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      COVID-19

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (Cape Verde)

      March 3, 2021

      General interest

      Fellow of EAN awarded 2021 Brain Prize

      March 3, 2021

      General interest

      Brain Talks: Professor Günther Deuschl addresses burden of neurological diseases in Europe

      March 3, 2021

      COVID-19

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      COVID-19

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (Cape Verde)

      March 3, 2021

      COVID-19

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      COVID-19

      COVID-19 continuous-EEG case series: A Descriptive Study

      March 3, 2021

      COVID-19

      Acute ischemic stroke and COVID-19: An analysis of 27 676 Patients

      March 3, 2021

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      Severe COVID-19-related encephalitis can respond to immunotherapy

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      Country of the Month: Lithuania

      March 1, 2021

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      March 1, 2021

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      Research Paper of the month: Safety and Efficacy of Omaveloxolone in Friedreich Ataxia (MOXIe Study)

      March 1, 2021

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      COVID-19 Paper of the month: Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine

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      Research Paper of the month: Trial of dexamethasone for chronic subdural hematoma

      February 1, 2021

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      First Virtual EAN Regional Teaching Course in Moscow, Russia

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      March 1, 2021

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      COVID-19 around the World: Clinician interviews on experience and impact of the virus (South Africa)

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      Brain Talks: Professor Günther Deuschl addresses burden of neurological diseases in Europe

      March 3, 2021

      COVID-19

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      COVID-19

      COVID-19 continuous-EEG case series: A Descriptive Study

      March 3, 2021

      COVID-19

      Acute ischemic stroke and COVID-19: An analysis of 27 676 Patients

      March 3, 2021

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      Scientific Committee Snapshot: Didier Leys

      April 1, 2020

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      August 11, 2020

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      June 3, 2020

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      Rare Neurological Diseases in the COVID-19 era: Suggestions for information to patients and caregivers

      May 13, 2020

      Scientific panels reports

      Scentific Panel of the Month: Higher Cortical Functions

      March 2, 2020

      Breaking news

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      Breaking news

      COVID-19 continuous-EEG case series: A Descriptive Study

      March 3, 2021

      Breaking news

      Acute ischemic stroke and COVID-19: An analysis of 27 676 Patients

      March 3, 2021

      Breaking news

      Inflammatory cytokine patterns associated with neurological diseases in COVID-19

      March 3, 2021

      Neurology updates

      Neurology Update: Dementia and Cognitive Disorders

      February 18, 2021

      Neurology updates

      Neurology Update: Dementia and Cognitive Disorders

      February 18, 2021

      Neurology updates

      Neurology Update: Dementia and Cognitive Disorders

      February 18, 2021

      Neurology updates

      Neurology Update: Dementia and cognitive disorders

      February 18, 2021

      Eur J Neurol

      EAN is proud to announce the 2020 Virtual Master Classes Christmas Special

      November 13, 2020

      Eur J Neurol

      EAN consensus statement for management of patients with neurological diseases during the COVID‐19 pandemic

      October 22, 2020

      Eur J Neurol

      BREAKING NEWS: A systematic review of neurological manifestations of SARS‐CoV‐2 infection: the devil is hidden in the details

      June 30, 2020

      Eur J Neurol

      EUROPEAN JOURNAL OF NEUROLOGY: CONTRIBUTIONS FROM SPANISH AUTHORS

      November 4, 2019

      Top 10 Articles

      EAN is proud to announce the 2020 Virtual Master Classes Christmas Special

      November 13, 2020

      Top 10 Articles

      EUROPEAN JOURNAL OF NEUROLOGY – TOP 15 ARTICLES 2018

      February 1, 2019

      Top 10 Articles

      Interview with Prof. Patrick Cras – UEMS Section of Neurology (SN)

      February 3, 2018

      Top 10 Articles

      Interview with Mr. Bertrand Daval and Mrs. Nathalie Paulus

      February 3, 2018

      Scientific Corner

      The Future of Brain Research: EU-Initiatives and Experts Together for a Shared European Brain Research Agenda

      March 1, 2021

      Scientific Corner

      New Scales & Scores on Sleep-wake disorders

      January 21, 2021

      Scientific Corner

      Registrar’s Reading List: Epilepsy Panel

      November 2, 2020

      Scientific Corner

      Registrar’s Reading List: Dementia

      September 22, 2020

  • Educational
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      March 1, 2021

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      Academic/Scientific

      New Scales & Scores on Dementia

      February 11, 2021

      E-Brain

      EBRA launches 3rd call for clusters

      May 1, 2020

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      February 28, 2020

      E-Brain

      ebrain to host the 2019 Neurology Formative Test Questions, from 15 April to 26 May

      April 1, 2019

      E-Brain

      ebrain update: Changes in the ebrain team

      November 1, 2018

      Grand Rounds

      eBrain: virtual case report from Belgium

      October 2, 2017

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      July 1, 2016

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      Ebrain granted Royal College of Physicians (UK) CPD/CME accreditation

      July 1, 2016

      Grand Rounds

      ebrain session of the month: neuromuscular junction

      February 1, 2016

      Continuing medical education

      CME online – June 2019 

      June 3, 2019

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      February 21, 2019

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      Continuing medical education

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      July 24, 2018

      Resident and Research Fellows

      EAN Spring School 2020 – Virtual – Webcasts

      November 20, 2020

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      November 13, 2020

      Resident and Research Fellows

      EAN VIRTUAL CONGRESS -Resident and Research Fellow Section General Assembly

      May 26, 2020

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      May 24, 2020

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      March 1, 2021

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      March 1, 2021

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      February 1, 2021

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      February 1, 2021

      Education corner

      First Virtual EAN Regional Teaching Course in Moscow, Russia

      March 1, 2021

      Education corner

      New Scales & Scores on Dementia

      February 11, 2021

      Education corner

      The First EAN Virtual Master Classes 2020 – Report

      January 1, 2021

      Education corner

      EAN Spring School – Application Deadline is 5 February 2021

      December 21, 2020

  • Miscellanea
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      March 3, 2021

      General interest

      Brain Talks: Professor Günther Deuschl addresses burden of neurological diseases in Europe

      March 3, 2021

      Miscellanea

      Alzheimer Europe adds two new trials to its Clinical Trials Watch

      March 1, 2021

      Miscellanea

      EMA public stakeholders meeting on the approval, safety monitoring and impact of COVID-19 vaccines in the EU

      March 1, 2021

      Holiday Calendar

      EAN Calendar 2020 – Template For Printing

      December 12, 2019

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      24.12. The last day

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      Grant opportunities

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      November 1, 2019

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      October 29, 2019

      Grant opportunities

      The Clinical Fellowship application deadline is approaching

      October 1, 2019

      News from EAN member societies

      News from EMA: First oral treatment for spinal muscular atrophy (SMA) recommended for approval

      March 3, 2021

      News from EAN member societies

      EMA’s Webinar on ”COVID-19 vaccination – what you need to know as a health professional”

      February 5, 2021

      News from EAN member societies

      Personalized plans, blood biomarkers and early interventions: Think Brain Health conference highlights

      February 1, 2021

      News from EAN member societies

      New gene therapy to treat rare genetic disorder metachromatic leukodystrophy

      January 18, 2021

      EBC

      EBC launches statement on the impact of COVID-19 on brain health

      February 1, 2021

      EBC

      EBC launches new series of disease fact sheets!

      December 1, 2020

      EBC

      Present Your Business or Idea at the Brain Innovation Days Pitch Competition

      October 27, 2020

      EBC

      Save the date for the Brain Innovation Days launch!

      October 1, 2020

      EFNA

      EFNA launch eLearning Platform for neurology advocates

      February 1, 2021

      EFNA

      ‘Me and My Brain’ – Art Competition winners announced!

      February 1, 2021

      EFNA

      Survey on the impact of COVID-19 on neurology service delivery

      November 1, 2020

      EFNA

      EFNA Advocacy Awards 2021 – ‘Action Against Stigma’

      October 1, 2020

      News in general

      WFN Brain Health Awareness Public Webinar

      February 16, 2021

      News in general

      EBC launches statement on the impact of COVID-19 on brain health

      February 1, 2021

      News in general

      European Neuromuscular Centre (ENMC) – Mid-Career Mentoring Programme

      February 1, 2021

      News in general

      Alzheimer Europe launches new guide targeted at health and social care workers and a policy briefing on intercultural care and support

      January 1, 2021

      Topic of the Month/Week

      Brain Awareness Week (BAW) is the global campaign to increase public awareness of the progress and benefits of brain research

      March 13, 2018

      Topic of the Month/Week

      Dystonia Europe celebrates 25 years

      March 13, 2018

      Patients societies reports

      News from Alzheimer Europe

      March 2, 2020

      Patients societies reports

      News from the WHO

      January 9, 2020

      Patients societies reports

      News from EFIC and the European Pain Forum

      January 3, 2020

      Patients societies reports

      News from EFIC and the European Pain Forum

      January 2, 2020

      Surveys

      Driving with an intracranial tumor

      July 13, 2020

      Surveys

      SURVEY: Driving with an intracranial tumor

      June 25, 2020

      Surveys

      EAN SURVEY: Neurological Symptoms in COVID-19 Patients

      April 10, 2020

      Surveys

      EMA communication: ICH Good Clinical Practice Guidelines (ICH E6) – Open Comment Opportunity – Deadline: 1 November 2019

      October 7, 2019

      Forum

      Call for Applications: e-Learning Platform Editor-in-Chief

      August 4, 2020

      Forum

      Neurological News from Denmark VI – the land of the 2nd EAN congress 2016: Pain Research in Denmark from a neurological perspective

      April 1, 2016

      Forum

      Neurological News from Denmark V – the land of the 2nd EAN congress 2016: Clinical Dementia Research in Denmark

      March 1, 2016

      Forum

      Updated recommendations to minimise the risk of the rare brain infection PML with Tysabri – Comment to EMA recommendation

      March 1, 2016

      Uncategorized

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (Saudi Arabia)

      January 12, 2021

      Uncategorized

      Effect of pre-exposure use of hydroxychloroquine on COVID-19 mortality: a population-based cohort study in patients with rheumatoid arthritis or systemic lupus erythematosus using the OpenSAFELY platform

      December 2, 2020

      Uncategorized

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (New Zealand)

      November 24, 2020

      Uncategorized

      Report from the annual Pain Forum meeting

      November 2, 2020

  • EAN
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eanpages

  • General interest
    • All COVID-19 Executive Page Country of the Month Paper of the Month EAN News EAN Congress news Interviews
      COVID-19

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (Cape Verde)

      March 3, 2021

      General interest

      Fellow of EAN awarded 2021 Brain Prize

      March 3, 2021

      General interest

      Brain Talks: Professor Günther Deuschl addresses burden of neurological diseases in Europe

      March 3, 2021

      COVID-19

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      COVID-19

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (Cape Verde)

      March 3, 2021

      COVID-19

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      COVID-19

      COVID-19 continuous-EEG case series: A Descriptive Study

      March 3, 2021

      COVID-19

      Acute ischemic stroke and COVID-19: An analysis of 27 676 Patients

      March 3, 2021

      Executive Page

      Executive page: From Website editor to Co-Chair Communication Committee

      February 1, 2021

      Executive Page

      Severe COVID-19-related encephalitis can respond to immunotherapy

      January 5, 2021

      Executive Page

      Executive Page: Happy New Year 2021 from the EAN, the Home of Neurology

      January 4, 2021

      Executive Page

      Executive Page: Recap of 2020 from Secretary-General

      December 1, 2020

      Country of the Month

      Country of the Month: Lithuania

      March 1, 2021

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      Country of the Month: Albania

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      Country of the Month

      Country of the Month: The Netherlands

      November 1, 2020

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      Country of the Month: Serbia

      October 1, 2020

      Paper of the Month

      COVID-19 Paper of the month: A non-inflammatory mRNA vaccine for treatment of experimental autoimmune encephalomyelitis

      March 1, 2021

      Paper of the Month

      Research Paper of the month: Safety and Efficacy of Omaveloxolone in Friedreich Ataxia (MOXIe Study)

      March 1, 2021

      Paper of the Month

      COVID-19 Paper of the month: Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine

      February 1, 2021

      Paper of the Month

      Research Paper of the month: Trial of dexamethasone for chronic subdural hematoma

      February 1, 2021

      EAN News

      First Virtual EAN Regional Teaching Course in Moscow, Russia

      March 1, 2021

      EAN News

      European Academy of Neurology endorses the ALBA declaration on Equity and Inclusion

      January 25, 2021

      EAN News

      The First EAN Virtual Master Classes 2020 – Report

      January 1, 2021

      EAN News

      Welcome to new year by Editor-in-Chief

      January 1, 2021

      EAN Congress news

      Congress Registration is open

      December 15, 2020

      EAN Congress news

      Abstract Submission is open

      December 15, 2020

      EAN Congress news

      EAN announces Virtual Congress in 2021

      December 1, 2020

      EAN Congress news

      Investigator Award Winners 2020

      September 14, 2020

      Interviews

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (Cape Verde)

      March 3, 2021

      Interviews

      Prof. Dafin Muresanu, Chair of the EAN Communication Committee interviews Prof. Raad Shakir, CBE

      March 1, 2021

      Interviews

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (South Africa)

      February 5, 2021

      Interviews

      COVID-19 around the World: Clinician interviews on experience and impact of the virus (Japan)

      February 1, 2021

  • Academic/Scientific
    • All Scientific committee reports Scientific panels reports Breaking news Neurology updates Eur J Neurol Top 10 Articles Scientific Corner
      General interest

      Brain Talks: Professor Günther Deuschl addresses burden of neurological diseases in Europe

      March 3, 2021

      COVID-19

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      COVID-19

      COVID-19 continuous-EEG case series: A Descriptive Study

      March 3, 2021

      COVID-19

      Acute ischemic stroke and COVID-19: An analysis of 27 676 Patients

      March 3, 2021

      Scientific committee reports

      Scientific Committee Snapshot: Didier Leys

      April 1, 2020

      Scientific committee reports

      Scientific Committee Snapshot: Rigmor Hojland

      February 26, 2020

      Scientific committee reports

      Scientific Committee Snapshot: Christian Enzinger

      December 1, 2019

      Scientific committee reports

      Scientific Committee Snapshot: Maurizio Leone

      November 1, 2019

      Scientific panels reports

      Coma and DOC Panel Update (May-June): news from the EAN Virtual Congress, personalized pain assessment, NIRS-EEG and machine learning to predict outcomes, prevalence of swallowing disorders and new multimodal predictive algorithms.

      August 11, 2020

      Scientific panels reports

      Statement of the EAN Sleep-Wake-Panel

      June 3, 2020

      Scientific panels reports

      Rare Neurological Diseases in the COVID-19 era: Suggestions for information to patients and caregivers

      May 13, 2020

      Scientific panels reports

      Scentific Panel of the Month: Higher Cortical Functions

      March 2, 2020

      Breaking news

      Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms

      March 3, 2021

      Breaking news

      COVID-19 continuous-EEG case series: A Descriptive Study

      March 3, 2021

      Breaking news

      Acute ischemic stroke and COVID-19: An analysis of 27 676 Patients

      March 3, 2021

      Breaking news

      Inflammatory cytokine patterns associated with neurological diseases in COVID-19

      March 3, 2021

      Neurology updates

      Neurology Update: Dementia and Cognitive Disorders

      February 18, 2021

      Neurology updates

      Neurology Update: Dementia and Cognitive Disorders

      February 18, 2021

      Neurology updates

      Neurology Update: Dementia and Cognitive Disorders

      February 18, 2021

      Neurology updates

      Neurology Update: Dementia and cognitive disorders

      February 18, 2021

      Eur J Neurol

      EAN is proud to announce the 2020 Virtual Master Classes Christmas Special

      November 13, 2020

      Eur J Neurol

      EAN consensus statement for management of patients with neurological diseases during the COVID‐19 pandemic

      October 22, 2020

      Eur J Neurol

      BREAKING NEWS: A systematic review of neurological manifestations of SARS‐CoV‐2 infection: the devil is hidden in the details

      June 30, 2020

      Eur J Neurol

      EUROPEAN JOURNAL OF NEUROLOGY: CONTRIBUTIONS FROM SPANISH AUTHORS

      November 4, 2019

      Top 10 Articles

      EAN is proud to announce the 2020 Virtual Master Classes Christmas Special

      November 13, 2020

      Top 10 Articles

      EUROPEAN JOURNAL OF NEUROLOGY – TOP 15 ARTICLES 2018

      February 1, 2019

      Top 10 Articles

      Interview with Prof. Patrick Cras – UEMS Section of Neurology (SN)

      February 3, 2018

      Top 10 Articles

      Interview with Mr. Bertrand Daval and Mrs. Nathalie Paulus

      February 3, 2018

      Scientific Corner

      The Future of Brain Research: EU-Initiatives and Experts Together for a Shared European Brain Research Agenda

      March 1, 2021

      Scientific Corner

      New Scales & Scores on Sleep-wake disorders

      January 21, 2021

      Scientific Corner

      Registrar’s Reading List: Epilepsy Panel

      November 2, 2020

      Scientific Corner

      Registrar’s Reading List: Dementia

      September 22, 2020

  • Educational
    • All E-Brain Grand Rounds Continuing medical education Resident and Research Fellows Fellowship reports Education corner
      Educational

      Clinical Fellowship Reports 2020

      March 1, 2021

      Educational

      First Virtual EAN Regional Teaching Course in Moscow, Russia

      March 1, 2021

      Educational

      Clinical Fellowship Reports 2019

      March 1, 2021

      Academic/Scientific

      New Scales & Scores on Dementia

      February 11, 2021

      E-Brain

      EBRA launches 3rd call for clusters

      May 1, 2020

      E-Brain

      News from ebrain

      February 28, 2020

      E-Brain

      ebrain to host the 2019 Neurology Formative Test Questions, from 15 April to 26 May

      April 1, 2019

      E-Brain

      ebrain update: Changes in the ebrain team

      November 1, 2018

      Grand Rounds

      eBrain: virtual case report from Belgium

      October 2, 2017

      Grand Rounds

      Free access to Ebrain for EAN members

      July 1, 2016

      Grand Rounds

      Ebrain granted Royal College of Physicians (UK) CPD/CME accreditation

      July 1, 2016

      Grand Rounds

      ebrain session of the month: neuromuscular junction

      February 1, 2016

      Continuing medical education

      CME online – June 2019 

      June 3, 2019

      Continuing medical education

      Continuing Medical Education

      February 21, 2019

      Continuing medical education

      CME online – October 2018

      October 1, 2018

      Continuing medical education

      CME online – July 2018

      July 24, 2018

      Resident and Research Fellows

      EAN Spring School 2020 – Virtual – Webcasts

      November 20, 2020

      Resident and Research Fellows

      EAN is proud to announce the 2020 Virtual Master Classes Christmas Special

      November 13, 2020

      Resident and Research Fellows

      EAN VIRTUAL CONGRESS -Resident and Research Fellow Section General Assembly

      May 26, 2020

      Resident and Research Fellows

      EAN Virtual Congress: Round table Special Session: Unleash your potential with EAN!

      May 24, 2020

      Fellowship reports

      Clinical Fellowship Reports 2020

      March 1, 2021

      Fellowship reports

      Clinical Fellowship Reports 2019

      March 1, 2021

      Fellowship reports

      Clinical Fellowship Reports III 2019

      February 1, 2021

      Fellowship reports

      Clinical Fellowship Reports II 2019

      February 1, 2021

      Education corner

      First Virtual EAN Regional Teaching Course in Moscow, Russia

      March 1, 2021

      Education corner

      New Scales & Scores on Dementia

      February 11, 2021

      Education corner

      The First EAN Virtual Master Classes 2020 – Report

      January 1, 2021

      Education corner

      EAN Spring School – Application Deadline is 5 February 2021

      December 21, 2020

  • Miscellanea
    • All Holiday Calendar Grant opportunities News from EAN member societies EBC EFNA News in general Topic of the Month/Week Patients societies reports Surveys Forum Uncategorized
      News from EAN member societies

      News from EMA: First oral treatment for spinal muscular atrophy (SMA) recommended for approval

      March 3, 2021

      General interest

      Brain Talks: Professor Günther Deuschl addresses burden of neurological diseases in Europe

      March 3, 2021

      Miscellanea

      Alzheimer Europe adds two new trials to its Clinical Trials Watch

      March 1, 2021

      Miscellanea

      EMA public stakeholders meeting on the approval, safety monitoring and impact of COVID-19 vaccines in the EU

      March 1, 2021

      Holiday Calendar

      EAN Calendar 2020 – Template For Printing

      December 12, 2019

      Holiday Calendar

      24.12. The last day

      December 24, 2018

      Holiday Calendar

      23.12. Last-minute gift idea

      December 23, 2018

      Holiday Calendar

      22.12. A chance to win…

      December 22, 2018

      Grant opportunities

      European Commission: Innovation and novelty in medical devices and in vitro diagnostic devices; towards common concepts of innovation-related risk assessments

      November 1, 2019

      Grant opportunities

      GBS|CIDP Foundation International 2020 Research Grant Opportunity

      October 29, 2019

      Grant opportunities

      The Clinical Fellowship application deadline is approaching

      October 1, 2019

      News from EAN member societies

      News from EMA: First oral treatment for spinal muscular atrophy (SMA) recommended for approval

      March 3, 2021

      News from EAN member societies

      EMA’s Webinar on ”COVID-19 vaccination – what you need to know as a health professional”

      February 5, 2021

      News from EAN member societies

      Personalized plans, blood biomarkers and early interventions: Think Brain Health conference highlights

      February 1, 2021

      News from EAN member societies

      New gene therapy to treat rare genetic disorder metachromatic leukodystrophy

      January 18, 2021

      EBC

      EBC launches statement on the impact of COVID-19 on brain health

      February 1, 2021

      EBC

      EBC launches new series of disease fact sheets!

      December 1, 2020

      EBC

      Present Your Business or Idea at the Brain Innovation Days Pitch Competition

      October 27, 2020

      EBC

      Save the date for the Brain Innovation Days launch!

      October 1, 2020

      EFNA

      EFNA launch eLearning Platform for neurology advocates

      February 1, 2021

      EFNA

      ‘Me and My Brain’ – Art Competition winners announced!

      February 1, 2021

      EFNA

      Survey on the impact of COVID-19 on neurology service delivery

      November 1, 2020

      EFNA

      EFNA Advocacy Awards 2021 – ‘Action Against Stigma’

      October 1, 2020

      News in general

      WFN Brain Health Awareness Public Webinar

      February 16, 2021

      News in general

      EBC launches statement on the impact of COVID-19 on brain health

      February 1, 2021

      News in general

      European Neuromuscular Centre (ENMC) – Mid-Career Mentoring Programme

      February 1, 2021

      News in general

      Alzheimer Europe launches new guide targeted at health and social care workers and a policy briefing on intercultural care and support

      January 1, 2021

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Grand Rounds

Case report: Lacunar warning syndrome in a patient with radiologically diagnosed temporal arteritis

August 1, 2013

by Anastasia Zekeridou, M. Tschirren, A. Fumeaux, Patrik Michel

A 71-year-old man presented with a sudden onset paresis of his left side. On clinical examination a pure left hemiparesis with mild dysarthria and with Babinski sign was found. The signs were fluctuating with an NIHSS score (National Institute of Health Stroke Score) varying between 3 and 8 points. Non-contrast CT was normal, and the patient received thrombolysis with rtPA 95 minutes after symptom onset. The patient had no history of conventional risk factors. He reported no headache, but an involuntary weight loss of 4kg in the last 3 months. On admission, moderate hypertension and a new hyperlipidemia were found. The clinical hypothesis was that of a lacunar warning syndrome.
On the admission CT-angiography, cervical arteries were found to be irregular (figure 1: reconstruction of the right vertebral artery) with discrete vessel wall enhancement after iodine injection, mainly on the vertebral arteries (figures 2a and 2b) and common carotid arteries. The MRI confirmed right lenticular lacunar stroke (figure 3: DWI MRI), but also confirmed the presence of wall thickening of extracranial arteries as seen in figures 4 and 5 (ophthalmic and temporal artery, respectively). The ESR was 20mm/h and the CRP 30mg/l (normal: <2) and the rest of the work-up for systemic vasculitis, eye fundoscopy and lumbar puncture were normal.
As a giant cell arteritis was suspected on radiological basis, a right temporal artery biopsy was performed that showed inflammation signs with the presence of giant cells and the diagnosis was confirmed (figure 6). The patient was given Prednisone treatment (60mg/day) with a normalisation of the CRP and ESR values.

Comment by the authors

This patient illustrates the rare situation of cerebral stroke related to Horton’s arteritis. In our patient, the small lacunar-like stroke could be due to participation of a small vessel to the vasculitis, or from an embolus from the inflamed carotid artery. This patient was lucky that the diagnosis of Horton’s arteritis was made despite near complete absence of typical symptoms, signs, and elevated ESR. This was due to the regular use and careful analysis of cervico-cerebral CT-angiography in our stroke patients already in the emergency room. Unfortunately diagnostic accuracy of CTA and MRA for Horton’s arteritis is not yet sufficiently known (1). Although the main burden of radiological vasculitis in our patient was in the vertebral arteries, as frequently described (2), his stroke occurred in the deep anterior circulation, suggesting a classical lacunar (or “capsular” warning syndrome).

References:
1. Prieto-González S et al Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis. 2012
2. Cid et al, The spectrum of vascular involvement in giant-cell arteritis: clinical consequences of detrimental vascular remodelling at different sites. APMIS Suppl. 2009 Jun;(127):10-20

Anastasia Zekederiou, M. Tschirren, A. Fumeaux and Patrik Michel work at the Neurology Service, Department of Clinical Neurosciences in Lausanne, Switzerland.

Comment by Gian Luigi Lenzi

The neurological case “Lacunar warning syndrome…” described by Zekeridou et al is an interesting hypothesis coupling an ischemic stroke as the final effect and Horton’s arteritis as its (possible) pathogenetic cause. Two facts are crystal clear: the patient had an ischemic stroke with a clinical presentation that is not easy to reconcile with a single small lesion in the right lenticular nucleus; the patient had a paucisymptomatic Horton’s arteritis.

I would like to make a few general comments as well as posing a few questions to the AA:

COMMENTS
The definition of this stroke moves from the “lacunar warning syndrome” in the title, to a “right lenticular lacunar stroke” or a “capsular warning syndrome” in the text.

So, we have: a) a lacunar syndrome; b) a capsular warning syndrome.
Is it lacunar?
Is it a warning syndrome?
About the lacunar syndrome, we have to remind the definition of lacunar stroke: an infarct 10-15mm in size, caused by the occlusion of a single perforating artery [if we use pathology as the main reference point] ; or one of the 23 different clinical syndromes described by M. Fisher [if we remain on clinical backgrounds]. The MR findings in this patient indicate a lacunar stroke and this lacunar stroke may well explain the clinical presentation of a left hemiparesis. However the mild dysarthria is left without an MR corrispective. The coupling of a left hemiparesis with dysarthria is not a “classical” lacunar syndrome. However M. Fisher in 1991 wrote “…MR has made dependence on clinical detail more or less obsolete”. And in 2002 J. Bamford summarised that “… up to 80 per cent of lacunes (or radiological small, deep infarcts) are clinically < silent >…” However, P. Rothwell in: Brain’s Diseases of the Nervous System, XII Ed, 2008, pg 1047, points out that “Lacunar syndromes are defined clinically “. Therefore it looks like we have in general a paradoxical situation: a lacunar syndrome is a clinical definition of a particular clinical presentation of a lacunar stroke that is due to a lacuna that in 80% of the cases is without a clinical presentation. The particularity of this case is the lacunar-plus-clinical presentation. The origin of this “plus” is not explained.
The second point refers to the original definition of the capsular warning syndrome by GA Donnan and coll., who described the occurrence of lacunar TIAs as prodromic to the final infarct in a crescendo flurry pattern. All this is not present in the patient presented by Zekeridou et al, who had no warning at all. Furthermore, assuming that the clinical presentation was a “warning” in the meaning of Donnan et al., it could be argued that it was a “warning TIA”, casting some concerns on the appropriateness of the thrombolytic therapy. That is, it could be more appropriate to delete the “warning” from the label given to the stroke of this patient.

QUESTIONS
a) Could the mild dysarthria have been due to a TIA in a different region, without MR counterpart?
b) How was the evolution of the clinical presentation and of the MR findings?
c) Since Horton arteritis is a “large arteries” disease, are there reports on giant cells presence in the walls of cerebral small arteries?
d) Which kind of therapeutical prescriptions were made? It appears that the AA prescribed prednisone; that is they treated the temporal arteritis only. No antiaggregants?

Gian Luigi Lenzi is Professor of Neurology at University “La Sapienza” in Rome, Italy; EFNS Vice President and Editor-in-chief of Neuropenews.

Case report: Lacunar warning syndrome in a patient with radiologically diagnosed temporal arteritis was last modified: July 25th, 2013 by Editor
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1 comment

Mohammad Ali Arami August 1, 2013 at 10:44 pm

This case isn’t a typical case of temporal arteritis at all. I think the treatment with prednisolone in this time wasn’t necessary because neither we have visual loss or satroke in progress. There are many reports that prove CRP could increas during acute stroke. No headach, no high ESR and no visual loss and no large arteries related cerebral infarctions. The only finding in favour of temporal arteritis are pathological findings. Is that enouph for definite diagnosis?
Three of the following five criteria were required to meet American College of Rheumatology (ACR) classification criteria for giant-cell arteritis:
1) Age 50 years or older,
2) New-onset localized headache,
3) Temporal artery tenderness or decreased temporal artery pulse,
4) Erythrocyte sedimentation rate of at least 50 mm/h
5) Abnormal artery biopsy specimen characterized by mononuclear infiltration or granulomatous inflammation.
Do we need a new criteria for “probable giant cell arteritis” or “pathologically defined giant cell arteritis”?
Finally I prefer closed follow up of the patient and begining of steroid if other clinical or laboratory (including ESR) findings support the giant cell arteritis diagnosis.

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