HYBRID EVENT: You can participate in person at Orlando, USA or Virtually from your home or work.

6th Edition of International Conference on Neurology and Brain Disorders

October 24 -26, 2022

October 24 -26, 2022 | Orlando, Florida, USA
INBC 2022

Mohammad Abu-Abaa

Speaker at Neurology and Brain Disorders 2022 - Mohammad Abu-Abaa
Capital Health Internal Medicine Residency, United States
Title : Importance of Blood Pressure Augmentation in Pontine Warning Syndrome, A Stuttering Lacune Presenting as AICA syndrome

Abstract:

A 43 years old male patient with a past medical history of hypertension and hyperlipidemia but noncompliant with medications presented to the hospital after his coworkers noticed a left sided facial droop. He also reports a transient episode of dizziness in the same morning. In ED, physical exam showed left sided upper and lower facial weakness, left sided abducens nerve palsy, left sided diminished facial sensation, left upper extremity subtle ataxia and bilateral hearing impairment. NIH stroke scale score was 4. He denied hyperacusis. Social History was positive for smoking and vaping. Blood pressure was elevated at 180/123. EKG showed sinus rhythm. Labs were remarkable only for hypokalemia at 3,5 with mild elevation of AST and ALT. CT head without contrast ruled out intracranial hemorrhage. Neurology was consulted at bedside and MRI brain without contrast, MRA head and MRA neck were pursued. All imaging tests were unremarkable. There was high suspicion for a stuttering AICA syndrome and the decision was to proceed with permissive hypertension less than 220 and challenge with IV fluid bolus and continue on maintenance IV fluid at 100 ml/hour overnight. He was also loaded with aspirin and clopidogrel. He also started on statin. Physical examination in the next morning revealed resolution of facial palsy, trigeminal nerve palsy and hearing impairment with only persistence of abducens nerve palsy that was improving. Transthoracic echo ruled out cardiac embolism. Blood pressure was persistently above 180 and lisinopril of 5 mg was started. Inflammatory causes of cranial polyneuropathies were ruled out by contrast enhanced MRI. Improvement of systolic pressure to 110 on the third day of hospitalization was associated with new dysarthria 6th International Conference on Neurology and Brain Disorders | October 24-26, 2022 and facial palsy and recurrence of other initial neurological deficits. Challenging with 1 liter of IV fluid, discontinuation of antihypertensive medication and flat bed position resulted in resolution of the deficits. The patient was discharged home on the fifth day of hospitalization.

What will audience learn from your presentation?

Occlusion of AICA is rare and results in a lateral pontine syndrome (AICA syndrome). The symptoms include sudden onset of vertigo, nystagmus, dysarthria, hearing loss, tinnitus and a variety of ipsilateral features (hemiataxia, loss of sensation of the face etc). Cases are often misdiagnosed as TIA Some of these pontine infarcts present with stuttering symptoms, referred to as pontine warning syndrome (PWS) Aggressive BP control and hypotension lead to progression or recurrence of symptoms in PWS and should avoided

Biography:

Dr. Abu-Abaa graduated from the University Of Basrah College Of Medicine in Iraq in the top 5% of his class. Following graduation, he completed a Transitional Year of training followed by two years of Internal Medicine and six months of neurology training experiences. He is currently doing Internal Medicine training at Capital Health, Trenton, NJ.

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