Journal of the neurological sciences
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Paradoxical embolism to the cerebral circulation is often difficult to diagnose clinically. We report a case that illustrates the usefulness of transesophageal echocardiography in the detection of paradoxical embolism. An 84-year-old woman presented with bilateral hemispheric strokes. ⋯ Transesophageal echocardiography confirmed a mobile 4-cm serpiginous thrombus wedged into a patent foramen ovale, extending from the right into the left atria. Multiple imaging modalities were used, allowing rapid diagnosis of paradoxical embolism, with an underlying DVT as the mechanism of stroke. Of all the investigations, visualization with TEE proved crucial in confirming the diagnosis.
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Ischemic stroke during hospitalization can occasionally be found, but the mechanisms and causes underlying stroke have not been investigated in detail. The present study aimed to identify differences in stroke etiology between in-hospital and out-of-hospital onset. ⋯ Ischemic stroke with in-hospital onset may be associated with AF and RLS.
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The Functional Assessment of Multiple Sclerosis (FAMS) quality of life (QoL) instrument is a disease-specific, self-report questionnaire that was developed originally for US English-speaking patients. Here, the psychometric properties of the FAMS QoL questionnaire for Italian-speaking patients with multiple sclerosis (MS) are evaluated and compared with the results from the original FAMS validation survey (n=377). Eighteen Italian centers and 344 patients with MS participated in the study. ⋯ No difference in QoL was found between patients with PPMS and those with secondary progressive MS. The Italian FAMS questionnaire is a valid measure to assess the QoL concerns of patients with MS. FAMS is also easy to administer and is well accepted by patients.
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Three cases of focal myelomalacia and syrinx formation occurring as complications of lumbar spinal anesthesia are reported. In all three instances complication occurred due to accidental injection of lidocaine into the substance of the spinal cord. The primary complaint in all the three cases was severe sharp and shooting pain in both lower limbs, being more severe in certain dermatomes. ⋯ MRI of the dorsolumbar spine done 4-6 months after the spinal anesthetic procedure showed myelomalacic changes with focal syrinx formation in the conus and epiconus region of the spinal cord. The syrinx extended 1-2 vertebral segments in the vertical plane but was confined to a small area in the axial plane. Attempting to use higher lumbar intervertebral spaces for access to the subarachnoid space or epidural space may lead to inadvertent puncture of the lower dorsal spaces; this makes the procedure of spinal anesthesia at this level prone for spinal cord injury, with subsequent risk of development of myelomalacic syrinx in the conus and epiconus region of the spinal cord.
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To demonstrate whether optical coherence tomography (OCT-3) and scanning laser ophthalmoscopy (HRT-2) can be used to measure changes of the optic disc and peripapillary retinal nerve fiber layer (RNFL) in eyes with acute retrobulbar optic neuritis that have no clinically apparent optic disc swelling. To correlate these findings with presentation magnetic resonance imaging (MRI) of the affected optic nerve. ⋯ OCT-3 and HRT demonstrate mild RNFL thickening or optic disc swelling in acute optic neuritis, even when swelling is not seen clinically. OCT-3 appears to reveal measurable RNFL thinning in the temporal quadrant after retrobulbar optic neuritis, even though vision improves. RNFL imaging may be useful in future studies of residual injury after optic neuritis.