Neurohospitalist最新文献

{"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":"19418744241289973"},"PeriodicalIF":0.9,"publicationDate":"2024-09-29","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}

{"title":"Primary Diffuse Leptomeningeal Gliomatosis.","authors":"Hannah Padilla, Michael D Liu, Reece M Hass, Ivan D Carabenciov, Rafid Mustafa","doi":"10.1177/19418744241289169","DOIUrl":"10.1177/19418744241289169","url":null,"abstract":"<p><p>We report a case highlighting key clinical, CSF, and imaging findings of primary diffuse leptomeningeal gliomatosis of the spine.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241289169"},"PeriodicalIF":0.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636169","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":"19418744241288288"},"PeriodicalIF":0.9,"publicationDate":"2024-09-26","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":"A Case Report of Systemic Lupus Erythematosus Presenting as Isolated Mononeuropathy Multiplex.","authors":"Mia Andreoli, Cecilia N Hollenhorst, Tulsi Malavia, Jasmine L May, Shubadra Priyadarshini, Arjun Seth, Karan Dixit","doi":"10.1177/19418744241285551","DOIUrl":"10.1177/19418744241285551","url":null,"abstract":"<p><p>Mononeuropathy multiplex is a pattern of progressive sensory and motor deficits in the distribution of two or more peripheral nerves. The differential for mononeuropathy multiplex includes vasculitis, autoimmune disorders, infectious diseases, sarcoidosis, amyloidosis, cryoglobulinemia, and paraneoplastic disease. We present a case of a 42-year-old woman with hypothyroidism who presented with 1 week of ascending numbness and weakness, persistent fevers, and 3 months of constant burning pain in both feet. Her neurologic exam was notable for asymmetric weakness, loss of sensation, and diminished reflexes of her lower extremities. Other than mild fever and tachycardia, there were no systemic exam findings. Her laboratory workup was significant for elevated inflammatory markers, positive ANA, anti-ribonucleoprotein, smooth muscle antibody, and lupus anticoagulant, high anti-dsDNA titers, and low complement levels. An MRI of her lumbar spine was negative for lumbosacral nerve root pathology. Cerebrospinal fluid studies demonstrated normal cell counts, glucose, and protein and no evidence of infection. An electromyography (EMG) and nerve conduction studies (NCS) demonstrated asymmetric involvement of multiple individual peripheral nerves. Given the patient's symptoms, asymmetric exam findings, laboratory results, and EMG/NCS findings, she was diagnosed with mononeuropathy multiplex secondary to systemic lupus erythematosus (SLE) and started on steroid and immunosuppressant therapy with symptomatic improvement. Overall, this case illustrates the unique presentation of mononeuropathy multiplex as the initial manifestation of SLE. The identification of this specific type of neuropathy may play a crucial role in the prompt diagnosis of SLE and timely initiation of treatment, preventing further complications of the disease.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241285551"},"PeriodicalIF":0.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630219","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":"Episodic Coma in Lewy Body Disorders: An Observational Report.","authors":"Joseph H Friedman","doi":"10.1177/19418744241286579","DOIUrl":"10.1177/19418744241286579","url":null,"abstract":"<p><strong>Background: </strong>and Purpose: Episodes of unresponsiveness are one of several criteria used to diagnose dementia with Lewy bodies and are also seen in people with Parkinson's disease dementia. Patients examined during episodes of coma, whose evaluations found no other explanation than the neurological disorder, have not been described. This paper describes four cases, seen in the past two years. The objective is to bring this uncommon phenomenon to the attention of hospital based neurologists and to demonstrate that this may not be due to autonomic dysfunction.</p><p><strong>Methods: </strong>These are brief case descriptions by medical personnel observing affected patients supplemented by family reports of similar episodes described on the internet.</p><p><strong>Results: </strong>Four cases are described, all older men with either dementia with Lewy bodies or Parkinson's disease dementia, who had single, or multiple episodes of otherwise unexplained coma and were examined during a spell. IRB approval waived.</p><p><strong>Conclusions: </strong>Episodic coma may occur in demented patients with an alpha-synucleinopathy and is the likely explanation when evaluations have found no other cause. This information will reassure the family and patient that this is the likely explanation but that spells may recur.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241286579"},"PeriodicalIF":0.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636168","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":"Optimal Timeline and Hematoma Size Parameters for Middle Meningeal Artery Embolization in Acute-On-Chronic Subdural Hematomas.","authors":"Michael Fana, Giulia Santangelo, Abdalla Albanna, Ammar Jum'ah, Mohammed Rehman","doi":"10.1177/19418744241285275","DOIUrl":"10.1177/19418744241285275","url":null,"abstract":"<p><strong>Background and purpose: </strong>Chronic subdural hematomas (cSDH) are subdural collection of blood for which the current treatment option remains as surgical evacuation due to recurring focal inflammation and angiogenesis. An adjunctive therapeutic intervention is endovascular embolization of the middle meningeal artery (MMA) to cease the prolific cycle of angiogenesis. Few investigations have been made into the indications of this treatment modality regarding the intervention timeline and hematoma size for non-surgical candidates with acute-on-chronic subdural hematomas.</p><p><strong>Methods: </strong>We examined the clinical outcomes of 19 patients with 31 acute-on-chronic SDHs undergone MMA embolization and highlighted preliminary trends in radiological and morbidity outcomes.</p><p><strong>Results: </strong>Primary outcomes identified a 57.6% success rate for MMA embolization of acute-on-chronic SDHs defined as significantly reduced hematoma size (i.e. >50%) without recurring bleeds, peri-procedural complications, post-procedural neurological deficits, and need for post-procedural surgical evacuation. Subgroup analysis demonstrated a success rate of 90.9% in patients undergone embolization after a minimum 3-week delay from initial CT head study compared to 33.3% with early intervention as well as a success rate of 75% in patients presenting with a large (i.e. >10 mm) SDH compared to 30% for small SDH.</p><p><strong>Conclusion: </strong>Our preliminary data in this retrospective cohort study demonstrates significantly improved outcomes of MMA embolization in patients presenting with large (>10 mm) acute-on-chronic SDHs and in patients undergone embolization after >3 weeks from initial CT head and symptomatic presentation.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241285275"},"PeriodicalIF":0.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630171","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":"High-Risk Plaque Features in the Non-stenosing Carotid Artery, How Frequently is This Reported? A Retrospective Study.","authors":"Ammar Jumah, Abdalla Jamal Albanna, Abdelrahman Elfaham, Lara Eltous, Sohaib Zoghoul, Daniel Miller","doi":"10.1177/19418744241283858","DOIUrl":"10.1177/19418744241283858","url":null,"abstract":"<p><strong>Background: </strong>High-risk features of non-stenosing (ie, <50%) carotid plaques are emerging as a possible source of embolism in patients with embolic stroke of undetermined source (ESUS). However, in the absence of hemodynamically significant stenosis, neuroradiology reports rarely describe these morphological features. Our aim was to determine how often high-risk features of non-stenosing plaques are included in diagnostic imaging reports.</p><p><strong>Methods: </strong>In this retrospective study, we evaluated computed tomography angiography (CTA) reports associated with the CTA imaging results for a previously published cohort study. Plaque features reporting frequencies were calculated and defined as the number of times specific plaque features were included in the CTA reports (Thickness, ulceration, length, soft component and calcification) divided by the number of occurrences of high-risk plaque features (Thickness >0.3 cm; ulceration; length >1.0 cm), soft component, or calcification identified in the CTA results. We used Fisher exact test to compare the reporting frequencies of the 5 plaque features.</p><p><strong>Results: </strong>We analyzed 152 CTA reports. The frequency of reporting plaque thickness (0/40; 0%), ulceration (3/37; 8.1%), and length (7/29; 24.1%) was significantly lower than the reporting of plaque calcification (122/122; 100%) and presence of soft component (31/34; 72.1%) when these features were present in CTA imaging results (all <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>When carotid plaques are not causing hemodynamically significant stenosis, neuroradiology reports frequency mention plaque density but often exclude other characteristics. Neuroradiologists and neurologists should collaborate to create algorithms, scoring systems and prediction models to accurately determine which plaque features are highly associated with embolism.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241283858"},"PeriodicalIF":0.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630150","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":"Mamillopontine Distance Before and After Treatment in Spontaneous Intracranial Hypotension.","authors":"Evan Madill, Narayan Kissoon, Shamik Bhattacharyya","doi":"10.1177/19418744241273313","DOIUrl":"10.1177/19418744241273313","url":null,"abstract":"<p><p>We describe a case of spontaneous intracranial hypotension secondary to a CSF-venous fistula that was treated with transvenous embolization. We present the imaging findings from a brain MRI before and after embolization demonstrating changes in the patient's mamillopontine distance. Decreased mamillopontine distance is a marker of spontaneous intracranial hypotension and a minor criterion in the Bern Score.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241273313"},"PeriodicalIF":0.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649054","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":"Cavitating Osmotic Demyelination Syndrome Following Correction of Chronic Hyponatremia in Sheehan's Syndrome: A Novel Case Report.","authors":"Alamgir Shaikh, Moisés León-Ruiz, Ritwik Ghosh, Manoj Soren, Bilwatosh Mukhopadhyay, Shyamal Kanti Pal, Julián Benito-León","doi":"10.1177/19418744241279491","DOIUrl":"10.1177/19418744241279491","url":null,"abstract":"<p><strong>Introduction: </strong>Rapid correction of hyponatremia can result in osmotic demyelination syndrome (ODS). Sheehan's syndrome, a rare pituitary disorder caused by severe postpartum hemorrhage, is a potential cause of chronic hyponatremia. This case report describes a rare progression of extrapontine myelinolysis to central pontine myelinolysis, ultimately leading to ODS, following the correction of chronic hyponatremia associated with Sheehan's syndrome. Notably, this event occurred a decade after the initial postpartum hemorrhage due to placenta previa.</p><p><strong>Case report: </strong>A 40-year-old woman from rural West Bengal, India, presented in a comatose state after five years of progressively worsening symptoms, including fatigue, gastrointestinal disturbances, cold intolerance, hair loss, and severe apathy, which had been misdiagnosed as psychogenic and treated with selective serotonin reuptake inhibitors. Two days before her admission to our hospital, she was diagnosed with a lower respiratory tract infection, dehydration, and severe hyponatremia (118 mEq/L) at a local private healthcare facility. Despite treatment with 3% sodium chloride and intravenous antibiotics, her condition deteriorated, prompting her transfer. At the time of hospitalization, the patient was diagnosed with chronic hyponatremia and hypopituitarism consistent with Sheehan's syndrome. This condition was attributed to a severe postpartum hemorrhage that occurred a decade prior, resulting from placenta previa. Initial MRI revealed extrapontine myelinolysis, and the correction of her \"compensated\" hyponatremia was identified as the cause of her neurological decline. Follow-up MRIs at 7 and 14 weeks confirmed the development of cavitating ODS.</p><p><strong>Discussion: </strong>This case highlights several key points: First, even a relatively gradual correction of hyponatremia can precipitate ODS, especially in patients with chronic conditions like Sheehan's syndrome. Second, it underscores the importance of meticulous management of chronic hyponatremia to prevent severe neurological outcomes. Third, it illustrates the diagnostic challenges of differentiating Sheehan's syndrome from primary psychiatric disorders, particularly in low-resource settings where the syndrome remains prevalent. The case also emphasizes the need for awareness among healthcare providers about the potential for severe complications arising from even minor corrections in serum sodium levels in such patients.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241279491"},"PeriodicalIF":0.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648978","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 38-year-Old Woman With Flaccid Tetraparesis after Presenting With Abdominal Pain.","authors":"Carolina Rodrigues Dal Bo, Julia Miranda Menezes, Barbara Gabriela Gomes Silva, Sarah Ingrid Farias Dos Santos, Marisa Petrucelli Doher, René de Araújo Gleizer","doi":"10.1177/19418744241281000","DOIUrl":"10.1177/19418744241281000","url":null,"abstract":"<p><p>A 38-year-old woman presented in the emergency department with acute abdominal pain. She underwent laparoscopic cholecystectomy. Postoperatively, she developed worsening abdominal pain, tachycardia, flaccid tetraparesis, urinary retention, constipation and SIADH. She also developed red-colored urine. Porphobilinogen was requested in an isolated urine sample, with the test result showing 256 mg/g of creatinine. This case didactically emphasizes the necessity of considering differential diagnosis in acute abdomen pain associated with neurological disorders.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241281000"},"PeriodicalIF":0.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648859","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}