Showing papers by "Krishna Nalleballe published in 2016"

Hypersomnia and Reduction in Essential Tremor after Bilateral Subthalamic Ischemic Stroke (P4.285)

Abstract: Objective:Unusual case of bilateral thalamic and subthalamic stroke with reduction in essential tremor and hypersomnia. Background:Excessive sleepiness affects up to 5[percnt] of the general population can result in significant disability due to inability to stay awake. Bilateral paramedian thalamic stroke is a rare stroke syndrome that can result in various symptoms including hypersomnia.The international classification of sleep disorders-3 classifies such hypersomnia as hypersomnia due to medical disorder.We present a rare case of an elderly female who had significant reduction of essential tremor and developed severe sleepiness after having a stroke in bilateral paramedian thalamic region. Design/Methods:Case report and review of literature. Results:87 year old female was taken to an outside hospital for acute onset of somnolence.MRI brain performed at the outside facility showed bilateral thalamic and subthalamic infarctions.MR angiography didn9t reveal anomalous vasculature in the posterior circulation though the patient didn9t undergo conventional angiogram.The patient was drowsy for few days but improved gradually during the hospital stay.During hospital course,both patient and relatives reported significant reduction in hand tremor for which she was on propranolol.She started to experience sleepiness in the next few weeks which persisted subsequently. Conclusions:Prevalence of hypersomnia among stroke patients ranges from 1.1 to 27[percnt].A reduction in the activity of arousal systems underlies most forms of post stroke hypersomnia.Multiple changes like reduction in the amount of NREM sleep, sleep time, sleep spindles, REM sleep ( in occipital strokes ) were also described depending on the location of the stroke. Thalamic and brainstem strokes can present with pathological EEG patterns like alpha coma.Along with bilateral thalamic strokes, strokes in thalamo-mesencephalic regions, upper pons and medial pontomedullary lesions can cause marked hypersomnia. Cortical and subcortical strokes,on the other hand tend to not cause significant sleepiness. Insomnia, parasomnias, periodic leg movements in sleep and sleep disordered breathing can also happen in the setting of stroke. Disclosure: Dr. Pesala has nothing to disclose. Dr. Nalleballe has nothing to disclose. Dr. Bollu has nothing to disclose.

Pearls & Oy-sters: Plasma cell meningitis An uncommon complication of multiple myeloma

Abstract: We report a case of plasma cell meningitis (PCM) presenting as a first-time seizure. Shilpa Deshmukh (Lincoln Medical and Mental Health Center) edited the manuscript for non-intellectual content.