Temporal Lobe Infarction Research Articles

Case Report: COVID-19 and Ischemic Stroke in A 16-Year-Old Patient

Introduction: Recent reports show an increasing trend of ischemic stroke at a young age. Diseases associated with ischemic stroke at a young age, namely hereditary hypercoagulable conditions. Case: In this case a 16-year-old boy with clinical complaints of sudden weakness of the right hand and leg, numbness, loss of appetite, nausea and vomiting. Laboratory tests showed results of increased levels of hemoglobin, hematocrit, erythrocyte count, platelet count, leukocyte count and NLR. The neutrophil-to-lymphocyte ratio (NLR), calculated as a simple ratio between the neutrophil and lymphocyte counts measured in peripheral blood. CT scan examination showed acute infarction in the medial left temporal lobe and old infarction in the left frontal lobe (medial gyrus). Thoracic CT Scan examination showed the results of bilateral pneumonia suggestive of viral. The patient encountered COVID-19. The patient experienced cough and shortness of breath and showed abnormal ABG results, namely respiratory alkalosis, decreased oxygen saturation, fever, increased procalcitonin and increased cardiac markers. Discussion: This case report prompts discussions on various aspects of ischemic stroke in young patients, including the role of COVID-19, hypercoagulable states, hematological abnormalities, and diagnostic challenges, with implications for patient management and future research directions. Conclusion: SARS CoV-2 can affect the nervous system through several mechanisms that cause persistent infection, resulting in neurological diseases, including stroke. Young ischemic stroke is usually hypercoagulable and the most common cause is APS. In this patient, polycythemia was occured,that causes blood flow slows and oxygen supply to the brain is reduced. This can cause ischemic stroke.

Assessment of cognitive dysfunction and its influencing factors after acute ischemic stroke

Objective In order to provide a more accurate and effective basis for clinical diagnosis and treatment, patients with cognitive dysfunction after acute ischemic stroke (AIS) were evaluated and their influencing factors were analyzed. Methods A rigorous and systematic logistic regression analysis was conducted to comprehensively investigate the various influencing factors that contribute to cognitive dysfunction. Results Among them, the sex granulocyte/lymphocyte ratio (NLR), low-density lipoprotein cholesterol (LDL-C) level, and C-reactive protein (CRP) were also higher than those in the control group (p < 0.05). The scores of memory, orientation, visual and spatial function, abstract thinking and language in the control group were higher than those in the experimental group (p < 0.05). The results of multivariate logistic regression analysis showed that history of diabetes mellitus, high NLR, high LDL-C, high CRP, smoking and temporal lobe infarction were risk factors for cognitive dysfunction after AIS, while elevated BMI and love of exercise were protective factors for cognitive dysfunction after AIS. Conclusion Patients with cognitive dysfunction had the highest incidence of temporal lobe infarction, and they scored lower than the control group on memory, orientation, visual and spatial function, abstract thinking, and language function. Multivariate logistic regression analysis showed that a history of diabetes mellitus, high NLR, high LDL-C, high CRP, smoking, and temporal lobe infarction were independent risk factors for cognitive dysfunction after acute ischemic stroke, while elevated BMI and a love of exercise were protective factors for cognitive dysfunction after acute ischemic stroke.

Development and validation of a risk prediction model for aspiration in patients with acute ischemic stroke

BackgroundAspiration is a frequently observed complication in individuals diagnosed with acute ischemic stroke, leading to potentially severe consequences. However, the availability of predictive tools for assessing aspiration probabilities remains limited. Hence, our study aimed to develop and validate a nomogram for accurately predicting aspiration probability in patients with acute ischemic stroke. MethodsWe analyzed 30 potential risk factors associated with aspiration in 359 adult patients diagnosed with acute ischemic stroke. Advanced statistical techniques, such as Least absolute shrinkage and selection operator (LASSO) and Multivariate Logistic regression, were employed to identify independent predictors. Subsequently, we developed a nomogram prediction model based on these predictors, which underwent internal validation through 1000 bootstrap resampling. Two additional cohorts (Cohort A n = 64; Cohort B, n = 105) were included for external validation. The discriminatory power and calibration performance of the nomogram were assessed using rigorous methods, including the Hosmer-Lemeshow test, area under the receiver operating characteristic curve (AUC), calibration curve analyses, and decision curve analyses (DCA). ResultsThe nomogram was established based on four variables: sputum suction, brain stem infarction, temporal lobe infarction, and Barthel Index score. The predictive model exhibited satisfactory discriminative ability, with an area under the receiver operating characteristic curve of 0.853 (95 % confidence interval, 0.795–0.910), which remained consistent at 0.852 (95 % confidence interval, 0.794–0.912) during the internal validation. The Hosmer-Lemeshow test (P = 0.394) and calibration curve demonstrated favorable consistency between the predicted and observed outcomes in the development cohort. The AUC was 0.872 (95 % confidence interval, 0.783–0.962) in validation cohort A and 0.877 (95 % confidence interval, 0.764–0.989) in validation cohort B, demonstrating sustained accuracy. DCA showed a good net clinical benefit of the nomogram. ConclusionsA nomogram for predicting the probability of aspiration in patients with acute ischemia has been successfully developed and validated.

Minimally Invasive Posterolateral Transcavernous Transtentorial Approach: 2-Dimensional Operative Video.

MIPLATTA uses a "key-exposure" concept aligning a small minipterional craniotomy with variations of extradural transcavernous transtentorial corridors to access the skull base. Safety and efficiency depend on mastery of the anterior clinoid process (ACP) and cavernous sinus (CS). Preoperative planning includes assessment of ACP pneumatization; tumor epicenter relative to the CS, ACP, and tentorium; and pattern of venous drainage (role of vein of Labbé). 1. Interfascial flap for facial nerve preservation.2. Minipterional craniotomy with extradural anterior clinoidectomy.3. Variable Transcavernous dissection according to the Hakuba method4. Dural opening parallel to the Sylvian fissure.5. Transtentorial with possible Kawase.6. Closure with autologous graft into the clinoidal triangle and water-tight dural closure. Incomplete release of the optic and oculomotor nerves during anterior clinoidectomy may lead to deficits. Insufficient caudal extent of the craniotomy may cause undue retraction on Labbé and a temporal lobe infarct. Thorough anatomic knowledge of the CS is a key for catastrophe prevention. 1. Basic MIPLATTA with minipterional and extradural anterior clinoidectomy (Hakuba approach) for optic nerve decompression and parasellar lesions.2. Extended MIPLATTA adds oculomotor nerve transposition and cavernous sinus peeling for middle fossa, sphenoid ridge, and giant clinoid tumors.3. Full MIPLATTA adds Kawase and internal auditory canal exposure with endoscopic-assisted microsurgery for tumors invading the posterior fossa.The patients consented to both surgery and publication of their images. Permission was obtained appropriately for the publication of the cadaveric images. The anatomic images and animations in the surgical anatomy section of the video are sole property of www.neurosurgicalanatomy.com and Neurosurgical Anatomy by Arnau Benet, MD, who shall retain copyright, and used with permission.

Unique Patterns of Ischemic Stroke from Combined Cocaine and Heroin Use: A Case Series (P3-5.031)

<h3>Objective:</h3> To describe cases of multiple territory ischemic stroke in young individuals secondary to combined cocaine and heroin use. <h3>Background:</h3> Abuse of cocaine and heroin has been linked to ischemic stroke via various mechanisms. Cocaine use can lead to vasospasm, direct cerebral vessel damage, or other end-organ damage which can promote clot formation. Heroin use has been linked to hypoxic-ischemic injury, promoting cardioembolism, and rarely hypereosinophilia. The effects of a combination of these two substances on acute ischemic stroke are less frequently reported. <h3>Design/Methods:</h3> Retrospective case series of three individuals. <h3>Results:</h3> <h3>Case 1:</h3> A 37-year-old female with a history of polysubstance use disorder presented after being found down. She was disoriented, confabulating, had ataxia and dysarthria with a NIHSS of 15. MRI revealed symmetric ischemic changes within the bilateral hippocampi, bilateral cerebellar regions, and right occipital lobe. The patient endorsed use of synthetic heroin and cocaine prior to presentation. <h3>Case 2:</h3> A 46-year-old male presented after being found down in a hotel room with an empty syringe, later endorsing combined cocaine and heroin use. On exam, he was severely obtunded and required intubation, NIHSS was 27. MRI revealed symmetric ischemic changes in the bilateral globus pallidus, centrum semiovale, corona radiata, and scattered foci of restricted diffusion in both cerebral hemispheres. <h3>Case 3:</h3> A 46-year-old male with a history of type 2 diabetes mellitus and polysubstance use disorder presented with a 5-day history of altered mental status. Exam notable for apraxia, short term memory loss, and shuffling gait, but NIHSS was 0. Use of cocaine and heroin was identified. MRI revealed bilateral globus pallidus infarcts with petechial hemorrhage, and a right temporal lobe infarct. <h3>Conclusions:</h3> The combined use of cocaine and heroin can lead to multiple territory ischemic stroke plus striking symmetric globus pallidus and/or hippocampus ischemia. <b>Disclosure:</b> Dr. Hasan has nothing to disclose. Dr. Pinna has nothing to disclose. Dr. Lynch has nothing to disclose. Dr. Kim has nothing to disclose.

Seizure in geriatric population - An unheeded integer.

Epilepsy is one of the most prevalent neurological conditions among the elderly. Age-related epileptogenic disorders as well as the ageing itself pose a risk for seizures in the elderly. The lack of witnesses, non-specific symptoms, and transient symptoms make the diagnosis challenging in the elderly. This study aimed to assess the various presentation and aetiology for the seizure disorder in the elderly population. A total of 125 elderly patients ≥60 years with new onset seizure were included in the study. Demographic data, co-morbidities, and clinical presentation of seizure were elicited. Hemogram, liver and renal function tests, random blood sugar, electrolytes, and serum calcium were analysed. Computed tomography (CT), magnetic resonance imaging (MRI) brain, and electroencephalogram (EEG) were performed. Seizure was seen predominantly in the males with age group of 60-70 years. Generalized tonic-clonic seizure was the commonest presentation, followed by focal seizures. The leading causes of seizures were cerebral vascular accidents, metabolic conditions, and alcohol. CT brain was abnormal in 49%, and 73% of the patients showed abnormality in MRI brain. EEG was abnormal in 17.3% of patients. Temporal lobe infarction was the commonest, trailed by parieto-temporal and frontal lobe involvement. Seizures in the elderly have varied clinical signs and aetiology. An awareness about these atypical presentation and aetiology is essential for the early diagnosis and management to prevent morbidity.

Acupuncture's effect on nerve remodeling among patients with dysphagia after cerebral infarction: a study based on diffusion tensor imaging: 基于弥散张量成像技术探讨针刺对脑梗死后吞咽障碍患者神经重塑的研究

ObjectiveTo investigate the clinical effect of acupuncture among patients with dysphagia after cerebral infarction, and the nerve remodeling of acupuncture using diffusion tensor imaging. MethodsOne hundred and twenty patients with dysphagia after cerebral infarction were randomly assigned to either acupuncture group or sham-acupuncture group with a 1:1 ratio. All patients received usual care and swallowing function training of neurology department. Additionally, acupuncture was applied at Sìshéncōng (四神聪EX-HN1), Băihuì (百会GV20), Tàiyáng (太阳EX-HN5), Fēngchí (风池GB20) and Shésānzhēn (舌三针three-tongue needling points, Extra) in acupuncture group. The needles were retained for 30 min each time, and five times a week for three weeks as a course of treatment. Two courses of treatments were required in total. In sham-acupuncture group, the blunt needles were put into the needle sleeve, and the top of needle was fixed on the skin. During treatment the blunt needle tip only had slight contact with the skin without any penetration. The blunt needle tips were placed on EX-HN1, GV20, EX-HN5, GB20 and three-tongue needling points, respectively. The duration of treatment in sham-acupuncture group was the same as that in acupuncture group. Before and after treatment, all patients underwent Kubota water swallowing test to evaluate the clinical effect. Using diffusion tensor image (DTI), the nerve remodeling was detected. ResultsClinical effect: After treatment and assessed by water swallowing test, there were 38 cases of normal swallowing function in acupuncture group, higher than 15 cases in sham-acupuncture group (P < 0.05). Nerve remodeling: (1) apparent diffusion coefficient (ADC): before treatment, ADC in acupuncture group and sham acupuncture group were 1.76 ± 0.45 mm/s and 1.68 ± 0.51 mm/s, respectively. After treatment, ADC were 0.66 ± 0.15 mm/s and 0.74 ± 0.11 mm/s, respectively. The difference in ADC had no statistical significance between two groups after treatment (P > 0.05); (2) fractional anisotropy (FA): after treatment, FA of acupuncture group was 0.57 ± 0.06, which was significantly higher than that of sham-acupuncture group (P < 0.05); (3) observation of different infarct lesions: after treatment, ADC of temporal lobe infarction in acupuncture group was (0.57 ± 0.11) mm/s, lower than 0.82 ± 0.24 mm/s of sham acupuncture group, while FA in acupuncture group was 0.61 ± 0.07, higher than 0.45 ± 0.10 in sham-acupuncture group, both with statistical significance (both P < 0.05). Regarding the changes of FA maps for temporal lobe infarction before and after treatment, the transverse bundles of the white matter fibers increased remarkably in infarct lesions and on the healthy side of temporal lobe. ConclusionAcupuncture could improve the swallowing function of patients with dysphagia after cerebral infarction. It reduced ADC and increased FA, especially among patients with temporal lobe infarction after treatment. Acupuncture may have a remodeling effect on transverse cortical fibers after temporal lobe infarction.

Verbal Auditory Agnosia Developed after Unilateral Temporal Lobe Infarction

Stroke results in sudden loss of function related to its damaged portion. When this occurs in temporal lobe, the function of hearing and listening may be affected, although receptive language processing is affected while hearing perception is relatively spared. This is called as “central deafness.” It has been known that hearing ability is seldom impaired in the case of temporal lobe stroke except in the case of bilateral lesions. However, we experienced a 72-year-old, right-handed woman who presented with both sudden hearing difficulty due to unilateral temporal lobe infarctions after suddenly not being able to respond to any verbal questions except environmental sounds. Pure-tone audiometry showed both flat sensorineural hearing loss of mild degree in both ears but she could not understand any verbal sound. Brain MRI demonstrated extensive ischemic infarcts in the left temporal lobes involving primary auditory cortex. She was diagnosed as verbal auditory agnosia and has received speech-language therapy.

Procedure-Related Temporal Infarct After Retractorless Transsylvian Selective Amygdalohippocampectomy and Impact on 2-Year Epilepsy Outcome.

Selective amygdalohippocampectomy (SAH) is designed to treat patients with mesial temporal lobe epilepsy (MTLE). To determine the volume and impact of temporal lobe infarction after retractorless transsylvian SAH (en bloc resection of the hippocampus) that have not been reported. A retrospective analysis of patients treated with retractorless transsylvian SAH. Infarctions were detected by magnetic resonance imaging (MRI) within the first week after the operation. Neuropsychological testing was performed preoperatively and 6 mo later. Seizure outcome was evaluated 2 yr after epilepsy surgery. Between 2010 and 2014, a total of 30 patients were included in this study. Analysis of postoperative MRI showed the following: (1) mean removal volume of the hippocampus-parahippocampus was 5.72 cm3, and (2) mean volumes of temporal and insular infarctions were 1.71 and 0.25 cm3, respectively. Twenty-five patients (83.3%) were free of disabling seizures (Engel class I) at 2 yr of outcome. Neuropsychological testing revealed improvement in Perceptual Organization Index (P=.036) and verbal paired associates II (P=.014) after the operation. Neither infarction volume nor removal volume was related to epilepsy outcome in linear regression model. Transsylvian SAH has comparable seizure outcomes but bears inherent risks of vasospasm/vascular injury. Immediate postoperative small infarction volume around resection cavity or along surgical corridor was noticed after retractorless transsylvian SAH, which did not cause neuropsychological deteriorations, in contrast to previous study with the use of self-sustaining rigid retraction system. Further study should be performed to compare procedure-related infarctions and their impacts on neuropsychological outcomes in different selective approaches.

25. Use of rituximab in refractory primary antiphospholipid syndrome with pulmonary and cerebral manifestations

25. Use of rituximab in refractory primary antiphospholipid syndrome with pulmonary and cerebral manifestations

Endovascular management of spontaneous delayed migration of the flow-diverter stent

Background and purposeSpontaneous delayed migration of the flow-diverter stent (FD) is an unusual complication that can be fatal. The purpose of this study is to report our experience and review the literature for the management of delayed FD migration. Materials and methodsBetween November 2013 and June 2017, 122 patients treated by FD at our institution were enrolled. We also performed a comprehensive review of the literature. ResultsSix patients (4.9%) were found to have spontaneous delayed migration of their FD. The device migrated proximally in 4 patients and distally in 2 patients. One patient had temporal lobe infarction due to stent migration, and another had subarachnoid haemorrhage (SAH). Three patients were treated with a 2nd or 3rd FD, while 2 were treated with stent-assisted coiling, and one was treated with sacrifice of the parent internal carotid artery. According to our results and the literature, the prevalence rate of delayed FD migration ranges from 2.2% to 4.9%, and the mortality and morbidity rate of delayed FD migration is 40%. ConclusionsNeuro-interventionalists should be aware of this complication and be familiar with risk factors, preventive methods and treatment options. If there is any concern regarding the size or position of the FD, early imaging follow-up and endovascular treatment should be indicated.

Neonatal Vein of Labbé Infarction Size is Associated With Long-Term Language Outcomes

BackgroundThe vein of Labbé is a superficial cortical vein, which drains the lateral surface of the temporal lobe. Thrombosis of the vein of Labbé can occur in the neonatal period. The developmental outcomes of infants who had vein of Labbé thrombosis are unknown as few studies of outcomes exist. MethodsWe completed a retrospective review of infants born ≥34 weeks of gestation, diagnosed with vein of Labbé thrombosis, and/or infarction on neuroimaging during the first 30 days of life. Size of each temporal lobe infarction was estimated based on the number of temporal lobe segments involved. Primary outcomes were the presence of major neurodevelopmental impairments in childhood and Bayley scores at two years. ResultsOur cohort of 19 infants had a median gestational age of 38 weeks (interquartile range 36 to 39) and mean birth weight 2892 ± 920 grams. The most common presenting symptoms of vein of Labbé thrombosis and infarction of surrounding tissue were seizures, apnea, lethargy, and either hypertonia or hypotonia. At the latest clinical follow-up appointment documented in the electronic medical record (mean 4.4 ± 3.08 years), 44% had major neurodevelopmental impairment. Patients with large vein of Labbé infarctions had significantly worse average Bayley scores than those with small to moderate lesions, and differences in language composite were statistically significant (72.7 vs 107.8, P = 0.017). ConclusionsNeonates with large vein of Labbé infarctions are more likely to have poor language outcomes. This finding suggests a need for targeted surveillance to ensure early identification of deficits and referral for intervention.

Seizure and Fever

Dr. Jonathan Sonis: Today's case is that of a 60-year-old man transferred from an outside hospital to our emergency department (ED) with status epilepticus and noncontrast head computer tomography (CT) findings concerning for a subacute right temporal lobe infarct.

Acamprosate Complements Ill-Sustained Response of ECT in Catatonic Frontotemporal Dementia

It is estimated that 10-15% of demented patients have clinical characteristics suggestive of Fronto-temporal dementia (FTD) or Pick’s disease. It is the third most common neurodegenerative cortical dementia after Alzheimer’s disease and diffuse Lewy’s Body disease. It equally affects both males and females, within the age group of 45-65 years. It manifests mainly as insidious onset of behavioral and personality changes. MRI characteristically shows parietal and anterior temporal lobar atrophy. Psychiatric aspects seem to respect the patterns of classical frontal lobe syndromes. Speech and language abnormalities often begin early and progress rapidly. Incontinence can occur early. Parkinsonism could be an association too. Examination is usually remarkable for witzelsucht, echo phenomena, primitive reflexes, gegenhalten, logopenia, anomia, perseverations but with relatively spared visuo-spatial skills and eventually lack of insight [1,2]. Catatonia, coined historically by Kahlbaum, could complicate organic, affective, schizophrenic, autistic and demented presentations and comprise a constellation of motor phenomena including, inter alia, automatic obedience, ambitendency, catalepsy, gelatio, cerea flexibilitas, echolalia, echopraxia, psychogenic pillow, mannerism, mitmachen, mitgehen, stereotypy, negativismus and stupor, only to mention a few [3,4]. Most experts agree that catatonia is exceedingly underdiagnosed in neuropsychiatric community. This is especially true in the case of FTD, where clinical distinction between both could be too arduous in which cases therapeutic testing with lorazepam or even ECT could be diagnostic [5,6]. It should be borne in mind; however, that catatonia and dementia are not mutually exclusive diagnoses and neurologic conditions associated with catatonia are protean including herpetic encephalitis, frontal lobe trauma, paraneoplastic, epilepsy, syphilis and temporal lobe infarction [7]. Prevalence of catatonia in dementia was circa 15% in a study from Scotland [8]. Cardinal catatonic features commonly overlap with advanced dementia [9]. Case reports of this composite presentation abound in the literature [10,11]. Even iatrogenic cases, due to the use of anti-dementia drug donepezil, were also reported [12]. It seems sensible that treating the catatonic component of a patient’s dementing process may ameliorate a reversible or modifying factor and we opine that patients should never be denied this opportunity, if any as the impact in toto could be tremendous [13]. For such puzzling cases of catatonic demented patients, unfortunately, there is no roadmap to guide clinicians as regards the most appropriate course of action in these scenarios. Neurobiologic underpinngs of catatonia basically involves cortical GABA deficiency and glutamate excitotoxicity [14]. Benzodiazepines and electro-convulsive therapy (ECT) are the treatment modalities of choice in catatonia irrespective of underlying causation [15]. Regrettably, clinicians are often-time skeptical and reluctant to pursue with this ostensibly “aggressive” manoeuvres in “frail” demented patients. Acamprosate is anti-craving agent in alcoholism with a putative NMDA-gluatmate antagonistic activity and GABAa enhancing activity [16]. In theory, it neatly fits with neurobiologic model of catatonia. Having said so, we report the following case of catatonic FTD that responded initially to ECT but this was short-lived ill-sustained response where addition of acamprosate resulted in well-sustained outcome. Interestingly, this was achieved with high tolerability and safety given that acamprosate has no effect on hepatic microsomal system.

Cortical Deafness

To review the literature regarding cortical hearing loss and document a case of cortical hearing loss including its presentation, diagnosis, and evolution over 32 months of follow-up. A 56-year-old woman with profound bilateral sensorineural hearing loss secondary to sequential hemorrhagic, temporal lobe infarctions separated in time by 8 months. Diagnostic. Sequential infarctions affecting the patient's auditory radiations and primary auditory cortices bilaterally combined to cause cortical hearing loss. At presentation, audiogram revealed a bilateral profound sensorineural hearing loss with no reliable responses to pure-tone or speech audiometry. She has subsequently recovered the ability to distinguish environmental sounds. At her 32-month follow-up, she had a pure-tone average (PTA) of 62 dB on the right and 70 dB on the left but continued to display a poor word recognition score (0%). A literature review was performed from the year 1891 until the present. Cortical deafness is an exceedingly rare entity. Presentation and recovery of hearing are dependent on the extent of the initial lesions. The majority of patients can expect improvements in pure-tone auditory thresholds over time; however patients should be counseled that recovery of the ability to understand speech is unlikely.

QTc-Prolongation in Posterior Circulation Stroke

To evaluate the relationship between infarct location and QTc-prolongation in patients with posterior circulation strokes. Admission electrocardiograms (ECG) of 131 patients among a prospective sample of 407 consecutive adult patients in the New England Medical Center Posterior Circulation Registry were retrospectively analyzed. The QT interval (ms) was measured and corrected using Bazett's formula (QTcBazett) as well as linear regression functions (QTcLinear). QTcBazett > 440 ms and QTcLinear ≥ 450 ms for men (≥460 ms for women) were considered prolonged. Multivariable linear and logistic regression analyses were used to identify independent predictors of the QTc. Overall, 34% of patients had a prolonged QTcBazett and 7% had a prolonged QTcLinear noted on the admission ECG. There was a significant association between temporal lobe infarction and QTcBazett and QTcLinear (p < 0.001 for both) in multivariable linear regression analyses adjusting for demographics, ECG parameters, and preadmission medication use. In multivariable logistic regression analysis, temporal lobe infarction emerged as an independent predictor of prolonged QTcBazett (p = 0.009) and QTcLinear (p = 0.008), respectively. Sensitivity analyses excluding patients with transient ischemic attack yielded similar results. Exploratory analyses indicated that patients with temporal lobe infarction had worse functional 30-day outcomes in multivariable logistic regression (p = 0.022). However, there was no significant association between QTc and 30-day functional outcome. QTc-prolongation is common after posterior circulation stroke and associated with temporal lobe infarction. Prospective studies are needed to confirm these preliminary findings and to examine potential long-term consequences.

E-037 Initial Multi-Centre Experience with the Penumbra PC 400 Detachable Coil in aneurysms 10 mm or greater

BackgroundAneurysm coil technology has changed considerably since the introduction of the GDC coil. We evaluated our initial clinical experience with a novel 0.020 Penumbra PC 400 coil to determine device...

Decision-making processing on patients with cerebral infraction in different regions

Objective To explore the decision-making processing changes of patients with cerebral infarction in different regions. Methods The patients with cerebral infarction were divided into 21 cases of frontal lobe infarction, 11 cases of temporal lobe infarction, 19 cases of the medial temporal lobe infarction, 25 cases of basal ganglia infarction; 25 cases of the anterior infarction, 51 cases of the posterior infarction, 62 cases of depression, 64 cases of anxiety ; and there were 125 cases in normal control group. All subjects completed the test of the six kinds of choice situational problems, and used MMSE to evaluate cognitive function, the Hamilton Depression and anxiety Scale Evaluation to evaluate emotion. Results All cerebral infarction patients(CI group)and normal control group in low-risk and no-risk of loss situation(choice scenario 2), high-risk and the no-risk of gain or loss situation(choice scenario 3 and 4), high-risk and low-risk of gain or loss situation(choice scenario 5 and 6) tended to choose conservative scheme, and the selection probability of conservative scheme were obviously higher than that of the normal group, and the differences were statistically significant (P<0.05). In choice scenario 3, the basal ganglia infarction group with frontal lobe infarction group, the medial temporal lobe infarction group comparison, the conservative income scheme selection probability increased significantly, all difference were statistically significant (P<0.01, P<0.05). In choice scenario 5 of the posterior infarction group, a higher probability of conservative income scheme was selected than the anterior infarction, and the difference was statistically significant (P<0.05). Accompanied with depression and anxiety , the basal ganglia infarction tended to select more conservative income program than the frontal lobe infarction group and the medial temporal lobe infarction group in choice scenario 3 , and the program infarction group selected a higher probability comparative differences were statistically significant (P<0.01, P<0.05). The posterior infarction group selected a higher probability of conservative income scheme than the anterior infarction in choice scenario 5, and the difference was statistically significant (P<0.05). Conclusion Cerebral infarction in patients exist decision-making processing abnormally, and perform as income conservative and loss risk averse. Whether associated with depression, anxiety, the basal ganglia infarction and posterior cerebral infarction patients are inclined to income conservative. Key words: Cerebral infraction; Decision-making; Different regions; Emotion

E-041 Subacute endovascular recanalization of supraclinoid internal carotid artery occlusions

PurposeManaging subacute or chronic cervical/intracranial thromboembolic occlusions can be challenging. With respect to the COSS trial, when medical treatment fails and ischemic symptoms persists, surgical bypass procedures may be considered...

Conscious and unconscious processing of fear after right amygdala damage: A single case ERP-study

In this study, we describe a 58-year-old male patient (FZ) with a right-amygdala lesion after temporal lobe infarction. FZ is unable to recognize fearful facial expressions. Instead, he consistently misinterprets expressions of fear for expressions of surprise. Employing EEG/ERP measures, we investigated whether presentation of fearful and surprised facial expressions would lead to different response patterns. We also measured ERPs to aversively conditioned and unconditioned fearful faces. We compared ERPs elicited by supraliminally and subliminally presented conditioned fearful faces (CS+), unconditioned fearful faces (CS–) and surprised faces. Despite FZ's inability to recognize fearful facial expressions in emotion recognition tasks, ERP components showed different response patterns to pictures of surprised and fearful facial expressions, indicating that covert or implicit recognition of fear is still intact. Differences between ERPs to CS+ and CS– were only found when these stimuli were presented subliminally. This indicates that intact right amygdala function is not necessary for aversive conditioning. Previous studies have stressed the importance of the right amygdala for discriminating facial emotional expressions and for classical conditioning. Our study suggests that the right amygdala is necessary for explicit recognition of fear, while implicit recognition of fear and classical conditioning may still occur following lesion of the right amygdala.