Neurohospitalist最新文献

{"title":"Continuous Intrathecal Milrinone Administration via IRRA<i>flow</i> Intraventricular Catheter for Refractory Cerebral Vasospasm in Subarachnoid Hemorrhage: A Case Report.","authors":"Hayley G Williams, Christine Ahrens, Joao A Gomes, Mark Bain, Catherine Hassett","doi":"10.1177/19418744251362522","DOIUrl":"10.1177/19418744251362522","url":null,"abstract":"<p><strong>Background/objective: </strong>The IRRA<i>flow</i> device combines intracerebroventricular (ICV) medication infusion, cerebrospinal fluid (CSF) irrigation, and continuous intracranial pressure (ICP) monitoring. While ICV milrinone is conventionally given as a bolus to manage vasospasm after aneurysmal subarachnoid hemorrhage (aSAH), this case presents the use of continuous ICV milrinone infusion via IRRA<i>flow</i> in a patient with refractory cerebral vasospasm following aSAH.</p><p><strong>Results: </strong>A 47-year-old female with aSAH (Hunt Hess 2, Modified Fisher Grade 4) underwent coil embolization for a ruptured left PICA aneurysm. Despite standard management, severe vasospasm was detected in the bilateral middle cerebral arteries and basilar arteries on hospital day 6. Following initiation of systemic milrinone IV and intra-arterial verapamil treatment, subsequent transcranial Doppler (TCD) and CT angiogram revealed persistent vasospasm. Elevated ICPs precluded further angiography or ICV bolus therapy through the existing external ventricular drain (EVD). An IRRA<i>flow</i> catheter was inserted intraventricularly for continuous CSF drainage and ICV milrinone administration (2.6 mg/kg/day). Over days 8 to 12, vasospasm improved significantly, ICP normalized, and neurologic examination permitted extubation. Continuous ICV milrinone therapy was tapered over 5 days, and the IRRA<i>flow</i> system removed on day 14 without complications, leading to discharge for acute rehabilitation. Patient consent for case publication was documented per institutional protocol.</p><p><strong>Conclusions: </strong>Continuous intrathecal milrinone infusion via IRRA<i>flow</i> may be a feasible adjunct for treating refractory vasospasm after aSAH. After the combined use of ICV milrinone via the IRRA<i>flow</i> catheter with standard-of-care therapies for severe vasospasm, the patient demonstrated favorable clinical and radiographic improvement without complications.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"98-102"},"PeriodicalIF":0.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776514","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 Young Man with Altered Mental Status, Rigidity, and Hyperthermia.","authors":"Ahmed Alsakha, Daniella Giardina, Nicholas Cochran-Caggiano, Andrew Curtin, Devin J Burke, Sarah G Burke","doi":"10.1177/19418744251364117","DOIUrl":"10.1177/19418744251364117","url":null,"abstract":"<p><p><b>Background</b>: We present a case report of a 24 year-old male who presented with encephalopathy, rigidity, and hyperthermia after receiving his medication. In this report, we guide you through the approach, differential diagnosis, investigation, and treatment modalities for similar presentations.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"66-69"},"PeriodicalIF":0.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12307332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761761","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":"Subarachnoid Hemorrhage, CNS Vasculitis and Stroke as a Sequela of Q Fever Infection.","authors":"Melinda C Arthur, Christopher S Medina, Erin Penn, Hector Ojeda-Martinez, Elie Dancour, Paul Wright","doi":"10.1177/19418744251361313","DOIUrl":"10.1177/19418744251361313","url":null,"abstract":"<p><p>A 64-year-old female with a history of Subarachnoid Hemorrhage (SAH) of non-aneurysmal origin underwent 4 cerebral Digital Subtraction Angiography (cDSA) studies to investigate the cause of the SAH. All angiograms were unrevealing. Two years and 3 months following her SAH, she presented to the emergency department with ataxia and aphasia. Magnetic Resonance Imaging (MRI) of the brain without contrast showed a right posterior parietal lobe stroke with a watershed appearance and a chronic right cerebellar infarct with encephalomalacia. Repeat cDSA showed stenosis in the right A3 of the Anterior Cerebral Artery (ACA) and right M2 of the Middle Cerebral Artery (MCA) suggesting CNS vasculitis. Known reversible and secondary causes of CNS vasculitis were tested and found to be negative. However, Indirect Immunofluorescence Assay (IFA) testing revealed a high titer of IgG phase II Coxiella indicating acute Q fever. CDC lab findings from 10 years earlier also showed a high titer IgG phase II Coxiella, indicating untreated Q fever prior to the SAH event. A whole-body Positron Emission Tomography (PET) scan was negative for systemic or CNS vasculitis. The patient was treated for Q fever and CNS vasculitis with 1 year of doxycycline and hydroxychloroquine. There was no recurrence of symptoms 15 months after treatment. We conclude that Q fever can present with SAH in addition to CNS vasculitis and stroke.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"93-97"},"PeriodicalIF":0.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676076","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":"Clot Migration after Tenecteplase (TNK): A Potential Cause of Neurological Deterioration in Stroke Patients.","authors":"Salvador F Gutierrez-Aguirre, Otavio F De Toledo, Amin Aghaebrahim, Eric Sauvageau, Mohamad Chmayssani, Ricardo A Hanel, Diane McLaughlin","doi":"10.1177/19418744251361744","DOIUrl":"10.1177/19418744251361744","url":null,"abstract":"<p><strong>Background: </strong>Tenecteplase (TNK) has been increasingly adopted as an alternative to alteplase (tPA) for ischemic stroke due to its ease of administration and pharmacologic advantages. However, recent studies suggest TNK may be associated with a higher incidence of clot migration, potentially contributing to early neurologic deterioration.</p><p><strong>Objective: </strong>To describe the incidence and clinical impact of clot migration following TNK administration in acute ischemic stroke patients.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients treated with TNK at our Comprehensive Stroke Center between May and August 2023. Clot migration was defined as a change in thrombus position without full distal reperfusion. Neurologic deterioration was defined as an NIHSS increase ≥4 or new-onset deficit. All patients underwent pre- and post-TNK vascular imaging.</p><p><strong>Results: </strong>Among 53 patients treated with TNK, 12 (22.6%) experienced neurological deterioration. Clot migration was identified in 4 patients (8.3%) among those with confirmed vessel occlusion on baseline imaging (n = 48). All exhibited new occlusions in anatomically compatible sites and clinical worsening shortly after TNK. One patient required mechanical thrombectomy; the remaining 3 had distal occlusions or low NIHSS scores. At discharge, two patients had good outcomes (mRS ≤2), and two had poor outcomes (mRS >2).</p><p><strong>Conclusion: </strong>Clot migration may contribute to early neurologic deterioration following TNK, particularly in posterior circulation strokes. Outcomes appear to depend on final clot location and clinical severity. As TNK becomes more widely used, increased awareness and early vascular imaging are critical for recognizing this phenomenon and guiding management.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"28-35"},"PeriodicalIF":0.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660647","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":"Opsoclonus-Myoclonus-Ataxia Syndrome in a Patient With West Nile Virus: Case Report and a Patient's Experience.","authors":"Alexander Wallace, Jonathan Thomas, Jake Boren, Chris Bryant, Jonathan Brewer, Rahim Dhanani","doi":"10.1177/19418744251361303","DOIUrl":"10.1177/19418744251361303","url":null,"abstract":"<p><p>Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare neurological condition most often diagnosed as a paraneoplastic or parainfectious syndrome. There have been some reports of OMAS in association with West Nile virus (WNV) in the literature, but both treatment and outcomes have been variable. Furthermore, some evidence suggests that patients who are treated earlier in the disease course have better outcomes, both in terms of time to disease remission and long-term symptom relief. Here, we present the case of a healthy 26-year-old patient who suddenly developed tremulousness and weakness of the lower extremities which progressively worsened over the course of 5 days; during this time, the patient developed nausea, gait unsteadiness, and rapid uncontrollable eye movements, leading to his hospital presentation. On hospital day two, the patient was diagnosed with OMAS due to exam findings of rapid, conjugate, saccadic bursts and myoclonic muscle activity, with serum and cerebrospinal fluid studies positive for WNV. Treatment with intravenous steroids and immunoglobulin began immediately afterwards and resulted in rapid improvement by the time of discharge 7 days after treatment was initiated. This case demonstrates the importance of developing broad differential diagnoses for uncommon disease presentations and the importance of treatment timeliness for better outcomes of OMAS. Furthermore, this report shows the need for more systematic studies on OMAS treatment and outcomes, as the current literature is somewhat limited due to the sporadic nature of the disease. Lastly, we highlight the patient's own heartfelt narrative of this illness and his experiences with recovery.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"88-92"},"PeriodicalIF":0.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676075","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":"Eye Movement Abnormalities After Thalamo-Mesencephalic Junction Infarction.","authors":"Arens Taga, Ariel Winnick, Kemar Green","doi":"10.1177/19418744251360300","DOIUrl":"10.1177/19418744251360300","url":null,"abstract":"<p><p>A 54-year-old man presented with coma and left mydriasis due to bilateral thalamic and left paramedian midbrain infarcts. Workup revealed paradoxical embolism from an intrapulmonary shunt. As the patient's mental status improved, complex eye movement abnormalities emerged, including vertical ophthalmoplegia, bilateral ptosis, and right pseudo-abducens palsy. This case highlights the complex and often-overlooked ocular motor neural circuitry in the thalamo-mesencephalic junction.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"124-125"},"PeriodicalIF":0.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660648","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":"New Onset Medically Refractory Seizures in an Adult With Parkinson's Disease and Vitamin B6 Deficiency Case Report.","authors":"Cody L Nathan, Dina Ghandour, Jasmine May, Danny Bega, Stephan Schuele","doi":"10.1177/19418744251360306","DOIUrl":"10.1177/19418744251360306","url":null,"abstract":"<p><strong>Background: </strong>The association between Parkinson's disease and epilepsy remains unclear. A higher proportion of patients with Parkinson's disease who have experienced seizures had at least one episode of status epilepticus compared to healthy controls. It is crucial to distinguish whether seizures are provoked or unprovoked as this changes the long-term treatment plan and prognosis.</p><p><strong>Case presentation: </strong>We report a case of new onset seizures refractory to multiple anti-seizure medications in a patient with Parkinson's disease in the context of vitamin B6 deficiency. The seizures started after a recent increase in carbidopa/levodopa dose. Seizures resolved with pyridoxine supplementation. The patient was able to successfully wean off all anti-seizure medications without any further seizures and had incomplete normalization of EEG.</p><p><strong>Practical implications: </strong>Clinicians should consider vitamin B6 deficiency as an etiology for new-onset refractory seizures in patients with Parkinson's disease on carbidopa/levodopa. Repletion of vitamin B6 can be curative, and patients may ultimately not require long term anti-seizure medications.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"83-87"},"PeriodicalIF":0.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627327","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":"Retrospective Study Supports that Pharmacologic Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage is Safe, Underused.","authors":"Camille Lh Carlisle, Tamela Stuchiner, Alexandra Lesko, John Zurasky","doi":"10.1177/19418744251358092","DOIUrl":"10.1177/19418744251358092","url":null,"abstract":"<p><strong>Background: </strong>Patients with spontaneous non-traumatic intracerebral hemorrhage (ICH) have a heightened risk for venous thrombosis (VTE). The Stroke 2022 Guidelines suggest initiating pharmacologic prophylaxis after hemorrhage stabilization, as measured on repeat imaging within the first 24 hours of admission. However, pharmacologic prophylaxis is underutilized and there remain concerns that initiation of pharmacologic prophylaxis could increase hemorrhage size. This study examines the safety of initiating pharmacologic prophylaxis after hemorrhage stabilization.</p><p><strong>Methods: </strong>This was a retrospective study of patients discharged with nontraumatic spontaneous ICH. The study population was from Providence Medical Centers in Washington, Oregon, and California. Patients, 18 years or older, presenting to a hospital between January 2018 and December 2021 with a primary diagnosis at discharge of ICH were included.</p><p><strong>Results: </strong>Among the 228 included, 65.4% (n = 149) received mechanical prophylaxis only and 34.6% (n = 79) received any pharmacologic prophylaxis (with or without mechanical prophylaxis). Of those patients who received any pharmacologic prophylaxis, 55.7% (44) were administered pharmacologic prophylaxis within 48 hours of stabilization. There were no significant differences in age, sex, medical history, hemorrhage type, severity, or mortality in-hospital or at 30 days.</p><p><strong>Conclusion: </strong>There were no significant differences in VTE events and hemorrhage expansion for spontaneous ICH patients who had pharmacologic with or without mechanical prophylaxis or mechanical only, consistent with previous literature. For patients who received pharmacologic prophylaxis after stabilization, none had hemorrhage expansion; our data support the 2022 guidelines that it is safe to administer pharmacologic prophylaxis after hemorrhage stabilization.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"21-27"},"PeriodicalIF":0.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585187","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":"Evaluation of Brain Abscess Prognostic Factors and Role of Surgical Intervention Within a Single Health System.","authors":"Jamie E Cronin, Timothy H Ung, Amanda L Piquet, Kelli M Money","doi":"10.1177/19418744251353544","DOIUrl":"10.1177/19418744251353544","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate patient, clinical, and treatment variables impacting mortality in patients with brain abscesses.</p><p><strong>Background: </strong>Brain abscesses are intraparenchymal infectious foci with significant morbidity and mortality. Management includes antimicrobial therapy +/- surgical intervention, and is dependent on suspected pathogen/source, patient factors, and clinician judgement. Treatment type and duration vary substantially and are often guided by imaging, inflammatory markers, and symptoms.</p><p><strong>Methods: </strong>186 patients with brain abscesses admitted at a single health system between 2010 and 2022 were analyzed. Patient demographics, clinical course, diagnostic studies, and abscess treatment were assessed for impact on mortality during admission via univariate and stepwise multivariate nominal logistic regression. Secondary outcomes of surgical drainage were evaluated with univariate and multivariate nominal logistic regression, and survival over time of those who received surgical drainage vs those who did not was evaluated with Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>10.7% of patients died during initial admission. Intravenous drug use, deep-seated abscess location, and surgical complication were independently predictive of death during admission. Patients without surgical intervention demonstrated increased likelihood of mortality over time but not during admission. Independent predictors of surgical intervention include lack of ventriculitis, larger abscess diameter, non-hematogenous or -pulmonary source, and mass effect.</p><p><strong>Conclusions: </strong>These findings suggest surgical intervention is generally avoided when infection is systemic, severe, or with intraventricular abscess rupture. Patients with overt symptoms of brain infection were more likely to receive prompt surgical drainage. In our patient population, surgical drainage in addition to antimicrobial therapy did not independently impact inpatient mortality although did impact overall survival.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"12-20"},"PeriodicalIF":0.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576612","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":"Curriculum Innovation: Clinical Documentation Integrity Education for Neurology Trainees.","authors":"Yasmin Aghajan, Bradley J Molyneaux","doi":"10.1177/19418744241307685","DOIUrl":"10.1177/19418744241307685","url":null,"abstract":"<p><strong>Background and purpose: </strong>High quality clinical documentation is a fundamental skill for practicing physicians and important for quality improvement. However, documentation and coding are rarely integrated into medical education curricula and there is a lack of standard neurology curriculum on this topic. We developed and evaluated a teaching session on clinical documentation for neurology resident physicians.</p><p><strong>Methods: </strong>The education consisted of a didactic session designed by a neurologist with content about risk-adjusted mortality, clinical documentation integrity (CDI), impact of documentation on patients, and neurology-specific documentation guidance. A pre-post survey design was used to compare baseline and post-intervention self-reported knowledge and attitudes.</p><p><strong>Results: </strong>61 responses were collected (37 pre- and 24 post-intervention). Residents had increased understanding of the impact of documentation on quality metrics (<i>P</i> = 0.004), risk-adjusted mortality (<i>P</i> < 0.0001), and impact on patients (<i>P</i> = 0.02). Attitude towards CDI education improved significantly (<i>P</i> = 0.0016), as well as agreement that CDI is important to resident physicians (<i>P</i> = 0.003). The portion of residents who agreed training on CDI is useful and valuable increased significantly (<i>P</i> = 0.004). 92% agreed this curriculum was useful, and 96% agreed they understood the role of CDI better after the session.</p><p><strong>Conclusions: </strong>In this study of a teaching session for neurology residents on clinical documentation, we found this format of teaching was well-received and highly effective in improving resident attitudes and self-reported knowledge.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"229-235"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830384","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}