Case Reports in Neurological Medicine最新文献

{"title":"\"At-Home\" Photobiomodulation: A New Approach for Bell's Palsy Treatment.","authors":"Carlo Fornaini,&nbsp;Zhao Meng,&nbsp;Elisabetta Merigo,&nbsp;Jean-Paul Rocca","doi":"10.1155/2021/5043458","DOIUrl":"https://doi.org/10.1155/2021/5043458","url":null,"abstract":"<p><strong>Objective: </strong>This report is the first one to describe the possibility to use \"self-administered\" photobiomodulation (PBM) for Bell's palsy (BP) treatment.</p><p><strong>Background: </strong>BP is a peripheral disorder of the facial nerve causing sudden paralysis of unilateral facial muscles, and PBM has been successfully suggested for its treatment without any side effect. This is the first case report where a laser device was successfully used at home by the patient herself to treat BP opening new perspectives on the therapy of this disease.</p><p><strong>Methods: </strong>This report describes the \"at-home PBM\" treatment performed on a 15-year-old girl who presented BP consisting of acute pain on the right side of her face, difficulty in biting and dripping saliva from the right side of her lips. The treatment was performed twice a day by cutaneous applications, each of 15 minutes (total fluence 48 J/cm²) in an area corresponding to the parotid gland by a device emitting at 808 nm at 250 mW output power.</p><p><strong>Results: </strong>Two weeks after PBM treatment, performed at home twice a day by the patient herself without any kind of pharmacological therapy, the complete disappearing of the disease was noticed with no side effects.</p><p><strong>Conclusion: </strong>With the limitations due to a single case report and with the need of further clinical trials to confirm it, \"at-home PBM\" seems to represent a good and safe approach to the treatment of BP.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"5043458"},"PeriodicalIF":0.9,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39443836","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":"Successful Treatment of Incomplete Susac Syndrome with Simultaneous Corticosteroids and Plasmapheresis Followed by Rituximab.","authors":"Mick B Reedy,&nbsp;Yanping Wang,&nbsp;Brad R Beinlich,&nbsp;William Nicholas Rose","doi":"10.1155/2021/5591559","DOIUrl":"https://doi.org/10.1155/2021/5591559","url":null,"abstract":"<p><p>We present a case report of a patient with incomplete Susac syndrome. He had cognitive impairment, corpus callosum lesions, and vestibulocochlear dysfunction on brainstem auditory evoked responses. He was treated with methylprednisolone and plasmapheresis, improved, and then, also received rituximab. His improvement has been lasting as of this writing. This case shares our experience with a successful treatment of this rare condition that is incompletely understood and lacks well-established treatment guidelines.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"5591559"},"PeriodicalIF":0.9,"publicationDate":"2021-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39475406","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 Hodgkin's Disease Presenting as a Clinically Isolated Cavernous Sinus Syndrome.","authors":"Aayesha Jalaluddin Soni,&nbsp;Edward Bernard Lee-Pan","doi":"10.1155/2021/3946231","DOIUrl":"https://doi.org/10.1155/2021/3946231","url":null,"abstract":"<p><strong>Background: </strong>Hodgkin's disease involving the central nervous system is uncommon and is usually seen in patients with uncontrolled systemic disease or those who have had multiple episodes of recurrent disease. Common symptoms of intracranial Hodgkin's disease are motor and/or sensory deficits, headache, papilloedema, coma, and seizures. The rarity of Hodgkin's disease presenting with intracranial involvement is marked, but patients presenting with cavernous sinus syndrome is even rarer. Despite its rarity, the presence of a cavernous sinus syndrome in a patient with a known history of Hodgkin's disease warrants full utilization of modern diagnostic techniques in terms of investigation. <i>Case Presentation</i>. A 34-year-old woman, known with previous Hodgkin's lymphoma and now in remission for the past 7 years, presented with signs and symptoms suggestive of a left cavernous sinus syndrome. She was otherwise systemically well with no other complaints. Extensive investigations revealed no obvious cause for the cavernous sinus syndrome. A CT chest revealed subclinical axillary lymphadenopathy, which on excisional biopsy confirmed recurrent Hodgkin's disease. The patient's sole clinical presentation of her recurrent disease was the cavernous sinus syndrome, with no other clinically obvious systemic signs or symptoms to suggest a relapse. This was treated with steroids, and clinical improvement was noted; she was referred to oncology for extensive chemotherapy.</p><p><strong>Conclusions: </strong>Whilst there is a paucity of literature around this topic, it must be remembered by the clinician that cavernous sinus syndrome may be the sole clinical presentation of recurrent Hodgkin's disease. Even though it is reported that lymphomatous involvement in the brain usually occurs late in the disease process, this case is evidence that cavernous sinus syndrome may precede other systemic signs and symptoms. Recognising this possibility will ensure a rigorous search for Hodgkin's disease, an early and effective diagnosis, and a better prognosis in affected patients.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"3946231"},"PeriodicalIF":0.9,"publicationDate":"2021-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39329111","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":"Novel Mutation in <i>CACNA1A</i> Associated with Activity-Induced Dystonia, Cervical Dystonia, and Mild Ataxia.","authors":"Benjamin Stampfl,&nbsp;Dominic Fee","doi":"10.1155/2021/7797770","DOIUrl":"https://doi.org/10.1155/2021/7797770","url":null,"abstract":"<p><p><i>CACNA1A</i> encodes the pore-forming <i>α</i>1 subunit of the neuronal voltage-gated Cav2.1 (P/Q-type) channels, which are predominantly localized at the presynaptic terminals of the brain and cerebellar neurons and play an important role in controlling neurotransmitter release. Mutations in <i>CACNA1A</i> have been associated with several autosomal dominant neurologic disorders, including familial hemiplegic migraine type 1, episodic ataxia type 2 (EA2), and spinocerebellar ataxia type 6. A 37-year-old woman presented with a history of slowly progressive, activity-induced stiffness, and pain in her right leg since age 15 and cervical dystonia since age 20. She denied any right leg stiffness or pain at rest, but when she began to walk, her right foot turned in and her right leg stiffened up. She also had neck pain, stiffness, and spams. There was no family history of similar symptoms. On physical exam, her strength, tone, and reflexes were normal in all extremities at rest. There was mild head titubation and very mild past pointing on finger-to-nose testing. MRI of the brain and spinal cord was unremarkable. This patient's clinical picture was felt to be most consistent with paroxysmal kinesigenic dyskinesia, as she has attacks of dystonia that are triggered by voluntary movement, last from a few seconds to a minute, and are relieved with rest. She was trialed on carbidopa/levodopa without improvement. A dystonia panel showed two potentially pathologic mutations, one in <i>CACNA1A</i> and the other in <i>PNKP</i>, along with a variant of unknown significance in <i>ATP7B</i>. The mutation in <i>CACNA1A</i> is C2324 G < A. It is heterozygous, autosomal dominant, and computer modeling suggests pathogenicity. This mutation has not been reported previously and is likely the cause of her paroxysmal dystonia; dystonia is sometimes seen during episodes of ataxia in EA2, and <i>CACNA1A</i> knockout mice exhibit dystonia and cerebellar atrophy. After receiving her genetic diagnosis, the patient was trialed on acetazolamide without improvement in her dystonia symptoms. This is the second case report of a patient with cervical dystonia and cerebellar ataxia associated with a mutation in <i>CACNA1A</i>.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"7797770"},"PeriodicalIF":0.9,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39313527","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 Dysgraphia after Cerebellar Infarction Where Functional NIRS Guided the Task Aimed at Activating the Hypoperfused Region.","authors":"Mutsumi Fujii,&nbsp;Kazumi Tanigo,&nbsp;Hirokazu Yamamoto,&nbsp;Keijyu Kikugawa,&nbsp;Masayuki Shirakawa,&nbsp;Miki Ohgushi,&nbsp;Takaaki Chin","doi":"10.1155/2021/6612541","DOIUrl":"https://doi.org/10.1155/2021/6612541","url":null,"abstract":"<p><strong>Background: </strong>Linguistic impairment following cerebellar lesions is characterized by a marked cerebellocerebral diaschisis with decreased perfusion in the left cerebral hemisphere.</p><p><strong>Case: </strong>We report on a 60-year-old right-handed French chef who presented with linguistic deficits following a right cerebellar infarction. Neurolinguistic examinations in the acute phase showed impaired graphomotor planning, especially for kanji (Japanese morphograms). Despite the absence of any structural damage to the supratentorial brain regions, a quantitative ¹²³I-IMP SPECT study revealed a relative hypoperfusion, mainly around the left posterior middle temporal gyrus, considered to be a crossed cerebellar-cerebral diaschisis. We performed functional near-infrared spectroscopy (fNIRS) and observed that a picture card task could increase blood perfusion in the affected area. This task was as follows: once he saw a picture card depicting a dish, the patient had to list the ingredients that make up the dish. For example, he had to name vegetables, meat, and spices upon seeing a \"curry\" picture card. We added this task to his daily speech-hearing therapy regimen. In the chronic phase, we confirmed symptom amelioration in linguistic performance-paralleled reduction in the level of hypoperfusion on SPECT study. <i>Discussion</i>. This case is the first report of an fNIRS approach used to evaluate evidence-based prospective speech-hearing tasks by observing blood flow to the hypoperfused area of the cerebral cortex surface.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"6612541"},"PeriodicalIF":0.9,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39183097","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":"Vertigo and Cytotoxic Lesions of the Corpus Callosum: Report with Review of the Literature.","authors":"John Rolshoven,&nbsp;Katelyn Fellows,&nbsp;Rolando Ania,&nbsp;Burton J Tabaac","doi":"10.1155/2021/5573822","DOIUrl":"https://doi.org/10.1155/2021/5573822","url":null,"abstract":"<p><strong>Background: </strong>The term cytotoxic lesions of the corpus callosum (CLOCCs) encompasses the entity reversible splenial lesion syndrome (RESLES). RESLES typically presents with altered levels of consciousness, seizures, and delirium and is distinguished radiographically by reversible focal lesions of the splenium of the corpus callosum. This disease pathology is associated with withdrawal of antiepileptic medications, infections, metabolic disturbance, or high-altitude cerebral edema.</p><p><strong>Methods: </strong>We presented an otherwise healthy 72-year-old female that was consulted for an episode of isolated vertigo lasting four hours. Initial workup included CT head without contrast, CT angiogram head and neck, and MRI brain with and without contrast. The patient experienced recurrent episodes of vertigo at one and four months after initial presentation. An extensive workup at one month included a wide spectrum of laboratory tests and repeat imaging.</p><p><strong>Results: </strong>Noncontrast CT of the head and CT angiogram of the head and neck were reassuring. MRI brain with and without contrast demonstrated hyperintensity in the splenium of the corpus callosum on FLAIR sequencing. A follow-up visit at one month revealed vitamin B12 deficiency and unchanged hyperintensity of the splenium of the corpus callosum. History and workup were negative for typical risk factors associated with RESLES.</p><p><strong>Conclusion: </strong>An otherwise healthy patient who presented with an isolated episode of vertigo was discovered to demonstrate radiographic features consistent with RESLES but lacked the common risk factors and typical presentation of RESLES. This case expands the possible clinical presentation of RESLES and highlights the possible relationship between vitamin B12 deficiency and radiographic features of RESLES.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"5573822"},"PeriodicalIF":0.9,"publicationDate":"2021-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39167281","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":"Diffuse Gonococcal Infection (DGI) in a Patient with Treatment-Refractory Acetylcholine Receptor Antibody-Positive (AChR+) Generalized Myasthenia Gravis (gMG) Treated with Eculizumab.","authors":"Nakul Katyal,&nbsp;Latika Nirola,&nbsp;Naureen Narula,&nbsp;Raghav Govindarajan","doi":"10.1155/2021/9713413","DOIUrl":"https://doi.org/10.1155/2021/9713413","url":null,"abstract":"<p><p>Patients receiving complement inhibitor, eculizumab, are at high risk for infections with encapsulated organisms such as <i>Neisseria</i> due to impaired opsonophagocytic activity. Impaired complement immunity may increase the risk for dissemination of asymptomatic <i>Neisseria gonorrhoeae</i>. Disseminated Gonococcal Infection (DGI) is a rare but potentially life-threatening complication associated with eculizumab. Physicians should obtain adequate sexual histories from the patients and educate them on safe sexual practices. Here, we describe a case of DGI in a 32-year-old African American female patient with acetylcholine receptor antibody-positive (AChR+) generalized myasthenia gravis (gMG), receiving eculizumab.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"9713413"},"PeriodicalIF":0.9,"publicationDate":"2021-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39162944","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":"Protracted COVID-19 during Treatment of Facial Palsy.","authors":"Mehrdad Hasibi,&nbsp;Maral Seyed Ahadi,&nbsp;Hamed Abdollahi,&nbsp;Mehrdad Jafari","doi":"10.1155/2021/5569841","DOIUrl":"https://doi.org/10.1155/2021/5569841","url":null,"abstract":"<p><p>Neurologic manifestations are increasingly reported as the coronavirus disease 2019 (COVID-19) pandemic continues. This is a report of a COVID-19 patient with Bell's palsy. Case Summary. A 52-year-old man with fever and malaise was tested positive for COVID-19. After a week, he developed right-sided peripheral facial palsy and was treated with corticosteroids in conjunction with antiviral treatment which resulted in complete recovery. Discussion. Concomitant treatment of corticosteroids and antiviral treatment can decrease morbidity in patients with COVID-19-related Bell's palsy.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"5569841"},"PeriodicalIF":0.9,"publicationDate":"2021-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39141380","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":"HaNDL Syndrome Presenting with Thunderclap Headache.","authors":"Melvin Parasram,&nbsp;Ashwin Malhotra,&nbsp;Andrea S Yoo,&nbsp;Saad A Mir","doi":"10.1155/2021/9925004","DOIUrl":"https://doi.org/10.1155/2021/9925004","url":null,"abstract":"<p><strong>Introduction: </strong>Transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) is defined as a secondary, nonvascular headache disorder characterized by the findings described in its name. Patients with HaNDL syndrome typically present with gradual onset migrainous headaches of moderate to severe intensity with transient neurological symptoms. <i>Case Report</i>. We discuss a patient who presented with thunderclap headache, recent transient neurologic deficits, and was ultimately diagnosed with HaNDL after an extensive neurologic evaluation.</p><p><strong>Conclusion: </strong>Thunderclap headache has very rarely been described in patients with HaNDL. After excluding emergent and secondary causes, HaNDL should be considered in patients with thunderclap-quality headaches, particularly when there is a history of transient neurological symptoms.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"9925004"},"PeriodicalIF":0.9,"publicationDate":"2021-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39058192","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":"Posterior Reversible Leukoencephalopathy Syndrome in a Patient after Acute COVID-19 Infection.","authors":"Ketino Kobaidze,&nbsp;Yoo Mee Shin,&nbsp;Mariam Japaridze,&nbsp;Ioannis Karakis,&nbsp;Xin Wu","doi":"10.1155/2021/5564802","DOIUrl":"https://doi.org/10.1155/2021/5564802","url":null,"abstract":"<p><p>The SARS-CoV-2 infection affects numerous organs, including the central nervous system. The neuroinvasive abilities and neuroinflammation may lead to short- and long-term neurological manifestations. Among neurological disorders associated with SARS-CoV-2 infection, posterior reversible encephalopathy syndrome (PRES) has been described in a few case-based observational studies during the acute phase of COVID-19 hospitalization. We present a case of a patient who developed seizures and PRES after recovering from an acute severe COVID-19 infection. A 90-year-old African American female with multiple comorbidities and a severe COVID-19 infection was discharged home in stable condition after two weeks of hospitalization. A week later, she developed new-onset generalized tonic-clonic seizures requiring readmission to the hospital. The patient's clinical course and brain imaging supported PRES. Her mentation returned to baseline with supportive care and anticonvulsant treatment. Follow-up brain MRI four months later demonstrated resolution of FLAIR signal abnormalities confirming PRES. SARS-CoV-2 insult on the cerebrovascular endothelial cells likely continued and despite the clinical recovery eventually resulted in PRES. We believe that this is the first case describing the presentation of PRES after recovery from severe acute COVID-19 infection.</p>","PeriodicalId":9615,"journal":{"name":"Case Reports in Neurological Medicine","volume":" ","pages":"5564802"},"PeriodicalIF":0.9,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39000037","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}