Neurohospitalist最新文献

{"title":"A Rare Radiological Mimic of Intracranial Hemorrhage -Interpeduncular Lipoma.","authors":"Somarajan Anandan, Sajeesh Rajendran","doi":"10.1177/19418744251325672","DOIUrl":"10.1177/19418744251325672","url":null,"abstract":"<p><p>Intracranial lipomas are rare congenital malformations which are neither hamartomas nor true neoplasms. Rarely lipomas show blooming on susceptibilty weighted images and this can be confused with subacute blood especially if the patient present with headache and MRI brain is the only available image. Do fat saturated images or CT scan if T1 weighted MRI brain shows hyperintensity along with blooming on susceptibilty weighted images.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251325672"},"PeriodicalIF":0.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Predictors of Stroke Mimics in Code Stroke Patients Evaluated via Telemedicine and Treated With Thrombolytic Therapy.","authors":"Andrea Loggini, Amber Schwertman, Jessie Henson, Julie Wesler, Jonatan Hornik, Karam Dallow, Alejandro Hornik","doi":"10.1177/19418744251324675","DOIUrl":"10.1177/19418744251324675","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis is an established treatment to improve functional outcomes in acute ischemic stroke. However, various acute central nervous system dysfunctions can mimic stroke, where thrombolytic therapy may provide no benefit and carries potential risks. The ability to accurately distinguish stroke mimics vs stroke by telemedicine evaluation is uncertain. This study aims to identify clinical predictors of stroke mimics in patients evaluated via telemedicine for suspected ischemic stroke and treated with thrombolytics.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients treated with thrombolytics for suspected acute ischemic stroke via telemedicine at Southern Illinois Healthcare between 2017 and 2024. Data on demographics, past medical history, clinical presentation, National Institutes of Health Stroke Scale (NIHSS), stroke metrics, and laboratory values were collected. Final diagnoses were categorized as cerebrovascular disease (CD), including acute ischemic stroke and transient ischemic attack, and stroke mimic (SM). Outcomes included hospital length of stay (LOS) and discharge disposition.</p><p><strong>Results: </strong>Of 171 patients treated with thrombolytics via telemedicine, 128 (75%) were diagnosed with CD, and 43 (25%) were SM, with toxic-metabolic encephalopathy being the most common mimic (40%, n = 17). Adjusted forward logistic regression showed age (OR: 0.957, 95% CI: 0.931-0.984, <i>P</i> = .002) and NIHSS (OR: 1.098, 95% CI: 1.032-1.168, <i>P</i> = .003) remained independently associated with SM. The predictive TeleStroke Mimic was score performed with c-statistic of 0.61. SM had shorter median LOS (3 [2-3] vs 3 [2-6], <i>P</i> < .01) and higher rate of discharge home (86% vs 55%, <i>P</i> < .01).</p><p><strong>Conclusions: </strong>In our population, younger age and higher NIHSS were associated with higher odds of SM diagnosis in patients treated with telemedicine-administered thrombolytics. These variables are insufficient to reliably identify a subgroup of patients evaluated via telemedicine for whom thrombolytics could be withheld. The poor performance of Telestroke Mimic score highlights the need for improved predictive tools. Until larger studies are conducted, telemedicine-administered thrombolytics should adhere to current in-person guidelines.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251324675"},"PeriodicalIF":0.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-Onset Multiple Acyl-CoA Dehydrogenase Deficiency Presenting as Hyperammonemia and Encephalopathy: Case Series.","authors":"Cristina Viguera Altolaguirre, Andrew B Stergachis, David A Sweetser, Nina B Gold","doi":"10.1177/19418744251324959","DOIUrl":"10.1177/19418744251324959","url":null,"abstract":"<p><p><b>Background:</b> Multiple acyl-CoA dehydrogenase deficiency (MADD) is an inherited metabolic disorder (IMD) that affects the electron transfer chain and fatty acid oxidation. The late-onset form of MADD has a heterogenous clinical presentation that typically results in episodic lethargy, hypoglycemia, acidosis, and rhabdomyolysis during metabolic decompensations. <b>Purpose:</b> In this case report series we describe three cases of late-onset MADD presenting with hyperammonemia and encephalopathy, a less frequent but severe complication. <b>Methods:</b> the medical records of three patients with MADD and hyperammonemia were retrospectively analyzed for details surrounding their presentation and workup. <b>Results:</b> One patient had hyperammonemia to 445 μmol/L, obtundation, and seizures, requiring venovenous hemodialysis. Two patients had abnormal brain imaging findings. Two of the cases were initially diagnosed as hepatic encephalopathy, but treatment for this did not reverse the hyperammonemia. Workup for IMDs revealed biochemical profiles consistent with MADD, with non-diagnostic genetic testing. MADD-directed therapy led to a reversal of hyperammonemia and return to neurologic baseline of all patients. <b>Conclusion:</b> This series highlights hyperammonemia as a presentation of late-onset MADD, a potentially lethal but treatable disorder.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251324959"},"PeriodicalIF":0.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Skilled Nursing Facility Length of Stay and Discharge After Aneurysmal Subarachnoid Hemorrhage.","authors":"Carl M Porto, Dylan N Wolman, Joshua R Feler, Carlin C Chuck, Gnaneswari Karayi, Radmehr Torabi, Krisztina Moldovan, Karen L Furie, Ali Mahta","doi":"10.1177/19418744251323639","DOIUrl":"10.1177/19418744251323639","url":null,"abstract":"<p><strong>Background and purpose: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality with survivors often requiring extended care at skilled nursing facilities (SNF). Predictors of SNF discharge to home (SNFdcH) remain unclear.</p><p><strong>Methods: </strong>Retrospective review of a single-center prospectively maintained aSAH database from June 2016-March 2024 was conducted. Patients discharged to SNF were grouped by subsequent discharge to home. Predictors of discharge to home and facility length of stay (LOS) were determined using t-tests, Fisher analyses, and cumulative link modeling.</p><p><strong>Results: </strong>Of 450 aSAH patients, 61 (13.5%) were discharged to SNFs. 49 (80.3%) returned home, with 61% achieving mRS <3 at discharge. Discharged patients were younger (mean 63.3 ± 11.5 vs 70.2 ± 9.3 years, <i>P</i> = .040) with lower median modified Fisher scores (3 [IQR 3-4] vs 4 [4-4], <i>P</i> = .046). Tracheostomy (OR = .14, 95% CI [.02, .75], <i>P</i> = .023) and gastrostomy tube (PEG) placement (OR = .13, 95% CI: .03-.51, <i>P</i> = .003) decreased the odds of SNFdcH. Discharged patients had shorter hospital LOS (26 ± 10 vs 39 ± 15 days, <i>P</i> < .001) and lower median modified Rankin scores (mRS) at hospital discharge (4 [4-5] vs 5 [4-5], <i>P</i> = .028) and at 90 days post-discharge (4 [3-5] vs 6 [5-6], <i>P</i> = .001). Multivariable regression identified age, PEG, and hospital LOS as predictors of SNFdcH. Tracheostomy and PEG predicted SNF LOS.</p><p><strong>Conclusions: </strong>Most aSAH patients discharged from SNFs returned home, with 61% achieving mRS <3. Patients not discharged were medically complex with neurological deficits. These findings may guide care discussions and highlight the role of SNFs in bridging hospitalization and independence.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251323639"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Problem Solving: A 67-year-old Man With Painful Leg Weakness and Difficulty Walking.","authors":"Ryan Verity, Elizabeth Raynor, Jonah Zuflacht","doi":"10.1177/19418744251324078","DOIUrl":"10.1177/19418744251324078","url":null,"abstract":"<p><p>Rapidly progressive neurologic symptoms can be alarming to both the patient and the clinician, given the concern for serious pathologies. In this case, a 67-year-old patient presents with painful sensorimotor symptoms that progress rapidly within days of onset. Proper localization and consideration of medical co-morbidities is essential for accurate diagnosis. This case highlights the importance of a detailed neurologic examination to aid in the localization and differential diagnosis. The case will take readers through a stepwise approach to this complex neurologic presentation, work-up and management.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251324078"},"PeriodicalIF":0.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfaction With Teleneurology in Low Resource Setting: A Cross-Sectional Study Among Patients and Healthcare Providers.","authors":"Mohammed Farhan Ansari, Deepak Menon, Milu Anna Ittycheria, Sarath Govindaraj, Rehan Shahed, Deenadayalan Boopalan, Rajani Parthasarathy, Girish N Rao, Faheem Arshad, Suvarna Alladi","doi":"10.1177/19418744251321552","DOIUrl":"10.1177/19418744251321552","url":null,"abstract":"<p><strong>Background and objectives: </strong>Teleneurology has become instrumental in extending neurologic care in remote and underserved areas, enhancing access, and potentially improving patient outcomes while reducing costs. This study evaluates the satisfaction of both patients and healthcare providers with teleneurology services for common neurological disorders.</p><p><strong>Methods: </strong>In this single-center, prospective observational study, 58 patients suffering from headache, epilepsy, stroke, or dementia were recruited through the \"Karnataka Brain Health Initiative.\" Teleconsultations were facilitated via Zoom, incorporating brief neurological examinations. Satisfaction levels were gauged using the Telemedicine Satisfaction Questionnaire (TSQ) for patients and the Patient and Physician Satisfaction with Monitoring Questionnaire (PPSM) for healthcare providers.</p><p><strong>Results: </strong>Of the 58 patients enrolled, 18 had headache, 12 epilepsy, 13 stroke, and 15 dementia, with a mean age of 43.7 years. All completed the TSQ, yielding a mean score of 4.47 ± 0.41. The average teleconsultation lasted 21.21 minutes. The PPSM questionnaire, completed by neurologists for all patients, resulted in a mean score of 4.33 ± 0.44. Of these, 36 consultations initiated by primary care physicians had a PPSM mean score of 4.47 ± 0.51. Agreement on quality of care was 60%, time-saving benefit 98%, and willingness for future use 95%.</p><p><strong>Discussion: </strong>The findings indicate high satisfaction among both patients and providers, underscoring the effectiveness of teleneurology in delivering quality care comparable to in-person consultations. The positive feedback from primary care physicians highlights teleneurology's potential as an integral component of healthcare delivery in low-resource settings.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251321552"},"PeriodicalIF":0.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Shift: Comparing Safety and Cost of Tenecteplase versus Alteplase in Acute Ischemic Stroke.","authors":"Carina Cassano, Daryl Schiller, Magda Fulman","doi":"10.1177/19418744251321530","DOIUrl":"10.1177/19418744251321530","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recently, institutions have been transitioning to tenecteplase (TNK) as the primary agent for stroke management instead of alteplase (tPA) due to its comparable safety and cost-effectiveness. Despite TNK's potential cost benefits, there's limited literature on how wasted doses impact the overall cost. This study aimed to compare the safety and cost of TNK to tPA following the transition to TNK as the primary agent for acute ischemic stroke (AIS) management at a community hospital.</p><p><strong>Methods: </strong>This retrospective study compared patients treated with tPA or TNK for AIS. The primary outcome was a composite of intracranial hemorrhage, any other bleed, and death from any cause. Secondary outcomes included the individual components of the primary outcome, length of hospitalization, time from administration decision to medication administration, readmission rate, medication costs, and wasted doses.</p><p><strong>Results: </strong>48 AIS patients who received either tPA or TNK between November 2021 and February 2024 were included. TNK didn't result in more occurrences of the primary outcome compared to tPA (OR 1.00, 95% CI 0.25 to 4.03). The TNK group had a shorter median length of hospitalization and decreased elapsed time from administration decision to administration. The cost difference between a 50 mg kit of TNK and a 100 mg vial of tPA is about $1100. The total number of wasted doses was 10 for tPA and 12 for TNK.</p><p><strong>Conclusions: </strong>There was no difference in safety between TNK and tPA. While TNK offers cost savings, poor waste management could undermine its overall cost-effectiveness.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251321530"},"PeriodicalIF":0.9,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Extended Duration Triple Antithrombotic Therapy in a Patient With an Intracranial Stent and Atrial Fibrillation.","authors":"Samuel C Greer, Drew A Wells, Ehizele Osehobo, Kerri Jones","doi":"10.1177/19418744251321547","DOIUrl":"10.1177/19418744251321547","url":null,"abstract":"<p><p>Our case report presents the clinical management of a 77-year-old female with recurrent acute ischemic stroke (AIS) due to severe intracranial large artery atherosclerosis (LAA), requiring intracranial stenting complicated by new-onset atrial fibrillation (AF). This clinical scenario necessitated the use of triple antithrombotic therapy (TAT) with aspirin, ticagrelor, and apixaban. While guidelines recommend minimizing the duration of TAT or favoring alternative regimens due to bleeding risks, this case highlights the safe application of an extended duration TAT course in a high-risk patient. The patient initially presented with recurrent AIS despite dual antiplatelet therapy (DAPT). Subsequent intracranial stenting and AF diagnosis posed challenges in balancing ischemic and bleeding risks. Multidisciplinary, shared decision-making guided the initiation of TAT. Despite a history of early recurrent strokes and high-risk stenting, no major, life-threatening, or minor bleeding complications were observed during the extended duration of TAT. This case underscores the need for tailored antithrombotic regimens in neurovascular patients with AF and high ischemic risk.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251321547"},"PeriodicalIF":0.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Cerebral Gnathostomiasis With Solely Steroid Administration: A Case Report.","authors":"Witoon Mitarnun, Lisa Kongngern","doi":"10.1177/19418744251321884","DOIUrl":"10.1177/19418744251321884","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251321884"},"PeriodicalIF":0.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Housing Status and Healthcare Utilization in People Presenting With Seizure.","authors":"Sandeepa S Mullady, Andrew J Wood, Elan L Guterman, Nicole Rosendale","doi":"10.1177/19418744251321877","DOIUrl":"10.1177/19418744251321877","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between housing status and healthcare utilization in individuals presenting with seizure.</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional analysis of all adults (age >18) presenting to a public hospital emergency department with seizures, defined by ICD-9/10 codes, between 1/1/2016 and 8/03/2019. They were categorized by housing status (people experiencing homelessness [PEH], people with housing). Healthcare utilization outcomes were 30-day re-visit to acute care, discharge disposition, and hospital length of stay for those admitted. We used multivariable linear and logistic regression models adjusting for age, comorbidities, and insurance status.</p><p><strong>Results: </strong>There were 6483 individuals (2092 [32.3%] PEH). Compared to people with housing, PEH were younger (48.2 vs 50.9, <i>P</i> < .0001), more likely to be a person of color (80.9 vs 75.1%, <i>P</i> < .0001), and have Medicaid (51.4% vs 42.9%, <i>P</i> < .0001). People with housing had a higher prevalence of admission to the intensive care unit (3.6% vs 1.8%, <i>P</i> < .0001). After adjustment, admitted PEH had higher odds of 30-day re-visit (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI] 1.58, 2.21), shorter length of stay (coef Β-12.87, 95% CI: -22.62, -3.11), and lower odds of being discharged to a facility (aOR 0.37, 95% CI: .26, .55) compared to people with housing.</p><p><strong>Conclusion and relevance: </strong>PEH with seizures had increased healthcare utilization. Further analysis, including imaging findings, anti-seizure medications prescribed, and presumed etiology, is needed to understand the drivers of healthcare utilization and identify appropriate interventions.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251321877"},"PeriodicalIF":0.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}