BMC Neurology最新文献

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder with a variety of clinical manifestations. It has been established that anti-NMDAR encephalitis may be related to ovarian teratoma in female patients. However, a considerable number of patients have no obvious evidence of ovarian teratoma during the onset of the disease.

Case: A 25-year-old previously-healthy female experienced a series of acute symptoms within two days, including confusion, disorientation, short-term memory loss, auditory hallucinations, abnormal behavior, refractory status epilepticus, etc. Her brain MRI and abdominal imaging showed no definite abnormality while her electroencephalogram exhibited the presence of low to moderate amplitude sharp, spike, and multi-spike waves. Serum and cerebrospinal fluid tests yielded positive results for anti-NMDAR antibodies. However, an ultrasound scan failed to identify an ovarian teratoma. Consequently, the diagnosis of anti-NMDAR encephalitis without teratoma was made after 4 days onset. After the plasma exchange and immunoglobulin therapy, her neurological symptoms improved and obtained a clinical cure. In the next eight months of follow-up, the patient accidentally touched a lump in the lower abdomen without any symptoms, and abdominal ultrasound and CT scan revealed a left ovarian tumor. Then she underwent left ovarian teratoma resection surgery and histopathology showed a mature cystic teratoma with neural components. The patient continued to receive five years of follow-up, and her condition remained stable without any recurrence, except that there had been a low titer of anti-NMDAR antibody in her serum.

Conclusion: Our case demonstrated the importance of long-term follow-up for female patients with anti-NMDAR encephalitis, since anti-NMDAR encephalitis-associated ovarian teratomas may develop in a delayed manner, even without any symptoms.

Background: Peripheral immunity and neuroinflammation interact with each other and they play important roles in the pathophysiology of idiopathic Parkinson's disease (IPD). There have been very few real-world reports on the relationship between peripheral immune inflammation and motor phenotypes of IPD. This study aimed to investigate the potential correlation between peripheral inflammatory indicators and motor subtypes in patients with IPD.

Methods: This observational, prospective case-control study examined patients with IPD and healthy controls (HC) matched for age and sex between September 2021 and July 2023 at the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University. The levels of peripheral inflammatory indicators were collected from each patient with IPD and HCs. Differences in the levels of peripheral inflammatory indicators among groups were compared. Binary logistic regression analysis was used to explore the inflammatory mechanism underlying the motor subtype of IPD.

Results: A total number of 94 patients with IPD were recruited at the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University between September 2021 and July 2023, including 49 males and 45 females, and 37 healthy volunteers matched for age and sex were also enrolled as the control group. Of the 94 patients with IPD, 42.6% performed as the TD motor subtype and 57.4% performed as the AR motor subtype. NLR and the plasma levels of IL-1βand TNF-α in the IPD group were higher than those in the HC group (P < 0.05). The disease duration, Hoehn and Yahr (H-Y) stage, NLR, and the levels of IL-1β in the AR group were higher than those in the TD group (P < 0.05). Additionally, IL-1β plasma levels and NLR were positively correlated with disease duration, H-Y stage, movement disorder society-Unified Parkinson's Disease Rating Scale-III motor score, and AR subtype. The binary logistic regression model revealed that the plasma level of IL-1β was mildly associated with the AR motor subtype and NLR was strongly associated with the AR motor subtype. The combination of NLR and IL-1β showed better performance in identifying the AR motor subtype.

Conclusion: NLR is strongly associated with the AR motor subtype in IPD, and peripheral immunity is probably involved in the pathogenesis of AR motor subtype in IPD.

Background: Atraumatic localized convexity subarachnoid hemorrhage (cSAH) is an uncommon form of nonaneurysmal subarachnoid hemorrhage characterized by bleeding limited to the cerebral convexities. Ipsilateral cSAH can result from a variety of causes, such as internal carotid artery stenosis, obstruction, and dissection, although concomitant contralateral cSAH is exceptionally rare. In this case, the initial findings of cSAH led us to discovering contralateral internal carotid artery dissection (ICAD) and an elongated styloid process (ESP). ESP is recognized as a risk factor for ICAD, which is a hallmark of Eagle syndrome. This sequence of findings led to the diagnosis of Eagle syndrome, illustrating a complex and intriguing interplay between cerebrovascular conditions and anatomical variations.

Case presentation: A 47-year-old Japanese woman experienced acute onset of headache radiating to her neck, reaching its zenith approximately two hours after onset. Given the intractable nature of the headache and its persistence for three days, she presented to the emergency department. Neurological examination revealed no abnormalities, and the coagulation screening parameters were within normal ranges. Brain computed tomography (CT) revealed right parietal cSAH, while CT angiography (CTA) revealed ICAD and an ESP measuring 30.1 mm on the left side, positioned only 1.4 mm from the dissected artery. The unusual occurrence of contralateral cSAH prompted extensive and repeated imaging reviews that excluded reversible cerebral vasoconstriction syndrome (RCVS), leading to a diagnosis of left ICAD secondary to Eagle syndrome. The patient underwent conservative management, and the dissected ICA spontaneously resolved. The patient has remained recurrence-free for two and a half years.

Conclusions: Managing cSAH requires diligent investigation for ICAD, extending beyond its identification to explore underlying causes. Recognizing Eagle syndrome, though rare, as a potential etiology of ICAD necessitates the importance of evaluating ESPs. The method for preventing recurrent cervical artery dissection due to Eagle syndrome is controversial; however, conservative management is a viable option.

Background: Cerebral angiography through the transradial approach (TRA) is associated with a low risk of complications, but in rare cases, these complications can be life-threatening.

Case presentation: A 56-year-old female patient was admitted for transradial cerebral angiography due to the complaint of right limb weakness and the diagnosis of cerebral infarction and cerebral artery stenosis. During the procedure, the patient coughed with expectoration and complained of throat discomfort, palpitations, and pains in the right shoulder and back. Emergency CT scan indicated hematoma in the middle mediastinum and the right thoracic cavity, and perforation of a branch of the subclavian artery was highly suspected. Subclavian artery angiography was conducted immediately, which revealed a patchy contrast medium overflow in a branch of the right costocervical trunk. Selective endovascular occlusion therapy was performed successfully with gelfoam particles and placement of 2 microcoils. At 12 days after cerebral angiography, the patient recovered well and was discharged from the hospital.

Conclusion: Mediastinal and thoracic hematoma may occur due to vessel perforation during TRA cerebral angiography, in which guidewire advancement must be cautious. Early detection and appropriate countermeasures can reduce the severity of vascular perforation and subsequent hematoma.

Background: Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant inherited vascular disorder that can involve multiple organs, thus can be associated with so many clinical departments that proper screening and diagnosis of HHT are needed for providing better management of both patients and their family members.

Case presentation: We present a 58-year-old female patient with recurrent paradoxical brain embolism due to HHT. She received aspirin therapy and underwent pulmonary arteriovenous malformation embolization, recovering well and discharged 3 days postoperatively. Though ischemic stroke caused by HHT-induced vascular disorders has been reported, our patient presented with both recurrent paradoxical brain embolisms and radiologic findings of bilateral globus pallidus manganese deposition at the same time, a combination rarely reported. We also review the literature on the clinical features and management of HHT for prompt diagnosis of this genetic disease behind paradoxical embolism.

Conclusions: When patients with ischemic stroke, especially recurrent ischemic stroke, have combined arteriovenous malformations (AVMs) in single or multiple organs, or clues for AVMs like manganese deposition in globus pallidus, genetic diseases such as HHT may be the reason for ischemic stroke and shouldn't be missed in the evaluation of embolic sources.

Background: In recent years, cases of dystextia (texting disabilities) and dystypia (typing disabilities) have been reported. However, reports describing isolated dystextia without aphasia or other cognitive impairments are rare, and the detailed pathophysiology is not fully understood. Most Japanese people use the alphabetical spelling system (Romaji) for texting and typing. Herein, we report the case of a man with isolated dystextia and dystypia resulting from Romaji conversion difficulties.

Case presentation: A 48-year-old, right-handed Japanese man developed texting and typing difficulties. The standard neuropsychological tests showed no signs of aphasia or other cognitive impairments, except for slight executive dysfunction. Thus, isolated dystextia and dystypia were diagnosed. Furthermore, the patient experienced Romaji conversion difficulties. Magnetic resonance imaging revealed a subcortical infarction in the left cerebral hemisphere. Single photon emission tomography revealed hypoperfusion, including in the left dorsolateral frontal cortex.

Conclusions: The left dorsolateral frontal cortex may be related to Romaji conversion in Japanese individuals. Therefore, diaschisis of the left dorsolateral frontal cortex due to subcortical lesions may have impaired Romaji conversion, leading to dystextia and dystypia, in this patient.

Background: Spinal cord injury (SCI) is one of the most catastrophic injuries that might lead to permanent use of a wheelchair and severely affects the quality of life, hence SCI patients report lower satisfaction with life (SWL) than the general population. Therefore, it is important to identify factors that determine SWL among wheelchair users with SCI. Our study aimed to assess the prevalence of low SWL and to identify its determinants among wheelchair users with SCI in Egypt.

Methods: A cross-sectional study included 105 wheelchair users with SCI from the Al Hassan Foundation for wheelchair users in Egypt. The main outcome measure was low SWL, while the independent variables included sociodemographic characteristics, injury-related characteristics, anxiety, depression, neuropathic pain, functional independence, and environmental barriers.

Results: The prevalence of low SWL among study participants was 57.1%. We found significant associations between SWL and age, area of living, and age at injury. Additionally, SWL correlated negatively with anxiety, depression, neuropathic pain, and environmental barriers, and positively with functional independence. Finally, the binary multiple logistic regression revealed that living in Upper Egypt (p = 0.017, OR = 13.7), depression (p = 0.034, OR = 6.08), older age (p = 0.002, OR = 1.21), and work and school environmental barriers (p = 0.022, OR = 0.46) were the predictors of low SWL.

Conclusion: To improve the SWL for wheelchair users with SCI we need to effectively manage neuropathic pain, depression, and anxiety, and promote functional independence. There is an urgent need to reinforce legislation to improve the living conditions for wheelchair users with SCI in Egypt, especially in Upper Egypt.

Background: Infectious endocarditis (IE) is an infectious disease caused by direct invasion of the heart valve, endocardium, or adjacent large artery endocardium by pathogenic microorganisms. Despite its relatively low incidence, it has a poor prognosis and a high mortality. Intracranial infectious aneurysms (IIA) and ruptured sinus of Valsalva aneurysm (RSVA) are rare complications of IE.

Case presentation: We report a young male patient with symptoms of respiratory tract infection, heart murmurs and other symptoms and signs. The patient also had kidney function impairment and poor response to symptomatic therapy. Blood culture was negative, but echocardiography was positive, which met the diagnostic criteria for infective endocarditis. Moreover, an echocardiography showed a ruptured sinus of Valsalva aneurysm with a ventricular septal defect. Finally, secondary rupture of an IIA with multiple organ damage led to a poor clinical outcome.

Conclusion: Therefore, in the clinical setting, for young patients with unexplained fever, chest pain, or palpitations, we need to be highly vigilant, considering the possibility of infective endocarditis and promptly performing blood culture, echocardiography, cerebrovascular imaging and so on, in order to facilitate early proper diagnosis and treatment.

Background: Stroke is a major cause of illness, death, and long-term disability and a major health concern worldwide. Experts consider insulin resistance (IR), a defining feature of the metabolic syndrome and a significant risk factor for stroke. Insulin resistance, or IR, is common among stroke patients. The triglyceride-glucose (TYG) index's relevance to both lipotoxicity and glucotoxicity has led to its proposal as an alternative indicator of IR.

Aim: Examining the connection between elevated TYG INDEX scores and worse clinical outcomes in ischemic stroke patients is the main goal. Finding out how often bad outcomes (recurrence and all-cause death) are in ischemic stroke patients is the secondary goal.

Method: This was a retrospective observational study that involved patients admitted to the 850-bed Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, a tertiary care teaching hospital located in the Krishna district of Andhra Pradesh (India). The study was conducted over a period of six months. All the 95 patients who satisfied the eligibility criteria were included. The patients' TYG INDEX values were first determined and patients with ischemic stroke who had elevated TYG INDEX values were then compared for clinical outcomes including recurrence and all-cause death with ischemic patients with normal TYG INDEX.

Results: In this study, the total cholesterol of the patients (mean ± SD) was 165.01 ± 51.5 mg/dL; Triglycerides was 157.031 ± 98.9 mg/dL; HDL-c was 37.253 ± 5.52 mg/dl; LDL-c was 107 ± 48.3 mg/Dl; and FBS was 153.74 ± 71.52 mg/dL. The chi-square test showed that only FBS, Triglyceride, and Total cholesterol were significantly associated with TYG INDEX whereas other variables like age, LDL, and HDL were not. There was no significant association between the TYG INDEX and clinical outcomes of ischemic stroke. In both groups of patients, risk and no risk TYG INDEX values, the mRS score showed variable and unpredictable relationship with the TYG INDEX.

Conclusion: Contrary to the few studies that discovered one, our research leads us to the conclusion that there may not be a relevant association between the TYG INDEX and clinical results in patients with ischemic stroke.

Background: Globally, 64-74 million individuals around the world are estimated to sustain traumatic brain injury every year. Moderate and severe traumatic brain injury can lead to a lifetime physical, cognitive, emotional, and behavioral changes. There were limited studies conducted in Ethiopia regarding to traumatic brain injury mortality.

Methods: An institutional based retrospective cohort study was conducted on 429 randomly selected traumatic brain injury patients aged 18 to 64 years who were admitted to East Amhara Comprehensive Specialized Hospitals from January 1, 2016 to December 31, 2021. Kobo toolbox was applied for data collection and exported to Stata version 17 for data processing and analysis. To estimate death free time, a Kaplan Meier failure curve was used. The Cox proportional hazards regression model was used at the 5% level of significance to determine effect of predictor variables on time to death.

Result: A total of 429 traumatic brain injury patients aged 18 to 64 years were included with response rate of 91.3% and 145(33.8%) were dead. Open injuries (AHR = 0.25; 95% CI: 0.18-0.36), co-existing injuries (AHR = 0.40; 95% CI: 0.24-0.66), ICU admission (AHR = 0.42; 95% CI: 0.29-0.60), arrival within 4-24 h (AHR = 3.48; 95% CI: 2.01-6.03), arrival after 24 h (AHR = 6.69; 95% CI: 3.49-12.28), subdural hematoma (AHR = 2.72; 95% CI: 1.77-4.19), serum albumin < 3.5 g/dL (AHR = 0.66; 95% CI: 0.49-0.94), moderate (AHR = 0.56; 95% CI: 0.21-0.89), and mild traumatic brain injury (AHR = 0.43; 95% CI: 0.29-0.56) were predictors of traumatic brain injury mortality.

Conclusion: The finding of this study showed that the mortality was 1/3rd of the total patients. Open injuries, co-existing injuries, ICU admission, arrival time (4-24 h and > 24 h), subdural hematoma, serum albumin < 3.5 g/dL and severity of traumatic brain injury (mild and moderate) were predictors of traumatic brain mortality. Therefore, working on these factors to reduce the morality of traumatic brain injury patients is very important.