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Lucas Alessandro, Miguel Wilken, Mauricio F Farez, Eugenia Arias Cebollada, Andrea C Mora, Ángel Cammarota, Marcelo Del Castillo
OBJECTIVES: Herpes simplex viruses (HSV) can produce encephalitis (HSE), which requires early detection, typically using polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). However, other neurological conditions not directly caused by HSV may also present with a positive HSV PCR in the CSF (NCNHPCR+). We aimed to analyze the clinical features of both groups of patients (HSE vs. NCNHPCR+) and to consider the potential relevance of this finding in the latter. METHODS: A retrospective analysis of clinical presentation, workup (CSF, EEG, and MRI) and outcome of patients with an HSV+ result in CSF was conducted from Jan-2007 to Sep-2015 in our institution...
November 2018: Neurologist
Ferhat Arslan, Gülhan Ertan, Ahmet N Emecen, Pierre Fillatre, Ali Mert, Haluk Vahaboglu
BACKGROUND: Listeria monocytogenes-associated encephalitis is a severe clinical condition that can also be seen in immunocompetent patients. Clinical manifestation and radiologic features of this entity need to be elaborated. REVIEW SUMMARY: We searched the medical literature during the period spanning from 1991 to 2017 using the keyword "listeria AND [abscess odds ratio (OR) brainstem OR encephalit* OR magnetic* OR imaging*]." We included in the review well-documented adult cases with a definitive diagnosis and having magnetic resonance imaging data...
November 2018: Neurologist
Michiaki Nagai, Mai Kikumoto, Tomohiko Ohshita, Masaya Kato, Hiroshi Yamashita, Keigo Dote
No abstract text is available yet for this article.
November 2018: Neurologist
Danielle S Warner, Bryan G Schwartz, Reji Babygirija, Richard A Rovin, Amin B Kassam, Lindsay Biddick, Rehan Sajjad, Adil Chohan, Kessarin Panichpisal
BACKGROUND: Patients with an acute ischemic stroke (AIS) following cardiac catheterization (CC) generally do not receive intravenous thrombolysis [intravenous tissue plasminogen activator (IV-tPA)] as it is contraindicated due to the coagulopathy related to the heparin used during the procedure. We report a case of AIS successfully treated with IV thrombolysis following protamine reversal of heparin effect. CASE REPORT: An 87-year-old man with diabetes mellitus, hypertension, neurofibromatosis, and hyperlipidemia underwent elective transradial CC following an abnormal stress test...
November 2018: Neurologist
Alyx B Porter, Terence T Sio, Kent D Nelson, Aditya Raghunathan, Bernard R Bendok, Maciej M Mrugala
We describe a gentleman diagnosed with a posterior fossa medulloblastoma in 1998, successfully treated with craniospinal radiation therapy (RT) and posterior fossa RT boost, followed by 12 months of adjuvant chemotherapy. Nineteen years later, at the age of 28, the patient presented with multiple cranial neuropathies and was found to have disseminated high-grade glioma with leptomeningeal dissemination. In addition to the salient features of this case, we provide a brief review of RT-induced malignancies and the need for further research regarding surveillance and prevention strategies...
November 2018: Neurologist
Georgios Tsivgoulis, Georgios N Papadimitropoulos, Stefanos Lachanis, Lina Palaiodimou, Christina Zompola, Roubina Antonellou, Konstantinos Voumvourakis
INTRODUCTION: High-resolution vessel wall imaging (HR-VWI) is emerging as a tool of notable utility in the diagnosis of intracranial vessel pathology. Its role in monitoring vessel wall disease response to treatment, however, is less well-established. CASE REPORT: We report the case of a 45-year-old man with left middle and anterior cerebral artery infarcts and an National Institute of Health Stroke Scale (NIHSS) score of 2. Time-of-flight magnetic resonance angiography and digital subtraction angiography showed multifocal intracranial vessel pathology without extracranial vessel involvement...
November 2018: Neurologist
Rory M C Abrams, Gregory A Elder
Polycythemia vera (PV) is a risk factor for systemic thromboses and ischemic stroke. This has been attributed to blood hyperviscosity, the result of increased blood cell production. Intravenous immunoglobulin, which is indicated for the treatment of numerous hematologic and neurological conditions also causes increased serum viscosity and has been associated with ischemic strokes in the setting of PV. Here we report a case of a 70-year-old man with prior stroke and PV who developed Guillain-Barré syndrome, an acute inflammatory demyelinating disorder of peripheral nerves causing ascending paresis, numbness, and paresthesia, who was treated safely with therapeutic plasma exchange...
November 2018: Neurologist
Dae Woong Bae, Jae Young An
INTRODUCTION: Aquaporin-4 antibody (AQP4-Ab) is specific for neuromyelitis optica spectrum disorder (NMOSD) and so is helpful to distinguish NMOSD from other autoimmune diseases. Several viral infections may play a role in the onset of NMOSD. CASE REPORT: We describe a case of a previous healthy 82-year-old woman who presented with acute visual loss occurring 3 weeks after scrub typhus. Physical examination showed a relatively afferent pupillary defect in the right eye and ophthalmoscopy revealed edema of the right optic disc...
November 2018: Neurologist
(no author information available yet)
No abstract text is available yet for this article.
September 2018: Neurologist
Cristina Valencia-Sanchez, F David Fortuin, John P Sweeney, Timothy J Ingall, Lisa A Marks, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: The clinical benefit of patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS) for recurrent stroke prevention has been a subject of extensive debate. Prior clinical trials failed to show superiority of PFO closure versus medical therapy. Meta-analyses suggested a possible benefit of PFO closure in select patients. OBJECTIVE: The objective of this study was to critically assess current evidence regarding the efficacy of PFO closure compared with medical therapy for recurrent stroke prevention in patients with CS...
September 2018: Neurologist
Lala Mehdikhanova, Ebru N Vanli Yavuz, Uğur Çikrikçili, Işin Baral Kulaksizoğlu, Nerses Bebek, Candan Gürses, Ayşen Gökyiğit, Betül Baykan
BACKGROUND: Studies on electrophysiological characteristics of patients with epilepsy and concomitant psychosis are limited. We aimed to investigate the clinical and video-electroencephalography (EEG) findings of patients with epilepsy-related psychosis (EP). MATERIALS AND METHODS: Fifteen patients diagnosed with EP, assessed at the video-EEG monitoring unit and were under follow-up at both epilepsy and psychiatry clinics, were included. A total of 67 nonpsychotic epilepsy patients, investigated at the video-EEG monitoring unit were randomly selected as the control group and compared statistically with the EP group...
September 2018: Neurologist
Faiz Hussain, Craig M Horbinski, Steven J Chmura, Bakhtiar Yamini, Rimas V Lukas
Pleomorphic xanthoastrocytoma (PXA) is a rare primary central nervous system tumor which frequently harbors mutations in BRAF. Anaplastic PXA follow a more aggressive course than their nonanaplastic counterparts. We present the case of an anaplastic PXA initially treated with the BRAF inhibitor vemurafenib. After progression of disease the MEK inhibitor trametinib was added to the regimen leading to radiographic improvement. The rationale for combined BRAF and MEK inhibition in PXA is reviewed.
September 2018: Neurologist
Kiran K Ramineni, Ravi K Jakkani, Suresh Girgani, Ankit Balani, Sandeep Satyanarayan
Reversible cerebral vasoconstriction syndrome is a rare clinical syndrome characterized by sudden thunderclap headache often an under diagnosed neurological emergency. It is often provoked by postpartum state or exposure to provocative drugs. We report a rare case of Rizatriptan-induced reversible cerebral vasoconstriction syndrome presenting with thunderclap headache and paraparesis with complete recovery of neurological and imaging findings.
September 2018: Neurologist
Vincent Keereman, Elise Platteau, Luc Crevits, Luc Algoed
INTRODUCTION: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a variant syndrome of internuclear ophthalmoplegia, consisting of primary gaze exotropia, adduction impairment, nystagmus of the abducting eye, and vertical gaze-evoked nystagmus. It seems to be most frequently associated with multiple sclerosis, although other etiologies such as brainstem ischemia or hydrocephalus have also been described. CASE REPORT: We report the case of a 25-year-old woman who presented with subacute progressive oculomotor disturbances, resulting in the development of a WEBINO over a few days...
September 2018: Neurologist
Giorgia Famoso, Marina Padroni, Cristiano Azzini, Alessandro De Vito, Andrea Saletti, Ilaria Casetta
INTRODUCTION: Spontaneous cervical artery dissection (sCAD) is a major cause of ischemic stroke in young and middle-aged adults, but the occurrence of multiple sCADs could suggest the presence of an underlying arteriopathy. Bilateral hypoglossal nerve palsy caused by extracranial internal carotid artery dissections have been rarely described. We present the case of a 3-vessel sCAD in a patient with repaired tetralogy of Fallot (ToF). CASE REPORT: A 50-year-old man was admitted to our stroke unit for a sudden onset of left cervical pain, mild left ptosis, dysarthria, and dysphagia...
September 2018: Neurologist
Maximiliano A Hawkes, Michel Toledano, Timothy J Kaufmann, Alejandro A Rabinstein
INTRODUCTION: Elsberg syndrome (ES) is a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis, mainly linked to reactivation, or occasionally primary, infection with herpes simplex virus type 2. West Nile virus neuroinvasive disease is rarely considered in the differential diagnosis of patients with ES. CASE REPORT: A 63-year-old man with pancreatic cancer in remission and polymyalgia rheumatica on low-dose prednisone presented with a 10-day history of low-back pain and a viral-type illness with low-grade fever, nausea, and vomiting...
September 2018: Neurologist
Veronica E Santini, Connie K Wu, Anna D Hohler
Residents are expected to be educators often without any formal schooling, and many continue a career in academic medicine where they play a pivotal role in education. However, few resident curricula have been published to include instruction in teaching, particularly in the field of Neurology. To guide Neurology residents as they take on their role as a clinician-educator, we developed a 1-year curriculum (Neurology Residents as Comprehensive Educators "Neuro RACE") with monthly sessions divided into didactics, small group discussions, and interactive kinetic learning...
September 2018: Neurologist
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
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