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Biomedical subjects

J M Ferro

Publications and source records attributed to J M Ferro.

At least 19 recordsLinked to original sources
PubMed2001

Hyperacute cognitive stroke syndromes.

Cognitive syndromes are common clinical manifestations of hyperacute stroke and may be the single or dominant presenting features. They are related to acute dysfunction of complex integrated distributed functional networks serving different cognitive domains. The most common cortical syndromes include nonfluent or fluent aphasia, neglect, collor agnosia, pure alexia and Balint's syndrome. Disturbances of declarative memory are common following posterior cerebral artery and thalamic strokes. Abulia can follow thalamic, caudate and capsular lesions. Intraventricular and subarachnoid haemorrhages can cause preeminent neuropsychological changes. Disorientation is present in about 40% of acute stroke patients and delirium complicates the course of 25% of acute strokes. Some hyperacute cognitive stroke syndromes are useful indicators of later disability. Cognitive syndromes may pose special difficulties to neurology residents, unless formal teaching in neuropsychology and psychiatry is included in their training programs.

Acute Disease↗
PubMed2001

Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998.

There is insufficient information on the prognosis and safety of anticoagulation in acute cerebral vein and dural sinus thrombosis (CVDST). To describe the clinical aspects and medical management of CVDST in Portuguese hospitals, to evaluate the safety of anticoagulation in this setting, and to identify subgroups of CVDST patients with different prognoses, we registered symptomatic CVDST patients admitted to Portuguese hospitals since 1980. Cases were collected from file review up to 6/95 and from consecutively admitted patients from 6/95 to 6/98. One hundred and forty-two patients were included from 20 centers (51 retrospectively and 91 prospectively). One hundred and twelve patients (79%) were anticoagulated. There were only 6 new intracranial hemorrhages (4 in anticoagulated patients) and 2 systemic hemorrhages. Nine (6%) patients died. At discharge, 96 (68%), had recovered completely and only 6 (4%) were dependent (Rankin > or = 3). Significant multivariate predictors of death/dependency were central nervous system infection as a predisposing cause (odds ratio, OR = 15.4; 95% confidence interval CI = 111-1.1), encephalopathy on admission (OR = 5.2; 95% CI = 18.7-1.5) and hemorrhage on admission CT/MR (OR = 3.6; 95% CI = 12.9-1). Significant predictors of complete recovery were no encephalopathy on admission (OR = 5; 95% CI = 12.5-2.1), age < 45 years (OR = 3.8; 95% CI = 9.2-1.6) and anticoagulation (OR = 3.8; 95% CI = 9.6-1.5). It is possible to identify CVDST patients with potential bad or good prognosis in the acute phase. Anticoagulation was safe and a predictor of complete recovery in acute CVDST.

Adult↗
PubMed2001

HITS in internal carotid dissections.

Carotid dissections can cause neurological deficits either by hemodynamic or embolic mechanisms. Anticoagulants are often used in this setting to prevent neurological deterioration and stroke recurrence. High-intensity transient signals (HITS) detected by transcranial Doppler may be due to microembolism. We investigated the presence and number of HITS in a series of 27 patients with carotid dissection. HITS were detected in 14 (52%) patients and only in cases with a less than 7-day evolution. No association was found between HITS and clinical or imagiological features of the dissection nor with neurological aggravation or treatment type. We failed to demonstrate any relevant clinical significance of HITS in carotid dissection.

Adult↗
PubMed2001

Epileptic seizures following subcortical infarcts.

Stroke is one of the most frequent causes of seizures in adulthood. Subcortical infarcts have been associated with post-stroke epileptic seizures, although less frequently than cortical ischaemia. We studied 113 patients from a hospital stroke registry. The patients had subcortical non-lacunar infarcts (64 striatocapsular infarcts, 13 thalamic, 8 choroidal artery territory, 28 internal border zone and white matter medullary infarcts) and at least 1 year of follow-up. Only 4 patients (3.5%) with striatocapsular infarcts suffered an epileptic seizure. Two seizures occurred within the first 24 h, 1 within the first month and 1 within the first year of stroke onset. Emboligenic cardiac conditions were significantly more common in patients with seizures (difference 37%; 95% confidence intervals 2-72%). Subsequently to subcortical infarct, epileptic seizures are infrequent, tend to occur early after stroke and have a very low 1-year recurrence risk.

Cerebral Infarction↗
PubMed2000

Cognitive and emotional consequences of perimesencephalic subarachnoid hemorrhage.

Little is known about the long-term cognitive-functional outcome of patients with perimesencephalic subarachnoid haemorrhage (PM SAH). We investigated the neurological, cognitive and emotional consequences of perimesencephalic subarachnoid haemorrhage in eighteen PM SAH patients admitted between November 1990 and July 1997 to the Neurology/Neurosurgery services of a University Hospital. The follow-up study consisted of a face-to-face interview, a neurological examination, an headache questionnaire, a neuropsychological evaluation (Mini-Mental State and a complementary battery to assess specific cognitive domains), the Hamilton Depression Rating Scale (HDRS) and the Blessed Dementia Scale. Thirteen patients performed below the 10th percentile in at least one cognitive domain. Six patients scored more than 12 points on the HDRS. Mini-Mental State and HDRS scores were moderately correlated (r = 0.55). Only three patients left their previous occupation. Minor cognitive deficits and high scores on a depression scale were frequent findings in this cohort of PM SAH patients. Reassurance and treatment of depressive symptoms could be important to improve the long-term outcome of PM SAH patients.

Adult↗
PubMed1999

A follow-up study of cognitive impairment due to inferior capsular genu infarction.

Abulia, memory loss, other cognitive deficits, and behavioral changes consistent with dementia can follow an inferior capsular genu infarction, but only little is known about the time course of these disturbances. The present study describes the long-term outcome of cognitive defects in four patients with inferior capsular genu infarction who underwent a neuropsychological examination within 3 and 12 months of onset. Three patients had infarcts in the inferior genu of the left internal capsule and had similar symptoms in the acute phase: disorientation, memory loss, language impairment, and behavioral changes. The patient with right-side infarct showed memory impairment and behavioral changes. Three patients had deficits in one or more cognitive domains on the first assessment, but none was demented. By the second evaluation all subjects had improved. In two patients there were a moderate memory defect persisted and a language disturbance. Improvement in these disturbances during long-time follow-up demonstrates that there are alternative pathways that reestablish the functional connections damaged by the strategically located capsular genu infarct. Inferior capsular genu infarction is not a cause of persisting "strategic infarct dementia."

Aged↗
PubMed1998

Venous transcranial Doppler in acute dural sinus thrombosis.

The value of conventional transcranial Doppler ultrasound in the diagnosis and monitoring of cerebral vein thrombosis is unclear. Previous studies have suggested the usefulness of this method in two cases with superior sagittal sinus thrombosis that showed increased velocities of deep cerebral veins. The purpose of the present study was to evaluate the deep intracranial venous circulation in patients with that pathology. Venous transcranial Doppler ultrasound was performed with a range-gated 2 MHz transducer in 17 healthy volunteers and in six cases of proven acute superior sagittal sinus thrombosis. Peak systolic, end diastolic and mean blood flow velocities were measured in the basal vein of Rosenthal (BVR) and deep middle cerebral vein (DMCV) through a posterior temporal window. In 16 controls and in one patient, the straight sinus was also studied through an occipital approach. Sex distribution and mean age of controls and patients were similar. Mean blood flow velocities in controls were as follows (mean, SD): DMCV, 10.4, 1.4 cm/s; BVR, 11.3, 1.8 cm/s; straight sinus, 29.5, 9.9 cm/s. Three of the patients with superior sagittal sinus thrombosis showed increased velocities either in the DMCV, the BVR or the straight sinus. One patient showed slightly increased velocities in the BVR, and the other two showed normal venous velocity values. This study confirms the usefulness of conventional transcranial Doppler ultrasound in detecting superior sagittal sinus thrombosis. However, a normal examination does not exclude this diagnosis.

Adult↗
PubMed1998

Vasculitis of the central nervous system.

Central nervous system (CNS) involvement and management in primary vasculitis (giant cell arteritis, primary angiitis of the CNS, Takayasu's disease, periarteritis nodosa, Kawasaki disease, Churg-Strauss syndrome, Wegener's granulomatosis) and vasculitis secondary to collagen vascular diseases, Beçhet's disease and other systemic conditions (excluding those secondary to infections) and the use of illicit drugs are reviewed. Vasculitis is an infrequent cause of stroke even in the young age groups, and routine screening of stroke patients for vasculitis is not cost-effective. CNS vasculitis may present with isolated CNS symptoms and signs (headaches, meningeal signs, encephalopathy, psychiatric syndromes, dementia, cranial nerve palsies, seizures, strokes), neuropathy or muscle damage, multiorgan involvement or non-specific systemic symptoms or a combination of the above. Magnetic resonance is the most sensitive ancillary procedure to detect CNS damage. Many of the angiographic features found in vasculitis are non-specific. Autoantibodies and tissue biopsy are also useful to the diagnosis. There are few controlled studies on the treatment of vasculitis. Usually a combination of steroids and cytotoxic drugs is used, but there is considerable variation between centres on current therapeutic regimens.

Brain↗
PubMed1998

Diagnosis of stroke by the nonneurologist. A validation study.

BACKGROUND AND PURPOSE: The first medical contact of an acute stroke victim is often a nonneurologist. Validation of stroke diagnosis made by these medical doctors is poorly known. The present study seeks to validate the stroke diagnoses made by general practitioners (GPs) and hospital emergency service physicians (ESPs). METHODS: Validation through direct interview and examination by a neurologist was performed for diagnoses of stroke made by GPs in patients under their care and doctors working at the emergency departments of 3 hospitals. RESULTS: Validation of the GP diagnosis was confirmed in 44 cases (85%); 3 patients (6%) had transient ischemic attacks and 5 (9%) suffered from noncerebrovascular disorders. Validation of the ESP diagnosis was confirmed in 169 patients (91%); 16 (9%) had a noncerebrovascular diagnosis. Overall, the most frequent conditions misdiagnosed as stroke were neurological in nature (cerebral tumor, 3; subdural hematoma, 1; seizure, 1; benign paroxysmal postural vertigo, 1; peripheral facial palsy, 2; psychiatric condition, 6; and other medical disorders, 7). CONCLUSIONS: In the majority of cases, nonneurologists (either GPs or ESPs) can make a correct diagnosis of acute stroke. Treatment of acute stroke with drugs that do not cause serious side effects can be started before evaluation by a neurologist and CT scan.

Adult↗
PubMed1998

Headaches in intracerebral hemorrhage survivors.

Few data exist on headache in survivors of acute cerebrovascular disease. During the second year of follow-up of a cohort of intracerebral hemorrhages (ICH), the lifetime history of headache before stroke and 2 years after stroke was characterized through a neurologic interview and a headache questionnaire. Headaches were classified following the International Headache Society classification categories. Disability (Rankin scale) and depression (CERAD depression scale) were also evaluated. Ninety survivors were interviewed. Comparing the distribution of pre- and post-ICH headaches, 24 subjects (27%) never had headaches, 39 subjects (43%) had ongoing headaches, 10 subjects (11%) complained of headaches only after ICH, and 17 subjects' (19%) headaches remitted after ICH. There was usually a delay of weeks or months between ICH and the first headache episode. Poststroke headaches were in general less severe and frequent than prestroke headaches. New-onset headaches after ICH were mainly of the tension type and were significantly associated with depression but not with new intracranial lesions. Headaches in remission after ICH were related to acute alcohol consumption and migraines. Chronic post-ICH headaches are usually tension type and occur in association with depression. Remission of headaches after ICH is related to removal of headache precipitants (alcohol) and possibly to structural or functional changes of the trigeminovascular system secondary to intracranial bleeding.

Adult↗
PubMed1998

[Secondary stroke prevention].

The guidelines for secondary stroke prevention, graded following available scientific evidence, are presented. Stroke and TIA are defined and the indications for referral established. Basic assessment of stroke patients should include laboratory evaluation, ECG, brain CT, ultrasound examination of the extracranial vessels for events in the carotid distribution, and transthoracic or transesophageal echocardiogram if cardioembolism is suspected. The pharmacological and non-pharmacological reduction of blood pressure and serum cholesterol, stopping smoking and reducing alcohol intake are general measures recommended for secondary stroke prevention, together with healthier life-style changes (eating a Mediterranean type diet and performing regular moderate physical exercise). Concerning antithrombotic therapy, oral anticoagulants are recommended for patients with atrial fibrillation and other high to medium emboligenic cardiac risk conditions. Antiplatelet drugs are recommended for all other survivors of an ischemic cerebral event. Aspirin (75-325 mg/day) is the drug of choice. Alternative antiplatelet agents are clopidrogrel, ticlopidine, dipiridamol or triflusal. They can be used in patients with intolerance or contraindication to aspirin or in high-risk subjects. Endarterectomy of the symptomatic carotid is an additional procedure recommended for patients with ischemic stroke or TIA and carotid stenosis > 80% on the side of the symptomatic cerebral hemisphere.

Anticoagulants↗
PubMed1997

Aphasia type, age and cerebral infarct localisation.

Stroke patients with nonfluent aphasia tend to be younger than fluent aphasics. We investigated whether this difference was due to an age-related change in the anatomicofunctional organisation of language areas or to an age-dependent variation on the distribution of infarct localisation. From a hospital prospective stroke database we selected those patients who suffered an ischaemic stroke with at least one non-lacunar infarct demonstrated by computed tomography (n = 423 patients). We retrieved information on language disturbance in the acute phase (no aphasia, non-fluent aphasia, fluent aphasia) and on infarct localisation by CT. Non-fluent aphasia predominated in young (aged < 51 years) patients while in elderly patients (aged > 70 years) the opposite was found (chi 2 = 8.03; P = 0.005). Posterior infarcts were also more frequent in elderly patients (chi 2 = 9.9; P = 0.002). There were 27 atypical cases (patients with lesions on language areas without aphasia) and 14 aphasics with atypical infarct localisation (9 fluent aphasics with anterior lesions and 5 non-fluent aphasics with posterior lesions). The proportions of atypical cases, their infarct location or fluency type were not influenced by age. It was concluded that the predominance of fluent aphasia in older patients was related to the higher proportion of posterior infarcts in these patients. The hypothesis of age-related changes in the anatomico-functional organisation of language areas was not supported by the present data.

Adolescent↗
PubMed1997

Botulinum toxin type A for the treatment of arm and hand spasticity in stroke patients.

BACKGROUND: Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect for botulinum toxin A (BTX-A) for relief of spasticity. OBJECTIVE: To evaluate the safety and efficacy of BTX-A in the treatment of spasticity in a homogeneous group of stroke patients. METHODS: In this phase III open label trial 19 stroke patients stable for at least six months were enrolled (mean age 53.1 (SD 3.27) years; range 26-72). There were 16 males and 4 females. ASSESSMENTS: Clinical (Ashworth spasticity rating scale, scores for joint mobility, pain and frequency of spasms, Frenchay arm test (FAT)) and subjective (semi-quantitative rating scale filled out by the patient). Only hand and finger flexors were injected. The maximum dosage was 150 U BOTOX (25 U/muscle), the mean dosage was 92.1 +/- 31.6 U BOTOX. RESULTS: Ashworth rating scale and joint mobility scores improved from a median value of 2 at baseline to a median value of 1 one month after treatment, FAT scores also improved from a median value of 0 at baseline to a median value of 1 one month after treatment (Kruskall-Wallis test p < 0.01). Two-thirds of the patients rated their functional improvement as none or mild. CONCLUSIONS: Our study confirmed that BTX-A has an anti-spastic effect but its functional impact needs further evaluation.

Adult↗
PubMed1997

[Is hospital admission urgent in stroke?].

OBJECTIVE: To review the evidence that strokes need urgent hospital admission. DEVELOPMENT: The need for urgent hospitalization varies with stroke type. Immediate hospital admission it is unquestionable for subarachnoid hemorrhage and probably also for intracerebral hemorrhages. An acute CT can disclose non-vascular pathology, an hemorrhage or early infarct signs. Being examined by a neurologist within six hours from onset improves outcome. How early should a cardioembolic stroke be anticoagulated is still a matter of debate. Aspirin and nadroparine given within 48 hours improve acute ischemic stroke outcome. A 10% benefit on functional outcome was obtained by IV rtPA, given within three hours. The majority of acute stroke trial with neuroprotectors have a six hours windows design, but the percentage of patients arriving hospital within that interval is variable. CONCLUSION: Early hospital admission of acute stroke is beneficial. An educational effort is needed to increase early hospital referral of acute stroke patients.

Brain Ischemia↗