Neurohospitalist最新文献_第3页

"Cerebral Edema Leading to Subfalcine and Uncal Herniation in a Patient With Retinal Vasculopathy With Cerebral Leukoencephalopathy and Systemic Manifestations". 脑水肿导致视网膜血管病变伴脑白质脑病和全身性表现患者的癌下和肛门疝。

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Neurohospitalist Pub Date : 2024-12-20 DOI: 10.1177/19418744241310473

Parker Hughes, Liang Lu, Michael Shi, Danial Syed

{"title":"\"Cerebral Edema Leading to Subfalcine and Uncal Herniation in a Patient With Retinal Vasculopathy With Cerebral Leukoencephalopathy and Systemic Manifestations\".","authors":"Parker Hughes, Liang Lu, Michael Shi, Danial Syed","doi":"10.1177/19418744241310473","DOIUrl":"10.1177/19418744241310473","url":null,"abstract":"Deterioration of a patient's state of consciousness is among the most concerning signs encountered in clinical practice. The evaluation of this finding carries a broad initial differential diagnosis and must account for any relevant medical history. We describe the case of a 41-year-old male with known retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) who presented with progressive mental status decline and acute onset intractable headache. Head computed tomography (CT) revealed extensive vasogenic edema, resulting in right to left shift of 11 millimeters at the level of the lateral ventricles, with associated uncal and subfalcine herniation. He was treated with a 5-day course of methylprednisolone, leading to resolution of his lethargy and headache. Follow up neuroimaging with magnetic resonance (MRI) brain demonstrated interval improvement with the midline shift reduced to 3 millimeters after completion of high dose corticosteroids. Neurosurgical intervention was considered, but ultimately not required given his improvement. This case describes the management of life-threatening cerebral edema as a complication of RVCL-S disease progression. Due to the rarity of this disease, there are no standardized guidelines for treatment and the care for such patients relies on expert opinion, case studies, and extrapolation of principles learned from related conditions. Our intention is that the reporting of this case will contribute to the limited body of literature and aid those affected by this condition.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241310473"},"PeriodicalIF":0.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878276","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}

引用次数: 0

Curriculum Innovation: Clinical Documentation Integrity Education for Neurology Trainees. 课程创新：神经学实习生临床文献完整性教育。

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Neurohospitalist Pub Date : 2024-12-13 DOI: 10.1177/19418744241307685

Yasmin Aghajan, Bradley J Molyneaux

{"title":"Curriculum Innovation: Clinical Documentation Integrity Education for Neurology Trainees.","authors":"Yasmin Aghajan, Bradley J Molyneaux","doi":"10.1177/19418744241307685","DOIUrl":"10.1177/19418744241307685","url":null,"abstract":"Background and purpose: High quality clinical documentation is a fundamental skill for practicing physicians and important for quality improvement. However, documentation and coding are rarely integrated into medical education curricula and there is a lack of standard neurology curriculum on this topic. We developed and evaluated a teaching session on clinical documentation for neurology resident physicians.Methods: The education consisted of a didactic session designed by a neurologist with content about risk-adjusted mortality, clinical documentation integrity (CDI), impact of documentation on patients, and neurology-specific documentation guidance. A pre-post survey design was used to compare baseline and post-intervention self-reported knowledge and attitudes.Results: 61 responses were collected (37 pre- and 24 post-intervention). Residents had increased understanding of the impact of documentation on quality metrics (P = 0.004), risk-adjusted mortality (P < 0.0001), and impact on patients (P = 0.02). Attitude towards CDI education improved significantly (P = 0.0016), as well as agreement that CDI is important to resident physicians (P = 0.003). The portion of residents who agreed training on CDI is useful and valuable increased significantly (P = 0.004). 92% agreed this curriculum was useful, and 96% agreed they understood the role of CDI better after the session.Conclusions: In this study of a teaching session for neurology residents on clinical documentation, we found this format of teaching was well-received and highly effective in improving resident attitudes and self-reported knowledge.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241307685"},"PeriodicalIF":0.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830384","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}

引用次数: 0

Multiple Central Nervous System Cryptococcomas Masquerading as Lymphoma. 伪装成淋巴瘤的多发性中枢神经系统隐球菌。

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Neurohospitalist Pub Date : 2024-12-09 DOI: 10.1177/19418744241307413

Alexander V Ortiz, Dhruven Mehta, Juli Horton, Adrian A Jarquin-Valdivia

引用次数: 0

Neurohospitalist Core Competencies. 核心能力。

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Neurohospitalist Pub Date : 2024-11-26 DOI: 10.1177/19418744241297187

Jana J Wold, Jetter Robertson, Jerome A Jeevarajan, Molly G Knox, Prateek Thatikunta, Guillermo E Solorzano, Kristin Galetta, Shefali Dujari, Tarini Goyal, Matthew E Ehrlich, Jonathan P Donnelly, Elizabeth Marriott, Vishal A Mandge, Roshni S Dhoot, Matthew W Luedke, Matthew B Maas, Margaret Y Yu, Michel Toledano, Rafid Mustafa, Jamie L Palaganas, Kathryn Kvam, Rachelle Dugue, Ethan Meltzer, Lahoud Touma, Maulik P Shah, Vanja C Douglas, Karen Orjuela, Brian J Scott, Joshua P Klein, David J Likosky, Jennifer R Simpson, Megan B Richie, Carolin Dohle, Jane G Morris, Carl A Gold

{"title":"Neurohospitalist Core Competencies.","authors":"Jana J Wold, Jetter Robertson, Jerome A Jeevarajan, Molly G Knox, Prateek Thatikunta, Guillermo E Solorzano, Kristin Galetta, Shefali Dujari, Tarini Goyal, Matthew E Ehrlich, Jonathan P Donnelly, Elizabeth Marriott, Vishal A Mandge, Roshni S Dhoot, Matthew W Luedke, Matthew B Maas, Margaret Y Yu, Michel Toledano, Rafid Mustafa, Jamie L Palaganas, Kathryn Kvam, Rachelle Dugue, Ethan Meltzer, Lahoud Touma, Maulik P Shah, Vanja C Douglas, Karen Orjuela, Brian J Scott, Joshua P Klein, David J Likosky, Jennifer R Simpson, Megan B Richie, Carolin Dohle, Jane G Morris, Carl A Gold","doi":"10.1177/19418744241297187","DOIUrl":"https://doi.org/10.1177/19418744241297187","url":null,"abstract":"The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each of the topics included as individual practices vary in scope and practice pattern. A few examples of how the complete set of competencies may be used include in the creation of curricula for neurohospitalist fellowships, to assist in defining the scope of practice of neurohospitalists for administrative leaders of hospitals and departments, and in influencing the direction of further research and quality improvement in the field.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241297187"},"PeriodicalIF":0.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751988","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}

引用次数: 0

The Role of Delayed Imaging at MRI in Rare Non-enhancing Prostate Cancer Brain Metastases: A Case Report. 磁共振成像延迟成像在罕见非增强型前列腺癌脑转移中的作用：病例报告。

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Neurohospitalist Pub Date : 2024-11-25 DOI: 10.1177/19418744241303538

Marco Parillo, Domiziana Santucci, Massimo Stiffi, Eliodoro Faiella, Bruno Beomonte Zobel, Carlo Augusto Mallio

{"title":"The Role of Delayed Imaging at MRI in Rare Non-enhancing Prostate Cancer Brain Metastases: A Case Report.","authors":"Marco Parillo, Domiziana Santucci, Massimo Stiffi, Eliodoro Faiella, Bruno Beomonte Zobel, Carlo Augusto Mallio","doi":"10.1177/19418744241303538","DOIUrl":"10.1177/19418744241303538","url":null,"abstract":"Brain metastases in prostate cancer are rare (<2% of cases). In magnetic resonance imaging, nearly all brain metastases exhibit contrast-enhancement, which may be affected by the time elapsed since the administration of the contrast agent. We discuss a case where the brain metastases in a patient with prostate cancer do not show a clear contrast-enhancement on magnetic resonance imaging using a standard brain metastases protocol. It also emphasizes the usefulness of delayed imaging in identifying blood-brain barrier damage. We present the case of a 69-year-old man diagnosed with prostate adenocarcinoma, currently in castration-resistant phase (last value of serum prostate-specific antigen: 45.1 ng/mL) with bone, mediastinal and inguinal lymph nodes, pulmonary, and hepatic metastases. In a contrast-enhanced whole-body computed tomography examination, the appearance of intra-axial brain lesions suspicious for metastases was documented. The subsequent contrast-enhanced brain magnetic resonance imaging showed the presence of 5 intra-axial lesions consistent with brain metastases. These lesions exhibited hyperintense signals in T2-fluid-attenuated inversion recovery images; after contrast agent administration, a ring-like contrast-enhancement was more clearly visible in T1-weighted images acquired later (about 15 minutes after contrast agent administration) than in those acquired earlier (about 5-7 minutes after contrast agent administration). In conclusion, for oncological subjects with multiple brain lesions lacking obvious contrast-enhancement using a standard magnetic resonance imaging protocol, we suggest acquiring late images. These might allow for the detection of even minimal post-contrast impregnation, improving confidence in the diagnosis of brain metastases.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241303538"},"PeriodicalIF":0.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740930","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}

引用次数: 0

A Case of Moyamoya Vasculopathy Presenting as Simultaneous Ischemic and Hemorrhagic Strokes. 一例同时表现为缺血性和出血性脑卒中的莫亚莫亚血管病病例

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Neurohospitalist Pub Date : 2024-11-21 DOI: 10.1177/19418744241299068

Wayne Zhong, Amit Mehta, Nicholas Haberli, Ahmed Elmashad, Rachel Forman, Jennifer Kim

{"title":"A Case of Moyamoya Vasculopathy Presenting as Simultaneous Ischemic and Hemorrhagic Strokes.","authors":"Wayne Zhong, Amit Mehta, Nicholas Haberli, Ahmed Elmashad, Rachel Forman, Jennifer Kim","doi":"10.1177/19418744241299068","DOIUrl":"10.1177/19418744241299068","url":null,"abstract":"Background: Moyamoya disease (MMD) is a rare pathological state characterized by progressive stenosis of the terminal portion of the internal carotid arteries (ICA). Complications include both ischemic and hemorrhagic strokes, for which there is no curative treatment for MMD. Early diagnosis with surgical intervention is vital for there is no definitive treatment. Due to the bimodal age distribution, moyamoya should be considered for patients presenting with stroke and supraclinoid ICA vasculopathy.Case: We present a case of a 23-year-old female who presented with left arm weakness and sudden onset thunderclap headache. Upon further questioning, it was revealed that the patient had started an estrogen-containing birth control two weeks prior to presentation. Neuroimaging at our tertiary care center demonstrated simultaneous ischemic and hemorrhagic strokes in the bilateral hemispheres associated with vasculopathy seen in both invasive and noninvasive cerebrovascular imaging. She was diagnosed with idiopathic moyamoya disease since her serum and cerebrospinal fluid studies did not reveal any obvious precipitators to suggest moyamoya syndrome (MMS).Conclusion: There were no obvious precipitating factors identified in the extensive workup for this patient. Therefore, further secondary prevention is difficult for this otherwise young and healthy individual. While there is data to support the use of antiplatelet medications for the prevention of ischemic stroke secondary to intracranial atherosclerotic disease, there are no clear guidelines for the treatment of MMD that simultaneously causes ischemic and hemorrhagic stroke. Further research on the pathophysiology and treatment modalities for MMD are needed to guide clinicians in treating this complex disease.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241299068"},"PeriodicalIF":0.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711040","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}

引用次数: 0

The In-Hospital Code Stroke: A Look Back and the Road Ahead. 院内代码中风：回顾过去，展望未来。

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Neurohospitalist Pub Date : 2024-10-29 DOI: 10.1177/19418744241298035

Andrea M Kuczynski, W David Freeman, Lesia H Mooney, Josephine F Huang, Andrew M Demchuk, Houman Khosravani

{"title":"The In-Hospital Code Stroke: A Look Back and the Road Ahead.","authors":"Andrea M Kuczynski, W David Freeman, Lesia H Mooney, Josephine F Huang, Andrew M Demchuk, Houman Khosravani","doi":"10.1177/19418744241298035","DOIUrl":"10.1177/19418744241298035","url":null,"abstract":"With increased patient volumes and complexity, stroke occurrence in hospitalized patients has become relatively more common. The process of activating a code stroke in-hospital differs in many institutions. An emergency team-based response to inpatient acute code stroke is warranted, with many protocols modeled similarly to the cardiac arrest response. However, several studies have demonstrated delays in recognition and management of acute stroke in-hospital as compared to those arriving directly to the emergency department (ED). Furthermore, there are several shared challenges with code stroke resuscitation in the emergency department and the ward, which include the assembly of ad hoc teams and requirement of access to urgent imaging. Delays in activating in-hospital code stroke contributes to increased morbidity, mortality, prolonged hospitalization, and associated health care costs. In the following commentary, we discuss the current landscape of acute in-hospital code stroke protocols, review the differences in neurologic outcomes between inpatient vs ED/out-of-hospital code stroke patients, and propose future directions for in-hospital code stroke paradigms for improved patient outcomes and quality of care.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241298035"},"PeriodicalIF":0.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630179","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}

引用次数: 0

Neurohospitalist Core Competencies: Development and Methodology. 神经医院专家核心能力：开发与方法。

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Neurohospitalist Pub Date : 2024-10-29 DOI: 10.1177/19418744241296908

Carl A Gold, Joshua P Klein, Megan B Richie, Jane G Morris, Jana J Wold

{"title":"Neurohospitalist Core Competencies: Development and Methodology.","authors":"Carl A Gold, Joshua P Klein, Megan B Richie, Jane G Morris, Jana J Wold","doi":"10.1177/19418744241296908","DOIUrl":"10.1177/19418744241296908","url":null,"abstract":"Background and purpose: Neurohospitalists specialize in the care of hospitalized patients with neurological conditions. As the neurohospitalist model of patient care has grown rapidly and in diverse ways, there has been increasing demand for a formal definition of the field, particularly to support curriculum development for learners at multiple levels.Methods: The Neurohospitalist Society (NHS) formed a Core Competencies Committee in 2021. This committee defined the scope of the Neurohospitalist Core Competencies and organized the competency topics into chapters. This chapter list was approved by the members of the NHS. An open invitation was made to the general membership of the NHS to write chapters on a first-come, first-served basis, using a standardized chapter template developed by the Committee. A three-step editing process was completed, with members of the Committee serving as editors. A dissemination strategy was designed, including drafting of 2 manuscripts (the Core Competencies themselves, and this accompanying manuscript) and outreach to the general membership of the NHS.Results: The Neurohospitalist Core Competencies include 27 chapters divided into 3 sections: neurological conditions; clinical interventions and interpretations of ancillary studies; and neurohospitalist role in the health care system. The complete version of the Neurohospitalist Core Competencies is published as a separate manuscript in this issue of The Neurohospitalist.Conclusions: The creation of the Neurohospitalist Core Competencies was a multi-year initiative intended to support practicing neurohospitalists, trainees interested in pursuing careers in the field, medical education leaders, and administrative leaders of hospitals and departments.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241296908"},"PeriodicalIF":0.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630158","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}

引用次数: 0

Meningeal Dissemination and Drop Metastasis From Glioma Presenting With Non-Epileptic Myoclonus and Minipolymyoclonus. 脑胶质瘤的脑膜播散和点滴转移伴有非癫痫性肌阵挛和小肌阵挛

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Neurohospitalist Pub Date : 2024-10-28 DOI: 10.1177/19418744241297396

Arens Taga, Ian Cheong, Kemar E Green, Michael D Kornberg

{"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":"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.","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}

引用次数: 0

CAA-ri Masquerading as a High-Grade Glioma: A Case Report. 伪装成高级别胶质瘤的 CAA-ri：病例报告。

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Neurohospitalist Pub Date : 2024-10-23 DOI: 10.1177/19418744241296198

Angela Xia, Vishal Mehta, Victoria Wei, Alexander Andreev, Robert Regenhardt

引用次数: 0