Neurohospitalist最新文献

{"title":"Claustrum Sign: An Increasingly Recognized Imaging Feature of New-Onset Refractory Status Epilepticus (NORSE).","authors":"Mohammad Abdullah, Tychicus Chen","doi":"10.1177/19418744251399731","DOIUrl":"10.1177/19418744251399731","url":null,"abstract":"<p><p>The claustrum sign, marked by increased MRI signal intensity of the claustrum, is an increasingly recognized imaging finding associated with new-onset refractory status epilepticus (NORSE), and may be associated with a more refractory disease course and worse outcomes. We present a 42-year old male patient who developed NORSE refractory to several treatments including immunotherapy, with MRI demonstrating the claustrum sign early in his disease course. We aim to highlight this sign as an important feature of NORSE, which could alert clinicians to the diagnosis, prompting more extensive workup and aggressive treatment earlier on.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251399731"},"PeriodicalIF":0.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12678137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702287","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":"Emergence of Atypical Lymphocytes Before Cryptogenic New Onset Refractory Status Epilepticus: A Case Report.","authors":"Hiroki Takatsu, Tatsushi Kokubu, Shusaku Omoto","doi":"10.1177/19418744251403823","DOIUrl":"10.1177/19418744251403823","url":null,"abstract":"<p><p>New-onset refractory status epilepticus (NORSE) is one of the most severe neurological manifestations of status epilepticus. The etiology is unknown in about 50% cases, as so-called cryptogenic NORSE (C-NORSE). We report a case with emergence of atypical lymphocytes just before C-NORSE. A 25-year-old woman with no significant medical history presented to our department with a 4-day history of headache and fever. Neurological examination and cerebrospinal fluid tests yielded normal results, but atypical lymphocytes were observed in the serum. Two days later, she was admitted to our emergency department in a comatose state, and subsequently developed convulsive refractory status epilepticus. The etiology remained unknown despite an extensive diagnostic work-up, so C-NORSE was diagnosed. Seizures were controlled with immunotherapies including corticosteroids, intravenous immunoglobulins, rituximab, tocilizumab, and administration of 4 antiseizure medications. The etiology of atypical lymphocytes involves hypercytokinemia similar to NORSE, and clarification of the emergence of atypical lymphocytes just before the onset of NORSE could contribute to the understanding of the pathophysiology of NORSE.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251403823"},"PeriodicalIF":0.7,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12643896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641136","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 Unique Case and Presentation of Anti-GAD Paraneoplastic Encephalitis.","authors":"Sung Jin Choi, Jared Brandon Ditkowsky, Rebecca Hellmann","doi":"10.1177/19418744251397792","DOIUrl":"10.1177/19418744251397792","url":null,"abstract":"<p><p>Altered mental status is a common chief complaint among patients who visit the emergency department. Encephalitis is one of many disease processes that can lead to altered mental status. We present a unique case of a 52-year-old man presenting in the emergency department with aggressive behavior and altered mental status. CT imaging revealed a newly-discovered renal cell cancer, as well as CSF analysis highly suggestive of anti-GAD-associated encephalitis. Patient was successfully treated with steroids and plasmapheresis to achieve significant clinical improvement. To our knowledge, this is the first reported case of anti-GAD paraneoplastic encephalitis in the setting of renal cell cancer that initially presented with aggressive behavior and altered mental status.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251397792"},"PeriodicalIF":0.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12640274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597340","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 Hemorrhagic Leukoencephalitis in Pregnancy.","authors":"Akshit Tuli, Alan Shaji, Vikas Bhatia, Neeraj Balaini, Ashok Kumar Pannu","doi":"10.1177/19418744251401395","DOIUrl":"10.1177/19418744251401395","url":null,"abstract":"<p><p>Acute hemorrhagic leukoencephalitis (AHLE) is a rare but fulminant variant of acute disseminated encephalomyelitis, an uncommon immune-mediated demyelinating disorder. We report a case of AHLE in a 27-year-old pregnant woman who presented with acute onset of fever, aphasia, and a generalized seizure, followed by rapid neurological deterioration. The hallmark neuroimaging findings made the prompt diagnosis. The patient responded dramatically to high-dose corticosteroid therapy, with full neurological recovery. She subsequently delivered a healthy full-term infant and remained asymptomatic at one-year follow-up.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251401395"},"PeriodicalIF":0.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12634393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588623","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":"Onion Skin Pattern of Facial Sensory Loss in Central Pontine Hemorrhage.","authors":"Ryoichi Inoue, Conor McConville, Lauren Offerle, Ridha Mohamed","doi":"10.1177/19418744251399728","DOIUrl":"10.1177/19418744251399728","url":null,"abstract":"<p><p><b>Results:</b> We report a case of central pontine hemorrhage presenting with pinpoint pupils and a unique \"onion-skin\" pattern of facial sensory loss. <b>Conclusions:</b> This distribution of sensory loss reflects selective rostral involvement of the spinal trigeminal nucleus, in contrast to the segmental distribution seen with trigeminal nerve involvement. These findings may serve as a localizing sign of pontine pathology on clinical examination.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251399728"},"PeriodicalIF":0.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12634385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588601","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":"The Role of Trendelenburg Positioning for the Acute Symptomatic Management of Spontaneous Intracranial Hypotension.","authors":"Tony Zhang, Sara J Hooshmand, Nathaniel P Rogers, David O Sohutskay, Michel Toledano, Derek W Stitt, Ivan D Carabenciov, Ajay A Madhavan, Jeremy K Cutsforth-Gregory, Rafid Mustafa","doi":"10.1177/19418744251399726","DOIUrl":"10.1177/19418744251399726","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracranial hypotension (SIH) results from cerebrospinal fluid (CSF) leakage due to spinal dural tears or CSF-venous fistulas. Orthostatic headache is the hallmark presentation, though severe downward displacement of the brainstem may lead to altered consciousness or coma. Definitive treatments include targeted epidural blood patches, venous embolization, or surgical repair.</p><p><strong>Methods: </strong>This article reviews the role of the Trendelenburg position as a temporizing measure in the acute management of SIH. We describe the correct technique, physiologic rationale, and practical considerations for its application, with attention to both therapeutic and diagnostic utility.</p><p><strong>Discussion: </strong>Positioning the patient with the feet elevated above the head can reduce brain sag and provide short-term symptomatic relief while awaiting definitive treatment. Although the Trendelenburg position is widely used in practice, supporting evidence remains limited, and clinicians must be aware of its benefits, indications, and inherent limitations. Its appropriate application may assist in stabilizing patients with acute or severe SIH, particularly those with impaired consciousness, until more definitive interventions are pursued.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251399726"},"PeriodicalIF":0.7,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557763","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":"Sudden Quadriparesis Due to a Ventral Cervical Neurenteric Cyst: A Rare but Reversible Cause of Acute Myelopathy.","authors":"Nirmalya Ray, Sashank Raj, Parthsarathi Mondal, Russoti Das, Shramana Deb, Ritwick Mondal, Jayanta Roy, Julián Benito-León","doi":"10.1177/19418744251398271","DOIUrl":"10.1177/19418744251398271","url":null,"abstract":"<p><strong>Introduction: </strong>Neurenteric cysts are rare congenital lesions of endodermal origin that typically present with slowly progressive myelopathy. Accounting for less than 2% of all spinal tumors, they most often occur in the cervical and upper thoracic spine. Acute neurological deterioration due to a neurenteric cyst is uncommon and represents a clinical emergency.</p><p><strong>Case presentation: </strong>We describe an 18-year-old woman with no prior medical history who developed sudden-onset neck pain, rapidly progressive quadriparesis, and respiratory compromise. Neurological examination revealed upper motor neuron signs with a C4 sensory level. Cervical magnetic resonance imaging showed a ventral intradural extramedullary cystic lesion at the C2-C3 level, compressing the spinal cord and producing cord edema. Emergent posterior C2-C3 laminectomy was performed, and a tense mucin-filled cyst was completely excised. Histopathology demonstrated a columnar mucinous epithelium with goblet cells, confirming the diagnosis of a neurenteric cyst. Postoperatively, the patient exhibited substantial neurological recovery, regaining independent ambulation within three months. Follow-up imaging at six months showed no recurrence.</p><p><strong>Discussion: </strong>This case underscores two important lessons. First, although neurenteric cysts are classically indolent, they may present with abrupt, life-threatening neurological decline, even in the absence of associated congenital vertebral anomalies. Second, prompt surgical decompression with gross total resection remains the cornerstone of management, offering excellent potential for recovery. Given the risk of recurrence, radiological surveillance is warranted. This report adds to the limited literature on cervical neurenteric cysts with hyperacute presentations and emphasizes the need for early recognition and timely intervention to optimize outcomes.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251398271"},"PeriodicalIF":0.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12615226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543079","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":"Response to \"Clarification on MTHFR Variants and Ischemic Stroke Risk\".","authors":"Alexis Robin, Cédric Gollion","doi":"10.1177/19418744251397213","DOIUrl":"10.1177/19418744251397213","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251397213"},"PeriodicalIF":0.7,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12597796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496981","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":"Atypical Parakinesia Brachialis Oscitans in a Patient With Mild Hemiparesis.","authors":"Juan Alcalá-Torres","doi":"10.1177/19418744251398268","DOIUrl":"10.1177/19418744251398268","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251398268"},"PeriodicalIF":0.7,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12597774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496989","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":"Intra-Population Disparities in Alcohol Consumption and Associated Intracerebral Hemorrhage Risk in East India.","authors":"Vishal Mehta, Divya Jyoti, Ujjwal Sahay, Rishi Tuhin Guria, Chandra Bhushan Sharma","doi":"10.1177/19418744251396854","DOIUrl":"10.1177/19418744251396854","url":null,"abstract":"<p><strong>Background: </strong>Heavy alcohol use is associated with an increased risk of Intracerebral Hemorrhage (ICH), but the relationship with lesser amounts of alcohol is uncertain. Tribals in East India have a higher prevalence of alcohol abuse. We assessed the dose-risk relationship between alcohol consumption and ICH and evaluated the intra-population variations of this risk.</p><p><strong>Methods: </strong>In this case-control study, we recruited 510 patients with ICH. Cases were matched 1:1 with ICH-free controls. Alcohol consumption patterns were designated into groups - none, rare, moderate, intermediate, and heavy. The no-alcohol consumption category was used as reference to determine ICH risk.</p><p><strong>Results: </strong>Rare and moderate alcohol consumption conferred a decreased risk of ICH (OR = 0.35, <i>P</i> value <0.001 and OR = 0.58, <i>P</i> value 0.008 respectively). Patients with heavy alcohol use were at a significantly higher risk (OR = 1.65, <i>P</i> value = 0.027). Subgroup analysis revealed similar risk profiles for rare and moderate consumption in both lobar and non-lobar ICH, whereas heavy alcohol conferred an increased risk only for non-lobar ICH. Heavy alcohol consumption was also associated with risk of ICH in tribals (OR = 3.24. P value = 0.04).</p><p><strong>Conclusion: </strong>Rare and moderate alcohol consumption may have a protective effect on ICH risk whereas heavy alcohol use is associated with an increased risk, Further, tribal populations have an increased ICH risk with heavy alcohol use with no decrease in risk with rare or moderate use. This highlights the need for culturally tailored prevention strategies for these communities.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251396854"},"PeriodicalIF":0.7,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12592106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483468","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}