22St Annual Meeting
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RESIDENT & FELLOW SECTION Clinical Reasoning: Section Editor An unusual case of subacute Mitchell S.V. Elkind, MD, MS encephalopathy Neal Parikh, MD SECTION 1 revealed wide-based gait and lower extremity dysmet- Alexander E. Merkler, A 52-year-old previously healthy man presented with 8 ria. Relevant laboratory evaluation revealed only a MD months of progressive cognitive decline. He complained C-reactive protein of 1.79 (normal 0–0.99). Natalie T. Cheng, MD of months of confusion, fatigue, depression, hypersom- Brain MRI obtained in Morocco 2 months prior Hediyeh Baradaran, MD nolence, headaches, and, subsequently, urinary inconti- to presentation had demonstrated bilateral thalamic Halina White, MD nence and unsteady gait. His family reported that he T2 hyperintensities and patchy enhancement in the Dana Leifer, MD spoke of his deceased mother as if she were alive. His right medial temporal lobe, midbrain, and basal gan- executive deficits progressed, leading to termination of glia. A right thalamic biopsy obtained in Morocco his employment and a motor vehicle accident. He had revealed “inflammatory cells” without evidence Correspondence to was evaluated and treated in Morocco before presenting of malignancy. Dr. Leifer: to our institution for further care. [email protected] Questions for consideration: Mental status examination was notable for slowed mentation and dyscalculia but was otherwise normal. 1. How can thalamic injury cause encephalopathy? Motor, sensory, and deep tendon reflex examination 2. What is the differential diagnosis for bilateral tha- results were normal. Cerebellar and gait examination lamic MRI abnormalities? GO TO SECTION 2 From the Departments of Neurology (N.P., A.E.M., N.T.C., H.W., D.L.) and Radiology (H.B.), Weill Cornell Medical Center, New York, NY. -
Management of Vertical Gaze Paresis from an Artery of Percheron Infarction
Abstract title: Management of Vertical Gaze Paresis from an Artery of Percheron Infarction. Abstract: A patient presents with vertical gaze paresis (down gaze > up gaze), a ‘drunk’ feeling when in a visually stimulating environment, speech impairment and memory impairment all stemming from a recent Artery of Percheron Infarction. Case History 40 year old white male Chief vision complaints on July 15, 2016: o Vertical gaze difficulty down gaze > up gaze o ‘Drunk’ feeling when in a visually stimulating environment (supermarket, crowd) Eye exam from 2015 was unremarkable o No glasses Rx was given o Patient has never worn glasses before Patient currently on Plavix and Lipitor medications Patient medical history: unremarkable, no prior medical issues o After event patient had speech impairment and mild memory impairment Pertinent findings Recent diagnosis of Artery of Percheron infarction (May 29, 2016) o Magnetic Resonance Imaging/Magnetic Resonance Angiogram images are available for viewing Poor convergence (27 cm) o Poor convergence even when adjusted for age Very low amplitude of accommodation for age: 2 D o Avg Amps for 40 yo = 5 D o Min Amps for 40 yo = 1.67 D Restricted down gaze > up gaze on EOM testing BCVA 20/20 OD/OS o Low Hyperopic Rx found o Minimal reading Rx found o Patient appreciated better vision with trial of glasses with manifest Rx Mild Meibomian Gland Dysfunction Posterior: unremarkable Blood work was negative except mildly elevated Protein S Differential diagnosis and reasons excluded Primary: ‘Top of the -
The Artery of Percheron Megan Quetsch, Sureshkumar Nagiah , Stephen Hedger
Case report BMJ Case Rep: first published as 10.1136/bcr-2020-238681 on 11 January 2021. Downloaded from Stroke masquerading as cardiac arrest: the artery of Percheron Megan Quetsch, Sureshkumar Nagiah , Stephen Hedger General Medicine, Flinders SUMMARY level of consciousness. The patient was extubated Medical Centre, Bedford Park, The artery of Percheron (AOP) is a rare arterial variant 24 hours later, with her GCS improving to 13–14 South Australia, Australia of the thalamic blood supply. Due to the densely packed over the next day. collection of nuclei it supplies, an infarction of the Correspondence to AOP can be devastating. Here we highlight a patient Dr Sureshkumar Nagiah; INVESTIGATIONS sureshkumar. nagiah@ health. who had an AOP stroke in the community, which was sa. gov. au initially managed as cardiac arrest. AOP strokes most CT of the brain and CT angiogram (CTA) were often present with vague symptoms such as reduced performed at the regional hospital 3 hours after Accepted 11 December 2020 conscious level, cognitive changes and confusion without the acute onset of symptoms. CT scan showed no obvious focal neurology, and therefore are often missed evidence of ischaemic damage. CTA showed no at the initial clinical assessment. This case highlights the filling defects, significant stenosis or aneurysmal importance of recognising an AOP stroke as a cause of changes. Blood tests, including complete blood otherwise unexplained altered consciousness level and examination, renal function, electrolytes, C reac- the use of MRI early in the diagnostic work- up. tive protein and creatine kinase were normal. Telemetry showed normal sinus rhythm. Electro- encephalogram showed no evidence of seizure activity. -
Otology & Neurotology
Otology & Neurotology 2017 Journal Citation Report® (Clarivate, 2018) 2017 Journal Citation Reports® -- Key Metrics 2016 2017 Impact Factor 2.024 2.182 5-Year Impact Factor 2.163 2.264 Immediacy Index 0.326 0.194 Citable Items 279 309 Total Cites 6,695 7,427 Cited Half-life 6.3 6.7 Citing Half-life 9.2 9.1 Eigenfactor™ Score .01216 .01161 Article Influence™ Score .595 .584 Category Ranking Clinical Neurology 121/194 121/197 Otorhinolaryngology 13/42 13/41 2017 Impact Factor calculation Cites in 2017 to items published in: 2016 = 505 Number of items published in: 2016 = 279 2015 = 763 2015 = 302 Sum: 1268 Sum: 581 Calculation: Cites to recent items 1268 = 2.182 Number of recent items 581 2017 5-year Impact Factor calculation Cites in 2017 to items published in: 2016 = 505 Number of items published in: 2016 = 279 2015 = 763 2015 = 302 2014 = 758 2014 = 330 2013 = 629 2013 = 266 2012 = 609 2012 = 265 Sum: 3264 Sum: 1442 Calculation: Cites to recent items 3264 = 2.264 Number of recent items 1442 2017 Immediacy Index calculation Cites in 2017 to items published in 2017 = 60 Number of items published in 2017 = 309 Calculation: Cites to current items 60 = 0.194 Number of current items 309 Impact Factor: 2013- 2017 2013 2014 2015 2016 2017 Citations 834 949 1164 1279 1268 Articles 522 531 596 632 581 Impact Factor 1.598 1.787 1.953 2.024 2.182 Citations Articles Impact Factor 1400 2.5 2.182 1200 1.953 2.024 1.787 2 1000 1.598 Factor Impact 800 1.5 600 1 400 0.5 200 0 0 2013 2014 2015 2016 2017 Category Ranking: 2013-2017 Category 2013 2014 2015 2016 2017 Clinical Neurology 135/194 122/192 115/193 121/194 121/197 Otorhinolaryngology 15/44 17/44 13/43 13/42 13/41 Journal Self Cites Self Cites 1141(15.363% of 7427) Self Cites to Years Used in Impact Factor Calculation 246(19.401% of 1268) Impact Factor without Self Cites 1.759 Top Cited Papers in 2017 Published in 2015-2016 Cites Pub In Total Rank Title Authors Year Vol Iss 2017 Cites Epidemiology of Balance Symptoms and Disorders in the Community: A Murdin, Louisa; Schilder, Anne G. -
Posterior Cerebral Artery Aneurysms Felix Göhre M.D
Posterior Cerebral Artery Aneurysms Felix Göhre M.D. Academic Dissertation To be publicly discussed with the permission of the Faculty of Medicine of the University of Helsinki in Lecture Hall 1 of Töölö Hospital on June 3th, 2016 at 12:00 noon University of Helsinki 2016 VERLAG JANOS STEKOVICS (Wettin-Löbejün OT Dößel) Supervised by: From the Department of Neurosurgery Helsinki University Central Hospital Professor emeritus Juha Hernesniemi, M.D., Ph.D. University of Helsinki Department of Neurosurgery Helsinki, Finland Helsinki University Central Hospital Helsinki, Finland Associate Professor Martin Lehecka, M.D., Ph.D. Department of Neurosurgery Helsinki University Central Hospital Helsinki, Finland Posterior Cerebral Artery Reviewed by: Aneurysms Associated Professor Sami Tetri, M.D., Ph.D. Department of Neurosurgery University of Oulu Oulu, Finland Dr. med. Felix Göhre Associated Professor Sakari Savolainen, M.D., Ph.D. Department of Neurosurgery University of Eastern Finland Kuopio, Finland To be discussed with: Professor Dr. med. habil. Andreas Raabe Department of Neurosurgery Inselspital, University of Bern Bern, Switzerland University of Helsinki 2016 VERLAG JANOS STEKOVICS for my parents, Gerd and Reinhilde Göhre Table of Contents List of Original Publications 7 Abbreviations 8 Abstract 9 1. Introduction 10 2. Literature Review 11 2.1 Intracranial Aneurysms 11 2.1.1 Incidence and Prevalence 11 2.1.2 Diagnosis and Imaging of Intracranial Aneurysms 11 2.1.3 Risk Factors 12 2.1.4 Morphology 12 2.1.5 Histology and Aneurysm Wall -
Scope of Practice in Audiology
SCOPE OF PRACTICE IN AUDIOLOGY AD HOC COMMITTEE ON THE SCOPE OF PRACTICE IN AUDIOLOGY Reference this material as: American Speech-Language-Hearing Association. (2018). Scope of Practice in Audiology [Scope of Practice]. Available from www.asha.org/policy. © Copyright 2018 American Speech Language Hearing Association. All rights reserved. Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain. Scope of Practice in Audiology ABOUT THIS DOCUMENT This scope of practice document is an official policy of the American Speech-Language-Hearing Association (ASHA) defining the breadth of practice within the profession of audiology. The Audiology Scope of Practice document has not been updated since 2004. The aim of this document is to reflect the current and evolving clinical practice in audiology. Such changes include, but are not limited to, telehealth, discussion of hearing technologies beyond traditional hearing devices (e.g., over-the-counter [OTC]), and personal sound amplification products (PSAPs). Additional updates in advancements in hearing device implantation, vestibular assessment and rehabilitation, hearing preservation, educational audiology, and interoperative monitoring practice are included. This document was developed by the ASHA Ad Hoc Committee on the Scope of Practice in Audiology. Committee members were Julie Honaker (chair), Robert Beiter, Kathleen Cienkowski, Gregory Mannarelli, Maryrose McInerney, Tena McNamara, Jessica Sullivan, Julie Verhoff, Robert Fifer (board liaison), and Pam Mason (ex officio). This document was approved by the ASHA Board of Directors on August 20, 2018. -
Learning Disabilities
LEARNING DISABILITIES Edited by Wichian Sittiprapaporn LEARNING DISABILITIES Edited by Wichian Sittiprapaporn Learning Disabilities Edited by Wichian Sittiprapaporn Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Martina Durovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from [email protected] Learning Disabilities, Edited by Wichian Sittiprapaporn p. -
A Rare Case of Ischemic Stroke
J M e d A l l i e d S c i 2 0 1 6 ; 6 ( 2 ) : 92- 95 Journal of www.jmas.in M edical & Print ISSN: 2 2 3 1 1 6 9 6 Online ISSN: 2 2 3 1 1 7 0 X Allied Sciences Case report A rare case of ischemic stroke Nikhil Sunkarineni, Srikant Jawalkar Department of Neurology, Deccan College of Medical Sciences, Kanchanbagh (PO), Hyderabad-500058, Telangana, India. Article history: Abstract Received 07 June 2016 The artery of Percheron is a rare vascular entity of cerebral circula- Revised 01 July 2016 tion. High degree of suspicion is required to diagnose this condition. Accepted 08 July 2016 Artery of Percheron infarction should be considered in all patients Early online 25 July 2016 presenting with sudden loss of consciousness. Magnetic resonance Print 31 July 2016 imaging (MRI) shows a characteristic pattern of bilateral paramedian Corresponding author thalamic infarcts with or without midbrain involvement. We report a case of a 45-year-old man with acute bilateral thalamic infarcts. Oc- Nikhil Sunkarineni clusion of the vessel was presumably due to hyperhomocysteinemia. Postgraduate, Department of Neurology, Key words: Artery of Percheron, Hyperhomocysteinemia, Ischemic Deccan College of Medical Sciences, stroke Kanchanbagh, Hyderabad-500058, Telangana, India. DOI: 10.5455/jmas.231031 Phone: +91-9963220001 Email: [email protected] © 2016 Deccan College of Medical Sciences. All rights reserved. ormal variants of the cerebral circulation are Coma Scale (GCS) was 5/15 (E2 M2 V1), pulse a common occurrence. Infarction resulting was 90 per minute and regular, and the blood N due to the occlusion of these variant arter- pressure was 240/120 mm of Hg in the supine po- ies can be difficult-to-diagnose. -
Cognitive Problems Related to Vertebrobasilar Circulation
Turkish Journal of Medical Sciences Turk J Med Sci (2015) 45: 993-997 http://journals.tubitak.gov.tr/medical/ © TÜBİTAK Review Article doi:10.3906/sag-1403-100 Cognitive problems related to vertebrobasilar circulation Abdulkadir KOÇER* Department of Neurology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey Received: 19.03.2014 Accepted/Published Online: 16.07.2014 Printed: 30.10.2015 Abstract: Neurodegenerative disorders are characterized by decreased regional cerebral blood flow. Supporting this concept, both cognitive training exercises and physical activity promote blood flow increase and correlate with healthy cognitive aging. The terminal branches of the posterior circulation supply blood to areas of the brain, such as the thalamus, hippocampus, occipital lobe, and cerebellum, involved with important intellectual functions, particularly recent memory, visual-spatial functioning, and visuomotor adaptations. Amnesia and visual agnosia may be a complication of not only posterior circulation infarctions but also vertebrobasilar insufficiency (VBI) without accompanying structural infarcts. The cognitive impairment may be a manifestation of transient attacks and may persist beyond resolution of symptoms related to ischemia. Early recognition of cognitive deficits in the VBI patient is important because several recent reports show stent placements or medical treatment may improve cognition. Key words: Cognition, dementia, vertebrobasilar insufficiency, amnesia, agnosia, aging 1. Introduction related to cognitive decline -