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Case Reports in Neurology

Yosuke Aiba, Ryuji Sakakibara, Tsuyoshi Ogata, Ayako Iimura, Keiichiro Terayama, Keiko Suzuki, Shuichi Katsuragawa, Yuuki Kato, Fuyuki Tateno, Hitoshi Terada, Tsutomu Inaoka, Tomoya Nakatsuka
Young-onset (< 65 years) dementia is a challenging clinical problem. A 61-year-old man visited our clinic because of a 2-year history of mild cognitive impairment of the executive disorder type. He was initially suspected of having young-onset Alzheimer's disease due to the lack of motor signs or hippocampal atrophy by conventional brain MRI. However, he proved to have anosmia, erectile dysfunction, hypersexuality, constipation, REM sleep behavior disorder, and emotional lability; imaging findings included positive brain perfusion SPECT, nigrosome MRI, DAT scan, and MIBG myocardial scintigraphy...
September 2018: Case Reports in Neurology
Alwaleed Aljohar, Taim Muayqil, Abdulrahman Aldeeri, Anwar Jammah, Ahmad Hersi, Khalid Alhabib
We report the case study of a 70-year-old gentleman who presented with isolated, slowly progressive dizziness after prolonged standing and was eventually diagnosed with pure autonomic failure. Initially, his symptoms improved with the use of midodrine and fludrocortisone, but gradually became refractory and disabling. Despite multiple therapeutic interventions, his symptoms persisted along with worsening supine hypertension. We discuss the challenges faced in the treatment of an uncommon condition and discuss the clinical utility of performing serial 24-h ambulatory monitoring to detect subclinical blood pressure fluctuations...
September 2018: Case Reports in Neurology
Fardad T Afshari, Dhruv Parikh, Vladimir Petrik
Spontaneous spinal epidural haematoma is a rare entity associated with high morbidity. Although there are previous reports of spinal haematoma secondary to X-linked genetic haemophilia, there are no such cases secondary to acquired autoimmune haemophilia. We report the case of a 71-year-old patient who presented with sudden quadriplegia secondary to cervical (C2 to T1) epidural haematoma as a result of undiagnosed autoimmune acquired haemophilia A. She underwent emergency cervical laminectomy and evacuation of spinal haematoma with significant recovery in upper limb function...
September 2018: Case Reports in Neurology
Yuki Nakatani, Natsuki Tanaka, Tomomi Enami, Seigo Minami, Tomoko Okazaki, Kiyoshi Komuta
Lambert-Eaton myasthenic syndrome (LEMS) is a representative paraneoplastic neurological syndrome. Recently, nivolumab, an anti-programmed cell death 1 inhibitor, has been approved for advanced non-small-cell lung cancer. Careful attention should be paid to immune-related adverse events (irAEs), including neurotoxicity. We herein report a 73-year-old woman with LEMS that occurred during nivolumab treatment for pulmonary squamous cell carcinoma. After the 20th week of nivolumab, she experienced various neurological symptoms such as ptosis, lower limb weakness, and photophobia...
September 2018: Case Reports in Neurology
Christian Saleh, Elvire Michel-de Cazotte, Margret Hund-Georgiadis
The azygos anterior cerebral artery (AACA) is a large single anterior cerebral artery that supplies both medial territories of the anterior cerebral hemispheres. Occlusion of the AACA can result, therefore, in bifrontal infarction. We report a patient who suffered from a tetraparesis following a bilateral anterior cerebral artery territory infarction due to an occluded AACA and provide a brief review of the literature.
September 2018: Case Reports in Neurology
Christian Saleh, Nino Akhalbedashvili, Maria Garcia Peraza, Konstantinos Athanasios Boviatsis, Margret Hund-Georgiadis
Hemangioblastomas represent 3% of all central nervous system (CNS) tumors. The majority of CNS hemangioblastomas are infratentorial, with the cerebellum being the most frequent location, while 13% are found in the brainstem. Symptoms of brainstem hemangioblastomas can be very subtle and might therefore be overlooked or misinterpreted. We report the case of a patient with a hemangioblastoma at the junction of the medulla oblongata and the cervical spine and provide a brief review of the literature.
September 2018: Case Reports in Neurology
Mathias Bürki, Liliane Kappeler, Robert Bühler, Dirk Springe, Lukas Ebnöther, Marcos Delgado
We report of a 75-year-old patient with stroke-like presentation, where cerebral imaging led to the diagnosis of a massive arteriovenous malformation (AVM) of the whole left hemisphere. We suggest considering AVM as a differential diagnosis in patients with symptoms of acute stroke despite age and, in the absence of contraindications, in this setting to obtain MRI or CT angiography of the brain.
September 2018: Case Reports in Neurology
Sarkis Morales Vidal, Geeta Verma, Carolyn Goldschmidt, José Biller
Stroke in young women is commonly cryptogenic or associated with an underlying hypercoagulable state (e.g., hormonal contraception). Paradoxical embolization has been postulated as a potential risk factor for stroke in young adults. Many sources of venous thrombosis leading to paradoxical embolization have been described. There have been few reported cases of uterine enlargement leading to iliac vein compression and paradoxical embolization. We present the case of a young adult woman who had a left middle cerebral artery infarction related to patent foramen ovale and right common iliac vein compression from an enlarged fibroid uterus...
September 2018: Case Reports in Neurology
Kyu-On Jung, Seung-Jae Lee, Hyung Jun Kim, Deokhyun Heo, Jeong-Ho Park
Cerebral ischemia may be rarely associated with a hypoplastic vertebrobasilar system. Intracranial lipoma is also a very rare congenital malformation. We report the case of a 52-year-old woman with vertebrobasilar transient ischemic attack associated with basilar artery hypoplasia and coincidental intracranial lipoma. She presented with sudden-onset dizziness, anarthria, and quadriplegia lasting for about 30 min. The patient's initial blood pressure was measured at 200/120 mm Hg. The magnetic resonance and computed tomographic images showed the absence of an acute ischemic lesion in the brain but revealed a hypoplasia of the basilar artery and bilateral V4 vertebral arteries...
September 2018: Case Reports in Neurology
Won-Bae Seung
The authors here report a case of stent-assisted angioplasty under intravascular ultrasound (IVUS) guidance for the treatment of spontaneous bilateral extracranial vertebral artery (VA) dissection. A 47-year-old woman presented with spontaneous severe posterior neck pain. Examinations revealed bilateral extracranial VA dissection, which was thought to be the reason for her symptom. However, since the pain was gradually worsening even after sufficient medical treatment, she underwent stent angioplasty under IVUS guidance, following which her symptoms improved...
September 2018: Case Reports in Neurology
Filadelfiya Zvinovski, Robert Battisti
Thiamine deficiency is a condition characterized by several different presentations, but one of the most devastating is dry beriberi. It is associated with polyneuropathy and muscle weakness which typically affects the lower extremities and progressively involves the upper extremities. This case outlines a case of a 41-year-old man that presented to the hospital with diffuse weakness and decreased sensation in his legs and hands over a 3-day period. The patient's medical history revealed a gastric bypass surgery 4 months previously in Tijuana, Mexico, with no follow-up, binge drinking on weekends, and emesis in the past few weeks...
September 2018: Case Reports in Neurology
Alexus P Taddonio, Eric J Veloso, Kelly J Baldwin
Necrotizing and granulomatous meningoencephalitis are common central nervous system diseases known to affect canines. To date, necrotizing granulomatous meningoencephalitis has yet to be described in humans. Current studies of presumed pathogenesis and possible treatment options have only been described in canines. This is a case report of a 55-year-old female patient who was diagnosed with necrotizing granulomatous meningoencephalitis in the setting of new-onset neurological symptoms without any infectious or malignant source...
September 2018: Case Reports in Neurology
Fumihito Yoshii, Yuichi Tomori, Teruo Mori
We present diffusion tensor tractography (DTT) findings in a case of hypertrophic olivary degeneration (HOD) and cerebellar ataxia. A 56-year-old man presented with abnormal ataxic gait and dysarthria. MRI 5 months after onset showed chronic pontine hematoma and enlarged bilateral inferior olivary nuclei. DTT showed decreased volume of the bilateral central tegmental tract, in accordance with the conventional hypothesis that HOD is associated with neurologic insult to the Guillain-Mollaret triangle. The patient's cerebellar ataxia was speculated to be due to decreased decussating fibers of the superior cerebellar peduncle, and this was confirmed by DTT...
September 2018: Case Reports in Neurology
Won-Bae Seung
A proximal occluded vertebral artery (VA) with reconstitution by muscular collateral vessels is a relatively common finding. However, due to inadequate intracranial anastomosis and hypoplasia or stenosis of the opposite VA, a number of patients develop symptoms of brain ischemia. In the current case, a 63-year-old man presented with repeat neurological symptoms such as dizziness, nausea, vomiting, dysarthria, left hemiparesis, and right hemianopsia. Magnetic resonance imaging revealed multiple posterior infarctions...
September 2018: Case Reports in Neurology
Sakis Lambrianides, Evgenios Kinnis, Eleni Leonidou, Marios Pantzaris
Psoriasis is a relatively common immune-mediated chronic inflammatory skin disease. It is well known that interferon-beta, a drug used in the management of relapsing-remitting multiple sclerosis, could exacerbate or induce de novo psoriasis. There is limited evidence in the literature based only on case reports that natalizumab could induce or aggravate psoriasis. In this case study, we present a 33-year-old patient who developed plaque psoriasis during natalizumab treatment.
September 2018: Case Reports in Neurology
Conan So, Naveed Chaudhry, Dheeraj Gandhi, John W Cole, Melissa Motta
Endovascular thrombectomy following an acute ischemic stroke can lead to improved functional outcome when performed early. Current guidelines suggest treatment within 6 h after symptom onset. Recent studies including the DEFUSE-3 and DAWN trials demonstrate that some patients may benefit from thrombectomy up to 16 and 24 h after symptom onset, respectively. We present a case of delayed thrombectomy in a 43-year-old man with acute dysarthria, left-sided weakness, and visual neglect. Initial MRI/A demonstrated a small completed stroke and a thrombus in the right middle cerebral artery...
September 2018: Case Reports in Neurology
Leema Reddy Peddareddygari, Kinsi Oberoi, Raji P Grewal
We report the clinical and genetic analysis of a 63-year-old man with progressive weakness developing over more than 20 years. Prior to his initial visit, he underwent multiple neurological and rheumatological evaluations and was treated for possible inflammatory myopathy. He did not respond to any treatment that was prescribed and was referred to our center for another opinion. He underwent a neurological evaluation, electromyography, magnetic resonance imaging of his legs, and a muscle biopsy. All testing indicated a chronic myopathy without inflammatory features suggesting a genetic myopathy...
September 2018: Case Reports in Neurology
Pushpa Raj Puri, Michael Anders Petersen
Vertebral artery aneurysms are rare and challenging as they are usually asymptomatic and, therefore, often overlooked. We report the case of a 73-year-old man with a history of progressive dysphagia for 1 year. Computed tomography (CT) and computed tomography with angiography (CTA) of the cerebrum revealed a giant vertebral artery aneurysm compressing the medulla. Fiberoptic endoscopic evaluation of swallowing (FEES) revealed recurrent nerve paralysis. The patient was managed conservatively since the aneurysm was completely thrombosed...
September 2018: Case Reports in Neurology
Maxim Oliver, Lisa Dyke, Alex Rico, Mario Madruga, Jorge Parellada, Steve J Carlan
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, fatal human prion disease that is characterized by progressive dementia and neurologic degeneration. It can mimic multiple other neurological disorders, and a high index of clinical suspicion is necessary to make a diagnosis. A 74-year-old woman with a 3-month history of a stroke and progressive neurologic deterioration was found to have sCJD. She expired within a week of her diagnosis. Autopsy revealed spongiform encephalopathy consistent with prion disease, and genetic analysis revealed 129 polymorphism and no pathologic mutation, confirming the diagnosis of nonfamilial human prion disease...
September 2018: Case Reports in Neurology
Takahiro Makino, Isamu Sugano, Ikuo Kamitsukasa
A 62-year-old male with a history of alcohol abuse was admitted with a headache and rapidly progressing altered consciousness that led to coma over several hours. Blood and cerebrospinal fluid cultures were positive for Edwardsiella tarda . Despite prompt treatment initiation, the patient died on the third hospital day. Autopsy showed meningitis of the entire cerebrum with ventriculitis, and alcoholic fatty liver was observed. Clinicians should be cognizant of E. tarda meningoencephalitis, a rare presentation which can be associated with poor outcomes in patients with excessive alcohol consumption and alcoholic liver disease...
May 2018: Case Reports in Neurology
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