Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2014
Clinical study of the visual field defects caused by occipital lobe lesions.
The central visual field is projected to the region from the occipital tip to the posterior portion of the medial area in the striate cortex. However, central visual field disturbances have not been compared with the location of the lesions in the striate cortex. ⋯ Lesions in the posterior portion of the medial area as well as the occipital tip caused central visual field disturbance in our study, as indicated in previous reports. Central homonymous hemianopia tended to be incomplete in patients with lesions in the posterior portion in the medial area. In contrast, complete central homonymous hemianopia and quadrantanopia were shown in patients with occipital tip lesions. Our study suggested that the fibers related to the central visual field were sparse in the posterior portion of the medial area in contrast to the occipital tip, and approached the occipital tip with a high concentration of fibers.
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Angioedema (AE) in stroke has been reported exclusively after thrombolysis with recombinant tissue-type plasminogen activator (rtPA). Previous studies proposed the insular cortex to play a specific role in the development of AE after stroke. We evaluated the incidence of AE in acute stroke and tried to identify the predominantly involved brain structures. ⋯ In contrast to AE in other conditions, AE in stroke seems to feature a unique cerebral pathology because it is mostly lateralized (contralateral to an infarction), is associated with a distinct brain area, may even occur without rtPA, and is far more frequent than after thrombolysis for other indications. rtPA is the major risk factor. Similar to prior studies, we identified ACEi to be another risk factor, and a diabetic autonomic instability might further increase the risk. Central pathways involving the insular and peri-insular cortex seem to play a major role in the pathophysiology of AE in stroke.