Neurohospitalist最新文献

{"title":"Cortical Venous Thrombosis Caused by Venous Compression by Arachnoid Cyst.","authors":"Andrea A Jones, Dakota J S J Peacock, William Guest, Laura K Wilson, Lily W Zhou","doi":"10.1177/19418744241262071","DOIUrl":"10.1177/19418744241262071","url":null,"abstract":"<p><strong>Clinical problem: </strong>Identification, work-up and treatment approach of isolated cortical venous thrombosis (ICVT) in the absence of traditional risk factors.</p><p><strong>Case presentation: </strong>A 66-year-old previously well male presenting with two episodes of left-sided spreading sensory symptoms, found to be secondary to ICVT from extrinsic compression by an arachnoid cyst.</p><p><strong>Key teaching points: </strong>Early identification of structural abnormalities causing extrinsic venous compression and ICVT or cerebral venous sinus thrombosis (CVST) is important for alternative treatment options and to avoid unnecessary testing.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"464-465"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298299","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":"Sociodemographic and Clinical Factors Associated With Clinical Outcome in Neuroinfectious Diseases: A Multicenter Retrospective Cohort Study.","authors":"Alexandra Boubour, Carla Y Kim, Sarah Torres, Dan T Jia, Evan Hess, Sibei Liu, Yifei Sun, Kathryn Fong, Samantha Epstein, Helena Yan, Nicole Luche, Kerry Gao, Brittany Glassberg, Michael Harmon, Hai Hoang, Allison Navis, Emily Schorr, Jacqueline S Gofshteyn, Anusha K Yeshokumar, Kiran T Thakur","doi":"10.1177/19418744241263138","DOIUrl":"10.1177/19418744241263138","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate sociodemographic and clinical factors associated with clinical outcomes in patients hospitalized with neuroinfectious diseases at three tertiary care centers in New York City.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at three large urban tertiary care centers between January 1, 2010 and December 31, 2017. Poor clinical outcome was defined as length of hospital stay (LOS) ≥2 weeks and/or discharge to a location other than home. Sociodemographic and clinical factors were obtained from electronic medical records and descriptively analyzed. Multivariate logistic regression analysis investigated relationships between sociodemographic and clinical factors, and outcomes.</p><p><strong>Results: </strong>Among 205 patients with definitive neuroinfectious diagnoses, older patients were more likely to have a LOS ≥2 weeks (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.05) and less likely to be discharged home (OR: 0.96; 95% CI: 0.94-0.98) than younger patients. Patients with an immunocompromised state were more likely to have a LOS ≥2 weeks (OR: 2.80; 95% CI: 1.17-6.69). Additionally, patients admitted to the intensive care unit (ICU) were more likely to have a LOS ≥2 weeks (OR: 4.65; 95% CI: 2.13-10.16) and less likely to be discharged home (OR: 0.14; 95% CI: 0.06-0.34). There were no statistically significant associations between sex, race, ethnicity, English proficiency, substance use, or poverty index, and clinical outcome.</p><p><strong>Conclusions: </strong>In this multicenter cohort of hospitalized neuroinfectious diseases, older age, history of immunocompromised state, and admission to the ICU were significantly associated with poor clinical outcome.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"396-405"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298305","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":"Neurosyphilis Manifesting as a Longitudinally Extensive Transverse Myelitis: A Case Report.","authors":"Gabriela A Bou, Qasem N AlShaer, Taylor B Harrison, Spencer K Hutto","doi":"10.1177/19418744241258694","DOIUrl":"10.1177/19418744241258694","url":null,"abstract":"<p><p><b>Background</b>: Evaluating patients with ascending sensorimotor deficits has a broad differential diagnosis at initial presentation which can be further narrowed upon neurologic examination but may represent a diagnostic and therapeutic dilemma in light of findings raising suspicion for multiple possible etiologies. <b>Data Collection</b>: In this case, a 29-year-old patient presented with ascending bilateral lower extremity sensory loss, paresthesias, and weakness which progressed to the inability to ambulate. <b>Conclusions</b>: This case highlights the diagnostic approach to patients with bilateral lower extremity sensorimotor deficits, discusses the development of a comprehensive differential diagnosis, and further evaluates the most likely etiologies. Furthermore, this case reviews complexities related to clinical reasoning in the setting of diagnostic uncertainty, particularly when the neurologic structures affected portend high risk for severe disability and early treatment may improve outcome.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"437-440"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298301","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":"Concurrent Miller Fisher Syndrome and Immune Thrombocytopenic Purpura: A Case Report and Review of the Literature.","authors":"Julie Fynke, Nicole Perez, Benjamin Wagner, Jonah Zuflacht","doi":"10.1177/19418744241275245","DOIUrl":"10.1177/19418744241275245","url":null,"abstract":"<p><p>Guillain-Barre syndrome (and its subvariants) and immune thrombocytopenic purpura, while both autoimmune disorders provoked by viral infection, rarely coincide. We present the case of a young man who developed both conditions after URI, review prior cases of comorbidity in the literature, and describe their pathophysiology, diagnosis, and management.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"457-459"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298298","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":"Differences in Interfacility Transfer from Emergency Department and Inpatient Services for Inpatient Neurologic Care.","authors":"Maulik P Shah, Anne G Douglas, Brian M Sauer, Megan B Richie, Vanja C Douglas, S Andrew Josephson, Elan L Guterman","doi":"10.1177/19418744241273205","DOIUrl":"10.1177/19418744241273205","url":null,"abstract":"<p><strong>Introduction: </strong>Interhospital transfer is an important mechanism for improving access to specialized neurologic care but there are large gaps in our understanding of interhospital transfer for the management of non-stroke-related neurologic disease.</p><p><strong>Methods: </strong>This observational study included consecutive patients admitted to an adult academic general neurology service via interhospital transfer from July 1, 2015 to July 1, 2017. Characteristics of the referring hospital and transferred patients were obtained through the American Hospital Association Directory, a hospital transfer database maintained by the accepting hospital, and the electronic medical record. The analyses used descriptive statistics to examine the cohort overall and compare characteristics of patients transferred from an emergency department and inpatient service.</p><p><strong>Results: </strong>504 patients were admitted via interhospital transfer during the study period. Of these, 395 patients (78.4%) were transferred because the referring hospital lacked capability, and 139 patients (27.6%) were transferred from an emergency department as opposed to inpatient service. Seizures was the most common diagnosis (23.8%). Patients who were transferred from an emergency department had a higher proportion covered by Medicaid (44.6%) than those transferred from an inpatient service (28.8%) and had a shorter median length of stay (3 days; IQR 2-7 vs 7 days; IQR 4-12).</p><p><strong>Conclusions: </strong>The majority of observed interhospital non-stroke neurologic transfers occurred to improve access to specialized neurological care for patients, though patients transferred from the ED, as opposed to an inpatient service, had lower health care utilization, and this will be important to consider when developing systems of care and in future research.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"406-412"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298300","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":"Pulseless Electrical Activity Arrest Presenting as Tonic Arm Stiffening and a Flat Electroencephalogram.","authors":"Nausheen Mahmood, Ernesto Gonzalez-Giraldo, Joseph E Sullivan","doi":"10.1177/19418744241273196","DOIUrl":"10.1177/19418744241273196","url":null,"abstract":"<p><p>This report highlights a case of PEA arrest which mimicked a tonic seizure and was discovered using electroencephalogram recordings.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"466-467"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298303","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 Letter by Zagardo, et al.","authors":"Giovanna Grigsby-Rocca, Camilo Bermudez, Jessica D White, Bryan J Neth, Joon H Uhm, Rafid Mustafa","doi":"10.1177/19418744241273115","DOIUrl":"10.1177/19418744241273115","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"471"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298304","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":"Comparison of Telemedicine-Administered Thrombolytic Therapy for Acute Ischemic Stroke by Neurology Subspecialty: A Cross-Sectional Study.","authors":"Andrea Loggini, Jonatan Hornik, Jessie Henson, Julie Wesler, Madison Nelson, Alejandro Hornik","doi":"10.1177/19418744241276244","DOIUrl":"10.1177/19418744241276244","url":null,"abstract":"<p><strong>Background and purpose: </strong>To determine if any difference exists in safety and outcomes of thrombolytic therapy for acute ischemic stroke administered via telemedicine, based on the subspeciality of the treating neurologist.</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional study using data from our local stroke registry of thrombolytic therapy administered via telemedicine at our rural stroke network over 5 years. The cohort was divided in 2 groups based on the subspecialty of the treating neurologist: vascular neurology (VN) and neurocritical care (NCC). Demographics, clinical characteristics, stroke metrics, thrombolytic complications, and final diagnosis were reviewed. In-hospital mortality and mRS and 30 days were noted.</p><p><strong>Results: </strong>Among 142 patients who received thrombolytic therapy via telemedicine, 44 (31%) were treated by VN specialists; 98 (69%) by NCC specialist. There was no difference in baseline characteristics and stroke metrics between the 2 groups. Compared to NCC, VN had a trend toward higher, but non-significant, sICH (6% vs 1%, <i>P</i> = 0.05). In a logistic regression analysis, correcting for NIHSS, SBP, door-to-needle time, and use of antiplatelet therapy, the type of neurology subspecialty was not independently associated with development of sICH (OR: 0.141, SE: 0.188, <i>P</i> = 0.141). The rate of in-hospital mortality was also similar between VN and NCC (7% vs 5%, <i>P</i> = 0.8). In a model that accounted for stroke severity, no association was established between the type of neurology subspecialty and mRS at 30 days (OR: 1.589, SE: 0.662, <i>P</i> = 0.266).</p><p><strong>Conclusions: </strong>Safety and outcome of thrombolytic therapy via telemedicine was not influenced by the subspecialty of treating neurologist. Our study supports the expansion of telemedicine for acute stroke patients in rural and underserved areas.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"413-418"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298296","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":"Complete Third Nerve Palsy: A Rare Occurrence in Fulminant IIH Case Report.","authors":"Eisa Hesham, Yash Nene, Daniel Reynolds, Deborah Bradshaw","doi":"10.1177/19418744241273094","DOIUrl":"10.1177/19418744241273094","url":null,"abstract":"<p><p>Idiopathic Intracranial Hypertension (IIH) is a condition characterized by elevated intracranial pressure of unknown cause. Classic symptoms include headache, vision loss, transient visual obscurations (TVOs), diplopia (often from sixth nerve palsy), divergence insufficiency, and pulsatile tinnitus. However, atypical presentations can occur, including asymmetric or unilateral papilledema, oculomotor disturbances such as third and fourth nerve palsies, internuclear ophthalmoplegia, and olfactory dysfunction, among others. Fulminant IIH is a subtype of IIH defined as acute onset of rapid worsening of vision over days (less than 4 weeks between symptom onset and severe vision loss). This case report details a rare presentation of fulminant IIH with unilateral complete third nerve palsy.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"450-453"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298297","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":"Progressive Multifocal Leukoencephalopathy in a Patient With Cirrhosis and Hepatocellular Carcinoma.","authors":"Eric Caliendo, Sally Williams, Spencer Hutto, Annie Massart, Brianna Burlock, Brent Weinberg, Julien Cavanagh, Hang Shi","doi":"10.1177/19418744241259072","DOIUrl":"10.1177/19418744241259072","url":null,"abstract":"<p><p>The following case describes a constellation of progressive cognitive and motor deficits in a 73-year-old man with cirrhosis and history of early-stage hepatocellular carcinoma confined to his liver. He had deficits in calculation, language, and writing, as well as subtle right-sided weakness. Magnetic resonance imaging (MRI) of the brain demonstrated non-enhancing white matter lesions without mass effect in the bilateral parietal and left occipitotemporal regions, correlating with neurologic exam findings. The patient's basic blood and cerebrospinal fluid (CSF) studies were within normal limits. Our differential included inflammatory and demyelinating conditions, hepatic encephalopathy, posterior reversible encephalopathy syndrome, progressive multifocal leukoencephalopathy (PML), and central nervous system (CNS) tumors. He did not improve with an empiric course of high-dose steroids or adequate hepatic encephalopathy treatment. A repeat lumbar puncture sent for additional CSF studies revealed a positive John Cunningham (JC) virus PCR test, confirming diagnosis of PML. Although the patient did not have any known overt immunosuppressive condition or treatment, the patient's cirrhosis and age placed him at higher risk for developing JC virus CNS reactivation. In a published case series of patients with PML and no classic immunosuppressive condition that includes several patients with concomitant cirrhosis, prognosis is much worse compared to those with known, reversible causes of immunosuppression.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 4","pages":"441-445"},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298302","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}