Paroxysmal Atrial Fibrillation (PFA) Detection With Cardiac Monitoring Devices Implanted by Neurologists in Patients With Embolic Strokes of Undetermined Source (ESUS).

Introduction Ischemic stroke is among the leading causes of death and disability. Approximately 50% of cryptogenic strokes are embolic strokes of undetermined source (ESUS). The most common cause of ESUS is atrial fibrillation. Therefore, the detection of atrial fibrillation with long-term implantable devices is needed. Neurologists are directly involved with acute and post-acute stroke care and have direct access to the management of stroke patients. Therefore, there is a need for neurologists to recommend, implant, and monitor cardiac implantable devices in patients with ESUS. Methods From November 2022 to October 2023, our group implanted 32 ESUS patients with Confirm Rx™ insertable cardiac monitors (Abbott, USA). Atrial fibrillation detection was supervised and monitored daily. Results In 24 months, atrial fibrillation was detected in 12.5% of patients (four patients), sinus bradycardia in 6.25% of patients (two patients), paroxysmal supraventricular tachycardia in 9.4% of patients (three patients), and asystole in one patient. Conclusion Our study shows that neurologists involved in the treatment of stroke care can safely implant, monitor, and detect atrial fibrillation accurately. Our rate of detection of atrial fibrillation in patients with ESUS was 12.8%, which is consistent with prior studies.

Sporadic Creutzfeldt-Jakob Disease: Case Report and Literature Review.

The proverbial "zebras" in neurology are often times missed due to their low prevalence and incidence in the community. The number of misdiagnoses and improper therapeutic interventions that occur are further increased when patients with these rare diseases present with signs and symptoms of more common disorders. One such disease is sporadic Creutzfeldt-Jakob disease (sCJD), a prion disease that causes neuronal derangement and classically presents as a rapidly progressing dementia with extrapyramidal signs, ataxia, behavioural problems, and myoclonus in the advanced stage. It falls into the category of neurodegenerative disease, which also includes Alzheimer's disease, Huntington's disease, Parkinson's disease, and other Parkinson-related diseases. Though these diseases have overlapping symptomologies - such as cognitive impairment and neuromuscular dysfunction - they can be differentiated from one another based on the time course of the illness and the specific constellation of signs and symptoms. Our case report describes a patient who was found to have sCJD after months of treatment for Parkinson's disease and trigeminal neuralgia. Thus, we are highlighting the importance of recognizing rare diseases so that proper management can be initiated in a timely manner. Furthermore, we review the current literature on the diagnosis and management of sCJD.

Pulmonary Edema and Stunned Myocardium in Subarachnoid Hemorrhage.

Aneurysmal subarachnoid hemorrhage is a life-threatening event that can cause permanent disability. This life-threatening event can be further complicated by subsequent cardiac and pulmonary disability. The presence of a neurogenic cardiomyopathy and pulmonary edema increases the morbidity and mortality of patients who suffer from aneurysmal subarachnoid hemorrhage.  In this paper, we discuss a 39-year-old woman who presented to the emergency department (ED) with a chief complaint of a pounding headache with associated nausea and vomiting for the past three days. She had a past medical history significant only for migraines. During her stay in the ED, she began to exhibit signs of altered consciousness, hemoptysis, and respiratory compromise. Neuroimaging showed evidence of subarachnoid hemorrhage. The exact source of her subarachnoid hemorrhage could not be located with neuroimaging or angiography. Her clinical course was complicated by pulmonary edema and neurogenic stunned myocardium, and is still ongoing.

Delayed Identification of Cortical Superficial Siderosis in a Patient with Recurrent Transient Focal Neurological Symptoms: A Case Report.

Cortical superficial siderosis (cSS), also referred to as sulcal siderosis, is a neurological condition characterized by hemosiderin subpial deposits in the cortical sulci over the convexities of cerebral hemispheres. These deposits are further found sparingly in the spinal cord, brainstem, and cerebellum. Patients typically present with transient focal neurological symptoms that make cSS challenging to differentiate from other acute neurological processes such as transient ischemic attacks (TIA), focal seizures, and acute convexity subarachnoid hemorrhage (cSAH). This condition is presently recognized as a characteristic feature of the age-associated disorder referred to as cerebral amyloid angiopathy (CAA). This paper describes a patient who presented with transient neurologic symptoms, first suspected to be secondary to acute subarachnoid hemorrhage (SAH), found to have cSS and cerebral amyloid angiopathy.

Neurological Disorders Associated with Glutamic Acid Decarboxylase Antibodies.

Anti-glutamic acid decarboxylase (GAD) antibodies have been discovered in a variety of neurological syndromes with unique presentations. These syndromes include limbic encephalitis (LE), stiff person syndrome (SPS), opsoclonus-myoclonus-ataxia syndrome, cerebellar ataxia, status epilepticus, and palatal myoclonus among others. We present two patients who presented with Guillain-Barré (GBS) and myasthenia gravis (MG) like syndromes, who were found to have anti-GAD antibodies. These case reports highlight the complex presentation of patients with neurological disorders associated with anti-GAD antibodies. The proper identification of anti-GAD antibody's presence has proven to be beneficial in treatment and provide enhanced quality of life.