Neurohospitalist最新文献

{"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}

{"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}