Stroke: Notable Case Reports and Issues

Clinical experience provides the foundation for learning neurology. Exposure to the stories and examination features of individual patients produces an appreciation for both the individual variations and the commonalities in clinical patterns of disease. Together these contribute to the development of diagnostic instincts and precise analysis strategies. Case reports can facilitate the learning process for physicians by expanding the scope of their own encounters, highlighting unusual aspects of pathophysiology or clinical manifestations, and illustrating quintessential clinical features that provide paradigms for recognition of future similar cases.

This issue of Practical Neurology features various case reports and issues in stroke. It begins with illustrative stroke case reports highlighting uncommon etiologies and manifestations that aim to foster the clinical learning process. The first 2 case reports serve to show unusual stroke localizations and signs, such as an infarction in the corpus callosum producing apraxia in the non-dominant limb, and a case of vertebrobasilar transient ischemic attack involving the subclavian steal syndrome. The next report describes a rare case of ischemic stroke in the setting of large-vessel vasculopathy in an individual with systemic lupus erythematosus. This is followed by 2 case reports documenting unusual causes of stroke, including a long-distance swim leading to bilateral vertebral artery dissection, and inadvertent intravascular injection of material during a facial cosmetic procedure leading to embolism of extracranial and intracranial vessels and severe stroke. The last case report demonstrates endovascular thrombectomy as a novel treatment for a life-threatening vein of Galen thrombosis. Review of cases like these can broaden the perspective of the practicing neurologist and improve recognition of unusual as well as common stroke presentations and treatment opportunities.

Finally, this issue includes a review pertinent to a commonly encountered but little-studied entity, the recrudescence of focal stroke signs with global impairment of cerebral function, and an overview of current and novel emergent approaches to lipid-lowering therapy for stroke prevention.

This collection of case reports and review articles aims to boost the awareness and exposure of practicing neurologist to some of the breadth of clinical presentations, treatment options, and preventative strategies encountered in the treatment of stroke patients.

Practical Neurology would like to thank Laurel Cherian, MD, for serving as a reviewer for this issue.