Surgical decision making in temporal lobe epilepsy: a comparison of [(18)F]FDG-PET, MRI, and EEG.

Objectives: The goals of this work were (1) to determine the effect of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), MRI, and EEG on the decision to perform temporal lobe epilepsy (TLE) surgery, and (2) to determine if FDG-PET, MRI, or EEG predicts surgical outcome.

Methods: All PET scans ordered (2000-2010) for epilepsy or seizures were tabulated. Medical records were investigated to determine eligibility and collect data.

Isolated Broca's area aphasia and ischemic stroke mechanism.

Cerebral embolism has been considered to be the most common stroke mechanism when the resulting stroke has at least some amount of aphasia as part of its clinical manifestations. To determine stroke mechanism and risk factor profile in patients with isolated Broca's area aphasia (Broca's infarct), we studied 34 consecutive patients with recent infarcts whose only or predominant clinical feature was that of nonfluent speech and compared these cases with 68 control patients with cortical infarcts in the middle cerebral artery distribution whose clinical features were not restricted to an isolated aphasia. Controls were age- and sex-matched and were selected from ischemic infarcts seen at our institutions over the same observation period.

Aspirin "failures," clopidogrel added to aspirin, and secondary stroke prevention in veterans presenting with TIA or mild-to-moderate ischemic stroke.

Our objective was to investigate whether clopidogrel added to low-dose aspirin reduced vascular events in male patients at our VA hospital who had "failed" aspirin therapy because of a mild-to-moderate stroke or a transient ischemic attack. Of 179 consecutive patients who both reported daily aspirin usage at the time of their newest ischemic event as well as were then operationally defined as aspirin "failures," 134 (group A) were treated with combined aspirin-clopidogrel, 15 (group B) underwent an early arterial procedure, 25 (group C) were anticoagulated, and 5 were not entered or continued because of either non-compliance or a refusal to participate. Study therapies were modified because of a vascular event in 4.

Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil.

A 20-year-old female with hemiplegic migraine was treated during an acute attack with intravenous verapamil, which reproducibly resolved the headache within 20 min but did not affect her hemiplegia. Magnetic resonance (MR) and computed tomographic (CT) angiography and perfusion performed during the attack showed vasodilation and hyperperfusion. Cerebral hyperperfusion concurrent with hemiplegia suggests a dissociation between cerebral perfusion and neuronal function in hemiplegic migraine.

Serial headache drawings by children with migraine: correlation with clinical headache status.

Children's artistic self-depictions of headache provide valuable insights into their experience of pain and aid in the diagnostic differentiation of headache types. In a previous study, we compared the clinical diagnosis (gold standard) and artistic diagnosis of headaches in 226 children. In approximately 90% of cases, the drawing predicted the clinical diagnosis of migraine versus nonmigraine headache correctly.

Atrial fibrillation is associated with severe acute ischemic stroke.

Atrial fibrillation (AF) is a common risk factor for disabling ischemic stroke in the elderly, but it is not clear that its severity is generally worse than that of ischemic stroke due to other etiologies. We reviewed the clinical presentations of patients with acute ischemic stroke admitted between 1990 and 2001. The etiologies of these strokes were also classified using well-established criteria.