Neurohospitalist最新文献

{"title":"Recurrent Stroke and Peripheral Neuropathy Associated With Multifactorial Hyperhomocysteinemia: A Case Report.","authors":"Alexis Robin, Adèle Meola, Mélanie Munio, Cédric Gollion, Vincent Fabry","doi":"10.1177/19418744251379634","DOIUrl":"10.1177/19418744251379634","url":null,"abstract":"<p><p><b>Background:</b> Hyperhomocysteinemia is a known risk factor for stroke and neuropathy, though their coexistence is rare. <b>Case Description:</b> A 43-year-old male with chronic myeloid leukemia developed progressive neuropathy and later suffered an ischemic stroke. Investigations revealed severe hyperhomocysteinemia and vitamin B12 deficiency, likely due to chronic nitrous oxide use, folate supplementation without cobalamin, and malnutrition. Despite B12 supplementation, recurrent strokes led to the identification of a homozygous MTHFR 677C>T mutation. <b>Conclusions:</b> This case underscores the essential need to consider all contributing factors and conduct a comprehensive etiological workup, avoiding a narrow focus on obvious causes.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"204-207"},"PeriodicalIF":0.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087757","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":"Aseptic Meningitis Following Rozanolixizumab in a Patient With Refractory Anti-MuSK Positive Myasthenia Gravis: A Case Report.","authors":"Hamza Maqsood, James Fleming","doi":"10.1177/19418744251378584","DOIUrl":"10.1177/19418744251378584","url":null,"abstract":"<p><p>Rozanolixizumab is a neonatal Fc receptor (FcRn) blocker recently approved for treating generalized myasthenia gravis (gMG), particularly in patients who are anti-AChR or anti-MuSK antibody positive. Although clinical trials have demonstrated a favorable safety profile, rare adverse neurological effects remain underreported. A 36-year-old woman with refractory anti-MuSK-positive generalized myasthenia gravis received an infusion of rozanolixizumab after failing to respond to corticosteroids and azathioprine. 5 days post-infusion, she presented with an acute-onset headache, nausea, vomiting, photophobia, phonophobia, and neck stiffness. Cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 150 cells/μL with 90% neutrophils, normal protein, and glucose levels. The infectious meningitis and encephalitis panel was negative. She was managed supportively, and her symptoms resolved over the following week without antimicrobial therapy. This case suggests a possible link between Rozanolixizumab and aseptic meningitis. Clinicians should be aware of this potential adverse effect and consider drug-induced etiologies in similar clinical scenarios. Early recognition may prevent unnecessary treatment and hospitalizations.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"297-299"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066066","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 Novel Radiographic and Genetic Variant of Adult-Onset Leukoencephalopathy With Axonal Spheroids and Pigmented Glia: Case Report.","authors":"Ariadne A Nichol, Angeline B Ngo, Meshari Alharthi, Kari Hird, Mallory Owen, Sophia Raefsky, Jennifer H Yang","doi":"10.1177/19418744251377118","DOIUrl":"10.1177/19418744251377118","url":null,"abstract":"<p><strong>Background: </strong>The differential for acute onset progressive leukoencephalopathy in adults is broad. Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia is a rare genetic white matter disorder with typical onset around 40 years. Variability in clinical presentation can often lead to misdiagnosis with other neurodegenerative disorders, underscoring the importance of taking a detailed medical history, obtaining comprehensive diagnostic evaluations, and considering timely genetic testing.</p><p><strong>Case presentation: </strong>A 53-year-old woman with a medical history of systemic lupus erythematosus and marginal zone B-cell lymphoma in remission presented with subacute onset fatigue, confusion, and slurred speech following SARS-CoV2 infection. Diagnostic testing was unremarkable except for elevated CSF interleukin-6, tumor necrosis factor, and myelin basic protein levels. The patient was diagnosed with presumed post-infectious encephalitis. Over the next 2 months, the patient's clinical syndrome progressed to include bradykinesia, hypophonia, dysphagia and resting tremor. Pathology and genetic testing revealed a rare diagnosis of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP).</p><p><strong>Conclusions: </strong>This case illustrates a stepwise process for constructing a comprehensive differential diagnosis for acute onset of progressive leukoencephalopathy and a general management strategy. We also report a novel radiographic finding and genetic variant in the <i>CSF1R</i> gene associated with ALSP.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"197-203"},"PeriodicalIF":0.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041758","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":"Who Obtains Informed Consent for Endovascular Thrombectomy in Acute Stroke? A Survey of Clinicians.","authors":"Amir A Mbonde, Ali A Alsarah, Bart M Demaerschalk, Adam A Dmytriw, Quentin J Moyer, Joshua A Hirsch, Aneesh B Singhal, Thabele M Leslie-Mazwi, Natalia S Rost, Aman B Patel, Michael J Young, Robert W Regenhardt","doi":"10.1177/19418744251377576","DOIUrl":"10.1177/19418744251377576","url":null,"abstract":"<p><strong>Background and purpose: </strong>Informed consent (IC) practices for endovascular thrombectomy (EVT) in acute stroke are not well elucidated. We investigated the roles and specialties of those obtaining EVT IC, aiming to provide insights for enhancing the process.</p><p><strong>Methods: </strong>We conducted a survey from July- December 2023 among acute stroke care clinicians. Utilizing Qualtrics, we disseminated a questionnaire through various national and international online platforms. This analysis summarizes the characteristics of individuals who obtain IC at respondents' institution.</p><p><strong>Results: </strong>Among 168 respondents, 71% were staff physicians, 70% practiced in the US and 70% worked at academic centers. Neurology (77%) was the most common specialty obtaining EVT IC, followed by neurosurgery (41%), radiology (30%) and emergency medicine (EM) (10%). Staff physicians were the most frequently involved (61%), followed by fellows (43%), residents (48%) and advanced practice providers (APPs) (36%). Comparatvely, non-US institutions were more likely to utilize neurologists alone (50% vs 31%, <i>P</i> = 0.016) and staff physicians (76% vs 54%, <i>P</i> = 0.008), while US institutions more often utilized neurosurgeons (51% vs 18%, <i>P</i> < 0.001), APPs (43% vs 18%, <i>P</i> = 0.002) and residents (56% vs 28%, <i>P</i> = 0.001). Non-academic institutions used EM (25% vs 5%, <i>P</i> < 0.001) and APPs (50% vs 31%, <i>P</i> = 0.031), while academic institutions commonly utilized neurosurgeons (48% vs 18%, <i>P</i> = 0.001), residents (59% vs 13%, <i>P</i> < 0.001) and fellows (52% vs 18%, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Neurologists and staff physicians are the primary providers obtaining EVT IC, with variations based on region and institution type. Future efforts to optimize the IC process should integrate various specialties and be widely adaptable.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"43-49"},"PeriodicalIF":0.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024338","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":"Cardiac Arrest: A Rare Complication of Intrathecal Baclofen Withdrawal.","authors":"Singh Karminder, Arora Niraj, Nattanmai Chandershekran Prem, Merchant Rameez","doi":"10.1177/19418744251370410","DOIUrl":"10.1177/19418744251370410","url":null,"abstract":"<p><p>Baclofen, a GABA agonist, is used for the management of spasticity. Intrathecal route is indicated in cases of severe spasticity associated with spinal cord injury. Baclofen withdrawal symptoms can happen after IT pump removal which can present as anxiety, paranoia, psychosis, seizures, hallucinations, severe spasticity and dyskinesia. Cardiac arrest after baclofen withdrawal is rare with only 2 cases in literature so far however in both cases IT-pump was replaced. We present a case of PEA arrest after baclofen IT-pump removal which was managed without replacing. 33 year-old male with history of paraplegia from cervical spinal cord injury (C-6) level, chronic spasticity, fibular osteomyelitis and chronic sacral ulcers presented with wound dehiscence and exposed baclofen pump which was replaced 4 weeks ago due to the end of the pump's life. After 24-48 h of removal of the baclofen pump, cardiovascular instability in the form of supra ventricular tachycardia with hypotension and altered mentation was noted. It evolved to progressive clinical worsening with stiffness of body, loss of responsiveness, and up-rolling of eyes. Patient underwent PEA, and ROSC after 3 rounds of CPR. He was subsequently intubated, mechanically ventilated and sedated with midazolam intravenously. Baclofen and clonazepam were started through the feeding tube. Over a period of 10 days, midazolam was weaned, and baseline clinical stability was achieved without IT-baclofen pump. Though rare, cardiac arrest can happen after baclofen withdrawal. High index of clinical suspicion is advised for long term baclofen pump patients after pump explant to prevent withdrawal symptoms and complications.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"181-184"},"PeriodicalIF":0.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973756","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":"Myelitis in a Young Patient With Testing Supportive for Both Angiostrongylus and Schistosoma Infection.","authors":"Kristen Murray, Noriko Salamon, Doojin Kim, Michael G Ho","doi":"10.1177/19418744251370935","DOIUrl":"10.1177/19418744251370935","url":null,"abstract":"<p><p>Schistosoma and Angiostrongylus are both parasites which can cause central nervous system manifestations in humans. These parasites live in several overlapping geographic areas as well as share several clinical features. Diagnosis and treatment can be difficult given these infections are rare, have non-specific symptoms, and have definitive testing that takes days to weeks to result. We present a case of myelitis secondary to Angiostrongylus cantonensis infection with false-positive Schistosoma serologies complicating the diagnostic process in which the patient had an excellent clinical response to treatment with steroids and antiparasitic agents.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"116-121"},"PeriodicalIF":0.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973802","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 Optic Neuritis Presenting in Late Pregnancy.","authors":"Kelsey M Donovan, Marielle Mahan, Narmien Murdock, Martin P Kolsky, Benjamin Osborne","doi":"10.1177/19418744251367172","DOIUrl":"10.1177/19418744251367172","url":null,"abstract":"<p><p>Myelin oligodendrocyte glycoprotein (MOG) antibody-associated optic neuritis is a demyelinating disease that shares clinical overlap with Neuromyelitis Optica Spectrum Disorder (NMOSD) and Multiple Sclerosis (MS). The immunosuppressive effects of pregnancy followed by a rebound in the immune system postpartum are thought to affect presentation and relapse rates of NMOSD and MS. Few studies exist describing pregnancy affecting MOG antibody-associated disease. In this case, a 29-year-old female from Ethiopia presented on postpartum day 8 with 4 weeks of progressive, painful bilateral vision loss that had acutely worsened over the past 6 days. Her visual acuity was light perception in the right eye and hand motion in the left eye with a right afferent pupillary defect. Dilated exam revealed bilateral optic nerve head elevation, vascular tortuosity, and macular folds. MRI of the brain and orbits with contrast revealed long segment bilateral optic nerve enhancement and nonspecific white matter changes. Serum MOG IgG was positive (1:160). Her vision rapidly improved with intravenous methylprednisolone 1000 mg daily for 5 days, followed by an oral prednisone taper. After 6 months, the patient's vision returned to 20/20 in each eye, and she has had no further clinical relapse. This case suggests that initial presentation of MOG optic neuritis may be affected by pregnancy. Physicians must appropriately triage patients with postpartum vision changes to ensure prompt treatment.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"111-115"},"PeriodicalIF":0.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822779","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":"Isolated Pancerebellar Syndrome With anti-GQ1b IgG Positivity: A Case Report.","authors":"Iyas Daghlas, Liza Solovey, Vanja C Douglas","doi":"10.1177/19418744251367176","DOIUrl":"10.1177/19418744251367176","url":null,"abstract":"<p><strong>Background: </strong>Ataxia is a hallmark of the anti-GQ1b antibody syndrome, though it is unclear whether this symptom arises primarily from sensory nerve injury or from cerebellar involvement. We report a case of a patient with a clinically isolated post-infectious pancerebellar syndrome with anti-GQ1b antibody positivity.</p><p><strong>Case presentation: </strong>A 22-year-old previously healthy woman presented with acute-onset, progressive imbalance, limb ataxia, and dysarthria following an upper respiratory tract infection. She had no paresthesias, numbness, or diplopia. Neurological examination revealed an isolated pancerebellar syndrome including ocular and limb dysmetria, intention tremor, and gait ataxia. All sensory modalities were unaffected, reflex testing was normal, and there was no ophthalmoplegia. In-hospital serum and CSF testing was unremarkable, and brain magnetic resonance imaging was normal. The patient was empirically treated with intravenous immunoglobulin. Her symptoms were moderately improved by discharge (hospital day 5), and fully resolved several months later. Serological testing sent during the hospitalization subsequently revealed anti-GQ1b IgG positivity.</p><p><strong>Conclusions: </strong>This case expands the spectrum of anti-GQ1b syndrome to include isolated cerebellar ataxia, suggesting that ataxia in this syndrome can have cerebellar origin. Clinicians should consider anti-GQ1b testing in cases of acute cerebellar ataxia following infection.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"107-110"},"PeriodicalIF":0.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817868","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":"Reversible Diffusion-Restricting White Matter Lesions in Sickle Cell Disease During Pain Crises: A Case Report.","authors":"Sangharsha Thapa, Meyer Herzog, Esewi Aifuwa, Joseph Quintas, Amir Steinberg, Sana Ali, Tomoko Kitago","doi":"10.1177/19418744251367181","DOIUrl":"10.1177/19418744251367181","url":null,"abstract":"<p><p>Sickle cell disease (SCD) is a chronic hemoglobinopathy characterized by recurrent vaso-occlusive events and significant neurological morbidity. While ischemic and hemorrhagic strokes are well-known complications, reversible diffusion-restricting white matter lesions are exceedingly rare and underreported. We present the case of an 18-year-old male with homozygous SCD (HbSS) who developed acute neurological deterioration during a vaso-occlusive pain crisis. MRI revealed symmetric areas of restricted diffusion and FLAIR hyperintensities in the splenium of the corpus callosum and periventricular white matter, typically associated with cytotoxic edema and irreversible injury. Remarkably, the patient experienced near-complete neurological recovery with aggressive disease-targeted therapy, including hydroxyurea, voxelotor, and serial exchange transfusions. Follow-up MRI at 4 months showed complete resolution of the prior abnormalities. This case underscores the importance of recognizing potentially reversible diffusion-restricting lesions in SCD and challenges the conventional interpretation of restricted diffusion as a marker of permanent injury. Early recognition, comprehensive management, and serial neuroimaging may improve neurological outcomes in similar cases. Clinicians should maintain a high index of suspicion for reversible white matter injury when evaluating patients with sickle cell disease presenting with acute neurological symptoms. Incorporating serial neuroimaging and a multidisciplinary treatment approach is essential for timely diagnosis and optimizing neurological recovery in this vulnerable population.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"103-106"},"PeriodicalIF":0.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800522","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 56-year-Old Woman With Initial Severe Electrolyte Imbalance Who Developed Altered Mental Status, Psychosis and Catatonia.","authors":"Mariana Peschard-Franco, Enrique Piña-Rosales, Anwar García-Santos","doi":"10.1177/19418744251364125","DOIUrl":"10.1177/19418744251364125","url":null,"abstract":"<p><p>Patients with acute psychiatric and cognitive symptoms can be challenging to evaluate, particularly in the context of renal or metabolic alterations. A 56-year-old woman initially presented with abdominal pain and vomiting, with no findings on physical examination. A severe chronic hypovolemic hypotonic hyponatremia was acknowledged in the lab work, leading to admission for sodium replacement and electrolyte imbalance correction. Two weeks later the patient developed altered mental status, agitation, psychosis and catatonia. This case highlights the diagnostic approach to patients with encephalopathy. Readers are guided through this stepwise approach, considering a wide range of differential diagnosis, including metabolic, infectious, autoimmune and paraneoplastic etiologies, with an extensive workup, ultimately arriving at the leading diagnosis.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"70-74"},"PeriodicalIF":0.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776513","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}