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Case Reports in Neurological Medicine

Abdallah Rahbani, Grace Adwane, Najo Jomaa
A 72-year-old man presented with a super-refractory partial status epilepticus following evacuation of a right subdural hematoma. He failed to respond to treatment with high doses of intravenous valproic acid, Levetiracetam, Lacosamide, Thiopental, and Midazolam. He was given 4 mg of Perampanel orally via nasogastric tube and the dose was rapidly increased to 8 mg after 12 hours with cessation of clinical and electrical seizures. Other antiepileptic drugs were tapered progressively with an excellent clinical outcome...
2019: Case Reports in Neurological Medicine
Soha Khan, Asma AlNajjar, Abdullah Alquaydheb, Shahpar Nahrir
Celiac disease epilepsy and occipital calcification (CEC) syndrome is a rare, emerging disease first described in 1992. To date, fewer than 200 cases have been reported worldwide. CEC syndrome is generally thought to be a genetic, noninherited, and ethnically and geographically restricted disease in Mediterranean countries. However, we report the first ever case of probable CEC in a Saudi patient. Furthermore, the patient manifested a magnitude of brain magnetic resonance imaging (MRI) signal abnormalities during the periictal period which, to the best of our knowledge, has never been described in CEC...
2019: Case Reports in Neurological Medicine
Stacey Ho, Antonio Liu
We report on a co-occurrence case of ocular myasthenia gravis with exacerbation leading to myasthenic crisis in addition to pharyngeal-cervical-brachial variant of Guillain-Barré syndrome in a patient with severe oropharyngeal dysphagia and acute respiratory failure.
2019: Case Reports in Neurological Medicine
Heela Azizi, Alexander Kilpatrick, Olaniyi Olayinka, Olusegun Poopola, Maleeha Ahmad, Alexa Kahn, Tasmia Khan, Dina Rimawi, Shantale Williams, Sinthuja Jayaraj, Ivan Leung, Sherina Langdon, Mirna Iskander, Ali Chohan, Deepa Nuthalapati, Ulunma Umesi, Geetha Vyas, Ayotomide Oyelakin, Kodjovi Kodjo, Chiedozie Ojimba, Oluwole Jegede, Carolina Nisenoff, Ayodeji Jolayemi
The basal ganglia have been considered to primarily play a role in motor processing. A growing body of theoretical and clinical evidence shows that in addition to the motor functions the basal ganglia play a key role in perceptual and visual disturbances. This role may be evident in patients with basal ganglia pathology and subsequent manifestation of symptoms that include cognitive, perceptual, and affective disturbances. We present three cases with basal ganglia pathology that demonstrate affective and psychotic symptoms...
2019: Case Reports in Neurological Medicine
Ritsuo Hashimoto, Asako Tagawa, Noriyo Komori, Tomoko Ogawa, Hiroyuki Kato
We presented a case of a 19-year-old woman who suffered from anti- N -methyl-D-aspartate (NMDA) receptor encephalitis associated with ovarian teratoma. The patient showed a variety of higher visual symptoms which changed over the recovery phase of the disease. In chronological order, she experienced cortical blindness, amblyopia, dyschromatopsia, static form agnosia, and prosopagnosia. Among these symptoms, the most intriguing was the static form agnosia. Although she could recognize the forms of moving objects, she could not make out those of stationary ones...
2019: Case Reports in Neurological Medicine
Hatem B Afana, Nidal M M Abuhadrous, Alaa Eldin Elsharkawy
Bithalamic infarction resulting from occlusion of the artery of Percheron after cervical spine surgery is a rare pathological entity. Diagnosis and early detection are challenging. Prompt management may help to improve the outcome. We present a case of a 39-year-old male patient, smoker, diagnosed with multiple cervical disc herniations, who underwent Anterior Cervical Discectomy and Fusion (ACDF) for C3-C4, C4-C5, and C5-C6. During the 2-hour and 50-minute surgery, the patient was lying supine with his neck hyperextended...
2019: Case Reports in Neurological Medicine
V Montano, C Simoncini, Cassi L Calì, A Legati, G Siciliano, M Mancuso
The classic features of deoxyguanosine kinase ( DGUOK ) deficiency are infantile onset hepatic failure with nystagmus and hypotonia; mitochondrial DNA studies on affected tissue reveal mitochondrial DNA depletion. Later, it has been shown that the mutations in the same gene may present with adult-onset mitochondrial myopathy and mitochondrial DNA multiple deletions in skeletal muscle. Here we report the case of a 42-year-old Italian woman presenting with a chronic progressive external ophthalmoplegia and myopathy with mtDNA multiple deletions and the compound heterozygous c...
2019: Case Reports in Neurological Medicine
Veronika Spahlinger, Annette Niessen, Sebastian Rauer, Stefan Krämer, Matthias Reinhard
Pathological yawning is rarely observed in cerebral or spinal diseases. A 67-year-old woman was admitted with a seven-day progressive hemisyndrome with left-sided limb ataxia and hypesthesia. The patient yawned with a high frequency, partially in salve-like episodes. MRI showed a cervical myelitis over more than three vertebral segments up to the lower medulla and Aquaporin-4-antibodies were positive (diagnostic criteria for a Neuromyelitis optica spectrum disorder were fulfilled). Under treatment with methylprednisolone, followed by plasmapheresis and immunoadsorption, clinical symptoms were regressive and the frequency of yawning completely normalized...
2019: Case Reports in Neurological Medicine
A Bitar De Zayas-Enriquez, C Soper
Aims: To present a 60-year-old female patient who manifested clinical and radiological features of posterior reversible encephalopathy syndrome (PRES) following the administration of Daptomycin for glycopeptide-resistant Enterococcal urinary tract infection. Material: Case report. Method: Posterior reversible encephalopathy syndrome was diagnosed in our patient following the administration of Daptomycin based on clinical suspicion as well as brain CT and MRI imaging...
2019: Case Reports in Neurological Medicine
Lawrence Chau, Antonio Liu
We discuss a patient who presented to our hospital with signs, symptoms, and clinical course consistent with transient global amnesia (TGA). Her hospital work-up was overall unremarkable except for the presence of a diffusion weighted imaging (DWI) abnormality on MRI suggestive of acute infarction in the left cingulate gyrus. Symptoms quickly resolved, and she was discharged home in stable condition. While the etiology of TGA remains controversial, in discussing this case and the current literature we hope to provide further data supporting the possibility of an underlying ischemic process, as well as help better illustrate the neurologic structures involved...
2019: Case Reports in Neurological Medicine
Bhupendra Shah, Roshan Chhetri
Takayasu arteritis is a rare chronic progressive granulomatous necrotizing large vessel panvasculitis mainly involving aorta and its main branches. It commonly affects the female in second to third decades. Common clinical features of Takayasu arteritis are hypertension, claudication, dizziness, headache, or fever. Takayasu arteritis is diagnosed with clinical history of claudication, absent pulse, discordant blood pressure, bruit over aorta, and typical angiographic findings. Stroke as a primary manifestation of Takayasu arteritis is rarely reported in the medical literatures...
2019: Case Reports in Neurological Medicine
Miyuki Miyamoto, Nobuyuki Ishii, Hitoshi Mochizuki, Kazutaka Shiomi, Tomoko Kaida, Hideki Chuman, Masamitsu Nakazato
We describe our encounter with a 39-year-old man who exhibited acute painless visual loss and progressive gait disturbance. He had tendinous xanthoma and several neuroophthalmological findings indicative of optic neuropathy in the right eye, including afferent pupillary defect, cecocentral scotoma, and optic disc swelling. Neurological examination showed cerebellar ataxia and pyramidal weakness. Brain magnetic resonance imaging revealed bilateral swelling in the optic nerves with gadolinium-enhancement suggesting optic neuritis, an enlarged fourth ventricle, atrophy of the cerebellum, and hyperintensities in the bilateral dentate nuclei...
2019: Case Reports in Neurological Medicine
Laura N Zamproni, Reinaldo T Ribeiro, Marina Cardeal
Recurrent painful ophthalmoplegic neuropathy, previously known as ophthalmoplegic migraine, is a rare condition that affects children and young adults. Its cause and classification are still controversial and, consequently, there are no published treatment guidelines or consensus. Glucocorticoids seem to be beneficial for some patients, but there is no established treatment when failure of this therapy occurs. The aim of this study was to report a case where pregabalin was successfully used after failure of glucocorticoid therapy in a patient with recurrent painful ophthalmoplegic neuropathy...
2019: Case Reports in Neurological Medicine
Carmine Franco Muccio, Luca De Lipsis, Rossella Belmonte, Alfonso Cerase
Marchiafava-Bignami Disease (MBD) is a toxic demyelinating disease often diagnosed in chronic alcoholics. The disease process typically involves the corpus callosum and clinically presents with various manifestations resulting in MBD type A and type B on the basis of clinical condition, extent of callosal involvement and extracallosal involvement at brain magnetic resonance imaging (MRI), and prognosis. The death rate is high. We report a patient affected by MBD type B, who presented an isolated reversible splenial lesion at brain MRI and achieved a favorable recovery...
2019: Case Reports in Neurological Medicine
Mohankumar Kurukumbi, James Leiphart, Anam Asif, Jing Wang
The treatment protocol of status epilepticus has many associated toxicities so there is interest in alternate nonmedicinal therapies for managing New Onset Refractory Status Epilepticus (NORSE) patients. Vagus nerve stimulation (VNS) is an FDA-approved therapy for refractory epilepsy that has been shown to decrease the frequency and severity of seizures. We present the case of a patient with new-onset refractory status epilepticus (NORSE) whose seizures were successfully treated with vagus nerve stimulation...
2019: Case Reports in Neurological Medicine
Krishnan Ravindran, Brandon M Zsigray, Michael P Wemhoff, John D Spencer, Ewa Borys, Chirag R Patel, Anand V Germanwala
Background: Pituitary metastasis of cervical adenocarcinoma is an exceedingly rare phenomenon. Case Description: The authors present a case of a 66-year-old female with cervical adenocarcinoma who was discovered to have a rapidly growing intrasellar mass in the work-up of adrenal insufficiency and hypothyroidism. The patient underwent subsequent endoscopic endonasal subtotal resection of the mass. Histopathological analysis of the resected lesion demonstrated features consistent with metastatic mucinous adenocarcinoma of the cervix...
2019: Case Reports in Neurological Medicine
Byung-Chul Son, Hak-Cheol Ko, Jin-Gyu Choi
Although primary hemifacial spasm (HFS) is mostly related to a vascular compression of the facial nerve at its root exit zone (REZ), its occurrence in association with distal, cisternal portion has been repeatedly reported during the last two decades. We report two patients with typical HFS caused by distal neurovascular compression, in which the spasm was successfully treated with microvascular decompression (MVD). Vascular compression of distal, cisternal portion of the facial nerve was identified preoperatively in the magnetic resonance imaging (MRI)...
2019: Case Reports in Neurological Medicine
Seyed Hamidreza Mohseni, Hanne Pernille Bro Skejoe, Jens Wuerfel, Friedemann Paul, Markus Reindl, Sven Jarius, Nasrin Asgari
Background: Recently, pathogenic serum immunoglobulin G (IgG) autoantibodies to myelin oligodendrocyte glycoprotein (MOG) have been detected in a subgroup of patients with central nervous system (CNS) demyelination, including in patients with myelitis. Relatively little is known so far about leptomeningeal involvement in MOG-IgG-positive myelitis. Findings: We report the case of a 30-year-old previously healthy woman presenting with longitudinally extensive transverse myelitis and tetraparesis, in whom both the leptomeningeal barrier and the blood-brain barrier (BBB) were altered, as demonstrated by gadolinium-enhanced MRI during relapse...
2018: Case Reports in Neurological Medicine
Maria-Gabriela Catană, Andreea-Alina Dan, Corina Roman-Filip
Most meningiomas are benign, encapsulated tumors (95% of the cases), generally undergoing a limited number of genetic aberrations. We present the case of a 74-year-old patient with no significant pathological history, who is admitted to the neurology ward for orofacial dyskinesias accompanied by hypoesthesia in the left hemiface, a symptomatology that had started insidiously about two months before and worsened progressively over the past 3 weeks. A cerebral MRI was performed which revealed a small mass with discrete T2 hyperintensity and T1 iso-signal compared to the gray matter located in the left pontine cistern, with a large, well-defined base at the level of the cerebral tentorium...
2018: Case Reports in Neurological Medicine
Yanetsy Olivera Arencibia, Mai Vo, Jennifer Kinaga, Jorge Uribe, Gloria Velasquez, Mario Madruga, S J Carlan
Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier...
2018: Case Reports in Neurological Medicine
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