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Among noniatrogenic neuromuscular disorders, myasthenia gravis remains the most prevalent. Diagnosing this disorder may become challenging in certain cases such as in patients with coexisting comorbid illnesses and non-specific clinical symptoms. This is a case of atypical myasthenia gravis in a middle aged hypertensive male, who initially presented symptoms suggestive of an acute ischemic stroke. Upon later investigation, prompted by persistent symptoms, the patient was found to have AchR antibodies and had the rare finding of a fissured and atrophied tongue (reversible on treatment). It is a well known fact that brainstem strokes can present with bulbar weakness resulting in aspiration pneumonitis, as was with the clinical presentation in the below mentioned report. Due to the initial misdiagnosis, he had received medical therapy aimed towards stroke management and prevention. Further investigation leading to a definitive diagnosis, was followed by medical therapy with neostigmine, pyridostigmine and oral prednisolone, leading to significant improvement in symptoms. Hence as a mandatory measure, while dealing with a case of a new onset of weakness, especially in cranial musculature, myasthenia gravis must not be excluded from the list of differential diagnosis. Myasthenia gravis (MG) is a potential ´stroke mimic´ especially in the elderly, however, due to recent change in trends of stroke statistics, this disease should be considered a possibility even in younger patients.

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A 46-year-old with a history of mild hypertension was working outside when a viper bit him on his right hand. The patient arrived at the nearest medical facility about 30 minutes after and received polyvalent antivenom serum, bite site care. He was taken to the emergency department (ED) by ambulance. At ED of our center, 2 hours after bite, the patient was unconscious, his blood pressure was initially unobtainable, and his cardiac monitor revealed a rate of 147/min. Breathlessness, hemoptysis and rales were heard in the lung bases. Neurological examination revealed right hemiplegia, a right facial droop, and dysarthria. A Foley catheter was placed and returned a hemorrhagic fluid. A blood samples examinations showed: a hematocrit was 45%, prothrombine (PT) greater than 120 seconds, HGB 8.7 g/dl, platelets 30 x103 /mm3. Blood oxygen saturation after oxygen facemask was low, and the patient was intubated, using in endotracheal tube and was placed on a ventilator. 6 hours following admission, after the patient was somewhat stabilized, a noncontrast computerized tomographic (CT) scan of the head demonstrated multiples stroke with hemorrhagic infarction left middle cerebral artery territory (a, b). A chest CT scan revealed an area of alveolar condensation reaching the superior right lobe and Fowlers segment related to hemorrhagic intra alveolar bleeding (c, d). The morning following admission, the patient was found to be hypoxic. His systolic blood pressure decreased. Later on second day, the patient became flaccid with nonreactive pupils and he was pronounced dead later the same day.

Abstract: Objective: Readmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences. Methods: Consecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined. Results: Two hundred sixty-five patients (50.9% male; 79.6%African American; mean age 60.9years) were included. There were 205(77.4%) strokes and 60(22.6%) TIAs. Thirteen (5%) patients died during their first admission. Of the remaining 252 patients, 25 (9.9%) were readmitted within 30days. The reason for readmission was neurological in 8/25 patients (32%; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68%). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5% vs. 14.7%; p=0.001) An NIH stroke scale ≥10 predicted readmission (50.0% vs. 25.4% for NIHSS <10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2% vs. 23.8%; p value=0.01). Interpretation: Disabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30days and determine best practices that prevent readmission. [Copyright &y& Elsevier]

Copyright of Les Cahiers de l'Année Gérontologique is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Intravenous thrombolytic therapy for ischemic stroke was performed on a 75-year-old patient at recovery from cervicocephalic superficial surgery. The patient recovered totally from ischemic stroke and no neurologic sequelae was observed. Thrombolytic therapy must be performed in an intensive care unit in order to manage some bleeding events which can occur. [Copyright &y& Elsevier]

Abstract: Medical management of a female passenger with acute stroke aboard a cruise ship at the sea allowed a fast evacuation towards a stroke unit by an helicopter staffed with an emergency medical doctor. Fibrinolysis begun in a short delay after magnetic resonance imaging. [Copyright &y& Elsevier]