Neurohospitalist最新文献_第8页

Trismus as the Initial Presentation of Anti-Hu Paraneoplastic Neurological Syndrome. 作为抗胡副肿瘤性神经综合征最初表现的 "三体症"。

IF 1

Neurohospitalist Pub Date : 2024-07-01 Epub Date: 2024-03-04 DOI: 10.1177/19418744241237593

Witoon Mitarnun, Metha Apiwattanakul, Narin Chindavech, Benyapha Sombat, Suttanon Jantapatsakun, Pheeracha Sornnuwat

{"title":"Trismus as the Initial Presentation of Anti-Hu Paraneoplastic Neurological Syndrome.","authors":"Witoon Mitarnun, Metha Apiwattanakul, Narin Chindavech, Benyapha Sombat, Suttanon Jantapatsakun, Pheeracha Sornnuwat","doi":"10.1177/19418744241237593","DOIUrl":"10.1177/19418744241237593","url":null,"abstract":"A 73-year-old man presented with subacute trismus and pancerebellar dysfunction. Brain imaging and routine blood test results were unremarkable. Chest computed tomography revealed an indistinctly enhancing 4.7 × 2.5 × 1.8-cm3 pulmonary mass in the right upper lung, with enlarged right paratracheal and hilar lymph nodes. Biopsy of the right supraclavicular lymph node confirmed metastatic carcinoma, with differential diagnoses of small cell carcinoma and poorly differentiated carcinoma, indicating lung cancer as the primary source. Paraneoplastic immunohistochemistry screening revealed anti-Hu antibodies in the serum at a titer of 1:7680 (normal range <1:240) and in the cerebrospinal fluid (CSF) at a titer of 1:256 (normal range <1:2). The line blot method yielded positive results for anti-Zic4 antibodies in serum, with a titer of >1:10 (normal range <1:10), whereas CSF anti-Zic4 was negative (normal range <1:2). The patient developed non-responsive hospital-acquired pneumonia and respiratory failure, and discharged himself against medical advice. This rare case indicates that trismus can be an initial manifestation of anti-Hu paraneoplastic neurological syndrome, and emphasizes the importance of clinical awareness.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 3","pages":"336-338"},"PeriodicalIF":1.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11181965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421376","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}

引用次数: 0

Elsberg Syndrome With Albuminocytologic Dissociation - A Guillain-Barré Syndrome Mimic or Guillain-Barré Syndrome Variant? 伴有白蛋白细胞学分离的埃尔斯伯格综合征--吉兰-巴雷综合征的拟态还是吉兰-巴雷综合征的变异？

IF 1

Neurohospitalist Pub Date : 2024-07-01 Epub Date: 2024-02-20 DOI: 10.1177/19418744241233621

Joseph M Ferrara, Courtney Litchmore, Smit Shah, Jeffery Myers, Khalil Ali

引用次数: 0

Neuromyelitis Optica Spectrum Disorder Resembling Wernicke's Encephalopathy: A Case Report and Review of the Literature. 类似韦尼克脑病的神经脊髓炎谱系障碍：病例报告与文献综述。

IF 1

Neurohospitalist Pub Date : 2024-04-01 Epub Date: 2024-01-16 DOI: 10.1177/19418744241228004

Sloan Lynch, Nil Saez Calveras, Anik Amin

{"title":"Neuromyelitis Optica Spectrum Disorder Resembling Wernicke's Encephalopathy: A Case Report and Review of the Literature.","authors":"Sloan Lynch, Nil Saez Calveras, Anik Amin","doi":"10.1177/19418744241228004","DOIUrl":"https://doi.org/10.1177/19418744241228004","url":null,"abstract":"We describe a case of Neuromyelitis Optica Spectrum Disorder (NMOSD) mimicking Wernicke's Encephalopathy (WE) to highlight an atypical presentation of NMOSD. A 39-year-old female presented with subacute encephalopathy and progressive ophthalmoplegia. Her MRI revealed T2 hyperintensities involving the mammillary bodies, periaqueductal grey matter, medial thalami, third ventricle, and area postrema. Whole blood thiamine levels were elevated and she did not improve with IV thiamine. CSF was notable for lymphocytic pleocytosis and elevated protein. She tested positive for serum Aquaporin-4 (AQP4) antibody. Subsequent imaging revealed multilevel lesions in the cervical and thoracic spinal cord. Her CSF GFAP antibody also came back positive. She steadily and significantly improved after high-dose IV steroids and plasmapheresis. She later started on chronic rituximab therapy. This represents a unique case of NMOSD presenting with the classical clinical and imaging features of WE, as opposed to the typical presenting symptoms of NMOSD. As such, demyelinating disorders should be considered when there is concern for diencephalic and midline pathologies, particularly without classic WE risk factors. Conversely, clinicians should be aware of secondary nutritional complications arising from severe area postrema syndrome.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"14 2","pages":"213-217"},"PeriodicalIF":1.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856233","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}

引用次数: 0

Impact of the COVID-19 Pandemic on Inpatient Utilization for Acute Neurologic Disease. 新冠肺炎疫情对急性神经系统疾病住院患者利用的影响

IF 0.9

Neurohospitalist Pub Date : 2024-01-01 Epub Date: 2023-08-17 DOI: 10.1177/19418744231196984

Alexander Yoo, Elan L Guterman, David Y Hwang, Robert G Holloway, Benjamin P George

{"title":"Impact of the COVID-19 Pandemic on Inpatient Utilization for Acute Neurologic Disease.","authors":"Alexander Yoo, Elan L Guterman, David Y Hwang, Robert G Holloway, Benjamin P George","doi":"10.1177/19418744231196984","DOIUrl":"10.1177/19418744231196984","url":null,"abstract":"Background and Objective: The initial months of the Corona Virus 2019 (COVID-19) pandemic resulted in decreased hospitalizations. We aimed to describe differences in hospitalizations and related procedures across neurologic disease. Methods: In our retrospective observational study using the California State Inpatient Database and state-wide population-level estimates, we calculated neurologic hospitalization rates for a control period from January 2019 to February 2020 and a COVID-19 pandemic period from March to December 2020. We calculated incident rate ratios (IRR) for neurologic hospitalizations using negative binomial regression and compared relevant procedure rates over time. Results: Population-based neurologic hospitalization rates were 29.1 per 100,000 (95% CI 26.9-31.3) in April 2020 compared to 43.6 per 100,000 (95% CI 40.4-46.7) in January 2020. Overall, the pandemic period had 13% lower incidence of neurologic hospitalizations per month (IRR 0.87, 95% CI 0.86-0.89). The smallest decreases were in neurotrauma (IRR 0.92, 95% CI 0.89-0.95) and neuro-oncologic cases (IRR 0.93, 95% CI 0.87-0.99). Headache admissions experienced the greatest decline (IRR 0.62, 95% CI 0.58-0.66). For ischemic stroke, greater rates of endovascular thrombectomy (5.6% vs 5.0%; P < .001) were observed in the pandemic. Among all neurologic disease, greater rates of gastrostomy (4.0% vs 3.5%; P < .001), intubation/mechanical ventilation (14.3% vs 12.9%, P < .001), and tracheostomy (1.4 vs 1.2%; P < .001) were observed during the pandemic. Conclusions: During the first months of the COVID-19 pandemic there were fewer hospitalizations to varying degrees for all neurologic diagnoses. Rates of procedures indicating severe disease increased. Further study is needed to determine the impact on triage, patient outcomes, and cost consequences.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"1 1","pages":"13-22"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10790622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41468783","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}

引用次数: 0

Neuromyelitis Optica Spectrum Disorder Management in the Setting of Chronic Hepatitis B and Latent Tuberculosis: A Case Report. 慢性乙型肝炎和潜伏性肺结核患者视神经脊髓炎谱系障碍的治疗：一例报告。

IF 0.9

Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-04 DOI: 10.1177/19418744231171464

Dylan Sadowsky, Kevin Delijani, William Davis, Amy Safadi, Petra Brayo, Benjamin Osborne

{"title":"Neuromyelitis Optica Spectrum Disorder Management in the Setting of Chronic Hepatitis B and Latent Tuberculosis: A Case Report.","authors":"Dylan Sadowsky, Kevin Delijani, William Davis, Amy Safadi, Petra Brayo, Benjamin Osborne","doi":"10.1177/19418744231171464","DOIUrl":"10.1177/19418744231171464","url":null,"abstract":"Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory autoimmune disorder of the central nervous system, with optic neuritis and transverse myelitis as its most common presentations. Although immunomodulatory treatment options for NMOSD have expanded, preventing reactivation of latent infections in patients can be both a therapeutic challenge and a special consideration for the neurohospitalist in an inpatient setting. We present a challenging case of a NMOSD patient who presented to the emergency department with worsening weakness and numbness in the setting of an NMOSD pseudo-relapse, later found to have untreated latent tuberculosis (TB) and chronic hepatitis B (HBV). She was briefly treated with high-dose IV methylprednisolone, which was stopped after her symptoms and imaging became more consistent with a pseudo-relapse. After confirmation that neither HBV nor TB had reactivated, the patient was discharged on isoniazid and entecavir. A month later, the patient's symptoms were stable, and she was started on inebilizumab for relapse prevention of NMOSD. This case report is the first to highlight the therapeutic complexities of managing NMOSD that requires immunosuppression in the setting of preventing reactivation of both TB and HBV.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"361-363"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239186","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}

引用次数: 0

Clinical Problem Solving: A 38-year-Old Woman With Systemic Lupus Erythematosus Presenting With Headache, Nausea, and Vomiting. 临床问题解决：一名患有系统性红斑狼疮的38岁女性，表现为头痛、恶心和呕吐。

IF 0.9

Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-06-08 DOI: 10.1177/19418744231182285

Andrew Silverman, Rachelle Dugue, Paul M George

引用次数: 0

Gummatous Neurosyphilis With Transient Worsening of Neurological Symptoms After Treatment Initiation. 牙龈性神经梅毒，治疗开始后神经症状短暂恶化。

IF 0.9

Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-10 DOI: 10.1177/19418744231175564

Valeria Ariza Hutchinson, Aya Shnawa, David P Lerner, Kenneth Wener, Anna Cervantes-Arslanian, Joseph D Burns

引用次数: 0

Hereditary Neuropathy With Liability to Pressure Palsy Detected During the Use of Recreational Drugs. 在使用娱乐性药物期间检测到遗传性神经病变与压力性麻痹的易感性。

IF 0.9

Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-12 DOI: 10.1177/19418744231174396

Giovanni Castellucci, Michelle Figueroa, Lalitha Sivaswamy

{"title":"Hereditary Neuropathy With Liability to Pressure Palsy Detected During the Use of Recreational Drugs.","authors":"Giovanni Castellucci, Michelle Figueroa, Lalitha Sivaswamy","doi":"10.1177/19418744231174396","DOIUrl":"10.1177/19418744231174396","url":null,"abstract":"Background: Nitrous oxide (N2O) has been an increasingly popular recreational drug over the past few years. Abuse is associated with severe neurological complications and even fatal outcomes. Purpose: Here we present a case of chronic nitric oxide abuse in a teenager presenting with rapidly progressive mixed sensory and motor polyneuropathy. Results: The initial diagnostic workup excluded electrolyte derangement, heavy metal intoxication, autoimmune neuropathy, myopathy, hematological disorders, and thyroid disease. On further questioning, patient reported 8-months of inhalation of nitrous oxide, commonly known as \"whippets\". Subsequent tests revealed low Vitamin B12 and elevated homocysteine level. Eventual genetic test demonstrated a heterozygous deletion in the gene that encodes the peripheral myelin protein 22 (PMP22), consistent with a diagnosis of Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). Conclusion: The association of neurologic and genetic findings with the timeline of nitrous oxide inhalation suggests a multifactorial etiology of her symptoms, with the N2O acting as a trigger to the axonal degeneration and demyelination detected on electrodiagnostic studies.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"376-380"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232155","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}

引用次数: 0

Elevations in Norclobazam Concentrations and Altered Mental Status in CYP2C19 Poor Metabolizer Phenotype: A Case Report. CYP2C19代谢不良表型患者诺氯巴赞浓度升高和精神状态改变:1例报告

IF 0.9

Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-07-10 DOI: 10.1177/19418744231189078

Kristy M Phillips, Josanna M Rodriguez-Lopez, Andrew J Webb

引用次数: 0

Utility of Repetitive Nerve Stimulation in the Diagnosis of Myasthenia Gravis in the Inpatient Setting. 重复神经刺激在住院重症肌无力诊断中的应用。

IF 0.9

Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-10 DOI: 10.1177/19418744231173829

Katherine M Clifford, Connie K Wu, David Post, Ruba Shaik, Srikanth Muppidi

{"title":"Utility of Repetitive Nerve Stimulation in the Diagnosis of Myasthenia Gravis in the Inpatient Setting.","authors":"Katherine M Clifford, Connie K Wu, David Post, Ruba Shaik, Srikanth Muppidi","doi":"10.1177/19418744231173829","DOIUrl":"10.1177/19418744231173829","url":null,"abstract":"Objectives: Sensitivity and specificity of Repetitive Nerve Stimulation (RNS) is typically reported from outpatient centers, and we hypothesized that these values might not apply to hospitalized patients with higher grades of weakness. RNS may be helpful in rapidly confirming diagnosis of myasthenia gravis (MG) in the inpatient setting, as results from confirmatory antibody testing are often delayed. We sought to characterize the sensitivity and specificity of RNS in the inpatient setting to assist in the early diagnosis of MG.Methods: We performed a retrospective analysis of all adult patients who had inpatient RNS at our center from 2016 to 2021. Inclusion criteria included RNS performed at least at one site and a neurological evaluation which prompted an electrodiagnostic study to evaluate for neuromuscular junction (NMJ) pathology. Descriptive statistics and Fisher exact analysis were performed.Results: Of the 32 identified hospitalized patients, 6 had greater than 10% decrement on slow RNS, confirming NMJ dysfunction. Five were diagnosed with MG, and 1 with Lambert-Eaton myasthenic syndrome. Of the 26 patients with normal RNS, 25 ultimately had alternative causes of weakness. One was later diagnosed as seronegative MG based on clinical improvement with acetylcholinesterase inhibitors. In our inpatient population, the overall sensitivity and specificity of RNS were 83.3% and 96.2% respectively. There was a statistically significant association between a positive RNS and diagnosis of MG (P = .0002).Conclusions: RNS is a highly sensitive and specific test for the diagnosis of MG in an inpatient setting, and these results are likely more rapidly available compared to antibody testing.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"364-370"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244489","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}

引用次数: 0