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The loss of a limb leads to sensorimotor modifications that are frequently accompanied by the vivid experience that the missing limb is still present, and that it can be moved at will. Furthermore, amputees can clearly distinguish between phantom movements of the fingers and of more proximal joints, like movements of the elbow. This phenomenon raises the question of whether these specific phantom movement experiences are translated into differentiated activity within the remaining muscles.
We examined the impact of discrete white matter lesions in the frontal lobes on event-related potential
(ERP) correlates of performance monitoring. We tested the hypothesis that abnormal performance monitoring may result from injury to white matter without evidence of injury to grey matter in the frontal lobes.
American Heart Journal Volume 152, Issue 1 , July 2006, Pages 102-109
Although studies have examined the incidence of stroke in heart failure (HF), their findings are inconsistent and difficult to interpret because of heterogeneity in study design and population. Although HF remains a highly fatal disease, the excess mortality imparted from stroke is unknown.
Different neuropsychological populations implicate diverse cortical regions in semantic memory: semantic dementia (SD) is characterized by atrophy of the anterior temporal lobes whilst poor comprehension in stroke aphasia is associated with prefrontal or temporalparietal infarcts. This study employed a case-series design to compare SD and comprehension-impaired stroke aphasic patients directly on the same battery of semantic tests.
The extent of recovery from stroke is dependent on the survival of neurons, particularly in peri-infarcted regions. Angiogenesis is critical for the development of new microvessels and leads to re-formation of collateral circulation, reperfusion and better recovery.
Limb amputation results in plasticity of connections between the brain and muscles, with the cortical motor representation of the missing limb seemingly shrinking, to the presumed benefit of remaining body parts that have cortical representations adjacent to the now-missing limb.
Patients with left-sided neglect frequently show repetitive behaviour on the ipsilesional side, such as re-markings on cancellation tasks or extensive elaboration on drawings. It is unclear whether these perseverative responses occur as a symptom of hemi-neglect or inattention in general, and/or whether they are related to anatomical brain correlates such as lesion location, lesion side or volume.
The trend to start disease-modifying therapy early in the course of multiple sclerosis makes it important to establish whether the benign form is a real entity. In previous studies, measures of magnetization transfer (MT) ratio
(MTr) have been shown to provide good estimates of the amount of tissue damage occurring in multiple sclerosis brains. Thus, with the hypothesis that if benign multiple sclerosis patients were really benign, sensitive measures of subtle tissue damage would be less pronounced in these patients than in very early relapsingremitting (RR) multiple sclerosis patients.
Cognitive Neuropsychology Volume 23, Number 6 / September 2006 972 - 989
Studies on the cerebral mechanisms of reading have mostly used Latin-based writing systems and assume that the left, but not the right, cerebral hemisphere is capable of phonological processing. The present study used Hebrew as the test language to examine the effects of phonological and orthographic information in the two hemispheres.
Cognitive Neuropsychology Volume 23, Number 6 / September 2006 990 - 999
Goal-driven control over saccade target selection requires the inhibition of task-irrelevant, stimulus-driven saccades. A widely held assumption is that frontal structures are of critical importance for this function. Here we report the oculomotor capture behaviour of a patient with a right
temporo-parietal lesion, which challenges this view.
Journal of Head Trauma Rehabilitation. Focus on Clinical Research and Practice, Part 2. 21(3):260-271, May/June 2006
To determine characteristics of patients with complicated mild traumatic brain injury
(CMTBI) on the inpatient rehabilitation unit and to accentuate limits of current classification systems for patients with mild
The authors report four adult-onset ataxia telangiectasia (AT) patients belonging to two families lacking pronounced cerebellar ataxia but displaying distal spinal muscular atrophy. AT was proven by genetic studies showing ATM mutations and a reduced level of ATM. ATM activity, as measured by phosphorylation of p53, was close to normal, indicating that the p53 response is not the only factor in preventing neural damage in anterior horn cells in AT.
Pediatric Emergency Care. 22(7):465-469, July 2006
In 1996, the American Academy of Pediatrics published practice parameters for the acute management of febrile seizure. These guidelines emphasize the typically benign nature of the condition and discourage aggressive neurodiagnostic evaluation. The extent to which these suggestions have been adopted by general emergency medicine practitioners is unknown. We sought to describe recent patterns of the emergency department (ED) evaluation of febrile seizures with respect to these parameters.
Control of blood pressure after stroke is important for reducing the risk of recurrent stroke. We examined the control of hypertension in a community-based population of 5-year stroke survivors. Cases of first-ever stroke from the North East Melbourne Stroke Incidence Study were interviewed at 5 years
Cerebral microembolism detected by transcranial Doppler occurs systematically during cardiac catheterization, but its clinical relevance remains unknown. Studies suggest that asymptomatic embolic cerebral infarction detectable by diffusion-weighted
(DW) MRI might exist after percutaneous cardiac interventions, especially after retrograde catheterization of the aortic valve in patients with valvular aortic
stenosis, with a frequency as high as 22% of cases. We investigated the incidence of new ischemic lesions on serial cerebral DW MRI after cardiac catheterization.
Muscle weakness is recognized as a key factor in gait performance of poststroke individuals, but its impact on lower-limb muscular effort has been scarcely studied. The aims of this study were to compare the level of effort of the lower limbs of hemiparetic and able-bodied individuals and to assess the effect of side, cadence, and muscle group.
It has been recently shown that a single session of repetitive transcranial magnetic stimulation
(rTMS) of the unaffected hemisphere can improve motor function in stroke patients; however, this improvement is short-lasting. We therefore conducted a randomized, sham-controlled, phase II trial to evaluate whether five sessions of low-frequency rTMS can increase the magnitude and duration of these effects and whether this approach is safe.
Clinical trials have illustrated warfarins protective effect on stroke risk in patients with atrial fibrillation (AF). The current study investigated temporal trends in AF prevalence, warfarin use, and its relation to stroke risk in Medicare patients with AF from 1992 to 2002.
Stroke is a leading cause of death and disability in the US. There is limited data on geographic variations in stroke incidence among older US populations who experience the majority of stroke burden. The purpose of this study was to compare stroke incidence and mortality rates in 4 US communities.
In the Cardiovascular Health Study (CHS), we previously observed lower stroke incidence in Allegheny County, PA compared with the other 3 study sites. The purpose of this study was to study possible reasons for the lower stroke incidence in Allegheny County.
CT scanning is important to identify stroke pathology and exclude mimics. Its poor availability in our environment makes the search for simple, reliable clinical-score imperative. This study aims to validate the Siriraj Stroke score
(SSS) and determine the discriminant values of its parameters in the black population of African-Nigerians.
Complement components are emerging risk factors for cardiovascular disease. In this study, we examined the relation among C3, C-reactive protein (CRP), factor B, and features of the insulin resistance
(IR) syndrome in 143 first-degree relatives of South Asian subjects with ischemic stroke, 141 South Asian controls, and 121 white controls.
Recent findings have implicated specific gene polymorphisms of arachidonate 5-lipoxygenaseactivating protein (ALOX5AP), and 2 at-risk haplotypes
(HapA, HapB) in myocardial infarction and stroke. To date, no prospective data are available.
C-reactive protein (CRP) has evolved as an inflammatory risk marker of cardiovascular disease. Several single-nucleotide polymorphisms at the CRP locus have been found to be associated with CRP levels. The aim of the present study was to investigate CRP levels and genetic variants in etiological subtypes of ischemic stroke.
Proxy respondents are often needed to report outcomes in stroke survivors, but they typically systematically rate impairments worse than patients themselves. The magnitude of this difference, the degree of agreement between patients and proxies, and the factors influencing agreement are not well known.
The concepts of consciousness and awareness are multifaceted, and steeped in cultural and intellectual history. This paper explores their complexities by way of a series of contrasts: (1) states of consciousness, such as wakefulness and sleep are contrasted with awareness, a term that picks out the contents of consciousness: these range across all our psychological capacities; the scientific background of the two concepts is briefly outlined; (2) consciousness is contrasted to self-consciousness, itself a complex term embracing self-detection, self-monitoring, self-recognition, theory of mind and self-knowledge; (3) narrow and broad senses of consciousness are contrasted, the former requiring mature human awareness capable of guiding action and self-report, the latter involving the much broader capacity to acquire and exploit knowledge; (4) an inner conception of consciousness, by which awareness is essentially private and beyond the reach of scientific scrutiny, is contrasted with an outer conception which allows that consciousness is intrinsically linked with capacities for intelligent
behaviour; (5) finally easy and hard questions of consciousness are distinguished, the former involving the underlying neurobiology of wakefulness and awareness, the latter the allegedly more mysterious process by which biological processes generate experience: Whether this final distinction is valid is a focus of current debate.
Unilateral damage to visual cortex of the parietal or occipital lobe can cause the patient to be unaware of contralesional visual information due to either hemispatial neglect or
hemianopia. It is now known that both neglect and hemianopia result from the disruption of a dynamic interaction between cortical visual pathways and more phylogenetically primitive visual pathways to the midbrain. We consider the therapeutic implications of these corticalsubcortical interactions in the rehabilitation of
Self-awareness deficits are common after acquired and (traumatic) brain injury (ABI), particularly in social
behaviour, yet the underlying cognitive and neuroanatomical structures supporting social self-awareness are not fully understood. This paper reviews the current literature on prevalence, type and severity of self-awareness deficits in
ABI. Neuropsychological and neuroanatomical models are reviewed and theoretical frameworks are examined.
Considerable emphasis has been placed upon cognitive neuropsychological explanations of awareness disorders in brain injury and Alzheimer's disease (AD), with relatively few models acknowledging the role of psychosocial factors. The present paper explores clinical presentations of unawareness in brain injury and AD, reviews the evidence for the influence of psychosocial factors alongside neuropsychological changes, and considers a number of key issues that theoretical models need to address, before going on to discuss some recently-developed models that offer the potential for developing a comprehensive biopsychosocial account. Building on these developments, we present a framework designed to assist clinicians to identify the specific factors contributing to an individual's presentation of unawareness, and illustrate its application with a case example.
Recent interest in the empirical exploration of patients' awareness in relation to their clinical states has resulted in a range of approaches taken to evaluate such awareness. These approaches vary in terms of the bases on which awareness is determined and rated, the contents of the measures used, the level of detail and complexity of judgements required, etc.
It has been known for well over a century that brain-damaged patients are often unaware of the very deficits that impair performance in everyday life. Pathologies of awareness have been described for many neurological, psychiatric and neuropsychological deficits and the construct of awareness or insight understandably now receives attention from many researchers within the clinical and cognitive neurosciences. This paper does not attempt to explain the nature of consciousness or its impairment but rather considers four aspects of consciousness/awareness that health care professionals interested in understanding, measuring and improving deficits of awareness should consider.
Unawareness related to brain injury has implications for participation in rehabilitation, functional outcomes, and the emotional well-being of clients. Addressing disorders of awareness is an integral component of many rehabilitation
programmes, and a review of the literature identified a range of awareness interventions that include holistic milieu-oriented neuropsychological
programmes, psychotherapy, compensatory and facilitatory approaches, structured experiences, direct feedback, videotaped feedback, confrontational techniques, cognitive therapy, group therapy, game formats and behavioural intervention.
The occurrence of an aura is often considered evidence of a partial rather than an idiopathic generalized epilepsy syndrome. The authors examined this hypothesis by prospectively recording reports of auras by patients being admitted for video-EEG monitoring. Auras were equally common (70%) among patients with idiopathic generalized epilepsy as they were among those with localization-related epilepsy. Presence of an aura is not a reliable indicator of localization-related epilepsy.
Sixty-eight patients with convulsive status epilepticus (SE) were randomly assigned to two groups to study the efficacy of sodium valproate
(VPA) and phenytoin (PHT). Seizures were aborted in 66% in the VPA group and 42% in the PHT group. As a second choice in refractory patients, VPA was effective in 79% and PHT was effective in 25%. The side effects in the two groups did not differ. Sodium valproate may be preferred in convulsive SE because of its higher efficacy.
The authors reorganized the emergency room (ER) by moving CT to the ER and streamlining triage by prenotification by emergency medical services (EMS), which reduced in-hospital delays and enhanced access to stroke
thrombolysis. CT delay dropped from 1 hour 3 minutes ± 14 minutes in 1999 to 7 ± 2 minutes in 2004 (p < 0.0001). Door-to-needle time dropped from 1 hour 28 minutes ± 7 minutes to 50 ± 3 minutes (p < 0.001), while symptom-to-needle time dropped from 2 hours 44 minutes ± 6 minutes to 2 hours 5 minutes ± 4 minutes (p < 0.0001). From 23 patients in 1999, thrombolysis access was increased to 100 patients in 2004 and 183 patients in 2005.
The authors investigated bihemispheric motor network reorganization supporting locomotor recovery after stroke over time. They determined longitudinal changes in locomotor function and fMRI in 10 stroke patients at the subacute stage and the chronic stage. The results suggest that the bihemispheric reorganization mechanism underlying locomotor recovery evolved from the ipsilateral
(contralesional) primary sensorimotor cortex (SM1) activation at the subacute stage to the contralateral
(ipsilesional) SM1 activation at the chronic stage.
Disability & Rehabilitation Volume 28, Number 15 / August 2006 899 - 907
The Tardieu Scale has been suggested a more appropriate clinical measure of spasticity than the Ashworth or modified Ashworth Scales. It appears to adhere more closely to Lance's definition of spasticity as it involves assessment of resistance to passive movement at both slow and fast speeds.
opean Journal of Neurology, Volume 13, Number 7, July 2006, pp. 736-741(6)
Visual dysfunction has been reported in patients diagnosed with epilepsy. Some of these visual disturbances may be attributable to either the disease process, or the anticonvulsant therapy prescribed to control the seizures.
The complement cascade has been implicated in ischemia/reperfusion injury, and recent studies have shown that complement inhibition is a promising treatment option for acute stroke. The development of clinically useful therapies has been hindered, however, by insufficient understanding of which complement subcomponents contribute to post-ischemic injury.
European Journal of Neurology, Volume 13, Number 7, July 2006, pp. 765-771(7)
To determine the factors predictive of fatality in massive middle cerebral artery (MCA) territory infarction and outcome of decompressive
hemicraniectomy, 62 patients who were retrospectively verified with first event massive MCA infarctions were enrolled in this study. Amongst them, 21 received decompressive hemicraniectomy during hospitalization.
European Journal of Paediatric Neurology Volume 10, Issue 3 , May 2006, Pages 142-144
We describe epileptic seizures including status epilepticus provoked by recurrent obstructive apnea in a child with Cornelia de Lange syndrome. From the age of 10 months, this boy had recurrent respiratory infections with obstructive apnea leading to cyanosis and loss of consciousness. Approximately, 25% of apneas were followed by clonic jerks usually lasting 10 min, but once status
epilepticus. He never had unprovoked epileptic seizures. At first he was diagnosed with symptomatic epilepsy and given carbamazepine and
phenobarbital, without benefit. Significant improvement occurred after his mother was taught to extract mucus from his upper airways before obstruction occurred. He is no longer on anti-epileptic drugs. With this management, he had only one episode of obstructive apnea followed by an epileptic component.
Blood, 1 August 2006, Vol. 108, No. 3, pp. 847-852
The Stroke Prevention Trial in Sickle Cell Anemia (STOP) was a randomized trial to evaluate whether chronic transfusion could prevent initial stroke in children with sickle-cell anemia at high risk as determined by transcranial Doppler
It was the aim of this study to compare the Barthel Index (BI) and the activities of daily living
(ADL) component of the Activity Index [AI(ADL)] regarding floor and ceiling effects, responsiveness and the predictive value for survival during the first week until 3 months after stroke onset.
The association between anticardiolipin antibody (aCL) and ischemic stroke is controversial, and there are few case-control studies of Asian populations. The aim of this study, therefore, was to determine whether aCL is an independent risk factor for ischemic stroke in Taiwanese patients over the age of 40 years.
We assessed the incidence of early recurrent ischemic stroke in stroke patients treated with intravenous tissue-type plasminogen activator
(tPA) and the temporal pattern of its occurrence compared with symptomatic intracranial hemorrhage
Deep vein thrombosis (DVT) is perceived as uncommon among Asian stroke patients. However, there is a paucity of published data, and thus, we studied the frequency, characteristics and prognosis of DVT following ischemic stroke in Asian patients with lower limb paresis.
We aim to assess whether social deprivation independently predicts case fatality after a stroke patient has been admitted to hospital, and to assess whether social deprivation affected duration of hospital stay.
Recovery of posterior communicating artery aneurysm-induced oculomotor nerve palsy
(ONP) after aneurysm coiling has been reported. However, the coil mass may compromise recovery of the nerve. Therefore, we compared the outcome of coiling and clipping for this indication.
Nonpilocytic low-grade glial tumors in adults occur mostly in the supratentorial compartment. However, a few cases of infratentorial low-grade gliomas
(LGG) have been described. The occurrence of LGG in the cerebellum in the setting of a previously existing supratentorial glioma is rare.
Journal of Head Trauma Rehabilitation. Focus on Clinical Research and Practice, Part 2. 21(3):199-212, May/June 2006
To document the frequency of insomnia (according to DSM-IV and ICSD criteria), to describe its sociodemographic and clinical characteristics, and to identify potential predictors of insomnia in persons with traumatic brain injury
Stroke is the third cause of death in older individuals living in Western Countries. The identification of predictors for mortality after stroke has a major importance for clinicians in order to allow the implementation of therapeutic and preventive strategies.
THE NOTION OF nanotechnology has evolved since its inception as a fantastic conceptual idea to its current position as a mainstream research initiative with broad applications among all divisions of science.
To determine whether relative cerebral blood volume (rCBV) can predict patient outcome, specifically tumor progression, in low-grade gliomas
(LGGs) and thus provide a second reference standard in the surgical and postsurgical management of
We present the case of a patient with continued deterioration of vision after endovascular treatment of an unruptured clinoidal segment aneurysm. In conjunction with a review of the literature, the findings in this case highlight the need for further refinements in our understanding of pathophysiological changes induced by coiling of cerebral aneurysms, especially those in aneurysms producing signs and symptoms relating to mass effect.
Obtaining and documenting informed consent is of vital importance to physicians. We developed a procedure-based consent form that facilitates patient discussion and validated this process by surveying the patient regarding elements of the consent process, using an independent evaluator.
The prophylactic use of nimodipine in patients with aneurysmal subarachnoid hemorrhage reduces the risk of ischemic brain damage. However, its efficacy seems to be rather moderate. The question arises whether other types of calcium antagonists offer better protection. Magnesium, nature's physiological calcium antagonist, is neuroprotective in animal models, promotes dilatation of cerebral arteries, and has an established safety profile. The aim of the current pilot study is to evaluate the efficacy of magnesium versus nimodipine to prevent delayed ischemic deficits after aneurysmal subarachnoid hemorrhage.
Clinical and experimental evidence suggests that hyperglycemia lowers the neuronal ischemic threshold, potentiates stroke volume in focal ischemia, and is associated with morbidity and mortality in the surgical critical care setting. It remains unknown whether hyperglycemia during carotid endarterectomy
(CEA) predisposes patients to perioperative stroke and operative related morbidity and mortality.
The independent risk factors for aneurysm growth were retrospectively investigated in 130 patients with unruptured aneurysms who were followed up by 0.5-T serial magnetic resonance angiography with stereoscopic images.
American Journal of Obstetrics and Gynecology Volume 194, Issue 5 , May 2006, Pages 1215-1220
The objective of the study was to determine the incidence, origin, and character of cerebral lesions in monochorionic twins with twin-to-twin transfusion syndrome treated with fetoscopic laser surgery.