Hot cross bun sign

Vestibular dysfunction in acute traumatic brain injury Abstract Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. Unfortunately, vestibular diagnoses are cryptogenic in 25% of chronic TBI cases, impeding therapy. We hypothesized that chronic adaptive brain mechanisms uncouple vestibular symptoms from signs. This predicts a masking of vestibular diagnoses chronically but not acutely. Hence, defining the spectrum of vestibular diagnoses in acute TBI should clarify vestibular diagnoses in chronic TBI. There are, however, no relevant acute TBI data. Of 111 Major Trauma Ward adult admissions screened (median 38-years-old), 96 patients (87%) had subjective dizziness (illusory self-motion) and/or objective imbalance were referred to the senior author (BMS). Symptoms included: feeling unbalanced (58%), headache (50%) and dizziness (40%). In the 47 cases assessed by BMS, gait ataxia was the commonest sign (62%) with half of these cases denying imbalance when asked. Diagnoses included BPPV (38%), acute peripheral unilateral vestibular loss (19%), and migraine phenotype headache (34%), another potential source of vestibular symptoms. In acute TBI, vestibular signs are common, with gait ataxia being the most frequent one. However, patients underreport symptoms. The uncoupling of symptoms from signs likely arises from TBI affecting perceptual mechanisms. Hence, the cryptogenic nature of vestibular symptoms in TBI (acute or chronic) relates to a complex interaction between injury (to peripheral and central vestibular structures and perceptual mechanisms) and brain-adaptation, emphasizing the need for acute prospective, mechanistic studies.

Stroke in supplementary motor area mimicking functional disorder: a case report Abstract Supplementary motor area, the posterior third of the medial aspect of superior frontal gyrus, is known to be a heterogeneous area in function. It is involved in self-initiated motor movements, planning and sequencing the motor action, response inhibition, and bimanual movements. Blood supply for supplementary motor area is mostly by callosomarginal branch of anterior cerebral artery. Stroke in anterior cerebral artery territory is relatively uncommon, moreover, isolated supplementary motor area stroke is a rare entity. Supplementary motor area stroke, as a syndrome, has variable symptoms consisting of impairment of volitional movements, hemineglect, dyspraxia of contralateral limbs, impaired muscle tone, mutism and contralateral weakness. As symptoms are sometimes ambivalent, patients may be misdiagnosed as functional disorder and lose the chance for immediate adequate treatments such as thrombolysis. We report a 59-year-old man with previous history for myocardial infarction, referred to emergency room with an acute dense right-side hemiplegia, positive Hoover sign, asymmetrical Babinski responses and intermittent ability to move his arm in some specific reflex actions despite plegia. Since brain computed tomography scan was unremarkable we could not be sure whether his symptoms were organic or functional until a diffusion weighted imaging of magnetic resonance imaging elucidated the situation. To our knowledge, there is only one case report in the literature prior to ours, presenting a supplementary motor area stroke patient, mimicking functional disorder. Therefore, we may claim our report to be the second reported case.

Labyrinthine infarction caused by vertebral artery dissection: consideration based on MRI

Isolated tonsilar infarction presenting with positional vertigo and nystagmus

Pioneers in neurology: Michel Jouvet (1925–2017)

Screening for cognitive impairment among patients with neuromyelitis optica using touchscreen cognitive testing in routine clinical care

Treatment of progressive multifocal leukoencephalopathy

Cerebellar tuberculous granuloma mimicking benign paroxysmal positional vertigo: progression after initial misdiagnosis

End-of-life measures in Huntington disease: HDQLIFE Meaning and Purpose, Concern with Death and Dying, and End of Life Planning Abstract Background and purpose Huntington disease (HD) is a progressive neurodegenerative disorder. There are no HD-specific measures to assess for end-of-life (EOL) preferences that have been validated for clinical use. The purpose of this study is to demonstrate reliability and validity of three HD-specific EOL measures for use in and clinical research settings. Methods We examined internal reliability, test–retest reliability, floor and ceiling effects, convergent and discriminant validity, known groups’ validity, measurement error, and change over time to systematically examine reliability and validity of the HDQLIFE EOL measures. Results Internal consistency and test–retest reliability were > 0.70. The measures were generally free of floor and ceiling effects and measurement error was minimal. Convergent and discriminant validity were consistent with well-known constructs in the field. Hypotheses for known groups validity were partially supported (there were generally group differences for the EOL planning measures, but not for meaning and purpose or concern with death and dying). Measurement error was acceptable and there were minimal changes over time across the EOL measures. Conclusions Results support the clinical utility of the HDQLIFE EOL measures in persons with HD.