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Source: Frontiers of Neurology and Neuroscience

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Neurology versus Psychiatry? Hallucinations, Delusions, and Confabulations.
Authors: Carota A, Bogousslavsky J Abstract Hallucinations, delusions, and confabulations are common symptoms between neurology and psychiatry. The neurological diseases manifesting with such symptoms (dementia, epilepsy, Korsakoff's disease, brain tumors, Parkinson's disease, migraine, right hemisphere stroke and others) would be the key to understand their biological mechanisms, while the cognitive sciences, neuropharmacology and functional neuroimaging would be the tools of such researches. It is possible to understand the perceptive rules of the mind and the mechanisms of the human consciousness based on these ...
Source: Frontiers of Neurology and Neuroscience - June 22, 2019 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Early History of Amnesia.
Authors: Langer KG Abstract Memory and forgetfulness have been viewed since antiquity from perspectives of physical, emotional, and spiritual states of well-being, and conceptualized philosophically. Numerous discussions of memory loss, or case reports, existed, but a fundamental advance in conceptualization of memory loss as a pathological clinical phenomenon originated when Sauvages classified "amnesia" as a medical disorder, in 1763. Originally, amnesia was recognized as a weakening or dissolution of memory, according to a taxonomy that ascribed known causes to the disorder. Etiologic factors included neurologic...
Source: Frontiers of Neurology and Neuroscience - June 22, 2019 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Transcranial Doppler.
We present the basic principles of TCD, techniques of test performance, diagnostic methods as well as some of the advanced applications of TCD in patients with intracranial stenosis. PMID: 27960192 [PubMed - in process]
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Pathological Characteristics.
Authors: Chen XY, Fisher M Abstract Within the intracranial vasculature, atherosclerosis occurs in two distinctive patterns: (1) in Western populations who have severe extracranial and systemic atherosclerosis, the severity of intracranial involvement is consistently less than that within extracranial arteries; and (2) in Asians, Africans, and Hispanics, who often have isolated intracranial arterial disease that is found to be more often accompanied by brain infarction than comparable extracranial atherosclerotic disease. Compared to coronary and extracranial carotid atherosclerosis, intracranial atherosclerosis ha...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Epidemiology.
Authors: Gorelick P, Wong KS, Liu L Abstract Intracranial atherosclerotic occlusive disease is an important and possibly the most common cause of stroke worldwide. Asian, Black and certain Hispanic populations have a high risk of harboring intracranial occlusive disease. In this chapter we review the epidemiology of intracranial occlusive disease by primarily focusing on studies from China, Japan, Korea, and other Asian countries. In addition, we compare and contrast the information from Asian countries with that from North America and related regions. Finally, we explore hypotheses concerning the origin of race-et...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Surgical Therapy.
Authors: Oh CW, Steinberg GK Abstract Many prior investigations have indicated the important role of medical treatment to prevent stroke in patients with intracranial atherosclerosis, with angioplasty and stenting occasionally being performed. In a subgroup of patients with severe hemodynamic impairment, extracranial-intracranial (EC-IC) bypass surgery may be considered. Additionally, in patients with massive infarctions due to middle cerebral artery (MCA) occlusion, the use of decompressive craniectomy may lower mortality rates and improve long-term quality of life. However, the benefit of these surgical procedure...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Antithrombotic Therapy.
Authors: Kwon SU, Kim JS Abstract Symptomatic cerebral atherosclerosis including intracranial atherosclerosis (ICAS) is associated with a high risk of recurrent stroke. Antithrombotic agents are the mainstay of therapy in these patients. Several studies have found anticoagulation (warfarin) to increase the risk of bleeding events and have an efficacy no better than that of aspirin. Therefore, anticoagulants are not widely used unless patients develop recurrent ischemic symptoms despite receiving antiplatelet therapy. Because ICAS progression is not uncommon and the risk of stroke recurrence is high when aspirin mon...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Stroke Mechanisms.
Authors: Wong KS, Caplan LR, Kim JS Abstract Recent advances in neuroimaging technologies, such as diffusion weighted magnetic resonance imaging (MRI), perfusion weighted computed tomography (CT)/MRI, MR/CT angiography and Doppler ultrasonography allow us to determine the mechanisms of stroke and transient ischemic attack. In addition, high-resolution vessel wall MRI is nowadays increasingly used to understand the stroke mechanism in patients with intracranial atherosclerosis. Artery to artery embolism, hypoperfusion and the combination of the two are the important stroke mechanisms in patients with extracranial at...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Angioplasty and Stenting.
Authors: Leung TW, Wabnitz AM, Miao Z, Chimowitz MI Abstract The high rate of recurrent strokes in patients with intracranial atherosclerotic disease (ICAS) despite medical therapy prompted intracranial angioplasty and/or stenting an adjunctive treatment option. The minute calibers of cerebral arteries, the relative paucity of supporting medial and adventitia layers, the presence of end-anastomosing perforator branches, and the vascular tortuosity from groin to head all demand specialized operative skills and dedicated tools. Since the stroke mechanism of ICAS is diverse, patient selection for endovascular treatmen...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Moyamoya Disease.
Authors: Fujimura M, Bang OY, Kim JS Abstract Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology is unknown, recent genetic studies have identified RNF213 in the 17q25-ter region as an important susceptibility gene of MMD among East Asian populations. A c.14576G>A polymorphism in RNF213 was identified in 95% of MMD patients with a family history and in 79% of sporadic cases, and patients carrying this polymorphism exhibite...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Clinical Stroke Syndromes.
Authors: Kim JS, Caplan LR Abstract The main mechanism of stroke in patients who have extracranial atherosclerosis is artery to artery embolism, occasionally associated with hemodynamic disturbances. Although these mechanisms are also important in patients with intracranial atherosclerosis, branch occlusion and in-situ thrombotic occlusion play a relatively more important role in these patients. Accordingly, clinical stroke syndromes differ between extracranial atherosclerosis and intracranial atherosclerosis. In anterior circulation, middle cerebral artery atherosclerosis frequently produces subcortical infarction...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Biomarkers, Natural Course and Prognosis.
Authors: Arenillas JF, López-Cancio E, Wong KS Abstract Increasing our knowledge about intracranial atherosclerosis (ICAS) natural history and prognostic factors is essential to improve its preventive therapy and thus reduce the dramatic clinical consequences caused by this entity. ICAS is characterized by a chronic and progressive course until it becomes symptomatic, mostly through complication of an unstable intracranial atherosclerotic plaque. Population-based studies in healthy subjects have shown that the prevalence of asymptomatic ICAS is higher in Asian than in Caucasian populations. In both settings, asymp...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Peculiarities of Neurological Disorders and Study Designs.
The objectives of treatments of neurodegenerative disorders include primary prevention, slowing or arrest of disease progression, and control of symptoms. Stroke is an acute clinical condition causing frequent disability and death, with only one approved treatment. There are many challenges to acute stroke clinical trials; among them, the very short therapeutic window and the issue of stroke heterogeneity. In this chapter, only the core elements of the study designs are outlined. KEY MESSAGES: The design of an RCT must be adapted to the basic characteristics of each clinical condition. PMID: 27463686 [PubMed - in process]
Source: Frontiers of Neurology and Neuroscience - July 29, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Composite Scores and Other Outcome Measures in Stroke Trials.
Authors: Pistoia F, Sacco S, Ornello R, Degan D, Tiseo C, Carolei A Abstract BACKGROUND: Randomized controlled trials represent the most useful tool to evaluate the effectiveness of a treatment in medical research. When designing a clinical trial, the choice of end points, assessment tools, and scores is crucial as they represent the prerequisites for the evaluation of outcomes and for the critical appraisal of findings. SUMMARY: In stroke research, outcomes are mainly represented by composite end points focusing on the occurrence of cardiovascular and cerebrovascular events in trials on primary and secondary p...
Source: Frontiers of Neurology and Neuroscience - July 29, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

New Insights into Blood Pressure Control for Intracerebral Haemorrhage.
Authors: Manning LS, Robinson TG Abstract Although blood pressure (BP) levels may rise in the weeks preceding intracerebral haemorrhage (ICH), in contrast to findings in the ischaemic stroke population, the initial post-ICH BP is often much higher than the last pre-morbid level. Elevated BP is therefore common in acute ICH, often with markedly elevated levels, and is associated with poor outcomes, though the exact pathophysiological mechanisms remain unclear. The Antihypertensive Treatment of Acute Cerebral Haemorrhage (ATACH) trial and the INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial (INT...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research