Characteristic Magnetic Resonance Image Features of Acute Network Injury in Young Patients
Cerebral infarction is known to cause secondary degeneration of the areas connected to the primarily damaged regions. This has been named as acute network injury and is usually recognized in newborns or babies by high signal intensity on diffusion-weighted imaging (DWI). In this article, we present 2 cases demonstrating several characteristics of network injury. Some features are comparable to previous studies and others are distinctive to our cases. The patients not only showed secondary injury in the thorough pyramidal tract along the longitudinal extensions of neural tracts as expected but also followed transverse conne...
Source: Case Reports in Neurology - September 21, 2021 Category: Neurology Source Type: research

A Case of Reversible Cerebral Vasoconstriction Syndrome: Postpartum Cerebral Angiopathy in a 32-Year-Old Primigravid Treated with Intravenous Immunoglobulin
This is a case of a 32-year-old primigravid who developed sudden severe headache on the 7th day postpartum associated with focal neurologic deficits and altered sensorium. She had a GCS score of 6, anisocoric pupils and an NIHSS score of 31. Cranial MRI with MRA showed multifocal hyperacute to acute infarcts on the left occipital lobe, left thalamus, and midbrain which was more prominent on the right. Due to clinical deterioration, a repeat Cranial MRI with MRA was done and showed progression of infarcts involving both thalami and right pons with interval appearance of contour irregularities in the proximal anterior cerebr...
Source: Case Reports in Neurology - September 14, 2021 Category: Neurology Source Type: research

Elderly-Onset Multiple System Atrophy with Lewy Body Pathology: A Case Report
An 81-year-old woman presented with a 2-year history of progressive dysarthria and gait disturbance. Subsequently, she developed orthostatic hypotension, obstructive sleep apnea, right-sided resting tremor, and rigidity. Together with characteristic findings of imaging studies, she was diagnosed with multiple system atrophy (MSA). Despite progressive dysphagia and repeated choking episodes, the patient elected not to use artificial feeding or tracheostomy. She died suddenly at age 91 after 12 years of illness. The autopsy revealed neuropathological features of both MSA and of Parkinson ’s disease. The peripheral auto...
Source: Case Reports in Neurology - September 14, 2021 Category: Neurology Source Type: research

Neurosarcoidosis Mimicking the Recurrence of Malignant Lymphoma
A 67-year-old woman with a recurrent history of malignant lymphoma (ML) presented with muscle weakness and paresthesia of the fingertips and feet. Due to the elevated level of serum soluble interleukin-2 receptor and increased18F-fluorodeoxyglucose uptake in a mediastinal lymph node, neurolymphomatosis was initially suspected. Neurological and electrophysiological examinations were consistent with mononeuropathy multiplex. A diagnosis of neurosarcoidosis was made based on the presence of noncaseating epithelioid granulomas in the mediastinal lymph node, along with the presence of the uveitis, cardiac inflammation, and mono...
Source: Case Reports in Neurology - September 14, 2021 Category: Neurology Source Type: research

Successful Treatment of a Paroxysmal Kinesigenic Dyskinesia Patient with Carbamazepine-Induced Stevens-Johnson Syndrome Using Oxcarbazepine Monotherapy: A Case Report
We report a 21-year-old male patient with PKD referred to our movement disorders clinic after being misdiagnosed with conversion syndrome. PRRT2 gene testing using next-generation sequencing revealed a mutation in c.649dupC p. (Arg217fs). The patient responded well to carbamazepine but had to withdraw the treatment due to carbamazepine-induced Stevens-Johnson syndrome after 3 weeks of medication. Our patient did not respond to trials of levetiracetam and phenytoin but finally responded well to oxcarbazepine. The patient was followed up for 4 years, during which he had no attacks and no side effects. Here, we present a PKD ...
Source: Case Reports in Neurology - September 13, 2021 Category: Neurology Source Type: research

Brain Tumor Presenting with Parkinsonism
We describe and discuss a 59-year-old female pati ent who presented for several months of increasing tremor in her left hand, which was caused by a large meningioma located in the right frontal area, pressing on the right frontal lobe and nucleus lenticularis.Case Rep Neurol 2021;13:595 –597 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - September 13, 2021 Category: Neurology Source Type: research

Unusual Presentation of Cerebral Lupus: A Case Report of Parkinsonism in Cerebral Lupus
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement that follows a relapsing and remitting course. It is characterized by an immune-mediated response to own body defense mechanism and mistakenly attacked healthy cells of the skin, joints, kidneys, blood cells, and nervous system. Cerebral lupus refers to a constellation of neurological and/or behavioral clinical syndromes in patients with SLE. The spectrum of presentation can vary widely ranging from mild symptoms such as headaches, slight cognitive dysfunction, and mood disorders to more serious conditions like seizures, stroke,...
Source: Case Reports in Neurology - September 13, 2021 Category: Neurology Source Type: research

TMS-Induced Seizure during FDA-Approved Bilateral DMPFC Protocol for Treating OCD: A Case Report
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation therapy that has become a method of choice for the treatment of several neuropsychiatric disorders such as depression and OCD. It is considered to be a safe and well-tolerated treatment, with only few side effects. The most serious adverse event during any rTMS treatment is the potential induction of a seizure. rTMS has shown very encouraging results for treatment-resistant OCD, although the optimal target area and the stimulation frequency are still matters of controversy. Here, we present a 19-year-old female patient with OCD who exper...
Source: Case Reports in Neurology - September 9, 2021 Category: Neurology Source Type: research

Medical Case Report on Repeat Treatment of Restless Legs Syndrome with Intravenous Infusion of Iron
Restless legs syndrome (RLS) is a debilitating neurological disorder for which a range of medical interventions with varied efficacy has been employed. Based on evidence of iron deficiency in the substantia nigra of the midbrain, there are reports of substantial benefits from intravenous iron infusion. This case report demonstrates a strong statistically significant negative correlation between serum ferritin and RLS severity of symptoms in a subject with RLS who received 2 intravenous infusions of ferric carboxymaltose over a period of 464 days. The results provide further evidence to support the treatment strategy.Case R...
Source: Case Reports in Neurology - September 2, 2021 Category: Neurology Source Type: research

Bihemispheric Cortical Infarcts in an Adult Secondary to < b > < i > Escherichia coli < /i > < /b > K1 Meningitis
This study demonstrates the necessity of early diagnosis and treatment ofE. coli meningitis to prevent neurological complications, including stroke.Case Rep Neurol 2021;13:572 –577 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - August 24, 2021 Category: Neurology Source Type: research

Early-Onset Vascular Dementia in a 43-Year-Old Man with Accelerated Atherosclerotic Disease, Elevated Lipoprotein (a), and a Missense DNAJC5 Variant with Potential Association to Adult-Onset Ceroid Lipofuscinosis
In conclusion, in patients with early-onset dementia and evidence of accelerated atherosclerosis, it is reasonable to measure Lp(a) and consider testing for variants in genes such as DNAJC5 and others, particularly when disease severity appears unexplained by known risk factors or circumstances.Case Rep Neurol 2021;13:565 –571 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - August 24, 2021 Category: Neurology Source Type: research

Varied Presentation and Importance of MR Neurography of the Common Fibular Nerve in Slimmer ’s Paralysis
We present 5 cases of slimmer’s paralysis in patients who had lost 32–57 kg in approximately 1 year. In 2 cases, MR neurogram of the knee demonstrated abnor malities of the common fibular nerve at the fibular head. Two patients underwent a common fibular nerve decompression at the fibular head and attained improved gait and sensorimotor function. Weight loss, diabetes mellitus, and immobilization may have contributed to slimmer’s paralysis in 1 case. Awareness of slimmer’s paralysis in patients who have lost a significant amount of weight in a short period of time is imperative to detect and treat a...
Source: Case Reports in Neurology - August 19, 2021 Category: Neurology Source Type: research

Leucine-Rich Glioma-Inactivated Protein 1 Antibody-Positive Polyradiculopathy Associated with Epstein-Barr Virus Infection
Epstein-Barr virus (EBV) has been associated with a plethora of neurological manifestations including polyneuropathy and polyradiculopathy. A 27-year-old man with a recent upper respiratory system infection presented with difficulty in walking. His neurological examination revealed reduced muscle strength in both proximal and distal lower limb muscles without sensory and autonomic signs. Needle electromyography showed abnormal spontaneous activity and reduced recruitment of motor units in muscles innervated by multiple lumbo-sacral roots. Cerebrospinal examination showed increased protein levels with normal cell counts. Wh...
Source: Case Reports in Neurology - August 19, 2021 Category: Neurology Source Type: research

Atypical Association of Autoimmune Limbic Encephalitis with Anti-NMDA Receptor Antibodies in a Young Male Patient: Clinical, Imaging, and Neuropsychological Characteristics
The spectrum of autoimmune encephalitis (AE) encompasses several entities characterized by a variable frequency of psychiatric symptoms, cognitive dysfunction, focal deficits, and seizures. Although patients with AE can be categorized in specific syndromes, overlapping manifestations are also common. Furthermore, atypical correlations between clinical phenotypes and autoantibody profiles could occur in rare cases. Here, we report the rare case of a young adult man attending due to new-onset seizures and a history of memory loss, autonomic disturbances, headache, behavioral changes, and visual and olfactory hallucinations. ...
Source: Case Reports in Neurology - August 19, 2021 Category: Neurology Source Type: research

Idiopathic Arachnoiditis of the Cauda Equina: A Case Report from Tanzania
We present a 26-year-old male with progressive lower back pain with radiation to the lower extremities, aggravated by movement and touch. We diagnosed idiopathic arachnoiditis based on cerebrospinal fluid analysis and magnetic resonance imaging. He was managed with a 5-day course of methylprednisolone and analgesics with a good outcome. Severe back pain without a specific cause in a young patient should be investigated with proper imaging modalities and lumbar puncture if warranted to evaluate the cause.Case Rep Neurol 2021;13:535 –540 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - August 19, 2021 Category: Neurology Source Type: research

A Middle-Aged Man Presented with Quadriparesis during COVID-19 Pandemic
The clinical presentation of COVID-19 is varied: from asymptomatic to severe neurological syndrome like stroke can happen. Guillain-Barr é syndrome (GBS) as a manifestation of COVID-19 is not very common. GBS is an acute immune-mediated polyradiculoneuropathy that usually occurs following previous exposure to infection. Here, we are reporting a case of GBS related to COVID-19 infection. The reported case presented with quadriparesis and was diagnosed with GBS after evaluation. At the same time, his RT-PCR for COVID-19 was also positive. Interestingly, this patient suffered from COVID-19 2 months before this presenta...
Source: Case Reports in Neurology - August 18, 2021 Category: Neurology Source Type: research

Test Battery Approach to Assess an Individual with Cerebral Venous Sinus Thrombosis: A Speech Language Pathologist ’s Perspective
Cerebral venous sinus thrombosis (CVST) is an uncommon stroke that has a varied clinical profile. Quite often, speech language pathologists limit the assessment of these patients to a language assessment alone. Subsequently, it is possible that they may miss out certain relevant information which can aid them in their intervention. The aim of the current study was to highlight the relevance of adopting a test battery approach to assess a patient diagnosed with CVST. Here, we present a test battery approach to assess a 43-year-old patient who reported to us after CVST. The test battery included various formal and informal m...
Source: Case Reports in Neurology - August 4, 2021 Category: Neurology Source Type: research

Mind the Gap: Acetazolamide Prolonged Periods without Paralysis in a Girl with Andersen-Tawil Syndrome
We present a case report of a 13-year-old girl with Andersen-Tawil Syndrome (ATS), a rare genetic disorder which is characterized by dysmorphic features, ventricular arrhythmias, and frequent episodes of muscle paralysis that interfere with daily activities and social engagement. After the introduction of off-label treatment with acetazolamide periods without paralysis lengthened, our patient became more independent of the help of her parents and required a wheelchair less frequently, thus improving her social life. Based on our experience, we recommend a trial of acetazolamide in patients with ATS.Case Rep Neurol 2021;13:...
Source: Case Reports in Neurology - August 2, 2021 Category: Neurology Source Type: research

Repeated Intravenous Thrombolysis in Patients with Recurrent Ischemic Stroke in the Vertebrobasilar Territory
Acute ischemic vertebrobasilar stroke (AIVBS) is usually associated with poor outcome and prognosis and in case of basilar artery occlusion (BAO) with high mortality. Intravenous thrombolysis (IVT), as a standard recanalization therapy of acute ischemic stroke (IS) within first 4.5 h, can be administrated beyond this therapeutic time window in case of symptomatic BAO. Repeated IVT is generally contraindicated in case of early recurrent IS, despite a risk of poor outcome or death after recurrent IS. The aim was to present 2 cases of repeated IVT for recurrent AIVBS and discuss specific situations where repeated IVT may be c...
Source: Case Reports in Neurology - July 29, 2021 Category: Neurology Source Type: research

Case Report: Ulcerative Colitis with Multiple Dural Venous Thrombosis
In conclusion, the sudden onset and/or acute worsening of neurological status such as headache and mental confusion in a patient with UC should alert the treating physician about the possibility of CVT so that timely intervention could be employed to prevent disabling and potentially lethal se quelae of this disease.Case Rep Neurol 2021;13:504 –509 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - July 29, 2021 Category: Neurology Source Type: research

Nemaline Myopathy: A Case Report
Generalized weakness in the pediatric and adolescent population is caused by many disorders that affect the neuromuscular axis. As next-generation sequencing (NGS) is becoming of high yield in replacing more invasive procedures, that is, muscle and nerve biopsy, more previously undiagnosed diseases of the muscles are now labeled with specific pathogenicity. A 16-year-old-girl diagnosed with nemaline myopathy but previously was misdiagnosed with congenital myasthenia and put-on unnecessary medications. Clinicians should be aware of congenital diseases that affect the muscles and know the importance of the NGS in reaching th...
Source: Case Reports in Neurology - July 21, 2021 Category: Neurology Source Type: research

Lower Urinary Tract Symptoms in Myasthenia Gravis
In conclusion, our study results showed that MG patients had significantly more LUTSs (overactive bladder) than healthy control subjects and had worse LUTS-related QOL; therefore, amelioration of LUTS in MG is important.Case Rep Neurol 2021;13:490 –498 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - July 20, 2021 Category: Neurology Source Type: research

Coming to Terms with a Conundrum: A Case of Primary Progressive Apraxia of Speech due to Corticobasal Degeneration?
Primary progressive apraxia of speech (PPAOS) is a progressive disorder impairing the motor speech act leaving linguistic function unattained. Although apraxia of speech frequently co-occurs with other neurodegenerative conditions, PPAOS defines a clinical syndrome where apraxia of speech is the sole or prominent symptom for much of the disease ’s natural history. Mounting evidence is beginning to fully define this disease as the epiphenomenon of 4-repeat (4R) tau pathology although other pathologic signatures have been reported. Indeed, PPAOS patients generally present a parkinsonian syndrome late into their natural...
Source: Case Reports in Neurology - July 20, 2021 Category: Neurology Source Type: research

Sellar Gangliocytoma: Case Report and Review of an Extremely Rare Tumour
In conclusion, this patient presented with a silent SG with likely pituitary hyperplasia. SGs are a challenging diagnosis, have a benign course, and may provide insights into PA tumourigenesis.Case Rep Neurol 2021;13:475 –482 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - July 19, 2021 Category: Neurology Source Type: research

Myocardial Injury and Stroke after Attempted Suicide
Self-stabbing is an uncommon method of suicide and attempt of suicide, mostly chosen by young men and people with a psychiatric history. A curious case of suicide attempt by self-stabbing with a huge pointed knife in a 56-year-old man is presented which resulted in a myocardial injury and was evaluated with a stroke after cardiorrhaphy.Case Rep Neurol 2021;13:470 –474 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - July 19, 2021 Category: Neurology Source Type: research

Therapy-Resistant Atypical Downbeat Nystagmus with Vertigo Confined to Specific Head-Hanging Positions: Mapping to the Gravity Vector on a Multi-Axis Turntable
Downbeat nystagmus (DBN) observed in head-hanging positions, may be of central or peripheral origin. Central DBN in head-hanging positions is mostly due to a disorder of the vestibulo-cerebellum, whereas peripheral DBN is usually attributed to canalolithiasis of an anterior semicircular canal. Here, we describe an atypical case of a patient who, after head trauma, experienced severe and stereotypic vertigo attacks after being placed in various head-hanging positions. Vertigo lasted 10 –15 s and was always associated with a robust DBN. The provocation of transient vertigo and DBN, which both showed no decrease upon re...
Source: Case Reports in Neurology - July 19, 2021 Category: Neurology Source Type: research

Neuropsychiatric Aspects in a Patient Diagnosed with Frontotemporal Dementia: Clinical Case of Low Incidence and Prevalence Disease in Colombia
Frontotemporal dementia (FTD) is a neuropsychiatric pathology characterized by dysfunctions in the frontal lobe of the brain, especially in planning, execution, and inhibition tasks, with an inability to make decisions and handle different sequences, also affecting the temporal lobe. The patient presents alterations to store, consolidate, and recall information. These neurocognitive deficits are accompanied by neurobehavioral disorders such as depression, anxiety, and apathy that contribute to the worsening of the quality of life, with a high impact on the individual, social, and family level. To identify the neurobehavior...
Source: Case Reports in Neurology - July 8, 2021 Category: Neurology Source Type: research

Aneurysm Arising at the Origin of a Duplicated Middle Cerebral Artery
A duplicated middle cerebral artery (DMCA) is a common anomaly. However, aneurysms arising from the origin of a DMCA are extremely rare. A 22-year-old female was admitted to our hospital with a World Federation of Neurosurgical Societies grade 2 subarachnoid haemorrhage. Four-vessel angiography revealed a DMCA and an aneurysm arising from the origin of this artery. The aneurysm was successfully treated by embolization, and the patient was discharged 2 weeks later. Ruptured aneurysms arising from the origin of a DMCA can be successfully treated by embolization. These aneurysms are small and 3D-computed tomography reconstruc...
Source: Case Reports in Neurology - July 8, 2021 Category: Neurology Source Type: research

Multiple Strokes in a Latin American Patient
We present a case of a recent immigrant from El Salvador without past medical history who presented to our hospital with symptoms concerning for acute stroke. Brain magnetic resonance imaging (MRI) with gadolinium confirmed an acute stroke along with multiple prior infarcts involving different vascular beds. Head magnetic resonance arteriogram did not reveal any occlusions/stenosis or aneurysmal changes. His subsequent extensive evaluation included an electrocardiogram (ECG) that revealed bifascicular block and echocardiography that suggested an apical aneurysm, but images were limited to assess. To further assess the like...
Source: Case Reports in Neurology - July 8, 2021 Category: Neurology Source Type: research

Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis
We present a case of secondary NPH due to biopsy-confirmed rheumatoid meningitis initially refractory to intravenous (IV) immunotherapy. Our patient reported an excellent response right after shunting. Her gait remains normal one and a half years later. We searched PubMed for similar cases of rheumatoid meningitis with gait abnormality for additional clinicopathologic discussion. The patient ’s movement disorder initially improved with steroid taper. However, she developed progressive symptoms, later on, refractory to IV solumedrol and rituximab. She underwent ventriculoperitoneal shunting (VPS) and reported an outst...
Source: Case Reports in Neurology - July 5, 2021 Category: Neurology Source Type: research

Incidental Finding of MEGDEL Syndrome Based on Neuroimaging: Case Report
This report presents a new neuroimaging finding by CT of MEGDEL syndrome.Case Rep Neurol 2021;13:429 –433 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 28, 2021 Category: Neurology Source Type: research

< b > < i > GJB1 < /i > < /b > Gene Analysis in Two Extended Families with X-Linked Charcot-Marie-Tooth Disease
Conclusions: There is a large clinical heterogeneity in CMTX, even amongst the family members.Case Rep Neurol 2021;13:422 –428 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 23, 2021 Category: Neurology Source Type: research

Initial Cerebellar Ataxia in Hereditary Adult-Onset Primary Lateral Sclerosis
Cerebellar ataxia preceding the apparition of primary lateral sclerosis (PLS) is reported herein. Three individuals from 2 independent kindreds experienced ataxia before developing clinical signs of PLS. Disease onset was during the sixth decade or later, and an insidious onset, with progression exceeding 11 years, was observed. Pathochrony was homogenous, consisting of initial gait instability, followed by hand dysmetria 2 years later. During a 5-year follow-up, cerebellar ataxia remained the sole clinical manifestation, preceding the appearance of muscle stiffness, which progressed to a paraparesis, and then to a purely ...
Source: Case Reports in Neurology - June 21, 2021 Category: Neurology Source Type: research

Contrast-Induced Encephalopathy after Cerebral Angiogram: A Case Series and Review of Literature
We present 4 individual cases of CIE who presented with stroke-mimic symptoms following surgery with localized iodixanol or ioversol injection. We outline a clinical timeline of all patients, showing that CIE follows a general pattern of delayed onset, worsening symptomology, and ultimately full recovery. All patients received IV hydration, corticosteroids, or both as part of their treatment protocol.Case Rep Neurol 2021;13:405 –413 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 18, 2021 Category: Neurology Source Type: research

Fatal Case of COVID-19 Pneumonia Associated with Acute Myelopathy
In December 2019, a novel coronavirus outbreak with multiple system involvement started initially in Wuhan City, Hubei Province of China. Coronavirus disease 2019 (COVID-19) infection is a systemic disorder typically presenting with fever, fatigue, and upper and lower respiratory symptoms, although neurological manifestations are increasingly reported, but pathological mechanisms have yet to be established. The symptoms of infection with COVID-19 are dependent on the patient ’s age and underlying medical illness, and on the condition of the immune system. Neurotropic and neuroinvasive capabilities of coronaviruses ha...
Source: Case Reports in Neurology - June 17, 2021 Category: Neurology Source Type: research

Reversible Severe Rhabdomyolysis Associated with Thyrotoxic Hypokalemic Periodic Paralysis
We report a case of reversible symptomatic rhabdomyolysis associated with thyrotoxic hypokalemic periodic paralysis. The patient had neither past medical nor family history of either disorder. The presenting neurological symptoms and signs, serum potassium, and creatine kinase levels returned to normal without specific treatment. Based on previous case reports, we attributed the combination of the disorders to a mutation of the calcium-gated channel (CACN) gene and its related encoded proteins.Case Rep Neurol 2021;13:394 –397 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 16, 2021 Category: Neurology Source Type: research

Heparin for Vertebral Intraluminal Thrombus Causing Retroperitoneal Hemorrhage from Occult Renal Angiomyolipoma
Stroke is a common cause of mortality and serious long-term disability worldwide. In the acute setting, current American Heart Association/American Stroke Association guidelines do not recommend routine anticoagulation for the management of acute ischemic strokes. However, short-term use of unfractionated heparin (UFH) in select subpopulations has demonstrated improved outcomes. While tools such as CHADSVASC and HASBLED scores are useful in stratifying risk of long-term anticoagulation in patients with nonvalvular atrial fibrillation and additional risk factors, the carefully selected patient populations for the design of ...
Source: Case Reports in Neurology - June 14, 2021 Category: Neurology Source Type: research

Lenin ’s Stroke
Lenin ’s stroke remains a matter of debate. Here, we propose to assess the potential mechanisms. Lenin died on January 21, 1924 at the age of 53 years. Although some doctors suggested that the origin of his health problems was neurosyphilis, the autopsy findings were consistent with a severe atheroscler osis. This process might account for his recurrent ischemic strokes. In view of the family vascular history, an early hereditary atherosclerosis may be proposed.Case Rep Neurol 2021;13:384 –387 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 14, 2021 Category: Neurology Source Type: research

A Case of Miller-Fisher Syndrome with Syndrome of Inappropriate Secretion of Antidiuretic Hormone
We report a 72-year-old woman with Miller-Fisher syndrome (MFS) with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). She developed diplopia and unsteady gait a week after an upper respiratory infection. Neurologic examination revealed ophthalmoplegia, ataxia, symmetrical weakness, numbness, and areflexia. She underwent intravenous immunoglobulin therapy. Her serum sodium concentration decreased to 119 mEq/L on day 12. She had low plasma osmolarity (254 mosm/kg), high urine osmolarity (457 mosm/kg), and high urine sodium level (73 mEq/L), while the blood level of antidiuretic hormone was normal. Anti-GD...
Source: Case Reports in Neurology - June 14, 2021 Category: Neurology Source Type: research

Successful Treatment of Airplane Headache with Rizatriptan: Case Report
Optimal management of airplane headache (AH) is still unresolved. A female, 53 years, complained of severe short-lasting jabbing pain attacks over the forehead and in the eyebrows, mainly on the left side, that occur during take-off and landing. Neurological, opthalmological, and otolaryngological examinations and brain MRI were normal. It was diagnosed as AH. The patient was recommended to take 10 mg rizatriptan 30 min before the flight. It resulted in a complete absence of headache during the take-off and significant decrease of pain intensity during the plane descending. Based on the flight duration (about 2.5 h) and ri...
Source: Case Reports in Neurology - June 14, 2021 Category: Neurology Source Type: research

A Case of Anterior Choroidal Artery Occlusion and Stroke Secondary to External Compression
The anterior choroidal artery (AChA) is a small artery commonly arising from the supraclinoid segment of the internal carotid artery (ICA). The significance of the AChA is related to its strategic supply to various important structures of the brain, such as the optic tract, the posterior limb of the internal capsule, the cerebral peduncle, the lateral geniculate body, medial temporal lobe, medial area of pallidum, and the choroid plexus [J Neurol. 1988;235:387 –91]. The AChA syndrome in its complete form consists of the triad of hemiplegia, hemisensory loss, and hemianopia. However, incomplete forms are more frequent...
Source: Case Reports in Neurology - June 14, 2021 Category: Neurology Source Type: research

Venipuncture-Related Median Nerve Palsy Disguised as Intraoperative Brachial Plexus Injury
We report a case of a woman who underwent craniectomy for treatment of trigeminal neuralgia. Intraoperatively, a transient decline in the amplitude of the left upper extremity somatosensory evoked potentials (SSEPs) was noted. This finding was presumed to be due to the traction on the brachial plexus as it improved with repositioning. Immediately upon waking from anesthesia, the patient experienced sensorimotor deficits in the left median nerve distribution. Ecchymoses from venipuncture were observed in this area. Electrodiagnostic studies confirmed a left median nerve neuropathy localized in the antebrachial area. Neurosu...
Source: Case Reports in Neurology - June 11, 2021 Category: Neurology Source Type: research

A Case Report of Adult-Onset Alexander Disease with a Tumor-Like Lesion in the Lateral Ventricle
This study aimed to present the case of a 37-year-old male patient initially diagnosed with an astrocytoma in the lateral ventricle that was later identified as GFAP mutation-confirmed AOAD.GFAP sequencing revealed a heterogeneous missense mutation point c.236G#x3e;A. Hence, AOAD should be considered in patients with tumor-like lesion brain lesion in association with atrophy of medulla oblongata and upper cervical spinal cord, and frontal white matter abnormality with contrast enhancement.Case Rep Neurol 2021;13:355 –360 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 11, 2021 Category: Neurology Source Type: research

Episodic Vestibulocerebellar Ataxia Associated with a < b > < i > CACNA1G < /i > < /b > Missense Variant
Episodic vestibulocerebellar ataxias are rare diseases, frequently linked to mutations in different ion channels. Our objective in this work was to describe a kindred with episodic vestibular dysfunction and ataxia, associated with a novelCACNA1G variant. Two individuals from successive generations developed episodes of transient dizziness, gait unsteadiness, a sensation of fall triggered by head movements, headache, and cheek numbness. These were suppressed by carbamazepine (CBZ) administration in the proband, although acetazolamide and topiramate worsened instability, and amitriptyline and flunarizine did not prevent hea...
Source: Case Reports in Neurology - June 11, 2021 Category: Neurology Source Type: research

Heterozygous VPS13A and PARK2 Mutations in a Patient with Parkinsonism and Seizures
We report a case of early onset parkinsonism and seizures in a 43-year-old male with a family history of NA. Neurologic examinations showed cognitive impairment and marked parkinsonian signs. MRI showed bilateral basal ganglia gliosis. He was found to have a novel heterozygous mutation in the VPS13A gene, in addition a heterozygous mutation in the PARK2 gene. His clinical picture was atypical for typical chorea-acanthocytosis (ChAc). The compound heterozygous mutations of VPS13A and PARK2 provide the most plausible explanation for this patient ’s clinical symptoms. This case adds to the phenotypic diversity of ChAc. ...
Source: Case Reports in Neurology - June 11, 2021 Category: Neurology Source Type: research

Ischemic Stroke in a 29-Year-Old Patient with COVID-19: A Case Report
We reported, instead, a case of an ischemic stroke in a young woman during her hospitalization for COVID-19-related pneumonia. A 29-year-old woman presented to the emergency department of our institution with progressive respiratory distress associated with a 2-day history of fever, nausea, and vomiting. The patient was transferred to the intensive care unit (ICU) where she underwent a tracheostomy for mechanical ventilation due to her severe clinical condition and her very low arterial partial pressure of oxygen. The nasopharyngeal swab test confirmed SARS-CoV-2 infection. Laboratory tests showed neutrophilic leucocytosis...
Source: Case Reports in Neurology - June 10, 2021 Category: Neurology Source Type: research

Eosinophilic Granulomatosis with Polyangiitis Presenting with Myocarditis as an Initial Symptom: A Case Report and Review of the Literature
A 66-year-old woman with a history of bronchial asthma had shortness of breath and fatigue upon mild exercise. She was diagnosed as congestive heart failure. A blood test showed eosinophilia without the presence of anti-neutrophil cytoplasmic antibody (ANCA), and a myocardial biopsy specimen revealed eosinophilic infiltration in the myocardium. Eosinophilia was improved when she was administered short-term methylprednisolone. After that, she had numbness and pain in her lower limbs with re-elevation of eosinophils. She had dysesthesia and hypalgesia in the distal part of the limbs. Sural nerve biopsy revealed axonal degene...
Source: Case Reports in Neurology - June 10, 2021 Category: Neurology Source Type: research

Cerebral Vasculitis in a COVID-19 Confirmed Postpartum Patient: A Case Report
This report was compatible with the pattern of viral-induced vasculitis and provides support to the mechanism of COVID-19-associated neurologic manifestation.Case Rep Neurol 2021;13:324 –328 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 10, 2021 Category: Neurology Source Type: research

Reasons for Diagnostic Delay of Foot Drop Caused by Parasagittal Meningioma: Two Case Reports
Foot drop is defined as an impaired ability or inability of dorsiflexion. Peripheral nervous system injuries are commonly considered as the cause of this condition. The central causes including parasagittal meningioma are also described in the literature but very rarely and commonly not recognized early. In this article, we report 2 patients with isolated unilateral foot drop as the first symptom of a parasagittal meningioma and discuss several reasons for delayed diagnosis. Two patients were treated with decompressive craniotomy. The histopathological findings demonstrated a fibroblastic meningioma and a meningothelial me...
Source: Case Reports in Neurology - June 1, 2021 Category: Neurology Source Type: research

Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report
We present a 75-year-old man, previously given a VP shunt at the age of 46, who developed a progressive gait disturbance and ataxia of the limbs after 27 years. MRI showed a cervical stenosis and myelopathy as a result of venous engorgement due to chronic overshunting of the VP shunt. Revision of the VP shunt resulted in complete resolution of his neurological symptoms and the cervical myelopathy. Cervical myelopathy due to chronic overshunting is a rare and potentially very late complication of a VP shunt. Our case underlines the importance of awareness of this complication while proper treatment can reverse the associate...
Source: Case Reports in Neurology - June 1, 2021 Category: Neurology Source Type: research