BMC Neurology最新文献

Background: Carbon monoxide (CO) intoxication can lead to various brain lesions, with the globus pallidus being the most common site of injury. Herein, we report a rare case of CO poisoning with acute bilateral hippocampal lesions and delayed midbrain involvement of the substantia nigra.

Case presentation: A woman in her twenties who attempted suicide by burning charcoal briquettes presented with a Glasgow Coma Scale score of 3/15. Initial head computed tomography revealed low-density areas in the bilateral globus pallidus and hippocampi. Magnetic resonance imaging (MRI) on day 3 showed high signal intensity in the same regions on diffusion-weighted imaging (DWI), with a corresponding low signal on the apparent diffusion coefficient map and high signal intensity on fluid-attenuated inversion recovery imaging. The patient underwent hyperbaric oxygen therapy (HBOT) and gradually regained consciousness. However, the patient experienced persistent short-term memory loss. Follow-up MRI on day 23 showed improvement in the hippocampal and globus pallidus lesions but revealed new bilateral high-signal lesions in the substantia nigra on DWI. Despite these findings, the patient did not exhibit any extrapyramidal signs. Subsequent HBOT sessions led to further improvements in her cognitive function, as evidenced by an increase in her Mini-Mental State Examination score from 13/30 to 27/30.

Conclusions: This case highlights the importance of serial neuroimaging in CO poisoning, as delayed midbrain lesions may occur more frequently than previously thought, even in the absence of overt neurological symptoms. The patient's cognitive recovery and lack of parkinsonism suggests that early intervention with HBOT may help mitigate the long-term consequences of CO-induced brain injury.

Background: Headache is a common neurological disorder that reduces the quality of life of millions of people globally. It is usually treated on an outpatient basis, but in a few particular conditions, the patient needs hospitalization. Analyzing the headache profiles of headache-related hospitalizations can provide decision-makers with valuable information for better headache treatment.

Methods: This prospective study aimed to analyze demographic information and clinical profiles of the patients hospitalized due to headache complaints at the Neurology ward of Sina Hospital between October 2022 and August 2024. Independent sample t-test and Welch's t-test were used to compare subgroups of patients, and the Mann-Kendall test was adopted to analyze the time series trend in admissions.

Results: Analyzing the data from 332 patients showed that the number of hospitalized patients increased monotonically during the study period. The patients diagnosed with secondary headaches were the largest group, followed by the patients with primary headaches and cranial neuropathies/facial pains. In all these categories, the female-to-male ratio was greater than one. Chronic migraine and medication-overuse headaches were the most common diagnoses among the primary and secondary headaches, respectively.

Conclusions: This study showed that women are more frequently hospitalized due to headaches than men. Most of the patients were diagnosed with secondary headaches due to the more challenging nature of this category.

Background: Neuronal intranuclear inclusion disease (NIID) is a rare, progressive multisystem disorder most commonly associated with GGC repeat expansion in the NOTCH2NLC gene. Parkinsonism can be an initial presentation and may be misdiagnosed as idiopathic Parkinson's disease, particularly when prominent non-motor features are present. While many cases are levodopa-responsive, diagnosis is challenging when prominent non-motor features and drug intolerance are present.

Case presentation: We report a case of a 70-year-old woman of Han Chinese who developed atypical parkinsonism, severe cognitive decline, and severe gastrointestinal dysfunction. A therapeutic trial of levodopa/benserazide produced only minimal and transient motor benefit but resulted in marked worsening of nausea and vomiting, precluding dose escalation. Brain MRI demonstrated a characteristic corticomedullary junction (CMJ) hyperintensity on diffusion-weighted imaging. Skin biopsy revealed intranuclear inclusions on electron microscopy, and genetic testing confirmed pathogenic GGC repeat expansion in NOTCH2NLC, establishing the diagnosis of NIID.

Conclusions: This case highlights that profound levodopa intolerance in patients with atypical parkinsonism, especially when accompanied by severe gastrointestinal dysfunction and early cognitive decline, should prompt consideration of NIID. Early recognition of this clinical pattern, together with characteristic MRI findings and confirmatory pathology/genetics, may help reduce diagnostic delay and facilitate timely multidisciplinary supportive care.

Background: Acute stroke is one of the leading causes of mortality and disability worldwide. In recent years, various scoring systems have been introduced to predict the outcomes of acute stroke patients, one of which is the Clot Burden Score (CBS). Therefore, the present study evaluates the prognostic value of the modified CBS in patients presenting with acute ischemic stroke.

Methods: This study was conducted from 2022 to 2024 at Ghaem Hospital, Mashhad. Patients presenting to the hospital's emergency department with symptoms of acute ischemic stroke were identified based on NIHSS clinical examination. NIHSS was assessed at admission, ASPECTS on baseline imaging, and the modified Rankin Scale at admission (mRS0) and 90 days post-stroke (mRS90). CBS, DWI-ASPECTS, mRS, and the modified CBS were measured for each patient. The collected data were analyzed using SPSS statistical software, and the prognostic value of both the original and modified CBS was assessed for predicting different outcomes, including mortality, disability, and severe disease.

Results: A total of 130 patients were included (mean age 64.9 ± 14.1 years; 53.1% male). Compared to CBS, mCBS showed stronger correlations with NIHSS (ρ=-0.569, p < 0.0001) and mRS90 (ρ=-0.568, p < 0.0001). For disability prediction (mRS90 ≥ 2), the AUC of mCBS was 0.807 versus 0.735 for CBS (p = 0.0019). For severity (NIHSS ≥ 15), the AUC was 0.778 versus 0.720 (p = 0.0156). For mortality, AUCs were 0.708 and 0.681, respectively, with no significant difference (p = 0.3821).

Conclusion: Based on the findings of this study, the modified CBS has greater prognostic value than the original CBS for predicting outcomes in acute stroke patients. If confirmed by future studies, the modified CBS may be considered a potential replacement for the conventional CBS scoring system.