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Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning – all desirable generic skills for health care professionals. This book is a teaching tool that bridges the gap between textbook information and everyday experience of clinicians 'in the trenches'. Leading practitioners bring a practical approach to these complex conditions, highlighting specific areas of diagnostic uncertainty in evaluation and treatment. Each case is taken from real-world clinical practice and reviews the diagnostic and treatment process in a systematic manner, identifying common challenges and potential pitfalls. This concise and useful guide in the Common Pitfalls series provides a step-by-step guide for everyday clinical practice, invaluable to anyone dealing with cerebrovascular disease on a front-line basis. The intended readership is trainees and non-specialist practitioners in neurology, stroke medicine, and neurosurgery.
Stroke has long been recognized as one of the most common causes of epileptic seizures, particularly in older people. This chapter provides an overview of the various epidemiological studies on poststroke seizures (PSS) and poststroke epilepsy (PSE), and attempts to give an understanding of their pathogenesis, outcome, and management. The most consistent risk factors for PSS at stroke onset are size and cortical involvement. Abnormal electroencephalography's (EEGs) have been noted in up to 38% of patients with lacunar infarction, and lateralizing EEG abnormalities in over 80% of patients with early seizures in lacunar strokes also supports the concept of associated cortical infarction. Large, anterior circulation, ischemic strokes carry the highest risk of seizures. Patients who develop PSE usually require pharmacological treatment. Seizures following stroke occur in less than 10% of patients in the first few weeks after stroke.
Acute, paroxysmal, recurrent, transient, permanent, and delayed movement disorders are occasionally reported in patients during the acute phase of stroke, or as delayed syndromes months or years after an acute vascular lesion. This chapter provides an overview on hyperkinetic manifestations of stroke. Transient or paroxysmal hemichorea-hemiballism can be difficult to distinguish from limb shaking, and has occasionally been considered as a vertebrobasilar transient ischemic attack (TIA). Orofacial dyskinesias have been found in a few patients with brainstem infarcts, associated with palatal myoclonus in one patient, and after thalamic infarcts. Mental dystonia has been reported in association with a posteroventrolateral thalamic infarct. Head or cervical tremor can develop in bilateral thalamic and midbrain infarcts and in bilateral cerebellar infarcts. Unilateral asterixis has been reported with contralateral lesions involving any structure involved with motion, and also with lesions in the territory of the PCA and particularly in patients with ipsilateral brainstem stroke.