Spectrum of clinical features and neuroimaging findings in acute cerebral infarction patients with unusual ipsilateral motor impairment- a series of 22 cases.

BACKGROUND: Cerebral infarction occurs when the arteries to brain are obstructed, and motor impairment contralateral to responsible lesion is commonly recognized. Few studies have profiled the characteristics of cases with ipsilateral motor impairment. We sought to characterize clinical features of patients with motor dysfunction caused by ipsilateral ischemic stroke. METHODS: We retrieved and analyzed the medical data for patients with ipsilateral cerebral infarction. Patients were regarded as having ipsilateral cerebral infarction if motor impairment is ipsilateral to recent stroke lesions. RESULTS: Only 22 patients with unusual ipsilateral cerebral infarction were included in this study. Ipsilateral limb paralysis was observed in all cases, and one case showed central facioplegia. Majority of patients with limb paralysis (90.9%, 20/22) presented with mild muscle strength deficits (MRC grading of 4 or more). Most of the patients (72.7%, 16/22) had a past history of stroke, and previous strokes were contralateral to the side of the recent stroke in 14 out of 16 patients (87.5%). No history of stroke or cerebral injury was identified in seven patients. With aspect of MRI findings, recent infarct lesions of all cases were located along the corticospinal tract. CONCLUSIONS: History of stroke plays an important role in the pathogenesis of ipsilateral motor impairment, and cortical reorganization in the unaffected hemisphere may contribute to the compensation of motor function after stroke. Besides that, some cases with first stroke may be due to impairment of ipsilateral uncrossed corticospinal fibers.

Successful treatment of reflex epilepsy with praxis induction by stimulus avoidance only.

PURPOSE: Reflex epilepsy is a type of epilepsy with seizures that are consistently triggered by a specific stimulus. Zipai is a Chinese ancient card game which has been popular in Southern China for hundreds of years. We sought to report and characterize clinical features of patients with reflex epilepsy evoked by playing Zipai. METHODS: We collected and analyzed clinical data of patients with Zipai-induced epilepsy. Patients were regarded as having Zipai-induced epilepsy if they suffered at least two seizure attack during the course of playing Zipai. Prolonged electroencephalography (EEG) and brain magnetic resonance imaging (MRI) were applied to all patients. All patients were advised to avoid watching and playing Zipai games in daily life, instead of using antiepileptic drugs. The seizure outcome was assessed during outpatient visits and by telephone contact. RESULTS: Five patients were included in this study. No spontaneous seizures occurred in all five patients. No patients had experienced myoclonic and coexistent absences with generalized tonic-clonic seizures (GTCS). All patients had normal MRI and prolonged EEG findings. All patients were advised to avoid the Zipai game, and became seizure-free without medication during the follow-up period (mean 5.4 years, range 3.5-7 years). CONCLUSION: Zipai-induced epilepsy may be an unreported subtype form of reflex epilepsy with praxis induction. Nonpharmacological conservative treatment plays a significant role in the treatment of reflex epilepsy.

Younger age at surgery and lesser seizure frequency as prognostic factors for favorable seizure-related outcome after glioma resection in adults.

The identification of variables predictive of good seizure control following surgical tumor resection in adult glioma patients with tumor-related epilepsy would greatly benefit treatment decisions. Therefore, we analyzed the clinical data of adult patients with tumor-related epilepsy who underwent tumor resection at our institute between November 2011 and August 2013. Patients were divided into seizure-free (Engel Ia) and unfavorable outcome groups (Engel Ib-IV), and potential prognostic factors were analyzed. Of 90 patients, 61 (68%) had a favorable outcome at an average of 3 years after surgery. Our analyses indicated that younger age at surgery (P=0.048) and rare seizure frequency (P=0.006) were associated with significantly more favorable postoperative seizure-related outcomes. In conclusion, younger age at surgery and lesser seizure frequency were independent predictors of favorable epileptic seizure control after glioma resection in adults. Thus, early surgical resection is necessary for achieving favorable seizure outcome.

Spectrum of neuroimaging findings in cryptococcal meningitis in immunocompetent patients in China - A series of 18 cases.

PURPOSE: Cryptococcosis is a devastating opportunistic disease commonly encountered in organ transplant recipients and patients with acquired immunodeficiency syndrome (AIDS). Few studies have profiled the disease in immunocompetent patients. We sought to characterize the neuroimaging findings of cryptococcal meningitis among immunocompetent patients in China. MATERIALS AND METHODS: Retrospective review of all patients diagnosed with cryptococcal meningitis at our institute, on the basis of CSF culture or India Ink test, between November 2011 and February 2016, was performed. Only apparently immunocompetent patients, for whom at least one brain MRI examination was performed, were included in the analysis. The MRI results were available for all these patients before CSF diagnosis. Data related to variables such as patient demographics, clinical features, neuroimaging characteristics and CSF findings were analyzed. RESULTS: Eighteen apparently immunocompetent patients, for whom brain MRI radiographs were available, were included in the analysis. Abnormal MRI findings were observed in 16 patients. These included multiple intraparenchymal lesions with or without enhancement, prominent basal ganglia involvement, miliary distribution of parenchymal nodules, multiple dilated Virchow-Robin spaces and leptomeningeal enhancement. Six patients had ventriculomegaly. CONCLUSION: In our study, intraparenchymal findings were more common than leptomeningeal enhancement and perivascular lesions. Cryptococcal meningitis should be considered in the differential diagnosis of immunocompetent patients with brain MRI findings of prominent parenchymal involvement such as bilateral patchy lesions in basal ganglia or miliary distribution of parenchymal nodules.