Case Reports in Neurological Medicine最新文献

Neurenteric cysts (NECs) are rare congenital, benign lesions of the central nervous system (CNS), predominantly located within the spinal cord. However, they may also occur less frequently within the brainstem, fourth ventricle, or cerebellopontine angle (CPA). Originating from anomalous interactions between embryonic layers, NECs are recognized for their potential to compress adjacent structures. We report a unique case of disseminated NECs exhibiting few to absent symptoms, which represents an unusual presentation of this disease, with only six similar reports in the literature. A 22-year-old female presented to our institute with chronic headaches resistant to nonsteroidal anti-inflammatory drugs (NSAIDs). Initially treated for intracranial hypertension (ICH) secondary to a cyst in the quadrigeminal cistern at the age of 17 via neuroendoscopic surgery and subsequent ventriculoperitoneal shunting, she experienced transient relief. However, follow-up at 22 years of age revealed multiple cysts in the basal and spinal cisterns, with MRI findings suggestive of neurocysticercosis. Despite treatment with albendazole and corticosteroids, subsequent MRIs showed no change in the size or number of the cysts. Six years later, symptoms had worsened, previously identified cysts had grown, and the detection of new cysts prompted surgical intervention. Histopathological examination confirmed the presence of NECs. This case highlights the diagnostic challenges posed by NECs, especially in regions endemic for neurocysticercosis, where clinical and radiological findings may initially suggest this condition. It underscores the importance of considering NECs in the differential diagnosis of cystic lesions in the CNS, even in the absence of typical symptoms of spinal cord compression. The recurrence and spread of NECs post-treatment demand a comprehensive management approach, encompassing surgical intervention and close monitoring.

An 18-year-old male presented with new-onset focal to bilateral tonic-clonic seizures 5 days after receiving the first dose of COVID-19 vaccine. 3 days later, an identical seizure occurred lasting 1 min, leading to an acute presentation to the hospital. In hospital, the patient was loaded with intravenous phenytoin and started on levetiracetam with no further seizure recurrence. CT venogram and scalp EEG were unremarkable. MRI brain revealed generalised atrophy with mild bilateral hippocampal atrophy. The patient was maintained on 500 mg levetiracetam twice daily and advised to proceed with subsequent doses of vaccination. Vaccinations have been associated with breakthrough seizures. In this case, COVID-19 vaccination possibly unmasked an underlying predisposition for epilepsy.

Apnea testing is a standard method when diagnosing brain or more specifically brainstem death; however, it is imperative to acknowledge the potential for lung injury during this procedure and follow clinical practice guideline recommendations that may reduce the risk of complications. Two cases of barotrauma leading to pneumothorax occurred during apnea tests that used higher-than-recommended oxygen flow rates. Additional data are necessary to clarify the mechanism and incidence of this life-threatening complication.

Atropa belladonna (A. belladonna), commonly known as deadly nightshade, is a poisonous plant belonging to the Solanaceae family. The toxic effects of A. belladonna are attributable to its alkaloid content, which possesses potent anticholinergic properties. These alkaloids are responsible for the plant's toxicity and can cause a range of adverse effects in humans and animals upon ingestion or contact. In this report, we describe two atypical cases of A. belladonna poisoning resulting from accidental ingestion of the plant's raw leaves, which were referred to the emergency room of a poisoning center in northern Iran. Both patients presented with symptoms of anticholinergic toxicity, including dry mouth, mydriasis, tachycardia, and delirium. The patients were managed conservatively with supportive measures, including hydration and administration of benzodiazepines to control agitation and delirium. With appropriate treatment, both patients showed improvement and were discharged from the hospital. A. belladonna intoxication is associated with a range of clinical manifestations, primarily due to its neurotoxic effects. These manifestations may include flushing, mydriasis, tachycardia, ataxia, agitation, delirium, and urinary retention. The severity of symptoms can vary depending on the amount of the toxin ingested and the individual's susceptibility. In severe cases, A. belladonna toxicity can lead to seizures, coma, and even death. These cases highlight the importance of awareness regarding the potential toxicity of A. belladonna and the necessity of prompt and appropriate management of its toxicity. In severe cases, physostigmine may be considered for the treatment of neurological symptoms due to the plant's anticholinergic effects.

Epilepsy is a common disorder caused by a myriad of drugs, of that levetiracetam is being commonly used late because of its strong safety profile and efficacy. With the increasing usage of drugs, some rare side effects may sometimes appear that can escape the most stringent checks, possibly due to the rarity of their occurrence. Rhabdomyolysis is known to occur in some patients owing to a variety of causes, even leading to kidney injury. When a drug has a side effect that is not well recognized in the literature, especially when the side effect can mimic an adverse effect of an uncommon primary illness, identifying the causal factor can be doubly difficult. To date, only limited studies have been published suggesting rhabdomyolysis linked to levetiracetam use. We report the first case of levetiracetam-induced rhabdomyolysis in Kuwait.

Background: Dry needling (DN) is a technique employed to mitigate spasticity and enhance functionality in stroke patients. We report the impact of DN on both corticospinal tract (CST) consistency and wrist flexors spasticity of an individual affected by stroke.

Case: The participant was a 57-year-old male who had experienced an ischemic stroke 9 months prior. The primary outcome measures included fractional anisotropy (FA), asymmetry FA (aFA), ratio FA (rFA), and Modified Modified Ashworth Scale (MMAS). Additionally, secondary outcomes encompassed wrist extension range of motion (ROM) and performance in the box and block test (BBT). These measurements were taken both before and after the administration of DN treatment.

Results: After the application of DN, the mean FA of the ipsilesional CST increased from 0.35 to 0.39, concomitantly with a decline in aFA from 0.18 to 0.13. Notably, the rFA exhibited a pre-DN value of 0.69, which subsequently rose to 0.76 post-DN. Moreover, a significant reduction in MMAS scores was detected, from a score of "3" prior to DN application to a post-DN score of "1". In terms of wrist mobility, both active and passive extension ROM exhibited favorable improvements, with an increase of 12° for active extension and 16° for passive extension. Furthermore, there was a substantial improvement in the BBT score, an indicator of manual dexterity, ascending from 12 to 24.

Conclusion: Enhancements in CST consistency suggest it as a potential mechanism contributing to the observed improvements following DN in this stroke case.

Rhabdomyolysis, an emergency medical condition linked to muscle necrosis and intracellular substances released into the bloodstream, significantly endangers military personnel in heat-stress conditions. Rhabdomyolysis can also be an initial presentation in inherited muscle disorders. This study reports a novel case of calpainopathy (LGMDR1) diagnosed in a 19-year-old male military cadet who initially presented with recurrent rhabdomyolysis during training, a rare presentation in LGMD patients. Furthermore, a persistent creatine kinase (CK) elevation was observed at baseline. The diagnosis was confirmed by identifying a compound heterozygous of a novel frameshift, c.606dup (p.Ala203CysfsTer9), a mutation in exon 4, and a missense, c.956C > T (p.Pro319Leu), a mutation in exon 7 of the CAPN3 gene, via whole exome sequencing. This case highlights the necessity of diagnostic investigation in individuals who have persistent high CK levels during the rhabdomyolysis episodes and possibly CK screening prior to military training to preemptively identify and mitigate complications from undiagnosed muscular dystrophies in military personnel in the future.

In order to discuss the clinical and MRI features, diagnosis, and prevention of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), we reported an adult case of MOG antibody-related disease misdiagnosed as cerebral infarction. This patient's first clinical symptom was limb weakness, that different from previous reports of MOG antibody-related diseases, such as brainstem encephalitis, neuromyelitis optical, and transverse myelitis. The main treatment plan is high-dose corticosteroid therapy combined with immunoglobulin therapy. This case indicated that some MOGAD patients lack of specificity in the clinical manifestations and imaging perhaps would be misdiagnosed as cerebral infarction, encephalitis, immune peripheral neuropathy, MS, NMOSD, and other diseases. For patients with atypical clinical manifestations or imaging, it is especially important to take antibody detection as early as possible to make correct diagnosis and active treatment in time to avoid disability.

Introduction: Longitudinal extensive transverse myelitis (LETM) has four main causes: inflammatory, malnutrition, vascular, and infectious causes. Among the commonly described viral causes leading to LETM are the Herpesviridae family, HIV, and HTLV-1. Case Presentation. A 43-year-old man presented with asymmetric weakness of the lower limbs (the left side was weaker), urinary retention, and flank pain. The symptoms began five days after shingle eruption and progressed over twelve days. He was diagnosed with longitudinal extensive transvers myelitis extending from T4 to T6, which corresponded to the same dermatome involved in shingles. The PCR result of cerebrospinal fluid was positive for varicella-zoster virus with a viral load of 500 copies/ml. Additionally, the initial HIV enzyme-linked immunosorbent assay (ELISA) test was positive, and his CD4 count was 72 cells/mm³. Other lab results were normal. Based on the appearance of LETM in the thoracic MRI at T4-T6, VZV myelitis was diagnosed, and treatment was initiated with acyclovir (30 mg/kg divided daily for twenty-one days), methylprednisolone (1 g/day for three days), prophylactic antibiotics (trimethoprim/sulfamethoxazole, rifampin, and isoniazid), and antiretroviral therapy (dolutegravir and Truvada). After 2-month follow-up, he was nearly free of symptoms.

Conclusion: Infection is one of the critical causes of transverse myelitis. When a patient presents with skin shingles along with myelopathy, varicella-zoster myelitis should be considered, and the patient should be evaluated in terms of immune system dysfunction. Treatment with acyclovir has been shown to be effective in reducing clinical symptoms in such cases.

In this case report, we describe a well-documented, severe anaphylactic reaction after intravenous administration of cerebrolysin, a neurotrophic agent derived from highly purified porcine brain tissue, consisting of peptides and free amino acids. Cerebrolysin has been in use for decades, in various neurological diseases, but especially stroke and traumatic brain injury, with the aim of enhancing cognitive performance. After administration of cerebrolysin to an 85-year-old male patient suffering from subacute stroke, he developed a fulminant anaphylactic reaction. Following institutional standards, vital functions were quickly restored. The anaphylactic reaction was clearly confirmed by laboratory tests. To date, only rare cases of anaphylaxis due to cerebrolysin have been published in the literature. The current report is intended to raise awareness for the possibility of such a reaction, given the widespread use of cerebrolysin in several indications in mostly critical patients. The case shows how a completely unexpected life-threatening situation can be successfully treated by targeted measures, if the situation is recognized quickly. In light of this event, we consider pathophysiology of allergic reactions and treatment guidelines.