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Teaching NeuroImages: Takayasu arteritis: Neuroimaging progression after immunosuppressant treatment
A 29-year-old woman presented with a 2-year history of heel pain, constitutional symptoms, and increased acute phase reactants. CT and magnetic resonance (MR) angiography revealed a thickening of aortic walls and a thread-like appearance of bilateral subclavian and common carotid arteries. The findings were consistent with Takayasu arteritis (TA)1 and the patient was prescribed methylprednisolone, followed by azathioprine. Follow-up MR angiography, 6 years later, showed an important improvement with only a mild luminal narrowing of both common carotid arteries (figures 1 and 2, A and B). TA is a large-artery inflammatory d...
Source: Neurology - May 15, 2017 Category: Neurology Authors: Martinez Rodriguez, L., Caminal Montero, L., Pena Suarez, J., Garcia-Cabo Fernandez, C., Calleja Puerta, S. Tags: MRI, Vasculitis, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Response to pain
She is lying there behind a glass wall too covered in white: air too white, people too white crowded around her funeral chorus of ridiculous moves: her arm is raised and left to fall her eyes are opened and left to close her blood is food to a machine that turns it white, its sins forgiven. White coats, birds of prey! where have you taken her? my faith in you has vanished like a hunted animal you seek to give your prisoner the gift of pain so she would rise in screams above the whiteness of that stiffening bed. In vain! you absurd creatures! what can you hope to save in violence? A soul? not possible. The body alone? not p...
Source: Neurology - August 21, 2017 Category: Neurology Authors: Parvan, A. Tags: All Cerebrovascular disease/Stroke REFLECTIONS: NEUROLOGY AND THE HUMANITIES Source Type: research

Mystery Case: A case of fulminant encephalopathy in a 69-year-old woman
A 69-year-old right-handed woman was admitted to the medical intensive care unit for acute encephalopathy. Her medical history included sickle cell disease (hemoglobin sickle cell [HbSC]) with bone involvement (bilateral femoral head osteonecrosis) and rare sickle cell crises with joint pain and hemolytic anemia requiring red blood cell transfusions, sarcoidosis, diabetes, hypertension, and hypothyroidism. She never smoked cigarettes and never used recreational drugs or alcohol, and there was no history of recent travel. The patient's daughter reported that the patient was found unresponsive lying on the floor in the morni...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lamotte, G., Williams, C. Tags: MRI, Other cerebrovascular disease/ Stroke, Coma, Critical care, Embolism RESIDENT AND FELLOW SECTION Source Type: research

Mystery Case: Diagnostic challenges in a young patient with hypereosinophilia
A 48-year-old woman with recent diagnosis of nonischemic cardiomyopathy and longstanding history of asthma and allergic rhinitis without additional vascular risk factors had intermittent chest pain and dyspnea for 6 weeks, treated with antibiotics and oral steroids without benefit. Subsequently, she developed bilateral leg edema, orthopnea, and chest pain, and was hospitalized twice at another institution. Transthoracic echocardiogram (TTE) demonstrated an ejection fraction (EF) of 30%. Cardiac catheterization was normal. CT of the chest showed a large pericardial effusion (~300 mL) and bilateral pleural effusions. She had...
Source: Neurology - September 25, 2017 Category: Neurology Authors: Ortiz, J. G., Douglas, P. W., Gill, C. E., Mehrotra, S., Biller, J. Tags: Stroke in young adults, Infarction RESIDENT AND FELLOW SECTION Source Type: research

TIPIC syndrome
A 31-year-old woman presented with left acute cervical pain. Cervical imaging showed a large pericarotid infiltration (figure 1). A diagnosis of transient perivascular inflammation of the carotid artery (TIPIC) syndrome was made. The patient received steroids with full clinical recovery 12 days after onset. The follow-up ultrasound showed striking decrease of the perivascular infiltration, confirming the diagnosis (figure 2).
Source: Neurology - October 9, 2017 Category: Neurology Authors: Lecler, A., Obadia, M., Sadik, J.-C. Tags: Secondary headache disorders, MRI, Ultrasound, Other cerebrovascular disease/ Stroke NEUROIMAGES Source Type: research

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