Myoclonus in Patients With Coronavirus Disease 2019: A Multicenter Case Series.

Objectives: To describe the risk factors for and outcomes after myoclonus in a cohort of patients with coronavirus disease 2019.

Design: Multicenter case series.

Setting: Three tertiary care hospitals in Massachusetts, Georgia, and Virginia.

Fixed and dilated pupils, not a contraindication for extracorporeal support: a case series.

Extracorporeal membrane oxygenation is considered a relative contraindication for patients with severe neurological injury manifested by fixed and dilated pupils. The inability to provide adequate cardiopulmonary support while attempting to treat the underlying neurologic disease results in a fatal outcome. The impairment of cerebral perfusion, compounded by the underlying neurologic condition, results in signs of brainstem dysfunction often equated with a fatal prognosis.

Intraosseous Administration of 23.4% NaCl for Treatment of Intracranial Hypertension.

Background/objective: Prompt treatment of acute intracranial hypertension is vital to preserving neurological function and frequently includes administration of 23.4% NaCl. However, 23.

Hypomagnesemia in Intracerebral Hemorrhage.

Background: Magnesium (Mg) is an essential element for the body's normal physiological functioning. It has a major role in modulating vascular smooth muscle tone and peripheral arterial resistance. A low serum Mg level on admission (HMg0) has been associated with more severe presentation in patients with subarachnoid hemorrhage.

Can the World Federation of Neurosurgical Societies Classification Accurately Predict Outcomes in Intracerebral Hemorrhage?

Background: Many scoring systems have been developed for the purpose of estimating of mortality and outcomes in intracerebral hemorrhage (ICH). However, the utility of the World Federation of Neurosurgical Society (WFNS) classification, which is routinely used in patients with subarachnoid hemorrhage, has never been specifically assessed in ICH.

Methods: A retrospective review of the records of consecutive ICH patients admitted over a 2-year period was carried out.

Plasmapheresis may be an option in urgent management of heparin-induced thrombocytopenia in the setting of acute intracerebral hemorrhage.

Background: We report a case of heparin-induced thrombocytopenia (HIT) that was complicated by acute intracerebral hemorrhage (ICH) and bilateral adrenal hemorrhage. In the setting of worsening thrombocytopenia, the risk of expansion of ICH and additional thrombotic events is concerning; hence, we employed plasmapheresis to reduce thrombotic risk.

Methods: We followed serial daily heparin antibody enzyme-linked immunosorbent assay (ELISA) optical density measurements as well as heparin-induced platelet aggregation (HIPA) assays on both pre- and post-pheresis samples in order to objectively determine when thrombotic risk was sufficiently decreased.

A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus.

Acute hypokalemic paralysis is characterized by muscle weakness or paralysis secondary to low serum potassium levels. Neurogenic diabetes insipidus (DI) is a condition where the patient excretes large volume of dilute urine due to low levels of antidiuretic hormone. Here, we describe a patient with neurogenic DI who developed hypokalemic paralysis without a prior history of periodic paralysis.

Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study.

Purpose: To examine patterns of use, efficacy, and safety of intravenous ketamine for the treatment of refractory status epilepticus (RSE).

Methods: Multicenter retrospective review of medical records and electroencephalography (EEG) reports in 10 academic medical centers in North America and Europe, including 58 subjects, representing 60 episodes of RSE that were identified between 1999 and 2012. Seven episodes occurred after anoxic brain injury.

Isolated central nervous system histoplasmosis presenting with ischemic pontine stroke and meningitis in an immune-competent patient.

Importance: Histoplasmosis, a systemic mycosis caused by the fungus Histoplasma capsulatum, primarily affects immune-suppressed patients and commonly involves the lung and rarely the central nervous system (CNS). Herein, we report a case of isolated CNS histoplasmosis presenting with pontine stroke and meningitis.

Observations: A 35-year-old, white, immune-competent man was transferred from an outside facility with worsening dysarthria and confusion after having presented 4 weeks prior with dysarthria, gait ataxia, and bilateral upper extremity weakness.

Advanced assessment of platelet function during adult donor care.

Abnormal platelet function may complicate the assessment and treatment of continuing blood loss, hypotension, and coagulation disorders during adult donor care. Antiplatelet drugs, such as aspirin, nonsteroidal anti-inflammatory drugs, clopidogrel (Plavix), ticlopidine (Ticlid), prasugrel (Effient), abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat) are commonly prescribed for older patients. These medications may be part of home therapy or may be given during acute cardiac or cerebrovascular crises that may lead to brain death and organ donation.

Cranial nerve palsies in renal osteodystrophy.

There is a wide differential diagnosis for patients presenting with multiple cranial nerve palsies, including infectious, inflammatory, malignant, genetic, toxic, and metabolic conditions. This report describes the clinical features, neuroimaging findings, and response to surgical treatment in a patient with bilateral deafness and recurrent episodes of bilateral facial nerve palsy that were caused by renal osteodystrophy. It is suggested that renal osteodystrophy be considered in the differential diagnosis of multiple cranial nerve palsies in the appropriate clinical setting.

Focal occipital seizures with cerebral polyopia.

Polyopia is the visual perception of multiple images of a single visual stimulus. Cerebral polyopia has previously been described as an ictal phenomenon associated with temporal lobe seizures. We report the case of a man with multiple cavernous angiomas and occipital lobe seizures manifesting as cerebral polyopia.

Ischemic stroke in the setting of tuberculous meningitis.

The clinical syndrome of tuberculous (TB) meningitis leading to ischemic strokes is rarely seen today in immunocompetent adults native to North America. This entity is also notoriously difficult to diagnose because the presenting symptoms are often nonspecific. The authors describe a case of a man with TB meningitis which progressed to recurrent ischemic cerebral infarcts.

Does malaria during pregnancy affect the newborn?

Objective: To investigate the effect of malarial infection during pregnancy on the newborn.

Methods: A retrospective cohort study was conducted at The Aga Khan University Hospital (AKUH), Karachi, using in-patient hospital records over an 11-year period from 1988 to 1999. The incidence of preterm delivery, low birth weight (LBW) and intrauterine growth retardation (IUGR) in 29 pregnant women with malaria, was compared with that in 66 selected pregnant women without malaria, who delivered at the AKUH during the same time period.