Journal of the neurological sciences
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Comparative Study
Comparison and utility of King-Devick and ImPACT® composite scores in adolescent concussion patients.
The King-Devick (KD) oculomotor test has recently been advocated for sideline diagnosis of concussion. Although visual processing and performance are often impaired in concussion patients, the utility of KD as a concussion diagnostic tool is not validated. ⋯ Cognitive visual performance testing using KD has utility in concussion evaluation. Validation would further establish KD as an effective ancillary tool in longitudinal concussion management and research.
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Acute brachial plexus neuropathy is characterized by acute onset of shoulder girdle and arm pain, followed by weakness of the shoulder and arm muscles. It affects primarily nerves of the upper trunk of the brachial plexus and the long thoracic nerve. Cranial nerve involvement is an infrequent association and implies a diagnostic challenge. We report a unique case of acute brachial plexus neuropathy with involvement of the cranial nerves IX, X, XI and XII. ⋯ This case illustrates the unique presentation of neuralgic amyotrophy with involvement of nerves outside the brachial plexus, and the importance of MRI for diagnosis, in the absence of electrophysiologic involvement.
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Coated-platelets are procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in non-lacunar ischemic stroke compared to either lacunar stroke or controls. In contrast, coated-platelet levels are decreased in spontaneous intracerebral hemorrhage (ICH) and inversely correlated with bleed size. We now report the first investigation of coated-platelets in patients with subarachnoid hemorrhage (SAH). ⋯ Coated-platelet levels are higher in SAH patients compared to controls. However, lower coated-platelet levels are associated with increased 1-month mortality in SAH patients, a finding compatible with prior observations of an inverse relationship between coated-platelet levels and bleed volume in ICH. The current data support the role played by these prothrombotic platelets in thrombosis or hemorrhage and suggest a potential place for coated-platelet levels in predicting prognosis after SAH.
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Observational Study
Post-intervention TCD examination may be useful to predict outcome in acute ischemic stroke patients with successful intra-arterial intervention.
Some acute stoke patients have a poor outcome despite successful arterial recanalization. We hypothesized that transcranial Doppler (TCD) findings from the rescued artery might predict poor outcome in patients with recanalization. ⋯ Follow-up TCD examination after IA intervention in acute stroke patients may predict poor outcome beyond angiographic residual TIMI flow.
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Case Reports
Diffuse cauda equina enhancement in a middle aged male with Susac syndrome and symptomatic cauda equina syndrome.
Susac syndrome is a rare neurologic disorder first described by Susac et al. in 1979. Clinically, Susac syndrome consists of a triad including encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. ⋯ Intracranial leptomeningeal enhancement may be seen, however, cauda equina involvement has not been described to our knowledge. We present a case of Susac syndrome in a middle-aged male with symptoms of cauda equina syndrome, and spinal MRI showing diffuse enhancement of the nerve roots of the cauda equina.