Neurohospitalist最新文献

{"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}

{"title":"Beyond Septic Encephalopathy: A Case Report of Severe RCVS and PRES in a Patient With HLH due to Appendicitis.","authors":"Kathryn Swider, Aleksey Tadevosyan, Mara M Kunst, Joseph D Burns","doi":"10.1177/19418744251319057","DOIUrl":"10.1177/19418744251319057","url":null,"abstract":"<p><p><b>Background and Objectives</b>: We report a rare case of severe posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) in an adult patient with hemophagocytic lymphohistiocytosis (HLH), and speculate that these three diagnoses are related by similar mechanisms of vascular endothelial dysfunction. <b>Methods</b>: Informed consent for this case report was obtained from the patient's legally authorized surrogate decision maker. <b>Discussion and Practical Implications</b>: Our patient initially presented with HLH secondary to intra-abdominal sepsis, and was later found to have severe PRES and RCVS resulting in extensive border-zone cortex infarction. Improvement of the severe systemic inflammatory syndrome characteristic of HLH and arrest of PRES and RCVS progression occurred only after HLH-specific treatment was initiated. In addition to illustrating the potential of HLH to manifest as PRES and RCVS, this case emphasizes the importance of prompt recognition and treatment of HLH and the role the neurologist can play in this process. This case also sheds light on the pathophysiological links between PRES, RCVS, and HLH. These three diagnoses may be related by similar mechanisms of vascular endothelial dysfunction caused by uncontrolled and severe systemic inflammation.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251319057"},"PeriodicalIF":0.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383627","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":"Inpatient Implementation of Portable Ocular Fundus Photography Among Neurology Residents.","authors":"Nicholas U Schwartz, Andrew Silverman, Shannon Beres, Heather E Moss, Kathryn Kvam, Kristin Galetta","doi":"10.1177/19418744251317260","DOIUrl":"10.1177/19418744251317260","url":null,"abstract":"<p><p><b>Background:</b> Nonmydriatic ocular fundus photography has been studied with demonstrated benefit in the evaluation of emergency department neurological complaints, particularly in triaging headache and focal neurological deficits. Likewise, portable fundus camera usage may be practical for inpatients with neurological complaints, although feasibility has not been studied in a neurology teaching service. <b>Purpose:</b> The objective of this study is to determine if a portable, nonmydriatic fundus camera could be integrated into routine clinical care by neurology inpatient housestaff at a tertiary medical center. <b>Research Design:</b> Housestaff were asked to obtain fundus photographs for patients with specific indications for fundoscopy. <b>Study Sample:</b> During a 1-month pilot period, housestaff were successfully able to upload images from 21 patients, which were reviewed by a neuro-ophthalmology attending, with input from on-call ophthalmology if desired. <b>Results:</b> Surveys of housestaff before (n = 13) and after (n = 12) implementation demonstrated increased confidence in camera operation and in ocular structure identification, description, and interpretation. Thematic analysis on qualitative feedback suggested benefits in clinical (improving fundus visualization, aiding in triage, sharing images with offsite staff), health systems (reducing length of stay, reducing ophthalmology consultations, reduced unnecessary testing), and educational domains (facilitating group discussions of images, sharing photographs with patients). <b>Conclusions:</b> Overall, inpatient portable fundus photography was shown to be feasible and effective for rapid fundus visualization for neurological inpatients, enhancing the ability to share, document, and compare examinations among neurology housestaff. Further work is needed to confirm clinical and educational benefits of portable fundus photography usage by neurology residents, as suggested by this healthcare quality improvement pilot study.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251317260"},"PeriodicalIF":0.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081413","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":"Midbrain Ischemic Stroke Manifesting With Rubral Tremor and Palato-Pharyngo-Laryngeal Myoclonus.","authors":"Shawn Banash, Jonathan Snider, Jeffrey R Vitt","doi":"10.1177/19418744241313151","DOIUrl":"10.1177/19418744241313151","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241313151"},"PeriodicalIF":0.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048150","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":"Factor XIa Inhibitor Reversal in Intracranial Hemorrhage: A Case Report.","authors":"Arshed Al-Obeidi, Draia Garavito, Sierra Smalley, Kayla John, Lee Ann Jones, Nigel Key, Tamara Strohm","doi":"10.1177/19418744251314534","DOIUrl":"10.1177/19418744251314534","url":null,"abstract":"<p><strong>Background/objectives: </strong>There is currently no consensus regarding the optimal strategy for reversal of anticoagulation in life-threatening hemorrhage associated with factor XIa (FXIa) inhibitors.</p><p><strong>Methods: </strong>For this clinical case report, informed consent was obtained from surrogate.</p><p><strong>Results and discussion: </strong>Here, we present the case of an 82-year-old female who sustained a large subdural hematoma after a fall. Her aPTT on admission was elevated at 90.4 s and remained persistently prolonged at 90.9 s 12-hour after receiving an adequate dose of 4-factor prothrombin complex concentrate (PCC). She was found to have received a factor XIa inhibitor in a clinical trial, and subsequently received recombinant activated factor VII (rFVIIa) 2 mg (45 mcg/kg) as a one-time dose, and tranexamic acid (TXA) 1 g intravenously for reversal given her intracranial bleeding in the setting of trauma complicated by recent factor XIa inhibitor use. However, given her clinical decline and high surgical risk, the patient's family elected to withdraw care and she expired three days later. Reversal of FXIa inhibitors is challenging but may best be achieved using a combination of rFVIIa and TXA.</p><p><strong>Practical implications: </strong>Clinicians should consider administration of low dose recombinant activated factor VII (rFVIIa) in conjunction with an anti-fibrinolytic inhibitor such as tranexamic acid (TXA) for reversal of life-threatening hemorrhage in bleeding patients with exposure to novel factor XIa inhibitors that are currently in clinical trials.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251314534"},"PeriodicalIF":0.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024404","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":"Impact of Post-Stroke Post-Traumatic Stress Disorder.","authors":"Swetha Renati, Sanita Raju, Alena Makarova, Marla Hairston, Kanita Beba Abadal, Andrea Bozeman, Henian Chen, Weiliang Cen, David Z Rose, W Scott Burgin","doi":"10.1177/19418744251315201","DOIUrl":"10.1177/19418744251315201","url":null,"abstract":"<p><strong>Introduction: </strong>Post-Traumatic Stress Disorder (PTSD) is associated with exposure to traumatic events, especially in the military setting. However, patients who experience stroke may develop anxiety about their stroke event and may re-experience transient neurological symptoms as a result. A significant portion develop the persistent and disabling symptoms of PTSD.</p><p><strong>Methods: </strong>At the University of South Florida, we conducted a single-center, IRB-approved, observational pilot study of 20 adult patients who were diagnosed with stroke or transient ischemic attack (TIA) in the previous 31 days to 1 year. Patients completed the post-traumatic stress disorder checklist-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), Stroke specific Quality of Life Scale (SS-QOL-12), Modified Rankin Scale of disability (mRS), and National Institutes of Health Stroke Scale (NIHSS) and provided blood and saliva samples.</p><p><strong>Results: </strong>All 20 subjects completed the PCL-5 and 19 subjects completed the follow up scales. Seven patients (35%) were found to have Post-Stroke Post-Traumatic Stress Disorder (PS-PTSD). Higher PCL-5 scores were significantly correlated with lower SS-QOL scores indicating worse quality of life (r = -0.709, <i>P</i> = .001) and higher PHQ-9 scores representing symptoms of depression (r = 0.727, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Post-Stroke Post-Traumatic Stress Disorder (PS-PTSD) is prevalent after stroke and TIA with patients experiencing concurrent depressive symptoms, correlating with a worsened quality of life.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251315201"},"PeriodicalIF":0.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013721","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: Two Patients With Gait Instability and Difficulty With Hand Coordination.","authors":"Trevor Glenn, Amine Awad, Galina Gheihman, Alexis Roy","doi":"10.1177/19418744251314210","DOIUrl":"10.1177/19418744251314210","url":null,"abstract":"<p><p>Subacute-to-chronic gait instability has a broad differential diagnosis. The neurological exam can help elucidate the localization and suggest an underlying etiology of the symptomatology, which can lead to a more focused diagnostic approach. Two patients are described - 1 with a month of worsening difficulty with ambulation that evolved to bilateral hand discoordination and another with 18 months of progressive difficulty with ambulation that also then progressed to involve her bilateral hands. These cases highlight an approach to gait dysfunction with hand discoordination secondary to sensory ataxia. The patients were ultimately diagnosed with copper deficiency myelopathy secondary to zinc excess, and different treatment regimens are discussed.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251314210"},"PeriodicalIF":0.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972643","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 63 year-Old Male With a Painful Subacute Demyelinating Neuropathy.","authors":"Audrey Blazek Ramsay, Kim Griffin, Michael Skolka, Michel Toledano, Marcus V Pinto","doi":"10.1177/19418744251314540","DOIUrl":"10.1177/19418744251314540","url":null,"abstract":"<p><p>Subacute, painful weakness is a common problem encountered by neurologists and can be associated with systemic symptoms. The patient presented with 6 weeks of progressive neuropathic pain followed by sensory changes and distal-predominant weakness. This case reviews the broad differential for such a presentation and a comprehensive, stepwise approach to diagnosis. Particular attention is paid to the potentially treatable polyradiculoneuropathies, including more recently recognized immune-mediated etiologies. Through this stepwise approach, we review how a definitive diagnosis was made.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251314540"},"PeriodicalIF":0.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972642","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":"Beyond de Patient: A Lesson in Vigilance and Care.","authors":"Mariana Peschard-Franco","doi":"10.1177/19418744241310478","DOIUrl":"https://doi.org/10.1177/19418744241310478","url":null,"abstract":"<p><p>A neurology resident reflects on a pivotal moment during the assessment of an elderly patient, when attention shifts unexpectedly to the patient's caregiver, his wife. The resident quickly recognizes a neurological deficit that could potentially be treated. Sensing the urgency, the resident rushes her to the emergency department, where immediate treatment enables the caregiver to regain her ability to continue caring for her husband. This experience teaches the resident a profound lesson about the importance of vigilance not only toward primary patients but also toward those quietly supporting them. It highlights how timely intervention can preserve the connections that bind families, emphasizing the role of healthcare providers in maintaining these bonds.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241310478"},"PeriodicalIF":0.9,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11701896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956588","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}