Journal of neurology
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Journal of neurology · Jun 2011
Central neuropathic pain after cerebral venous thrombosis is not so uncommon: an observational study.
Central neuropathic pain (CNP) after stroke has not been studied in sufficient detail and published studies have only included patients with cerebral artery infarct or hemorrhage. This study evaluates the prevalence and factors associated with CNP after cerebral venous (and sinus) thrombosis (CVT). This observational study included all patients admitted to our stroke unit for CVT between January 2002 and December 2007. ⋯ Initial motor deficit (87 vs. 17%, p < 0.001), initial sensory deficit (62 vs. 20%, p = 0.03), cerebral infarction (75 vs. 23%, p = 0.009), right-sided lesion on initial MRI (62 vs. 17%, p = 0.017), thalamic (37 vs. 0%, p = 0.005) and basal ganglia involvement (25 vs. 0%, p = 0.03) and vein of Galen occlusion (25 vs. 0%) were significantly associated with CNP. Despite several methodological limitations, CNP after CVT seems to be frequent, accounting for one-fifth of all cases of CVT. Some clinical and radiological factors might contribute to the development of CNP.
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Journal of neurology · Jun 2011
Case ReportsSMART syndrome: a late reversible complication after radiation therapy for brain tumours.
With intensified treatment leading to longer survival, complications of therapy for brain tumours are more frequently observed. Regarding radiation therapy, progressive and irreversible white matter disease with cognitive decline is most feared. We report on four patients with reversible clinical and radiological features occurring years after radiation for brain tumours, suggestive for the so called SMART syndrome (stroke-like migraine attacks after radiation therapy). ⋯ The pathophysiology of the SMART syndrome is poorly understood but bears similarities with the posterior reversible encephalopathy syndrome (PRES). These four cases underline that the SMART syndrome should be considered in patients formerly treated with radiation therapy for brain tumours, who present with new neurologic deficits. Before the diagnosis of SMART syndrome can be established other causes, such as local tumour recurrence, leptomeningeal disease or ischemic disease should be ruled out.
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Journal of neurology · May 2011
Aneurysmal and clinical characteristics as risk factors for intracerebral haematoma from aneurysmal rupture.
Intracerebral haematoma (ICH) occurs in one-third of patients with aneurysmal subarachnoid haemorrhage (SAH) and is associated with poor prognosis. Identification of risk factors for ICH from aneurysmal rupture may help in balancing risks of treatment of unruptured aneurysms. We assessed potential clinical and aneurysmal risk factors for ICH from aneurysmal rupture. ⋯ The RRs of other aneurysmal characteristics varied between 0.9 and 1.2. Patients with MCA aneurysms are at a higher risk of developing ICH. The other aneurysmal or clinical factors have no or only minor influence on the risk of ICH after rupture and are, therefore, not helpful in deciding on treatment of unruptured aneurysms.