Neurohospitalist最新文献

{"title":"Stroke Hospitalization Administration & Monitoring: Routine or COVID-19 Care (SHAMROCC).","authors":"Timothé Langlois-Thérien, Michel Shamy, Brian Dewar, Tim Ramsay, Ronda Lun, Dylan Blacquiere, Robert Fahed, Dar Dowlatshahi, Grant Stotts, Célina Ducroux","doi":"10.1177/19418744251338601","DOIUrl":"https://doi.org/10.1177/19418744251338601","url":null,"abstract":"<p><strong>Background: </strong>Monitoring stroke patients in critical-care units for 24 h after thrombolysis or endovascular thrombectomy is considered standard of care in current guidelines but is not evidence-based. Due to the COVID-19 pandemic, our center adopted a targeted protocol in April 2021 with 24-h critical-care monitoring no longer being guaranteed for stroke patients receiving reperfusion treatment. We aim to compare the incidence and timing of complications during the year under the targeted approach compared to prior years when the standard of care was followed.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study. We analyzed data from stroke patients treated with thrombolysis and/or endovascular thrombectomy in 2019 (pre-COVID-19, standard of care), 2020 (during COVID-19, standard of care) and 2021 (during COVID-19, targeted protocol). Data extracted included demographics, the nature and timing of complications within the first 24 h, and the unit at the time of complication.</p><p><strong>Results: </strong>Three hundred forty-nine patients were included in our study: 78 patients in 2019, 115 patients in 2020, and 156 patients in 2021. In 2021, 32% of patients experienced at least 1 complication within the first 24 h compared to 34% in 2020 and 27% in 2019. In 2021, 33% of patients admitted to critical-care units had a complication compared to 29% in non-critical care units. In 2021, 70% of complications had occurred by hour 8 compared to 49% in 2020 and 29% in 2019.</p><p><strong>Conclusions: </strong>The incidence and timing of complications did not significantly worsen under the targeted approach compared to prior years and were not associated with hospital location.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251338601"},"PeriodicalIF":0.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029657","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":"Spontaneous Abnormal Vertical Eye Movements of Coma.","authors":"Claire Allen, Siena Duarte, Jaeho Hwang, Romergryko G Geocadin, Kemar E Green","doi":"10.1177/19418744251331649","DOIUrl":"https://doi.org/10.1177/19418744251331649","url":null,"abstract":"<p><p>Spontaneous vertical eye movements in the critical care setting are often a source of confusion and alarm; while their origin remains at least partly theoretical, understanding their classification and associated clinical implications can inform the diagnostic workup and further clinical management. This case describes a patient who demonstrated ocular dipping: slow conjugate downward eye movements with a quick return to primary gaze. Ocular dipping is a rare phenomenon that was initially described in patients with hypoxic brain injury and has since been described in only a handful of cases. Dipping resides in a spectrum of spontaneous vertical eye movements, with ocular bobbing being the first of these described eye movements. Ocular bobbing is characterized by a fast downward movement followed by a slow return to the mid gaze position which is classically associated with pontine injury. Other vertical eye movements that can be seen in patients with a disorder of consciousness include other variations of ocular bobbing and dipping, vertical myoclonus, and small-amplitude mainly vertical movements.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251331649"},"PeriodicalIF":0.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024287","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":"Salivary Gland Botulinum Toxin a Injections for Treating Sialorrhea Among Critically Ill Patients With Neurological Disorders.","authors":"Fazila Aseem, Kayla E John, Daniel King, Miriam Sklerov, Daniel A Roque, Nina M Browner, Julia M Carlson","doi":"10.1177/19418744251338148","DOIUrl":"https://doi.org/10.1177/19418744251338148","url":null,"abstract":"<p><p><b>Background:</b> Sialorrhea is associated with various neurological conditions. Among critically ill patients with acute neurological injuries (ANI), sialorrhea leads to several adverse consequences, including extubation failure, inability to initiate non-invasive ventilation, aspiration pneumonia and prolonged hospitalization. Botulinum toxin (BoTN) injections can reduce salivary production. Both BoTN-A and BoTN-B are effective in managing sialorrhea among patients with neurogenic dysphagia. BoTN utilization for sialorrhea in critically ill adult ANI patients is not well-studied. <b>Purpose:</b> The purpose of this study to evaluate the safety and feasibility of using BoTN-A salivary injections to reduce sialorrhea in ANI patients. <b>Research Design:</b> In this case series, we retrospectively reviewed the off-label use of BoTN-A for sialorrhea in ANI patients at the University of North Carolina Neurosciences Intensive Care Unit. Study Sample: Six patients with ANI who received BoTNA treatment for neurogenic sialorrhea in absence of infection and medications with known side-effect of sialorrhea. <b>Data Collection:</b> For safety evaluation, we reviewed any documented adverse effects of BoTN-A injection. For efficacy, we evaluated the drooling severity, suctioning frequency, oxygen requirements, continued days on the ventilator, and pneumonia diagnoses. <b>Results:</b> All patients had reduction in their documented drooling and suctioning requirements following BoTN-A injection. None had adverse events associated with BoTN-A injections. All patients experienced recurrent ventilator-associated pneumonias prior to BoTN-A injections whereas four patients had no pneumonia events after injections. Also, two patients were successfully weaned of oxygenation prior to discharge. <b>Conclusions:</b> This case series highlights the safety and potential efficacy of salivary gland BoTN-A for reducing refractory sialorrhea among critically ill ANI patients. Future studies are needed to evaluate whether sialorrhea reduction can lead to reduced hospital complications and overall length of hospital stay.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251338148"},"PeriodicalIF":0.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053737","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":"An Overview of the Dengue Viruses.","authors":"Barrie L Schmitt, Lakshmi Chauhan, Amanda L Piquet, Kenneth L Tyler, Daniel M Pastula","doi":"10.1177/19418744251334717","DOIUrl":"https://doi.org/10.1177/19418744251334717","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251334717"},"PeriodicalIF":0.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990331","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":"<i>Streptococcus</i> <i>p</i> <i>neumoniae</i> Meningitis with Diffuse Cerebral Microhemorrhages.","authors":"Harleen Sood, Ramesha Chinakarihalli Gangadharappa, Rahul Dey, Vikas Bhatia, Ashok Kumar Pannu","doi":"10.1177/19418744251332982","DOIUrl":"https://doi.org/10.1177/19418744251332982","url":null,"abstract":"<p><p><i>Streptococcus pneumoniae</i> is the leading cause of community-acquired bacterial meningitis across all age groups. Despite appropriate antibiotic therapy, the prognosis for pneumococcal meningitis remains poor. While common acute complications include cerebral edema, brain herniation, ventriculitis, hydrocephalus, and cerebral infarctions, hemorrhagic events are rarely reported. We present a case of a young male with <i>S. pneumoniae</i> meningitis, who developed diffuse cerebral microhemorrhages, an extremely rare complication. Despite culture-guided antibiotic therapy, the patient's condition deteriorated, requiring mechanical ventilation. Magnetic resonance imaging revealed diffuse cerebral microhemorrhages, prompting intensive supportive care. Prolonged mechanical support and a two-week antibiotic therapy led to gradual recovery, and the patient was discharged without neurological sequelae. This case highlights the importance of early imaging and timely intervention in managing rare complications of bacterial meningitis.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251332982"},"PeriodicalIF":0.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11985466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006279","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":"Scrub Typhus Meningoencephalitis Presenting as Generalized Convulsive Status Epilepticus with Basal Ganglia and Extra-limbic Cortical Involvement, Complicated by Cortical Multifocal Myoclonus.","authors":"Uttam Biswas, Moisés León-Ruiz, Ritwik Ghosh, Ritun Sarkar, Raghul Bheeman, Arpan Mukhopadhyay, Julián Benito-León","doi":"10.1177/19418744241276903","DOIUrl":"10.1177/19418744241276903","url":null,"abstract":"<p><strong>Background: </strong>Scrub typhus is an acute febrile infectious disease highly prevalent in the Asia Pacific region, often referred to as the \"tsutsugamushi triangle.\" This mite-borne rickettsial zoonosis is caused by <i>Orientia tsutsugamushi</i>, an intracellular Gram-negative organism that primarily targets endothelial cells. The resulting vasculitis leads to multisystem involvement. In terms of neurological manifestations, meningoencephalitis is the most common presentation of scrub typhus. Other frequent neurological manifestations include cranial nerve paresis, transverse myelitis, and polyneuropathy. Status epilepticus, while reported, is a rare presenting feature of this infection. Although scrub typhus has been documented to present as limbic encephalitis, there have been no previous descriptions in the literature of neuroradiological patterns affecting the basal ganglia or extra-limbic cortices in this condition.</p><p><strong>Case report: </strong>We report a case of a 23-year-old previously healthy woman who presented with scrub typhus meningoencephalitis. The condition manifested as encephalitis with involvement of the basal ganglia and extra-limbic cortices. She presented with generalized convulsive status epilepticus, which was complicated by cortical multifocal myoclonus.</p><p><strong>Discussion: </strong>Scrub typhus can be a significant diagnostic challenge, potentially presenting with generalized convulsive status epilepticus and mimicking both clinical and radiological features of arboviral encephalitides, such as those caused by West Nile and Japanese encephalitis viruses. Furthermore, as demonstrated in this case, its radiological presentation can resemble that of autoimmune encephalitis. Given that scrub typhus is amenable to treatment with antibiotics, such as doxycycline and azithromycin, which do not increase seizure risk, it should be considered in the differential diagnosis for patients presenting with seizures or encephalitis, especially in endemic areas.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"182-187"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648964","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":"Long-Term Seizure Outcomes in Autoimmune Encephalitis.","authors":"Lucy Jia, Carla Y Kim, Maria Pleshkevich, Runze Cui, Yifei Sun, Julien Hébert, Claude Steriade, Kiran T Thakur","doi":"10.1177/19418744251331650","DOIUrl":"10.1177/19418744251331650","url":null,"abstract":"<p><strong>Introduction: </strong>Seizures are common in autoimmune encephalitis (AE), but identifying patients at risk of chronic epilepsy in the post-acute phase remains challenging. This study aims to identify risk factors of treatment-resistant postencephalitic epilepsy.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with AE who experienced new-onset seizures within one year of symptom onset from two tertiary care centers in New York. EEG findings were analyzed separately based on whether the EEG recording was obtained in the acute (<3 months from symptom onset) or subacute phase. A multivariate logistic regression model was used to identify independent predictors of postencephalitic epilepsy.</p><p><strong>Results: </strong>Eighty-nine patients were included (median age: 33 years). Neural antibodies were present in 73% of patients (NMDAR: 35, LGI1: 19, GAD65: 9, Hu: 1, AGNA-1: 1). Over a median follow-up of 4.9 years, 29.2% developed treatment-resistant postencephalitic epilepsy. Independent predictors of postencephalitic epilepsy included focal slowing on acute EEG (OR 0.15, CI 0.02-0.90), interictal epileptiform discharges (IEDs) or periodic discharges (PDs) on subacute EEG (OR 20.01, CI 1.94-206.44), and cell surface antibodies (OR 0.21, CI 0.05-0.89). Immunotherapy within three months of onset was associated with decreased epilepsy development in patients with neural antibodies (OR 4.16, CI 1.11-16.30).</p><p><strong>Conclusions: </strong>Nearly one-third of patients with AE and acute seizures developed treatment-resistant postencephalitic epilepsy, with significant predictors including absence of focal slowing on acute EEG, presence of IEDs and PDs on subacute EEG, absence of cell surface antibodies, and absence of early immunotherapy treatment of patients with positive neural antibodies.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251331650"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781474","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 Hepatic Porphyria Presenting as Guillain-Barré Syndrome: Importance of Early Recognition and Screening.","authors":"Kumar Porakapalli Yuvasai, Sanveer Singh, Pratiksha Jayant Pai, Sathvik Reddy Erla, Ashok Kumar Pannu","doi":"10.1177/19418744251331651","DOIUrl":"10.1177/19418744251331651","url":null,"abstract":"<p><p>Acute hepatic porphyria (HP) often presents with recurrent neurovisceral symptoms in young adults, mimicking more common neurological conditions such as Guillain-Barré Syndrome (GBS) and posing significant diagnostic challenges. We report a case of a 25-year-old male who presented with progressive weakness of all 4 limbs over 4 days, culminating in respiratory paralysis requiring mechanical ventilation. Neurological examination revealed acute flaccid paralysis with areflexia, and nerve conduction studies showed acute motor axonal neuropathy, initially supporting a diagnosis of GBS. However, the patient's young post-pubertal age, onset in the upper limb with proximal weakness, pure motor axonal neuropathy, and presence of hyponatremia due to the syndrome of inappropriate antidiuresis raised suspicion of acute HP. Screening with qualitative urine porphobilinogen testing, followed by quantitative confirmation, diagnosed acute HP. The patient was treated with intravenous dextrose in the absence of hemin, resulting in gradual clinical improvement. This case underscores the importance of distinguishing acute HP from GBS and the need for early recognition and screening to initiate life-saving therapy.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251331651"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781471","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 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}