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This pattern of performance may reflect a preservation of category information, coupled with a loss of those specific attributes that make it possible to differentiate semantically related objects-hence the confusion with other items from the same category. Demented patients can be quite accurate (95% correct) when asked to recognize features that were attributes of a target (Grober et al. These studies used a variety of latent structure techniques, including multidimensional scaling, to analyze the organization of information in semantic memory. In addition, relationships among the stimuli along the multidimensional axes also differed between the patients and controls. Nebes (1992) has argued that one possible source for this discrepancy lies in the differing cognitive demands imposed by the experimental tasks. While not minimizing the nonsemantic processing demands of individual tasks, consistent findings across several tasks would point toward a degradation of semantic knowledge. Indeed, their data demonstrate a high reliability between tests (and within items). This may reflect, in part, the multifactorial aspects of semantic memory, and may also reflect the fact that various aspects of semantic memory function are subsumed in different neuroanatomical regions. The heterogeneity of symptoms and symptom clusters may reflect both cognitive and pathological variation. For our studies, the focus is on the grey matter and these images are smoothed (using a 3-D Gaussian filter) and analyzed using a between-group analysis to identify the voxels with significant differences in intensity, reflecting differences in brain volumes (see also Sowell et al. The left-hand image shows the cortical atrophy in the languagedominant left hemisphere, with the typical temporoparietal gray matter loss. The right-hand image shows a view in the coronal plane, demonstrating the tissue loss in the inferior temporal lobe and hippocampus. There were no significant differences between groups in education or on overall cognitive impairment, but the groups did differ significantly on age. The analysis revealed a significant difference in the gray matter volume of several temporal lobe structures. In addition, middle inferior regions of the temporal lobe, the fusiform gyrus and parahippocampal gyrus, also had significant differences in density between groups, such that the patients with poor naming had reduced volumes relative to those with good naming. These structural data are consistent with the existing functional neuroimaging and neuropsychological studies that have demonstrated the critical role of the temporal lobe in the processes needed to execute semantic memory tasks. There is reliable functional activation of the left temporal lobe during object-naming tasks (Martin et al. However, a functional neuroimaging analysis of a semantic task revealed activity in the left posterior inferior temporal gyrus, and they suggested that the decreased functional activation found in these patients was due to lack of input from the atrophied anterior temporal lobe to the posterior inferior temporal gyrus, and not due to atrophy of the posterior inferior temporal gyrus. Thus, while there appears to be a common final pathway to explain the naming defect, the cause of that defect differs between diseases. Analysis of the neuroanatomical abnormalities in patients with language disturbance associated with frontotemporal dementia (Snowden et al. Specifically, superior and middle temporal cortex are affected, as well as the hippocampus and peri-hippocampal regions. C) with language disturbance associated with frontotemporal dementia, showing brain in regional atrophy. First, the inferior temporal lobe, and perhaps most importantly the parahippocampal gyrus, is critical for the ability to successfully name objects. Thus, at various points during the progression of the disease, the neuropsychological profile will reflect the relative impairments and sparing of cognitive functions, based on the underlying patterns of neuropathological change. These patterns of impairments should, and do, follow the "natural fracture lines of behavior" (Thomas et al. Spence (eds), the Psychology of Learning and Motivation: Advances in Research and Theory, Vol. Profiles of demented and amnesic patients on the California Verbal Learning Test: implications for the assessment of memory disorders.

Intracardiac thrombus or clot (intraventricular thrombus or clot, ventricular aneurysm with clot, atrial myxoma) is a type of blood clot that has formed within the heart. Spontaneous echo contrast is sometimes referred to as "smoke" or "Rouleaux formation. Valvular heart disease, which does not include mitral valve prolapse, is the improper functioning of the heart valves. Valvular stenosis is the narrowing of a valve opening that limits the forward flow of blood. Valvular insufficiency (regurgitation, incompetence or "leaky valve") occurs when a valve does not close tightly, allowing blood to leak backwards across the valve. Aortic arch atheroma is a mass of plaque composed of lipids, cholesterol, and the degenerated, thickened inner layer of the aorta at its arch. Answer "yes" only if atrial fibrillation/myocardial infarction were believed to be present at event onset. Sources: Operative report, discharge or death summary More than one item may be marked for each subquestion. Embolic stroke is caused by an embolus (clot) that has traveled from an artery in another part of the body, lodged in a smaller artery in the brain, and decreased or stopped blood flow in that artery. Atherosclerotic stroke is caused by the occlusion (by plaque) of an artery that supplies blood to the brain. A ventriculostomy procedure should not be considered as surgical or autopsy evidence of a stroke. This type of therapy is typically administered emergently (within three hours of the stroke) to a patient who has a confirmed ischemic stroke. A known history of an artificial valve should be marked as "Rheumatic heart disease or any valvular heart disease. Systemic or pulmonary embolus is an embolus in any part of the body other than the brain. Hematologic abnormality: hypercoagulable state is a condition of being prone to developing blood clots. Other evidence of cause of stroke: [write on form in capital letters] Tumor includes brain neoplasm, glioma, meningioma, astrocytoma, oligodendroglioma, pituitary adenoma, brain metastasis, neuroma or subarachnoid cyst; conditions that are "probable" or "consistent with brain tumor. The Central Abstractor should then inform the Field Center to indicate "no event" on the Final Notification form as well. If any of the above (tumor, trauma, infection, or hemorrhagic state) were present but did not cause the stroke, they should instead be recorded in the next category ("Other non-stroke disease process that likely caused a focal neurological deficit"). At the time of discharge, had the participant made a complete recovery from this neurologic event? The presence of any residual deficits or any weakness is an indication of an incomplete recovery. At the time of discharge, did the participant require more help from another person for everyday activities. Please answer the following for the hospital admission abstracted on this form: Date of admission: o Unknown o Month / Day / Year: / / Date of discharge or death: o Unknown o Month / Day / Year / / 4. Yes Obtain hospital records from other hospital and complete relevant abstraction form(s). Is duration of this event known to be: Unknown More than 24 hours Until death within 24 hours Resolved within 24 hours (specify below): o Hours Minutes 9. Yes No Unknown Answers to questions 10 should be based on the neurologic exam done at or around the time of admission or, for strokes occuring during the hospitalization, after the stroke. Lumbar Puncture Yes No Unknown If yes: (otherwise go to 11D) o Evidence of hemorrhage Yes No Unknown 11D. Are any of the following conditions documented as having been present within four weeks prior to or during this hospitalization? Myocardial infarction o Yes o No o Unknown Atrial fibrillation or flutter o Yes o No o Unknown Rheumatic heart disease or any valvular heart disease o Yes o No o Unknown Intracardiac thrombus o Yes o No o Unknown Systemic or pulmonary embolus o Yes o No o Unknown Hematologic abnormality: hypercoagulable state o Yes o No o Unknown Other evidence of cause of stroke. At the time of discharge, had the patient made a complete recovery from this event? At the time of discharge, did the patient require more help from another person for everyday activities compared to state prior to event? The physician questionnaire is intended to be used primarily with non-hospitalized events (i.

Physical activity and coronary heart disease in women: Is "no pain, no gain" passe? Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Characteristics of inactive primary care patients: Baseline data from the activity counseling trial. Management of hypertensive patients with left ventricular hypertrophy and diastolic dysfunction. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. Comparison of left ventricular mass and geometry in Black and White patients with essential hypertension. Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996). Effect of single-drug therapy on reduction of left ventricular mass in mild to moderate hypertension: Comparison of six antihypertensive agents. Placebo-controlled comparison of captopril, atenolol, labetalol, and pindolol in hypertension complicated by intermittent claudication. Beta blockade and intermittent claudication: Placebo controlled trial of atenolol and nifedipine and their combination. Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. Risks of untreated and treated isolated systolic hypertension in the elderly: Meta-analysis of outcome trials. Antihypertensive drugs in very old people: A subgroup meta-analysis of randomised controlled trials. Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. The association between orthostatic hypotension and recurrent falls in nursing home residents. An autopsy study of the incidence of lacunes in relation to age, hypertension, and arteriosclerosis. Magnetic resonance imaging cerebral abnormalities and neuropsychologic test performance in elderly hypertensive subjects. Association of midlife blood pressure to late-life cognitive decline and brain morphology. Serial magnetic resonance imaging of rat brain after induction of renal hypertension. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. Sclerosing vasculopathy of the central nervous system in nonelderly demented patients. Further observations on the pathology of subcortical lesions identified on magnetic resonance imaging. Systolic blood pressure within an intermediate range may reduce memory loss in an elderly hypertensive cohort. Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Dufouil C, de Kersaint-Gilly A, Besancon V, Levy C, Auffray E, Brunnereau L, et al. Cognitive decline associated with worsening of white matter lesions: A 6-year follow-up study. Prevention of dementia in randomised doubleblind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Statement from the National High Blood Pressure Education Program: Prevalence of hypertension. Conventional and ambulatory blood pressure and menopause in a prospective population study. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. Prospective study of oral contraceptives and hypertension among women in the United States.

A favorable outcome on the 8-point extended Glasgow Outcome Scale at 6 months was used as the primary end point. Good outcome was dichotomized, with lower expectations set for those with worse prognosis. Twenty-six percent of the patients in the surgical arm achieved a favorable outcome compared with 24% in the medical arm. Notably, 26% of patients initially assigned to conservative management ultimately underwent surgery. Subgroup analysis suggested that patients with lobar hemorrhages within 1 cm of the cortical surface might benefit from surgery. The study randomized patients to early surgery (within 12 hours of randomization) plus medical management or medical management alone. The primary outcome was a prognosis-based dichotomized (favorable or unfavorable) outcome of the extended Glasgow Outcome Scale. Forty-one percent of patients in the early surgery group had a favorable outcome compared with 38% in the medical arm; this difference was not statistically significant. Twenty-one percent of patients randomized to initial medical management ultimately underwent surgery, with the most common reason described as patient deterioration. Given the broad lack of clinical equipoise for surgical evacuation of cerebellar hemorrhages, especially those >3 cm in diameter occurring in potentially salvageable patients, it is unlikely that a randomized trial could be conducted to compare surgery versus conservative treatment. Three patients in the study group died compared with 8 in the control group, whereas 9 patients had a study-defined good outcome. Although there was no significant impact on mortality, 3-month neurological outcome was better in the aspiration group. This study compared 79 surgical patients with 39 Craniotomy for Posterior Fossa Hemorrhage Because of the narrow confines of the posterior fossa, deterioration can occur quickly in cerebellar hemorrhage caused by obstructive hydrocephalus or local mass effect on the brainstem. The study demonstrated a significant reduction in perihematomal edema in the hematoma evacuation group with a trend toward improved outcomes. Randomized prospective trials to date have reported on a wide time frame for surgery that ranges from 4 to 96 hours after symptom onset. Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible (Class I; Level of Evidence B). However, 5 patients in the nonrestarted group developed thromboembolism (2 with stroke) compared with none in the group who restarted warfarin. In patients with prosthetic heart valves, early resumption of anticoagulation may be necessary because of the high risk of embolism. There are also problems associated with the insensitivity of many of the outcome measures used in rehabilitation to allow detection of clinically meaningful differences between groups. Cognition, mood, motivation, and social support all influence recovery, and it is difficult to separate intrinsic from adaptive recovery. In part this represents a need to tailor services to ensure optimal recovery for patients, and in part it is attributable to fiscal pressures on costly health services. Given strong evidence for the benefits of well-organized, multidisciplinary inpatient (stroke unit) care in terms of improved survival, recovery, and returning home compared with care provided in conventional nondedicated stroke wards,319 efforts have been made to extend this service model of coordinated care into the community. Specifically, early supported hospital discharge and home-based rehabilitation programs have been shown to be cost-effective,319 whereas home-based therapy for stable patients has been shown to produce comparable outcomes to conventional outpatient rehabilitation. Improvement was significantly greater for the rehabilitation group, measured by Fugl-Meyer and Barthel scales over 6 months, with the greatest improvement evident in the first month after stroke. A key portion of rehabilitation should include education for the patient and caregiver regarding secondary stroke prevention and means to achieve rehabilitation goals. Rehabilitation programs should consider lifestyle changes, depression, and caregiver burden as important issues to address with the patient and caregivers. Another major focus in future years will be determining whether minimally invasive surgery231 can provide the advantages of hematoma removal with less surgical trauma and therefore greater net benefit to patients. Selim Daniel Woo University of Washington University of Michigan Harvard Medical Faculty Physicians University of Cincinnati None None None None None None None None None None None None None None None None None None None None Daiichi-Sankyo* None None None this table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. Hemphill et al Reviewer Disclosures Reviewer Sepideh Amin-Hanjani Charlotte Cordonnier Matthew L. Smith University of Calgary None None None None None this table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.