Background and Purpose-Perinatal stroke causes most term-born hemiplegic cerebral palsy. Many suffer additional sequelae. Periventricular venous infarction (PVI) is a common fetal stroke in which isolated subcortical injury may cause only motor deficits. However, cognitive, language, and behavioral deficits also occur. We hypothesized that ipsilesional cortical gray matter volumes are reduced in PVI. Methods-Children (12 months to 18 years) with MRI-confirmed PVI were identified through the Alberta Perinatal Stroke Project. We developed an MRI method to quantify sectional gray (GM) and white matter (WM) volumes from lesioned and unlesioned (control) hemispheres (OsiriX software). Differences in cortical GM and WM volumes were compared between hemispheres in preselected regions "above" the lesion (middle) and anterior and posterior to this. Outcomes dichotomized for "cortical dysfunction" (cognitive, behavioral, language) and motor deficit severity (Pediatric Stroke Outcome Measure) were compared with GM volumes.

Routine postoperative CT scans were found to have no significant effect on outcomes and complications, and a clinician's individual practice was the most significant factor for whether a patient received a routine postoperative CT scan. Future work should aim at providing well-defined indications for postoperative imaging.

Cytomegalovirus (CMV) is a double-stranded DNA virus from the herpes virus family. Disseminated or focal end-organ disease typically occurs in immunocompromised individuals, often in the setting of advanced HIV or organ transplantation. Neurologic manifestations include focal encephalitis, meningitis, ventriculoencephalitis, and polyradiculitis. After the advent of highly active antiretroviral therapy (HAART), the incidence of CMV disease has decreased by as much as 80%. 1 This decrease largely predates the widespread adoption of MRI into routine patient care. As a result, our understanding of CMV and the spectrum in which it radiographically manifests is limited. 2 We report a case of CMV ventriculoencephalitis and myelitis radiographically mimicking lateral medullary stroke in a patient with advanced HIV. Case reportA 50-year-old HIV-positive man was admitted for a 4-day history of diarrhea. He was referred to neurology for left-sided sensorimotor deficits, and an MRI reported as demonstrating a lateral medullary infarct (figure 1A). He was diagnosed with HIV 14 years ago and was well controlled on HAART up until 4 years ago, at which time he stopped all treatment because of a refusal to accept his diagnosis. His CD4 + count reached a nadir of 10 cells/mm 3 , and the peak viral load was 263,132 copies/mL. Seven months before presentation, he was admitted with disseminated CMV infection manifesting as CMV colitis and retinitis. At that time, he was treated with IV ganciclovir and discharged on prolonged suppressive therapy with oral valganciclovir. Collateral history revealed that he began having slowly progressive left hemibody sensorimotor symptoms 11 months before his current admission.

Purpose: St. Paul’s Hospital serves a low-SES, high-risk population in Vancouver’s ‘Downtown East Side.’ Our study characterizes the changing epidemiology, neurologic complications, investigation methods and outcomes of this group from 1995 to 2014. To date, our database is among the world’s largest. Methods: This retrospective chart review used ICD-9 codes to identify 922 cases of infective endocarditis satisfying Duke Criteria. We collected demographic data including Intravenous drug use (IVDU), HIV and Hepatitis status, and clinical data including neurologic complications, mortality rates and treatment. The cohort was divided into IVDU and non-IVDU and ‘first decade’ (1995-2005) versus ‘second decade’ (2006-2014). Univariate analysis was performed using chi-square and non-parametric t-tests. Results: Mortality was not different between the first and second decades [105/669 (15.7%) vs 35/253 (13.8%) p=0.4] but was significantly greater in non-IVDUs than IVDUs in the first decade only [61/297 (20.5%) vs 44/369 (11.9%) p=0.002]. Neurologic complications [141/922 (15.3%)] were more frequent in non-IVDUs versus IVDUs in the first decade only [44/310 (14.2%) vs 33/359 (9.2%) p=0.04]. Neurologic complications were more frequent in the second versus first decade [64/253 (25.3%) vs 77/669 (11.5%) p<0.001]. Mycotic aneurysms (MA) were more frequent in the second decade [11/253 (4.3%) vs 4/665 (0.6%) p<0.001]. In patients investigated for MA, CTA was employed more frequently in the second decade [31/64 (48%) vs 5/77 (6.5%) p<0.001]. Subjects with neurologic complications were more likely to receive cardiac surgery than those without neurologic complications in the first decade (OR=2.4, 95% CI:1.9-2.9) only. Conclusions: Our data show a trend toward a reduction in overall mortality from IE, but an increase in neurologic complications, particularly in non-IVDU patients. Embolic stroke remains the most frequent neurologic complication. Mycotic aneurysms remain uncommon. We observed a shift in favor of CTA vs DSA for the detection of MAs, with a corresponding increase in the frequency of MAs. The appropriateness of this practice remains to be determined.