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Teaching NeuroImages: Eagle syndrome: Cerebrovascular complications
A 70-year-old man developed acute onset of aphasia and right-sided hemiplegia in the setting of mild hypotension after hemodialysis. Brain MRI (figure, D and E) revealed diffusion restriction in the left anterior and middle cerebral artery territories. Brain CT (figure, A–C) was significant for an elongated styloid process causing mild compression of the left internal carotid artery. A comprehensive workup for stroke etiology was otherwise unremarkable.
Source: Neurology - July 10, 2016 Category: Neurology Authors: Kavi, T., Lahiri, S. Tags: CT, MRI, All Cerebrovascular disease/Stroke, All Neurotology, Critical care RESIDENT AND FELLOW SECTION Source Type: research

One Little Mind, Our Lie, Dr. Lie
Medicine, like life, is made up of moments. Their significance may not be apparent while you are living them, but become clearer when recalled through the fog of memory. Here is a moment that haunts me, making me wish that I had done things differently—recording, storing, and enjoying its significance.
Source: Neurology - July 10, 2016 Category: Neurology Authors: Smith, M. S. Tags: All Cerebrovascular disease/Stroke, Aphasia REFLECTIONS: NEUROLOGY AND THE HUMANITIES Source Type: research

Early effect of intra-arterial treatment in ischemic stroke on aphasia recovery in MR CLEAN
Conclusions: IAT results in better early recovery from aphasia than usual care alone. The early effect of IAT on aphasia is smaller than the effect on motor deficits. Classification of evidence: This study provides Class II evidence that for patients with acute ischemic stroke IAT increases early recovery from aphasia and that the early effect on aphasia, as measured by the NIHSS, is smaller than the effect on motor deficits.
Source: Neurology - May 29, 2016 Category: Neurology Authors: Crijnen, Y. S., Nouwens, F., de Lau, L. M. L., Visch-Brink, E. G., van de Sandt-Koenderman, M. W. M. E., Berkhemer, O. A., Fransen, P. S. S., Beumer, D., van den Berg, L. A., Lingsma, H. F., Roos, Y. B. W. E. M., van der Lugt, A., van Oostenbrugge, R. J., Tags: Clinical trials Randomized controlled (CONSORT agreement), Aphasia, Infarction ARTICLE Source Type: research

Combined PET/MRI: Multimodality insights into acute stroke hemodynamics
A 61-year-old man underwent simultaneous PET/MRI 5.5 hours after sudden onset of aphasia (NIH Stroke Scale 4), which revealed a diffusion/perfusion mismatch of different extents as measured with pulsed arterial spin-labeling MRI (59 mL), perfusion-weighted MRI (27 mL), and [15O]H2O-PET (36 mL) (figure). Due to spontaneous recanalization, the penumbra tissue did not progress towards infarction. This demonstrates that the outcome of critically hypoperfused stroke brain tissue may be favorable even without sufficient collateral flow and without therapeutic intervention.1 Here, PET/MRI offers the chance to cross-evaluate MRI-b...
Source: Neurology - May 15, 2016 Category: Neurology Authors: Werner, P., Saur, D., Mildner, T., Moller, H., Classen, J., Sabri, O., Hoffmann, K.-T., Barthel, H. Tags: MRI, PET, DWI, All Cerebrovascular disease/Stroke NEUROIMAGES Source Type: research

Drawing on the right brain for aphasia recovery
Champions of the right brain as a wheelhouse for cognition in stroke recovery, take heart. Evidence inconsistent with Marcel Kinsbourne's theory of transcallosal interhemispheric inhibition1 has long been available. However, some researchers maintain that the main influence of right brain regions in patients with aphasia due to stroke is to further disrupt or reduce the functional activation of already damaged left brain language networks. The study presented by Pani et al.2 in this issue of Neurology® will help restore depth to this important issue.
Source: Neurology - April 24, 2016 Category: Neurology Authors: Barrett, A. M., Hamilton, R. H. Tags: MRI, All Cerebrovascular disease/Stroke, Aphasia, All Rehabilitation, Plasticity EDITORIALS Source Type: research

Right hemisphere structures predict poststroke speech fluency
Conclusions: Right hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia. This may indicate premorbid anatomical variability beneficial for recovery or be the result of poststroke remodeling.
Source: Neurology - April 24, 2016 Category: Neurology Authors: Pani, E., Zheng, X., Wang, J., Norton, A., Schlaug, G. Tags: MRI, All Cerebrovascular disease/Stroke, Aphasia, All Rehabilitation, Plasticity ARTICLE Source Type: research

Detecting Cognitive Impairment in Acute Stroke Using the Oxford Cognitive Screen: Characteristics of Left and Right Hemisphere Strokes, with More Severe Impairment in AF Strokes (P1.190)
CONCLUSIONS: it is feasible to use the OCS in acute stroke, and it can detect deficits in multiple domains which might otherwise have eluded detection. The frequency of such deficits is high, and higher in patients in AF. The OCS can pick up differences in functional performance between left and right hemisphere strokes which can guide rehabilitation and monitor progress. A pie chart summarises the distribution of domains affected.Disclosure: Dr. Collas has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Collas, D. Tags: Ischemic Stroke Outcomes Source Type: research

Factors Associated with Follow-Up in Stroke Clinic after Hospital Discharge (P2.323)
Conclusions: Stroke clinic follow-up is best achieved in patients admitted to the neurology service. Ensuring standardized discharge instructions with provided time and date of outpatient appointment is the key for successful follow-up.Disclosure: Dr. Bakradze has nothing to disclose. Dr. Taboada has nothing to disclose. Dr. Narwal has nothing to disclose. Dr. Nouh has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Bakradze, E., Taboada, S., Narwal, P., Nouh, A. Tags: Stroke Systems of Care Source Type: research

Recurrent Alternating Homonymous Hemianopia Due to Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-Like Episodes (MELAS) (P4.260)
CONCLUSIONS: We describe a unique phenomenon of recurrent alternating homonymous hemianopia in MELAS, which should prompt consideration of this diagnosis.Disclosure: Dr. Krysko has nothing to disclose. Dr. Arun has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Krysko, K., Arun, S. Tags: Neuro-ophthalmology/Neuro-otology Source Type: research

Domain general neurocognitive networks: A new player in poststroke recovery from aphasia?
The clinical neurology of speech production has long been mounted on the assumption of functional localization to the Broca area. Since its inception, however, this notion has proved controversial.1 The Wernicke-Lichtheim tradition, which continues, in its more recent incarnations, to underpin worldwide neurologic practice, postulated a strictly localized center for speech production. A second line of thought, represented by neurologists such as Hughlings Jackson, Sigmund Freud, and Alexander Luria, conceived of language production as hierarchical gradients organized around, but extending beyond, motor mechanisms of speech...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Saling, M. M. Tags: All Cerebrovascular disease/Stroke, Aphasia EDITORIALS Source Type: research

Network dysfunction predicts speech production after left hemisphere stroke
Conclusions: Speech production is dependent on complex interactions among widely distributed brain networks, indicating that residual speech production after stroke depends on more than the restoration of local domain-specific functions. Our understanding of the recovery of function following focal lesions is not adequately captured by consideration of ipsilesional or contralesional brain regions taking over lost domain-specific functions, but is perhaps best considered as the interaction between what remains of domain-specific networks and domain-general systems that regulate behavior.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Geranmayeh, F., Leech, R., Wise, R. J. S. Tags: All Cerebrovascular disease/Stroke, Aphasia ARTICLE Source Type: research

Case Report - IV Thrombolysis with Subsequent SAH in Setting of Occult Spontaneous MCA Dissection (P4.346)
Conclusions: Spontaneous isolated middle cerebral artery dissection is a rare entity which most commonly presents as ischemic stroke and may complicate the administration of IV-rtPA. It should be considered in cases of thrombolysis and development of subsequent SAH.Disclosure: Dr. Saeed has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Bunka has nothing to disclose. Dr. Razak has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Saeed, A., Chaudhry, S., Bunka, J., Razak, A. Tags: Cerebrovascular Case Reports Source Type: research

Unique CT Perfusion Imaging in a Case of HaNDL: New Insight into Pathophysiology of Acute Attacks (P4.114)
Conclusions: The pattern of global left hemispheric hypoperfusion seen in this case supports previous hypotheses of secondary oligemia induced by a hemispheric wave of cortical spreading depression (CSD). However, the right ACA territory hypoperfusion represents a phenomenon never previously reported in this field. We speculate that the secondary vasomotor changes induced by CSD in the left hemisphere, spread to the right hemisphere via the anomalous vascular supply. Such a mechanism of direct vascular propagation through vessel gap junctions has been described in animal studies. This unique case provides a valuable contri...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Burke, M., Lamb, M., Hohol, M., Lay, C. Tags: Headache: Imaging and Other Source Type: research

Formal Education, Socioeconomic Status and Severity of Neglect (P1.119)
Conclusions: These findings suggest that higher years of education do not decrease the severity of neglect in patients after stroke involving the non-dominant hemisphere. Unlike language disorders, neglect does not seem to be affected by education level. Patients from higher SES class showed less severe neglect; further research is needed to determine if this can be explained by differences in stroke characteristics, brain characteristics (e.g. leukoareosis), or interventions.Disclosure: Dr. Kharal has nothing to disclose. Dr. Suneja has nothing to disclose. Dr. Hillis received personal compensation in an editorial capacit...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kharal, A., Suneja, A., Hillis, A. Tags: Cerebrovascular Disease: Epidemiology Source Type: research

Aphasia Is an Independent Risk Factor Affecting Acute Stroke Outcomes (P1.186)
CONCLUSIONS: Aphasia is independently associated with increased length of stay and complications during the acute stroke admission, with an impact at least comparable to hemiparesis. There was equivalent disability at discharge. These data suggest that greater attention is needed on developing adaptive communication skills during this period to improve outcomes.Disclosure: Dr. Lazar has received personal compensation for activities with Claret Medical, Inc. Dr. Boehme has nothing to disclose. Dr. Marshall has received personal compensation in an editorial capacity for JAMA Neurology. Dr. Martin-Schild has received personal...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Lazar, R., Boehme, A., Marshall, R., Martin-Schild, S. Tags: Ischemic Stroke Outcomes Source Type: research

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