Alice in Wonderland Syndrome-Like Seizure and Refractory Supraventricular Tachycardia

Alice in Wonderland syndrome (AIWS) is a rarely curious visual perceptual disorder which has been associated with diverse neurologic and psychiatric problems. It may be a manifestation in migraine, epileptic seizures, encephalitis, other brain lesions, medication-related side effects, schizophrenia, and depressive disorders. Principal character of AIWS is the disproportion between the external world and the self-image in which micropsia (objects appear smaller), macropsia (objects appear larger), and teleopsia (objects appear further away) are frequently reported. The cases of temporal lobe epilepsy may present with complex visual auras of visual distortions (e.g., micropsia and macropsia) like AIWS. We report an unusual case of an elderly man who presented with AIWS, focal impaired awareness seizures, ictal tachyarrhythmia, multiple episodes of transient visual disturbances of macropsia and transient loss of consciousness. During those symptoms, telemetry showed self-limited supraventricular tachycardia several times which could not be regulated with heart rate-controlled medication. The electroencephalography was later tested and showed rhythmic theta activity over the right cerebral hemisphere. He was treated with levetiracetam, and all his symptoms and tachyarrhythmias were gradually resolved thereafter. Refractory response to treatment would remind the physicians to reassess for the correct diagnosis.

A Test of Three Models of Character Reversal in Typically Developing Children’s Writing

Multisensory learning to read involves, to a large extent, learning to write. A major problem in the initial teaching of handwriting is preventing children from producing reversed letters, especially when the reversed letters are identical to other letters. Torres et al. (2021) offer an efficient method for remediating this problem. Here, we analyze the reversals in their writing data, obtained on Brazilian first-graders (Mage = 6.0 years). Surprisingly, this analysis led to the observation that the first graders almost systematically reverse both the letters b and d in the particular copying conditions (the students look at one letter at a time for 3 s, then immediately after they had to write it while blindfolded). We first describe succinctly and discuss three models susceptible to account for reversal writing, with the aim to question their capacity of account for the curious observation just mentioned. The three models respectively attribute a major role to 1) initial (perceptive) mirror equivalence, 2) intra-hemispheric transfer, 3) orientation of the letters. Because none of the three models examined accounts convincingly for the observation, we accommodated and specified Model 2, adding also a major idea of Model 3. The resulting model assumes that the mirror-letter reversed image representation (b for d and vice-versa) is strongly activated in the right cerebral hemisphere, and that the top-down processes originating from this hemisphere were exacerbated by the eyes closed condition. Of course, this post-hoc and speculative model should be tested in other conditions and with other children.

Case Report: A 62-Year-Old Woman With Contrast-Induced Encephalopathy Caused by Embolization of Intracranial Aneurysm

Contrast-induced encephalopathy (CIE) is a rare complication of endovascular treatment and is extensively reported as a transient and reversible phenomenon. This report describes a 62-year-old woman for embolization of an internal carotid artery (ICA) aneurysm. The operation was successful, but postoperation the patient suffered unconsciousness, blindness, hemiplegia, ophthalmoplegia, fever, and seizures. CT of the brain without the contrast showed widespread edema in the right cerebral hemisphere, which is involved in the frontal, parietal, temporal, and occipital lobes. She was diagnosed with CIE in time and treated with supportive management as soon as possible, and fortunately, the patient improved a benign course and was discharged without any neurological deficits. This study emphasizes the prevention of the CIE and the importance of early diagnosis and symptomatic treatment.

The vestibular system modulates the contributions of head and torso to egocentric spatial judgements

Egocentric representations allow us to describe the external world as experienced from an individual’s bodily location. We recently developed a novel method of quantifying the weight given to different body parts in egocentric judgments (the Misalignment Paradigm). We found that both head and torso contribute to simple alter-egocentric spatial judgments. We hypothesised that artificial stimulation of the vestibular system would provide a head-related signal, which might affect the weighting given to the head in egocentric spatial judgments. Bipolar Galvanic Vestibular Stimulation (GVS) was applied during the Misalignment Paradigm. A Sham stimulation condition was also included to control for non-specific effects. Our data show that the weight given to the head was increased during left anodal and right cathodal GVS, compared to the opposite GVS polarity (right anodal and left cathodal GVS) and Sham stimulation. That is, the polarity of GVS, which preferentially activates vestibular areas in the right cerebral hemisphere, influenced the relative weightings of head and torso in egocentric spatial judgments.

Acro-Renal Syndrome with Open Lip Schizencephaly – A Rare Case Report

A 7-day-old new-born was referred to Department of Radiodiagnosis of North Bengal Medical College and Hospital to evaluate enlargement of head circumference. On clinical examination of this new-born we found macrocephaly and absent right thumb as well as deformed left thumb. No other clinical abnormalities were seen in this new-born apart from this. Facial structures, spine, upper and lower limbs, trunks were normal clinically. Transcranial ultrasound was done using LOGIQ P9 ultrasound machine which revealed an open lip schizencephaly involving right cerebral hemisphere with absence of corpus callosum. Trans abdominal sonography revealed non visualisation of left kidney in left renal fossa as well as in its usual ectopic position. Therefore, the new-born underwent magnetic resonance imaging (MRI) of brain and whole abdomen which confirmed ultrasound findings. MRI additionally revealed there was no ocular, anorectal and genito-urinary malformations. Infantogram was done to evaluate the skeleton of this new-born. Fetal echocardiography revealed no obvious cardiac anomalies.

Clinical-enabled aspects after Neurotoxoplasmosis in a patient with immunosuppression: a case report

Background: Neurotoxoplasmosis is an opportunistic infection caused by the protozoan Toxoplasma Gondii, frequent in patients with Acquired Immunodeficiency Syndrome who become immunosuppressed by the presence of the disease. It can be presented by one or more brain abscesses, encephalitis or ventriculitis. Objectives: case report of a volunteer after neurological sequelae of neurotoxoplasmosis in order to highlight the relevant findings for a neurofunctional rehabilitation. Design and setting: This is an observational, cross-sectional case report type study conducted at the Clínica Escola de Fisioterapia of the University of Franca (UNIFRAN), with CEP approval (CAAE 83164918.2.0000.5495). Methods: Female patient, 53 years old. In the physiotherapy sector, neurological evaluation of the components was performed: sensitivity, movement, tone, reflexes, motor coordination, balance and gait. Balance and gait were assessed using the Berg Balance Scale, the Standing and Walking Test and the Dynamic Walking Index. Results: After clinical investigation, neurological toxoplasmosis infection was found in the right cerebral hemisphere. The physiotherapeutic evaluation showed the presence of left hemiparesis, the presence of spastic hypertonia, patellar and achilles hyperreflexia, the absence of fine motor skills and the presence of a reaping gait. The BSE result was 32 points, the TUG was 10.3 seconds and IMD was 20 points. Conclusion: The compromises found have an impact on the functionality of the volunteer. This study emphasizes the valorization of neurofunctional physiotherapeutic semiology for a treatment proposal that promotes greater functional independence.

Non-aneurismatic subarachnoidal hemorrahge of hypertensive etiology: case report

Context: Subarachnoid hemorrhage (SAH) is a neurological emergency defined by the leakage of blood into the spaces that cover the central nervous system. Non-aneurysmatic SAH is defined according to the blood distribution on computed tomography (CT). Perimensencephalic SAH (PM-SAH) has blood distribution in perimesencephalic cisterns in front of the brain stem. Non- perimesencephalic SAH has a more diffuse distribution. Case report: A 54 years old man with systemic arterial hypertension. He reported that he had consumed alcoholic beverages the night before. On the morning of hospitalization he had a headache with loss of sensation on the left side of his body. In the EC, he presented sweating, left parestesia, mild dyslalia and deviation from the right rhyme. A cranial CT scan was performed revealing SAH involving the cisterns and furrows near the right cerebral hemisphere, next to the Sylvian fissure. The clinical and imaging results demonstrated SAH grade II Hunt & Hess and Fischer II, Glasgow 15, without motor loss. Cerebral angiography, the gold standard for the diagnosis and mapping of aneurysms, was performed, with a negative result. On the last day of hospitalization, CT and Doppler indicated resorption of edema and absence of vasospasm, respectively. There was also an adjustment of the hypertensive medications of the patient who did not have sequelae. Conclusion: PMs-SAH have excelente prognosis in short and long term with no risk of future rebleeds. The event occurred after an episode of excessive alcohol consumption in addition to decompensated arterial hypertension.

Superior Hypophyseal Artery Ruptured Aneurysm in a 5-Month-Old Child Presenting as an Acute Subdural Hematoma: A Case Report

<b><i>Introduction:</i></b> We present a very rare case of ruptured superior hypophyseal artery (SHA) aneurysm that presented as an acute subdural hematoma (SDH) discussing its initial presentation, diagnosis, and treatment modalities. To our knowledge it is one of very few if any cases of a ruptured aneurysm in infants regarding that specific vascular location. <b><i>Case Report:</i></b> A 5-month-old boy was referred to our department due to acute SDH over the right cerebral hemisphere without significant mass effect nor hydrocephalus. Further evaluation revealed a right internal carotid artery (ICA) aneurysm arising from the SHA segment. Microsurgical clip ligation using a fenestrated, angled clip was performed with simultaneous subdural clot removal and proximal control of the ICA dissected in the neck. Our patient made an excellent recovery without any complicating features. <b><i>Conclusion:</i></b> Surgical management seems to be a better option in this subgroup of patients given the long life expectancy and durability of microsurgical clip ligation. We believe that our brief case report would add some insight into the management of this rare subgroup of patients, leading to better decision-making and outcome.

The topology of higher-order complexes associated with brain hubs in human connectomes

Higher-order connectivity in complex systems described by simplexes of different orders provides a geometry for simplex-based dynamical variables and interactions. Simplicial complexes that constitute a functional geometry of the human connectome can be crucial for the brain complex dynamics. In this context, the best-connected brain areas, designated as hub nodes, play a central role in supporting integrated brain function. Here, we study the structure of simplicial complexes attached to eight global hubs in the female and male connectomes and identify the core networks among the affected brain regions. These eight hubs (Putamen, Caudate, Hippocampus and Thalamus-Proper in the left and right cerebral hemisphere) are the highest-ranking according to their topological dimension, defined as the number of simplexes of all orders in which the node participates. Furthermore, we analyse the weight-dependent heterogeneity of simplexes. We demonstrate changes in the structure of identified core networks and topological entropy when the threshold weight is gradually increased. These results highlight the role of higher-order interactions in human brain networks and provide additional evidence for (dis)similarity between the female and male connectomes.

Isolated leptomeningeal angiomatosis in the sixth decade of life, an adulthood variant of Sturge Weber Syndrome (Type III): role of advanced Magnetic Resonance Imaging and Digital Subtraction Angiography in diagnosis

Background Sturge-Weber syndrome (SWS) is primarily diagnosed in pediatric population, but clinical presentation in late adulthood is rarely reported. Evolution of radiological findings in the adulthood variant of SWS with isolated leptomeningeal angiomatosis has never been reported to our knowledge. Case presentation We report here a case of an isolated temporo-parieto-occipital leptomeningeal angiomatosis on the right cerebral hemisphere in a sixty-two-year-old male who presented with generalized seizure, GCS score 14/15 (E4 V4 M6) with equal and reacting pupils, psychomotor slowing, left hemineglect and grade 4 power in the left upper and lower limbs. Over a period of 48 h his neurological status deteriorated, but recovered spontaneously over a week on titration with anticonvulsants. He had a prior history of treatment for focal leptomeningitis, three years ago. Cerebrospinal fluid (CSF) analysis showed glucose of 75 mg/dL, proteins of 65 mg/dL and culture grew no organisms. On follow-up, he had intermittent episodes of focal seizure for two years. Initial, computed tomography of brain showed hyperdense lesion in the parieto-occipital convexity subarachnoid space on the right cerebral hemisphere mimicking subarachnoid hemorrhage and computed tomography angiography showed no significant abnormality. Magnetic resonance imaging (MRI) of brain showed intense pial enhancement in the right temporo-parieto-occipital region with a subtle T2W hyperintense signal in the underlying subcortical white matter without edema or infarct or mass effect. Digital subtraction cerebral angiography (DSA) showed hypertrophy of the cerebral arteries, arteriolo-capillary bed and venules in the right temporo-parieto-occipital territory associated with early arterio-capillary and venous opacification. Serial MRI done after six months, one and two years showed increase in the T2W hyperintense signal in the subcortical white matter and cortical atrophy with no changes in the pial enhancement. MR perfusion imaging showed reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) in the right parieto-temporo-occipital cortical and subcortical regions and increased perfusion in the leptomeninges with reduction of the NAA / Cr ratios in spectroscopy. Conclusion Conglomeration of various radiological findings in MRI, Perfusion, MRS and DSA with the clinical presentation can aid in establishing the diagnosis of this rare presentation of SWS-type 3 variant in late adulthood.