Neurocase最新文献

A 12-year-old adolescent diagnosed with Anti-N-Methyl-D-Aspartate receptor encephalitis (ANMDAE) with catatonia was successfully treated with a course of zolpidem after inadequate response and lack of tolerance to first-line treatments, including benzodiazepines and electroconvulsive therapy (ECT). ANMDAE is an immune-mediated disease comprising a complex neuro-psychiatric clinical presentation that can range from memory deficits, seizures, and psychosis, to malignant catatonia. Catatonia is a psychomotor disorder that can increase the risk of medical complications. Current catatonia treatment guidelines include the use of benzodiazepines followed by ECT. Benzodiazepines are highly effective to treat catatonia in adults, with lower remission rates in children and adolescents. However, there are no defined guidelines if a patient fails to respond to the aforementioned treatments. Other treatment options may include zolpidem. To our knowledge, there is little literature on the treatment of catatonia with zolpidem in adolescents with underlying neurological conditions such as ANMDAE. This brief report highlights the importance of early recognition and treatment of ANMDAE with catatonia. It also underscores the lack of treatment guidelines for adolescents treated with immunotherapy presenting catatonia refractory to treatment with benzodiazepines and ECT. Zolpidem may be an alternative treatment for catatonia for patients not responding or tolerating benzodiazepines or ECT.

Lobotomy was a widespread neurosurgical procedure in the first half of the 20th century. It was used as a treatment for various mental disorders. The development of psychosurgeries in Brazil, their indications, effects, consequences, advancements, as well as the social context of the population subjected to it are revised herein. Also, an illustrative case report of an elderly Brazilian bipolar disorder patient who underwent this procedure in the 1940's is described in this paper. The article promotes a critical debate around the ethical and social implications of this practice, contributing to the understanding and reflection on the history of psychiatry, neuroscience, and research ethics.

We report a case of a 19-year-old woman with drug-resistant focal epilepsy whose typical seizure semiology involved sensations of déjà-vu. She underwent intracranial stimulation, leading to déjà-vu upon stimulation of the posterior cingulate cortex (PCC). Most reports of induced déjà-vu and epilepsy-associated déjà-vu emphasize networks including temporal lobe, especially the rhinal cortices, as the generator of this phenomenon. However, evidence from healthy individuals and those with confirmed cingulate epilepsy suggests that the PCC may play a role in some experiences of déjà-vu or other dreamy state phenomena. This case adds to the body of evidence suggesting a role for the PCC in déjà-vu. It also highlights the importance of including the PCC in intracranial investigations of some suspected temporal lobe epilepsies.

Colpocephaly, a cause of hydrocephalus, is characterized by disproportionately enlarged occipital horns of the lateral ventricles. It is rarely seen in the older adults. Few cases were reported as colpocephaly in elderly individuals in the literature. However, it has not been reported as idiopathic normal pressure hydrocephalus-like clinical presentation in older adults. To the best of our knowledge, the co-existence of colpocephaly and Alzheimer's disease has not been reported previously. In these respects, it is the first case in the literature.

Sleep spindles (SS) and slow waves (SW) serve as indicators of the integrity of thalamocortical connections, which are often compromised in individuals with autism spectrum disorder (ASD). Transcranial magnetic stimulation (TMS) can modulate brain activity associated with ASD. This study evaluated the effects of TMS on SS and SW in an 11-year-old male with ASD who received 17 sessions of TMS on the dorsolateral prefrontal cortex. Both SS and SW were detected before and after TMS and were analyzed using self-organizing maps (SOM). Using the SOM, a subset of SS and SW was identified that exhibited structural changes after TMS.

Executive function (EF) deficits are common in epilepsy and impact quality of life. This study compares EF in idiopathic generalized epilepsy (IGE) and temporal lobe epilepsy (TLE) patients to healthy controls. Fifty-six IGE patients, 56 TLE patients, and 60 controls (matched by age) completed cognitive tests assessing attention, memory, learning, and verbal fluency. Both epilepsy groups performed worse than controls, with TLE patients showing significantly poorer verbal learning and memory compared to IGE patients. These findings suggest that TLE patients have more severe EF impairments, likely due to focal temporal lobe dysfunction and disruptions in EF networks.

Psychotic symptoms, characterized by hallucinations, delusions, and cognitive disturbances, are associated with various psychiatric and neurological disorders. This manuscript explores two cases of acute psychotic episodes triggered by the regular consumption of herbal products. The cases highlight the need for increased awareness of the potential toxic side effects of herbal products. The impact of herbal ingredients like maca and matcha on neurotransmitter activity is explored, shedding light on the underlying mechanisms leading to psychosis. The manuscript highlights the need to report both the benefits and risks of herbal products, challenging the misconception that they are inherently safe.

Moyamoya is a rare chronic brain vascular disease with a set of potential life-threatening consequences due to a high probability of stroke occurrence. Here we present a case of a patient with moyamoya disease, who has been dynamically observed over more than 4 years after the first manifestation of her symptoms. In this study we report fMRI and DTI findings obtained at the final follow-up point, four years after two revascularization surgeries were successfully performed. Our findings lend support to the idea that revascularization surgery is effective in preventing future strokes, but may lead to only minor improvement in cognitive performance.

Introduction: Othello syndrome is a psychosis with delusions of infidelity, where the patient harbors a persistent, unfounded belief - a "delusion" - that their partner is being unfaithful. This condition can manifest in certain psychiatric conditions and neurological disorders, such as neurodegenerative diseases, as parkinson's disease treatment side effects, or occasionally after a stroke.

Case: We report a rare case of a 50-year-old woman, with no previous psychiatric history, who developed a delusion of infidelity, leading to verbal and physical aggressions with bladed weapons, days after experiencing a bi-thalamic infarct due to the occlusion of the Percheron artery.

Discussion: Psychosis is the third most common psychiatric symptom post-stroke, with delusional disorders being the most prevalent type. Within this category, delusional jealousy is the second most common subtype, following persecutory delusions. Although no specific brain lesions are exclusively responsible for jealousy delusions, lesions in various regions, particularly in the right hemisphere, have been implicated. Thalamic strokes disrupt the frontal-subcortical-thalamic circuitry, crucial for executive functions, and the dorsomedial nuclei, leading to alterations in limbic circuitry and emotional regulation. These damages can result in significant impairments in impulse control and judgment, manifesting as behavioral disorders due to a flawed interpretation of a partner's actions as infidelity. In this case, our patient experienced a bi-thalamic infarct predominantly on the right side.

Conclusion: Othello syndrome represents a challenging post-stroke complication, highlighting the intricate relationship between neurological damage and psychiatric manifestations. Recognizing and promptly addressing this syndrome is crucial, given its potential for dangerous outcomes.

Naming impairment is a hallmark of logopenic primary progressive aphasia (lvPPA), yet its effects in bilingualism remain understudied. This study examined naming accuracy in a 78-year-old Chinese-English bilingual woman with lvPPA over two years using a modified Boston Naming Test. Naming accuracy was higher in her second, but more frequently used language (English) than her first, but less frequently used language (Chinese). Regression analyses revealed that familiarity predicted naming in Chinese, while word length and age of acquisition influenced English. Decline was linked to age of acquisition in Chinese and emotional properties in English, highlighting language-specific patterns in bilingual lvPPA.