Episodic stuttering as the presenting manifestation of acute ischemic stroke: A case report and systematic literature review.

BACKGROUND: Acquired episodic stuttering in adulthood represents a rare condition, which has been infrequently described in the literature. CASE PRESENTATION: We describe the case of a 62-year-old male who presented to the emergency room with three episodes of new-onset brief isolated stuttering with no other speech impairment or associated focal neurologic deficits. His brain magnetic resonance imaging was notable for the presence of a small acute ischemic stroke involving the left precuneus cortex. SYSTEMATIC LITERATURE REVIEW: We performed a systematic literature review to evaluate the association between stroke and acquired neurogenic stuttering. The evidence published to this date suggests that the underlying pathophysiology of acquired stutter does not localize to an isolated or focal region. The development of stuttering secondary to strokes may be the result of a disruption at any level in a cortico-striato-cortical integrative pathway mediating speech execution. CONCLUSION: Here we aimed to emphasize the importance of carefully evaluating new-onset recurrent episodic stuttering to rule out an underlying stroke or another neurogenic etiology. We provide a comprehensive review of acquired stuttering, its differential diagnosis, and its evaluation.

Good outcome associated with blood-brain barrier disruption and lower blood pressure after endovascular therapy.

OBJECTIVES: To evaluate the association between post-endovascular thrombectomy (EVT) blood-brain barrier (BBB) disruption on MRI or CT and average systolic blood pressure (SBP) with favorable 90-day functional outcome. Observational studies have found elevated SBP associated with worse outcomes post-EVT, while recent randomized trials found no difference in targeted BP reduction. There may be a subgroup of patients who benefit from targeted BP reduction post-EVT. METHODS: This is a single-center study of 1) anterior large vessel occlusion stroke patients treated with EVT from 2015 to 2021, 2) achieved mTICI grade 2b or 3. Hyperintense acute reperfusion marker (HARM), hemorrhagic transformation (HT), and midline shift at 3 h post-EVT and 24 h imaging were assessed independently by multiple raters. Binary logistic regression models were used to determine the association of post-EVT SBP with outcomes. BBB disruption was defined as HT or HARM on 3h post-EVT imaging. RESULTS: Of 103 patients, those with SBP 100-129 versus SBP 130-160 found no significant difference in favorable 90-day outcome (64% vs. 46%, OR 2.11, 95% CI 0.78-5.76, p=0.143). However, among 71 patients with BBB disruption, a significant difference in favorable outcome of 64% in SBP 100-129 vs. 39% in SBP 130-160 group (OR 5.93, 95% CI 1.50-23.45, p=0.011) was found. There was no difference in symptomatic ICH, 90-day mortality, midline shift (≥5 mm), and hemicraniectomy, between BP or BBB groups. CONCLUSIONS: BBB disruption on 3h post-EVT imaging and lower SBP was associated with favorable outcome. This imaging finding may guide targeted BP therapy and suggests need for a randomized control trial.

Primary Exercise Headache.

PURPOSE OF REVIEW: Primary exercise headache has gone through many descriptors in the past but generally is a headache that is precipitated by strenuous exercise without significant intracranial pathology. Its presentation can remain vague, often confused with other primary and secondary headache disorders and thus undertreated. This review aims to discuss primary exercise headache in the context of epidemiology, presentation, pathophysiology, differential diagnosis, and treatment. RECENT FINDINGS: Two large epidemiological studies in Iran and Japan have further characterized a predilection for female patients, comorbidity with migraine, and frequent bilateral nature of headache. While large-scale epidemiological studies have aided in further characterization and determining varying prevalence, a lack of randomized clinical trials in the treatment of primary exercise headache remains. Indomethacin and beta-blocker use remain the mainstays of treatment based on case series with several case reports that urge caution when diagnosing said headache.

A Review of Spontaneous Intracranial Hypotension.

PURPOSE OF REVIEW: Spontaneous intracranial hypotension (SIH) is an underdiagnosed phenomenon predominantly presenting with low cerebrospinal fluid (CSF) pressure and postural headache in setting of CSF leak. The goal of this paper is to provide updates on the pathology, diagnosis, and management of SIH. The utility of multiple imaging modalities and the use of epidural blood patches and fibrin glue polymers are explored. RECENT FINDINGS: In regard to diagnosis, new non-invasive modalities in detection of SIH including transorbital ultrasound and serum biomarkers are found. In addition, increased efficacy of large volume and repeated placement of multiple epidural blood patches (EBP) are seen. In addition, the management of refractory SIH using fibrin glue polymers has proved efficacious in recent case series. While the diagnosis may be challenging for clinicians, future research in SIH is leading to more rapid detection methods. Future studies may target optimal use of EBP in comparison to fibrin glue polymers, in addition to new developments in increased understanding of SIH physiology and phenotype.