ABSTRACT BACKGROUND Cerebral amyloid angiopathy (CAA) has been reported to present as convexity subarachnoid hemorrhage (cSAH). Lesser known is that cSAH can herald intracerebral hemorrhage (ICH) and ischemic lesions. We present seven new cases with 11 C‐Pittsburgh compound B (PiB) positive positron emission tomography (PET) scans including two with biopsy, review the literature and comment on clinical and radiological findings. METHODS Patients with cSAH identified on CT, underwent MR imaging and MR angiography to exclude intracranial aneurysm. Nonaneurysmal cSAH were further prospectively evaluated for amyloid angiopathy using PiB. Clinical and radiological features of cSAH, subsequent ICH and ischemic lesions were characterized. RESULTS Seven patients with nonaneurysmal cSAH fulfilled the Boston criteria for probable CAA. All had PiB PET scans consistent with CAA. Of the 4 patients who had contrast MR Imaging all had enhancement overlying the cSAH, followed by ICH in three cases. All patients presented with transient sensory symptoms. All patients had small punctate subcortical and cortical infarcts on diffusion‐weighted MR imaging. Literature review revealed subsequent ICH in approximately 11/79 patients. CONCLUSION The finding of cSAH and PiB binding in our patients suggest underlying CAA. cSAH may be associated with ischemic lesion as well as future ICH occurrence.

Purpose: Cardiac asystole is known to cause clinical manifestations mimicking seizures. The recognition of this uncommon phenomenon is important to expedite appropriate clinical intervention and avoid unnecessary morbidity as well as potential mortality.Methods: We retrospectively reviewed video-electroencephalographic (EEG) records from January 2008 to December 2013 for relevant cases.Results: We identified four patients who experienced nine events of asystole accompanied by seizure-like activity captured on video-EEG. None had evidence of epilepsy on video-EEG. Semiological features of captured clinical events included aura, automatisms, generalized tonic activity and focal as well as generalized myoclonus. No patient had generalized tonic-clonic seizures. A peculiar rapid breathing pattern was seen preceding the onset of asystole. General pallor was observed during asystole, followed by flushing on recovery. Seizure-like semiology was observed in three stages; pre-asystole, during asystole and after resumption of cardiac rhythm. The EEG demonstrated generalized slowing followed by generalized suppression during asystole and generalized slowing again on resumption of sinus rhythm ("slow-flat-slow" pattern). All patients had dual-chamber pacemakers implanted. On follow-up, they have remained symptom-free without antiepileptic medications.Conclusions: Cardiac asystole can be associated with features closely mimicking seizures. Recurrent episodes of cardiac asystole can be stereotypical in a given patient. There are some diagnostic clues in semiology. Crown Copyright (C) 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

BACKGROUND AND AIM:The difficulties in differentiating epileptic seizures (ES) from psychogenic non-epileptic seizures (PNES) are well known. However, interventions to enhance diagnostic accuracy have not been well studied. We sought to evaluate the accuracy of discrimination between ES and PNES before and after targeted training among medical students.METHODS:A teaching module incorporating videos of typical ES and PNES was used for training. Typical ES and PNES, 10 each, were shown in a random mix. The participants were asked to make a diagnosis as the baseline test, followed by a detailed discussion on videos. One month later, a 1 h lecture was delivered on the diagnosis and classification of seizures, followed by two more tests 3 and 6 months later, using a similar format, but different videos. A group of emergency medicine trainees also went through the preteaching test for comparison. We used summary receiver operating characteristic curves and area under the curve (AUC) to quantify the discriminating ability and z scores to assess the differences between AUC between different stages of training.RESULTS:In medical students, the AUC improved significantly from 0.52 (95% CI 0.49 to 0.55) at the baseline to 0.64 (95% CI 0.59 to 0.69, p<0.001) at 3 months and 0.63 (95% CI 0.57 to 0.69, p<0.001) at 6 months. At 3 and 6 months testing, they achieved results similar to that of emergency medicine trainees (p=0.5).CONCLUSIONS:Targeted video-based training increases the accuracy of visual discrimination of seizures short-term and medium-term.

Severe cardioinhibitory vasovagal syndrome is characterised by syncope accompanied by cardiac asystole which may lead clinically to seizure-like motor activity. Vasovagal syncope usually occurs in erect posture and is often provoked by emotional or physical triggers. We report two patients who presented with severe cardioinhibitory vasovagal syncope accompanied by cardiac asystole resulting in seizure-like motor manifestations in sleep and supine posture. Both cases were initially diagnosed as epilepsy and treated with antiepileptic drugs. We discuss the putative mechanisms of this rare condition and its potential for misdiagnosis as epilepsy.

Background: Computer-assisted-telephone-interviewing (CATI), widely used in market research, could be a useful alternative for conducting diagnostic interviews in epilepsy epidemiology.Methods: We administered a diagnostic seizure questionnaire by CATI, interpreting the responses with standardized classification guidelines, compared against an epilepsy specialist's assessment, for agreement [Kappa statistic (kappa)], sensitivity, specificity, positive predictive value, negative predictive value and Youden's Index (YI).Results: 99 outpatients with 382 lifetime events participated: 22 generalized-onset epilepsy [16 Idiopathic Generalized Epilepsy (IGE)], 59 partial-onset epilepsy, 12 non-epileptic and 6 uncertain. We observed almost perfect agreement in diagnosing epilepsy (kappa = 0.94), seizure-onset types (kappa = 0.84), simple or complex partial seizures (kappa = 0.87), any generalized non-convulsive seizure (kappa = 0.82), and IGE (kappa = 0.82). Although substantial, agreement was not as close for secondarily generalized seizures (kappa = 0.74), and generalized tonic-clonic seizures (kappa = 0.79). This related more to under-recognition of individual generalized non-convulsive seizures rather than misinterpretation of partial seizures.Discussion: Epilepsy diagnostic questionnaires administered by CATI and interpreted with standardized diagnostic guidelines can effectively classify epilepsy, most seizure types and IGE in outpatients with suspected seizures. Applying this diagnostic method in 'field' settings will allow firmer conclusions to be drawn on its wider epidemiological utility. (C) 2010 Elsevier B.V. All rights reserved.

Background: There are sporadic case reports of amyloid angiopathy presenting as subarachnoid haemorrhage (SAH). In previous case reports, the prognosis appears to be relatively benign. We have encountered three such cases where the prognoses are less benign. The clinical, imaging and biopsy features will be described below.