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Neurologist

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https://www.readbyqxmd.com/read/29722747/is-adjunctive-progesterone-effective-in-reducing-seizure-frequency-in-patients-with-intractable-catamenial-epilepsy-a-critically-appraised-topic
#1
Cristina Valencia-Sanchez, Amy Z Crepeau, Matthew T Hoerth, Kristina A Butler, Diana Almader-Douglas, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: Catamenial epilepsy refers to cyclic seizure exacerbation in relation to the menstrual cycle. Three distinct patterns have been described: C1-perimenstrual, C2-periovulatory, and C3-inadequate luteal. There is experimental and clinical evidence that gonadal steroid hormones affect neuronal excitability with estrogens being mainly proconvulsant and progesterone anticonvulsant. If reproductive steroids have a role in seizure occurrence, they may also have a role in treatment...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722746/spot-sign-in-acute-intracerebral-hemorrhage-in-magnetic-resonance-imaging-a-case-report-and-review-of-the-literature
#2
Zalan Khan, Premkumar Nattanmai, Pravin George, Christopher R Newey
INTRODUCTION: Intracranial hemorrhage (ICH) is associated with significant mortality and morbidity. Current treatment paradigms focus on correcting hypertension and coagulopathy to prevent hematoma expansion. Magnetic resonance imaging (MRI) is becoming more common in the hyperactive phase of ICH management. The finding of contrast extravasation (ie, spot sign) on MRI may be a marker of active bleeding. We present a case of MRI spot sign and review of the literature. CASE REPORT: We present a patient on oral coumadin for history of deep venous thrombosis and pulmonary embolus who presented with a right basal ganglia hemorrhage...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722745/vertebral-artery-occlusion-causing-facial-colliculus-and-opalski-stroke-syndromes-simultaneously
#3
Saeed Alghamdi, Omar Ayoub, Nasser Alzahrani, Hussein Algahtani, Bader Shirah
Brainstem stroke syndromes refer to a group of vascular disorders that occur secondary to occlusion of small perforating arteries of the posterior circulation. Although such syndromes result in a characteristic clinical picture, they are challenging to localize. In practice, such syndromes are rarely seen in their pure form, and the clinical consequences of a given vascular lesion are probably less predictable than for arteries in the anterior circulation. If 2 or more brainstem strokes happen simultaneously, localization becomes much harder...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722744/the-mayo-clinic-experience-with-the-neurological-complications-of-the-ctla-4-inhibitor-ipilimumab
#4
Michael W Ruff, Michelle L Mauermann
Neurological complications are an increasingly recognized complication of the use of the immune checkpoint inhibitors in the treatment of solid tumors. Ipilimumab is a monoclonal antibody against cytotoxic T-lymphocyte antigen-4, an immune checkpoint inhibitor that suppresses T-cell effector function. The clinical spectrum of ipilimumab-associated neurological complications and optimum treatment approach is not established. We describe our institution's experience with ipilimumab and illustrate 2 cases of presumed autoimmune neurological phenomenon resulting from its use...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722743/ongoing-photosensitivity-in-an-elderly-patient-with-jeavons-sydrome
#5
Yeşim Gülen Abanoz, Yasin Abanoz, Çiğdem Özkara
INTRODUCTION: Photosensitivity, which is a main feature of Jeavons syndrome, can be seen in other types of idiopathic or genetic epilepsies with focal or generalized seizures and tends to disappear spontaneously usually in the second decade. Although it responds well to antiepileptic treatment, especially to valproic acid, it may continue into adulthood in rare cases. CASE REPORT: We describe a 63-year-old male patient with eyelid myoclonia with absences, generalized tonic-clonic seizures, and severe photosensitivity accompanied by eyelid myoclonia...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722742/neuromyelitis-optica-and-herpes-simplex-virus-2-a-viral-trigger-for-aquaporin-4-autoimmunity
#6
I Vanessa Marin Collazo, Charles L Howe, Claudia F Lucchinetti, W Oliver Tobin
The clinical and radiographic spectrum of Neuromyelitis optica spectrum disorder has broadened following the description of the aquaporin-4 antibody. The initial triggering event and reason for disease quiescence between relapses is unclear. We present a case of myeloradiculitis associated with aquaporin-4 antibody and concomitant herpes simplex virus 2 infection.
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722741/neuroinvasive-listeriosis-could-petechial-hemorrhages-be-a-diagnostic-clue
#7
Sevda Diker, Serhat Okar, Lale Mehdikhanova, Ethem Murat Arsava, Asli Kurne, Işin Ünal Çevik, Yakut Akyön, Şehnaz Alp, Çağkan İnkaya, Murat Akova, Melike Mut, Rahşan Göçmen, Kader Karli Oğuz, Mehmet Akif Topçuoğlu
INTRODUCTION: Listeria monocytogenes-related central nervous system infections may involve the cerebral parenchyma. Meningitis and meningoencephalitis are the most commonly seen forms and mainly affect immunocompromised patients; however, a less frequent form, rhombencephalitis, can occur in otherwise healthy people. Early treatment with appropriate antibiotic therapy is crucial for this otherwise fatal disorder. However, it is not always possible to rapidly establish the diagnosis because of varying presentations and discrepancies in diagnostic tests...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722740/rheumatoid-meningitis-a-case-review
#8
Angela M Parsons, Leslie A Zuniga, Joseph M Hoxworth, Mark Lyons, Fawad Aslam, Brent P Goodman
INTRODUCTION: Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA) and has a high mortality rate. It can present as a first diagnosis of RA, in long-standing disease, or in active or well-controlled disease. Neurological manifestations vary widely. CASE REPORT: A patient with a 30-year history of RA, well controlled with methotrexate therapy, presented with new-onset seizures. Magnetic resonance imaging showed leptomeningeal and pachymeningeal enhancement...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722739/stroke-severity-affects-timing-time-from-stroke-code-activation-to-initial-imaging-is-longer-in-patients-with-milder-strokes
#9
Kimberly T Kwei, John Liang, Natalie Wilson, Stanley Tuhrim, Mandip Dhamoon
Optimizing the time it takes to get a potential stroke patient to imaging is essential in a rapid stroke response. At our hospital, door-to-imaging time is comprised of 2 time periods: the time before a stroke is recognized, followed by the period after the stroke code is called during which the stroke team assesses and brings the patient to the computed tomography scanner. To control for delays due to triage, we isolated the time period after a potential stroke has been recognized, as few studies have examined the biases of stroke code responders...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29722738/analysis-of-risk-factors-in-patients-with-peripheral-vertigo-or-central-vertigo
#10
Yunlin Wang, Jing Liu, Zhijie Cui, Lili Yan, Jianping Si
INTRODUCTION: This study was aimed to determine risk factors for central vertigo (CV) in patients with isolated vertigo accompanied by hearing loss or not. PATIENTS AND METHODS: Patients with CV or peripheral vertigo (PV) who were admitted to our hospital between January 2014 and July 2016 were retrospectively reviewed. All patients underwent thorough physical examination with detailed medical histories recorded, including smoking, hypertension, diabetes, cardiovascular disease, and stroke history...
May 2018: Neurologist
https://www.readbyqxmd.com/read/29494441/acute-basilar-artery-occlusion-does-recanalization-improve-clinical-outcome-a-critically-appraised-topic
#11
Chia-Chun Chiang, Oana M Dumitrascu, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: Acute basilar artery occlusion (BAO) is a devastating, life-threatening condition that accounts for approximately 1% of all strokes. Currently, there is no consensus on the best treatment strategy for patients with BAO. Whereas endovascular reperfusion therapy is proven to improve outcomes in anterior circulation stroke, its benefit in acute BAO has not been confirmed in randomized controlled trials. OBJECTIVE: To critically assess the current evidence regarding recanalization in acute BAO, and to discuss the outcomes of different treatment strategies in the management of acute BAO...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494440/frequency-of-and-factors-associated-with-obstructive-sleep-apnea-and-periodic-limb-movements-in-stroke-and-tia-patients
#12
Gaurav Gadodia, Srikant Rangaraju, Syed A Raza, Ammar Razzak, Labib Marmarchi, Brittaine Davis, Laura Henriquez, Lynn M Trotti, David Rye, Fadi Nahab
INTRODUCTION: Obstructive sleep apnea (OSA) and periodic limb movements (PLMs) have been associated with an increased risk of cardiovascular disease. There is limited data on the relationship between OSA and PLMs with atrial fibrillation and resistant hypertension in stroke and transient ischemic attack (TIA) patients. METHODS: Consecutive stroke and TIA patients referred by a vascular neurologist for diagnostic polysomnography (PSG) from September 1, 2012 to August 31, 2015 were included in a retrospective analysis...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494439/magnesium-sulfate-treatment-correlates-with-improved-neurological-function-in-posterior-reversible-encephalopathy-syndrome-pres-report-of-a-case
#13
Aakriti Pandita, David F Lehmann
Posterior reversible encephalopathy syndrome (PRES) is a potentially reversible failure of cerebral autoregulation managed by correction of hypertension or underlying medical condition. Nonresponding cases progress to irreversible brain damage. There is some evidence of association of hypomagnesemia with PRES. We describe a case of nonresolving PRES where use of magnesium sulfate led to improvement in neurological function and eventual recovery. Our case highlights the need for a randomized controlled trial to test the efficacy of magnesium in PRES...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494438/admission-systolic-blood-pressure-predicts-the-number-of-blood-pressure-medications-at-discharge-in-patients-with-primary-intracerebral-hemorrhage
#14
Ayaz M Khawaja, Harn Shiue, Amelia K Boehme, Karen C Albright, Anand Venkatraman, Gyanendra Kumar, Michael J Lyerly, Angela Hays-Shapshak, Maira Mirza, Toby I Gropen, Mark R Harrigan
BACKGROUND: Control of systolic blood pressure (SBP) after primary intracerebral hemorrhage improves outcomes. Factors determining the number of blood pressure medications (BPM) required for goal SBP<160 mm Hg at discharge are unknown. We hypothesized that higher admission-SBPs require a greater number of BPM for goal discharge-SBP<160 mm Hg, and investigated factors influencing this goal. MATERIALS AND METHODS: We conducted a retrospective review of 288 patients who presented with primary intracerebral hemorrhage...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494437/autoimmune-encephalitis-with-multiple-autoantibodies-a-diagnostic-and-therapeutic-challenge
#15
Albert E Kim, Peter Kang, Robert C Bucelli, Cole J Ferguson, Robert E Schmidt, Arun S Varadhachary, Gregory S Day
INTRODUCTION: Indications for autoantibody testing in patients with rapid-onset cognitive impairment have expanded in step with the growing number of disease-associated autoantibodies and clinical syndromes. Although increased access to autoantibody testing has broadened our understanding of the spectrum of autoimmune encephalitis (AE), it has also produced new challenges associated with deciphering the contributions of disease-associated autoantibodies in patients with atypical clinical features and/or multiple autoantibodies...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494436/diagnostic-evaluation-in-primary-cns-lymphoma
#16
Rimas V Lukas, Peter Riedell, Peleg M Horowitz, Peter Pytel, David O Kamson
The diagnosis of primary central nervous system lymphoma (PCNSL) may be fraught with difficulty. After initial imaging reveals enhancing intracranial mass lesions steroids are often initiated. This leads to a decreased diagnostic yield of tumor biopsies which may be associated with delay in treatment initiation. We review a case of PCNSL treated with a very brief steroid course. Initial nondiagnostic biopsy histopathology is juxtaposed against subsequent diagnostic pathology. Imaging before and after steroids is presented, as is imaging after tumor regrowth in a noncontiguous location...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494435/valproate-induced-hyperammonemic-encephalopathy-presenting-as-catatonia
#17
Rodrigo Pérez-Esparza, Nelcy Oñate-Cadena, Jesús Ramírez-Bermúdez, Mariana Espínola-Nadurille
Hyperammonemic encephalopathy secondary to the use of valproate is rare without evidence of hepatotoxicity, and it usually presents with confusion, agitation, irritability, cognitive disturbances, lethargy, coma, and death. We present the case of a 21-year-old woman presenting with catatonia as a manifestation of hyperammonemic encephalopathy that resolved with the normalization of ammonia and suspension of valproate.
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494434/association-between-the-apolipoprotein-e-gene-polymorphism-and-atherosclerotic-middle-cerebral-artery-stenosis
#18
Zhengsheng Zhang, Xiang-Yan Chen, Larry Baum, Ho Keung Ng, Vincent Mok, Ka Sing Wong
OBJECTIVES: Stenosis of the intracranial large arteries, especially the middle cerebral artery (MCA), is common in the Chinese population. We conducted a case-control study to investigate clinical and apolipoprotein E (ApoE) gene polymorphism of MCA atherosclerosis in the Chinese population. MATERIALS AND METHODS: Polymerase chain reaction-based protocols were used to identify the genotypes of polymorphisms in ApoE genes. Clinical parameters and the genotypes of polymorphisms in the ApoE genes were compared in patients with and without MCA stenosis...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494433/continuous-intravenous-valproate-as-abortive-therapy-for-pediatric-status-migrainosus
#19
Muhammad S Zafar, Alejandra M Stewart, David N Toupin, Aaron M Cook, Robert J Baumann
OBJECTIVE: This study describes the use of continuous intravenous valproate as an abortive therapy for pediatric status migrainosus. BACKGROUND: Intravenous valproate as a bolus dose has been shown to be an effective abortive therapy for status migrainosus in children; however, Valproate's pharmacokinetic profile suggests that it would be safer and more therapeutic as a continuous infusion. This dosing strategy results in less serum concentration fluctuations, more consistent therapeutic effects, and less adverse effects...
March 2018: Neurologist
https://www.readbyqxmd.com/read/29494432/preventive-antibiotics-for-poststroke-infection-in-patients-with-acute-stroke-a-systematic-review-and-meta-analysis
#20
Xiaonian Han, Jing Huang, Xiaotao Jia, Lirong Peng, Kangkang Yan, Xin Zan, Li Ma
AIMS: To determine if preventive antibiotics is effective in poststroke infection in patients with acute stroke in comparison with no prophylaxis. MATERIALS AND METHODS: MEDLINE (1950 to January 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2017) and EMBASE (1974 to January 2017) databases were used to search for randomized controlled trials with intervening measures related to the preventive antibiotics in patients with acute stroke...
March 2018: Neurologist
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