Acute Vertigo with Double Vision – Brainstem Stroke or Stroke Mimic?

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

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Vulgar Habits and Hume's Double Vision Argument

Journal of Scottish Philosophy ◽

10.3366/jsp.2010.0005 ◽

2010 ◽

Vol 8 (2) ◽

pp. 169-187

Author(s):

Annemarie Butler

Keyword(s):

David Hume ◽

Double Vision ◽

Raw Data ◽

The Senses

In Treatise 1.4.2, David Hume seeks to explain how we come to believe in the external existence of bodies. He offers a complicated psychological account, where the imagination operates on the raw data of the senses to produce the ‘vulgar’ belief in the continued existence of the very things we sense. On behalf of philosophers, he presents a perceptual relativity argument that purports to show that the vulgar belief is false. I argue that scholars have failed to appreciate Hume's peculiar formulation of the perceptual relativity argument and its relation to his psychological account of the vulgar belief. On my interpretation, in order to account for all the premises that Hume explicitly offers, the argument is best interpreted as beginning with a reductio that opposes the effects of the senses and the imagination in the vulgar belief. Thus Hume can be interpreted as identifying an ‘antinomy’ in the habits of the vulgar mind that produce belief in bodies.

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Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

Stroke ◽

10.1161/strokeaha.120.028821 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2480-2487

Author(s):

Salvatore Rudilosso ◽

Alejandro Rodríguez ◽

Sergio Amaro ◽

Víctor Obach ◽

Arturo Renú ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Predictive Value ◽

Brain Perfusion ◽

Complete Recovery ◽

Vascular Perfusion ◽

Computed Tomography Perfusion ◽

Stroke Mimic ◽

Ischemic Attack

Background and Purpose: Acute onset aphasia may be due to stroke but also to other causes, which are commonly referred to as stroke mimics. We hypothesized that, in patients with acute isolated aphasia, distinct brain perfusion patterns are related to the cause and the clinical outcome. Herein, we analyzed the prognostic yield and the diagnostic usefulness of computed tomography perfusion (CTP) in patients with acute isolated aphasia. Methods: From a single-center registry, we selected a cohort of 154 patients presenting with acute isolated aphasia who had a whole-brain CTP study available. We collected the main clinical and radiological data. We categorized brain perfusion studies on CTP into vascular and nonvascular perfusion patterns and the cause of aphasia as ischemic stroke, transient ischemic attack, stroke mimic, and undetermined cause. The primary clinical outcome was the persistence of aphasia at discharge. We analyzed the sensitivity, specificity, positive and negative predictive values of perfusion patterns to predict complete clinical recovery and ischemic stroke on follow-up imaging. Results: The cause of aphasia was an ischemic stroke in 58 patients (38%), transient ischemic attack in 3 (2%), stroke mimic in 68 (44%), and undetermined in 25 (16%). CTP showed vascular and nonvascular perfusion pattern in 62 (40%) and 92 (60%) patients, respectively. Overall, complete recovery occurred in 116 patients (75%). A nonvascular perfusion pattern predicted complete recovery (sensitivity 75.9%, specificity 89.5%, positive predictive value 95.7%, and negative predictive value 54.8%), and a vascular perfusion pattern was highly predictive of ischemic stroke (sensitivity 94.8%, specificity 92.7%, positive predictive value 88.7%, and negative predictive value 96.7%). The 3 patients with ischemic stroke without a vascular perfusion pattern fully recovered at discharge. Conclusions: CTP has prognostic value in the workup of patients with acute isolated aphasia. A nonvascular pattern is associated with higher odds of full recovery and may prompt the search for alternative causes of the symptoms.

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Intraorbital wooden foreign body detected by computed tomography and magnetic resonance imaging

The Neuroradiology Journal ◽

10.1177/1971400916678245 ◽

2016 ◽

Vol 30 (1) ◽

pp. 88-91 ◽

Cited By ~ 3

Author(s):

Alfredo Di Gaeta ◽

Francesco Giurazza ◽

Eugenio Capobianco ◽

Alvaro Diano ◽

Mario Muto

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Magnetic Resonance ◽

Delayed Diagnosis ◽

Clinical History ◽

Definitive Diagnosis ◽

Double Vision ◽

Resonance Imaging ◽

Wooden Foreign Body ◽

The Right

To identify and localize an intraorbital wooden foreign body is often a challenging radiological issue; delayed diagnosis can lead to serious adverse complications. Preliminary radiographic interpretations are often integrated with computed tomography and magnetic resonance, which play a crucial role in reaching the correct definitive diagnosis. We report on a 40 years old male complaining of pain in the right orbit referred to our hospital for evaluation of eyeball pain and double vision with an unclear clinical history. Computed tomography and magnetic resonance scans supposed the presence of an abscess caused by a foreign intraorbital body, confirmed by surgical findings.

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