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Case Reports in Neurology

Keiko Hatano, Hideyuki Matsumoto, Akihiko Mitsutake, Junko Yoshimura, Aya Nomura, Sumihisa Imakado, Yukitoshi Takahashi, Hideji Hashida
We report on a 44-year-old woman who was diagnosed with toxic epidermal necrolysis (TEN) during the recovery phase from autoimmune limbic encephalitis with anti-glutamate receptor antibodies. Both, autoimmune limbic encephalitis and TEN are very rare diseases. The co-existence of the two diseases has not yet been reported. We speculate that the total of 18 drugs needed for the treatment of encephalitis might have increased the risk of TEN. Similar reports would be required to elucidate the pathophysiology of the co-existence...
May 2018: Case Reports in Neurology
Daisuke Yasugi, Takeshi Sasaki, Go Taniguchi
The diagnosis of nonconvulsive status epilepticus (NCSE) largely relies on electroencephalography (EEG) findings, but the existing diagnostic criteria for EEG results are sometimes inconsistent. Much debate has centered on periodic epileptic discharges (PEDs) and their relationship with seizures. The recently published Salzburg Consensus Criteria for diagnosis of NCSE, which consider PEDs to be ictal findings under several conditions, have been proven to have high diagnostic accuracy. However, the criteria do not include periodic slow waves (PSWs) and do not consider these as overall ictal electrographic changes...
May 2018: Case Reports in Neurology
Sheng-Hsiang Yang, Poh-Shiow Yeh, Tai-Yuan Chen
We present the case of a middle-aged man suffering from epilepsia partialis continua 3 weeks before the start of cognition decline, visual disturbance, and pyramidal dysfunction. The epilepsia partialis continua was difficult to control, and the underlying cause was uncertain even after thorough surveys for infection, inflammation, autoimmunity, and neoplasm. However, progressive signal intensity changes were noted over the involved cortical gyri, bilateral caudate, and putamen on serial magnetic resonance diffusion-weighted images, which were compatible with sporadic Creutzfeldt-Jacob disease...
May 2018: Case Reports in Neurology
Nobuhiro Takahashi, Minpei Kawamura, Yasutaka Kobayashi
The present report discusses the case of a 73-year-old right-handed man who exhibited signs of aphasia caused by cerebral infarction in the left temporoparietal region. Neuropsychological evaluation revealed that he had difficulty in comprehending words related to indoor objects, body parts, and family relationships, compared to his vocabulary comprehension in other semantic categories. Although several reports have described cases in whom category-specific impairments in word comprehension are observed, few have documented cases in whom these impairments are accompanied by impairments in the comprehension of words indicating family relationships...
May 2018: Case Reports in Neurology
Kana Fukumoto, Yasuhiro Manabe, Shunya Fujiwara, Yoshio Omote, Hisashi Narai, Haruto Yamada, Takashi Saito, Koji Abe
We report a rare case of meningitis due to a combination of Streptococcus mitis and Neisseria subflava . An 80-year-old female had a 4-year history of type II diabetes mellitus (DM) and an 11-year history of rheumatoid arthritis, which was treated with prednisolone, tacrolimus, and methotrexate. One month after the removal of a dental implant, she complained of a disturbance of consciousness and suffered a convulsion. A cerebrospinal fluid culture was found to be positive for both S. mitis and N. subflava ...
May 2018: Case Reports in Neurology
Peter Flachenecker, Francesco Saccà, Carlos Vila
Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune demyelinating disease of the central nervous system. Patients exhibit heterogeneous patterns of disabling symptoms, including spasticity. In the majority of patients with MS spasticity, it and its associated symptoms contribute to disability, interfere with performance of everyday activities, and impair quality of life. Even under treatment with oral antispasticity drugs, about a third of patients continue to experience spasticity of moderate to severe intensity, underscoring the need for additional treatment options...
May 2018: Case Reports in Neurology
Mathieu Cuchanski, Kelly Jo Baldwin
Hereditary spastic paraplegias (HSP) are a rare heterogeneous group of inherited neurodegenerative diseases characterized by progressive lower extremity spasticity and weakness. Mutations of the kinesin family member 5A (KIF5A) gene lead to a spectrum of phenotypes ranging from spastic paraplegia type 10 to Charcot-Marie Tooth Disease type 2. We report the second known case of a mutation in the KIF5A gene at c.610C>T presenting with HSP plus an axonal sensorimotor neuropathy.
May 2018: Case Reports in Neurology
Jin Wook Kim, Won-Bae Seung
Clip rotation after clipping is a major cause of delayed cerebral ischemia and may occur after any of several intraoperative monitoring techniques. We experienced 3 cases of clip rotation in 3 patients after clipping between March 2011 and December 2013. One of these patients has permanent motor weakness of the left upper extremity because of delayed occlusion of the right M1 lenticulostriate artery. The other two developed delayed occlusion of the frontopolar artery or of the A1 perforating artery, but did not have any neurologic deficits...
May 2018: Case Reports in Neurology
Peter O Okokhere, Cyril O Erameh, Francis Alikah, Peter E Akhideno, Christopher O Iruolagbe, Omoregie O Osazuwa, Idowu A Bankole, Donatus I Adomeh, Ikponmwosa Odia, Chris O Aire, Jennifer Oyakhilome, Jacqueline Agbukor, Rebecca O Atafo, Danny A Asogun, Christian T Happi, Pardis C Sabeti, Stephan Günther, George O Akpede
It is rare both to have the central nervous system (CNS) as the main focus in the acute phase of Lassa fever infection without associated bleeding, and to find Lassa virus (LAV) in the cerebrospinal fluid (CSF) but not in the serum. We report the case of a 38-year-old Nigerian woman with mainly CNS manifestation of Lassa fever. She was admitted twice within 11 days because of persistent fever. A clinical diagnosis of acute LAV encephalitis was made because of a high index of suspicion and CNS involvement confirmed by positive reverse transcriptase polymerase chain reaction (RT-PCR) for LAV in the CSF, while her blood was repeatedly negative for LAV by RT-PCR test...
May 2018: Case Reports in Neurology
Naoya Iwabuchi, Atsushi Saito, Kentaro Fujimoto, Taigen Nakamura, Tatsuya Sasaki
Some cases of aneurysms originating from the fenestrated A1 segment of the anterior cerebral artery (ACA) have been reported, but the pitfalls of the surgical procedure have not been well determined. We herein report 2 cases of a saccular aneurysm arising from the fenestrated A1 segment. Case 1 was a 72-year-old man incidentally diagnosed with an unruptured left ACA aneurysm on magnetic resonance imaging (MRI). Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the left A1 segment...
May 2018: Case Reports in Neurology
Marjon E M van der Hoeven, Lisa M H de Pont, Hille Koppen
We present the case of a woman who developed severe nightly thoracic pain during pregnancy without neurological deficits upon examination. Spontaneously after childbirth, the pain was markedly reduced. Further investigation showed that her pain was caused by an ependymoma in the cervicothoracic spinal cord. Gross total resection was accomplished, and the patient has been free of pain ever since. With this case, we want to draw attention to a rare, but possibly very disabling, cause of increasing nightly thoracic pain during pregnancy...
May 2018: Case Reports in Neurology
Dana Khaled Almedallah, Dana Yousef Alshamlan, Erum Mubbashir Shariff
Myoclonus is an abnormal involuntary movement that has been previously reported with administration of high doses of opioids for prolonged periods of time. In this case, however, we report an acute myoclonic reaction and review the literature on the possible causative pathophysiology. We report the case of a 24-year-old woman who was admitted for postdated cesarean section. She started to have abnormal involuntary movements after administration of an epidural anesthesia containing 700 μg of fentanyl with 115 mL (0...
May 2018: Case Reports in Neurology
Cyprian Popescu
Fluoroquinolones increase the risk of peripheral neuropathy. The present work aims to report a case of fluoroquinolone-related severe axonal neuropathy. The subject of this study was a 62-year-old man who exhibited generalized sensory disturbances 4 days after treatment by ciprofloxacin prescribed for urinary infection. Electrodiagnostic studies revealed severe motor-sensory axonal neuropathy with widespread fibrillation potentials in support of generalized motor polyradiculopathy. There was no evidence of conduction blocks or albuminocytologic dissociation in favor of an autoimmune inflammatory reaction...
May 2018: Case Reports in Neurology
Frans Kauw, Jan W Dankbaar, Jesse Habets, Maarten J M Cramer, Hugo W A M de Jong, Birgitta K Velthuis, L Jaap Kappelle
This case report describes a patient who experienced a recurrent ischemic stroke within 24 h. Dual-energy computed tomography (DECT) angiography on admission showed 2 intracardiac thrombi, 1 in the left ventricle and 1 in the left atrial appendage. Following the second ischemic event, repeated DECT angiography showed that the ventricular thrombus had considerably diminished, suggesting that the recurrent brain infarction was caused by cardioembolism. This case emphasizes (1) the potential benefit of cardiac evaluation through CT angiography in the acute stroke setting, and (2) the use of DECT angiography for the detection of thrombus and the differentiation between thrombus, the myocardial wall, and a slow flow of contrast...
May 2018: Case Reports in Neurology
Syugo Ueki, Masataka Nakamura, Risa Sasaki, Yoichiro Okada, Keisuke Yoshikawa, Susumu Kusunoki, Kazuyoshi Ishii, Hirofumi Kusaka, Takayuki Kondo
A 71-year-old man with Waldenström macroglobulinemia (WM) presented with a slowly progressive sensory disturbance and mild weakness predominantly affecting the distal portion of the limbs over the course of 6 months. Cervical magnetic resonance imaging (MRI) showed a long hyperintense lesion at the C1-C4 level. Nerve conduction studies (NCS) revealed prolongation of distal latency, slowed conduction velocity, and conduction block. His serum IgM level was increased, and he was positive for anti-myelin-associated glycoprotein (MAG) and anti-sulfoglucuronyl paragloboside (SGPG) IgM antibodies...
January 2018: Case Reports in Neurology
Toshiya Osanai, Kiyohiro Houkin
Sinus pericranii is a rare vascular anomaly, and most cases occur in children and develop at the midline. In previous reports of sinus pericranii, T2 hyperintensity lesion has not been regarded as a common sequela. We report an extremely rare case of orbital sinus pericranii with associated T2 hyperintensity lesion. A 50-year-old man was admitted to our hospital with a history of right upper eyelid swelling that had been present for several years. Computed tomography, magnetic resonance imaging, and digital subtraction angiography demonstrated a connection between the lesion and normal cerebral venous system...
January 2018: Case Reports in Neurology
Sho Mitsumune, Yasuhiro Manabe, Taijun Yunoki, Shyoichiro Kono, Kazutoshi Aoyama, Yoko Shinno, Hisashi Narai, Koji Abe
This is the first report about a patient with concomitant polymyositis (PM), myasthenia gravis (MG), and aplastic anemia (AA). A 54-year-old male developed myalgia and muscle weakness, which gradually progressed over 2 months. He was persistently affected by MG and AA. Brachium magnetic resonance imaging showed increased signal intensity in the left triceps and deltoid muscles on short tau inversion recovery images. A muscle biopsy examination revealed perifascicular atrophication and inflammatory myopathy...
January 2018: Case Reports in Neurology
Hiromasa Sato, Toshiyuki Yamamoto, Masako Sato, Yoshihiko Furusawa, Miho Murata
Objective: The causes of "delayed-on" and "no-on" phenomena in Parkinson disease (PD) are thought to have some impact on the progress of L-DOPA from the time of ingestion until it reaches the brain and is converted to dopamine. Dysphagia can cause fluctuating symptom expression in L-DOPA therapy for PD. Case Description: A 69-year-old man with PD presented with "delayed-on" and "no-on" phenomena. The patient developed a gait disorder at age 60 years, and he began coughing on his food during breakfast at age 64 years...
January 2018: Case Reports in Neurology
Fardad T Afshari, Barbara Wysota, Michelle Oswal, Gordan Mazibrada, Edward A White
Tonsillar herniation and coning is a rare and often late presentation of meningoencephalitis, and is associated with poor neurological outcome. We report the case of a 16-year-old female who presented unresponsive with radiological evidence of tonsillar herniation secondary to meningoencephalitis. She underwent an emergency foramen magnum decompression and C1 laminectomy with full recovery and no residual neurological deficit.
January 2018: Case Reports in Neurology
Eva Auffenberg, Friedemann Bender, Tobias Freilinger
Hemicrania continua (HC) is a rare primary headache disorder, characterized by persistent unilateral pain associated with cranial autonomic symptoms and prompt response to indomethacin. While migrainous features (including aura) have been recognized in cluster headache, there have been only single reports of HC with aura. Here, we report the case of a 53-year-old man with constant right-sided headache and superimposed exacerbations to severe pain lasting for several hours. Secondary etiologies were excluded, and a diagnosis of HC was established after prompt and complete response to treatment with indomethacin...
January 2018: Case Reports in Neurology
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