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Gregory S Day, David F Tang-Wai, Michel C F Shamy
We review the case of a young man who developed a constellation of symptoms and signs-bizarre behavior, seizures, abnormal movements, and autonomic instability-that evaded diagnosis at the time of presentation. We use this case to explore the way medical knowledge changes over time. Despite the dramatic advances in our understanding of neurological diseases in recent decades, physicians tend to approach diseases and diagnoses as if they were immutable. Our case reinforces how the diagnosis and treatment of disease are determined by an ever-changing historical context driven by the rapid expansion of medical knowledge...
October 2016: Neurohospitalist
Anita Tipirneni, Sebastian Koch, Jose G Romano, Amer M Malik
No abstract text is available yet for this article.
October 2016: Neurohospitalist
Mary Carter Denny, Leon L Lai, Robert Laureno
It is important to recognize the signs and symptoms of human African trypanosomiasis (HAT) in order to facilitate early diagnosis and treatment. A 36-year-old man developed encephalitis caused by HAT. This encephalitis can appear many years after well-tolerated systemic infection. The neurologic manifestations developed 7 years after he had emigrated from Cameroon to the United States. We demonstrate the magnetic resonance imaging before, during, and after his treatment with intravenous eflornithine. Clinical signs and symptoms of HAT can be nonspecific and precede abnormalities on magnetic resonance imaging...
October 2016: Neurohospitalist
Emily Johnson, Yousef Hannawi, Nirma Carballido Martinez, Eva K Ritzl
Cefepime has been associated with encephalopathy and with nonconvulsive seizure activity, primarily in patients with renal impairment. Here, we report a case of cefepime-associated encephalopathy in a patient with normal renal function with stimulus-induced rhythmic activity seen on electroencephalogram, which resolved on discontinuation of cefepime. We bring this to the attention of the neurohospitalist community, as cefepime is widely used in the hospital setting, and cefepime-related neurotoxicity may go overlooked, especially in patients with normal renal function...
October 2016: Neurohospitalist
C A Gold, N Odom, S Srinivasan, L Schaff, A Haggiagi, Yazmín Odia
We describe video electroencephalography (video-EEG) correlates of transient neurological attacks due to plateau waves-paroxysmal elevations in intracranial pressure-in patients with leptomeningeal metastases. We identified 3 patients with leptomeningeal metastases, intracranial hypertension, and transient neurological attacks captured on video-EEG without evidence of seizures or epileptiform activity. We identified all clinical events on video and reviewed the corresponding EEG data for evidence of abnormalities...
October 2016: Neurohospitalist
Zachary D Threlkeld, Mohan Kottapally, Aimee Aysenne, Nerissa Ko
Intracranial pressure (ICP) monitoring frequently guides key decisions in the management of diseases causing intracranial hypertension. Although typically measured by invasive means, contraindications may leave the clinician with little recourse for dynamic ICP evaluation-particularly when the patient's mental status is compromised. We describe here a healthy 18-year-old woman who subacutely progressed to coma due to diffuse cerebral venous sinus thrombosis. Heparinization precluded the use of invasive ICP monitoring, and electroencephalography (EEG) was used novelly as a surrogate ICP monitor...
October 2016: Neurohospitalist
Eric C Landsness, Leo H Wang, Robert C Bucelli
Migraine headache is among the most prevalent neurologic disorders. Status migrainosus often leads to hospitalization, and multiple medications are sometimes required for symptomatic relief. In 2008, neurologists at our institution started using the atypical antipsychotic ziprasidone as an abortive medication for status migrainosus. The Clinical Investigation Data Exploration Repository was used to search for patients admitted to the Barnes-Jewish Hospital inpatient neurology service with diagnoses of "headache" or "migraine...
October 2016: Neurohospitalist
Ava L Liberman, Hooman Kamel, Michael T Mullen, Steven R Messé
BACKGROUND: Cerebral venous thrombosis (CVT) is a relatively rare and understudied disease. We sought to determine the accuracy of International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes to identify CVT. METHODS: Retrospective chart review using the electronic medical record (EMR) to identify all patients discharged with CVT following admission or emergency department visit from May 1, 2010 to May 1, 2015 at our center. RESULTS: We identified 111 patients with an ICD-9 discharge diagnosis code of 325...
October 2016: Neurohospitalist
S Y Modi, D Dharaiya, A M Katramados, P Mitsias
BACKGROUND: Patients with status migrainosus often need to be admitted due to the severity of their headaches. Their hospitalization is often prolonged due to poor headache control. Large sample studies looking into the factors associated with prolonged length of stay (pLOS) in status migrainosus are lacking. METHODS: We utilized the Nationwide Inpatient Sample database to identify 4325 patients with primary discharge diagnosis of status migrainosus. Length of inpatient stay (LOS) of more than 6 days (90th percentile of LOS) was defined as pLOS...
October 2016: Neurohospitalist
(no author information available yet)
[This corrects the article DOI: 10.1177/1941874415591500.].
October 2016: Neurohospitalist
Nuri Jacoby, Ulrike Kaunzner, Marc Dinkin, Joseph Safdieh
This is a case of a 52-year-old man with a past medical history of 2 episodes of coital thunderclap headaches as well as recent cocaine, marijuana, and pseudoephedrine use, who presented with sudden, sharp, posterior headache associated with photophobia and phonophobia. His initial magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head, and magnetic resonance venography (MRV) of the head were all normal as well as a normal lumbar puncture. Given the multiple risk factors for reversible cerebral vasoconstriction syndrome (RCVS), the patient was treated for suspected RCVS, despite the normal imaging...
July 2016: Neurohospitalist
J David Avila
No abstract text is available yet for this article.
July 2016: Neurohospitalist
Muhammad Ubaidulhaq, Young Ah Lee, Huiyuan Jiang
No abstract text is available yet for this article.
July 2016: Neurohospitalist
Ahmad AlSibai, Adnan I Qureshi
High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial...
July 2016: Neurohospitalist
Adam B King, Anne E O'Duffy, Avinash B Kumar
We report a challenging case of cerebral venous sinus thrombosis (multiple etiologic factors) that was complicated by heparin resistance secondary to suspected antithrombin III (ATIII) deficiency. A 20-year-old female previously healthy and currently 8 weeks pregnant presented with worsening headaches, nausea, and decreasing Glasgow Coma Scale/Score (GCS), necessitating mechanical ventilatory support. Imaging showed extensive clots in multiple cerebral venous sinuses including the superior sagittal sinus, transverse, sigmoid, jugular veins, and the straight sinus...
July 2016: Neurohospitalist
Anna Coles, Bradley Haveman-Gould, Muhammad U Farooq, Kristopher J Selke, Philip B Gorelick
Patent foramen ovale (PFO) has been proposed as a mechanism for cardioembolic stroke, especially in younger patient populations. Complex PFOs, with tunnel lengths exceeding 8 mm, lead to a higher risk of neurological sequelae than simple PFOs and may also be harder to detect with transthoracic echocardiography (TTE). In this article, we present a 29-year-old woman who, after polypharmacy overdose, developed deep venous thrombosis and multiple pulmonary emboli (PE) and subsequent cardioembolic stroke. Initial TTE showed intact interatrial septum with late appearance of agitated saline in the left atrium after the seventh cardiac cycle...
July 2016: Neurohospitalist
Christina Mijalski, Katarina Dakay, Cameron Miller-Patterson, Ali Saad, Brian Silver, Muhib Khan
We describe 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) with refractory headache aborted by intravenous magnesium. Case 1 is a 53-year-old woman with subarachnoid hemorrhage due to RCVS presented with refractory headache and persistent vasospasm, despite aggressive treatment with calcium channel blockers (CCBs) and systemic corticosteroids. Subsequently, she experienced dramatic relief of symptoms with intravenous magnesium therapy. She continued oral maintenance therapy and remained symptom free...
July 2016: Neurohospitalist
Sara K Rostanski, Joshua Stillman, Olajide Williams, Randolph S Marshall, Shadi Yaghi, Joshua Z Willey
BACKGROUND AND PURPOSE: Reducing door-to-imaging (DIT) time is a major focus of acute stroke quality improvement initiatives to promote rapid thrombolysis. However, recent data suggest that the imaging-to-needle (ITN) time is a greater source of treatment delay. We hypothesized that language discordance between physician and patient would contribute to prolonged ITN time, as rapidly taking a history and confirming last known well require facile communication between physician and patient...
July 2016: Neurohospitalist
Shadi Yaghi, Joshua Z Willey, Howard Andrews, Amelia K Boehme, Randolph S Marshall, Bernadette Boden-Albala
BACKGROUND AND PURPOSE: The ability of the National Institutes of Health Stroke Scale (NIHSS) score to predict functional outcome in minor stroke is controversial. In this study, we examined the association of itemized NIHSS score with discharge outcome. METHODS: We included all patients with final diagnosis of stroke with an NIHSS score of 0 to 5 untreated with thrombolysis enrolled in the "Stroke Warning Information and Faster Treatment" trial. Individual components of the NIHSS score were the primary predictors...
July 2016: Neurohospitalist
Elisabeth B Marsh, Erin Lawrence, Rebecca F Gottesman, Rafael H Llinas
BACKGROUND AND PURPOSE: The National Institute of Health Stroke Scale (NIHSS) is rapid and reproducible, a seemingly attractive metric for the documentation of clinical progress in patients presenting with ischemic stroke. Many institutions have adopted it into daily clinical practice. Unfortunately, the scale may not adequately capture all forms of functional change. We evaluate its utility as a measure of recovery in patients treated with intravenous tissue plasminogen activator (IV tPA) for ischemic stroke...
July 2016: Neurohospitalist
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