Case Reports in Neurological Medicine最新文献

{"title":"Severe Neurotoxicity due to <i>Atropa belladonna</i> Poisoning: A Case Report and Literature Review.","authors":"Seyed Javad Boskabadi, Sima Ramezaninejad, Zakaria Zakariaei","doi":"10.1155/2024/5411258","DOIUrl":"10.1155/2024/5411258","url":null,"abstract":"<p><p><i>Atropa belladonna</i> (<i>A. belladonna</i>), commonly known as deadly nightshade, is a poisonous plant belonging to the Solanaceae family. The toxic effects of <i>A. belladonna</i> are attributable to its alkaloid content, which possesses potent anticholinergic properties. These alkaloids are responsible for the plant's toxicity and can cause a range of adverse effects in humans and animals upon ingestion or contact. In this report, we describe two atypical cases of <i>A. belladonna</i> poisoning resulting from accidental ingestion of the plant's raw leaves, which were referred to the emergency room of a poisoning center in northern Iran. Both patients presented with symptoms of anticholinergic toxicity, including dry mouth, mydriasis, tachycardia, and delirium. The patients were managed conservatively with supportive measures, including hydration and administration of benzodiazepines to control agitation and delirium. With appropriate treatment, both patients showed improvement and were discharged from the hospital. <i>A. belladonna</i> intoxication is associated with a range of clinical manifestations, primarily due to its neurotoxic effects. These manifestations may include flushing, mydriasis, tachycardia, ataxia, agitation, delirium, and urinary retention. The severity of symptoms can vary depending on the amount of the toxin ingested and the individual's susceptibility. In severe cases, <i>A. belladonna</i> toxicity can lead to seizures, coma, and even death. These cases highlight the importance of awareness regarding the potential toxicity of <i>A. belladonna</i> and the necessity of prompt and appropriate management of its toxicity. In severe cases, physostigmine may be considered for the treatment of neurological symptoms due to the plant's anticholinergic effects.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"5411258"},"PeriodicalIF":0.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371056","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":"Rhabdomyolysis Induced by Levetiracetam: A Case Report in Kuwait.","authors":"Moaz Qureshi, Prakash A Abraham, Abdullah Al-Faras, Omar M Bamasood, Kamal M Matar","doi":"10.1155/2024/1234738","DOIUrl":"https://doi.org/10.1155/2024/1234738","url":null,"abstract":"<p><p>Epilepsy is a common disorder caused by a myriad of drugs, of that levetiracetam is being commonly used late because of its strong safety profile and efficacy. With the increasing usage of drugs, some rare side effects may sometimes appear that can escape the most stringent checks, possibly due to the rarity of their occurrence. Rhabdomyolysis is known to occur in some patients owing to a variety of causes, even leading to kidney injury. When a drug has a side effect that is not well recognized in the literature, especially when the side effect can mimic an adverse effect of an uncommon primary illness, identifying the causal factor can be doubly difficult. To date, only limited studies have been published suggesting rhabdomyolysis linked to levetiracetam use. We report the first case of levetiracetam-induced rhabdomyolysis in Kuwait.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"1234738"},"PeriodicalIF":0.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342257","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":"Changes in Corticospinal Tract Consistency after Dry Needling in a Stroke Patient.","authors":"Masoome Ebrahimzadeh, Noureddin Nakhostin Ansari, Iraj Abdollahi, Behnam Akhbari, Jan Dommerholt","doi":"10.1155/2024/5115313","DOIUrl":"10.1155/2024/5115313","url":null,"abstract":"<p><strong>Background: </strong>Dry needling (DN) is a technique employed to mitigate spasticity and enhance functionality in stroke patients. We report the impact of DN on both corticospinal tract (CST) consistency and wrist flexors spasticity of an individual affected by stroke.</p><p><strong>Case: </strong>The participant was a 57-year-old male who had experienced an ischemic stroke 9 months prior. The primary outcome measures included fractional anisotropy (FA), asymmetry FA (aFA), ratio FA (rFA), and Modified Modified Ashworth Scale (MMAS). Additionally, secondary outcomes encompassed wrist extension range of motion (ROM) and performance in the box and block test (BBT). These measurements were taken both before and after the administration of DN treatment.</p><p><strong>Results: </strong>After the application of DN, the mean FA of the ipsilesional CST increased from 0.35 to 0.39, concomitantly with a decline in aFA from 0.18 to 0.13. Notably, the rFA exhibited a pre-DN value of 0.69, which subsequently rose to 0.76 post-DN. Moreover, a significant reduction in MMAS scores was detected, from a score of \"3\" prior to DN application to a post-DN score of \"1\". In terms of wrist mobility, both active and passive extension ROM exhibited favorable improvements, with an increase of 12° for active extension and 16° for passive extension. Furthermore, there was a substantial improvement in the BBT score, an indicator of manual dexterity, ascending from 12 to 24.</p><p><strong>Conclusion: </strong>Enhancements in CST consistency suggest it as a potential mechanism contributing to the observed improvements following DN in this stroke case.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"5115313"},"PeriodicalIF":0.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11416164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280600","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":"Recurrent Rhabdomyolysis in a Medical Cadet during Military Training as a Rare Initial Presentation in Calpainopathy.","authors":"Sethapong Lertsakulbunlue, Boonsub Sakboonyarat, Piradee Suwanpakdee, Boonchai Boonyawat","doi":"10.1155/2024/2775517","DOIUrl":"https://doi.org/10.1155/2024/2775517","url":null,"abstract":"<p><p>Rhabdomyolysis, an emergency medical condition linked to muscle necrosis and intracellular substances released into the bloodstream, significantly endangers military personnel in heat-stress conditions. Rhabdomyolysis can also be an initial presentation in inherited muscle disorders. This study reports a novel case of calpainopathy (LGMDR1) diagnosed in a 19-year-old male military cadet who initially presented with recurrent rhabdomyolysis during training, a rare presentation in LGMD patients. Furthermore, a persistent creatine kinase (CK) elevation was observed at baseline. The diagnosis was confirmed by identifying a compound heterozygous of a novel frameshift, c.606dup (p.Ala203CysfsTer9), a mutation in exon 4, and a missense, c.956C > T (p.Pro319Leu), a mutation in exon 7 of the <i>CAPN3</i> gene, via whole exome sequencing. This case highlights the necessity of diagnostic investigation in individuals who have persistent high CK levels during the rhabdomyolysis episodes and possibly CK screening prior to military training to preemptively identify and mitigate complications from undiagnosed muscular dystrophies in military personnel in the future.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"2775517"},"PeriodicalIF":0.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11383649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280601","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 Confused Case Diagnosed as Cerebral Infarction or Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.","authors":"Yanan Ding, Li Zhang, Anqi Huang, Xianyue Meng, Xueli Li","doi":"10.1155/2024/9941341","DOIUrl":"10.1155/2024/9941341","url":null,"abstract":"<p><p>In order to discuss the clinical and MRI features, diagnosis, and prevention of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), we reported an adult case of MOG antibody-related disease misdiagnosed as cerebral infarction. This patient's first clinical symptom was limb weakness, that different from previous reports of MOG antibody-related diseases, such as brainstem encephalitis, neuromyelitis optical, and transverse myelitis. The main treatment plan is high-dose corticosteroid therapy combined with immunoglobulin therapy. This case indicated that some MOGAD patients lack of specificity in the clinical manifestations and imaging perhaps would be misdiagnosed as cerebral infarction, encephalitis, immune peripheral neuropathy, MS, NMOSD, and other diseases. For patients with atypical clinical manifestations or imaging, it is especially important to take antibody detection as early as possible to make correct diagnosis and active treatment in time to avoid disability.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"9941341"},"PeriodicalIF":0.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11364470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104721","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":"Longitudinal Extensive Transverse Myelitis due to Varicella-Zoster Virus Infection in an Undiagnosed HIV-Positive Patient.","authors":"Elahe Yaghmaei, Ahmad Najafi, Reza Daneshvar Kakhki","doi":"10.1155/2024/9027198","DOIUrl":"10.1155/2024/9027198","url":null,"abstract":"<p><strong>Introduction: </strong>Longitudinal extensive transverse myelitis (LETM) has four main causes: inflammatory, malnutrition, vascular, and infectious causes. Among the commonly described viral causes leading to LETM are the <i>Herpesviridae</i> family, HIV, and HTLV-1. <i>Case Presentation</i>. A 43-year-old man presented with asymmetric weakness of the lower limbs (the left side was weaker), urinary retention, and flank pain. The symptoms began five days after shingle eruption and progressed over twelve days. He was diagnosed with longitudinal extensive transvers myelitis extending from T4 to T6, which corresponded to the same dermatome involved in shingles. The PCR result of cerebrospinal fluid was positive for varicella-zoster virus with a viral load of 500 copies/ml. Additionally, the initial HIV enzyme-linked immunosorbent assay (ELISA) test was positive, and his CD4 count was 72 cells/mm³. Other lab results were normal. Based on the appearance of LETM in the thoracic MRI at T4-T6, VZV myelitis was diagnosed, and treatment was initiated with acyclovir (30 mg/kg divided daily for twenty-one days), methylprednisolone (1 g/day for three days), prophylactic antibiotics (trimethoprim/sulfamethoxazole, rifampin, and isoniazid), and antiretroviral therapy (dolutegravir and Truvada). After 2-month follow-up, he was nearly free of symptoms.</p><p><strong>Conclusion: </strong>Infection is one of the critical causes of transverse myelitis. When a patient presents with skin shingles along with myelopathy, varicella-zoster myelitis should be considered, and the patient should be evaluated in terms of immune system dysfunction. Treatment with acyclovir has been shown to be effective in reducing clinical symptoms in such cases.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"9027198"},"PeriodicalIF":0.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757307","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":"Life-Threatening Anaphylaxis due to Cerebrolysin®.","authors":"Helmut Trimmel, Wolfgang Tauber, Martin Zikeli","doi":"10.1155/2024/2332908","DOIUrl":"10.1155/2024/2332908","url":null,"abstract":"<p><p>In this case report, we describe a well-documented, severe anaphylactic reaction after intravenous administration of cerebrolysin, a neurotrophic agent derived from highly purified porcine brain tissue, consisting of peptides and free amino acids. Cerebrolysin has been in use for decades, in various neurological diseases, but especially stroke and traumatic brain injury, with the aim of enhancing cognitive performance. After administration of cerebrolysin to an 85-year-old male patient suffering from subacute stroke, he developed a fulminant anaphylactic reaction. Following institutional standards, vital functions were quickly restored. The anaphylactic reaction was clearly confirmed by laboratory tests. To date, only rare cases of anaphylaxis due to cerebrolysin have been published in the literature. The current report is intended to raise awareness for the possibility of such a reaction, given the widespread use of cerebrolysin in several indications in mostly critical patients. The case shows how a completely unexpected life-threatening situation can be successfully treated by targeted measures, if the situation is recognized quickly. In light of this event, we consider pathophysiology of allergic reactions and treatment guidelines.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"2332908"},"PeriodicalIF":0.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757306","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":"Clinical Experience with Dimethyl Fumarate and Natalizumab in Pregnant Women with Multiple Sclerosis: A Four-Patient Case Series.","authors":"Satoshi Saito, Ryotaro Ikeguchi, Kazuo Kitagawa, Yuko Shimizu","doi":"10.1155/2024/7808140","DOIUrl":"10.1155/2024/7808140","url":null,"abstract":"<p><p>Interferon <i>β</i> and glatiramer acetate are the disease-modifying drugs (DMDs) considered relatively safe for use in pregnant women with multiple sclerosis (MS); however, the safety profile of dimethyl fumarate (DMF) and natalizumab (NTZ) in this population remains inconclusive. Here, we present four cases of pregnant women with MS who were treated with DMF and NTZ (<i>n</i> = 2 patients, each) during their pregnancy and discuss our observations with the use of these drugs and the clinical courses of the patients. We retrospectively examined relapse of MS during pregnancy and after delivery; duration of exposure to DMDs; maternal, fetal, and neonatal adverse events; breastfeeding; and timing of resumption of DMDs. The two patients treated with DMF discontinued treatment 5 or 6 weeks after the discovery of pregnancy. DMF was resumed 1 week postpartum, and mixed breastfeeding was initiated. Brain magnetic resonance imaging in one patient 9 months after delivery revealed a new lesion; however, it was not classified as a clinical relapse. In two patients treated with NTZ, the dosing interval was extended to 6 weeks after the discovery of pregnancy. One patient discontinued NTZ at 30 weeks and the other at 25 weeks of gestation, as a slight restriction in fetal growth was observed owing to hyperemesis gravidarum. Both patients opted for formula feeding, and no relapse was observed within 1 year postpartum. Additionally, no abnormalities were observed in any of the patients during the perinatal period, and their development was normal. Investigation of drug safety in pregnant and parturient women primarily relies on registries, postmarketing surveillance, and case reports due to ethical limitations on conducting randomized controlled trials. Our findings demonstrated that DMF and NTZ were not contraindicated during pregnancy or the perinatal period in women with MS; nevertheless, vigilant monitoring is essential to ensure the safety of these drugs.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"7808140"},"PeriodicalIF":0.9,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11265946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751199","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 Severe Alzheimer's Disease Patient Improved by Intravenous Mesenchymal Stem Cell Transplant.","authors":"Takahiro Honda Pazili","doi":"10.1155/2024/8353492","DOIUrl":"10.1155/2024/8353492","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is a progressive neurological disorder and is the most common form of dementia. The terminal stage of AD is characterized by severe cognitive and substantial functional decline, requiring extensive assistance with daily activities. As effective therapies at this stage are not fully available, development of therapeutics that can recover any symptoms would be important to improve the quality of life. Recently, stem cell therapy has gathered a lot of attention in several neurological diseases, including AD. Here, we report an AD patient at the terminal stage whose symptoms were improved by the intravenous administration of <i>ex vivo</i>-expanded bone marrow-derived mesenchymal stem cells (MSC). The case is a 61-year-old woman with severe Alzheimer's disease who had been admitted to the special nursing home. She could neither walk nor sit up independently. She also did neither smile nor gaze properly when talked to. Rigidity including neck motion was observed. She was on dysphagia diets. We cultured her bone-marrow-derived MSCs and intravenously administered 1,5 × 10⁸ cells. After the treatment, smile loss, eye movement dysfunction, and neck immobility were improved. This is the first case report that showed the therapeutic effects of MSCs on terminal symptoms of AD.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"8353492"},"PeriodicalIF":0.9,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747538","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":"Impact of Focal Muscle Vibration on Flaccid Upper Limb Motor Paralysis following Acute Brain Disease: A Case Study.","authors":"Hirotaka Saito, Haruka Kobayashi, Kodai Oba, Yosuke Hamaya","doi":"10.1155/2024/2469074","DOIUrl":"10.1155/2024/2469074","url":null,"abstract":"<p><p>Focal muscle vibration (FMV) is increasingly being recognized as a rehabilitative therapy for enhancing motor function in central nervous system (CNS) diseases, particularly in patients with fine motor control deficits stemming from CNS damage. Brain lesions from these diseases disrupt the motor networks, necessitating novel rehabilitation strategies. By applying vibrations to muscles, FMV stimulates sensory fibers to induce cortical activity and kinesthetic illusions. While initial studies have highlighted FMV's role in reducing spasticity, recent evidence points to its potential in treating motor paralysis. However, prior research has been limited by the lack of acute-phase studies and a focus on patients with minimal muscle contraction capability. This report aimed to explore FMV's efficacy on upper limb motor function in patients with flaccid motor paralysis immediately after acute CNS diseases. We report the case of a septuagenarian male with a brain abscess in the right parietal lobe, leading to flaccid motor paralysis. Rehabilitation included 28 sessions of occupational and physical therapy that incorporated FMV. Significant improvements were observed in upper extremity function, with moderate to very large effect sizes, while lower limb function showed lesser improvement without adverse effects. This case suggests the utility of FMV in enhancing upper-limb motor function after acute CNS injuries, potentially serving as a supplementary therapy for spontaneous recovery. This report contributes to emerging evidence on FMV's benefits in acute flaccid motor paralysis, expanding the documented therapeutic scope.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2024 ","pages":"2469074"},"PeriodicalIF":0.9,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11219211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491010","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}