The association between neuroimaging data and presence of lateropulsion after stroke.

BACKGROUND: Post-stroke lateropulsion is prevalent and has been associated with varied lesion locations, but existing imaging studies are limited by small participant cohorts. Evidence to guide lateropulsion rehabilitation is also limited. Improved understanding of lesion localization associated with lateropulsion post-stroke may inform more targeted intervention approaches. OBJECTIVES: This study investigated the associations between stroke neuroimaging data and presence of lateropulsion at inpatient rehabilitation admission. METHODS: This prospective, observational study included participants aged ≥65 years, admitted for inpatient stroke rehabilitation. Using routinely collected clinical neuroimaging data, stroke type, location, and volume were reported, and their association with lateropulsion presence (Four-Point Pusher Score - 4PPS) at admission was explored. RESULTS: Of 144 included participants, 82 (56.9%) had lateropulsion (4PPS ≥1). Lateropulsion presence was univariately associated with hemorrhagic stroke (p = 0.002), frontal cortical involvement (OR = 2.17, 95%CI 1.02-6.46), and white matter involvement (OR = 2.45, 95%CI 1.24-4.85), particularly frontal white matter (p = 0.021). Lesions involving the posterior limb of the internal capsule (OR = 2.88, 95% CI 1.14-7.27) and those involving the entire thalamus (OR = 1.0, p = 0.03) were associated with lateropulsion presence. When stratified by stroke type, no specific location was significantly associated with lateropulsion presence in hemorrhagic strokes. Among participants with ischemic stroke, involvement of the pre-central gyrus (OR = 2.45, 95%CI 1.05-5.76), post-central gyrus (OR = 2.76, 95%CI 1.15-6.60), inferior parietal cortex (OR = 3.95, 95%CI 1.43-10.90), and supramarginal gyrus (OR = 3.73, 95%CI 1.25-11.13) were associated with lateropulsion presence. The stroke laterality and size were not significantly associated with lateropulsion presence. CONCLUSIONS: The findings indicate a role of network disconnection in the post-stroke lateropulsion presence. Future, larger-cohort lesion-network mapping studies are recommended.

Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study.

BACKGROUND: Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking. OBJECTIVES: This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke. METHODS: Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. RESULTS: The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: <0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022). CONCLUSIONS: This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion.

Dental procedure induced cerebellar haemorrhage with visual tilt and unsuspected CADASIL.

A man in his late 60s had vertigo and vision tilt following a dental procedure. A cerebellar haemorrhage and cerebral microbleeds (CMBs) were diagnosed on imaging. Subsequent testing revealed CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The role of the dental procedure as a trigger for intracerebral haemorrhage (ICH) is discussed. The incidence of CMBs and ICH in CADASIL is discussed. A summary of the causes and pathology associated with visual tilt is documented.

Inflammatory epilepsy (FIRES) and haemophagocytic lymphohistiocytosis (HLH): an adult case.

We describe a man in his 30s with haemophagocytic lymphohistiocytosis (HLH), secondary to an upper respiratory tract infection, with subsequent febrile infection-related epilepsy syndrome. He had a prolonged hospital admission, during which he was treated with chemotherapy for HLH and antiepileptic medications for refractory seizures. He was discharged fully dependent to a care facility and died from aspiration pneumonia 11 months later. This case report highlights his management and discusses these conditions' pathophysiology and future management.

Cerebral embolism and carotid-hyoid impingement syndrome.

Embolic stroke of undetermined source (ESUS) is not uncommon in young patients. Here, we describe two cases of stroke from an unusual aetiology; cerebral embolization from carotid artery injury presumed secondary to hyoid bone impingement. Both patients demonstrated angiographic evidence of hyoid bone impingement. Following resection of the greater cornu of the hyoid bone, neither patient had further strokes.

Vanishing bone disease of the orbital roof: now you see it, now you don't.

We describe a rare case of vascularised orbital roof and calvarial erosions with an associated venous malformation. In the absence of infection, malignancy, trauma and eosinophillic granuloma, the closest previously described entity is vanishing bone disease. Computed tomography (CT), MRI, catheter angiography and pathology were all important in the diagnostic workup to enable surgical planning for biopsy and reconstruction. Ongoing CT and MRI follow-up imaging will determine future treatment planning.

Susceptibility weighted imaging as a useful imaging adjunct in hemichorea hyperglycaemia.

Hyperglycaemia with hemichorea (HGHC) is an unusual clinical entity that can be associated with corpus striatum hyperintensity on T1-weighted (T1W) magnetic resonance imaging (MRI) sequences. We report the utility of the susceptibility weighted image (SWI) sequence and the filtered phase SWI sequence in the imaging assessment of HGHC.

Arterial origin subdural hematoma and associated pial pseudoaneurysm following minor head trauma.

The vast majority of primary acute subdural hematomas following trauma are venous in origin. We report a very rare case of a primary acute subdural hematoma following minor head trauma that was arterial in origin and was associated with a pial cortical branch pseudoaneurysm. The patient was managed conservatively, and follow-up imaging demonstrated complete resolution of both lesions.