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Daniel Mendes Filho, Patrícia D C Ribeiro, Lucas F Oliveira, Diógenes R M de Paula, Vanessa Capuano, Thaís S F de Assunção, Valdo J D da Silva
BACKGROUND: Parkinson disease (PD) is a neurodegenerative disorder affecting the basal nuclei, causing motor and cognitive disorders. Bearing in mind that standard treatments are ineffective in delaying the disease progression, alternative treatments capable of eliminating symptoms and reversing the clinical condition have been sought. Possible alternative treatments include cell therapy, especially with the use of mesenchymal stem cells (MSC). REVIEW SUMMARY: MSC are adult stem cells which have demonstrated remarkable therapeutic power in parkinsonian animals due to their differentiation competence, migratory capacity and the production of bioactive molecules...
July 2018: Neurologist
Pasquale F Finelli
Diagnostic error is an increasing health care concern. An intravenous drug abuser with chronic meningitis died after a prolonged hospitalization from fungal meningitis diagnosed at autopsy. We examine the diagnostic pitfalls and consider how a computer-assisted diagnostic system may influence the outcome of an otherwise fatal condition.
July 2018: Neurologist
Benzion Blech, Cumara O'Carroll
INTRODUCTION: Acute cerebral injuries, such as cerebral ischemic or hemorrhagic events, have been repeatedly correlated with sudden electrocardiogram (ECG) changes, such as cardiac arrhythmias, QT prolongation, and T-wave inversion (the "cerebral T-wave"). Injuries to the insular cortex have been reported in the literature to result in such changes, possibly due to increased sympathetic tone to the cardiac system. CASE REPORT: A 65-year-old gentleman presented with an acute right middle cerebral artery territory infarction, and was found to have ECG abnormalities and left ventricular dysfunction, which improved after the acute phase of the stroke...
July 2018: Neurologist
Inês B Marques, Natália Marto, Anabela Raimundo, Raquel Gil-Gouveia
Brucellosis, an endemic zoonosis in Portugal, is a multisystem disease, presenting with neurological manifestations in up to 25% of cases. Neurobrucellosis diagnostic criteria include evidence of central nervous system invasion, either by documenting increased blood-brain barrier permeability that normalizes after treatment or by Brucella isolation. We report 2 patients with systemic brucellosis presenting with neurological symptoms: A 28-year-old female with progressive hemiparesis associated with severe refractory thoracic and lumbar pain, whose spinal magnetic resonance imaging identified longitudinally extensive myelitis...
July 2018: Neurologist
Choong Sik Chae, Kyoung Min Kwon, Jung Soo Lee, Yeo Hyung Kim
INTRODUCTION: Patients with overlapping Miller Fisher syndrome (MFS), Guillain-Barré syndrome (GBS), and the Bickerstaff brainstem encephalitis (BBE) have rarely been reported, and the diverse clinical features and sequelae are challenging for physicians. Through this case report, we present the clinical course, treatment, recovery, and sequelae of an overlapping MFS, GBS, and BBE syndrome and provide a review of the literature. CASE REPORT: A 76-year-old woman was initially presented with diplopia, ophthalmoplegia, and ataxia, but she later developed weakness of limbs, respiratory failure, deterioration of consciousness, and cognitive impairment...
July 2018: Neurologist
Giulio Zuccoli, Raffaele Nardone, Deepa Rajan, Abdullah S Khan, Dana D Cummings
Descriptions of the natural history of cerebrovascular complications of sickle cell disease (SCD) characterize ischemic stroke as common during childhood and hemorrhagic stroke as more common in adulthood. Childhood ischemic stroke is attributed to vasculopathy with moyamoya syndrome. Hemorrhagic stroke is commonly attributed to aneurysms accompanying HbSS cerebral vasculopathy in SCD. However, a growing body of literature highlights multiple contributing factors to hemorrhagic stroke in children. Primary hemorrhagic stroke is one of the most devastating neurological complications of SCD...
July 2018: Neurologist
Ava L Liberman, Sara K Rostanski, Ilana M Ruff, Ashley N D Meyer, Matthew B Maas, Shyam Prabhakaran
BACKGROUND AND PURPOSE: Patients who present emergently with acute neurological signs and symptoms represent unique diagnostic challenges for clinicians. We sought to characterize the reliability of physician diagnosis in differentiating aborted or imaging-negative acute ischemic stroke from stroke mimic. METHODS: We constructed 10 case-vignettes of patients treated with thrombolysis with subsequent clinical improvement who lacked radiographic evidence of infarction...
July 2018: Neurologist
Ahmet Gürdal, Kudret Keskin, Dilek N Orken, Gözde Baran, Kadriye Kiliçkesmez
OBJECTIVES: Epicardial adipose tissue is metabolically active and is an important predictor of metabolic and cardiovascular diseases. This study investigated the echocardiographic epicardial adipose tissue measurement in young patients with embolic stroke of undetermined source (ESUS). MATERIALS AND METHODS: We studied 77 volunteers, including 40 patients with ESUS (mean age 43±8 y, 16 female patients) and 37 healthy subjects (mean age 38±7 y, 20 female subjects)...
July 2018: Neurologist
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
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
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
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
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
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
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
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
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
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
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
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
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