Acta Neurologica Taiwanica[JOURNAL]
Sun
200 papers
Fulminant Idiopathic Intracranial Hypertension: An Unusual Case of Polycythemia Vera.
Singh A, Dogra A, Mehta P
Acta Neurol Taiwan · 2025 Oct · PMID 41467266 · Publisher ↗
A 42-year-old female patient presented with complaints of headache and painless progressive vision loss for 3 weeks. She was evaluated and found to have grade 5 papilledema, and her blood investigations revealed polycyth...
A 42-year-old female patient presented with complaints of headache and painless progressive vision loss for 3 weeks. She was evaluated and found to have grade 5 papilledema, and her blood investigations revealed polycythemia vera (PV) with a positive Janus Kinase 2 (JAK2) mutation, and cerebrospinal fluid manometry study showed a markedly raised opening pressure of 270 mm Hg. The magnetic resonance imaging brain with venogram showed normal study and patent sinuses. The patient was managed with drugs such as hydroxyurea, antiplatelet drugs, and phlebotomy. The most notable feature of this intriguing case is PV manifesting as idiopathic intracranial hypertension and vision loss despite normal patent sinuses, which is explainable by hypercoagulability causing sluggish flow in venous sinuses and raised pressure over the optic nerves, resulting in papilledema and vision loss.
Neuronal Intranuclear Inclusion Disease Mimicking Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Case Report.
Chen SC, Chen YH, Fang SY … +6 more , Hsu HT, Chang FP, Jih KY, Liao YC, Lee YC, Lai KL
Acta Neurol Taiwan · 2025 Oct · PMID 41467265 · Publisher ↗
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory neuropathy, characterized by a slowly progressive onset and symmetrical, sensorimotor involvement. Several diseases, nevertheless, may p...
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory neuropathy, characterized by a slowly progressive onset and symmetrical, sensorimotor involvement. Several diseases, nevertheless, may present similar features as CIDP. It is of paramount importance to recognize these mimics to yield an optimal therapeutic effect. Neuronal intranuclear inclusion disease (NIID) is a rare, progressive neurodegenerative disorder known for its diverse clinical manifestations. Since it may present as sporadic as well as inherited manner and may only involve the peripheral nerve system, it might resemble the clinical course of CIDP. Here, we report the case of a 61-year-old male who presented with subacute onset progressive paresthesia and weakness in lower extremities associated with gait disturbance. Nerve conduction studies demonstrated the features of demyelinating polyneuropathy with predominantly motor involvement. Under the impression of CIDP, immunomodulating therapy was given but with limited clinical response, prompting our consideration of seeking other diseases. Guided by characteristic magnetic resonance image findings during the second round survey, a diagnosis of NIID was confirmed by tissue and molecular pathologies. This is the first report in Taiwan to describe a patient with NIID who initially presented with clinical, electrophysiological, and laboratory features of CIDP, yet later confirmed to be NIID by tissue and molecular proof. Clinicians need to be aware of the possibility of NIID when diagnosing CIPD, especially if atypical presentation such as multi-system involvement or poor therapeutic responsiveness is present.
Successful Nonsurgical Treatment of Unruptured Basilar Artery Dissecting Aneurysm Complicated by Ischemic Stroke: A Case Report and Literature Review.
Ruan YZ, Lin YK, Lee JT … +2 more , Chou CH, Yang FC
Acta Neurol Taiwan · 2025 Oct · PMID 41467264 · Publisher ↗
The purpose of this case report is to describe the clinical presentation and successful management of an isolated basilar artery dissecting aneurysms (BADAs), highlighting the challenges in decision-making and the outcom...
The purpose of this case report is to describe the clinical presentation and successful management of an isolated basilar artery dissecting aneurysms (BADAs), highlighting the challenges in decision-making and the outcomes of nonsurgical treatment. A 60-year-old man presented with vertigo, vomiting, slurred speech, and hearing loss on one side. Imaging revealed a BADA with a mural thrombus, compressing the brainstem. His condition quickly worsened, resulting in left-sided hemiplegia, dysphagia, and ataxia. Despite anticoagulant treatment, follow-up imaging showed new strokes. Surgical intervention in BADAs carries high risks, including morbidity and mortality. For unruptured aneurysms causing brainstem compression, endovascular treatment is often preferred. Aspirin is recommended for patients with cerebral ischemia, while patients without ischemia or hemorrhage are generally monitored without antithrombotic therapy. The timing of intervention for asymptomatic cervical artery dissection aneurysms remains unclear, and treatment decisions should be made on a case-by-case basis. In this case, the patient received nonsurgical treatment, which successfully controlled the infarction without aneurysm rupture or hemorrhage. However, individualized treatment decisions remain essential.
A Case of Anti-MuSK Antibody-positive Myasthenia Gravis Presenting as Limb-Girdle Muscle Atrophy.
Dhing HK, Hussain M, Nath P
Acta Neurol Taiwan · 2025 Oct · PMID 41467263 · Publisher ↗
To diagnose a case anti-MuSK myasthenia gravis (anti-MuSK MG) is always a challenge in view of a distinct clinical phenotype that differs from typical MG (anti-acetylcholine receptors (antibody positive). We herein repor...
To diagnose a case anti-MuSK myasthenia gravis (anti-MuSK MG) is always a challenge in view of a distinct clinical phenotype that differs from typical MG (anti-acetylcholine receptors (antibody positive). We herein report a case of anti-MuSK MG, whose history and clinical phenotype differ from typical MG and are more suggestive of myopathy or anterior horn cell disease. Therefore, testing anti-MuSK antibody is very important if there is suspicion of anti-MuSK MG.
Physiotherapy Rehabilitation Strategies as an Adjunct to Hyperbaric Oxygen Therapy in a Patient with Diving-related Spinal Cord Decompression Sickness: A Case Report.
Belgen Kaygisiz B, Selcuk F, Çoban F … +1 more , Izbul T
Acta Neurol Taiwan · 2025 Oct · PMID 41467262 · Publisher ↗
"Decompression Sickness" (DCS) is a rare neurologic condition that is generally seen in divers which sometimes lead to decreased physical and functional capacity. The purpose of our study is to investigate the effects of...
"Decompression Sickness" (DCS) is a rare neurologic condition that is generally seen in divers which sometimes lead to decreased physical and functional capacity. The purpose of our study is to investigate the effects of a high-intensity physiotherapy rehabilitation program on the physical capacity and functional level of a patient diagnosed with DCS who had residual physical impairments. A 65-year-old male with acute incomplete T4 spinal cord injury was diagnosed with DCS when he got on the boat after 35 min of diving. He experienced acute-onset paresthesia and upon moving his lower extremities, he noted bilateral leg weakness and difficulty in standing up and walking. The physiotherapy and rehabilitation program in addition to hyperbaric oxygen therapy started on the 1st day of hospitalization and continued six times per week during the first 3 months and four times per week for the next 3 months. The motor and sensory level of the patient was evaluated by the American Spinal Injury Association. Functional independence level, static and dynamic balance ability were recorded with functional ındependence measurement and functional reach test, respectively. Clinically important improvements have been observed in the patient's muscle strength, sensation, balance ability, and ambulation parameters. Treatment of DCS should be supported by a physiotherapy rehabilitation program when there are residual physical impairments to increase functionality and prevent permanent disability. Different rehabilitation strategies must be further examined.
The Characteristics of Imaging Patterns on Whole-body Magnetic Resonance Imaging of Anti-signal Recognition Particle Antibody-positive Immune-mediated Necrotizing Myopathy.
Hou YY, Huang WC, Huang CR … +3 more , Chen SS, Tsai NW, Chen SF
Acta Neurol Taiwan · 2025 Oct · PMID 41467261 · Publisher ↗
BACKGROUND: Immune-mediated necrotizing myopathy (IMNM) is a rapidly progressive subtype of inflammatory myositis that can be managed with early immunotherapy. Anti-signal recognition particle (anti-SRP)-positive IMNM is...
BACKGROUND: Immune-mediated necrotizing myopathy (IMNM) is a rapidly progressive subtype of inflammatory myositis that can be managed with early immunotherapy. Anti-signal recognition particle (anti-SRP)-positive IMNM is frequently associated with severe muscle weakness and respiratory complications, while whole-body muscle MRI involvement remains insufficiently characterized. OBJECTIVES: The aim of this study was to identify the characteristics of muscle magnetic resonance imaging (MRI) of patients with immune-mediated necrotizing myopathy (IMNM) with anti-signal recognition particle (SRP) antibody and to further evaluate the correlation between these MRI features and clinical presentation. MATERIALS AND METHODS: We identified 16 patients with anti-SRP myopathy, the diagnosis of IMNM was confirmed by muscle biopsy, and the whole-body MRI was performed in all 16 patients. Clinical information and laboratory data were collected. The severity of the short-T1 inversion recovery (STIR) sequences was classified into three grades (0, 0.5, and 1) according to the pattern and intensity of individual muscle involvement. Serial muscle group grading was performed using Friedman's test, and the correlation between MRI STIR pattern and clinical data was calculated using Spearman's rank correlation coefficient. RESULTS: The 16 patients included 9 women and 7 men, with an average age of 43.4. The mean time-to-onset was 5.5 months. Whole-body muscle MRI STIR sequencing revealed muscle edema in all tested patients. Marked edema was noted in the pelvis, bilateral shoulders, posterior compartment of the arm, and concentric muscles of the shoulder and pelvis (all P < 0.001). Correlation analysis indicated that higher muscle STIR signaling was correlated with higher values of erythrocyte sedimentation rate, SRP antibody titer, and compound motor action potential (CMAP) reduction. In addition, we observed lower values of C-reactive protein, forced vital capacity (FVC), ejection fraction, clinical pretreatment with steroids (premedication steroids), and Medical Research Council scores in specific muscles. Reduced FVC was further found to correlate with edema in the muscles of the cervical spine, shoulder, anterior forearm, and pelvis, leading to reduced respiratory function. CONCLUSIONS: Whole-body MRI in anti-SRP patients revealed a characteristic edema pattern with an affinity for specific muscles of the shoulders and pelvis with a radial distribution, with edema severity corresponding to clinical severity, particularly respiratory function. Pretreatment with steroids reduced edema, indicating the efficacy of this treatment.
Evaluation of Intravenous Thrombolytic Therapy on Acute Ischemic Stroke Outcome: A Single-center Observation Prospective Cohort Study.
Sharifi-Razavi A, Sedaghat Z, Karimi N
Acta Neurol Taiwan · 2025 Oct · PMID 41467260 · Publisher ↗
BACKGROUND: Intravenous thrombolysis (IVT) is a standard treatment for acute ischemic stroke (AIS). We started IVT about 4 years ago (since 2017) in our center. OBJECTIVES: The aim of the thrombolysis outcome in ischemic...
BACKGROUND: Intravenous thrombolysis (IVT) is a standard treatment for acute ischemic stroke (AIS). We started IVT about 4 years ago (since 2017) in our center. OBJECTIVES: The aim of the thrombolysis outcome in ischemic stroke study was to confirm whether the efficacy and safety of IVT recognized in published studies could be reproduced in routine clinical practice in Iran. MATERIALS AND METHODS: This study was a prospective observational cohort study on consecutive patients diagnosed with AIS, who received IVT from January 2017 to March 2019 (ClinicalTrials registration: NCT04309357). The primary outcome was the rate of functional independence at 3 months, defined as the Barthel Index (BI) 85-100. Binary outcomes included independence compared with disability or death. The secondary outcome was the rate of fatal and symptomatic intracerebral hemorrhage. RESULTS: Out of 214 patients registered in this study, 59.34% were male and the median (interquartile range) age of patients was 69 (61-78) years. Pretreatment median scores of the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale were 3 and 10, respectively. At discharge time, 40.65% of patients achieved good outcomes. Follow-up within 3 months, 43.45% achieved BI 85-100, and 44.72% had an mRS score 0-2. The rate of all types of intracranial hemorrhages was 19.6%, of which 9.3% were symptomatic. In addition, the mortality rate during the 3 months was 17.28%. CONCLUSIONS: In our study, the efficacy of IVT was reasonable compared to international data. However, to increase efficiency, poststroke rehabilitation programs need to be organized and promoted.
Unraveling the Link between Sleep Disturbances and Parkinson's Disease: A Narrative Review.
Cardenas-Saenz O, Macias-Ortiz FG, Becerra-Aguiar NN … +4 more , Sainz-Del Real SMLA, Orozco-Puga P, Camacho-Ordoñez A, Rodriguez-Violante MJ
Acta Neurol Taiwan · 2025 Oct · PMID 41467259 · Publisher ↗
Parkinson's disease (PD) is characterized by both motor and nonmotor symptoms, many of which originate from the pathophysiology of the disease and its progression. Nonmotor symptoms are diverse and can often be more debi...
Parkinson's disease (PD) is characterized by both motor and nonmotor symptoms, many of which originate from the pathophysiology of the disease and its progression. Nonmotor symptoms are diverse and can often be more debilitating for patients than motor symptoms. Among these, sleep disorders are particularly significant, as they can occur several years before the onset of motor symptoms and have profound implications for the patient's quality of life (QoL). Sleep problems typically manifest at all stages of the disease and are frequently regarded as a separate entity. This analysis aims to explore and summarize knowledge of the main sleep disorders associated with PD, their characteristics, prevalence, and treatment options. A comprehensive literature review was conducted, examining studies published on sleep disturbances in PD, focusing on the epidemiology, etiology, pathophysiology, implications, diagnosis, and treatment. Findings indicate that sleep disorders are prevalent in over 90% of patients with PD and often manifest years before the onset of motor symptoms. Specific disorders such as rapid eye movement sleep behavior disorder (RBD), insomnia, and excessive daytime sleepiness are highlighted as significant contributors to reduced QoL. The literature also emphasizes the complex interplay of factors, including dopaminergic treatments and disease progression, which exacerbate these disturbances. Sleep disorders are critical nonmotor symptoms of PD that significantly affect QoL. Early identification and tailored management of these symptoms are essential for improving patient outcomes. Further research is needed to develop effective treatment strategies that address the multifaceted nature of sleep disturbances in this population.
Benefits and Drawbacks of Teleneurosurgery in Low- and Middle-Income Countries: A Scoping Review.
Janjua MI, Abbasi S, Idrees A … +4 more , Yaqoob E, Montemurro N, Chaurasia B, Javed S
Acta Neurol Taiwan · 2025 Oct · PMID 41467258 · Publisher ↗
Telemedicine is an emerging medical technology that allows us to bridge the gap between remote healthcare access and resource provision. Low- to middle-income countries (LMICs), which would benefit greatly from this emer...
Telemedicine is an emerging medical technology that allows us to bridge the gap between remote healthcare access and resource provision. Low- to middle-income countries (LMICs), which would benefit greatly from this emerging technology, also face hurdles in its implementation. This scoping review aims to map the existing literature and evidence on the challenges and limitations of adopting teleneurosurgery. This is important for establishing policies to facilitate wider implementation of teleneurosurgery and telemedicine across Pakistan. This review was conducted following the methodology framework outlined by Arksey and O'Malley. Studies were searched using PubMed and Google Scholar, where search domains included telemedicine, telehealth, teleneurosurgery, and LMICs. A manual search of the reference list of selected studies was conducted, and studies were finalized after expert consultation. Challenges in the implementation of teleneurosurgery were analyzed. Quantitative, qualitative, and critical analysis of the included studies was completed. Results were reported according to the already existing scoping review guidelines (PRISMA-ScR). Telemedicine, particularly in neurosurgery, emerges as a sign of a prospect poised to offer transformative solutions to global healthcare delivery. It relies heavily on robust technological infrastructure, with high-speed Internet connectivity serving as its backbone. Yet, inadequate bandwidth and connectivity issues stand as the prime hurdles, impacting surgical precision, and hindering patient safety. Owing to all the challenges, teleneurosurgery is open to diverse opportunities for improvement. Regular training programs, collaborative efforts with healthcare providers, and addressing technological issues can enhance the effects of teleneurosurgery in patient care.
Postinfectious Manifestation of Wilson's Disease in COVID-19 Presenting as Writer's Cramp: A Case Report.
Verma R, Bal KPA, Chakraborty R
Acta Neurol Taiwan · 2025 Oct · PMID 41230787 · Publisher ↗
Wilson's disease (WD) is a neurometabolic disorder of copper metabolism with varied neurological presentations. COVID-19 has been associated with a multitude of multisystemic involvement, especially nervous system due to...
Wilson's disease (WD) is a neurometabolic disorder of copper metabolism with varied neurological presentations. COVID-19 has been associated with a multitude of multisystemic involvement, especially nervous system due to direct involvement, systemic inflammation, and immune-mediated phenomena. Movement disorders, however, represent a small domain of COVID-19 illness. A 23-year-old male developed behavioral changes, writer's cramp, and other neuropsychiatric symptoms following a COVID-19 infection, leading to a diagnosis of WD. Examination revealed Kayser-Fleischer rings and brain imaging abnormalities. Diagnosis was confirmed by low ceruloplasmin levels, elevated 24 h urine copper, and genetic testing. This case highlights the postinfectious manifestations of WD and its rare presentation as a writer's cramp.
Vertebral Artery Dissection Following COVID-19 Infection.
Wu HW, Wu CH, Chang FC
Acta Neurol Taiwan · 2025 Jul · PMID 41020467 · Publisher ↗
Abstract loading — click title to view on PubMed.
Anterior Spinal Cord Artery Dissection.
Wu CW, Chou CL
Acta Neurol Taiwan · 2025 Jul · PMID 41020466 · Publisher ↗
Abstract loading — click title to view on PubMed.
Primary Central Nervous System Melanoma Masquerading as Subarachnoid Hemorrhage: A Case Report.
Lin YC, Chou CL
Acta Neurol Taiwan · 2025 Jul · PMID 41020465 · Publisher ↗
Primary central nervous system (CNS) malignant melanoma is a rare occurrence that can mimic subarachnoid hemorrhage (SAH) on imaging. We present the case of a patient with primary CNS melanoma presenting as an SAH. A 46-...
Primary central nervous system (CNS) malignant melanoma is a rare occurrence that can mimic subarachnoid hemorrhage (SAH) on imaging. We present the case of a patient with primary CNS melanoma presenting as an SAH. A 46-year-old man presented with a 2-week history of subacute thunderclap headaches, blurred vision in the left eye, bilateral hearing impairment, and recent weight loss of 10 kg in a year. Noncontrast head computed tomography scan revealed several spotting hyper-attenuations in the brainstem. Magnetic resonance imaging of the head showed hyper-intensity on the T1 sequence with leptomeningeal enhancement at both cerebral convexities, the surface of the brainstem, the superior cerebellum, both facial/vestibulocochlear nerve complexes, and trigeminal nerves. Cytospin smear of cerebrospinal fluid (CSF) found atypical cells with intracytoplasmic melanin pigment. The patient was operated upon for hydrocephalus, and the pathology result of a surgical piece confirmed the diagnosis of melanoma. Melanoma should be considered in patients with suspected SAH on imaging with nonbloody and nonxantochromatic CSF. A careful cytologic examination of CSF is needed.
Subtle Manifestation of Lower Cavernous Sinus Syndrome as the Initial and Sole Presentation of Pterygopalatine Squamous Cell Carcinoma Invasion from the Skull Base: A Case Report.
Wu BP, Huang P
Acta Neurol Taiwan · 2025 Jul · PMID 41020464 · Publisher ↗
We present a case highlighting the critical role of early recognition of partial cavernous sinus syndrome (CSS), as diagnostic delay can lead to irreversible tumor progression. A 50-year-old woman presented with subtle b...
We present a case highlighting the critical role of early recognition of partial cavernous sinus syndrome (CSS), as diagnostic delay can lead to irreversible tumor progression. A 50-year-old woman presented with subtle binocular diplopia and facial tingling sensation for 1 month. Neurological examination revealed isolated right abducens nerve (VI) palsy and paresthesia at territories of right ophthalmic (V1) and maxillary (V2) nerves. Partial CSS was suspected. Brain magnetic resonance image (MRI) revealed a contrast-enhancing mass involving the pterygopalatine fossa, sphenoid, and maxillary sinuses extending into the cavernous sinus. Fiberscope biopsy confirmed nonkeratinizing squamous cell carcinoma (SCC). After consultation with otolaryngologist, concurrent chemoradiation as the initial treatment modality was suggested. We describe an uncommon etiology of CSS by pterygopalatine SCC invasion, presenting initially as subtle cranial nerve palsies. Involvement of lower anatomical structures in cavernous sinus and "mandibular sparing" can be a hint of invasive lesion from pterygopalatine fossa. This case emphasizes the importance of high clinical suspicion for partial CSS, as early recognition can have great impact on patient's prognosis.
Unusual Manifestation of Bilateral Meralgia Paresthetica Following Laparoscopic Appendectomy: A Case Report.
Chou S, Huang P
Acta Neurol Taiwan · 2025 Jul · PMID 41020463 · Publisher ↗
Meralgia paresthetica (MP), a mononeuropathy of the lateral femoral cutaneous nerve (LFCN), presents with dysesthesias in the anterolateral thigh. While often idiopathic, iatrogenic causes are increasingly recognized. We...
Meralgia paresthetica (MP), a mononeuropathy of the lateral femoral cutaneous nerve (LFCN), presents with dysesthesias in the anterolateral thigh. While often idiopathic, iatrogenic causes are increasingly recognized. We report a rare case of bilateral MP following laparoscopic appendectomy, highlighting its severe impact on quality of life and the need for surgical awareness. A 47-year-old male presented with persistent bilateral thigh numbness, severe pain, and allodynia after laparoscopic appendectomy. He reported significant functional limitations and sleep disturbances. Bilateral MP was diagnosed based on clinical findings and magnetic resonance imaging evidence of inflammation near the LFCN course. This case underscored the atypical presentation of bilateral MP following laparoscopic appendectomy and expands the literature on iatrogenic causes. Clinicians should include MP in the differential diagnosis of postoperative lower limb paresthesia. Surgical awareness of the LFCN vulnerability, coupled with precise trocar placement, could minimize the risk of this potentially debilitating complication.
Seronegative but Cerebrospinal Fluid-positive NMDA Receptor Encephalitis in an Alzheimer's Dementia Patient with Good Treatment Outcome: A Case Report.
Lee YC, Tai YC
Acta Neurol Taiwan · 2025 Jul · PMID 41020462 · Publisher ↗
We present a rare case of elderly-onset anti-N-methyl-D-aspartate (NMDA) receptor encephalitis combined with underlying Alzheimer dementia, characterized by seronegativity but cerebrospinal fluid (CSF) antibody positivit...
We present a rare case of elderly-onset anti-N-methyl-D-aspartate (NMDA) receptor encephalitis combined with underlying Alzheimer dementia, characterized by seronegativity but cerebrospinal fluid (CSF) antibody positivity, which showed a significant improvement following intravenous immunoglobulin (IVIG) treatment. The case highlights serial electroencephalogram (EEG) changes. We focus the discussion on factors contributing to favorable recovery. A 78-year-old woman with Alzheimer's dementia and hypertension experienced rapid onset of further cognitive decline over 1 week, presenting with disorientation, irrelevant speech, and disorganized behaviors. Myoclonus of both upper limbs and focal seizures 10 days later which lead her into intensive care unit (ICU) admission. Test results revealed positive anti-NMDA antibodies in CSF but negative in serum. Serial electroencephalograms (EEG) exhibited extreme delta brush activity transitioning to excess beta activity. Initial treatment with a 5-day course of steroid pulse therapy showed limited efficacy. Subsequently, 5 days of IVIG therapy provided marked improvement in consciousness and cognitive function and also normalized the EEG. This patient presented with severe neurological dysfunction, the need for ICU management, and presence of extreme delta brush EEG pattern. Generally, the prognosis was unfavorable. However, advanced age onset and anti-NMDA antibody positivity in CSF with seronegativity in serum may imply better prognosis. Thus, testing anti-NMDA receptor antibody in both serum and CSF is mandatory and under this complicated situation, timely immunotherapy may be the influencing factors of good prognosis.
Isolated Intracranial Hypertension Following Coronavirus Disease in 2019 AstraZeneca Vaccine: Report of 2 Consecutive Cases.
Farzi MA, Bavil MH, Assi MH
Acta Neurol Taiwan · 2025 Jul · PMID 41020461 · Publisher ↗
Herein reported are two patients that developed symptoms of isolated intracranial hypertension (IIH) following vaccination with AstraZeneca ChAdOx1-S vaccine. Patient identified during daily practice and selected for fur...
Herein reported are two patients that developed symptoms of isolated intracranial hypertension (IIH) following vaccination with AstraZeneca ChAdOx1-S vaccine. Patient identified during daily practice and selected for further evaluation for headache based on clinical findings. Both patients underwent diagnostic lumbar puncture, and after detection of high cerebrospinal fluid (CSF) opening pressure, therapeutic CSF extraction was performed. Although causative relationship couldnt be inferred between AstraZeneca ChAdOx1-S vaccine and IIH, solely based on these two cases, all clinicians should be vigilant about IIH in recipients of this vaccine.
Clinical Features and Outcome in Myasthenia Gravis Patients with Antimuscle-specific Tyrosine Kinase Antibody: A Retrospective Study.
Chung YC, Yeh JH, Chiu HC … +2 more , Lien LM, Chen WH
Acta Neurol Taiwan · 2025 Jul · PMID 41020460 · Publisher ↗
BACKGROUND: Myasthenia gravis (MG) patients with anti-MuSK (muscle-specific tyrosine kinase) antibody (MuSK-MG) are uncommon. Compare with MG patient with anti-ACh (acetylcholine) receptor antibody (AChR-MG), MuSK-MG exh...
BACKGROUND: Myasthenia gravis (MG) patients with anti-MuSK (muscle-specific tyrosine kinase) antibody (MuSK-MG) are uncommon. Compare with MG patient with anti-ACh (acetylcholine) receptor antibody (AChR-MG), MuSK-MG exhibit unique features. OBJECTIVES: The aim of this study is to analyze the difference of the clinical characteristics and electrophysiological features between MuSK-MG and AChR-MG. MATERIALS AND METHODS: We retrospectively review the medical records of generalized MG patients from 2004 to 2019 at Shin Kong Memorial Wu Ho-Su Hospital. We enrolled 47 MuSK-MG patients (33 females and 14 males), and 48 AChR-MG patient (23 females and 25 males). RESULTS: MuSK-MG patients have a female predominance (70.2% vs. 47.9%, P = 0.027) and no significant difference to AChR-MG in onset age (44.02 ± 15.06 vs. 47.52 ± 15.85, P = 0.273). MuSK-MG are more likely to involve facial (76.6% vs. 16.7%, P < 0.001), bulbar (100% vs. 50%, P < 0.001), neck (55.3% vs. 22.9%, P = 0.001), and respiratory muscles (61.7% vs. 10.4%, P < 0.001). MuSK-MG tent to experience more severe symptoms with MGFA Class III or greater (72.3% vs. 50.0%, P = 0.032). The thymic pathology in MuSK-MG is likely to be normal (55.3% vs. 18.8%) or thymic hyperplasia (44.7% vs. 25%). The overall positive rate for repetitive nerve stimulation (RNS) in MuSK-MG patients is less than AChR-MG patients (66.0% vs. 85.4%, P = 0.027). Further analysis shows the difference is mainly by recording from trapezius muscles (51.1% vs. 79.2%, P = 0.004), whereas there is no difference in nasalis muscles (60% vs. 67.6%, P = 0.544) and abductor digiti minimi muscles (13% vs. 18.4%, P = 0.582). The positive rate for single fiber electromyography (SFEMG) recording from orbicularis oculi is very high in both MuSK-MG and AChR-MG (100% vs. 97.2%, P = 0.289). Both MuSK-MG and AChR-MG patients achieved good outcome after proper treatment (68.1% vs. 75%, P = 0.4455). CONCLUSIONS: MuSK-MG patients have a female predominance and more facial, bulbar, neck, and respiratory muscles involvements. The electrodiagnostic features of MuSK-MG are lower positive rate of RNS at trapezius and high positive rate of SFEMG at facial muscles. Although MuSK-MG patients are associated with a more progressive course, proper diagnosis and treatment still can lead to a favorable outcome.
Assessment of Cognitive Functions and Event Related Potentials in Female Patients with Migraine without Aura: A Cross-sectional Study.
Fathi S, Abdelalim A, Hussein AF … +3 more , Shamloul R, Shazly SR, Hatem G
Acta Neurol Taiwan · 2025 Jul · PMID 41020459 · Publisher ↗
BACKGROUND: Migraine is associated with cognitive symptoms during its all phases. Both migraine and cognitive impairment are more common in females. OBJECTIVES: This study aimed to assess cognitive functions in females w...
BACKGROUND: Migraine is associated with cognitive symptoms during its all phases. Both migraine and cognitive impairment are more common in females. OBJECTIVES: This study aimed to assess cognitive functions in females with migraine without aura using cognitive tests and event related potential (ERP) (P 300). MATERIALS AND METHODS: Forty-one female patients diagnosed with migraine without aura according to the International Classification of Headache Disorders, 3rd edition, and 40 healthy controls matched for age, sex, and education were included, and all participants performed the Arabic version of the Addenbrooke's Cognitive Examination (ACE-III), the Brief Visuospatial Memory Test-Revised, the Symbol Digit Modalities Test (SDMT), and underwent ERP-P300 using the auditory oddball paradigm. RESULTS: Patients showed better total score of ACE-III and visuospatial score than healthy control group (P = 0.027, P < 0.0001, respectively), no significant difference between both groups regarding attention, memory, language, and processing speed (P > 0.05). A negative correlation between P 300 latency and SDMT and a positive correlation between SDMT, attention and amplitude not reaching statistical significance were found (P > 0.05). CONCLUSIONS: Migraine patients showed a better performance in some cognitive functions compared to heathy control. P 300 could be used as a tool for detecting early and subtle cognitive impairment.
Communicating Neurological Bad News: An Essential Skill for Neurologists and a Fundamental Medical Education Core Competency.
Algahtani H, Shirah B, Alfaifi OM … +2 more , Alghtanie YA, Jamaluddin HA
Acta Neurol Taiwan · 2025 Jul · PMID 41020458 · Publisher ↗
The effective communication of bad news in neurology is a critical and delicate process that profoundly influences patient experiences and outcomes. This comprehensive discussion emphasizes the importance of thorough pre...
The effective communication of bad news in neurology is a critical and delicate process that profoundly influences patient experiences and outcomes. This comprehensive discussion emphasizes the importance of thorough preparation, appropriate settings, trust-building, clear language, active listening, and provision of support. Recognizing the impact on psychological well-being, the process extends beyond information delivery to demonstrating empathy and commitment to holistic care. The evolution of communication training, now integral to medical education, is highlighted. The call for universal implementation underscores the need for ongoing training and development, emphasizing cultural sensitivity and interdisciplinary collaboration. Integrating bad news delivery programs into educational curricula is proposed, ensuring healthcare professionals are adept at navigating these conversations with empathy. Effective communication of bad news contributes to patient-centered care, fostering a compassionate healthcare environment that prioritizes patient' and families' well-being.
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