The Importance of F-Wave Patterns in a Patient with Cerebrovascular Disease Characterized by a Markedly Increased Tone of the Thenar Muscles
This study aimed to investigate the F-wave patterns in a patient with cerebrovascular disease who had no voluntary movement of the hand, particularly the thumb, caused by a considerably increased tone of the thenar muscles. A patient with right hemiplegia caused by left cerebral hemorrhage (putamen) showed a considerably increased tone of the thumb flexors and no voluntary movements. F-waves were recorded from the affected thenar muscles with median nerve stimulation in the supine lying position during the first trial. Exercise therapy that included stretching of the affected thenar muscles was performed twice a week for 2...
Source: Case Reports in Neurology - October 31, 2022 Category: Neurology Source Type: research
Serial Magnetic Resonance Imaging and Magnetic Resonance Angiographic Findings of Reversible Cerebral Vasoconstriction Syndrome Associated with Postpartum
We report 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) associated with postpartum. In case 1, a 26-year-old woman developed sudden-onset headache, nausea, and vomiting 1 h after an uncomplicated vaginal delivery. In case 2, a 27-year-old woman developed generalized seizures 9 days after an uncomplicated vaginal delivery. In both cases, initial angiographic studies showed no significant vasoconstriction; however, repeat studies revealed reversible vasoconstriction. Serial magnetic resonance imaging (MRI) revealed transient brain lesions during 6 months. RCVS remains poorly characterized, misdiagnosed, and...
Source: Case Reports in Neurology - October 31, 2022 Category: Neurology Source Type: research
Multiple Dural Arteriovenous Fistulas as the Mystery of Rapidly Progressive Dementia with Bilateral Thalamic Lesions
Dementia is a gradual and irreversible loss of higher mental function, particularly memory. Dural arteriovenous fistulas (DAVFs) are one of the rare causes of a rapid decline in cognitive function, which can be curable. DAVFs are pathological shunts between the dural artery and the dural venous sinus, dural vein, or cortical vein. Here, we present a case that initially manifested nausea and dizziness and developed rapidly progressive dementia caused by DAVFs in the left transverse sinus-sigmoid sinus junction area and the sinus confluence area, combined with cerebral venous sinus thrombosis. Moreover, our case has multiple...
Source: Case Reports in Neurology - October 31, 2022 Category: Neurology Source Type: research
Rapid Change in Shape of Unruptured Intracranial Aneurysm with Acute Perforating Infarction
Acute ischemic stroke is a rare complication resulting from an unruptured intracranial aneurysm (UIA). Ischemic stroke adjacent to the aneurysms is considered the risk of rupture of aneurysms. However, there is presently no consensus on the optimal strategy for the management of UIAs with ischemic stroke. A 27-year-old woman presented with sudden onset left hemiparesis. Acute infarction of the right basal ganglia and an aneurysm of the right middle cerebral artery were discovered on brain imaging. Antiplatelet therapy was used to treat her. The diagnosis revealed ischemic stroke caused by a thrombosed aneurysm due to the c...
Source: Case Reports in Neurology - October 31, 2022 Category: Neurology Source Type: research
Eteplirsen Use in a Boy with Duchenne Muscular Dystrophy and Sickle Cell Anemia
We present the case of a 4-year-old boy with a DMD exon deletion amenable to treatment with eteplirsen and comorbid sickle cell anemia. He has received eteplirsen treatment for 3 years with no clear adverse effects, including no increase in sickle cell crises.Case Rep Neurol 2022;14:404 –407 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - October 24, 2022 Category: Neurology Source Type: research
Punctate Enhancement of Bilateral Basal Ganglia in a Case of Epstein-Barr Virus Encephalitis
Epstein-Barr virus (EBV) encephalitis is caused by initial infection or reactivation of EBV. In adults, the risk factors of EBV encephalitis include human immunodeficiency virus infection, immunosuppressant drugs, congenital immune deficiencies, post-stem cell transplantation, and post-solid organ transplantation. However, a few cases of adult-onset EBV encephalitis without these risk factors were also reported. The efficacy of steroid or intravenous immunoglobulin remains unclear in the treatment of EBV encephalitis. Herein, we report a case of an 82-year-old man with fever and disturbance of consciousness who was diagnos...
Source: Case Reports in Neurology - October 6, 2022 Category: Neurology Source Type: research
Post Stroke Mirror Movements Preventing Performance of Bilateral Movements and Activities of Daily Living
We report the rare case of a patient with MMs of the affected hand due to atherothrombotic cerebral infarction of the right postcentral and precentral gyri. An 85-year-old Japanese man presented with left-sided hemiplegia and sensory impairment. MMs were observed in the left (affected) hand during many ADLs and could not be suppressed by the patient ’s will even when the examiner verbally instructed the patient to move only the unaffected hand. The patient was aware that his hand moved on its own, but he could not control it. The patient was trained on various types of bilateral coordinated motor exercises for 114 days a...
Source: Case Reports in Neurology - October 6, 2022 Category: Neurology Source Type: research
Effectiveness of Transcranial Direct Current Stimulation in Chronic Daily Headaches: An Experimental Single Case Report with a Novel Protocol
Chronic daily headaches are often refractory to prescribed or non-prescribed medications. Transcranial direct current stimulation (tDCS) is a new technological-based intervention with various modes of applicability. Therefore, we aimed to study the effectiveness of tDCS in an individual with symptoms of chronic daily headaches and the associated comorbidities like depression, anxiety, stress, and RLS or sleepiness, numbness, a sensation of fullness, or ringing in the ears. Based on DASS-21 and Epworth questionnaires, headache diary, and semi-structured interviews, we used repeated measures for assessing the symptoms such a...
Source: Case Reports in Neurology - September 30, 2022 Category: Neurology Source Type: research
Surgical Masks May Hide Neurological Diagnoses
We present a case that highlights one of the many ways in which the pandemic has negatively impacted the care of the non-COVID patient. A patient presented to the ED with a chief complaint of diffuse weakness and a new-onset cough on awakening. His daughter noted that he was slurring his words. An emergency medicine resident evaluated him, ordered laboratory studies, and decided to monitor the patient. The same resident later noted the patient veering to the left when walking, prompting a more detailed neurological examination. On removing the patient ’s facemask, a left lower facial weakness was evident. The resident ca...
Source: Case Reports in Neurology - September 30, 2022 Category: Neurology Source Type: research
The Usefulness of Swallowing Pressure Assessment in the Identification of Mild Pharyngeal Weakness of Myasthenia Gravis: A Case Report
Despite the clinical impact of dysphagia in myasthenia gravis (MG), a standard protocol for diagnosing dysphagia reliably has not yet been established. High-resolution manometry (HRM) provides precise information on pharyngeal pressure. We hypothesized that swallowing pressure assessment using HRM during the edrophonium chloride (EC) test could identify mild bulbar symptoms with no abnormalities on videoendoscopic (VE) and videofluorographic (VF) examination of swallowing, and we tested this hypothesis on a 72-year-old female patient diagnosed with ocular MG who developed slight pharyngeal discomfort over 3 months. The pat...
Source: Case Reports in Neurology - September 30, 2022 Category: Neurology Source Type: research
Hope, Cure, and Adverse Effects in Immunotherapy: Atezolizumab-Associated Encephalitis in Metastatic Small Cell Lung Cancer – A Case Report and Literature Review
This article describes a case of atezolizumab-associated encephalitis in a patient with metastatic small cell lung cancer.Case Rep Neurol 2022;14:366 –371 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - September 20, 2022 Category: Neurology Source Type: research
Donepezil-Induced Complex Multimodal Hallucinations: Two Cases and a Review of the Literature
Hallucinations are common in neurodegenerative dementias, being present in a significant proportion of patients. Most of the available studies show that acetylcholinesterase inhibitors may be beneficial in preventing and treating hallucinations in patients with neurodegenerative and even psychiatric disorders, even though there are reports that they might also develop as an adverse effect of such therapy. However, a clear causal relationship for the latter association was not previously established. Here we describe 2 cases of patients treated with donepezil who developed complex multimodal hallucinations, which could be c...
Source: Case Reports in Neurology - September 19, 2022 Category: Neurology Source Type: research
The Development of Pulmonary Edema after Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patient; Neurogenic or Non-Neurogenic?
In this study, we reported four cases of post-thrombolytic ischemic stroke patients who suffer from pulmonary edema with different symptoms and onset times as well as we discuss the possible explanation behind these different outcomes.Case Rep Neurol 2022;14:348 –358 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - August 30, 2022 Category: Neurology Source Type: research
Clinical Reasoning: Wilbrand ’s Knee, Scotoma of Traquair, and Normal Tension Glaucoma
An otherwise healthy 63-year-old woman was given a diagnosis of normal tension glaucoma (NTG) in the right eye (OD) 2 months before presentation. Standard computerized perimetry showed a unilateral right hemianoptic temporal field defect. On examination visual acuity was preserved, intraocular pressure was normal, there was a right relative afferent pupillary defect (RAPD) with an asymmetric cupping of the disc, but no pallor. Brain magnetic resonance imaging (MRI) showed a meningioma compressing the right optic nerve at its junction with the chiasm. Compressive disorders on the anterior chiasm, albeit rarely, may cause cu...
Source: Case Reports in Neurology - August 30, 2022 Category: Neurology Source Type: research
Neurosarcoidosis Presenting with Prominent Periventricular White-Matter Lesions during Steroid Treatment for Autoimmune Hepatitis
A 63-year-old woman under treatment of autoimmune hepatitis presented with headache, memory loss, and somnolence. Three months before admission, the patient experienced liver inflammation relapse after prednisolone (PSL) cessation. Consequently, PSL was resumed and then tapered. Cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis with remarkably reduced glucose and elevated angiotensin-converting enzyme and soluble interleukin-2 receptor levels. Magnetic resonance imaging (MRI) revealed prominent bilateral periventricular white-matter lesions, hydrocephalus, ischemic stroke with gadolinium enhancement of f...
Source: Case Reports in Neurology - August 19, 2022 Category: Neurology Source Type: research
