Case Reports in Neurological Medicine最新文献

{"title":"Pontine Hemorrhage Mimicking Bell's Palsy: Isolated Facial Nerve Palsy-A Case Report.","authors":"Rei Takeichi, Nobukazu Miyamoto, Haruka Takeshige-Amano, Wataru Sako, Nobutaka Hattori","doi":"10.1155/crnm/2754979","DOIUrl":"10.1155/crnm/2754979","url":null,"abstract":"<p><p>Bell's palsy, the most common cause of idiopathic peripheral facial palsy, is typically attributed to viral reactivation; however, rare cases due to cerebrovascular disease must always be considered in the differential diagnosis. We report the case of a 75-year-old man with poorly controlled hypertension, diabetes mellitus, and a history of smoking who presented with progressive left-sided facial paralysis over four days. Initially suspected to have Bell's palsy due to the lower motor neuron pattern and gradual onset, further neuroimaging revealed a different etiology. T2^∗-weighted MRI showed a low-signal area in the left pons, and a noncontrast CT confirmed a small hemorrhage. This atypical presentation, characterized by a gradual onset and absence of additional neurological symptoms, was attributed to focal compression of the facial nerve by the hematoma. The patient was treated conservatively with hemostatic agents, bed rest, and rehabilitation, leading to symptomatic improvement. His symptoms began to improve by the fourth day of hospitalization, and follow-up imaging showed no hematoma expansion, with signs of absorption by Day 7. He was discharged after 15 days. This case highlights the diagnostic challenge in distinguishing Bell's palsy from facial peripheral paralysis secondary to brainstem cerebrovascular events, particularly in patients with vascular risk factors. It underscores the importance of a \"selective imaging strategy,\" emphasizing that neuroimaging should be strongly considered in atypical or progressive cases, even when classic signs of a stroke are absent.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"2754979"},"PeriodicalIF":0.7,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307114","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 14-Year-Old Male With Susac Syndrome: A Case Report.","authors":"M-Jaber Kojak, Mouhammed Sleiay, Bilal Sleiay, Abdulrahman Dokhan, Ghassan Hamzeh, Hasan Alsmoudi, Bara'a Merie Alghadi","doi":"10.1155/crnm/9280625","DOIUrl":"10.1155/crnm/9280625","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Susac syndrome (SuS) is a rare autoimmune microangiopathy involving the brain, retina, and inner ear. It is uncommon in children, and early diagnosis is essential to prevent irreversible deficits.</p><p><strong>Case presentation: </strong>A 14-year-old boy presented with decreased consciousness following 18 days of excessive sleepiness, vomiting, blurred vision, and unsteady gait. There was no family history of autoimmune diseases. MRI showed \"snowball-like\" corpus callosum lesions suggestive of SuS. Cerebrospinal fluid (CSF) revealed lymphocytic pleocytosis and elevated protein. He improved partially with intravenous methylprednisolone but later developed status epilepticus, requiring plasma exchange. During steroid taper, he experienced relapses with visual and gait disturbances. Fluorescein angiography (FA) confirmed branch retinal artery occlusions (BRAOs). Immunosuppressive therapy with azathioprine and rituximab was initiated, achieving disease stability.</p><p><strong>Clinical discussion: </strong>MRI findings of corpus callosum \"snowball\" lesions are a key clue for early diagnosis. Multimodal management-including corticosteroids, plasma exchange, and long-term immunosuppression-is essential to control relapses and prevent permanent sequelae. The patient's fluctuating course underscores the need for ongoing monitoring.</p><p><strong>Conclusion: </strong>The identification of snowball lesions in the corpus callosum, in conjunction with a \"string of pearls\" appearance in the internal capsule, mandates prompt immunotherapeutic intervention. Rituximab is currently regarded as the preferred agent, given that azathioprine has demonstrated limited efficacy in moderating disease activity.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"9280625"},"PeriodicalIF":0.7,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293558","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-Ma2 Antibody-Associated Paraneoplastic Cerebellar Degeneration Mimicking the Cerebellar Ataxic Subtype of Hashimoto's Encephalopathy: A Case Report.","authors":"Masato Okitsu, Shintaro Nojiri, Tomoya Kawazoe, Akihito Hao, Kazushi Takahashi","doi":"10.1155/crnm/1445118","DOIUrl":"10.1155/crnm/1445118","url":null,"abstract":"<p><p>Autoimmune cerebellar ataxia (ACA) is an immune-mediated cerebellar disorder arising from various underlying conditions. Because ACA is potentially treatable, identifying associated neuronal antibodies is important for diagnosis. We report the case of a 55-year-old woman with subacute progressive ataxia who presented with dysarthria and impaired handwriting and gait. Her scale for the assessment and rating of ataxia (SARA) score was 20.5, with particularly high subscores for gait and stance. She had a history of Hashimoto's thyroiditis. Laboratory testing showed markedly elevated antithyroid antibody levels with normal thyroid function, initially suggesting the cerebellar ataxic subtype of Hashimoto's encephalopathy (HE). Cerebral blood flow single-photon emission computed tomography revealed cerebellar hypoperfusion, which was most prominent in the superior cerebellar vermis. Intravenous methylprednisolone (1000 mg/day for 3 days) was administered; however, her response was poor. Further evaluation revealed positivity for anti-Ma2 antibodies, leading to a diagnosis of anti-Ma2-associated ACA. Subsequent intravenous immunoglobulin therapy improved the clinical symptoms and imaging findings, and the follow-up SARA score decreased to 10. Comprehensive imaging revealed no underlying malignancy. This case is unique not only because both rare diseases were key considerations in the differential diagnosis, but also because it is instructive in two respects: the construct of HE remains insufficiently specific and should not preclude consideration of alternative immune-mediated etiologies, and patients positive for anti-Ma2 antibody require sustained oncological surveillance, even in the absence of malignancy at presentation.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"1445118"},"PeriodicalIF":0.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249283","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":"Insights Into Subacute Combined Degeneration of the Cord: 'Rabbit Ear Sign' as a Radiodiagnostic Clue in Case of Vitamin B12 Deficiency Associated With Schizophrenia.","authors":"Muhammad Husnain, Muhammad Hasnat, Ahmad Nawaz, Sana Iqbal, Ahsan Numan, Muhammad Ahmad Malik, Wisha Komal, Noor Sehar, Rabia Nawaz, Talha Ali, Izhad Farooq","doi":"10.1155/crnm/5583285","DOIUrl":"10.1155/crnm/5583285","url":null,"abstract":"<p><strong>Background: </strong>Subacute combined degeneration manifests as the degeneration of the dorsal and lateral columns of the spinal cord. Typical symptoms include sensory deficits, weakness, ataxia, and disturbances in gait which can progress to spasticity and paraplegia. Prolonged vitamin B12 deficiency can result in irreversible neurological damage and psychiatric manifestations such as depression, irritability, hallucinations, dementia, and delirium in the affected individuals. To date, only a few cases of schizophrenia with vitamin B12 deficiency with SCD have been reported in the literature.</p><p><strong>Objective: </strong>To report a case of vitamin B12 deficiency with neuropsychiatric manifestations and rabbit ear sign as a radiological clue supporting subacute combined degeneration of the cord in vitamin B12 deficiency.</p><p><strong>Case description: </strong>A 44-year-old male, who is a smoker and was diagnosed with schizophrenia 18 months ago, presented with a gradual, symmetrical, and painless weakness affecting all four limbs over the past 6 months. Neurological examination revealed spastic quadriparesis with impaired dorsal column. Laboratory tests were suggestive of mild to moderate anemia with a peripheral blood smear showing macrocytosis. Neuroimaging of the craniocervical junction revealed a characteristic \"rabbit ear sign\" or \"inverted V sign\". Although serum vitamin B12 and folate levels were within normal range, homocysteine levels were significantly elevated, leading to a diagnosis of subacute combined degeneration (SCD) of the spinal cord secondary to vitamin B12 deficiency. Methylmalonic acid testing was unavailable locally; however, marked hyperhomocysteinemia (> 15 μmol/L) with neuropsychiatric manifestations and anemia strongly supports functional vitamin B12 deficiency, as neurological features may occur in the absence of overt macrocytosis. Vitamin B12 replacement resulted in marked improvement in functional status of the patient, in terms of spasticity, as well as, motor, sensory and psychiatric symptoms.</p><p><strong>Conclusion: </strong>This case highlights the need to evaluate vitamin B12 deficiency in young patients with neuropsychiatric symptoms, even with mild to moderate anemia, as early replacement can prevent irreversible neurological damage from SCD.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"5583285"},"PeriodicalIF":0.7,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197562","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":"The Sanctuary Within: Development of CD20+ CNS Lymphoma Despite Peripheral B-Cell Depletion by Rituximab in a Multiple Sclerosis Patient.","authors":"Mohammad Hossein Harirchian, Seyed Ehsan Mohammadianinejad, Asghar Bayati, Vahid Soleimani, Zahra Sarvestani, Maryam Kaeedi, Sanaz Heydari Havadaragh","doi":"10.1155/crnm/1186165","DOIUrl":"10.1155/crnm/1186165","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with multiple sclerosis (MS) are not immune to developing comorbid conditions, including malignant disorders. A new neurologic worsening in a known MS patient, despite being on immunosuppressive or even antineoplastic therapy, could be a malignant condition, other than MS relapse.</p><p><strong>Case presentation: </strong>We report a middle-aged woman with a known history of MS and under treatment with rituximab from a few years ago, who subsequently developed clinical and imaging features that were not typical for MS relapse, which was pathologically confirmed to be a diffuse large B-cell lymphoma (DLBCL).</p><p><strong>Conclusion: </strong>It is important to consider the possibility of superimposed comorbid disorders, especially malignant conditions, in the setting of immunosuppressive therapy in MS patients. Considering red flags is an important task before the diagnosis of MS relapse as an explanation for new neurologic worsening.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"1186165"},"PeriodicalIF":0.7,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052882","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":"Eosinophil Recruitment and Activity in CNS Lesions of MOG Antibody-Associated Myelitis Following Influenza Vaccination: A Case Report.","authors":"Hiroshi Adachi, Misa Takashima, Naonobu Futamura","doi":"10.1155/crnm/6886402","DOIUrl":"10.1155/crnm/6886402","url":null,"abstract":"<p><p>The appearance of eosinophils in the cerebrospinal fluid (CSF) is considered atypical in patients with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). In this article, we report the case of a 24-year-old male who received an influenza vaccine and subsequently presented with sensory disturbances in his limbs and trunk, accompanied by urinary retention. On spinal cord magnetic resonance imaging (MRI), T2-weighted images showed intramedullary high-intensity lesions. Meanwhile, brain MRI revealed no lesions. CSF testing showed pleocytosis (180 cells/μL), and eosinophils were present in approximately 6% of the CSF white blood cells. Additionally, MOG antibodies (MOG-IgG) were present in the serum and CSF, leading to the diagnosis of MOG-IgG-associated myelitis induced by immunization following influenza vaccination. It is speculated that perivascular infiltration of eosinophils can occur within demyelinating lesions in patients with MOGAD, possibly due to elevated levels of eosinophil-associated cytokines and chemokines in the central nervous system (CNS) lesions. However, it remains unclear whether immunological responses triggered by vaccination contribute to the secretion of these mediators in such lesions.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"6886402"},"PeriodicalIF":0.7,"publicationDate":"2026-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148027313","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 Case Series of Steroid-Responsive Encephalopathy Associated With Autoimmune Thyroiditis (SREAT) With Atypical Thyroid Lab and Imaging Findings.","authors":"Mariah S Johnson, Maxim Petrovsky, Rachel Rinehart Mimbella, Adnan Ecizi, Madelynn Paul, Anna Hohler","doi":"10.1155/crnm/8314930","DOIUrl":"10.1155/crnm/8314930","url":null,"abstract":"<p><p>Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a rare, potentially reversible neuropsychiatric syndrome linked to autoimmune thyroid disease. However, its clinical heterogeneity may stray from the most accepted diagnostic criteria often leading to a delay in its recognition. In this paper, we describe two patients who presented with subacute encephalopathy for which the diagnosis of SREAT was established after the detection of elevated antithyroid antibody titers and the exclusion of alternative etiologies. Notably, both cases exhibited atypical features, namely CSF lymphocytic pleocytosis and leptomeningeal enhancement in Case 1 and a complex differential confounded by multiple comorbidities in Case 2. Treatment strategies included corticosteroid-based immunosuppression, with one patient also receiving intravenous immunoglobulin and thyroid hormone replacement. Both patients demonstrated substantial neurological improvement following therapy, underscoring the reversibility of this condition when appropriately treated. Together, these cases highlight the importance of maintaining diagnostic suspicion for SREAT in patients with unexplained encephalopathy, even in the absence of overt thyroid dysfunction, atypical lab and imaging findings, and a complex past medical history. Early recognition and initiation of immunotherapy can significantly alter outcomes and prevent prolonged morbidity. By presenting these cases, we aim to add to the limited body of literature on SREAT and emphasize the critical role of maintaining suspicion for SREAT in atypical cases of probable autoimmune encephalitis to facilitate timely diagnosis and intervention in optimizing patient recovery.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"8314930"},"PeriodicalIF":0.7,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926656","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":"Two Cases of Oculomotor Nerve Palsy in Idiopathic Intracranial Hypertension and a Literature Review.","authors":"Parth A Patel, Jayachandra Muppa, Dan-Victor Giurgiutiu","doi":"10.1155/crnm/9730076","DOIUrl":"10.1155/crnm/9730076","url":null,"abstract":"<p><p>Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure in the absence of a secondary cause. Classically, it presents with headache, visual obscurations, pulsatile tinnitus, and diplopia, most commonly due to abducens nerve palsy. Involvement of other cranial nerves is rare. We report two patients with oculomotor nerve palsy in the setting of IIH. The first, a 26-year-old woman with a body mass index (BMI) of 35 kg/m², had a unilateral complete oculomotor nerve palsy, with imaging supportive of IIH and lumbar puncture opening pressure > 55 cmH₂O. The second, a 19-year-old man with a BMI of 38.5 kg/m², had a unilateral partial oculomotor nerve palsy, bilateral abduction paresis, and left-sided tongue dysgeusia, with imaging supportive of IIH and opening pressure of 36 cmH₂O. Both demonstrated marked symptomatic improvement on acetazolamide. Including the patients initially presented here, a literature review identified 21 documented cases of oculomotor nerve palsy associated with apparent IIH. Of these, 13 satisfied contemporary or historic diagnostic criteria for IIH. These cases underscore the rarity of this manifestation and the importance of recognizing IIH as a potential cause of oculomotor nerve palsy to ensure timely diagnosis and management and to prevent irreversible vision loss.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"9730076"},"PeriodicalIF":0.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926622","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":"Rapidly Evolving Acute Brainstem Syndrome With Respiratory Insufficiency due to Intracranial Dural Arteriovenous Fistula.","authors":"Hong Kiat Lim, Duncan Street, Wen-Xern Chong, Amrit-Deep Samra","doi":"10.1155/crnm/8666719","DOIUrl":"10.1155/crnm/8666719","url":null,"abstract":"<p><p>A 52-year-old female presented with one week of progressive quadriparesis followed by the development of diplopia, dysphonia and dysphagia over 48 h. Initial impression was of an inflammatory myelitis given mild cerebrospinal fluid pleocytosis and diffuse cervical cord swelling extending to the lower brainstem on MRI. Treatment with intravenous methylprednisolone was commenced. Her condition continued to progress with a brief cardiac arrest secondary to diaphragmatic insufficiency due to brainstem involvement. She survived the cardiac arrest after a period of cardiopulmonary resuscitation and was admitted to the intensive care unit. Subsequent MRI suggested a chronic right sigmoid venous sinus thrombosis with venous congestion in the brainstem and upper cervical cord. Digital subtraction angiogram revealed a right dural arteriovenous fistula (DAVF) between the right transverse venous sinus and perimesecephalic veins. The dural arteriovenous fistula was embolised with subsequent rapid improvement in bulbar function. Limb weakness also improved, and she was transferred to a rehabilitation unit for physiotherapy. Our case highlights the importance of rapid recognition of an intracranial DAVF mimicking an inflammatory myelitis in the setting of an acute brainstem syndrome. Symptoms can progress quickly if untreated with the risk of progression following the administration of corticosteroids.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"8666719"},"PeriodicalIF":0.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834103","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":"Diagnostic Challenges of LRP4 Antibody Testing in Myasthenia Gravis: A Case Series of Four LRP4 Positive Cases With Uncertain Diagnostic Significance.","authors":"Katherine Rosella Kinnard, Ehtesham Khalid","doi":"10.1155/crnm/3092521","DOIUrl":"10.1155/crnm/3092521","url":null,"abstract":"<p><p>Myasthenia gravis is an autoimmune disorder characterized by muscle weakness due to impaired neuromuscular transmission. While antibodies against the acetylcholine receptor and muscle-specific kinase are commonly used for diagnosis, a subset of patients remains seronegative, necessitating alternative biomarkers. Low-density lipoprotein receptor-related Protein 4 antibodies have emerged as a potential diagnostic marker in seronegative myasthenia gravis cases. However, misleading positive results have obscured diagnosis and management. This study explores the clinical relevance of low-density lipoprotein receptor-related Protein 4 antibodies in myasthenia gravis through four patient case studies. Patients presenting with concern for myasthenia gravis underwent a comprehensive diagnostic evaluation, including antibody testing for acetylcholine receptor, muscle-specific kinase, and low-density lipoprotein receptor-related Protein 4. Volitional single-fiber electromyography was also performed. All tests were employed per standardized laboratory protocols. All four patients were initially evaluated for suspected myasthenia gravis; however, despite positive low-density lipoprotein receptor-related Protein 4 antibody results, comprehensive clinical and electrophysiological evaluation ultimately excluded the diagnosis of myasthenia gravis. These cases underscore the limitations of low-density lipoprotein receptor-related Protein 4 antibody testing.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2026 ","pages":"3092521"},"PeriodicalIF":0.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811391","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}