Neurohospitalist最新文献

{"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}

{"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}