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Aphasia, Apraxia and Neglect Due to Stroke in the Light of the "Dual-Loop-Model" (P6.217)
The dual-loop-model proposes a domain general brain framework, consisting of two parallel loops connecting frontal with parietal and temporal cortex along long association tracts, which course either above ("dorsal") or below ("ventral") the sylvian fissure with different computational abilities ("sequences" versus "structure"). The dorsal system serves fast sensorimotor mapping ("dorso-dorsal"), blue prints (e.g. "tool use") and working memory ("dorso-ventral"). Structural analysis in the ventral system is slow and deep, maps sensory onto (lexical) conceptual representations to extract meaning or when categorical decision...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Weiller, C., Beume, L.-A., Dressing, A., Kummerer, D., Martin, M., Musso, M., Umarova, R., Umarova, R., Vry, M., Rijntjes, M. Tags: Behavioral and Cognitive Neurology: Clinical Syndromes Source Type: research

Acute Stroke Due to High Voltage Electrocution (P4.347)
We present a case of acute stroke due to high voltage electrocution. Case presentation 38 year old white male accidently grabbed a live wire in the field and got electrocuted. He sustained 2nd degree electric burns at the entry wound in his right palm with a small exist wound in the right foot. On admission, he was stable with total amnesia of the incident event. He had no major medical, psychiatric or substance abuse problems. He remained confused in the hospital with expressive aphasia. Repeat CT scan of the head showed multiple hypo density in both frontal and left partial region. MRI confirmed the presence of acute isc...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kokatnur, L., Khan, I., Chernyshev, O., Rudrappa, M. Tags: Cerebrovascular Case Reports Source Type: research

Stroke Due to Air Embolism Related to Laser Ablation of Accessory Vein (P4.357)
Conclusions: Air embolism leading to devastating stroke may occur few hours after laser treatment of varicose veins. Chest symptoms associated with the procedure should raise the possibility of air embolism. Immediate therapeutic measures like 100[percnt] oxygen, hyperbaric oxygen chamber and/or hypothermia should be considered to prevent neurologic complications.Disclosure: Dr. Kale has nothing to disclose. Dr. Javed has nothing to disclose. Dr. Pednekar has nothing to disclose. Dr. Sahni has nothing to disclose. Dr. Resor has nothing to disclose. Dr. Tenner has nothing to disclose. Dr. Ahluwalia-Singh has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kale, P., Javed, B., Pednekar, N., Sahni, R., Resor, L., Tenner, M., Ahluwalia-Singh, B. Tags: Cerebrovascular Case Reports Source Type: research

Aortic Sarcoma Mimicking a Thrombus Filling Vascular Lumen: A Rare Cause of Cerebral Infarction (P4.364)
Conclusion- Primary aortic sarcoma is an extremely rare cause of stroke. This sarcoma may be misinterpreted as a thrombus filling vascular lumen on CT angiography, but no elevation of D-dimer is incompatible with a large thrombus. The final diagnosis can be made by surgical biopsy.Disclosure: Dr. Kim has nothing to disclose. Dr. Jeon has nothing to disclose. Dr. Park has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Kwon has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kim, H., Jeon, S.-B., Park, K.-W., Kim, H., Kim, B. J., Kwon, S. Tags: Cerebrovascular Case Reports Source Type: research

Ischemic Stroke After Plasma Donation (P4.365)
Conclusions: Plasma donation may result in arterial thrombosis in patients with a mild hypercoagulable disorder, which is otherwise not phenotypically expressed. Further studies are needed to evaluate plasma donation as a potential etiology for ischemic stroke.Disclosure: Dr. Salahuddin has nothing to disclose. Dr. Hussaini has nothing to disclose. Dr. Tietjen holds stock and/or stock options in Johnson & Johnson and Stryker.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Salahuddin, H., Hussaini, S., Tietjen, G. Tags: Cerebrovascular Case Reports Source Type: research

Unusual Intersection: Elucidating the Role of Erdheim Chester Disease in Stroke (P4.366)
Conclusion:A unifying diagnosis of ECD was identified for this gentleman presenting with a stroke in the setting of critical ICA stenosis. Pathology from his CEA suggests that while ECD involves multisystem inflammation, it did not appear to play a direct role in his stroke.Disclosure: Dr. Sheikhi has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Sheikhi, L. Tags: Cerebrovascular Case Reports Source Type: research

Strokes Occurring in the Hospital; Quality of Care and Outcome in a Tertiary Academic Medical Center (P6.045)
Conclusions: Increased symptom recognition was found within the ICU/ER cohorts staffed by specialized nurses. Only small number of patients with in-hospital strokes received brain imaging according to ASA/AHA guidelines which is an important opportunity for QI efforts for this group of patients.Disclosure: Dr. Kamal has nothing to disclose. Dr. Mowla has nothing to disclose. Dr. Shirani has nothing to disclose. Dr. Lail has nothing to disclose. Dr. Cheema has nothing to disclose. Dr. Memon has nothing to disclose. Dr. Deline has nothing to disclose. Dr. Crumlish has nothing to disclose. Dr. Singh has nothing to disclose. D...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kamal, H., Mowla, A., Shirani, P., Lail, N., Cheema, B., Memon, A., Deline, C., Crumlish, A., Singh, K., Ching, M., Sawyer, R. Tags: In-Hospital Stroke and Stroke Complications Source Type: research

Getting the Most from the NIH Stroke Scale (P6.048)
Conclusions Adding picture description scores improves accuracy of NIHSS in accounting for lesion volume in LH stroke and yields complementary information about lesion localization, without adding time to administration of NIHSS.Disclosure: Dr. Hillis received personal compensation in an editorial capacity from Lippincott for serving as Associate Editor of Stroke and from Elsevier for serving as Associate Editor of Practice Update Neurology. Dr. Davis has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Hillis, A., Davis, C. Tags: Prehospital Stroke Care and Uses of NIHSS Source Type: research

Stroke from Meningitis Induced Vasculopathy: Vasospasm vs. Vasculitis (P4.378)
Conclusions:This case illustrates that vasculopathy from bacterial meningitis is likely often from vasospasm rather than true vasculitis.Disclosure: Dr. Moussawi has nothing to disclose. Dr. Vaitkevicius has nothing to disclose. Dr. Feske has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Moussawi, K., Vaitkevicius, H., Feske, S. Tags: Cerebrovascular Case Reports Source Type: research

Intracranial Fibromuscular Dysplasia in a Middle-Aged Woman with Recurrent Ischemic Stroke (P4.388)
Conclusions: FMD is a rare disease and has very rarely been described in the intracranial arteries. This case illustrates the natural history and progression of FMD in this patient and elucidates the limited treatment options for preventing disease progression and secondary complications. FMD most predominantly affects younger to middle-aged females and if the disease process goes unrecognized it can have devastating consequences. It is important to continue research endeavors into the genetic and biologic determinants of FMD in order to develop better prevention and therapeutic strategies for this condition.Disclosure: Dr...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Beaton, N., Malik, A., Maque-Acosta, Y., Koch, S. Tags: Non-Atherosclerotic Arteriopathies Source Type: research

Susceptibility to MELAS Exacerbations in a POLG1 Mutation Carrier (P5.264)
We describe a case of a 46-year-old woman who presented with expressive aphasia, disorientation, and inappropriate laughter. She notably had a history of bilateral sensorineural hearing loss and two stroke-like episodes in her 30s characterized by left hemiparesis. Over the preceding six months, she experienced rapidly progressive vision loss, headaches, and an episode of non-convulsive status epilepticus. Incidentally, she had undergone renal transplantation nine months earlier for autosomal dominant polycystic kidney disease, and was on immunosuppressive therapy with two calcineurin inhibitors—cyclosporine and tacr...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Nadkarni, D., Restrepo, L. Tags: General Neurology: Genetics Source Type: research

Proximal Occlusion Scale for Rapid Triage of Potential Endovascular Therapy Candidates (S47.002)
Conclusions: We report a proximal occlusion score to rapidly identify and triage patients most likely to benefit from urgent evaluation for endovascular therapy. Using multivariate analysis selected features of the presenting neurological exam were predictive of proximal arterial occlusion significantly better that that achieved by an NIHSS cutoff. The proximal occlusion scale could be performed faster than the NIHSS. Utilization of this tool in community hospitals without direct neurologist support may aid in the triage of stroke patients in need of endovascular therapy. Further evaluation in larger cohorts is required.Di...
Source: Neurology - February 7, 2016 Category: Neurology Authors: Holder, D., Jickling, G. Tags: IV-tPA and Endovascular Therapy Source Type: research

Acute Stroke Code Accuracy in the Inpatient Versus Emergency Department (ED) Setting (S16.003)
Conclusion FP were more common for inpatient versus ED codes AMS or SS were infrequently associated with stroke diagnosis. Better education for non-neuroscience hospital providers, regarding acute stroke criteria, is needed.Disclosure: Dr. Schneck has received research support from NIH (POINT, COSS, ARUBA, ALIAS, Lundbeck (DIAS4), TIMI-50 Consortium, and Local PI Multicenter Clincial trials. Dr. Bruzzone has nothing to disclose. Dr. Vlahovic has nothing to disclose. Dr. Durazo-Arvizu has nothing to disclose. Dr. Biller has received personal compensation in an editorial capacity for the Journal of Stroke and Cerebrovascular...
Source: Neurology - February 7, 2016 Category: Neurology Authors: Schneck, M., Bruzzone, M., Vlahovic, L., Durazo-Arvizu, R., Biller, J., Flaster, M., Morales-Vidal, S., Ruland, S., Ray, J. Tags: Prehospital/Emergency Room Stroke Care and Intracerebral Hemorrhage Source Type: research

Patient care with empathy and acceptance: How not why
"Why?" my mother asked, not with the exuberant curiosity of a child but with frustration and annoyance. "W-w-h-h-y-y?" This time she enunciated each letter as if trying to will it into a different sound to form the word she was actually trying to express. Flustered, she just started repeating herself, "Why? Why? Why?" I could tell our collective patience and resolve to communicate was wavering.
Source: Neurology - November 23, 2015 Category: Neurology Authors: Jaremko, K. M. Tags: Other cerebrovascular disease/ Stroke, Aphasia, All Education, Professional conduct and ethics REFLECTIONS: NEUROLOGY AND THE HUMANITIES Source Type: research

Clinical Reasoning: A 68-year-old man with a history of lung cancer presenting with right-sided weakness and aphasia
A 68-year-old man with paroxysmal atrial fibrillation on warfarin, left subclavian thrombosis treated with carotid-subclavian bypass, and lung adenocarcinoma treated with pneumonectomy, chemotherapy, and prophylactic cranial irradiation and in remission since 1987 was admitted to our neurocritical care unit with acute onset of right-sided weakness, expressive aphasia, and lethargy. On admission his temperature was 101.7°F, and initial blood pressure was 140/60 mm Hg. There was no nuchal rigidity. He was alert and mute with impaired comprehension. He had left gaze preference. Vision was impaired in the right field. Ther...
Source: Neurology - October 5, 2015 Category: Neurology Authors: Gupta, A., Etherton, M. R., McKee, K., Baker, J. M., Izzy, S., Feske, S. K. Tags: All Cerebrovascular disease/Stroke, Radiation therapy-tumor, All Epilepsy/Seizures RESIDENT AND FELLOW SECTION Source Type: research

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