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BackgroundStroke is the leading cause of long-term disability in adults, causing residual sensorimotor deficits in many survivors. Patients may have different impairments according to laterality of injury, as well as different responses to some therapies.ObjectiveThis preliminary study sought to investigate motor learning in rehabilitation of stroke patients with non-immersive virtual environment by process (electroencephalography) and product (performance) measures in stroke patients with left and right cerebral hemispheres damage.MethodsThe study included 10 chronic stroke patients; 5 with left brain injury (LI), mean age 48.8 years (±4.76), and 5 with right brain injury (RI), mean age 52 years (±10.93). Patients were evaluated for electroencephalographic activity (alpha and beta frequencies) and performance (absolute error) in a darts game on XBOX Kinect (Microsoft®). Then they underwent a virtual darts game training task, 12 sessions for 4 weeks (acquisition stage). After training, they were revaluated (long-term retention).ResultsRI group increased alpha power and decreased beta in ipsilesional areas, increased activation on left hemisphere and decreased the absolute error of performance; LI group increased right hemisphere activation and did not decrease the absolute error.ConclusionsPatients with right brain injury reduce neural effort and errors after virtual darts training, which did not happen to patients with left brain injury. Therefore, the laterality of lesion should be considered in studies that use virtual reality for stroke rehabilitation. 相似文献
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Robert J. Marquardt Sung-Min Cho Prateek Thatikunta Abhishek Deshpande Dolora Wisco Ken Uchino 《Journal of stroke and cerebrovascular diseases》2019,28(8):2207-2212
Objectives: To evaluate the safety of acute ischemic stroke (AIS) therapy in patients with infective endocarditis (IE) with intravenous thrombolysis (IVT) or endovascular therapy (EVT) such as mechanical thrombectomy. Methods: We conducted a retrospective study of patients who underwent AIS therapy with IVT or EVT at a tertiary referral center from 2013 to 2017, that were later diagnosed with acute IE as the causative mechanism. We then performed a systematic review of reports of acute ischemic reperfusion therapy in IE since 1995 for their success rates in terms of neurological outcome, and mortality, and their risk of hemorrhagic complication. Results: In the retrospective portion, 8 participants met criteria, of whom 4 received IVT and 4 received EVT. Through systematic review, 24 publications of 32 participants met criteria. Combined, a total of 40 participants were analyzed: 18 received IVT alone, 1 received combined IVT plus EVT, and 21 received EVT alone. IVT compared to EVT were similar in rates of good neurologic outcomes (58% versus 76%, P= .22) and mortality (21% versus 19%, P= .87), but had higher post-therapy intracranial hemorrhage (63% versus 18% [P= .006]). Conclusion: IV thrombolysis has a higher rate of post-therapy intracranial hemorrhage compared to EVT. EVT should be considered as first-line AIS therapy for patients with known, or suspected, IE who present with a large vessel occlusion. 相似文献
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Nathan L. Haas Adam Nicholson Mary R.C. Haas 《The American journal of emergency medicine》2019,37(10):1990.e3-1990.e5
Delusional parasitosis manifests as a fixed, false belief that an individual is infested by living organisms. Primary delusional parasitosis is a psychiatric disorder with the delusion as an isolated manifestation, whereas secondary delusional parasitosis is a delusion occurring secondary to a psychiatric disorder, substance use, or medical illness. A 62-year-old woman with no psychiatric history presented to the Emergency Department with two to three months of “whole body itching” and seeing small insects crawling on her skin and in her hair. Exam of her skin and scalp was notable for no appreciable lesions, rashes, excoriations, or insects. Her neurologic exam was notable for full visual fields, and no localizing deficits. A non-contrast head CT demonstrated a nonspecific heterogeneous low-attenuation lesion within the medial right occipital lobe, and a follow up MRI confirmed a right posterior cerebral artery distribution subacute infarction. She was admitted for two days, and ultimately was discharged on aspirin and atorvastatin for secondary prevention. An emergency physician should remain vigilant in his/her assessment of patients with seemingly psychiatric symptoms, in particular elderly patients with no known psychiatric illnesses. Neuroimaging should be amongst studies considered in the evaluation of elderly patients presenting with new onset psychiatric complaints. 相似文献
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《中国现代医生》2019,57(33):100-103
目的探讨脑血管病认知功能障碍患者应用单唾液酸四己糖神经节苷脂治疗的效果。方法选取2017年9月~2018年9月期间我院收治的60例脑血管病认知功能障碍患者,按照患者入院先后顺序将60例患者分为对照组(n=30)和观察组(n=30),对照组采取尼莫地平进行治疗,观察组采取静脉滴注方式给予单唾液酸四己糖神经节苷脂治疗,观察两组患者临床有效率、治疗前后MMSE评分、ADL与WMS评分。结果观察组临床总有效率(96.67%)明显高于对照组(73.33%),差异具有统计学意义(P0.05);治疗前,两组患者ADL、WMS、MMSE各项评分无显著差异(P0.05);治疗后,观察组ADL评分低于对照组,WMS评分高于对照组,组内比较治疗后ADL评分均低于治疗前,WMS评分较治疗前更高,差异具有统计学意义(P0.05);观察组MMSE各项评分明显高于对照组,组内比较治疗后各项评分均高于治疗前,差异均有统计学意义(P0.05)。结论脑血管病认知功能障碍患者中应用单唾液酸四己糖神经节苷脂治疗临床效果显著,可改善患者认知功能和精神状态,提高记忆力和生活能力,临床中可广泛应用。 相似文献
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目的 应用经颅彩色多普勒超声(transcranial color Doppler ultrasound,TCD)结合屏气试验分析颈动脉狭窄患者的脑血管反应性(cerebrovascular reactivity,CVR),为干预缺血性卒中的发生进展及预防时机的选择提供依据。方法 选取2018年1月至2020年1月于延边大学附属医院神经内科就诊者150例,分为脑梗死组110例,对照组(无颅内外血管狭窄及脑梗死者)40例。脑梗死患者根据是否存在颈动脉狭窄、狭窄程度及有无临床症状进行组别比较。采用经颅彩色多普勒超声检测仪检测双侧大脑中动脉屏气试验前后的血流速度,计算平均血流速度变化值(change value of average blood flow velocity,ΔVm)和呼吸抑制指数(breath–holding index,BHI)。结果 脑梗死组ΔVm及BHI值分别低于对照组,差异有统计学意义(P<0.05)。梗死组依据是否合并颈动脉狭窄分为狭窄组和非狭窄组,狭窄组ΔVm及BHI值分别低于对照组,差异有统计学意义(P<0.05)。患侧轻、中度分别与重度狭窄组比较,差异有统计学意义(P<0.05)。狭窄程度与患侧BHI值呈负相关。结论 经颅多普勒超声检测CVR具有可行性,BHI可作为评价CVR指标之一。脑血管的反应性与缺血性卒中的发生有相关性,可作为预测缺血性脑卒中发生风险的指标之一。脑血管反应性与颈动脉狭窄程度呈负相关,随着狭窄程度的增加CVR逐步减低。 相似文献