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4 results

  • Chapter 10 - Auditory disorders in stroke

  • from Section 1 - Clinical manifestations
  • Edited by Louis R. Caplan, Jan van Gijn
  • Book:
    Stroke Syndromes, 3ed
    Published online:
    05 August 2012
    Print publication:
    12 July 2012, pp 131-143

  • Summary

    Ataxia is the most important sign of cerebellar disease, but there are other potential causes of ataxia. Postural and limb tremor are additional signs of cerebellar disease. Patients with cerebellar disorders may walk with a wide-based, staggering gait, making it seem as if they were intoxicated by alcohol. Frontal lobe disorders might cause cerebellar-like symptoms with walking difficulties and clumsiness. Frontal lobe lesions are commonly associated with impairment of cognitive function and changes in personality, and often cause urinary incontinence. Lesions of the cerebellar hemisphere are followed by ipsilateral limb ataxia including hypotonia in acute lesions, and if the dentate nucleus is involved, kinetic tremor. Vascular lesions of the cerebellum itself and of the corticopontocerebellar and dentatothalamic pathways might result in ataxia. Limb ataxia and ataxia of gait are common in superior cerebellar artery (SCA), the posterior inferior cerebellar artery (PICA), and the anterior inferior cerebellar artery (AICA) territory infarctions.

  • Electrophysiological changes in late life depression and their relation to structural brain changes

  • Sebastian Köhler, C. Heather Ashton, Richard Marsh, Alan J. Thomas, Nicky A. Barnett, John T. O'Brien
  • Journal:
    International Psychogeriatrics / Volume 23 / Issue 1 / February 2011
    Published online by Cambridge University Press:
    18 June 2010, pp. 141-148

  • Background: Late life depression is often accompanied by slowed information processing during neuropsychological testing, and this has been related to underlying cerebrovascular disease. We investigated whether changes in electrophysiological markers of information processing might share the same pathological correlates.

    Methods: Differences in power spectra frequency, contingent negative variation (CNV), post-imperative negative variation (PINV), and auditory P300a amplitude and latency in 19 patients with DSM-IV major depression aged ≥ 60 years were compared with 25 recordings in age-matched healthy controls. Associations with total brain volume and degree of white matter hyperintensities (WMH) were examined in those who had undergone additional magnetic resonance imaging (MRI).

    Results: Compared with healthy controls, patients had more slow-wave delta (group difference: p = 0.024) and theta activity (p = 0.015) as well as alpha activity (p = 0.005) but no decrease in beta band frequency (p = 0.077). None of these changes related differently to brain volume or WMH in patients or controls. Patients further showed prolonged P300a latencies (p = 0.027), which were associated with decreased total brain volume in patients but not controls (interaction by group: p = 0.004). While there were no overall differences in PINV between both groups, patients showed a decrease in PINV magnitude with increasing WMH, a relation that was not seen in controls (interaction by group: p = 0.024).

    Conclusion: Patients with late life depression show changes in several electrophysiological markers of cerebral arousal and information processing, some of which relate to brain atrophy and WMH on MRI.

  • Chapter 11 - Deep trophoblast invasion and spiral artery remodeling

  • from Section 4: - Deep placentation
  • Edited by Robert Pijnenborg, Ivo Brosens, Roberto Romero
  • Book:
    Placental Bed Disorders
    Published online:
    06 July 2010
    Print publication:
    03 June 2010, pp 97-108

  • Summary

    This chapter reviews the features of defective physiological changes of the spiral arteries in the placental bed in association with preeclampsia and fetal growth restriction and the methodology of placental bed vascular studies. The incidence of acute atherosis ranges from 41% to 48% in a series examining placental bed biopsies, placental basal plates, and amniochorial membranes. The basal plate of a delivered placenta is highly insufficient for the study of spiral arteries as it does not even represent the whole thickness of the decidua. The total number of spiral artery openings in the placental bed for a normal pregnancy was estimated at 120 and for severe preeclampsia 72. Indeed, examination of large hysterectomy specimens with placenta in situ has shown that in severe cases of preeclampsia a small, central part of the placenta may contain spiral arteries with fully developed physiological changes.

  • 12 - STROKE AND NEUROSARCOIDOSIS

  • 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 75-80

  • Summary

    Bürger's disease or thromboangiitis obliterans (TAO) is a nonatherosclerotic segmental inflammatory obliterative vascular disease that affects medium- and small-sized arteries as well as superficial veins. Bürger's disease manifested in the brain has the following morphologic characteristics: arterial occlusions caused by thrombosis in small arteries without arteriosclerosis, and spatial predilection for the cerebral surface in the watershed region between the middle cerebral, anterior, and posterior cerebral arteries. TAO is characterized by claudication or ischemia of both legs and less so of the arms. The disease begins distally and progresses more proximally. The diagnosis of TAO requires the exclusion of an embolic source, autoimmune disease, diabetes, and hyperlipidemia. Arteriography should show the distal involvement with normal arterial lumen proximal to the popliteal or distal brachial level and the absence of atheromatous changes in the large vessels. Abstinence from tobacco will likely halt disease progression and sometimes result in regression of vascular changes.