Neurologist
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Neurosarcoidosis has a variety of clinical presentations. Common manifestations include leptomeningeal inflammation with seizures, headache, cranial nerve palsies, hydrocephalus, or focal neurological deficits with white matter lesions or mass lesions. Stroke is relatively rare, and hemorrhage is much less common than ischemia due to vasculitis. We present a patient with histopathologically confirmed neurosarcoidosis presenting with headache, seizures, and cognitive decline with multiple recurrent primary intracerebral hemorrhages.
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Patients with intracerebral hemorrhage (ICH) are at risk for venous thromboembolic (VTE) complications after stroke. The dilemma remains on whether it is safe to initiate low-dose low-molecular weight heparin (LMWH) in patients with ICH without risking expansion of the initial bleed. ⋯ Initiation of low-dose LMWH in spontaneous ICH patients for the purpose of VTE prophylaxis is likely safe. However, a clinical decision based solely on the results of this study cannot be made due to numerous methodological and design shortcomings. A well-designed randomized controlled trial is still needed to answer this clinical question.
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The ideal efficacy outcome after surgery for medically refractory epilepsy is seizure freedom without need for antiepileptic drug (AED) therapy but the appropriate timing of AED withdrawal and other prognostic factors remain unclear. ⋯ In adults who have undergone neocortical resection surgery for medically refractory epilepsy, longer time from surgery to beginning AED taper (eg, greater than 9 months) is associated with a greater proportion of patients maintaining seizure freedom. Other risk factors associated with lower rate of seizure freedom after AED taper include longer duration of epilepsy, normal preoperative magnetic resonance imaging, and occurrence of postoperative seizures before initiation of AED withdrawal, but not cortical location of the epilepsy focus.
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Migraine with aura has long been believed to be related to the phenomenon of cortical spreading depression. Clinically, there are no consistent neuroimaging findings corresponding to an attack of migraine with aura. ⋯ There have been reports of various etiologies associated with a temporary focal lesion in the splenium of the corpus callosum manifested as obviously restricted diffusion. These findings may be the consequence of a high vulnerability of the splenium of the corpus callosum to cytotoxic damage. Migraine with aura was considered to be the cause of the reversible focal injury of the splenium in this case. This association has not been reported earlier.
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Myasthenia gravis is an autoimmune disease, which commonly presents with extraocular muscle weakness, eyelid ptosis, bulbar dysfunction, and proximal limb weakness. We report an unusual differential diagnosis for myasthenia gravis. ⋯ Chiari type I malformation is an unusual differential for sero-negative myasthenia gravis. Magnetic resonance imaging of the brain, carried out in patients with all classical signs and symptoms of myasthenia gravis, helps identify this anomaly. Headaches, although a classic feature of Chiari type I malformation, need not be an early manifestation. Eyelid ptosis as a manifestation of Chiari malformation has not been reported in the literature.