A rare case of lupus cerebritis presenting as ictal epileptic headache: A case report.

Ictal epileptic headache, characterized by headache as the sole symptom of a seizure attack, is a rare condition. In this case report, we present a 52-year-old female with a history of systemic lupus erythematosus who sought medical attention at the headache clinic due to a new type of headache. The headache was described as an intense painful wave followed by a dull headache, without autonomic symptoms or migrainous features. Magnetic resonance imaging revealed an enhancing lesion in the left hippocampus in addition to two other lesions in the corpus callosum and left parieto-occipital lobe. Electroencephalography during the headache episodes showed epileptic discharges originating from the left fronto-temporal region. The patient was initiated on levetiracetam, which resulted in the resolution of both the epileptic discharges and the headaches. This case underscores the significance of considering ictal epileptic headache as a potential secondary cause for headaches, particularly in patients with underlying conditions that may predispose them to epilepsy, such as systemic lupus erythematosus.

Magnitude and predictors of post-stroke cognitive impairment among Ethiopian stroke survivors: A facility-based cross-sectional study.

Background: Stroke is emerging as a public health threat in sub-Saharan African countries including Ethiopia. Even though cognitive impairment is increasingly being recognized as a major cause of disability among stroke survivors there is a paucity of information on the magnitude of stroke-related cognitive dysfunction in Ethiopia. Thus, we assessed the magnitude and predictors of post-stroke cognitive impairment among Ethiopian stroke survivors. Methods: A facility-based cross-sectional study was employed to assess the magnitude and predictor of post-stroke cognitive impairment among adult stroke survivors who came for follow-up at least 3 months after the last stoke episode from February to June 2021 in three outpatient neurology clinics in Addis Ababa, Ethiopia. We used the Montreal Cognitive Assessment Scale-Basic (MOCA-B), modified Rankin Scale (mRS), and Patient Health Questionnaire-9 (PHQ-9) to assess post-stroke cognition, functional recovery, and depression, respectively. Data were entered and analyzed using SPSS software version 25. A binary logistic regression model was employed to identify the predictors of post-stroke cognitive impairment. A p-value of 0.05 was considered statistically significant. Results: Of the 79 stroke survivors approached, 67 were included. The mean (SD) age was 52.1 (12.7) years. Over half (59.7%) of the survivors were males and most (67.2%) were urban residents. The median stroke duration was 3 years ranging from 1 to 4 years. Almost half (41.8%) of stroke survivors had cognitive impairment. Increased age (AOR=0.24, 95% CI=0.07,0.83), lower education (AOR=4.02, 95% CI=1.13,14.32), and poor function recovery (mRS 33) (AOR=0.27, 95% CI=0.08-0.81) were predictors significantly associated with post-stroke cognitive impairment. Conclusion: Nearly one in two stroke survivors had cognitive impairment. The major predictors associated with cognitive decline were age above 45 years, low literacy, and poor recovery in physical function. Although causality cannot be inferred, physical rehabilitation and better education are essential in building cognitive resilience among stroke survivors.

Do Headache Patients Require More Care in Between Visits Than Other Neurology Outpatients?

BACKGROUND: There is evidence that time spent in patient care in between patient visits is increasing and a contributor to physician burnout. The extent of this work on providers in the field of headache medicine is unknown. OBJECTIVES: To establish whether headache outpatients require a high level of care in addition to clinic visits, based on the quantity of remote encounters per patient (phone calls and secure email communication to the clinics), in comparison to other neurologic clinics. METHODS: In an academic referral clinic, a total of 3164 established patients were included in this retrospective analysis, 275 from the headache clinic, the remainder from various other neurology clinics (2 physician providers per clinic except 3 physician providers in the headache clinic). Patients presenting for a follow-up visit between January 2014 and April 2016 were observed for a 12-month period during which the number of a) telephone and b) secure email (MyChart) encounters per patient was recorded, and in addition, the number of entries related to each of these encounters. This analysis did not require IRB approval as per institutional guidelines. RESULTS: Headache clinic patients required a high frequency of remote encounters (composite of both telephone and email messages) per patient, second only to the MS clinic patients. Use of secure email messaging (MyChart) per patient was much higher in the headache clinic compared to all other clinics. CONCLUSION: Patients in a headache clinic in an academic tertiary care setting require a high intensity of remote outpatient care, more so than patients in other neurology subspecialty clinics and general neurology clinic, with the exception of the neuroimmunology/MS clinic. This is to a large extent secondary to the very frequent use of secure email linked to the electronic medical record by headache patients.

Extended Multiple-Field High-Definition transcranial direct current stimulation (HD-tDCS) is well tolerated and safe in healthy adults.

BACKGROUND: High definition transcranial direct current stimulation (HD-tDCS) has been administered over single brain regions for small numbers of sessions. Safety, feasibility and tolerability of HD-tDCS over multiple brain regions, multiple daily stimulations and long periods are not established. OBJECTIVE: We studied safety, feasibility and tolerability of daily HD-tDCS over 2-4 brain regions for 20 sessions in healthy adults. METHODS: Five healthy adults underwent physical and neurological examination, electrocardiogram (EKG), electroencephalogram (EEG) and cognitive screening (ImpACT) before, during and after HD-tDCS. Four networks (left/right temporoparietal and frontal) were stimulated in sequence (20 min each) using HD-tDCS in 20 daily sessions. Sessions 1-10 included sequential stimulation of both temporoparietal networks, sessions 11-15 stimulations of 4 networks and sessions 16-20 two daily stimulation cycles of 4 networks/cycle (1.5 mA/network). Side effects, ImpACT scores and EEG power spectrum were compared before and after HD-tDCS. RESULTS: All subjects completed the trial. Adverse events were tingling, transient redness at the stimulation site, perception of continuing stimulation after end of session and one self-resolving headache. EEG power spectrum showed decreased delta power in frontal areas several days after HD-tDCS. While at the group level ImpACT scores did not differ before and after stimulations, we found a trend for correlation between decreased EEG delta power and individual improvements in ImpACT scores after HD-tDCS. CONCLUSION: Prolonged, repeat daily stimulation of multiple brain regions using HD-tDCS is feasible and safe in healthy adults. Preliminary EEG results suggest that HD-tDCS may induce long lasting changes in excitability in the brain.

Neurocysticercosis in Wisconsin: 3 cases and a review of the literature.

Neurocysticercosis is the most common parasitic infection of the brain. Endemic in many regions of the world, neurocysticercosis is now showing up in nonendemic areas such as Wisconsin. We present 3 patients that illustrate features typical for neurocysticercosis in anon-endemic area, including immigrant/travel status, presentation with focal seizures, classic magnetic resonance imaging features of single enhancing lesions, and good response to treatment with anticonvulsants, anti-inflammatory agents, and cysticidal drugs. It behooves physicians involved in the care of at-risk populations to be aware of the clinical features, radiographic signs, diagnostic tests, and general principles for treating neurocysticercosis.

Diagnosis of posterior cortical atrophy delayed by coexisting Fuchs' Endothelial Corneal Dystrophy.

Posterior cortical atrophy (PCA), also known as the visual variant of Alzheimer's Disease, is a rare neurodegenerative disorder that affects the visuospatial systems in its initial stages. Due to the rarity of this condition and the presence of relatively preserved memory during its early stages compared to other dementias, its accurate diagnosis can be delayed. When accompanied by a comorbid visual disorder, the diagnostic process becomes even more challenging. This study describes the disease course of a patient whose diagnosis of Fuchs' Endothelial Corneal Dystrophy served to delay an additional diagnosis of PCA, illustrating the necessity of careful scrutiny of symptom presentation and especially its course.