Recurrent status epilepticus as the primary neurological manifestation of CADASIL: A case report.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) often presents with a history of migraine with aura and eventual manifestations of dementia with unrelenting, repeated cerebral vascular insults. Only 6-10% of patients with CADASIL have been reported to develop seizures, and status epilepticus (SE) is exceedingly rare. Here, we describe a patient who presented with recurrent SE, with eventual biopsy diagnosis of CADASIL.

Spinal epidural hematoma: an important stroke mimic.

Tissue plasminogen activator (tPA) is, on occasion, given to patients who do not suffer from acute cerebral ischemia. As the underlying conditions often mistaken for acute ischemic stroke tend to produce transient dysfunction, and are generally seen in individuals younger than stroke patients, the outcome of such mistaken treatment is generally benign. We will describe two elderly patients with acute hemiparesis caused by spinal epidural hematomas (SEDH), both of whom were initially considered candidates for tPA.

Effects of Mendelsohn maneuver on measures of swallowing duration post stroke.

Purpose: The purpose of this pilot study was to determine whether intensive use of the Mendelsohn maneuver in patients post stroke could alter swallow physiology when used as a rehabilitative exercise.

Method: Eighteen outpatients between 6 weeks and 22 months post stroke were enrolled in this prospective study using a crossover design to compare 2 weeks of treatment with 2 weeks of no treatment. Each participant received an initial videofluoroscopic swallow study (VFSS) and an additional VFSS at the end of each week for 1 month for a total of 5 studies.

Cerebral infarcts in the setting of eosinophilia: three cases and a discussion.

Objective: To describe 3 cases of stroke associated with hypereosinophilic syndrome and discuss the pathogenesis of such strokes.

Design: Retrospective medical record review.

Setting: University hospital.

An unusual case of multiple discrete brain lesions.

The case of a patient with multiple enhancing lesions in the brain is presented, along with discussion of the differential diagnosis of granulomatous lesions of the brain, and a brief review of the essential features and neurological complications of the eventual diagnosis. Aspects of the disease of interest to neurologists are emphasized.

Motor neuron disease presenting with slow saccades and dementia.

A 46-year-old man with a 2-year history of dementia presented with very slow saccades and tongue fasciculations. The diagnosis of amyotrophic lateral sclerosis (ALS) was established by electrophysiologic studies and ultimately on autopsy. Rarely, slowed saccades may be present in ALS, and slow saccades in a relatively young demented patient should prompt consideration of ALS.

Cystic solitary intracerebral metastasis from prostate adenocarcinoma.

Brain metastases from prostate adenocarcinoma are rare; spread to brain as the only site of metastasis is even rarer. We present a patient with a large, cystic, solitary intracerebral metastasis from prostate adenocarcinoma. The pertinent literature is reviewed.

Is testing for inherited coagulation inhibitor deficiencies in young stroke patients worthwhile?

Objective: To test the hypothesis that in patients under age 50, with a first, arterial, ischemic cerebral infarct, whose family history and medical history do not suggest an inherited coagulation inhibitor deficiency, the yield of a laboratory search for these disorders will be low.

Materials And Methods: In 55 such patients under age 50, we systematically searched for deficiencies of protein C, protein S, and antithrombin III.

Results: No abnormalities of protein C or antithrombin III were found.

Delayed postanoxic demyelination and arylsulfatase-A pseudodeficiency.

We report a patient with delayed postanoxic demyelination who had pseudodeficiency of arylsulfatase A, reducing his enzyme activity to 10 to 30% of normal. This may have implications regarding the pathogenesis of postanoxic demyelination.

Brain tissue injury and blood-brain barrier opening induced by injection of LGE2 or PGE2.

The hypothesis that the accumulation of prostaglandin (PG)E2 during reperfusion of severely ischemic tissue contributes to a breakdown in the blood-brain barrier (BBB) was expanded to include a parallel role for levuglandins(LGs), gamma-ketoaldehydes produced by rearrangement of PGH2. LGE2 was shown to be more potent than PGE2 in causing breakdown of the BBB when injected intrahemispherically. Brain tissue necrosis was clearly evident with total doses of levuglandin as low as 100 nmole.

Transient neurologic deficit caused by chronic subdural hematoma.

Transient neurologic deficits are an unusual presentation of chronic subdural hematoma. Presented herein are three patients with transient aphasia and right-sided sensory-motor abnormalities caused by subdural hematoma. Review of the literature revealed 32 cases similar to ours.

Datura delirium.

Poisoning with tropine alkaloids from cultivated plants and pharmaceuticals is an uncommon cause of delirium and coma. We report a patient with a toxic delirium following ingestion of the tropine alkaloid-containing root of Datura innoxia. Thin-layer chromatography and gas chromatography/mass spectrometry confirmed the presence of atropine and scopolamine in samples of the ingested root.

Characterization of basement membranes of rat choroid plexus using the critical electrolyte concentration technique.

Using the critical electrolyte concentration technique, with ruthenium red as a strain for polyanionic macromolecules, we examined the basement membranes of the rat choroid plexus. Concentrations of Na+ exceeding 3.0 M were required to reversibly inhibit discrete staining of endothelial and epithelial basement membranes by ruthenium red, whereas 2.

Studies of endothelial mitochondrial density in degenerating rat optic nerve.

The greater mitochondrial density found in blood-brain barrier endothelium has been attributed to greater utilization of energy, for tasks such as maintaining ionic homeostasis of brain extracellular fluids. To examine whether endothelial mitochondrial density changes in parallel with neural activity, we studied capillaries in rat optic nerves rendered functionless by enucleation. We found no change in endothelial mitochondrial density compared with that in contralateral control nerves.

The glucose transporter of the human brain and blood-brain barrier.

We identified and characterized the glucose transporter in the human cerebral cortex, cerebral microvessels, and choroid plexus by specific D-glucose-displaceable [3H]cytochalasin B binding. The binding was saturable, with a dissociation constant less than 1 microM. Maximal binding capacity was approximately 7 pmol/mg protein in the cerebral cortex, approximately 42 pmol/mg protein in brain microvessels, and approximately 27 pmol/mg protein in the choroid plexus.