Clinical approaches for poststroke seizure: a review.

Poststroke seizure is a potential complication of stroke, which is the most frequent acute symptomatic seizure in adults. Patients with stroke may present with an abnormal or aggressive behavior accompanied by altered mental status and symptoms, such as hemiparesis, dysarthria, and sensory deficits. Although stroke manifestations that mimic seizures are rare, diagnosing poststroke seizures can be challenging when accompanied with negative postictal symptoms. Differential diagnoses of poststroke seizures include movement disorders, syncope, and functional (nonepileptic) seizures, which may present with symptoms similar to seizures. Furthermore, it is important to determine whether poststroke seizures occur early or late. Seizures occurring within and after 7 d of stroke onset were classified as early and late seizures, respectively. Early seizures have the same clinical course as acute symptomatic seizures; they rarely recur or require long-term antiseizure medication. Conversely, late seizures are associated with a risk of recurrence similar to that of unprovoked seizures in a patient with a focal lesion, thereby requiring long-term administration of antiseizure medication. After diagnosis, concerns regarding treatment strategies, treatment duration, and administration of primary and secondary prophylaxis often arise. Antiseizure medication decisions for the initiation of short-term primary and long-term secondary seizure prophylaxis should be considered for patients with stroke. Antiseizure drugs such as lamotrigine, carbamazepine, lacosamide, levetiracetam, phenytoin, and valproate may be administered. Poststroke seizures should be diagnosed systematically through history with differential diagnosis; in addition, classifying them as early or late seizures can help to determine treatment strategies.

Transient unilateral weakness: is it a transient ischaemic attack?

Transient ischaemic attack is an emergency medical condition that causes brief negative focal neurological symptoms such as unilateral weakness. The symptoms herald a high risk of stroke and hence require urgent assessment. The challenge lies in the brevity and compendium of associated symptoms that can 'mimic' a plethora of other conditions. The result is a high rate of referrals to transient ischaemic attack clinics for these stroke mimics. This article highlights the diagnostic challenges in transient ischaemic attack with relevance to unilateral weakness.

Pseudo-Anterior Interosseus Nerve Syndrome: A Case Report and a Review of Clinical Signs, Pathology and Functional Anatomy of the Precision Grip.

Precision grip, a prehensile function of humans, is exacted through the action of the median nerve and its main tributary, the anterior interosseus nerve (AIN). In the forearm, the AIN can be subject to nerve entrapment by tendinous and fibrous arches or accessory and variant muscles. It is also vulnerable to trauma of the upper arm and forearm. To the neurologist, an isolated neuritis or an immune-mediated medial cord or lower trunk brachial plexopathy (Parsonage-Turner syndrome) is the usual mode of presentation. When the spread of muscle weakness is beyond the territory of the AIN, the syndrome is referred to as a pseudo-AIN. The AIN is grouped into fascicles that are compartmentalized separately from the median nerve proper, and trauma in the upper arm may selectively involve the AIN. We present a case of pseudo-AIN following elbow arthroscopic surgery and outline the pathology, clinical signs, and functional anatomy of the AIN and the precision grip.

Disability and Anxiety in Vestibular Diseases: A Cross-Sectional Study.

Introduction Patients with dizziness and vertigo usually experience psychological, physical, and social functioning limitations that may affect their daily living activities. In order to better understand disability and anxiety in patients with vertigo, in the present study we aimed to investigate the correlation between disability and anxiety in four different types of diseases causing vertigo. Moreover, the difference between the observed disabilities in these etiologies of vertigo was studied. Materials and methods In this analytic cross-sectional design, 130 patients (52 male, 78 female; age range: 18-75 years) with dizziness/vertigo who were referred to our balance clinic participated. All patients underwent a detailed diagnostic procedure including neurological, clinical, and otological evaluations. Dizziness Handicap Inventory (DHI) and the Beck Anxiety Inventory (BAI) were used to assess handicap and anxiety, respectively. Results There were no significant differences in "total DHI" and DHI subcomponent scores among different study populations (p>0.05). In terms of the BAI score, the one-way analysis of variance (ANOVA) test indicated no significant differences among the four groups (p=0.158). Our results exhibited a significant positive correlation between the BAI and "total DHI" and "DHI subcomponents" values. Conclusion The degree of disability and anxiety is not different between patients with Benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), unilateral weakness (UW), and central causes. The significant positive correlation between the BAI and "total DHI" and "DHI subcomponents" values shows that the possibility of anxiety in patients with vertigo should not be ignored.

Vestibular evoked myogenic potentials in practice: Methods, pitfalls and clinical applications.

Vestibular evoked myogenic potentials (VEMPs) are a useful and increasingly popular component of the neuro-otology test battery. These otolith-dependent reflexes are produced by stimulating the ears with air-conducted sound or skull vibration and recorded from surface electrodes placed over the neck (cervical VEMPs) and eye muscles (ocular VEMPs). VEMP abnormalities have been reported in various diseases of the ear and vestibular system, and VEMPs have a clear role in the diagnosis of superior semicircular canal dehiscence. However there is significant variability in the methods used to stimulate the otoliths and record the reflexes. This review discusses VEMP methodology and provides a detailed theoretical background for the techniques that are typically used. The review also outlines the common pitfalls in VEMP recording and the clinical applications of VEMPs.

Modified head shake sensory organization test: Sensitivity and specificity.

The Sensory Organization Test (SOT) of Computerized Dynamic Posturography (EquiTest™ equipment) is a valuable tool for investigating how an individual uses balance system sensory input (vestibular, vision, proprioception/somatosensory) to maintain quiet stance; however, it is limited as a screening tool for identifying peripheral vestibular system dysfunction. Previous research has shown that adding horizontal head-shake to portions of the standard SOT battery improved the identification of peripheral vestibular system asymmetry; however, flaws in the methods were noted. The objective of this work was to evaluate the sensitivity and specificity of the modified head-shake SOT (HS-SOT) protocol for identification of peripheral vestibular system lesion. Fifteen patients with chief complaint of instability, vertigo, and/or lightheadedness, with and without a caloric unilateral weakness (UW) and fifteen age-matched healthy controls were included in the final analysis. Ten of the 15 patients demonstrated a caloric UW≥25%. Participants completed standard conditions 2 and 5 of SOT with head still and during four horizontal head-shaking tasks (i.e., HS-SOT2-60°/s, HS-SOT2-120°/s, HS-SOT5-15°/s, and HS-SOT5-60°/s). Average equilibrium scores decreased as condition difficulty increased (SOT2, HS-SOT2-60°/s, HS-SOT2-120°/s, SOT 5, HS-SOT5-15°/s, and HS-SOT5-60°/s) for each group; as expected, a lower decline was noted for controls (slope=-6.59) compared to patients (slope=-11.69). The HS-SOT5-15°/s condition was superior for identifying peripheral vestibular asymmetry (AUC=0.90 sensitivity=70%, specificity=100%), with the strongest correlation to caloric UW% (rs=-0.743, p=0.000006). HS-SOT5-15°/s appears to be a promising screening measure for peripheral vestibular asymmetry.