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Afternoon Tea Hemichorea
A 78-year-old woman, with a medical history of hypertension, presented to the Accident & Emergency Department after a sudden onset of right-sided involuntary movements while she was having afternoon tea with her friends. Examination showed isolated unilateral chorea, affecting the right arm and leg (Video 1). Her blood glucose and sodium levels were normal. The MRI head scan showed a left globus pallidus infarct (Figure). Tetrabenazine was prescribed with very good response and weaned off after 4 weeks. Hyperkinetic movement disorders are uncommon in acute stroke (1%).1 Lesions in regions functionally connected to the ...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Williams, S., Kirby, J., Garcia, A. M. Tags: MRI, Clinical neurology examination, Chorea, All Cerebrovascular disease/Stroke, Infarction Case Source Type: research

Loss of Vision Because of Bilateral Lateral Geniculate Body Infarction After Traumatic Brain Injury
In patients with TBI, LPG infarction as a consequence of descending transtentorial herniation should be considered as a possible etiology of bilateral blindness.
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Rausch, C., Bartsch, L., Gorodetski, B., Salih, F. Tags: MRI, Visual loss, All Cerebrovascular disease/Stroke, Brain trauma, Evoked Potentials/Visual Case Source Type: research

Caveats to Acute Imaging for Acute Stroke in the Setting of Venoarterial Extracorporeal Membrane Oxygenation
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for cardiorespiratory support in medically refractory cases. The high rate of neurologic complications, specifically cerebrovascular disorders such as acute ischemic stroke, in VA-ECMO patients frequently prompts the acquisition of neuroimaging studies such as CT with angiography and perfusion imaging. Clinicians must be familiar with the ECMO-related artifacts when interpreting such studies. Here, we describe a case of asymmetric contrast opacification in a VA-ECMO patient with axillary artery cannulation.
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Viamonte, M. A., Yu, J., Echevarria, F. D., Nagae, L., Youn, T. S., Tahsili-Fahadan, P., Simpkins, A. N. Tags: Stroke in young adults, CT, All Cerebrovascular disease/Stroke Case Source Type: research

Catastrophic Cerebral Fat Embolism Syndrome Lacks Hyperacute MRI Findings
In patients who experience stroke due to cerebral fat embolism, hyperacute MRI may lack the characteristic diffusion-weighted imaging/fluid-attenuated inversion recovery changes expected in acute ischemic stroke.
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Gusler, M. T., Vagal, A., Gilday, S. D., Flaherty, M. L. Tags: Stroke in young adults, MRI, Other cerebrovascular disease/ Stroke, Hematologic, Embolism Case Source Type: research

Progressive and Fatal Brainstem Stroke in Systemic Giant Cell Arteritis
A 74-year-old woman presented with acute worsening of a 6-month long history of vertigo and postural instability with MRI evidence of cerebellar and brainstem acute infarcts. Extensive neurovascular assessment revealed a severe vascular damage with multiple stenoses and occlusions along the vertebrobasilar axis (Figure 1). Duplex ultrasonography showed hypoechoic halo sign along facial artery, whereas PET-CT highlighted increased fluorine-18-fluorodeoxyglucose uptake along vertebral and other larger arteries, thus allowing a diagnosis of giant cell arteritis (Figure 2).1,2 Despite prompt treatment with high-dose steroids a...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Poretto, V., Piffer, S., Bignamini, V., Tranquillini, E., Donner, D., Cavatorta, F. P., Barbareschi, M., Petralia, B., Giometto, B. Tags: MRI, PET, Ultrasound, Vasculitis Case Source Type: research

Nurses: The Missing Link in Continuous EEG Monitoring?
The past decade has been marked by the advent of continuous EEG (cEEG) monitoring, which is now recommended as the standard of care in numerous medical conditions seen in the neurologic intensive care unit (ICU).1,2 In clinical practice, its main indications are seizure detection, treatment monitoring, and prognostication in various conditions such as seizures/status epilepticus, ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, brain tumor, encephalitis/sepsis-associated encephalopathy, extracorporeal membrane oxygenation, targeted temperature management, and cardiac arrest.2,3
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Jacq, G., Legriel, S. Tags: Practice Current, EEG Editorial Source Type: research

Human Herpesvirus 6 in the CSF of a Woman With New-Onset Seizures: Encephalitis or Genomic Integration?
Human herpesvirus 6 (HHV-6) can successfully integrate itself into the human genome, which may complicate the diagnosis of HHV-6 encephalitis. Headache and visual symptoms can rarely be caused by epileptic seizure (ictal headache and hemicrania epileptica).
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Wenner, A. M., Weitz, L., Ostertag, K., Hubmer, S., Springer, E., Stoiser, B., Baumgartner, C., Riederer, F. Tags: Encephalitis, All Cerebrovascular disease/Stroke, EEG; see Epilepsy/Seizures Case Source Type: research

Giant Lumbar Pseudomeningocele Compression Mimicking Stroke and Seizure
Acute awareness impairment, confusion, or other neurologic symptoms occurring in supine position should raise the possibility of transient intracranial hypertension, notably through the compression of a possible pseudomeningocele.
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: d'Esneval, M., Zegarek, G., Pugin, D., Vargas, M. I., Tessitore, E., Vulliemoz, S. Tags: EEG; see Epilepsy/Seizures, Syncope Case Source Type: research

Familial Cerebral Cavernous Malformation Mimicking Cerebral Amyloid Angiopathy
A 67-year-old man was referred from ophthalmology for possible cerebral amyloid angiopathy (CAA) discovered during work-up of possible optic neuropathy. MRI (figure) demonstrated innumerable periventricular, brainstem, and cortical cerebral microhemorrhages (CMHs). Scattered, nonspecific white matter hyperintensities were seen on T2-weighted imaging without surrounding hypointense rim. He had no hypertension, and the distribution was uncharacteristic for CAA. Despite absent family history of stroke or seizure, testing for familial cerebral cavernous malformation (FCCM) identified a pathogenic mutation of KRIT1 (c.382G>T).
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Ridha, M., Aziz, Y., Broderick, J. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Case Source Type: research

Thrombotic Thrombocytopenic Purpura Without Schistocytes: Beware of Misdiagnosis
A 43-year-old woman was admitted for acute unusual headache, vertigo, and left upper limb weakness. She had been complaining of asthenia for the past few weeks. Her medical history included uterine cervix cancer treated with conisation and 2 pregnancies without serious complications. No allergy or recent drug introduction was noted. After ruling out current pregnancy, magnetic resonance imaging (MRI) was immediately performed and showed recent ischemic strokes in multiple territories. Doppler ultrasound imaging showed no carotid or vertebral arteries lesion. Electrocardiogram showed no ST elevation or atrial fibrillation, ...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Decker, P., Moulinet, T., Revuz, S., Perez, P., Jaussaud, R. Tags: Autoimmune diseases, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research

Wearables for Neurologic Conditions: Considerations for Our Patients and Research Limitations
We present a narrative review to raise awareness of wearable technologies that may be relevant to the field of neurology. We also discuss the implications of these wearables for our patients and briefly discuss issues related to researching new wearable technologies. Recent Findings There are a variety of wearables for neurologic conditions, e.g., stroke (for potential arrhythmia capture), epilepsy, Parkinson disease, and sleep. Research is being performed to capture the risk of neuropsychiatric relapse. However, data are limited and adherence to these wearables is often poorly studied. Summary The care of neurology pati...
Source: Neurology Clinical Practice - August 9, 2021 Category: Neurology Authors: Minen, M. T., Stieglitz, E. J. Tags: Parkinson's disease/Parkinsonism, All Cerebrovascular disease/Stroke, All Sleep Disorders, All Epilepsy/Seizures Review Source Type: research

Neuromelioidosis Presenting as a Stroke-like Syndrome
Clinically, neuromelioidosis can present with varying clinical features including a stroke-like syndrome. In the presence of characteristic findings on magnetic resonance imaging, neuromelioidosis should be suspected even in nonendemic regions.
Source: Neurology Clinical Practice - August 9, 2021 Category: Neurology Authors: Jabeen, S., Saini, J., Mishra, T., Mailankody, P., TS, L., Chandrashekar, N. Tags: MRI, Bacterial infections, Critical care Case Source Type: research

Cerebral Vasoconstriction After Carotid Endarterectomy and the Role of Conventional Cerebral Angiography
Hemorrhage after carotid revascularization should prompt detailed vascular imaging such as serial conventional angiograms.
Source: Neurology Clinical Practice - August 9, 2021 Category: Neurology Authors: Tolla, A. S., Farooq, M. U., Haveman-Gould, B., Naisan, G., Gorelick, P. B. Tags: Other cerebrovascular disease/ Stroke, Subarachnoid hemorrhage Case Source Type: research

Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS
Conclusions The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.
Source: Neurology Clinical Practice - August 9, 2021 Category: Neurology Authors: Ford, C. D., Gray, M. S., Crowther, M. R., Wadley, V. G., Austin, A. L., Crowe, M. G., Pulley, L., Unverzagt, F., Kleindorfer, D. O., Kissela, B. M., Howard, V. J. Tags: All Cerebrovascular disease/Stroke, Depression, Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), All epidemiology Research Source Type: research

Variability of the Modified Rankin Scale Score Between Day 90 and 1 Year After Ischemic Stroke
Conclusion We describe the patient-level spectrum of mRS change from day 90 to 1 year after ischemic stroke in 3 high-quality randomized trials. The patient-level shifts consisted of a sufficiently counterbalanced number of mRS improvements and declines, which masked clinical evolution occurring in over one-third of patients. These results may have important implications, both for clinical trial design and outcome adjudication in stroke research and duration of rehabilitative therapy.
Source: Neurology Clinical Practice - June 7, 2021 Category: Neurology Authors: de Havenon, A., Tirschwell, D. L., Heitsch, L., Cramer, S. C., Braun, R., Cole, J., Reddy, V., Majersik, J. J., Lindgren, A., Worrall, B. B. Tags: Other cerebrovascular disease/ Stroke, All Rehabilitation, Infarction Research Source Type: research

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