Neurohospitalist最新文献

{"title":"Rasmussen-Like Asymmetric Cortical Atrophy in Anti-NMDA Receptor Encephalitis.","authors":"Yoji Hoshina, Otto Rapalino, Jenny Linnoila","doi":"10.1177/19418744261489707","DOIUrl":"10.1177/19418744261489707","url":null,"abstract":"<p><p>An 18-year-old man presented with 1 week of insomnia and headache, followed by erratic behavior, encephalopathy, seizures, and left-sided weakness. Brain MRI demonstrated cortical T2/FLAIR hyperintensity predominantly involving the right cerebral hemisphere, followed by progressive right-greater-than-left cortical volume loss over 2 months. FDG-PET showed extensive hypometabolism, predominantly affecting the right cerebral hemisphere and thalami. CSF revealed lymphocyte-predominant pleocytosis (87 cells/μL), with normal protein and glucose. Anti-NMDA receptor IgG was positive in serum and CSF by cell-based assay (titer not available). Body FDG-PET was negative for malignancy. He was treated with intravenous corticosteroids, immunoglobulin, and rituximab. At 6-month follow-up, he followed simple commands, walked independently with a spastic gait, and was seizure-free on 2 anti-seizure medications. Repeat serum anti-NMDA receptor IgG remained positive at 1:40. While asymmetric cortical atrophy is classically associated with Rasmussen encephalitis, autoimmune encephalitis can rarely have a similar radiographic appearance. The presence of milder contralateral imaging abnormalities and persistent anti-NMDA receptor seropositivity after clinical stabilization supports an atypical presentation of anti-NMDA receptor encephalitis. This case expands the literature on Rasmussen-like autoimmune encephalitis and potential overlap syndromes.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261489707"},"PeriodicalIF":0.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963540","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":"Downbeat Nystagmus as a Manifestation of Myoclonic Status Epilepticus in a Patient With Anoxic Brain Injury.","authors":"T Maxwell Parker, Scott N Grossman, Laura J Balcer, Steven L Galetta, Janet C Rucker","doi":"10.1177/19418744261477539","DOIUrl":"10.1177/19418744261477539","url":null,"abstract":"<p><strong>Background/purpose: </strong>Downbeat nystagmus (DBN) is an uncommon finding in comatose patients, especially as a manifestation of epileptiform activity. We report a 59-year-old man who developed DBN in the context of myoclonic status epilepticus following anoxic brain injury secondary to cardiac arrest. The DBN was phase-locked with generalized periodic epileptiform discharges (GPDs) on electroencephalography (EEG) and resolved with pharmacologic burst suppression.</p><p><strong>Conclusion: </strong>This case suggests a potential link between DBN and cortical epileptiform activity, which we hypothesize may be due to bilateral cortical hyperexcitability and cerebellar disinhibition. The presence of DBN in this setting may indicate a poor prognosis.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261477539"},"PeriodicalIF":0.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898000","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":"Cognitive Screening as a Gateway to Cerebral Microbleed Detection in Atrial Fibrillation: The DAME Study.","authors":"David Z Rose, Chan Gu, Alexander Glaser, Henian Chen, Weiliang Cen, Hannah Lucin, Danielle Vargas, Marla Hairston, Nicholas C Hilker, Andrea Bozeman, Elizabeth Remo-Platt, W Scott Burgin, Bibhu D Mohanty, Xavier E Prida","doi":"10.1177/19418744261480466","DOIUrl":"10.1177/19418744261480466","url":null,"abstract":"<p><p>Atrial fibrillation (AF) and dementia prevalence increase with age. For patients with both co-morbidities, oral anticoagulation (OAC) reduces ischemic stroke risk, but augments intracranial hemorrhage (ICH) risk, especially for dementia from cerebral amyloid angiopathy (CAA). Thus, AF patients with CAA face a therapeutic dilemma: take OAC with elevated ICH risk or withhold OAC and increase ischemic risk. Screening AF outpatients for dementia remains unexplored. The DAME-Detect study (Dementia in Atrial fibrillation with Micro-bleeds Early Detection) was a prospective, interdisciplinary, longitudinal cohort study to assess co-morbid CAA and AF in cardiology clinics. After informed consent, patients/proxy completed the SED-11Q (Symptoms of Early Dementia-11 Questionnaire) and vascular neurologists reviewed subjects' brain MRIs. At 90-day follow-up, SED-11Q and OAC prescriptions were re-assessed. DAME-Detect enrolled 122 patients (68% male; mean age 77.5 years); 21 (17.2%) screened dementia-positive on SED-11Q while 101 (82.8%) screened dementia-negative. Of the 53 (43.0%) respondents at 90-day follow-up, 15.0% screened dementia-positive, of whom 62.5% had cerebral microbleeds (CMBs) on brain MRI, vs 13.3% of the 85.0% who screened dementia-negative (<i>P</i> = 0.012). Although antiplatelet use was similar (62.5% vs 66.7%, <i>P</i> = 0.999), OAC was significantly less in dementia-positive subjects (25.0% vs 86.7%, <i>P</i> < 0.001). In this prospective study, one-sixth of AF patients screened dementia-positive in cardiology clinic, two-thirds of whom had microbleeds on brain MRI. Dementia-positive patients were prescribed OAC less, presumably reflecting ICH concern. Dementia screening for AF patients in cardiology clinics is feasible and may enable OAC risk stratification. Future studies are warranted to explore alternatives (ie, Left atrial appendage closure) in this vulnerable population.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261480466"},"PeriodicalIF":0.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833311","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":"Fulminant Leptomeningitis Without Hemorrhagic Lesions as an Atypical Initial Presentation of Cerebral Amyloid Angiopathy-Related Inflammation.","authors":"David O Sohutskay, Michael J Rigby, Amra Sakusic, Alejandro A Rabinstein, Ashley R Santilli","doi":"10.1177/19418744261483219","DOIUrl":"10.1177/19418744261483219","url":null,"abstract":"<p><p>Cerebral amyloid angiopathy related inflammation (CAA-ri) is a rare neuroinflammatory condition that may present with a wide spectrum of clinical and radiographic findings. Classic imaging features include areas of asymmetric subcortical white matter hyperintensities due to vasogenic edema, together with the classic hemorrhagic lesions of cerebral amyloid angiopathy (CAA) including microhemorrhages, superficial siderosis, or convexity subarachnoid hemorrhage. We describe a case of CAA-ri appearing as fulminant leptomeningitis without other obvious radiographic features of CAA at presentation.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261483219"},"PeriodicalIF":0.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819896","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 Reasoning: A 28-Year-Old Man with Subacute-Onset Ataxic Gait.","authors":"Mauricio Benetti, Francisco Caiza-Zambrano, Ricardo Reisin, Claudia Shanley, Nicolás Roccatagliata, Luciana León-Cejas","doi":"10.1177/19418744261484200","DOIUrl":"10.1177/19418744261484200","url":null,"abstract":"<p><p>The diagnostic approach to subacute progressive polyneuropathy can be challenging, particularly when accompanied by systemic features. We present a 28-year-old man with subacute-onset ataxic gait. Four months before his initial evaluation at our center, he was assessed by orthopedics for a poorly differentiated tumor of the right tibia. He also reported intermittent fever and unintentional weight loss. Neurologic examination revealed marked weakness in all four limbs, with deep tendon reflexes absent in the lower extremities. Sensory testing demonstrated a stocking-glove distribution of hypoesthesia. Vibration and proprioception were decreased in all four limbs. Romberg sign was positive, and he had a broad-based ataxic gait with bilateral steppage. Nerve conduction studies demonstrated a demyelinating sensorimotor polyneuropathy. Initial laboratory and imaging studies showed thrombocytosis and radiologic evidence of organomegaly. This case highlights a stepwise diagnostic approach to progressive polyneuropathy with red flags for systemic disease and emphasizes the importance of integrating neurologic and systemic findings to expand the differential diagnosis, guide targeted investigations, and identify potentially treatable underlying conditions.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261484200"},"PeriodicalIF":0.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833294","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":"Probable Cerebral Amyloid Angiopathy-Related Inflammation With Spontaneous Remission. A Rare Presentation of a Rare Disease.","authors":"Francisco Caiza-Zambrano, Luis Ariel Miquelini, Fabio Gonzalez, Julio Galarza, Mauricio Benetti, Yemina Neme-Segura, Patxi Zavala-Gottau, Carlos Rugilo, Claudia Uribe-Roca, Manuel Fernández-Pardal, Luciana León-Cejas, Ricardo Reisin, Pablo Bonardo","doi":"10.1177/19418744261480458","DOIUrl":"10.1177/19418744261480458","url":null,"abstract":"<p><p>Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a rare condition caused by an inflammatory response against perivascular β-amyloid deposits. CAA-ri with spontaneous remission has been described in a few cases. We report a 76-year-old man who presented with headache and confusion. No neurological deficit was evidenced on physical examination. Brain MRI showed asymmetric white matter hyperintensities with leptomeningeal enhancement and multiple cortical microbleeds, compatible with probable CAA-ri. One month later, brain MRI showed complete resolution of the white matter abnormalities without treatment. This case suggests that the course of CAA-ri may be self-limited. Furthermore, we conducted a review of previously reported cases. This allows physicians to know this entity, properly rule out differential diagnoses, and recognize findings in imaging studies.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261480458"},"PeriodicalIF":0.6,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819814","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":"Pharmacologically Induced Hypertension after Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.","authors":"Baher Boktor, Mahmoud M Afia, Rafael T Tatit, Stephen W English, Lauren K Ng, Josephine F Huang, Rabih G Tawk, Michael A Pizzi, William D Freeman, Michelle P Lin","doi":"10.1177/19418744261474344","DOIUrl":"https://doi.org/10.1177/19418744261474344","url":null,"abstract":"<p><p>The effect of induced hypertension (iHTN) on functional outcomes in noncardioembolic acute ischemic stroke (AIS) with early neurological deterioration remains unclear. We performed a systematic review and meta-analysis evaluating the safety and efficacy of iHTN vs medical management. A literature search of PubMed/MEDLINE, Web of Science, Ovid Embase, and Scopus from inception through November 6th, 2025. The protocol was registered in PROSPERO (CRD420261282211). Studies evaluating iHTN within 72 h of AIS onset and reporting 90-day functional independence (modified Rankin Scale [mRS] 0-2) were included. Safety outcome was hemorrhagic transformation. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using random-effects model based on Restricted Maximum-Likelihood (REML) methods. Three studies were included, comprising 366 patients (iHTN, n = 180; control, n = 186). Mean age was 65.8 ± 11.8 years, 60.9% were men, and the mean initial NIHSS was 5.4 ± 3.5. Target systolic blood pressure (SBP) was a 15-25% increase from baseline SBP using phenylephrine. Functional independence at 90-days occurred more often in the iHTN group than in controls (68.8% vs 50.5%; RR = 1.37; 95% CI, 1.09-1.73; <i>P</i> = 0.007). Hemorrhagic transformation was uncommon and did not differ significantly between groups (3.3% vs 0.5%; RR = 2.08; 95% CI, 0.05-88.07; <i>P</i> = 0.70). In our study, phenylephrine-induced hypertension was associated with greater 90-day functional independence in selected AIS subtypes,without a significant increase in hemorrhagic transformation. However, the limited studies, predominance of retrospective designs, exclusively Asian cohorts, and heterogeneity in treatment protocols and populations warrant cautious interpretation and underscore the need for larger multicenter RCTs.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261474344"},"PeriodicalIF":0.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799259","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":"Thrombotic Thrombocytopenic Purpura Causing Multiple Large Vessel Occlusions: A Case Report.","authors":"Meg B McCalley, Xueqing Zhang, Alexander Vorobyev, Narmada Mannem, Ghada A Mohamed","doi":"10.1177/19418744261475525","DOIUrl":"https://doi.org/10.1177/19418744261475525","url":null,"abstract":"<p><strong>Background: </strong>Thrombotic thrombocytopenic purpura (TTP) is a hematologic disorder characterized by a severe deficiency or absence of the disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 enzyme (ADAMTS13), which is a protease essential for cleaving von Willebrand factor. This deficiency promotes microvascular thrombosis and can lead to ischemic strokes.</p><p><strong>Case presentation: </strong>We present the case of a 29-year-old female with a history of rheumatological disease controlled with chronic low-dose prednisone who presented with an acute ischemic stroke due to a large vessel occlusion (LVO). She underwent mechanical thrombectomy, during which extensive recurrent clot formation occurred with recurrent intracranial occlusions. Further evaluation revealed nonbacterial thrombotic endocarditis. Interestingly, her initial hematological workup revealed only fluctuating thrombocytopenia, and her remaining hematologic tests were largely unremarkable. ADAMTS13 level was markedly reduced, and she was ultimately treated with plasma exchange, high-dose corticosteroids, and rituximab, with a good response and no recurrent ischemic events during follow-up.</p><p><strong>Conclusions: </strong>In this case, we highlight the importance of including hematological disorders like TTP in the differential diagnosis of cryptogenic stroke and particularly in the presence of autoimmune conditions or subtle hematologic abnormalities.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261475525"},"PeriodicalIF":0.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799298","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":"Documentation and Coding for the Pediatric Neurohospitalist.","authors":"Matthew Chase Lustig","doi":"10.1177/19418744261477795","DOIUrl":"https://doi.org/10.1177/19418744261477795","url":null,"abstract":"<p><p>In 2021 and 2023, the American Medical Association (AMA) revised evaluation and management (E/M) service reporting. Clinicians now determine most service levels by medical decision making or total time spent on the date of service. Trainees often receive little formal education about how documentation and coding affect clinical practice. Clinicians may also receive limited structured feedback on their documentation and coding. This review discusses inpatient pediatric neurology notes, critical care reporting, electroencephalography (EEG) interpretation, and attestation by the teaching physician. It also considers improvement models such as pathway-linked templates and department billing and coding review programs.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261477795"},"PeriodicalIF":0.6,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799331","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":"Cerebral Herniation and Sudden Death in Autoimmune Glial Fibrillary Acidic Protein (GFAP) Astrocytopathy: A Case Report.","authors":"Bishow C Mahat, Mohamed F Doheim, Lamees Alzyoud, Katharine Dermigny, Islam Zaydan, Rock Heyman, Madison Pilato","doi":"10.1177/19418744261476486","DOIUrl":"10.1177/19418744261476486","url":null,"abstract":"<p><p>We describe what, to our knowledge, is the third reported fatal outcome in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy secondary to cerebral edema and brainstem herniation. A 42-year-old woman presented with neck and back pain with tremors, progressing to confusion and memory impairment. Neuroimaging revealed encephalomyelitis. CSF revealed antibodies to GFAP. After an initial response to corticosteroids, she had recurrence of encephalopathy. Following a repeat lumbar puncture, she developed diffuse cerebral edema with herniation and brain death. Diffuse cerebral edema should be considered a rare but potentially fatal presentation of GFAP astrocytopathy. Clinicians involved in the care of patients diagnosed with or suspected to have GFAP astrocytopathy should remain vigilant about the development of cerebral edema throughout the diagnostic and treatment process and evaluate the patient with neuroimaging before initial and subsequent lumbar punctures.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261476486"},"PeriodicalIF":0.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713998","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}