Pub Date : 2024-06-04DOI: 10.1177/19418744241258684
Luca Clerici, Pietro Lucotti, Francesco Lombardi, Giannantonio Spena, E. Lovati, A. Di Sabatino, C. Zoia
Background: Pituitary apoplexy (PA) represents a rare but extremely serious complication of pituitary adenoma. It is characterized by the rapid onset of headache, nausea and vomiting, changes in vision, paralysis of the oculomotor nerves and alteration of the sensory. Due to the rarity of this complication and the non-specificity of symptoms, the patient’s clinical presentation may not be interpreted correctly, leading to a diagnostic delay and a worsening of prognosis. Case Description: This case report relates to a 73-year-old man with ACTH-secreting macroadenoma infiltrating the cavernous sinuses bilaterally and causing the rapid onset of headache, bilateral eyelid ptosis, complete bilaterally ophthalmoplegia and bitemporal hemianopia. The patient underwent urgent surgery to remove the lesion by transsphenoidal route and subsequent monitoring of pituitary function by endocrinologist specialist obtaining a near-total recovery from illness. Conclusions: PA is often characterized by the appearance of unilateral ocular or neurological deficits, while a clinical presentation given by ophthalmoplegia and bilateral ptosis is a very rare condition, difficult to find in the literature. Therefore, similar symptoms should not be underestimated and should raise the diagnostic suspicion of PA. In this case, in fact, a prompt treatment and multidisciplinary management of the patient allowed to markedly improve the prognosis. Furthermore, the instrumental findings supported a picture of ischemic pituitary apoplexy without signs of haemorrhage, a condition reported only sporadically in the literature.
背景：垂体性脑瘫（PA）是垂体腺瘤的一种罕见但极其严重的并发症。其特点是迅速出现头痛、恶心和呕吐、视力改变、眼球运动神经麻痹和感觉改变。由于这种并发症的罕见性和症状的非特异性，患者的临床表现可能无法被正确理解，从而导致诊断延误和预后恶化。病例描述：本病例报告涉及一名 73 岁的男性患者，他患有分泌促肾上腺皮质激素的大腺瘤，该瘤浸润了双侧海绵窦，导致患者迅速出现头痛、双侧眼睑下垂、双侧完全性眼肌麻痹和双颞偏盲。患者接受了紧急手术，通过经蝶窦途径切除了病灶，随后由内分泌专科医生对垂体功能进行了监测，最终几乎完全康复。结论PA 通常以出现单侧眼部或神经功能障碍为特征，而以眼球震颤和双侧上睑下垂为临床表现的情况非常罕见，在文献中很难找到。因此，类似症状不应被低估，并应引起对 PA 的诊断怀疑。事实上，在本病例中，对患者的及时治疗和多学科管理使预后得到了明显改善。此外，仪器检查结果支持缺血性脑垂体卒中，但无出血迹象，这种情况在文献中仅有零星报道。
{"title":"A Case of Ischemic Pituitary Apoplexy Secondary to ACTH-Secreting Macroadenoma","authors":"Luca Clerici, Pietro Lucotti, Francesco Lombardi, Giannantonio Spena, E. Lovati, A. Di Sabatino, C. Zoia","doi":"10.1177/19418744241258684","DOIUrl":"https://doi.org/10.1177/19418744241258684","url":null,"abstract":"Background: Pituitary apoplexy (PA) represents a rare but extremely serious complication of pituitary adenoma. It is characterized by the rapid onset of headache, nausea and vomiting, changes in vision, paralysis of the oculomotor nerves and alteration of the sensory. Due to the rarity of this complication and the non-specificity of symptoms, the patient’s clinical presentation may not be interpreted correctly, leading to a diagnostic delay and a worsening of prognosis. Case Description: This case report relates to a 73-year-old man with ACTH-secreting macroadenoma infiltrating the cavernous sinuses bilaterally and causing the rapid onset of headache, bilateral eyelid ptosis, complete bilaterally ophthalmoplegia and bitemporal hemianopia. The patient underwent urgent surgery to remove the lesion by transsphenoidal route and subsequent monitoring of pituitary function by endocrinologist specialist obtaining a near-total recovery from illness. Conclusions: PA is often characterized by the appearance of unilateral ocular or neurological deficits, while a clinical presentation given by ophthalmoplegia and bilateral ptosis is a very rare condition, difficult to find in the literature. Therefore, similar symptoms should not be underestimated and should raise the diagnostic suspicion of PA. In this case, in fact, a prompt treatment and multidisciplinary management of the patient allowed to markedly improve the prognosis. Furthermore, the instrumental findings supported a picture of ischemic pituitary apoplexy without signs of haemorrhage, a condition reported only sporadically in the literature.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267330","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}
Pub Date : 2024-05-24DOI: 10.1177/19418744241257724
Yoji Hoshina, Jory Z. Liang
{"title":"Kratom Neurotoxicity: T1 Hyperintensity in the Basal Ganglia","authors":"Yoji Hoshina, Jory Z. Liang","doi":"10.1177/19418744241257724","DOIUrl":"https://doi.org/10.1177/19418744241257724","url":null,"abstract":"","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"15 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100056","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}
Pub Date : 2024-05-24DOI: 10.1177/19418744241254580
Nikhil Vojjala, Srikant Kashinath Malegaonkar, Kajal Arora, I. Sehgal, A. K. Pannu
Anticholinergic toxicity and neuroleptic malignant syndrome (NMS) are common toxidromes in medical emergencies. However, their co-occurrence, resulting in a dual toxidrome, is rare and presents significant diagnostic and therapeutic challenges. We present the case of a 23-year-old young male with polysubstance dependence, admitted following combined trihexyphenidyl and risperidone toxicity. He was diagnosed with a dual toxidrome of anticholinergic storm and NMS. Treatment of NMS included lorazepam and bromocriptine. Due to the unavailability of physostigmine, the preferred antidote for anticholinergic syndrome, intrathecal neostigmine was administered. The patient subsequently recovered and was discharged. This case highlights the complexity of managing dual toxidromes and the need for alternative therapeutic strategies in resource-limited settings.
{"title":"Dual Toxidrome of Anti-cholinergic Storm and Neuroleptic Malignant Syndrome: A Therapeutic Challenge Overcome by Intrathecal Neostigmine","authors":"Nikhil Vojjala, Srikant Kashinath Malegaonkar, Kajal Arora, I. Sehgal, A. K. Pannu","doi":"10.1177/19418744241254580","DOIUrl":"https://doi.org/10.1177/19418744241254580","url":null,"abstract":"Anticholinergic toxicity and neuroleptic malignant syndrome (NMS) are common toxidromes in medical emergencies. However, their co-occurrence, resulting in a dual toxidrome, is rare and presents significant diagnostic and therapeutic challenges. We present the case of a 23-year-old young male with polysubstance dependence, admitted following combined trihexyphenidyl and risperidone toxicity. He was diagnosed with a dual toxidrome of anticholinergic storm and NMS. Treatment of NMS included lorazepam and bromocriptine. Due to the unavailability of physostigmine, the preferred antidote for anticholinergic syndrome, intrathecal neostigmine was administered. The patient subsequently recovered and was discharged. This case highlights the complexity of managing dual toxidromes and the need for alternative therapeutic strategies in resource-limited settings.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"3 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100910","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}
Pub Date : 2024-05-23DOI: 10.1177/19418744241257032
Amgad Ishak, H. Kamel, Jed H Kaiser, Vanessa Liao, Jenny Rotblat, Anokhi Pawar, R. Lappin, Junaid Razzak, Halina White, Catherine Ng, A. Liberman
Identifying patients with acute brain injury among patients who present to the Emergency Department (ED) with severe hypertension can be challenging. We explored rates of brain injury in a cohort of ED patients with severe hypertension in whom acute target-organ damage was or was not initially suspected. We conducted a retrospective chart-review study at two different hospitals within the same urban health system. Consecutive adult patients seen from 10/1/2020 to 5/1/2022 with a systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥120 mmHg were included. A total of 972 patients met our eligibility criteria. The average age was 59 years (SD: 16.5), 454 (46.7%) were women, and 582 (59.9%) were non-White. A total of 186/972 (19.1%) patients were initially thought to have acute target-organ damage in the ED with 97/186 (52.2%) diagnosed with stroke or TIA. The remaining 786/972 (80.9%) patients were not initially diagnosed with target-organ damage (hypertensive urgency [HU]). Of the 786 patients with HU, a head CT was obtained in 216/786 (27.7%) and brain MRI in 74/786 (9.4%). Of the HU patients with a brain MRI, 23/74 (31.1%) had acute abnormalities; most abnormalities on brain MRI (17/23 [73.9%]) were not seen on preceding head CT. In a multicenter study of ED patients, nearly 1 in 5 patients though to have HU who eventually underwent brain MRI had unexpected acute neurological findings, though brain MR was obtained in only 9%.
{"title":"Rates of Acute Brain Injury Among Severely Hypertensive Patients Seen in the Emergency Department","authors":"Amgad Ishak, H. Kamel, Jed H Kaiser, Vanessa Liao, Jenny Rotblat, Anokhi Pawar, R. Lappin, Junaid Razzak, Halina White, Catherine Ng, A. Liberman","doi":"10.1177/19418744241257032","DOIUrl":"https://doi.org/10.1177/19418744241257032","url":null,"abstract":"Identifying patients with acute brain injury among patients who present to the Emergency Department (ED) with severe hypertension can be challenging. We explored rates of brain injury in a cohort of ED patients with severe hypertension in whom acute target-organ damage was or was not initially suspected. We conducted a retrospective chart-review study at two different hospitals within the same urban health system. Consecutive adult patients seen from 10/1/2020 to 5/1/2022 with a systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥120 mmHg were included. A total of 972 patients met our eligibility criteria. The average age was 59 years (SD: 16.5), 454 (46.7%) were women, and 582 (59.9%) were non-White. A total of 186/972 (19.1%) patients were initially thought to have acute target-organ damage in the ED with 97/186 (52.2%) diagnosed with stroke or TIA. The remaining 786/972 (80.9%) patients were not initially diagnosed with target-organ damage (hypertensive urgency [HU]). Of the 786 patients with HU, a head CT was obtained in 216/786 (27.7%) and brain MRI in 74/786 (9.4%). Of the HU patients with a brain MRI, 23/74 (31.1%) had acute abnormalities; most abnormalities on brain MRI (17/23 [73.9%]) were not seen on preceding head CT. In a multicenter study of ED patients, nearly 1 in 5 patients though to have HU who eventually underwent brain MRI had unexpected acute neurological findings, though brain MR was obtained in only 9%.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"47 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141103457","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}
Pub Date : 2024-05-15DOI: 10.1177/19418744241254897
Ehab Harahsheh, Omer Elshaigi, Nour Alhayek, Skye A. Buckner, Jaxon K. Quillen, Cumara B. O’Carroll, Oana M. Dumitrascu
Patients with atrial fibrillation (AF) are at increased risk of ischemic cerebrovascular events despite anticoagulants (AC). We aim to evaluate whether changing AC or adding antiplatelet therapy to anticoagulants (AP + AC) in patients with AF presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite AC, decreases the risk of recurrent AIS/TIA compared to patients continued on same AC regimen. Patients with AF on AC presenting with AIS or TIA at our center between 2011- 2021 were included. Data on Demographics, index event, antithrombotic therapy before and after index event, recurrent AIS/TIA, or major bleeding events (MBE) were extracted. Cox proportional hazards models were used to compare outcomes between AC unchange vs AC change, and AP + AC vs AC only groups. One hundred eighty-five patients were included (mean age 78.3 years; 62% males, median follow-up 9 months (IQR 1-34)). Seventeen patients (9%) had AC change, 100 (54%) received AP + AC, 39 (21%) had recurrent AIS/TIA, and 27 (15%) had MBE following index event. No difference was observed between AC unchange vs AC change and AP + AC vs AC only groups regarding recurrent AIS/TIA (HR 1.72 [.65-4.57], P = .27 and HR 1.02 [.53- 1.98], P = .95, respectively) or MBE (HR .85 [.19-3.67], P = .83 and HR 1.49 [.67-3.33)], P = .33, respectively). Fourteen vascular neurologists treated this cohort and 9(64%) implemented AC changes. In this single center retrospective study of 185 patients with AF and AIS/TIA despite AC, changing AC or adding AP agents did not decrease the risk of ischemic cerebrovascular events.
尽管服用了抗凝剂（AC），心房颤动（AF）患者发生缺血性脑血管事件的风险仍在增加。我们旨在评估，与继续使用相同抗凝药物方案的患者相比，在使用抗凝药物的房颤患者出现急性缺血性卒中（AIS）或短暂性脑缺血发作（TIA）时，更换抗凝药物或在使用抗凝药物的同时增加抗血小板治疗（AP + AC）是否会降低复发 AIS/TIA 的风险。本研究纳入了2011-2021年间在本中心接受房颤治疗并出现AIS或TIA的患者。提取的数据包括人口统计学、指数事件、指数事件前后的抗血栓治疗、复发性 AIS/TIA 或大出血事件 (MBE)。采用 Cox 比例危险模型比较 AC 不变组与 AC 变更组、AP + AC 组与仅 AC 组之间的结果。共纳入 185 名患者（平均年龄 78.3 岁；62% 为男性，中位随访 9 个月（IQR 1-34））。17 名患者（9%）更换了 AC，100 名患者（54%）接受了 AP + AC，39 名患者（21%）复发了 AIS/TIA，27 名患者（15%）在指数事件后出现了 MBE。在复发性 AIS/TIA 方面，AC 未改变组与 AC 改变组和 AP + AC 组与仅 AC 组之间未观察到差异（分别为 HR 1.72 [.65-4.57]，P = .27 和 HR 1.02 [.53-1.98]，P = .95）或 MBE（分别为 HR .85 [.19-3.67]，P = .83 和 HR 1.49 [.67-3.33)]，P = .33）。14 位血管神经科医生对该组患者进行了治疗，其中 9 位（64%）实施了 AC 改变。在这项针对 185 名房颤和 AIS/TIA 患者的单中心回顾性研究中，尽管使用了 AC，但更换 AC 或添加 AP 药物并未降低缺血性脑血管事件的风险。
{"title":"The Impact of Changing Antithrombotic Management in Patients With Atrial Fibrillation and Ischemic Cerebrovascular Events Despite Anticoagulation","authors":"Ehab Harahsheh, Omer Elshaigi, Nour Alhayek, Skye A. Buckner, Jaxon K. Quillen, Cumara B. O’Carroll, Oana M. Dumitrascu","doi":"10.1177/19418744241254897","DOIUrl":"https://doi.org/10.1177/19418744241254897","url":null,"abstract":"Patients with atrial fibrillation (AF) are at increased risk of ischemic cerebrovascular events despite anticoagulants (AC). We aim to evaluate whether changing AC or adding antiplatelet therapy to anticoagulants (AP + AC) in patients with AF presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite AC, decreases the risk of recurrent AIS/TIA compared to patients continued on same AC regimen. Patients with AF on AC presenting with AIS or TIA at our center between 2011- 2021 were included. Data on Demographics, index event, antithrombotic therapy before and after index event, recurrent AIS/TIA, or major bleeding events (MBE) were extracted. Cox proportional hazards models were used to compare outcomes between AC unchange vs AC change, and AP + AC vs AC only groups. One hundred eighty-five patients were included (mean age 78.3 years; 62% males, median follow-up 9 months (IQR 1-34)). Seventeen patients (9%) had AC change, 100 (54%) received AP + AC, 39 (21%) had recurrent AIS/TIA, and 27 (15%) had MBE following index event. No difference was observed between AC unchange vs AC change and AP + AC vs AC only groups regarding recurrent AIS/TIA (HR 1.72 [.65-4.57], P = .27 and HR 1.02 [.53- 1.98], P = .95, respectively) or MBE (HR .85 [.19-3.67], P = .83 and HR 1.49 [.67-3.33)], P = .33, respectively). Fourteen vascular neurologists treated this cohort and 9(64%) implemented AC changes. In this single center retrospective study of 185 patients with AF and AIS/TIA despite AC, changing AC or adding AP agents did not decrease the risk of ischemic cerebrovascular events.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"58 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140974945","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}
Pub Date : 2024-01-27DOI: 10.1177/19418744241230728
K. Ramphul, S. Sombans, R. Verma, P. Lohana, B. Dhillon, Stephanie Gonzalez Mejias, S. Sanikommu, Y. Ramphul, P. K. Pekyi-Boateng
At the start of the COVID-19 pandemic, several experts raised concerns about its impact on Multiple Sclerosis (MS) patients. This study aims to provide a perspective using the biggest inpatient database from the United States. We screened for COVID-19 cases between April to December 2020, via the 2020 National Inpatient Sample (NIS). Various outcomes were analyzed. We identified 1,628,110 hospitalizations with COVID-19, including 7620 (.5%) MS patients. 8.9% of MS patients with COVID-19 died, and it was lower than non-MS cases (12.9%). Less MS patients with COVID-19 needed non-invasive ventilation (4.5% vs 6.4%) and mechanical ventilation (9.0% vs 11.2%). Furthermore, MS patients with COVID-19 reported higher odds of non-invasive ventilation if they were ≥60 years, had chronic pulmonary disease (CPD), obesity, or diabetes. Private insurance beneficiaries showed reduced risk, vs Medicare. Similarly, for mechanical ventilation, those ≥60 years, with alcohol abuse, obesity, diabetes, hypertension, or dialysis had higher odds, while females, smokers, and those with depression or hyperlipidemia showed reduced odds. The study revealed higher odds of mortality among those aged ≥60, who had CPD, obesity, CKD, or a history of old MI while females, smokers, as well as those with depression, and hyperlipidemia showed better outcomes. Blacks had lower odds, whereas Hispanics had higher odds of death, vs Whites. Medicaid and Privately insured patients had lower odds of dying vs Medicare. We found several differences in patient characteristics and outcomes among MS and non-MS patients with COVID-19.
{"title":"Characteristics and Outcomes of 7620 Multiple Sclerosis Patients Admitted With COVID-19 in the United States","authors":"K. Ramphul, S. Sombans, R. Verma, P. Lohana, B. Dhillon, Stephanie Gonzalez Mejias, S. Sanikommu, Y. Ramphul, P. K. Pekyi-Boateng","doi":"10.1177/19418744241230728","DOIUrl":"https://doi.org/10.1177/19418744241230728","url":null,"abstract":"At the start of the COVID-19 pandemic, several experts raised concerns about its impact on Multiple Sclerosis (MS) patients. This study aims to provide a perspective using the biggest inpatient database from the United States. We screened for COVID-19 cases between April to December 2020, via the 2020 National Inpatient Sample (NIS). Various outcomes were analyzed. We identified 1,628,110 hospitalizations with COVID-19, including 7620 (.5%) MS patients. 8.9% of MS patients with COVID-19 died, and it was lower than non-MS cases (12.9%). Less MS patients with COVID-19 needed non-invasive ventilation (4.5% vs 6.4%) and mechanical ventilation (9.0% vs 11.2%). Furthermore, MS patients with COVID-19 reported higher odds of non-invasive ventilation if they were ≥60 years, had chronic pulmonary disease (CPD), obesity, or diabetes. Private insurance beneficiaries showed reduced risk, vs Medicare. Similarly, for mechanical ventilation, those ≥60 years, with alcohol abuse, obesity, diabetes, hypertension, or dialysis had higher odds, while females, smokers, and those with depression or hyperlipidemia showed reduced odds. The study revealed higher odds of mortality among those aged ≥60, who had CPD, obesity, CKD, or a history of old MI while females, smokers, as well as those with depression, and hyperlipidemia showed better outcomes. Blacks had lower odds, whereas Hispanics had higher odds of death, vs Whites. Medicaid and Privately insured patients had lower odds of dying vs Medicare. We found several differences in patient characteristics and outcomes among MS and non-MS patients with COVID-19.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139592537","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}
Pub Date : 2024-01-17DOI: 10.1177/19418744241228630
A. L. Kuhn, Jasmeet Singh, Ajit S. Puri
Dual antiplatelet therapy is often required for neurointerventional procedures, especially when a stent or flow diverter is placed in the cervical and intracranial vessels. Patients are usually started on aspirin and clopidogrel given the simplicity of the once daily regimen with reasonable cost. Unfortunately, about a third of patients do not show the desired antiplatelet response to clopidogrel and another agent needs to be introduced. Ticagrelor is a potent antiplatelet medication that has a favorable pharmacological profile and has emerged as a reliable alternative to clopidogrel in recent years. Despite ticagrelor non-responders being rare, they do exist, and identification of these patients is important. A 74-year-old female was incidentally found to harbor a right posterior communicating aneurysm which was successfully treated electively with stent-assisted coiling. Platelet inhibition testing revealed non-responsiveness to Clopidogrel. Ticagrelor was initiated but the patient’s platelet reactivity unit remained in the normal range. Management algorithms to maximize a patient’s ticagrelor response by facilitating enteral absorption were applied but no platelet inhibition was achieved. The patient was eventually identified as a true ticagrelor non-responder. Resistance to antiplatelet medication can result in devastating complications with permanent neurological deficits. Ticagrelor non-responders are rare but do exist. Platelet inhibition testing should be part of the preprocedural workup for neurointerventions.
{"title":"Dual Antiplatelet Non-Responder: Resistance to Clopidogrel and Ticagrelor","authors":"A. L. Kuhn, Jasmeet Singh, Ajit S. Puri","doi":"10.1177/19418744241228630","DOIUrl":"https://doi.org/10.1177/19418744241228630","url":null,"abstract":"Dual antiplatelet therapy is often required for neurointerventional procedures, especially when a stent or flow diverter is placed in the cervical and intracranial vessels. Patients are usually started on aspirin and clopidogrel given the simplicity of the once daily regimen with reasonable cost. Unfortunately, about a third of patients do not show the desired antiplatelet response to clopidogrel and another agent needs to be introduced. Ticagrelor is a potent antiplatelet medication that has a favorable pharmacological profile and has emerged as a reliable alternative to clopidogrel in recent years. Despite ticagrelor non-responders being rare, they do exist, and identification of these patients is important. A 74-year-old female was incidentally found to harbor a right posterior communicating aneurysm which was successfully treated electively with stent-assisted coiling. Platelet inhibition testing revealed non-responsiveness to Clopidogrel. Ticagrelor was initiated but the patient’s platelet reactivity unit remained in the normal range. Management algorithms to maximize a patient’s ticagrelor response by facilitating enteral absorption were applied but no platelet inhibition was achieved. The patient was eventually identified as a true ticagrelor non-responder. Resistance to antiplatelet medication can result in devastating complications with permanent neurological deficits. Ticagrelor non-responders are rare but do exist. Platelet inhibition testing should be part of the preprocedural workup for neurointerventions.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":" July","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618054","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}
Pub Date : 2024-01-16DOI: 10.1177/19418744241228006
Rumyar Ardakani, Lakshmi Chauhan, Amanda L. Piquet, Kenneth L. Tyler, Daniel M. Pastula
{"title":"An Overview of Saint Louis Encephalitis","authors":"Rumyar Ardakani, Lakshmi Chauhan, Amanda L. Piquet, Kenneth L. Tyler, Daniel M. Pastula","doi":"10.1177/19418744241228006","DOIUrl":"https://doi.org/10.1177/19418744241228006","url":null,"abstract":"","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139620018","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}
Pub Date : 2024-01-12DOI: 10.1177/19418744241228353
Amalie Chen, Sashank Prasad, Michael Bowley, Edward Krupat, Kristin Galetta
In-person prerounding has long been a routine practice for residents in the field of neurology. However, with the emergence of the COVID-19 pandemic, many institutions, including our two academic neurology centers, have shifted to computer rounding. This study aims to assess the effects of computer rounding alone compared to a combination of computer rounding and in-person prerounding from the perspective of neurology residents. A mixed-methods approach was employed, including a survey administered to 79 neurology residents and a qualitative thematic analysis of their responses. The quantitative analysis revealed that residents who engaged in inperson prerounding spent significantly more time on prerounding and computer rounding compared to those who did not. The majority of residents reported a neutral effect of in-person prerounding on their relationship with patients and bedside time, but a significant impact on personal lives and other tasks. Qualitative analysis identified four key themes: accessibility to team members, learning opportunities gained and lost, inefficiency, and sleep disturbance. Overall, residents perceived in-person prerounding as inefficient and causing sleep disruption for both patients and themselves. While some residents valued the face-to-face interaction and improved accessibility, others felt that computer rounding allowed for thorough review of patient data, improving preparedness and efficiency. The potential elimination of in-person prerounding from residents' routines may enhance their overall wellbeing. Further research is needed to assess the advantages and drawbacks of removing this classic approach to caring for patients from the perspective of residents, attendings and patients.
{"title":"Perception of In-Person Prerounding Amongst Neurology Residents Across Two Academic Centers","authors":"Amalie Chen, Sashank Prasad, Michael Bowley, Edward Krupat, Kristin Galetta","doi":"10.1177/19418744241228353","DOIUrl":"https://doi.org/10.1177/19418744241228353","url":null,"abstract":"In-person prerounding has long been a routine practice for residents in the field of neurology. However, with the emergence of the COVID-19 pandemic, many institutions, including our two academic neurology centers, have shifted to computer rounding. This study aims to assess the effects of computer rounding alone compared to a combination of computer rounding and in-person prerounding from the perspective of neurology residents. A mixed-methods approach was employed, including a survey administered to 79 neurology residents and a qualitative thematic analysis of their responses. The quantitative analysis revealed that residents who engaged in inperson prerounding spent significantly more time on prerounding and computer rounding compared to those who did not. The majority of residents reported a neutral effect of in-person prerounding on their relationship with patients and bedside time, but a significant impact on personal lives and other tasks. Qualitative analysis identified four key themes: accessibility to team members, learning opportunities gained and lost, inefficiency, and sleep disturbance. Overall, residents perceived in-person prerounding as inefficient and causing sleep disruption for both patients and themselves. While some residents valued the face-to-face interaction and improved accessibility, others felt that computer rounding allowed for thorough review of patient data, improving preparedness and efficiency. The potential elimination of in-person prerounding from residents' routines may enhance their overall wellbeing. Further research is needed to assess the advantages and drawbacks of removing this classic approach to caring for patients from the perspective of residents, attendings and patients.","PeriodicalId":509682,"journal":{"name":"The Neurohospitalist","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139624605","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：