Effect of Repetitive Transcranial Magnetic Stimulation on the Right Superior Temporal Gyrus for Severe Aphasia Caused by Damage to the Left Inferior Frontal Gyrus
This study attempted to perform low-frequency rTMS on the right posterior superior temporal gyrus (BA22), which is the center for language reception for aphasia patients with a drastic decline in verbal expression due to damage to the left inferior frontal gyrus and a considerable decline in language perception. The participants performed a language task that was displayed on a computer monitor during rTMS. In addition, intensive speech-language and hearing therapy was performed by the therapist after rTMS. This study reports that a resultant improvement in language perception was observed in the activated brain regions ba...
Source: Case Reports in Neurology - May 28, 2019 Category: Neurology Source Type: research

Intradural Lipoma at the Craniocervical Junction Presenting with Progressing Hemiparesis: A Case Report
We report a rare case of spinal lipoma without dysraphism and with progressing hemiparesis. A 60-year-old woman had incidental lipoma at the craniocervical junction observed for more than 5 years. Recently, she developed right-sided hemiparesis and sensory disturbance. Radiological studies revealed a large lipoma compressing the dorsal medulla and C1 –C2 spinal cord. Standard midline suboccipital craniotomy and C1 laminectomy were performed, and the lipoma was removed subtotally. The lipoma showed severe adhesion to the dorsal medulla and C1 spinal cord; therefore, the excision was limited as internal debulking. Her ...
Source: Case Reports in Neurology - May 23, 2019 Category: Neurology Source Type: research

Positive Effect of Steroids in Posterior Reversible Encephalopathy Syndrome
We present a case of posterior reversible encephalopathy syndrome with severe clinical manifestation. Apart from initial aphasia, hemiparesis, and a generalized seizure, the patient had a prolonged loss of consciousness. Although blood pressure was normalized, the clinical status deteriorated continuously. After adding steroids to the therapy, the patient recovered rapidly, suggesting that this could have been a useful therapeutic approach. Even the vasogenic edema in the cerebral magnetic resonance imaging disappeared shortly within 6 days.Case Rep Neurol 2019;11:173 –177 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - May 22, 2019 Category: Neurology Source Type: research

Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chronic daily complaints of headache. The headache was located frontoparietally and kept him awake at night. Imaging (nonenhanced computed tomography [CT], magnetic resonance imaging, and positron emission tomography/CT) showed a hypermetabolic mass on the right side of the skull base, in the middle ear, and in the mastoid process, with invasion and partial destruction of the surrounding elements of the petrous bone, the occipital bone, and the sphenoid bone on the right, with extension by way of the clivus into the apex of the lef...
Source: Case Reports in Neurology - May 22, 2019 Category: Neurology Source Type: research

Unusual Pattern of Reading Errors in a Patient with Posterior Cortical Atrophy
Posterior cortical atrophy (PCA) is a degenerative condition characterized by a progressive deterioration of visual processing. Dyslexia constitutes an early and frequent visual symptom of the disease and previous comprehensive investigations in series of individuals have extensively documented a characteristic abundance of visual errors as the most prevalent error category in this population. Here we describe the profile of a patient with PCA, C.P., who presents an unusual prevalence of phonological, instead of purely visual, errors in his reading, in the context of an otherwise classic PCA phenotype. In keeping with the ...
Source: Case Reports in Neurology - May 8, 2019 Category: Neurology Source Type: research

Cerebellar Transcranial Magnetic Stimulation Improves Ataxia in Minamata Disease
Minamata disease (MD) is a form of intoxication involving the central nervous system and is caused by ingesting seafood from methylmercury-contaminated areas in Japan. In MD, cerebellar ataxia is a cardinal feature observed in approximately 80% of MD patients. Although cerebellar transcranial magnetic stimulation (TMS) has recently been used for treating cerebellar ataxia, the optimal stimulation conditions remain unclear. Here, we report the first case of cerebellar ataxia in an MD patient that was significantly improved after high-frequency cerebellar TMS. To determine the optimal stimulation conditions, we examined the ...
Source: Case Reports in Neurology - May 8, 2019 Category: Neurology Source Type: research

Atypical Lyme Neuroborreliosis, Guillain-Barr é Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations
We report the case of a 62-year-old woman presenting with asymmetrical tetraparesis and hyporeflexia. Initially the presumed diagnosis of Guillain-Barré syndrome with a possible functional component was suspected and treatment with intravenous immunoglobulin was initiated. Due to partial response to therapy and further test results including positive serologies and cerebrospinal fluid antibodies for Borrelia, the diagnosis of neuroborreliosis was considered. Furthe r exploring revealed the possibility of exposure to ticks although there was no report of typical skin lesions. Daily physical therapy and appropriate an...
Source: Case Reports in Neurology - May 5, 2019 Category: Neurology Source Type: research

Unusual Course of an Aggressive Pituitary Prolactinoma: Case Report and Review of the Literature
We describe the case of a 35-year-old male who presented with an invasive prolactinoma, managed initially with a transsphenoidal resection, postsurgical radiotherapy and DA agonists. The patient posteriorly presented a sole metastatic lesion to the lumbar spine that was later managed with local radiotherapy. Due to pituitary recurrence of the lesion, multiple surgical resections were needed until further treatment was declined. The clinical course in this patient was unusual. He lived for 13 years after initial diagnosis, with a very invasive tumor without systemic chemotherapy. Radiotherapy is used in pituitary tumors in ...
Source: Case Reports in Neurology - May 5, 2019 Category: Neurology Source Type: research

When Nothing Goes Right: An Unexpected Tongue Deviation in Internal Carotid Artery Dissection
We describe a case of a 55-year-old man who presented with right internal carotid artery dissection and deviation to the left of the protruded tongue. The direction of the deviation of the protruded tongue was unexpected in this patient, because if the XII nerve palsy was due to mass effect related to the intramural hematoma of the dissected artery, a deviation to the right should have happened. Anyway, a subsequent magnetic resonance revealed also an acute ischemic lesion in the right tongue area in the primary motor cortex of the patient, providing a rare, but a fitting neuroanatomical explanation of the deviation and al...
Source: Case Reports in Neurology - April 24, 2019 Category: Neurology Source Type: research

Gastrointestinal Beriberi and Wernicke ’s Encephalopathy Triggered by One Session of Heavy Drinking
An otherwise healthy 30-year-old male acquired gastrointestinal beriberi and subsequent Wernicke ’s encephalopathy after 1 session of heavy drinking. Nausea, vomiting, and anorexia relentlessly progressed. The patient developed external ophthalmoplegia after 2 months. Intravenous 1,000 mg thiamine reversed both neurologic and gastrointestinal symptoms within hours. It is hard to diagnose gast rointestinal beriberi since the symptoms are nonspecific. The patient underwent 11 emergency room visits, 3 hospital admissions, and laparoscopic cystectomy within 2 months, but the gastrointestinal symptoms continued to progres...
Source: Case Reports in Neurology - April 18, 2019 Category: Neurology Source Type: research

Trismus as a Presenting Symptom in a Case of Progressive Encephalopathy with Rigidity and Myoclonus
In this report we present a clinical case of trismus. The patient in question showed symptoms of trismus for 3 days, rapidly leading to respiratory insufficiency. Afterwards she developed myoclonus and progressive encephalopathy. Neurological workup showed no relevant abnormalities. A CT of the abdomen revealed a mass in the lower abdomen, which turned out to be an ovarian teratoma. Progressive encephalopathy with rigidity and myoclonus (PERM) was diagnosed clinically. Treatment with corticosteroids, benzodiazepines, and levetiracetam did not ameliorate the patient ’s condition. Only after the introduction of plasmap...
Source: Case Reports in Neurology - April 18, 2019 Category: Neurology Source Type: research

Herpes Simplex Virus Type 2 Radiculomyelitis Disguised as Conversion Disorder
We report the case of a patient with a lengthy psychiatric history who presented with lower extremity pain and weakness. Cervical, thoracic, and lumbar MRI scans with and without gadolinium contrast revealed no significant stenosis, neural compression, or other abnormal findings, and the brain MRI with and without gadolinium contrast was normal. The initia l diagnosis was conversion disorder due to myriad psychological stressors. Polymerase chain reaction (PCR) of CSF detected HSV-2 and a lymphocytic pleocytosis, and the diagnosis of radiculomyelitis was confirmed. She was treated with i.v. acyclovir for 3 weeks followed b...
Source: Case Reports in Neurology - April 17, 2019 Category: Neurology Source Type: research

Horner Syndrome as Complication of Acute Sphenoid Sinusitis
Horner syndrome is described in this case report as a rare complication of bacterial sphenoid sinusitis. A patient presented with miosis, ptosis, and ophthalmic nerve palsy with acute sphenoid sinusistis and cavernous sinus thrombosis on MRI. The impairment of sympathetic fiberscan can be explained through the direct septic effects of the sphenoid sinusitis and indirectly through thrombosis of the cavernous sinus at the level of the carotid plexus.Case Rep Neurol 2019;11:112 –116 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - April 15, 2019 Category: Neurology Source Type: research

Juvenile Muscular Atrophy of the Proximal Upper Extremity as So-Called Proximal-Type Hirayama Disease: Case Report and Review of the Literature
We report herein a case with Hirayama disease-like juvenile muscular atrophy involving proximal muscles in the upper extremities. In this case, in the flexion position of the neck, cervical magnetic resonance imaging revealed that the spinal cord was compressed by expansion of the posterior extradural space with forward displacement of the dura matter. These neuroimaging results are identical to those of Hirayama disease. However, the involved muscles in this case were the proximal muscles, unlike Hirayama disease. Five previous cases have displayed this rare subtype of Hirayama disease. The cause of the unique phenotype m...
Source: Case Reports in Neurology - March 21, 2019 Category: Neurology Source Type: research

Bilateral Chronic Subdural Hematoma in the Posterior Fossa Treated with a Burr Hole Irrigation: A Case Report and Review of the Literature
We report a case of bilateral CSH in the posterior fossa successfully treated with a single-burr hole surgery. A 74-year-old man under anticoagulation and antiplatelet therapy developed headache and nausea during observation for an asymptomatic supratentorial CSH. Radiological examinations revealed appearance of bilateral CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient ’s consciousness, an urgent treatment was required. A burr hole was made near the transverse-sigmoid junction on the left side to access the hematoma. No ventricular drainage was placed as his conscious...
Source: Case Reports in Neurology - March 20, 2019 Category: Neurology Source Type: research

Citalopram Improves Obsessive-Compulsive Crossword Puzzling in Frontotemporal Dementia
Behavioral variant frontotemporal dementia (bvFTD) is characterized by severe changes in personality/behavior. Recent studies have provided evidence that a decrease in serotonin receptors and neuronal loss in the raphe nuclei play a role in the bvFTD pathology. Serotonergic antidepressants have been reported to diminish behavioral disturbances in bvFTD, particularly repetitive behaviors, disinhibition, apathy, sexually inappropriate behaviors, and hyperorality. Here, we present the case of an 80-year-old Caucasian male patient with clinically and biomarker supported bvFTD ( “probable” bvFTD; disease-specific al...
Source: Case Reports in Neurology - March 20, 2019 Category: Neurology Source Type: research

Transcranial Direct Current Stimulation Improves Pusher Phenomenon
An 83-year-old man suffered from cerebral infarction of the right middle cerebral artery territory. In association with severe left hemiparesis and hemispatial neglect on the left side, he showed severe pusher phenomenon (PP), which made rehabilitation difficult. Transcranial direct current stimulation (tDCS) was applied to the parietal area (2 mA × 20 min/day; anode on the right and cathode on the left) for 8 days, which resulted in remarkable improvement of PP and caused prolongation of static sitting time. tDCS of the parietal area could be a novel treatment option of PP following stroke.Case Rep Neurol 2019;11:61...
Source: Case Reports in Neurology - March 7, 2019 Category: Neurology Source Type: research

Paraneoplastic opsoclonus-myoclonus syndrome secondary to melanoma metastasis form occult primary cancer
Discussion: While the incidence of melanoma of unknown primary is between 2.6 and 3.2%, with a median overall survival ranging between 24 and 127 months, when melanoma patients develop OMS their survival is markedly decreased. Although only 5 cases of paraneoplastic OMS secondary to melanoma have been reported in the literature, all had a poor prognosis, dying within 8 months of OMS onset.Case Rep Neurol 2019;11:66 –79 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - March 7, 2019 Category: Neurology Source Type: research

Insomnia and Dysautonomia with Contactin-Associated Protein 2 and Leucine-Rich Glioma Inactivated Protein 1 Antibodies: A “Forme Fruste” of Morvan Syndrome?
Morvan syndrome (MoS) is typically characterized by neuromyotonia, sleep dysfunction, dysautonomia, and cognitive dysfunction. However, MoS patients with mild peripheral nerve hyperexcitability (PNH) or encephalopathy features have been described. A 46-year-old woman presented with a 2-month history of constipation, hyperhidrosis, and insomnia. Neurologic examination revealed muscle twitching and needle electromyography showed myokymic discharges in all limbs. No clinical or electrophysiological features of neuromyotonia were present. Although the patient denied any cognitive symptoms, neuropsychological assessment reveale...
Source: Case Reports in Neurology - March 7, 2019 Category: Neurology Source Type: research

An Outbreak of Peripheral Neuropathy in a Prison
Prisoners are at risk for both physical and psychological diseases. Here, we report an outbreak of peripheral neuropathy in a prison in northeast Thailand. Between July and December 2014, there were 88 male prisoners at Bueng Kan Provincial Prison in Bueng Kan, Thailand suffering from peripheral neuropathy out of a total of 1,464 prisoners (6.01%). The common age range was 20 –39 years (58 patients; 65.91%). The three most common features were hyporeflexia/areflexia of the lower extremities (36 patients; 83.72%). On laboratory vitamin B1 deficiency was detected in 4/5 patients, positive rhinovirus polymerase chain re...
Source: Case Reports in Neurology - February 26, 2019 Category: Neurology Source Type: research

Acute Intermittent Porphyria: A Report of 3 Cases with Neuropathy
The porphyrias are metabolic disorders due to a defect in the heme biosynthetic pathway. Patients have diverse clinical presentations with neuropathy being frequent in acute intermittent porphyria (AIP). Associated symptoms are abdominal pain and seizures. Three patients presenting with neuropathy were later diagnosed with AIP on the basis of clinical features, erythrocyte porphobilinogen deaminase activity, neuropathic patterns, and nerve conduction studies. Testing for the HMBS genetic mutation confirmed the diagnosis of AIP in 1 patient. The findings from this case series confirm that porphyric neuropathy in AIP is a pr...
Source: Case Reports in Neurology - February 8, 2019 Category: Neurology Source Type: research

Acute Ischemic Stroke in Pregnancy
Stroke is an uncommon but serious potential complication of pregnancy. The management of acute ischemic stroke in pregnant women remains a complex challenge that extends beyond the limits of clinical trial evidence. Patient 1 was a 29-year-old woman 27 weeks into her first pregnancy, without remarkable past medical history or vascular risk factors. She was admitted 1 h after sudden onset of a left total anterior circulation syndrome (National Institute of Health Stroke Scale [NIHSS] score of 23). CT and angio-CT scans were normal. Thrombolysis was performed, with mild clinical improvement. Brain MRI showed multi-territoria...
Source: Case Reports in Neurology - February 8, 2019 Category: Neurology Source Type: research

Acute Ischemic Stroke in Late Pregnancy Treated with Intravenous Thrombolysis and Endovascular Therapy
Pregnancy has usually been an exclusion criterion in clinical trials with thrombolysis and endovascular therapy in acute ischemic stroke. For that reason, these therapies are not recommended causing lack of evidence and vice versa. In this case report, we describe a pregnant woman in week 33 + 3 presenting with acute ischemic stroke, which was successfully treated with systemic thrombolysis and endovascular therapy, resulting in a good clinical outcome for both mother and child. The altered fibrinolytic system and the risk factors related to pregnancy constitute a challenge for clinicians when choosing the most suitable tr...
Source: Case Reports in Neurology - February 8, 2019 Category: Neurology Source Type: research

Acute Ischemic Stroke in a Child Successfully Treated with Thrombolytic Therapy and Mechanical Thrombectomy
We present the case of a 4-year-old boy with complex congenital heart disease, admitted 30 min after sudden onset of an aphasia and right hemiplegia, scoring 14 on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS). Non-contrast brain computed tomography (CT) showed no evidence of acute ischemia. CT angiogram demonstrated a thrombus in the M1 segment of the left middle cerebral artery. Intravenous recombinant tissue plasminogen activator (rTPA) was infused 3.5 h after onset of symptoms. An improvement was observed in the hour after rTPA, with a PedNIHSS score of 7. Digital subtraction angiography was perfo...
Source: Case Reports in Neurology - February 8, 2019 Category: Neurology Source Type: research

Sixth Cranial Nerve Palsy and Craniocervical Junction Instability due to Metastatic Urothelial Bladder Carcinoma
We describe an unusual case of clival and CCJ metastases presenting with VI cranial nerve palsy and neck pain secondary to CCJ instability from metastatic bladder urothelial carcinoma. The patient was first treated with an endoscopic endonasal approach to the clivus for decompression of the VI cranial nerve and then with occipitocervical fixation and fusion to treat CCJ instability. At the 6-month follow-up, the patient experienced complete recovery of VI cranial nerve palsy. To the best of our knowledge, the simultaneous involvement of the clivus and the CCJ due to metastatic bladder carcinoma has never been reported in t...
Source: Case Reports in Neurology - January 31, 2019 Category: Neurology Source Type: research

Effects of Prednisone on a Patient with Dysferlinopathy Assessed by Maximal Voluntary Isometric Contraction: Alternate-Day Low-Dose Administration for a 17-Year Period
Glucocorticoids are candidates for the pharmacological treatment of dysferlinopathy. Deflazacort, however, showed a worse effect on muscle strength than placebo. Alternate-day low-dose prednisone may have beneficial effects with fewer adverse effects. The outcomes for a female patient with dysferlinopathy (limb-girdle muscular dystrophy type 2B) were assessed by maximal voluntary isometric contraction (MVIC) using a newly devised chair and arm table with push-pull type strain gauges. Grip strength was also measured isometrically. Prednisone 15 mg was started orally at the age of 24 years and was taken every other day in th...
Source: Case Reports in Neurology - January 27, 2019 Category: Neurology Source Type: research

Limbic Encephalitis following Guillain-Barr é Syndrome Associated with < b > < i > Mycoplasma < /i > < /b > Infection
This article describes a notable case of limbic encephalitis following GBS associated with prodromalMycoplasma infection. It is interesting that autoimmune encephalopathy is concomitant with autoimmune polyneuropathy subsequent toMycoplasma infection.Case Rep Neurol 2019;11:17 –23 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - January 27, 2019 Category: Neurology Source Type: research

Coil Extrusion into the Naso- and Oropharynx Ten Years after Internal Carotid Artery Pseudoaneurysm Embolization: A Case Report
We reported the unique case of a patient with coil extrusion into the naso- and oropharynx 10 years after internal carotid artery pseudoaneurysm embolization. The pseudoaneurysm occurred after an internal carotid artery injury during an endoscopic endonasal surgery for a clival giant cell tumor.Case Rep Neurol 2019;11:4 –9 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - January 17, 2019 Category: Neurology Source Type: research

Meningitis Caused by < b > < i > Streptococcus agalactiae < /i > < /b > after Professional Tooth Cleaning: First Case
We report the first case of meningitis caused byStreptococcus agalactiae (group B streptococcus; GBS) after professional tooth cleaning in a previously healthy patient. GBS is a common commensal of the human gastrointestinal and vaginal flora. Although occurrence in the oral flora is unusual, oral transmission and thus occurrence can be assumed.Case Rep Neurol 2019;11:1 –3 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - January 13, 2019 Category: Neurology Source Type: research

Young-Onset Dementia with Lewy Bodies
Young-onset (#x3c; 65 years) dementia is a challenging clinical problem. A 61-year-old man visited our clinic because of a 2-year history of mild cognitive impairment of the executive disorder type. He was initially suspected of having young-onset Alzheimer ’s disease due to the lack of motor signs or hippocampal atrophy by conventional brain MRI. However, he proved to have anosmia, erectile dysfunction, hypersexuality, constipation, REM sleep behavior disorder, and emotional lability; imaging findings included positive brain perfusion SPECT, nigroso me MRI, DAT scan, and MIBG myocardial scintigraphy. All these clini...
Source: Case Reports in Neurology - December 20, 2018 Category: Neurology Source Type: research

Spontaneous Spinal Epidural Haematoma Secondary to Autoimmune Acquired Haemophilia
We report the case of a 71-year-old patient who presented with sudden quadriplegia secondary to cervical (C2 to T1) epidural haematoma as a result of undiagnosed autoimmune acquired haemophilia A. She underwent emergency cervical laminectomy and evacuation of spinal haematoma with significant recovery in upper limb function. This case highlights the importance of haematological investigations in patients with spontaneous spinal haematoma.Case Rep Neurol 2018;10:353 –356 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - December 14, 2018 Category: Neurology Source Type: research

Pure Autonomic Failure with Asymptomatic Hypertensive Urgency: A Case Report and Literature Review
We report the case study of a 70-year-old gentleman who presented with isolated, slowly progressive dizziness after prolonged standing and was eventually diagnosed with pure autonomic failure. Initially, his symptoms improved with the use of midodrine and fludrocortisone, but gradually became refractory and disabling. Despite multiple therapeutic interventions, his symptoms persisted along with worsening supine hypertension. We discuss the challenges faced in the treatment of an uncommon condition and discuss the clinical utility of performing serial 24-h ambulatory monitoring to detect subclinical blood pressure fluctuati...
Source: Case Reports in Neurology - December 14, 2018 Category: Neurology Source Type: research

Lambert-Eaton Myasthenic Syndrome Caused by Nivolumab in a Patient with Squamous Cell Lung Cancer
Lambert-Eaton myasthenic syndrome (LEMS) is a representative paraneoplastic neurological syndrome. Recently, nivolumab, an anti-programmed cell death 1 inhibitor, has been approved for advanced non-small-cell lung cancer. Careful attention should be paid to immune-related adverse events (irAEs), including neurotoxicity. We herein report a 73-year-old woman with LEMS that occurred during nivolumab treatment for pulmonary squamous cell carcinoma. After the 20th week of nivolumab, she experienced various neurological symptoms such as ptosis, lower limb weakness, and photophobia. Findings from a nerve conduction study and a po...
Source: Case Reports in Neurology - December 5, 2018 Category: Neurology Source Type: research

Intermittent Myokymia as a Pointer to Hemangioblastoma of the Cervical Spine: A Case Report
We report the case of a patient with a hemangioblastoma at the junction of the medulla oblongata and the cervical spine and provide a brief review of the literature.Case Rep Neurol 2018;10:338 –341 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - December 4, 2018 Category: Neurology Source Type: research

Tetraparesis following an Anterior Circulation Stroke: A Case Report
We report a patient who suffered from a tetraparesis following a bilateral anterior cerebral artery territory infarction due to an occluded AACA and provide a brief review of the literature.Case Rep Neurol 2018;10:342 –345 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - December 4, 2018 Category: Neurology Source Type: research

Massive Arteriovenous Malformation with Stroke-Like Presentation
We report of a 75-year-old patient with stroke-like presentation, where cerebral imaging led to the diagnosis of a massive arteriovenous malformation (AVM) of the whole left hemisphere. We suggest considering AVM as a differential diagnosis in patients with symptoms of acute stroke despite age and, in the absence of contraindications, in this setting to obtain MRI or CT angiography of the brain.Case Rep Neurol 2018;10:332 –337 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - November 30, 2018 Category: Neurology Source Type: research

Stroke due to Paradoxical Embolization Related to Fibroid Uterus Enlargement Compressing the Right Common Iliac Vein
We present the case of a young adult woman who had a left middle cerebral artery infarction related to patent foramen ovale and right common iliac vein compression from an enlarged fibroid uterus.Case Rep Neurol 2018;10:328 –331 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - November 23, 2018 Category: Neurology Source Type: research

Stent-Assisted Angioplasty of Spontaneous Bilateral Extracranial Vertebral Dissections under Intravascular Ultrasound Guidance
The authors here report a case of stent-assisted angioplasty under intravascular ultrasound (IVUS) guidance for the treatment of spontaneous bilateral extracranial vertebral artery (VA) dissection. A 47-year-old woman presented with spontaneous severe posterior neck pain. Examinations revealed bilateral extracranial VA dissection, which was thought to be the reason for her symptom. However, since the pain was gradually worsening even after sufficient medical treatment, she underwent stent angioplasty under IVUS guidance, following which her symptoms improved. We propose that stent placement under IVUS guidance is a safe an...
Source: Case Reports in Neurology - November 14, 2018 Category: Neurology Source Type: research

Transient Anarthria and Quadriplegia in a Patient with Basilar Artery Hypoplasia and Coincidental Intracranial Lipoma: A Case Report
We report the case of a 52-year-old woman with vertebrobasilar transient ischemic attack associated with basilar artery hypoplasia and coincidental intracranial lipoma. She presented with sudden-onset dizziness, anarthria, and quadriplegia lasting for about 30 min. The patient ’s initial blood pressure was measured at 200/120 mm Hg. The magnetic resonance and computed tomographic images showed the absence of an acute ischemic lesion in the brain but revealed a hypoplasia of the basilar artery and bilateral V4 vertebral arteries. A lipoma of 11 mm in long diameter was al so found in the quadrigeminal cistern and at th...
Source: Case Reports in Neurology - November 14, 2018 Category: Neurology Source Type: research

The Wrong Turn to Tijuana: Dry Beriberi after Gastric Bypass Surgery with Incidental Spinal Stenosis
Thiamine deficiency is a condition characterized by several different presentations, but one of the most devastating is dry beriberi. It is associated with polyneuropathy and muscle weakness which typically affects the lower extremities and progressively involves the upper extremities. This case outlines a case of a 41-year-old man that presented to the hospital with diffuse weakness and decreased sensation in his legs and hands over a 3-day period. The patient ’s medical history revealed a gastric bypass surgery 4 months previously in Tijuana, Mexico, with no follow-up, binge drinking on weekends, and emesis in the ...
Source: Case Reports in Neurology - November 8, 2018 Category: Neurology Source Type: research

Human Chronic Necrotizing Granulomatous Meningoencephalitis: A Novel Case Report
Necrotizing and granulomatous meningoencephalitis are common central nervous system diseases known to affect canines. To date, necrotizing granulomatous meningoencephalitis has yet to be described in humans. Current studies of presumed pathogenesis and possible treatment options have only been described in canines. This is a case report of a 55-year-old female patient who was diagnosed with necrotizing granulomatous meningoencephalitis in the setting of new-onset neurological symptoms without any infectious or malignant source.Case Rep Neurol 2018;10:302 –308 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - October 24, 2018 Category: Neurology Source Type: research

Diffusion Tensor Imaging in a Case of Pontine Bleeding Showing Hypertrophic Olivary Degeneration and Cerebellar Ataxia
We present diffusion tensor tractography (DTT) findings in a case of hypertrophic olivary degeneration (HOD) and cerebellar ataxia. A 56-year-old man presented with abnormal ataxic gait and dysarthria. MRI 5 months after onset showed chronic pontine hematoma and enlarged bilateral inferior olivary nuclei. DTT showed decreased volume of the bilateral central tegmental tract, in accordance with the conventional hypothesis that HOD is associated with neurologic insult to the Guillain-Mollaret triangle. The patient ’s cerebellar ataxia was speculated to be due to decreased decussating fibers of the superior cerebellar pe...
Source: Case Reports in Neurology - October 17, 2018 Category: Neurology Source Type: research

A Modified Surgical Technique for Transposition of the Vertebral Artery to the Common Carotid Artery
A proximal occluded vertebral artery (VA) with reconstitution by muscular collateral vessels is a relatively common finding. However, due to inadequate intracranial anastomosis and hypoplasia or stenosis of the opposite VA, a number of patients develop symptoms of brain ischemia. In the current case, a 63-year-old man presented with repeat neurological symptoms such as dizziness, nausea, vomiting, dysarthria, left hemiparesis, and right hemianopsia. Magnetic resonance imaging revealed multiple posterior infarctions. Angiography revealed the VA to be occluded and reconstituted by collateral vessels. Considering the above re...
Source: Case Reports in Neurology - October 9, 2018 Category: Neurology Source Type: research

Limb Girdle Muscular Dystrophy due to Digenic Inheritance of < b > < i > DES < /i > < /b > and < b > < i > CAPN3 < /i > < /b > Mutations
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. Whole-exome sequencing test...
Source: Case Reports in Neurology - September 18, 2018 Category: Neurology Source Type: research

Endovascular Thrombectomy in Acute-Onset Ischemic Stroke – beyond the Standard Time Windows: A Case Report and a Review of the Literature
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. Thirty-seven hours after symptom onset, his weakness acutely worsened. A repeat MRI revealed an unchanged core infarct volume and a cerebral angiogram suggested an abrupt occlusion of the right distal M1. Thrombectomy was performed with complete reperfusion and the patient ’s strength recovered following the procedure. We compared our clinical reasoning with the DEFUSE-3 and DAWN study crit...
Source: Case Reports in Neurology - September 18, 2018 Category: Neurology Source Type: research

Does Natalizumab Induce or Aggravate Psoriasis? A Case Study and Review of the Literature
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.Case Rep Neurol 2018;10:286 –291 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - September 18, 2018 Category: Neurology Source Type: research

Rapidly Progressing Sporadic Creutzfeldt-Jakob Disease Presenting as a Stroke
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 nonfamilia...
Source: Case Reports in Neurology - September 17, 2018 Category: Neurology Source Type: research

Recurrent Nerve Palsy due to a Giant Vertebral Artery Aneurysm
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.Case Rep Neurol 2018;10:266 –271 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - September 17, 2018 Category: Neurology Source Type: research

Herniated Proximal Marker of the Stent into the Meningohypophyseal Trunk after Stent-Assisted Coil Embolization for Intracranial Aneurysms
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. After successful coil embolization, we detached the Solitaire s...
Source: Case Reports in Neurology - September 2, 2018 Category: Neurology Source Type: research

A Fatal Case of Herpes Simplex Encephalitis with Two False-Negative Polymerase Chain Reactions
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. Shortly after the change in management, the patient died from cardi...
Source: Case Reports in Neurology - September 2, 2018 Category: Neurology Source Type: research