Sequential Bilateral Vertebral Artery Dissections with Prompt Resolution of Initial Insult
Vertebral arterial dissection is a known cause of stroke in young adults. There has been a multitude of cases of bilateral vertebral dissections, including progression from one vertebral artery to another. This case reports the curious sequential nature of the healing of a previously dissected vertebral artery with subsequent dissection of the collateral vertebral artery. Follow-up neuroimaging evaluation performed several months later showed healed bilateral vertebral artery. The potential trigger was neck cracking.Case Rep Neurol 2020;12:189 –198 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 11, 2020 Category: Neurology Source Type: research
Cluster-Like Headache Revealing Polycythemia Vera: A Case Report
Herein, we report on a 44-year-old man who presented with cluster headache (CH)-like pain triggered by polycythemia vera (PV). He had severe unilateral head pain attacks lasting about 30 min not associated with cranial autonomic symptoms. After the exclusion of secondary etiologies, the patient was screened for a neoplastic process through biological markers, and the diagnosis of PV was established. The results of the initial laboratory examination showed hemoglobin at 18.1 g/L and Hct at 54%. JAK2 mutation analysis was positive at 54%, and marrow biopsy confirmed the hematopoietic clonal expansion, without myelofibrosis. ...
Source: Case Reports in Neurology - June 10, 2020 Category: Neurology Source Type: research
Probable Creutzfeldt-Jakob Disease Presenting Dementia and Urinary Retention
We describe the case of an 80-year-old woman with probable Creutzfeldt-Jakob disease (CJD) presenting dementia and urinary retention. Although the number of patients previously examined, including ours, is small for conclusion, provided that other etiologies of urinary retention are carefully excluded, urinary retention seems to become a feature in CJD, presumably reflecting spinal cord pathology in CJD. Physicians are advised to evaluate pelvic floor function in CJD particularly by checking post-void residuals.Case Rep Neurol 2020;12:180 –183 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - June 10, 2020 Category: Neurology Source Type: research
Efficacy of Deep Brain Stimulation in a Patient with Genetically Confirmed Chorea-Acanthocytosis
Chorea-acanthocytosis (ChAc) is a rare autosomal recessive neurodegenerative disease due to mutation of the VPS13A gene encoding the protein chorein. ChAc is a slowly progressive disorder that typically presents in early adulthood, and whose clinical features include chorea and dystonia with involuntary lip, cheek, and tongue biting. Some patients also have seizures. Treatment for ChAc is symptomatic. A small number of ChAc patients have been treated with bilateral deep brain stimulation (DBS) of the globus pallidus interna (GPi), and we now present an additional case. Patient chart, functional measures, and laboratory fin...
Source: Case Reports in Neurology - June 26, 2019 Category: Neurology Source Type: research
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 neur...
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 antibiot...
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 progress. T...
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 plasmaphere...
Source: Case Reports in Neurology - April 18, 2019 Category: Neurology Source Type: research
