Acute Transient Encephalopathy after Moderna COVID-19 Vaccine
We describe a patient with prior COVID-19 infection who developed acute transient encephalopathy with elevated inflammatory markers within 24 h of her first injection of Moderna COVID-19 vaccine. A 69-year-old cognitively normal woman presented with intermittent inattention, disorientation, left/right confusion, weakness, gait instability, and decreased speech. Head CT, brain MRI and MRA, complete blood count, liver enzymes, hepatitis B serology, ammonia, thyroid function, vitamin B12, and pulse oximetry were normal. Electroencephalography performed 48 h after symptom onset showed diffuse triphasic waves, diffuse theta and...
Source: Case Reports in Neurology - May 9, 2022 Category: Neurology Source Type: research
Amnesia of Uncertain Etiology in an Adolescent during COVID-19 Pandemic: A Case Report
The objective of this study was to describe the case of an unexplained sudden memory loss that only partially fits with the criteria for dissociative amnesia, in a juvenile patient aged 16 years, which occurred during the COVID-19 lockdown. After the exclusion of any organic disturbances, 10 days after the clinical onset, a series of psychometric (neuropsychological and psychodiagnostics) tests were administered to the patient. Recent distress associated with COVID-19 lockdown was reported, while no previous significant distress or psychiatric history emerged during the clinical interview, conducted with the patient and pa...
Source: Case Reports in Neurology - May 3, 2022 Category: Neurology Source Type: research
Glioblastoma, IDH-wildtype: A New Association with IgM Paraproteinaemic Neuropathy?
We present 3 cases of classica l IgM paraproteinaemic neuropathy who developed glioblastoma in the course of their illness following treatment with chemoimmunotherapy (CIT). Due to the progressive symptomatic nature of their neuropathy, all 3 patients were treated with CIT. The patients presented with glioblastoma, IDH-wildtype a t 9 months, 5 years, and 6 years following treatment completion. None of the patients had unequivocal evidence of known predisposing factors for glioblastoma. Both disorders are exceedingly rare and the chance of random association is less than one in a million. Potential common pathogenic mechani...
Source: Case Reports in Neurology - April 22, 2022 Category: Neurology Source Type: research
Small-Fiber Neuropathy Possibly Associated with COVID-19
COVID-19 has caused several neurological complications by affecting the central and peripheral nervous systems (PNS). Studies on the PNS involvement in COVID-19 are limited. These complications are likely unreported, given the difficulty of obtaining further diagnostic information, such as expert neurologist evaluation, electrodiagnostic testing, and skin biopsy. Herein, we report 2 cases of possible COVID-19-related small-fiber neuropathy (SFN). These cases are reported to increase awareness of a possible link between COVID-19 and SFN. Additional investigation, including neurology consultation, nerve conduction studies, a...
Source: Case Reports in Neurology - April 22, 2022 Category: Neurology Source Type: research
A Case of Pure Autonomic Failure Initially Presenting with Hemihypohidrosis: Twelve-Year Follow-Up
Although it is generally recognized that pure autonomic failure (PAF) is a progressive neurodegenerative disease selectively involving the autonomic nervous system, its mode of progression remains to be settled. A 57-year-old man presented with sweat reduction on the left side during previous 3 years. The thermoregulatory sweat test revealed left-sided multi-segmental hypohidrosis more markedly on the face. Pharmacological sweating was relatively preserved except for the face. During the subsequent 8 years, he developed erectile dysfunction and overt orthostatic hypotension. Plasma norepinephrine was markedly reduced witho...
Source: Case Reports in Neurology - April 19, 2022 Category: Neurology Source Type: research
Paramedian Midbrain Infarction Presenting with Bilateral Ptosis and Unilateral Median Longitudinal Fasciculus Syndrome: A Peculiar Midbrain Syndrome
We report a case of bilateral ptosis due to paramedian midbrain infarction, which was associated with ipsilateral impaired adduction of the eye and contralateral ataxia. T2-weighted magnetic resonance imaging of the brain revealed a right paramedian midbrain infarction. The ptosis rapidly improved without a difference between the left and right sides, while the other symptoms mostly resolved within a month following treatment with antiplatelet agents and rehabilitation. An infarction of the paramedian dorsocaudal portion of the midbrain can involve both the central caudal nucleus and the median longitudinal fasciculus (MLF...
Source: Case Reports in Neurology - April 4, 2022 Category: Neurology Source Type: research
First Reported Case of Atypical Meningioma in an Individual with Down Syndrome
Individuals with Down syndrome are at decreased risk of developing most types of solid tumors, including central nervous system malignancies. Several mechanisms have been proposed to explain how additional genetic material on chromosome 21 may confer this increased protection. Only two individuals with Down syndrome and meningioma have been described in the medical literature, whose tumors were both World Health Organization (WHO) grade 1. Here, we report the first individual with Down syndrome to our knowledge who developed an atypical meningioma, WHO grade 2. We also provide a hypothesis for how this tumor could have ari...
Source: Case Reports in Neurology - April 4, 2022 Category: Neurology Source Type: research
Isaac Syndrome with Intractable Neuropathic Pain Features: A Case Report
We describe a case of IS characterized by muscle twitching and intractable neuropathic pain. Diagnostic workup included elevated VGKC complex antibodies and EMG/NC that showed neuromyotonic discharges. Neuropathic pain was initially difficult to reli eve even after using multiple medications, including opiates, benzodiazepines, anticonvulsants, and intravenous immunoglobulin (IVIg). Moderate pain control was eventually achieved with long-term use of carbamazepine and subcutaneous immunoglobulin (SCIg). Common manifestations of IS are muscle twit ching, stiffness hypertrophy, and dysautonomia [Ahmed and Simmons.Muscle Nerve...
Source: Case Reports in Neurology - March 29, 2022 Category: Neurology Source Type: research
Wernicke Encephalopathy following Gastric Bypass: A Case Report
Bariatric surgery is used as a treatment for morbid obesity and often results in rapid weight loss. This procedure has been associated with postoperative nutritional deficiencies. Neurological complications due to nutritional deficiencies include Wernicke encephalopathy, a disorder that affects the central and peripheral nervous system due to thiamine (vitamin B1) deficiency. Wernicke encephalopathy can lead to irreversible consequences if not treated early. Here, we present a case of a 40-year-old woman that developed Wernicke encephalopathy 2 months after gastric bypass surgery, with additional findings of flat affect an...
Source: Case Reports in Neurology - March 29, 2022 Category: Neurology Source Type: research
The Many Faces of Blurry Vision in Parkinson ’s Disease: An Illustrative Case Series
We report two persons with PD who bot h experienced blurry vision, but each with a different underlying pathology that called for specific ophthalmological and neurological treatments. In case 1, the blurry vision was presumably caused by strabismus and convergence insufficiency, while case 2 had blurry vision partly due to palinopsia, a higher order visual processing deficit. Adequate treatment improved vision in both cases. Neurologists should be aware of the different underlying causes of blurred vision, should master the basic therapeutic approaches, and know when to refer a patient to the ophthalmology department.Case...
Source: Case Reports in Neurology - March 29, 2022 Category: Neurology Source Type: research
Delayed Visual Loss in a Patient with Snake Bite: Case Report of an Unusual Neuro-Ophthalmic Presentation
Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a 70-year-old female who developed bilateral painless loss of vision after she received treatment with anti-snake venom (ASV). She had only perception of light on assessment of visual acuity on admission which then improved drastically after administration of intravenous methylprednisolone (MP) after making the provisional diagnosis of ON on the basis of history and clinical findings of the patient. Imaging and visual-evoked potential could not be done initially, and they were done after the administration of intravenous MP whic...
Source: Case Reports in Neurology - March 24, 2022 Category: Neurology Source Type: research
Unilateral Poststroke Periodic Limb Movements: A Case Series
We report 2 patients with unilateral poststroke PLM with similar clinical pictures but different symptoms, therapy, and outcome. The first is a long-lasting unilateral PLM video case with chronic vascular lesions leading to insomnia even if with no urgence or any subjective symptoms as in RLS but well responding only to a definite RLS treatment. The second case is an acute, short-duration self-limiting PLM with positive brain MRI lesion imaging. Our cases suggest that unilateral poststroke PLM even if distinct in subjective and radiological features from secondary RLS can sometimes have a definite and effective dopaminergi...
Source: Case Reports in Neurology - March 21, 2022 Category: Neurology Source Type: research
Stiff Person-Like Syndrome: An Unusual Presentation of Pituitary Macroadenoma with Panhypopituitarism
We report a 68-year-old man who presented with progressive lower limb stiffness associated with truncal instability mimicking a stiff person syndrome (SPS). Hypoglycaemia and hyponatraemia prompted the discovery of pituitary macroadenoma with panhypopituitarism. Investigation showed pituitary macroadenoma on magnetic resonance imaging with hypocortisolism, hypothyroidism, and hypogonadotropic hypogonadism. After initiating hydrocortisone replacement, the patient had complete resolution of lower limb stiffness with no permanent neurological sequelae. It is postulated that hypocortisolism and hyponatraemia disrupt the metabo...
Source: Case Reports in Neurology - March 18, 2022 Category: Neurology Source Type: research
Cerebral Amyloid Angiopathy-Related Inflammation following Multiple Cancers and Chemotherapies
Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rare autoimmune encephalopathy of aging caused by an autoantibody immune response against A β protein deposited in the brain of older adults affected by cerebral amyloid angiopathy (CAA) and Alzheimer’s disease pathology. Its most common clinical manifestations are (sub)acute-onset cognitive and behavioral abnormalities, focal deficits, seizures, and headaches. Brain magnetic resonance imaging shows characteristic extensive and confluent white matter hyperintensities and CAA features. The response to immunosuppressive treatment is generally good. Here, we re...
Source: Case Reports in Neurology - March 15, 2022 Category: Neurology Source Type: research
The Combined Use of Neuropsychiatric and Neuropsychological Assessment Tools to Make a Differential Dementia Diagnosis in the Presence of “Long-Haul” COVID-19
The longer term neurocognitive/neuropsychiatric consequences of moderate/severe COVID-19 infection have not been explored. The case herein illustrates a complex web of differential diagnosis. The onset, clinical trajectory, treatment course/response, serial neuroimaging findings, and neuropsychological test data were taken into account when assessing a patient presenting 8 months post-COVID-19 (with premorbid attention-deficit hyperactivity disorder, diabetes mellitus, mood difficulties, and a positive family history of vascular dementia). Her acute COVID-19 infection was complicated by altered mental status associated wit...
Source: Case Reports in Neurology - March 15, 2022 Category: Neurology Source Type: research
