journal
https://read.qxmd.com/read/38666270/rethinking-the-likelihood-of-myasthenia-gravis-exacerbations
#21
JOURNAL ARTICLE
Sohyeon Kim, Jae-Joon Lee, Hung Youl Seok
No abstract text is available yet for this article.
April 2024: Neurohospitalist
https://read.qxmd.com/read/38666269/reversible-cerebral-vasoconstriction-syndrome-secondary-to-loperamide-ingestion-a-case-report
#22
Ammar Jumah, Abdalla Jamal Albanna, Momina Qureshi, Shaneela Malik
Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular disorder highlighted by diffuse and multifocal vasoconstriction of the cerebral circulation. This syndrome has been reported to be associated with provoking vasoactive agents, and the identification of such offenders is quite challenging. In our case, the patient's RCVS was caused by the ingestion of loperamide. Although being reported in the cardiac literature, cerebral vasoconstriction due to loperamide has not been reported yet.
April 2024: Neurohospitalist
https://read.qxmd.com/read/38666268/steroid-responsive-parkinsonism-and-encephalopathy-a-case-report
#23
Toluwalase Oluwakemi Tofade, G Kyle Harrold, Arjun Laud, Anne-Marie Wills, Nagagopal Venna
We describe a patient who presented with rapidly progressive parkinsonism and encephalopathy and was diagnosed with seronegative autoimmune encephalitis (AE). Subacute parkinsonism as a manifestation of seronegative AE is uncommon with only a handful of similar cases published in literature. A 71-year-old man presented with severe flu like symptoms, rapidly progressive cognitive decline and was found to have parkinsonian features on examination. Initial brain magnetic resonance imaging (MRI) was unremarkable however, cerebrospinal fluid (CSF) analysis revealed a lymphocytic pleocytosis and elevated protein level...
April 2024: Neurohospitalist
https://read.qxmd.com/read/38666267/extended-window-thrombolytics-for-ischemic-stroke-a-telestroke-versus-in-person-experience
#24
JOURNAL ARTICLE
Nick M Murray, Paul Johnson, Marilyn McKasson, Julie Martinez, Stephen Chatwin, Adrian Püttgen
BACKGROUND AND PURPOSE: Telestroke evaluation of patients with acute ischemic stroke is supported by American Heart and Stroke Association Guidelines. However, there is no data on outcomes or safety of administering IV thrombolytic stroke therapy using extended window criteria (>4.5 h since onset of symptoms with a hyperacute MRI diffusion T2/FLAIR mismatch) via telestroke. Here, we report adverse events and outcomes of extended-window thrombolysis by telestroke vs in-person care...
April 2024: Neurohospitalist
https://read.qxmd.com/read/38666266/bihemispheric-seizure-without-generalization
#25
JOURNAL ARTICLE
Bryan J Neth, Rafid Mustafa
A 70-year-old male without prior psychiatric history presented with recurrent episodes (<60 seconds each, every 5-10 minutes) of left hemibody and right lower extremity jerking movements concerning for seizure with preserved awareness (Video). Examination showed left hemiparesis (leg > arm) in addition to right lower extremity weakness. Computed tomography showed a right parafalcine acute subdural hematoma (SDH). Clinical events did not recur after intravenous lorazepam (4 mg) and levetiracetam load (3500 mg), and his weakness improved...
April 2024: Neurohospitalist
https://read.qxmd.com/read/38235037/endovascular-thrombectomy-with-or-without-thrombolysis-for-stroke-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#26
JOURNAL ARTICLE
Rami Z Morsi, Yuan Zhang, Julián Carrión-Penagos, Harsh Desai, Elie Tannous, Sachin Kothari, Assem Khamis, Andrea J Darzi, Ammar Tarabichi, Reena Bastin, Layal Hneiny, Sonam Thind, Elisheva Coleman, James R Brorson, Scott Mendelson, Ali Mansour, Shyam Prabhakaran, Tareq Kass-Hout
BACKGROUND: To this date, whether to administer intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) for stroke patients still stirs some debate. We aimed to systematically update the evidence from randomized trials comparing EVT alone vs EVT with bridging IVT. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT with or without IVT in patients presenting with stroke secondary to a large vessel occlusion...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235036/concurrent-cardio-cerebral-infarction-a-case-report-and-literature-review
#27
Cortney de la Torre, Jaime S Wagner, Jindong Xu
Concurrent cardio-cerebral infarction (CCI) describes the simultaneous occurrence of an acute myocardial infarction and an acute ischemic stroke. It is a rare phenomenon, and no consensus yet exists on how to best treat it. CCI patients present with variable clinical scenarios and complications which makes the establishment of a treatment guideline difficult. We present here a case of a 67-year-old male with concurrent acute ST-elevation myocardial infarction and acute ischemic stroke due to right middle cerebral artery occlusion who was successfully treated with Tenecteplase and mechanical thrombectomy...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235035/an-unusual-cause-of-neck-pain-and-headache-in-pregnancy
#28
JOURNAL ARTICLE
Marcelo Morrice, Andrew Wilner
A previously healthy 21-year-old Caucasian female G1P0 at 32 weeks gestation presented to the ED for an episode of syncope. She also complained of headaches, neck pain, and blurry vision. Physical examination revealed a healthy pregnant female. Neurological examination demonstrated Grade III papilledema but was otherwise unremarkable. CT brain revealed hydrocephalus and intraventricular hemorrhage of unclear etiology MRI of the head was negative for a mass lesion. MRA/MRV of the head was negative, ruling out cavernous sinus thrombosis...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235034/impact-of-the-covid-19-pandemic-on-inpatient-utilization-for-acute-neurologic-disease
#29
JOURNAL ARTICLE
Alexander Yoo, Elan L Guterman, David Y Hwang, Robert G Holloway, Benjamin P George
Background and Objective: The initial months of the Corona Virus 2019 (COVID-19) pandemic resulted in decreased hospitalizations. We aimed to describe differences in hospitalizations and related procedures across neurologic disease. Methods: In our retrospective observational study using the California State Inpatient Database and state-wide population-level estimates, we calculated neurologic hospitalization rates for a control period from January 2019 to February 2020 and a COVID-19 pandemic period from March to December 2020...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235033/41-year-old-male-with-sub-acute-encephalopathy-seizures-and-end-stage-renal-disease-a-unifying-diagnosis-and-response-to-therapy
#30
JOURNAL ARTICLE
Tameena Wais, Karen P Ibarra, Dattanand M Sudarshana, Meghana Eswarappa, Meyeon Park, Renata C Gallagher, Brian Tsui, Stephanie Teixeira, S Andrew Josephson, Megan Richie
We describe a case of a 41-year-old male with a history of end-stage renal disease, hypertension, epilepsy, ischemic stroke, and traumatic brain injury transferred to our tertiary care center for subacute, progressive cognitive impairment. He was found to have disproportionate brain atrophy, focal seizures, and refractory hypertension. Given suspicion for an underlying genetic etiology, a genetic panel for progressive renal disease was sent, revealing two known pathogenic variants in a gene for a cobalamin metabolism disorder, Cobalamin C deficiency...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235032/parakinesia-brachialis-oscitans-and-excessive-yawning-from-tumefactive-demyelination
#31
JOURNAL ARTICLE
Chia-Chen Tsai, Joshua D Lee, Tychicus Chen
We present a case and video of a 31-year-old man with biopsy-confirmed tumefactive demyelination affecting the right internal capsule causing left hemiplegia, excessive yawning, and the curious but well-described phenomenon of parakinesia brachialis oscitans (PBO) with transient tonic elevation of his paralyzed arm while yawning. PBO is most commonly reported in ischemic stroke with internal capsule or pontomedullary brainstem lesions. Our case uniquely demonstrates this phenomenon in the case of tumefactive demyelination...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235031/tick-borne-encephalitis-in-a-6-year-old-patient-a-case-report
#32
JOURNAL ARTICLE
Carlo Alberto Cesaroni, Daniele Frattini, Marco Lecis, Federico Bonvicini, Domenico Bartolomeo, Susanna Rizzi, Carlotta Spagnoli, Manuela Napoli, Rosario Pascarella, Alessandro De Fanti, Carlo Fusco
Background: Tick-Borne Encephalitis virus (TBEV) is a positive-sense single-stranded RNA virus belonging to the Flaviviridae family. TBEV transmission typically occurs through infected Ixodes tick bite or by consumption of unpasteurised milk from infected cattle. Case report: We report the clinical, neuroimaging, electroencephalogram (EEG), and laboratory (microbiological tests and spinal tap) data of a 6- year-old boy with Tick-borne encephalitis. Our patient presented with a biphasic course, initially with a myositis-like picture on his first admission to the emergency department, and after a few days with an encephalitic picture, resulting in a second hospitalization...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235030/treating-the-neurologic-manifestations-of-wilson-s-disease-with-liver-transplantation
#33
Sarah Marmol, Paul Walker Maeder-York, Jennifer Hislop, Danielle S Shpiner, Jason Margolesky
Wilson's Disease (WD) manifests with systemic and neuropsychiatric symptoms, caused by an ATP7B genetic mutation, leading to an accumulation of copper. Presentations are diverse and the diagnosis should be considered in anyone under 50 with a new onset movement disorder. Early recognition and treatment can limit morbidity. While liver transplantation (LT) is recommended in WD patients with hepatic failure, its use for pure neurologic indication remains controversial. We present a patient who failed medical management and underwent LT for pure neurologic indications...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235029/anti-nmda-receptor-encephalitis-presenting-as-a-progression-of-disease-in-a-patient-with-underlying-congenital-leukodystrophy-case-report
#34
Garrett Friedman, James Hammock, Niki Holtzman-Hayes, Lauren Gluck
Anti-NMDA Receptor (NMDAR) Encephalitis (NMDARE) is an autoimmune disorder that is often debilitating and difficult to diagnose. Patients, especially those with underlying neuropsychiatric disorders, may experience delayed or misdiagnosis of NMDARE. Here, we report on a patient with known congenital leukodystrophy (CLD) and epilepsy with a challenging diagnosis of NMDARE. The patient first presented with progressive behavior changes and seizure-like episodes. Initial workup, including video EEG and brain MRI, were mostly unremarkable, and the patient's symptoms were resistant to treatment with multiple anti-epileptic drugs...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235028/outcomes-associated-with-levetiracetam-use-after-spontaneous-intracerebral-hemorrhage
#35
JOURNAL ARTICLE
Mary Stewart Leatherwood, Leslie A Hamilton, Jacob Barber, A Shaun Rowe
BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of seizures in patients with spontaneous intracerebral hemorrhage (ICH) who received prophylactic levetiracetam. METHODS: This was a retrospective cohort study evaluating the use of levetiracetam in patients without a history of seizures who experienced a spontaneous intracerebral hemorrhage. Patients were excluded if they were younger than 18 years of age, had a documented history of a seizure disorder, or had an antiseizure drug documented on their home medication list...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235027/evaluation-of-medication-exposure-on-exacerbation-of-disease-in-patients-with-myasthenia-gravis
#36
JOURNAL ARTICLE
Nick Petrucelli, Megan E Barra, Jennifer L Koehl
BACKGROUND AND PURPOSE: In patients with myasthenia gravis (MG), worsening of symptoms poses a risk of respiratory failure which can be precipitated by medication use. Although purported, the risks associated with administration of certain medications are not fully elucidated. Thus, clinical decision support involving a best practice alert was executed to caution providers of drug-disease interactions when ordering a potentially harmful medication. We performed an analysis of the alert overrides with subsequent medication exposure to determine the incidence of MG exacerbations...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235026/recurrent-pleomorphic-xanthoastrocytoma-presenting-with-diffuse-leptomeningeal-spread
#37
JOURNAL ARTICLE
Giovanna Grigsby-Rocca, Camilo Bermudez, Jessica D White, Bryan J Neth, Joon H Uhm, Rafid Mustafa
We report a case highlighting key clinical, CSF, and imaging findings of recurrent pleomorphic xanthoastrocytoma with leptomeningeal spread.
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235025/new-onset-seizures-in-hospitalized-covid-19-patients-a-systematic-review-and-meta-analysis
#38
JOURNAL ARTICLE
Daniah Shamim, Fatima Ganatra, Murtaza Khan, Gary Gronseth
OBJECTIVE: Seizures in COVID-19 patients continue to be a common reason for consulting the neurology service in the inpatient setting. This paper assesses the frequency of new onset seizures in adult hospitalized COVID-19 patients. METHOD: PubMed and EMBASE were searched, with fifteen cohort studies identified to calculate the primary outcome, which was the frequency of new onset seizures in hospitalized COVID-19 patients. An inverse variance meta-analysis of single proportions with a random effects model was applied to these cohort studies to calculate the primary outcome...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235024/diffuse-cerebral-edema-with-uncal-herniation-leading-to-brain-death-in-patient-with-fulminant-susac-syndrome-rare-complication-of-rare-disease
#39
Mariam Tsikvadze, Baltazar Machado De Villafane, Mariah Rose, Sarah Peacock, Jeffrey Brent Peel, Lauren Ng, Christopher Kramer, William D Freeman
Susac Syndrome was first described as an inflammatory microangiopathy of the brain and retina. Since then, multiple articles have been published in attempts to improve the understanding of this rare disease. Clinically Susac Syndrome is known to present with triad of encephalopathy, sensorineural hearing loss and branch of retinal artery occlusion (BRAO), along with characteristic "snowball" or "spoke" appearing white matter lesions of the corpus callosum. It has been characterized by vast heterogeneity in terms of its presenting symptoms, severity, and clinical course...
January 2024: Neurohospitalist
https://read.qxmd.com/read/38235023/severe-mimic-of-transverse-myelitis-spontaneous-non-traumatic-intramedullary-hematomyelia-a-case-report
#40
Devin Simon
Spinal cord hemorrhage remains an uncommon vascular pathology with no standard approach to treatment. Intramedullary hematomyelia is the rarest subtype and has only been described in case reports, making it a diagnosis easier to miss. A 55-year-old male with history of polysubstance abuse presented for abrupt onset non-traumatic back pain that progressed over several days evolving into paraplegia, sensory loss up to the T3 dermatome, and incontinence of bowel and bladder. His MRI imaging of the cervical and thoracic spine was concerning for a T1 and T2 hyperintense lesion extending from the internal medulla to the upper thoracic spine causing edema...
January 2024: Neurohospitalist
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