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Teaching NeuroImages: Superficial siderosis due to a dural cervical arteriovenous fistula
A 58-year-old man presented to our hospital with cerebellar ataxia, pyramidal signs, dysarthria, bilateral deafness, and cognitive impairment. These symptoms were consistent with superficial siderosis (SS) of the CNS, confirmed by MRI (figure A).1 Cerebral angiography showed a dural arteriovenous fistula perispinal and pontic with venous drainage in the left foramen C1-C2, fed by meningeal branches of the vertebral artery (figure, B). The fistulous point was clipped. SS of CNS is a rare disease resulting from hemosiderin deposition on the surface of the CNS and cranial nerves.2 At diagnosis, the etiology may...
Source: Neurology - February 19, 2017 Category: Neurology Authors: Madkouri, R., Grelat, M. Tags: All Cerebrovascular disease/Stroke, All Spinal Cord, Arteriovenous malformation, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

And why not thrombolysis in the ambulance (at least for some)?
The fear that alteplase may aggravate primary intracerebral hemorrhages has led to the mandatory prerequisite for prealteplase imaging in all acute stroke patients in order to exclude such hemorrhages. Consequently, in a situation in which "time is brain," administration of alteplase is delayed until the patients are transferred to a hospital where such imaging is available, at the cost of additional ischemic damage to the brain parenchyma. Yet, theoretical considerations and empirical data suggest that alteplase's effects on primary intracerebral hemorrhages may not be that detrimental. Moreover, at least some of the pati...
Source: Neurology - July 10, 2016 Category: Neurology Authors: Rosenberg, G., Steiner, I. Tags: CT, All Clinical trials, All Cerebrovascular disease/Stroke, Intracerebral hemorrhage VIEWS & amp;amp; REVIEWS Source Type: research

Journal Club: Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage
Intracerebral hemorrhage (ICH) remains one of the most catastrophic stroke subtypes, with high case-fatality rate and poor functional outcomes. In the Journal Club article "Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage" by Jolink et al.,1 hospital and population registries were used to assess age- and sex-specific trends in incidence and case fatality of patients with ICH in the Netherlands. The study provides a significant epidemiologic contribution examining a large cohort of patients with ICH from 1980 to 2010. The authors report a decline in incidence, case-fatality, and mortality r...
Source: Neurology - May 15, 2016 Category: Neurology Authors: Charidimou, A., Morotti, A., Valenti, R., Giese, A.-K., Boulouis, G., Pasi, M., Roongpiboonsopit, D., Lauer, A., Xiong, L., Van Harten, T. W., Karadeli, H., Fotiadis, P., Jessel, M. J., Viswanathan, A. Tags: All Cerebrovascular disease/Stroke, All Education, Intracerebral hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Hemorrhagic stroke following use of the synthetic marijuana "spice"
The association between the street drug spice (K-2 or herbal incense), a synthetic marijuana, and intracranial hemorrhage (ICH) has not yet been described, but it has with acute ischemic stroke (AIS),1 seizure, and myocardial infarction.2 Two young patients (31 and 25 years old) independently presented to our hospital with subarachnoid hemorrhage (SAH) after spice inhalation. The first also had 2 large intraparenchymal hemorrhages (IPH); the other also had AIS. Both were previously healthy without hypertension, coagulopathy, bleeding diathesis, thrombocytopenia, intracranial aneurysm, arteriovenous malformation, connective...
Source: Neurology - September 28, 2015 Category: Neurology Authors: Rose, D. Z., Guerrero, W. R., Mokin, M. V., Gooch, C. L., Bozeman, A. C., Pearson, J. M., Burgin, W. S. Tags: Stroke in young adults, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Other toxicology, Intracerebral hemorrhage CLINICAL/SCIENTIFIC NOTES Source Type: research

CARES (Changing and Advancing Risk factor control through Educations after Stroke): A Pilot Trial of a Transitions in Care Post-discharge Telephone Intervention for Stroke Patients (S13.006)
OBJECTIVE: The purpose of study is to test the feasibility and effectiveness of a telephonic post-discharge intervention designed to improve access to care, reinforce self-management skills, improve health literacy, and screen for complications in a government-run safety net system. BACKGROUND: In the United States, risk factor control after stroke is poor, particularly among socio-economically disadvantaged populations with poor access to care. The immediate post-discharge period is a vulnerable time for stroke patients, given their risk of recurrent stroke, worsening symptoms, complications, and need for medication titra...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Hudson, L., Corrales, M., Moreno, L., Valle, N., Razmara, A., Dutta, T., Ramirez-Gomez, L., Towfighi, A. Tags: Cerebrovascular Disease and Interventional Neurology: Epidemiology and Risk Factors Source Type: research

Rare Presentation of Churg-Strauss Syndrome: Intracerebral Hemorrhage, Subdural Hemorrhage and an Intracranial Aneurysm (P2.103)
DISCUSSION:CSS can present with rare neurologic complications namely peripheral neuropathy, ischemic and hemorrhagic stroke and much less commonly - intracranial aneurysms. Our patient also had cardiac masses that resolved after treatment with high dose steroids. Subdural hemorrhage along with a left MCA aneurysm related to CSS has not been previously reported in literature.Disclosure: Dr. Chahil has nothing to disclose. Dr. Morgan has nothing to disclose. Dr. Gonzales has nothing to disclose. Dr. Wu has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Chahil, M., Morgan, J., Gonzales, N., Wu, T.-C. Tags: Cerebrovascular Disease and Interventional Neurology: Acquired and Congenital Vascular Malformations Source Type: research

Is Achondroplasia Linked to Stroke? (P6.265)
CONCLUSIONS:This case shows an interesting correlation between achondroplasia and carney complex related myxomas that has not been described in literature before. Achondroplasia is an autosomal dominant mutation in FGFR3 gene on chromosome 4P. Mutaions in carney complex are also described to be autosomal dominant mostly involving chromosome 17q23-q24 . There has been no clear pathogenesis described pertaining this correlation yet but more genetics have to be explored.Study Supported by:Disclosure: Dr. Kaur has nothing to disclose. Dr. Mittal has nothing to disclose. Dr. Hosley has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Kaur, H., Mittal, S., Hosley, C. Tags: Cerebrovascular Disease and Interventional Neurology: Case Reports Source Type: research

Warfarin treatment and thrombolysis: How to persuade procrastinators?
This study, which uses data from the American Heart Association Get With The Guidelines (GWTG)–Stroke Registry, concluded that there was no association between IV thrombolysis and symptomatic intracranial hemorrhage (SICH).1 These findings are in agreement with some2–4 but contrast with other studies (including 2 meta-analyses).5–8 The study by Xian et al. is the largest study to date drawing from hospitals throughout the United States, including 23,437 patients who received IV thrombolysis.1 Nearly 8% of these patients had prior warfarin use and 48.6% of the warfarin-treated patients who met the eligibil...
Source: Neurology - February 4, 2013 Category: Neurology Authors: Seet, R. C. S., Harrer, J. U. Tags: EDITORIALS Source Type: research