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case report neurology

Carmen T Mulet, Luis E Arroyo-Mora, Lorena A Leon, Elizabeth Gnagy, Anthony P DeCaprio
Methylphenidate (MPH), which is metabolized into ritalinic acid (RA), is an amphetamine derivative largely used in the treatment of attention-deficit hyperactivity disorder, a neurological condition commonly diagnosed in early childhood. Ensuring that patients comply with clinical treatment is crucial and compliance is generally monitored in blood or urine specimens which, especially in the case of children, can be challenging to obtain on a repetitive basis. Here we report validation of a specific, non-invasive, and rapid dilute-and-shoot analytical method for the detection and quantitation of MPH and RA in oral fluid (OF)...
June 20, 2018: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Hong Zhang, Bing Qing, Jian Zheng
BACKGROUND: Gastroparesis following resection of a fourth ventricle tumor has never been reported in the literature. We report a unique case of gastroparesis following resection of a fourth ventricle ependymoma in a child. CASE DESCRIPTION: A 14-year-old boy presented with 12-day history of headache, nausea and vomiting. Magnetic resonance imaging revealed a tumor in the fourth ventricle. He underwent a posterior median craniotomy and total removal was achieved...
June 19, 2018: World Neurosurgery
George Vasquez-Rios, Hani Alkhankan, Boutros Peter Sawaya, Javier A Neyra
INTRODUCTION: Methanol intoxication is an infrequent cause of poisoning in the United Sates. It can present with prominent stroke-like features and acute kidney injury. Despite the life-threatening nature of this condition, it is poorly identified by clinicians. We aim to present a case of rapidly progressive mental decline and renal involvement, discuss a diagnostic work-up and provide a critical review on therapeutic strategies. CASE PRESENTATION: A 24-year-old patient presented to the emergency department with acute encephalopathy and diffuse muscular rigidity...
June 22, 2018: Clinical Nephrology
Eva Pamias-Portalatin, Deependra Mahato, Jordina Rincon-Torroella, Tito Vivas-Buitrago, Alfredo Quiñones-Hinojosa, Kofi O Boahene
Clival lesions are still considered surgically complex due to their anatomical location. Critical structures, such as the internal carotid arteries (ICAs), cavernous sinuses, cranial nerves, and brainstem, may be encased within the lesion. Although advances in endoscopic endonasal approaches have provided new routes to these lesions, exposure and resection of clival tumors through the endonasal route remain a technical challenge. Here, the authors report a left-sided endoscopic transmaxillary approach to access the right aspect of the clivus and the hypoglossal canal...
June 22, 2018: Journal of Neurosurgery
Randall B Graham, Mathew Cotton, Antoun Koht, Tyler R Koski
Various complications of prone positioning in spine surgery have been described in the literature. Patients in the prone position for extended periods are subject to neurological deficits and/or loss of intraoperative signals due to compression neuropathies, but positioning-related spinal deficits are rare in the thoracolumbar deformity population. The authors present a case of severe kyphoscoliotic deformity with critical thoracolumbar stenosis in which, during the use of a hinged open frame in the prone position, complete loss of intraoperative neural monitoring signals occurred while the frame was flexed into kyphosis to facilitate exposure and instrumentation placement...
June 22, 2018: Journal of Neurosurgery. Spine
Dimitrios Anyfantakis, Angeliki Damianaki, Vasiliki Krietsepi, Evdokia Panou, Serafim Kastanakis
Cytomegalovirus can cause severe disease with adverse outcome in immunocompromised patients. Severe cytomegalovirus infection in previously healthy individuals is rare. Here we present an unusual case of cytomegalovirus infection with neurological and pulmonary involvement in a previously healthy young woman with no history of immuno-suppression. Unfortunately, the disease followed a malignant course and despite the efforts of the medical staff the patient died. CMV infection should be considered in the diagnostic work-up of immunocompetent patients with fever and unexplained neurological or pulmonary manifestations...
June 1, 2018: Le Infezioni in Medicina
Rahul Raj, Miikka Korja, Päivi Koroknay-Pál, Mika Niemelä
Background: Exogenous sex hormones may play a role in meningioma development and growth. Thus, transsexual patients being on long-standing hormone replacement therapy (HRT) may be at particular risk for meningioma development and growth. Here we present two cases of two male-to-female transsexual patients taking HRT for an extended period of time with both patients requiring surgical treatment at our institution due to multiple growing meningiomas. Case Description: The first patient was a 50-year-old genetic male (male-to-female transsexual) who presented 7 years after an extensive sex-change operation due to progressive bitemporal visual defects...
2018: Surgical Neurology International
Chen Han Yong, Wilson Vallat, Graham Norton
We present a case involving an 85-year-old man with acute confusion and new onset seizure following a 1-week history of respiratory prodrome. This case report describes a case of influenza B-related meningoencephalitis supported by evidence of an influenza B infection and temporal relation of the neurological event and respiratory illness in the absence of other identifiable cause. Diagnosis is guided by cerebrospinal fluid profile and nasopharyngeal PCR. Treatment is largely supportive and the effect of vaccination on prevention of this neurological complication remains unclear...
June 21, 2018: BMJ Case Reports
Girard Cua, Neal Holland, Ashleigh Wright
BACKGROUND: Anticoagulation is the mainstay of treatment for pulmonary embolism. However, if bleeding unfortunately occurs, the risks and benefits of anticoagulation present a challenge. Management of one hemorrhagic complication, retroperitoneal hematoma, is rare, difficult, and controversial. CASE PRESENTATION: A 73-year-old white man presented with left lower extremity swelling and dyspnea. He was tachycardic, hypertensive, and demonstrated poor oxygen saturation of 81% on ambient air...
June 22, 2018: Journal of Medical Case Reports
Anne L Dalle Ave, James L Bernat
The whole-brain criterion of death provides that a person who has irreversibly lost all clinical functions of the brain is dead. Bedside brain death (BD) tests permit physicians to determine BD by showing that the whole-brain criterion of death has been fulfilled. In a nonsystematic literature review, we identified and analyzed case reports of a mismatch between the whole-brain criterion of death and bedside BD tests. We found examples of patients diagnosed as BD who showed (1) neurologic signs compatible with retained brain functions, (2) neurologic signs of uncertain origin, and (3) an inconsistency between standard BD tests and ancillary tests for BD...
January 1, 2018: Journal of Intensive Care Medicine
Ju-Hwi Kim, Woo-Youl Jang, Tae-Young Jung, Kyung-Sub Moon, Shin Jung, Kyung-Hwa Lee, In-Young Kim
In this study, we report a case of solitary Langerhans cell histiocytosis (LCH) without skull or systemic lesions, including reviewing the initial magnetic resonance (MR) findings of cerebral LCH. A 36-year-old male patient presented with generalized tonic-clonic type seizure. Brain MR imaging showed a 3cm mass lesion involving the right frontal lobe. It showed iso-intensity on T1-weighted images and hyperintensity on T2-weighted images. After gadolinium enhancement, the mass showed heterogeneous enhancement with perilesional edema and additional adjacent leptomeningeal enhancement...
June 18, 2018: World Neurosurgery
Lisa K Akison, Jenny Kuo, Natasha Reid, Roslyn N Boyd, Karen M Moritz
Prenatal alcohol exposure results in cognitive, behavioral and neurological deficits in offspring. There is an urgent need for safe and effective treatments to overcome these effects. Maternal choline supplementation has been identified as a potential intervention. Our objective was to review preclinical and clinical studies using choline supplementation in known cases of fetal alcohol exposure to determine its effectiveness in ameliorating deficits in offspring. A systematic search of six electronic databases was conducted and studies selected by reviewing titles/abstracts against specific inclusion/exclusion criteria...
June 21, 2018: Alcoholism, Clinical and Experimental Research
Chihiro Fujii, Kyoko Itoh, Kozo Saito, Yu Satoh, Masahiro Makino, Masanori Nakagawa, Kyohei Yamaguchi, Shinji Fushiki, Toshiki Mizuno
We have reported an autopsy case of neuromyelitis optica (NMO) that exhibited persisting active inflammatory lesions in the central nervous system (CNS) despite a 45-year-long treatment with oral corticosteroids. To our knowledge, our case had received the longest course of maintenance treatment. This case study suggests that the current treatment of NMO with immunosuppressive agents may offer a good prospect for improving life expectancy. On the other hand, it also suggest that microscopic active lesions which were clinically silent and difficult to detect by neurological examination or MRI studies may persist in the CNS in patients with NMO, despite prolonged and continuous immunosuppressive treatment...
June 2018: ENeurologicalSci
Hirofumi Matsuyama, Takekazu Ohi
The varicella zoster virus (VZV) is a neurotropic virus that becomes latent in the sensory ganglia, but later causes various neurologic complications such as meningitis, encephalitis, myelitis, meningoencephalitis, cranial neuropathy, and peripheral neuropathy [1]. While acute cerebellitis is one of the most frequent acute cerebellar diseases associated with VZV in childhood, VZV rarely causes cerebellitis in adults, with or without skin manifestations, and only a few isolated cases of adult VZV cerebellitis have been reported...
June 2018: ENeurologicalSci
Francisco Ismael Villarreal-García, Pedro Martin Reyes-Fernández, Oscar Armando Martínez-Gutiérrez, Víctor Manuel Peña-Martínez, Rodolfo Morales-Ávalos
Introduction: Stab-wound injuries to the spinal cord are rare and currently, do not have a well-established management in the literature despite its strong association with neurological injury. Case presentation: We report a case of a patient with a stab-wound injury with a knife in the lumbar region, who underwent direct removal in the operating room without surgical exploration. Upon admission, the patient had no neurological deficit. The X-rays and CT scan before removal showed the involvement of >50% of the intramedullary canal at L2...
2018: Spinal Cord Series and Cases
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
Fumiaki Kanamori, Takashi Yamanouchi, Yuya Kano, Naoki Koketsu
Although vascular complications after head trauma is well recognized, basilar artery entrapment within the longitudinal clivus fracture is rare. A 69-year-old man presented with progressive disturbance of consciousness and right hemiplegia after trauma. Computed tomography scan showed a right-sided acute subdural hematoma and multiple skull fractures, including a longitudinal clivus fracture. Magnetic resonance imaging revealed basilar artery occlusion and a small infarction at the ventral part of the pons...
June 20, 2018: Neurologia Medico-chirurgica
William Wareing, Brian Ho, David Ewins, Kausik Chatterjee
Hypoglycaemia is a well-documented 'stroke mimic'. The literature documents numerous case reports of patients presenting with focal neurological deficits subsequently attributed to hypoglycaemia. The significant majority of these cases are found in patients with pre-existing diabetes. We present case histories of two patients with no history of diabetes presenting to secondary care with reactive hypoglycaemia causing transient symptoms that were responsible for referral as a possible transient ischaemic attack...
June 19, 2018: BMJ Case Reports
J Reginald Fils-Aimé, David J Grelotti, Tatiana Thérosmé, Bonnie N Kaiser, Giuseppe Raviola, Yoldie Alcindor, Jennifer Severe, Emmeline Affricot, Katherine Boyd, Rupinder Legha, Shin Daimyo, Stephanie Engel, Eddy Eustache
This study evaluates the use of a mental health mobile clinic to overcome two major challenges to the provision of mental healthcare in resource-limited settings: the shortage of trained specialists; and the need to improve access to safe, effective, and culturally sound care in community settings. Employing task-shifting and supervision, mental healthcare was largely delivered by trained, non-specialist health workers instead of specialists. A retrospective chart review of 318 unduplicated patients assessed and treated during the mobile clinic's first two years (January 2012 to November 2013) was conducted to explore outcomes...
2018: PloS One
M A Cherniavskiĭ, A A Gusev, D V Chernova, I V Iarkov, M L Gordeev
Prevention of neurological complications in cardiosurgical and reconstructive vascular surgery is one of the priority tasks of preserving ability to work and decreasing invalidization of patients in the postoperative period. Presented in the article is a clinical case report regarding multiple-stage treatment of a female patient with a combined aortic defect, coronary pathology, and a multilevel bilateral lesion of the brachiocephalic arteries. The first stage consisted in performing a hybrid operation, i. e...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
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