Cerebellar Stroke in a Young Adult Following an Amusement Park Ride.

The incidence of stroke in young individuals has been showing an increasing trend. In such cases, atypical mechanisms of stroke should be considered. Here, we report a case of a 37-year-old healthy female who presented with complaints of right-sided ataxia and clumsiness that started after an amusement park ride where she was swung rapidly. Imaging revealed an infarct in the right cerebellar hemisphere. This case report highlights certain mechanisms that can cause a stroke in this situation, with special emphasis on recognition, timely medical management, public awareness of such risk factors, and the prevention of complications.

Timely Diagnosis of Basilar Artery Occlusion Leading to Improved Outcomes: A Case Report.

This is a case report of an 83-year-old female who presented to the emergency department within eight hours of symptom onset. A CT angiogram revealed a distal basilar artery occlusion, as well as a perfusion deficit in the right superior cerebellar artery. Her symptoms fluctuated, and she was started on a heparin drip, but later in the evening her symptoms worsened. A mechanical thrombectomy was performed by interventional radiology. The following morning, most of the patient's deficits had resolved, and, when seen in the clinic several weeks later, she continued to be asymptomatic. This case report highlights the importance of timely diagnosis and intervention in the management of distal basilar artery occlusion.

Cervical Spine Ischemic Stroke Complicated by Spastic Quadriparesis and Ogilvie Syndrome: A Case Report and Literature Review.

Infarction or ischemia of the spinal cord is a rare entity and is often misdiagnosed as inflammatory myelopathy in acute settings. Atherosclerotic disease can affect spinal arteries, leading to cord ischemia with clinical presentation mixed with myelopathy. We present a case of a 66-year-old male who came to the hospital with unsteady gait and numbness of all extremities without associated pain for the past 48 hours. The neurological examination on admission directed the diagnosis towards myelopathy of the cervical spine. However, the initial magnetic resonance imaging (MRI) of the cervical spine demonstrated gliosis and restricted diffusion of the cord with multilevel neuroforaminal stenosis but without central canal stenosis or cord compression. The MRI brain, cerebrospinal fluid analysis, and rheumatologic evaluation were unremarkable. Four days into the clinical course, the patient developed weakness and spasticity of all extremities prompting further evaluation. Computed tomography angiography (CTA) scan of the head and neck revealed right vertebral artery occlusion and intracranial atherosclerotic disease. He was started on aspirin and clopidogrel for secondary risk reduction. The hospital course was further complicated by Ogilvie syndrome (OS), and the patient underwent uncomplicated cecostomy.

Thyrotoxicosis-Induced Cardiogenic Shock with Encephalopathy and Acute Respiratory Distress: A Case Report and Literature Review.

Thyrotoxicosis-induced cardiomyopathy and cardiogenic shock (CS) can lead to sudden mortality in adults. Hemodynamic instability and collapse occur due to functional alterations in both peripheral circulation and myocardium. Thyroid storm (TS) increases preload and decreases afterload along with an increase in cardiac contractility and heart rate leading to high output acute failure. We present a case of a 30-year-old female who presented with a complaint of watery diarrhea and dehydration for almost a week. At her visit to the emergency room, she was unresponsive with hemodynamic collapse leading to altered mental status and tachycardia. The computed tomography (CT) scan of head was non-contributory. The condition worsened with respiratory distress, and eventually, mechanical ventilation with intubation was completed. Further, laboratory workup showed acute thyrotoxicosis. The severe cardiomyopathy on echocardiography with compromised left ventricle function and diffuse pulmonary congestion led to acute respiratory distress syndrome (ARDS). The multi-organ failure, impending ARDS and CS with encephalopathy led to the sudden death of a patient within 24 hours of intensive care unit (ICU) stay before even extracorporeal membrane oxygenation (ECMO) could be started.

Developmental vascular anomaly associated hemi facial spasms and botox injections therapy.

Hemifacial spasm (HFS) is characterized by involuntary synchronous contractions or spasms of one side of the face, usually beginning around the eye. They are typically brief, irregular clonic movements but are occasionally tonic. We present a case of a 41-year-old female who presented to the neurology clinic with complaints of recurrent right facial spasms. These involuntary spontaneous movements had affected her quality of life. The neuroimaging revealed the vascular malformation right cranial nerves (CN) VII/VIII complex. It was considered to be responsible for the patient's HFSs. The patient responded well symptomatically to the botox injections without any neurovascular decompression.

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.

Techniques for improving efficiency in the emergency department for patients with acute ischemic stroke.

The past 15 years have witnessed significant strides in the management of acute stroke. The most significant advance, reperfusion therapy, has changed relatively little, but the integrated healthcare systems-stroke systems-established to effectively and safely administer stroke treatments have evolved greatly. Driving change is the understanding that "time is brain." Data are compelling that the likelihood of improvement is directly tied to time of reperfusion. Regional stroke systems of care ensure patients arrive at the most appropriate stroke-capable hospital in which intrahospital systems have been created to process the potential stroke patient as quickly as possible. The hospital-based systems are comprised of prehospital care providers, emergency department physicians and nurses, stroke team members, and critical ancillary services such as neuroimaging and laboratory. Given their complexity, these systems of care require maintenance. Through teamwork and ownership of the process, more patients will be saved from potential death and long-term disability.