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Kidney Disease and Epilepsy
The family of a 47-year-old man with end stage renal failure on hemodialysis brought him to the emergency room. He had missed 3 sessions of dialysis due to concerns for COVID-19 precautions. He had developed increasing confusion and generalized weakness. Examination showed altered mental status and disorientation to date and place. He had bilateral gaze evoked nystagmus and asterixis in his upper extremities. His lab work showed Blood Urea Nitrogen (BUN) of 75  mg/dL and Creatinine of 6.2 mg/dL. His EEG showed generalized triphasic waves (Fig. 1).
Source: Journal of Stroke and Cerebrovascular Diseases - February 10, 2021 Category: Neurology Authors: Mona Sazgar Source Type: research

Reducing the Risk of Stroke in Patients with Impaired Renal Function: Nutritional Issues
Patients with renal failure have extremely high cardiovascular risk; in dialysis patients the risk of stroke is increased approximately 10-fold over that in the general population. Reasons include not only a high prevalence of traditional risk factors such as diabetes, hypertension and dyslipidemia, but also the accumulation of toxic substances that are eliminated by the kidneys, so have very high levels in patients with renal failure. These include plasma total homocysteine, asymmetric dimethylarginine, thiocyanate, and toxic products of the intestinal microbiome (Gut-Derived Uremic Toxins; GDUT), which include trimethyla...
Source: Journal of Stroke and Cerebrovascular Diseases - November 17, 2020 Category: Neurology Authors: J. David Spence Tags: Review Article Source Type: research

An unusual combination of neurological manifestations and sudden vision loss in a child with familial hyperphosphatemic tumoral calcinosis
We report a child with hyperphosphatemia who presented with multiple episodes of neurologic dysfunction involving lower motor neuron facial nerve palsy along with sequential visual loss. He also had an episode of stroke. There was an extensive metastatic calcification of soft tissue and vasculature. Hyperphosphatemia with normal serum alkaline phosphatase, calcium, parathyroid hormone, and renal function was noted. He was managed with hemodialysis and sevelamer (3 months) without much success in reducing serum phosphate level, requiring continuous ambulatory peritoneal dialysis (3 years). Intact fibroblast growth factor 23...
Source: Annals of Indian Academy of Neurology - June 30, 2019 Category: Neurology Authors: Lokesh Lingappa Shoji Ichikawa Amie K Gray Dena Acton Michael J Evans Rajsekara Chakravarthi Madarasu Ramesh Kekunnaya Sirisharani Siddaiahagari Source Type: research

Neurological Involvement in Primary Systemic Vasculitis
Conclusion Neurological involvement is a common complication of PSV (Table 1), and neurologists play an important role in the identification and diagnosis of PSV patients with otherwise unexplained neurological symptoms as their chief complaint. This article summarizes the neurological manifestations of PSV and hopes to improve neuroscientists' understanding of this broad range of diseases. TABLE 1 Table 1. Common CNS and PNS involvements of primary systemic vasculitis. Author Contributions SZ conceived the article and wrote the manuscript. DY and GT reviewed and edited the manuscript. All authors ...
Source: Frontiers in Neurology - April 25, 2019 Category: Neurology Source Type: research

Variables affecting Stroke Outcome for TPA received between 3 to 4.5 hours (P2.301)
Conclusions: Age, NIHSS and renal dysfunction were significantly associated with worse outcome in patients who had received t-PA between 3 to 4.5 hours. Our findings were consistent but more robust than previous studies showing poorer outcome with renal dysfunction (Meta-analysis OR1.06 NS). After controlling for age and NIHSS, diabetes or hypertension did not additionally contribute to poor outcome. Prognostic and risk stratification scales are useful as predictors of outcome but do not imply efficacy of t-PA therapy or lack thereof.Disclosure: Dr. Yeo has nothing to disclose. Dr. McCane has nothing to disclose. Dr. Katz ...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Yeo, C., McCane, D., Katz, L., Ling, K., Capetillo, A., Bledsoe, D., Chiu, D. Tags: Acute Therapy: IV t-PA Source Type: research

Acute Renal Failure Is Associated With Higher Death and Disability in Patients With Acute Ischemic Stroke: Analysis of Nationwide Inpatient Sample Brief Reports
Conclusions— ARF in patients with AIS is associated with significantly higher rates of moderate to severe disability at discharge and in-hospital mortality.
Source: Stroke - April 28, 2014 Category: Neurology Authors: Saeed, F., Adil, M. M., Khursheed, F., Daimee, U. A., Branch, L. A., Vidal, G. A., Qureshi, A. I. Tags: Acute Cerebral Infarction Brief Reports Source Type: research

Lacunar Infarct Presenting Like Axillary Nerve Lesion: A Case Report (P6.250)
Conclusion: Our case was thought like an axillary nerve lession primarily as a result of history and physical examination. But after the tests our diagnosis was an infarct. We can’t find affected only proximal upper extremities like axillary nerve lesion in the literature. We want to point to lacuner infarct that can be presented like peripheral nerve lesion.Disclosure: Dr. Oz has nothing to disclose. Dr. Tasdemir has nothing to disclose. Dr. Akgun has nothing to disclose. Dr. Alay has nothing to disclose. Dr. Cetiz has nothing to disclose. Dr. Odabasi has nothing to disclose. Dr. Demirkaya has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Oz, O., Tasdemir, S., Akgun, H., Alay, S., Cetiz, A., Odabasi, Z., Demirkaya, S. Tags: Cerebrovascular Disease and Interventional Neurology: Case Reports Source Type: research

Response to the Letter by Tariq
We stated in our discussion section that “A previous study16 reported 35% mortality within 30 days of IV rt-PA treatment in dialysis dependent renal failure patients.” The mention of IV rt-PA in these patients is a mistake on our part. The 35% mortality within 30 days reported by Sozio et al was reported for all stroke subtypes including hemorrhagic strokes. The following study does not mention if IV rt-PA was administered or not in these patients.
Source: Journal of Stroke and Cerebrovascular Diseases - July 1, 2013 Category: Neurology Authors: Nauman Tariq, Adnan I. Qureshi Tags: Letters to the Editor Source Type: research

Outcomes of Thrombolytic Treatment for Acute Ischemic Stroke in Dialysis-Dependent Patients in the United States
Conclusions: The 2-fold higher odds of in-hospital mortality associated with administration of IV thrombolytics in dialysis-dependent patients who present with acute ischemic stroke warrant a careful assessment of risk–benefit ratio in this population.
Source: Journal of Stroke and Cerebrovascular Diseases - April 30, 2013 Category: Neurology Authors: Nauman Tariq, Malik M. Adil, Fahad Saeed, Saqib A. Chaudhry, Adnan I. Qureshi Tags: Original Articles Source Type: research