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Case Reports in Neurology

Sakis Lambrianides, Evgenios Kinnis, Eleni Leonidou, Marios Pantzaris
Psoriasis is a relatively common immune-mediated chronic inflammatory skin disease. It is well known that interferon-beta, a drug used in the management of relapsing-remitting multiple sclerosis, could exacerbate or induce de novo psoriasis. There is limited evidence in the literature based only on case reports that natalizumab could induce or aggravate psoriasis. In this case study, we present a 33-year-old patient who developed plaque psoriasis during natalizumab treatment.
September 2018: Case Reports in Neurology
Conan So, Naveed Chaudhry, Dheeraj Gandhi, John W Cole, Melissa Motta
Endovascular thrombectomy following an acute ischemic stroke can lead to improved functional outcome when performed early. Current guidelines suggest treatment within 6 h after symptom onset. Recent studies including the DEFUSE-3 and DAWN trials demonstrate that some patients may benefit from thrombectomy up to 16 and 24 h after symptom onset, respectively. We present a case of delayed thrombectomy in a 43-year-old man with acute dysarthria, left-sided weakness, and visual neglect. Initial MRI/A demonstrated a small completed stroke and a thrombus in the right middle cerebral artery...
September 2018: Case Reports in Neurology
Leema Reddy Peddareddygari, Kinsi Oberoi, Raji P Grewal
We report the clinical and genetic analysis of a 63-year-old man with progressive weakness developing over more than 20 years. Prior to his initial visit, he underwent multiple neurological and rheumatological evaluations and was treated for possible inflammatory myopathy. He did not respond to any treatment that was prescribed and was referred to our center for another opinion. He underwent a neurological evaluation, electromyography, magnetic resonance imaging of his legs, and a muscle biopsy. All testing indicated a chronic myopathy without inflammatory features suggesting a genetic myopathy...
September 2018: Case Reports in Neurology
Pushpa Raj Puri, Michael Anders Petersen
Vertebral artery aneurysms are rare and challenging as they are usually asymptomatic and, therefore, often overlooked. We report the case of a 73-year-old man with a history of progressive dysphagia for 1 year. Computed tomography (CT) and computed tomography with angiography (CTA) of the cerebrum revealed a giant vertebral artery aneurysm compressing the medulla. Fiberoptic endoscopic evaluation of swallowing (FEES) revealed recurrent nerve paralysis. The patient was managed conservatively since the aneurysm was completely thrombosed...
September 2018: Case Reports in Neurology
Maxim Oliver, Lisa Dyke, Alex Rico, Mario Madruga, Jorge Parellada, Steve J Carlan
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, fatal human prion disease that is characterized by progressive dementia and neurologic degeneration. It can mimic multiple other neurological disorders, and a high index of clinical suspicion is necessary to make a diagnosis. A 74-year-old woman with a 3-month history of a stroke and progressive neurologic deterioration was found to have sCJD. She expired within a week of her diagnosis. Autopsy revealed spongiform encephalopathy consistent with prion disease, and genetic analysis revealed 129 polymorphism and no pathologic mutation, confirming the diagnosis of nonfamilial human prion disease...
September 2018: Case Reports in Neurology
Takahiro Makino, Isamu Sugano, Ikuo Kamitsukasa
A 62-year-old male with a history of alcohol abuse was admitted with a headache and rapidly progressing altered consciousness that led to coma over several hours. Blood and cerebrospinal fluid cultures were positive for Edwardsiella tarda . Despite prompt treatment initiation, the patient died on the third hospital day. Autopsy showed meningitis of the entire cerebrum with ventriculitis, and alcoholic fatty liver was observed. Clinicians should be cognizant of E. tarda meningoencephalitis, a rare presentation which can be associated with poor outcomes in patients with excessive alcohol consumption and alcoholic liver disease...
May 2018: Case Reports in Neurology
Bente Rona Jensen, Anne Sofie Bøgh Malling, Bo Mohr Morberg, Ole Gredal, Per Bech, Lene Wermuth
Bipolar pulsed electromagnetic stimulation applied to the brain (T-PEMF) is a non-pharmacological treatment which has been shown to stimulate nerve growth, attenuate nerve abnormalities, and improve microcirculation. We report on a 62-year-old, medically well-treated man with idiopathic Parkinson's disease. He was treated with T-PEMF, 30 min per day for three 8-week periods separated by two 1-week breaks. The disease made his handwriting impossible to read mainly due to small letters and lack of fluency. Forearm EMG measured during standardized conditions showed an involuntary spiky EMG pattern with regular burst activity (on his left side) at baseline...
May 2018: Case Reports in Neurology
Nobuhiro Takahashi, Mimpei Kawamura, Yasutaka Kobayashi
We report a 68-year-old right-handed female who was admitted to our hospital complaining chiefly of incontinence and decreased activity. Her brain images showed characteristics of Marchiafava-Bignami disease, such as symmetrical abnormal signals localized in the corpus callosum. The patient had no drinking habits. Her past medical history included total gastric resection to treat gastric cancer. On hospital admission she was markedly underweight. This appeared to be a rare case of Marchiafava-Bignami disease not attributable to heavy drinking and occurring in a state of malnutrition...
May 2018: Case Reports in Neurology
Naoki Urushidani, Shoji Kinoshita, Takatsugu Okamoto, Hiroaki Tamashiro, Masahiro Abo
There is still no agreement on the most suitable time and modality for application of repetitive transcranial magnetic stimulation (rTMS) to improve motor recovery in subacute stroke patients. The underlying mechanism of motor recovery following low-frequency rTMS is considered to be modulation of the interhemispheric asymmetry. On the other hand, the cortical balance of brain activity during the acute to chronic phase of stroke is reported to be unstable. Therefore, we conducted this study to clarify the time course of the interhemispheric asymmetry and the effect of application of low-frequency rTMS combined with occupational therapy on motor recovery and cortical imbalance of brain activity in a subacute stroke patient...
May 2018: Case Reports in Neurology
Aldo A Mendez, Annaliese Bosco, Lama Abdel-Wahed, Kendra Palmer, Karra A Jones, Annie Killoran
An 88-year-old man presented with a 1-month history of altered mental status and seizures. His electrographic and imaging findings were suggestive of herpes simplex encephalitis (HSE), for which he was empirically treated with acyclovir. He underwent two lumbar punctures 3 days apart; both cerebrospinal fluid analyses tested negative for herpes simplex virus (HSV) by polymerase chain reaction (PCR). These negative results and his continued deterioration after 9 days of acyclovir therapy prompted treatment with steroids for possible autoimmune encephalitis...
May 2018: Case Reports in Neurology
Won-Bae Seung
The SolitaireTM AB Neurovascular Remodeling Device (ev3, Irvine, CA, USA) is used to retain coils within an aneurysm, reducing the risk of embolic complications from coil herniation into the parent artery. Stents are deployed after confirming the optimal position of the stent markers across the aneurysm to avoid entry into perforators or branching arteries. Stent marker position is very important to prevent perforating or branching artery infarction. We performed stent-assisted coil embolization using the Solitaire AB stent to treat 2 aneurysms simultaneously...
May 2018: 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
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