R Srinivasa

Acute seizures in cerebral venous sinus thrombosis: What predicts it?

BACKGROUND Seizures are the presenting feature of cerebral venous sinus thrombosis (CVST) in 12-31.9% of patients. 44.3% of patients have seizures in the early stage of the disease. Acute seizures (AS), refers to seizures which take place before the diagnosis or during the first 2 weeks afterward. OBJECTIVE To report the predictors of acute seizures in cerebral venous sinus thrombosis (CVST). METHODS 100 patients with CVST were included in the study. The occurrence of acute seizures was noted. The predictors of acute seizure were evaluated by univariate analysis including the demographic (gender, age), clinical (headache, focal neurological deficit, papilloedema, GCS score), type and number of risk factors, MRI findings (Type of lesion: hemorrhagic infarction or hematoma, location of lesion) and MRV findings (superficial or deep sinus, cortical veins). RESULTS A total of 46 patients had acute seizures. On univariate analysis, altered mental status (p<0.001), paresis (p=0.03), GCS score <8 (p=0.009), hemorrhagic infarct on imaging (p=0.04), involvement of frontal lobe (p=0.02), superior sagittal sinus (p=0.008), and high D-dimer levels (p=0.03) were significantly associated with acute seizure. On multivariate analysis, the hemorrhagic infarct on MRI and high D-dimer was independently predictive for early seizure. CONCLUSION The predictive factors for the acute seizures are altered mental status (GCS<8), focal deficits, hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus with high D-dimer levels.

Unilateral spatial neglect as a presenting manifestation of nonconvulsive status epilepticus.

Sir, Nonconvulsive status epilepticus (NCSE) is defined as a change in the mental status of at least 30 to 60 minutes duration, associated with continuous or near continuous ictal discharges detectable on an electroencephalography (EEG).[1] A diagnosis of NCSE requires the clinical manifestation of an abnormal mental status with reduced responsiveness, a supportive EEG, and a response to an antiepileptic drug. Unilateral spatial neglect (USN) as a manifestation of NCSE has not been reported till date. Here, we report the case of an elderly gentleman who presented with left spatial neglect with his EEG showing continuous, sharp wave discharges from the right parietooccipital region suggestive of the background presence of a NCSE.

Diffusion restriction in pons resembling "reverse moustache" in dengue encephalitis

1. Read RW, Holland GN, Rao NA, Tabbara KF, Ohno S, Arellanes‐Garcia L, et al. Revised diagnostic criteria for Vogt‐Koyanagi‐Harada disease: Report of an international committee on nomenclature. Am J Ophthalmol 2001;131:647‐52. 2. Tavsanli M, Uluduz D, Saip S, Kendiroglu G. Vogt‐Koyanagi‐Harada disease: Headache as an initial manifestation. J Headache Pain 2008;9:255‐6. 3. Headache classification committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013;33:629‐808. 4. Lee MS, Lesell S. Orbital myositis posing as cluster headache. Arch Neurol 2002;59:635‐6. 5. Harley JS, Ahmad F. Cluster‐like headache heralding inflammatory orbital pseudotumour. Cephalalgia 2008;28:401‐2. 6. Evers S, Sörös P, Brilla R, Gerding H, Husstedt IW. Cluster headache after orbital exenteration. Cephalalgia 1997;17:680‐2.

Photosensitive posthypoxic reflex myoclonus in a postcardiac arrest individual: An interesting finding

movements were absent on acoustic stimulus. These involuntary movements were suggestive of myoclonus which was stimulus sensitive to light only [Video 1]. The movements were not elicited on acoustic stimulus. There were no generalized tonic–clonic seizures or spontaneous myoclonus. The patient succumbed to death within 12 h. Electroencephalogram (EEG) revealed diffuse slowing of background rhythm.

Clinical impression and western aphasia battery classification of aphasia in acute ischemic stroke: Is there a discrepancy?

Background: Language disturbance is a common symptom of stroke, a prompt identifier of the event, and can cause devastating cognitive impairments. There are many inconsistencies and discrepancies between the different methods used for its evaluation. The relationship between Western Aphasia Battery (WAB) and a simple bedside clinical examination is not clear. Aim: The aim of this study is to determine if bedside clinical impression of aphasia type can reliably predict WAB classification of aphasia and to describe the discrepancies between them. Materials and Methods: Eighty-two consecutive cases of acute ischemic stroke and aphasia were evaluated with bedside aphasia assessment, handedness by Edinburgh Handedness Inventory and WAB scoring was done. Kappa statistics was used to find the overall agreement of clinical impression and WAB. Results: Disagreement was seen predominantly for the nonfluent aphasias when the clinical impression was compared with WAB classification. WAB also had diagnosed three cases as having anomic aphasia using taxonomic classification, but same cases had normal language by aphasia quotient scoring of WAB. There was an overall agreement of 63.4% between patients bedside clinical impression and WAB classification of aphasia, with a P < 0.001. Conclusion: Clinical impression was fairly reliable, as compared to WAB in assessing the type of aphasia. Clinical impression was appropriate in an acute setting, but WAB was required to quantify the severity of deficit, which may help in accessing prognosis, monitoring progression, and rehabilitation planning. Along with WAB, a bedside clinical impression should be done for all the patients to strengthen the description of aphasic deficit.

Co-occurrence of basilar artery and cerebral venous sinus thrombosis in antiphospholipid antibody syndrome

552 Neurology India | Sep-Oct 2014 | Vol 62 | Issue 5 of cerebral pheohyphomycosis are immunocompetent.[3] Various theories regarding the spread to brain have been proposed: Hematogenous dissemination, spread through lymphatic vessels, contiguous spread from adjacent organs such as orbits/sinuses.[1] Clinical presentation is like that of any other space occupying lesion with a shorter duration of symptoms than tumor. Classically described MRI findings are ring enhancing lesions on T1-weighted imaging, hypointensity of the rings on T2-weighted imaging, and low to high signal on DWI.[1] We were misled to the preoperative diagnosis of high-grade glioma in the present case because of absence of fever and other constitutional symptoms of infection and hyperintensity on T2-weighted imaging. Intraoperative frozen section is of paramount importance in such cases. This helps in instituting loading dose of antifungal intraoperatively. Any delay in starting antifungal therapy may affect the outcome.