Acta neurologica Taiwanica最新文献

{"title":"Successful Nonsurgical Treatment of Unruptured Basilar Artery Dissecting Aneurysm Complicated by Ischemic Stroke: A Case Report and Literature Review.","authors":"Yuan-Zhen Ruan, Yu-Kai Lin, Jiunn-Tay Lee, Chung-Hsing Chou, Fu-Chi Yang","doi":"10.4103/ANT.ANT_113_0049","DOIUrl":"https://doi.org/10.4103/ANT.ANT_113_0049","url":null,"abstract":"<p><p>The purpose of this case report is to describe the clinical presentation and successful management of an isolated basilar artery dissecting aneurysms (BADAs), highlighting the challenges in decision-making and the outcomes of nonsurgical treatment. A 60-year-old man presented with vertigo, vomiting, slurred speech, and hearing loss on one side. Imaging revealed a BADA with a mural thrombus, compressing the brainstem. His condition quickly worsened, resulting in left-sided hemiplegia, dysphagia, and ataxia. Despite anticoagulant treatment, follow-up imaging showed new strokes. Surgical intervention in BADAs carries high risks, including morbidity and mortality. For unruptured aneurysms causing brainstem compression, endovascular treatment is often preferred. Aspirin is recommended for patients with cerebral ischemia, while patients without ischemia or hemorrhage are generally monitored without antithrombotic therapy. The timing of intervention for asymptomatic cervical artery dissection aneurysms remains unclear, and treatment decisions should be made on a case-by-case basis. In this case, the patient received nonsurgical treatment, which successfully controlled the infarction without aneurysm rupture or hemorrhage. However, individualized treatment decisions remain essential.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"235-238"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859530","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}

{"title":"Physiotherapy Rehabilitation Strategies as an Adjunct to Hyperbaric Oxygen Therapy in a Patient with Diving-related Spinal Cord Decompression Sickness: A Case Report.","authors":"Beliz Belgen Kaygisiz, Ferda Selcuk, Fahriye Çoban, Tarık Izbul","doi":"10.4103/ANT.ANT_112_0091","DOIUrl":"https://doi.org/10.4103/ANT.ANT_112_0091","url":null,"abstract":"<p><p>\"Decompression Sickness\" (DCS) is a rare neurologic condition that is generally seen in divers which sometimes lead to decreased physical and functional capacity. The purpose of our study is to investigate the effects of a high-intensity physiotherapy rehabilitation program on the physical capacity and functional level of a patient diagnosed with DCS who had residual physical impairments. A 65-year-old male with acute incomplete T4 spinal cord injury was diagnosed with DCS when he got on the boat after 35 min of diving. He experienced acute-onset paresthesia and upon moving his lower extremities, he noted bilateral leg weakness and difficulty in standing up and walking. The physiotherapy and rehabilitation program in addition to hyperbaric oxygen therapy started on the 1st day of hospitalization and continued six times per week during the first 3 months and four times per week for the next 3 months. The motor and sensory level of the patient was evaluated by the American Spinal Injury Association. Functional independence level, static and dynamic balance ability were recorded with functional ındependence measurement and functional reach test, respectively. Clinically important improvements have been observed in the patient's muscle strength, sensation, balance ability, and ambulation parameters. Treatment of DCS should be supported by a physiotherapy rehabilitation program when there are residual physical impairments to increase functionality and prevent permanent disability. Different rehabilitation strategies must be further examined.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"224-231"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859457","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}

{"title":"The Characteristics of Imaging Patterns on Whole-body Magnetic Resonance Imaging of Anti-signal Recognition Particle Antibody-positive Immune-mediated Necrotizing Myopathy.","authors":"Ya-Yuan Hou, Wei-Chin Huang, Chi-Ren Huang, Shun-Sheng Chen, Nai-Wen Tsai, Shu-Fang Chen","doi":"10.4103/ANT.ANT_113_0054","DOIUrl":"https://doi.org/10.4103/ANT.ANT_113_0054","url":null,"abstract":"<p><strong>Background: </strong>Immune-mediated necrotizing myopathy (IMNM) is a rapidly progressive subtype of inflammatory myositis that can be managed with early immunotherapy. Anti-signal recognition particle (anti-SRP)-positive IMNM is frequently associated with severe muscle weakness and respiratory complications, while whole-body muscle MRI involvement remains insufficiently characterized.</p><p><strong>Objectives: </strong>The aim of this study was to identify the characteristics of muscle magnetic resonance imaging (MRI) of patients with immune-mediated necrotizing myopathy (IMNM) with anti-signal recognition particle (SRP) antibody and to further evaluate the correlation between these MRI features and clinical presentation.</p><p><strong>Materials and methods: </strong>We identified 16 patients with anti-SRP myopathy, the diagnosis of IMNM was confirmed by muscle biopsy, and the whole-body MRI was performed in all 16 patients. Clinical information and laboratory data were collected. The severity of the short-T1 inversion recovery (STIR) sequences was classified into three grades (0, 0.5, and 1) according to the pattern and intensity of individual muscle involvement. Serial muscle group grading was performed using Friedman's test, and the correlation between MRI STIR pattern and clinical data was calculated using Spearman's rank correlation coefficient.</p><p><strong>Results: </strong>The 16 patients included 9 women and 7 men, with an average age of 43.4. The mean time-to-onset was 5.5 months. Whole-body muscle MRI STIR sequencing revealed muscle edema in all tested patients. Marked edema was noted in the pelvis, bilateral shoulders, posterior compartment of the arm, and concentric muscles of the shoulder and pelvis (all P < 0.001). Correlation analysis indicated that higher muscle STIR signaling was correlated with higher values of erythrocyte sedimentation rate, SRP antibody titer, and compound motor action potential (CMAP) reduction. In addition, we observed lower values of C-reactive protein, forced vital capacity (FVC), ejection fraction, clinical pretreatment with steroids (premedication steroids), and Medical Research Council scores in specific muscles. Reduced FVC was further found to correlate with edema in the muscles of the cervical spine, shoulder, anterior forearm, and pelvis, leading to reduced respiratory function.</p><p><strong>Conclusions: </strong>Whole-body MRI in anti-SRP patients revealed a characteristic edema pattern with an affinity for specific muscles of the shoulders and pelvis with a radial distribution, with edema severity corresponding to clinical severity, particularly respiratory function. Pretreatment with steroids reduced edema, indicating the efficacy of this treatment.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"216-223"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859567","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}

{"title":"Evaluation of Intravenous Thrombolytic Therapy on Acute Ischemic Stroke Outcome: A Single-center Observation Prospective Cohort Study.","authors":"Athena Sharifi-Razavi, Zahra Sedaghat, Narges Karimi","doi":"10.4103/ANT.ANT_110_0027","DOIUrl":"10.4103/ANT.ANT_110_0027","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis (IVT) is a standard treatment for acute ischemic stroke (AIS). We started IVT about 4 years ago (since 2017) in our center.</p><p><strong>Objectives: </strong>The aim of the thrombolysis outcome in ischemic stroke study was to confirm whether the efficacy and safety of IVT recognized in published studies could be reproduced in routine clinical practice in Iran.</p><p><strong>Materials and methods: </strong>This study was a prospective observational cohort study on consecutive patients diagnosed with AIS, who received IVT from January 2017 to March 2019 (ClinicalTrials registration: NCT04309357). The primary outcome was the rate of functional independence at 3 months, defined as the Barthel Index (BI) 85-100. Binary outcomes included independence compared with disability or death. The secondary outcome was the rate of fatal and symptomatic intracerebral hemorrhage.</p><p><strong>Results: </strong>Out of 214 patients registered in this study, 59.34% were male and the median (interquartile range) age of patients was 69 (61-78) years. Pretreatment median scores of the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale were 3 and 10, respectively. At discharge time, 40.65% of patients achieved good outcomes. Follow-up within 3 months, 43.45% achieved BI 85-100, and 44.72% had an mRS score 0-2. The rate of all types of intracranial hemorrhages was 19.6%, of which 9.3% were symptomatic. In addition, the mortality rate during the 3 months was 17.28%.</p><p><strong>Conclusions: </strong>In our study, the efficacy of IVT was reasonable compared to international data. However, to increase efficiency, poststroke rehabilitation programs need to be organized and promoted.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"210-215"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859473","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}

{"title":"Fatal Recurrent Cardioembolic Stroke Related to Thyroid Storm: A Case Report.","authors":"Chu-Fang Cheng, Chih-Yang Liu, Shinn-Kuang Lin","doi":"10.4103/ant.ANT-D-24-00012","DOIUrl":"https://doi.org/10.4103/ant.ANT-D-24-00012","url":null,"abstract":"<p><p>Thyroid storm is a rare and life-threatening condition that develops in thyrotoxic patients with multiple systems involved. A 50-year-old woman with a history of hyperthyroidism and paroxysmal atrial fibrillation (AF) without regular treatment presented with acute left limb weakness and slurred speech. Electrocardiography indicated AF with a rapid ventricular rate of 165 beats per minute. Chest radiography revealed cardiomegaly with bilateral pleural effusion. The patient received thrombolytic therapy at 78 min after symptom onset. Brain computed tomography angiography revealed normal results. Laboratory tests revealed elevated free thyroxine, triiodothyronine, antithyroid-stimulating hormone (TSH) receptor antibody, and reduced TSH content. We immediately initiated intravenous digoxin, oral propranolol, and propylthiouracil. Echocardiography revealed global left ventricular hypokinesia. Recurrent fatal large infarction involving the bilateral hemispheres resulted in coma with quadriplegia on day 3. Thyroid storm should be diagnosed with early as possible. Simultaneous treatment of ischemic stroke and thyroid storm is challenging.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"251-257"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859528","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}

{"title":"Unraveling the Link between Sleep Disturbances and Parkinson's Disease: A Narrative Review.","authors":"Omar Cardenas-Saenz, Fátima Gabriela Macias-Ortiz, Naomi Nazareth Becerra-Aguiar, Susana María de Los Angeles Sainz-Del Real, Patricia Orozco-Puga, Azyadeh Camacho-Ordoñez, Mayela de Jesus Rodriguez-Violante","doi":"10.4103/ant.ANT-D-25-00003","DOIUrl":"https://doi.org/10.4103/ant.ANT-D-25-00003","url":null,"abstract":"<p><p>Parkinson's disease (PD) is characterized by both motor and nonmotor symptoms, many of which originate from the pathophysiology of the disease and its progression. Nonmotor symptoms are diverse and can often be more debilitating for patients than motor symptoms. Among these, sleep disorders are particularly significant, as they can occur several years before the onset of motor symptoms and have profound implications for the patient's quality of life (QoL). Sleep problems typically manifest at all stages of the disease and are frequently regarded as a separate entity. This analysis aims to explore and summarize knowledge of the main sleep disorders associated with PD, their characteristics, prevalence, and treatment options. A comprehensive literature review was conducted, examining studies published on sleep disturbances in PD, focusing on the epidemiology, etiology, pathophysiology, implications, diagnosis, and treatment. Findings indicate that sleep disorders are prevalent in over 90% of patients with PD and often manifest years before the onset of motor symptoms. Specific disorders such as rapid eye movement sleep behavior disorder (RBD), insomnia, and excessive daytime sleepiness are highlighted as significant contributors to reduced QoL. The literature also emphasizes the complex interplay of factors, including dopaminergic treatments and disease progression, which exacerbate these disturbances. Sleep disorders are critical nonmotor symptoms of PD that significantly affect QoL. Early identification and tailored management of these symptoms are essential for improving patient outcomes. Further research is needed to develop effective treatment strategies that address the multifaceted nature of sleep disturbances in this population.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"196-209"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859538","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}

{"title":"Fulminant Idiopathic Intracranial Hypertension: An Unusual Case of Polycythemia Vera.","authors":"Amandeep Singh, Avantika Dogra, Piyush Mehta","doi":"10.4103/ant.ANT-D-24-00005","DOIUrl":"10.4103/ant.ANT-D-24-00005","url":null,"abstract":"<p><p>A 42-year-old female patient presented with complaints of headache and painless progressive vision loss for 3 weeks. She was evaluated and found to have grade 5 papilledema, and her blood investigations revealed polycythemia vera (PV) with a positive Janus Kinase 2 (JAK2) mutation, and cerebrospinal fluid manometry study showed a markedly raised opening pressure of 270 mm Hg. The magnetic resonance imaging brain with venogram showed normal study and patent sinuses. The patient was managed with drugs such as hydroxyurea, antiplatelet drugs, and phlebotomy. The most notable feature of this intriguing case is PV manifesting as idiopathic intracranial hypertension and vision loss despite normal patent sinuses, which is explainable by hypercoagulability causing sluggish flow in venous sinuses and raised pressure over the optic nerves, resulting in papilledema and vision loss.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"245-247"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859492","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}

{"title":"Benefits and Drawbacks of Teleneurosurgery in Low- and Middle-Income Countries: A Scoping Review.","authors":"Minahil Iman Janjua, Shanza Abbasi, Amna Idrees, Eesha Yaqoob, Nicola Montemurro, Bipin Chaurasia, Saad Javed","doi":"10.4103/ant.ANT-D-24-00041","DOIUrl":"10.4103/ant.ANT-D-24-00041","url":null,"abstract":"<p><p>Telemedicine is an emerging medical technology that allows us to bridge the gap between remote healthcare access and resource provision. Low- to middle-income countries (LMICs), which would benefit greatly from this emerging technology, also face hurdles in its implementation. This scoping review aims to map the existing literature and evidence on the challenges and limitations of adopting teleneurosurgery. This is important for establishing policies to facilitate wider implementation of teleneurosurgery and telemedicine across Pakistan. This review was conducted following the methodology framework outlined by Arksey and O'Malley. Studies were searched using PubMed and Google Scholar, where search domains included telemedicine, telehealth, teleneurosurgery, and LMICs. A manual search of the reference list of selected studies was conducted, and studies were finalized after expert consultation. Challenges in the implementation of teleneurosurgery were analyzed. Quantitative, qualitative, and critical analysis of the included studies was completed. Results were reported according to the already existing scoping review guidelines (PRISMA-ScR). Telemedicine, particularly in neurosurgery, emerges as a sign of a prospect poised to offer transformative solutions to global healthcare delivery. It relies heavily on robust technological infrastructure, with high-speed Internet connectivity serving as its backbone. Yet, inadequate bandwidth and connectivity issues stand as the prime hurdles, impacting surgical precision, and hindering patient safety. Owing to all the challenges, teleneurosurgery is open to diverse opportunities for improvement. Regular training programs, collaborative efforts with healthcare providers, and addressing technological issues can enhance the effects of teleneurosurgery in patient care.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"189-195"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859155","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}

{"title":"Neuronal Intranuclear Inclusion Disease Mimicking Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Case Report.","authors":"Shih-Chieh Chen, Yi-Hao Chen, Shih-Yu Fang, Hsiang-Ting Hsu, Fu-Pang Chang, Kang-Yang Jih, Yi-Chu Liao, Yi-Chung Lee, Kuan-Lin Lai","doi":"10.4103/ANT.ANT_113_0050","DOIUrl":"https://doi.org/10.4103/ANT.ANT_113_0050","url":null,"abstract":"<p><p>Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory neuropathy, characterized by a slowly progressive onset and symmetrical, sensorimotor involvement. Several diseases, nevertheless, may present similar features as CIDP. It is of paramount importance to recognize these mimics to yield an optimal therapeutic effect. Neuronal intranuclear inclusion disease (NIID) is a rare, progressive neurodegenerative disorder known for its diverse clinical manifestations. Since it may present as sporadic as well as inherited manner and may only involve the peripheral nerve system, it might resemble the clinical course of CIDP. Here, we report the case of a 61-year-old male who presented with subacute onset progressive paresthesia and weakness in lower extremities associated with gait disturbance. Nerve conduction studies demonstrated the features of demyelinating polyneuropathy with predominantly motor involvement. Under the impression of CIDP, immunomodulating therapy was given but with limited clinical response, prompting our consideration of seeking other diseases. Guided by characteristic magnetic resonance image findings during the second round survey, a diagnosis of NIID was confirmed by tissue and molecular pathologies. This is the first report in Taiwan to describe a patient with NIID who initially presented with clinical, electrophysiological, and laboratory features of CIDP, yet later confirmed to be NIID by tissue and molecular proof. Clinicians need to be aware of the possibility of NIID when diagnosing CIPD, especially if atypical presentation such as multi-system involvement or poor therapeutic responsiveness is present.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"239-244"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859495","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}

{"title":"A Case of Anti-MuSK Antibody-positive Myasthenia Gravis Presenting as Limb-Girdle Muscle Atrophy.","authors":"Hemanga Kumar Dhing, Masaraf Hussain, Prabal Nath","doi":"10.4103/ANT.ANT_113_0051","DOIUrl":"10.4103/ANT.ANT_113_0051","url":null,"abstract":"<p><p>To diagnose a case anti-MuSK myasthenia gravis (anti-MuSK MG) is always a challenge in view of a distinct clinical phenotype that differs from typical MG (anti-acetylcholine receptors (antibody positive). We herein report a case of anti-MuSK MG, whose history and clinical phenotype differ from typical MG and are more suggestive of myopathy or anterior horn cell disease. Therefore, testing anti-MuSK antibody is very important if there is suspicion of anti-MuSK MG.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"34 4","pages":"232-234"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859163","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}