Acta Neurologica Taiwanica[JOURNAL]
Sun
200 papers
ALS Regional Variants (Brachial Amyotrophic Diplegia and Amyotrophic Leg Diplegia): Still A Diagnostic Challenge in Neurology.
Koh YH, Pang YH, Lim EW
Acta Neurol Taiwan · 2023 Mar · PMID 36474455
PURPOSE: We illustrate three patients with regional amyotrophic lateral sclerosis (ALS) variants and hope to improve accuracy in diagnosis for this scarce group of diseases. CASE REPORT: Amyotrophic lateral sclerosis (AL...
PURPOSE: We illustrate three patients with regional amyotrophic lateral sclerosis (ALS) variants and hope to improve accuracy in diagnosis for this scarce group of diseases. CASE REPORT: Amyotrophic lateral sclerosis (ALS) represents a broad spectrum of acquired and inherited neurodegenerative conditions involving the upper and motor neurons. Typical ALS remains a clinical diagnosis that is not hard to diagnose. Still, when it comes to atypical forms of ALS, the physicians may face some difficulties differentiating between atypical forms of ALS and other neurological diseases, such as multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, and spinal muscular atrophy. Both brachial amyotrophic diplegia (BAD) and leg amyotrophic diplegia (LAD) are considered regional variants of ALS. We are here to report two cases of BAD and one case of LAD. All these 3 cases showed progression of the disease after longitudinal follow- up for approximately two years. However, after two years, their disease progressions were slow and confined to their 'regions' of upper or lower limbs. CONCLUSION: BAD and LAD are unique regional variants of ALS with a significantly better prognosis than typical ALS. The phenotypic characteristics of regional ALS variants must be recognized when physicians are to tailor advice on disease progression, disease outcome, drug therapy, and end-of-life planning for patients with ALS or ALS variants.
Refractory Convulsive Status Epilepticus Provoked by Intoxication with Dalfampridine in a Patient with Multiple Sclerosis and Depression Disorder: A Case Report and Literature Review.
Maghbooli M, Jourahmad Z, Golizadeh M
Acta Neurol Taiwan · 2023 Mar · PMID 36474454
PURPOSE: Dalfampridine (DFP) is used to improve motor functions in patients with multiple sclerosis (MS). Overdose of DFP can occur for a variety of reasons and can lead to a state of epilepsy. CASE REPORT: A 24-year-old...
PURPOSE: Dalfampridine (DFP) is used to improve motor functions in patients with multiple sclerosis (MS). Overdose of DFP can occur for a variety of reasons and can lead to a state of epilepsy. CASE REPORT: A 24-year-old woman with MS was admitted to hospital with severe sweating and delirium after attempting suicide by overdosing on DFP. At the time of hospitalization, she developed a tonic-clonic seizure that did not respond to immediate intravenous (IV) diazepam injection, followed by intravenous sodium valproate. Therefore, according to the hospital protocol of the neurology department, the patient was intubated and IV infusion of midazolam was started, Due to the persistence of seizures, sodium thiopental began and the patient was admitted to the intensive care unit (ICU). In the ICU, she received an infusion of sodium thiopental and intravenous sodium valproate, monitored by a daily electroencephalogram (EEG). The patient was discharged after four days due to her stable medical condition. CONCLUSION: Epilepsy in case of overuse of DFP should be considered as a life-threatening side effect and timely treatment should be done to prevent damage to the nervous system.
Challenges of Large Vessel Vasculitis Stroke Patient with Complicated Endovascular Thrombectomy: A Case Report.
Lee HY, Wang SO, Ciou YW … +2 more , Chiu CC, Ou YH
Acta Neurol Taiwan · 2023 Mar · PMID 36474453
PURPOSE: The causes of acute stroke in patients with SLE are multifactorial. Antiphospholipid-associated hypercoagulability and inflammation-induced platelet activation are major causes of ischemic stroke in SLE patients...
PURPOSE: The causes of acute stroke in patients with SLE are multifactorial. Antiphospholipid-associated hypercoagulability and inflammation-induced platelet activation are major causes of ischemic stroke in SLE patients. As such patients underwent intravenous thrombolysis and endovascular thrombectomy, they may have higher risk of complications and less favorable outcome. CASE REPORT: A 30-year-old woman with underline SLE and Takayasu arteritis who presented with right CCA and MCA occlusion status post rtPA and endovascular thrombectomy. Twelve hours after the procedure, head CT was ordered due to anisocoria with loss of pupillary light reflex. The head CT showed partial obliteration of suprasellar and quadrigeminal cistern due to extensive brain edema, leading to her decompressive craniectomy. Two days later, patient's both pupil became dilated with head CT showing occlusion of the left MCA. Her condition drastically went downhill when complications such as central DI and myocardial stunning occurred. CONCLUSION: Although autoimmune vasculitis is not listed as an absolute contraindication to endovascular thrombectomy, given the antecedent reports, it is prudent to disclose possible complications to both the patient and family while making the decision.
Intracranial Vertebrobasilar Artery Dissection with Silent Rapid Progression.
Chiu HH, Chung CP, Chang FC … +1 more , Liu HY
Acta Neurol Taiwan · 2023 Mar · PMID 36474452
PURPOSE: Intracranial vertebrobasilar artery dissection (iVBD) is a potentially lethal disease, and progression of the dissected vessels is not uncommon. Our report is aimed at providing further clinical experience of th...
PURPOSE: Intracranial vertebrobasilar artery dissection (iVBD) is a potentially lethal disease, and progression of the dissected vessels is not uncommon. Our report is aimed at providing further clinical experience of the timing of follow-up vascular imaging or endovascular intervention in iVBD patients. CASE REPORT: We report a case of iVBD with silent rapid progression. The 48-year-old woman presented as transient right limbs weakness. Brain MRI showed a small acute infarct over the left cerebellum, and MRA revealed a short segment of dissection over the left distal vertebral artery extending to proximal basilar artery. With no new clinical symptoms and signs, follow-up of vascular imaging within 1 week showed progressive critical narrowing of the dissected vertebrobasilar arteries. The blood flow of the vertebrobasilar system was restored by endovascular stenting. CONCLUSION: iVBD might progress without clinical manifestations. Early follow-up of vascular imaging should be considered in the patients with high risk for progression.
Delayed Unilateral Eagle Syndrome with Fractured Styloid Process.
Chen TH, Hsu PS, Chang KL … +1 more , Liu HS
Acta Neurol Taiwan · 2023 Mar · PMID 36474451
PURPOSE: Minor injury to head and neck is usually neglected for potential neurological consequences. We report a woman who suffered left Eagle syndrome due to styloid process fracture two years after a minor motorcycle c...
PURPOSE: Minor injury to head and neck is usually neglected for potential neurological consequences. We report a woman who suffered left Eagle syndrome due to styloid process fracture two years after a minor motorcycle collision. CASE REPORT: A 53-year-old woman complained pain at her left upper neck, lower face and periauricular area after minor motorcycle collision at 2 years ago. The pain usually occurred spontaneously but was occasionally triggered or exacerbated by specific postural changes, including looking up or turning head to right side. Moreover, a foreign body sensation occurred at throat during swallowing. Physical examination provoked pain at the left submandibular area. Carotid bruit was absent. Otherwise, other neurological function was preserved. Computerized tomography revealed linear fracture at the middle of left styloid process. After inform, patient preferred conservative treatments including abortive non- steroidal anti-inflammatory drugs and an avoidance of rapid head rotations. Since afterwards, the frequency and intensity of neck pain greatly decreased and she could tolerate and maintain a normal daily living. CONCLUSIONS: Asymptomatic or paucisymptomatic styloid process fracture may be neglected in case of minor injury to head and neck. A careful evaluation of neck should be completed in traumatic individuals to reveal underlying damage and prevent further harmful consequence.
Normal norms of carotid vessel wall volume in Taiwanese adults as measured using three-dimensional ultrasound.
Liao CC, Chen PY, Lin SK
Acta Neurol Taiwan · 2023 Mar · PMID 36474450
PURPOSE: The three-dimensional (3D) measurement of vessel wall volume (VWV) and plaque volume is sensitive for predicting cardiovascular risk. We established the normal norms of carotid VWV. METHODS: We retrospectively e...
PURPOSE: The three-dimensional (3D) measurement of vessel wall volume (VWV) and plaque volume is sensitive for predicting cardiovascular risk. We established the normal norms of carotid VWV. METHODS: We retrospectively enrolled 352 patients with normal findings of the carotid ultrasound studies. Two-dimensional carotid intima-media thickness (IMT) was measured online. Grayscale 3D images of both sides of the carotid arteries were analyzed offline for measurement of IMT (QIMT) and VWV. RESULTS: The median age of the enrollees was 59 years. The median carotid IMT, QIMT, and VWV was 0.61 mm, 0.72 mm, and 90 mm3, respectively. No differences in IMT and VWV were observed between men and women or between the right and left side. We stratified participants into four groups, namely young adults (≤50 years), middle-aged adults (51-65 years), older adults (66-75 years), and senior adults (≥75 years). All the values of measured variables increased with advancing age. The median VWV of each group was 84, 90, 100, and 112 mm3, respectively. The increment percentage from young to senior adults was similar in terms of IMT and VWV. Nevertheless, the difference in the value of VWV (28 mm3) was much larger than that in IMT (0.18 mm). All three measured variables exhibited a positive linear correlation with age. CONCLUSION: Both IMT and VWV have positive linear correlations with age. The application of QIMT measurements was limited by its inconsistent accuracy. VWV not only has a strong correlation with IMT but also enables observation of dynamic vessel wall changes, which is valuable for clinical observational studies.
Does proton pump inhibitor reduce the antiaggregant efficacy of aspirin in ischemic stroke?
Özel T, Ünal A, Özdem S … +1 more , Dora B
Acta Neurol Taiwan · 2023 Mar · PMID 36474449
OBJECTIVE: To evaluate the effect of using acetylsalicylic acid (aspirin) together with lansoprazole in the secondary prevention of ischemic stroke. MATERIALS AND METHODS: 199 patients with a diagnosis of ischemic stroke...
OBJECTIVE: To evaluate the effect of using acetylsalicylic acid (aspirin) together with lansoprazole in the secondary prevention of ischemic stroke. MATERIALS AND METHODS: 199 patients with a diagnosis of ischemic stroke and transient ischemic attack (TIA) using 100 mg aspirin regularly were included in the study. All patients were evaluated for the presence of aspirin resistance before starting the study. 57 patients with aspirin resistance were excluded from the study. The remaining 142 patients were divided into two groups: the 1st group consisted of those with stomach discomfort and the 2nd group consisted of those without stomach discomfort. Patients in group 1 were given 30 mg of lansoprazole taken before breakfast in addition to aspirin therapy. All patients were re-evaluated for the presence of aspirin resistance at a one-month follow-up. The antiaggregant activity was evaluated by the impedance aggregometry method in both groups. RESULTS: Of 142 patients, 75 were in group 1, and 67 were in group 2. There was no difference between the two groups in terms of age and gender distribution of vascular risk factors. There was no statistically significant difference between the two groups in terms of aspirin efficacy. The dose of aspirin was increased in patients with aspirin resistance (AR). CONCLUSION: The combination of 30 mg lansoprazole and 100 mg aspirin does not cause a decrease in antiaggregant activity in the early period, but chronic use was not evaluated in this study. Patients with AR may benefit from an increase in the dose of aspirin.
2022 Taiwan Guidelines for Acute Treatment of Migraine.
Lau CI, Wang YF, Treatment Guideline Subcommittee of the Taiwan Headache Society
Acta Neurol Taiwan · 2022 Jun · PMID 36153693
The Taiwan Headache Society published its guidelines for acute migraine treatment in 2017. Since then, emerging drugs and treatment options have developed rapidly. The migraine-specific drugs gepants and ditans and sever...
The Taiwan Headache Society published its guidelines for acute migraine treatment in 2017. Since then, emerging drugs and treatment options have developed rapidly. The migraine-specific drugs gepants and ditans and several noninvasive neuromodulation devices have been approved for use in Europe and the United States. Although not all emerging drugs and treatment options have been approved for use in Taiwan, keeping pace with international trends and updating treatment guidelines are imperative. Therefore, the Treatment Guideline Subcommittee of the Taiwan Headache Society reviewed the quality of recent trials, evaluated the corresponding grade of evidence, and appraised the reported clinical efficacy to reach a new consensus. To ensure that the updated Taiwan guidelines are appropriate and feasible, the subcommittee also referred to the guidelines from the United States, Europe, Canada, and other countries concerning the main roles, recommendation levels, clinical efficacy, and adverse reactions of drugs for the acute migraine treatment. Several types of drugs are currently available for acute migraine treatment in Taiwan. These drugs can be categorized into migraine-specific and migraine-non-specific. Among them, migraine-specific triptans (oral or nasal spray formulations) and migraine-nonspecific acetaminophen and NSAIDs (diclofenac, ibuprofen, naproxen) are highly recommended because they are supported by strong evidence and demonstrate high efficacy. Prochlorperazine injection has been upgraded to a highly recommended level because of the rich clinical experience for this treatment. Ergotamine/caffeine remains a second-line drug because of its lower specificity and efficacy compared with triptans. High-dose aspirin was downgraded to rescue treatment because of potential gastrointestinal side effects. Although evidence supports the combination of oral tramadol and acetaminophen, this combination should be used as a rescue treatment due to concerns about dependence. Evidence supporting the use of intravenous tramadol or morphine is insufficient; therefore, their use is not recommended. As for non-pharmacological approaches, there are only limited controlled data. The choice of treatment for acute migraine attacks should follow the concept of "stratified care." For mild to moderate migraine attacks, oral NSAIDs are the first choice, with combination analgesics, intravenous/intramuscular NSAIDs as alternatives. For moderate to severe attacks, oral or nasal spray triptans and ergotamine/caffeine compounds are recommended and should be administered in the early stage of migraine attacks. Antiemetics can be used as supplements to alleviate nausea and vomiting. Other emerging migraine-specific drugs, such as gepants or ditans, may also have a role in the future. Notably, a combination of a triptan and a NSAID yielded a better efficacy compared with either therapy alone. Parenteral steroids and fluid supply are the first-line treatment for status migrainosus. Acetaminophen is suitable for mild to moderate migraine attacks and remains the first choice for children and pregnant women. To prevent medication overuse headache, the use of acute treatment should be limited to a maximum of 2 days per week. Key words: acute migraine treatment, evidence-based medicine, treatment guidelines, triptans, ergotamine, neuromodulation.
2022 Taiwan Guidelines for Preventive Treatment of Migraine.
Wu JW, Yang CP, Treatment Guideline Subcommittee of the Taiwan Headache Society
Acta Neurol Taiwan · 2022 Sep · PMID 36089629
The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated the medications currently used for migraine prevention in Taiwan. The subcommittee assessed the results of recently published trials, meta-ana...
The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated the medications currently used for migraine prevention in Taiwan. The subcommittee assessed the results of recently published trials, meta-analyses, and guidelines. After expert panel discussions, the subcommittee reached a consensus on the preventive treatment of migraine in Taiwan, which includes recommendation levels, the strength of evidence, and essential prescription information (i.e., dosage and adverse effects) . The recent introduction of CGRP monoclonal antibodies has had a substantial effect on migraine treatment. Thus, the subcommittee updated the previous version of the treatment guideline published in 2017. Preventive medications for migraines can be divided into the following categories: ß-blockers, anticonvulsants, calcium channel blockers, antidepressants, onabotulinumtoxinA, anti-CGRP monoclonal antibodies, and complementary and alternative medicine. For episodic migraine prevention, propranolol, flunarizine, and topiramate are recommended as the first-line medications. Second-line medications for episodic migraine prevention include valproic acid, amitriptyline, and anti-CGRP monoclonal antibodies. Other treatment options could be used as third-line treatments. For chronic migraine prevention, topiramate, flunarizine, onabotulinumtoxinA, and anti-CGRP monoclonal antibodies are recommended as first-line therapies. Preventive medications for episodic migraine can also be used as second-line treatments for chronic migraine. For menstrual migraines, nonsteroidal anti-inflammatory drugs and triptans can be used for short-term prophylaxis. Indications for starting preventive treatment include a headache frequency of ≥4 days per month, profound disabilities, failure of or contraindication to acute therapies, a complicated migraine with debilitating (e.g., hemiplegic) auras, and migrainous brain infarction. The general principle for oral preventives is to "start low and go slow" while monitoring for adverse events and comorbid conditions. Physicians could consider gradually tapering the medications in patients with sustained improvement over 3 to 6 months in episodic migraine and 6 to 12 months in chronic migraine. Education about not overusing acute medications is also essential for all patients with migraine. Key words: migraine, preventive treatment, evidence-based medicine, guidelines, CGRP monoclonal antibodies, onabotulinumtoxinA, neuromodulation.
Right Fusiform Gyrus Infarct with Acute Prosopagnosia.
Koh YH
Acta Neurol Taiwan · 2022 Dec · PMID 35470413
A 56-year-old, right-handed man with no known past medical history presented with sudden onset of inability to recognize familiar individuals in person, including his wife and his mother. He also couldn't recognize himse...
A 56-year-old, right-handed man with no known past medical history presented with sudden onset of inability to recognize familiar individuals in person, including his wife and his mother. He also couldn't recognize himself in the mirror. There was no weakness, numbness, visual disturbances, or speech difficulty. Face recognition test, using Warrington Recognition Memory Test (1), showed the presence of complete prosopagnosia. The rest of the neurological and cranial nerves examinations were normal. Magnetic resonance imaging (MRI) of the brain showed restricted diffusion at the right temporal and occipital lobes (the fusiform gyrus) [Figure 1]. Magnetic resonance angiogram (MRA) of the brain was unremarkable. The 24-hours Holter monitoring showed paroxysmal atrial fibrillation. The transthoracic echocardiogram and carotid doppler ultrasound scan were normal. He was then treated with rivaroxaban 20mg daily for secondary stroke prevention in non-valvular atrial fibrillation. Face recognition skill training was started in the ward, which includes compensatory strategies to achieve person recognition by circumventing the face processing impairment, and remediation to enhance mnemonic function for face recognition. His prosopagnosia resolved completely after one week. Prosopagnosia, also known as face blindness, is an impairment in recognizing faces. The core defects are the loss of familiarity with previously known faces and the inability to recognize new faces. Patients with prosopagnosia may present with poor recognition of familiar individuals in person or in the photograph, confusion with plotlines in movies or plays with numerous characters, and difficulty distinguishing individuals wearing a uniform or similar clothing. Stroke is the most common cause of acquired prosopagnosia (2). Other less common aetiologies include traumatic brain injury, carbon monoxide poisoning, temporal lobectomy, and encephalitis. Literature has shown that areas involved in acquired prosopagnosia are the right fusiform gyrus or anterior temporal cortex, or both (3). The fusiform gyrus is part of the lateral temporal lobe and occipital lobe in 'Brodmann area 37' (4). The fusiform gyrus is considered a key structure for functionally specialized computations of high-level vision such as face perception, object recognition, and reading. Individuals with fusiform lesions are more likely to have apperceptive prosopagnosia, while those with anterior temporal lesions have an amnestic variant (5). In summary, prosopagnosia can be the sole presentation for the right fusiform gyrus stroke. It is important to recognize prosopagnosia for early stroke diagnosis and avoid misdiagnosing it as a psychiatric or ocular disorder. Keywords: prosopagnosia, fusiform gyrus, stroke.
Status Epilepticus Related Takotsubo Syndrome - A Case Report.
Hsiao CL, Yeh KH, Chen PY … +3 more , Yang FY, Chen IA, Lin SK
Acta Neurol Taiwan · 2022 Dec · PMID 35470412
PURPOSE: Takotsubo syndrome (TTS) is characterized angiographically by transient left ventricular systolic dysfunction sparing the basal segments of the left ventricle and absence of obstructive coronary artery disease....
PURPOSE: Takotsubo syndrome (TTS) is characterized angiographically by transient left ventricular systolic dysfunction sparing the basal segments of the left ventricle and absence of obstructive coronary artery disease. Epileptic seizures as triggering events for TTS are uncommon, having only been described in approximately 100 previous cases Case report: A 64-year-old woman with a history of recent stroke-related seizures was admitted for an acute onset of right hemiparesis with dull response. Neurological examination revealed a forced deviation of the eyeballs to the left side and quadriplegia. No large intracranial artery occlusion was disclosed through computed tomography angiography, but an acute infarction at the right corona radiata was identified through magnetic resonance imaging. Electroencephalography showed frequent spike-and-wave complexes over the right cerebral hemisphere indicating subtle status epilepticus. Her consciousness deteriorated to a stuporous state, and her eyeballs were forced deviated to the right side with persistent twitching of the right limbs 10 hours later. The convulsive status epilepticus (CSE) subsided after intravenous infusion of midazolam. However, atrial flutter with inverted T-wave and elevated high-sensitivity troponin I were observed 12 hours after CSE. Arrhythmia was soon alleviated through appropriate treatment. A further coronary angiography did not show significant coronary artery stenosis but indicated that the midsection and the apex of the left ventricle ballooned out during systole as the base contracted normally, indicating a Takotsubo syndrome. CONCLUSION: Physicians need to monitor unusual arrhythmias, particularly atrial and ventricular arrhythmias, for the possibility of TTS in patients with epileptic seizure.
Concomitant Sympathetic and Parasympathetic Dysfunction after Acute Ischemic Stroke.
Chang TY, Chen PS, Yeh SJ … +3 more , Tang SC, Tsai LK, Jeng JS
Acta Neurol Taiwan · 2022 Dec · PMID 35470411
PURPOSE: Autonomic dysfunction is an underrecognized complication of acute ischemic stroke. The cortical regulation of sympathetic activation is predominantly lateralized to the right hemisphere and parasympathetic activ...
PURPOSE: Autonomic dysfunction is an underrecognized complication of acute ischemic stroke. The cortical regulation of sympathetic activation is predominantly lateralized to the right hemisphere and parasympathetic activation to the left hemisphere. However, prior evidence is lacking regarding ischemic lesions in unilateral hemisphere that concomitantly cause sympathetic and parasympathetic dysfunction. CASE REPORT: We present the case of a 73-year-old woman with acute ischemic stroke in the left middle cerebral artery territory, whose neurological symptoms improved significantly after thrombolysis and endovascular thrombectomy. She presented residual scattered small infarctions involving the left insula and lateral parietal cortex. However, she experienced obvious autonomic symptoms that included orthostatic hypotension, which is indicative of sympathetic dysfunction, and micturition difficulty with exaggerated reflex tachycardia, indicative of parasympathetic dysfunction. The sympathetic and parasympathetic functions sequentially resolved on days 10 and 20 after stroke onset, respectively. CONCLUSION: The case revealed insight into the phenomenon and recovery course of concurrent sympathetic and parasympathetic dysfunction associated with ischemic lesions in the left hemisphere.
Basilar Artery Thrombosis in the Postpartum Period During COVID - 19 Pandemic: A Lethal But Avoidable Complication.
Kaur M, Sharma A, Sharma S … +1 more , Tiwari S
Acta Neurol Taiwan · 2022 Dec · PMID 35470410
PURPOSE: To highlight the factors leading to the delayed diagnosis of basilar artery occlusion and poor outcome in the postpartum period during the prevailing Corona Virus Disease-2019 (COVID-19) pandemic. CASE REPORT: W...
PURPOSE: To highlight the factors leading to the delayed diagnosis of basilar artery occlusion and poor outcome in the postpartum period during the prevailing Corona Virus Disease-2019 (COVID-19) pandemic. CASE REPORT: We here report a case of a 34-year female who presented with a headache localized to the occipital region after cesarean section under spinal anesthesia. Her headache severity increased over time, and she developed a generalized seizure episode and became unconscious. Subsequently, basilar artery thrombosis was diagnosed. Despite all efforts, she succumbed to death. We believe that we might have saved the patient's life if we could have made the diagnosis beforehand. CONCLUSION: We recommend that unless shown otherwise, postpartum headache and neck discomfort, even in individuals with no known risk factors, should have a low index of suspicion, early diagnosis using non-invasive radiological study such MRI to rule out this uncommon but deadly illness quickly.
Improvement After Celecoxib Treatment in Patients with Thalamic Hemorrhage - A Case Report.
Lin YW, Yeh SJ, Tang SC … +2 more , Tsai LK, Jeng JS
Acta Neurol Taiwan · 2022 Dec · PMID 35470409
PURPOSE: Perihematomal edema of intracerebral hemorrhage (ICH) is caused by a hematoma-induced inflammatory reaction, which usually contributes to delayed deterioration of neurological function and poor outcomes. Celecox...
PURPOSE: Perihematomal edema of intracerebral hemorrhage (ICH) is caused by a hematoma-induced inflammatory reaction, which usually contributes to delayed deterioration of neurological function and poor outcomes. Celecoxib is a commonly used nonsteroidal anti-inflammatory drug that selectively inhibits cyclooxygenase-2. High-dose celecoxib (400 mg twice daily) for 14 days has been shown to reduce perihematomal edema and hematoma enlargement in patients with ICH, but without improvement in long-term functional outcome, which may be confounded by the heterogeneity of hematoma location. Low-dose celecoxib may be an effective management for symptoms caused by perihematomal edema in patients with ICH, particularly those involving the thalamus. CASE REPORT: We reported two patients with acute thalamic ICH; a common symptom between the two was delayed onset of drowsiness caused by perihematomal edema involving the thalamus. Their consciousness improved after low-dose celecoxib (200 mg once daily) administration for 3 and 2 days in case A and B, respectively. Furthermore, other symptoms that concomitantly improved included poor appetite caused by perihematomal edema involving the left hypothalamus in case A, and limb weakness caused by perihematomal edema of the internal capsule in case B. CONCLUSION: These cases revealed that low-dose celecoxib may be an effective management for symptoms caused by perihematomal edema in patients with ICH, particularly those involving the thalamus.
Antiplatelets and Anticoagulants in Ischemic Stroke,Transient Ischaemic Attack: A Practice Survey Among Singapore Neurologists.
Venketasubramanian N
Acta Neurol Taiwan · 2022 Dec · PMID 35470408
PURPOSE: Evidence-based stroke clinical practice guidelines provide guidance as how to best manage patients with cerebrovascular disease. Where there are grey zones, the clinician decides what she/he feels is the most ap...
PURPOSE: Evidence-based stroke clinical practice guidelines provide guidance as how to best manage patients with cerebrovascular disease. Where there are grey zones, the clinician decides what she/he feels is the most appropriate in that circumstance. This study was performed to determine how adult neurologists in Singapore would use antiplatelets(AP) and anticoagulants(AC) for their ischemic stroke patients in various settings where the evidence is uncertain. METHODS: A standardised questionnaire was sent to adult neurologists in Singapore. The questions evaluated their preferred type and dose of AP, use of heparin prior to initiating warfarin, and their preferred treatments in 6 different clinical scenarios. RESULTS: A total of 31/33 neurologists responded (93.9%). For long term secondary prevention, 71.0% preferred aspirin only, 22.6% clopidogrel/ticlopidine only, 6.5% aspirin plus dipyridamole. Anticoagulation with warfarin was initiated with a heparin bolus by 45.2%. AC were preferred by 80.6% for stroke in evolution, 80.6% for presumed basilar artery thrombosis, 54.8% for crescendo TIAs. For patients awaiting CEA, 58.1% preferred AP, 32.3% AC. For patients on preferred AP developing another cerebrovascular event with no new underlying cause, 48.4% would change AP, 25.8% would add another AP. For patients on adequate AC for non-cardioembolism developing another cerebrovascular event, 54.8% would add anti-platelet, 19.4% would increase AC. CONCLUSIONS: The widespread use of aspirin for long-term secondary prevention is similar to other countries. The variation in the use of antithrombotic agents in other settings may reflect the lack of sufficient evidence to guide therapy in the various specific stroke patient management scenarios. KEY WORDS: neurologist, practice, antiplatelet, anticoagulant, stroke, cerebrovascular disease.
The Effect of Age and Sex on Ischemıc Stroke: A Sıngle-Centred Neuro-Intensıve Care Unıt Experıence.
Guzeldag S
Acta Neurol Taiwan · 2022 Dec · PMID 35470407
BACKGROUND: Age and sex are important determinants in the acute ischemic stroke (AIS). In this study, we examine the effects of age and sex on stroke survival and treatment in our clinic. METHODS: We reviewed 368 AIS pat...
BACKGROUND: Age and sex are important determinants in the acute ischemic stroke (AIS). In this study, we examine the effects of age and sex on stroke survival and treatment in our clinic. METHODS: We reviewed 368 AIS patients' records between January 1, 2019, and January 1, 2020, and formed three groups of age; Group 1:18-64 years, Group 2:65-79 years, and Group 3:more than 80 years. Then, we analyzed patients' data (sex, risk factors, hospital outcome, etc.), reperfusion therapy (RT) types (tissue plasminogen activator(tPA), endovascular therapy(EVT) and tPA+EVT), and reasons for none- RT (time mismatch, absolute and relative contraindications). RESULTS: The majority of patients were age less than 65 years (48.6%), and the proportion of women increased in the older (56.1%). The most common stroke risk factor was hypertension (44.7%), but for those less than 65 years, it was obesity (46.6%). The most common RT type was tPA (56.7%), and no patients more than 80 years received tPA+EVT. The most common none-RT reason was time mismatch (65%). Being more than 80 years and female over 80 years (p=0.001, and p=0.005) were associated with increased mortality risk. While the frequency of none-RT patients was 28.8% in general, it increased up to 62.8% for the ones age more than 80 years. Also, the mortality rate was the highest in the none-RT(p less than 0.01). CONCLUSIONS: RT practices differed according to patients' age and sex. The main determinant of the mortality rate was the lack of RT. However, the older patients and older women had less opportunity for RT.
Comparison of clinical profile and outcome of de novo convulsive status epilepticus with those with a past history of epilepsy in the elderly populace.
Verma A, Kumar A, Sachan D
Acta Neurol Taiwan · 2022 Sep · PMID 35437744
AIM: To compare the clinical characteristics and etiological differences between de novo convulsive status epilepticus (CSE) with those with a past history of epilepsy in the elderly populace and the predictors of in-hos...
AIM: To compare the clinical characteristics and etiological differences between de novo convulsive status epilepticus (CSE) with those with a past history of epilepsy in the elderly populace and the predictors of in-hospital mortality. METHODS: One hundred twenty-two elderly (≥60 years of age) hospitalized patients with CSE were evaluated for clinical profile, etiologies and predictors of in-hospital mortality. RESULTS: The mean age of the study population was 67.2±7.7 years. Among them, 77 (63.1%) cases were of de novo CSE and 45 (36.9%) cases had a past history of epilepsy. Most common etiologies in de novo CSE were acute symptomatic in 68.8%, followed by remote symptomatic in 24.7% of cases. Inhospital mortality in de novo CSE was 38.9 % and on multivariate analysis, it was found variables significantly related to mortality in CSE were the presence of comorbidities (odds ratio (OR) = 0.229, 95% confidence interval (CI) = 0.059- 0.897; p=0.03) low Glasgow Coma Scale (GCS) (OR =0.045 , 95% CI =0.013- 0.160 ; p= 0.01) and de novo CSE ( OR= 0.093, 95% CI = 0.017- 0.503 ;p= 0.01 ). CONCLUSIONS: De novo CSE in the elderly was associated with poorer outcomes in comparison to those with a past history of epilepsy. In-hospital mortality in CSE was related to the presence of comorbidities, low GCS and de novo CSE. Prompt and aggressive management of de novo CSE is the most effective way of preventing in-hospital mortality in the elderly.
Seasonal variation and Incidence of rupture of intracranial aneurysm : A prospective study and Literature review.
Hr D, Praneeth K, Aggarwal A … +2 more , Gupta SK, Sachdeva N
Acta Neurol Taiwan · 2022 Sep · PMID 35437743
OBJECTIVES: Some studies have found an association of incidence of aneurysmal Sub arachnoid hemorrhage (aSAH) seasonal variations and weather patterns but others have refuted this. With conflicting reports in the literat...
OBJECTIVES: Some studies have found an association of incidence of aneurysmal Sub arachnoid hemorrhage (aSAH) seasonal variations and weather patterns but others have refuted this. With conflicting reports in the literature, we tried to find out whether climatic conditions influence the incidence of aSAH. PATIENTS AND METHODS: This was a prospective single centre study involving patients with aSAH operated in a tertiary care hospital over one calendar year. Meteorological parameters like temperature, barometric pressure, humidity and sunshine hours were noted for 2 consecutive days prior to the ictus and on the day of ictus. RESULTS: 392 patients of aSAH who underwent clipping were enrolled. There was no significant difference in the incidence of aSAH across various seasons (p > 0.05). Pre ictus fall in temperature lead to a surge in number of cases. 241 patients (61.5%) reported were from geographical areas which had experienced a fall in temperature over preceding 2 days, with a mean fall in temperature of 1.1(SD 2.1) degree celsius (p less then 0.05). The incidence of aSAH patients in low sunshine hour seasons (1.13 patients/day) was significantly more than that in higher sunshine hour seasons (0.9 patients/day) (p less than 0.05 ). CONCLUSIONS: Seasonal variation had no direct bearing on the incidence of aSAH. Pre ictus fall in temperature lead to a rise in number of cases. Also, higher incidence of aneurysmal subarachnoid haemorrhage was seen in lower sunshine hour seasons.
Evaluation of Intracranial Vascular and Non-Vascular Pathologies in Patients Hospitalized due to COVID-19 Infection.
Usta NC, Bulut E
Acta Neurol Taiwan · 2022 Sep · PMID 35437742
OBJECTIVE: Although Coronavirus disease 2019 (COVID-19) is a respiratory virus different clinical presentations may appear by affecting other organs and systems. Along with vascular diseases in COVID-19 disease, other co...
OBJECTIVE: Although Coronavirus disease 2019 (COVID-19) is a respiratory virus different clinical presentations may appear by affecting other organs and systems. Along with vascular diseases in COVID-19 disease, other conditions involving the central nervous system (CNS) such as meningocephalitis, cerebral edema, and lesions on corpus callosum. Neuroimaging has an extremely important place in the diagnosis when central nervus system involvement is clinically suspected in people infected with COVID-19. METHODS: The study was monocentric, retrospectively designed between March 2020 and May 2021 in a tertiary healthcare facility. Among the patients who underwent neurological evaluation, patients with anomaly in brain MRI and CT were included in the study. RESULTS: Among 5,430 patients who have been admitted due to COVID-19 between the dates mentioned above, 51 patients including 27 (52.9%) females and 24 (47.1%) males presented abnormal findings in cerebral radiological tests. Vascular abnormality was detected in 45 patients whereas 6 patients presented non-vascular abnormality. General demographic data and concomitant diseases of the patients were presented in Table 1and Table 2. CONCLUSION: In line with the literature, this study which reviewed abnormalities of CNS involvement reflected on brain MRI and CT among neurological complications due to COVID-19 infection revealed that vascular abnormalities. Presence of concomitant diseases including advanced age and hypertension was detected as risk factors for development of vascular abnormality. It was documented that non-vascular brain anomalies which are less common and treated differently and these are at earlier ages when compared to patients with vascular anomalies with fewer co-morbidities and shorter duration of infection.
Urgent Demand of Network Access for Acute Ischemic Stroke Management in Taiwan.
Yin JH, Wu HY, Chien C … +4 more , Hsu LC, Lee JT, Hu HH, Peng GS
Acta Neurol Taiwan · 2022 Sep · PMID 35437741
Time is the major determinant in successful reperfusion therapy of acute ischemic stroke. The evolving diagnostic tools and treatment of acute stroke has made a great progress in the past 2 decades and is remolding curre...
Time is the major determinant in successful reperfusion therapy of acute ischemic stroke. The evolving diagnostic tools and treatment of acute stroke has made a great progress in the past 2 decades and is remolding current management practices. It demands a timely neurologic evaluation and a neuroimaging study to determine if stroke patients are appropriate candidates for reperfusion demands. Therefore, it is critical for the setting of stroke center accreditation levels and capabilities so that timely and appropriate treatment is initiated for the eligible stroke patients. Optimal acute ischemic stroke treatment requires all levels of stroke center network operating efficiently. In the future, Taiwan should revise the criteria of stroke center accreditation and set up the efficient acute stroke treatment network as soon as possible. Keywords: stroke, reperfusion, intra-arterial thrombectomy, intravenous recombinant tissue plasminogen activator.
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