Neuropsychology of acute stroke (original) (raw)
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INTERNATIONAL NEUROLOGICAL JOURNAL, 2021
The article considers the topical problem of neurology, neurobiology and cognitive psychology — the question of pathogenetic mechanisms of origin and development of unilateral neglect after a cerebral infarction. The paper analyzes the scientific literature on the neuropsychological signs of hemineglect syndrome, its causes, features, manifestations and methods of rehabilitation. The role of the laws of neuroaesthetics in the perception and reproduction of environmental information in the brain is shown. New data on the peculiarities of the influence of the laws of neuroaesthetics on the process of the unilateral neglect formation are presented. It is emphasized that the principles of neuroaesthetics in oxidative stress after vascular catastrophe of the brain create conditions for the development of the pathological circle, the manifestation of which is lack of attention and loss of ability to respond to stimuli in one half of the field of view. It is determined that the exact neuro...
Neuropsychological assessment in acute stroke patients
Neurological Sciences, 2020
Background and purpose The number of people suffering from stroke is strongly increasing, giving rise to multiple cognitive deficits which frequently prevent a full recovery. The identification of both spared and impaired cognitive domains has a key role to plan adequate interventions. However, the existing standard tests are either too expensive in terms of time and efforts for patients in acute stage or they derived from instruments addressing different pathologies such as dementia. Methods We developed a brief neuropsychological battery (mental performance in acute stroke, MEPS) to assess different cognitive domains (language, memory, praxis, visual perception) in acute stroke patients. MEPS was validated by enrolling a sample of 204 patients suffering from stroke in acute stage, and 263 healthy controls participants. Results The results indicated an adequate construct validity and a high ability in discriminating patients from healthy controls. Conclusions MEPS can be considered a simple and highly valuable bedside battery, easy to administer, with values of sensitivity and specificity suitable to be proposed as a screening tool for patients with acute stroke.
Acute Psychiatric Manifestations of Stroke: A Clinical Case Conference
Psychosomatics, 2003
C erebrovascular accidents are common and debilitating medical events that frequently result in significant functional impairment and medical comorbidity. Further, they are associated with substantial emotional and behavioral sequelae that significantly exacerbate such disability. Due to the high rates of psychiatric sequelae of stroke, the general hospital psychiatrist is frequently called on to evaluate and treat poststroke patients.
Higher cortical function deficits among acute stroke patients: The stroke data bank experience
Journal of Stroke and Cerebrovascular Diseases, 1997
Objectives. Both the number and type of higher cortical function deficits (HCFD) in acute stroke patients are important diagnostically and for gauging the extent of neurological deficits. Methods. The Stroke Data Bank (SDB) provided a large prospective data base for such evaluation. Thirty-one different HCFDs, each defined in the SDB manual, were considered. Results. Of 1,805 patients in the SDB, 641 instances of HCFD in 422 patients were recorded in alert patients at initial examination (within the first 7 to 10 days of ictus). Aphasia (41%) was the most commonly found HCFD, followed by neglect syndrome (27.2%), apraxia (11.7%), and anosognosia (11.1%). Agnosia (3.9%), alexia (3.3%), and aprosodia (1.5%) were less frequently found HCFDs. Cardioembotic infarct was most likely to have associated HCFDs (66%), and lacunar infarction was least likely to be accompanied by HCFDs (6%), with infarction caused by large artery thrombosis (50%) and infarct of undetermined cause (47%) having similar frequencies. The co-occurrence of sensory and motor deficits among the eight major subgroups of HCFD showed that neglect syndrome, apraxia, and anosognosia were most likely to be associated with long tract signs, whereas alexia, aprosodia, and agnosia invariably were not associated with sensorimotor impairment. Approximately half of aphasic patients had associated sensorimotor impairment. Conclusion. Our findings show that higher cortical function deficits are prevalent in the acute phase of stroke, particularly aphasia and neglect syndromes. They are more often associated with nonlacunar stroke and some are less likely to be associated with any sensorimotor deficits.
Stroke, 1976
Previous surveys of stroke populations have offered only cursory information on language disturbance, and, conversely, few surveys of aphasic populations have dealth exclusively with stroke or with acute phenomena. This paper describes aphasia in 850 acute stroke patients consecutively registered by the Harlem Regional Stroke Program, of whom 177 (21%) were aphasic; of these, nine were of Broca's type, 24 were of Wernicke's type, 14 were of anomic, ten were conduction, seven were of "isolation" type, and 107 were "mixed." An unexpected finding was a significant over-representation of men among the nonfluent aphasics. During the following four to 12 weeks, 12% of fluent aphasics died, and 12% remained moderately or severely impaired; among survivors, aphasia improved in 74%, and in 44% it cleared completely. During the same period, 32% of nonfluent aphasics died, and 34% remained moderately or severely impaired; among survivors, aphasia improved in 52%, an...
Stroke syndromes and clinical management
QJM, 2013
The knowledge of brain syndromes is essential for stroke physicians and neurologists, particularly those that can be extremely difficult and challenging to diagnose due to the great variability of symptom presentation and yet of clinical significance in terms of potential devastating effect with poor outcome. The diagnosis and understanding of stroke syndromes has improved dramatically over the years with the advent of modern imaging, while the management is similar to general care as recommended by various guidelines in addition to care of such patients on specialized units with facilities for continuous monitoring of vital signs and dedicated stroke therapy. Such critical care can be provided either in the acute stroke unit, the medical intensive care unit or the neurological intensive care unit. There may be no definitive treatment at reversing stroke syndromes, but it is important to identify the signs and symptoms for an early diagnosis to prompt quick treatment, which can prevent further devastating complications following stroke. The aim of this article is to discuss some of the important clinical stroke syndromes encountered in clinical practice and discuss their management.
2. Outcome of Patients with Disorders of Consciousness in Acute Stroke
Introduction/Objectives: Th e central idea of our presentation is MCI -a conceptual and pathological entity defi ned by Petersen et al. in 1995 and still under debate, surrounded by a sustained attention mainly because it is a stage where suitable medical and nonmedical interventions could potentially be more successful by comparison with later stages in which the changes are more and more dramatic and less susceptible to be amended.
Unawareness of deficit in acute stroke: Neuropsychological therapy matters
2010
Motor deficiency is the leading cause of disability following stroke and the main target of neurorehabilitation. However, the co-occurrence of certain cognitive deficits, such as unawareness (lack of insight into one's stroke-induced symptoms) may impede rehabilitation and lead to poor functional outcome. 1 Such patients are unaware of their rehabilitation needs and thus fail to comply with and benefit from interventions.
Global aphasia as a predictor of mortality in the acute phase of a first stroke
Arquivos de Neuro-Psiquiatria, 2011
Objective: To establish whether vascular aphasic syndromes can predict stroke outcomes. Method: Thirty-seven adults were evaluated for speech and language within 72 hours after a single first-ever ischemic brain lesion, in blind association to CT and/or MR. Results: Speech or language disabilities were found in seven (87.5%) of the eight deceased patients and twenty-six (89.7%) of the twenty-nine survivors. Global aphasia was identified in eleven patients, all with left hemisphere lesions (nine mute; five deceased), consisting on a risk factor for death in the acute stroke phase (ρ=0.022). Age (z=1.65; ρ>0.09), thrombolysis (ρ=0.591), infarct size (ρ=0.076) and side (ρ=0.649) did not significantly influence survival. Absence of aphasia did not predict a better evolution, regardless of the affected hemisphere. Prevalence of cardiovascular risk factors was similar for all patient groups. Conclusion: Global aphasia in acute stroke can adversely affect prognosis, translated into impairment of dominant perisylvian vascular territories, with mutism as an important semiological element.