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Diagnostic test results in primary CNS vasculitis: A systematic review of published cases
Conclusions: Cerebral angiography and pathologic tissue examination were undertaken in a minority of published cases with a diagnosis of PCNSV. When both diagnostic tests were performed, disagreement between them was more than 5 times more likely than agreement. Diagnostic criteria for PCNSV may require revision to classify the clinical, pathologic, and radiologic features of this condition more accurately.
Source: Neurology Clinical Practice - June 12, 2017 Category: Neurology Authors: McVerry, F., McCluskey, G., McCarron, P., Muir, K. W., McCarron, M. O. Tags: All Imaging, Other cerebrovascular disease/ Stroke, Vasculitis, All Clinical Neurology, All Cerebrovascular disease/Stroke Review Source Type: research

Role of MRI in early detection of stroke secondary to neurosyphilis in an elderly patient coinfected with HIV
We report an unusual case of meningovascular neurosyphilis with basilar artery enhancement secondary to syphilitic arteritis in an elderly man with HIV coinfection.
Source: Neurology Clinical Practice - April 10, 2017 Category: Neurology Authors: Ruisanchez, A., Vicente-Olabarria, I., Escalza-Cortina, I., Anguizola, D., Garcia-Gorostiaga, I., Gomez-Beldarrain, M., Garcia-Monco, J. C. Tags: MRI, Bacterial infections, HIV, All Cerebrovascular disease/Stroke Case Source Type: research

Recurrent stroke in a patient with vitamin B12 deficiency and MTHFR mutation
We report an unusual case of recurrent stroke in a patient with vitamin B12 deficiency who was also homozygous for the methylene tetrahydrofolate reductase (MTHFR) gene mutation. The patient was a 35-year-old male vegetarian with no known medical history who initially presented with global aphasia, slurred speech, right facial weakness, and right-sided hemiplegia and was found to have a stroke (NIH Stroke Scale score of 25). At that time a CT scan of the head ruled out intracranial hemorrhage and a CT angiogram of the head and neck was done. The patient was found to have occlusion of the M1 segment of the left middle cereb...
Source: Neurology Clinical Practice - February 12, 2017 Category: Neurology Authors: Zacharia, G., Shani, D., Ortiz, R. A. Tags: Stroke in young adults, Stroke prevention, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research

Validation of olfactory deficit as a biomarker of Alzheimer disease
Conclusions: Olfactory identification deficit is a useful screening tool for AD-related amnestic disorder, with sensitivity and specificity comparable to other established biomarkers, with benefits such as ease of administration and low cost. Olfactory identification deficit can be utilized to stratify risk of conversion from aMCI to AD and enrich clinical trials of disease-modifying therapy. Classification of evidence: This study provides Class III evidence that smell identification (10-item UPSIT subset) accurately identifies patients with amnestic disorders.
Source: Neurology Clinical Practice - February 12, 2017 Category: Neurology Authors: Woodward, M. R., Amrutkar, C. V., Shah, H. C., Benedict, R. H. B., Rajakrishnan, S., Doody, R. S., Yan, L., Szigeti, K., On behalf of the Texas Alzheimer Research and Care Consortium Tags: Alzheimer's disease, Class III, MCI (mild cognitive impairment) Research Source Type: research

Hemorrhagic primary CNS angiitis and vasoconstrictive drug exposure
Conclusions: In this study, hemorrhagic PACNS was exclusively associated with sympathomimetic drug exposure. The high rate of thunderclap headache, lobar hemorrhages, and the self-limited clinical course suggests a shared mechanism between hemorrhagic PACNS and the reversible cerebral vasoconstriction syndrome (RCVS), a PACNS mimic. This RCVS-PACNS overlap syndrome may result from sympathomimetic drug–induced prolonged distal vasoconstriction, culminating in inflammation.
Source: Neurology Clinical Practice - February 12, 2017 Category: Neurology Authors: Topcuoglu, M. A., Jha, R. M., George, J., Frosch, M. P., Singhal, A. B. Tags: Secondary headache disorders, Stroke in young adults, Other cerebrovascular disease/ Stroke, Infarction, Intracerebral hemorrhage Research Source Type: research

Rapidly progressive bilateral optic nerve and retinal infarctions due to rhinocerebral mucormycosis and pseudoephedrine use
We report rapidly progressive bilateral visual loss from mucormycosis due to bilateral optic nerve and retinal infarction in a patient with diabetes.1
Source: Neurology Clinical Practice - December 11, 2016 Category: Neurology Authors: Merkler, A. E., Duggal, I., Kaunzner, U., Maciel, C. B., Miller, A. M., Scognamiglio, T., Dinkin, M. J. Tags: MRI, Other cerebrovascular disease/ Stroke, Fungal infections, Clinical neurology examination, Visual loss Case Source Type: research

Stuttering lacunar infarction captured on serial MRIs
A 61-year-old man with a history of untreated hyperlipidemia presented with acute onset of dysarthria and right-sided weakness. His symptoms had improved but not resolved upon arrival at the hospital (NIH Stroke Scale [NIHSS] score was 4). Brain MRI showed a hyperintense lesion in the medial left pons on diffusion-weighted imaging (DWI) with a matching area of hypointensity on apparent diffusion coefficient map. The fluid-attenuated inversion recovery (FLAIR) sequence showed no changes in this area, suggesting a hyperacute lesion. There was no evidence of focal stenosis of the large intracranial vessels (figure 1) or intra...
Source: Neurology Clinical Practice - October 16, 2016 Category: Neurology Authors: Tahsili-Fahadan, P., Simpkins, A. N., Leigh, R., Merino, J. G. Tags: MRI, All Cerebrovascular disease/Stroke Case Source Type: research

Decompressive craniectomy in malignant middle cerebral artery infarction: To be, or not to be?
Complete or subtotal infarction in the territory of the middle cerebral artery (MCA) may be complicated by the formation of a space-occupying cerebral edema, which leads to fatal transtentorial herniation within a few days. Even maximum conservative treatment may not change the course of the disease substantially. These so-called malignant MCA infarctions (MMI) are, therefore, life-threatening events and survivors have permanent disability.1
Source: Neurology Clinical Practice - October 16, 2016 Category: Neurology Authors: Neugebauer, H., Woitzik, J. Tags: All Cerebrovascular disease/Stroke, Clinical trials Systematic review/meta analysis, Critical care, Infarction Editorial Source Type: research

Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics
Conclusions: Language discordance was not associated with acute stroke misdiagnosis among patients treated with IV tPA. Prospective evaluation of communication during acute stroke encounters is needed to gain clarity on the role of language discordance in acute stroke misdiagnosis.
Source: Neurology Clinical Practice - October 16, 2016 Category: Neurology Authors: Rostanski, S. K., Williams, O., Stillman, J. I., Marshall, R. S., Willey, J. Z. Tags: Clinical neurology history, All Cerebrovascular disease/Stroke Research Source Type: research

Early decompressive craniectomy for malignant cerebral infarction: Meta-analysis and clinical decision algorithm
Conclusions: Early DC increases the rate of excellent outcomes, i.e., functional independence, in addition to favorable and unfavorable outcomes; however, these findings must be interpreted within the context of patients' goals of care. We have developed a clinical decision algorithm that incorporates goals of care, which may guide consideration of early DC for MCI in clinical practice.
Source: Neurology Clinical Practice - October 16, 2016 Category: Neurology Authors: Streib, C. D., Hartman, L. M., Molyneaux, B. J. Tags: All Cerebrovascular disease/Stroke, Clinical trials Systematic review/meta analysis, Critical care, Infarction Source Type: research

Swollen superficial temporal artery in dural arteriovenous fistula
A 55-year-old man with no antecedent events was brought to the emergency department by ambulance soon after he suddenly felt motor weakness in the left extremities. Emergency CT demonstrated a right frontal cerebral hemorrhage (figure, A). On admission, he was well-oriented and had left-sided hemiparesis. He could barely lift his left knee, and his left upper extremity was completely paralytic. The bilateral superficial temporal arteries (STAs) were notably swollen (figure, B), which the patient reported he had noticed about 1 year prior. Carotid angiography disclosed multiple dural arteriovenous fistulas (dAVFs) at the su...
Source: Neurology Clinical Practice - August 14, 2016 Category: Neurology Authors: Haisa, T., Shojima, M. Tags: All Cerebrovascular disease/Stroke, Arteriovenous malformation, Intracerebral hemorrhage Case Source Type: research

Stroke due to large vessel atherosclerosis: Five new things
Purpose of review: Extracranial (EC) and intracranial (IC) large vessel atherosclerosis account for about 20% of ischemic stroke cases. In recent years, new treatments have emerged for treatment of both EC and IC disease. Recent findings: The stroke rate in patients with carotid stenosis is decreasing with modern medical therapy. For patients with asymptomatic stenosis, the stroke rate is likely <1% per year. Some subsets of patients with symptomatic carotid disease benefit less from revascularization, and medical management can be considered in these patients. A second clinical trial has confirmed that aggressive medi...
Source: Neurology Clinical Practice - June 12, 2016 Category: Neurology Authors: Marulanda-Londono, E., Chaturvedi, S. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Infarction Review Source Type: research

Practice Current: What is your diagnostic evaluation of cryptogenic stroke?
Cryptogenic stroke (CS) accounts for up to one-third of cases of stroke or TIA.1 CS is defined as brain infarction not attributable to a source of definite cardioembolism, large artery atherosclerosis, or small artery disease despite extensive vascular, cardiac, and serologic evaluation.2 Patients with CS are heterogeneous by definition and the pathogenic mechanism of CS remains contested. Some authors have stressed the potential role of occult embolism as the prominent etiology for CS and have identified a subset of cases of CS as embolic strokes of undetermined source, defined as a nonlacunar brain infarct without proxim...
Source: Neurology Clinical Practice - June 12, 2016 Category: Neurology Authors: Bartolini, L. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Infarction Commentary Source Type: research

Minor ischemic stroke: Triaging, disposition, and outcome
Conclusions: Outpatient evaluation of patients with nondisabling minor stroke is potentially cost-effective after excluding large artery atherosclerosis and ensuring a rapid access outpatient evaluation. Larger studies on the cost-effectiveness and safety of this approach are necessary.
Source: Neurology Clinical Practice - April 3, 2016 Category: Neurology Authors: Yaghi, S., Willey, J. Z., Khatri, P. Tags: All Cerebrovascular disease/Stroke, Infarction Review Source Type: research

Ipsilateral eye closure and hemifacial weakness: Useful clinical clue to diagnose pseudostroke
A 16-year-old boy with anxiety was admitted for evaluation of acute-onset left face/hemibody numbness and weakness. Because of the possibility of an acute stroke, he was admitted to an outside hospital and underwent extensive investigations before transfer to our center. On examination, left hemifacial weakness was seen with pulling of the angle of the mouth to the right and left eye closure (video at Neurology.org/cp). CT head, CT perfusion, MRI, and magnetic resonance angiography of the brain did not show any evidence of ischemia or vasculopathy. EEG was normal. Symptoms resolved completely within several weeks with phys...
Source: Neurology Clinical Practice - February 15, 2016 Category: Neurology Authors: Gillson, N., Khuhro, A. L., Ghosh, D. Tags: Childhood stroke, Clinical neurology examination, Pediatric conversion, Conversion Case Source Type: research

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