A case of spontaneous spinal epidural hematoma mimicking transient ischemic attack.

Spontaneous spinal epidural hematoma (SSEH), a disease with exact etiology unknown, is characterized by acute onset of neck or back pain and rapidly progressive nerve root or spinal cord compression. It is rare in clinical practices, with a prevalence of approximately one in a million. Due to the lack of population-based epidemiological survey data for SSEH, clinicians have a serious lack of understanding of the disease and are prone to miss the best time for treatment, leaving patients with neurological dysfunction which is difficult to recover. In this paper, we report a case of SSEH with rare clinical manifestations, to improve clinicians' understanding of SSEH. The patient was mainly characterized by episodic left lower limb weakness and had been misdiagnosed as TIA.

Association of Lymphocyte-to-Monocyte Ratio with Poststroke Depression in Patients with Acute Ischemic Stroke.

BACKGROUND Poststroke depression (PSD) is a common neuropsychiatric disorder after stroke. The neuroinflammatory response exerts a vital effect in the development of PSD. Lymphocyte-to-monocyte ratio (LMR), a systemic inflammation biomarker, is associated with poor prognosis of acute ischemic stroke (AIS). The purpose of this study was to determine the association between LMR and PSD at 3 months. MATERIAL AND METHODS AIS patients (507) were included in this study. Patients were categorized into 3 tertiles and each tertile contains 169 patients: tertile1 (>4.85), tertile 2 (2.96 to 4.85), and tertile 3 (<2.96), based on LMR values and the numbers of patients. PSD was diagnosed with a 17-item Hamilton Depression Scale score of 8 or higher. RESULTS Patients (141; 27.8%) were diagnosed with PSD at 3-month follow-up. Patients in the PSD group presented with more severe stroke and lower LMR values (P<0.001). Decreased LMRs were independently associated with occurrence of PSD (middle tertile: odds ratio [OR] 1.823, P=0.037; lowest tertile: OR 3.024, P<0.001). A significant association of a lower LMR value with PSD severity was found (middle tertile: OR 1.883, P=0.031; lowest tertile: OR 2.633, P=0.001). The receiver operating characteristic curve indicates that the optimal threshold of LMR as a predictor for PSD was 3.14, which yielded a sensitivity of 72.4% and a specificity of 68.1%. CONCLUSIONS Decreased LMR is independently associated with PSD and increased PSD severity.

Ramsay Hunt syndrome with pontine lesion: A case report.

RATIONALE: The coexistence of Ramsay Hunt syndrome (RHS) and varicella-zoster virus (VZV) encephalitis is rare. A patient who developed RHS after being infected with VZV, along with a pontine lesion, is reported in the present study. PATIENT CONCERNS: A 41-year-old male patient presented with his mouth askew for 7 days, and dizziness, accompanied by hearing loss for 3 days. DIAGNOSES: The patient was initially diagnosed with RHS. Brainstem encephalitis was confirmed by lumbar puncture and cerebrospinal fluid. Brain magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) revealed how VZV entered the intracranial space along the vestibulocochlear nerve and facial nerve in the acute period. INTERVENTIONS: Intravenous acyclovir, IV, immunoglobulins (IVIg) and methylprednisolone were administered. OUTCOMES: The herpes was cleared up and left facial nerve palsy was improved, but hearing loss in the left ear did not improve. LESSONS: An MRI was necessary for some VZV infections limited to the cranial nerve, although there was no evidence of brain stem injury. DWI provided evidence, showing how VZV entered the brain in the early stage. This allowed the doctor to judge the necessity of a lumbar puncture.

Third ventricle tumor with Bruns sign as the first manifestation: a case report.

This article reported a case of a third ventricle tumor with Bruns syndrome sudden disturbance of consciousness as the first manifestation, to improve the clinician's understanding and awareness of the fatal signs. A 38-year-old healthy man was admitted to our hospital for a sudden onset coma for 2 hours. Head magnetic resonance imaging (MRI) showed midbrain aqueduct occlusion, intraductal abnormal nodule signal, considering space-occupying lesions. On the fourth day of admission, the patient was scheduled to undergo ventriculoscopic resection of the mass, but the patient had a small ventricular foramen, which was difficult to explore the posterior part of the third ventricle, and the possibility of injuring the vein was high. Finally, the third ventriculostomy was performed by ventriculoscope. 6 months later, the tumor grew slowly and the patient had no hydrocephalus.

Recurrent cerebral infarction in anterior and posterior circulation territories associated with persistent primitive hypoglossal artery and carotid artery dissection: a case report.

The persistent primitive hypoglossal artery (PPHA) is the second most common persistent carotid-vertebrobasilar anastomosis. We present a rare case of an 82-year-old woman who diagnosed as acute cerebral infarction three times in both the anterior and posterior circulation territories with a right-sided PPHA and ipsilateral carotid artery dissection (CAD). Microembolus monitoring results suggested that microembolic caused by CAD associated with PPHA should be recognized as a possible cause of multiple infarctions in both the anterior and posterior circulation territories. For these patients, appropriate treatment measures should be taken for prevention of stroke recurrence.

Lateral medullary infarction with similar features of Brown Sequard syndrome caused by vertebrobasilar dysplasia and Klippel-Feil syndrome: A case report.

RATIONALE: Patients with Klippel-Feil syndrome (KFS) are always anomaly associated with vertebrobasilar dysplasia. That may present commonly as infarction of brainstem, medulla, and cerebellum. In this article, we reported a rare case of lateral medullary infarction (LMI) with similar features of Brown Sequard syndrome caused by vertebrobasilar dysplasia and KFS, and the 2 rare conditions that are causally related. The case is being reported because of its unusual and rare presentation. PATIENT CONCERNS: A 38-year-old female presented with acute unsteadiness, along with a tendency to lean to the left side while walking or sitting, and paresthesia in the right lower limb and trunk, at 2 days before admission. She had no history of hypertension and diabetes, but had a 20 years history of neck pain and dizziness, which was related to head movement. DIAGNOSES: Brown Sequard syndrome and a lesion of the left thoracic spinal cord were suspected initially. KFS was confirmed by the cervical magnetic resonance imaging (MRI) and computed tomographic angiography (CTA) results. Transcranial Doppler (TCD) results confirmed that there was a causal link between LMI and KFS. INTERVENTIONS: The patient rejected the operation of stabilization of the cervical spine with fusion at appropriate levels. OUTCOMES: No recurrence of stroke, but neck pain and dizziness remained after 6 months of discharge. LESSONS: For such patients, the conventional treatment of cerebral infarction might be ineffective, but stabilization of the cervical spine with fusion at appropriate levels can successfully prevent further episodes of syncope and stroke.