Persistent hiccups following thalamic hemorrhage: A case report.

Persistent hiccups (lasting more than 48 hours) can cause physical and emotional distress. They can result in dehydration, exhaustion, malnutrition, insomnia, wound dehiscence, ventilatory desynchronization, and hemodynamic changes. Hiccups are thought to be due to a complex reflex arc involving peripheral nerves and central structures such as the brainstem, temporal lobe, basal ganglia, hypothalamus, and spinal cord levels C3-5. Medullary strokes, for instance, have been reported to cause hiccups. We report a patient with a thalamic bleed who developed persistent hiccups. A 56-year-old man was brought to the hospital in an unresponsive state. He was intubated for airway protection. CT brain showed a left thalamic hemorrhage with edema and mass effect on the 3rd ventricle, intraventricular extension of hemorrhage, and hydrocephalus. An external ventricular drain was placed successfully with adequate drainage. One week after admission, the patient developed persistent abdominal jerks. These jerks were occurring every 3-4 seconds and would last for hours with brief periods of remission. He was started on levetiracetam 1000 mg IV bid and then increased to 1500 mg IV BID without any improvement of symptoms. The patient was also placed on EEG which did not reveal any epileptiform abnormality but did show an EMG artifact. His electrolytes including sodium, and potassium, and corrected calcium levels were normal. He did not have any evidence of pneumonia or other infections. It was determined that these jerks were likely hiccups. Metoclopramide 10 mg IV was tried without any benefit. He was then started on Baclofen 10 mg PO TID which resulted in a significant improvement in hiccups. Our case suggests that thalamic lesions might also lead to persistent hiccups.

Hemichorea-Hemiballism as a Delayed Manifestation of Hyperglycemia: A Case Report.

Hemichorea is characterized by involuntary, continuous, non-patterned movements on one side of the body. While it is most commonly caused by strokes, it can also be caused by metabolic derangements such as hyperglycemia. We present two patients who developed hemichorea in the setting of hyperglycemia. Our first patient had a history of uncontrolled diabetes mellitus and developed chorea 2 weeks following a hyperglycemic event. The second patient developed chorea while being on steroids for hip pain and was later diagnosed to have underlying diabetes mellitus. MRI showed hyperintensity in the contralateral lentiform nucleus in both cases. The chorea did not improve despite the correction of the hyperglycemia. Both patients were started on Tetrabenazine with significant improvement. Hyperglycemia-induced hemichorea might be underdiagnosed given the prevalence of diabetes mellitus in the population. Chorea can even be the presenting symptom of diabetes mellitus and in some cases is a delayed manifestation of hyperglycemia.

An Update on Medical and Surgical Treatments of Parkinson's Disease.

Parkinson's disease (PD) is characterized by degeneration of dopaminergic neurons in the substantia nigra pars compacta and other neuronal populations. The worldwide prevalence of PD is over 7 million and has been increasing more rapidly than many other neurodegenerative disorders. PD symptoms can be broadly divided into motor (slowness, stiffness, tremor) and non-motor symptoms (such as depression, dementia, psychosis, orthostatic hypotension). Patients can also have prodromal symptoms of rapid eye movement sleep behavior disorder, hyposmia, and constipation. The diagnosis of PD is mainly clinical, but dopamine transporter single-photon emission computed tomography can improve the accuracy of the diagnosis. Dopamine based therapies are used for the treatment of motor symptoms. Non-motor symptoms are treated with other medications such as selective serotonin reuptake inhibitors (depression/anxiety), acetylcholinesterase inhibitors (dementia), and atypical antipsychotics (psychosis). Patients with motor fluctuations or uncontrolled tremor, benefit from deep brain stimulation. Levodopa-carbidopa intestinal gel is an alternative to deep brain stimulation for uncontrolled motor fluctuations. Rehabilitative therapies such as physical, occupational, and speech therapy are important during all stages of the disease. Management of PD is complex but there have been significant advancements in the treatment of motor and non-motor symptoms over the past few years. This review discusses the updates in the medical and surgical management of PD.

Psychosocial and Physiologic Characteristics of Patients with Non-epileptic Events: A Retrospective Study.

Background The main focus of this study is to aid early identification of psychogenic non-epileptic seizure (PNES) patients by identifying physical and psychosocial characteristics to reduce the health care burden, to reduce the unnecessary use of anti-epileptic medications and their side effects, and maximizing cost-effective use of video electroencephalography (VEEG). Methods We analyzed PNES subject data from VEEG monitoring performed at the Epilepsy Center at the Marshall University School of Medicine. We reviewed more than 360 episodes in 54 subjects older than 18 years (mean age ± standard deviation (SD): 48 ± 12.97 years; 83% female). Results We found that most of our PNES patients were older than 45 years of age (66.7%), females (83.3%); obese (66.6%) or overweight (18.5%); either single (33.3%), separated (7.4%), divorced (22.2%), or widowed (14.8%); of low education, unemployed (either received government assistance (83.3%) or disability benefits (57.4%)) with associated physical illness (85.2%) and psychiatric illness (96.3%).  Conclusion Our study adds to the current knowledge of the sociodemographic and sociocultural variability of PNES. It might enable early diagnosis and management of patients with PNES.

Make Kids Stroke-Smart: A Community Based Interventional Study.

BACKGROUND: Stroke is the third leading cause of death and the major cause of long-term disability in the United States. Timely recognition of symptoms is critical. Family members are crucial in recognizing stroke symptoms since <5% patients can call Emergency Medical Services themselves due to inability to speak or dial the phone. This might be of significance, especially, in family units where children have frequent contact with multiple generations. This study was undertaken to assess and improve the knowledge about stroke amongst children. METHODS: A community-based interventional study was conducted among 305 kids ranging from second to eighth grade. A pre-test questionnaire was administered and later health education regarding stroke was imparted using audiovisual aids. Post-test was done to assess the impact of stroke education. Components of education included were: 1) What is stroke? 2) FAST mnemonic. 3) Time sensitive treatment. 4) Risk factors for stroke 5) How can they help? 6) Whom to call and where to go? The data was compiled and analyzed using Chi square test. RESULTS: There was a significant lack of knowledge in the pretest groups. The post-test showed statistically significant improvement in all the tested components irrespective of age or grade (p<0.001). CONCLUSION: Targeting the younger generation for stroke education is one way to improve community knowledge of stroke symptoms thus increasing the chances that the stroke patient may receive acute stroke therapy. Children can also be used as a conduit to transmit educational information to parents and other family members thus further raising awareness.

Intravenous tPA in the treatment of acute stroke related to aortic dissection.

A 61-year-old woman with no prior medical illness presented with acute onset stroke symptoms. She had no chest pain at the time of presentation. However, CT angiogram showed an extensive aortic dissection, resulting in hypoperfusion of the right cerebral hemisphere and thus causing stroke symptoms. Due to this finding, tissue plasminogen activator was not given and a negative outcome was avoided.