Neurohospitalist最新文献

{"title":"Meningeal Dissemination and Drop Metastasis From Glioma Presenting With Non-Epileptic Myoclonus and Minipolymyoclonus.","authors":"Arens Taga, Ian Cheong, Kemar E Green, Michael D Kornberg","doi":"10.1177/19418744241297396","DOIUrl":"10.1177/19418744241297396","url":null,"abstract":"<p><p>We describe the case of a 36-year-old woman with a past medical history of low grade right frontal lobe glioma and focal epilepsy presenting with subacute, progressive, multifocal myoclonus and neck and back pain. Unlike her typical seizures, the myoclonus exhibited a distinct semiology, involving both positive and negative muscle jerks affecting multiple limb muscles while sparing the face. In addition, neurological examination revealed low-amplitude, arrhythmic movements of the hands and fingers, resembling minipolymyoclonus. There were no other neurological exam findings, including mental status changes, extrapyramidal signs or signs of myelopathy. Brain and spine MRI indicated leptomeningeal and spinal \"drop\" enhancing lesions, suggesting likely malignant evolution of the glioma. EEG ruled out a cortical origin of the myoclonus. Pharmacological trials with benzodiazepines and other antiepileptic medications were ineffective. The patient's myoclonus was most likely spinal segmental in origin from meningeal spread of glioma. The spinal roots or anterior horns of the spinal cord may have represented a focus of hyperexcitability responsible for generating minipolymyoclonus. Our case expands the etiological spectrum of non-epileptic myoclonus and minipolymyoclonus to encompass meningeal carcinomatosis and drop metastases from glioma. These cases may occur even without overt signs of myelopathy. Recognizing such presentations holds significance due to the poor prognosis associated with meningeal spread of glioma and the limited response of non-epileptic myoclonus to symptomatic treatments.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241297396"},"PeriodicalIF":0.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683024","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":"CAA-ri Masquerading as a High-Grade Glioma: A Case Report.","authors":"Angela Xia, Vishal Mehta, Victoria Wei, Alexander Andreev, Robert Regenhardt","doi":"10.1177/19418744241296198","DOIUrl":"10.1177/19418744241296198","url":null,"abstract":"<p><p>This case describes a 76-year-old male with initial clinical concern for a high-grade glioma, who was ultimately diagnosed with cerebral amyloid angiopathy-related inflammation The patient's presentation included a tonic-clonic seizure followed by aphasia and right-sided hemiparesis. Magnetic resonance brain imaging demonstrated a large left frontal lesion with parenchymal contrast enhancement. Magnetic resonance spectroscopy indicated elevated choline to creatine and choline to N-acetyl aspartate ratios, further suggestive of high-grade glioma. However, subsequent biopsy findings revealed perivascular amyloid deposits, confirming the diagnosis of CAA-ri. To our knowledge, this is the first case in literature to report elevated choline to creatine and choline to N-acetyl aspartate ratios in cerebral amyloid angiopathy-related inflammation.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241296198"},"PeriodicalIF":0.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630227","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":"Crossed Wernicke's Aphasia With Focal Clonic Cluster Seizures With Secondary Generalization Mimicking Faciobrachial Seizures Following a Right Middle-Cerebral-Artery Ischemic Stroke: A Novel Phenotypic Presentation.","authors":"Ritwik Ghosh, Moisés León-Ruiz, Julián Benito-León, Souvik Dubey","doi":"10.1177/19418744241295418","DOIUrl":"10.1177/19418744241295418","url":null,"abstract":"<p><p>Crossed Wernicke's aphasia (CWA) following a stroke is a rare clinical phenomenon, particularly when associated with seizures. This case report presents a unique instance of crossed CWA accompanied by focal clonic cluster seizures affecting the left arm and face, with secondary generalization, in a monolingual Bengali-speaking patient following a right middle cerebral artery ischemic stroke. The patient, a 70-year-old male from rural India, presented with acute behavioral abnormalities and language impairment. He experienced left-sided focal motor-onset clonic seizures with impaired awareness, followed by fluent yet unintelligible speech, characterized by phonemic and semantic paraphasias, as well as neologistic jargon. Neuroimaging revealed a right parieto-occipital infarct. Although initially misdiagnosed and treated for acute psychosis, thorough clinical evaluation ultimately led to the diagnosis of CWA-a rare form of aphasia in a right-handed individual after a right hemisphere stroke. This case underscores the diagnostic challenges associated with stroke-related language disorders and highlights the importance of recognizing variations in language lateralization. Furthermore, the occurrence of CWA in a Bengali-speaking individual emphasizes the potential impact of linguistic and cultural factors on brain organization and language processing. This case also adds to the limited body of literature regarding the co-occurrence of post-stroke seizures and aphasia, particularly in atypical presentations such as CWA.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241295418"},"PeriodicalIF":0.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630234","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":"Neurological Complications and Outcomes in Critically Ill Patients With COVID-19: Results From International Neurological Study Group From the COVID-19 Critical Care Consortium.","authors":"Syed Ameen Ahmad, Yunis Mayasi, Thu-Lan Kelly, Nicole White, Jacky Suen, Denise Battaglini, Gianluigi Li Bassi, John F Fraser, Lavien Premraj, Rakesh C Arora, Diego Bastos, Glenn Whitman, Matthew Griffee, Jonathon P Fanning, Chiara Robba, Sung-Min Cho","doi":"10.1177/19418744241292487","DOIUrl":"10.1177/19418744241292487","url":null,"abstract":"<p><strong>Background: </strong>In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with SARS-CoV2 infection.</p><p><strong>Methods: </strong>The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) across 23 centers between 1/7/2020 to 6/23/2022. Incidence of neurological complications was estimated as number of events per hospital days and per admission using Poisson regression. Associations between neurological complications and risk factors were assessed using multivariable Poisson regression.</p><p><strong>Results: </strong>713 patients were included. Median age = 56 years (interquartile range (IQR) = 45-65). Neurological complications reported in 61/480 patients (12.7%) with the majority being ischemic stroke (2.9%), intracranial hemorrhage (ICH) (2.8%), and seizures (2.6%). Multivariable analysis for neurological complications per admitted days showed comorbid neurological conditions (incidence rate ratio (IRR) = 6.35, 2.57-15.7) were an independent risk factor for ischemic stroke. Extracorporeal membrane oxygenation (IRR = 5.32, 1.52-18.6), low-middle income countries (LMIC) vs high income countries (HIC) (IRR = 4.70, 1.62-13.7), and age >55 (IRR = 3.66, 1.23-10.9) were independent risk factors for ICH. Co-morbid neurological conditions (IRR = 3.43, 1.11-10.6), LMIC vs HIC (IRR = 8.69, 2.15-35.2), July-December 2020 vs January-June 2020 (IRR = 0.17, 0.04-0.69) and age >55 (IRR = 4.05, 1.15-14.3) were independent risk factors for seizure.</p><p><strong>Conclusions: </strong>Decision-making should incorporate salient risk factors to inform management of SARS-CoV2 infection and avoid neurological complications.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241292487"},"PeriodicalIF":0.9,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630168","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":"Patterns of Arterial Wall Lesions in Eagle Syndrome: Case Series and Literature Review.","authors":"Pacôme Constant Dit Beaufils, Solène de Gaalon, Christophe Ferron, Guillaume Marc, Elisabeth Auffray-Calvier, Benjamin Daumas-Duport, Benoît Guillon","doi":"10.1177/19418744241292481","DOIUrl":"10.1177/19418744241292481","url":null,"abstract":"<p><p><b>Background</b>: Impingement of an elongated styloid process (ESP) or calcified stylohyoid ligament on surrounding neck structures defines Eagle syndrome. The vascular variant, also called stylocarotid syndrome, results from impingement of vascular structures and remains poorly known among physicians. <b>Research Design</b>: We report our own experience and review the literature in order to clarify the diagnostic and therapeutic management. Patients with vascular events in relation to an ESP and hospitalized at our institution were extracted from our databank and retrospectively reviewed. We also performed a comprehensive review of the literature on Eagle syndrome using PubMed® and Google Scholar, analysing the presentation, management, and follow-up. <b>Results</b>: We report five cases of the vascular variant of Eagle syndrome: one carotid perforation, one focal arteriopathy, one with both acute and chronic dissection and two acute internal carotid dissection. Vascular compression, whether permanent or transient, is also reported in the literature. Management varies, although styloidectomy is deemed appropriate for symptomatic compression, while stenting is preferred in cases of perforation. <b>Conclusions</b>: A common definition of Eagle syndrome is required for better diagnosis and management. The choice of styloidectomy is understandable for compression but remains to be investigated in other cases.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241292481"},"PeriodicalIF":0.9,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630173","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":"Acute Ischemic Stroke Presenting as Hemiparkinsonism: A Case Report.","authors":"Essam Al-Sibahee, Mustafa Najah Al-Obaidi, Asmaa Al-Sharee","doi":"10.1177/19418744241290847","DOIUrl":"10.1177/19418744241290847","url":null,"abstract":"<p><p>Parkinsonism, commonly associated with Parkinson disease (PD), can also arise from other neurodegenerative disorders or non-neurodegenerative causes such as vascular parkinsonism (VP). This case highlights the acute onset of VP following a stroke, contributing to the understanding of VP's varied presentations and the challenges in its diagnosis. A 54-year-old male with a history of cerebrovascular disease presented with behavioral changes and reduced activity, initially raising the suspicion of a central nervous system infection. Clinical findings included agitation, decreased social interaction, mutism, drooling, immobility, and rigidity. Imaging revealed acute infarction in the left cortical parieto-occipital region, caudate nucleus, and putamen, along with old infarcts, confirming VP. The primary diagnosis was vascular parkinsonism and he was started on anticoagulation therapy and levodopa/carbidopa, which showed minimal improvement over 6 months. This case underscores the importance of considering VP in patients with acute parkinsonian symptoms and a history of cerebrovascular disease. It highlights the necessity for prompt evaluation and management of vascular risk factors to optimize patient outcomes. Additionally, it emphasizes the need for a multidisciplinary approach in treating VP, given the limited efficacy of traditional Parkinson disease medications.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241290847"},"PeriodicalIF":0.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630224","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":"Uptake of Dual Antiplatelet Therapy After High-Risk Transient Ischemic Attack at a University Hospital.","authors":"Morin Beyeler, Philipp Bücke, Pasquale Castigliego, Joel Baumann, Victor Ziegler, Babak B Navi, Simon Jung, Marcel Arnold, Ava L Liberman","doi":"10.1177/19418744241289625","DOIUrl":"10.1177/19418744241289625","url":null,"abstract":"<p><p>Multiple randomized controlled trials have demonstrated that dual antiplatelet therapy (DAPT) significantly reduces the risk of subsequent stroke as compared to aspirin monotherapy after high-risk transient ischemic attack (TIA) or minor ischemic stroke. We sought to evaluate the uptake of DAPT after high-risk TIA at a single center. We conducted a retrospective cohort study of consecutive TIA patients admitted via the Emergency Department (ED) of Bern University Hospital (1/1/2018-12/31/2019). We use descriptive statistics to detail cohort characteristics and compared patients treated with DAPT to those not treated. Statistical significance was set at α = 0.05 and all tests of comparison were two-sided. A total of 383 TIA patients were seen during the study period, 247 were eligible for DAPT. Among those eligible for DAPT, mean age was 72 years and 51% were female. A total of 49 (19.8%) eligible TIA patients were treated with DAPT; use of DAPT significantly increased from 2018 to 2019. Patients admitted to the stroke unit or intensive care unit (n = 33) had a significantly higher proportion of DAPT treatment as compared to those admitted to the general neurology ward or discharged to home from the ED. DAPT use was also significantly higher in patients with large artery atherosclerotic disease (n = 23) as compared to other etiological subtypes and significantly higher among patients who arrived to the ED within 24 h of symptom onset (n = 178). In conclusion, we found that only 2 out of every 10 high-risk TIA patients received DAPT in the years following its introduction in the clinical practice. Our results suggest that strategies to improve the uptake of new, evidence-based secondary stroke prevention treatment after high-risk TIA are needed.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241289625"},"PeriodicalIF":0.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630190","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 19-Year-Old Woman With Progressive Neurological Decline and Multiple Intracranial Lesions.","authors":"Rumyar Ardakani, Kimmo Hatanpaa, Yanel De Los Sanotos, Paula Hardeman, Lauren Tardo","doi":"10.1177/19418744241273283","DOIUrl":"10.1177/19418744241273283","url":null,"abstract":"<p><p>The differential diagnosis for multiple intracranial lesions in a young adult is broad and includes demyelinating, neoplastic, and infectious etiologies. In this report, we describe the case of a 19-year-old immunocompetent woman presenting with progressive headaches and aphasia. MRI of the brain revealed multiple, large supratentorial lesions with concentric bands of alternating T2 signal intensities and peripheral contrast enhancement. Cerebrospinal fluid (CSF) analysis was overall bland with negative oligoclonal bands. Serum antibody testing for neuromyelitis optica (NMO) and myelin-oligodendrocyte associated disease (MOGAD) were negative. A broad infectious work-up was also unrevealing. A definitive diagnosis was ultimately obtained after brain biopsy and the patient was started on appropriate therapy. This case highlights a diagnostic framework in evaluating immunocompetent patients presenting with multiple intracranial lesions and progressive neurological decline. The main differential diagnoses for this constellation of radiological and clinical findings are discussed and a literature review is performed on the revealed diagnosis. Lastly, both acute and long-term therapeutic approaches are reviewed.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"419-422"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298295","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":"Cortical Venous Thrombosis Caused by Venous Compression by Arachnoid Cyst.","authors":"Andrea A Jones, Dakota J S J Peacock, William Guest, Laura K Wilson, Lily W Zhou","doi":"10.1177/19418744241262071","DOIUrl":"10.1177/19418744241262071","url":null,"abstract":"<p><strong>Clinical problem: </strong>Identification, work-up and treatment approach of isolated cortical venous thrombosis (ICVT) in the absence of traditional risk factors.</p><p><strong>Case presentation: </strong>A 66-year-old previously well male presenting with two episodes of left-sided spreading sensory symptoms, found to be secondary to ICVT from extrinsic compression by an arachnoid cyst.</p><p><strong>Key teaching points: </strong>Early identification of structural abnormalities causing extrinsic venous compression and ICVT or cerebral venous sinus thrombosis (CVST) is important for alternative treatment options and to avoid unnecessary testing.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"464-465"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298299","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":"\"Recurrent Pleomorphic Xanthoastrocytoma Presenting with Diffuse Leptomeningeal Spread\".","authors":"Valentina Zagardo, Anna Viola, Gianluca Scalia, Paolo Palmisciano, Giuseppe Emmanuele Umana, Gianluca Ferini","doi":"10.1177/19418744241273267","DOIUrl":"10.1177/19418744241273267","url":null,"abstract":"<p><p>We have read with great interest the recent paper by Grigsby-Rocca et al regarding recurrent pleomorphic xanthoastrocytoma (PXA) with leptomeningeal dissemination. While acknowledging the challenges in managing such cases, we wish to highlight the role of radiotherapy for symptom palliation and potential life extension. We report a case of a 27-year-old woman with recurrent anaplastic PXA and diffuse leptomeningeal spread, who was offered radiotherapy to the spinal axis. Initially presenting with headaches and seizures, she underwent surgical excision, postoperative radiotherapy, and temozolomide. Despite initial disease control, subsequent recurrences required additional surgeries and systemic therapies. With disease progression to leptomeningeal spread, radiotherapy was administered, resulting in clinical stability. This case underscores the importance of considering palliative radiotherapy to improve quality of life and potentially prolong survival in patients with recurrent PXA and leptomeningeal dissemination.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"468-470"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298294","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}