With its increasing incidence in younger population and as a leading cause of disability, ischemic stroke represents a real public health problem. This chapter aims to evaluate the most common risk factors and causes for ischemic stroke in the young. Though some are identical to those found in older patients, most of them are specific to this population segment. Furthermore, another objective is to provide some guidance in approaching the case based on some important clinical clues. Due to the lack of universal management guidelines, it is up to the physician to judge the particularities of each case and to carry out the variety of investigations necessary for determining the cause.
Part of the book: Ischemic Stroke
Inflammatory demyelinating diseases are defined as being a miscellaneous group of disorders that develop as a consequence of an acute or chronic inflammatory process. The types of demyelinating disease with a high prevalence are multiple sclerosis, neuromyelitis optica and acute-disseminated encephalomyelitis. Patients with multiple sclerosis frequently experience depressive and anxiety symptoms including cognitive impairments. Depression is correlated with an unsatisfatory quality of life, having a conceivably important psychological impact on all the aspects of the patient’s live, including less efficient coping mechanisms and a decreased compliance with disease-modifying drugs. As a general rule among population, depression in multiple sclerosis patients is regularly correlated with anxiety. The clinical importance of neuropsychiatric symptoms should not be neglected because multiple sclerosis patients are more prone to be affected in all the aspects of life, in view of the morbidity that these symptoms bring in patients with neurodegenerative diseases.
Part of the book: Demyelination Disorders
Aphasia denotes an acquired central disorder of language, which alters patient’s ability of understanding and/or producing spoken and written language. The main cause of aphasia is represented by ischemic stroke. The language disturbances are frequently combined into aphasic syndromes, contained in different vascular syndromes, which may suffer evolution/involution in the acute stage of ischemic stroke. The main determining factor of the vascular aphasia’s form is the infarct location. Broca’s aphasia is a non-fluent aphasia, comprising a wide range of symptoms (articulatory disturbances, paraphasias, agrammatism, anomia, and discrete comprehension disorders of spoken and written language) and is considered the third most common form of acute vascular aphasia, after global and Wernicke’s aphasia. It is caused by a lesion situated in the dominant cerebral hemisphere (the left one in right-handed persons), in those cortical regions vascularized by the superior division of the left middle cerebral artery (Broca’s area, the rolandic operculum, the insular cortex, subjacent white matter, centrum semiovale, the caudate nucleus head, the putamen, and the periventricular areas). The role of this chapter is to present the most important acquirements in the field of language and neurologic examination, diagnosis, and therapy of the patient with Broca’s aphasia secondary to ischemic stroke.
Part of the book: Aphasia Compendium