Ischemic optic neuropathy and carotid dissection

Abstract

Abstract-Objective:To evaluate the prognostic value of domain-specific cognitive abilities in acute stroke with respect to long-term cognitive and functional outcome in addition to neurologic and demographic predictors. Methods: The authors evaluated 168 patients within the first 3 weeks after first-ever stroke. The prevalence of neuropsychological impairment was calculated vs 75 matched healthy controls. The authors also recorded demographic data, vascular risk factors, lesion characteristics, and clinical factors at admission. Independent predictor variables associated with long-term cognitive impairment (assessed with a follow-up neuropsychological examination) and functional impairment (assessed with the modified Barthel Index and the Frenchay Activities Index) were identified with stepwise multiple logistic regression. Areas under receiver operator characteristic curves were used to compare the predictive value of three models, i.e., a standard medical model, a purely cognitive model, and a model consisting of both medical and cognitive predictors. Results: Thirty-one percent of patients showed long-term cognitive impairment. Basic and instrumental ADL disturbances remained present in 19% and 24% of patients. Domain-specific cognitive functioning predicted cognitive and functional outcome better than any other variable. Moreover, the prediction of instrumental ADL functioning improved when cognitive predictors were added to the standard medical model (p Ͻ 0.05). Impairments in abstract reasoning and executive functioning were independent predictors of long-term cognitive impairment. Inattention and perceptual disorders were more important in predicting long-term functional impairment. Conclusion: Domain-specific cognitive abilities in the early phase of stroke are excellent independent predictors of long-term cognitive and functional outcome. NEUROLOGY 2005;64:821-827 Several factors have been identified as predictors for long-term disability and adverse outcome, such as initial stroke severity and lesion characteristics, functional status at admission with respect to activities of daily life (ADL), vascular risk factors, and demographic factors.1-5 While cognitive disorders are among the most frequent and devastating early consequences of stroke, 6,7 few studies have examined the prognostic importance of these acute disorders. 8,9 Moreover, most of these studies have used global cognitive screening measures in the early phase of stroke, although these measures demonstrate poor sensitivity in detecting cognitive impairment in stroke patients.10 Also, these global measures do not allow evaluation of cognitive performance in specific domains. Other studies on poststroke cognitive impairment have focused on the prognostic value of isolated impairments such as unilateral neglect, 11,12 anosognosia, 13 aphasia, 14 or apraxia. 15 A detailed neuropsychological evaluation covering the whole cognitive spectrum in acute stroke has not been reported, probably because of uncertainty about the feasibility and reliabi...

Traumatic dissection of the internal carotid artery: simultaneous infarct of optic nerve and brain

“…Our patient was categorized as the nonarteritic form, where there is an association with a variety of diseases, among which are cerebrovascular disease, occlusive carotid disease, and ICAD, among many others [34,35]. PION produced by an occlusion of the central retinal artery (CRA) is rare (1%) [27,28,36], and even then, it is in the joint presence of cerebral infarction and PION, as it is in the case of this particular patient. Therefore, there have been no well-documented cases, so far [37].…”

Feature of Ocular-Ischemic Syndrome in Patients with Cardiovascular Pathology. Literature Review

“…К возникновению медленно прогрессирующей ЗИОН может привести ишемия вследствие прогрессирующей окклюзии каротидной артерии [43], а также после расслоения каротидной артерии [44].…”