Acta Neurologica Taiwanica[JOURNAL]
Sun
200 papers
Neuromyelitis Optica Spectrum Disorders Mimicking Wernicke's Encephalopathy: A Difficult Differential Diagnosis.
Algahtani H, Shirah B, Alahmri F … +2 more , Abdelghaffar N, Alqahtani SA
Acta Neurol Taiwan · 2025 Jan · PMID 40396803 · Publisher ↗
Neuromyelitis optica spectrum disorders (NMOSD) encompass a spectrum of immunomediated diseases presenting with diverse syndromes. Conversely, Wernicke's encephalopathy denotes an acute neurological condition stemming fr...
Neuromyelitis optica spectrum disorders (NMOSD) encompass a spectrum of immunomediated diseases presenting with diverse syndromes. Conversely, Wernicke's encephalopathy denotes an acute neurological condition stemming from severe thiamine (Vitamin B1) deficiency. We report a unique case of NMOSD manifesting with clinical and radiological characteristics resembling Wernicke's encephalopathy, exhibiting unresponsiveness to thiamine therapy and subsequent clinical deterioration. Our report highlights an atypical and rare presentation of NMOSD, initially confounded by changes on magnetic resonance imaging attributed to thiamine deficiency, delaying appropriate management during the early hospitalization period. While brain abnormalities are frequently documented in NMOSD, the occurrence of vertigo as an inaugural symptom is seldom reported. The patient demonstrated recovery following aggressive therapeutic interventions, including pulse steroids, plasma exchange, and rituximab therapy. Our case underscores the importance of considering NMOSD in patients displaying clinical and radiological features reminiscent of Wernicke's encephalopathy, particularly when thiamine replacement fails to elicit a response. Clinicians must recognize this unusual presentation of NMOSD promptly and initiate aggressive therapeutic measures. Early diagnosis assumes critical significance to promptly commence aggressive immunomodulatory therapy.
Intramedullary Cavernoma with Hematomyelia and Unusual Clinical Findings of Brown-Sequard Syndrome: A Case Report.
Shah JM, Manohararaj N, Hoay KY
Acta Neurol Taiwan · 2025 Jan · PMID 40396802 · Publisher ↗
We aim to report an extremely rare case of a primary thoracic intramedullary cavernoma with Brown-Sequard syndrome (BSS), its transcranial magnetic stimulation (TMS)/somatosensory evoked potential (SSEP) neurophysiology...
We aim to report an extremely rare case of a primary thoracic intramedullary cavernoma with Brown-Sequard syndrome (BSS), its transcranial magnetic stimulation (TMS)/somatosensory evoked potential (SSEP) neurophysiology tests, and their localizing value. A 53-year-old Chinese male with a history of multiple arteriovenous malformations (AVMs) presented with an intermittent 3-year history of the left lower limb weakness with recent worsening and findings of dissociated sensory loss. Neurophysiological testing showed prolonged central motor conduction time to his left lower limb on TMS while tibial SSEP showed prolonged P37 latencies. Magnetic resonance imaging spine showed a T4-5 intramedullary expansile enhancing cord lesion, suggestive of a thoracic cavernoma, with surrounding acute hematomyelia and cord edema from C7 to T6. A spinal angiogram did not reveal any vascular malformation. He was conservatively treated for possible T4-5 cavernoma with hematomyelia. Repeat imaging showed complete resolution of edema with a T3-5 internal T2-weighted hyperintensity and residual susceptibility focus likely representing a cavernoma that had bled with no evidence of AVM. A repeat tibial SSEP still showed prolonged tibial SSEPs, but TMS was now normal. Primary thoracic intramedullary cavernomas may be a rare cause of BSS. TMS and SSEP may have a role in the diagnostic evaluation of BSS.
Guillain-Barre Syndrome-Like Polyneuropathy Induced by Immune Checkpoint Inhibitors: A Case Report.
Cheng BK, Ko CA, Kuo CL … +4 more , Nai TC, Lin W, Chou CH, Sung YF
Acta Neurol Taiwan · 2025 Jan · PMID 40396801 · Publisher ↗
Over the past decade, immune checkpoint inhibitors (ICIs) have emerged as a crucial therapeutic option for treating various malignancies. Nivolumab, an ICI, is a monoclonal antibody directed against programmed cell death...
Over the past decade, immune checkpoint inhibitors (ICIs) have emerged as a crucial therapeutic option for treating various malignancies. Nivolumab, an ICI, is a monoclonal antibody directed against programmed cell death protein 1. However, many studies indicate that ICIs can lead to various immune-related adverse events (irAEs), with neurological irAEs accounting for approximately 1%-5% of these cases. Neurological adverse events such as Guillain-Barre syndrome (GBS) are rare but life threatening. This report presents the case of a 72-year-old male diagnosed with sarcomatoid squamous cell carcinoma of the trachea, who was admitted with rapid-onset weakness of the upper limbs 7 days following the latest nivolumab treatment. These symptoms progressed quickly to quadriplegia and respiratory failure, requiring intubation and mechanical ventilation. Serum antiganglioside antibodies were positive for immunoglobulin (Ig) M-GM1, IgM-GD1b, and IgG-GM3. His clinical symptoms improved significantly after steroid and intravenous immunoglobulin treatment. This rare and atypical case highlights the complexity of ICI-related GBS. Early recognition of associated symptoms is crucial for timely and appropriate treatment.
Nasopharyngeal Carcinoma with Spinal Cord Metastasis and Secondary Syringomyelia: A Case Report.
Chan WC, Chen YC, Lin JC … +4 more , Liu CS, Wu SL, Tung CH, Yeh KT
Acta Neurol Taiwan · 2025 Jan · PMID 40396800 · Publisher ↗
Nasopharyngeal cancer with central nervous system metastases is rare. True metastasis to the distal regions of the central nervous system, especially the spinal cord, is incredibly uncommon, although tumor invasion to in...
Nasopharyngeal cancer with central nervous system metastases is rare. True metastasis to the distal regions of the central nervous system, especially the spinal cord, is incredibly uncommon, although tumor invasion to intracranial locations through the skull base can be prevalent. We report on a 45-year-old male who had been suffering from progressive unsteady gait and numbness of lower limbs for 3 weeks. The numbness eventually ascended to the thigh area and the patient required a wheelchair. His muscle power was normal. Magnetic resonance imaging showed multiple enhancing nodular lesions in the thoracolumbar spinal cord with mild mass effect, causing diffuse syringomyelia and cord edema. Metastasis was confirmed by pathology after tumor excision. The patient underwent concurrent radiotherapy and steroid therapy, after which he eventually could walk with crutches. Due to the complexity and rarity of such case, the standard treatment for this type of disease is unclear. Management should be individualized and multidisciplinary.
Cerebral Infarction with Cerebral Thrombosis in Crohn's Disease: A Case Report.
Reddy N, Vidal SM
Acta Neurol Taiwan · 2025 Jan · PMID 40396799 · Publisher ↗
We describe a case report of a young male with Crohn's disease who presented with cerebral infarction and cerebral thrombosis. The patient's Crohn's disease had been in remission for 7 years without any recurrent strokes...
We describe a case report of a young male with Crohn's disease who presented with cerebral infarction and cerebral thrombosis. The patient's Crohn's disease had been in remission for 7 years without any recurrent strokes during this period. Our case highlights the need to consider inflammatory bowel disease as a potential cause of stroke in young patients and underscores the importance of managing the condition to reduce recurrent stroke risk.
Focal Chronic Inflammatory Demyelinating Polyneuropathy - A Case Report with Clinical Application and Validation of 2021 European Academy of Neurology/Peripheral Nerve Society Criteria.
Hiew FL, Paan WLM
Acta Neurol Taiwan · 2025 Jan · PMID 40396798 · Publisher ↗
The updated 2021 criteria of the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) for chronic inflammatory demyelinating polyneuropathy (CIDP) has excellent diagnostic sensitivity and specificity for typi...
The updated 2021 criteria of the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) for chronic inflammatory demyelinating polyneuropathy (CIDP) has excellent diagnostic sensitivity and specificity for typical and variants of CIDP. For focal CIDP, applications of these criteria may be different due to limited peripheral nerve involvement. We illustrate using a rare case of focal CIDP on the applicability of 2021 EAN/PNS criteria and its practical limitations. A young woman presented with progressive right foot drop and numbness over 5 years. Clinically, she had areflexic right lower limb monoparesis with a sensory deficit over the dorsum of the right foot. A nerve conduction study showed normal right peroneal distal compound motor action potential but marked temporal dispersion with conduction block and significantly prolonged F-waves latency suggestive of demyelination. Right sural sensory nerve action potentials (SNAPs) were small in amplitude with the absence of right superficial peroneal SNAP. These findings suggested a focal sensorimotor acquired demyelinating neuropathy involving right lower limb nerves and fulfilled possible focal CIDP as per the 2021 EAN/PNS criteria. Cerebrospinal fluid (CSF) analysis revealed albuminocytological dissociation. Magnetic resonance imaging of the lumbosacral plexus was unremarkable. She received intravenous methylprednisolone, followed by oral prednisolone and mycophenolate mofetil. Clinically, right lower limb power is in parallel with functional scores. With an objective positive clinical response to treatment in addition to elevated CSF protein as supportive criteria, the diagnosis of possible focal CIDP was upgraded to focal CIDP. The inclusion of supportive criteria in the updated EAN/PNS diagnostic criteria improves diagnostic certainty in focal CIDP.
The Predictive Role of Neutrophil-to-LymPhocyte Ratio in Seizure Recurrence in Patients with Epilepsy.
Issı ES, Algın Dİ, Erdinç OO
Acta Neurol Taiwan · 2025 Jan · PMID 40396797 · Publisher ↗
BACKGROUND: The aim of this retrospective study was to investigate the importance of leukocyte, neutrophil, lymphocyte, and neutrophil/lymphocyte (NLR) ratios in epileptic seizure recurrence and whether there is a relati...
BACKGROUND: The aim of this retrospective study was to investigate the importance of leukocyte, neutrophil, lymphocyte, and neutrophil/lymphocyte (NLR) ratios in epileptic seizure recurrence and whether there is a relationship between them. OBJECTIVES: To evaluate the predictive value of leukocyte, neutrophil, lymphocyte, and monocyte parameters in assessing the likelihood of seizure recurrence in epilepsy patients. MATERIALS AND METHODS: Sixty-five epilepsy patients who were on follow-up for epilepsy were included in the study. The study group consisted of epilepsy patients who had routine complete blood counts taken within the first 24 hours of emergency room visits due to seizures and for control purposes at outpatient clinic visits. The parameters examined were leukocyte, neutrophil, lymphocyte, platelet counts (PLT) (×10³ mm³), mean platelet volume (MPV), and NLR. NLR was calculated by dividing the absolute number of neutrophils by the absolute number of lymphocytes. RESULTS: Leukocyte, neutrophil, NLR, and monocyte values (P < 0.001) were significantly higher in patients with seizure recurrence in the first 30 days compared to those without recurrence. The predictive value of leukocyte, neutrophil, NLR, and monocyte parameters for seizure recurrence was assessed using receiver operating characteristic (ROC) analysis. Since the area under the curve (AUC) value for NLR was larger than that of neutrophil and monocyte values, the diagnostic performance of NLR was found to be superior. For NLR, the AUC value was 0.73 (95% confidence interval: 0.639-0.807, P = 0.0001), with sensitivity and specificity of 52.31% and 94.23%, respectively. NLR had the highest predictive value for seizure recurrence. CONCLUSIONS: Our study suggests that neutrophil-mediated inflammation plays a role in epileptic seizures and that monocyte values are also important. NLR and monocyte values may serve as predictive biomarkers for seizure recurrence.
Personal Protective Equipment and Headaches: A Cross-sectional Study among Healthcare Professionals in A Military Hospital in Bangladesh.
Huq MR, Khan AM, Kawnayn G … +4 more , Khalil MM, Chowdhury MI, Anwar MB, Mahanta TR
Acta Neurol Taiwan · 2025 Jan · PMID 40396796 · Publisher ↗
BACKGROUND: During the COVID-19 pandemic, healthcare professionals took various protective measures including personal protective equipment (PPE) such as masks, eyewear, and protective jumpsuits. These protective devices...
BACKGROUND: During the COVID-19 pandemic, healthcare professionals took various protective measures including personal protective equipment (PPE) such as masks, eyewear, and protective jumpsuits. These protective devices may pose certain health hazards, such as headaches. OBJECTIVES: This study aims to find out the association between new-onset headaches (de novo) or exacerbation of preexisting headaches in military healthcare professionals using PPE. MATERIALS AND METHODS: A total of 209 healthcare professionals participated in this cross-sectional observational study. Data were collected on headaches before and after using PPE through a self-administered questionnaire. RESULTS: Most participants were young with a mean age of 26.7 ± 5.6 years. The number of male participants was almost twice that of females (64.6%). de novo headache occurred in 88 participants (47.6%). Previous primary headaches were present in 24 patients, of whom 83.3% experienced exacerbation of primary headaches after using PPE. Doctors and nurses suffered from headaches significantly more than the other healthcare workers (P < 0.001). N95 mask usage was significantly associated with headaches (P < 0.001). In addition, the combination of masks, specifically surgical and N95 combination, was also associated with headaches (P = 0.019 and P < 0.001, respectively). Use of eye protection, irrespective of type was found to be associated with headaches (P < 0.05). Additional PPE, such as the protective jumpsuits, was also associated with headaches (P < 0.001). Our study did not find any significant association between headaches and the duration of hours of usage of masks or protective eyewear (P > 0.05). CONCLUSIONS: Masks, eye protective gear, and additional protective gown use are associated with new-onset headaches or exacerbation of previous headaches. These protective devices should be redesigned not compromising safety and to increase comfort and compliance.
Gut Microbiota and Alzheimer Disease.
Huarcaya LRD
Acta Neurol Taiwan · 2025 Jan · PMID 40396795 · Publisher ↗
The hallmarks of Alzheimer's disease (AD) include brain dysfunction and the buildup of amyloid and tau proteins. The onset of dementia is one of the latter symptoms. Imaging diagnostics allowed for the detection of amylo...
The hallmarks of Alzheimer's disease (AD) include brain dysfunction and the buildup of amyloid and tau proteins. The onset of dementia is one of the latter symptoms. Imaging diagnostics allowed for the detection of amyloid buildup in the brain 10-20 years before the emergence of overt signs of the disease. The application of imaging diagnostic techniques allowed for this identification. Within the next few decades, the incidence and frequency of this disease are expected to reach epidemic proportions unless measures are done to stop or slow its growth. However, unless action is taken to slow or stop the disease's progression, it will continue to threaten the health of the general public. Recently, there has been some speculation that the gut flora might contribute to the development of AD. Not only that, but the rapidly expanding ischemia etiology is another possible contributor to the issue. Rumor has it that there's a network connecting the brain and the stomach called the "gut-brain-microbiota axis." The hypothesis is based on this network. Furthermore, a large amount of evidence implies that the gut microbiota (GMB) could potentially contribute to the onset of AD. It has been suggested that the GMB could play a role in the onset of AD. This notion has been bolstered by new studies. It is quite probable that this review will address the prospect of a link between the microbiome and AD. This concept could be explored as a potential therapy or preventative measure. Some techniques that show promise as new treatments for AD include changes to the GMB, which can be achieved through dietary changes or positive microflora interventions, and changes to microbiological partners and their products, like amyloid protein.
Ischemic Stroke Due to Septic Emboli in a 78-Year-Old Man With Portal Vein Thrombosis.
Tsai CP, Chen PH, Chang CP
Acta Neurol Taiwan · 2025 Apr · PMID 40392692 · Publisher ↗
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Cure the Incurable: Update of Treatment in Inherited Neuromuscular Disorders.
Yu CH, Lai KL
Acta Neurol Taiwan · 2024 Dec · PMID 39743757
Originally thought to be incurable, huge therapeutic progress has been made in recent years in the field of inherited neuromuscular disorders. Approaches aiming to rescue the underlying pathophysiology, i.e. loss-of-func...
Originally thought to be incurable, huge therapeutic progress has been made in recent years in the field of inherited neuromuscular disorders. Approaches aiming to rescue the underlying pathophysiology, i.e. loss-of-function or gain-of-function mutations, have been developed via end-product replacement or gene delivery/modulation, with promising results. In the review, advanced treatment in some of the inherited neuromuscular disorders will be discussed. On the other hand, it has been found more than 1000 genes are responsible for the clinical diversities in this group of diseases, and finding a way which owns the therapeutic potential to various diseases is the optimal goal. The discovery of CRISPR-Cas9 system in the last decade offers such an opportunity and is under rigorous investigation. This important issue will also be discussed. Keywords: CRISPR-Cas9, gene therapy, gene delivery/modulation, inherited neuromuscular disorders, therapeutic advances.
Lafora Disease Presenting with Ataxia and DM1: A Case Study.
Khanalizadeh R, Karimi K
Acta Neurol Taiwan · 2024 Dec · PMID 39743739
Here we presented a rare case of Lafora disease with neuropathy, ataxia and progression of symptoms into type one DM, GTCS and myoclonus during years. We believe that it is important to keep the diagnosis of Lafora disea...
Here we presented a rare case of Lafora disease with neuropathy, ataxia and progression of symptoms into type one DM, GTCS and myoclonus during years. We believe that it is important to keep the diagnosis of Lafora disease in mind in every child presenting with myoclonus especially when mental and cerebellar deficits develop as well. Keywords: Drug-resistant seizure, Ataxia, Myoclonic jerky movements, Lafora.
Recent Advance in Disease Modifying Therapies for Spinal Muscular Atrophy.
Tsai LK, Ting CH, Liu YT … +3 more , Hsiao CT, Weng WC, Society for Neurological Rare Disorders-Taiwan
Acta Neurol Taiwan · 2024 Sep · PMID 39363429
Spinal muscular atrophy (SMA) is an autosomal recessive motor neuron disease characterized by progressive weakness and atrophy of skeletal muscles. With homozygous survival motor neuron 1 (SMN1) gene mutation, all SMA pa...
Spinal muscular atrophy (SMA) is an autosomal recessive motor neuron disease characterized by progressive weakness and atrophy of skeletal muscles. With homozygous survival motor neuron 1 (SMN1) gene mutation, all SMA patients have at least one copy of the SMN2 gene, which provides an opportunity for drug targeting to enhance SMN expression. Current three disease modifying drugs, including nusinersen, onasemnogene abeparvovec, and risdiplam, have demonstrated impressive effectiveness in SMA treatment. Nusinersen is an antisense oligonucleotide targeting SMN2 pre-messenger RNA (mRNA) to modify alternative splicing and is effective in SMA children and adults, administrating via intermittent intrathecal injection. Onasemnogene abeparvovec is an adeno-associated viral vector carrying human SMN1 gene, featuring intravenous injection once in a lifetime for SMA patients less than 2 years of the age. Risdiplam is a small molecule also targeting SMN2 pre-mRNA and is effective in SMA children and adults with administration via oral intake once per day. Patients with SMA should receive these disease modifying therapies as soon as possible to not only stabilize disease progression, but potentially obtain neurological improvement. The development in these therapies has benefited patients with SMA and will potentially provide insight in future drug discovery for other neurodegenerative diseases. Keywords: Adeno-associated viral vector, antisense oligonucleotide, disease modifying therapy, gene therapy, motor neuron disease, spinal muscular atrophy.
Application of Perfusion Imaging in the Telehealth Setting for Acute Ischemic Stroke.
Valente M, Phan T, Parsons M … +1 more , Ma H
Acta Neurol Taiwan · 2024 Jun · PMID 39363420
In the remote telehealth setting, computed tomography perfusion (CTP) provides important information in assessing the suitability of reperfusion therapy for patients with stroke syndromes. This review will discuss key co...
In the remote telehealth setting, computed tomography perfusion (CTP) provides important information in assessing the suitability of reperfusion therapy for patients with stroke syndromes. This review will discuss key concepts surrounding the use of CTP, including basic science, clinical applications, pitfalls, recent trials, and technical considerations. CTP can enhance decision‑making for patients who are in the extended window from stroke onset, and this review will address key concepts relevant to its use.
Guillain-Barré Syndrome as a paraneoplastic neurological disease of pulmonary adenocarcinoma and squamous cell carcinoma: A case report.
Lin ZH, Hoe ZY
Acta Neurol Taiwan · 2024 Dec · PMID 38073172
We present the case of a 69-year-old male who presented with profound weakness in the extremities. Remarkably, he lacked any identifiable precipitating factors preceding the onset of his illness. However, a diagnosis of...
We present the case of a 69-year-old male who presented with profound weakness in the extremities. Remarkably, he lacked any identifiable precipitating factors preceding the onset of his illness. However, a diagnosis of Guillain-Barré syndrome (GBS) was established based on typical clinical symptoms, cerebrospinal fluid analysis, and neurological examination. During his hospitalization, an incidental discovery of lung cancer was made. Subsequent pathology confirmed adenocarcinoma and squamous cell carcinoma in the lungs. This case report serves to underscore the exceptional rarity of the simultaneous occurrence of lung cancer and GBS, renewing interest in investigating GBS as a potential paraneoplastic neurological syndrome. Keywords: Guillain-Barré syndrome, paraneoplastic neurological disease, pulmonary adenocarcinoma, squamous cell carcinoma.
Assessing the quantity of neuropeptide Y in the serum of patients referred to Baqiyatallah Hospital with covid-19 concerning inflammatory factors following steroid therapy.
Mousavi N, Shankayi Z, Bahrami F … +4 more , Mohammadzadeh T, Alishiri GH, Rezaei MA, Saberi M
Acta Neurol Taiwan · 2024 Dec · PMID 38073167
PURPOSE: With the extensive presence of Covid-19, it is imperative to find compounds that can obstruct the virus's inflammatory activity and perhaps even stop the inflammatory phase from occurring. Several neuropeptides...
PURPOSE: With the extensive presence of Covid-19, it is imperative to find compounds that can obstruct the virus's inflammatory activity and perhaps even stop the inflammatory phase from occurring. Several neuropeptides act as immune system regulators, which nerve terminals release as co-transmitters. It has been suggested that Neuropeptide Y (NPY) may be involved in inflammatory diseases through its ability to regulate the function of inflammatory cells. Consequently, the present study was designed to examine the changes in this neuropeptide in the serum of patients with Covid-19 disease, particularly following anti-inflammatory treatment, and its relationship with other inflammatory factors such as TNF-α. METHODS: The demographic information, vital and clinical signs (blood oxygen saturation level, blood pressure, heart rate, and body temperature), laboratory factors such as blood factors, inflammation, and blood electrolytes, as well as the use of steroids, were collected before and after steroid treatment the patient files. As part of the study, serum samples from patients were used to measure levels of NPY and TNF-α inflammatory factors using an ELISA kit. Additionally, the correlation between NPY values, other inflammatory factors, and other variables was examined before and after treatment. RESULTS: NPY, TNF-α, c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels were significantly reduced after steroid treatment. But the blood urea nitrogen (BUN) factor level increased after treatment compared to the initial evaluation. Lymphocytes and neutrophils also changed after drug treatment. Results indicated a high correlation between NPY and TNF-α. In addition to TNF-α, NPY, creatinine, and BUN presented a direct and significant relationship. ESR and BUN factors showed a positive and significant correlation regarding the length of hospitalization. However, the correlation between NPY and TNF-α with hospitalization length was insignificant. CONCLUSION: Since the current study had a significant association between NPY and TNF-α, the regulating function of this peptide in Covid-19 inflammatory processes may be validated. Enough that it is crucial to consider NPY as a marker and its antagonist as a potential Covid-19 therapy. Also, the considerable reduction in NPY levels after steroid therapy to lower inflammatory variables supports the regulatory function of this peptide in inflammatory processes.
Cerebral Venous Thrombosis Presenting as Simultaneous Intracerebral Hemorrhage.
Jiménez-Ruiz A, Aguilar-Fuentes V, Benavides-Gómez F … +1 more , Ruiz-Sandoval JL
Acta Neurol Taiwan · 2024 Dec · PMID 38073163
A 37-year-old pregnant woman presented to the emergency department with central facial palsy, ipsilateral right hemiparesis, and seizures. Brain Computed Tomogram (CT) showed intracerebral hemorrhage (ICH) and bilateral...
A 37-year-old pregnant woman presented to the emergency department with central facial palsy, ipsilateral right hemiparesis, and seizures. Brain Computed Tomogram (CT) showed intracerebral hemorrhage (ICH) and bilateral frontal edema. Magnetic resonance imaging (MRI) revealed multifocal hemorrhages consistent with a diagnosis of multiple simultaneous ICH (MSICH) (Figure 1). We suspected cerebral venous thrombosis (CVT) and performed a MR angiogram confirming this diagnosis (Figure 2). Upon admission, the patient was treated with low-molecular-weight heparin and transitioned to direct oral anticoagulation at discharge. Non traumatic MSICH is a rare imaging finding with high mortality, usually arterial in origin (1). However, since treatment options vary, cerebral venous thrombosis should always be considered in the differential diagnosis, especially in young female patients with known risk factors, such as pregnancy and puerperium (2-4). MRI modalities (Echo-GRE) are valuable tools in identifying ICH when CT is inconclusive (5).
Tumefactive Demyelination Lesions: Report on three cases.
Lin CJ, Lin SC, Yu KW … +3 more , Ou Yang WY, Lee YC, Liao YC
Acta Neurol Taiwan · 2024 Dec · PMID 38073158
PURPOSE: Tumefactive demyelination (TD) lesion and its subtype Balo's concentric sclerosis (BCS), are rare manifestations of central nervous system demyelinating disease. Because of its rarity, physicians might hesitate...
PURPOSE: Tumefactive demyelination (TD) lesion and its subtype Balo's concentric sclerosis (BCS), are rare manifestations of central nervous system demyelinating disease. Because of its rarity, physicians might hesitate in reaching a diagnosis or initiating steroid pulse therapy. This study aims at pinpointing the key neuroimaging features to distinguish TD lesions from surgical conditions, and illustrating the clinical outcomes of patients with TD lesions. CASE REPORT: Two of the three patients had solitary TD lesions, one 47-year-old man presenting with newly onset seizure and another 54-year-old women suffering from progressive hemiparesis. The male patient underwent craniotomy for mass excision without further steroid therapy, while the female patient received methylprednisolone pulse therapy only. Both patients remained free of clinical and radiological relapses over the past 6-7 years, leading to the diagnosis of clinically isolated syndrome. The third case is a 30-year-old woman with subacute onset of dysarthria and hemiparesis. She had two BCS lesions along with other demyelinating lesions in the juxtacortical and periventricular regions, cerebellar peduncles, and spinal cord, fulfilling dissemination in time and space. Her neurological deficits resolved after pulse therapy, and she received long-term disease modifying therapy for multiple sclerosis. CONCLUSION: This study underscores the diverse neuroimaging and clinical presentations of patients with TD lesions, and emphasizes the importance of clinical vigilance regarding this rare condition.
Taste Disorder and Tongue Numbness After Lithium Overdose.
Chu SY, Wang HC, Hsieh MH … +1 more , Chang CC
Acta Neurol Taiwan · 2024 Dec · PMID 38030229
PURPOSE: Drug-induced taste disturbances are prevalent in clinical practice, with dysgeusia being a frequent manifestation. This study aims to present a case of taste disorders and tongue numbness induced by a lithium ov...
PURPOSE: Drug-induced taste disturbances are prevalent in clinical practice, with dysgeusia being a frequent manifestation. This study aims to present a case of taste disorders and tongue numbness induced by a lithium overdose. CASE REPORT: A 33-year-old woman with bipolar II disorder attempted suicide by ingesting multiple drugs, including lithium and benzodiazepines. She exhibited weakness but was conscious after admission. Laboratory analyses indicated elevated serum lithium and urine benzodiazepine levels. Admitted to a psychiatric ward, her symptoms included diarrhea, poor appetite, and postprandial nausea. Two weeks later, she reported altered taste sensations and tongue numbness following the overdose. Her ongoing medication included venlafaxine, valproate sodium, and clozapine. Symptoms improved over time without specific treatment, aligning with increased appetite and weight gain. CONCLUSION: Drug-induced taste disturbances have a substantial impact on patients' quality of life and medication adherence. This case brings attention to taste disorders induced by lithium and suggests potential mechanisms that could contribute to taste alterations. It underscores the importance of conducting thorough assessments in patients experiencing gustatory symptoms, particularly during the ongoing pandemic.
Challenges in The Diagnosis of Ischemic stroke, Tuberculous Meningitis, and Co-Infection with HIV in a Socially Isolated Elderly Patient.
Huang HK, Chuang CS
Acta Neurol Taiwan · 2024 Dec · PMID 38030228
BACKGROUND: Ischemic stroke has been a common cause of death and disability in Taiwan, particularly among the elderly. Social isolation is a significant issue in an aging society, which can be associated with delayed med...
BACKGROUND: Ischemic stroke has been a common cause of death and disability in Taiwan, particularly among the elderly. Social isolation is a significant issue in an aging society, which can be associated with delayed medical care and difficulties in diagnosis. CASE: A 76-year-old man presented with altered mental status, left-sided weakness, and declining cognitive function over three months. He had limited social connections and an unknown medical history. Initial brain imaging showed communicating hydrocephalus. Cerebrospinal fluid analysis revealed increased lymphocytes and high protein levels. Further imaging revealed multiple hyperintense lesions in the brain's white matter and acute ischemic stroke in specific areas. The patient was diagnosed with tuberculosis and HIV coinfection, leading to probable tuberculous meningitis, HIV encephalopathy, and pneumocystis jirovecii pneumonia. Treatment with antituberculous agents, antibiotics, and steroids improved the patient's level of consciousness. CONCLUSION: Addressing social isolation and altered consciousness in elderly individuals requires a thoughtful approach. Reconsidering the differential diagnosis is crucial when it doesn't match the clinical severity. Clinicians should consider rare co-occurrences like ischemic stroke, TBM, and HIV infection in atypical TBM cases. A biopsychosocial perspective helps gather a comprehensive medical history for holistic care. Early diagnosis and timely intervention are vital for better outcomes in severe infections.
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