Case Reports in Neurological Medicine最新文献

{"title":"Something Got Your Tongue? A Unique Cause of Hypoglossal Nerve Palsy.","authors":"Alan Tesson,&nbsp;Peter Kranz,&nbsp;Ali Zomorodi,&nbsp;Joel Morgenlander","doi":"10.1155/2022/2884145","DOIUrl":"https://doi.org/10.1155/2022/2884145","url":null,"abstract":"<p><strong>Introduction: </strong>The authors report a rare cause of isolated hypoglossal nerve palsy caused by a high cervical osteophyte. This case increases clinical knowledge of an underreported condition and teaches the clinician radiologic pearls in making the diagnosis. To their knowledge, this is the first case report showing surgical remediation of this condition. <i>Symptoms and Clinical Findings</i>. A 73-year-old female presented with several months of occipital headache, progressive dysarthria, dysphagia, and tongue deviation to the right. Her neurologic exam was significant for atrophy of the right hemitongue with tongue fasciculations. On protrusion, her tongue deviated rightward. <i>Diagnosis and Therapeutic Intervention</i>. Careful review of her initial head computed tomography (CT) imaging revealed that a high cervical osteophyte caused unilateral, isolated hypoglossal nerve palsy. Neurosurgery performed a right, far lateral approach for decompression of this osteophyte and over the ensuing months her symptoms improved.</p><p><strong>Conclusion: </strong>High cervical osteophyte is an underrecognized cause of isolated hypoglossal nerve palsy. The imaging investigation should be systematic and focus on the skull base with magnetic resonance imaging (MRI) or CT. This is a rare occasion when high resolution CT of the skull base can actually be the more helpful imaging modality. As shown in this case, an osteoarthritic cause can be surgically ameliorated.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"2884145"},"PeriodicalIF":0.9,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9708331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40457534","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":"Right Unilateral Spatial Neglect Improves with Intrinsic Motivation.","authors":"Hirotaka Saito,&nbsp;Haruka Kobayashi,&nbsp;Junichi Yatsu,&nbsp;Shigeru Obayashi","doi":"10.1155/2022/4828549","DOIUrl":"https://doi.org/10.1155/2022/4828549","url":null,"abstract":"<p><p><i>Background</i>. In the acute phase of stroke, it is well known that the incidence and severity of unilateral spatial neglect (USN) are more significant in the right hemisphere injuries. Still, the detection of USN in left hemisphere injuries has been increasing in recent years. This trend is because behavioral assessments have prevented the exclusion of patients who are difficult to assess for USN or apathy using conventional paper-and-pencil tests (e.g., aphasia). Right USN and post-stroke apathy share many common lesions. Therefore, clinical symptoms may overlap, but little validation considers this. <i>Case Study</i>. A man (62 years old) determined to have the right USN and apathy was treated for six weeks in 3 terms. In the first term (weeks 1 to 2), the patient was treated for the right USN by conventional therapy. In the second term (3-4 weeks), treatment for right USN and apathy by goal-directed therapy based on affinity behavior was implemented. In the third term (5-6 weeks), goal-directed therapy based on affinity behavior was discontinued, and treatment was returned to conventional therapy only. In the second term (goal-directed therapy based on affinity behavior), the improvement in patients' apathy (clinical assessment for spontaneity) was more significant than the effect size in the third term (conventional therapy). There were no significant differences in USN (catherine bergego scale) and intrinsic motivation (pittsburgh rehabilitation participation scale). However, the effect size in the second term tended to be larger than in the third term (conventional therapy). <i>Clinical Rehabilitation Impact</i>. This report aims to demonstrate the limitations of current treatment for cases determined to have both right USN and apathy. Second, to assess the extent to which this new intervention can complement the limitations of current treatment.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"4828549"},"PeriodicalIF":0.9,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40685275","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":"Guillain-Barré Syndrome Associated with COVID-19 in a Japanese Male.","authors":"Yoshiki Esa,&nbsp;Yuta Kajiyama,&nbsp;Misako Kaido,&nbsp;Yushi Watanabe,&nbsp;Harutoshi Fujimura,&nbsp;Iwao Gohma,&nbsp;Kenichi Takahashi,&nbsp;Junya Kobayashi","doi":"10.1155/2022/6837851","DOIUrl":"https://doi.org/10.1155/2022/6837851","url":null,"abstract":"<p><p>April 2021 saw a widespread outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Osaka, Japan. We encountered the case of a 52-year-old man who had Guillain-Barré syndrome associated with coronavirus disease 2019 (COVID-19). After the relief of the respiratory symptoms owing to COVID-19, the patient experienced muscle weakness, which spread from his fingers to his extremities, and was unable to walk. Further examinations revealed mild protein elevation in the cerebrospinal fluid. In addition, nerve conduction studies showed demyelinating polyneuropathy, leading to the diagnosis of Guillain-Barré syndrome. After the administration of intravenous immunoglobulin and intravenous methylprednisolone, his symptoms drastically improved, and he was able to walk unaided 21 days after the onset of symptoms. On day 40, the patient was discharged with minimal muscle fatigue. Because Guillain-Barré syndrome associated with COVID-19 is expected to have a good prognosis, early diagnosis and treatment are important. Therefore, Guillain-Barré syndrome should be considered as a possible factor for muscle weakness during and after COVID-19 treatment.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"6837851"},"PeriodicalIF":0.9,"publicationDate":"2022-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9617722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40460025","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":"Serologic Presentation of Lamotrigine-Induced Lupus.","authors":"Hannah Dempsey,&nbsp;Gabriella Aitcheson,&nbsp;Gretchen Goble,&nbsp;Riley Snook","doi":"10.1155/2022/8756308","DOIUrl":"https://doi.org/10.1155/2022/8756308","url":null,"abstract":"<p><p>This paper discusses the presentation of a rare drug side effect, a case of drug-induced lupus presenting with weight loss, weakness, hepatitis, and pancreatitis. A 24-year-old male with a history of major depressive disorder and childhood seizures presented to the ER with symptoms of abdominal pain, significant weight loss, and weakness. Initial workup revealed acute pancreatitis, elevated liver function enzymes (LFTs), and abnormal anti-double-stranded DNA antibody (anti-dsDNA) 1 : 640. He showed no classical clinical signs of lupus including rash, arthritis, or photosensitivity. He had multiple hospitalizations in the previous 6 months for excessive weight loss, malnutrition, weakness, and altered mental status. He had been taking lamotrigine for seizure prevention and mood stabilization while on a selective serotonin reuptake inhibitor (SSRI) and had a decline in health since the lamotrigine dose was increased. Antihistone antibodies were positive suggesting a drug-induced lupus syndrome. We hope to bring awareness to the possible rare complication of lamotrigine-induced lupus.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"8756308"},"PeriodicalIF":0.9,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33495138","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":"Long-Lasting Unruptured Large Intracranial Aneurysm in Bilateral Moyamoya Disease: Case Report.","authors":"Eunyoung Chae,&nbsp;Soomin Jeong,&nbsp;Chan-Hyuk Lee","doi":"10.1155/2022/2635724","DOIUrl":"https://doi.org/10.1155/2022/2635724","url":null,"abstract":"<p><strong>Introduction: </strong>The rupture risk of intracranial aneurysms in patients with moyamoya disease is higher than that in the general population. We report a confirmed case of moyamoya disease with bilateral middle cerebral artery (MCA) occlusion with a large and long-lasting aneurysm.</p><p><strong>Case: </strong>A 71-year-old woman visited the clinic with a large intracranial aneurysm. The patient was diagnosed with an ischemic stroke 2 months ago. She exhibited weakness in the left upper and lower extremities and dysarthria and was taking aspirin. The brain magnetic resonance imaging showed complete occlusion in the bilateral MCA proximal (M1) and a large 11 × 11 mm nonruptured cerebral aneurysm in the A3 segment of the left anterior cerebral artery. On transfemoral cerebral angiography, the patient was diagnosed with Suzuki grade VI moyamoya disease with bilateral MCA occlusion. After 7 years, the cerebral aneurysm size further increased, but it remained unruptured.</p><p><strong>Conclusions: </strong>Here, the patient had moyamoya disease with a large aneurysm, but aneurysmal rupture did not occur even after 7 years. Our case report might help in understanding the mechanisms of cerebral aneurysm occurrence and rupture in moyamoya patients.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"2635724"},"PeriodicalIF":0.9,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33514210","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":"Targeted Anterior Cervical Epidural Blood Patch in a Patient with Spontaneous Intracranial Hypotension.","authors":"Ravindra Singh Shekhawat,&nbsp;Ming Hui Yong,&nbsp;Si Ying Julienne Keong,&nbsp;Kunihiko Chen,&nbsp;Chow Wei Too,&nbsp;Shahul Hameed","doi":"10.1155/2022/8872775","DOIUrl":"https://doi.org/10.1155/2022/8872775","url":null,"abstract":"<p><p>A 45-year-old male was admitted with severe orthostatic headache secondary to spontaneous intracranial hypotension. He had the site of cerebrospinal fluid (CSF) leakage identified at the anterolateral aspect of the C7-T1 spinal level. He first underwent a conventional posterior-approach cervical epidural blood patch (EBP) which provided immediate relief to the patient's symptoms; however, his symptoms recurred two days later. To better target the anterolateral leakage site, we employed an anterior-approach EBP under computed tomography (CT) guidance. After this attempt, the patient experienced complete relief of his symptoms, and the headache eventually resolved.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"8872775"},"PeriodicalIF":0.9,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33514212","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":"Ischemic Stroke and Ruptured Mycotic Aneurysm, Two Complications of Infective Endocarditis in One Patient.","authors":"Alassane Mamadou Diop,&nbsp;Ahmadou Bamba Mbodj,&nbsp;Serigne Abdou Aziz Fall,&nbsp;Ibrahima Niang","doi":"10.1155/2022/6275537","DOIUrl":"https://doi.org/10.1155/2022/6275537","url":null,"abstract":"<p><p>The incidence of infective endocarditis is estimated to be around 30 cases per million inhabitants/year. It can be responsible for various neurological complications such as cerebral infarction, meningitis, cerebral abscesses, and cerebral hemorrhage due to ruptured mycotic aneurysms. Several germs have been incriminated in this condition including <i>Staphylococcus</i>, <i>Streptococcus</i>, and <i>Enterococcus</i>. We report the case of a 64-year-old patient who presented with an acute motor deficit of the left upper limb associated with dysarthria. MRI showed infarcts in both cerebral hemispheres, and the TOF sequence showed an amputation of M2. On transesophageal ultrasound, there was evidence of vegetations at the mitral valve. Blood culture isolated <i>Streptococcus oralis</i>. With antibiotic treatment, the evolution was marked by a stable apyrexia with regression of the dysarthria. Before her surgery, she suddenly developed aphasia with worsening of the motor deficit. CT scan showed a right fronto-parietal hematoma which was related to a ruptured cerebral aneurysm. She underwent endovascular embolisation and subsequent cardiac surgery.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"6275537"},"PeriodicalIF":0.9,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33514213","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 of Poisoning with <i>Abrus precatarius</i> Complicated with Bilateral Basal Ganglia Haemorrhage.","authors":"Arun Rajaratnam,&nbsp;Kishan Dissanayake,&nbsp;Kiertie Kularatne,&nbsp;Sunil Bowattage","doi":"10.1155/2022/3318197","DOIUrl":"https://doi.org/10.1155/2022/3318197","url":null,"abstract":"<p><p><i>Abrus precatarius</i> is a tropical climber, whose seeds contain abrin, which is known to cause toxicity in humans. We report a case of a young girl, who presented with haemorrhagic enterocolitis, bilateral septal vein thrombosis, and basal ganglia haemorrhage leading to seizures and coma, following ingestion of toxic <i>A. precatarius</i> seeds. To the best of our knowledge, this is the first ever case to describe such an intracranial complication of abrin poisoning.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"3318197"},"PeriodicalIF":0.9,"publicationDate":"2022-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9436552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40350246","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":"Simultaneous Pulmonary Embolism and Carotid Thrombosis as a Presenting Manifestation of COVID-19.","authors":"Leon Smith,&nbsp;Brian Zeman","doi":"10.1155/2022/4933172","DOIUrl":"https://doi.org/10.1155/2022/4933172","url":null,"abstract":"<p><p>Although COVID-19 was initially described predominantly as a respiratory infection, subsequent reports noted that it can produce generalised inflammation with effects on multiple organ systems. As a result, it is possible for patients with COVID-19, including those with severe disease, to present initially with nonrespiratory signs and symptoms. Neurological manifestations, including ischaemic stroke, may be the first presenting issue and can result from carotid thrombosis. Similarly, the risk of both arterial and venous thrombosis is increased in COVID-19, which may result from hypercoagulability associated with systemic inflammation.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"4933172"},"PeriodicalIF":0.9,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9427261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40340748","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":"Primary Cerebral Venous Thrombosis in a Patient with Immune Thrombocytopenic Purpura.","authors":"M Taher Farfouti,&nbsp;Christina Masri,&nbsp;Mike Ghabally,&nbsp;George Roumieh","doi":"10.1155/2022/1346269","DOIUrl":"https://doi.org/10.1155/2022/1346269","url":null,"abstract":"<p><strong>Introduction: </strong>Immune thrombocytopenic purpura is an autoimmune hematological disorder characterized by low platelet level due to its destruction through autoimmune antibodies. Cerebral venous thrombosis is a serious condition defined by a thrombosis in the cerebral venous sinuses that occurs mostly in the presence of a hypercoagulable state. Hemorrhage and thrombosis are processes with a paradoxical etiology; thus, the association between these two conditions seems to be extremely rare. <i>Case Presentation</i>. We herein report a case of a 19-year-old female with a chief compliant of generalized tonic-clonic episode, severe headache, and blurred vision. Physical examination was significant for a bilateral Babinski's sign and severe bilateral papilledema. Laboratory workup, computed tomography, and magnetic resonance imaging were normal except for severe thrombocytopenia. Magnetic resonance venography was diagnostic for cerebral venous thrombosis. Her past medical history was significant for immune thrombocytopenic purpura that was treated with prednisolone 40 mg per day which posed a therapeutic challenge. High-dose prednisolone and platelet transfusion were initiated; enoxaparin was administrated and switched to warfarin after stabilization of platelet count. The patient was neurologically intact after 14 days of appropriate treatment and was on follow-up. Many hypotheses were suggested to explain the unexpected thrombotic events in a patient with immune thrombocytopenic purpura which were related to the disease etiology or treatment, taking into account common risk factors (such as age, obesity, smoking, hypertension, diabetes mellitus, dyslipidemia, splenectomy, and oral contraceptive agents).</p><p><strong>Conclusion: </strong>The association between immune thrombocytopenic purpura (which is a major risk factor for bleeding) and cerebral venous thrombosis ( which is caused by a thromboembolic event )has carried a major challenge to the management plan. We believe that immune thrombocytopenic purpura and its treatment methods should be taken into consideration as risk factors for thromboembolic phenomenon.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"1346269"},"PeriodicalIF":0.9,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9417784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33444590","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}