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Case Reports in Neurological Medicine

Simonas Jesmanas, Kristina Norvainytė, Rymantė Gleiznienė, Algirdas Mačionis
A 50-year-old male presented with a one-day history of right leg weakness, numbness, and urinary retention. Weakness was present for two weeks but worsened significantly during the last 24 hours. On the right there was sensory loss in the leg and below the Th8 dermatome. On the left there was sensory loss below the Th10 dermatome and distal loss of temperature sensation. Past medical history revealed a cervical trauma 30 years ago when a glass chip lodged into the left side of the neck. The patient did not seek medical attention after removing it himself...
2018: Case Reports in Neurological Medicine
K H D Thilini Hemachandra, M B Kavinda Chandimal Dayasiri, Thamara Kannangara
Background: Acute flaccid paralysis is an uncommon, but potentially life threatening, sequel of severe hyperkalemia. Reported primary aetiologies include renal failure, Addison's disease, potassium sparing diuretics, potassium supplements, and dietary excess. Coconut water, when consumed in excess, has been reported to cause severe hyperkalemia. We report the case of acute ascending flaccid paralysis secondary to hyperkalemia induced by multiple trigger factors-king coconut water, renal failure, diabetes, metabolic acidosis, and potassium sparing diuretics...
2018: Case Reports in Neurological Medicine
Homajoun Maslehaty, Johannes Van de Nes, Sarah Teuber-Hanselmann, Christoph Moenninghoff, Ulrich Sure, Neriman Oezkan
The occurrence of medulloblastoma (MB) in the elderly is an absolutely rare event. Concerning this issue we report on two MB patients beyond the 70th year of life. Two patients older than 70 years presented with a mass in the posterior fossa without evidence of a preexisting malignant tumor. After careful radiological work-up the suspected diagnosis was metastasis of an unknown primary tumor. Both patients underwent surgery and histopathological analysis revealed MB in both cases (classical MB and desmoplastic type)...
2018: Case Reports in Neurological Medicine
Behiye Deniz Kosovali, Asiye Yavuz, Fatma Irem Yesiler, Mustafa Kemal Bayar
Melkersson-Rosenthal Syndrome (MRS) is a rare disease characterized by persistent or recurrent orofacial oedema, relapsing peripheral facial paralysis, and furrowed tongue. Pathologically, granulomatosis is responsible for oedema of face, labia, oral cavity, and facial nerve. We present a patient with MRS admitted to our hospital with acute respiratory distress syndrome (ARDS). 45-year-old woman was admitted to an emergency department with dyspnea and swelling on her hands and face. She was intubated because of ARDS and accepted to intensive care unit (ICU)...
2018: Case Reports in Neurological Medicine
Alan Lucerna, James Espinosa, Taimur Zaman, Risha Hertz, Douglas Stranges
Limb pain as a presenting feature of an ischemic or hemorrhagic stroke is extremely rare. Here we present a case of a 65-year-old male with complaints of left arm pain and allodynia (specifically light touch to any part of the left arm produced significant discomfort) who was found to have a right parietal lobe intraparenchymal bleed after smoking crack cocaine. Acute central pain is mainly associated with parietal, thalamic, and brainstem lesions. It has been proposed that acute limb pain from a parietal lobe stroke is due to the disconnection of the parietal cortex from the thalamus secondary to the interruption of the pathways between the hemisphere and thalamus/basal ganglia...
2018: Case Reports in Neurological Medicine
Jonathan S Sidlow, Mark J Raden, Richard Sidlow
Neck-Tongue Syndrome is a rare entity, and when it presents in the pediatric age group, it is usually due to osseous, ligamentous, or nervous anatomic variation. We present below a case involving a patient whose bilateral symptoms were intermittently present from the age of five to the age of twenty-one years and discuss this case in light of the present theories of the anatomic substrate underlying this syndrome.
2018: Case Reports in Neurological Medicine
Sira Carrasco García de León, Juan Pablo Cabello, Ramón Ortiz, Julia Vaamonde
Sporadic Creutzfeldt-Jakob disease (sCJD) is a type of progressive, subacute encephalopathy associated with spongiform degeneration of the central nervous system. sCJD includes a broad and heterogeneous spectrum of clinical variants, but extrapyramidal symptoms and signs at disease onset were rarely reported. We describe a case of unilateral parkinsonism associated with pathological 123 I-ioflupane SPECT (DaTSCAN) results as the initial manifestation of M129V subtype sCJD patient. To the best of our knowledge, only 2 cases of Creutzfeldt-Jakob disease demonstrating nigrostriatal dopaminergic deficits in vivo using DaTSCAN have been published in the literature...
2018: Case Reports in Neurological Medicine
Sara Khodor, Scott Blumenthal
Computed Tomography (CT) with myelogram is a relatively safe procedure. It requires the use of nonionic contrast agents which, unlike ionic contrast agents, have been associated with low complication rates. We report a case of a 69-year-old female who developed diffuse bilateral cerebral edema following a lumber myelogram with the use of intrathecal nonionic contrast agent Omnipaque (Iohexol) 300. We were able to find one other reported case of cerebral edema following the use of intrathecal nonionic contrast agent in the literature...
2018: Case Reports in Neurological Medicine
Juan Carlos Izquierdo Velásquez, Luis Felipe Romero Moreno
Diffuse dural enhancement of the internal auditory canal in T1-weighted gadolinium-enhanced magnetic resonance imaging could be a helpful and early clinical sign in a very aggressive limited granulomatosis with polyangeitis disease, called previously Wegener Disease (WD) .
2018: Case Reports in Neurological Medicine
Durga Shankar Meena, Gopal Krishana Bohra, Mahadev Meena, Bharat Kumar Maheshwari
Moyamoya disease is a chronic progressive cerebrovascular disease characterized by bilateral occlusion or stenosis of arteries around circle of Willis. We report a case of 18-year-old female presented with recurrent episodes of headache and vertigo. On cerebral angiography, the patient was diagnosed to have moyamoya disease. On further evaluation, thrombophilia profile showed increased homocysteine level. The patient was treated conservatively with cobalamin and aspirin and advised for revascularization. According to the literature, there are few case reports of moyamoya disease with thrombotic disorders...
2018: Case Reports in Neurological Medicine
Ritsuo Hashimoto, Tomoko Ogawa, Asako Tagawa, Hiroyuki Kato
We report the case of a 53-year-old woman diagnosed with corticobasal syndrome (CBS) due to antiphospholipid syndrome (APS) secondary to systemic lupus erythematosus. Brain MRI showed marked cortical atrophy, several small infarctions in the deep white matter, and mild white matter changes, all of which were probably due to thrombosis manifestations of APS and could also be related to the CBS. To the best of our knowledge, this is the fourth reported case of CBS due to APS. It is noteworthy that although the common underlying pathologies of the CBS are neurodegenerative diseases, either primary or secondary APS can manifest itself as the CBS...
2018: Case Reports in Neurological Medicine
Costantini Antonio, Tiberi Massimo, Zarletti Gianpaolo, Pala Maria Immacolata, Trevi Erika
Cluster headache is a rare painful primary disorder occurring in either episodic or chronic patterns. Several authors found that the hypothalamus, the brain region regulating endocrine function and autonomic system, is involved in the pathophysiology of cluster headache. Some authors have found in patients affected by this disease abnormality in glucose metabolism. Considering the role of thiamine in brain function, in energetic metabolism, and in pain modulation, we treated a patient affected by cluster headache with oral high-dose thiamine...
2018: Case Reports in Neurological Medicine
Hosam Al-Jehani, Judith Marcoux, Kawthar Hadhiah, Faisal Alabbas, Mark Angle, Jeanne Teitelbaum
Background: Vasospasm is a challenging component of the subarachnoid hemorrhage "syndrome" that is unpredictable and very difficult to monitor using noninvasive or invasive monitoring technologies in neurocritical units. Methods: We describe the novel use of computerized tomography perfusion (CTP) imaging to choose proper targets for invasive cerebral blood flow monitors. Results: A total of 3 patients are included in this report...
2018: Case Reports in Neurological Medicine
Gabriela Moreno Legast, Armin Schnider, Nicolas Nicastro
Lyme neuroborreliosis is a rare cause of ischemic stroke; it has only been described in case reports and mostly in Europe. Diagnostic criteria have been proposed for Lyme neuroborreliosis but the association with a cerebral ischemic presentation is not always straightforward. We here describe the case of an 83-year-old man for whom we strongly suspect Lyme neuroborreliosis as the etiology of his stroke. This case reminds us of the importance of a thorough history taking (i.e., tick bite) and to perform the adequate ancillary tests accordingly (lumbar puncture) so as to propose validated treatment...
2018: Case Reports in Neurological Medicine
Chiaki Takahashi
Infarction located in the midbrain and pons presents various ophthalmic symptoms, because of the damage of the nuclei that control the movement of internal and external ocular and palpebral muscles. We experienced a case which presented with rare ocular symptoms and course. A 61-year-old man presented with left hemiparesis and dysarthria, bilateral ptosis, and bilateral impaired eyeball movement: right eyeball movement was totally impaired and left could only perform slight adduction. MRI showed fresh stroke in the right thalamus, cerebral crus, and posterior lobe and cuneate lesion on bilateral paramedian portion of the midbrain...
2018: Case Reports in Neurological Medicine
Keithan Sivakumar, Manveer Garcha, Dev Mehta, Megan C Leary, Hussam A Yacoub
Central alveolar hypoventilation disorders denote conditions resulting from underlying neurologic disorders affecting the sensors, the central controller, or the integration of those signals leading to insufficient ventilation and reduction in partial pressures of oxygen. We report a patient who presented with a left lateral medullary ischemic stroke after aneurysm repair who subsequently developed a rare complication of CAH. Increased awareness of this condition's clinical manifestations is crucial to make an accurate diagnosis and understand its complications and prognosis...
2018: Case Reports in Neurological Medicine
Francesco Berti, Zeeshan Arif, Cris Constantinescu, Bruno Gran
Hypothermia is a rare and poorly understood complication of Multiple Sclerosis (MS). We report on a 66-year-old patient currently with Secondary Progressive MS (SP-MS) who developed unexplained hypothermia associated with multiple hospitalisations and we review the literature on this topic. In our case, magnetic resonance imaging (MRI) of the brain failed to highlight hypothalamic disease, but spinal MRI identified a number of spinal cord lesions. Given the incidence and clinical significance of spinal involvement in MS and the hypothermic disturbances observed in high Spinal Cord Injury (SCI), we hypothesise that upper spinal cord pathology, along with hypothalamic and brainstem dysfunctions, can contribute to hypothermia...
2018: Case Reports in Neurological Medicine
Sean Lance, Stuart Mossman, Gemma Poke
Episodic ataxia is a heterogenous group of uncommon neurological disorders characterised by recurrent episodes of vertigo, dysarthria, and ataxia for which a variety of different genetic variations have been implicated. Episodic ataxia type two (EA2) is the most common and also has the largest number of identified causative genetic variants. Treatment with acetazolamide is effective in improving symptoms, so accurate diagnosis is essential. However, a large proportion of patients with EA2 have negative genetic testing...
2018: Case Reports in Neurological Medicine
Adam D Roche, Dominic Rowley, Francesca M Brett, Seamus Looby
Cerebral toxoplasmosis is one of the most common causes of focal brain lesions in immunocompromised patients, such as those with human immunodeficiency virus (HIV). Differentiating toxoplasmosis from other central nervous system (CNS) lesions provides a significant clinical challenge. Magnetic resonance (MR) imaging of the brain is key to prompt diagnosis and treatment of cerebral toxoplasmosis. Several specific signs on MRI of brain have been described in recent literature including the "concentric target sign" and "eccentric target sign...
2018: Case Reports in Neurological Medicine
Richa Tripathi, Evanthia Bernitsas
Background: Autonomic dysfunction is common in Multiple Sclerosis (MS) patients. Most spinal cord lesions entail some degree of autonomic nervous system dysfunction. MS patients may develop autonomic dysfunction later in their disease course. Methods: We report a patient with no prior history of MS presenting with orthostatic symptoms and diagnosed initially with postural orthostatic tachycardia syndrome (POTS). Four months later, she was diagnosed with radiologically isolated syndrome (RIS)...
2018: Case Reports in Neurological Medicine
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