Mimic of transient ischemic attack by anemia-induced asterixis: A novel differential diagnosis of stroke with critical pitfalls

Hanazono, Akira; Shimada, Hinako; Yasuda, K.; Takahashi, Yoshiko; Funasaka, Homare; Sanpei, Yui; Sugawara, Masashiro

doi:10.1016/j.jstrokecerebrovasdis.2023.106994

Cited by 1 publication

(1 citation statement)

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“…Hanazono reported a case of a patient misdiagnosed with asterixis of limb-shaking TIA, which upon further investigation revealed callosal infarction secondary to severe anemia associated with colon cancer. This case is interesting because the patient’s asterixis immediately improved after blood transfusion, suggesting a relationship between anemia and neurological symptoms [ 113 ].…”

Section: Differential Diagnosismentioning

confidence: 99%

Flapping Tremor: Unraveling Asterixis—A Narrative Review

Rissardo,

Muhammad,

Yatakarla

et al. 2024

Medicina

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Asterixis is a subtype of negative myoclonus characterized by brief, arrhythmic lapses of sustained posture due to involuntary pauses in muscle contraction. We performed a narrative review to characterize further asterixis regarding nomenclature, historical aspects, etiology, pathophysiology, classification, diagnosis, and treatment. Asterixis has been classically used as a synonym for negative myoclonus across the literature and in previous articles. However, it is important to distinguish asterixis from other subtypes of negative myoclonus, for example, epileptic negative myoclonus, because management could change. Asterixis is not specific to any pathophysiological process, but it is more commonly reported in hepatic encephalopathy, renal and respiratory failure, cerebrovascular diseases, as well as associated with drugs that could potentially lead to hyperammonemia, such as valproic acid, carbamazepine, and phenytoin. Asterixis is usually asymptomatic and not spontaneously reported by patients. This highlights the importance of actively searching for this sign in the physical exam of encephalopathic patients because it could indicate an underlying toxic or metabolic cause. Asterixis is usually reversible upon treatment of the underlying cause.

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Section: Differential Diagnosismentioning

confidence: 99%