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Michael E Christiansen, Ryan C Van Woerkom, Bart M Demaerschalk, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: Adults with cryptogenic stroke often undergo transesophageal echocardiogram (TEE) because this is the gold-standard for evaluation of potential proximal sources of emboli. The risks of performing this invasive test must be weighed against its clinical efficacy and limitations, determined by the rate of positive findings, and the impact on clinical outcome for the patient. OBJECTIVE: To critically appraise current evidence regarding the rate of positive TEE findings in cryptogenic stroke patients, and analyze the implications of these findings on management decisions and outcomes...
January 2018: Neurologist
Shailendra Kapoor
No abstract text is available yet for this article.
January 2018: Neurologist
Fanny Duval, Idoia Lacoste, Gaël Galli, Hugo Chaumont, Guilhem Solé, François Léger, Nathalie Damon-Perrière, Marie Rouanet, Gwendal Le Masson, Stéphane Mathis
INTRODUCTION: Giant cell arteritis (GCA), a vasculitis involving large-sized and medium-sized vessels (which most commonly involves temporal arteries), is easily recognized in older patients presenting with headache, scalp tenderness, and raised inflammatory markers. Neurological complications (either central or peripheral) are classically described in GCA. CASE REPORT: We report the case of an 85-year-old woman with bilateral acute brachial radiculoplexopathy, a rare neurological complication of GCA...
January 2018: Neurologist
Zheng Jiang, Zhiping Hu
INTRODUCTION: Intravenous recombinant tissue-type plasminogen activator thrombolysis in pregnancy for acute ischemic stroke is infrequent. As a rare complication of thrombolysis, remote intracerebral hemorrhage (rICH) whose mechanisms are unclear has not gained enough attention until now. CASE REPORT: We present here a case of 26-year-old pregnant woman at 31 weeks gestation who suffered from sudden onset right-sided hemiparesis and slurred speech. She successfully received intravenous recombinant tissue-type plasminogen activator thrombolysis within 2...
January 2018: Neurologist
Dmitry Tchapyjnikov, Mohamad A Mikati
INTRODUCTION: Glucose transporter type 1 deficiency syndrome (GLUT1 DS) is caused by impaired glucose transport across the blood-brain barrier and commonly presents as severe early onset epilepsy, developmental delay, and movement abnormalities. In rare instances, GLUT1 DS can present as a paroxysmal movement disorder without the other classic symptoms. Episodic ataxia (EA) secondary to GLUT1 DS has been previously reported, but all previous patients had seizures and/or baseline abnormalities on neurological examination...
January 2018: Neurologist
Ugur Uygunoglu, Melih Tutuncu, Ayse Altintas, Sabahattin Saip, Aksel Siva
BACKGROUND: Fingolimod withdrawal may trigger the return of pretreatment disease activity. It is difficult to identify patients at risk of disease reactivation. We compared the demographic and clinical features of patients experiencing severe disease reactivation (SDR) after fingolimod cessation with those of patients who did not. METHODS: All patients who commenced fingolimod and who continued therapy for at least 6 months were included. The demographic and clinical features of the 2 groups (SDR vs...
January 2018: Neurologist
Chiao-Zhu Li, Feng-Cheng Liu, Chiao-Ching Li, Meng-Chi Lin, Chih-Chuan Hsieh, Bon-Jour Lin, Nan-Fu Chen, Chun-Lin Chen, Tzu-Tsao Chung, Chi-Tun Tang, Dueng-Yuan Hueng, Da-Tong Ju, Hsin-I Ma, Ming-Ying Liu, Ching Hsiang Lu, Yuan-Hao Chen
OBJECTIVE: We investigated the efficacy of plasma exchange (PE) in antiphospholipid antibody (aPL)-positive patients with a spontaneous intracerebral hemorrhage (ICH) and high D-dimer levels. MATERIALS AND METHODS: From May 2013 to May 2016, we evaluated 32 patients who were below the age of 50 and presented with spontaneous ICH. Five patients were positive for aPL antibody and 3 had a higher level of D-dimer. These 3 patients underwent 5 sessions of PE using fresh frozen plasma as replacement fluid...
January 2018: Neurologist
Iris V Marin Collazo, W O Tobin
OBJECTIVE: Facial Myokymia and hemifacial spasm have been associated with multiple sclerosis; however, their etiology and clinical outcome is uncertain. Here, we describe the clinical, radiologic features, and treatment outcomes of a cohort of patients with multiple sclerosis and history of facial myokymia or hemifacial spasm. METHODOLOGY: We reviewed the clinical features, radiologic features, and treatment outcomes of 35 patients with a diagnosis of multiple sclerosis and facial myokymia (28) or hemifacial spasm (7) seen at Mayo Clinic (Rochester, MN)...
January 2018: Neurologist
Jennifer M Gass, Anvir Cheema, Jessica Jackson, Patrick R Blackburn, Jay Van Gerpen, Paldeep S Atwal
INTRODUCTION: Alexander disease is a rare neurodegenerative disease caused by variants in the glial fibrillary acidic protein gene (GFAP). This disorder can develop as an infantile, juvenile or adult-onset form and is characterized by several clinical features, including macrocephaly, seizures, ataxia, and bulbar/pseudobulbar signs. While the majority of these patients have the more progressive infantile form which causes severe leukodystrophy and early death; the less common adult form is more variable (ie, onset age, symptoms), with bulbar dysfunction as the primary feature...
November 2017: Neurologist
Mario Meloni, Rita Farris, Paolo Solla, Marcello M Mascia, Francesco Marrosu, Antonino Cannas
INTRODUCTION: Large expansions of the noncoding GGGGCC repeat (more than 30) in the first intron of the C9ORF72 gene have been demonstrated to cause amyotrophic lateral sclerosis and frontotemporal dementia. Recent papers have investigated the possible pathogenic role and associated clinical phenotypes of hexanucleotide expansions with intermediate repeat lengths ranging between 20 and 29 repeats. CASE REPORT: We report a case of a 71-year-old Sardinian female patient with a long history of psychiatric disorders such as mixed anxiety-depressive disorder associated with somatization disorder and histrionic personality who developed a slowly progressive cerebellar syndrome, mild cognitive impairment, pyramidal signs, and rapid eye movement sleep behavior disorder with imaging abnormalities on the DaTSCAN single-photon emission computed tomography indicating an alteration in the presynaptic dopaminergic system...
November 2017: Neurologist
Ezequiel Gleichgerrcht, Ming Y Lim, Tanya N Turan
INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin exposure. A limited number of studies have reported cerebral venous sinus thrombosis (CVST) as the presenting thrombotic event induced by HIT, only one of which occurred with exposure to low-molecular-weight heparin (LMWH), with death as outcome. Here, we present a unique case of LMWH-induced HIT leading to CVST but resulting in good clinical outcome. CASE REPORT: A 52-year-old woman received subcutaneous LMWH for deep vein thrombosis prophylaxis while in rehabilitation following kyphoplasty for spinal fracture related to recent trauma...
November 2017: Neurologist
Paul Sampognaro, Kathy T Vo, Megan Richie, Paul D Blanc, Kevin Keenan
INTRODUCTION: Bismuth salts have been used to treat gastroenterological disorders and are readily available over-the-counter and via the internet. Even though generally considered safe, bismuth compounds can cause a syndrome of subacute, progressive encephalopathy when taken in large quantities. CASE REPORT: We present the case of woman who developed progressive encephalopathy, aphasia, myoclonus, and gait instability after chronically ingesting large amounts of bismuth subgallate purchased from a major online marketing website to control symptoms of irritable bowel syndrome...
November 2017: Neurologist
Dimitrios Parissis, Panagiotis Ioannidis, Georgios Papadopoulos, Dimitrios Karacostas
X-linked Charcot-Marie-Tooth disease (CMT 1X) is the second most common form of inherited demyelinating neuropathy. It is established that patients suffering from CMT 1X can have episodes of hemiparesis, paraparesis, quadriparesis, ataxia, aphasia, and dysarthria, which can be fully reversible, and 'trigger' factors for these episodes are usually febrile illness, high altitudes, hyperventilation, and physical activity. We describe a 22-year-old patient with a history of viral infection and sleep deprivation who presented to our department because of acute difficulty in walking and neurophysiological findings suggesting Guillain-Barre syndrome...
November 2017: Neurologist
Karthy Thiagarajan, Vinodh Jeevanantham, Raymond Van Ham, Thomas G Gleason, Vinay Badhwar, YueFang Chang, Parthasarathy D Thirumala
OBJECTIVE: Perioperative stroke rate after surgical aortic valve replacement (SAVR) varies between 1.3% and 6.2%, whereas the operative mortality ranges between 1% and 16.4%. The aim of this study was to determine whether perioperative stroke is a risk factor for operative mortality after SAVR by performing a meta-analysis of relevant studies. MATERIALS AND METHODS: PubMed, EMBASE, and Web of Science databases were searched to retrieve relevant literature. Screening of the articles was done independently on the basis of predetermined criteria...
November 2017: Neurologist
Man Sum Chi, Lok Yiu Chan
INTRODUCTION: There are many exclusion criteria in early randomized control trials for intravenous recombinant tissue plasminogen activator use in acute ischemic stroke, thus, many patients were not eligible for the treatment. OBJECTIVE: This study aimed to compare the safety and short-term treatment outcome between those who fulfilled the criteria and those who did not. METHODS: All acute ischemic stroke patients treated with intravenous thrombolysis from 2004 to 2015 in Tuen Mun hospital were recruited...
November 2017: Neurologist
Mitra Assadi, Mandy Binning, Kenneth Liebman, Erol Veznedaroglu
OBJECTIVE: The co-occurrence of headaches and cerebral aneurysms is common in clinical practice, although a clear causal relationship has not been ascertained. We aimed to investigate the impact of endovascular obliteration of aneurysms on headaches using a cross-sectional, prospective, open-label protocol. We also sought to characterize the preexisting headaches in patients harboring cerebral aneurysms using the International Classification of Headache Disorders criteria. METHODS: A total of 33 patients were recruited into the study and underwent endovascular treatment for obliteration of their aneurysms...
November 2017: Neurologist
Patricia E Penovich, Janice Buelow, Kathy Steinberg, Joseph Sirven, James Wheless
OBJECTIVES: To characterize the burden of seizure clusters (SC) on patients and caregivers, a large internet-based survey was conducted. METHODS: The Seizure Cluster Burden of Illness US Survey was conducted online by Harris Poll on behalf of The Epilepsy Foundation in September 2014. Respondents included adult patients 18 years and above with epilepsy or a seizure disorder who had experienced SC in the past year (defined as ≥2 seizures within 24 h outside the patient's typical seizure pattern), caregivers providing current care for a patient with SC (adult or child), and clinicians (neurologists, epileptologists) who treat adult or pediatric patients...
November 2017: Neurologist
Yannick Béjot, José-Luis Barnay, Adrien Chavent, Benoit Daubail, Agnès Jacquin, Apolline Kazemi, Frédéric Ricolfi, Maurice Giroud
INTRODUCTION: Moyamoya syndrome is a rare progressive cerebrovascular occlusive disease for which several associated conditions have been described. CASE REPORT: We report the case of a 76-year-old woman with a history of May-Hegglin anomaly who presented with an isolated unusual diffuse headache. Initial laboratory investigations showed only thrombocytopenia (platelet count 95000/μL). Unenhanced brain computed tomography scan revealed a small subarachnoid hemorrhage in the left frontal lobe...
September 2017: Neurologist
James E Siegler, Alexander J George, Sheryl Martin-Schild
A "stroke mimic" refers to any clinical condition that causes neurological symptoms clinically indistinguishable from a cerebral lesion that affects a vascular distribution, but is not caused by ischemia. One subtype of stroke mimic, termed stroke reexpression, is a form of mimicry in which previously recovered or improved stroke symptoms recur in the setting of a neurological disturbance (seizure, hypoperfusion state) or a systemic disturbance (toxic, metabolic, infectious). Many reports of stroke reexpression exist in the literature and are well known to clinicians, but there has been no consensus regarding terminology that has been published to date...
September 2017: Neurologist
Brian Appavu, Jordana Fox, Robert Little, John F Kerrigan, Makram Obeid
INTRODUCTION: Reflex epilepsies represent a form of epilepsy in which unique modes of seizure precipitation are characterized by endogenous or exogenous stimuli. Hot water epilepsy represents a subtype of reflex epilepsy in which seizure precipitation arises from the act of immersing the head with hot water. Bathing epilepsy represents another subtype of reflex epilepsy in which seizure precipitation arises from the immersion with water at lukewarm temperatures. CASE SERIES: We report on 2 boys with a unique form of bathing epilepsy characterized by the act of exiting out of water...
September 2017: Neurologist
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