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Data regarding the risk of cerebrovascular events following transient global amnesia (TGA) remain controversial. While some neuroradiological studies suggest an underlying cerebrovascular etiology, results from the clinical studies have been largely conflicting. We, therefore, aimed to evaluate the risk of ischemic stroke in a large, nationally representative sample of patients with TGA. We utilized the Nationwide Readmissions Database 2010–2015 to identify all hospitalizations with the primary discharge diagnosis of TGA. We selected a 2% random sample of all elective admissions to be included as controls. A propensity score-matched analysis was performed to match patients with TGA and the controls. The primary outcome was readmission due to ischemic stroke up to 1 year following discharge from the index hospitalization, assessed using the Kaplan–Meier survival analysis in the propensity-matched groups. There were 24,803 weighted hospitalizations due to TGA (mean ± SD age: 65.6 ± 10.4 years, female: 54.9%) and 699,644 corresponding controls. At baseline, patients with TGA were significantly older, more likely to be male, and had a higher prevalence of hypertension, hyperlipidemia, coronary artery disease, cerebrovascular disease, and migraine, as compared to the controls. However, after propensity score matching, we obtained 21,202 cases and 21,293 well-matched corresponding controls, and the risk of readmission due to ischemic stroke in patients with TGA was not different compared to the control group (HR: 1.13, 95% CI 0.62–2.05, P 0.686) during the mean (SD) follow-up period of 192.2 (102.4) days. After adjustment for demographics and cerebrovascular risk factors, TGA is not associated with an increased risk of subsequent ischemic stroke.

Low serum albumin levels have been reported to be an independent predictor of increased morbidity and mortality in multiple disease conditions. The aim of our study was to identify the impact of low serum albumin levels on mortality and outcomes at discharge in patients with intracerebral hemorrhage. We retrospectively reviewed our prospective database of patients with intracerebral hemorrhage from January 2010 to December 2011. Patients were dichotomized into two groups based on their serum albumin levels upon admission. Hypoalbuminemia was defined as serum albumin levels ≤3.4 g/dl. The two groups were compared using Fisher's exact test for categorical variables and t test for continuous variables. Poor outcome was defined as death or discharge to a long-term nursing facility (modified Rankin Score 4-6). Out of 97 patients admitted with intracerebral hemorrhage, 90 met our inclusion criteria (42 had normal levels and 48 had hypoalbuminemia). The baseline characteristics, risk factors, etiology, location and volume of intracerebral hemorrhage, admission blood glucose, white cell count, length of hospital stay, length of intensive care unit stay, and complications were similar between both groups. Although admission hypoalbuminemia did not impact in-hospital mortality (28 vs 24 %, p = 0.635), there was a significant increase in poor outcomes at discharge (59 vs 31 %, p = 0.009) (OR 1.8; 95 % CI; 1.2-2.8). Similar to other diseases, hypoalbuminemia was associated with poor functional outcomes in patients with intracerebral hemorrhage. This will need to be confirmed in larger prospective studies before adopting therapeutic and preventive strategies in future.

Objective: We are reporting a patient with pneumocephalus presenting as orthostatic headache. Introduction: Orthostatic headache is a prototypical manifestation of post-dural puncture headache (PDPH). A less common and under-recognized cause of post-epidural headache is pneumocephalus, which is characterized by a lack of relief by lying down. However, in a patient with coexisting PDPH, improvement of headache after lying down cannot reliably rule out the possibility of pneumocephalus. Design/Methods: Case report and literature review Results: A 24 year-old man received his first epidural steroid injection for his chronic low back pain. Immediately after the procedure, he complained of bilateral frontal headache that was worse on standing and better in supine position. IV fluids, caffeine and blood patch did not completely alleviate the presumed PDPH. A computed tomography (CT) of head revealed pneumocephalus in the frontal and temporal part of the right lateral ventricle. In the view of unexpected pneumocephalus on CT head, a magnetic resonance imaging (MRI) of brain with contrast was pursued. MRI brain again showed pneumocephalus. However, MRI brain did not reveal any abnormal leptomeningeal enhancement or subdural hygroma to suggest the presence of intracranial hypotension. His headache was further improved with high-flow oxygen therapy. Repeat head CT at one week post-discharge showed resolution of pneumocephalus. Discussion / Conclusion: Here we report a rare case of coexisting PDPH and pneumocephalus after epidural steroid injection. The lack of MRI brain findings for intracranial hypotension was unexpected, but not surprising as studies have shown up to 20-30[percnt] of patients with intracranial hypotension would have a normal cranial MRI. Since orthostatic headache is not reliable to rule out pneumocephalus, especially in patient with coexisting PDPH, we believe early brain imaging might be indicated in patients with orthostatic headache that is refractory of conventional therapy. Disclosure: Dr. Limaye has nothing to disclose. Dr. Mahuwala has nothing to disclose. Dr. Lee has nothing to disclose.