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Biomedical subjects

L R Caplan

Publications and source records attributed to L R Caplan.

At least 199 records · Page 11Linked to original sources
PubMed1983

Cerebral emboli of paradoxical origin.

A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.

Adult↗
PubMed1983

Behavioral abnormalities after right hemisphere stroke.

We evaluated 41 patients with unilateral right hemisphere strokes for hemiparesis, hemianopia, constructional apraxia, neglect, extinction, unilateral spatial neglect on drawing (USND), dressing apraxia, anosognosia, prosopagnosia, and motor impersistence. Low correlations were found among USND, neglect, and extinction. Constructional apraxia showed a higher correlation with USND than with hemianopia. Motor impersistence and anosognosia correlated with the severity of the hemiplegia. Left neglect, motor impersistence, and anosognosia tended to occur only with large strokes. Injury to the right parietal lobe appears to be an important determinant of USND and constructional apraxia. In most cases of motor impersistence, left neglect, and anosognosia, there was injury to the right parietal lobe and also to structures beyond the parietal lobe. In two cases, small deep lesions produced behavioral abnormalities comparable to those of larger superficial cortical lesions.

Apraxias↗
PubMed1983

Recovery of behavioral abnormalities after right hemisphere stroke.

We studied recovery of function in 41 patients with right hemisphere stroke. Recovery was rapid for left neglect, prosopagnosia, anosognosia, and unilateral spatial neglect on drawing (USN). Recovery was slower for h mianopia, hemiparesis, motor impersistence, and extinction. Rates of recovery were intermediate for constructional apraxia and dressing apraxia. Sex had no influence on the rate of recovery. Younger patients recovered from prosopagnosia more rapidly than older patients. Patients with smaller lesions recovered more quickly from anosognosia, USN, and hemiparesis than patients with larger lesions. Patients with hemorrhages recovered more rapidly from constructional apraxia, neglect, and motor impersistence than patients with infarcts. Recovery of function and the factors influencing recovery can by studied systematically by life table methods.

Age Factors↗
PubMed1983

Bilateral distal vertebral artery occlusion.

Nine patients with bilateral occlusions of the distal vertebral arteries had clinical profiles that differed from patients with other vertebrobasilar lesions and formed a recognizable subunit. Bilateral distal vertebral artery occlusion is uncommon; it occurs primarily in hypertensive patients, and neurologic deficits develop progressively or stepwise over a longer time period than in basilar artery or branch occlusion. It causes mostly cerebellar and lower brainstem signs as a result of chronic low flow in the posterior circulation; it may cause sudden respiratory death. The prognosis is grave. Anticoagulant therapy alone is probably ineffective.

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PubMed1982

Fisher's Rules.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1982

Lateral tegmental brainstem hemorrhages.

Hypertension intracerebral hemorrhages are caused by leakage from small penetrating branches of larger cerebral vessels. In the brainstem, these vessels penetrate in a median, paramedian, and more lateral orientation. As illustrated by three patients reported here, hemorrhage from the lateral vessels may be limited to the lateral tegmentum, or spread to the dorsal basis pontis. The syndrome is relatively consistent and includes (1) ipsilateral conjugate gaze palsy, (2) ipsilateral internuclear ophthalmoplegia, (3) small reactive pupils with a smaller pupil ipsilateral to the lesion, (4) limb ataxia of the cerebellar type (often greater ipsilaterally), (5) contralateral hemiplegia, and (6) contralateral severe hemisensory loss. Patients frequently survive after lateral tegmental hemorrhages, which can be diagnosed by CT.

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PubMed1982

Central nervous system complications of addiction to "T's and Blues".

Thirteen patients displayed neurologic complications of intravenous abuse of "T's and Blues" (pentazocine and tripelennamine). In six, the major presentation was seizures. Three patients had strokes, and three had CNS infections, two fungal and one related to subacute bacterial endocarditis. One patient had hepatic failure and an unusual encephalopathy. Foreign body embolization is common; the materials enter the cerebral circulation because of pulmonary arteriovenous shunts. Emboli may cause seizures, which also occur as a toxic effect of the drugs. Infection is due to unsterile injections. Enzyme elevations and diffuse vasculopathy raise the possibility of immune mechanisms.

Adult↗
PubMed1980

Multiple sclerosis and hysteria. Lessons learned from their association.

Four patients with organic neurological disease (multiple sclerosis) had additional major hysterical disability. Patients with unequivocal organic disease often have coexistent psychological disturbances. The preexisting personality, nature of the organic disease and its disability, and the psychosocial setting interact and create an illness whose components are difficult to separate. In some patients there are definite secondary gains from an illness. The combination of hysteria and multiple sclerosis serves as a model for the coexistence of organic and psychological disorders; it serves as an example of the general questions of how the sick deal with their infirmities and how the physician comprehensively deals with illness.

Adult↗
PubMed1980

The Oklahoma complex. A common form of conversion hysteria.

Hysteria is not a homogeneous illness. Some patients with symptoms of apparent neurological dysfunction develop a disability because they cannot cope with life's demands. This article calls attention to several hysterical patients who share similar histories. Treatment by a nonpsychiatric physician in these three cases consisted of simple emotional support and easing of responsibilities, ie, saying no for the patient. Recognition of the psychological state of some patients with hysterical symptoms, and administration of treatment that eases environmental stresses, can be effective.

Adult↗
PubMed1980

Dysconjugate gaze in hepatic coma.

During an episode of hepatic encephalopathy, an elderly woman developed ocular divergence at rest and dysconjugate gaze after caloric stimulation. Metabolic encephalopathy may rarely produce oculomotor dysfunction, usually attributed to structural brainstem lesions.

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PubMed1980

"Top of the basilar" syndrome.

Infarction of rostral brainstem and cerebral hemispheral regions fed by the distal basilar artery causes a clinically recognizable syndrome characterized by visual, oculomotor, and behavioral abnormalities, often without significant motor dysfunction. Rostral brainstem infarction produces oculomotor and pupillary signs that are identical to those in thalamic hemorrhage. Somnolence, vivid hallucinations and dreamlike behavior may also accompany rostral brainstem infarction. Temporal and occipital infarctions are frequently accompanied by hemianopia with distinctive characteristics, fragments of the Balint syndrome, amnestic dysfunction, and agitated behavior. The "top of the basilar" syndrome is most often due to an embolus.

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