosed on admission. Misdiagnosis was significantly more frequent in patients below 60 years of age and in patients with vertebral artery dissection, and significantly less frequent in patients with dysarthria. It tended to be more frequent in patients with the medial branch of posterior inferior cerebellar artery territory infarction, and infrequent in patients with the medial branch of the superior cerebellar artery territory infarction. Thirty out of 32 (94%) misdiagnosed patients were seen by physicians that were not neurologists at the first visit. Twenty-four of 32 (75%) misdiagnosed patients were screened only by brain CT. However, patients were not checked by brain MRI or follow-up CT until their conditions worsened. CONCLUSIONS: Patients below 60 years of age and patients with vertebral artery dissection are more likely to have a cerebellar infarction misdiagnosed by physicians other than neurologists.

Concepts: Central nervous system, Medicine, Brain, Stroke, Cerebellum, Posterior inferior cerebellar artery, Vertebral artery dissection, Anterior inferior cerebellar artery

28

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is more suitable than the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment. In this study, we performed a correlation analysis of MoCA/MMSE scores with daily physical activity in patients with subcortical ischemic white matter changes. METHODS: Ten patients (average 75.9 ± 9.1 years old) with extensive leukoaraiosis detected on magnetic resonance imaging underwent cognitive testing, including the MMSE and the Japanese version of the MoCA (MoCA-J). Physical activity was monitored with the Kenz Lifecorder EX device (Suzuken, Nagoya, Japan) to assess daily physical activity in terms of caloric expenditure, motor activity, number of steps, and walking distance for 6 months. Correlations of individual physical activity with total and subscale scores of MMSE/MoCA-J or 6-month interval change of MoCA-J scores were assessed. RESULTS: The total or subscale scores of the MMSE did not correlate with any parameters of physical activity. However, the mean number of steps and walking distance significantly correlated with the total MoCA-J scores (r = .67 and .64, respectively) and its visuospatial/executive subscores (r = .66 and .66, respectively). The mean interval change of MoCA-J was + .6; those who improved number of steps (n = 4; 80.5 ± 3.0 years of age) had significantly preserved MoCA-J scores compared to those who did not (n = 6; 73.0 ± 11.6 years of age; +2.0 versus - .3; P = .016). CONCLUSIONS: These results suggest that MoCA is useful to detect a biologically determined specific relationship between physical activity and executive function. In addition, physical exercise, such as walking, may help enhance cognitive function in patients with vascular cognitive impairment of subcortical origin.

Concepts: Spearman's rank correlation coefficient, Exercise, Magnetic resonance imaging, Assessment, White matter, Arithmetic mean, Correlation and dependence, Pearson product-moment correlation coefficient

27

Emergency medical dispatchers represent the first line of communication with a patient, and their decision plays an important role in the prehospital care of stroke. We evaluated the rate and accuracy of stroke diagnosis by dispatchers and its influence in the prehospital care of potential stroke patients.

Concepts: Hospital, Physician, Emergency medical services, Paramedic, Emergency medical technician

26

Antiplatelet drugs are recommended for patients with acute noncardioembolic stroke. However, few randomized clinical trials have investigated the safety and efficacy of dual antiplatelet therapy for these patients. The aim of this study was to evaluate the effects of treatment with clopidogrel and aspirin (combination therapy) and aspirin alone (monotherapy) on neurologic deterioration, platelet activation, and other short-term outcomes in patients with acute large-artery atherosclerosis stroke.

Concepts: Pharmacology, Myocardial infarction, Effectiveness, Platelet, Clopidogrel, Antiplatelet drug, Aspirin, Ticlopidine

25

Studies evaluating the association between coffee consumption and neurovascular diseases have frequently yielded contradictory results. The aim of this study was to investigate the association of coffee consumption with small-vessel disease (SVD) incidence in a healthy urban population while accounting for multiple demographic and lifestyle risk factors.

Concepts: Medicine, Epidemiology, Infectious disease, Poverty, Demography, Prevalence, Diseases of poverty

23

22

Post-stroke cognitive impairment is a clinically heterogeneous condition and its types have a different course and prognosis. The aim of the present study is to address the roles of inflammation, white matter pathology, and brain atrophy in different neuropsychological types of cognitive impairment in the acute period of ischemic stroke.

Concepts: Present, Time, Psychology, Stroke, Traumatic brain injury, Cerebellum

22

The aim of the experiment was to analyze the influence of posturographic platform biofeedback training on the static and dynamic balance of patients who experienced ischemic stroke.

Concepts: Hypertension, Stanford prison experiment, Stroke, Transient ischemic attack, Urinary incontinence, Biofeedback