The Neurohospitalist最新文献

A Case of Ischemic Pituitary Apoplexy Secondary to ACTH-Secreting Macroadenoma 继发于促肾上腺皮质激素分泌性大腺瘤的缺血性脑垂体瘫痪病例

The Neurohospitalist Pub Date : 2024-06-04 DOI: 10.1177/19418744241258684

Luca Clerici, Pietro Lucotti, Francesco Lombardi, Giannantonio Spena, E. Lovati, A. Di Sabatino, C. Zoia

{"title":"A Case of Ischemic Pituitary Apoplexy Secondary to ACTH-Secreting Macroadenoma","authors":"Luca Clerici, Pietro Lucotti, Francesco Lombardi, Giannantonio Spena, E. Lovati, A. Di Sabatino, C. Zoia","doi":"10.1177/19418744241258684","DOIUrl":"https://doi.org/10.1177/19418744241258684","url":null,"abstract":"Background: Pituitary apoplexy (PA) represents a rare but extremely serious complication of pituitary adenoma. It is characterized by the rapid onset of headache, nausea and vomiting, changes in vision, paralysis of the oculomotor nerves and alteration of the sensory. Due to the rarity of this complication and the non-specificity of symptoms, the patient’s clinical presentation may not be interpreted correctly, leading to a diagnostic delay and a worsening of prognosis. Case Description: This case report relates to a 73-year-old man with ACTH-secreting macroadenoma infiltrating the cavernous sinuses bilaterally and causing the rapid onset of headache, bilateral eyelid ptosis, complete bilaterally ophthalmoplegia and bitemporal hemianopia. The patient underwent urgent surgery to remove the lesion by transsphenoidal route and subsequent monitoring of pituitary function by endocrinologist specialist obtaining a near-total recovery from illness. Conclusions: PA is often characterized by the appearance of unilateral ocular or neurological deficits, while a clinical presentation given by ophthalmoplegia and bilateral ptosis is a very rare condition, difficult to find in the literature. Therefore, similar symptoms should not be underestimated and should raise the diagnostic suspicion of PA. In this case, in fact, a prompt treatment and multidisciplinary management of the patient allowed to markedly improve the prognosis. Furthermore, the instrumental findings supported a picture of ischemic pituitary apoplexy without signs of haemorrhage, a condition reported only sporadically in the literature.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Kratom Neurotoxicity: T1 Hyperintensity in the Basal Ganglia Kratom 神经毒性：基底节的 T1 高强度

The Neurohospitalist Pub Date : 2024-05-24 DOI: 10.1177/19418744241257724

Yoji Hoshina, Jory Z. Liang

引用次数: 0

Dual Toxidrome of Anti-cholinergic Storm and Neuroleptic Malignant Syndrome: A Therapeutic Challenge Overcome by Intrathecal Neostigmine 抗胆碱能风暴和神经性恶性综合征的双重毒性：鞘内新斯的明克服的治疗难题

The Neurohospitalist Pub Date : 2024-05-24 DOI: 10.1177/19418744241254580

Nikhil Vojjala, Srikant Kashinath Malegaonkar, Kajal Arora, I. Sehgal, A. K. Pannu

引用次数: 0

Rates of Acute Brain Injury Among Severely Hypertensive Patients Seen in the Emergency Department 急诊科就诊的严重高血压患者中的急性脑损伤发生率

The Neurohospitalist Pub Date : 2024-05-23 DOI: 10.1177/19418744241257032

Amgad Ishak, H. Kamel, Jed H Kaiser, Vanessa Liao, Jenny Rotblat, Anokhi Pawar, R. Lappin, Junaid Razzak, Halina White, Catherine Ng, A. Liberman

{"title":"Rates of Acute Brain Injury Among Severely Hypertensive Patients Seen in the Emergency Department","authors":"Amgad Ishak, H. Kamel, Jed H Kaiser, Vanessa Liao, Jenny Rotblat, Anokhi Pawar, R. Lappin, Junaid Razzak, Halina White, Catherine Ng, A. Liberman","doi":"10.1177/19418744241257032","DOIUrl":"https://doi.org/10.1177/19418744241257032","url":null,"abstract":"Identifying patients with acute brain injury among patients who present to the Emergency Department (ED) with severe hypertension can be challenging. We explored rates of brain injury in a cohort of ED patients with severe hypertension in whom acute target-organ damage was or was not initially suspected. We conducted a retrospective chart-review study at two different hospitals within the same urban health system. Consecutive adult patients seen from 10/1/2020 to 5/1/2022 with a systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥120 mmHg were included. A total of 972 patients met our eligibility criteria. The average age was 59 years (SD: 16.5), 454 (46.7%) were women, and 582 (59.9%) were non-White. A total of 186/972 (19.1%) patients were initially thought to have acute target-organ damage in the ED with 97/186 (52.2%) diagnosed with stroke or TIA. The remaining 786/972 (80.9%) patients were not initially diagnosed with target-organ damage (hypertensive urgency [HU]). Of the 786 patients with HU, a head CT was obtained in 216/786 (27.7%) and brain MRI in 74/786 (9.4%). Of the HU patients with a brain MRI, 23/74 (31.1%) had acute abnormalities; most abnormalities on brain MRI (17/23 [73.9%]) were not seen on preceding head CT. In a multicenter study of ED patients, nearly 1 in 5 patients though to have HU who eventually underwent brain MRI had unexpected acute neurological findings, though brain MR was obtained in only 9%.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"47 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141103457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Isolated Left Foot Paralysis Secondary to Diffuse Axonal Injury: A Unique Case 继发于弥漫性轴突损伤的孤立性左足瘫痪：一个独特的病例

The Neurohospitalist Pub Date : 2024-05-16 DOI: 10.1177/19418744241255719

Linda Sherine Alfred, Jenson Ma, Andrew Wilner

引用次数: 0

The Impact of Changing Antithrombotic Management in Patients With Atrial Fibrillation and Ischemic Cerebrovascular Events Despite Anticoagulation 改变抗血栓治疗方法对心房颤动和抗凝治疗后仍发生缺血性脑血管事件患者的影响

The Neurohospitalist Pub Date : 2024-05-15 DOI: 10.1177/19418744241254897

Ehab Harahsheh, Omer Elshaigi, Nour Alhayek, Skye A. Buckner, Jaxon K. Quillen, Cumara B. O’Carroll, Oana M. Dumitrascu

{"title":"The Impact of Changing Antithrombotic Management in Patients With Atrial Fibrillation and Ischemic Cerebrovascular Events Despite Anticoagulation","authors":"Ehab Harahsheh, Omer Elshaigi, Nour Alhayek, Skye A. Buckner, Jaxon K. Quillen, Cumara B. O’Carroll, Oana M. Dumitrascu","doi":"10.1177/19418744241254897","DOIUrl":"https://doi.org/10.1177/19418744241254897","url":null,"abstract":"Patients with atrial fibrillation (AF) are at increased risk of ischemic cerebrovascular events despite anticoagulants (AC). We aim to evaluate whether changing AC or adding antiplatelet therapy to anticoagulants (AP + AC) in patients with AF presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite AC, decreases the risk of recurrent AIS/TIA compared to patients continued on same AC regimen. Patients with AF on AC presenting with AIS or TIA at our center between 2011- 2021 were included. Data on Demographics, index event, antithrombotic therapy before and after index event, recurrent AIS/TIA, or major bleeding events (MBE) were extracted. Cox proportional hazards models were used to compare outcomes between AC unchange vs AC change, and AP + AC vs AC only groups. One hundred eighty-five patients were included (mean age 78.3 years; 62% males, median follow-up 9 months (IQR 1-34)). Seventeen patients (9%) had AC change, 100 (54%) received AP + AC, 39 (21%) had recurrent AIS/TIA, and 27 (15%) had MBE following index event. No difference was observed between AC unchange vs AC change and AP + AC vs AC only groups regarding recurrent AIS/TIA (HR 1.72 [.65-4.57], P = .27 and HR 1.02 [.53- 1.98], P = .95, respectively) or MBE (HR .85 [.19-3.67], P = .83 and HR 1.49 [.67-3.33)], P = .33, respectively). Fourteen vascular neurologists treated this cohort and 9(64%) implemented AC changes. In this single center retrospective study of 185 patients with AF and AIS/TIA despite AC, changing AC or adding AP agents did not decrease the risk of ischemic cerebrovascular events.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"58 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140974945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characteristics and Outcomes of 7620 Multiple Sclerosis Patients Admitted With COVID-19 in the United States 美国 7620 例 COVID-19 多发性硬化症患者的特征和治疗结果

The Neurohospitalist Pub Date : 2024-01-27 DOI: 10.1177/19418744241230728

K. Ramphul, S. Sombans, R. Verma, P. Lohana, B. Dhillon, Stephanie Gonzalez Mejias, S. Sanikommu, Y. Ramphul, P. K. Pekyi-Boateng

{"title":"Characteristics and Outcomes of 7620 Multiple Sclerosis Patients Admitted With COVID-19 in the United States","authors":"K. Ramphul, S. Sombans, R. Verma, P. Lohana, B. Dhillon, Stephanie Gonzalez Mejias, S. Sanikommu, Y. Ramphul, P. K. Pekyi-Boateng","doi":"10.1177/19418744241230728","DOIUrl":"https://doi.org/10.1177/19418744241230728","url":null,"abstract":"At the start of the COVID-19 pandemic, several experts raised concerns about its impact on Multiple Sclerosis (MS) patients. This study aims to provide a perspective using the biggest inpatient database from the United States. We screened for COVID-19 cases between April to December 2020, via the 2020 National Inpatient Sample (NIS). Various outcomes were analyzed. We identified 1,628,110 hospitalizations with COVID-19, including 7620 (.5%) MS patients. 8.9% of MS patients with COVID-19 died, and it was lower than non-MS cases (12.9%). Less MS patients with COVID-19 needed non-invasive ventilation (4.5% vs 6.4%) and mechanical ventilation (9.0% vs 11.2%). Furthermore, MS patients with COVID-19 reported higher odds of non-invasive ventilation if they were ≥60 years, had chronic pulmonary disease (CPD), obesity, or diabetes. Private insurance beneficiaries showed reduced risk, vs Medicare. Similarly, for mechanical ventilation, those ≥60 years, with alcohol abuse, obesity, diabetes, hypertension, or dialysis had higher odds, while females, smokers, and those with depression or hyperlipidemia showed reduced odds. The study revealed higher odds of mortality among those aged ≥60, who had CPD, obesity, CKD, or a history of old MI while females, smokers, as well as those with depression, and hyperlipidemia showed better outcomes. Blacks had lower odds, whereas Hispanics had higher odds of death, vs Whites. Medicaid and Privately insured patients had lower odds of dying vs Medicare. We found several differences in patient characteristics and outcomes among MS and non-MS patients with COVID-19.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139592537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dual Antiplatelet Non-Responder: Resistance to Clopidogrel and Ticagrelor 双重抗血小板非应答者：对氯吡格雷和替卡格雷耐药

The Neurohospitalist Pub Date : 2024-01-17 DOI: 10.1177/19418744241228630

A. L. Kuhn, Jasmeet Singh, Ajit S. Puri

{"title":"Dual Antiplatelet Non-Responder: Resistance to Clopidogrel and Ticagrelor","authors":"A. L. Kuhn, Jasmeet Singh, Ajit S. Puri","doi":"10.1177/19418744241228630","DOIUrl":"https://doi.org/10.1177/19418744241228630","url":null,"abstract":"Dual antiplatelet therapy is often required for neurointerventional procedures, especially when a stent or flow diverter is placed in the cervical and intracranial vessels. Patients are usually started on aspirin and clopidogrel given the simplicity of the once daily regimen with reasonable cost. Unfortunately, about a third of patients do not show the desired antiplatelet response to clopidogrel and another agent needs to be introduced. Ticagrelor is a potent antiplatelet medication that has a favorable pharmacological profile and has emerged as a reliable alternative to clopidogrel in recent years. Despite ticagrelor non-responders being rare, they do exist, and identification of these patients is important. A 74-year-old female was incidentally found to harbor a right posterior communicating aneurysm which was successfully treated electively with stent-assisted coiling. Platelet inhibition testing revealed non-responsiveness to Clopidogrel. Ticagrelor was initiated but the patient’s platelet reactivity unit remained in the normal range. Management algorithms to maximize a patient’s ticagrelor response by facilitating enteral absorption were applied but no platelet inhibition was achieved. The patient was eventually identified as a true ticagrelor non-responder. Resistance to antiplatelet medication can result in devastating complications with permanent neurological deficits. Ticagrelor non-responders are rare but do exist. Platelet inhibition testing should be part of the preprocedural workup for neurointerventions.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":" July","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An Overview of Saint Louis Encephalitis 圣路易斯脑炎概述

The Neurohospitalist Pub Date : 2024-01-16 DOI: 10.1177/19418744241228006

Rumyar Ardakani, Lakshmi Chauhan, Amanda L. Piquet, Kenneth L. Tyler, Daniel M. Pastula

引用次数: 0

Perception of In-Person Prerounding Amongst Neurology Residents Across Two Academic Centers 两个学术中心的神经病学住院医师对亲自预习的看法

The Neurohospitalist Pub Date : 2024-01-12 DOI: 10.1177/19418744241228353

Amalie Chen, Sashank Prasad, Michael Bowley, Edward Krupat, Kristin Galetta

{"title":"Perception of In-Person Prerounding Amongst Neurology Residents Across Two Academic Centers","authors":"Amalie Chen, Sashank Prasad, Michael Bowley, Edward Krupat, Kristin Galetta","doi":"10.1177/19418744241228353","DOIUrl":"https://doi.org/10.1177/19418744241228353","url":null,"abstract":"In-person prerounding has long been a routine practice for residents in the field of neurology. However, with the emergence of the COVID-19 pandemic, many institutions, including our two academic neurology centers, have shifted to computer rounding. This study aims to assess the effects of computer rounding alone compared to a combination of computer rounding and in-person prerounding from the perspective of neurology residents. A mixed-methods approach was employed, including a survey administered to 79 neurology residents and a qualitative thematic analysis of their responses. The quantitative analysis revealed that residents who engaged in inperson prerounding spent significantly more time on prerounding and computer rounding compared to those who did not. The majority of residents reported a neutral effect of in-person prerounding on their relationship with patients and bedside time, but a significant impact on personal lives and other tasks. Qualitative analysis identified four key themes: accessibility to team members, learning opportunities gained and lost, inefficiency, and sleep disturbance. Overall, residents perceived in-person prerounding as inefficient and causing sleep disruption for both patients and themselves. While some residents valued the face-to-face interaction and improved accessibility, others felt that computer rounding allowed for thorough review of patient data, improving preparedness and efficiency. The potential elimination of in-person prerounding from residents' routines may enhance their overall wellbeing. Further research is needed to assess the advantages and drawbacks of removing this classic approach to caring for patients from the perspective of residents, attendings and patients.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139624605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0