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Source: Neurology Clinical Practice
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Total 200 results found since Jan 2013.
Do efforts to decrease door-to-needle time risk increasing stroke mimic treatment rates?
An unintended consequence of rapid thrombolysis may be more frequent treatment of stroke mimics, nonvascular conditions that simulate stroke. We explored the relationship between door-to-needle (DTN) times and thrombolysis of stroke mimics at a single academic center by analyzing consecutive quartiles of patients who were treated with IV tissue plasminogen activator for suspected stroke from January 1, 2010 to February 28, 2014. An increase in the proportion of stroke mimic patients (6.7% in each of the 1st and 2nd, 12.9% in the 3rd, and 30% in the last consecutive case quartile; p = 0.03) and a decrease in median DTN time...
Source: Nature Clinical Practice - June 8, 2015 Category: Neurology Authors: Liberman, A. L., Liotta, E. M., Caprio, F. Z., Ruff, I., Maas, M. B., Bernstein, R. A., Khare, R., Bergman, D., Prabhakaran, S. Tags: Harm/ risk (analysis), All Cerebrovascular disease/Stroke, Infarction Eye on Practice Source Type: research
Freezing of gait after a hemorrhagic stroke can respond to venlafaxine and rivastigmine
We describe successful treatment of FOG developing after a hemorrhage with venlafaxine and rivastigmine.
Source: Nature Clinical Practice - June 8, 2015 Category: Neurology Authors: Sarva, H., Deik, A., Swan, M. C., Severt, W. L. Tags: Gait disorders/ataxia, Intracerebral hemorrhage Cases Source Type: research
Blood pressure management in stroke: Five new things
Source: Nature Clinical Practice - April 13, 2015 Category: Neurology Authors: Lattanzi, S., Silvestrini, M., Bowry, R., Navalkele, D., Gonzales, N. Tags: The Nerve! Readers Speak Source Type: research
"Metastatic" embolic lesions and enlarging pseudoaneurysms associated with cardiac myxoma
Myxoma is the most common primary cardiac tumor, with a reported incidence of 0.5 cases per million people. The initial triad of symptoms includes obstructive cardiac signs present in 60%, constitutional systemic symptoms in 30%, and embolic manifestations in 30%–40% of the cases. The left atrium is the most common location of these tumors. There is high prevalence of systemic embolism, with cerebral involvement accounting for half of the cases.1
Source: Nature Clinical Practice - April 13, 2015 Category: Neurology Authors: Chacon-Quesada, T., Maud, A., O'Neill, T. J., Ramos-Duran, L., Akle, N., Cruz-Flores, S., Rodriguez, G. J. Tags: All Imaging, Other cerebrovascular disease/ Stroke, Metastatic tumor, Cardiac, Embolism Cases Source Type: research
Aspirin and intracerebral hemorrhage: Where are we now?
For the past 3 decades, aspirin has been widely used for prevention of ischemic stroke and myocardial infarction. Although the evidence supporting the effectiveness of aspirin in prevention of vascular events is clear, data regarding the risk of acute and recurrent intracerebral hemorrhage related to the use of this medication have been conflicting. We review past and contemporary data on aspirin use in relation to intracerebral hemorrhage.
Source: Nature Clinical Practice - February 16, 2015 Category: Neurology Authors: Behrouz, R., Miller, C. M. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Clinical and Ethical Challenges Source Type: research
Is nonadmission-based care for TIA patients cost-effective?: A microcosting study
We previously demonstrated the safety and effectiveness of a nonadmission-based model for TIA care (Monash TIA Triaging Treatment [M3T]). In this microcosting study, we used a pre–post cohort design with multivariable uncertainty analyses to compare actual resource utilization costs between M3T (years 2004–2007) and the previous admission-based model (2003). Average total episode costs per patient were significantly less for M3T (Australian dollars [AUD] 1,927.00, 95% confidence interval [CI] AUD 1,829.00–1,037.00) compared with the admission-based model (AUD 4,841.00, 95% CI AUD 4,178.00–5,590.00)....
Source: Nature Clinical Practice - February 16, 2015 Category: Neurology Authors: Sanders, L. M., Cadilhac, D. A., Srikanth, V. K., Chong, C. P., Phan, T. G. Tags: Cost effectiveness/economic, Stroke prevention, All Cerebrovascular disease/Stroke, Models of care Eye on Practice Source Type: research
Recurrent paradoxical embolic cerebral ischemia after patent foramen ovale closure
We report a case of recurrent paradoxical brain embolism in spite of PFO closure.
Source: Nature Clinical Practice - February 16, 2015 Category: Neurology Authors: Farina, F. M., Baracchini, C. Tags: Stroke in young adults, Other cerebrovascular disease/ Stroke, Arteriovenous malformation, Embolism, All Genetics Cases Source Type: research
Capgras-like visual decomposition in Lewy body dementia with therapeutic response to donepezil
We report 2 cases of LBD where visual phenomena including Capgras-like syndrome responded favorably to the use of a cholinesterase inhibitor.
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Reimers, K., Emmert, N., Shah, H., Benedict, R. H. B., Szigeti, K. Tags: Hallucinations, Dementia with Lewy bodies, Cognitive neuropsychology in dementia Cases Source Type: research
Spinal dural arteriovenous fistula with intramedullary cord hemorrhage: Diagnostic challenges
We present a man with a SDAVF and associated intramedullary cord hemorrhage.
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Schmidt, K. A., Huang, J. F., Black, D. F., Kaufmann, T. J., Lanzino, G., Kumar, N. Tags: MRI, All Clinical Neurology, All Cerebrovascular disease/Stroke, Spinal cord tumor, All Spinal Cord Cases Source Type: research
Hashimoto encephalopathy with angiographic CNS vasculitis
Hashimoto encephalopathy (HE)—also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis—is a rare syndrome loosely associated with Hashimoto thyroiditis. HE mostly affects middle-aged women; is characterized by delirium, seizures, and myoclonus; and is thought to be an immune-mediated disorder. The pathophysiology of HE is not entirely understood. Most cases appear to be due to autoimmune vasculitis or an immune complex deposition that disrupts the cerebral microvasculature. This immunologic phenomenon has been observed on brain biopsy with a lymphocytic infiltration around small ar...
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Al-Wafai, A., Wahba, M., Doss, V. T., Elijovich, L. Tags: Other cerebrovascular disease/ Stroke, Autoimmune diseases, Vasculitis Cases Source Type: research
Pontine infarction responsible for wall-eyed bilateral internuclear ophthalmoplegia syndrome
A 68-year-old man with hypertension, cardiac arrhythmia, and a mechanical heart valve replacement treated with vitamin K antagonists was admitted for the acute onset of diplopia. Neuro-ophthalmologic examination showed a bilateral exotropia in primary gaze position (wall-eyed) with bilateral adduction deficit that did not improve by convergence (figure, video at Neurology.org/cp). In lateral gaze, a horizontal nystagmus of the abducting eyes appeared. Vertical saccades were normal (video). Pupils were symmetric and reactive to light. Brain MRI with diffusion-weighted images showed an acute pontine ischemic lesion (figure)....
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Mathis, T., Ducray, F., Tilikete, C., Vighetto, A., Biotti, D. Tags: Clinical neurology examination, All Neuro-ophthalmology, Ocular motility, Diplopia (double vision), All Cerebrovascular disease/Stroke Cases Source Type: research
Eight-and-a-half syndrome
A 62-year-old left-handed man with a history of hypertension, hyperlipidemia, and diabetes mellitus awoke with double vision. On examination, the patient had right eye exotropia with left eye midline at rest and conjugate gaze while focusing on an object. He had conjugate horizontal gaze palsy to the left (figure, A). On right lateral horizontal gaze, the patient had impaired left eye adduction with retained ability to abduct the right eye, which evoked a right lateral nystagmus (figure, B). Convergence with near fixation was spared. Additionally, the patient had impaired left eye closure and ipsilateral flattened nasolabi...
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Duffy, A., Shen, P. Y., Verro, P., Nidecker, A. E., Chow, M. Tags: Other cerebrovascular disease/ Stroke, All Neuro-ophthalmology, Diplopia (double vision), All Cerebrovascular disease/Stroke, Infarction Cases Source Type: research
MRI spot sign
A 47-year-old woman presented with fever and acute right subdural hematoma. Her neurologic examination was normal, but she experienced persistent severe headache and repeat CT showed increasing mass effect. Lumbar puncture was deferred for risk of herniation. MRI was performed to evaluate for septations, abnormal enhancement, or other atypical features that would suggest an alternative diagnosis such as subdural empyema. An area of active contrast extravasation was seen on MRI (figure) and corresponded, at surgical evacuation, to a small bleeding artery that was ablated with bipolar cautery. Despite extensive evaluation, n...
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Cutsforth-Gregory, J. K., Black, D. F., Hoffman, E. M., Datar, S. V., Wijdicks, E. F. Tags: MRI, All Cerebrovascular disease/Stroke, Critical care Cases Source Type: research
SMART syndrome: Stroke-like migraine attack after radiation therapy
A 57-year-old woman presented with intense headache 13 years after cranioplasty and radiation treatment for occipital osteosarcoma. Examination showed anomia and paraphasic errors, right homonymous hemianopia, and dysmetria of the right arm. MRI during hospitalization demonstrated diffuse pathologic enhancement in the left parieto-occipital lobe (figure, A) and extensive gyral edema (figure, B and C). EEG while she was symptomatic showed left-predominant posterior quadrant slowing without epileptiform abnormalities. She was diagnosed with stroke-like migraine attacks after radiation therapy (SMART) syndrome and treated wit...
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Wang, N., Prasad, S. Tags: All Headache, MRI, Radiation therapy-tumor Cases Source Type: research
Acute peripheral vestibulopathy in a cocaine addict: Cracking the vestibular nucleus
A previously healthy 58-year-old man developed vertigo, imbalance, nausea, and vomiting shortly after smoking cocaine. He denied hearing loss, double vision, limb weakness, or sensory loss. Examination showed left-beating horizontal nystagmus with a torsional component, skew deviation, and positive right-sided head-impulse test. His urine tested positive for cocaine. Autoimmune workup, lipid panel, and echocardiography were unremarkable. MRI revealed acute right medial vestibular nucleus (VN) infarction (figure, A and B) and subcortical T2 hyperintensities (figure, C). Cerebral angiography was unremarkable. Presenting symp...
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Feyissa, A. M., Masel, T., Busby, S. P. Tags: Stroke in young adults, Nystagmus, All Neurotology, Vertigo, Cocaine Cases Source Type: research
