Haemiballism/haemichorea: an atypical presentation of ischaemic stroke

2021 ◽  
Vol 14 (6) ◽  
pp. e240439
Author(s):  
Raman Nohria ◽  
Stacey Bennett ◽  
Yasmin Ali O'Keefe
Keyword(s):  
Brain Mri ◽  
Acute Onset ◽  
Cerebral Peduncle ◽  
Atypical Presentation ◽  
Cerebrospinal Fluid Analysis ◽  
Medication Therapy ◽  
Fluid Analysis ◽  
Ct Head ◽  
The Right ◽  
Distressing Condition

A 76-year-old man was admitted to the hospital with acute onset of involuntary movements of the left side of his body. His neurological examination revealed he was oriented only to himself, and aforementioned movements of his left arm and leg. CT head demonstrated old infarcts in his right aspect of his pons and basal ganglia. Cerebrospinal fluid analysis was unremarkable. He initially had a normal blood glucose with an elevated anion gap and elevated creatine kinase. Brain MRI showed a small lacunar-type ischaemic infarct within the anteromedial aspect of the right cerebral peduncle, which localised to his haemiballism. To prevent worsening rhabdomyolysis associated with his haemiballism, the primary team initiated both tetrabenazine and diazepam. His movements improved after 1 week of medication therapy. This report discusses a thorough workup for this movement disorder and when to intervene for this distressing condition.

scholarly journals An Atypical Presentation of Cystic Echinococcosis

2020 ◽  
Vol 4 (2) ◽  
pp. 164-166
Author(s):  
Bhavana Tetali ◽  
Daniel Grahf ◽  
Elian Abou Asala ◽  
Daniel Axelson
Keyword(s):  
Emergency Department ◽  
Echinococcus Granulosus ◽  
Cystic Echinococcosis ◽  
Acute Onset ◽  
Atypical Presentation ◽  
Hepatic Lobe ◽  
Secondary Lesion ◽  
The Right

Cystic echinococcosis (CE) is an infection caused by the Echinococcus granulosus tapeworm. CE generally manifests in the liver, but it may present in any organ. These patients often first present to the emergency department. Mortality over 10 years is significant for those who go undiagnosed. We report the case of a 34-year-old patient who immigrated from Yemen six years earlier. She presented with acute onset dysuria, suprapubic pain, and fever. Imaging revealed a primary multicystic mass on the right renal pole with a secondary lesion in the right hepatic lobe. On further investigation, the patient’s serum was positive for echinococcus antibodies.

scholarly journals Successful treatment of Yersinia pseudotuberculosis hepatitis in a cat presenting with neurological abnormalities

2019 ◽  
Vol 5 (1) ◽  
pp. 205511691985364 ◽  
Author(s):  
Dan Thompson
Keyword(s):  
Yersinia Pseudotuberculosis ◽  
Total Bilirubin ◽  
Brain Mri ◽  
In Situ Hybridisation ◽  
Clinical Signs ◽  
Reference Interval ◽  
Acute Onset ◽  
Fluid Analysis ◽  
Neurological Abnormalities ◽  
Veterinary Antimicrobials

Case summary A 3-year-7-month-old female neutered domestic shorthair cat was presented for further investigation of acute-onset neurological abnormalities, including marked decreased mentation, ataxia and abnormal cranial nerve responses, with concurrent marked pyrexia (40ºC). Initial blood testing was non-specific with mild-to-moderate increases in alanine aminotransferase (ALT) (194 IU/l; reference interval [RI] 17–62 IU/l), aspartate aminotransferase (AST; 150 IU/l [RI 0–51 IU/l]) and total bilirubin (20 µmol/l; RI 0–11 µmol/l), and neutropenia (1.17 ×109/l; RI 2.5–12.5 ×109/l). Brain MRI and cerebrospinal fluid analysis were unremarkable and Toxoplasma serology was negative. Worsening of hepatic biochemical parameters (ALT 265 IU/l, AST 205 IU/l, total bilirubin 42.9 µmol/l) led to further investigations for liver disease, including ultrasound, fine-needle aspirate cytology, histology, fluorescent in situ hybridisation and culture of liver tissue and bile, resulting in a diagnosis of Yersinia pseudotuberculosis hepatitis. The cat was treated with a combination of potentiated amoxicillin (62.5 mg PO q12h), marbofloxacin (5mg PO q24h) and combined s-adenosyl methionine (SAMe)/silybin (90 mg PO q24h), and made a full recovery. Follow-up over 14 months identified a persistent mild increase in ALT, despite no apparent ongoing disease. Relevance and novel information Yersinia pseudotuberculosis hepatitis should be considered as a differential diagnosis in cats presenting with acute-onset neurological signs, and, when diagnosed, can be successfully treated with a combination of marbofloxacin, potentiated amoxicillin and SAMe/silybin. This is the first such case treated successfully with licensed veterinary antimicrobials and the first instance where Y pseudotuberculosis hepatitis has presented with primarily neurological clinical signs.

scholarly journals Wallerian-Like Degeneration After Ischemic Stroke Revealed by Diffusion - Weighted Imaging

2007 ◽  
Vol 34 (2) ◽  
pp. 243-244 ◽  
Author(s):  
P. N. Sylaja ◽  
M. Goyal ◽  
T. Watson ◽  
M. D. Hill
Keyword(s):  
Cerebral Artery ◽  
Diffusion Weighted Imaging ◽  
Acute Onset ◽  
Cerebral Peduncle ◽  
Diffusion Weighted ◽  
Intravenous Tissue Plasminogen Activator ◽  
Hyperintense Signal ◽  
Apparent Diffusion ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

A 22-year-old female was seen in the emergency within one hour of acute onset of right sided headache followed by weakness of the left side of body. On neurological examination, she was mildly drowsy, had forced right gaze deviation, dysarthria, left hemiplegia and left hemisensory loss. Computed tomography (CT) scan revealed early ischemic changes in the right middle cerebral artery (MCA) territory. The CT angiography done showed evidence of dissection of the supraclinoid segment of the right internal carotid artery with reduced flow distally into the MCA, which was confirmed by a conventional angiogram. In view of the intracranial carotid dissection, the patient was not treated with intravenous tissue plasminogen activator. Magnetic resonance imaging (MRI) of the brain done on the next day revealed evidence of acute ischemic lesions in the right MCA and anterior cerebral artery territory on diffusion-weighted imaging (DWI), with normal brainstem. [Figure 1] A repeat MRI performed 13 days after ictus showed hyperintense signal on DWI in the right cerebral peduncle which was hypointense on apparent diffusion coefficient (ADC) map suggestive of Wallerian-like degeneration. [Figure 2] The signal changes were less conspicuous on T2-weighted images. She had antigravity strength in the left leg but remained weak in her left arm at one month.

scholarly journals Persistent Autobiographical Amnesia: A Case Report

2007 ◽  
Vol 18 (1) ◽  
pp. 13-17 ◽  
Author(s):  
C. Repetto ◽  
R. Manenti ◽  
V. Sansone ◽  
M. Cotelli ◽  
D. Perani ◽  
...  
Keyword(s):  
Brain Mri ◽  
Motor Impairment ◽  
Acute Onset ◽  
Memory Deficit ◽  
Learning Abilities ◽  
Arterial Blood ◽  
Retrograde Memory ◽  
Global Amnesia ◽  
One Year ◽  
The Right

We describe a 47-year-old man who referred to the Emergency Department for sudden global amnesia and left mild motor impairment in the setting of increased arterial blood pressure. The acute episode resolved within 24 hours. Despite general recovery and the apparent transitory nature of the event, a persistent selective impairment in recollecting events from some specific topics of his personal life became apparent. Complete neuropsychological tests one week after the acute onset and 2 months later demonstrated a clear retrograde memory deficit contrasting with the preservation of anterograde memory and learning abilities. One year later, the autobiographic memory deficit was unmodified, except for what had been re-learnt. Brain MRI was normal while H20 brain PET scans demonstrated hypometabolism in the right globus pallidus and putamen after 2 weeks from onset, which was no longer present one year later. The absence of a clear pathomechanism underlying focal amnesia lead us to consider this case as an example of functional retrograde amnesia.

scholarly journals Benign Recurrent Aseptic Meningitis (Mollaret’s Meningitis) in an Elderly Male: A Case Report

2021 ◽  
Vol 59 (241) ◽  
pp. 916-918
Author(s):  
Swati Chand ◽  
Sangharsha Thapa ◽  
Khusal Gautam ◽  
Anu Radha Twayana ◽  
Maryrose R.Laguio-Vila ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Cerebrospinal Fluid ◽  
Aseptic Meningitis ◽  
Acute Onset ◽  
Chain Reaction ◽  
Elderly Male ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Polymerase Chain ◽  
Mollaret's Meningitis

Mollaret’s meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn’s criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviraldue to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.

scholarly journals An Atypical Presentation of CLIPPERS, a Challenging Diagnosis of Reversible Early-Onset Dementia

2020 ◽  
Vol 12 (3) ◽  
pp. 307-313
Author(s):  
Mirella Russo ◽  
Alberto Piermartiri ◽  
Claudia Carrarini ◽  
Fedele Dono ◽  
Maria Vittoria De Angelis ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Brain Mri ◽  
Antidepressant Drugs ◽  
Laboratory Research ◽  
Inflammatory Disorder ◽  
Atypical Presentation ◽  
Ataxic Gait ◽  
Laboratory Findings ◽  
Early Onset Dementia ◽  
Fluid Analysis

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare inflammatory disorder featured by pontocerebellar dysfunctions and, in some cases, later cognitive disturbances. Here, we describe an atypical presentation of CLIPPERS, characterized by clinical onset with neuropsychiatric and cognitive symptoms. A 45-year-old man was referred to our Memory Clinic due to difficulties at work for over a month, caused by confusion and asthenia. Furthermore, insomnia and mood changes appeared. These disturbances were unresponsive to antipsychotic and antidepressant drugs. At admission, the patient presented also with severe cognitive impairment, urinary incontinence, ataxic gait, and limitation of lateral conjugate gaze. During the hospitalization, the patient underwent cerebrospinal fluid analysis, serum systemic autoimmune disorders laboratory research, neoplastic markers analysis, and brain MRI scan. The radiological and laboratory findings were compatible with the diagnosis of CLIPPERS. The sudden clinical and radiological improvement of the patient’s conditions, after only a week of steroid therapy, further confirmed our clinical suspicion. The present case enhances the necessity to consider CLIPPERS in the differential diagnosis of pre-senile cognitive impairment, even in the absence of early pontocerebellar neurological signs. Before the spreading of the neuroinflammatory and degenerative processes, CLIPPERS represents one among the few possible reversible causes of cognitive decline.

scholarly journals A Case of Classic Raymond Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Nicholas George Zaorsky ◽  
Jin Jun Luo
Keyword(s):  
Nerve Palsy ◽  
Brain Mri ◽  
Abducens Nerve ◽  
Acute Onset ◽  
Common Type ◽  
Facial Paresis ◽  
Clinical Observations ◽  
The Face ◽  
The Common ◽  
The Right

Classic Raymond syndrome consists of ipsilateral abducens impairment, contralateral central facial paresis, and contralateral hemiparesis. However, subsequent clinical observations argued on the presentation of facial involvement. To validate this entity, we present a case of classic Raymond syndrome with contralateral facial paresis. A 50 year-old man experienced acute onset of horizontal diplopia, left mouth drooling and left-sided weakness. Neurological examination showed he had right abducens nerve palsy, left-sided paresis of the lower part of the face and limbs, and left hyperreflexia. A brain MRI showed a subacute infarct in the right mid-pons. The findings were consistent with those of classic Raymond syndrome. To date, only a few cases of Raymond syndrome, commonly without facial involvement, have been reported. Our case is a validation of classic Raymond syndrome with contralateral facial paresis. We propose the concept of two types of Raymond syndrome: (1) the classic type, which may be produced by a lesion in the mid-pons involving the ipsilateral abducens fascicle and undecussated corticofacial and corticospinal fibers; and (2) the common type, which may be produced by a lesion involving the ipsilateral abducens fascicle and undecussated corticospinal fibers but sparing the corticofacial fibers.

Isolated third cranial nerve palsy as the first presentation of multiple myeloma

2021 ◽  
Vol 14 (3) ◽  
pp. e239917
Author(s):  
Tejasvini Vaid ◽  
Rishi Dhawan ◽  
Mukul Aggarwal ◽  
Seema Tyagi
Keyword(s):  
Multiple Myeloma ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cns Involvement ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Third Cranial Nerve Palsy ◽  
The Right ◽  
Rare Diagnosis

A 50-year-old woman presented with a right-sided isolated third cranial nerve palsy. MRI brain showed a mass lesion arising from the right clivus with extension into the cavernous sinus. Blood investigations and bone marrow biopsy were suggestive of multiple myeloma with hypercalcaemia and renal dysfunction. It was unclear at first if the intracranial lesion was due to myelomatous involvement or a separate disease entirely. The patient declined consent for a biopsy and cerebrospinal fluid analysis was inconclusive. She was treated with bortezomib based chemotherapy and the palsy resolved by day 6, which helped clinch the rare diagnosis of central nervous system (CNS) involvement by multiple myeloma. Most patients with CNS myeloma have a dismal survival of under 6 months but she is on therapy for relapse 26 months after diagnosis. While placed under the umbrella of CNS myeloma, patients with osteodural myeloma have better outcomes, perhaps due to their distinct aetiopathogenesis.

Aphasia and confusion – influenza encephalopathy: atypical presentation of influenza

2020 ◽  
Vol 13 (10) ◽  
pp. e235559
Author(s):  
Reiichiro Obata ◽  
Kristina Ernst
Keyword(s):  
Influenza Infection ◽  
Adult Population ◽  
Acute Onset ◽  
Close Attention ◽  
Fatal Disease ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Rare Manifestation ◽  
Upper Respiratory ◽  
Upper Respiratory Symptoms

Influenza encephalopathy, a rare manifestation of influenza infection in the adult population which is not widely recognised, can present with confusion and focal neurological symptoms, including aphasia. The aim of this report is to illustrate the unique presentation of influenza encephalopathy and discuss the need for close attention to and monitoring of this rare but highly fatal disease.A 28-year-old woman was admitted with acute-onset confusion and incoherent speech. CT of the head was unremarkable. Cerebrospinal fluid analysis showed elevation of protein, but was otherwise unremarkable. A detailed history revealed recent upper respiratory symptoms which prompted a rapid influenza test which was positive and oseltamivir was started. The patient’s confusion and aphasia gradually improved and her speech was back to her baseline by the next day.

Haemorrhagic encephalitis in the garb of scrub typhus

2020 ◽  
Vol 13 (8) ◽  
pp. e235790
Author(s):  
Saurabh Gaba ◽  
Swati Garg ◽  
Monica Gupta ◽  
Rekha Gupta
Keyword(s):  
Scrub Typhus ◽  
Brain Mri ◽  
Midline Shift ◽  
Recovery Sequence ◽  
Cerebrospinal Fluid Analysis ◽  
Hyperintense Lesion ◽  
Fluid Analysis ◽  
Elevated Protein ◽  
Normal Glucose ◽  
The Brain

A 19-year-old girl presented with fever, headache, vomiting and drowsiness. She had grade 1 papilloedema and neck rigidity but no focal deficits or seizures. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, slightly elevated protein and normal glucose. MRI of the brain showed a hyperintense lesion in left ganglio-capsular region on the fluid attenuation inversion recovery sequence with perilesional oedema and mild midline shift. Haemorrhage was seen in the region on susceptibility weighted imaging . The patient was thoroughly investigated for known causes of meningoencephalitis, but the diagnosis of scrub typhus was delayed till the 10th day of illness. She was treated with doxycycline for 2 weeks and had marked improvement, both clinically and radiologically. Literature review has revealed that although meningoencephalitis in scrub typhus is not uncommon, such atypical lesions on brain MRI are a rarity. Serial imaging was performed to document the disease progression and resolution on treatment.

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