We studied the safety of use of acute reperfusion therapies in patients with stroke- on- awakening using a computed tomographic angiography (Cta) based large vessel occlusion-good scan paradigm in clinical routine.

the Cta database of the Calgary stroke program was reviewed for the period January 2003-March 2010. patients with stroke-on-awakening with large artery occlusions on Cta, who received conservative, iV thrombolytic and/or endovascular treatment at discretion of the attending stroke neurologist were analyzed. time of onset was defined by the time last seen or known to be normal. Baseline non-contrast Ct scan (nCCt) alberta Stroke program early Ct Score (aSpeCtS) > 7 was considered a good scan. hemorrhage was defined on follow-up brain imaging using eCaSS 3 criteria. independence (mrS≤2) at three months was considered a good clinical outcome. Standard descriptive statistics and multivariable analysis were done.

among 532 patients with large artery occlusions, 70 patients with stroke-on-awakening (13.1%) were identified. the median age was 69.5 (iQr 24) and 41 (58.6%) were female; 41 (58.6%) received anti-platelets only and 29 (41.4%) received thrombolytic treatment [iV-12 (17.1%), iV/ia-12 (17.1%) and ia-5(7.1%)]. unadjusted analysis showed that baseline nCCt aSpeCtS ≤ 7 (p=0.002) and higher nihSS scores (p=0.018) were associated with worse outcomes. there were no ph2 hemorrhages in the iV thrombolytic or endovascular treated group. functional outcome was not different by treatment.

When carefully selected using Ct –Cta, by a good scan (aSpeCtS > 7) occlusion paradigm, acute reperfusion therapies in patients with stroke-on-awakening can be performed safely in clinical routine.

few studies have addressed the association between the characteristics of ischemic lesions detected by diffusion-weighted imaging (dWi) and the clinical outcome in patients with hyperacute posterior circulation ischemic stroke. this study demonstrates a relationship between the findings assessed by dWi and the outcome in patients with hyperacute posterior circulation ischemic stroke.

We reviewed data from 118 patients who had posterior circulation ischemic stroke within six hours from the onset of their symptoms. the clinical outcome included early neurological deterioration (end) and a favorable outcome at three months after the onset of symptoms. using dWi, the lesion volume and the number and location of injured anatomical regions were analyzed to evaluate whether the results correlated with the clinical outcome measures.

the number of injured anatomical regions assessed by dWi was associated with the initial and delayed neurological status. Both the total volume and the number of injured anatomical regions associated with end and a favorable outcome. analysis of the location of the injured regions determined that only a pontine lesion independently associated with end. interestingly, four out of five patients who underwent decompressive craniectomy exhibited a large infarction volume but minor symptoms.

in patients with hyperacute posterior circulation ischemic strokes, the lesions assessed by dWi were associated with the clinical outcome, regardless of the initial neurological status. dWi is an effective initial imaging tool for assessing the extent of lesions and clinical outcomes in patients with hyperacute posterior circulation ischemic stroke.

Endovascular coiling of aneurysms crossing the Circle of Willis has been described in small case series. The technical challenges in manipulating a stent across the Circle of Willis lie in negotiating difficult angles and small arteries. We present our experience with treating aneurysms by stent assistance in which the Circle of Willis was crossed to facilitate optimal stent deployment.

We retrospectively reviewed the cases in our institution from January 2009 to June 2012 in which the Circle of Willis was traversed to facilitate optimal stent deployment. We measured the diameter of the communicating arteries traversed, caliber of the target arteries in which the stent was deployed and the most acute angle negotiated (“critical angle”). We compare our results with other published series in the literature.

Eight patients fulfilled the criteria: 5 males (45-66 years). There were three anterior and five posterior circulation aneurysms. Four of the aneurysms were ruptured. The PCOM was traversed in five cases, the ACOM in three cases. The mean diameter of the communicating artery was 1.17mm. The mean diameter of target arteries was 1.27mm. The “critical angle” was 72-147 degrees. In all patients, there was satisfactory obliteration of the aneurysm. There were two cases of minor SAH post procedure.

Utilizing the Circle of Willis for optimal stent placement in aneurysm remodeling is technically feasible but challenging. This technique can be performed successfully in patients with acute SAH. The procedural risk must be balanced against potential complications such as SAH.

We explored the early expression of NF-κB, MCP-1 and -MMP 9 in a rabbit carotid aneurysm model, and investigated the possible mechanism of aneurysm.

twenty four adult new Zealand rabbits were divided into four groups. normal control (group a); rabbits received elastase induction for 1, 2 3 weeks (group b, C and d respectively); hematoxylin-eosin stains were performed for observation. the mrna and protein expression of NF-κB, MCP-1 and MMP-9 were analyzed using RT-PCR and immunohistochemical methods.

the expression of NF-κB and MCp-1 reached their peaks after induction for one week, then decreased. their expression in week 1 and week 2 had no statistical difference. the expression of MMP-9 increased after induction. We observed the highest expression at week 3. as the induction time increased, the number of smooth muscles reduced. endothelial cells were damaged; the aneurysm wall elastic layer was damaged.

activation of NF-κB may be one of the initiating factors contributing to the occurrence and development of cerebral aneurysm. MCP-1 induced macrophage adhesion and infiltration in the artery wall of cerebral aneurysms, and contributed to the occurrence and development of brain aneurysm. damage to elastic fibers is one of the key factors for aneurysm formation. increased infiltration of inflammatory cells and the secretion of MMP-9 are the main reasons for elastic fiber damage.

To determine the prevalence of glaucoma in older adults with dementia of the alzheimer's type (DAT).

retrospective chart review: the prevalence of glaucoma was determined in older adults with a diagnosis of DAT or mixed dementia (DAT with vascular contribution) admitted to the geriatric and neurology units of the Centre hospitalier de l'université de Montréal and the hôpital Maisonneuve-rosemont between april 2008 and april 2009 (n=220; DAT group). they were matched for age and date of hospitalisation to the first 220 individuals without dementia (control group) recruited from other medical units in the same hospitals: gastroenterology, internal medicine or cardiology. a diagnosis of glaucoma was deemed positive if recorded in the chart or if there was a medication compatible with this diagnosis. Chi-square tests were used for between-group comparisons.

Subjects' age ranged from 66 to 101 years. the prevalence of glaucoma was 6.8% in our study population (n=30/440). glaucoma was significantly more prevalent in the DAT group (n= 21; 9.5%) than in the control group (n= 9; 4.1%) [χ1 2 = 5.15; p = 0.023].

the prevalence of glaucoma was higher in a group of older adults with DAT than in a comparable control group. these results underscore the importance of providing regular eyecare for persons affected by DAT.

the maternally inherited MTTL1 A3243G mutation in the mitochondrial genome causes MelaS (Mitochondrial encephalopathy lactic acidosis with Stroke-like episodes), a condition that is multisystemic but affects primarily the nervous system. Significant intra-familial variation in phenotype and severity of disease is well recognized.

retrospective and ongoing study of an extended family carrying the MTTL1 A3243G mutation with multiple symptomatic individuals. tissue heteroplasmy is reviewed based on the clinical presentations, imaging studies, laboratory findings in affected individuals and pathological material obtained at autopsy in two of the family members.

there were seven affected individuals out of thirteen members in this three generation family who each carried the MTTL1 A3243G mutation. the clinical presentations were varied with symptoms ranging from hearing loss, migraines, dementia, seizures, diabetes, visual manifestations, and stroke like episodes. three of the family members are deceased from MelaS or to complications related to MelaS.

the results of the clinical, pathological and radiological findings in this family provide strong support to the current concepts of maternal inheritance, tissue heteroplasmy and molecular pathogenesis in MelaS. neurologists (both adult and paediatric) are the most likely to encounter patients with MelaS in their practice. genetic counselling is complex in view of maternal inheritance and heteroplasmy. newer therapeutic options such as arginine are being used for acute and preventative management of stroke like episodes.

To describe a delayed severe complication of temporal lobectomy for intractable epilepsy.

A case of amnesia occurring 24 years after surgery is described and five similar cases from the literature reviewed.

Mean age at surgery (5 right) was 40 years (19-62 years), 3 female. Four of five tested had impaired visual and verbal memory preoperatively but not sufficient to contraindicate surgery. Pathology was mesial temporal sclerosis in 3, 1 cavernoma, 1 dysembryoplastic neuroepithelial tumor (DNET) and 1 normal. Postoperatively, four were seizure free 3-12 years off medication and two continued with seizures. There was no unexpected postoperative memory change until incapacitating anterograde amnesia developed 1-24 years after surgery. In five patients, including ours, this followed definite or possible status epilepticus with new mesial temporal sclerosis on the opposite side in the four that were investigated by MRI. One patient developed a glioblastoma in the opposite temporal lobe.

Continuing or late recurrence of seizures from the remaining temporal lobe after temporal lobectomy can result in incapacitating amnesia if status epilepticus occurs. Other new lesions on the opposite side to surgery can have the same effect.

To determine the representation of Tourette Syndrome (TS) in fictional movies and television programs by investigating recurrent themes and depictions.

Television and film can be a source of information and misinformation about medical disorders. Tourette Syndrome has received attention in the popular media, but no studies have been done on the accuracy of the depiction of the disorder.

International internet movie databases were searched using the terms “Tourette’s”, “Tourette’s Syndrome”, and “tics” to generate all movies, shorts, and television programs featuring a character or scene with TS or a person imitating TS. Using a grounded theory approach, we identified the types of characters, tics, and co-morbidities depicted as well as the overall representation of TS.

Thirty-seven television programs and films were reviewed dating from 1976 to 2010. Fictional movies and television shows gave overall misrepresentations of TS. Coprolalia was overrepresented as a tic manifestation, characters were depicted having autism spectrum disorder symptoms rather than TS, and physicians were portrayed as unsympathetic and only focusing on medical therapies. School and family relationships were frequently depicted as being negatively impacted by TS, leading to poor quality of life.

Film and television are easily accessible resources for patients and the public that may influence their beliefs about TS. Physicians should be aware that TS is often inaccurately represented in television programs and film and acknowledge misrepresentations in order to counsel patients accordingly.

To compare the efficacy and tolerability of the subcutaneous administration of N alpha methyl histamine versus oral propranolol in the treatment of migraine prophylaxis.

N alpha methyl histamine has a selective affinity for H3 receptors and could constitute a new therapeutic drug in migraine prophylaxis.

Sixty patients with migraine were selected and enrolled in a 12-week double-blind controlled clinical trial to evaluate the efficacy of subcutaneous administration of N-alpha methyl histamine (1 to 3 ug twice a week ) n=30, compared to administration of 120 mg/day of oral propranolol n=30. the variables were: headache intensity, frequency of attacks, duration of migraine attacks and analgesic intake.

fifty five patients completed the study. the data collected during the 4th week of treatment revealed that N alpha methyl histamine and propranolol caused a significantly (p<0.01) greater reduction between the basal values and final values of every variable studied.

Both N alpha methyl histamine and propranolol are similarly effective in reducing or eliminating the headache in migraine prophylaxis. low doses of N-alpha methyl histamine injected subcutaneously may represent a novel and effective therapeutic alternative in migraine patients and may lay the clinical and pharmacological groundwork for the use of H3 receptor agonist in migraine prophylaxis.

Hemifacial spasm (HFS) may be due to peripheral axon ephapsis or central motor neuron hyperexcitability. Low facial motor evoked potential (MEP) thresholds or MEP responses to single pulse stimulation (normally multipulse stimulation is needed) may support the central hypothesis.

We retrospectively compared response thresholds for facial MEPs in 65 patients undergoing surgical microvascular decompression (MVD) for HFS and 29 patients undergoing surgery for skull base tumors.

Single pulse stimulation elicited facial Mep in up to 87% of HFS patients whereas only 10% of tumor patients responded to single pulse stimulation. When comparing facial MEP thresholds using multi-pulse stimulus trains the voltage required in the HFS group were significantly lower then in skull base tumor patients (p < 0.001). the MEP latencies and amplitudes at threshold stimulation were similar between the two groups.

these results suggest the facial corticobulbar pathway demonstrates enhanced excitability in HFS.

This study describes the socio-demographic and clinical profile of persons with amyotrophic lateral sclerosis (ALS) in home care, nursing homes and complex continuing care settings in several Canadian jurisdictions.

A cross-sectional study was conducted using available Resident Assessment Instrument (RAI 2.0 and RAI Home Care) national databases from 1996- 2011. The profile of ALS patients was compared with patients without pre-specified neurological conditions.

There were 2,092 ALS patients identified in these settings. Persons with ALS were more likely than those in the comparison group to suffer from health instability (25.4%) and minor to major depressive symptoms (27.2%) , to experience falls (44.0%) and weight loss (22.9%), to require extensive assistance in activities of daily living (54.9%), and to receive rehabilitation services: physical (23.9%), speech language pathology (8.9%), and occupational therapy 43.3%).

The ALS population in this study are greatly affected by a number of health issues. They are more likely than the comparison group to require therapies, medical interventions, and psychotropic drug use. While persons with ALS have a poor prognosis, a great deal could be done to enhance their quality of life and the quality of care they receive.