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Neurological Cases

ISSN 2374-3522 (Print)

ISSN 2374-3530 (Online)

Website: http://www.researchpub.org/journal/nc/nc.html

Volume 03, Number 02  (December 2016)
A Case Report of Endovascular Therapy of Acute Basilar Artery Occlusion: Beyond the Restricted Time Window
Author(s) Tim T Lai, Monica Lavian, Lama Al-Khoury, Shuichi Suzuki and Wengui Yu


Approximately 60% of patients with acute basilar artery occlusion (BAO) have stuttering and progressive symptoms beyond 24 hours. Recent randomized trials have demonstrated benefit of endovascular therapy of large vessel occlusion in anterior circulation within 6 hours of symptom onset. Time window for endovascular therapy of BAO remains unknown. Case series and multicenter registry have shown potential benefit of recanalization within 24 hours of symptom onset. We describe a case of acute BAO after 2 weeks of recurrent stroke and its successful endovascular therapy. A 25- year-old female developed recurrent cerebellar and brainstem infarcts from bilateral vertebral artery dissections following chiropractic neck manipulation. Two weeks after her initial stroke, she became locked-in from acute BAO despite combined warfarin and aspirin therapy. After emergent reversal of warfarin effect, she underwent endovascular therapy without complications. She had complete functional recovery at 6-month follow-up. Our case report and literature review suggest that endovascular therapy of BAO can be safe and beneficial in patients with recurrent stroke beyond 24 hours.

Posterior Reversible Encephalopathy Syndrome After the Treatment of Guillain-Barré Syndrome With IVIG: A Case Report
Author(s) Yi Li, Oleg Yerokhin, Jatinder S Patti, Catherine A Phillips, Isabelita Bella and Lan Qin


Guillain-Barré syndrome (GBS) is an autoimmune-mediated peripheral demyelinating disorder. Posterior reversible encephalopathy syndrome (PRES) is frequently seen in hypertensive crisis due to altered capillary membrane permeability. Concurrence of GBS with PRES is rare. We reported a 35-year old Caucasian woman who presented with seven days of ascending paresthesia, weakness, and severe back pain; examination disclosed absent deep tendon reflexes and weakness. Findings of increased level of CSF protein by lumbar puncture and demyelinating features by electrophysiologic studies supported the clinical diagnosis of GBS. Intravenous immunoglobulin (IVIG) was started on day 2 of admission. Five hours after receiving her first dose of IVIG, she had an episode of visual loss followed by a generalized tonic-clonic seizure. MRI revealed hyperintensity in the bilateral parieto-occipital regions consistent with PRES. Treatment with IVIG was switched to plasmapheresis. Her neurological symptoms stabilized and she had no further seizures. By three months she fully recovered without any neurological deficits; her initial PRES lesions also completely resolved on MRI. IVIG is a recommended treatment for GBS but may cause PRES. Knowledge of this possibility and promptly switching IVIG to plasmapheresis, if it occurs, may ensure a promising prognosis of GBS and possibly prevent further CNS neurological deficits.

Book Reviewer: Manual of Traumatic Brain Injury: Assessment and Management. 2nd
Author(s) Jin Jun Luo


Book Reviewer: Epilepsy: Board Review
Author(s) Jin Jun Luo


Meeting Report: The First Chinese American Neurological Association (CANA) Annual Meeting
Author(s) Jin Li, Rui Song and Jin Jun Luo