| 03/15/2006
03:39 PM
Improvement in Stroke Mortality in Canada and the United States 1990 to 2002
Circulation. 2006;113:1335-1343
In the United States and Canada, folic acid fortification of enriched grain products was fully implemented by 1998. The resulting population-wide reduction in blood homocysteine concentrations might be expected to reduce stroke mortality if high homocysteine levels are an independent risk factor for stroke.
03/15/2006
03:38 PM
Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack
Circulation. 2006;113:e409-e449
The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations.
03/15/2006
03:37 PM
An Observational Study of Cognitive Impairment in Amyotrophic Lateral Sclerosis
Arch Neurol. 2006;63:345-352
To further delineate the frequency, nature, and implications of cognitive impairment in ALS and to assess previously identified risk factors.
03/15/2006
03:36 PM
Cognitive Sequelae of Diffuse Axonal Injury
Arch Neurol. 2006;63:418-424
To further clarify the extent and severity of a possibly DAI-associated cognitive impairment by the use of magnetic resonance imaging (MRI) and detailed neuropsychological testing.
03/15/2006
11:24 AM
Computerized errorless learning based memory rehabilitation for Chinese patients with brain injury A preliminary quasi experimental clinical design study
Brain Injury Volume 20, Number 3 / March 2006 219 - 225
To evaluate the effectiveness of a computerized, errorless learning-based memory rehabilitation program for Chinese patients with traumatic brain injury (TBI).
03/15/2006
03:42 PM
An Observational Study of Cognitive Impairment in Amyotrophic Lateral Sclerosis
Arch Neurol. 2006;63:345-352
To further delineate the frequency, nature, and implications of cognitive impairment in ALS and to assess previously identified risk factors.
03/15/2006
11:23 AM
Replicated positive results for the VCC model of vocational intervention after ABI within the social model of disability
Brain Injury Volume 20, Number 3 / March 2006 227 - 236
Replicated evaluation of the Vocational Case Co-ordinator (VCC) Model for vocational rehabilitation after acquired brain injury (ABI).
03/15/2006
03:40 PM
Lewy Body Pathology in Familial Alzheimer Disease
Arch Neurol. 2006;63:370-376
To examine LBP in the brainstem, limbic cortex, and neocortex of a large number of familial AD cases with mutations in 2 presenilin (PSEN) genes.
03/15/2006
11:22 AM
Spatial temporal characteristics of perceptual organization following acquired brain injury
Brain Injury Volume 20, Number 3 / March 2006 237 - 244
To assess characteristics of perceptual organization following brain injury. Research design: A repeated measures between groups design.
03/15/2006
11:21 AM
Tracking neuropsychological recovery following concussion in sport
Brain Injury Volume 20, Number 3 / March 2006 245 - 252
The purpose of this study was to illustrate the serial use of computerized neuropsychological screening with ImPACT to monitor recovery in a clinical case series of injured athletes.
03/15/2006
11:20 AM
Exploring the use of social comparison by individuals recovering from traumatic brain injury
Brain Injury Volume 20, Number 3 / March 2006 253 - 262
To explore if and how individuals with traumatic brain injury (TBI) use social comparison during adjustment to disability. It was hypothesized that comparison activity may change with time since injury.
03/15/2006
11:19 AM
Brain atrophy and cognitive impairment in survivors of acute respiratory distress syndrome
Brain Injury Volume 20, Number 3 / March 2006 263 - 271
Acute Respiratory Distress Syndrome (ARDS) is characterized by severe acute lung injury, hypoxemia and is associated with neurological and cognitive impairments. This study assessed quantitative brain and ventricular volumes in survivors of ARDS with brain computed tomography (CT) scans compared to normal controls. It also compared the medical and cognitive outcome data of patients with ARDS with and without CT scans.
03/15/2006
11:18 AM
Basal ganglia lesions following carbon monoxide poisoning
Brain Injury Volume 20, Number 3 / March 2006 273 - 281
Carbon monoxide (CO) is the most common cause of poisoning and may result in basal ganglia lesions. This study reviewed the literature of carbon monoxide poisoning and basal ganglia lesions and prospectively assessed the prevalence of basal ganglia lesions in a cohort of patients with CO poisoning.
03/15/2006
11:17 AM
Sex differences in mortality after traumatic brain injury Colorado 1994 1998
Brain Injury Volume 20, Number 3 / March 2006 283 - 291
The purpose of this study was to assess the relationship between sex and traumatic brain injury (TBI) mortality.
03/15/2006
11:16 AM
Dizziness after traumatic brain injury Overview and measurement in the clinical setting
Brain Injury Volume 20, Number 3 / March 2006 293 - 305
Traumatic brain injury (TBI) may result in a variety of cognitive, behavioural and physical impairments. Dizziness has been reported in up to 80% of cases within the first few days after injury. The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. The literature provides widely differing estimates of prevalence and vestibular system dysfunction appears to be the best reported of impairments contributing to this symptom. The variety of results is discussed and other possible causes for dizziness were reviewed. Functional difficulties caused by dizziness were not reported for this population in the literature and review of cognitive impairments suggests that existing measurement tools for dizziness may be problematic in this population. Research on the functional impact of dizziness in the TBI population and measurement of these symptoms appears to be warranted.
03/15/2006
11:15 AM
The overt behaviour scale OBS A tool for measuring challenging behaviours following ABI in community settings
Brain Injury Volume 20, Number 3 / March 2006 307 - 319
The Overt Behaviour Scale (OBS) was designed as a comprehensive measure of common challenging behaviours observed after acquired brain injury (ABI) in community settings. The OBS comprises 34 items in nine categories that measure aggression, inappropriate sexual behaviour, perseveration, wandering, inappropriate social behaviour and lack of initiation. The aim of the current study was to determine the reliability, validity and responsiveness of the OBS.
03/15/2006
11:14 AM
Post acute service utilisation and parental satisfaction with health care services after mild traumatic brain injury in children and adolescents
Brain Injury Volume 20, Number 3 / March 2006 321 - 326
The objectives of this study were to describe and analyse the current aftercare practise following define TBI in four German cities. A retrospective, cross-sectional design was chosen in order to investigate the research questions. Methods and procedures included a questionnaire mailed to parents whose children were admitted with TBI to one of seven collaborating hospitals. A total of 564 parents participated in the study. The results indicate that aftercare services were rarely utilised. Furthermore, it was found that the behaviour of the physician in charge had a great impact on parental satisfaction with healthcare services. In conclusion, the findings described in this article underline the need to improve communication between acute and post-acute services.
03/15/2006
11:13 AM
Rehabilitation is compromised by arousal and sleep disorders Results of a survey of rehabilitation centres
Brain Injury Volume 20, Number 3 / March 2006 327 - 332
One hundred and thirty-five adults with acquired brain injury were reported by rehabilitation staff in seven centres across the UK for presence of arousal and/or sleep disturbance, the impact on rehabilitation and daily living and treatment strategies in use.
03/15/2006
11:12 AM
The vegetative state A report of two cases with a long term follow up
Brain Injury Volume 20, Number 3 / March 2006 333 - 338
To demonstrate that patients with Prolonged Vegetative State (PVS) can show signs of improvements and important changes and, consequently, to strengthen the necessity to evaluate them with long-term serial follow-ups. Setting: Rehabilitation of patients with severe traumatic brain injury (TBI).
03/15/2006
11:07 AM
The efficacy of donepezil hydrochloride on memory functioning in three adolescents with severe traumatic brain injury
Brain Injury Volume 20, Number 3 / March 2006 339 - 343
To explore efficacy of donepezil on memory in adolescents with severe traumatic brain injury (TBI). Design: Single subject, unblinded, multiple baseline design.
03/15/2006
11:00 AM
Memory performance during the intracarotid amobarbital procedure and neuropsychological assessment in medial temporal lobe epilepsy The limits of material specificity
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 422-428
We investigated the relationship between material-specific memory performance elicited during the Wada test, or intracarotid amobarbital procedure (IAP), and classic neuropsychological assessment in 89 surgical candidates with refractory medial temporal lobe epilepsy (MTLE). The neuropsychological battery included measures of simple and complex verbal and visual memory, whereas the IAP material consisted of verbal and dually encodable stimuli. Neuropsychological testing revealed that reduced verbal memory performance was associated with left-sided MTLE, whereas visual memory tasks revealed no differences between patients with left-sided and right-sided MTLE. During IAP, memory performance was worse with the ipsilesional hemisphere, regardless of lesion side. Most importantly, performance on verbal memory tests was significantly, but moderately, correlated with left hemispheric IAP performance, indicating that memory tasks using verbal material are a valid marker of left hemispheric integrity in left language-dominant MTLE patients and significantly predict left hemispheric memory performance during IAP. In contrast, performance on classic visual memory tests is unrelated to right hemispheric IAP performance, suggesting that the currently used visual memory stimuli do not reflect right hemispheric sensitivity.
03/15/2006
10:59 AM
Low grade chronic metabolic acidosis is a contributory mechanism in the development of chronic epilepsy
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 347-349
In most people with epilepsy, the condition is readily controlled, but 20–30% develop chronic epilepsy. An estimated 80,000 patients with epilepsy require ongoing specialist care in the United Kingdom. Nutrition may be a factor in the development of chronic epilepsy. Modern Western diets are thought to produce a low-grade chronic metabolic acidosis. The hydrogen ion, H+, is a potent modulator of NMDA-activated currents, and in cultured neurons, increased external [H+] strongly suppresses these currents. The effect of chronic metabolic acidosis in vivo has not been fully studied. It is possible that low-grade chronic metabolic acidosis chronically inhibits the NMDA-activated currents, and this may lead to upregulation of the NMDA receptor. This would result in a greater hyperexcitable state and may contribute to the development of chronic epilepsy.
03/15/2006
10:58 AM
Recent developments in oximetry and perfusion based mapping techniques and their role in the surgical treatment of neocortical epilepsy
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 363-375
Detailed understanding of neurovascular coupling during epilepsy is critical for the interpretation of various perfusion-based imaging techniques, such as positron emission tomography, single-photon-emission computed tomography, and functional magnetic resonance imaging, which are used to guide surgical therapy. We used high-resolution intrinsic signal- and voltage-sensitive dye imaging, as well as oxygen-sensitive electrodes, to map the precise spatiotemporal relationship between excitatory and inhibitory neuronal activity, cerebral blood volume, and oximetry during epilepsy. We observed a rapid focal decrease in tissue oxygenation and an increase in deoxygenated hemoglobin in association with both interictal and ictal events. This “epileptic dip” in oxygenation lasts several seconds following both interictal and ictal events, implying that for a period, cerebral blood flow is inadequate to meet metabolic demand. We also observed a rapid focal increase in cerebral blood volume that soon spread to adjacent nonepileptic gyri. Likewise, a diffuse decrease in deoxygenated hemoglobin, related to the blood oxygen level-dependent signal recorded with functional magnetic resonance imaging, spread to adjacent gyri and was poorly localized.
03/15/2006
10:57 AM
Tian ma an ancient Chinese herb offers new options for the treatment of epilepsy and other conditions
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 376-383
Our purpose is to bring attention to the antiepileptic properties of the Chinese herb tian ma and its constituents, as well as to suggest the potential for the development of new antiepileptic drugs (AEDs) related to this herb. All available literature regarding the chemistry, pharmacology, animal data, and clinical use of tian ma and its constituents are reviewed, showing that tian ma, its constituents, and its symbiotic fungus Armillaria mellea have antiepileptic properties in in vitro and in vivo models. One clinical study reportedly demonstrated the AED effects of a component of tian ma, vanillin. Thus, tian ma, its constituent vanillin, and its symbiotic fungus armillaria hold promise as cost-effective and less toxic alternatives to standard AEDs. In addition, similar chemical compounds may be developed as AEDs.
03/15/2006
10:54 AM
The importance of parental expectations of cognitive improvement for their children with epilepsy prior to starting the ketogenic diet
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 406-410
Although the success rates and complications of various treatment options for children with intractable epilepsy have been described, the actual expectations of parents for these treatments are less clear. Since 1998, parents at our institution have written their goals in a letter before starting their children on the ketogenic diet. One hundred consecutive letters were evaluated. The most common first goal was seizure improvement, second was anticonvulsant reduction, and third was cognitive improvement. Ninety percent requested improvement in cognition or alertness. These expectations were either met or exceeded at 6 months in 52–60% of children. Achieving or surpassing parental expectations for cognitive improvement correlated with longer diet duration (P = 0.04), but meeting goals for seizure or anticonvulsant reduction did not. Cognitive improvement (P < 0.001) and >90% seizure reduction (P = 0.04) at 6 months positively correlated with longer eventual diet duration. Expectations for cognitive improvement need to be discussed prior to beginning the ketogenic diet.
03/15/2006
10:53 AM
Teachers knowledge about epilepsy and attitudes toward students with epilepsy Results of a national survey
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 397-405
The attitudes and epilepsy-related knowledge of teachers are an important component of the educational experiences of children with epilepsy. Unfortunately however, the exploration of teacher attitudes and knowledge has been extremely limited in the United States. This article describes a survey-based research study of the attitudes and epilepsy-related knowledge of a randomly selected national sample of 512 elementary and middle school teachers in the United States. The questionnaire included the Scale of Attitudes Toward Persons with Epilepsy (ATPE), a summated rating scale that measures both attitudes toward persons with epilepsy and knowledge about epilepsy, as well as a demographic and teaching experience survey and several additional attitude and knowledge items developed by the researchers. The results suggest that although teachers’ attitudes about epilepsy were generally positive, there were significant deficits in terms of general knowledge about epilepsy, its impact in educational settings, and the appropriate management of epilepsy and seizures in the classroom. Critical areas in which to focus remedial education and outreach efforts are identified.
03/15/2006
10:52 AM
Decline in seizure propensity in seizure free patients as reflected in the evolution of the therapeutic antiepileptic drug threshold
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 384-390
To better understand mechanisms of remission, the decline in seizure propensity in seizure-free patients was investigated. Plasma antiepileptic drug levels were measured in 199 adults seizure-free for 2 or more years, who consented to reduction and eventual discontinuation of therapy. Among 117 patients on monotherapy, drug dosage was reduced in 82 and therapy was terminated in 35. The initial therapeutic threshold was known in 51 cases, and the new threshold was determined in all cases of relapse. Four types of evolution were observed: no decline in seizure propensity; restricted decline and relapse; greater decline but relapse; and decline below the intrinsic seizure threshold (no relapse). Patients with seizure control immediately after onset of treatment were more likely to obtain remission. Our findings indicate that in seizure-free patients, seizure propensity only rarely remains unchanged, remission is attained by both qualitative and quantitative mechanisms, and there may be different mechanisms underlying quantitative declines in seizure propensity.
03/15/2006
10:51 AM
Erectile dysfunction associated with pregabalin add on treatment in patients with partial seizures Five case reports
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 418-421
Sexual dysfunction has been reported in both men and women with epilepsy. Associated factors are diverse but include, among others, antiepileptic drugs. We present the cases of 5 men who reported mild to moderate erectile dysfunction or impotence for the first time when treated with the new antiepileptic drug pregabalin as add-on therapy.
03/15/2006
10:49 AM
Traumatic intracranial hemorrhage in patients with seizures Descriptive characteristics
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 429-433
We reviewed the records of all patients with recurrent seizures and severe head injury-induced traumatic intracranial hemorrhage (TIH) between 1989 and 2003 in three Israeli medical centers. We identified 52 cases (44 males, mean age = 43 ± 19 years, range = 8–84; 8 females; mean age = 74 ± 12 years, range = 48–85). Twenty-seven (52%) had additional known risk factors for TIH, e.g., older age, alcohol abuse, and anticoagulant use. All five children and adolescents had mental retardation. Approximately one-half of patients with seizures and TIH have additional risk factors for TIH. Non-mentally retarded children and adolescents with seizures are probably at low risk of developing TIH. Women less than 70 years old with seizures are much less prone to TIH than men. In young “otherwise healthy” patients with epilepsy, suboptimal treatment seems to be an important factor in the occurrence of TIH.
03/15/2006
10:48 AM
Wilsons disease and benign epilepsy of childhood with centrotemporal rolandic spikes
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 438-441
Cases with a clinical and electroencephalographic phenotype of benign epilepsy of childhood with centrotemporal spikes (BECTS) in association with a proven organic brain lesion have rarely been reported. To our knowledge, we herein describe for the first time a patient with Wilson’s disease who subsequently manifested BECTS. Our case bolsters the argument that in at least some cases, BECTS is associated with organic brain disease.
03/15/2006
10:45 AM
Insights from molecular investigations of traditional Chinese herbal stroke medicines: Implications for neuroprotective epilepsy therapy
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 350-362
Traditional Chinese herbal medicine is the most widely practiced form of herbalism worldwide. It is based on a sophisticated system of medical theory and practice that is distinctly different from orthodox Western scientific medicine. Most traditional therapeutic formulations consist of a combination of several drugs. The combination of multiple drugs is thought to maximize therapeutic efficacy by facilitating synergistic actions and ameliorating or preventing potential adverse effects while at the same time aiming at multiple targets. Orthodox drug therapy has been subject to critical analysis by the “evidence-based medicine” movement, and demands have been made that herbal medicine should be subject to the same kind of scrutiny. However, evaluation of the effectiveness of herbal medicines can be challenging, as their active components are often not known. Accordingly, it may be difficult to ensure that an herbal preparation used in clinical trials contains the components underlying its purported therapeutic effect.
03/15/2006
10:44 AM
Early Stroke and Cerebral Vasculopathy in Children With Facial Hemangiomas and PHACE Association
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 959-964
PHACE association is a rare neurocutaneous syndrome that may include posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities, and sternal defects. The arterial abnormalities may be developmental or acquired and usually involve the cervical and cerebral vasculature. We believe that infants with PHACE association are at increased risk of arterial ischemic stroke and describe 5 infants with facial hemangiomas and structural and acquired arterial anomalies, all of whom suffered an arterial ischemic stroke during infancy.
03/15/2006
10:42 AM
Decline in seizure propensity in seizure free patients as reflected in the evolution of the therapeutic antiepileptic drug threshold
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 384-390
To better understand mechanisms of remission, the decline in seizure propensity in seizure-free patients was investigated. Plasma antiepileptic drug levels were measured in 199 adults seizure-free for 2 or more years, who consented to reduction and eventual discontinuation of therapy. Among 117 patients on monotherapy, drug dosage was reduced in 82 and therapy was terminated in 35. The initial therapeutic threshold was known in 51 cases, and the new threshold was determined in all cases of relapse. Four types of evolution were observed: no decline in seizure propensity; restricted decline and relapse; greater decline but relapse; and decline below the intrinsic seizure threshold (no relapse). Patients with seizure control immediately after onset of treatment were more likely to obtain remission. Our findings indicate that in seizure-free patients, seizure propensity only rarely remains unchanged, remission is attained by both qualitative and quantitative mechanisms, and there may be different mechanisms underlying quantitative declines in seizure propensity.
03/15/2006
10:40 AM
Risk factors for depression in patients with epilepsy
Epilepsy & Behavior Volume 8, Issue 2 , March 2006, Pages 411-417
Symptoms of depression are present in 40 to 60 percent of patients with epilepsy. Prior research indicated significant correlation between the incidence and frequency of focal seizures and clinical depression, especially in patients with temporal lobe epilepsy. Anticonvulsive drugs and psychosocial factors contribute to the occurrence of depression as well. The aim of the study was to determine the major depression risk factors in patients with epilepsy.
03/15/2006
10:39 AM
Frequency of Delirium in a Neurological Emergency Room
J Neuropsychiatry Clin Neurosci 18:108-112, February 2006
The authors present a cross-sectional survey designed to evaluate the presence of delirium in patients with neurological emergencies. Two hundred and two patients were included in the study: 14.9% of subjects had delirium; 62.4% had no arousal disturbances; and 22.7% presented a coma or stupor state. Findings revealed that the presence of a cerebral infection, the presence of multiple etiologies, and the location of lesions in the frontal and temporal lobes were all associated with delirium. Results substantiate that delirium is a frequent occurrence in neurological patients and that the presence of multiple etiologies must be investigated in each patient.
03/15/2006
10:36 AM
Acquired Extroversion Associated With Bitemporal Variant of Frontotemporal Dementia
J Neuropsychiatry Clin Neurosci 18:100-107, February 2006
Frontotemporal dementia (FTD) is characterized by alterations in personality. The nature of the personality changes depend on the localization of the pathology. The authors present three patients with acquired extroversion who met criteria for FTD. All three patients exhibited predominant bilateral temporal involvement as determined with functional neuroimaging. Possible mechanisms for acquired extroversion in bitemporal FTD include bilateral amygdalar damage with decreased interpersonal fear or sense of threat, orbitofrontal-ventromedial damage with social disinhibition, and relative sparing of dorsolateral frontal and anterior cingulate regions with preserved interpersonal agency. FTD can be a vehicle for unraveling the basis of personality characteristics such as the introversion/extroversion dimension.
03/15/2006
10:35 AM
Predictors of Personality Change Due to Traumatic Brain Injury in Children and Adolescents Six to Twenty Four Months After Injury
J Neuropsychiatry Clin Neurosci 18:21-32, February 2006
Phenomenology and predictive factors of personality change due to traumatic brain injury (TBI) 6 to 24 months after injury was investigated in children, ages 5 to 14 years, enrolled from consecutive admissions and followed prospectively for 2 years. Injury and preinjury psychosocial variables were assessed. Personality change occurred in 13% of participants between 6 and 12 months after injury and 12% in the second year after injury. Severity of injury consistently predicted personality change, and preinjury adaptive function predicted personality change only in the second year postinjury. Lesions of the superior frontal gyrus were associated with personality change between 6 and 12 months following injury, after controlling for severity of injury and the presence of other brain lesions. Only lesions in the frontal lobe white matter were significantly related to personality change in the second year after injury. After childhood TBI, neural correlates of personality change evolve between 6 and 12 months and 12 to 24 months after injury. The data implicate the dorsal prefrontal cortex and frontal lobe white matter in the emergence of personality change involving the effortful or conscious regulation of affective states.
03/15/2006
10:33 AM
Influence of Angiotensin Converting Enzyme Polymorphism on Neuropsychological Subacute Performance in Moderate and Severe Traumatic Brain Injury
J Neuropsychiatry Clin Neurosci 18:39-44, February 2006
Traumatic brain injury (TBI) frequently results in cerebrovascular lesions that may increase secondary damage and cause neuropsychological impairment. Previous studies suggest an association among the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE), cardiovascular disease, and cognitive performance. Clinical and experimental studies have demonstrated the beneficial effects of ACE inhibitor treatment on vascular injury, hypertension, brain ischemia, and cognitive functioning. In a sample of 73 moderate and severe TBI patients, the authors assessed whether cognitive sequelae differed in relation to the ACE I/D polymorphism. D allele carrier patients performed worse than those with I/I polymorphism on tests involving attention and processing speed. Findings suggest that the physiopathological changes associated with TBI may have greater consequences in ACE D allele carriers.
03/15/2006
10:33 AM
Serotonin Transporter Gene Promoter Region Polymorphism Associated With Poststroke Major Depression
J Neuropsychiatry Clin Neurosci 18:96-99, February 2006
The authors examined variations of serotonin transporter-linked promoter region (5-HTTLPR) functional polymorphism in 26 stroke patients with major depression and in 25 unrelated nondepressed stroke subjects of Caucasian descent. Findings indicate a significant association between 5-HTTLPR short variant genotype and poststroke major depression.
03/15/2006
10:31 AM
Optimal INR for prevention of stroke and death in atrial fibrillation a critical appraisal
Thrombosis Research Volume 117, Issue 5 , 2006, Pages 493-499
Patients with nonvalvular atrial fibrillation are at increased risk for systemic embolism, predominantly disabling stroke. To study how stroke and mortality rates vary with different degrees of anticoagulation reflected by the international normalised ratio (INR) we critically assess information from different sources.
03/15/2006
10:28 AM
Yield of Transesophageal Echocardiography for Nonbacterial Thrombotic Endocarditis and Other Cardiac Sources of Embolism in Cancer Patients With Cerebral Ischemia
The American Journal of Cardiology Volume 97, Issue 6 , 15 March 2006, Pages 894-898
Cerebrovascular events occur frequently in patients who succumb to cancer, and nonbacterial thrombotic endocarditis (NBTE) is a frequent postmortem finding in these patients. Despite the excellent diagnostic accuracy of transesophageal echocardiography (TEE) for cardiac sources of cerebral embolism, however, the prevalence of NBTE and other cardioembolic sources in patients with cancer and cerebral ischemia has not been investigated using this modality. This study examined the frequency of cardioembolic findings in consecutive patients with cancer referred to our institution for TEE evaluation of cerebrovascular events. The study cohort comprised 51 patients, of whom 18% had marantic vegetations, and 47% and 55% of whom had definite and definite or probable cardiac sources of embolism, respectively. The present study documents, for the first time, a high frequency of marantic endocarditis and other cardioembolic sources in patients with cancer and cerebrovascular events selected for TEE. This finding has important implications for evaluation and management in this patient population.
03/15/2006
10:26 AM
Effects of magnetic resonance imaging diffusion gradient recalled echo on a patient with an intracranial hemorrhage presenting to the emergency department
European Journal of Emergency Medicine. 13(2):117-118, April 2006
Generally, a computed tomography scan is conducted for the diagnosis of stroke in the emergency department, because these scans are easier and faster in the detection of stroke. If there are no signs of hemorrhage on computed tomography scan, an ischemic stroke is diagnosed and treated accordingly. A magnetic resonance imaging scan may be taken in order to verify ischemic stroke. This process may lead to improper treatment and is time consuming. To address this situation, case studies are presented in which magnetic resonance imaging diffusion-weighted imaging and gradient recalled echo were performed to detect hemorrhagic and ischemic stroke and particularly, subarachnoid hemorrhage, which is undetectable with a computed tomography scan.
03/11/2006
01:23 PM
Modified Experimental Mild Traumatic Brain Injury Model
Journal of Trauma-Injury Infection & Critical Care. 60(3):558-565, March 2006
Experimental models of traumatic brain injury (TBI), using a variety of techniques and species, have been devised with the aim of producing repeatable lesions resembling those found in head injuries. There are various TBI models mentioned in the literature. In experimental head trauma models, emphasis has been placed on the severe head injuries. There are only a few models developed to study mild traumatic brain injury (MTBI). In fact, MTBI is as an important a problem as severe head injuries for neurosurgeons.
03/11/2006
01:20 PM
Traumatic Brain Injury in Anticoagulated Patients
Journal of Trauma-Injury Infection & Critical Care. 60(3):553-557, March 2006
Coumadin is widely used in the elderly population. Despite its widespread use, little is known about its effect on the outcome of elderly traumatic brain-injured patients. This study was undertaken to describe the outcomes of such a cohort.
03/11/2006
01:19 PM
Health Related Quality of Life During the First Year After Traumatic Brain Injury
Arch Pediatr Adolesc Med. 2006;160:252-260
To document health-related quality of life (HRQOL) of children with traumatic brain injury (TBI) and to examine the relationship between TBI severity and HRQOL during the first year after injury.
03/11/2006
01:18 PM
Speech arrest with stimulation may not reliably predict language deficit after epilepsy surgery
NEUROLOGY 2006;66:592-594
The authors present a patient in whom electrical cortical stimulation of the posterior temporal cortex induced speech arrest, comprehension deficits, and other language-related impairments. This area was ultimately resected because of persistence of a severe seizure disorder. No postoperative aphasia was observed despite the cortical stimulation results, and the patient is since seizure free. These findings question the well-established principle that corticography directly reflects local cortical functions in all patients.
03/11/2006
01:17 PM
MRI evidence of mesial temporal sclerosis in sporadic benign temporal lobe epilepsy
NEUROLOGY 2006;66:562-565
To determine whether there is MRI-detectable mesial temporal sclerosis (MTS) in patients with sporadic benign temporal lobe epilepsy (BTLE).
03/11/2006
01:16 PM
Effects of intermittent levetiracetam dosing in a patient with refractory daily seizures
NEUROLOGY 2006;66:590-591
Some epilepsy patients quickly develop resistance to antiepileptic drugs (AEDs). We report a case of a patient with refractory epilepsy with daily seizures who initially responded to levetiracetam daily therapy, but then returned to baseline seizure frequency. However, when levetiracetam was given once weekly, the patient had significantly fewer seizures on the day of and after administration. These results suggest a useful treatment strategy for patients with refractory epilepsy who have developed resistance to AEDs.
03/11/2006
01:15 PM
Chronic posttraumatic stress symptoms after nonsevere stroke
NEUROLOGY 2006;66:513-516
To determine whether posttraumatic stress disorder (PTSD)–related symptoms were present 1 year after a nonsevere stroke and, if so, to examine the relationship between PSTD, coexisting cognitive variables, and infarct localization.
03/11/2006
01:24 PM
Influence of a New Province Wide Trauma System on Motor Vehicle Trauma Care and Mortality
Journal of Trauma-Injury Infection & Critical Care. 60(3):548-552, March 2006
Mature trauma systems have evolved to respond to high rates of major injury morbidity and mortality. Characterized by prehospital care, triage, transportation, aggressive resuscitation, surgery, and rehabilitation, trauma systems have been found to improve survival for seriously injured patients. In Nova Scotia, a province-wide trauma system was implemented between 1995 and 1998. This study investigated the influence of the province-wide trauma system on motor vehicle trauma care and mortality in its first 2 years of existence.
03/11/2006
01:26 PM
Routine Repeat Head CT for Minimal Head Injury is Unnecessary
Journal of Trauma-Injury Infection & Critical Care. 60(3):494-501, March 2006
Patients with MHI and a positive head computed tomography (CT) scan frequently have a routine repeat head CT (RRHCT) to identify possible evolution of the head injury requiring intervention. RRHCT is ordered based on the premise that significant injury progression may take place in the absence of clinical deterioration.
03/11/2006
01:12 PM
Energy Expenditure in Patients With Nontraumatic Intracranial Hemorrhage
Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 2, 2006 71-75
Patients with intracerebral (ICH), intraventricular (IVH) and subarachnoid hemorrhage (SAH) have increased morbidity and mortality compared with other forms of stroke. We postulate that the systemic inflammatory state triggered by these forms of nontraumatic intracranial hemorrhage (IH) translates into higher nutrition requirements than traditionally assumed. In order to test this hypothesis, we performed a retrospective study comparing the resting energy expenditure (REE) of 14 mechanically ventilated IH patients with the REE of 6 severe traumatic brain injury (sTBI) patients (a disease known to induce an increased metabolic state).
03/11/2006
01:10 PM
The Effect of Major Depression on Subjective and Objective Cognitive Deficits in Mild to Moderate Traumatic Brain Injury
J Neuropsychiatry Clin Neurosci 18:33-38, February 2006
The effect of major depression on subjective and objective cognitive deficits 6 months following mild to moderate traumatic brain injury (TBI) was assessed in 63 subjects. Patients with subjective cognitive complaints (n=63) were more likely to be women, with higher Glasgow Coma Scale (GCS) scores and have a diagnosis of major depression. They also performed significantly more poorly on various measures of memory, attention and executive functioning. Group differences on most but not all cognitive measures disappeared in a multivariate analysis when controlling for depression. In mild to moderate TBI, subjective cognitive deficits are linked in large measure to comorbid major depression. However, other mechanisms may also account for these deficits.
03/11/2006
01:05 PM
Pharmacologic Treatment of Central Post Stroke Pain
Clinical Journal of Pain. 22(3):252-260, March 2006
Almost 100 years after the first report of the thalamic syndrome, the scientific basis for the treatment of central post-stroke pain (CPSP) is remarkably small. Therefore, the authors aimed to provide evidence-based recommendations for the treatment of CPSP.
03/11/2006
01:01 PM
Physical Therapy for Central Vestibular Dysfunction
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 76-81
Forty-eight patients with central vestibular dysfunction met the criteria for inclusion in this retrospective chart review. The 48 patients were divided into various subgroups including central vestibulopathy, cerebellar dysfunction, stroke, mixed central and peripheral vestibulopathy, and posttraumatic central disorders.
03/11/2006
01:00 PM
A Community Based Upper Extremity Group Exercise Program Improves Motor Function and Performance of Functional Activities in Chronic Stroke A Randomized Controlled Trial
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 1-9
03/11/2006
12:59 PM
Back From the Brink Electromyography Triggered Stimulation Combined With Modified Constraint Induced Movement Therapy in Chronic Stroke
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 27-31
To determine the efficacy of a regimen that combines electromyography-triggered neuromuscular stimulation (ETMS) with modified constraint-induced movement therapy (mCIMT) in patients with chronic stroke.
03/11/2006
12:58 PM
Speed of Finger Tapping as a Predictor of Functional Outcome After Unilateral Stroke
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 40-44
To determine (1) if the speed of finger tapping of the hand ipsilateral to the lesion (ie, unaffected hand) remains stable during the first 6 months after stroke and (2) if the speed of finger tapping of the unaffected hand is related to functional outcome after neurorehabilitation, which is of relevance to clinical practice.
03/11/2006
12:56 PM
Determination of the Minimal Clinically Important Difference in the FIM Instrument in Patients With Stroke
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 32-39
Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.
03/11/2006
12:54 PM
Summary Proceedings From the Neurology Group on Hypoxic Ischemic Encephalopathy
PEDIATRICS Vol. 117 No. 3 March 2006, pp. S28-S33
Hypoxic-ischemic cerebral injury that occurs during the perinatal period is one of the most commonly recognized causes of severe, long-term neurologic deficits in children; it is often referred to as cerebral palsy. Despite improvements in perinatal practice during the past several decades, the incidence of cerebral palsy attributed to intrapartum asphyxia has remained essentially unchanged, primarily because management strategies were supportive and not targeted toward the processes of ongoing injury. Two processes of neuronal injury can be demonstrated after hypoxia-ischemia: neuronal necrosis and apoptosis. Because the mechanisms of these processes likely differ, strategies to minimize brain damage in an affected infant after hypoxia-ischemia likely will have to include interventions that target both processes. The goals of management of a newborn infant who has sustained a hypoxic-ischemic insult and is at risk for evolving injury should include (1) early identification of the infant at highest risk for evolving to the syndrome of hypoxic-ischemic encephalopathy, (2) supportive care to facilitate adequate perfusion and nutrients to the brain, and (3) consideration of interventions to ameliorate the processes of ongoing brain injury. Although the neurology group was unable to develop a definitive framework for the study of neuroprotective strategies for neonatal encephalopathy, it (1) listed key questions to be addressed before exploring possible study designs for managing hypoxic-ischemic encephalopathy in neonates, (2) identified important study-design issues, (3) determined general principles and key elements for neuroprotective-treatment strategies, (4) identified potential treatment strategies, (5) proposed a clinical-trial framework, and (6) identified key elements for a potential clinical-trial framework comparing hypothermia with hypothermia "plus" for moderate-to-severe encephalopathy.
03/11/2006
12:52 PM
Neurologic Deterioration Secondary to Unrecognized Spinal Instability Following Trauma A Multicenter Study
Spine. 31(4):451-458, February 15, 2006
A retrospective study was undertaken that evaluated the medical records and imaging studies of a subset of patients with spinal injury from large level I trauma centers.
03/11/2006
12:51 PM
A Follow Up Study of Older Adults With Traumatic Brain Injury Taking Into Account Decreasing Length of Stay
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 57-62
Frankel JE, Marwitz JH, Cifu DX, Kreutzer JS, Englander J, Rosenthal M. A follow-up study of older adults with traumatic brain injury: taking into account decreasing length of stay.
03/11/2006
12:06 PM
Predictors of Personality Change Due to Traumatic Brain Injury in Children and Adolescents Six to Twenty Four Months After Injury
J Neuropsychiatry Clin Neurosci 18:21-32, February 2006
Phenomenology and predictive factors of personality change due to traumatic brain injury (TBI) 6 to 24 months after injury was investigated in children, ages 5 to 14 years, enrolled from consecutive admissions and followed prospectively for 2 years. Injury and preinjury psychosocial variables were assessed. Personality change occurred in 13% of participants between 6 and 12 months after injury and 12% in the second year after injury. Severity of injury consistently predicted personality change, and preinjury adaptive function predicted personality change only in the second year postinjury. Lesions of the superior frontal gyrus were associated with personality change between 6 and 12 months following injury, after controlling for severity of injury and the presence of other brain lesions. Only lesions in the frontal lobe white matter were significantly related to personality change in the second year after injury. After childhood TBI, neural correlates of personality change evolve between 6 and 12 months and 12 to 24 months after injury. The data implicate the dorsal prefrontal cortex and frontal lobe white matter in the emergence of personality change involving the effortful or conscious regulation of affective states.
03/07/2006
11:32 AM
Does Preinjury Alcohol Use or Blood Alcohol Level Influence Cognitive Functioning After Traumatic Brain Injury
Rehabilitation Psychology. 2006 Feb Vol 51(1) 78-86
Objective: To examine the relations among preinjury alcohol use patterns and admission blood alcohol level (BAL) and postinjury cognitive functioning among individuals with recent TBI. Design: Cohort survey with chart review and follow-up cognitive assessment. Setting: Acute inpatient rehabilitation program in a Level I trauma center. Participants: 124 consecutive initial admissions meeting inclusion criteria. Measures: Admission BAL, preinjury alcohol consumption, consequences, and symptoms of dependence, as well as initial injury severity and subsequent cognitive functioning. Results: Higher BAL at hospital admission was related to greater initial injury severity (lower Glasgow Coma Scale score). Preinjury alcohol consumption and admission BAL were not consistently related to any postinjury assessment of cognition. Conclusion: Alcohol use at the time of injury may exacerbate the initial severity of TBI. Cognitive functioning soon after injury does not appear to be related to any preinjury drinking behavior.
03/07/2006
11:34 AM
The Associations Among Self Awareness Emotional Well Being and Employment Outcome Following Acquired Brain Injury A 12 Month Longitudinal Study
Rehabilitation Psychology. 2006 Feb Vol 51(1) 50-59
Objective: To investigate self-awareness and emotional well-being according to change in employment outcome in people with acquired brain injury (ABI). Design: A 12-month longitudinal study. Participants and Setting: Fifty adults with ABI attending outpatient rehabilitation (n = 17) or vocational rehabilitation services (n = 33). Time since injury ranged from 6 months to 12 years (M = 4.3 years, SD = 4.1). Main Outcome Measures: Self Awareness of Deficits Interview, Self-Regulation Skills Interview, Hospital Anxiety Depression Scale, and employment outcome (stable employment, improved employment, and stable unemployment). Results: At the initial assessment, level of awareness for the improved employment group was significantly lower than that for the stable employment group (p = .017), whereas no between-groups differences were found at the 12-month follow-up assessment. Employment outcome was not significantly associated with changes in self-monitoring or emotional well-being (p = .017). Demographic and injury-related variables were generally not related to employment outcome. Conclusions: The findings empirically support the theoretical view that an increase in self-awareness is associated with improved employment status, although the direction of this relation is unclear.
03/07/2006
11:35 AM
Group Psychotherapy Focusing on Self Concept Change Following Acquired Brain Injury A Pilot Investigation
Rehabilitation Psychology. 2006 Feb Vol 51(1) 30-35
Objective: The current study explored the effectiveness of a group therapy intervention that was focused specifically on self-concept changes following acquired brain injury (ABI). Method: Eighteen individuals in the postacute phase of recovery underwent a 6-week group therapy intervention and were administered a self-concept measure before and after the intervention. Results: Group members showed a significant increase (improvement) in self-concept ratings at the end of the group intervention. Conclusions: Although the results of this study suggest that this intervention may be helpful in improving self-concept following ABI, further exploration is clearly warranted. Future research is needed to investigate the impact of self-concept on emotional adjustment, participation in rehabilitation activities, and functional outcome.
03/07/2006
11:44 AM
Intracranial Pathology in Elders with Blunt Head Trauma
Acad Emerg Med Volume 13, Number 3 302-307
To examine presentations and prevalence of head injury among elder victims of blunt trauma and to estimate the prevalence of occult injuries associated with a normal level of consciousness, absence of neurologic deficit, and no evidence of significant skull fracture.
03/07/2006
11:42 AM
Role of CT Angiography in Thrombolysis Decision Making for Patients With Presumed Seizure at Stroke Onset
Stroke. 2006;37:915
The presence of seizure at stroke onset is a contraindication for intravenous tissue plasminogen activator treatment. A significant proportion of these patients’ deficits are not attributable to Todd’s paralysis and could be attributable to reversible ischemia. Currently there are no established methods of differentiating Todd’s paralysis from ischemic stroke/early seizure. We sought to determine whether computed tomographic angiography (CTA) can be helpful in differentiating the 2.
03/07/2006
11:41 AM
Left insular stroke is associated with adverse cardiac outcome
NEUROLOGY 2006;66:477-483
After stroke, 10% of patients have adverse cardiac outcomes. Left insular damage may contribute to this by impairing sympathovagal balance (associated with cardiac structural damage and arrhythmias).
03/07/2006
11:36 AM
Cerebral Microhemorrhages Predict New Disabling or Fatal Strokes in Patients With Acute Ischemic Stroke or Transient Ischemic Attack
Stroke. 2006;37:911
Cerebral microhemorrhages (MHs) are common among patients presenting with acute ischemic stroke and may predict both subsequent ischemic and hemorrhagic strokes.
03/07/2006
11:33 AM
Long Term Psychosocial and Adaptive Outcomes in Children With Arteriovenous Malformations
Rehabilitation Psychology. 2006 Feb Vol 51(1) 60-68
Objective: To describe the long-term social-emotional and adaptive functioning of a small sample of children and adolescents with repaired arteriovenous malformations (AVMs). Participants: Five children (11-15 years of age) with AVMs in the cerebellum and frontal, temporal, and parietal lobes. Main Outcome Measures: Vineland Adaptive Behavior Scales, Behavior Assessment System for Children, Parent Stress Inventory, Children's Depression Inventory, Revised Children's Manifest Anxiety Scale, and a clinical interview. Results: Although overall emotional functioning appeared adequate, there were suggestions of defensiveness and areas of worry. Global adaptive functioning was below average for most children, and parents have concerns about their child's socialization. Conclusion: These children are adapting variably, with more positive than negative findings. The results can help guide clinicians to generate effective rehabilitation strategies to improve the quality of life of children with AVMs.
03/07/2006
11:31 AM
Lateralization of the Startle Reflex Circuit in Humans An Examination With Monaural Probes Following Unilateral Temporal Lobe Resection
Behavioral Neuroscience. 2006 Feb Vol 120(1) 24-39
Startle reflex (SR) modulation elicited by monaural probes during affective picture viewing was investigated in patients following left temporal lobectomy (LTL; n = 8) and right temporal lobectomy (RTL; n = 10) and in controls (n = 18). All patients had undergone anteromedial temporal lobe (ATL) resection. LTL participants exhibited attenuated overall SR magnitude. Affective SR modulation in controls was significant for left ear probes, at both eyes, but not for right ear probes. RTL but not LTL participants displayed significant startle attenuation during pleasant picture viewing. Results suggest that monaural startle probes primarily activate structures in the ipsilateral ATL and that the ATLs are interconnected, with the left ATL more critical in perceiving arousing properties of affective stimuli, necessary for affective SR modulation.
03/07/2006
11:31 AM
The Effects of Orbital Frontal Cortex Damage on the Modulation of Defensive Responses by Rats in Playful and Nonplayful Social Contexts
Behavioral Neuroscience. 2006 Feb Vol 120(1) 72-84
In a series of 3 experiments on rats, 2 hypotheses were tested: (a) that damage to the orbital frontal cortex (OFC) would alter the socially relevant context for executing defensive responses but not their performance and (b) that damage done to the OFC in early infancy would produce more deficits in social behavior than similar damage occurring in adulthood. Bilateral or unilateral OFC damage in adult males did not impair their ability to defend themselves during play fighting and when protecting their food but did impair their ability to modify the pattern of defense in response to different partners. Rats that sustained bilateral damage at 3 days of age not only had deficits in partner-related modulation of defense but also exhibited hyperactivity in their play. The findings thus supported the proposed hypotheses.
03/06/2006
09:43 AM
Bench to Bedside Evidence for Brain Injury after Concussion Looking beyond the Computed Tomography Scan
Acad Emerg Med Volume 13, Number 2 199-214
The emergency management of cerebral concussion typically centers on the decision to perform a head computed tomography (CT) scan, which only rarely detects hemorrhagic lesions requiring neurosurgery. The absence of hemorrhage on CT scan often is equated with a lack of brain injury. However, observational studies revealing poor long-term cognitive outcome after concussion suggest that brain injury may be present despite a normal CT scan. To explore this idea further, the authors reviewed the evidence for objective neurologic injury in humans after concussion, with particular emphasis on those with a normal brain CT. This evidence comes from studies involving brain tissue pathology, CT scanning, magnetic resonance image (MRI) scanning, serum biomarkers, formal cognitive and balance tests, functional MRI, positron emission tomography, and single-photon emission computed tomography scanning. Each section is accompanied by technical information to help the reader understand what these tests are, not to endorse their use clinically. The authors discuss the strengths and weaknesses of the evidence in each case. These reports make a compelling case for the existence of concussion as a clinically relevant disease with demonstrable neurologic pathology. Areas for future emergency medicine research are suggested.
03/04/2006
09:27 AM
The significance of clumsy gestures in apraxia following a left hemisphere stroke
Neuropsychological Rehabilitation Volume 16, Number 1 / February 2006 38 - 65
Individuals who sustain a cerebrovascular accident (CVA) in the dominant (typically left) hemisphere, are at increased risk of developing motor skill deficits due to motor-sensory impairments, as well as cognitive impairments (e.g., apraxia). Clumsiness is a central component affecting motor skills in individuals with a left hemisphere CVA (LCVA). The term “clumsiness” however, has not been adequately operationalised in the apraxia literature in clinical terms, thereby making diagnosis difficult and its contribution to apraxic disorders uncertain. Accordingly, in this study “clumsiness” was explicitly defined by establishing a set of four criteria. The non-dominant (left) hand movements of three groups of participants were examined: 10 individuals with limb-apraxia (APX); 8 individuals without limb apraxia who had sustained a LCVA (NAPX); and 19 healthy individuals without a history of brain impairment (NBD). Performance was examined on four sets of motor tasks, including a conventional praxis test, basic perceptual-motor co-ordination and fine movement tasks, and a naturalistic actions test. A striking finding that emerged was that clumsy errors occurred frequently in all groups, including the NBD group, particularly on the praxis and fine motor tasks. In terms of quantity of clumsy errors emitted, the APX group made significantly more clumsy gestures across all four tasks in comparison to the NBD group. No differences emerged between the two clinical groups, however, in terms of total clumsy gestures emitted on the naturalistic action tasks, or the type of clumsy errors emitted on the fine motor tasks. Thus, frequency and types of clumsy gestures were partly determined by task demands. These results highlight the need to consider the contribution of clumsy gestures in limb functioning following hemispheric brain damage. In broad terms, these findings emphasise the importance of adopting more detailed analyses of movement errors in apraxia and assessments of cognitive-based motor functioning following brain impairment.
03/04/2006
09:25 AM
Successful guidance by automatic output of music and verbal messages for daily behavioural disturbances of three individuals with dementia
Neuropsychological Rehabilitation Volume 16, Number 1 / February 2006 66 - 82
There have been no previous reports of daily home activities of individuals with dementia being guided by the combination of music and verbal messages. This study evaluated the effectiveness for three individuals of music and messages which were automatically output by an IC recorder. After music was presented, messages instructed the participants to go to a day care centre, behave more peacefully and eat more at meals, respectively. These stimuli were highly effective for guiding the above activities. This study suggests that automatic output of music and messages has potential as a strategy for guiding individuals with dementia at their home. For the third individual, the music and messages were output through a doll. The implications of using a doll are also discussed.
03/04/2006
09:24 AM
The Effects of Prosthetic Foot Design on Physiologic Measurements Self-Selected Walking Velocity and Physical Activity in People With Transtibial Amputation
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 123-129
To investigate the physiologic differences during multispeed treadmill walking and physical activity profiles for the Otto Bock C-Walk foot (C-Walk), Flex-Foot, and solid ankle cushion heel (SACH) foot in people with transtibial amputation.
03/04/2006
09:22 AM
The Effect of Custom Made Braces for the Ankle and Hindfoot on Ankle and Foot Kinematics and Ground Reaction Forces
Archives of Physical Medicine and Rehabilitation Volume 87, Issue 1 , January 2006, Pages 130-135
To assess the effects on gait of custom-made polypropylene orthoses: ankle-foot orthosis (AFO), rigid hindfoot orthosis (HFO-R), and articulated hindfoot orthosis (HFO-A).
03/04/2006
09:21 AM
Impact of White Matter Hyperintensities Scoring Method on Correlations With Clinical Data
Stroke. 2006;37:836
White matter hyperintensities (WMH) are associated with decline in cognition, gait, mood, and urinary continence. Associations may depend on the method used for measuring WMH. We investigated the ability of different WMH scoring methods to detect differences in WMH load between groups with and without symptoms.
03/04/2006
09:20 AM
Anterior Posterior Ground Reaction Forces as a Measure of Paretic Leg Contribution in Hemiparetic Walking
Stroke. 2006;37:872
Walking after stroke is characterized by slow gait speed, poor endurance, reduced quality and adaptability of walking patterns, and an inability to coordinate the legs. Estimates based on mechanical work calculations have suggested that the paretic leg does 30% to 40% of the total mechanical work over the gait cycle, regardless of hemiparetic severity, but these work estimates may not describe the contribution of each leg to forward propulsion. The purpose of this study was to establish a quantifiable link between hemiparetic severity and paretic leg contribution to propulsion during walking, which we propose to quantify using a measure based on the anterior-posterior ground reaction forces (A-P GRFs).
03/04/2006
09:19 AM
Ictal vomiting in a left hemisphere language dominant patient with left-sided temporal lobe epilepsy
Epilepsy & Behavior Volume 8, Issue 1 , February 2006, Pages 323-327
Ictal vomiting in patients with focal epilepsy has mostly been associated with an epileptogenic zone in the non-language-dominant hemisphere. Here we present the case of a left hemisphere language-dominant patient suffering from typical mesial temporal lobe epilepsy with histologically proven hippocampal sclerosis and ictal vomiting during complex partial seizures. He became seizure-free after selective left-sided amygdalohippocampectomy. This case implies that ictal vomiting may not necessitate invasive electrophysiological exploration of left hemisphere language-dominant patients with temporal lobe epilepsy if surface EEG and MRI indicate a left-sided epileptogenic zone. It thus corroborates that with concordant imaging and neurophysiological data, clinical signs become less valuable.
03/04/2006
09:18 AM
Prefrontal disturbances as the sole manifestation of simple partial nonconvulsive status epilepticus
Epilepsy & Behavior Volume 8, Issue 1 , February 2006, Pages 331-335
We describe a case of frontal lobe epilepsy with rare nocturnal generalized tonic–clonic seizures and repeated prolonged episodes of altered behavior lasting 1 to 2 days. The changes consisted of poor organizational strategies, impaired set shifting, emotional indifference, reduced motivation, and impairment of emotional decision making. Memory and consciousness were undisturbed, as she was able to follow her profession as a teacher. During the episode, the EEG was marked by right frontal rhythmical spikes and waves with spread to the homologous left region. Behavioral abnormalities and EEG changes were successfully treated with intravenous diazepam. The clinical representation can be ascribed to alterations of prefrontal-subcortical circuits, especially the anterior cingulate and orbitofrontal circuits. This unique case is classified as simple partial nonconvulsive status epilepticus with prefrontal disturbances as the sole manifestation.
03/04/2006
09:16 AM
Recurrent status epilepticus as the main feature of Hashimotos encephalopathy
Epilepsy & Behavior Volume 8, Issue 1 , February 2006, Pages 328-330
Hashimoto’s encephalopathy (HE) is a severe but treatable condition that rarely complicates Hashimoto’s thyroiditis. Clinically it is characterized by progressive or relapsing symptoms, including tremor, myoclonus, stroke-like episodes, seizures, impairment of consciousness, and dementia. We describe a patient presenting with recurrent generalized convulsive status epilepticus (GCSE), despite antiepileptic medications, who was successfully treated with methylprednisolone. Our observation confirms that the clinical spectrum of HE at presentation is heterogeneous and diagnosis is often difficult. This case highlights the crucial importance of antithyroid antibody measurement in patients presenting with otherwise unexplained episodes of GCSE with or without adjunctive signs of encephalopathy or thyroiditis.
03/04/2006
09:15 AM
Complex behavioral automatism arising from insular cortex
Epilepsy & Behavior Volume 8, Issue 1 , February 2006, Pages 315-319
We describe two cases of complex partial seizures with ictal violent movements arising from the insular cortex. The first patient, a 14-year-old girl, presented with hyperkinetic behavior such as rolling, thrashing, and pedaling, and the second case, a 38-year-old woman, had been suffering from frequent daytime hyperkinetic seizures characterized by bizarre vocalization, jumping, and violent bimanual movements. Both patients showed a slight high signal change in the right posterior ventral insular cortex in fluid-attenuated inversion recovery (FLAIR) studies involving magnetic resonance imaging, and extensive subdural electroencephalographic monitoring revealed EEG seizure onset from the temporal lobe. The posterior ventral insular and lateral temporal cortices were resected, resulting in complete seizure freedom in both cases. The histological diagnoses were focal cortical dysplasia in the first case and gliosis in the second case. There may exist a group of patients with complex partial seizures with ictal violent automatism that can be ameliorated by the resection of epileptogenic lesions in the insular cortex. Careful inspection of the insular cortex is necessary to diagnose this type of epileptic seizure.
03/04/2006
09:14 AM
Internal and Cortical Border Zone Infarction
Stroke. 2006;37:841
The pathogenesis of internal border-zone (IBZ) and cortical border-zone (CBZ) infarcts is unclear. Both types of infarct have been combined into a single group in most previous reports, which has produced conflicting results. We hypothesized that different pathogenic mechanisms underlie IBZ and CBZ infarcts.
03/04/2006
09:11 AM
Seropositivity to Chlamydia pneumoniae Is Associated With Risk of First Ischemic Stroke
Stroke. 2006;37:790
Serologic evidence of infection with Chlamydia pneumoniae has been associated with cardiovascular disease, but its relationship with stroke risk remains uncertain. The objective of this study is to determine whether serological evidence of C pneumoniae infection is associated with risk of ischemic stroke.
03/04/2006
09:09 AM
Interobserver Agreement for the Bedside Clinical Assessment of Suspected Stroke
Stroke. 2006;37:776
Stroke remains primarily a clinical diagnosis, with information obtained from history and examination determining further management. We aimed to measure inter-rater reliability for the clinical assessment of stroke, with emphasis on items of history, timing of symptom onset, and diagnosis of stroke or mimic. We explored reasons for poor reliability.
03/04/2006
09:08 AM
Distinguishing Between Stroke and Mimic at the Bedside
Stroke. 2006;37:769
The bedside clinical assessment of the patient with suspected stroke has not been well studied. Improving clinical skills may accelerate patient progress through the emergency department. We aimed to determine the frequency and nature of stroke mimics and to identify the key clinical features that distinguish between stroke and mimic at the bedside.
03/04/2006
09:06 AM
Characteristics of an Ill Defined Diagnosis for Stroke
Stroke. 2006;37:781
Rapid and accurate evaluation of stroke subtypes is crucial for optimal treatment and outcomes. This study assessed factors associated with the likelihood of an "ill-defined" diagnosis for stroke hospitalizations.
03/04/2006
09:05 AM
The Impact of a Concurrent Trauma Alert Evaluation on Time to Head Computed Tomography in Patients with Suspected Stroke
Acad Emerg Med Volume 13, Number 3 349-352
The authors hypothesized that the presence of a trauma alert evaluation would impede the time to head computed tomography (hCT) in patients with stroke-like symptoms.
03/04/2006
09:04 AM
Quality of Randomized Controlled Trials Reporting in the Primary Treatment of Brain Tumors
Journal of Clinical Oncology, Vol 24, No 7 (March 1), 2006: pp. 1136-1144
To assess the reporting quality of randomized controlled trials (RCTs) in the primary treatment of brain tumors and to identify significant predictors of quality.
03/04/2006
09:01 AM
Effects of an Occupational Therapy Program on Functional Outcomes in Older Stroke Patients
Gerontology 2006;52:85-91
During the last decade, occupational therapy has gained increasing importance as component of the rehabilitation programs in disabled patients.
03/04/2006
08:59 AM
|
What
is RSS?
