Case Studies in Stroke: Common and Uncommon Presentations

by Michael G. Hennerici , Michael Daffertshofer , Louis R. Caplan , Kristina Szabo

• ISBN13: 9780521673679
• ISBN10: 0521673674
• Edition: 1st
• Format: Paperback
• Copyright: 2006-12-11
• Publisher: Cambridge University Press

Summary

Neurologists learn from their patients, and this selection of 60 stroke cases will inform and challenge clinicians at all stages in their careers. Including both common and unusual cases, the aim is to reinforce diagnostic skills through careful analysis of individual presenting patterns, and to guide treatment decisions. Each case consists of a clinical history, examination findings and special investigations, usually involving imaging before a diagnosis is given. There then follows for each case a discussion of the clinical issues raised by the case, in which the main teaching points are emphasized. Selected references, frequently including the first description, are provided at the conclusion of each case. Drawing on the expertise of leading teachers and practitioners, and liberally illustrated, these case studies and the discussions that accompany them are an essential guide to learning the complexity of stroke diagnosis.

Author Biography

Kristina Szabo is Senior Lecturer at the University of Heidelberg University Hospital in Mannheim and the MR-Neurology Research Unit.

Table of Contents

List of contributors	xi
List of abbreviations	xii
Preface	xv
Introduction	1	(12)
Part I Common cases of stroke	13	(52)
Dysarthria and clumsy hand syndrome	15	(4)
Sudden numbness of the right extremities	19	(4)
A 52-year-old woman with sudden hemiparesis	23	(4)
Sudden difficulty reading the left side of the morning paper	27	(4)
An 85-year-old man with difficulty expressing himself on the telephone	31	(4)
Transient loss of vision	35	(4)
Massive intracerebral hemorrhage	39	(5)
Tinnitus during cycling in an orthopedic surgeon	44	(3)
Headache after an exhausting tennis match	47	(5)
Anticoagulation-associated hemorrhage	52	(4)
Worst headache of his life	56	(4)
Drooping eyelid and gait problems	60	(5)
Part II Uncommon cases of stroke	65	(194)
Similar infarction -- different outcome: the importance of the brain network	67	(4)
An 80-year-old woman with sudden paresis and normal motor latencies	71	(4)
Lower limb weakness after surgery	75	(4)
A young engineer with suspected MS	79	(3)
Vertigo after lifting a heavy suitcase	82	(4)
A 79-year-old man with a typical MCA-stroke?	86	(4)
A man with slowly progressive weakness of the left hand	90	(4)
Sudden weakness after holidays in Kenya	94	(4)
Recurrent spells of right-sided weakness	98	(4)
An uncommon cause of CVT	102	(4)
``My arm no longer belongs to me . . .''	106	(5)
Coma of unknown onset in an old lady	111	(5)
Spreading sensation of the left arm and face	116	(4)
From dysarthria to locked-in syndrome	120	(3)
The woman who could not smile on command	123	(4)
Severe headache and facial palsy	127	(3)
Isolated difficulty, writing and grasping	130	(3)
Young mother found comatose on the bathroom floor	133	(4)
Progressive mental decline and fever	137	(4)
Aphasia after laproscopic cholecyslectomy	141	(5)
Risks of carotid surgery in longstanding asymptomatic disease	146	(5)
Recurrent weakness after major car accident	151	(4)
Stroke at awakening	155	(3)
Cognitive impairment and seizures	158	(4)
Progressive headache, tinnitus, and nausea	162	(4)
Small problem with severe consequences	166	(5)
Dizzy spells and double vision	171	(3)
Bad disease with good outcome	174	(4)
Livid skin and stroke	178	(4)
Stroke mimicking vestibular neuronitis	182	(4)
Scuba diver with decompression sickness	186	(3)
Memory loss after gastrointestinal endoscopy	189	(4)
Aphasia and severe headache	193	(4)
Progressive neurological decline and fever	197	(6)
Lady who did not want to get up in the morning	203	(4)
Vermont farmer with many spells of rotating and whirling objects	207	(3)
Woman with right arm discomfort and sudden blindness	210	(4)
A 22-year-old woman with sudden right limb weakness and a mixed aphasia	214	(5)
10-year follow-up of a woman with bilateral MCA disease	219	(5)
Dysarthria reoccurring after 2 years	224	(3)
54-year-old man with AVM	227	(3)
Alternating transient numbness	230	(5)
Typical intracerebral hemorrhage -- or not?	235	(4)
The butcher and his wife	239	(5)
Malignant MCA infarction	244	(3)
Stroke in Recklinghausen's disease	247	(5)
Painful double vision and a ``hissing'' sound	252	(3)
Spontaneous resolution of PWI/DWI mismatch	255	(4)
Index	259