Temporal Arteritis Presenting as an Isolated Bilateral Abducens Nerve Palsy: A Rare Case of a 65-Year-Old Male

Giant cell arteritis (GCA) or temporal arteritis (TA) is a granulomatous inflammation of medium to large-sized arteries. It may have a diverse presentation. The most common presenting symptoms of GCA are fever, malaise, unilateral headache, jaw claudication, polymyalgia rheumatica (PMR) and ophthalmoplegia. Most severe sequelae of GCA could be blindness. We report a case of a 65-year-old Caucasian male who presented for the third time with recurrent episodes of diplopia. Neurologic exam showed bilateral cranial nerve (CN) VI palsy, slightly worse on the right than the left side. Other focal neurological deficits were absent. GCA was considered and biopsy of the temporal artery was performed which showed necrotizing pan-arteritis, consistent with GCA. The patient was empirically treated with intravenous (IV) methylprednisolone while awaiting the biopsy results which resulted in the resolution of the symptoms. As far as we know, this is the second case in the literature about the bilateral sixth CN involvement in the background of GCA

Pineal Gland Tumor but not Pinealoma: A Case Report

The pineal gland is a small pinecone-shaped and functionally endocrine structure located in the epithalamus region. Developmentally, the pineal gland is considered as a part of the epithalamus. It plays a role in the entrainment of the circadian rhythms of an organism by producing melatonin, a functionally important hormone. Lesions of the pineal region are rare compared to other parts of the brain. A lesion may be tumorous or non-tumorous in nature. The most common lesions are tumors that are pineal parenchymal tumors (PPT) in origin. Gliomas are the second most common tumors in the pineal region. We report a case of a high-grade oligodendroglioma, not commonly seen in the pineal region, in a 45-year-old male. The patient was suspected to have a mass in the pineal region on a computed tomography (CT) scan and histology confirmed the diagnosis of oligodendroglioma. This is a unique case because only five such cases have been reported so far

Burden of Arrhythmias in Epilepsy Patients: A Nationwide Inpatient Analysis of 1.4 Million Hospitalizations in the United States

Arrhythmias have been one of the common complications in epilepsy patients and have also been the reason for death. However, limited data exist about the burden and outcomes of arrhythmias by subtypes in epilepsy. Our study aims at evaluating the burden and differences in outcomes of various subtypes of arrhythmias in epilepsy patient population. The Nationwide Inpatient Sample (NIS) database from 2014 was examined for epilepsy and arrhythmias related discharges using appropriate International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) codes. The frequency of arrhythmias, gender differences in arrhythmia by subtypes, in-hospital outcomes and mortality predictors was analyzed. A total of 1,424,320 weighted epilepsy patients was determined and included in this study. Around 23.9% (n = 277,230) patients had cardiac arrhythmias. The most frequent arrhythmias in the descending frequency were: atrial fibrillation (AFib) 9.7%, other unspecified causes 7.3%, sudden cardiac arrest (SCA) 1.4%, bundle branch block (BBB) 1.2%, ventricular tachycardia (VT) 1%. Males were more predisposed to cardiac arrhythmias compared to females (OR [odds ratio]: 1.1, p \u3c 0.001). The prevalence of most subtypes arrhythmias was higher in males. Arrhythmias were present in nearly a quarter of patients with epilepsy. Life threatening arrhythmias were more common in male patients. The length of stay (LOS) and mortality were significantly higher in epilepsy patients with arrhythmia. It is imperative to develop early diagnosis and prompt therapeutic measures to reduce this burden and poor outcomes due to concomitant arrhythmias in epilepsy patients

Impact of Cocaine Use on Acute Ischemic Stroke Patients: Insights from Nationwide Inpatient Sample in the United States

Cocaine is the third most common substance of abuse after cannabis and alcohol. The use of cocaine as an illicit substance is implicated as a causative factor for multisystem derangements ranging from an acute crisis to chronic complications. Vasospasm is the proposed mechanism behind adverse events resulting from cocaine abuse, acute ischemic strokes (AIS) being one of the few. Our study looked into in-hospital outcomes owing to cocaine use in the large population based study of AIS patients. Using the national inpatient sample (NIS) database from 2014 of United States of America, we identified AIS patients with cocaine use using International Classification of Disease, Ninth Revision (ICD-9) codes. We compared demographics, mortality, in-hospital outcomes and comorbidities between AIS with cocaine use cohort versus AIS without cocaine use cohort. Acute ischemic strokes (AIS) with cocaine group consisted of higher number of older patients (\u3e 85 years) (25.6% versus 18.7%, p \u3c 0.001) and females (52.4% versus 51.0%, p \u3c 0.001). Cocaine cohort had higher incidence of valvular disorders (13.2% versus 9.7%, p \u3c 0.001), venous thromboembolism (3.5% versus 2.6%, p \u3c 0.03), vasculitis (0.9% versus 0.4%, p \u3c 0.003), sudden cardiac death (0.4% versus 0.2%, p \u3c 0.02), epilepsy (10.1% versus 7.4%, p \u3c 0.001) and major depression (13.2% versus 10.7%, p \u3c 0.007). The multivariate logistic regression analysis found cocaine use to be the major risk factor for hospitalization in AIS cohort. In-hospital mortality (odds ratio (OR)= 1.4, 95% confidence interval= 1.1-1.9, p \u3c 0.003) and the disposition to short-term hospitals (odds ratio (OR)= 2.6, 95% confidence interval = 2.1-3.3, p \u3c 0.001) were also higher in cocaine cohort. Venous thromboembolism was observed to be linked with cocaine use (OR= 1.5, 95% confidence interval= 1.0-2.1, p \u3c 0.01) but less severely than vasculitis (OR= 3.0, 95% confidence interval= 1.6-5.8, p \u3c 0.001). Further prospective research is warranted in this direction to improve the outcomes for AIS and lessen the financial burden on the healthcare system of the United States

Thirty-day readmissions in multiple sclerosis: An age and gender-based US national retrospective analysis

•The 30-day readmission rate (30-DRR) in multiple sclerosis was observed at 10.2%.•The higher 30-DR was observed in age >40 patients due to burden of comorbidities.•Readmission cost and LOS were higher which is concerning for economic burden.•The readmission causes were MS exacerbations, sepsis, and respiratory complications.•Multiple comorbidities, IVIG and PLEX were associated with higher readmission rate. Hospital readmission rate is an important indicator of the quality of care, healthcare economic burden, and post-discharge care. Multiple sclerosis (MS) is a potentially progressive neurological disease predominantly affecting young women. The natural history of the disease involves intermittent relapses and/or accrued baseline disability overtime especially in older patients contributing to frequent hospitalizations. The readmission metrics for patients with MS have not been studied. To estimate nationwide 30-day readmission (30-DR) rate among patients hospitalized with MS and to study the predictors of readmission based on age and gender. This was a retrospective observational cohort study of patients hospitalized with primary discharge diagnosis of MS using 2013 Nationwide Readmission Database (NRD). The cases were identified by ICD 9-CM code (340) linked to MS diagnosis. We used patient unique identifiers 'NRD visit link' to identify MS index hospitalizations and readmissions. Age (40 years) and gender-based analyses were performed using multivariable logistic regression adjusting co-variables to identify the patient/system-specific factors associated with 30-DR. The overall 30-day readmission rate (30-DRR) was 10.2%. No gender difference was seen in the readmission rates (men 10.7% vs. women 10.1%, p = 0.56); higher readmission rates were observed in older patients (11.2% vs. 8.8%; p = 0.0055). However, readmission cost was higher in younger age group (≈ $12,586 vs. ≈$ 11,827; p = 0.62) and among women (≈$12,217 vs. ≈$ 11,746; p = 0.75). The common causes of 30-DR were MS exacerbation (42.5%), sepsis (13.7%) and respiratory complications (7.3%). The predictors of higher 30-DRR in younger patients were diabetes (OR 1.87, p = 0.02), intravenous immunoglobulin (IVIG) use (OR 3.64, p = 0.016), and discharge to a nursing facility (OR 1.66, p = 0.03), whereas in older age group, higher Charlson-Deyo Comorbidity Index (CCI) (OR 1.15, p = 0.0057), and plasma exchange (PLEX) (OR 2.38, p = 0.03) were predictive of higher readmission rate. The longer length of stay (LOS) during index admission (OR 1.81, p = 0.03) in men and higher CCI (OR 1.15, p = 0.007) and intravenous immunoglobulin (IVIG) use (OR 2.27, p = 0.04) in women increased the odds of readmission. The overall 30-day readmission rate among patients following hospitalization for MS was 10.2%. The readmission rate was higher in older (>40 years) patients. The common causes of readmission were MS exacerbation, respiratory complications, and sepsis. A higher systemic disease burden, longer length of stay, and treatment with IVIG and PLEX were associated with higher risk of readmission. The readmissions were associated with higher cost of care and longer LOS compared to index admissions highlighting the economic impact of readmissions. Future strategies to lower the risk of readmissions in patients with MS should focus on optimal management of medical co-morbidities and infections

Stroke in young cannabis users (18–49 years): National trends in hospitalizations and outcomes

Background: Recent legalization of therapeutic and recreational cannabis use makes it imperative to have an insight into odds and trends in young-onset stroke-related hospitalizations among cannabis users (18–49 years). Methods: The National Inpatient Sample dataset (2007–2014) was utilized to assess national trends, odds of young-onset stroke-related hospitalizations, and outcomes among cannabis users vs. nonusers using provided discharge weights, strata, and cluster design. The rates are described per 100,000 hospitalizations among cannabis users and non-users. Results: A total of 3,307,310 hospitalizations were identified among young adults with current or previous cannabis use. Of these, 34,857 (1.1%) were related to young-onset stroke. A relative increase of 13.92% (553 in 2007 to 630 in 2014; p trend < 0.001) in young-onset stroke admissions was reported among cannabis users. The odds of any stroke (OR 1.16, 95% CI 1.14–1.19, p < 0.001) and acute ischemic stroke (OR 1.41, 95% CI 1.31–1.51, p < 0.001) hospitalizations were considerably higher among cannabis users as compared to nonusers. In-hospital mortality rates were increasing (3.7% to 4.3%) among cannabis users whereas decreasing (7.7% to 5.9%) in nonusers from 2007 to 2014 (p trend < 0.001). The mean length of stay and the hospitalization charges showed increasing trends in cannabis-related young-onset stroke admissions. There was an increasing trend in young-onset stroke admissions among male cannabis users (578 to 701; p trend < 0.001) but not among females (516 to 457; p trend = 0.14). The maximum rise in the young-onset stroke-related admissions was seen in African Americans (743 to 996; p trend < 0.001). Conclusions: We identified rising trends and higher risk (16% higher of overall young-onset stroke, 41% higher of acute ischemic stroke) of stroke-related hospitalizations and worse outcomes among cannabis users aged 18–49 years from 2007 to 2014

Corrigendum to “Frequency of takotsubo cardiomyopathy in epilepsy-related hospitalizations among adults and its impact on in-hospital outcomes: A national standpoint” [Int. J. Cardiol. 299 (2020): 67–70] (International Journal of Cardiology (2020) 299 (67–70), (S0167527319324726), (10.1016/j.ijcard.2019.07.034))

The authors humbly request you that the affiliation of one of the co-authors Yash Varma (f), to be changed from the Department of Medicine, Government Medical College, Bhavnagar, Gujarat, India to Government Medical College, Bhavnagar. The authors would like to apologize for any inconvenience caused. We appreciate your guidance on this matter