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Clinical Reasoning: A 66-year-old man with recurrent multi-territory infarcts
A 66-year-old man was referred to our center for evaluation of recurrent infarcts in multiple vascular territories over the preceding 6 months (figure 1). The patient first presented with a 3-month, stuttering course of transient neurologic deficits, including right arm and leg hemiparesis, expressive aphasia, and right homonymous hemianopia. He was initially evaluated at a community Stroke Prevention Clinic. His medical history was significant for several classic vascular risk factors: coronary artery disease requiring a coronary artery bypass graft, dyslipidemia for which he was taking atorvastatin 20 mg daily, and obstr...
Source: Neurology - June 8, 2015 Category: Neurology Authors: Kouzmitcheva, E., Steriade, C., Prica, A., Hazrati, L.-N., Mandell, D. M. Tags: All Cerebrovascular disease/Stroke, All Education RESIDENT AND FELLOW SECTION Source Type: research

Teaching Video NeuroImages: Movement of a paralyzed arm with yawning
A 63-year-old man presented with aphasia and right arm paralysis (Medical Research Council [MRC] grade 0), sparing the leg (video 1 on the Neurology® Web site at Neurology.org). With yawning, his right arm consistently rose to his chest (video 2). Paralysis resumed after yawning. MRI confirmed an acute ischemic stroke in the left middle cerebral artery distribution (figure). This movement ceased after 2 weeks following partial recovery of arm strength (MRC grade 4). This phenomenon, first described in the 1844, was recently coined parakinesia brachialis oscitans. It is speculated to be a release event in which damaged ...
Source: Neurology - April 20, 2015 Category: Neurology Authors: Kang, P., Dhand, A. Tags: Clinical neurology examination, All Movement Disorders, All Education, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Differences in Ischaemic and Haemorrhagic Strokes in Sri Lanka: 7-year data from the Ragama Stroke Registry (P1.092)
CONCLUSIONS:Clinical and risk factor profiles were different between ICH and IS patients. Stroke severity and functional disability were higher among ICH patients. Study Supported by:Ragama Stroke Registry has been partly supported by research grants from the University of Kelaniya and Research Institute, International Medical Centre of Japan.Disclosure: Dr. Ranawaka has nothing to disclose. Dr. Peiris has nothing to disclose. Dr. Thirumavalavan has nothing to disclose. Dr. Premawansa has nothing to disclose. Dr. Kasthuriratne has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Ranawaka, U., Peiris, A., Thirumavalavan, K., Premawansa, G., Kasthuriratne, A. Tags: Neuroepidemiology: Cerebrovascular Disease, Critical Care, Epilepsy, Child Neurology, and Sleep Source Type: research

"I know it but I can't say it": Using self-report to understand the experience of inner speech in aphasia (P1.211)
CONCLUSIONS: Most people with aphasia report experience of internal word retrieval processes that surpass overt naming ability. Their subjective reports suggest that they can distinguish between the two distinct internal experiences of anomia reflected by our hypothesis. Preliminary VLSM results further support the dissociation. We suggest that these two experiences reflect differing levels of lexical access: sIS relies on phonological access, whereas the perception of "knowing it" relies on semantic or lemma access.Disclosure: Dr. Fama has nothing to disclose. Dr. Snider has nothing to disclose. Dr. Hayward has nothing to...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Fama, M., Snider, S., Hayward, W., Friedman, R., Turkeltaub, P. Tags: Aging, Dementia, Cognitive, and Behavioral Neurology: Attention and Aphasia Source Type: research

Transient Neurologic Deficit Presenting with Cortical Vein Thrombosis Caused by Intracranial Hypotension: Case Report (P1.028)
CONCLUSION We hypothesized that intracranial hypotension led to venous engorgement (based on the Monroe-Kelli doctrine) and the subsequent cortical vein thrombosis, which then produced vasogenic edema, cortical irritability, and focal seizure that mimicked ischemic stroke. Based on our findings, clinicians should consider intracranial hypotension in patients presenting with dural sinus or cortical vein thrombosis, and orthostatic headache or imaging findings of dural enhancement.Disclosure: Dr. Plancher has nothing to disclose. Dr. Flaherty has received personal compensation for activities with CSL Behring as a consultant ...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Plancher, J. M.-O., Flaherty, M. Tags: Cerebrovascular Disease and Interventional Neurology: Case Reports Source Type: research

Symptomatic Cerebral Air Embolism after Central Venous Catheter Removal. (P1.034)
CONCLUSIONS: Central air embolism is a rare complication of central venous catheter removal or insertion. GRE or DWI is useful for diagnosis of cerebral air embolism. Clinician should be aware of this uncommon complication and take the necessary precaution to prevent it.Disclosure: Dr. Ferdous has nothing to disclose. Dr. Tantikittichaikul has nothing to disclose. Dr. Hasan has nothing to disclose. Dr. Eldokla has nothing to disclose. Dr. Kim has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Ferdous, J., Tantikittichaikul, S., Hasan, R., Eldokla, A., Kim, J. Tags: Cerebrovascular Disease and Interventional Neurology: Case Reports Source Type: research

A Case Report of Rheumatoid Meningitis, an unusual complication of Rheumatoid Arthritis (P4.056)
CONCLUSIONS: Rheumatoid Meningitis is an extremely uncommon complication of Rheumatoid Arthritis. Initial presentations can vary from altered mental status (most common), cranial neuropathies, hemiparesis/paraparesis, seizure, headache and very rarely stroke like symptoms. This patient with Rheumatoid Arthritis presented with multiple stroke like episodes, lepomeningeal enhancement. Diagnosis was established on the basis of Imaging and Histopathology after excluding other potential causes of granulomatous meningitis. Study Supported by: Not applicableDisclosure: Dr. roy has nothing to disclose. Dr. Brink has nothing to dis...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Roy, B., Brink, J., Bakradze, E., Al Zahmi, F., Uphoff, D., Silverman, I. Tags: MS and CNS Inflammatory Diseases: CNS Inflammatory Diseases and Differential Diagnosis Source Type: research

Induction of Functional and Structural Plasticity by Intermittent Theta Burst Stimulation in Post-Stroke Aphasia (I10-2E)
CONCLUSIONS: The involvement of left frontal areas in verb generation after iTBS increased. iTBS applied to the affected left hemispheric language areas may facilitate re-organization of cortical language networks and restore inhibition of right frontal areas during language tasks.Disclosure: Dr. Griffis has nothing to disclose. Dr. Nenert has nothing to disclose. Dr. Allendorfer has nothing to disclose. Dr. Szaflarski has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Griffis, J., Nenert, R., Allendorfer, J., Szaflarski, J. Tags: The Dynamic Brain in Health and Disease: Plasticity and Reprogramming Poster Presentations Source Type: research

Crossed Subcortical Aphasia (P1.048)
CONCLUSIONS: This patient is a rare case in which right-sided subcortical damage results in aphasia. The most comprehensive evidence on language lateralization comes from functional studies of healthy adults that differ in their degree of handedness. It appears that the degree of right-handedness correlates, with the degree of left hemisphere language dominance.Disclosure: Dr. Murray has nothing to disclose. Dr. Kase has nothing to disclose. Dr. Nguyen has nothing to disclose. Dr. Bickart has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Murray, C., Kase, C., Nguyen, T., Bickart, K. Tags: Cerebrovascular Disease and Interventional Neurology: The Spectrum of Small Vessel Cerebrovascular Disease Source Type: research

Late adult onset MELAS, presenting as non-convulsive status and atypical strokes. (P2.257)
CONCLUSIONS: Adult-onset strokes due to MELAS have rarely been described and are usually suspected in the setting of recurrent strokes. Our patient was diagnosed at her initial attack because of her unique presentation. We believe that MELAS should be considered in all adult patients presenting with atypical strokes and seizures.Disclosure: Dr. Raval has nothing to disclose. Dr. El-Ghanem has nothing to disclose. Dr. Hillen has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Raval, B., El-Ghanem, M., Hillen, M. Tags: Cerebrovascular Disease and Interventional Neurology: Genetics and Stroke Source Type: research

Demographic Characteristics and Prognostic Factors in Acute Ischemic Stroke in a Tertiary Care Hospital in Nepal (P1.073)
Conclusions: The factors that are independently associated with functional status at one month after acute ischemic stroke are the age of the patient at the time of stroke and the baseline neurological status as measured by the National Institute of Health Stroke Scale score. Study Supported by: Not applicableDisclosure: Dr. Gajurel has nothing to disclose. Dr. Oli has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Gajurel, B., Oli, K. Tags: Cerebrovascular Disease and Interventional Neurology: Epidemiology Source Type: research

Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) with stroke like symptoms. A case report. (P5.104)
Conclusion: Clinicians should consider SREAT in the differential diagnosis of patients presenting with stroke like symptoms/vasculitis especially if investigations fail to establish a diagnosis.Disclosure: Dr. Javalkar has nothing to disclose. Dr. Abbas has nothing to disclose. Dr. Harris has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Javalkar, V., Abbas, S., Harris, M. Tags: Edema, Encephalopathy, and Encephalitis Source Type: research

Tactile unawareness in acute right hemispheric stroke (P1.207)
CONCLUSIONS:Tactile unawareness is common in acute right MCA stroke. Bedside findings can help dissociate primary sensory deficit from somatosensory hemi-inattention. The importance of spatial attention in tactile awareness is substantiated by the lesion sites associated with the disorder: regions crucial for multi-sensory integration and bodily awareness. Study Supported by:Disclosure: Dr. Antoniello has nothing to disclose. Dr. Gottesman has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Antoniello, D., Gottesman, R. Tags: Aging, Dementia, Cognitive, and Behavioral Neurology: Attention and Aphasia Source Type: research

Lateral Eye Deviation and Post-Stroke Spatial Neglect (P1.208)
CONCLUSIONS: Why CBS-defined and BIT-defined neglect resulted in different patterns of eye deviation is unclear. This could reflect greater sensitivity of functional performance testing for neglect, or greater relation of spontaneous behavior assessed by the CBS with eye deviation, as contrasted with responses directly elicited during neuropsychological testing. Research to identify specific mechanisms predisposing patients to rightward eye deviation may be helpful to develop a more complex model to evaluate for potential clinical screening. Study Supported by: NIH, NIDRR, Kessler Foundation, Wallerstein FoundationDisclosu...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Barrett, A., Shirodkar, S., Yao, B., Chen, P. Tags: Aging, Dementia, Cognitive, and Behavioral Neurology: Attention and Aphasia Source Type: research

Anatomical and Psychophysical Comparison of Subjective Verticals in Patients with Right Brain Damage (P1.209)
CONCLUSIONS: Errors in visual and visual-haptic SVs were related to lesions in visual associative cortex. The visual SV and especially the visual-haptic SV provide valuable estimates of patient difficulties, in view of the lower associated variable errors (i.e. greater precision) and closer relationships with clinical disorders.Disclosure: Dr. SAJ has nothing to disclose. Dr. Honore has nothing to disclose. Dr. Braem has nothing to disclose. Dr. Rousseaux has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Saj, A., Honore, J., Braem, B., Rousseaux, M. Tags: Aging, Dementia, Cognitive, and Behavioral Neurology: Attention and Aphasia Source Type: research

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