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Uncontrolled inflammation of the nervous system: Inherited CD59 deficiency
Eculizumab may be effective in reversing neurologic symptoms of inherited CD59 deficiency.
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Yuksel, D., Oguz, K. K., Azapagası, E., Kesici, S., Cavdarli, B., Konuskan, B., Topaloglu, H. Tags: Childhood stroke, Peripheral neuropathy, All Spinal Cord, All Demyelinating disease (CNS), All Genetics Case Source Type: research

Subclavian steal syndrome due to dialysis fistula corrected with subclavian artery stenting
Consider stenting of the proximal subclavian artery to correct symptomatic subclavian steal syndrome due to dialysis arteriovenous fistula.
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Agarwal, S., Schwartz, L., Kwon, P., Selas, G., Farkas, J., Arcot, K., Tiwari, A. Tags: All Imaging, All Cerebrovascular disease/Stroke Case Source Type: research

Rheumatoid meningitis: A rare cause of aseptic meningitis with frequently stroke-like episodes
Conclusions RM is a rare manifestation of RA and often presents with stroke-like episodes. It is currently not implemented in the workup of aseptic meningitis in national guidelines. Crucial clues for diagnosis included recurrent stroke-like episodes refractory to antiepileptic treatment, headache and constitutional symptoms, meningeal enhancement on MRI, CSF pleocytosis, and positive serology findings for ACPA and RF. Prognosis is favorable with early immunosuppressive treatment.
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Schuster, S., Braass, H., Iking-Konert, C., Schnoor, U., Matschke, J., Gerloff, C., Thomalla, G., Magnus, T. Tags: Autoimmune diseases, Meningitis, All Clinical Neurology Review Source Type: research

Autoimmune limbic encephalitis in association with acute stroke
A 60-year-old woman with no known medical history presented with acute-onset altered mental status and aphasia. She was in her usual state of health until the time of presentation. She was found to have left middle and posterior cerebral artery (MCA and PCA) acute ischemic strokes and subsequently developed refractory status epilepticus. CT angiography showed moderate stenosis of the proximal left internal carotid artery (ICA), occlusion of the right ICA at its origin, and near-complete occlusion of the left vertebral artery (figure). Strokes were attributed to large-vessel atherosclerotic disease in the setting of multipl...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Kaas, B., Zeiler, S. R., Bahouth, M. N., Llinas, R. H., Probasco, J. C. Tags: All Immunology, All Cerebrovascular disease/Stroke Case Source Type: research

Challenges of diagnosing and treating Charles Bonnet syndrome
Charles Bonnet syndrome (CBS) is characterized by complex visual hallucinations in visually impaired but otherwise psychologically normal individuals.1 CBS is primarily diagnosed in patients with an ophthalmic disease but is also seen in stroke patients with hemianopsia.2 Treatment of these vivid hallucinations is challenging and there is no standard treatment. Here, we present a stroke patient with CBS successfully treated with melperone.
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Franke, M., Rauschenberger, L., Fluri, F. Tags: Visual loss, All Cerebrovascular disease/Stroke, Hallucinations Case Source Type: research

Papillary fibroelastoma, an unexpected cause of stroke: Outcomes after acute reperfusion therapy
We present 3 cases of cardiac papillary fibroelastoma (PFE) revealed by acute ischemic stroke (table).
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Moreno-Estebanez, A., Luna Rodriguez, A., Ugarriza Serrano, I., Blanco Martin, E., Gonzalez-Pinto, T., Larrazabal Lopez, J., Perez-Concha, T. Tags: All Cerebrovascular disease/Stroke, Cardiac, Embolism Case Source Type: research

Multifocal stroke with proliferation of small cerebral arteries in hepatopulmonary syndrome
Cirrhosis of the liver has been linked to several changes in risk of cerebrovascular disease and may increase the risk of hemorrhage while reducing the risk of ischemic stroke.1,2 The pathophysiology underlying these changes remains unclear, though intracranial hemorrhage and vascular malformations related to liver disease have been described.1,3 Cirrhosis may be complicated by hepatopulmonary syndrome (HPS), in which distal pulmonary arteries dilate, become tortuous, produce shunt physiology, and often produce arteriovenous (AV) malformations.4
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Younce, J. R., Cross, D. T., Goyal, M. S., Lee, J.-M. Tags: MRI, Other cerebrovascular disease/ Stroke, Gastrointestinal, Arteriovenous malformation Case Source Type: research

Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality
Conclusions In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease.
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Sico, J. J., Baye, F., Myers, L. J., Concato, J., Ferguson, J., Cheng, E. M., Jadbabaie, F., Yu, Z., Arling, G., Zillich, A. J., Reeves, M. J., Williams, L. S., Bravata, D. M. Tags: All Cerebrovascular disease/Stroke Research Source Type: research

Stroke code simulation benefits advanced practice providers similar to neurology residents
Conclusion Simulation training is a beneficial part of medical education for APPs and should be considered in addition to traditional didactics and clinical training. Further research is needed to determine whether simulation education of APPs results in improved treatment times and outcomes of acute stroke patients.
Source: Neurology Clinical Practice - April 9, 2018 Category: Neurology Authors: Khan, M., Baird, G. L., Price, T., Tubergen, T., Kaskar, O., De Jesus, M., Zachariah, J., Oostema, A., Scurek, R., Coleman, R. R., Sherman, W., Hingtgen, C., Abdelhak, T., Smith, B., Silver, B. Tags: All Cerebrovascular disease/Stroke, Methods of education Research Source Type: research

Carotid ergotism with retinal ischemia
Ergot poisoning was first described more than 2,000 years ago with the consumption of food contaminated with mycotoxins. It acquired special importance during the 20th century because of an excessive consumption of ergot pharmaceuticals as symptomatic treatment of migraine.1,2
Source: Neurology Clinical Practice - April 9, 2018 Category: Neurology Authors: Altuna-Azkargorta, M., Herrera-Isasi, M., Zandio-Amorena, B., Bacaicoa-Saralegui, M. C. Tags: Migraine, All Clinical Neurology, All Cerebrovascular disease/Stroke, Critical care Case Source Type: research

Sickle cell disease, fat embolism syndrome, and "starfield" pattern on MRI
A 45-year-old man with history of hemoglobin sickle cell disease (SCD) was admitted to the medical intensive care unit from an outside hospital with a several-day history of progressive chest and extremity pain, fever, tachycardia, tachypnea, and hypoxemia, and underwent red cell exchange for acute chest syndrome. He concomitantly developed progressive decline in mental status over several hours. His examination was notable for Glasgow Coma Scale 5 with no motor response to pain, and he was subsequently intubated.
Source: Neurology Clinical Practice - April 9, 2018 Category: Neurology Authors: Kang, J. H., Hargett, C. W., Sevilis, T., Luedke, M. Tags: Stroke in young adults, MRI, All Cerebrovascular disease/Stroke, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke, Embolism Case Source Type: research

Using light microscopy for diagnosing the cause of a case of acute stroke
A 60-year-old febrile man was transferred to the emergency department after being found alone and unconscious in a park. No medical history was available. Brain CT revealed a hyperdense lesion in the basilar artery (figure, A) suggesting a thromboembolic occlusion, which was subsequently thromboaspirated (figure, B and C). The fresh thrombus was retrieved (figure, D) and urgently analyzed using light microscopy, which revealed colonies of gram-positive bacilli (figure, E). A cardiac echogram showed severe mitral valve insufficiency and vegetations on its anterior leaflet (figure, F). After mitral valve repair and a long co...
Source: Neurology Clinical Practice - April 9, 2018 Category: Neurology Authors: Hajdu, S. D., Maillard, M., Antiochos, P., Saliou, G. Tags: Stroke in young adults, All Infections, Embolism Case Source Type: research

Wake-up stroke is not associated with sleep-disordered breathing in women
Conclusions In this population-based study, WUS represented about 30% of all generally mild severity ischemic strokes in women and was not associated with SDB.
Source: Neurology Clinical Practice - February 12, 2018 Category: Neurology Authors: Brown, D. L., Li, C., Chervin, R. D., Case, E., Garcia, N. M., Tower, S. D., Lisabeth, L. D. Tags: All Cerebrovascular disease/Stroke, Sleep apnea Research Source Type: research

Pilot study of volume contracted state and hospital outcome after stroke
Conclusions Acute stroke patients in a VCS demonstrate worse short-term outcomes compared to euvolemic patients, independent of infarct size. Results suggest an opportunity to explore current hydration practices.
Source: Neurology Clinical Practice - February 12, 2018 Category: Neurology Authors: Bahouth, M. N., Gaddis, A., Hillis, A. E., Gottesman, R. F. Tags: Outcome research, Medical care, All Cerebrovascular disease/Stroke, Critical care Source Type: research

Anticoagulation for atrial fibrillation after intracranial hemorrhage: A systematic review
Conclusions NVAF is highly prevalent among ICH survivors. The risks of IS, recurrent ICH, and mortality are heightened in this group. Most published data show a net benefit in terms of IS prevention and mortality when anticoagulation is restarted. However, those studies are observational and mostly retrospective, therefore selection bias may play a major role in the results observed in these cohorts. Only randomized controlled trials, either pragmatic or explanatory, can provide more conclusive answers for this important clinical question.
Source: Neurology Clinical Practice - February 12, 2018 Category: Neurology Authors: Hawkes, M. A., Rabinstein, A. A. Tags: Stroke prevention, Embolism, Intracerebral hemorrhage Review Source Type: research

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