Frontiers Of Neurology And Neuroscience[JOURNAL]
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200 papers
Capgras Syndrome and Other Delusional Misidentification Syndromes.
Barrelle A, Luauté JP
Front Neurol Neurosci · 2018 · PMID 29151089 · Publisher ↗
The delusional misidentification syndromes (DMS) are a group of disorders, characterized by patients mistaking the identity of people they know, although they recognize them physically. The term DMS is an umbrella term w...
The delusional misidentification syndromes (DMS) are a group of disorders, characterized by patients mistaking the identity of people they know, although they recognize them physically. The term DMS is an umbrella term which may cover disorders whose definition extends to objects other than people, such as animals, places, or familiar material objects. The most common and best known DMS is Capgras syndrome. In this disorder, the misidentification leads to the delusional conviction that a close friend or relative has been replaced by an identical - or almost identical - "double," whose original has disappeared. This double is an imposter without name or identity. Most often considered as a persecutor, the double may be subjected to aggression, which may be very violent. Neuropsychological hypotheses based on cerebral dysfunctions are now commonly considered to be at the origin of the disorder. They have been elaborated from achievements in the neurosciences, particularly the facial recognition models. In return, knowledge about the normal cognitive processes involved in recognition and familiarity has benefited from the work that cognitive neuropsychiatry has invested in these disorders. The DMS are observed in various contexts of morbidity: primary psychiatric diagnosis, or secondary to various organic disorders, particularly in neurodegenerative disease; they are rarely met in isolated form. Most often, they develop in line with the associated pathology. In the absence of consensual clinical description, the epidemiology of DMS is uncertain; they may be more frequent than previously supposed. There is no specific treatment for these disorders; neuroleptics are generally used in association with treatment of the concomitant disorder. The frequent association of DMS with organic disorders which may be curable and the particularly dangerous profile of these patients are factors that underline the need for better screening.
Cotard Syndrome.
Dieguez S
Front Neurol Neurosci · 2018 · PMID 29151088 · Publisher ↗
Cotard's syndrome is often described as the delusional belief that one is dead or non-existent. However, Jules Cotard's initial description (1880) of the "delusion of negations" was much richer and also involved delusion...
Cotard's syndrome is often described as the delusional belief that one is dead or non-existent. However, Jules Cotard's initial description (1880) of the "delusion of negations" was much richer and also involved delusions and claims of immortality and enormity, feelings of damnation, and illusions of bodily dissolution and transformation. Alternatively conceived as an extreme case of depression, hypochondria, or psychosis, the condition is considered rare and remains poorly understood. Cotard himself provided a taxonomy and several explanations for the condition, focusing on its distinction from classical persecutory delusions and suggesting that it could be a kind of reversed grandiosity. He proposed a psychosensory basis in the dissolution of mental imagery, which he then extended to a more general psychomotor impairment of volition. Other early authors highlighted a disorder of the bodily self, and more recent theories postulated an impairment of right hemispheric functions, leading to perceptual and somatosensory feelings of unreality, which coupled with reasoning impairments and an internalized attributional style led in turn to beliefs of non-existence. However, despite its striking presentation and its relevance to our understanding of self-awareness, Cotard's syndrome remains an elusive condition, rarely reported and poorly researched.
Ganser Syndrome.
Dieguez S
Front Neurol Neurosci · 2018 · PMID 29151087 · Publisher ↗
Ganser's syndrome is a rare and controversial condition, whose main and most striking feature is the production of approximate answers (or near misses) to very simple questions. For instance, asked how many legs a horse...
Ganser's syndrome is a rare and controversial condition, whose main and most striking feature is the production of approximate answers (or near misses) to very simple questions. For instance, asked how many legs a horse has, Ganser patients will reply "5", and answers to plain arithmetic questions will likewise be wrong, but only slightly off the mark (e.g., 2 + 2 = 3). This symptom was originally described by Sigbert Ganser in 1897 in prisoners on remand and labeled Vorbeigehen ("to pass by"), although the term Vorbeireden ("to talk beside the point") is also frequently used. A number of associated symptoms were also reported: "clouding of consciousness," somatoform conversion disorder, hallucinations, sudden and spontaneous recovery, subsequent amnesia for the episode, premorbid traumatic psychosocial experience and/or (usually mild) head trauma. Etiological, epidemiological and diagnostic issues have never been resolved for Ganser's syndrome. Ganser saw it as a form of "twilight hysteria," whereas others suggested that malingering, psychosis or dissociation were more appropriate labels, oftentimes combined with organic impairment and a subjectively intolerable psychosocial context. A central conundrum of Ganser's syndrome is whether it could simultaneously be a cultural and pathological representation of insanity, whereas cognitive, organic, affective, motivational and social factors would converge towards a naïve idea of what mental illness should look like, especially through the provision of approximate answers.
Charles Bonnet Syndrome and Other Hallucinatory Phenomena.
Boller F, Birnbaum DS, Caputi N
Front Neurol Neurosci · 2018 · PMID 29145190 · Publisher ↗
Descriptions of hallucinatory phenomena have figured prominently since the beginning of recorded history. Jean Etienne Esquirol (1772-1840) is usually credited for having introduced the term in 1817, differentiating betw...
Descriptions of hallucinatory phenomena have figured prominently since the beginning of recorded history. Jean Etienne Esquirol (1772-1840) is usually credited for having introduced the term in 1817, differentiating between hallucinations and illusions. Both are wrong perceptions, but in illusions, an external stimulus is always present whereas hallucinations are perceptions that occur in the absence of corresponding sensory stimuli. They occur in a variety of conditions but more often in the mentally ill, especially in schizophrenia where hallucinations, particularly auditory hallucinations represent for many, such as Henri Ey one of the cardinal features. This chapter, however, deals with visual hallucinations as found in individuals who are not necessarily mentally ill: the Charles Bonnet syndrome and autoscopy.
REM Sleep Behavior Disorder.
Bassetti CL, Bargiotas P
Front Neurol Neurosci · 2018 · PMID 29145189 · Publisher ↗
Rapid eye movement sleep behavior disorder (RBD) is a brain disorder, characterized by the dream enactment during rapid eye movement (REM) sleep due to a lack of physiologic muscle atonia and increased muscle twitching....
Rapid eye movement sleep behavior disorder (RBD) is a brain disorder, characterized by the dream enactment during rapid eye movement (REM) sleep due to a lack of physiologic muscle atonia and increased muscle twitching. Schenk was the first to describe this disorder in 1986; however, few authors reported in the 1970-1980s loss of physiological muscle atonia combined with dream enactment in the course of brainstem disorders and as a consequence of alcoholism and antidepressant treatment. RBD affects less than 1% of the adult population, but can be found in up to 25-50% of neurodegenerative disorders including Parkinson's disease, multisystem atrophy, and dementia with Lewy body. In the last decade, many studies provided evidence that RBD precedes parkinsonian motor signs by several years, suggesting that RBD should no longer be considered a complication but a part of the prodromal phase of these diseases. Etiologically, primary (idiopathic RBD) and several secondary forms in addition to neurodegeneration (related to focal brainstem damage, narcolepsy, autoimmune disorders, and drugs) are known. Pathophysiologically, brainstem and supratentorial mechanisms involving glutamatergic, glycinergic, and GABA-ergic neurotransmission have been implicated. Recently, an animal model of RBD has been described. Clinical features consist of characteristic nocturnal behaviors, but also daytime symptoms including excessive sleepiness and cognitive alterations. The diagnosis of RBD is made according to international diagnostic criteria, based on medical history, and video-polysomnographic features. Current treatment strategies include actions which ensure a safe sleep environment, the avoidance of triggering/exacerbating factors and if necessary pharmacological (mainly clonazepam and melatonin) and non-pharmacological (e.g., behavioral measures) interventions. Future research should clarify the exact sleep-wake characteristics of RBD (also beyond REM sleep) and their evolution over time, the contribution of brainstem but also supratentorial mechanisms to its pathophysiology, and the (early?) diagnostic and (causative?) treatment consequences of RBD in the context of neurodegeneration.
Brueghel Syndrome or Meige Syndrome? Two Sides of a Same Disease.
Béreau M, Tatu L
Front Neurol Neurosci · 2018 · PMID 29145188 · Publisher ↗
Different eponyms such as "Wood syndrome," Meige syndrome, "Brueghel syndrome," "Blepharospasm plus syndrome" have been used to describe segmental craniocervical dystonias. These facial and/or oromandibular movement diso...
Different eponyms such as "Wood syndrome," Meige syndrome, "Brueghel syndrome," "Blepharospasm plus syndrome" have been used to describe segmental craniocervical dystonias. These facial and/or oromandibular movement disorders are characterized by muscle contractions and spasms involving eyes, facial region, and sometimes pharynx, jaw, floor of the mouth, and tongue. The pathophysiology of craniocervical dystonia is poorly understood, but abnormal plasticity and impaired inhibition are suspected. Injection of botulinum toxin appears to be the best therapeutic option for treating segmental craniocervical dystonia. The objective of this chapter is to depict the history of segmental craniocervical dystonia in order to delineate the phenotypic spectrum of the disorders and to distinguish this entity from other facial and/or oromandibular movement disorders.
Diogenes Syndrome.
Assal F
Front Neurol Neurosci · 2018 · PMID 29145187 · Publisher ↗
Diogenes syndrome (DS) is not a specific disease but a real neurobehavioral syndrome, characterized by severe domestic squalor, pathological hoarding, lack of insight into the condition, and no need for help. DS can be s...
Diogenes syndrome (DS) is not a specific disease but a real neurobehavioral syndrome, characterized by severe domestic squalor, pathological hoarding, lack of insight into the condition, and no need for help. DS can be secondary when associated to psychosis or bipolar disorder, or primary when it occurs as a single entity, usually in the elderly. DS is a clinically complex transnosographic syndrome for which multidimensional approaches need to be considered: medical, psychiatric, neurological, social, scientific, and ethical. Known for more than 40 years mainly by geriatricians, psychiatrists, nurses or social workers and more recently by forensic specialists, the fine grained mechanisms of the syndrome are still incompletely understood. From a neurocognitive standpoint, frontal vulnerability certainly disrupts normal decision-making processes, explaining squalor, pathological hoarding, and lack of insight but we need to better understand the connection between the main symptoms and the neural underpinning of the full syndrome. We should definitely intervene earlier, before patients refuse any help, and when the syndrome is supposedly milder, to improve our clinical knowledge, follow patients prospectively, experiment hypothesis in laboratory settings, and launch randomized controlled trials for treatments. There is hope for future pharmacological and non-pharmacological strategies to alleviate this socially disastrous condition.
The Klüver-Bucy Syndrome.
Lanska DJ
Front Neurol Neurosci · 2018 · PMID 29145186 · Publisher ↗
In 1937, Heinrich Klüver and Paul Bucy described a dramatic behavioral syndrome in monkeys after bilateral temporal lobectomy. The full Klüver-Bucy syndrome (KBS) - hyperorality, placidity, hypermetamorphosis, dietary ch...
In 1937, Heinrich Klüver and Paul Bucy described a dramatic behavioral syndrome in monkeys after bilateral temporal lobectomy. The full Klüver-Bucy syndrome (KBS) - hyperorality, placidity, hypermetamorphosis, dietary changes, altered sexual behavior, and visual agnosia - is evident within 3 weeks following operation. Some KBS features (i.e., hyperorality, placidity, hypermetamorphosis) persist indefinitely, whereas others gradually resolve over several years. Klüver and Bucy were initially unaware of an earlier report of KBS by Sanger Brown and Edward Schäfer in 1888. Human cases were recognized in the 1950s, as surgeons employed bilateral temporal lobectomies to treat seizures. Various attempts were made to localize the component features to specific areas of the temporal lobe, with mixed success. Bilateral ventral temporal ablations and bilateral temporal lobectomies produced marked impairment in visual discrimination, whereas lateral resections or unilateral lesions did not. Discrete bilateral lesions of the lateral amygdaloid nucleus produced a permanent "hypersexed state." By the 1970s, it was clear that the major symptoms of KBS are produced by destroying either the temporal neocortex or the amygdala bilaterally. KBS is now thought to be caused by disturbances of temporal portions of limbic networks that interface with multiple cortical and subcortical circuits to modulate emotional behavior and affect. The clinical features of KBS in man are similar to those in monkeys, but the full syndrome is rarely seen, probably because the anterior temporal lobe dysfunction is usually less severe than that following total temporal lobe ablation in monkeys. Human KBS does not occur in isolation, but is typically part of a complex behavioral syndrome that almost always includes amnesia and aphasia, and that may also include dementia and seizures. The treatment of KBS is difficult and often unsatisfactory.
Hypersexuality in Neurological Disorders: From Disinhibition to Impulsivity.
Béreau M
Front Neurol Neurosci · 2018 · PMID 29145185 · Publisher ↗
Little is known about the neurological control of human sexual behavior. Investigating and measuring this behavior by using quantitative and objective methods is difficult. Insights from lesion studies contribute to anal...
Little is known about the neurological control of human sexual behavior. Investigating and measuring this behavior by using quantitative and objective methods is difficult. Insights from lesion studies contribute to analyze the effects of neurological disorders on human sexual behavior. In this chapter, we focus on frontal lobe lesions, brain injuries, epilepsia, dementia, and Parkinson disease to describe human sexual behavior disorders, in order to highlight cortical and subcortical brain regions and neural networks involved in human sexual behavior.
Addictive (Non-Drug) and Obsessive-Compulsive Symptoms after Focal Brain Lesions.
Müri RM, Cazzoli D
Front Neurol Neurosci · 2018 · PMID 29145184 · Publisher ↗
This chapter presents an overview of different addictive and obsessive-compulsive symptoms and their constellations due to focal brain lesions. In general, such symptoms are not systematically reported in the literature,...
This chapter presents an overview of different addictive and obsessive-compulsive symptoms and their constellations due to focal brain lesions. In general, such symptoms are not systematically reported in the literature, and the knowledge about the networks involved is sometimes sparse. Finally, we present an original case with an unusual combination of kleptomania and hyper-religiosity.
Catastrophe Reaction and Emotionalism.
Carota A, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29145183 · Publisher ↗
The catastrophic reaction (CR; a disruptive and uncontrolled behavior triggered by anger, irritability, and hostility) and emotionalism (a condition of uncontrolled crying or laughing) are disorders of the emotional regu...
The catastrophic reaction (CR; a disruptive and uncontrolled behavior triggered by anger, irritability, and hostility) and emotionalism (a condition of uncontrolled crying or laughing) are disorders of the emotional regulation and expression, the prevalence of which is underestimated in neurology. Their occurrence is an additional factor of poor outcome for neurologic patients. Although they have been recognized and completely described in their clinical manifestations more than a century ago, many issues remain unsolved regarding their pathogenesis and the respective role of the brain damage and psychological factors. Thus, if pathological crying and laughing can be linked to one or more lesions within the corticospinal tracts, the emotional lability and CR have uncertain connections within specific functional brain systems and seem to be influenced by personality factors or depression and anxiety generated by coping with a serious neurological disease. These epistemological difficulties are also the consequence of some methodological limits of the questionnaires and scales, which diagnose these disorders and for which the cut-off values between the normal and pathological condition could be questioned. Thus, their assessment requires new psychophysical. The CR and emotionalism manifest in association with several different neurological disease (degenerative, vascular, inflammatory, epilepsy) and psychiatric conditions as psychosis, mania, and mood disorders. Across these different diseases, the findings of common patterns of lesion location, cognitive dysfunction, emotional changes, and behavioral responses to new paradigms might clarify the pathogenesis and orient the treatment.
Pathological Yawning, Laughing and Crying.
Walusinski O
Front Neurol Neurosci · 2018 · PMID 29145182 · Publisher ↗
Yawning, laughing, and crying are normal physiological behaviors of humans in good health. As with all physiological behaviors, their deregulation can reveal disorders. Pathological yawning occurs in salvos of 10-20 succ...
Yawning, laughing, and crying are normal physiological behaviors of humans in good health. As with all physiological behaviors, their deregulation can reveal disorders. Pathological yawning occurs in salvos of 10-20 successive yawns, and the number of yawns per day can exceed one hundred. After listing the functional etiologies, we will give the clinical keys for differentiating the most serious causes: iatrogenic, tumors, strokes, amyotrophic lateral sclerosis, and intracranial hypertension. Sudden, uncontrollable episodes of emotional display involving pathological laughing and crying (PLC) may be encountered in various neurological diseases: amyotrophic lateral sclerosis, multiple system atrophy (cerebellar), cerebrovascular disease, traumatic brain injuries, mass lesions in the cerebellopontine junction, and epilepsy. After describing the pathophysiology of PLC and the use of diagnostic scales for PLC, we will discuss the current treatments.
Pali and Echo Phenomena: Symptoms of Persistence and Perseveration.
Magnin E, de Bustos EM, Moulin T
Front Neurol Neurosci · 2018 · PMID 29145181 · Publisher ↗
Some neurological or psychiatric positive, productive symptoms are an abnormal persistence of a sensorial feeling or abnormal repetition of a motor, behavioral or cognitive process corresponding to a perseverative sympto...
Some neurological or psychiatric positive, productive symptoms are an abnormal persistence of a sensorial feeling or abnormal repetition of a motor, behavioral or cognitive process corresponding to a perseverative symptom. Palinopsia, palinacousis, and related sensorial symptoms have been described. Verbal and motor symptoms include echolalia, palilalia, echopraxia, and motor perseveration. Cognitive disorders induce perseverative behavior, perseverative thinking, including palipsychism, flashbulb memories, and reduplicative paramnesia (also known as "palimnesia") and many related perseverative symptoms. We propose a review of physiological phenomena and pathological symptoms involving these perseverative or repetitive characteristics and discuss the potential mechanisms and neural network involved in this productive semiology.
Misoplegia.
Delgado MG, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29145180 · Publisher ↗
In 1974, Critchley described misoplegia as the phenomenon in which a hemiplegic patient develops a morbid dislike towards the offending immobile limbs. Patients with misoplegia may employ, but more commonly strike their...
In 1974, Critchley described misoplegia as the phenomenon in which a hemiplegic patient develops a morbid dislike towards the offending immobile limbs. Patients with misoplegia may employ, but more commonly strike their paretic limbs not recognized as self. The pathophysiological mechanism is not well understood. The handful of cases of misoplegia described in the literature, frequently presented a right hemispheric damage. However, patients with chronic spinal cord injury may also present this symptomatology. Not only the modification of behavior by this organic injury, but also the patient reaction to disability and previous personality, may provoke the emergence of misoplegia, probably from other right hemispheric self-unawareness syndromes. No data exists related to treatment option, but we have to remember that the lack of awareness of the deficits in these patients makes the rehabilitation process difficult. Misoplegia is one of the passionate syndromes of the still "not-enough well-known" self-awareness syndromes of the right hemisphere, which shows how brain damage goes much further beyond neurological deficit.
Phantom Sensations, Supernumerary Phantom Limbs and Apotemnophilia: Three Body Representation Disorders.
Tatu L, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29145179 · Publisher ↗
Body representation disorders continue to be mysterious and involve the anatomical substrate that underlies the mental representation of the body. These disorders sit on the boundaries of neurological and psychiatric dis...
Body representation disorders continue to be mysterious and involve the anatomical substrate that underlies the mental representation of the body. These disorders sit on the boundaries of neurological and psychiatric diseases. We present the main characteristics of 3 examples of body representation disorders: phantom sensations, supernumerary phantom limb, and apotemnophilia. The dysfunction of anatomical circuits that regulate body representation can sometimes have paradoxical features. In the case of phantom sensations, the patient feels the painful subjective sensation of the existence of the lost part of the body after amputation, surgery or trauma. In case of apotemnophilia, now named body integrity identity disorder, the subject wishes for the disappearance of the existing and normal limb, which can occasionally lead to self-amputation. More rarely, a brain-damaged patient with 4 existing limbs can report the existence of a supernumerary phantom limb.
Minor Hemisphere Major Syndromes.
Carota A, Bogousslavsky J
Front Neurol Neurosci · 2018 · PMID 29145178 · Publisher ↗
A right "minor hemisphere" does not exist as the right hemisphere is dominant for awareness (nosognosia), spatial attention, emotional regulation, facial and voice expressions, visual recognition, and topographical orien...
A right "minor hemisphere" does not exist as the right hemisphere is dominant for awareness (nosognosia), spatial attention, emotional regulation, facial and voice expressions, visual recognition, and topographical orientation. Without the right hemisphere, the world would be flat, deprived of general and spatial attentions, pointing preferentially to the right side of the space, lacking visual experiences and emotions, exhibiting diminished awareness of the self and environment. Clinical-related syndromes of the right hemisphere are unilateral spatial neglect, object and face visual agnosia, the anosognosia for hemiparesis and/or hemianopia, misidentification syndromes, mania, and other obsessions for the food and the body. Another key function of the right hemisphere is the modulation of the emotional processes of the linguistic communication (as prosody and facial expressions), and the tuning of some holistic aspects of language as the understanding of the abstract and figurative characters. The great mysteries of the right brain hemisphere concern the origin of the emotional nature of the human being, the way by which cognition interacts with perception and finally the human consciousness. Multidisciplinary researches in the domains of neurology, cognitive psychology, neuropsychiatry, functional neuroimaging, and neurophysiology will reveal in the future some of these mysteries.
Transcranial Doppler.
Sharma VK, Wong KS, Alexandrov AV
Front Neurol Neurosci · 2016 · PMID 27960192 · Publisher ↗
Transcranial Doppler ultrasonography (TCD) is the only diagnostic modality that provides a reliable evaluation of intracranial blood flow patterns in real-time. The physiological information obtained from TCD is compleme...
Transcranial Doppler ultrasonography (TCD) is the only diagnostic modality that provides a reliable evaluation of intracranial blood flow patterns in real-time. The physiological information obtained from TCD is complementary to the anatomical details obtained from other neuroimaging modalities. TCD is relatively cheap, can be performed bedside, and allows monitoring in acute emergency settings. TCD criteria for intracranial stenosis have been validated against various forms of angiographic studies and serve as reliable tools for screening, diagnostic as well as follow up purposes. TCD findings of intracranial stenosis have acceptable accuracy parameters for anterior as well as posterior circulation. Extended applications of TCD, especially emboli monitoring and assessment of vasomotor reactivity, provide important information about the pathophysiology of cerebrovascular ischemia and risk stratification. Therefore, TCD has become an integral component of the armamentarium of stroke neurologists for understanding stroke etiopathogenesis, planning and monitoring definitive treatment and determining the prognosis. 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.
Pathological Characteristics.
Chen XY, Fisher M
Front Neurol Neurosci · 2016 · PMID 27960191 · Full text
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 c...
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 has distinct pathological characteristics compared to that of extracranial arteries. Intracranial atherosclerosis (ICAS) had been understudied due to the relative inaccessibility of cerebral artery specimens under current treatment strategies. Acquiring post-mortem cerebral vessel specimens for histology processing is the most direct method to analyze the pathological characteristics of ICAS, in order to analyze both lumen stenosis and plaque components contributing to brain infarctions. The developments in high resolution magnetic resonance imaging (HRMRI) make it feasible to assess human ICAS in vivo. It is nevertheless challenging to understand vessel wall changes within brain vasculature demonstrated on HRMRI, as well as to identify biomarkers for stroke risk stratification and treatment strategy modification. Knowledge about intracranial atherosclerosis remains limited due to lack of human arterial specimens, and the development of proper animal models of human cerebral atherosclerosis is necessary to explore the pathogenesis of intracranial atherosclerosis and to assess various strategies preventing or treating ICAS-related stroke.
Epidemiology.
Gorelick P, Wong KS, Liu L
Front Neurol Neurosci · 2016 · PMID 27960190 · Publisher ↗
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 di...
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-ethnic differences in the distribution of extracranial and intracranial atherosclerotic disease.
Surgical Therapy.
Oh CW, Steinberg GK
Front Neurol Neurosci · 2016 · PMID 27960189 · Publisher ↗
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...
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 procedures in patients with intracranial atherosclerosis has long been controversial. In this chapter, we review the surgical therapies for patients with intracranial atherosclerosis. This review does not include EC-IC bypass surgery for moyamoya disease, which is discussed in another chapter.
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