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Neurologist

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https://www.readbyqxmd.com/read/28644261/is-intravenous-thrombolysis-safe-and-effective-in-central-retinal-artery-occlusion-a-critically-appraised-topic
#1
Oana M Dumitrascu, Joanne F Shen, Madhavi Kurli, Maria I Aguilar, Lisa A Marks, Bart M Demaerschalk, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic emergency associated with poor visual recovery. There is a dilemma regarding the appropriate treatment, as formal guidelines are lacking. Despite being considered an ocular equivalent of cerebral infarction, the time window of intravenous (IV) thrombolysis administration for maximum efficacy and safety in CRAO remains uncertain. OBJECTIVE: To critically assess the current evidence regarding the safety and effectiveness of IV thrombolysis in the treatment of patients with CRAO...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644260/intravenous-alteplase-for-acute-stroke-and-pulmonary-embolism-in-a-patient-with-recent-abdominoplasty
#2
Michael E Christiansen, Gyanendra Kumar, Raman C Mahabir, Richard A Helmers, Bernard R Bendok, Cumara B O'Carroll
INTRODUCTION: Major surgery in the past 14 days is a relative contraindication to treatment of acute stroke with intravenous (IV) alteplase. The 2016 American Heart Association/American Stroke Association scientific statement discussing inclusion and exclusion criteria for alteplase in acute stroke allows for provider judgment citing a lack of evidence to support surgery as an absolute contraindication. CASE REPORT: A 59-year-old woman presented with acute left hemiparesis, dysarthria, and acute respiratory failure...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644259/antiphospholipid-syndrome-with-a-distinctive-constellation-of-neurological-manifestations-blue-toes-red-valves-white-retinal-spots
#3
Brandon T Nokes, Oana M Dumitrascu, Fadi E Shamoun, Cumara B OʼCarroll
Antiphospholipid syndrome (APS) encompasses a hypercoagulable state with a markedly increased risk for cerebrovascular complications. In addition to the classic stroke features of APS, however, there are numerous recently described "non-criteria" neurological conditions such as headaches, seizures, and cognitive impairment. We present a case of APS with uncommon neurological manifestations.
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644258/multifocal-motor-neuropathy-associated-with-infliximab-a-case-report-and-a-literature-review
#4
Ayse O Bayrak, Hasan Ulusoy, Necdet Bolat, Baki Doğan, Taner Ozbenli
Multifocal motor neuropathy with conduction block (MMN-CB) is purely a motor neuropathy with progressive weakness that is characteristically caused by conduction blocks. Association with antiganglioside antibodies and a good response to immunomodulating therapies suggest an autoimmune etiology. In rare cases, MMN-CB has been reported as an adverse effect of infliximab, a tumor necrosis factor-α blocker. We present a case of MMN-CB due to infliximab in a 45-year-old man with psoriatic arthritis who was exposed to the drug for 2 years because of a delayed diagnosis...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644257/holmes-tremor-secondary-to-cerebellopontine-angle-epidermoid-cyst
#5
Sanjay Pandey
Holmes' tremor is characterized by a combination of rest, postural, and intention tremor. Tremor is predominantly proximal and more severe during posture; however, the tremor frequency is usually <4 Hz on surface electromyography. We report Holmes' tremor in a patient secondary to cerebellopontine angle epidermoid cyst.
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644256/cluster-like-headache-secondary-to-focal-cervical-myelitis
#6
Dong-Eun Kim, Ji-Yun Park, Hyeonuk Ha, Geum-Jin Yoon, Bang-Hoon Cho, Seung-Han Lee
BACKGROUND: Cluster headache (CH) is characterized by attacks of severe periorbital pain associated with autonomic symptoms. As with other forms of primary headache, structural lesions should be excluded, particularly if the headache presents with an atypical pattern. CASE: We report a 41-year-old woman who had no previous history of primary headache and showed a poor response to medication for CH. The patient was finally diagnosed as secondary headache with CH feature due to focal myelitis at the cervical level of the spinal cord...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644255/periodic-paralysis-and-encephalopathy-as-initial-manifestations-of-graves-disease-case-report-and-review-of-the-literature
#7
Theocharis Tsironis, Athanasios Tychalas, Dimitrios Kiourtidis, Jannis Kountouras, Georgia Xiromerisiou, Jobst Rudolf, Georgia Deretzi
BACKGROUND: Thyrotoxic periodic paralysis (TPP) is an uncommon complication of Graves' disease, characterized by the triad of acute hypokalemia without total body potassium deficit, episodic muscle paralysis, and thyrotoxicosis. Graves' encephalopathy is an extremely rare form of encephalopathy associated with autoimmune thyroid disease (EAATD), characterized by neuropsychiatric symptoms, increased antithyroid antibodies and cerebrospinal fluid protein concentration, nonspecific electroencephalogram abnormalities, and cortico-responsiveness...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644254/sporadic-creutzfeldt-jakob-disease-with-unilateral-symptoms-in-the-setting-of-metastatic-renal-cell-carcinoma
#8
Kyle C Rossi, Christine M Stahl, Pengfei Zhang, John W Liang, Lara V Marcuse, Fred Lublin
INTRODUCTION: Although it is not rare for magnetic resonance imaging findings in Creutzfeldt-Jakob disease to be asymmetric, unilateral clinical syndromes are uncommonly reported and may confound diagnosis. In addition, neurological paraneoplastic syndromes are not common in renal cell carcinoma, though there are cases reported, often without an offending antibody isolated. CASE REPORT: A 66-year-old man was admitted with 1 month of left-sided numbness and "loss of control" of the left arm...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644253/spectrum-of-autonomic-nervous-system-impairment-in-sj%C3%A3-gren-syndrome
#9
Brent P Goodman, Amy Crepeau, Priya S Dhawan, Julie A Khoury, Lucinda A Harris
OBJECTIVE: To describe the spectrum of autonomic dysfunction in a uniformly evaluated cohort of patients with Sjögren syndrome. METHODS: A series of 13 patients underwent a comprehensive evaluation for suspected autonomic impairment, including a neurological examination, autonomic testing, and laboratory studies. A diagnosis of Sjögren syndrome was established as the cause of autonomic dysfunction in all. Clinical features, findings on autonomic testing, and laboratory results are described...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644252/antineuroinflammation-of-minocycline-in-stroke
#10
Yi Chen, Zhiyou Cai, Zunyu Ke
Accumulating research substantiates the statement that inflammation plays an important role in the development of stroke. Both proinflammatory and anti-inflammatory mediators are involved in the pathogenesis of stroke, an imbalance of which leads to inflammation. Anti-inflammation is a kind of hopeful strategy for the prevention and treatment of stroke. Substantial studies have demonstrated that minocycline, a second-generation semisynthetic antibiotic belonging to the tetracycline family, can inhibit neuroinflammation, inflammatory mediators and microglia activation, and improve neurological outcome...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644251/risk-factors-etiological-classification-topographical-location-and-outcome-in-medullary-infarctions
#11
Elif Gökçal, Gözde Baran, Elvin Niftaliyev, Vildan Güzel, Talip Asil
An understanding of the etiological mechanisms is important for therapeutic decisions and prognostic evaluation of patients with ischemic stroke. The object of this study was to evaluate the risk factors, etiological subtypes, and topography of lesion in patients with medullary infarctions (MIs). Besides, we also investigated early neurological deterioration, new vascular events, and functional outcome of all patients at 3-month follow-up. We analyzed our database consisting of patients who were diagnosed with acute MI and who were admitted within 24 hours of onset...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644250/cholesterol-levels-and-hemorrhagic-stroke-risk-in-east-asian-versus-non-east-asian-populations-a-systematic-review-and-meta-analysis
#12
Liang Xie, Wei Wu, Jin Chen, Jianglong Tu, Jun Zhou, Xueliang Qi, Xiaoping Yin
BACKGROUND: The aim of this work was to evaluate the relationships between cholesterol levels and risk of hemorrhagic stroke [including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)] in East Asian versus non-East Asian populations. MATERIALS AND METHODS: Relevant prospective studies were identified from systematic searches of PubMed and EMBASE. A random-effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) that were used to compare the relationships between cholesterol levels and risk of hemorrhagic stroke in East Asian versus non-East Asian populations...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644249/incidental-hippocampal-hyperintensity-on-diffusion-weighted-mri-individual-susceptibility-to-transient-global-amnesia
#13
Moonyoung Jeong, Jaehyun Jin, Jeong Hee Kim, Yeonsil Moon, Jin Woo Choi, Hahn Young Kim
OBJECTIVES: Dot-like hippocampal hyperintensities (HHs) on diffusion-weighted MRI (DWI) have been reported as an interesting imaging finding of transient global amnesia (TGA) that is characterized by typical anterograde amnesia. However, we found that these dot-like HHs are occasionally seen in some patients without clinical symptoms of TGA. METHODS: We identified 8 patients who did not show clinical symptoms of TGA, despite the presence of hippocampal lesions on DWI (No-TGA group, n=8)...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28471902/recurrent-optic-neuritis-associated-with-mog-antibody-seropositivity
#14
Thashi Chang, Patrick Waters, Mark Woodhall, Angela Vincent
INTRODUCTION: Optic neuritis (ON) can be the first manifestation of autoimmune central nervous system diseases such as multiple sclerosis and neuromyelitis optica, but it can also occur as an isolated monophasic or relapsing disease. A proportion of these patients have antibodies against myelin oligodendrocyte glycoprotein (MOG). We report a case of recurrent ON with MOG antibodies in a South Asian patient. CASE REPORT: A 50-year-old Sri Lankan female with a previous history of 2 episodes of steroid-responsive ON presented with a 20/120 visual impairment of her right eye...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28471901/right-hand-weakness-and-headache-during-ascent-to-mount-everest-a-case-of-cerebral-venous-infarction
#15
Jeong Hee Kim, Soo Jeong Kim, Hahn Young Kim
INTRODUCTION: The increasing popularity of trekking in alpine regions has drawn attention to high altitude-associated health concerns. CASE REPORT: Here, we report a case of cerebral venous infarction as a consequence of a hypercoagulable state induced by secondary polycythemia as an adaptation to high altitude. CONCLUSIONS: When patients present focal neurological symptoms such as hemiparesis in addition to symptoms of acute mountain sickness or high-altitude cerebral edema such as headache, nausea, vomiting, and dizziness, cerebral venous infarction should be considered...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28471900/early-carotid-occlusion-after-endarterectomy-in-a-patient-with-a-mutation-for-mthfr-a1298c-polymorphism
#16
Simone Vidale, Silvio Bellocchi, Paolo Casiraghi, Roberto Caronno, Marco Arnaboldi
INTRODUCTION: Significant carotid stenosis is a well-documented risk factor for ischemic stroke. Carotid endarterectomy (CEA) and carotid artery stenting are effective procedures for the prevention of stroke in patients with this disease. However, the occurrence of restenosis could contribute to an increase in the risk of ischemic stroke. CASE REPORT: A 79-year-old woman was admitted to the Neurosurgical Department to undergo a CEA because of a progressive stenosis...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28471899/angioinvasive-aspergillus-associated-stroke-in-an-immunocompetent-host-following-cardiac-surgery-and-ecmo
#17
Tapan Kavi, Nikhil Madan, Tamara Majic, Axel Rosengart, Marcel Maya, Serguei Bannykh, Shouri Lahiri
INTRODUCTION: Invasive cerebral aspergillosis is an uncommon cause of stroke among immunocompetent patients and has not been reported in association with cardiac surgery or extracorporeal membrane oxygenation (ECMO). We report the case of an immunocompetent host who developed aspergillus-associated stroke following coronary artery bypass graft (CABG) and ECMO. CASE REPORT: A 59-year-old woman developed cardiogenic shock after 3-vessel-CABG requiring intra-aortic balloon pump placement and subsequent veno-arterial ECMO...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28471898/early-neurological-deterioration-during-alteplase-infusion-for-acute-ischemic-stroke-an-uncommon-complication-of-intravenous-thrombolysis
#18
Apostolos Safouris, Odysseas Kargiotis, Georgios Magoufis, Aristeidis H Katsanos, Eleftherios Stamboulis, Georgios Tsivgoulis
INTRODUCTION: Recognizing new-territory ischemic stroke as an uncommon complication of intravenous thrombolysis is very important as it can lead to neurological deterioration during tissue-plasminogen-activator infusion. CASE REPORT: We report a case of an 80-year-old patient that has been treated with intravenous thrombolysis for right middle cerebral artery acute ischemic stroke. During infusion he had an abrupt neurological deterioration that proved to be a distal embolization of an asymptomatic non-occluding tip-of-the-basilar thrombus to the territory of left posterior cerebral artery that has been missed by the treating neurologist and radiologist in the pretreatment computed tomography angiography...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28471897/thrombolyic-and-vasodilator-treatment-in-a-patient-with-prolonged-retinal-ischemia
#19
Sri Raghav Sista, John H Pula, Deepak Reddy, Chris Abdo, Sarah Parker, Mark A Getz, Jorge C Kattah
Vasospastic transient monocular vision loss associated with systemic lupus erythematosus and antiphospholipid syndrome is typically short lasting and responsive to vasodilators. Virchow's triad of endothelial dysfunction, arterial stasis, and a hypercoagulable state are factors in systemic lupus erythematosus/antiphospholipid syndrome that may potentially contribute to prolonged retinal hypoperfusion and central retinal artery occlusion. Consequently, rapid intervention to address all components of Virchow's triad may increase the probability of a good outcome...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28471896/a-case-report-of-transient-cortical-blindness-after-angiography
#20
Chih Yen Chen, Chi Jen Chen, Ying Chi Tseng
INTRODUCTION: Transient cortical blindness (TCB) is a rare complication after angiography and is proposed to be related to contrast extravasation. We present the first case of TCB after angiography that was evaluated using serial arterial spin-labeling magnetic resonance perfusion (ASLMRP) and susceptibility-weighted imaging (SWI). CASE REPORT: A 65-year-old woman with dyslipidemia who had been treated for left vertebral artery dissection 3 months previously presented with dizziness and right hemiparesis...
May 2017: Neurologist
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