22. European Stroke Conference 142 Interesting and challenging cases “Functional Strokes: A Case Series” M. Mandiratta1, B.S. Sidhu2, A. Salam3, A.K. Banerjee4, J. Winter5 ST3 Doctor, Russells Hall Hospital, Dudley, UNITED KINGDOM1, CT1 Doctor, Russells Hall Hospital, Dudley, UNITED KINGDOM2, Consultant Stroke Physician, Stroke Medicine, Russells Hall Hospital, Dudley, UNITED KINGDOM3, Consultant Stroke Physician and Clinical Lead, Stroke Medicine, Russells Hall Hospital, Dudley, UNITED KINGDOM4, Lead Physiotherapist in Stroke Medicine, Russells Hall Hospital, Dudley, UNITED KINGDOM5 Background: The classic neurological signs and symptoms associated with a Stroke are managed in a very methodical way. Guidelines exist across all hospitals. Uncertainty arises when brain im-aging shows no abnormalities. Many stroke mimics have been documented. The most intriguing of these are Functional Strokes. It is postulated that psychiatric conditions are intrinsically linked with Strokes. Functional strokes, similar in nature to conversion disorders, are poorly understood. Previ-ous research is limited and involves isolated case reports. Methods: We retrospectively looked at 14 cases of Functional Stroke admitted to the Stroke Unit at Russells Hall Hospital. Information was collated through direct patient discussion, case notes re-view, and MDT discussion. Results: Average age 51. 8/14 cases female. 6/14 had a mental health history. Past medical histo-ry was varied with some preponderance of arteriopathic conditions. 9/14 presented with left sided symptoms, 3/14 with right sided. 13/14 patients had CT scans. 11/14 showed no abnormalities on imaging. 11/14 had more than one brain scan, the maximum being 8. Patients largely underwent a battery of investigations most commonly USS Carotid Doppler. 3/14 were thrombolysed. 2/14 had previous thrombolysis. 9/14 were commenced on secondary prevention. Average length of admis-sion was 5 days, and follow up period ranged from nil to 2 years. Only 1/14 warranted physiothera-py post discharge. 8/14 had symptom recurrence. Conclusion: Functional Strokes have been poorly recognised compared to other psychosomatic conditions. This case series provides valuable information on presentation, diagnosis, investigation and long term outcome from a holistic perspective. The enhanced knowledge around this topic as a result of this case series will improve management through: earlier diagnosis; appropriate investiga-tion and use of resources; avoidance of thrombolysis; reduced admission time; appropriate tailored 356 © 2013 S. Karger AG, Basel Scientific Programme therapy/follow-up. 143 Interesting and challenging cases Neurological worsening after seizure in epilepsy post-stroke M.G. Delgado1, J. Bogousslavsky2 Hospital universitario central de asturias, oviedo, SPAIN1, Clinique Valmont, Montreaux, SWIT-ZERLAND2 Introduction: While pathogenesis of the epilepsy post-stroke has been widely studied, data about clinical worsening of the previous neurological deficit in some stroke patients has been scarcely re-ported in the literature. Case report: A 54-year-old male was admitted due to a right hemiparesis and global aphasia (NIHSS 17). A cranial CT showed an extensive ischemic lesion in the left middle cerebral artery (MCA) territory. Follow-up showed a neurological progressive improvement with a slight motor aphasia and a sensitive-motor right hemiparesis (5-/5) five months later. On May 2012, the patient reported brief myoclonus on the right side with a posterior transient worsening of the previous hemiparesis. A cranial CT didn’t show new lesion and an EEG showed a left temporal slowing. Due to patient’s preference, we applied for a sleep deprivation study previous to initiate a specific treatment. On Au-gust 2012, the patient suffered from a convulsive generalized seizure and levetiracetam was initiat-ed. A worsening of the aphasia and of the previous right hemiparesis (4/5) were seen. A cranial MRI showed a chronic left MCA ischemic stroke without new lesions. Discussion: Epileptic seizures may cause neuron injury inducing long-term changes directly or in-directly, such as hypoxemia that causes neurological injury. An increase of the mismatch between energy supply and demand under ischaemic conditions may allow an irreversible injury. On the oth-er hand, repeated seizure in the setting of cerebral ischemia may increase infarct size and can impair functional recovery. Moreover, progressive pathological changes may be seen associated with epi-lepsy in relation with neuronal plasticity. Conclusion: Aberrant neurogenesis and other mechanism such as hypoxic or metabolic disturbances may be implicated in absence of recovery after a seizure in previously infarcted tissue. The possibil-ity of this worsening may be taken in account in order to establish an adequate and early antiepilep-tic treatment as soon as seizure is suspected.
Karger_ESC London_2013
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