Case Reports in Neurological Medicine最新文献

{"title":"Intradural Extramedullary Cavernous Malformation of the Spinal Cord with Hemorrhagic Transformation and Rapid Expansion.","authors":"Prabhat Poudel,&nbsp;Amrit K Chiluwal,&nbsp;Mohsen Nouri","doi":"10.1155/2022/8677298","DOIUrl":"https://doi.org/10.1155/2022/8677298","url":null,"abstract":"<p><p>Intradural extramedullary cavernous malformations in the spinal cord are rarely occurring vascular lesions. Mostly they are clinically silent unless the hemorrhagic transformation causes subarachnoid hemorrhage or neurologic deficits. We report the case of a 51-year-old man who developed a headache and weakness of the lower limb. Spinal cord magnetic resonance imaging revealed that the cause of his symptoms was a spinal intradural and extramedullary cavernous malformation with hemorrhagic transformation causing subarachnoid hemorrhage and compression of the thoracic spinal cord. Surgical decompression of the spinal cord followed by the resection of the lesion resulted in significant neurological improvement. Early diagnosis and early surgical extirpation of the lesion should be done to prevent recurrent hemorrhagic transformation and development of neurological symptoms.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"8677298"},"PeriodicalIF":0.9,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9391149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40433121","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":"Recovering Voiding and Sex Function in a Patient with Chronic Complete Spinal Cord Injury by Olfactory Ensheathing Cell Transplantation.","authors":"Di Chen,&nbsp;Haitao Xi,&nbsp;Ke Tan,&nbsp;Hongyun Huang","doi":"10.1155/2022/9496652","DOIUrl":"https://doi.org/10.1155/2022/9496652","url":null,"abstract":"<p><p>Spinal cord injury (SCI) is life-altering damage for patients, their family, and society. Transplantation of olfactory ensheathing cells has demonstrated neurorestoration effects for many neurological conditions, including SCI. But voiding and sex dysfunction in patients with chronic complete SCI is still a major issue even though neurorestorative therapies can restore their partial neurological functions. Here we report a case with traumatic complete SCI at the level of C6-C7 one year ago, who received OEC transplantation with intensive neurorehabilitation. The patient started to show clinical improvements within a few days after cell treatment. Six-year follow-up demonstrated his American Spinal Injury Association (ASIA)-Impairment Scale change from ASIA A to become ASIA C. The scores of International Association of Neurorestoratology Spinal Cord Injury Functional Rating Scale changed from 14 (prior to cell therapy) to 31 + 3 (six years after cell therapy). His main improvements in activity of daily life included eating, dressing and writing by himself, standing and walking, and urine control or voiding. His sex function recovered to be normal. He married and had a son through natural sex life. His improving functions and activities of daily life stayed stable in subsequent phone call follow-up. This was one individual case report. In the future, the deep mechanisms of why he got positive results, but other patients with similar condition did not get so much benefits from OEC transplantation should be explored.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"9496652"},"PeriodicalIF":0.9,"publicationDate":"2022-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9279098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40612951","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":"Extensive Longitudinal Transverse Myelitis Temporally Related to the Use of AZD1222, AstraZeneca COVID-19 Vaccine: Cerebrospinal Fluid Analysis and Recent Data Review","authors":"Paulo Diniz da Gama, Tiago Gomes de Alcantara, Rafaela Ramos Smaniotto, Penélope de Lima Petuco, Wammer Alves de Almeida, Rodrigo Assad Diniz da Gama, Y. Fragoso","doi":"10.1155/2022/8999853","DOIUrl":"https://doi.org/10.1155/2022/8999853","url":null,"abstract":"While mass immunization against coronavirus disease 2019 (COVID-19) rolls out around the globe, safety concerns and adverse events that need prompt evaluation are also emerging. Neurological complications such as transverse myelitis raise concerns as cases were observed in clinical trials. Cerebrospinal fluid analysis is routine in these cases and the characteristics of the abnormalities found are of great help not only in establishing the diagnosis but also in understanding this rare condition. We present a case of extensive longitudinal transverse myelitis after vaccination with AZD1222, AstraZeneca COVID-19 vaccine, which was the first case reported in Brazil. The abnormalities found in the study of the cerebrospinal fluid in our case are reported and discussed using data from recent publications.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"51 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90547520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue Revascularisation in Acute Internal Carotid Artery Occlusion with a Super Extended Time Window of More than 48 hours","authors":"Katharina Berger, Jennifer Sartor-Pfeiffer, Annerose Mengel, U. Ernemann, U. Ziemann, F. Hennersdorf, Katharina Feil","doi":"10.1155/2022/9036082","DOIUrl":"https://doi.org/10.1155/2022/9036082","url":null,"abstract":"Methods We present the case of a 71-year-old Caucasian male “minor stroke” patient with LVO, good collateral flow via the ophthalmic artery, receiving rescue MT following clinical deterioration after >48 hours. NIHSS and modified Rankin scale (mRS) were used for follow-up and modified treatment in cerebral infarction (mTICI) score for angiographic results. Results Excellent angiographic result (mTICI 3) and clinical improvement were achieved (NIHSS preintervention 18, on discharge 2 points). 90-day follow-up showed excellent outcome (mRS 1). Conclusions Late intervention MT should be encouraged when clinical deficit exceeds infarct demarcation. Standardized identification based on clinical and imaging data is required to target critical patients with LVO and low NIHSS, favouring a primary intervention.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"33 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83922054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amantadine as a Potential Treatment for Marchiafava–Bignami Disease: Case Reports and a Possible Mechanism","authors":"Leenil C Noel, Martin A. Myers, Tigran Kesayan","doi":"10.1155/2022/4585206","DOIUrl":"https://doi.org/10.1155/2022/4585206","url":null,"abstract":"Introduction Several reports have described the use of amantadine for managing symptoms in Marchiafava–Bignami disease (MBD); however, amantadine's role for the treatment of MBD symptoms is unclear. Here, we describe 2 patients with MBD who were treated with amantadine and hypothesize a potential mechanism responsible for clinical benefit. Case 1. A 38-year-old woman with excessive wine drinking presented with agitation, impaired speech, and a minimally conscious state. MRI revealed lesions in the splenium and genu. After being diagnosed with MBD, she was treated with intravenous thiamine, multivitamins, and 100 mg of amantadine twice a day for 2 weeks. She recovered to near baseline after 3 weeks. Case 2. A 54-year-old woman with years of heavy alcohol use presented with sudden bradyphrenia, acalculia, disinhibited behavior, weakness, and urinary incontinence. MRI revealed a large anterior callosal lesion. Two years after initial recovery from MBD, she noted that consuming “energy drinks” resulted in a transient, near-complete resolution of her residual behavioral, fatigue, and language symptoms. 100 mg of amantadine twice a day was trialled. After noted improvement, a further escalation to 200 mgs 3 times a day resulted in significant improvement in language and behavioral symptoms. Conclusion Amantadine in addition to vitamins may be beneficial in the treatment of MBD. It is possible that the dopaminergic effect of amantadine leads to improved recovery and function in dopamine-mediated pathways, including mesocortical and mesolimbic pathways during initial recovery, as well as improved speech, behavior, and fatigue in the following months. The role of amantadine in the treatment of MBD warrants further study.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"88 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79732714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artery of Percheron Infarction: A Case Report of Bilateral Thalamic Stroke Presenting with Acute Encephalopathy","authors":"C. Donohoe, Nooshin Kiani Nia, P. Carey, Vamsi Vemulapalli","doi":"10.1155/2022/8385841","DOIUrl":"https://doi.org/10.1155/2022/8385841","url":null,"abstract":"The artery of Percheron (AOP) is a relatively rare anatomic variant in which a solitary arterial trunk branches from the proximal segment of the posterior cerebral artery and provides arterial supply to the paramedian region of the thalami bilaterally and often to the rostral part of the midbrain. Occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with and without midbrain involvement. Recognition of this condition as an acute stroke may be challenging due to various nonlocalized clinical presentations, given the wide range of neurological functions subserved by the thalamus. Prompt neuroimaging, preferably with magnetic resonance imaging (MRI), in conjunction with familiarity with this relatively rare vascular variation can facilitate initiation of appropriate time contingent thrombolytic treatment and improved long-term prognosis. We present a case of a 56-year-old African American female with a bilateral thalamic infarct secondary to the artery of Percheron thromboembolism. This patient presented unresponsive without focal neurologic findings but with an initial Glasgow Coma Score (GCS) of 7, and subsequent computed tomographic (CT) head revealed bilateral thalamic hypodensities. Confirmatory MRI exhibited bilateral subacute thalamic infarcts, which were thought to be embolic with the source from the left ventricular thrombus as the patient had at least three distinct clots. Unfortunately, the patient's mental status did not improve significantly, and she was discharged to a nursing facility for extended care. AOP infarction may be missed on vascular imaging utilizing CT, MRI, and even catheter angiography. Clinical recognition that the AOP is one of the only single artery occlusions that can affect bilateral structures and frequently present solely as altered mental status without focal neurologic deficits is crucial to the diagnosis.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84144154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatigue and Exercise Intolerance as Initial Manifestations of a Nonsyndromic Mitochondrial Disorder Due to the Variant m.3243A>G","authors":"J. Finsterer, Sinda Zarrouk","doi":"10.1155/2022/7846852","DOIUrl":"https://doi.org/10.1155/2022/7846852","url":null,"abstract":"Objectives Fatigue and exercise intolerance have been only rarely reported as initial- and sole-onset manifestations of a mitochondrial disorder (MID). We present a patient with nonsyndromic MID with fatigue and exercise intolerance as its initial manifestations of the disease. Case Report. A 39 yo female experienced fatigue since age 18 and exercise intolerance since age 21. Later on, she developed Hashimoto thyroiditis, recurrent diffuse headache, and double vision upon exercise. Clinical exam revealed short stature, bilateral ptosis, partially reduced tendon reflexes, and hypertrophic calves. Serum lactate was elevated, and the lactate stress test was abnormal. Workup for suspected MID revealed ragged-red fibers and NADH-deficient muscle fibers, and biochemical investigations revealed a mild complex-I defect. mtDNA sequencing revealed the variant m.3243A>G with a heteroplasmy rate of 70% in the muscle. Conclusions This case shows that the initial manifestation of a MID can be fatigue and exercise intolerance. MIDs due to the m.3243A>G variant may have a slowly progressive course and only delayed multisystem involvement. The variant m.3243A>G may not only manifest as syndromic MID, particularly MELAS but also as nonsyndromic phenotype. MIDs should be considered as differentials of chronic fatigue even if no other phenotypic manifestation of a MID is present.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"74 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75889139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and Delayed Rebound Intracranial Hypertension following Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension","authors":"E. Jafari, M. Karaminia, M. Togha","doi":"10.1155/2022/5637276","DOIUrl":"https://doi.org/10.1155/2022/5637276","url":null,"abstract":"Background Spontaneous intracranial hypotension (SIH) is a secondary headache that has been attributed to a cerebrospinal fluid (CSF) leak. It may resolve spontaneously or require conservative treatment. An epidural blood patch (EBP) with autologous blood is performed in cases exhibiting an inadequate response to conservative methods. Rebound intracranial hypertension (RIH) can develop following an EBP in up to 27% of patients. It is characterized by a change in the headache features and is often accompanied by nausea, blurred vision, and diplopia. Symptoms commonly begin within the first 36 hours, but could develop over days to weeks. It is important to differentiate this rebound phenomenon from unimproved SIH, as the treatment options differ. Case Presentation. Here, we present an interesting case of a patient with SIH who was treated with EBP and developed both immediate RIH after 24 hours and delayed RIH 3 weeks following EBP. Conclusions Following EBP for treatment of SIH, new onset of headache having a different pattern and location should always be monitored for the occurrence of RIH. A lumbar puncture should be done if the symptoms of elevated CSF pressure become intolerable or if the diagnosis is uncertain. Lack of early diagnosis and treatment and differentiation from SIH can cause complications and could affect the optic nerves.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"4 3","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72465044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demyelinating Neurological Adverse Events following the Use of Anti-TNF-α Agents: A Double-Edged Sword","authors":"Miral H Gharib, M. AlKahlout, Beatriz Garcia Canibano, Dirk Theophiel Deleu, Hani Malallah AlEssa, S. AlEmadi","doi":"10.1155/2022/3784938","DOIUrl":"https://doi.org/10.1155/2022/3784938","url":null,"abstract":"Background Tumor necrosis factor antagonists (anti-TNF-α) are an established therapeutic option for several autoimmune and inflammatory bowel diseases. Despite their clinical effectiveness, neurological adverse events have been reported, and literature data suggest a potential role of anti-TNF-α in the induction of demyelination. Case Presentation. In this series, we present three cases of demyelination after the use of anti-TNF-α agents. The first case involved a 21-year-old man with HLA-B27 negative peripheral spondylarthritis who had been taking adalimumab for 2 years. He developed headache, urinary incontinence, and bilateral lower extremity numbness that progressed to the middle of the trunk for 2 days. Magnetic resonance imaging (MRI) showed multiple hyperintense enhancement lesions in the left paramedian anterior pons consistent with multiple sclerosis (MS). The second case included a 17-year-old woman who was on 2 years of adalimumab treatment for juvenile idiopathic arthritis and chronic anterior uveitis and developed new-onset dizziness and tremors. The clinical examination showed signs of cerebellar dysfunction. MRI findings were consistent with multiple sclerosis. The third case was a 34-year-old male who was on 5 years of infliximab treatment for ankylosing spondylitis when he developed left hand numbness and weakness. Cerebrospinal fluid (CSF) analysis and MRI findings were consistent with demyelination. Discontinuation of tumor necrosis factor antagonists (anti-TNF-α) resulted in resolution of the symptoms with no recurrence in the first case, but there was evidence of recurrence in the other 2 cases, where one was managed with rituximab and the second one improved with pulse steroid therapy. Conclusion Despite the small number of patients, our series adds to the growing body of evidence supporting a causal link between anti-TNF-α agents and demyelination. Thus, we can conclude that on suspicion of any neurological side effects, early discontinuation of the TNF-α blockers and requesting urgent MRI scan to confirm the diagnosis is of utmost importance.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"1205 ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72494887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance-Guided Diagnosis of Spontaneous Intracranial Hypotension in a Middle-Aged Woman","authors":"Jordan Hughes, Briana Chavez","doi":"10.1155/2022/4438923","DOIUrl":"https://doi.org/10.1155/2022/4438923","url":null,"abstract":"Spontaneous intracranial hypotension (SIH) is a rare condition caused by a cerebrospinal fluid (CSF) leak. It is diagnosed by clinical features that include an orthostatic headache combined with imaging findings demonstrating intracranial hypotension and a CSF leak. We present the case of a 45-year-old woman with an orthostatic headache who was found to have a sagging brain with a downward-displaced cerebellum and pachymeningeal enhancement with gadolinium contrast. This was initially misidentified as a Chiari I malformation, but the constellation of symptoms and MRI findings were later recognized as characteristic of SIH. Diagnosis of SIH and a CSF leak was confirmed with CT myelography. She was treated with a nontarget epidural blood patch, and her symptoms resolved. An orthostatic headache, a sagging brain, and pachymeningeal enhancement on MRI are highly specific for SIH, raising suspicion for this uncommon and often missed diagnosis.","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90071501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}