A Meta-Analysis and Meta-Regression of Frequency and Risk Factors for Poststroke Complex Regional Pain Syndrome

Background and Objectives: This article aimed to investigate the risk factors for poststroke complex regional pain syndrome (CRPS). Materials and Methods: We searched electronic databases including PubMed, Medline, Web of Science, Cochrane Library, and Embase up to 27 October 2021. We enrolled analytical epidemiological studies comprising cohort, case-control, and cross-sectional studies. A quality assessment was performed using the Newcastle–Ottawa Quality Assessment Scale for cohort and case-control studies and the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Binary outcomes were reported as odds ratios (ORs), and continuous outcomes were described as standardized mean differences (SMDs) with 95% confidence intervals. For the meta-regression, beta coefficient and p value were adopted. Results: We included 21 articles comprising 2225 participants. Individuals with shoulder subluxation and spasticity were found to have higher risks for poststroke CRPS. Spasticity with higher modified Ashworth scale score, lower Brunnstrom hand stage, and inferior Barthel index scores were observed in patients with poststroke CRPS. The pooled incidence proportion in nine articles was 31.7%, and a correlation was found between effect sizes and the ratio of women and the proportion of left hemiparesis. The summarized prevalence in nine cross-sectional studies was 33.1%, and a correlation was observed between prevalence and the subluxation ratio and Brunnstrom stage. Conclusions: Based on our meta-analysis, being female, left hemiparesis, shoulder subluxation, spasticity, a lower Brunnstrom stage of distal upper limb, and an inferior Barthel index are all features for poststroke CRPS. Larger studies with greater statistical power may confirm our findings and clarify some other unknown risk factors for poststroke CRPS.

Acute prolonged motor aura resembling ischemic stroke after COVID − 19 vaccination (CoronaVac): the first case report

Background We report the first case of a patient who suffered transient focal neurological deficit mimicking stroke following CoronaVac vaccination. However, instead of an ischemic stroke, motor aura was suspected. Case presentations A 24 year-old Thai female presented with left hemiparesis fifteen minutes after receiving CoronaVac. She also had numbness of her left arm and legs, flashing lights, and headaches. On physical examination, her BMI was 32.8. Her vital signs were normal. She had moderate left hemiparesis (MRC grade III), numbness on her left face, arms, and legs. Her weakness continued for 5 days. A brain CT scan was done showing no evidence of acute infarction. Acute treatment with aspirin was given. MRI in conjunction with MRA was performed in which no restricted diffusion was seen. A SPECT was performed to evaluate the function of the brain showing significant hypoperfusion of the right hemisphere. The patient gradually improved and was discharged. Discussions In this study, we present the first case of stroke mimic after CoronaVac vaccination. After negative imaging studies had been performed repeatedly, we reach a conclusion that stroke is unlikely to be the cause. Presumably, this phenomenon could possibly have abnormal functional imaging study. Therefore, we believed that it might be due to cortical spreading depression, like migraine aura, which we had conducted a literature review.

Migrainous Infarction with Adjacent Cortical Enhancement

A 26-year old woman developed left homonymous superior quadrantanopia followed by severe pulsating headache with vomiting. Thereafter, she experienced recurrent left hemiparesis and paresthesia with or without headache. Brain magnetic resonance imaging showed diffusion restriction in the territory of the right posterior cerebral artery and contrast enhancement in the right lingual gyrus adjacent to the diffusion-restricted region. This case suggests an occurrence of cerebral infarction and blood-brain barrier disruption associated with migraine with aura.

Brain ischemia due to direct vascular compression associate with rapid enlargement of unruptured middle cerebral artery aneurysm: A case report

Background: Acute cerebral infarction is a rare complication resulting from an unruptured cerebral aneurysm (UCA). There is presently no consensus on the optimal strategy for the management of UCAs with cerebral infarctions. Case Description: A 53-year-old man presented with transient dysarthria and left hemiparesis. Magnetic resonance imaging (MRI) demonstrated the presence of a 7 mm UCA originating from the middle cerebral artery bifurcation, and diffusion-weighted imaging showed no evidence of cerebral infarction. One month later, his transient left hemiparesis recurred, and the patient was admitted to our hospital. Computed tomography angiography showed enlargement of the aneurysm. His left hemiparesis worsened 3 days later. MRI showed cerebral infarction in the area of perforating arteries and further enlargement of the aneurysm with surrounding parenchymal edema. Therefore, the rupture risk was considered to be rarely high and dome clipping was performed immediately. Postoperatively, his neurological status improved without any recurrent brain ischemia. Conclusion: We report a rare case of a rapidly enlarging aneurysm that presented with cerebral infarction. This is the first report describing aneurysmal sac enlargement that can lead to perforating artery obstruction and brain ischemia. The case illustrates the importance of performing close follow-up examinations to confirm findings that suggest a high rupture risk.

Sneddon’s Syndrome: a case report

Context: Sneddon’s Syndrome is a small and medium caliber arteries vasculopathy, characterized by concomitant occurrence of cerebrovascular disease and livedo reticularis. It’s a rare disorder, more prevalent in women. In up to 80% of cases, positive antiphospholipid’s antibodies are found. Case report: A 28-year-old woman was admitted to Hospital das ClínicasUFTM on May 21th, 2020, referred under suspicion of stroke with ictus on May 19th, 2020. The exam revealed left hemiparesis, anomic afasia and livedo reticularis on her thighs and thorax. She denied having comorbidities or previous episodes of thromboembolism. She had taken combined oral contraceptive for eleven years, having changed medication a year ago. In the cranial angioresonance exam, acute ischemia was confirmed in addition to moderate microangiopathy and an area of encephalomalacia. In the etiological investigation, HEP-2 positive antibody (antinuclear factor in a fine dotted nuclear pattern) was detected. She was discharged with a prescription of 100 mg of acetylsalicylic acid daily, maintained as a form of secondary prophylaxis. Conclusions: The case illustrates the importance of a thorough physical examination and anamnesis in cerebrovascular disease patients, in order to get a accurate aetiological diagnosis of these diseases, enabling a more effective prognostic evaluation and secondary prophylaxis.

Recurrence of glioblastoma multiforme in a childhood: A case report

GBM is a highly aggressive malignant tumor that rarely happens in children. Pediatric GBM is the primary cause of death in children with brain neoplasms. Treatment of GBM is a difficult and challenging condition, especially in pediatric GBM. Surgical tumor resection combined with chemoradiotherapy suggests as standard therapeutic approaches for GBM. However, the recurrence of GBM is an inevitable event and can occur in more than 90% of patients. We present an unusual case of an 11-years-old girl with recurrence of GBM. She complained of progressive headache and left hemiparesis as an initial manifestation. She was diagnosed with GBM three years before. Near-total surgical resection followed with chemotherapy, and radiotherapy was done after the diagnosis. Head imaging showed a smaller lesion, and her symptoms were improved significantly. Two years after, she was admitted to the hospital with worsening symptoms. Imaging evaluation showed the enlargement of tumor lesions. Recurrence of GBM is a great challenge to manage, and there are no well-defined management protocols. Several studies suggest that treatment options may follow the adult patients' approach, but pediatric GBM has significantly different characteristics than adults.

Acute Carotid Dissection Causing Acute Ischemic Stroke Due to Cocaine Sniffing

Introduction Mechanism of acute ischemic stroke in young adults due to acute carotid dissection can be due to cocaine sniffing, as it is sympathomimetic for cranial circulation. Methods A 24-year-old female presented with acute onset of right-sided neck pain and transient left hemiparesis lasting for 15 minutes after sniffing of cocaine. She had another episode of left hemiparesis with dysarthria (with National Institutes of Health Stroke Scale [NIHSS] score 7), which did not recover after second sniffing of cocaine. Her urgent magnetic resonance imaging of the brain and computed tomography angiography showed acute ischemic stroke in the right middle cerebral artery territory with acute right proximal carotid dissection with thrombus. She was having high blood pressure during presentation, which was optimized with labetalol, and was started on low-molecular-weight heparin and antiplatelet and statins. She improved gradually and her NIHSS score at discharge was 4. Discussion Cocaine, due to its sympathomimetic properties, causes sudden vasoconstriction; acute surge in blood pressure shortly after intake of cocaine may increase shear stress in the aortic wall, leading to a disruption of the intimal layer and a dissection with an intramural hematoma that subsequently may rupture into the lumen and cause acute ischemic stroke. In our case clinical history was unique in that episodes of cocaine sniffing caused progressive carotid dissection and subsequent stroke. Treatment needs optimal control of blood pressure and anticoagulation and antiplatelet medication. Conclusion Cocaine sniffing is one of the rare causes of acute ischemic stroke in young adults, and the mechanism can be acute carotid dissection.

Ischemic Stroke in a Young Patient with Nephrotic Syndrome and Antiphospholipid Syndrome

We report a case of a 21-year-old man with underlying nephrotic syndrome (NS) secondary to minimal change disease, who developed an ischemic stroke with left hemiparesis. He received intravenous thrombolysis followed by a mechanical thrombectomy. After mechanical thrombectomy, he developed acute kidney injury which subsequently required haemodialysis. Further workup revealed that he had concomitant antiphospholipid syndrome (APS) and NS. He was started on vitamin K antagonist anticoagulant. This case report illustrates the importance of workup in identifying causes of ischemic stroke in a young patient.

Teaching NeuroImages: All hemiparesis are not contralateral

A 56-yr-old hypertensive male presented with left-sided weakness of 2-h duration. He made complete recovery from right hemiparesis due to left parietal infarct. Examination showed dysarthria and left hemiparesis (NIHSS 8/42). MR-brain showed both left parietal acute infarct and gliosis from old infarct (Figure-1). He was successfully thrombolysed with intravenous alteplase. Present stroke was diagnosed as ipsilateral hemiparesis, confirmed by DTI (Figure-2). Ipsilateral hemiparesis, mostly seen with posterior fossa malformations and remote infarctions, results from injury to uncrossed corticospinal tract (CST) in patients of remote brain injury or with no decussation of CST or injury to ipsilateral extrapyramidal motor pathway.

Left Hemiparesis in Acute Myeloblastic Leukemia with High Mortality

BACKGROUND: Leukemia is a blood malignancy that has a variety of types with a variety of clinical manifestations in the body organs in each patient. Acute myeloblastic leukemia (AML) occurs more frequently in adults with clinical manifestations in the central nervous system, especially on the M4 and M5 subtypes. CASE REPORT: A 42-year-old woman came with a complaint of sudden left hemiparesis. The laboratory results obtained leukocytosis, normochromic normocytic anemia, and thrombocytopenia. Peripheral blood smear found immature cells of the myeloblasts and monoblasts series and monocytosis. CONCLUSION: The conclusion of the clinical diagnosis and laboratory of the patient is left hemiparesis caused by AML with the suspect of subtype M4 or M5. Patients died within a few hours later, so bone marrow puncture and brain fluid retrieval for malignant cell analysis could not be performed. Brain fluid analysis is important to be performed to enforce the diagnosis of cerebral leukemia.