A 41 �year-old man had headaches, hearing loss, and left facial palsy for five months. Examination was remarkable for left seventh nerve palsy, left sided hearing loss and hemi tongue atrophy. MRI showed left cerebellopontine angle dural thickening.(Figure1and 2). Laboratory studies (CSF and blood) were unremarkable for an infectious, neoplastic and autoimmune etiology except for an elevated Antineutrophil cytoplasmic antibody titer. A dural biopsy showed chronic inflammation with granuloma formation. He was started on prednisone with plans to start immunosuppresants as outpatient.
{"title":"Wegener’s Granulomatosis presenting with multiple cranial neuropathies.","authors":"M. Lowden, Aiesha Ahmed","doi":"10.5580/263e","DOIUrl":"https://doi.org/10.5580/263e","url":null,"abstract":"A 41 �year-old man had headaches, hearing loss, and left facial palsy for five months. Examination was remarkable for left seventh nerve palsy, left sided hearing loss and hemi tongue atrophy. MRI showed left cerebellopontine angle dural thickening.(Figure1and 2). Laboratory studies (CSF and blood) were unremarkable for an infectious, neoplastic and autoimmune etiology except for an elevated Antineutrophil cytoplasmic antibody titer. A dural biopsy showed chronic inflammation with granuloma formation. He was started on prednisone with plans to start immunosuppresants as outpatient.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126942822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Sethi, D. Labar, J. Torgovnick, P. Sethi, E. Arsura, T. Barliya, A. Wasterlain
Patients with epilepsy may also have non-epileptic seizures (pseudo seizures). One study showed that 1 out of 5 people presenting to a comprehensive epilepsy center with the diagnosis of medically intractable epilepsy actually had non-epileptic events when monitored. It is particularly difficult to diagnose non-epileptic seizures in patients who also suffer from real epileptic seizures. Various non-epileptic clinical presentations have been reported in the literature. Patients may present with predominantly non-epileptic convulsions characterized by out of phase thrashing movements of the limbs, pelvic thrusting and side to side movements of the head. At other times the non-epileptic manifestations are predominantly psychiatric in character with patients exhibiting bizarre behavior, reporting vivid visual and somatosensory hallucinations or directed vocalizations. We present here a patient with medically intractable epilepsy who presented with dense hemiplegia and hemisensory loss after reported seizures at home. Patient was considered an ideal candidate for intravenous tissue plasminogen activator (tPA) therapy so an acute stroke up was initiated at the time of presentation to the ER. CT scan and MRI brain with DWI was negative for acute stroke. Neurological examination was suggestive of psychogenic weakness. Patient made a full recovery over a course of 2 days. Pseudoparalysis or pseudo Todd’s palsy should be considered in the differential of a patient with epilepsy presenting with acute hemiplegia and other focal neurological deficits especially if they are young and lack traditional vascular risk factors for stroke.
{"title":"Pseudo Todd’s palsy in a patient with medically intractable epilepsy","authors":"N. Sethi, D. Labar, J. Torgovnick, P. Sethi, E. Arsura, T. Barliya, A. Wasterlain","doi":"10.5580/1942","DOIUrl":"https://doi.org/10.5580/1942","url":null,"abstract":"Patients with epilepsy may also have non-epileptic seizures (pseudo seizures). One study showed that 1 out of 5 people presenting to a comprehensive epilepsy center with the diagnosis of medically intractable epilepsy actually had non-epileptic events when monitored. It is particularly difficult to diagnose non-epileptic seizures in patients who also suffer from real epileptic seizures. Various non-epileptic clinical presentations have been reported in the literature. Patients may present with predominantly non-epileptic convulsions characterized by out of phase thrashing movements of the limbs, pelvic thrusting and side to side movements of the head. At other times the non-epileptic manifestations are predominantly psychiatric in character with patients exhibiting bizarre behavior, reporting vivid visual and somatosensory hallucinations or directed vocalizations. We present here a patient with medically intractable epilepsy who presented with dense hemiplegia and hemisensory loss after reported seizures at home. Patient was considered an ideal candidate for intravenous tissue plasminogen activator (tPA) therapy so an acute stroke up was initiated at the time of presentation to the ER. CT scan and MRI brain with DWI was negative for acute stroke. Neurological examination was suggestive of psychogenic weakness. Patient made a full recovery over a course of 2 days. Pseudoparalysis or pseudo Todd’s palsy should be considered in the differential of a patient with epilepsy presenting with acute hemiplegia and other focal neurological deficits especially if they are young and lack traditional vascular risk factors for stroke.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127843947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A case is presented of a 66 year old lady with long standing lymphocytopenia who developed the sudden onset of inability to walk. She was subsequently diagnosed with both cryptococcal meningitis and idiopathic CD4+ T-lymphocytopenia. This report highlights important points regarding these diagnoses and their association.
{"title":"Cryptococcal Meningitis in a Patient with Idiopathic CD4+ T-lymphocytopenia.A case report","authors":"N. Gomes, F. Gomes","doi":"10.5580/458","DOIUrl":"https://doi.org/10.5580/458","url":null,"abstract":"A case is presented of a 66 year old lady with long standing lymphocytopenia who developed the sudden onset of inability to walk. She was subsequently diagnosed with both cryptococcal meningitis and idiopathic CD4+ T-lymphocytopenia. This report highlights important points regarding these diagnoses and their association.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114290566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Limb-shaking transient ischemic attacks (LSTIAs) are a rare manifestation of carotid occlusive disease. We report the case of an 81 year old woman who presented with recurrent LSTIAs and received conservative treatment with cessation of her antihypertensive medications. Multi-Slice Detector CT Angiography (MSCTA) demonstrated a right internal carotid artery occlusion with evidence of cerebral autoregulatory compensation via leptomeningeal vessels. This case characterizes LSTIAs and demonstrates the use of MSCTA in diagnosis, prognosis, and management.
{"title":"Limb-Shaking Transient Ischemic Attacks: Diagnosis, Prognosis, and Management","authors":"D. Pérez, L. Elijovich","doi":"10.5580/15bb","DOIUrl":"https://doi.org/10.5580/15bb","url":null,"abstract":"Limb-shaking transient ischemic attacks (LSTIAs) are a rare manifestation of carotid occlusive disease. We report the case of an 81 year old woman who presented with recurrent LSTIAs and received conservative treatment with cessation of her antihypertensive medications. Multi-Slice Detector CT Angiography (MSCTA) demonstrated a right internal carotid artery occlusion with evidence of cerebral autoregulatory compensation via leptomeningeal vessels. This case characterizes LSTIAs and demonstrates the use of MSCTA in diagnosis, prognosis, and management.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"286 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114095259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: We report a case of hydrocephalus as manifestation of neurosarcoidosis in absence of pulmonary features. The diagnosis and management could be a challenge in such atypical presentation of hydrocephalus in previously healthy young adult. The goal is to emphasize on importance to recognize atypical presentation in timely manner as neurologic involvement is significant cause of mortality and morbidity.
{"title":"Acute Hydrocephalus: Unsual Presentation of Neurosarcoidosis","authors":"S. Dewani, V. Wood, S. Srivastava","doi":"10.5580/1a45","DOIUrl":"https://doi.org/10.5580/1a45","url":null,"abstract":"Objective: We report a case of hydrocephalus as manifestation of neurosarcoidosis in absence of pulmonary features. The diagnosis and management could be a challenge in such atypical presentation of hydrocephalus in previously healthy young adult. The goal is to emphasize on importance to recognize atypical presentation in timely manner as neurologic involvement is significant cause of mortality and morbidity.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"243 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116054742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a case of presumed inflammatory central nervous system demyelination in association with the use of bupropion for smoking cessation. The patient developed paraesesthesia and Lhermitte's phenomenon shortly after starting the drug. There were oligoclonal bands in cerebrospinal fluid and white matter lesions in the cerebral hemispheres and cervical spinal cord. The case is discussed in the light of the known side effects of the drug.
{"title":"CNS demyelination after treatment with bupropion","authors":"J. Burge, J. Ball, J. Chataway","doi":"10.5580/dc6","DOIUrl":"https://doi.org/10.5580/dc6","url":null,"abstract":"We present a case of presumed inflammatory central nervous system demyelination in association with the use of bupropion for smoking cessation. The patient developed paraesesthesia and Lhermitte's phenomenon shortly after starting the drug. There were oligoclonal bands in cerebrospinal fluid and white matter lesions in the cerebral hemispheres and cervical spinal cord. The case is discussed in the light of the known side effects of the drug.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122509751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A forty-eight year old woman presented with convulsive status epilepticus and respiratory arrest 45 minutes after a lumbar myelogram with iopamidol. Status epilepticus in epileptic patients are very rare complication after myelography with iopamidol and to our knowledge status epilepticus in non epileptic patients have been previously reported only in one patient. Although it is a rare complication, physicians should be aware of this potential complication, myelogram should be performed in a full organized hospital. It will be better to observe patients carefully after the procedure.
{"title":"Iopamidol Myelography Induced Status Epilepticus","authors":"H. Dib, K. Ağan, I. Midi, Canan Aykut‐Bingol","doi":"10.5580/1a64","DOIUrl":"https://doi.org/10.5580/1a64","url":null,"abstract":"A forty-eight year old woman presented with convulsive status epilepticus and respiratory arrest 45 minutes after a lumbar myelogram with iopamidol. Status epilepticus in epileptic patients are very rare complication after myelography with iopamidol and to our knowledge status epilepticus in non epileptic patients have been previously reported only in one patient. Although it is a rare complication, physicians should be aware of this potential complication, myelogram should be performed in a full organized hospital. It will be better to observe patients carefully after the procedure.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115750222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a patient with sudden onset of right wrist drop mimicking radial nerve palsy, found to be due to a borderzone infarct due to spontaneous carotid artery dissection (CAD).
{"title":"An unusual clinical presentation of ischemic stroke due to carotid dissection: The wrist drop","authors":"A. Pikula, J. Romero, C. Kase","doi":"10.5580/377","DOIUrl":"https://doi.org/10.5580/377","url":null,"abstract":"We report a patient with sudden onset of right wrist drop mimicking radial nerve palsy, found to be due to a borderzone infarct due to spontaneous carotid artery dissection (CAD).","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130739626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intracranial lipomas (ICLs) are rare intracranial lesions. They represent a group of congenital malformations of the brain parenchyma, located more frequently in the pericallosal cistern and associated with other parenchymal or brain vascular malformations in up to half of cases.
{"title":"Intracranial Lipomas; Radiographic and Clinical Characteristics.","authors":"A. Zamora, J. Asconapé","doi":"10.5580/1665","DOIUrl":"https://doi.org/10.5580/1665","url":null,"abstract":"Intracranial lipomas (ICLs) are rare intracranial lesions. They represent a group of congenital malformations of the brain parenchyma, located more frequently in the pericallosal cistern and associated with other parenchymal or brain vascular malformations in up to half of cases.","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115626287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Foix-Chavany-Marie syndrome (FCMS) or anterior opercular syndrome is a rare neurological syndrome most commonly caused by cerebrovascular accident. The anatomical substrate of the classical (clinical type A) FCMS is constituted by any combination of bilateral cortical (opercular) or subcortical (subopercular) lesion, typically as a result of subsequent strokes. FCMS is characterized by facio-labio-pharyngo-glosso-masticatory paralysis with automatic-voluntary dissociation where involuntary movements of the affected muscles are preserved. A 79 year old woman with FCMS is presented to discuss the assessment,
{"title":"The Classical Type of Foix-Chavany-Marie Syndrome: Assessment and Treatment of Dysphagia","authors":"I. Chernev, R. Petrea, M. Reynolds, Feng Wang","doi":"10.5580/184a","DOIUrl":"https://doi.org/10.5580/184a","url":null,"abstract":"Foix-Chavany-Marie syndrome (FCMS) or anterior opercular syndrome is a rare neurological syndrome most commonly caused by cerebrovascular accident. The anatomical substrate of the classical (clinical type A) FCMS is constituted by any combination of bilateral cortical (opercular) or subcortical (subopercular) lesion, typically as a result of subsequent strokes. FCMS is characterized by facio-labio-pharyngo-glosso-masticatory paralysis with automatic-voluntary dissociation where involuntary movements of the affected muscles are preserved. A 79 year old woman with FCMS is presented to discuss the assessment,","PeriodicalId":232166,"journal":{"name":"The Internet Journal of Neurology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122516349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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