Case Report Hemorrhagic Longitudinally Extensive Transverse Myelitis

Longitudinally extensive transverse myelitis (LETM) may be associated with viral triggers, including both infections and vaccinations. We present a case of a healthy immunocompetent 33-year-old woman who developed a hemorrhagic LETM 2 weeks after seasonal influenza vaccination. Hemorrhagic LETM has not to our knowledge been reported after influenza vaccination. It may represent a forme fruste variant of acute hemorrhagic leukoencephalitis

Idiopathic Intracranial Hypertension (IIH) without Papilledema: Headache and Visual Aspects

IIH may occur with (IIHWP) or without papilledema (IIHWOP). While studies have reviewed headache and visual characteristics of IIHWP, the clinical characteristics of IIHWOP have not been directly compared to IIHWP

Rehabilitation of Homonymous Hemianopias: A Literature Review

Historically, visual field defects from geniculostriate lesions are believed to be irreversible, with little attention given to visual rehabilitation

Giant Arachnoid Granulations in IIH: Innocent Bystander or Pathologic Entity?

Prior studies have hypothesized that giant arachnoid granulations can cause venous obstruction and secondary intracranial hypertension. To evaluate the role of giant arachnoid granulations, the authors reviewed the pressure gradient across arachnoid granulations found on dural sinus manometry in patients diagnosed with idiopathic intracranial hypertension

Hemorrhagic Longitudinally Extensive Transverse Myelitis

Longitudinally extensive transverse myelitis (LETM) may be associated with viral triggers, including both infections and vaccinations. We present a case of a healthy immunocompetent 33-year-old woman who developed a hemorrhagic LETM 2 weeks after seasonal influenza vaccination. Hemorrhagic LETM has not to our knowledge been reported after influenza vaccination. It may represent a forme fruste variant of acute hemorrhagic leukoencephalitis

Coiled Internal Carotid Arteries Associated with Bilateral Sequential Strokes

The risk of stroke and management of coiling of the cervical internal carotid artery in the absence of an atherosclerotic carotid bulb lesion is unclear. We report a case of an otherwise healthy 39-year-old woman who developed bilateral sequential strokes associated with bilateral coiled internal carotid arteries. We discuss the risk of stroke and management of coiled carotid arteries as they relate to the patient presented

Past Cigarette Smoking Is More Common among Those with Cholinergic Than Noncholinergic Dementias

Background. Patients with progressive dementing disorders associated with cortical cholinergic dysfunction gradually develop cholinergic deficits many years before symptom onset and may begin to smoke cigarettes during midlife as a form of self-medication. The aim of this study was to compare self-reported past smoking rates between those with and without cholinergic dementias, to determine if those who developed cholinergic dementias were more likely to smoke during midlife than those who did not. Methods. Retrospective cross-sectional study of past smoking status among patients treated at an outpatient clinic during a three-year period. Results. A total of 440 patients were evaluated during the study period, including 224 with cholinergic dementias and 216 with noncholinergic dementias and controls. Past smoking rates were greater among those with cholinergic dementias compared to those without cholinergic dementias (43.92% versus 26.96%, P=0.012). Additionally, smokers with cholinergic dementias reported significantly greater mean pack-years of smoking (P=0.038). Conclusions. Greater midlife smoking rates and greater pack-years of smoking were associated with cholinergic dementias. These results suggest midlife smoking may be an early indicator for those developing brain cholinergic deficits related to progressive dementing disorders and support initiating treatment prior to symptom onset in cholinergic dementias

Diffuse Leukoencephalopathy and Subacute Parkinsonism as an Early Manifestation of Systemic Lupus Erythematosus

Parkinsonism in SLE is rare. Diffuse leukoencephalopathy is equally uncommon and is associated with a poor prognosis. We present a single case of a 50-year-old Filipino man who presented with a generalized discoid rash after starting lisinopril. The rash persisted despite discontinuation of lisinopril, and over the next three months, he developed rapidly progressive parkinsonism. Brain MRI showed symmetric confluent T2-hyperintensities involving the white matter and basal ganglia. Four of the 11 American College of Rheumatology criteria for the classification of SLE were met. A rheumatologist made a diagnosis of SLE with cutaneous and central nervous system involvement. Significant neurologic and radiologic improvement occurred following treatment with IV steroids followed by a prolonged taper. This report highlights a case of subacute parkinsonism with a diffuse leukoencephalopathy as an early manifestation of SLE which resulted in a good recovery following treatment with only immunosuppressive therapy

Regional cortical thinning associated with detectable levels of HIV DNA.

High levels of human immunodeficiency virus (HIV) DNA in peripheral blood mononuclear cells (PBMCs), and specifically within CD14+ blood monocytes, have been found in HIV-infected individuals with neurocognitive impairment and dementia. The failure of highly active antiretroviral therapy (HAART) to eliminate cognitive dysfunction in HIV may be secondary to persistence of HIV-infected PBMCs which cross the blood-brain barrier, leading to perivascular inflammation and neuronal injury. This study assessed brain cortical thickness relative to HIV DNA levels and identified, we believe for the first time, a neuroimaging correlate of detectable PBMC HIV DNA in subjects with undetectable HIV RNA. Cortical thickness was compared between age- and education-matched groups of older (>40 years) HIV-seropositive subjects on HAART who had detectable (N = 9) and undetectable (N = 10) PBMC HIV DNA. Statistical testing revealed highly significant (P < 0.001) cortical thinning associated with detectable HIV DNA. The largest regions affected were in bilateral insula, orbitofrontal and temporal cortices, right superior frontal cortex, and right caudal anterior cingulate. Cortical thinning correlated significantly with a measure of psychomotor speed. The areas of reduced cortical thickness are key nodes in cognitive and emotional processing networks and may be etiologically important in HIV-related neurological deficits