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Case Reports in Neurology

Susanna Nuvoli, Silvia Contu, Bi Llie Joy Pung, Patrizia Solinas, Giuseppe Madeddu, Angela Spanu
Leptomeningeal carcinomatosis (LC) diagnosis is based on cerebrospinal fluid (CSF) cytological analysis and contrast-enhanced magnetic resonance imaging (MRI); however, low sensitivity was evidenced in some cases delaying prompt and adequate treatments. Brain18 F-fluorodeoxyglucose positron emission tomography (18 F-FDG PET) was also employed in doubtful cases. We retrospectively described 4 suspected LC cases with uncertain or undetectable MRI and initially negative CSF cytology. Whole-body (WB) and brain18 F-FDG PET/computed tomography (CT) were used, the latter showing intracranial tracer uptakes suspected for LC in 3/4 cases...
January 2018: Case Reports in Neurology
Raji P Grewal, Kinsi Oberoi, Leema Reddy Peddareddygari
Charcot-Marie-Tooth disease type 4C, an autosomal recessive genetic neuropathy, is caused by mutations in the SH3TC2 (SH3 domain and tetratricopeptide repeats 2) gene. Interestingly, although mutations in this gene have been observed in European gypsies, a population that originated in India, there are few publications describing Indian patients. We report our analysis of a 50-year-old woman of Asian Indian descent with onset of progressive distal weakness and sensory loss in childhood. A clinical examination revealed the presence of a neuropathy with pes cavus without spinal abnormalities...
January 2018: Case Reports in Neurology
Caspar Godthaab Sørensen, William Kristian Karlsson, Faisal Mohammad Amin, Mette Lindelof
Introduction: Encephalopathy and convulsive seizures are rare manifestations of metronidazole toxicity. The incidence is unknown, but the condition has most frequently been reported in patients in their fifth to sixth decades. Usually, this condition is regarded as reversible, but permanent deficits and even death have been reported. Case Report: A 66-year-old female patient undergoing metronidazole treatment for pleural empyema was admitted to our institution after her second episode of seizure...
January 2018: Case Reports in Neurology
Sang-Woo Lee, Seung-Jae Lee
Posterior reversible encephalopathy syndrome (PRES) is a disorder of reversible vasogenic brain edema which mainly involves the parieto-occipital lobes in various clinical settings. The main mechanism is known to be cerebral autoregulation failure and endothelial dysfunction leading to the disruption of the blood-brain barrier. We report the case of a 47-year-old woman with PRES which involved the brain stem and thalami, sparing the cerebral hemispheres. She was admitted to the emergency room because of acute-onset confusion...
January 2018: Case Reports in Neurology
Christopher Hollen, Omer Suhaib, Aaron Farrow, Evgeny Sidorov
We present a case of an 82-year-old man with new-onset neuromyelitis optica (NMO) spectrum disorder, the treatment of which was complicated by a severe pre-existing prednisone allergy. His age caused much initial doubt about his diagnosis, and his corticosteroid allergy altered our management as we attempted to minimize risk to the patient. Our patient was a healthy 82-year-old, right-handed man who presented with sensory loss of the bilateral lower extremities and progressive, painless vision loss. MRI showed bilateral pre-chiasmatic optic nerve and optic chiasm enhancement, along with enhancement within the thoracic spinal cord from T3 to T7...
January 2018: Case Reports in Neurology
Sandra C Signore, Birka Brauns, Gunther Schütze, Christoph P Dohm, Mathias Bähr, Rotraut Mössner, Pawel Kermer
The tumor necrosis factor-α (TNF-α) antagonists infliximab, adalimumab, and etanercept have been approved for the treatment of chronic inflammatory diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriasis, and psoriatic arthritis. Manifestations of demyelinating disease have been reported for patients receiving TNF-α antagonists. We describe a rare manifestation of a chronic inflammatory process affecting both the central and peripheral nervous system in a patient who received infliximab for the treatment of psoriasis and psoriatic arthritis...
January 2018: Case Reports in Neurology
Yasutaka Kobayashi
A 67-year-old woman was hospitalized for rehabilitation from the after effects of a traumatic brain injury. In addition to memory impairment, attention disorder, and executive dysfunction, she experienced musical hallucinations. Brain magnetic resonance imaging revealed cerebral contusion in the bilateral temporal lobes and the left frontal lobe. Case reports of musical hallucinations caused by traumatic brain injury are extremely rare.
January 2018: Case Reports in Neurology
Flavio Nigri, Jucilana Dos Santos Viana, Pedro Henrique da Costa Ferreira Pinto, Elington Lannes Simões, Carlos Roberto Telles Ribeiro
Microsurgery remains the gold standard treatment for intraventricular lesions, but it is not without limitations. The cerebral ventricles approach is considered a challenge for neurosurgeons because of their deep location and their intimate association with critical areas of the brain. It has been shown that direct endoscopic view is superior to magnetic resonance imaging (MRI) in identifying intraventricular structures and lesions. Also, during neuroendoscopy, there is no cerebrospinal fluid leak causing brain collapse as seen in microsurgery...
January 2018: Case Reports in Neurology
Muhammad Taimur Malik, Edgar J Kenton Iii, Dana Vanino, Shamsher S Dalal, Ramin Zand
Posterior inferior cerebellar artery (PICA) aneurysms are rare. The most common complication of intracranial aneurysms is rupture causing subarachnoid hemorrhage. Ischemic infarct, although more common in giant thrombosed aneurysms, is a very rare manifestation of small intracranial aneurysms. Here we describe a patient who presented with lateral medullary acute infarction associated with an ipsilateral, small (4 × 3.5 mm), unruptured and non-thrombosed PICA aneurysm.
September 2017: Case Reports in Neurology
Marc Vecchi, Ricardo Pereira Mestre, S Luciamma Thiekalamuriyil, Roberto Cartolari
In the context of painful cranial neuropathies, a very rare cause is represented by the irritation of the glossopharyngeal nerve due to various aetiologic factors. Here, we present a case of neuralgia of the ninth right cranial nerve due to a compression of its nerve root upon the kinking of the homolateral vertebral artery, resulting in a disabling clinical overview for the patient. Our objective was to focus the reader's attention on the clinical manifestation, which alone could lead to an immediate diagnosis...
September 2017: Case Reports in Neurology
Hideyuki Matsumoto, Hideji Hashida, Yukitoshi Takahashi
This report describes a rare case presenting with dystonic seizures due to anti-N-methyl-D-aspartate (NMDA) receptor encephalitis. The patient was an 18-year-old woman with repeated right-dominant dystonic seizures even under sedation. Single-photon emission computed tomography (SPECT) showed intense hyperperfusion of the caudate nuclei, putamen, globus pallidus, thalamus, and insula on the left side, suggesting encephalitis. Antibodies against NMDA receptors were detected in the sera and cerebrospinal fluids...
September 2017: Case Reports in Neurology
Takahiro Makino, Ikuo Kamitsukasa, Shoichi Ito
A 72-year-old Japanese woman with rheumatoid arthritis whose activity decreased with previous treatments had recurrent thunderclap headaches during an atovaquone regimen for the treatment of pneumocystis pneumonia. The recurrent headaches disappeared after discontinuation of the drug. Brain magnetic resonance images showed multiple cerebral vasoconstrictions of cerebral arteries with vasogenic cerebral white matter edema, which diminished several weeks later. We diagnosed the patient's headaches as reversible cerebral vasoconstriction syndrome due to atovaquone...
September 2017: Case Reports in Neurology
Elisabeth B Lucassen, William T Delfyett, Mark C Stahl
Background: Neurological complications of diabetes and hyperglycemia are relatively common but the specific manifestations can vary widely. Diabetic striatal disease or "diabetic striatopathy" is an uncommon condition usually thought to result from hyperglycemic injury to the basal ganglia, producing a hyperkinetic movement disorder, usually choreiform in nature. Symptoms are generally reversible with treatment of the hyperglycemia. Case Description: We report the case of a 57-year-old woman presenting with a unilateral choreoathetosis of the left upper extremity, persistent for 4 years...
September 2017: Case Reports in Neurology
Sandra Sousa, Nuno Vasco Costa, Cátia Carmona, Élia Coimbra, Fernando Pita
Introduction: Cryptogenic stroke is present in about 40% of ischemic stroke patients. Extracardiac shunt related to pulmonary arteriovenous fistula (PAVF) could be a rare potential risk factor for embolic stroke. Most PAVFs are multiple, congenital, and associated with hereditary conditions. On the other hand, isolated PAVFs are rare conditions and an uncommon cause of cryptogenic stoke. Case Report: We describe a case of a young woman without history of respiratory diseases or vascular risk factors, who presented with acute onset of transitory aphasia and right hemiplegia...
September 2017: Case Reports in Neurology
Antti Huotarinen, Martin Reich, Jens Volkmann, Eero Pekkonen
Background: STB DBS (deep brain stimulation of the subthalamic nucleus) is commonly used to treat advanced Parkinson disease (PD) while posterior hypothalamic DBS for cluster headache (CH) remains experimental. Methods: We present a case where a middle-aged man was diagnosed with both CH and PD and received medical treatment for both. The patient was treated with bilateral STN DBS after developing side effects related to L-dopa. Findings: STN DBS not only alleviated PD symptoms but also the CH, and hence the CH treatment could be withdrawn...
September 2017: Case Reports in Neurology
Maliheh Mohamadpour, Genevieve Gabriel, Arthur C Grant
Unverricht-Lundborg disease (ULD) is an autosomal recessive progressive myoclonic epilepsy. The prevalence is highest in specific European countries and North Africa. Affected individuals have myoclonic and tonic-clonic seizures and a variable degree of ataxia and cognitive impairment. We report a native Haitian woman with ULD who was wheelchair bound due to nearly continuous myoclonic seizures exacerbated by activity and emotional distress. The seizures and their dramatic increase with volitional activity were recorded during video electroencephalography monitoring...
September 2017: Case Reports in Neurology
Fabrício Diniz de Lima, Gustavo José Luvizutto, Arthur Oscar Schelp, Gabriel Pereira Braga, Rodrigo Bazan
Objective: Stroke chameleons encompass an atypical group of syndromes that do not initially appear to be cerebrovascular accidents. The objective of this study was to report patients with different lesions of central origin clinically presenting as wrist drop and with a semiology similar to that produced by peripheral lesions of the radial nerve at different topographical levels. Methods: This is a case series study of patients presenting with wrist drop during the acute phase of stroke who were assessed by clinical examination and CT and MRI brain scans...
September 2017: Case Reports in Neurology
Fumihito Yoshii, Hitoshi Tomiyasu, Ryo Watanabe, Masafuchi Ryo
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant spinocerebellar degeneration, associated with extended repeats of the trinucleotide CAG in the ATXN2 gene on the long arm of chromosome 12. Magnetic resonance imaging (MRI) of SCA2 showed significant atrophies of the brainstem, middle cerebellar peduncles, and cerebellum. We report two genetically proven SCA2 patients who showed hypertrophy of the inferior olivary nuclei on proton density- and T2-weighted MRI. This pattern has never been reported in patients with SCA1, SCA3, or SCA6, and may make it possible to differentiate SCA2 from other hereditary spinocerebellar ataxias...
September 2017: Case Reports in Neurology
Kenji Yoshiki, Kouichi Misaki, Iku Nambu, Issei Fukui, Masanao Mohri, Naoyuki Uchiyama, Mitsutoshi Nakada
An unruptured aneurysm was incidentally found in the right middle cerebral artery in a 67-year-old woman. During an attempt to turn the temporalis muscle for surgical clipping, systolic blood pressure suddenly increased. After opening the dura mater, we found a subarachnoid hemorrhage and severe brain swelling. We promptly expanded the craniotomy area to reach the aneurysm while pulling part of the frontal lobe to apply a clip. We retrospectively analyzed the aneurysm using computational fluid dynamics. Our analysis suggests that the rupture of the aneurysm occurred at a location with very low wall shear stress...
September 2017: Case Reports in Neurology
Ryuichiro Hayashi, Shigeki Yamaguchi, Toshio Narimatsu, Hiroshi Miyata, Yasushi Katsumata, Masaru Mimura
We report a 60-year-old woman with posterior cortical atrophy (PCA) who presented with left homonymous hemianopsia persisting for 5 years; the patient's condition was observed using static, but not kinetic, perimetry. This statokinetic dissociation of hemianopsia, which is often called Riddoch syndrome, might have been caused by a dysfunction of the right primary visual and visual association cortices, representing a functional imbalance within a disturbed visual cortex. In patients with PCA and visual field defects, both static and kinetic perimetry may be useful for understanding the extent of degeneration in the visual cortex, in addition to examinations of unilateral neglect...
September 2017: Case Reports in Neurology
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