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Abbie S Ornelas, Alyx B Porter, Akanksha Sharma, Molly G Knox, Lisa A Marks, Dean M Wingerchuk, Cumara B O'Carroll
Alternating electrical fields can disrupt mitosis leading to apoptosis of rapidly dividing cancer cells. The device that utilizes this mechanism is known as tumor-treating fields (TTFields). TTFields can be applied by ceramic transducer arrays on a shaved scalp to deliver the alternating electric activity to patients with glioblastoma (GBM). It has FDA approval for use in both recurrent and newly diagnosed GBM. The objective is to critically appraise the current evidence for the use of TTFields as adjunctive treatment to newly diagnosed GBM...
March 2019: Neurologist
Sara C LaHue, Dolores Torres, Nicole Rosendale, Vineeta Singh
OBJECTIVES: To describe the clinical characteristics and risk factors of male-to-female transgender (transwomen) patients with acute stroke. METHODS: The study population included all patients admitted for stroke at San Francisco General Hospital from October 1, 2010 through August 31, 2017 who self-identified as transwomen. Patient charts were reviewed by the study coauthors for demographics, stroke risk factors, stroke characteristics, and clinical outcomes. Means, percentiles, and ranges were calculated...
March 2019: Neurologist
Donal Fitzpatrick, Alberto Blanco-Campal, Lorraine Kyne
Posterior cortical atrophy (PCA) and logopenic variant primary progressive aphasia (LvPPA) are considered early-onset dementias most commonly caused by Alzheimer pathology. PCA is characterized by a progressive decline in higher order visual processing functions, whereas LvPPA is a form of primary progressive aphasia. The clinical presentation of both syndromes is typically earlier in life relative to the more typical "amnestic" form of Alzheimer disease. Prominent language deficits have been well described in PCA...
March 2019: Neurologist
Kate W Grimsrud, Maciej M Mrugala
INTRODUCTION: Epidermal growth factor receptor (EGFR) mutation status is strongly correlated with leptomeningeal carcinomatosis in non-small cell lung cancer. Historically, patients were treated with radiotherapy, intrathecal chemotherapy or first-generation EGFR tyrosine kinase inhibitors (TKIs); however, most would eventually develop resistance and disease progression. Therefore, recent interest has sparked in investigating next-generation EGFR-TKI monotherapy. CASE REPORTS: We describe 2 patients with non-small cell lung adenocarcinoma who later presented with leptomeningeal disease, treated with next-generation EGFR-TKI monotherapy, independent of whole-brain radiotherapy, with favorable response and outcome...
March 2019: Neurologist
Stela Celaj, Shyam Prabhakaran
Transthoracic echocardiogram (TTE) is widely used as part of the work-up for ischemic stroke. However, the added utility of TTE in the management of small single subcortical infarcts (SSSI) has not been extensively evaluated. Therefore, we aimed to determine the frequency of high-risk and medium-risk cardioembolic sources diagnosed by TTE in SSSI patients, and whether the findings altered clinical management. We performed a retrospective analysis of a prospective cohort of patients with confirmed acute ischemic stroke enrolled in a single-center observational registry between August 2012 and July 2014...
March 2019: Neurologist
Aaron I Loochtan, Andrew R Spector, Saurabh R Sinha, David P Lerner
OBJECTIVES: Neurological emergencies comprise much of neurology residency, but there may be a lack of clinical experience. For our program, oral examinations have been used to assess resident readiness for additional clinical independence. In this study, we examined the perceptions of learners and examiners of oral case examinations. METHODS: Six attending physicians administered case-based oral examinations to 8 trainees. Each case involved a chief complaint and progressed through a clinical encounter...
March 2019: Neurologist
José Beato-Coelho, Ricardo Varela, Luciano Almendra, Mário Carvalho, Cristina Duque, Miguel Patrício, João Sargento-Freitas, António Freire, João Lemos
OBJECTIVE: Presumed microvascular ischemia is the most frequent cause of ocular motor palsy (OMP). Ischemic stroke incidence after an episode of microvascular OMP (mOMP) is not established, contrasting with other common vascular conditions, such as lacunar ischemic stroke (LS). We sought to compare the incidence of subsequent ischemic stroke between mOMP and LS populations. METHODS: A retrospective observational analysis was conducted on acute patients presenting with either mOMP or LS...
March 2019: Neurologist
Benzion Blech
No abstract text is available yet for this article.
March 2019: Neurologist
Benzion Blech, Brian W Chong, Kara A Sands, Dean M Wingerchuk, William T Jackson, Lisa A Marks, Cumara B O'Carroll
Mechanical thrombectomy (MT) is the standard of care for patients who present with an acute ischemic stroke within 6 hours of symptom onset, and up to 24 hours in appropriately selected patients. However, optimal postoperative management of these patients remains uncertain, especially with regard to blood pressure control. To review the existing literature to define potential blood pressure goals in the immediate postoperative period in patients who undergo MT for acute ischemic stroke. The topic was defined through a clinical scenario and the subsequent development of a targeted clinical question...
January 2019: Neurologist
Karissa N Arca, Bart M Demaerschalk, Diana Almader-Douglas, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: The risk of developing intracerebral hemorrhage (ICH) after the administration of intravenous tissue plasminogen activator for acute ischemic stroke is well established in the general population. However, the risk associated with stroke thrombolysis in patients with a history of cerebral microbleeds (CMBs) is undetermined. OBJECTIVE: The main objective of this study was to critically assess current evidence with regard to the risk of development of ICH after the administration of intravenous tissue plasminogen activator for acute ischemic stroke in patients with CMBs...
January 2019: Neurologist
Tamra Ranasinghe, SoHyun Boo, Amelia Adcock
OBJECTIVE: Illustrates the importance of differentiating limb-shaking transient ischemic attack (LS-TIA) from focal seizures and carefully selecting patients for intracranial stenting. BACKGROUND: LS-TIA is associated with severe carotid stenosis or occlusion, often precipitated by cerebral hypoperfusion. A case study of 313 patients with symptomatic intracranial artery stenosis/occlusion reported 11% with LS-TIA. In our literature search, we did not find any other cases of successful treatment of LS-TIA with an intracranial Wingspan stent...
January 2019: Neurologist
J Bernardo Escribano Paredes, Rodrigo Carrasco Moro, María López Gutiérrez, Héctor Pian Arias, Mónica García-Cosío, Sebastián García Madrona, Velina Nedkova Hristova, Javier Martínez Poles, Javier Buisán Catevilla Francisco
INTRODUCTION: Castleman disease (CD) is a rare pathologic process of unknown etiology, characterized by non-neoplastic lymph node enlargement. Two distinct histologic patterns are recognized; the hyaline-vascular type and the less common plasma cells type. Another intermediate type has been described. The clinical features are classified into 2 categories, localized (unicentric) and generalized (multicentric), the later associated with systemic manifestations and poor prognosis. CD affecting the central nervous system is extremely rare...
January 2019: Neurologist
Jamir P Rissardo, Ana L F Caprara, Juliana O F Silveira
INTRODUCTION: Jarisch-Herxheimer reaction (JHR) is defined as a transient immunologic reaction, classically seen in patients during syphilis treatment. JHR is a rare cause of status epilepticus (SE) in neurosyphilis. We describe a case of generalized convulsive SE (GCSE) probably secondary to JHR in a patient with neurosyphilis. CASE REPORT: A 23-year-old man presented with progressive behavioral changes with 4 months of onset and pupillary alteration with 9 months of onset...
January 2019: Neurologist
Agustin Pappolla, Facundo Silveira, Jorge Norscini, Luis Miquelini, Liliana Patrucco
Giant cell arteritis is a large vessel vasculitis with neurological manifestations that range from visual disturbances to ischemic stroke. Among the former, visual acuity and visual field defects are prevalent, with anterior ischemic optic neuropathy being their most frequent cause. We present a clinical case in which the presenting ocular feature of the disease was a peripheral monocular visual field defect secondary to optic perineuritis.
January 2019: Neurologist
Qin Zhang, Bei Cao, Yongping Chen, Yan Liang, Qianqian Wei, Dong Zhou, Huifang Shang
INTRODUCTION: Facial onset sensory and motor neuronopathy (FOSMN) syndrome was a rare and slowly progressive neurodegenerative disorder, which heralded by sensory symptoms within the face, and followed by evolution of sensory and motor deficits in the face and limbs. The underlying pathogenesis of FOSMN remains to be fully elucidated. CASE REPORT: A 40-year-old man was admitted to our hospital with facial sensory deficits spreading in a rostral-caudal manner. He then developed diffuse fasciculation, bulbar signs, atrophy and weakness of facial, neck, and limb muscles progressively, a process resembling amyotrophic lateral sclerosis...
January 2019: Neurologist
Michael E Christiansen, Cumara B O'Carroll, Gyanendra Kumar, Brandon T Larsen, Oana M Dumitrascu
INTRODUCTION: Takayasu arteritis is a large-vessel vasculitis that may cause oculo-cerebral ischemia. We report a patient with visual loss as initial manifestation, and discuss transcranial Doppler (TCD) findings before and after surgical revascularization. CASE DESCRIPTION: A 19-year-old female developed episodes of transient positional right vision loss, progressing to permanent right vision loss and bright light-induced left amaurosis. Examination demonstrated subclavian bruits, palpable epigastrium aortic pulsation, faint radial pulses, right retinal pallor, arteriolar narrowing, and bilateral boxcarring...
January 2019: Neurologist
Zilong Hao, Xiaohui Lai
Sturge-Weber syndrome (SWS) is a sporadically occurring neurocutaneous syndrome characterized by port-wine stain over the face, ocular abnormalities (glaucoma and choroidal hemangioma), and leptomeningeal angiomas. It is usually diagnosed in infancy, but it may occasionally present in adulthood with seizures or stroke-like episodes. Here, we report a 46-year-old male patient, having SWS coexisting with moyamoya disease, attending our hospital due to sudden loss of consciousness. We also searched PubMed (from its earliest date to August 2014) for case reports mentioning that SWS presents in adulthood...
January 2019: Neurologist
Tanya N Turan, Sami Al Kasab, Azhar Nizam, Jessica Hannah, Neil Gordon, Michael J Lynn, Colin P Derdeyn, David Fiorella, L Scott Janis, Bethany F Lane, Jean Montgomery, Marc I Chimowitz
BACKGROUND: Analyses from the Stenting and Aggressive Medical management for prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial showed that good control of vascular risk factors (systolic blood pressure, low-density lipoprotein, and exercise) was associated with fewer vascular events and exercise had the biggest impact on the outcome. We sought to determine the type and duration of exercise performed by SAMMPRIS patients during the trial. METHODS: SAMMPRIS aggressive medical management included a telephonic lifestyle modification program, INTERVENT, that was provided free of charge to all subjects during the study...
January 2019: Neurologist
Harsh V Gupta, Christopher W Finlay, Sajish Jacob, Sunil K Raina, Ricky W Lee, Archana Hinduja
OBJECTIVE: Our study aimed to determine the prognostic value of elevated Brain Natriuretic Peptide (BNP) among patients who received intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). BACKGROUND: The elevation in BNP level is correlated with infarct size, poststroke mortality, and CHADS2 score. Currently, there is a lack of validated biomarker to predict the outcome in patients with acute ischemic stroke, and there is a complex interaction amongst multiple variables...
January 2019: Neurologist
Min Li, Zhuolin Chen, Li Xu, Zhouqing Gan, Fuhua Peng, Jia Liu
Cryptococcal meningitis (CM) is found to occur in immunosuppressed patients and those who are immunocompetent. This study aimed to compare the presentation and outcome of CM in patients who are human immunodeficiency virus (HIV) negative with and without immunosuppression. We reviewed 255 clinical records from patients with CM who are HIV negative. The demographic and clinical characteristics, cerebrospinal fluid profiles, brain magnetic resonance imaging, treatment, and outcomes of these individuals were retrospectively analyzed...
January 2019: Neurologist
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