Hemigeographic tongue following an acute ischemic stroke

Slides:

Advertisements

Similar presentations

63 year-old woman with subacute parkinsonism Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Advertisements

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 68 year old woman with transient ptosis on awakening.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Intracranial mass presenting with hemorrhage and respiratory.

A 56-year-old man with intense facial pain Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section ©

A 62-year-old man presented with mild left hemiparesis, headache and blurred vision of his right eye Teaching NeuroImages Neurology Resident and Fellow.

A TWO YEAR OLD GIRL WITH PROGRESSIVE WEAKNESS Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 62-year-old man with progressive action tremor and a 74-year-old man with progressive ataxia Teaching NeuroImages Neurology Resident and Fellow Section.

A 68 year old woman with a troublesome chin tremor Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A patient with red dot on the forehead A 32-year old woman presented with red dot on her forehead and eyelid ecchymosis Teaching NeuroImages Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology 46 year-old women with acute headache, post seizure confusion.

A 38-year-old patient with partial seizures Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 53-year-old man with abrupt hearing loss Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology An unusual cause of conus medullaris syndrome.

Thalamic Aphasia Syndrome Teaching NeuroImages by Umair Afzal and Muhammad U. Farooq © 2013 American Academy of Neurology.

A 30-year male with cognitive decline and unsteady gait Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages 50 year old woman underwent therapeutic hypothermia after a witnessed cardiac arrest Teaching NeuroImages Neurology Resident and Fellow.

A 39-year old man with facial diplegia Teaching NeuroImages Neurology Resident and Fellow Section Campbell J, et al © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 23 month old full term male with seizures.

68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section.

Progressive fetal intracranial lesion Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 26 year old woman with headache, diplopia, and pulsatile tinnitus Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy.

67-old man with 45-min onset left hemiparesis Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 4 Year Old Boy With Proptosis of Left Eye Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 71 year old man with rapid onset of anterograde amnesia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

2 year old girl with mild ataxia and truncal dystonia Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology MRI-visible Virchow-Robin Perivascular Spaces in Cerebral.

A 36 year old woman with diplopia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 35-year-old patient with motor aphasia Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 70 YEAR OLD MAN WITH APHASIA AND RIGHT SIDED HEMIPLEGIA.

A 58 year old woman with acute-onset paresthesias

Neurology Resident and Fellow Section

A 54-year-old man with acute-onset diplopia and weakness

Teaching NeuroImages Neurology Resident and Fellow Section

Neurology Resident and Fellow Section

A 50 year-old female with right hemiplegia and encephalopathy

Teaching NeuroImages Neurology Resident and Fellow Section

A 22 year old male with acute seizures and hemiparesis

A 58-year-old man with cerebellar ataxia

A 41-year-old man with progressive quadriparesis

Resident and Fellow Section

A 60 year-old male with vertigo, dysarthria and weakness

Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm

Abnormal movements in an unconscious adult Teaching NeuroImages Neurology Resident and Fellow Section © 2018 American Academy of Neurology.

A 46 year old woman with visual loss after thrombectomy

68-year-old patient with memory impairment

Teaching NeuroImages Neurology Resident and Fellow Section

A 64-year-old female with progressive parkinsonian syndrome

Neurology Resident and Fellow Section

Neurology Resident and Fellow Section

Acute bilateral ptosis in an 82-year old man

Patient 2: CNS vasculitis in a 37-year-old woman with systemic lupus erythematosus. Patient 2: CNS vasculitis in a 37-year-old woman with systemic lupus.

20 year old man with multiple strokes territories

Figure 1 Radiologic features of human myelin oligodendrocyte glycoprotein immunoglobulin G–positive patients with cranial nerve involvement Radiologic.

Figure 2 Cerebral and spinal MRI (A) Restricted diffusion of both optic nerves (arrows) on diffusion-weighted and apparent diffusion coefficient imaging.

Neurology Resident and Fellow Section

A 26-year-old Turkish male with progressive spastic gait and premature alopecia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American.

Neurology Resident and Fellow Section

63-year-old patient with right hemiparesis.

Parent artery occlusion of a giant serpentine aneurysm of the PCA complicated by cerebral infarction in the distal arterial territory. Parent artery occlusion.

T2-weighted images of a patient with an infarction within the anterior MCA branch territory on day 5 (patient 15) show high SI changes within the ipsilateral.

Three perfusion sections.

A 2 year old girl with progressive neurological deficits

An acute stroke patient with severe stenosis of the left internal carotid artery. An acute stroke patient with severe stenosis of the left internal carotid.

63 year old female in coma status post occipital craniectomy

Teaching NeuroImages Neurology Resident and Fellow Section

Hyperperfused stroke territory on ASL

A 71-year-old woman who underwent imaging 7 hours after onset of right hemiparesis and aphasia. A 71-year-old woman who underwent imaging 7 hours after.

A 3-year-old boy with increased head circumference

A 21-year-old woman with a right sensory-motor deficit and aphasia for 60 minutes. A 21-year-old woman with a right sensory-motor deficit and aphasia for.

Presentation transcript:

Hemigeographic tongue following an acute ischemic stroke Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology

Vignette We present two patients with a hemigeographic tongue following an acute ischemic stroke. A 70-year-old male was admitted due to a left MCA stroke (Fig 1 A and B) with global aphasia and a right hemiparesis. A 43-year-old male was admitted due to a subcortical left ischemic stroke (Fig 2 A and B) with dysarthria and a right hemiparesis. Delgado et al © 2015 American Academy of Neurology

Imaging Figure 1. A. Hemigeographic tongue in a 70-year-old patient (white arrow). B. Brain CT showed an ischemic stroke in the middle cerebral artery territory (white arrow). Delgado et al © 2015 American Academy of Neurology

Imaging Figure 2. A. Hemigeographic tongue in a 43-year-old male (white arrow). B. Cranial MRI (FLAIR T2 sequences) showed a lenticular ischemic stroke (white arrow). Delgado et al © 2015 American Academy of Neurology

Hemigeographic tongue following an acute ischemic stroke Trigeminal trophic syndrome (TTS) is an unusual complication of trigeminal injury that causes a neuropathic disorder which characteristically involves ulceration of the nasal ala, and less frequently, the ipsilateral cheek, upper lip, and forehead. Several causes of TTS have been described, amongst which are trigeminal nerve section or infarction of the brainstem. The presence of a not previously described, contralateral hemigeographic tongue following a hemispheric acute stroke, points toward a central trigeminal disturbance, probably related with a cortical connection lesion. This would suggest a complex mechanism in the occurrence of the TTS in which supranuclear lesions should also be included. 1. Pichard DC, Cowen EW. Trigeminal trophic syndrome after stroke. Mayo Clin Proc. 2014 Sep;89:e87-8. 2. Curtis AR, Oaklander AL, Johnson A, Yosipovitch G. Trigeminal trophic syndrome from stroke: an under-recognized central neuropathic itch syndrome. Am J Clin Dermatol. 2012 Apr 1;13:125-8. © 2015 American Academy of Neurology