22. European Stroke Conference 180 Interesting and challenging cases Disorders of Diminished Motivation in bilateral caudate infarcts and their impact on stroke rehabilitation - a case report. E. Mallouppa1, G. Pratt2, H. Leeman3 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM1, Shef-field Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM2, Rotherham Hos-pital NHS Foundation Trust, Rotherham, UNITED KINGDOM3 Background: Isolated caudate infarction is a rare cause of stroke, the only published series suggest-ing that it accounts for approximately 1% of all cases. Abulia and psychic akinesia are prominent features of caudate infarcts. Methods: We present the case of an 84 year old lady, with a background history of atrial fibrillation and progressive cognitive decline, who was admitted with sudden onset right sided weakness and increased confusion. MRI Brain imaging confirmed acute bilateral caudate nuclei infarcts. Echo-cardiography revealed a cardiac tumour arising from the papillary muscles which was the presumed aetiology of her stroke. Results: Her motor deficit improved rapidly but she exhibited severe abulia with marked apathy and reduced spontaneity. This limited all rehabilitation attempts. Despite a successful discharge home with a care package and extensive family involvement she was re-admitted a month later with a fur-ther ischaemic stroke. She continued to deteriorate and eventually died from pneumonia. Conclusions: This case highlights the impact of cognitive and behavioural problems on the rehabili-tation and overall outcome of stroke patients. Abulia and psychic akinesia form part of the disorders of diminished motivation, with a reported incidence of 48% in caudate infarct cases. Diminished motivation is seen when there is a decrease in all aspects of goal-directed behaviour. Based on our experience as well as other published case reports, bilateral caudate infarcts appear to carry a poor prognosis. No evidence exists as to the best way to manage such problems, other than anecdotal re-ports regarding the use of dopaminergic or stimulant treatment. 378 © 2013 S. Karger AG, Basel Scientific Programme 181 Interesting and challenging cases A rare case of common carotid occlusion in acute ischemic stroke patient. T. Worakijthamrongchai1, T. Tantirithisak2, S. Hanchaiphiboolkul3 Prasat neurological Institute, Bangkok, THAILAND1, Prasat neurological Institute, Bangkok, THAILAND2, Prasat neurological Institute, Bangkok, THAILAND3 Background : Internal carotid artery (ICA) severe stenosis or occlusions are frequently found in stroke patient but common carotid artery (CCA) occlusions are rare. Occlusion of the CCA has pre-viously been reported as occurring in 2% to 27% of patients with extracranial occlusive disease. CASE : A 60 year-old man presented with sudden left hemiparesis for 8 hours. He couldn’t spoke and eye force deviated to the right. The blood pressure was 170/110 mmHg. The neurological ex-aminations were drowsiness, left facial weakness, severe spastic dysarthria, left hemiparesis grade I. CT brain showed hypodensity at right frontotemporoinsular lobe, right basal ganglia which indi-cated extensive infarction of right middle cerebral artery (MCA). The carotid duplex Ultrasonogra-phy( CDUS) showed large homogenous plaques and filled total occlusion at carotid bifurcation (BIF) with absent blood flow from the right proximal CCA to distal CCA. The MRA study showed total occlusion of the whole right CCA with evidence of reconstitution of the right ECA branch and distal right ICA. ECG interpreted normal sinus rhythm. At the forth days, the CDUS was re-performed and increasely retrograde thrombosis from the level of right BIF to the right proximal CCA that meant the ICA and ECA were the first to occlude and CCA thrombosis was the secondary event related to inadequate blood flow. Conclusion : The occlusion of CCA are uncommon in stroke. The etiology of common carotid oc-clusion is almost always arteriosclerosis, although arteritis and cardioarterial embolus have been im-plicated on rare occasions.
Karger_ESC London_2013
To see the actual publication please follow the link above