London, United Kingdom 2013 24 Interesting and challenging cases Ischemic stroke presenting as thunderclap headache: a diagnostic pitfall. L.V. Yperzeele1, S.N. De Blauwe2 University Hospital Antwerp, Edegem, BELGIUM1, University Hospital Antwerp, Edegem, BELGIUM2 Background Headache has often been described in ischemic stroke and is present at onset in 27% of patients. Thunderclap headache, however, is rare and is seldom the main manifestation of ischemic stroke. Methods A MEDLINE search was performed with MeSH terms thunderclap headache and stroke. Addition-ally reference lists of articles and reviews were analyzed for relevant reports. Studies in which thun-derclap headache was reported as the main manifestation of ischemic stroke were included. Reports that lacked clinical information or an unequivocal relationship between thunderclap headache and stroke, and cases in which other causes of thunderclap headache could be identified, were excluded. Information about age, gender, stroke etiology, history of headache, relationship between headache and stroke localization, additional symptoms and acute work-up were obtained. Results So far 10 cases have been described in which thunderclap headache was caused by acute ischemic stroke. In only 7 sufficient clinical information was provided to allow further analysis. We add 2 cases from our center. The frequency of thunderclap headache in stroke was twice as high in females as in males. Associated complaints like nausea and vomiting were often unspecific and did not sug-gest underlying stroke. A history of migraine has previously been demonstrated as a risk factor for the development of headache at ischemic stroke onset, but could not be shown in thunderclap head-ache. In 67% of cases there is a correlation between the localization of thunderclap headache and the ischemic stroke site. The cause of ischemia is not clearly associated with the risk of thunderclap headache at stroke onset. Conclusion After exclusion of subarachnoid hemorrhage with CT imaging and lumbar punction with spectro-photometry, additional investigation is necessary in selected cases to exclude other causes of thun-derclap headache like ischemic stroke. In rare cases, thunderclap headache can be the main manifes-tation of ischemic stroke. E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 605 23 Interesting and challenging cases Isolated typing impairment due to stroke: case report and literature review. F.A.B. Cook1, S.D.J. Makin2, M.S. Dennis3, J.M. Wardlaw4 University of Edinburgh, Edinburgh, UNITED KINGDOM1, University of Edinburgh, Edin-burgh, UNITED KINGDOM2, University of Edinburgh, Edinburgh, UNITED KINGDOM3, Univer-sity of Edinburgh, Edinburgh, UNITED KINGDOM4 Background: Typing is a multi-functional task requiring language, motor and visuospatial function. Typing may be affected by strokes which cause aphasia, alexia or visual-spatial neglect., Damage to the dorsolateral prefrontal cortex, the posterior parietal cortex or the connecting networks between them may result in impairment in visual-spatial memory of key positions. We present a case report and literature review. Case report: A 68 year old man, who was a proficient typist using a two-finger technique, presented with sudden difficult typing, which resulted in jumbled letters, though he was still able to write leg-ibly using a pen, which gradually improved over the following three weeks. On examination there was no sign of receptive or expressive dysphasia, alexia, motor weakness or neglect. He had a histo-ry of ischaemic heart disease, and well controlled, Parkinson’s disease. Magnetic resonance imaging at 36 hours after onset revealed a recent 21mm lesion in the left poste-rior insular cortex involving a very small area of the transverse temporal gyrus. Speech and language assessment three weeks post-stroke revealed that his handwriting was back to pre-stroke level with no spelling errors. His typing remained impaired, but had improved since pre-sentation, with errors typically involving an extra stroke on an adjacent key, or letter order error. The errors were not confined on one particular part of the keyboard, as would be seen in patients with visuospatial neglect. We identified three other reports of patients with isolated typing impairment and preserved motor and language function who had frontal lobe lesions and one with a parietal lobe lesion, although this patient also had a mild aphasia. Discussion Clinicians should be aware that typing disturbance can occur in the absence of writing, language or motor impairment, which may present a significant problem to patients in the current era of a near universal need for the ability to type on a computer.
Karger_ESC London_2013
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