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Acute Stroke Diagnosis
Am Fam Physician. 2022 Jun 1;105(6):616-624.ABSTRACTStroke accounts for significant morbidity and mortality and is the fifth leading cause of death in the United States, with direct and indirect costs of more than $100 billion annually. Expedient recognition of acute neurologic deficits with appropriate history, physical examination, and glucose testing will help diagnose stroke and rule out mimicking presentations. The National Institutes of Health Stroke Scale should be used to determine stroke severity and to monitor for evolving changes in clinical presentation. Initial neuroimaging is used to differentiate between isc...
Source: American Family Physician - June 15, 2022 Category: Primary Care Authors: Edwin Y Choi Gilberto A Nieves Darrell Edward Jones Source Type: research

HSV-2 Encephalitis Presenting as Multifocal Ischemic Stroke (P4.375)
CONCLUSION A high index of suspicion needs to be maintained to diagnose infectious vasculitis. A history of immunosuppression and headache preceding cerebral infarction were important factors that ultimately led to the appropriate work up and diagnosis in this case. Lumbar puncture and prompt initiation of antiviral treatment is essential in stroke case of suspected CNS infection with HSV-2.Disclosure: Dr. Zhang has nothing to disclose. Dr. Sumida has nothing to disclose. Dr. Margolesky has nothing to disclose. Dr. Tornes has nothing to disclose. Dr. Ramos has nothing to disclose. Dr. Koch has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Zhang, F., Sumida, A., Margolesky, J., Tornes, L., Ramos, A., Koch, S. Tags: Cerebrovascular Case Reports Source Type: research

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis mimicking an acute stroke
ConclusionsThe decision to thrombolyse or perform an LP in HaNDL patients mimicking a stroke is difficult in the acute setting. Perfusion CT can provide misleading results and CTA may be useful in ruling out occlusion of a cerebral vessel.
Source: European Journal of Neurology - April 22, 2016 Category: Neurology Authors: M. Guillan, A. DeFelipe‐Mimbrera, A. Alonso‐Canovas, M. C. Matute, R. Vera, A. Cruz‐Culebras, N. Garcia‐Barragan, J. Masjuan Tags: Original Article Source Type: research

Staring you in the face! sturge-weber syndrome is a spectrum disorder and late presentation is possible
A 52 year old man with a four year history of migraine with aura presented to hospital with a severe right sided headache and prolonged episode of left sided sensory and motor disturbance. Examination revealed left homonymous hemianopia, sensory inattention and hemiparesis (3/5). Reflexes were symmetrical and plantars downing. He had a facial port wine stain in a V1 distribution on the right. Unenhanced CT scan was normal. Migrainous infarction was the working diagnosis and he was commenced on aspirin. Two days later he experienced intermittent episodes of left face and arm twitching consistent with focal motor seizures, t...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Cosgrove, J., Hassan, A. Tags: Genetics, Drugs: CNS (not psychiatric), Epilepsy and seizures, Headache (including migraine), Pain (neurology), Stroke, Radiology, Radiology (diagnostics) Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP) Source Type: research

Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis Clinical Sciences
Conclusions— In patients presenting with thunderclap headache and normal neurological examination, normal brain CT within 6 hours of headache is extremely sensitive in ruling out aneurysmal SAH.
Source: Stroke - February 22, 2016 Category: Neurology Authors: Dubosh, N. M., Bellolio, M. F., Rabinstein, A. A., Edlow, J. A. Tags: Computerized Tomography (CT), Cerebral Aneurysm, Cerebrovascular Disease/Stroke, Intracranial Hemorrhage Clinical Sciences Source Type: research

Letter to the Editor: Pneumocephalus: Is the needle size significant?
Discussion. Pneumocephalus is defined by two mechanisms: a ball-valve and an inverted bottle concept.1 The ball-valve type implies positive pressure events, such as coughing or valsalva maneuvers, that prevent air escape. Tension pneumocephalus is included in this mechanism, causing a parenchymal mass effect. The inverted bottle theory includes a negative intracranial pressure gradient following cerebrospinal fluid drainage, relieved by air influx. A small pneumocephalus is usually sealed by blood clots or granulation, allowing spontaneous reabsorption and resolution.[1] Otherwise, the lateral positioning of a patient duri...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Assessment Tools CNS Infections Current Issue Letters to the Editor Neurologic Systems and Symptoms Neurology Stroke Traumatic Brain Injury epidural needle size Pneumocephalus spinal tap Source Type: research

Decreased CSF Levels of ß-Amyloid in Patients With Cortical Superficial Siderosis
Conclusions: Our results demonstrate that the presence and extent of cSS are associated with reduced CSF ß-amyloid 42 levels. Further studies are needed to investigate the underlying mechanisms of this association. Introduction Cerebral amyloid angiopathy (CAA)—characterized by the deposition of ß-amyloid in the walls of leptomeningeal vessels—is a common cerebral small vessel disease and a major cause of intracerebral hemorrhage in the elderly (1–3). Furthermore, it has become evident that CAA is associated with cognitive impairment (4). Specifically, it has been shown that ...
Source: Frontiers in Neurology - April 25, 2019 Category: Neurology Source Type: research

En mann i 40- årene med akutt innsettende talevansker og ensidig lammelse.
En mann i 40-årene med akutt innsettende talevansker og ensidig lammelse. Tidsskr Nor Laegeforen. 2019 Dec 10;139(18): Authors: Jahr SH, Myro AZ, Vegge K, Campbell P Abstract BACKGROUND: Stroke has several causes and the diagnostic investigation can be challenging. Neurosyphilis occurs when Treponema pallidum infects the central nervous system, and is a rare cause of stroke. CASE PRESENTATION: A man in in his late forties with diabetes mellitus and overweight presented with headache, speech impairment and right-sided stroke symptoms. He also had cognitive impairment and psychiatric symptoms. He ...
Source: Tidsskrift for den Norske Laegeforening - December 9, 2019 Category: General Medicine Authors: Jahr SH, Myro AZ, Vegge K, Campbell P Tags: Tidsskr Nor Laegeforen Source Type: research

Myriad Manifestations of a Global Infectious Disease (I7-5A)
CONCLUSIONS: This case exhibits the myriad manifestations of tuberculosis in one patient; including meningitis, vasculitis, and tuberculomas. It also highlights that insular stroke in the non-dominant hemisphere could affect the cardiovascular-autonomic system.Disclosure: Dr. Prabhu has nothing to disclose. Dr. Raghupathi has nothing to disclose. Dr. Dissin has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Prabhu, A., Raghupathi, R., Dissin, J. Tags: The Global Burden of Neurological Infections: Epidemiology, Treatment, and Prevention Poster Presentations Source Type: research

Recognition and evaluation of nontraumatic subarachnoid hemorrhage and ruptured cerebral aneurysm.
Abstract Swift diagnosis and treatment are critical for good outcomes in patients with nontraumatic subarachnoid hemorrhage, which is usually caused by a ruptured aneurysm. This type of stroke often results in death or disability. Rates of misdiagnosis and treatment delays for subarachnoid hemorrhage have improved over the years, but these are still common occurrences. Subarachnoid hemorrhage can be more easily diagnosed in patients who present with severe symptoms, unconsciousness, or with thunderclap headache, which is often accompanied by vomiting. The diagnosis is more elusive in patients who present in good c...
Source: American Family Physician - October 1, 2013 Category: Primary Care Authors: Cohen-Gadol AA, Bohnstedt BN Tags: Am Fam Physician Source Type: research

The Rhino Without It's Sugar (P2.324)
We present a case of a non-diabetic patient with stroke like symptoms that was determined to be due to mucormycosis invading the sphenoid sinus.A 64 year old female was admitted for slurred speech and right-sided weakness. She was brought to the ER after being found unresponsive. Family members stated she had been experiencing difficulty speaking, and mild right facial weakness. She has been complaining of headaches for the past seven months and 15 pound weight loss. On admission, temperature was 98.4°F, BP 122/77, PR 78, and RR 18. Exam was significant for right-sided facial asymmetry/droop, expressive aphasia, and sl...
Source: Neurology - April 9, 2014 Category: Neurology Authors: Kahlon, J., Gahley, H., Sonpal, N., Graham, R. Tags: Fungi, Parasites, and Other Pathogens Source Type: research

The Case Files: Unusual Headache
By Al-Hashimi, Siddhartha DO; Leavens, John MD A 23-year-old woman with a history of migraine headaches presented to the emergency department for a different-than-usual headache. She had a six-day history of intermittent headaches. The onset was at rest, and there was no history of trauma.   The headache was located behind her left eye, and it radiated into the posterior portion of her head. She characterized it as being 8/10 in intensity. Bright lights were reported as an exacerbating factor. The headache was associated with nausea and multiple episodes of emesis. She had 10 episodes of vomiting the evening prior to arri...
Source: The Case Files - June 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Dural puncture: an overlooked cause of cerebral venous thrombosis
Abstract Cerebral venous thrombosis (CVT) accounts for 0.5–1 % of all strokes. Although dural puncture is proposed as one of the rare risk factors, this association has only been mentioned in anecdotal reports. Headache, i.e., usually the first and the most frequent clinical symptom on admission, is often attributed to the dural puncture itself. We investigated the frequency of CVT following a recent dural puncture in our stroke database, together with the other risk factors. The computerized medical records of patients (n = 10,740) registered in our tertiary-care neurology clinic stroke database were review...
Source: Acta Neurologica Belgica - March 1, 2015 Category: Neurology Source Type: research

022 Preliminary results from a consultant-led acute neurology service based in the emergency department
Conclusions Acute Neurology input in the ED had major impacts on working diagnoses, hospital admis- sions, urgent outpatient referrals, and emergency investigations.
Source: Journal of Neurology, Neurosurgery and Psychiatry - August 12, 2022 Category: Neurosurgery Authors: Alim-Marvasti, A., See, I., Kandasamy, R., Hutchinson, J., Lane, C., Baruah, T., Balaratnam, M., Chandratheva, A., Simister, R., Haider, S. Tags: Poster presentations Source Type: research

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