Neurologist
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Rarely, both paramedian thalami receive arterial blood flow from a single unilateral vessel arising from the first segment of 1 posterior cerebral artery. This artery has received the name of artery of Percheron (AP). There is no consensus regarding the true prevalence of this anatomical variant. Bilateral paramedian thalamic infarcts are uncommon (0.1% to 2% of ischemic strokes). The main cause is the occlusion of the AP due to cardioembolism. Diffusion-weighted magnetic resonance imaging demonstrates the lesion in the acute setting. ⋯ Clinical presentation and imaging patterns described in this group of patients were similar to published data. High level of suspicion based on clinical and imaging findings is essential for early diagnosis of this rare condition. None of our patients had an early diagnosis of acute ischemic stroke and received proper thrombolytic treatment.
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Neuromyelitis optica (NMO) is an immune-mediated, chronic relapsing, inflammatory disease characterized by severe attacks of optic neuritis and myelitis. ⋯ Our results revealed a lower rate of NMO IgG positivity, more severe disability in patients with NMO/neuromyelitis optica spectrum disorders presenting with either transverse myelitis or late-onset NMO, and no correlation between disability and NMO IgG status.
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Lumbar puncture is a safe and commonly performed procedure, with an overall complication rate of 0.1% to 0.5%. Well-known contraindications to lumbar puncture are an intracranial tumor, noncommunicating hydrocephalus, coagulopathy, and ruptured aneurysm with subarachnoid hemorrhage. ⋯ To the best of our knowledge, post-tap intraparenchymal hematoma is extremely rare and only 1 case has been reported previously. In consideration, all patients undergoing a lumbar puncture should be informed about this possible rare complication, even in the absence of documented hemorrhagic risk factors.
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Review Case Reports
Acute global ischemic stroke after cranioplasty: case report and review of the literature.
Cranioplasty procedures are performed usually after devastating neurological injuries requiring craniectomies. Although relatively safe, global intracerebral infarction is a poorly understood, and most often, lethal complication after cranioplasty. We report here one such case with a thorough literature review with insight as to possible etiologies of this injury. ⋯ Although global intracerebral infarction after cranioplasty is extremely rare, the concepts of vessel injury, venous stasis, and reperfusion into dysfunctional cerebral tissue after cranioplasty should be considered when evaluating the risk of this procedure.
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Complications of cranioplasty are known to include infection, wound breakdown, intracerebral hemorrhage, bone resorption, and status epilepticus. Intracerebral hemorrhagic infarction after a cranioplasty is a very rare complication with only 2 reported cases to date. We present the first case in the literature of both supratentorial and infratentorial hemorrhagic infarctions after a cranioplasty. ⋯ This is the first in the literature to report the complication of both supratentorial and infratentorial strokes after a cranioplasty procedure. Reperfusion, vessel injury, and venous stasis after cranioplasty as evaluated by multiple neurological imaging modalities are examined as possible mechanisms for this unique complication. These factors must be considered when evaluating the safety of the procedure for a patient.