Case Reports in Neurological Medicine最新文献

{"title":"Radial Nerve Palsy as an Iatrogenic Complication of Shoulder Replacement Surgery With Significant Bone Loss of the Humerus Resembling Gorham-Stout Disease: Case Report and Review of the Literature.","authors":"Lisa B E Shields, Vasudeva G Iyer, Yi Ping Zhang, Christopher B Shields","doi":"10.1155/crnm/9969463","DOIUrl":"10.1155/crnm/9969463","url":null,"abstract":"<p><p>Gorham-Stout disease (GSD), also known as vanishing bone disease or massive osteolysis, is a rare entity characterized by destruction of the osseous matrix and proliferation of vascular structures resulting in bone resorption. While neurological complications such as cerebrospinal rhinorrhea secondary to cranial involvement and paraplegia from spinal involvement have been reported, peripheral nerve complications are not known. We describe a case of radial nerve palsy that was an iatrogenic complication of shoulder replacement surgery with bone loss of the humerus resembling GSD. A 71-year-old male with a history of left total shoulder arthroplasty followed by a revision reverse total shoulder arthroplasty noted a \"bone protruding\" and pain in the left upper arm 12 years later. X-rays showed that the proximal portion of the humerus was not detectable. CT scan of the left upper extremity revealed loosening of the humeral component with prominent osteolysis most pronounced around the distal stem. The patient underwent a revision of the reverse total shoulder arthroplasty with replacement of the humeral head and shaft. He experienced numbness, pain, and weakness of the left shoulder and arm with wrist drop postoperatively. Physical exam revealed marked weakness of the dorsiflexors of the wrist and digits, wasting and weakness of the brachioradialis muscle, and loss of pinprick sensation of the superficial radial nerve distribution. Needle EMG showed denervation changes in the extensor digitorum communis, brachioradialis, and extensor carpi radialis longus muscles. An ultrasound (US) study showed enlargement of the left radial nerve at the spiral groove. The EDX and US findings suggested a left radial nerve palsy at the spiral groove. There were minimal EMG abnormalities in the deltoid and triceps muscles suggesting additional involvement of the posterior cord of the brachial plexus. This case illustrates the potential for iatrogenic radial nerve palsy following shoulder replacement surgery with significant bone loss of the humerus resembling GSD.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"9969463"},"PeriodicalIF":0.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504917","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":"Hemichorea Associated With Nigrostriatal Dysfunction: Case Report of a Patient With an Ipsilateral Infarct in the Lenticular Nucleus and Internal Capsule.","authors":"Makoto Kobayashi","doi":"10.1155/crnm/6054686","DOIUrl":"10.1155/crnm/6054686","url":null,"abstract":"<p><p>Hemichorea is a rare manifestation of ischemic stroke whose lesion is typically located in the contralateral basal ganglia. Its pathomechanism has not been elucidated completely; however, it may be related to nigrostriatal dysfunction. In patients with hemichorea, dopamine transporter-single photon emission computed tomography (DAT-SPECT) reportedly displayed decreased tracer accumulation in the contralateral striatum. Moreover, in exceptional cases, responsible lesions were located in the ipsilateral cerebral hemisphere. This case report describes an 84-year-old man who presented with three weeks of intermittent, involuntary, and twisting movements in his right limbs. On physical examination, the patient had right-sided hemichorea without other neurological deficits. The choreic movements were more frequent in the lower limb than in the upper and provoked when he tried to take a certain posture or engaged in mental arithmetic. Magnetic resonance imaging performed on suspicion of stroke detected a right hemispheric subacute infarct in the posterior part of the lenticular nucleus and posterior limb of the internal capsule. Furthermore, DAT-SPECT revealed decreased tracer accumulation in the right striatum. He was administered oral antiplatelet medication after being diagnosed with lacunar infarction. The choreic movements gradually reduced over the next 8 months and eventually disappeared. The lesion in the lenticular nucleus and internal capsule was considered to have induced ipsilesional hemichorea, considering the temporal proximity between the hemichorea and ischemic stroke. Although DAT-SPECT findings in patients with ipsilesional hemichorea have not been reported, this case suggests that nigrostriatal dopamine dysfunction can contribute to the pathogenesis of ipsilesional hemichorea.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"6054686"},"PeriodicalIF":0.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483260","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":"Posterior Reversible Encephalopathy Syndrome Induced by Mirtazapine Overdose: A Case Report.","authors":"Min-Chiao Tsai, Wei-Hao Lin","doi":"10.1155/crnm/4690032","DOIUrl":"10.1155/crnm/4690032","url":null,"abstract":"<p><p><b>Introduction:</b> Posterior reversible encephalopathy syndrome (PRES) is a neurological emergency typically associated with hypertension or drug toxicity. Although mirtazapine is not a classical serotonergic agent, overdose may induce serotonin syndrome, which can contribute to PRES. <b>Case Presentation:</b> A 50-year-old woman presented with seizures, impaired consciousness, and autonomic instability following ingestion of > 300 mg mirtazapine. Magnetic resonance image (MRI) revealed vasogenic edema in the parieto-occipital and frontal lobes. Her clinical features fulfilled the Hunter criteria for serotonin syndrome. Treatment with cyproheptadine led to full clinical and radiological recovery. <b>Discussion:</b> Serotonin syndrome may disrupt cerebral autoregulation and impair endothelial integrity, contributing to PRES. Although rare, similar cases have been reported with other serotonergic agents. This is the first reported case of mirtazapine overdose resulting in serotonin syndrome-associated PRES. <b>Conclusion:</b> Clinicians should recognize that mirtazapine overdose can cause serotonin syndrome and secondary PRES. Early identification and serotonin antagonism are crucial for recovery and prevention of sequelae.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"4690032"},"PeriodicalIF":0.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301179","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":"Pudendal Nerve Irritation as Unique Symptom of Pelvic Congestion Syndrome.","authors":"Christos Dimopoulos, Sotirios Bisdas, Theodosios Bisdas","doi":"10.1155/crnm/7952359","DOIUrl":"10.1155/crnm/7952359","url":null,"abstract":"<p><p>Pelvic congestion syndrome (PCS) is an underdiagnosed but not rare cause of chronic pelvic pain, affecting approximately 10%-30% of women of reproductive age. It is characterized by venous insufficiency and dilation of the ovarian and pelvic veins, often presenting with symptoms that worsen during menstruation or prolonged standing, and improve in the supine position. Dyspareunia and a sensation of pelvic heaviness are also frequently reported. Neurological manifestations-such as pudendal or femoral nerve irritation-are rare but may offer key diagnostic clues. We present a case of a 30-year-old woman with right-sided pelvic pain radiating to the groin and proximal thigh, consistent with neural irritation. Magnetic neurography revealed dilated pelvic veins in close proximity to the right psoas muscle and the L5 nerve root, suggesting perineural venous engorgement. Selective venography confirmed bilateral ovarian vein insufficiency, and the patient underwent successful embolization with Ruby coils and adjunct sclerotherapy. Postoperative recovery was uneventful, with complete resolution of symptoms. Follow-up at 1 year showed no recurrence, and the patient later achieved a successful pregnancy. This case highlights the potential for pelvic venous congestion to mimic or cause neural symptoms and emphasizes the diagnostic value of magnetic neurography in complex pain presentations. Endovascular treatment proved safe and effective, even in cases with neurological involvement.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"7952359"},"PeriodicalIF":0.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265323","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":"Anti-NMDAR Encephalitis With Serial Negative MRI Findings: An Evaluation Using Autoimmune Psychosis Criteria.","authors":"Satoshi Saito, Go Taniguchi, Chihiro Nakata, Hideo Kato, Mao Otake, Masahiro Umeda, Yuichiro Fuji, Eiji Nakagawa","doi":"10.1155/crnm/4561447","DOIUrl":"10.1155/crnm/4561447","url":null,"abstract":"<p><p>Autoimmune psychosis criteria have been proposed for autoimmune encephalitis with prominent psychiatric symptoms as an alternative to biomarker-based diagnostic approaches such as the Graus criteria. We present a case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis that was initially misdiagnosed as a psychiatric disorder due to serial negative MRI findings and subsequently re-evaluated correctly using autoimmune psychosis criteria. A 15-year-old male developed sudden-onset generalized convulsive seizures that increased progressively in frequency and fluctuating psychiatric symptoms that gradually worsened to include reduced reactivity, language deterioration, and catatonia. On admission, both brain MRI and cerebral spinal fluid (CSF) findings were unremarkable; however, autoimmune encephalitis was strongly suspected based on autoimmune psychosis criteria and subsequently confirmed by detection of oligoclonal bands (OCBs) and anti-NMDAR antibodies in the serum and CSF. Repeated steroid pulse therapy resulted in significant clinical improvement. The patient met multiple autoimmune psychosis criteria, including subacute onset of psychiatric symptoms, catatonia, disproportionate cognitive dysfunction, decreased level of consciousness, and the emergence of seizures. These features are not typically present in primary psychiatric disorders. Anti-NMDAR encephalitis can present with a variety of symptoms, complicating its differentiation from primary psychiatric conditions. The application of autoimmune psychosis criteria may serve as a valuable diagnostic aid, particularly when MRI findings are repeatedly negative.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"4561447"},"PeriodicalIF":0.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265322","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":"\"Sentinel Oculomotor Nerve Palsy\": A Harbinger of Subarachnoid Hemorrhage.","authors":"Vijay Renga","doi":"10.1155/crnm/6786272","DOIUrl":"10.1155/crnm/6786272","url":null,"abstract":"<p><p>Subarachnoid hemorrhage (SAH) is a life-threatening condition most commonly caused by aneurysmal rupture. Sentinel headaches, often described as the \"worst headache of life\" or a \"thunderclap headache,\" are critical warning signs that may precede SAH. However, atypical headaches can complicate early diagnosis. Oculomotor nerve palsy, though rare, may occur as a complication of both aneurysmal and nonaneurysmal SAH. We report a unique case of a 64-year-old woman who initially presented with atypical headache followed by isolated oculomotor nerve palsy, preceding the onset of a nonaneurysmal SAH. This case highlights isolated oculomotor palsy as a potential unrecognized sentinel sign of SAH.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"6786272"},"PeriodicalIF":0.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109502","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":"Cerebellar Hemorrhage Masquerading as Unilateral Vestibulopathy: A Case Report.","authors":"Thomas Zeyen, Thomas Klockgether, Christina Schaub, Daniel Paech, Timo Vogt, Delia Kurzwelly","doi":"10.1155/crnm/9611619","DOIUrl":"https://doi.org/10.1155/crnm/9611619","url":null,"abstract":"<p><p>Pseudovestibular syndrome refers to central pathologies that mimic acute unilateral peripheral vestibulopathy, often posing a diagnostic challenge, particularly when key symptoms indicating a central origin are absent. The most common etiology is brain ischemia resulting from posterior inferior cerebellar artery occlusion. This article presents a rare case of a left paramedian cerebellar hemorrhage initially misdiagnosed as right-sided vestibular neuritis. Cerebellar hemorrhage can induce pseudovestibular syndrome by disrupting the connective fibers from the flocculus to the ipsilateral vestibular nucleus in the pons. Additionally, central pathologies affecting the vestibular system may occasionally manifest a pathological vestibulo-ocular reflex. This case report underscores the importance of considering potentially severe central-origin conditions in the differential diagnosis of seemingly benign unilateral peripheral vestibulopathy.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"9611619"},"PeriodicalIF":0.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076234","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":"Chronic Inflammatory Demyelinating Polyneuropathy Following Natural Influenza A Infection in a Pediatric Patient: A Case Report and Literature Review.","authors":"Emily Grew, Garrett Gianneschi, Janet Elgallab","doi":"10.1155/crnm/8840308","DOIUrl":"10.1155/crnm/8840308","url":null,"abstract":"<p><p>Chronic inflammatory demyelinating polyneuropathy (CIDP) following viral infections and influenza vaccination has been well documented. However, there have been no confirmed natural influenza A infections leading to development of CIDP. Therefore, we present the case of a 6-year-old male who developed CIDP following a confirmed influenza A infection. Initially presenting with typical flu-like symptoms, the patient experienced a gradual onset of gait instability and leg weakness approximately 1 month later. Despite initial improvement with intravenous immunoglobulin therapy following a diagnosis of Guillain-Barré syndrome, his symptoms relapsed, including lower extremity weakness, incontinence, and sensory loss. Electromyography confirmed a demyelinating polyneuropathy, leading to a diagnosis of CIDP.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"8840308"},"PeriodicalIF":0.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977577","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":"Atypical Presentation of Susac Syndrome in 55-Year-Old: From Unremarkable Stroke Workup to Rapid Diagnosis of \"Snowball Strokes\" and Successful Immunosuppressive Treatment.","authors":"Yasaman Pirahanchi","doi":"10.1155/crnm/3178952","DOIUrl":"https://doi.org/10.1155/crnm/3178952","url":null,"abstract":"<p><p>We report the case of a 55-year-old right-handed female with a medical history of hypothyroidism and gastric bypass surgery. The patient initially presented with cognitive impairment, dizziness, and unsteady gait. Despite an unremarkable stroke workup, her symptoms progressed rapidly within 2 days, leading to subsequent admissions and a complex diagnostic journey revealing Susac syndrome-a rare autoimmune disorder affecting the brain's microvasculature, retina, and cochlea. The patient's treatment involved aggressive immunosuppression with corticosteroids, IVIG, mycophenolate, and cyclophosphamide. The patient responded well and had progressive improvement, with discharge to home. This case highlights the diagnostic challenges and management strategies for Susac syndrome.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"3178952"},"PeriodicalIF":0.9,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977574","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":"Exploring Central Venous Thrombosis as a Rare Postinfectious Complication of Dengue: A Case Report.","authors":"Linda Angela Mbah, Parvinder Kaur, Dakshin Meenashi Sundaram, Shubh Mehta, Zenia Elavia, Seyi Olaniyi, Jubran Al Balushi, Jeffrin John Varghese, Archit Kumar Nigam, Mansi Singh","doi":"10.1155/crnm/5368634","DOIUrl":"10.1155/crnm/5368634","url":null,"abstract":"<p><p>Dengue fever, caused by a flavivirus transmitted through Aedes mosquitoes, presents a spectrum of clinical manifestations ranging from mild to severe. Several neurological complications, including encephalopathy and encephalitis, have been increasingly recognized. Here, we report a case of central venous thrombosis (CVT) as a postinfectious complication of dengue fever. A 38-year-old previously healthy male presented with classic dengue symptoms and later developed persistent headaches and visual disturbances. Neurological examination revealed papilledema, and imaging confirmed CVT involving the superior straight sinus. Prompt initiation of anticoagulant therapy led to gradual improvement in neurological symptoms and partial recanalization of the thrombosed sinus. Our case underscores the importance of considering thrombotic complications in dengue infections, despite the predominance of hemorrhagic manifestations. Understanding pathophysiology and appropriate management of thrombotic events in dengue fever is crucial for favorable patient outcomes.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2025 ","pages":"5368634"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11978471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810531","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}