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Bertini A, Lenti S, Libelli G, Ronco R, Oliveri S, Montemagno K, Priori A, Bocci T. When the diagnosis is in the patient's hand and in the neurologist's eye. Neurol Sci 2024:10.1007/s10072-024-07626-1. [PMID: 38833097 DOI: 10.1007/s10072-024-07626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/25/2024] [Indexed: 06/06/2024]
Abstract
The objective of this study was to encompass current knowledge about pathophysiological mechanisms of those specific hand postures or deformities caused by central nervous system disorders. In the era of high-resolution neuroimaging and molecular biology, clinicians are progressively losing confidence with neurological examination. Careful hand observation is of key importance in order to differentiate neurological from non-neurological conditions, central from peripheral aetiologies, and organic from functional disorders. Localizing the potential anatomical site is essential to properly conduct subsequent exams. We provided a practical guide for clinicians to recognize hand patterns caused by central nervous system disorders, avoiding mimicking conditions, thus optimizing and prompting the diagnostic pathway.
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Affiliation(s)
- Alessandro Bertini
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Sveva Lenti
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Giorgia Libelli
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Riccardo Ronco
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Serena Oliveri
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Kora Montemagno
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy.
- Clinical Neurology Unit, Department of Health Sciences, Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy.
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Cuony J, Lorton O, Tomkova Chaoui E, Comet C, Schaller K, Salomir R, Momjian S, Fleury V. Hand Dystonia after Focused Ultrasound Thalamotomy in Essential Tremor. Stereotact Funct Neurosurg 2024:1-6. [PMID: 38834047 DOI: 10.1159/000538931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/10/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for drug-resistant tremor. The most frequent side effects are ataxia, gait disturbance, paresthesias, dysgeusia, and hemiparesis. Here, we report the first case of thalamic hand dystonia rapidly occurring after MRgFUS thalamotomy of the ventral intermediate nucleus (V.im). CASE PRESENTATION MRgFUS thalamotomy was performed in a 60-year-old left-handed patient for his disabling medically refractory essential tremor. The intervention resulted in a marked reduction of his action tremor. However, the patient developed an unvoluntary abnormal posture in his left hand a few days after the procedure with difficulty holding a cigarette between his fingers. Brain MRI revealed the expected MRgFUS lesion within the right V.im as well as an extension of the lesion anteriorly to the V.im in the ventro-oralis nucleus. Tractography showed that the lesion disrupted the dentato-rubro-thalamic tract as expected with a lesion suppressing tremor. However, the lesion also was interrupted fibers connecting to the superior frontal and pre-central cortices (primary motor cortex, premotor cortex, and supplementary area). We hypothesized that the interventional MRgFUS thalamotomy was slightly off target, which induced a dysfunction within the cortico-striato-thalamo-cortical network and the cerebello-thalamo-cortical pathway reaching a sufficient threshold of basal ganglia/cerebellum circuitry interference to induce dystonia. CONCLUSION This rare side effect emphasizes the risk of imbalance within the dystonia network (i.e., basal ganglia-cerebello-thalamo-cortical circuit) secondary to V.im thalamotomy.
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Affiliation(s)
- Johanna Cuony
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Orane Lorton
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland
- Image Guided Interventions Laboratory, University of Geneva, Geneva, Switzerland
| | | | - Camille Comet
- Department of Neurology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory, University of Geneva, Geneva, Switzerland
- Division of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Shahan Momjian
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vanessa Fleury
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Rigon L, Genovese D, Piano C, Brunetti V, Guglielmi V, Cimmino AT, Scala I, Citro S, Bentivoglio AR, Rollo E, Di Iorio R, Broccolini A, Morosetti R, Monforte M, Frisullo G, Caliandro P, Pedicelli A, Caricato A, Masone G, Calabresi P, Marca GD. Movement disorders following mechanical thrombectomy resulting in ischemic lesions of the basal ganglia: An emerging clinical entity. Eur J Neurol 2024; 31:e16219. [PMID: 38299441 DOI: 10.1111/ene.16219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND AND PURPOSE Post-stroke movement disorders (PMDs) following ischemic lesions of the basal ganglia (BG) are a known entity, but data regarding their incidence are lacking. Ischemic strokes secondary to proximal middle cerebral artery (MCA) occlusion treated with thrombectomy represent a model of selective damage to the BG. The aim of this study was to assess the prevalence and features of movement disorders after selective BG ischemia in patients with successfully reperfused acute ischemic stroke (AIS). METHODS We enrolled 64 consecutive subjects with AIS due to proximal MCA occlusion treated with thrombectomy. Patients were clinically evaluated by a movement disorders specialist for PMDs onset at baseline, and after 6 and 12 months. RESULTS None of the patients showed an identifiable movement disorder in the subacute phase of the stroke. At 6 and 12 months, respectively, 7/25 (28%) and 7/13 (53.8%) evaluated patients developed PMDs. The clinical spectrum of PMDs encompassed parkinsonism, dystonia and chorea, either isolated or combined. In most patients, symptoms were contralateral to the lesion, although a subset of patients presented with bilateral involvement and prominent axial signs. CONCLUSION Post-stroke movement disorders are not uncommon in long-term follow-up of successfully reperfused AIS. Follow-up conducted by a multidisciplinary team is strongly advisable in patients with selective lesions of the BG after AIS, even if asymptomatic at discharge.
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Affiliation(s)
- Leonardo Rigon
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Danilo Genovese
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
- The Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement Disorders, New York University Langone Health, New York, New York, USA
| | - Carla Piano
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Valerio Brunetti
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Valeria Guglielmi
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | | | - Irene Scala
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Citro
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Bentivoglio
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Eleonora Rollo
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Di Iorio
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Aldobrando Broccolini
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Roberta Morosetti
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Mauro Monforte
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Giovanni Frisullo
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Pietro Caliandro
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Alessandro Pedicelli
- UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Anselmo Caricato
- Neuro Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Masone
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Paolo Calabresi
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
| | - Giacomo Della Marca
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Rome, Italy
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Ryu HU, Kim HJ, Shin BS, Kang HG. Clinical approaches for poststroke seizure: a review. Front Neurol 2024; 15:1337960. [PMID: 38660095 PMCID: PMC11039895 DOI: 10.3389/fneur.2024.1337960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Poststroke seizure is a potential complication of stroke, which is the most frequent acute symptomatic seizure in adults. Patients with stroke may present with an abnormal or aggressive behavior accompanied by altered mental status and symptoms, such as hemiparesis, dysarthria, and sensory deficits. Although stroke manifestations that mimic seizures are rare, diagnosing poststroke seizures can be challenging when accompanied with negative postictal symptoms. Differential diagnoses of poststroke seizures include movement disorders, syncope, and functional (nonepileptic) seizures, which may present with symptoms similar to seizures. Furthermore, it is important to determine whether poststroke seizures occur early or late. Seizures occurring within and after 7 d of stroke onset were classified as early and late seizures, respectively. Early seizures have the same clinical course as acute symptomatic seizures; they rarely recur or require long-term antiseizure medication. Conversely, late seizures are associated with a risk of recurrence similar to that of unprovoked seizures in a patient with a focal lesion, thereby requiring long-term administration of antiseizure medication. After diagnosis, concerns regarding treatment strategies, treatment duration, and administration of primary and secondary prophylaxis often arise. Antiseizure medication decisions for the initiation of short-term primary and long-term secondary seizure prophylaxis should be considered for patients with stroke. Antiseizure drugs such as lamotrigine, carbamazepine, lacosamide, levetiracetam, phenytoin, and valproate may be administered. Poststroke seizures should be diagnosed systematically through history with differential diagnosis; in addition, classifying them as early or late seizures can help to determine treatment strategies.
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Affiliation(s)
- Han Uk Ryu
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hong Jin Kim
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Stevens CM, Ragland AR, Nair S, Fort J. Suicide Attempt in a Poststroke Patient After Undergoing Deep Brain Stimulation: A Case Report. Cureus 2024; 16:e53520. [PMID: 38445158 PMCID: PMC10911984 DOI: 10.7759/cureus.53520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Deep brain stimulation (DBS) is a type of therapy involving electrical stimulation of the brain and is primarily used to treat movement disorders. While perhaps beneficial, DBS has also been shown to have some potential major side effects, including increased risk for depression and suicide. In the present article, we report a case of a suicide attempt in a depressed patient two months after undergoing DBS for treatment of acute dystonia the patient had suffered from a prior ischemic stroke. This manuscript serves as a reminder of the negative ramifications that can be associated with DBS and why we should be cautious in providing DBS to patients who are either currently depressed or have a history of depression.
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Affiliation(s)
- Christopher M Stevens
- Interventional Radiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Amanda R Ragland
- Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sachin Nair
- Psychiatry, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Juliana Fort
- Psychiatry, Louisiana State University Health Sciences Center, Shreveport, USA
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García-Calderón Díaz MN, Ramos García MI. [Frontal-subcortical syndrome: When the network fails, about a case]. Rev Esp Geriatr Gerontol 2023; 58:101379. [PMID: 37450984 DOI: 10.1016/j.regg.2023.101379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 07/18/2023]
Abstract
Depression and parkinsonism are direct consequences of a lesion, usually vascular, that affects some structure of the frontal-subcortical circuit. Their detection represents a diagnostic challenge and has important repercussions in therapeutic management. The case is presented of a 79-year-old male patient with good overall baseline status, who was admitted to a Psychogeriatric Unit after an autolytic attempt. Initially, a non-psychotic frank depression is observed, and an increase in the base of support for walking and bradykinesia is noted. After adjustment of antidepressant treatment, a notable improvement in affective symptoms is evidenced but not in motor symptoms, so it is decided to request a magnetic resonance imaging that shows ischemic lesions in the basal ganglia. This case provides clear support for the frontal-subcortical circuit model, in which the clinical presentation, neuropsychiatric evaluation, neuroimaging data and therapeutic response contribute to understanding the deficits following these types of lesions. We believe that this article will provide brief and accurate information on the pathophysiological mechanisms, evaluation, diagnostic approach, and treatment of the frontal-subcortical syndrome.
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Saroha D, Ruparelia J, Panda S, Bhaskar S, Tiwari S. Post-Stroke Stereotypies in Aneurysmal Subarachnoid Haemorrhage with Thalamic Infarct - A Case Report. Ann Indian Acad Neurol 2023; 26:305-307. [PMID: 37538414 PMCID: PMC10394449 DOI: 10.4103/aian.aian_843_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Deepika Saroha
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Jigish Ruparelia
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Teraoka Y, Hanada K, Iki S, Kawaguchi T, Yokoi K, Fujii H, Inoue K, Hirayama K. Dystonia-like Movement Disorders Ameliorated by Shear Force and Pressure Stimulation after Small Infarction in the Left Posterolateral Thalamus. Intern Med 2023; 62:893-902. [PMID: 35989278 PMCID: PMC10076139 DOI: 10.2169/internalmedicine.9543-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Focal dystonia (FD) can develop after thalamic lesions. Abnormal somatic sensations were argued to be responsible for FD. Our patient experienced FD-like movement disorders, agraphesthesia, and a reduced sense of shear force on the skin and pressure to deep tissues of the right upper limb following a small infarction in the left posterolateral thalamus. FD-like symptoms improved while the skin was being pulled or the deep tissue was being pushed in a manner proportional to the strength of muscle contractions. Therefore, the lack of these sensations was suggested to be related to FD-like symptoms.
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Affiliation(s)
- Youki Teraoka
- Department of Occupational Therapy, Kawaguchi Neurosurgery Rehabilitation Clinic, Japan
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Keisuke Hanada
- Department of Rehabilitation, Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan
| | - Shinya Iki
- Department of Occupational Therapy, Kawaguchi Neurosurgery Rehabilitation Clinic, Japan
| | - Takuya Kawaguchi
- Department of Occupational Therapy, Kawaguchi Neurosurgery Rehabilitation Clinic, Japan
| | - Kayoko Yokoi
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Hiromi Fujii
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Kaori Inoue
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Kazumi Hirayama
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
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Pandey S, Joutsa J, Mehanna R, Shukla AW, Rodriguez‐Porcel F, Espay AJ. Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders. Mov Disord 2022; 37:1996-2007. [DOI: 10.1002/mds.29218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/19/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology Govind Ballabh Pant Institute of Postgraduate Medical Education and Research New Delhi India
- Department of Neurology, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad Delhi National Capital Region India
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Neurocenter Turku University Hospital Turku Finland
| | - Raja Mehanna
- UT Move, Department of Neurology University of Texas Health Science Center at Houston‐McGovern Medical School Houston Texas USA
| | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases University of Florida Gainesville Florida USA
| | | | - Alberto J. Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders University of Cincinnati Academic Health Center Cincinnati Ohio USA
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Mishra A, Pandey S. Clinical Features, Neuroimaging, and Levodopa-Responsiveness in Holmes' Tremor: A Video-Based Case-Series with a Review of the Literature. Mov Disord Clin Pract 2022; 9:805-815. [PMID: 35937478 PMCID: PMC9346238 DOI: 10.1002/mdc3.13501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Holmes' tremor (HT) is a low-frequency tremor characterized by a combination of rest, posture, and action components. We are reporting the clinical features, neuroimaging findings, and levodopa responsiveness in 12 patients with HT. CASES The majority of the patients were male (11/12). Dystonia was observed in 10 patients and the remaining two patients had head tremor, a "forme-fruste" of cervical dystonia. The underlying etiologies were vascular (n = 8), head trauma (n = 2), and tumor resection (n = 2). Neuroimaging showed isolated involvement of the midbrain in four, thalamus in two, and basal ganglia and cerebellum in one patient each. A combination of the lesion (thalamus and cerebellum = 2; cerebellopontine angle = 1, and cortical/subcortical = 1) was present in four patients. Levodopa responsiveness was seen in 75% of patients including one with levodopa-induced dyskinesia. LITERATURE REVIEW Of 139 patients from 49 studies, levodopa was tried in 123 patients. Improvement with levodopa was seen in 71 patients (57.72%). No improvement with levodopa was observed in 33 patients (26.82%) and details regarding therapeutic response were unavailable in 19 patients (15.44%). CONCLUSIONS Dystonia is an important clinical manifestation of HT. Levodopa responsiveness seen in the majority of the patients is consistent with the hypothesis that nigrostriatal pathway damage is crucial for the pathophysiology of HT.
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Affiliation(s)
- Anumeha Mishra
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and ResearchNew DelhiIndia
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and ResearchNew DelhiIndia
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Shahali H, Farahani RH, Asgari A, Hazrati E. Thalamic hemi-chorea: a rare complication after receiving the adenoviral vector-based COVID-19 vaccine: a case report. Clin Exp Vaccine Res 2022; 11:217-221. [PMID: 35799877 PMCID: PMC9200646 DOI: 10.7774/cevr.2022.11.2.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/28/2022] [Accepted: 04/30/2022] [Indexed: 11/27/2022] Open
Abstract
Lacunar strokes occur when a branch of a large cerebral artery is blocked. The thalamus is often affected, causing uncontrollable motions. A 72-year-old previously healthy man presented with involuntary motions in the right limbs, which were present at rest, and exacerbated during voluntary actions. He had received the first dose of the adenoviral vector-based coronavirus disease 2019 vaccine (ChAdOx1 nCoV-19) 9 days ago. Severe thrombocytopenia and elevated levels of lactate dehydrogenase, ferritin, C-reactive protein, and D-dimer were found, without any evidence of connective tissue disease. Electromyography demonstrated typical choreiform movements, and the brain magnetic resonance imaging indicated a small high signal lesion on the left side of the thalamus. Detection of the immunoglobulin G antibodies against platelet factor 4 in the blood, negative heparin-induced platelet activation (HIPA) test, and positive modified HIPA test confirmed the thalamic stroke due to the vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). He was admitted to the intensive care unit and received nadroparin, sodium ozagrel, edaravone, methylprednisolone, and haloperidol. His hemi-chorea improved gradually over 2 weeks, and he was discharged after 21 days with rehabilitation advice. VIPIT due to the ChAdOx1 nCoV-19 is a novel immune-mediated response that needs clinicians' awareness and further investigations.
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Affiliation(s)
- Hamze Shahali
- Faculty of Aerospace and Sub-Aquatic Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Department of Infectious and Tropical Diseases, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ali Asgari
- Department of Infectious and Tropical Diseases, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- Department of Anesthesiology and Critical Care, Trauma Research Center, AJA University of Medical Sciences, Tehran, Iran
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12
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Datta AK, Chakraborty U, Chandra A. The thalamic hand: an enigmatic sequela of thalamic stroke. QJM 2022; 115:239-240. [PMID: 35176160 DOI: 10.1093/qjmed/hcac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A K Datta
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital Annex-1, 52/1a Shambhunath Pandit Street, Kolkata 700025, West Bengal, India
| | - U Chakraborty
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital Annex-1, 52/1a Shambhunath Pandit Street, Kolkata 700025, West Bengal, India
| | - Atanu Chandra
- A. Chandra, Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata 700004, West Bengal, India
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13
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Trapp SD, Noachtar S, Kaufmann E. Kinesigenic dyskinesias after ENT surgery misdiagnosed as focal epilepsy. BMJ Case Rep 2022; 15:e247760. [PMID: 35351750 PMCID: PMC8966546 DOI: 10.1136/bcr-2021-247760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/03/2022] Open
Abstract
We describe a man in his 30s who presented with paroxysmal right-sided dyskinesias of the arm and neck, misdiagnosed with drug-resistant focal epilepsy. Two months earlier he had undergone surgery for chronic sinusitis. Immediately after this procedure, he developed hemiparesis, hemiataxia, paresthesias and disturbances in verbal fluency. Cranial MRI revealed a disruption of the left lamina cribrosa and an intracerebral injury resembling a branch canal spanning to the left dorsal third of the thalamus. Single-photon emission tomography imaging demonstrated malperfusion of the left ventral thalamus, left-sided cortex and right cerebellar hemisphere. During continuous video-EEG monitoring, three dyskinetic episodes with tremor of the right arm and dystonia of the finger and shoulder could be recorded. The paroxysmal dyskinesias did not improve with carbamazepine, valproate and tiapride. This case demonstrates an unusual symptomatic cause of a thalamic movement disorder misdiagnosed as focal epilepsy and highlights the postoperative complications, diagnostic and treatment efforts.
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Affiliation(s)
- Selina Denise Trapp
- Neurology, Faculty of Medicine, Ludwig Maximilians University Munich, Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich, Muenchen, Germany
| | - Elisabeth Kaufmann
- Neurology, Faculty of Medicine, Ludwig Maximilians University Munich, Munich, Germany
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14
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Fénelon G. From Dreams to Hallucinations: Jean Lhermitte's Contribution to the Study of Peduncular Hallucinosis and the Dissociation of States. J Neuropsychiatry Clin Neurosci 2022; 34:16-29. [PMID: 34711070 DOI: 10.1176/appi.neuropsych.20120314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Jean Lhermitte (1877-1959) was one of the pioneers of behavioral neurology, including the field of hallucinations. This article focuses on his work concerning the relationship between hallucinations, sleep, and dreams. From 1910, Lhermitte became interested in sleep and its disorders, particularly narcolepsy and its accompanying symptoms. He also reported on sleep disorders and hallucinations occurring in people with lesions of the diencephalic region ("infundibular syndrome"), and later encephalitis lethargica. In 1922, he described a syndrome of complex, predominantly visual hallucinations in patients with vascular damage to the midbrain, known as peduncular hallucinosis. Twelve historical cases of peduncular hallucinosis, including 10 from Lhermitte, are reviewed. He gave a precise phenomenological description of peduncular hallucinosis, and put forward the hypothesis that the lesion disrupted the anatomy and connections of a center regulating wakefulness and sleep, thus enabling a dissociation of the mechanisms of dream and waking states. Although the pathophysiology of peduncular hallucinosis remains to this day partly obscure, the model of a limited subcortical lesion acting through complex mechanisms and ultimately involving the cortex remains valid. Lhermitte was also a pioneer in characterizing what contemporary sleep specialists call dissociation of states.
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Affiliation(s)
- Gilles Fénelon
- Service de Neurologie, Centre Expert Parkinson, Hôpital Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Département d'Etudes Cognitives, École Normale Supérieure, Paris Sciences et Lettres University, Paris; and Equipe NeuroPsychologie Interventionnelle, Institut Mondor de Recherche Biomédicale, Paris-Est Créteil Val-de-Marne University, Créteil, France
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15
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Lee Y, Shin S. Improvement of Gait in Patients with Stroke Using Rhythmic Sensory Stimulation: A Case-Control Study. J Clin Med 2022; 11:jcm11020425. [PMID: 35054122 PMCID: PMC8780685 DOI: 10.3390/jcm11020425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with stroke suffer from impaired locomotion, exhibiting unstable walking with increased gait variability. Effects of rhythmic sensory stimulation on unstable gait of patients with chronic stroke are unclear. This study aims to determine the effects of rhythmic sensory stimulation on the gait of patients with chronic stroke. Twenty older adults with stroke and twenty age- and gender-matched healthy controls walked 60 m under four conditions: normal walking with no stimulation, walking with rhythmic auditory stimulation (RAS) through an earphone in the ear, walking with rhythmic somatosensory stimulation (RSS) through a haptic device on the wrist of each participant, and walking with rhythmic combined stimulation (RCS: RAS + RSS). Gait performance in the stroke group significantly improved during walking with RAS, RSS, and RCS compared to that during normal walking (p < 0.008). Gait variability significantly decreased under the RAS, RSS, and RCS conditions compared to that during normal walking (p < 0.008). Rhythmic sensory stimulation is effective in improving the gait of patients with chronic stroke, regardless of the type of rhythmic stimuli, compared to healthy controls. The effect was greater in patients with reduced mobility, assessed by the Rivermead Mobility Index (RMI).
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Affiliation(s)
- Yungon Lee
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
| | - Sunghoon Shin
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
- Correspondence: ; Tel.: +82-10-8940-2406
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16
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Beloozerova IN. Neuronal activity reorganization in motor cortex for successful locomotion after a lesion in the ventrolateral thalamus. J Neurophysiol 2022; 127:56-85. [PMID: 34731070 PMCID: PMC8742732 DOI: 10.1152/jn.00191.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Thalamic stroke leads to ataxia if the cerebellum-receiving ventrolateral thalamus (VL) is affected. The compensation mechanisms for this deficit are not well understood, particularly the roles that single neurons and specific neuronal subpopulations outside the thalamus play in recovery. The goal of this study was to clarify neuronal mechanisms of the motor cortex involved in mitigation of ataxia during locomotion when part of the VL is inactivated or lesioned. In freely ambulating cats, we recorded the activity of neurons in layer V of the motor cortex as the cats walked on a flat surface and horizontally placed ladder. We first reversibly inactivated ∼10% of the VL unilaterally using glutamatergic transmission antagonist CNQX and analyzed how the activity of motor cortex reorganized to support successful locomotion. We next lesioned 50%-75% of the VL bilaterally using kainic acid and analyzed how the activity of motor cortex reorganized when locomotion recovered. When a small part of the VL was inactivated, the discharge rates of motor cortex neurons decreased, but otherwise the activity was near normal, and the cats walked fairly well. Individual neurons retained their ability to respond to the demand for accuracy during ladder locomotion; however, most changed their response. When the VL was lesioned, the cat walked normally on the flat surface but was ataxic on the ladder for several days after lesion. When ladder locomotion normalized, neuronal discharge rates on the ladder were normal, and the shoulder-related group was preferentially active during the stride's swing phase.NEW & NOTEWORTHY This is the first analysis of reorganization of the activity of single neurons and subpopulations of neurons related to the shoulder, elbow, or wrist, as well as fast- and slow-conducting pyramidal tract neurons in the motor cortex of animals walking before and after inactivation or lesion in the thalamus. The results offer unique insights into the mechanisms of spontaneous recovery after thalamic stroke, potentially providing guidance for new strategies to alleviate locomotor deficits after stroke.
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Affiliation(s)
- Irina N. Beloozerova
- 1School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia,2Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
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17
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Abu-Hegazy M, Elmoungi A, Eltantawi E, Esmael A. Electrophysiological characteristics and anatomical differentiation of epileptic and non-epileptic myoclonus. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Electrophysiological techniques have been used for discriminating myoclonus from other hyperkinetic movement disorders and for classifying the myoclonus subtype. This study was carried out on patients with different subtypes of myoclonus to determine the electrophysiological characteristics and the anatomical classification of myoclonus of different etiologies. This study included 20 patients with different subtypes of myoclonus compared with 30 control participants. Electrophysiological study was carried out for all patients by somatosensory evoked potential (SSEP) and electroencephalography (EEG) while the control group underwent SSEP. SSEP was evaluated in patients and control groups by stimulation of right and left median nerves.
Results
This study included 50 cases with myoclonus of different causes with mean age of 39.3 ± 15.7 and consisted of 23 males and 27 females. Twenty-nine (58%) of the patients were epileptics, while 21 (42%) were non-epileptics. Cases were classified anatomically into ten cases with cortical myoclonus (20%), 12 cases with subcortical myoclonus (24%), and 28 cases with cortical–subcortical myoclonus (56%). There was a significant difference regarding the presence of EEG findings in epileptic myoclonic and non-epileptic myoclonic groups (P = 0.005). Also, there were significant differences regarding P24 amplitude, N33 amplitude, P24–N33 peak-to-peak complex amplitude regarding all types of myoclonus. Primary myoclonic epilepsy (PME) demonstrated significant giant response, juvenile myoclonic epilepsy (JME) demonstrated no enhancement compared to controls, while secondary myoclonus demonstrated lower giant response compared to PME.
Conclusion
Somatosensory evoked potential and electroencephalography are important for the diagnosis and anatomical sub-classification of myoclonus and so may help in decision-making regarding to the subsequent management.
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18
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Schaller-Paule MA, Oeckel AM, Schüre JR, Keil F, Hattingen E, Foerch C, Rauch M. Isolated thalamic stroke - analysis of clinical characteristics and asymmetry of lesion distribution in a retrospective cohort study. Neurol Res Pract 2021; 3:49. [PMID: 34511109 PMCID: PMC8436465 DOI: 10.1186/s42466-021-00148-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background More patients with left-hemispheric than right-hemispheric strokes are admitted to hospitals. This is due to the easier recognition of cortical symptoms of the dominant-hemisphere. The thalamus constitutes a “micro-model” of the brain cortex with structure-function relationships known to be asymmetric, especially for language, memory, and visuo-spatial neurocognitive functions. The goal of this study was to characterize clinical symptoms and lesion distribution patterns of patients with acute isolated thalamic stroke (ITS) and to evaluate whether left-sided lesions are overrepresented in the hospital. Methods We performed a radiological database search including all brain scans performed in the Center of Neurology and Neurosurgery of the University Hospital Frankfurt between 2010 and 2019. A total of 5733 patients presenting with acute ischemic stroke were screened for ITS. Based on the MRI data, a lesion-overlap map was then generated to visualize the ITS lesion distribution. Results Fifty-eight patients with unilateral ITS were identified. A majority of 38 patients (65.5%) showed left-sided ITS, whereas only 20 patients (34.5%) had right-sided ITS (p = 0.012). A particular difference was found for ITS lesions in the anterior thalamus of the anterolateral (n = 10) and anteromedian (n = 3) vascular territory, which were located in the left thalamus in 85% of patients (p = 0.011). No distribution difference was found for ITS lesions in the inferomedial (n = 7), central (n = 8), inferolateral (n = 23) and posterior (n = 7) vascular territories. The neuropsychological symptoms of thalamic aphasia (n = 8), neurocognitive impairment (n = 6), behavioral changes (n = 2), neglect (n = 2) and memory deficits (n = 3) were described predominantly in patients with left-sided ITS (p < 0.01). In contrast, other stroke symptoms (e.g., sensorimotor hemi-syndromes) did not reveal a side preponderance. Conclusions The better recognizability of left anterior compared to right anterior thalamic stroke symptoms may have an impact on the frequency in which ITS patients are admitted to the hospital. Clinical characteristics of right anterior thalamic stroke should therefore be further investigated, and diagnostic instruments towards their detection be identified.
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Affiliation(s)
- Martin A Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2 - 16, D-60528, Frankfurt am Main, Germany.
| | - Ariane Martinez Oeckel
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2 - 16, D-60528, Frankfurt am Main, Germany
| | - Jan-Rüdiger Schüre
- Brain Imaging Center, Goethe-University, Frankfurt am Main, Germany.,Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Fee Keil
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2 - 16, D-60528, Frankfurt am Main, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
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19
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Negative Myoclonus Secondary to Thalamic Infarction: Case Report. Tremor Other Hyperkinet Mov (N Y) 2021; 11:25. [PMID: 34249473 PMCID: PMC8253164 DOI: 10.5334/tohm.629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background Movement disorders are an infrequent presentation to stroke, and in this context, negative myoclonus is not among the most common movement disorders, hence we present a case of negative myoclonus secondary to thalamic stroke. Case A 75 year old male presented with left central facial palsy and negative myoclonus on his left upper limb. He was submitted to a diagnostic workup, with evidence of a right thalamic stroke. He was started on Phenobarbital 50 mg and the movement disorder resolved. Conclusion Given the relevance of cerebrovascular disease as a cause of morbidity and mortality, it is important to the clinician to be aware of the less typical presentations such as the observed in our case, in order to provide adequate care to the patient.
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20
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Yu QW, Ye TF, Qian WJ. Rare coexistence of multiple manifestations secondary to thalamic hemorrhage: A case report. World J Clin Cases 2021; 9:4817-4822. [PMID: 34222453 PMCID: PMC8223845 DOI: 10.12998/wjcc.v9.i18.4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/26/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A growing body of literature indicates that the occurrence of thalamic lesions could lead to various dysfunctions, such as somatosensory disturbances, hemiparesis, language deficits, and movement disorders. However, clinical cases describing the coexistence of these types of manifestations have not been reported. Herein, we report a patient who exhibited these rare complications secondary to thalamic hemorrhage.
CASE SUMMARY A 53-year-old right-handed man experienced sudden left hemiparesis, numbness of the left side of body, and language alterations due to an acute hemorrhage located in the right basal ganglia and thalamus 18 mo ago. Approximately 17 mo after the onset of stroke, he exhibited rare complications including dysphasia, kinetic tremor confined to the left calf, and mirror movement of the left arm which are unique and interesting, and a follow-up computed tomography scan revealed an old hemorrhagic lesion in the right thalamus and posterior limb of the internal capsule.
CONCLUSION Hypophonia may be a recognizable clinical sign of thalamus lesions; thalamus injury could cause tremor confined to the lower extremity and mimicking extremity movements.
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Affiliation(s)
- Qi-Wei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu Province, China
| | - Tian-Fen Ye
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu Province, China
| | - Wen-Jun Qian
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu Province, China
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21
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Tater P, Pandey S. Post-stroke Movement Disorders: Clinical Spectrum, Pathogenesis, and Management. Neurol India 2021; 69:272-283. [PMID: 33904435 DOI: 10.4103/0028-3886.314574] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Involuntary movements develop after 1-4% of strokes and they have been reported in patients with ischemic and hemorrhagic strokes affecting the basal ganglia, thalamus, and/or their connections. Hemichorea-hemiballism is the most common movement disorder following a stroke in adults while dystonia is most common in children. Tremor, myoclonus, asterixis, stereotypies, and vascular parkinsonism are other movement disorders seen following stroke. Some of them occur immediately after acute stroke, some can develop later, and others may have delayed onset progressive course. Proposed pathophysiological mechanisms include neuronal plasticity, functional diaschisis, and age-related differences in brain metabolism. There are no guidelines regarding the management of post-stroke movement disorders, mainly because of their heterogeneity.
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Affiliation(s)
- Priyanka Tater
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
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22
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Kim GS, Stephenson JM, Al Mamun A, Wu T, Goss MG, Min JW, Li J, Liu F, Marrelli SP. Determining the effect of aging, recovery time, and post-stroke memantine treatment on delayed thalamic gliosis after cortical infarct. Sci Rep 2021; 11:12613. [PMID: 34131204 PMCID: PMC8206333 DOI: 10.1038/s41598-021-91998-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
Secondary injury following cortical stroke includes delayed gliosis and eventual neuronal loss in the thalamus. However, the effects of aging and the potential to ameliorate this gliosis with NMDA receptor (NMDAR) antagonism are not established. We used the permanent distal middle cerebral artery stroke model (pdMCAO) to examine secondary thalamic injury in young and aged mice. At 3 days post-stroke (PSD3), slight microgliosis (IBA-1) and astrogliosis (GFAP) was evident in thalamus, but no infarct. Gliosis increased dramatically through PSD14, at which point degenerating neurons were detected. Flow cytometry demonstrated a significant increase in CD11b+/CD45int microglia (MG) in the ipsilateral thalamus at PSD14. CCR2-RFP reporter mouse further demonstrated that influx of peripheral monocytes contributed to the MG/Mϕ population. Aged mice demonstrated reduced microgliosis and astrogliosis compared with young mice. Interestingly, astrogliosis demonstrated glial scar-like characteristics at two years post-stroke, but not by 6 weeks. Lastly, treatment with memantine (NMDAR antagonist) at 4 and 24 h after stroke significantly reduced gliosis at PSD14. These findings expand our understanding of gliosis in the thalamus following cortical stroke and demonstrate age-dependency of this secondary injury. Additionally, these findings indicate that delayed treatment with memantine (an FDA approved drug) provides significant reduction in thalamic gliosis.
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Affiliation(s)
- Gab Seok Kim
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Jessica M Stephenson
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Abdullah Al Mamun
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Ting Wu
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Monica G Goss
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Jia-Wei Min
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Jun Li
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Fudong Liu
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Sean P Marrelli
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA.
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23
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Wang Y, Taylor E, Zikopoulos B, Seta F, Huang N, Hamilton JA, Kantak KM, Morgan KG. Aging-induced microbleeds of the mouse thalamus compared to sensorimotor and memory defects. Neurobiol Aging 2021; 100:39-47. [PMID: 33477010 PMCID: PMC8162167 DOI: 10.1016/j.neurobiolaging.2020.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/20/2020] [Accepted: 11/27/2020] [Indexed: 12/30/2022]
Abstract
The aim of this study is to investigate the relationship between aging and brain vasculature health. Three groups of mice, 3, 17-18, and 24 months, comparable to young adult, middle age, and old human were studied. Prussian blue histology and fast imaging with steady precession T2∗-weighted magnetic resonance imaging were used to quantify structural changes in the brain across age groups. The novel object recognition test was used to assess behavioral changes associated with anatomical changes. This study is the first to show that the thalamus is the most vulnerable brain region in the mouse model for aging-induced vascular damage. Magnetic resonance imaging data document the timeline of accumulation of thalamic damage. Histological data reveal that the majority of vascular damage accumulates in the ventroposterior nucleus and mediodorsal thalamic nucleus. Functional studies indicate that aging-induced vascular damage in the thalamus is associated with memory and sensorimotor deficits. This study points to the possibility that aging-associated vascular disease is a factor in irreversible brain damage as early as middle age.
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Affiliation(s)
- Yandan Wang
- Department of Health Sciences, Sargent College, Boston, MA, USA
| | - Erik Taylor
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, MA, USA
| | | | - Francesca Seta
- Department of Medicine, Boston University School of Medicine, Evans Biomed Research Centre, Boston, MA, USA
| | - Nasi Huang
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, MA, USA
| | - James A Hamilton
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, MA, USA
| | - Kathleen M Kantak
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
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24
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Victorino DB, Guimarães-Marques M, Nejm M, Scorza FA, Scorza CA. COVID-19 and stroke: Red flags for secondary movement disorders? eNeurologicalSci 2020; 21:100289. [PMID: 33200103 PMCID: PMC7654224 DOI: 10.1016/j.ensci.2020.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 12/04/2022] Open
Abstract
Hypercoagulability may predispose COVID-19 patients to thromboembolic complications. Movement disorders may develop as complications of vascular events and infections. Health professionals should be vigilant for abnormal movements in COVID-19 patients.
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25
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Carbayo Á, Sarto J, Santana D, Compta Y, Urra X. Hemichorea as Presentation of Acute Cortical Ischemic Stroke. Case Series and Review of the Literature. J Stroke Cerebrovasc Dis 2020; 29:105150. [PMID: 32912504 PMCID: PMC7384777 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/12/2020] [Indexed: 12/22/2022] Open
Abstract
Hemichorea and other hyperkinetic movement disorders are a rare presentation of stroke, usually secondary to deep infarctions affecting the basal ganglia and the thalamus. Chorea can also result from lesions limited to the cortex, as shown in recent reports. Still, the pathophysiology of this form of cortical stroke-related chorea remains unknown. We report 4 cases of acute ischemic cortical strokes presenting as hemichorea, with the infarction being limited to the parietal and insular cortex in perfusion computed tomography scans and magnetic resonance imaging. These cases suggest potential dysfunction of pathways connecting these cortical regions with the basal ganglia.
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Affiliation(s)
- Álvaro Carbayo
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Jordi Sarto
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Daniel Santana
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Yaroslau Compta
- Parkinson's Disease & Movement Disorders Unit, Hospital Clínic/IDIBAPS/CIBERNED(CB06/05/0018-ISCIII)/European Reference Network for Rare Neurological Diseases (ERN-RND)/Institut de Neurociències, Universitat de Barcelona, 170 Villarroel street, Barcelona 08036, Catalonia, Spain.
| | - Xabier Urra
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
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Norris SA, Jinnah HA, Klein C, Jankovic J, Berman BD, Roze E, Mahajan A, Espay AJ, Murthy AV, Fung VSC, LeDoux MS, Chang FCF, Vidailhet M, Testa C, Barbano R, Malaty IA, Bäumer T, Loens S, Wright LJ, Perlmutter JS. Clinical and Demographic Characteristics of Upper Limb Dystonia. Mov Disord 2020; 35:2086-2090. [PMID: 32845549 DOI: 10.1002/mds.28223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Knowledge of characteristics in upper limb dystonia remains limited, derived primarily from small, single-site studies. OBJECTIVE The objective of this study was to characterize demographic and clinical characteristics of upper limb dystonia from the Dystonia Coalition data set, a large, international, multicenter resource. METHODS We evaluated clinical and demographic characteristics of 367 participants with upper limb dystonia from onset, comparing across subcategories of focal (with and without dystonia spread) versus nonfocal onset. RESULTS Focal onset occurred in 80%; 67% remained focal without spread. Task specificity was most frequent in this subgroup, most often writer's cramp and affecting the dominant limb (83%). Focal onset with spread was more frequent in young onset (<21 years). Focal onset occurred equally in women and men; nonfocal onset affected women disproportionately. CONCLUSIONS Upper limb dystonia distribution, focality, and task specificity relate to onset age and likelihood of regional spread. Observations may inform clinical counseling and design, execution, and interpretation of future studies. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Scott A Norris
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hyder A Jinnah
- Departments of Neurology and Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emmanuel Roze
- Sorbonne University, Inserm U 1127, National Centre for Scientific Research, Joint Research Units 7225, Institut du Cerveau et de la Moelle épinière and Assistance Public Hôpitaux de Paris, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Abhimanyu Mahajan
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Victor S C Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark S LeDoux
- Department of Psychology and School of Health Studies, University of Memphis, Memphis, Tennessee, USA.,Veracity Neurosciences LLC, Memphis, Tennessee, USA
| | - Florence C F Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Marie Vidailhet
- Department of Neurology, Salpetriere Hospital, AP-HP, Paris, France.,Department of Neurology, Sorbonne Université, Paris, France.,Brain & Spine Institute, Joint Research Units 1127, INSERM 1127, Center National De Recherche Scientific 7235, Paris, France
| | - Claudia Testa
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Irene A Malaty
- University of Florida Department of Neurology, Fixel Institute for Neurologic Diseases, Gainesville, Florida, USA
| | - Tobias Bäumer
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Laura J Wright
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Departments of Neuroscience, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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Russo M, Carrarini C, Dono F, Di Stefano V, De Angelis MV, Onofrj M, Sensi SL. Posterior Variant of Alien Limb Syndrome with Sudden Clinical Onset as Self-Hitting Associated with Thalamic Stroke. Case Rep Neurol 2020; 12:35-39. [PMID: 32095130 PMCID: PMC7011710 DOI: 10.1159/000503857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
We present a case of sudden postischaemic onset of alien limb syndrome, with unintentional self-injury. Alien limb syndrome is an uncommon neurological disorder featured by uncontrolled and involuntary movements of a limb. Three variants of alien limb syndrome have been described: the anterior, featured by grasping of surrounding objects, the callosal, presenting with intermanual conflict, and the posterior, associated with involuntary levitation of the limb. Our patient suffered from an acute presentation of the posterior variant of the alien limb syndrome, resulting from an isolated thalamic stroke which was documented using 24-h computed tomography brain scan. Only one previous case of alien limb syndrome after thalamic infarct has been reported. Our case enhances the possibility that pure thalamic injury may represent a trigger for this condition.
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Affiliation(s)
- Mirella Russo
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Maria Vittoria De Angelis
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center of Excellence on Aging and Translational Medicine - CeSI-MeT, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Departments of Neurology and Pharmacology, Institute for Mind Impairments and Neurological Disorders - iMIND, University of California, Irvine, California, USA
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28
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Vascular Parkinsonism by Infarctions at Different Locations on 18F-FP-CIT PET/CT. Clin Nucl Med 2019; 44:e627-e628. [DOI: 10.1097/rlu.0000000000002721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Chandradevan R, Rutkofsky IH, Lynn B, Kitchen FL, Simmons ML. Acute Post-stroke Hemiparkinsonism and Hemiparesis: A Unique Case with Successful Therapy. Cureus 2019; 11:e4950. [PMID: 31453024 PMCID: PMC6701904 DOI: 10.7759/cureus.4950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of a new onset movement disorder after a stroke has important clinical implications. The early assessment and timely diagnosis of post-stroke disorders is essential for influencing long-term outcomes. Localizing lesions and determining the underlying etiology is vital in targeting appropriate therapy. New and sudden onset of hemiparkinsonism with hemiparesis, rigidity, and tremor following an acute ischemic stroke is described here. This presentation was clinically diagnosed as acute post-stroke parkinsonism (APSP). The patient’s level of impairment was significant enough to compromise his activities of daily living (ADL), physical therapy (PT), and occupational therapy (OT) in an inpatient rehabilitation center. In the inpatient rehabilitation center, the patient received a trial of levodopa for suspected APSP. After levodopa therapy was initiated, we observed an improvement of his parkinsonian features with a sustained response and reached the conclusion that the clinical recognition of post-stroke parkinsonism treated with a targeted trial with levodopa may improve the quality of life. Proper treatment of APSP has the potential to provide the best opportunity for recovery and positively influence the long-term outcomes in similar patients.
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Affiliation(s)
| | | | - Bryan Lynn
- Internal Medicine, Mercer University, Macon, USA
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Sul B, Kim JS, Hong BY, Lim SH. The effect of dopamine for focal hand dystonia after stroke. Neurol Sci 2019; 40:1301-1302. [DOI: 10.1007/s10072-019-3705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
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Affiliation(s)
| | - Vinay Goyal
- Neurology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Sarma N, Mahanta A. Dystonia and asterixis in acute thalamic infarct. ANNALS OF MOVEMENT DISORDERS 2019. [DOI: 10.4103/aomd.aomd_6_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pandey S, Chouksey A. Poststroke movement disorders: One etiology many phenotypes. ANNALS OF MOVEMENT DISORDERS 2019. [DOI: 10.4103/aomd.aomd_10_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sarma N. Reply: Dystonia and asterixis in acute thalamic infarct. ANNALS OF MOVEMENT DISORDERS 2019. [DOI: 10.4103/aomd.aomd_25_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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