A 44-year old female presented with locally advanced breast cancer that had been treated with neoadjuvant chemotherapy followed by modified radical mastectomy and thereafter three cycles of paclitaxel. She presented with severe refractory headache that was unresponsive to oral analgesics including morphine. Both CT and MRI scans with contrast were normal, however her cerebrospinal fluid was positive for malignant cells. The patient's headache responded to whole brain radiotherapy.
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J Neuroimmunol
December 2024
Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, United States of America; Brain and Spine Center, Primary Children's Hospital, Intermountain Healthcare, United States of America.
Refractory seizures are common in pediatric neurology; consideration of whether seizures are acutely symptomatic of an underlying disease process is critical. In this case, a previously healthy 7-year-old patient presented with intractable focal seizures in the setting of a viral prodrome and headache. This case highlights a comprehensive work up of new-onset refractory seizures in a patient with features of encephalitis and describes a diagnostic quandary that ultimately led to a rare unifying diagnosis.
View Article and Find Full Text PDFFront Neurol
December 2024
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Background/objective: Preventive medications are crucial in migraine prevention. In cases of refractory migraine headaches, multiple medications may be required. We seek to identify a comprehensive list of preventive migraine headache medications that can be used as two, three, and four drug combinations without drug-drug interactions.
View Article and Find Full Text PDFJ Neurosurg Case Lessons
December 2024
Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California.
Background: Glossopharyngeal neuralgia (GPN) is a rare condition typically manifesting as paroxysms of sharp, lancinating pain localized to the middle ear and auditory canal, base of the tongue, tonsillar fossa, and region just inferior to the angle of the mandible. Vascular compression is a common etiology, and microvascular decompression (MVD) has been established as a safe and efficacious treatment in adults. With the exception of one report of an adult patient undergoing the procedure for symptomatology that began in adolescence, there are no published cases of MVD for GPN in pediatric patients to the author's knowledge.
View Article and Find Full Text PDFmedRxiv
December 2024
Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA.
Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).
Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024).
Crohns Colitis 360
October 2024
Division of Gastroenterology, University of Washington, Seattle, WA, USA.
Background: Medically refractory Crohn's disease (CD) is associated with a high risk of complications. Mycophenolate mofetil (MMF), a small molecule immunosuppressant, has limited data in patients with CD, and objective endoscopic response to MMF has not been reported.
Aims: We evaluated the safety and clinical, endoscopic, and biochemical effectiveness of off-label MMF for refractory CD as monotherapy or in combination with a biologic in patients with CD.
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