Case Reports in Neurological Medicine最新文献

{"title":"Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review.","authors":"Raman Sohal,&nbsp;Steven H Adams,&nbsp;Vishal Phogat,&nbsp;Abha Harish,&nbsp;Carlos Ynigo D Lopez,&nbsp;Michael P A Williams,&nbsp;Kamal K Khurana,&nbsp;Basel Abuzuaiter,&nbsp;Nia Jagroop,&nbsp;Bhavya Narapureddy","doi":"10.1155/2020/5269352","DOIUrl":"https://doi.org/10.1155/2020/5269352","url":null,"abstract":"<p><strong>Introduction: </strong>Paraneoplastic limbic encephalitis (PLE) is a rare disease that presents as rapid onset dementia characterized by short-term memory loss (STM), anxiety, and behavioral changes. Anti-NMDAR antibodies are unfrequently reported in PLE associated with small-cell lung cancer (SCLC). Given that PLE can precede the diagnosis of cancer, it is very important that once infectious, metabolic, nutritional, or structural disorders associated with short-term memory loss are ruled out that vigorous effort must be made to rule out underlying malignancy.</p><p><strong>Case: </strong>We report a rare case of PLE as the presenting symptom of SCLC. A 72-year-old male with history of COPD was brought to the ED by his wife after he was found to have short-term memory loss, including forgetfulness of his wedding anniversary the day before, and anxiety. Neurological exam showed impaired short-term recall on MOCA. CT head showed no evidence of infarct. Lumbar puncture was performed which showed lymphocytic pleocytosis, a nonspecific inflammatory change. CSF panel was negative for HSV, <i>Neisseria</i>, <i>Hemophilus</i>, <i>E. coli</i>, and HIV. Initial EEG was unremarkable, though a repeat EEG showed mild slowing of the posterior dominant rhythm consistent with mild encephalopathy. MRI showed equivocal increased FLAIR on T2-weighted images in the bilateral temporal lobes, left greater than right. CTA thorax showed bulky mediastinal and right hilar LAD. FNA of the R4 lymph node revealed SCLC. The NM bone scan showed no osteoblastic lesions. While the serum autoantibody panel was positive for anti-NMDAR, the CSF autoantibody panel returned entirely negative. Chemotherapy with etoposide and cisplatin was started on Day 4 of admission. The patient's neurological symptoms showed improvement following chemotherapy.</p><p><strong>Conclusion: </strong>This case highlights the importance of recognizing short-term memory loss as a feature of PLE.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"5269352"},"PeriodicalIF":0.9,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5269352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38068697","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":"Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula.","authors":"Yuwa Oka, Kenichi Komatsu, Soichiro Abe, Naoya Yoshimoto, Junya Taki, Sadayuki Matsumoto","doi":"10.1155/2020/2630959","DOIUrl":"10.1155/2020/2630959","url":null,"abstract":"<p><p>Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"2630959"},"PeriodicalIF":0.9,"publicationDate":"2020-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38052548","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":"Manganese Neurotoxicity as a Complication of Chronic Total Parenteral Nutrition.","authors":"Alisha Khan,&nbsp;Jonathan Hingre,&nbsp;Amit S Dhamoon","doi":"10.1155/2020/9484028","DOIUrl":"https://doi.org/10.1155/2020/9484028","url":null,"abstract":"<p><p>Manganese accumulation in the central nervous system creates clinical symptoms of cognitive dysfunction, behavioral changes, and movement disorders resembling Parkinson's disease. Radiographic features of this rare clinical entity include symmetric T1 hyperintensities in the bilateral globus pallidi, with corresponding hypointensities on T2-weighted images. Total parenteral nutrition (TPN) is an increasingly used potentially lifesaving therapy for patients who cannot tolerate enteral nutrition. However, when used over a period of several weeks to months, its associated risks and complications carry significant morbidity and mortality. One of the more rare complications of TPN use is manganese toxicity. We provided care for a 38-year-old female on chronic TPN who presented to the hospital with Parkinsonian features, confusion, falls, and lethargy. MRI brain showed T1 hyperintensities in the bilateral globus pallidi, which were attributed to manganese toxicity from chronic TPN use. Supporting evidence for this rare entity included decreased signal intensity in the bilateral globus pallidi on T2-weighted images and T1 hyperintensities in the substantia nigra. With antifungal treatment and permanent cessation of TPN, her mentation and neurological symptoms began to improve within a week. Repeat MRI brain performed one month after discontinuation of TPN revealed improvement of the T1 hyperintensities in the bilateral globus pallidi. Our objective in presenting this case is to highlight manganese neurotoxicity as a rare complication of TPN in a patient without known hepatic dysfunction and to emphasize the importance of routinely monitoring patients for the possible adverse effects of chronic TPN. Our case is among the handful of published cases in which a patient without known liver dysfunction, which is the primary organ responsible for manganese elimination from the body, developed manganese neurotoxicity.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"9484028"},"PeriodicalIF":0.9,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9484028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37904546","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":"Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient.","authors":"Lindsey Dalka,&nbsp;Antoine Harb,&nbsp;Kael Mikesell,&nbsp;Gillian Gordon Perue","doi":"10.1155/2020/4536145","DOIUrl":"https://doi.org/10.1155/2020/4536145","url":null,"abstract":"<p><p>Multiple sclerosis (MS) is a relapse remitting immune-mediated demyelinating neurological disorder that primarily affects women of childbearing age. In most patients, the hormonal changes during pregnancy are protective against MS relapses. When relapses do occur, treatment options are limited to use of intravenous steroids and plasmapheresis rescue therapy. We present a case of steroid refractory MS-transverse myelitis with quadriplegia in a 25-year-old pregnant super morbidly obese woman. Our clinical case is unique because the severity of her relapse early in pregnancy, which was intractable and resistant to steroids. This may have been a rebound demyelination due to the discontinuation of fingolimod; a newly recognized entity by the FDA. Our case report therefore seeks to raise awareness about a potential complication of discontinuing MS disease modifying therapies, highlighting that these rebound relapses can be steroid resistant and occur despite the usual protective hormonal influence of early pregnancy and that plasma exchange is a valid treatment option. Finally, we discuss the challenges of determining exchange volumes for plasmapheresis in the super morbid obese population to secure good maternal and fetal outcomes.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"4536145"},"PeriodicalIF":0.9,"publicationDate":"2020-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4536145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37853721","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":"Contrast-Induced Encephalopathy following Cerebral Angiography in a Hemodialysis Patient.","authors":"Marija Bender,&nbsp;Gojko Bogdan,&nbsp;Dorijan Radančević,&nbsp;Nataša Pejanović-Škobić","doi":"10.1155/2020/3985231","DOIUrl":"https://doi.org/10.1155/2020/3985231","url":null,"abstract":"<p><p>Contrast-induced encephalopathy (CIE) is a rare complication of contrast media use during angiographic procedures. With the growing use of endovascular interventions, this complication is likely to become more common. We present a case of a 46-year-old woman with hypertension, hypothyroidism, and chronic renal failure. She developed CIE following cerebral angiography for diagnosis of intracranial aneurysm. We had a high index of suspicion for CIE, excluded the most common differential such as stroke, and immediately started hemodialysis with a short course of corticosteroids. The disease runs a benign course, and neurological symptoms resolved completely after five days. We emphasize the need for increased awareness of CIE to make a valid diagnosis and to start supportive therapy as soon as possible.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"3985231"},"PeriodicalIF":0.9,"publicationDate":"2020-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3985231","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37853720","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":"Composite Anatomical Variations between the Sciatic Nerve and the Piriformis Muscle: A Nepalese Cadaveric Study.","authors":"Ameet Kumar Jha,&nbsp;Prakash Baral","doi":"10.1155/2020/7165818","DOIUrl":"https://doi.org/10.1155/2020/7165818","url":null,"abstract":"<p><p>Piriformis syndrome is a rare syndrome which is one of the main causes of nondiscogenic sciatica causing severe low back pain due to entrapment of sciatic nerve either by the hypertrophy or by inflammation of the piriformis muscle. We have carried out dissection in 20 Nepalese cadavers. Out of 40 dissected gluteal regions, 37 exhibited typical appearance of sciatic nerve, piriformis muscle, and their relations resembling type-a, whereas 3 gluteal regions showed composite structural variations resembling type-b and type-c based on Beaton and Anson's classification. Knowledge pertaining to such variations will be helpful during a surgical intervention in the gluteal region and in turn reduces the risk of injuring these nerves which are more susceptible to damage. Our study reports such variations in Nepalese population which will be helpful during evaluation of the pain induction in various test positions and also useful for analysis of the range of the neurological deficiency in sciatic nerve neuropathies. The present study also explains the basis of the unsuccessful attempt of the sciatic nerve block during popliteal block anaesthesia.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"7165818"},"PeriodicalIF":0.9,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/7165818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37835405","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 Features of Painful Ophthalmoplegia with a High-Intensity Ring Appearance around the Optic Nerve on MRI: A Case Series.","authors":"Yasunobu Nosaki,&nbsp;Ken Ohyama,&nbsp;Maki Watanabe,&nbsp;Takamasa Yokoi,&nbsp;Katsushige Iwai","doi":"10.1155/2020/6737018","DOIUrl":"https://doi.org/10.1155/2020/6737018","url":null,"abstract":"<p><strong>Objective: </strong>Painful ophthalmoplegia includes nonspecific magnetic resonance imaging (MRI) manifestations and various clinical features including orbital pain and cranial nerve palsies. Treatment for painful ophthalmoplegia remains controversial. The aim of this report was to describe detailed clinical features, MRI findings, treatments, and prognosis of patients with painful ophthalmoplegia. <i>Patients and Methods</i>. We retrospectively investigated four cases of patients with painful ophthalmoplegia diagnosed using the International Classification of Headache Disorders, 3rd edition.</p><p><strong>Results: </strong>All patients experienced unilateral orbital pain and oculomotor nerve palsy with diplopia but no vision loss. One of the four patients was diagnosed with Tolosa-Hunt syndrome based on the appearance of a granulomatous inflammation of the cavernous sinus on MRI. No specific lesions were detected on brain MRI for the other three patients; therefore, their headaches were attributed to ischaemic ocular motor nerve palsy. In all patients, a high-intensity ring appearance around the ipsilateral optic nerve was observed on MRI. Steroid therapy was administered to these patients, and good prognoses were anticipated.</p><p><strong>Conclusion: </strong>These results indicate that prednisolone is a useful treatment for painful ophthalmoplegia that displays ipsilateral hyperintense ring lesions around the optic nerve on MRI, regardless of the presence of granulomatous inflammation of the cavernous sinus.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"6737018"},"PeriodicalIF":0.9,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/6737018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37835404","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":"Effect of Zolpidem in the Aftermath of Traumatic Brain Injury: An MEG Study.","authors":"Praveen Sripad,&nbsp;Jessica Rosenberg,&nbsp;Frank Boers,&nbsp;Christian P Filss,&nbsp;Norbert Galldiks,&nbsp;Karl-Josef Langen,&nbsp;Ralf Clauss,&nbsp;N Jon Shah,&nbsp;Jürgen Dammers","doi":"10.1155/2020/8597062","DOIUrl":"https://doi.org/10.1155/2020/8597062","url":null,"abstract":"<p><p>In the past two decades, many studies have shown the paradoxical efficacy of zolpidem, a hypnotic used to induce sleep, in transiently alleviating various disorders of consciousness such as traumatic brain injury (TBI), dystonia, and Parkinson's disease. The mechanism of action of this effect of zolpidem is of great research interest. In this case study, we use magnetoencephalography (MEG) to investigate a fully conscious, ex-coma patient who suffered from neurological difficulties for a few years due to traumatic brain injury. For a few years after injury, the patient was under medication with zolpidem that drastically improved his symptoms. MEG recordings taken before and after zolpidem showed a reduction in power in the theta-alpha (4-12 Hz) and lower beta (15-20 Hz) frequency bands. An increase in power after zolpidem intake was found in the higher beta/lower gamma (20-43 Hz) frequency band. Source level functional connectivity measured using weighted-phase lag index showed changes after zolpidem intake. Stronger connectivity between left frontal and temporal brain regions was observed. We report that zolpidem induces a change in MEG resting power and functional connectivity in the patient. MEG is an informative and sensitive tool to detect changes in brain activity for TBI.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"8597062"},"PeriodicalIF":0.9,"publicationDate":"2020-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8597062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37808699","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":"Into a Shaking Limbo: Case Report of a Nonneoplastic Limbic Encephalitis with Faciobrachial Dystonic Seizures and Parkinsonism.","authors":"Vijay Renga","doi":"10.1155/2020/3796807","DOIUrl":"https://doi.org/10.1155/2020/3796807","url":null,"abstract":"<p><p>This case report describes a rare but classic presentation of a non-paraneoplastic, antibody-mediated limbic encephalitis. The clinical course did put us in a limbo as it evolved from seizure to Parkinsonism and then from metastasis to stroke, before it finally announced itself by its pathognomonic finding. Knowledge of this rare condition is important as early identification and treatment can change the course.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"3796807"},"PeriodicalIF":0.9,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3796807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37808775","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":"Bilateral Femoral Neuropathy: A Rare Complication of Drug Overdose due to Prolonged Posturing in Lithotomy Position.","authors":"D Tsiptsios,&nbsp;D Daud,&nbsp;K Tsamakis,&nbsp;E Rizos,&nbsp;A Anastadiadis,&nbsp;A Cassidy","doi":"10.1155/2020/2352850","DOIUrl":"https://doi.org/10.1155/2020/2352850","url":null,"abstract":"<p><strong>Background: </strong>Bilateral femoral neuropathy is an uncommon complication of various surgical and nonsurgical procedures, such as pelvic/abdominal surgery or vaginal delivery. <i>Case Report</i>. We report a case of a 41-year-old male who was found unresponsive against the wall in a \"lithotomy-type\" position with both knees flexed at approximately 90 degrees and both hips flexed and externally rotated at approximately 90 and 60 degrees, respectively, 24-48 hours after a drug overdose (combination of dihydrocodeine, paracetamol, diazepam, and amitriptyline). During his recovery, he complained of severe bilateral proximal lower limb weakness and bilateral distal lower limb pain and allodynia. His symptoms were initially attributed to critical illness myopathy/neuropathy (CIMN). However, thorough clinical and neurophysiological evaluation revealed that his symptoms were due to severe bilateral femoral neuropathies.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first reported case of bilateral femoral nerve palsy due to prolonged posturing in a \"lithotomy-type\" position in the context of a drug overdose.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":"2020 ","pages":"2352850"},"PeriodicalIF":0.9,"publicationDate":"2020-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2352850","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37788639","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}