IgG4-Related Peripheral Neuropathy with Unilateral Cervical Nerve Root and Brachial Plexus Swelling: A Case Report
A 64-year-old man presented with left upper limb weakness and dysesthesia for 4 months. Magnetic resonance imaging demonstrated swelling from the 6th –8th left cervical nerve roots to the left brachial plexus. The serum IgG4 level was elevated (762.7 mg/dL).18F-FDG-PET showed high uptake in the mediastinal lymph nodes, and biopsy revealed infiltration of IgG4-positive plasma cells. We diagnosed IgG4-related neuropathy, and steroid therapy administration improved the symptoms. IgG4-related disease should be considered in the differential diagnosis of peripheral nerve swellings. If biopsy of the disordered nerves is diffic...
Source: Case Reports in Neurology - August 16, 2022 Category: Neurology Source Type: research
Immunocompetence after SARS-CoV-2 Infection in a Patient with Multiple Sclerosis Treated with Ofatumumab: A Case Report
Ofatumumab is the first fully human anti-CD20 monoclonal antibody that, on March 26, 2021, was approved by the EMA to treat patients with relapsing multiple sclerosis. This paper aimed to present a case confirming the ability to produce and maintain anti-SARS-CoV-2 antibodies in a patient treated with ofatumumab for over 4 years. The course of the infection was moderate, and the patient did not require hospitalization. Antibody measurements were performed five times post-COVID-19 infection. The first test was performed in the fourth month (131 days), and the last, over 1 year after the infection. To date, only 2 cases have...
Source: Case Reports in Neurology - August 16, 2022 Category: Neurology Source Type: research
Myasthenia Gravis Complicated by Eosinophilic Granulomatosis with Polyangiitis: A Case Report
A 55-year-old woman with a history of allergic sinusitis was being administered cyclosporine for ptosis and diplopia due to myasthenia gravis since age 46 years. She developed painful dysesthesia that began in her feet and later spread to her palms, leading to difficulty in walking. Eosinophils were markedly increased in the peripheral blood. Nerve conduction studies revealed mononeuritis multiplex. Nerve biopsy showed the infiltration of eosinophils in the superior neurovasculature. Based on these findings, eosinophilic granulomatous polyangiitis was diagnosed. Methylprednisolone pulse therapy was followed by oral prednis...
Source: Case Reports in Neurology - July 11, 2022 Category: Neurology Source Type: research
A Case of Perimesencephalic Subarachnoid Hemorrhage with Cerebral Venous Sinus Thrombosis due to Stenosis of the Junction of the Vein of Galen and Rectus Sinus
We report a case of PMSAH caused by stenosis of the junction of the vein of Galen (VG) and the rectus sinus (RS). A 39-year-old man presented with restlessness at work. He was administered diazepam, and a few minutes later, his consciousness became clear. Imaging showed subarachnoid hemorrhage (SAH) around the right midbrain, occlusion of the right sigmoid sinus and the right transverse sinus, stenosis of the junction of the VG and RS, T2 hyperintensity in the right middle temporal gyrus, and obstruction of the right vein of Labbe. The location of the SAH coincided with stenosis of the junction of the VG and RS. PMSAH was ...
Source: Case Reports in Neurology - July 8, 2022 Category: Neurology Source Type: research
Anomia with Amnesia Caused by Hemorrhage in the Left Anterior and Medial Thalamus: Thalamic Anomia Particularly for Artificial Objects
We herein report the case of a patient who showed pure anomia and amnesia caused by hemorrhage in the left thalamus, involving the anterior, ventral anterior, and mediodorsal nuclei. It was revealed that the anomia was characterized by impaired retrieval of object names, which was more pronounced in artificial objects, and abundant perseveration, whereas the amnesia was mild and limited to daily routine events, which was made clear from the results of an episodic memory scale. Detailed lesion localization and literature review revealed that a combination of pure anomia and amnesia can occur in a lesion involving the anteri...
Source: Case Reports in Neurology - June 30, 2022 Category: Neurology Source Type: research
Refractory Seizures Secondary to Vitamin B6 Deficiency in Parkinson Disease: The Role of Carbidopa-Levodopa
Carbidopa-levodopa has been used for more than 50 years in the treatment of Parkinson disease (PD) and other movement disorders. Pyridoxal 5 ′-phosphate (PLP), an active form of vitamin B6 (pyridoxine), is involved in the decarboxylation of levodopa to dopamine; carbidopa, which is combined with levodopa to reduce peripheral levodopa conversion and minimize peripheral dopamine side effects, binds irreversibly with PLP. As a result, car bidopa-levodopa may cause vitamin B6 deficiency and associated sequelae, including seizures, especially in high doses. A 78-year-old gentleman with a 6-year history of PD on carbidopa-levo...
Source: Case Reports in Neurology - June 27, 2022 Category: Neurology Source Type: research
Cerebral Venous Thrombosis due to Cryptococcus in a Multiple Sclerosis Patient on Fingolimod
We report a case of cerebral venous thrombosis secondary to cryptococcus in a patient receiving fingolimod. A 61-year-old male with multiple sclerosis treated with fingolimod presented with a 2-week history of headache, chills, and night sweats. An MRI of the brain revealed a left transverse and sigmoid sinus thrombosis. Two blood cultures revealedCryptococcus neoformans; a serum cryptococcal antigen was also positive. HIV testing was negative. A lumbar puncture was deferred as the patient was placed on heparin and, subsequently, warfarin for the cerebral venous thrombosis. The patient received antifungal therapy for 14 da...
Source: Case Reports in Neurology - June 24, 2022 Category: Neurology Source Type: research
Sensory Predominant Guillain-Barr é Syndrome Concomitant with Dengue Infection: A Case Report
Guillain-Barre syndrome is an acute demyelinating polyneuropathy disease which is autoimmune in nature and usually follows gastrointestinal or respiratory infections. Dengue fever is however not a common trigger to the condition. Here, we report a patient who developed sensory predominant demyelinating polyradiculopathy during febrile phase of dengue fever. It was later confirmed with serology test and nerve conduction study. He was successfully treated with intravenous immunoglobulin and discharged home well. The purpose of this case report is to highlight that Guillain-Barr é syndrome can occur as an uncommon neurologic...
Source: Case Reports in Neurology - June 17, 2022 Category: Neurology Source Type: research
Recurrent and Multiple Intracerebral Hemorrhages in Polycythemia Vera Secondary to Myelofibrosis: A Case Report and Literature Review
Polycythemia vera (PV) is one of the myeloproliferative neoplasms and has higher frequency of theJAK2 V617F mutation. Hemorrhagic stroke is rare in PV, and myelofibrosis is secondary to PV. A 76-year-old Japanese man was diagnosed as PV with theJAK2 V617F mutation at the age of 63 years. He developed anemia together with secondary myelofibrosis, and then 40 mg ruxolitinib was started at 70 years. At 76 years, he presented with apathy and was diagnosed with intracerebral hemorrhage (ICH) in the right thalamus. Six months later, he developed multiple ICHs in bilateral cerebellar hemispheres. Leukocyte count was 57,600/ μL, ...
Source: Case Reports in Neurology - June 7, 2022 Category: Neurology Source Type: research
Delayed Detection of Hydrocephalus following Mildly Traumatic Subarachnoid Hemorrhage in Corticobasal Degeneration: A Case Report
A 65-year-old woman presented with slowly progressive aphasia with gait disturbance associated with parkinsonism. She experienced a fall that resulted in a brain trauma. Brain imaging revealed a small amount of subarachnoid hemorrhage (SAH) with intraventricular bleeding. Despite conservative therapy, gait disturbance and hyporesponsiveness gradually deteriorated following that brain trauma. One month later, she was transferred to our hospital, and magnetic resonance imaging revealed prominent communicating hydrocephalus. A ventriculoperitoneal shunt and brain biopsy were performed. Neurosurgical intervention did not impro...
Source: Case Reports in Neurology - May 30, 2022 Category: Neurology Source Type: research
Severe Hemophilia A and Moyamoya Syndrome in a 19-Year-Old Boy Caused by Xq28 Microdeletion
In conclusion, diagnosis of MMD should be considered in any male, young patient with symptoms of ischemic stroke with no obvious explanation, and especially in patients with known hemophilia, since a relationship between the two conditions has been documented.Case Rep Neurol 2022;14:261 –267 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - May 30, 2022 Category: Neurology Source Type: research
A Unique Constellation of Multiple Cranial Neuropathies in a Patient with Preeclampsia
In conclusion, multiple cranial neuropathies may occur in and even be a presenting symptom of preeclampsia. In this study, we report the first case of multiple cranial neuropathies involving cranial nerves IX, X, XI, and XII in a patient with preeclampsia. Possible pathogenic mechanisms of cranial neuropathy in preeclampsia include immune-mediated neuropathy with or without demyelination, microvascular thromboses, and perineural edema.Case Rep Neurol 2022;14:256 –260 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - May 30, 2022 Category: Neurology Source Type: research
Fulminant Idiopathic Intracranial Hypertension in Pregnancy
Fulminant IIH in pregnancy requires multidisciplinary collaboration and immediate CSF diversion.Case Rep Neurol 2022;14:251 –255 (Source: Case Reports in Neurology)
Source: Case Reports in Neurology - May 16, 2022 Category: Neurology Source Type: research
Bilateral Vocal Cord Paralysis Associated with Meningeal Carcinomatosis from Lung Adenocarcinoma
Cranial neuropathy is a clinical manifestation of meningeal carcinomatosis (MC); however, the glossopharyngeal and vagus nerves are rarely impaired. Therefore, dysphagia and bilateral vocal cord paralysis (BVCP) are extremely rare manifestations of MC. Here, we present a case of MC from a lung adenocarcinoma presenting with dysphagia and BVCP. An 84-year-old man with a 4-year history of left lung adenocarcinoma developed dysphagia and hoarseness. Flexible nasopharyngoscopy revealed BVCP. Ten days later, the patient developed stridor and respiratory distress. A tracheotomy was performed to prevent airway obstruction. Gadoli...
Source: Case Reports in Neurology - May 10, 2022 Category: Neurology Source Type: research
Stiff Person Syndrome: A Case Report with Sudden Onset and Coexistence of Sero-Positive Antibodies to Glutamic Acid Decarboxylase and Anti-SOX1 Antibodies
Stiff Person Syndrome (SPS) is an extremely rare neurological condition characterized by muscle stiffness and painful muscle spasms. The symptoms often progress slowly and can cause disability. Antibodies to glutamic acid decarboxylase (anti-GAD) have been reported in up to 80% of the classic type of SPS. Paraneoplastic syndrome comprises 5% of SPS cases. These patients present with different malignancies including lung, thymus, breast, colon, and lymph nodes. In this paper, we report a case of a 25-year-old Vietnamese female patient with SPS presenting with unusual clinical manifestations of sudden onset, rapidly progress...
Source: Case Reports in Neurology - May 10, 2022 Category: Neurology Source Type: research
