Neurohospitalist最新文献

{"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}

{"title":"Pitfalls in the Evaluation of Respiratory Failure in Myasthenia Gravis Patients: A Case Series.","authors":"Sanem Pinar Uysal, Yuebing Li","doi":"10.1177/19418744241280528","DOIUrl":"10.1177/19418744241280528","url":null,"abstract":"<p><strong>Objectives: </strong>To highlight the importance of recognizing different presentations of respiratory failure due to myasthenic and non-myasthenic etiologies in myasthenia gravis (MG) patients.</p><p><strong>Methods: </strong>We describe 3 patients with different presentations of respiratory failure in MG.</p><p><strong>Cases: </strong>Patient 1 is a 49-year-old female with longstanding MG who presented with lethargy and neck weakness without notable respiratory distress. She was found to be in hypercarbic respiratory failure, which improved with plasmapheresis treatment. Patient 2 is a 58-year-old female who presented with ptosis, dysphagia, and dyspnea requiring intubation. Her hypophonia and dyspnea persisted despite escalation in MG treatment, and further workup revealed glottal stenosis secondary to granulomatosis with polyangiitis. Patient 3 is an 85-year-old female with MG presenting with refractory hypoxia, which was secondary to a large patent foramen ovale resulting in right-to-left shunting.</p><p><strong>Discussion: </strong>All 3 cases emphasize the role of clinical reasoning and careful analysis based on thorough history taking, detailed neurologic exam and comprehensive laboratory findings to determine the etiologies for respiratory dysfunction in MG and provide appropriate treatment.</p><p><strong>Conclusion: </strong>A lack of overt signs of respiratory distress in MG does not rule out the presence of respiratory failure due to the sedating effect of hypercapnia. There is a need to consider alternative etiologies of hypoxia in MG patients if typical symptoms or signs of MG exacerbations are absent.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241280528"},"PeriodicalIF":0.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648957","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 (Spastic) Isolated Unilateral Foot Drop: The Foot Knob Area.","authors":"Jamir Pitton Rissardo, Ana Letícia Fornari Caprara","doi":"10.1177/19418744241279884","DOIUrl":"10.1177/19418744241279884","url":null,"abstract":"<p><p>Foot drop is a condition characterized by impairment of the ability to dorsiflex the foot at the ankle joint. We aim to review the literature and report a case of isolated unilateral foot drop of central causes. A 59-year-old male previously healthy presenting with a right foot drop was admitted. Severe weakness of ankle dorsiflexion with intact plantar flexion was observed. Deep tendon reflexes were normal, no clonus was appreciated, and a plantar response resulted in flexion of all toes. Neuroimaging showed a lesion in the high left frontal lobe, centered along the medial aspect of the precentral gyrus. Levetiracetam and dexamethasone were started, and after four days, the patient reported a slight improvement in his ability to dorsiflex his ankle. Abdominal imaging showed a large right renal mass with invasion of the renal pelvis fat, suggestive of renal cell carcinoma, and cytology diagnosed clear cell renal cell carcinoma. There are 25 articles containing 33 individuals with unilateral foot drop secondary to non-traumatic central causes in the literature. The mean and median age were 50.26 (SD = 20.57) and 55.5 years old (12 - 79 years). Most of the patients were males, which accounted for 55.88% (19/34). The side of the foot drop was right at 58.82% (20/34).</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241279884"},"PeriodicalIF":0.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648983","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":"19418744241274507"},"PeriodicalIF":0.9,"publicationDate":"2024-08-22","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":"A 22-Year-Old Man With Headache, Facial Numbness, Diplopia and Left Leg Numbness.","authors":"Daniel Gabay Moreira, Paul E Sanmartin","doi":"10.1177/19418744241276711","DOIUrl":"10.1177/19418744241276711","url":null,"abstract":"<p><p>We present a 22-year-old male with a subacute course of chin numbness, ophthalmoplegia, headache and left leg numbness in the setting of fever, chills and night sweats. Initial imaging investigations revealed cauda equina enhancement plus an infiltrative process at the basis of the skull associated with extensive bone marrow infiltration and lymphadenopathy elsewhere. We discuss the localization, differential diagnosis, and appropriate investigations for this unique clinical scenario. Important laboratory findings and treatment considerations are reviewed for this unusual final diagnosis.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744241276711"},"PeriodicalIF":0.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648857","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}