Neurohospitalist最新文献

{"title":"Crossed Wernicke's Aphasia With Focal Clonic Cluster Seizures With Secondary Generalization Mimicking Faciobrachial Seizures Following a Right Middle-Cerebral-Artery Ischemic Stroke: A Novel Phenotypic Presentation.","authors":"Ritwik Ghosh, Moisés León-Ruiz, Julián Benito-León, Souvik Dubey","doi":"10.1177/19418744241295418","DOIUrl":"10.1177/19418744241295418","url":null,"abstract":"<p><p>Crossed Wernicke's aphasia (CWA) following a stroke is a rare clinical phenomenon, particularly when associated with seizures. This case report presents a unique instance of crossed CWA accompanied by focal clonic cluster seizures affecting the left arm and face, with secondary generalization, in a monolingual Bengali-speaking patient following a right middle cerebral artery ischemic stroke. The patient, a 70-year-old male from rural India, presented with acute behavioral abnormalities and language impairment. He experienced left-sided focal motor-onset clonic seizures with impaired awareness, followed by fluent yet unintelligible speech, characterized by phonemic and semantic paraphasias, as well as neologistic jargon. Neuroimaging revealed a right parieto-occipital infarct. Although initially misdiagnosed and treated for acute psychosis, thorough clinical evaluation ultimately led to the diagnosis of CWA-a rare form of aphasia in a right-handed individual after a right hemisphere stroke. This case underscores the diagnostic challenges associated with stroke-related language disorders and highlights the importance of recognizing variations in language lateralization. Furthermore, the occurrence of CWA in a Bengali-speaking individual emphasizes the potential impact of linguistic and cultural factors on brain organization and language processing. This case also adds to the limited body of literature regarding the co-occurrence of post-stroke seizures and aphasia, particularly in atypical presentations such as CWA.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241295418"},"PeriodicalIF":0.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630234","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":"Neurological Complications and Outcomes in Critically Ill Patients With COVID-19: Results From International Neurological Study Group From the COVID-19 Critical Care Consortium.","authors":"Syed Ameen Ahmad, Yunis Mayasi, Thu-Lan Kelly, Nicole White, Jacky Suen, Denise Battaglini, Gianluigi Li Bassi, John F Fraser, Lavien Premraj, Rakesh C Arora, Diego Bastos, Glenn Whitman, Matthew Griffee, Jonathon P Fanning, Chiara Robba, Sung-Min Cho","doi":"10.1177/19418744241292487","DOIUrl":"10.1177/19418744241292487","url":null,"abstract":"<p><strong>Background: </strong>In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with SARS-CoV2 infection.</p><p><strong>Methods: </strong>The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) across 23 centers between 1/7/2020 to 6/23/2022. Incidence of neurological complications was estimated as number of events per hospital days and per admission using Poisson regression. Associations between neurological complications and risk factors were assessed using multivariable Poisson regression.</p><p><strong>Results: </strong>713 patients were included. Median age = 56 years (interquartile range (IQR) = 45-65). Neurological complications reported in 61/480 patients (12.7%) with the majority being ischemic stroke (2.9%), intracranial hemorrhage (ICH) (2.8%), and seizures (2.6%). Multivariable analysis for neurological complications per admitted days showed comorbid neurological conditions (incidence rate ratio (IRR) = 6.35, 2.57-15.7) were an independent risk factor for ischemic stroke. Extracorporeal membrane oxygenation (IRR = 5.32, 1.52-18.6), low-middle income countries (LMIC) vs high income countries (HIC) (IRR = 4.70, 1.62-13.7), and age >55 (IRR = 3.66, 1.23-10.9) were independent risk factors for ICH. Co-morbid neurological conditions (IRR = 3.43, 1.11-10.6), LMIC vs HIC (IRR = 8.69, 2.15-35.2), July-December 2020 vs January-June 2020 (IRR = 0.17, 0.04-0.69) and age >55 (IRR = 4.05, 1.15-14.3) were independent risk factors for seizure.</p><p><strong>Conclusions: </strong>Decision-making should incorporate salient risk factors to inform management of SARS-CoV2 infection and avoid neurological complications.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241292487"},"PeriodicalIF":0.9,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630168","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":"Patterns of Arterial Wall Lesions in Eagle Syndrome: Case Series and Literature Review.","authors":"Pacôme Constant Dit Beaufils, Solène de Gaalon, Christophe Ferron, Guillaume Marc, Elisabeth Auffray-Calvier, Benjamin Daumas-Duport, Benoît Guillon","doi":"10.1177/19418744241292481","DOIUrl":"10.1177/19418744241292481","url":null,"abstract":"<p><p><b>Background</b>: Impingement of an elongated styloid process (ESP) or calcified stylohyoid ligament on surrounding neck structures defines Eagle syndrome. The vascular variant, also called stylocarotid syndrome, results from impingement of vascular structures and remains poorly known among physicians. <b>Research Design</b>: We report our own experience and review the literature in order to clarify the diagnostic and therapeutic management. Patients with vascular events in relation to an ESP and hospitalized at our institution were extracted from our databank and retrospectively reviewed. We also performed a comprehensive review of the literature on Eagle syndrome using PubMed® and Google Scholar, analysing the presentation, management, and follow-up. <b>Results</b>: We report five cases of the vascular variant of Eagle syndrome: one carotid perforation, one focal arteriopathy, one with both acute and chronic dissection and two acute internal carotid dissection. Vascular compression, whether permanent or transient, is also reported in the literature. Management varies, although styloidectomy is deemed appropriate for symptomatic compression, while stenting is preferred in cases of perforation. <b>Conclusions</b>: A common definition of Eagle syndrome is required for better diagnosis and management. The choice of styloidectomy is understandable for compression but remains to be investigated in other cases.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241292481"},"PeriodicalIF":0.9,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630173","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 Ischemic Stroke Presenting as Hemiparkinsonism: A Case Report.","authors":"Essam Al-Sibahee, Mustafa Najah Al-Obaidi, Asmaa Al-Sharee","doi":"10.1177/19418744241290847","DOIUrl":"10.1177/19418744241290847","url":null,"abstract":"<p><p>Parkinsonism, commonly associated with Parkinson disease (PD), can also arise from other neurodegenerative disorders or non-neurodegenerative causes such as vascular parkinsonism (VP). This case highlights the acute onset of VP following a stroke, contributing to the understanding of VP's varied presentations and the challenges in its diagnosis. A 54-year-old male with a history of cerebrovascular disease presented with behavioral changes and reduced activity, initially raising the suspicion of a central nervous system infection. Clinical findings included agitation, decreased social interaction, mutism, drooling, immobility, and rigidity. Imaging revealed acute infarction in the left cortical parieto-occipital region, caudate nucleus, and putamen, along with old infarcts, confirming VP. The primary diagnosis was vascular parkinsonism and he was started on anticoagulation therapy and levodopa/carbidopa, which showed minimal improvement over 6 months. This case underscores the importance of considering VP in patients with acute parkinsonian symptoms and a history of cerebrovascular disease. It highlights the necessity for prompt evaluation and management of vascular risk factors to optimize patient outcomes. Additionally, it emphasizes the need for a multidisciplinary approach in treating VP, given the limited efficacy of traditional Parkinson disease medications.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241290847"},"PeriodicalIF":0.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630224","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":"Uptake of Dual Antiplatelet Therapy After High-Risk Transient Ischemic Attack at a University Hospital.","authors":"Morin Beyeler, Philipp Bücke, Pasquale Castigliego, Joel Baumann, Victor Ziegler, Babak B Navi, Simon Jung, Marcel Arnold, Ava L Liberman","doi":"10.1177/19418744241289625","DOIUrl":"10.1177/19418744241289625","url":null,"abstract":"<p><p>Multiple randomized controlled trials have demonstrated that dual antiplatelet therapy (DAPT) significantly reduces the risk of subsequent stroke as compared to aspirin monotherapy after high-risk transient ischemic attack (TIA) or minor ischemic stroke. We sought to evaluate the uptake of DAPT after high-risk TIA at a single center. We conducted a retrospective cohort study of consecutive TIA patients admitted via the Emergency Department (ED) of Bern University Hospital (1/1/2018-12/31/2019). We use descriptive statistics to detail cohort characteristics and compared patients treated with DAPT to those not treated. Statistical significance was set at α = 0.05 and all tests of comparison were two-sided. A total of 383 TIA patients were seen during the study period, 247 were eligible for DAPT. Among those eligible for DAPT, mean age was 72 years and 51% were female. A total of 49 (19.8%) eligible TIA patients were treated with DAPT; use of DAPT significantly increased from 2018 to 2019. Patients admitted to the stroke unit or intensive care unit (n = 33) had a significantly higher proportion of DAPT treatment as compared to those admitted to the general neurology ward or discharged to home from the ED. DAPT use was also significantly higher in patients with large artery atherosclerotic disease (n = 23) as compared to other etiological subtypes and significantly higher among patients who arrived to the ED within 24 h of symptom onset (n = 178). In conclusion, we found that only 2 out of every 10 high-risk TIA patients received DAPT in the years following its introduction in the clinical practice. Our results suggest that strategies to improve the uptake of new, evidence-based secondary stroke prevention treatment after high-risk TIA are needed.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241289625"},"PeriodicalIF":0.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630190","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 Deceptive Reassurance of a \"Negative\" Test - A Difficult Case Highlighting the BioFire^© Meningitis/Encephalitis Panel and Medical Heuristics.","authors":"Hai E Hoang","doi":"10.1177/19418744241290274","DOIUrl":"10.1177/19418744241290274","url":null,"abstract":"<p><p><b>Purpose:</b> Neurolisteriosis is a difficult neurologic infectious disease to diagnose. Here, we present a case in which the diagnosis was suspected, but repeated testing for the pathogen was negative. Ultimately the diagnosis was made after the patient iatrogenically worsened. <b>Results:</b> This prompted an investigation into the widely used diagnostic test, the BioFire© Meningitis/Encephalitis Panel. Although the company reports high sensitivities and specificities for the panel, real world studies have demonstrated insufficient evidence that all 14 pathogens tested on the panel have similar results. <b>Conclusion:</b> This case is a reminder of the heuristics involved in medicine and how with every medical advancement, clinicians should always go back to the fundamentals of history-taking and physical examinations to ensure no steps have been overlooked in the diagnosis and management of challenging cases.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241290274"},"PeriodicalIF":0.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636170","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":"Dramatic Reanimation and Spontaneous Re-Canalization of a Fourth Ventricular Hemorrhage: \"REVIVE\" Phenomenon.","authors":"Saif Salman, Andrea Janu, Rohan Sharma, Diane McLaughlin, Morgan Hardman, Rabih Tawk, W David Freeman","doi":"10.1177/19418744241289972","DOIUrl":"10.1177/19418744241289972","url":null,"abstract":"<p><strong>Background: </strong>Intraventricular hemorrhage is a calamitous type of stroke where bleeding into the ventricular system can be defined as: primary, if confined within the ventricles; or secondary, due to intracerebral hemorrhage extending from adjacent parenchyma. Intraventricular blood clot can lead to secondary insult and inflammatory responses that culminates in hydrocephalus as the most common cause of death.</p><p><strong>Purpose: </strong>THerein, we report a patient with a high modified Graeb scale and low Glasgow coma scale. She spontaneously recanalized her fourth ventricle, decompressed her reticular activating system with remarkable spontaneous bilateral eye opening, and a consequently experienced a halfway drop in her mGS.</p><p><strong>Results: </strong>This is the first reported case of a spontaneous recanalization of 4th ventricle obstruction secondary to IVH without intervention and subsequent dramatic neurological improvement. We believe that the apixaban primarily preserved the liquid state of hemorrhage and her presumed elevated ICP was sufficient to push out the liquified blood in the 4th ventricle into the upper spinal canal , recanalizing the 4th ventricle by continuously creating downward CSF pressure waves. Given the RAS location around the 4th ventricle, we hypothesize spontaneous decompression from the clot lysis triggered the RAS activation with sudden arousal manifested as spontaneous bilateral eyes opening. Hence, we refer to this as the reticular activating system reactivation after ventricular hemorrhage evacuation, or simply the \"REVIVE\" phenomenon.</p><p><strong>Conclusion: </strong>This dramatic improvement from coma to awake state is worthy of recognition for future neurotherapeutic interventions.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241289972"},"PeriodicalIF":0.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630238","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 Ghost in the Machine: Artificial Intelligence in Neurocardiology Will Advance Stroke Care.","authors":"Harneel Saini, David Z Rose","doi":"10.1177/19418744241288887","DOIUrl":"10.1177/19418744241288887","url":null,"abstract":"<p><p><b>Background:</b> Innovations in artificial intelligence (AI) and machine learning (ML) are poised to transform stroke care, particularly for Neuro-Cardiac Programs (NCP) within both academic and community hospital systems. <b>Purpose:</b> Given AI's success in large-vessel occlusion (LVO) detection and perfusion mapping delivered to our smartphones, the next leap for this \"Ghost in the Machine\" technology seems to be into the world of NCP: AI-enhanced logistics have started to help with cardiac monitoring after cryptogenic, large-artery and small-vessel stroke, looking for atrial fibrillation (AF) with an insertable loop recorder (ILR) and/or external patch. <b>Results:</b> The 'CONNECT' study from UCSD demonstrated that AI can increase protocol efficiency and reduce patient wait-times for ILR; with more AF detected, fewer strokes may result as more patients receive anticoagulation or Left Atrial Appendage Closure (LAAC). <b>Conclusion:</b> Therefore, organically, the next AI and ML-enhanced NCP frontier may involve inter-departmental \"Shared Decision-Making\" (SDM) process with LAAC, and/or Patent Foramen Ovale (PFO), in appropriately selected patients. In this editorial, we explore AI's capability to disrupt current antiquated siloed communication tools, refine and streamline SDM processes and tailor patient-specific treatment plans, nevertheless advocating for intercalation of AI into NCP pathways in a secure, ethically-guided manner.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241288887"},"PeriodicalIF":0.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630176","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: A 19-Year-Old Woman With Progressive Neurological Decline and Multiple Intracranial Lesions.","authors":"Rumyar Ardakani, Kimmo Hatanpaa, Yanel De Los Sanotos, Paula Hardeman, Lauren Tardo","doi":"10.1177/19418744241273283","DOIUrl":"10.1177/19418744241273283","url":null,"abstract":"<p><p>The differential diagnosis for multiple intracranial lesions in a young adult is broad and includes demyelinating, neoplastic, and infectious etiologies. In this report, we describe the case of a 19-year-old immunocompetent woman presenting with progressive headaches and aphasia. MRI of the brain revealed multiple, large supratentorial lesions with concentric bands of alternating T2 signal intensities and peripheral contrast enhancement. Cerebrospinal fluid (CSF) analysis was overall bland with negative oligoclonal bands. Serum antibody testing for neuromyelitis optica (NMO) and myelin-oligodendrocyte associated disease (MOGAD) were negative. A broad infectious work-up was also unrevealing. A definitive diagnosis was ultimately obtained after brain biopsy and the patient was started on appropriate therapy. This case highlights a diagnostic framework in evaluating immunocompetent patients presenting with multiple intracranial lesions and progressive neurological decline. The main differential diagnoses for this constellation of radiological and clinical findings are discussed and a literature review is performed on the revealed diagnosis. Lastly, both acute and long-term therapeutic approaches are reviewed.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"419-422"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298295","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":"\"Recurrent Pleomorphic Xanthoastrocytoma Presenting with Diffuse Leptomeningeal Spread\".","authors":"Valentina Zagardo, Anna Viola, Gianluca Scalia, Paolo Palmisciano, Giuseppe Emmanuele Umana, Gianluca Ferini","doi":"10.1177/19418744241273267","DOIUrl":"10.1177/19418744241273267","url":null,"abstract":"<p><p>We have read with great interest the recent paper by Grigsby-Rocca et al regarding recurrent pleomorphic xanthoastrocytoma (PXA) with leptomeningeal dissemination. While acknowledging the challenges in managing such cases, we wish to highlight the role of radiotherapy for symptom palliation and potential life extension. We report a case of a 27-year-old woman with recurrent anaplastic PXA and diffuse leptomeningeal spread, who was offered radiotherapy to the spinal axis. Initially presenting with headaches and seizures, she underwent surgical excision, postoperative radiotherapy, and temozolomide. Despite initial disease control, subsequent recurrences required additional surgeries and systemic therapies. With disease progression to leptomeningeal spread, radiotherapy was administered, resulting in clinical stability. This case underscores the importance of considering palliative radiotherapy to improve quality of life and potentially prolong survival in patients with recurrent PXA and leptomeningeal dissemination.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"468-470"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298294","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}