Neurohospitalist最新文献

{"title":"Acute Hepatic Porphyria vs. Guillain-Barré Syndrome: Response to \"Axonal Neuropathy in Hepatic Porphyria Should Not be Confused With Guillain-Barre Syndrome\".","authors":"Ashok Kumar Pannu","doi":"10.1177/19418744251342109","DOIUrl":"https://doi.org/10.1177/19418744251342109","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251342109"},"PeriodicalIF":0.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001213","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":"Stroke Hospitalization Administration & Monitoring: Routine or COVID-19 Care (SHAMROCC).","authors":"Timothé Langlois-Thérien, Michel Shamy, Brian Dewar, Tim Ramsay, Ronda Lun, Dylan Blacquiere, Robert Fahed, Dar Dowlatshahi, Grant Stotts, Célina Ducroux","doi":"10.1177/19418744251338601","DOIUrl":"https://doi.org/10.1177/19418744251338601","url":null,"abstract":"<p><strong>Background: </strong>Monitoring stroke patients in critical-care units for 24 h after thrombolysis or endovascular thrombectomy is considered standard of care in current guidelines but is not evidence-based. Due to the COVID-19 pandemic, our center adopted a targeted protocol in April 2021 with 24-h critical-care monitoring no longer being guaranteed for stroke patients receiving reperfusion treatment. We aim to compare the incidence and timing of complications during the year under the targeted approach compared to prior years when the standard of care was followed.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study. We analyzed data from stroke patients treated with thrombolysis and/or endovascular thrombectomy in 2019 (pre-COVID-19, standard of care), 2020 (during COVID-19, standard of care) and 2021 (during COVID-19, targeted protocol). Data extracted included demographics, the nature and timing of complications within the first 24 h, and the unit at the time of complication.</p><p><strong>Results: </strong>Three hundred forty-nine patients were included in our study: 78 patients in 2019, 115 patients in 2020, and 156 patients in 2021. In 2021, 32% of patients experienced at least 1 complication within the first 24 h compared to 34% in 2020 and 27% in 2019. In 2021, 33% of patients admitted to critical-care units had a complication compared to 29% in non-critical care units. In 2021, 70% of complications had occurred by hour 8 compared to 49% in 2020 and 29% in 2019.</p><p><strong>Conclusions: </strong>The incidence and timing of complications did not significantly worsen under the targeted approach compared to prior years and were not associated with hospital location.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251338601"},"PeriodicalIF":0.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029657","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":"Spontaneous Abnormal Vertical Eye Movements of Coma.","authors":"Claire Allen, Siena Duarte, Jaeho Hwang, Romergryko G Geocadin, Kemar E Green","doi":"10.1177/19418744251331649","DOIUrl":"https://doi.org/10.1177/19418744251331649","url":null,"abstract":"<p><p>Spontaneous vertical eye movements in the critical care setting are often a source of confusion and alarm; while their origin remains at least partly theoretical, understanding their classification and associated clinical implications can inform the diagnostic workup and further clinical management. This case describes a patient who demonstrated ocular dipping: slow conjugate downward eye movements with a quick return to primary gaze. Ocular dipping is a rare phenomenon that was initially described in patients with hypoxic brain injury and has since been described in only a handful of cases. Dipping resides in a spectrum of spontaneous vertical eye movements, with ocular bobbing being the first of these described eye movements. Ocular bobbing is characterized by a fast downward movement followed by a slow return to the mid gaze position which is classically associated with pontine injury. Other vertical eye movements that can be seen in patients with a disorder of consciousness include other variations of ocular bobbing and dipping, vertical myoclonus, and small-amplitude mainly vertical movements.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251331649"},"PeriodicalIF":0.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024287","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":"Salivary Gland Botulinum Toxin a Injections for Treating Sialorrhea Among Critically Ill Patients With Neurological Disorders.","authors":"Fazila Aseem, Kayla E John, Daniel King, Miriam Sklerov, Daniel A Roque, Nina M Browner, Julia M Carlson","doi":"10.1177/19418744251338148","DOIUrl":"https://doi.org/10.1177/19418744251338148","url":null,"abstract":"<p><p><b>Background:</b> Sialorrhea is associated with various neurological conditions. Among critically ill patients with acute neurological injuries (ANI), sialorrhea leads to several adverse consequences, including extubation failure, inability to initiate non-invasive ventilation, aspiration pneumonia and prolonged hospitalization. Botulinum toxin (BoTN) injections can reduce salivary production. Both BoTN-A and BoTN-B are effective in managing sialorrhea among patients with neurogenic dysphagia. BoTN utilization for sialorrhea in critically ill adult ANI patients is not well-studied. <b>Purpose:</b> The purpose of this study to evaluate the safety and feasibility of using BoTN-A salivary injections to reduce sialorrhea in ANI patients. <b>Research Design:</b> In this case series, we retrospectively reviewed the off-label use of BoTN-A for sialorrhea in ANI patients at the University of North Carolina Neurosciences Intensive Care Unit. Study Sample: Six patients with ANI who received BoTNA treatment for neurogenic sialorrhea in absence of infection and medications with known side-effect of sialorrhea. <b>Data Collection:</b> For safety evaluation, we reviewed any documented adverse effects of BoTN-A injection. For efficacy, we evaluated the drooling severity, suctioning frequency, oxygen requirements, continued days on the ventilator, and pneumonia diagnoses. <b>Results:</b> All patients had reduction in their documented drooling and suctioning requirements following BoTN-A injection. None had adverse events associated with BoTN-A injections. All patients experienced recurrent ventilator-associated pneumonias prior to BoTN-A injections whereas four patients had no pneumonia events after injections. Also, two patients were successfully weaned of oxygenation prior to discharge. <b>Conclusions:</b> This case series highlights the safety and potential efficacy of salivary gland BoTN-A for reducing refractory sialorrhea among critically ill ANI patients. Future studies are needed to evaluate whether sialorrhea reduction can lead to reduced hospital complications and overall length of hospital stay.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251338148"},"PeriodicalIF":0.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053737","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":"An Overview of the Dengue Viruses.","authors":"Barrie L Schmitt, Lakshmi Chauhan, Amanda L Piquet, Kenneth L Tyler, Daniel M Pastula","doi":"10.1177/19418744251334717","DOIUrl":"https://doi.org/10.1177/19418744251334717","url":null,"abstract":"","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251334717"},"PeriodicalIF":0.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990331","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":"<i>Streptococcus</i> <i>p</i> <i>neumoniae</i> Meningitis with Diffuse Cerebral Microhemorrhages.","authors":"Harleen Sood, Ramesha Chinakarihalli Gangadharappa, Rahul Dey, Vikas Bhatia, Ashok Kumar Pannu","doi":"10.1177/19418744251332982","DOIUrl":"https://doi.org/10.1177/19418744251332982","url":null,"abstract":"<p><p><i>Streptococcus pneumoniae</i> is the leading cause of community-acquired bacterial meningitis across all age groups. Despite appropriate antibiotic therapy, the prognosis for pneumococcal meningitis remains poor. While common acute complications include cerebral edema, brain herniation, ventriculitis, hydrocephalus, and cerebral infarctions, hemorrhagic events are rarely reported. We present a case of a young male with <i>S. pneumoniae</i> meningitis, who developed diffuse cerebral microhemorrhages, an extremely rare complication. Despite culture-guided antibiotic therapy, the patient's condition deteriorated, requiring mechanical ventilation. Magnetic resonance imaging revealed diffuse cerebral microhemorrhages, prompting intensive supportive care. Prolonged mechanical support and a two-week antibiotic therapy led to gradual recovery, and the patient was discharged without neurological sequelae. This case highlights the importance of early imaging and timely intervention in managing rare complications of bacterial meningitis.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251332982"},"PeriodicalIF":0.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11985466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006279","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":"Myelin Oligodendrocyte Glycoprotein G Antibody-Positive Paraneoplastic Myelopathy in Seminoma: A Case Report and Literature Review.","authors":"Umair Hamid, Jamir Pitton Rissardo, Luisa F Alviz, Ana Letícia Fornari Caprara, Tiffani S Franada","doi":"10.1177/19418744241288288","DOIUrl":"10.1177/19418744241288288","url":null,"abstract":"<p><p>Myelin oligodendrocyte glycoprotein-associated disorders (MOGAD) are autoimmune diseases that often manifest in the context of infections. They can also arise less commonly following vaccination but even more rarely in a paraneoplastic context. Herein, we will report a patient presenting with subacute inflammatory myelopathy after a fourth dose of the mRNA COVID-19 vaccine. Concurrently, a diagnosis of MOGAD was made with a metastatic abdominal seminoma. The patient was acutely treated with high-dose steroids followed by plasma exchange therapy and was subsequently started on a chemotherapy regimen for the underlying germ cell tumor. The patient had a complete resolution of neurological symptoms upon the last follow-up. Overall, 72 cases of COVID-19 vaccination associated with MOGAD were analyzed (median age at onset 39 years old; female to male ratio = 1.2:1). All cases occurred in adults except for an adolescent, with the majority occurring after vaccination with ChAdOx nCoV-19 (87%), and an average temporal profile between vaccination and symptom onset of 19 days. There were no reported cases after the third or fourth doses, and most patients were diagnosed with new-onset MOGAD after their first vaccine (76%). Although COVID-19 vaccination could be a potential causality, there are significant discrepancies between the reported cases and this patient, alongside the unlikely causality assessment obtained with the Bradford Hill criteria. Vaccination could unmask potential pre-existing autoimmune diseases, such as in this patient, where myelopathy was most likely part of a paraneoplastic syndrome associated with a newly diagnosed seminoma.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"195-201"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630154","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":"163-166"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","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":"Feasibility of Percutaneous Gastrostomy Tube Placement Using Only Local Anesthetic in Patients With Neuromuscular Dysfunction.","authors":"Srinidhi Shanmugasundaram, Nardine Mikhail, Tarek Jazmati, Abhishek Kumar, Pratik A Shukla","doi":"10.1177/19418744241274507","DOIUrl":"10.1177/19418744241274507","url":null,"abstract":"<p><strong>Background: </strong>Patients with neuromuscular disorders often require gastrostomy tube placement for feeding but routinely have contraindication to sedation due to poor airway control with intubation avoided at the risk of ventilator dependence.</p><p><strong>Purpose: </strong>To assess the feasibility of percutaneous gastrostomy tube (G-tube) placement using only local anesthesia in patients with neuromuscular dysfunction.</p><p><strong>Research design: </strong>A retrospective chart review was performed from 2013 to 2019 for all patients who underwent percutaneous G-tube placement under local anesthesia only.</p><p><strong>Study sample: </strong>12 patients (6 females, 6 males; mean age = 52.3 ± 21.8) with neuromuscular disorders underwent G-tube placement with only local anesthesia.</p><p><strong>Data collection: </strong>Data collected included demographic data, medical history (source of neuromuscular dysfunction), procedural information, and complications.</p><p><strong>Results: </strong>Technical success was achieved in 100% of patients with no major complications.</p><p><strong>Conclusion: </strong>Placement of a percutaneous gastrostomy tube using only local anesthesia is safe and feasible in patients who have a contraindication to sedation due to poor airway control and for whom intubation is avoided due to risk of ventilator dependence.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"133-135"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649024","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":"CONNECT: Coordinating Options for Neurovascular Patients Needing Electrophysiology Consults and Treatments.","authors":"Melissa Mortin, Ben Shifflett, Dawn M Meyer, Lovella Hailey, Stephanie Yoakum, Jonathan C Hsu, Brett C Meyer","doi":"10.1177/19418744241289973","DOIUrl":"10.1177/19418744241289973","url":null,"abstract":"<p><strong>Background and purpose: </strong>Though Event Monitors (EM) and Implantable Loop Recorders (ILR) are prevalent in stroke workups, complex processes to obtain placement of these device might result in delays. Our aim was to determine if the CONNECT (Coordinating Options for Neurovascular patients Needing Electrophysiology Consults and Treatments) pathway could improve Stroke-to-Electrophysiology (EP) communications, increase EM and ILR device placements prior to discharge, shorten placement time, and preserve satisfaction.</p><p><strong>Methods: </strong>We assessed device placements when an EP consult was obtained [Pre-CONNECT (5/1/21-4/30/22), CONNECT (5/1/22-4/30/23)] for patients with stroke. In the Pre- period, consults were sent via EPIC electronic medical record (EMR), with additional direct communication when desired. In the CONNECT period, the pathway and module allowed for immediate communication between services. Outcomes included case rate, times, length of stay, and satisfaction. Hospital reports detailed Order to Activation (O-A) days. EM report review was used to obtain O-A time. Clinician satisfaction was assessed using Qualtrics survey. Patient satisfaction was assessed with Hospital Consumer Assessment of Health care Clinicians and Systems (HCAHPS) survey. Man-Whitney U test was used.</p><p><strong>Results: </strong>78 patients were included (30EM(38.5%), 48ILR(61.5%)). Age was 68 years (<i>P</i> = 0.58). For ILRs, inpatient placements prior to discharge increased (3Pre vs 51 CONNECT; <i>P</i> < 0.0001) as did outpatient placements (5 vs 16; <i>P</i> = 0.02). Order to Activation (O-A) time savings were significant for ILR overall (32 days vs 1 day; <i>P</i> = 0.03) and for Inpatient EM (13 days vs 3 days; <i>P</i> = 0.003). Time for consultant to view was 4 min and to respond was 6 min. Devices were placed at a median 6 hrs 32 min (EM: 4 hrs 19 min; ILR:7 hrs36 min). All (12/12) clinicians preferred the technique. Patient satisfaction improved on 13/19 (68%) questions.</p><p><strong>Conclusions: </strong>There was a 1600% increase in ILR placements prior to discharge that was associated with the time period that the CONNECT process was in place. The robust improvement in ILR placements prior to discharge, high satisfaction, ease of use, closed loop communication, and respect for autonomy allowing more organic parallel discussions with patients improved clinician workflow which could potentially improve future risk reduction strategies.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"105-112"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630231","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}