Recovering Voiding and Sex Function in a Patient with Chronic Complete Spinal Cord Injury by Olfactory Ensheathing Cell TransplantationRead the full article
Case Reports in Neurological Medicine publishes case reports and case series focusing on diseases of the nervous system, as well as abnormal neurological function.
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Extensive Longitudinal Transverse Myelitis Temporally Related to the Use of AZD1222, AstraZeneca COVID-19 Vaccine: Cerebrospinal Fluid Analysis and Recent Data Review
While mass immunization against coronavirus disease 2019 (COVID-19) rolls out around the globe, safety concerns and adverse events that need prompt evaluation are also emerging. Neurological complications such as transverse myelitis raise concerns as cases were observed in clinical trials. Cerebrospinal fluid analysis is routine in these cases and the characteristics of the abnormalities found are of great help not only in establishing the diagnosis but also in understanding this rare condition. We present a case of extensive longitudinal transverse myelitis after vaccination with AZD1222, AstraZeneca COVID-19 vaccine, which was the first case reported in Brazil. The abnormalities found in the study of the cerebrospinal fluid in our case are reported and discussed using data from recent publications.
Rescue Revascularisation in Acute Internal Carotid Artery Occlusion with a Super Extended Time Window of More than 48 hours
Background and Aim. Mechanical thrombectomy (MT) and intravenous thrombolysis are the gold standard treatment for large vessel occlusion (LVO) strokes. 10–20% of LVO patients present as “minor strokes” with a National Institutes of Health Stroke Scale (NIHSS) ≤5 points. Therefore, MT is often not primarily performed. These patients rely on collateral blood flow but are prone to clinical deterioration and unfavourable outcome. MT is performed after clinical deterioration, often in an extended time window within 24 hours. No scores identify patients at risk for clinical deterioration. Methods. We present the case of a 71-year-old Caucasian male “minor stroke” patient with LVO, good collateral flow via the ophthalmic artery, receiving rescue MT following clinical deterioration after >48 hours. NIHSS and modified Rankin scale (mRS) were used for follow-up and modified treatment in cerebral infarction (mTICI) score for angiographic results. Results. Excellent angiographic result (mTICI 3) and clinical improvement were achieved (NIHSS preintervention 18, on discharge 2 points). 90-day follow-up showed excellent outcome (mRS 1). Conclusions. Late intervention MT should be encouraged when clinical deficit exceeds infarct demarcation. Standardized identification based on clinical and imaging data is required to target critical patients with LVO and low NIHSS, favouring a primary intervention.
Long-Term Sequelae in Young Convalescent COVID-19 Patients
As of March 2022, over 78 million cases of COVID-19 and 900,000 deaths have been reported in the United States. The consequences in the acute phase due to the SARS-COV-2 infection are well defined. Beyond the direct effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) involving the lung parenchyma, the post-viral complications within the central nervous system are still largely unknown, and a comprehensive evaluation regarding the long-term neuropsychological sequelae from this disease is not well characterized. An increasing number of patients previously diagnosed with COVID-19 have now presented with ongoing symptoms of inattention, executive function, and memory difficulties. These symptoms are collectively and commonly known by the public as ‘brain fog’, with many expressing concerns over their inability to engage in the workplace due to these symptoms. Here, we describe three patients who were seen in the Memory Disorders Clinic at Duke University to characterize the long-term neuropsychological symptoms, neuropsychological test results and brain MRI findings after infection with SARS-CoV-2 in a cohort of patients under the age of 60.
Amantadine as a Potential Treatment for Marchiafava–Bignami Disease: Case Reports and a Possible Mechanism
Introduction. Several reports have described the use of amantadine for managing symptoms in Marchiafava–Bignami disease (MBD); however, amantadine’s role for the treatment of MBD symptoms is unclear. Here, we describe 2 patients with MBD who were treated with amantadine and hypothesize a potential mechanism responsible for clinical benefit. Case 1. A 38-year-old woman with excessive wine drinking presented with agitation, impaired speech, and a minimally conscious state. MRI revealed lesions in the splenium and genu. After being diagnosed with MBD, she was treated with intravenous thiamine, multivitamins, and 100 mg of amantadine twice a day for 2 weeks. She recovered to near baseline after 3 weeks. Case 2. A 54-year-old woman with years of heavy alcohol use presented with sudden bradyphrenia, acalculia, disinhibited behavior, weakness, and urinary incontinence. MRI revealed a large anterior callosal lesion. Two years after initial recovery from MBD, she noted that consuming “energy drinks” resulted in a transient, near-complete resolution of her residual behavioral, fatigue, and language symptoms. 100 mg of amantadine twice a day was trialled. After noted improvement, a further escalation to 200 mgs 3 times a day resulted in significant improvement in language and behavioral symptoms. Conclusion. Amantadine in addition to vitamins may be beneficial in the treatment of MBD. It is possible that the dopaminergic effect of amantadine leads to improved recovery and function in dopamine-mediated pathways, including mesocortical and mesolimbic pathways during initial recovery, as well as improved speech, behavior, and fatigue in the following months. The role of amantadine in the treatment of MBD warrants further study.
Post-COVID-19 Longitudinally Extensive Transverse Myelitis with Myelin Oligodendrocyte Glycoprotein Antibodies
Background. Myelin oligodendrocyte glycoprotein (MOG) antibody disease most commonly presents with optic neuritis, though myelitis is also possible. It is rare in the post-infectious and particularly post-COVID-19 setting. Case Presentation. We present the case of a 57-year-old man who tested positive for COVID-19 and experienced respiratory symptoms that completely resolved within one week. About 3 weeks after testing positive, he began experiencing acute onset anuria, followed by lower extremity paresthesia and paraparesis, which progressed to bilateral lower extremity paraplegia, complete loss of sensation of pain, temperature, vibration, and proprioception, and a T4 sensory level. He was initially diagnosed with and treated for acute inflammatory demyelinating polyradiculoneuropathy (AIDP), after which he made minimal clinical improvement. The diagnosis was shifted to longitudinally extensive transverse myelitis, and his CSF tested positive for MOG antibodies. He is being treated with a steroid regimen and extensive outpatient physical therapy. Conclusion. The neurologic manifestations of COVID-19 are still being uncovered. Neurologic symptoms should be included in patient education on symptom monitoring, even after recovery of respiratory illness, so that COVID-19-related CNS pathology can be urgently treated.
Artery of Percheron Infarction: A Case Report of Bilateral Thalamic Stroke Presenting with Acute Encephalopathy
The artery of Percheron (AOP) is a relatively rare anatomic variant in which a solitary arterial trunk branches from the proximal segment of the posterior cerebral artery and provides arterial supply to the paramedian region of the thalami bilaterally and often to the rostral part of the midbrain. Occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with and without midbrain involvement. Recognition of this condition as an acute stroke may be challenging due to various nonlocalized clinical presentations, given the wide range of neurological functions subserved by the thalamus. Prompt neuroimaging, preferably with magnetic resonance imaging (MRI), in conjunction with familiarity with this relatively rare vascular variation can facilitate initiation of appropriate time contingent thrombolytic treatment and improved long-term prognosis. We present a case of a 56-year-old African American female with a bilateral thalamic infarct secondary to the artery of Percheron thromboembolism. This patient presented unresponsive without focal neurologic findings but with an initial Glasgow Coma Score (GCS) of 7, and subsequent computed tomographic (CT) head revealed bilateral thalamic hypodensities. Confirmatory MRI exhibited bilateral subacute thalamic infarcts, which were thought to be embolic with the source from the left ventricular thrombus as the patient had at least three distinct clots. Unfortunately, the patient’s mental status did not improve significantly, and she was discharged to a nursing facility for extended care. AOP infarction may be missed on vascular imaging utilizing CT, MRI, and even catheter angiography. Clinical recognition that the AOP is one of the only single artery occlusions that can affect bilateral structures and frequently present solely as altered mental status without focal neurologic deficits is crucial to the diagnosis.