Neurohospitalist最新文献_第9页

Recurrent Intraventricular Haemorrhage in Cerebral Proliferative Angiopathy - A Case Report and Review of the Literature. 脑增殖性血管病复发性脑室内出血一例报告并文献复习。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-29 DOI: 10.1177/19418744231180046

Jakob V E Gerstl, Joshua D Bernstock, Ari D Kappel, Erickson F Torio, Rose Du

引用次数: 0

Vertebral and Basilar Artery Dissection in a Patient With Alport Syndrome. Alport综合征患者的椎基底动脉夹层。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-11 DOI: 10.1177/19418744231175561

Haley K Talbot-Stetsko, Sara Saleh, Ashley Brent, Sandra Camelo-Piragua, David Gordon, Craig A Williamson

{"title":"Vertebral and Basilar Artery Dissection in a Patient With Alport Syndrome.","authors":"Haley K Talbot-Stetsko, Sara Saleh, Ashley Brent, Sandra Camelo-Piragua, David Gordon, Craig A Williamson","doi":"10.1177/19418744231175561","DOIUrl":"10.1177/19418744231175561","url":null,"abstract":"Basilar artery occlusion (BAO) is a rare cause of stroke associated with significant morbidity and mortality. It is most frequently thromboembolic in nature, but may be caused by vertebral artery dissection. We present a case of BAO in a 36-year-old woman with Alport syndrome. She was treated with emergent thrombectomy via the right vertebral artery with return to baseline neurological status. Her clinical status deteriorated later the same day and she was found to have re-occlusion. Repeat thrombectomy was complicated by persistent re-occlusion requiring 7 passes to achieve reperfusion. Unfortunately, her neurological exam remained poor and she was transitioned to comfort care, expiring on admission day 3. An autopsy demonstrated acute dissection of the left vertebral artery, basilar artery, and bilateral posterior cerebral arteries. Alport syndrome is a type IV collagenopathy most known for causing kidney disease. It may also be associated with vascular fragility as type IV collagen forms a significant component of the vascular basement membrane. There are reports of aortic, coronary, and cervical dissections, but few reports of intracranial dissections in patients with Alport syndrome. While iatrogenic dissection cannot be ruled out, the histological findings in this case are most consistent with spontaneous arterial dissection as the cause of her initial neurologic presentation. This highlights the need for further investigation into the relationship between Alport syndrome and vascular fragility and should alert clinicians to the possibility of intracranial dissection in patients with AS.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"410-414"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232156","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

Neuro-Sweet Syndrome: A Diagnostic Conundrum. 神经甜味综合征：诊断难题。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-10 DOI: 10.1177/19418744231174949

Karlos Acurio, Miguel Chuquilin

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Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice. 住院患者神经系统死亡和出院到临终关怀中心的相关因素。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-10 DOI: 10.1177/19418744231174577

Shefali Dujari, Janet Wei, Lironn Kraler, Tarini Goyal, Eric Bernier, Neil Schwartz, Karen Hirsch, Carl A Gold

{"title":"Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice.","authors":"Shefali Dujari, Janet Wei, Lironn Kraler, Tarini Goyal, Eric Bernier, Neil Schwartz, Karen Hirsch, Carl A Gold","doi":"10.1177/19418744231174577","DOIUrl":"10.1177/19418744231174577","url":null,"abstract":"Background and purpose: The Neurology Mortality Review Committee at our institution identified variability in location of death for patients on our inpatient neurology services. Hospice may increase the number of patients dying in their preferred locations. This study aimed to characterize patients who die on inpatient neurology services and explore barriers to discharge to hospice.Methods: This retrospective study was completed at a single, quaternary care medical center that is a Level I Trauma Center and Comprehensive Stroke Center. Patients discharged by an inpatient neurology service between 6/2019-1/2021 were identified and electronic medical record review was performed on patients who died in the hospital and who were discharged to hospice.Results: 69 inpatient deaths and 74 discharges to hospice occurred during the study period. Of the 69 deaths, 54 occurred following withdrawal of life sustaining treatment (WLST), of which 14 had a referral to hospice placed. There were 88 \"hospice-referred\" patients and 40 \"hospice-eligible\" patients. Hospice-referred patients were less likely to require the intensive care unit than hospice-eligible patients. Hospice-referred patients had their code status changed to Do Not Intubate earlier and were more likely to have advanced directives available.Conclusion: Our data highlight opportunities for further research to improve discharge to hospice including interhospital transfers, advanced directives, earlier goals of care discussions, palliative care consultations, and increased hospice bed availability. Importantly, it highlights the limitations of using in-hospital mortality as a quality indicator in this patient population.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"337-344"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244490","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

Perplexing Initial Presentations of MOGAD in Two Children: Intracranial Hypertension and New-Onset Seizure. 两个儿童MOGAD的初始表现令人困惑:颅内高压和新发癫痫。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-07-25 DOI: 10.1177/19418744231192159

Daniel J Zhou, Andria M Powers, Caleb A Cave, Emily K Dickas, Mary C Rickard, Geetanjali Rathore, Rhonda R Wright, Rana K Zabad, Sookyong Koh

{"title":"Perplexing Initial Presentations of MOGAD in Two Children: Intracranial Hypertension and New-Onset Seizure.","authors":"Daniel J Zhou, Andria M Powers, Caleb A Cave, Emily K Dickas, Mary C Rickard, Geetanjali Rathore, Rhonda R Wright, Rana K Zabad, Sookyong Koh","doi":"10.1177/19418744231192159","DOIUrl":"10.1177/19418744231192159","url":null,"abstract":"We report two distinct challenging initial presentations of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Case 1 describes a 12-year-old boy who developed headaches refractory to pain medication followed by cranial neuropathies and intracranial hypertension, confirmed by lumbar puncture with an opening pressure >36 cm H2O. Case 2 describes a 3-year-old boy who developed new-onset seizures refractory to antiseizure medications, a presentation of FLAIR-hyperintense lesions in MOG-antibody associated encephalitis with seizures (FLAMES). On repeat magnetic resonance imaging, both patients were found to have cortical T2 hyperintensities, leptomeningeal contrast enhancement, and bilateral optic nerve enhancement. In the cerebrospinal fluid, both patients had CSF pleocytosis with neutrophilic predominance. The patients were treated with intravenous immunoglobulins, plasma exchange, and high-dose corticosteroids. The first patient achieved disease remission, whereas the second patient required the addition of rituximab for management of seizures. The two cases highlight the pleomorphic clinical phenotypes of MOGAD.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"438-444"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239194","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

Subacute Sclerosing Panencephalitis in a 63-Year-Old Woman Presenting as Generalized Choreoathetosis. 63岁女性的亚急性硬化性全脑炎，表现为全身性舞蹈病。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-19 DOI: 10.1177/19418744231177105

Ritwick Mondal, Shramana Deb, Manoj Mahata, Somesh Saha, Durjoy Lahiri, Julián Benito-León

引用次数: 0

Subacute Brachial Plexopathy due to Intraneural Epithelioid Hemangioma: A Case Report. 神经上皮样血管瘤引起的亚急性臂丛病：一例报告。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-08 DOI: 10.1177/19418744231174688

Vihang Nakhate, Robert P McInnis, Albert Sy, Marcelo Matiello

{"title":"Subacute Brachial Plexopathy due to Intraneural Epithelioid Hemangioma: A Case Report.","authors":"Vihang Nakhate, Robert P McInnis, Albert Sy, Marcelo Matiello","doi":"10.1177/19418744231174688","DOIUrl":"10.1177/19418744231174688","url":null,"abstract":"Brachial plexopathy is a common consideration in the differential diagnosis of upper extremity sensory and motor deficits, and neoplasms signify one possible etiology of brachial plexopathy. Of the neoplastic brachial plexopathies, hemangiomas involving the brachial plexus are rare. Most reported cases describe extraneural brachial plexus hemangiomas that present as a palpable, tender neck mass associated with pain and sensory disturbance, with minimal motor deficits. Here we share the case of a 48 year-old man with intraneural epithelioid hemangioma of the brachial plexus who presented with prominent motor weakness and no palpable mass. The patient presented with subacute onset of left arm pain, numbness and progressive weakness. Neurologic exam revealed lower motor neuron signs and weakness spanning multiple nerve root and peripheral nerve distributions. Dedicated brachial plexus MRI showed two mass lesions involving the cords of the brachial plexus, with corresponding FDG-avidity on PET/CT. Biopsy revealed intraneural atypical epithelioid hemangioma. After nerve transfer surgery, he had moderate improvement in left arm strength. This case serves to: emphasize the importance of both clinical localization and dedicated brachial plexus imaging in the evaluation of brachial plexopathy; introduce to the literature a new clinical presentation of brachial plexus hemangiomas; encourage consideration of neoplastic brachial plexopathy even when faced with an illness script resembling Parsonage-Turner Syndrome, to avoid delays in diagnosis and treatment.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"399-402"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239193","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

Intravascular Lymphoma as a Cause of Recurrent Strokes - Case Report and Review of the Literature. 血管内淋巴瘤是卒中复发的一个原因——病例报告及文献回顾。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-06-12 DOI: 10.1177/19418744231183483

Charlie Weige Zhao, Tracey H Fan, Thomas Denize, Alba Coraini, Andrew Kraft, Anusha M Kumar, Lucy G Gao, Mayra E Lorenzo, Lyn M Duncan, Erica C Camargo Faye, David J Lin

{"title":"Intravascular Lymphoma as a Cause of Recurrent Strokes - Case Report and Review of the Literature.","authors":"Charlie Weige Zhao, Tracey H Fan, Thomas Denize, Alba Coraini, Andrew Kraft, Anusha M Kumar, Lucy G Gao, Mayra E Lorenzo, Lyn M Duncan, Erica C Camargo Faye, David J Lin","doi":"10.1177/19418744231183483","DOIUrl":"10.1177/19418744231183483","url":null,"abstract":"Background: Intravascular lymphoma is an uncommon cause of ischemic strokes. Because of its rarity and atypical pattern, most diagnoses are made post-mortem.Case study: We present a case of a 68-year-old male with multiple cardiovascular risk factors and recent SARS-CoV-2 infection who presented with recurrent strokes. Because of his stroke risk factors, he was initially managed with a sequentially escalating antithrombotic regimen. A malignant process was low on the differential at this point given his lack of systemic symptoms. When he continued to have new strokes despite these measures, including a spinal cord infarct, a broad workup was sent including for hypercoagulable states, vasculitis, and intravascular lymphoma. Eventually, a skin biopsy of a cherry angioma returned positive for lymphoma cells. He was treated with methotrexate followed by chemotherapy and rituximab. Unfortunately, he did not improve and was made comfort measures only by his family.Conclusion: This case illustrates the importance of considering intravascular lymphoma as a potential etiology of recurrent strokes, as early diagnosis and treatment are important for preventing irreversible neurological damage.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"419-424"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232153","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

Post COVID mRNA-Vaccine Associated Cerebral Ischemia: Comment. COVID - 19 mrna疫苗相关脑缺血:评论

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-15 DOI: 10.1177/19418744231176178

Amnuay Kleebayoon, Viroj Wiwanitkit

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Postpartum Sciatic Neuropathy After Uncomplicated Vaginal Delivery. 无并发症阴道分娩后的产后坐骨神经病变。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-07-10 DOI: 10.1177/19418744231180939

Nader Boutros, Dina Saba, Bhavesh Trikamji

{"title":"Postpartum Sciatic Neuropathy After Uncomplicated Vaginal Delivery.","authors":"Nader Boutros, Dina Saba, Bhavesh Trikamji","doi":"10.1177/19418744231180939","DOIUrl":"10.1177/19418744231180939","url":null,"abstract":"Postpartum neuropathies are common, including femoral neuropathy, peroneal neuropathy, lumbosacral trunk plexopathy, and lateral femoral cutaneous neuropathy. Sciatic mononeuropathy in the peripartum period is rare. Postpartum sciatic neuropathy (PSN) in the setting of cesarean section has been reported before. We present a case series of 2 sciatic mononeuropathies after vaginal delivery. Case 1 is a 25-year-old woman who presented with a left foot drop after normal vaginal delivery after being in labor for 3 hours. Case 2 is a 24-year-old woman who presented with a right foot drop after normal vaginal delivery and being in labor for 31 hours. Both cases noted foot drops in the immediate postpartum period. Neurologic examinations revealed flail foot, 4/5 hamstring muscle strength on MRC scale and intact hip abduction. They had paresthesia on the posterolateral aspect of the leg, dorsal and plantar aspect of the foot with absent ankle reflex. MRI did not show evidence of spinal cord, nerve root or plexus involvement. Electrodiagnostic studies revealed evidence of sciatic mononeuropathy proximal to the short head of biceps femoris. They were discharged home with an ankle brace and therapy. At 3 months follow up, they had complete resolution of weakness. There have been a few reported cases of PSN secondary to cesarean section. Sciatic involvement after vaginal delivery is extremely rare. We report 2 cases of PSN after vaginal delivery to highlight that sciatic mononeuropathy can occur not only after cesarean section, but also after uncomplicated vaginal delivery and should raise awareness of this risk to clinicians.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"429-433"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232157","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