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Hyponatremia in Acute Stroke: To Treat or Not to Treat?
Hyponatremia is the most common electrolyte disorder both in hospitalized patients and individuals from the community with a reported incidence mounting up to 30% and 8%, respectively.1,2 Its association with increased risk of mortality has been well-established.3-5 Several meta-analyses have demonstrated that hyponatremia increases mortality in patients with common clinical conditions, such as acute myocardial infarction, heart failure, cirrhosis, and chronic kidney disease,3-5 while “correction” of serum sodium levels improves survival.
Source: Journal of Stroke and Cerebrovascular Diseases - September 30, 2019 Category: Neurology Authors: Fotios Barkas, George Liamis, Haralampos Milionis Tags: Letter to the Editor Source Type: research

Multiple recurrent intracerebral hemorrhages and hepatopulmonary syndrome
Patients with liver cirrhosis complicated by hepatopulmonary syndrome may show vascular changes in cerebral angiography, which may predispose them to spontaneous intracerebral hemorrhage.
Source: Neurology Clinical Practice - August 11, 2019 Category: Neurology Authors: Carvalho, A., Rodrigues, M., Rocha, M., Nunes, J., Cunha, A., Costa, H., Barros, P. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Case Source Type: research

Stroke Dysbiosis Index (SDI) in Gut Microbiome Are Associated With Brain Injury and Prognosis of Stroke
Conclusions: We developed an index to measure gut microbiota dysbiosis in stroke patients; this index was significantly correlated with patients' outcome and was causally related to outcome in a mouse model of stroke. Our model facilitates the potential clinical application of gut microbiota data in stroke and adds quantitative evidence linking the gut microbiota to stroke. Introduction Ischemic stroke imposes a heavy burden on society, with 24.9 million cases worldwide (1). Although intravenous thrombolysis and endovascular treatment greatly improve some patients' prognosis, the prognosis for most pa...
Source: Frontiers in Neurology - April 23, 2019 Category: Neurology Source Type: research

The Paradoxical Protective Effect of Liver Steatosis on Severity and Functional Outcome of Ischemic Stroke
Conclusions: Our study shows that a higher burden of liver steatosis seems to be associated with less severe stroke and better functional outcome after ischemic stroke or TIA. Introduction Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases from simple steatosis to steatohepatitis with varying degree of fibrosis, and liver cirrhosis (1, 2). NAFLD is becoming the most common chronic liver disease worldwide including Korea, affecting approximately 25% of the general population (3, 4). NAFLD is closely associated with obesity, insulin resistance, and type 2 diabetes mellitus, and is even recognized as ...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Multifocal stroke with proliferation of small cerebral arteries in hepatopulmonary syndrome
Cirrhosis of the liver has been linked to several changes in risk of cerebrovascular disease and may increase the risk of hemorrhage while reducing the risk of ischemic stroke.1,2 The pathophysiology underlying these changes remains unclear, though intracranial hemorrhage and vascular malformations related to liver disease have been described.1,3 Cirrhosis may be complicated by hepatopulmonary syndrome (HPS), in which distal pulmonary arteries dilate, become tortuous, produce shunt physiology, and often produce arteriovenous (AV) malformations.4
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Younce, J. R., Cross, D. T., Goyal, M. S., Lee, J.-M. Tags: MRI, Other cerebrovascular disease/ Stroke, Gastrointestinal, Arteriovenous malformation Case Source Type: research

Clinical Reasoning: A 61-year-old man with conjugate gaze deviation, hemiparesis, and asymmetric reflexes
A 61-year-old man with a history of alcoholic cirrhosis was transferred from an outside hospital for spontaneous bacterial peritonitis, septic shock, and respiratory failure after intubation. The patient was initially on sedation; however, more than 48 hours after the sedative was discontinued, his mental status remained depressed and he also developed new onset of conjugate rightward gaze deviation. On neurologic examination, the patient was unresponsive to verbal stimuli and sternal rub. He could not follow any command, including closing or opening eyes and squeezing hands. He had remarkable conjugate, forced eye deviati...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lin, C.-Y., Yoo, J. Y., Doshi, A., Colman, R. Tags: MRI, Clinical neurology examination, All Cerebrovascular disease/Stroke, Critical care, Video/ EEG use in epilepsy RESIDENT AND FELLOW SECTION Source Type: research

Cirrhosis and Stroke in a Nationally Representative Cohort
This cohort study of Medicare claims data investigates the association between cirrhosis and various stroke types.
Source: JAMA Neurology - June 5, 2017 Category: Neurology Source Type: research

Liver Cirrhosis Tied to Increased Stroke Risk Liver Cirrhosis Tied to Increased Stroke Risk
A study challenges the notion that ischemic stroke does not occur in patients with liver cirrhosis and calls for heightened awareness of the risk for hemorrhagic stroke in these patients, researchers say.Medscape Medical News
Source: Medscape Neurology and Neurosurgery Headlines - March 7, 2017 Category: Neurology Tags: Neurology & Neurosurgery News Source Type: news

Imaging of a Fatal Air Embolism from ERCP (P4.363)
CONCLUSIONS: Though most of the occurrences in relation to ERCP are portal venous air embolisms, which are absorbed spontaneously, serious and sometimes fatal complications have occurred including arterial air embolisms causing multiorgan damage including cerebral infarcts. Case history, pertinent imaging and pathological findings are discussed to bring awareness of this rare complication of ERCP and emphasize its early recognition. Disclosure: Dr. Jens has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Ibrahimi has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Jens, W., Lee, A., Ibrahimi, M. Tags: Cerebrovascular Case Reports Source Type: research

Burden and Outcomes of Acute Ischemic Stroke in Patients with Cirrhosis (P5.218)
Conclusions: Our study displayed an increasing proportion of cirrhotic patients admitted due to AIS in the last decade. This burden is associated with worse outcomes and warrants further investigation.Disclosure: Dr. Lunagariya has nothing to disclose. Dr. Patel has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Onteddu has nothing to disclose. Dr. Mehta has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Lunagariya, A., Patel, A., Shah, H., Onteddu, S., Mehta, S. Tags: Cerebrovascular Disease: Genetics and Risk Factor Variation Source Type: research

HCV, but not HIV, is a risk factor for cerebral small vessel disease
Conclusions: This tissue-based analysis of cerebral arteriolar disease demonstrates that HCV constitutes an independent risk, in addition to African American race, hypertension, and cART. Further study is needed to understand what aspects of HCV and cART contribute to cerebrovascular neuropathogenesis.
Source: Neurology Neuroimmunology and Neuroinflammation - September 4, 2014 Category: Neurology Authors: Morgello, S., Murray, J., Van Der Elst, S., Byrd, D. Tags: Other cerebrovascular disease/ Stroke, HIV Article Source Type: research

Acute stroke-like presentation of acquired hepatocerebral degeneration
B. Smita, V. Abdul Gafoor, K. Saifudheen, James JoseAnnals of Indian Academy of Neurology 2014 17(2):204-206Neurological manifestations in liver diseases have been well-described. Parkinsonism developing in cirrhotic patients is a unique clinical, neuroradiological, and biological entity. The symptoms are often insidious in onset and occur after liver disease has made its presentation. Acute dysarthria as the presenting manifestation of cirrhosis is rare. Here we report three cases where liver disease made an unusual presentation as acute dysarthria. In all cases the abruptness of the onset prompted the treating physicians...
Source: Annals of Indian Academy of Neurology - May 17, 2014 Category: Neurology Authors: B. SmitaV. Abdul GafoorK. SaifudheenJames Jose Source Type: research

Risk of subarachnoid haemorrhage in people admitted to hospital with selected immune-mediated diseases: record-linkage studies
Conclusions: Our findings strongly support the suggestion that patients with some immune-mediated diseases have an increased risk of SAH. Further studies of the mechanisms behind this association are warranted.
Source: BMC Neurology - November 14, 2013 Category: Neurology Authors: Sreeram RamagopalanJulia PakpoorOlena SeminogRaph GoldacreLee GrahamMichael Goldacre Source Type: research

Bilirubin labeling of borderzone and anterior cerebral artery territory infarction
A 50-year-old woman developed multiorgan system failure secondary to sepsis. She became obtunded during a period of hypotension, and cranial CT demonstrated diffuse borderzone infarction. Brain autopsy revealed green pigmentation in areas of infarction due to vascular leakage of bilirubin at sites of blood–brain barrier disruption, mapping the borderzone regions and bilateral anterior cerebral artery territories with this endogenous label (total bilirubin at time of death was 24 mg/dL; direct bilirubin 19 mg/dL) (figure). This brain–liver association evokes the first description of pathology in the borderzone r...
Source: Neurology - September 30, 2013 Category: Neurology Authors: Berkowitz, A. L., Sheu, S.-H., Rose, M. F., Delalle, I., Folkerth, R. D. Tags: Gastrointestinal, All Cerebrovascular disease/Stroke NEUROIMAGES Source Type: research