Sleep Medicine: Parasomnias.

Parasomnias are abnormal and undesirable behaviors during sleep and are thought to be due to the sleep state instability. Some of them are benign, while some of them point to a possible underlying neurodegenerative process. This article briefly discusses the clinical characteristics, demographics, and pathophysiology of major parasomnias and associated disorders.

Warfarin versus aspirin for prevention of stroke in heart failure: a meta-analysis of randomized controlled clinical trials.

Background: There is clinical equipoise between warfarin and aspirin for stroke prevention in patients with heart failure in sinus rhythm (SR). The objective of this meta-analysis was to pool risk estimates for stroke, mortality, and intracerebral hemorrhage (ICH) from published clinical randomized controlled trials (RCTs).

Methods: MEDLINE, EMBASE, the Cochrane Library, and clinicaltrials.

Levetiracetam-induced thrombocytopenia among inpatients: a retrospective study.

Lately, few case reports have brought forth limited cases of levetiracetam (LEV)-induced thrombocytopenia. To estimate the burden of LEV-induced thrombocytopenia, we reviewed medical records of 758 patients aged 18 years or older who received LEV during their stay at the University Hospital from June 2005 to December 2008. In patients identified with thrombocytopenia, records were reviewed to establish a cause of thrombocytopenia and possible causal role of LEV.

Isolated hypersomnia due to bilateral thalamic infarcts.

We describe a unique patient who developed hypersomnia as the sole presenting symptom of bilateral thalamic infarcts.

Electroencephalographic abnormalities in baclofen-induced encephalopathy.

We report a patient in whom the characteristic electroencephalographic features of baclofen intoxication are highlighted and emphasize the role of electrographic abnormalities in the diagnosis of this condition.

Lentiform Fork sign: a unique MRI picture. Is metabolic acidosis responsible?

Background And Purpose: Bilateral basal ganglia lesions are neither diagnostic nor pathognomonic of uremic encephalopathy (UE). Nonetheless, bilateral basal ganglia T2/FLAIR hyperintensities have been widely reported to be associated with UE. The aim of this study was to describe a unique neuroradiological sign seen on the MRI brain in UE, present a retrospective chart review of patients with UE over the past 10 years for evidence of similar MRI appearance, review literature for evidence of this sign, and generate a hypothesis to explain its pathophysiological basis.

Reversible sensorineural hearing loss with normal brainstem auditory evoked potentials in pontine hemorrhage due to capillary telangiectasia.

Capillary telangiectasias are vascular malformations most commonly found in the pons that are rarely associated with hemorrhage. We describe a unique case of pontine capillary telangiectasia causing central brainstem hemorrhage leading to reversible sensorineural deafness associated with a normal brainstem auditory evoked response.

Recurrent epileptic Wernicke aphasia.

We report a patient with recurrent epileptic Wernicke aphasia who prior to this presentation, had been misdiagnosed as transient ischemic attacks for several years. This case report emphasizes the consideration of epileptic nature of aphasia when a clear alternate etiology is unavailable, even when EEG fails to show a clear ictal pattern. We also present a brief discussion of previously reported ictal aphasias.

Penumbra, the basis of neuroimaging in acute stroke treatment: current evidence.

In modern medicine brain imaging is an essential prerequisite not only to acute stroke triage but also to determining the specific therapy indicated. This article reviews the need for imaging the brain in acute stroke, penumbral pathophysiology, penumbral imaging techniques, as well as current status of various imaging modalities that are being employed to select patients for specific therapeutic approaches.

Necrobacillosis resulting in isolated carotid thrombosis and massive stroke: a unique Lemierre variant?

We describe a healthy, young adult male patient who developed isolated carotid artery thrombosis and occlusion following acute pharyngitis due to Fusobacterium necrophorum. We believe this is the first case of isolated occlusion of internal carotid artery (ICA) with F.necrophorum without associated internal jugular vein (IJV) thrombosis.