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8 results

  • Cognitive and Behavioral Disorders in Patients with Superior Parietal Lobule Infarcts

  • Emre Kumral, Fatma Ece Çetin, Hüseyin Nezih Özdemir
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 50 / Issue 4 / July 2023
    Published online by Cambridge University Press:
    10 June 2022, pp. 542-550
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  • Background/Objective:

    The superior parietal lobule (SPL) plays a strategic role in somatosensory and visuomotor integration. This study aims to evaluate the clinical, neurocognitive, and behavioral characteristics of isolated SPL stroke.

    Methods

    We assessed neuropsychological and behavioral findings in 14 patients with isolated SPL stroke among 4200 patients with ischemic stroke. All patients underwent neuroimaging, clinical and neuropsychological assessment after stroke.

    Results:

    Of the 14 patients enrolled, the first complaints were tactile and visuospatial disorders at stroke onset. Except for 6 patients with only 1 cognitive impairment, the majority of patients (57%) experienced more than 1 cognitive impairment category. Functional hemispheric asymmetries have been found in different cognitive processes, such as between visuospatial and body image functions and language process. Among visuospatial abilities disorders, spatial disorientation, visuospatial neglect, and visual extinction were found in two-thirds (63%) of patients with right SPL lesion. Body schema and image disorders were observed in all patients with right-sided lesions, such as alien hand, autotopagnosia for body parts (36%), autotopagnosia for sensory sensations (36%), and fading limb (21%). Two-thirds (57%) of patients with left SPL had impairment in language abilities.

    Conclusion

    Our findings after stroke suggest that SPL plays a pivotal role in the regulation of visuospatial abilities, body schema and body image processing, and language skills through bilateral frontoparietal networks and interhemispheric parietal networks.

  • The Clinical and Cognitive Spectrum of Artery of Percheron Infarction: 1-Year Follow-Up

  • Fatma Ece Çetin, Emre Kumral, Birgül Dere
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 49 / Issue 6 / November 2022
    Published online by Cambridge University Press:
    10 September 2021, pp. 774-780
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  • Objective:

    Survivors of patients with artery of Percheron infarction (API) often have a prolonged and disabling form of cognitive impairment that remains insufficiently characterized. We aimed to examine the clinical and cognitive features of API in the short and long term after stroke.

    Methods:

    We reviewed 6400 patients with a first-ever stroke included in the Stroke Registry between 2011 and 2021. The diagnosis of API was based on clinical diagnosis and imaging confirmation. All patients underwent neuropsychological assessment at hospital stay and 1 year after stroke. A z-score of each patients’ cognitive test point was calculated, and a z-score inferior to 2 was considered as pathological.

    Results:

    Of the 10 patients enrolled, all had cognitive impairment, consciousness, and behavioral disorders at stroke onset. Six patients had pure bilateral thalamic involvement while four had bilateral thalamic and rostral midbrain involvement. At 12 months, 50% of patients had global mental state scores 2 SD below the population mean (z-score mean ± SD, −2.17 ± 0.4). Most of the prefrontal cortex cognitive processes including executive functions such as planning and cognitive control (z-score mean ± SD, −3.92 ± 0.3), processing speed (−4.42 ± 0.5), working memory (−3.97 ± 0.3) were severely impaired at stroke onset. Especially in patients with thalamic and rostral midbrain involvement, deficiencies in executive function (z-score mean ± SD, −2.60 ± 0.4), processing speed (−2.22 ± 0.5), working (−3.76 ± 0.4), and episodic memory (−2.23 ± 0.3) continued 12 months after stroke.

    Conclusions:

    The occlusion of the artery of Percheron results in severe behavioral and cognitive disorders in the short and long term after stroke.

  • Chapter 37 - Multiple and bihemispheric infarcts

  • from Section 2 - Vascular topographic syndromes
  • Edited by Louis R. Caplan, Jan van Gijn
  • Book:
    Stroke Syndromes, 3ed
    Published online:
    05 August 2012
    Print publication:
    12 July 2012, pp 426-438

  • Summary

    This chapter reviews the current literature on the frequency and causes of multiple brain infarcts, particular clinical and/or topographical patterns that suggest specific underlying mechanisms, and etiologies. The presence of multiple lacunar infarcts is an important prognostic indicator not only for functional recovery but also for a higher rate of recurrence. Various underlying conditions associated with multifocal involvement of the cerebral vasculature and/or a high rate of recurrent strokes may be responsible for multiple brain infarcts. Acute multiple infarcts may involve both hemispheres and may suggest some specific clinical pictures, particular causes, such as large artery disease, cardioembolism, angiitis, hematological disorders, hemodynamic mechanisms, or venous infarcts. In patients with simultaneous multiple, bihemispheric, and multilevel infarcts, most causes seem to be of similar type. Simultaneous multiple and multilevel infarcts may be associated with specific neurocognitive/psychological dysfunction patterns in most of the patients, allowing diagnosis accuracy.

  • 11 - BEHÇET’S DISEASE

  • from PART I: - INFECTIOUS AND INFLAMMATORY CONDITIONS
  • Edited by Louis R. Caplan, Julien Bogousslavsky
  • Book:
    Uncommon Causes of Stroke
    Published online:
    06 January 2010
    Print publication:
    09 October 2008, pp 67-74

  • Summary

    In Takayasu disease, the aortic arch, with its main arterial trunks and the descending aorta, as well as renal arteries, is the main site of inflammation. Takayasu disease is thought to begin clinically with symptoms of systemic inflammation or with eye symptoms. Cerebral vascular disease is usually a consequence of severe hypertension, or carotid or brachiocephalic obstruction. Recently, it has been emphasized that use of Doppler ultrasound, computed tomography angiography, and positron emission tomography (PET) scan, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in combination, may facilitate the detection of Takayasu disease activity at a more treatable stage. Concerning the treatment and management of Takayasu disease patients with stroke, one has to consider the treatment of Takayasu disease and stroke separately. Subclavian steal syndrome or moderate carotid stenosis, as well as renal artery stenosis may be an indication for angioplasty and/or stenting.

  • 38 - Multiple, multilevel and bihemispheric infarcts

  • from PART II - VASCULAR TOPOGRAPHIC SYNDROMES
    • By Emre Kumral, School of Medicine, Ege University, Bornova, Izmir, Turkey
  • Edited by Julien Bogousslavsky, Université de Lausanne, Switzerland, Louis R. Caplan, Harvard Medical School
  • Book:
    Stroke Syndromes
    Published online:
    17 May 2010
    Print publication:
    24 May 2001, pp 499-511

  • Summary

    Recent studies emphasize multiple cerebral infarcts as new clinical patterns. The underlying clinical, topographic, etiologic and functional characteristics are now well known. The term multiple brain infarcts has been used to designate a variety of different infarcts which appear in one or both hemispheres, or in supratentorial and infratentorial arterial territories (multilevel). Multiple brain infarcts are composed either of simultaneous multiple infarcts or of infarcts of different chronological age. We will review in the following sections the current literature on the frequency and causes of multiple brain infarcts, particular clinical and/or topographic patterns that suggest specific underlying mechanisms and causes.

    Frequency and incidence of multiple cerebral infarcts

    Previous studies using different methods (first strokes vs. all strokes, acute and old) give a variety of definitions related to multiple brain infarcts. Disagreement exists about the definition of the disorder. In the Lausanne Stroke Registry, among 2000 consecutive patients whose first strokes were confirmed by cranial computed tomography (CT) or magnetic-resonance imaging (MRI), 3% of the patients had infarcts in ‘multiple territories’ supplied by the carotid arteries, 2% had multiple infarcts in the vertebrobasilar artery territory, and 2% had multiple infarcts in the territories of the carotid and vertebrobasilar arteries (Bogousslavsky, 1991a). In our hospital-based Ege Stroke Registry, we found almost similar frequency of multiple infarcts; 2% of the multiple infarcts were in the carotid territory, 3% were in the vertebrobasilar artery territory, and 3% were in the territories of the carotid and vertebrobasilar arteries (Kumral et al., 1998).