Ictal and interictal ocular motor abnormalities in EAs, including DBN, have been mostly described in EA2/PxMD-CACNA1A and are believed to be rare or absent in EA1/PxMD-KCNA1. 1 Previously, only interictal gaze-evoked nystagmus has been described in a single EA1/PxMD-KCNA1 patient. 2 Here, we expand interictal ocular motor impairment in EA1/PxMD-KCNA1 by showing the presence of central positional DBN, suggesting involvement of cerebellar nodulus, uvula, and/or tonsil. 3 The midline cerebellar atrophy found in our patients is consistent with this finding. 1,3 Ictally, there was spontaneous DBN in two of our patients, further suggesting transient floccular/parafloccular dysfunction. 3 Genetic assessment showed a novel disease-causing KCNA1 variant. Most pathogenic variants in EA1/PxMD-KCNA1 are missense changes, which ultimately disturb Kv1.1 channel opening, leading to excessive GABA release into Purkinje cells and reduced cerebellar inhibitory output. 4 In sum, interictal positional DBN, ictal spontaneous DBN, and cerebellar atrophy can be present in EA1/PxMD-KCNA1. The use of self-recording of eye movements, occlusive ophthalmoscopy, and positional testing with the help of video-oculography in the dark might further increase the detection of interictal and ictal forms of nystagmus in EAs. Informed Consent and Ethics Committee ApprovalWritten informed consent was obtained from the patients for the anonymized information to be published in this article. Ethics committee approval was also obtained.

Background Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. Methods Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. Results Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale <2. Twelve presented with acute basilar artery occlusion and were submitted to mechanical thrombectomy before percutaneous transluminal angioplasty and stenting, while the remaining had severe basilar artery stenosis. Successful stent placement was achieved in 22 (88%). Procedure-related complications included new small ischemic lesions (16%), basilar artery dissection (8%), vertebral artery dissection (12%) and death (12%). At 3 months post-percutaneous transluminal angioplasty and stenting, 10 out of 23 patients (43.5%) were independent (mRS ≤ 2) and six died. Fourteen patients underwent transcranial Doppler ultrasound 3 months post-percutaneous transluminal angioplasty and stenting: 12 showed residual stenosis, one significant stent restenosis and one presented stent occlusion. Conclusions Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.

Introduction: Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned. Objectives: To compare patients treated with IVT before MT with those treated with MT alone, in a real-world scenario. Methods: Retrospective analysis of AIS patients with LVO of the anterior circulation who underwent MT, with or without previous IVT, between 2016 and 2018. Results: A total of 524 patients were included (347 submitted to IVT+MT; 177 to MT alone). No differences between groups were found except for a higher time from stroke onset to CT and to groin puncture in the MT group (297.5 min vs 115.0 min and 394.0 min vs 250.0 min respectively, p < 0.001). Multivariable analysis showed that age<75 years (OR 2.65, 95% CI 1.71À4.07, p < 0.001), not using antiplatelet therapy (OR 1.93, 95% CI 1.21À3.08, p = 0.006), low prestroke mRS (OR 4.33, 95% CI 1.89À9.89, p < 0.001), initial NIHSS (OR 0.89, 95% CI 0.86À0.93, p < 0.001), absent cerebral edema (OR 7.83, 95% CI 3.31À18.51, p < 0.001), and mTICI 2b/3 (OR 4.56, 95% CI 2.17À9.59, p < 0.001) were independently associated with good outcome (mRS 0-2). Conclusions: Our findings support the idea that IVT before MT does not influence prognosis, in a real-world setting.

Background: Acute vertigo (AV) is often a challenging condition. Because of its multiple causes, patients are frequently observed by neurologists and physicians from other areas of specialites, particularly Ear, Nose, and Throat (ENT). We aimed to assess the diagnostic accuracy of AV in patients observed by Neurology and other medical specialties. Materials and Methods: Retrospective cross-sectional study with the selection of all patients with AV observed by Neurology at the Emergency Department (ED) of a tertiary center in 2019, regarding demographic data, imaging studies, diagnosis by Neurology and ENT at the ED, and diagnosis after ED discharge by different medical specialties. Results: In all, 54 patients were selected, 28 (52%) of them were women. The mean age was 59.96±14.88 years; 48% had a history of AV and 89% underwent imaging studies (computed tomography scan and/or magnetic resonance imaging scan). The most frequent diagnosis established by Neurology was benign paroxysmal positional vertigo, followed by vestibular neuronitis; 28 patients were also observed by ENT with an overall concordance rate of diagnosis of 39%. After ED discharge, most patients were observed at the Balance Disorders Outpatient Clinic. Diagnosis by Neurology at the ED was not significantly different from observation by other medical specialties after ED discharge regarding the distinction between peripheral and central causes of AV (κ=0.840, 95% confidence interval: 0.740 to 0.941, P<0.005). Conclusions: Neurologists can effectively differentiate central and peripheral causes of AV at the ED. Patients with AV should be primarily evaluated by Neurology at the ED, avoiding redundant observations and allowing faster patient management.

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