Case Reports in Neurology 

About: Case Reports in Neurology is an academic journal published by Karger Publishers. The journal publishes majorly in the area(s): Medicine & Stroke. It has an ISSN identifier of 1662-680X. It is also open access. Over the lifetime, 767 publications have been published receiving 4638 citations.

Intra-Arterial Mechanical Thrombectomy: An Effective Treatment for Ischemic Stroke Caused by Endocarditis

Abstract: Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis Mechanical thrombectomy is most likely a more effective and safer treatment than intravenous thrombolysis in this patient group

Stem Cells in the Treatment of Refractory Chronic Migraines.

Abstract: Background: Autologous adipose-derived stromal vascular fraction (SVF), which is rich in mesenchymal stromal cells, has been reported to be effective for the treatment of trigeminal neuropathic pain and chronic migraine and tension-type headaches. It is possible that stem cell activity targets neurogenic inflammation, which is a well-documented aspect of migraine pathogenesis. Methods: Adult patients with severe migraine-related disability as measured by the Migraine Disability Assessment (MIDAS) score who failed botulinum toxin injections and at least 3 prophylactic drugs were included in this study. The primary outcome measure was the change in MIDAS score 3 months after treatment. Standard liposuction was performed to obtain adipose tissue, from which SVF was isolated by centrifugation. A sample of each patient’s SVF was tested for the number of nucleated cells and their viability. Between 8 and 10 mL of SVF with 2.5–8.6 million viable cells were injected into the pericranial, neck, and trapezius muscles. Results: One man and 8 women were enrolled in the study. The mean age was 48 years, the mean duration of headaches was 16 years, the mean number of prophylactic drugs tried was 10, and the mean MIDAS score at baseline was 122. Three months after the procedure the mean MIDAS score was 88. Seven out of 9 patients had a decrease in their MIDAS score, but only 2 had meaningful improvement. Conclusion: The use of autologous adipose-derived SVF may be effective in the treatment of chronic refractory migraines. It is possible that the use of allogenic stem cells could offer a more practical and more effective approach.

Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series

Abstract: COVID-19 has been associated with a hypercoagulable state causing cardiovascular and neurovascular complications. To further characterize cerebrovascular disease (CVD) in COVID-19, we review the current literature of published cases and additionally report the clinical presentation, laboratory and diagnostic testing results of 12 cases with COVID-19 infection and concurrent CVD from two academic medical centers in Houston, TX, USA, between March 1 and May 10, 2020. To date, there are 12 case studies reporting 47 cases of CVD in COVID-19. However, only 4 small case series have described the clinical and laboratory findings in patients with COVID-19 and concurrent stroke. Viral neurotropism, endothelial dysfunction, coagulopathy and inflammation are plausible proposed mechanisms of CVD in COVID-19 patients. In our case series of 12 patients, 10 patients had an ischemic stroke, of which 1 suffered hemorrhagic transformation and two had intracerebral hemorrhage. Etiology was determined to be embolic without a clear cause identified in 6 ischemic stroke patients, while the remaining had an identifiable source of stroke. The majority of the patients had elevated inflammatory markers such as D-dimer and interleukin-6. In patients with embolic stroke of unclear etiology, COVID-19 may have played a direct or indirect role in the processes that eventually led to the strokes while in the remaining cases, it is unclear if infection contributed partially or was an incidental finding.

Lambert-Eaton Myasthenic Syndrome Caused by Nivolumab in a Patient with Squamous Cell Lung Cancer.

Abstract: Lambert-Eaton myasthenic syndrome (LEMS) is a representative paraneoplastic neurological syndrome. Recently, nivolumab, an anti-programmed cell death 1 inhibitor, has been approved for advanced non-small-cell lung cancer. Careful attention should be paid to immune-related adverse events (irAEs), including neurotoxicity. We herein report a 73-year-old woman with LEMS that occurred during nivolumab treatment for pulmonary squamous cell carcinoma. After the 20th week of nivolumab, she experienced various neurological symptoms such as ptosis, lower limb weakness, and photophobia. Findings from a nerve conduction study and a positive anti-P/Q-type voltage-gated calcium channel antibody made a diagnosis of LEMS. Pyridostigmine and 3,4-diaminopyridine temporarily improved her symptoms. This was the first case of LEMS as a neurological irAE. LEMS should be considered as a possible neurological irAE.

Herpes Simplex Encephalitis with Two False-Negative Cerebrospinal Fluid PCR Tests and Review of Negative PCR Results in the Clinical Setting

Abstract: Introduction: Herpes simplex virus encephalitis (HSE) is an acute infection accompanied by significant morbidity and mortality with the diagnosis often made by cerebrospinal fluid (CSF) polymerase chain reaction (PCR) testing. Case Presentation: We report a case of a healthy 35-year-old woman presenting with altered mental status. Due to suspicion of herpes encephalitis, a CSF PCR for herpes virus was sent for examination and acyclovir was started. The patient had an immediate response to acyclovir; however, when the PCR returned negative she was discharged without therapy. The altered mental status returned and she was started on acyclovir therapy and a second CSF PCR sample was sent and was again negative. MRI performed at initial hospitalization was negative, but a repeat MRI demonstrated bilateral temporal lobe involvement suggestive of herpes encephalitis. The patient was successfully treated for 21 days with acyclovir. Conclusion: CSF PCR for herpes virus is highly sensitive and specific and remains the standard for diagnosing herpes encephalitis. Clinicians should be aware of the pitfalls of CSF PCR testing, specifically false-negative results. Although rare, these false negatives can result in premature termination of treatment.