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 outstandi...
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 have b...
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 in ...
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
