Parkinson’s disease (PD) is traditionally regarded as a neurodegenerative movement disorder, however, nigrostriatal dopaminergic degeneration is also thought to disrupt non-motor loops connecting basal ganglia to areas in frontal cortex involved in cognition and emotion processing. PD patients are impaired on tests of emotion recognition, but it is difficult to disentangle this deficit from the more general cognitive dysfunction that frequently accompanies disease progression. Testing for emotion recognition deficits early in the disease course, prior to cognitive decline, better assesses the sensitivity of these non-motor corticobasal ganglia-thalamocortical loops involved in emotion processing to early degenerative change in basal ganglia circuits. In addition, contrasting this with a group of healthy aging individuals demonstrates changes in emotion processing specific to the degeneration of basal ganglia circuitry in PD. Early PD patients (EPD) were recruited from a randomized clinical trial testing the safety and tolerability of deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) in early-staged PD. EPD patients were previously randomized to receive optimal drug therapy only (ODT), or drug therapy plus STN-DBS (ODT + DBS). Matched healthy elderly controls (HEC) and young controls (HYC) also participated in this study. Participants completed two control tasks and three emotion recognition tests that varied in stimulus domain. EPD patients were impaired on all emotion recognition tasks compared to HEC. Neither therapy type (ODT or ODT + DBS) nor therapy state (ON/OFF) altered emotion recognition performance in this study. Finally, HEC were impaired on vocal emotion recognition relative to HYC, suggesting a decline related to healthy aging. This study supports the existence of impaired emotion recognition early in the PD course, implicating an early disruption of fronto-striatal loops mediating emotional function.

Emotion recognition is an important aspect of social interaction. Deficits in emotion recognitionhave been tied to poor social competence, interpersonal functioning, and communication along with a reduced quality of life and inappropriate social behavior. Recent experimental evidence suggests that emotion recognition ability across modalities seems to change in an age-dependent way, with deficits specifically noted for negative emotion recognition. Therefore, the primary purpose of this study is to assess emotion recognition ability in both the visual and auditory modalities in healthy elderly patients versus healthy young patients to test the hypothesis that deficits in emotion recognition ability are age-related and increase with age across visual and auditory modalities. The secondary purpose of this study is to assess valence-specific emotion recognition ability to test the hypothesis that increased deficits for elderly individuals as compared to young healthy subjects occur for negative emotion recognition specifically. We examined the ability to recognize emotion in the auditory and visual modality in two groups of patients: healthy elderly subjects and healthy young subjects. The Montreal Affective Voices task (MAV), the Distorted Tunes task (DTT), the Awareness of Social Inference test (TASIT), and the BaronCohen Mind in the Eyes Test (EYES) were used to gauge emotion recognition ability. For the visual tasks (TASIT and EYES), the elderly subjects and young subjects did not have significant differences in performance. In addition, a significant difference was also not found for the DTT, indicating that both populations had intact lower-level auditory processing abilities. Significant differences were found between the two populations on the MAV task in both baseline accuracy and valence-specific performance. These findings suggest that age-related deficits in emotion recognition may be specific to the recognition of auditory emotion.

Guillain-Barré syndrome (GBS) is an inflammatory polyneuropathy that classically presents with low back pain, sensory paresthesias, and rapidly progressive weakness. Patients with GBS can develop dysautonomia, and Takotsubo cardiomyopathy (TCM) is a rare potential manifestation of this dysautonomia. This association has been reported only 12 times in the literature so far, which we review here. We present two cases of GBS associated with TCM, to increase awareness with regard to this comorbid relationship, which would encourage prompt initiation of proper supportive care to avoid morbidity and mortality.We report the case of two patients -a 58-year-old man and a 79-year-old woman -who developed TCM in the setting of axonal variants of GBS. Electrodiagnostic results, cerebrospinal fluid profiles, and echocardiogram findings were consistent with these diagnoses. Both patients were treated with intravenous immunoglobulin (IVIG) in an intensive care unit (ICU) setting. Echocardiogram findings were reversible.TCM should be recognized as a potential complication of GBS in patients with dysautonomia. This case series adds to the sparse body of literature describing the association between these two conditions. It is not clear if patients with axonal variants of GBS are more predisposed to developing TCM; further, larger case series in the future may help identify the risk factors associated with it. We hope to shed more light on this possible association to expedite the diagnosis and management of this condition.

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thrombolysis in one patient (3%). Successful revascularization was achieved in 31 patients (94%), including TICI III in 16 patients (48.5%). The average number of passes to reperfusion was 1.6 (95% CI 1.3-2.0). Mean time to reperfusion was 47 minutes. Symptomatic intraparenchymal hemorrhage following reperfusion occurred in 2 patients (6%). Procedural complications occurred in 4 patients (12%), including dissection, microwire perforation, and hemorrhage into a pre-existing intracranial tumor; all complications were unrelated to the SOFIA. Mortality was 21.2% secondary to failed revascularization, hemorrhagic transformation, and severe baseline medical disease. Conclusion SOFIA is a safe and effective intermediate catheter for mechanical and aspiration thrombectomy in acute stroke intervention. In conjunction with stent retrievers and suction aspiration technique, successful revascularization was 94%, with average number of passes of 1.6. There were no complications directly attributable to the use of SOFIA.

Introduction: Neovascular glaucoma (NVG) has been rarely reported as an acute complication of carotid endarterectomy, but there is scant literature available regarding this potential condition following carotid artery stenting (CAS). We present a case of severe worsening of NVG occurring after bilateral CAS with progressive deterioration of vision ultimately leading to blindness. Case Description: A 66-year-old male with multiple stroke risk factors, bilateral cataract extraction, proliferative diabetic retinopathy of left eye, and nonproliferative diabetic retinopathy of right eye, and prior left eye pars plana vitrectomy presented with episodes of transient right eye vision loss in context of bilateral high-grade internal carotid artery stenoses. He underwent right CAS with subsequent elevation of bilateral intraocular pressures (IOPs) concerning for acute NVG. Over time, the patient had some interval improvement in IOPs and underwent planned left CAS. After the procedure, he again developed elevated IOPs, concerning for acute NVG which eventually led to right eye pars plana vitrectomy for vitreous hemorrhage and refractory IOP elevation. At 6-month follow-up from initial stenting, the patient was blind in both eyes. Discussion: We present a case of recurrent IOP elevations following CAS eventually resulting in bilateral eye blindness. This case is important not only as an illustration of an underrecognized postprocedural CAS complication but also as a demonstration of likely elevated risk of NVG following CAS for patients with other predisposing risk factors for ocular hypertension such as glaucoma, proliferative diabetic retinopathy, prior cataract extraction, and prior pars plana vitrectomy.

Background: A significant proportion of mechanical thrombectomies for large vessel occlusion (LVO) stroke are avoidable with improved oral anticoagulant (OAC) use in patients with atrial fibrillation (AF). We sought to identify the proportion of avoidable thrombectomies in elderly patients (age ≥70) with stroke due to AF. Methods: This study included 348 consecutive MT cases at a high-volume stroke center from Feb 2015 to Sept 2018. A retrospective chart review was conducted to identify patient sociodemographics, presence of AF, use of anticoagulation, stroke severity, CHA 2 DS 2 -VASc scores, and functional outcome Results: A total of 191 (55%) patients were ≥70 years (median age 81±7, 61% female), of which 116 (61%) had AF (median age 82±6, 67% female). Elderly patients with AF were more likely to have hypertension and heart failure and be on antiplatelets and OACs. Pre-existing AF was present in 75 (39%) patients, of which 38 (49%) were not on OACs prior to stroke. Of the 39 (51%) patients with known AF on OACs, 10 (68%) had subtherapeutic INR levels and 5 (21%) were not adherent to direct OACs. Overall, 53/191 (28%) patients with known AF were not adequately anticoagulated prior to the index stroke. There was no significant difference in modified Rankin Scale score at discharge or rate of symptomatic intracerebral hemorrhage between the two groups. Conclusion: In our study, about 1 in 4 elderly patients with known AF were not adequately anticoagulated prior to stroke and underwent potentially avoidable thrombectomy. Better practice strategies are needed to increase OAC utilization and adherence to reduce the burden of stroke in patients with AF, especially in elderly women.

Introduction A 38 year‐old right‐handed female is a fully functional teacher with past medical history of hypertension, type II Diabetes Mellitus, polycystic ovarian syndrome, and infertility. She presented to our emergency department (ER) on the same day she was discharged twice from a local ER for acute onset persistent non‐fluctuating left‐sided weakness and painful bilateral leg spasms that woke her from sleep. Patient had pertinent exam findings of moderate pharyngeal dysarthria, mild right nasolabial flattening, mild weakness of left upper extremity (LUE), and stereotyped, painful tonic extensor posturing of the bilateral lower extremities associated with back arching and extensor response of bilateral toes. NIH Stroke Scale was 10. Methods We conducted a review of patient clinical documentation. Results MRI Brain showed anterior asymmetric bilateral pontine ischemic strokes at the ventral pontomedullary junction. MRA brain with black blood sequencing revealed multifocal vasculopathy at the right V4, mid‐basilar and left M1 segments. An angiogram showed Moya‐moya type collaterals. Tonic posturing and spasms persisted for several hours requiring muscle relaxants and benzodiazepines for symptomatic management. Unfortunately, the patient had worsening LUE weakness, inability to swallow and was found to have total vocal cord paralysis. She was intubated for airway protection and after failing extubation required tracheostomy and percutaneous gastrostomy placement. Initial workup revealed poorly controlled hyperlipidemia (LDL 162) and diabetes (A1c 8.7%), CRP 7–9, hypercoagulable panel and transthoracic echocardiogram were unremarkable. Lumbar puncture was also unremarkable (CSF TNC 2, RBC 3, glucose 116, protein 35, Enterovirus and HSV 1,2 PCR, Streptococcus antigen and VDRL were negative). Anticoagulation was started for an incidental right lower lobe subsegmental pulmonary embolism. Ultimately, the patient was discharged to inpatient rehabilitation (IPR) with a Modified Rankin Scale (mRS) of 4, on day 19th of hospitalization with some improvement in oral intake and decannulation of tracheostomy. Conclusions Movement disorders caused by strokes have been described in the literature. In their majority, they are secondary to a supratentorial injury. There have been some cases published of infratentorial, unilateral lesions that have caused different types of involuntary movements. More specifically, two papers described tonic spasms seen in pontine strokes. To our knowledge, this is a novel description of a case of bilateral pontine ischemic stroke that causes painful tonic spasms associated with decerebrate rigidity or posturing. Our hypothesis is that given the localization of the strokes in the anterior area of the inferior segment of the pons there may be involvement of the corticospinal, corticobulbar, and rubrospinal tracts which may be responsible for this presentation. Posterior circulation strokes can be missed about 9–14% of the time, possibly due to atypical presentations. We believe that presenting this case can help to improve the current available literature on this topic.