Post-ictal, lateralized hyperkinetic motor behavior.

Recognition of a transient, focal neurologic dysfunction after a seizure is important when evaluating patients with idiopathic epilepsy. Todd's palsy, a transient focal weakness after a seizure, is a highly accurate clinical sign indicative of a contralateral, cerebral epileptic focus. In contrast, a transient, lateralized hyperkinetic motor behavior from a contralateral, hemispheric ictal focus has not been emphasized as a localizing clinical sign. The following case demonstrates that transient hyperkinetic behavior occurs as a post-ictal phenomenon and may have a localizing value, as in Todd's palsy.

Clinical recognition of varicella zoster virus vasculopathy.

INTRODUCTION: It is important to recognize acutely evolving ischemic stroke attributable to reactivation of varicella zoster virus vasculopathy since antiviral agents are effective. METHODS: Three cases seen by the author over a 2-year period are highlighted. RESULTS: All patients presented with an evolving arterial or venous ischemia in the background of postherpetic neuralgia proceeding for weeks to months. CONCLUSION: Chronic neuralgic pain in a dermatomal distribution of an evolving central nervous system vasculopathy is an important clue to its recognition.

Combined Striatum, Brain Stem, and Optic Nerve Involvement due to Mycoplasma pneumoniae in an Ambulatory Child.

In children, Mycoplasma pneumoniae encephalitis has been characterized by acute onset of an encephalopathy associated with extrapyramidal symptoms and symmetric basal ganglia with or without brain stem involvement on magnetic resonance imaging. Our case, showing unilateral optic neuritis, ophthalmoplegia, no extrapyramidal symptoms, and typical striatal involvement on magnetic resonance imaging, broadens the spectrum of varying clinical manifestations of childhood M. pneumoniae-associated encephalopathy.

Foot-dipping in coma: a physical sign indicative of evolving herniation.

OBJECTIVE: Intermittent spontaneous recurrent foot movement characterized by sudden ankle dorsiflexion followed by slower relaxation, termed foot-dipping (FD), may occur in coma. The clinical significance of this easily overlooked sign is unknown. METHODS: Twenty-three cases were identified by a single observer over a 10-year period of predominant inpatient neurologic care. Details of neurologic examination, clinical outcome, and CT and/or MRI findings were collected and analyzed. RESULTS: All 23 patients presented with either an acute supratentorial vascular lesion accompanied by a midline brain shift (Group I, 12 cases) or a primary brainstem or cerebellar insult (Group II, 11 cases). FD in Group I patients was observed transiently only during evolving transtentorial herniation manifested by coma and partial brainstem areflexia. CONCLUSION: The onset of FD in patients with acute supratentorial vascular lesion is indicative of a transtentorial herniation with secondary brainstem encroachment.

Lateralized infarction in cerebral air embolism due to patient positioning.

Two patients are presented with cerebral air embolism. Neurological examination and neuroradiologic studies suggested predominant right hemispheric ischemia. Intestinal mucosal trauma allowed air introduction into the systemic vascular system and left-decubitus positioning of the patients resulted in predominant right-sided brain lesions.

Right sensory alien hand phenomenon from a left pontine hemorrhage.

BACKGROUND: Acute onset of a sensory alien hand phenomenon has been observed only from a supratentorial lesion involving the non-dominant hand, mostly from a right posterior cerebral artery infarction. A single acute vascular lesion resulting in a dominant hand sensory alien hand syndrome has not been previously documented. CASE REPORT: A 78-year old right-handed woman exhibited right sensory alien hand phenomenon from a left pontine hemorrhage. Disturbance of proprioceptive input and visuospatial perception are likely to play a role in manifesting the sign. CONCLUSIONS: Dominant-hand sensory alien hand phenomenon may occur in an acute setting from a left pontine hemorrhage.

MR findings in Hashimoto encephalopathy.

A 35-year-old Korean woman had Hashimoto encephalopathy of varying MR imaging appearance over 5 years that ranged from that of transient subcortical ischemia to that of gradually evolving multifocal signal intensity change accompanied by unilateral cerebellar atrophy. Thus, the MR imaging appearance of Hashimoto encephalopathy may simulate an ischemic stroke, multiple tumors or granulomas, or even a degenerative process.