Neuropathy in a Patient With Congenital Absence of the Inferior Vena Cava.

Neuropathic pain is a frequent complaint in the neurology clinic. We present a case of a 31-year-old male with congenital absence of the inferior vena cava (AIVC) resulting in venous hypertension who complained of lower extremity pain interfering with his daily activities. His AIVC was thought to be incidental rather than causative of his pain complaints. His examination was consistent with peripheral neuropathy. Simple lifestyle adaptations, such as restriction of physical activity and leg elevation, were sufficient to relieve his symptoms. Recognition of the role of AIVC may have prevented additional invasive procedures in our patient.

The Great Masquerader: Recurrent Ischemic Strokes Secondary to Meningovascular Syphilis in a Man With Cardiovascular Stroke Risk Factors.

A male in his 60s with stroke risk factors presented with confusion and word-finding difficulties. He was diagnosed with acute ischemic stroke in the right basal ganglia. He was started on secondary stroke prevention measures including dual antiplatelet therapy and a high-dose statin. A highly reactive rapid plasma reagin (RPR) was performed as part of the workup and found to be positive. Follow-up fluorescent treponemal antibody absorption (TPA) test was also positive, confirming a diagnosis of syphilis. He was discharged home with a scheduled course of antibiotic treatment for tertiary syphilis but returned due to a new episode of transient facial paralysis. Further workup and physical exam findings revealed the patient had neurosyphilis. He was started on the appropriate antibiotic therapy, which significantly improved his confusion and prevented new episodes of stroke.

Clinical Diagnosis of Temporal Arteritis With Seronegative and Negative Biopsy Studies.

Giant cell arteritis (GCA), also known as temporal arteritis is the most common of the systemic vasculitides. It occurs in individuals older than 50 years of age and peaks in incidence in the seventh decade. The gold standard for diagnosis of GCA is temporal artery biopsy (TABx) which will show transmural inflammation, but a negative biopsy does not rule out the disease. We present a case of a 66-year-old male with a classic clinical presentation of temporal arteritis with a normal erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and negative bilateral temporal artery biopsies. He was discharged on prednisone. Ten days later, he unilaterally stopped his corticosteroid treatment leading to a recurrence of symptoms and conversion to seropositivity (ESR negative and CRP positive). The objective of this article is to point out that the diagnosis of temporal arteritis is clinical and is not discarded by a negative TABx. Patients with classic clinical manifestations of temporal arteritis but with a negative TABx should be treated aggressively.

Neurologic Sequela of COVID-19: Guillain-Barré Syndrome Following Johnson & Johnson COVID-19 Vaccination.

Guillain-Barré syndrome after Pfizer and Astra-Zeneca vaccinations against COVID-19 has been previously reported in the literature. The objective of this study was to report the first case of Guillain-Barré following the COVID-19 vaccination with the Johnson & Johnson COVID-19 vaccine. We report the case of a 53-year-old female who presented to the Emergency Department complaining of bilateral lower extremity weakness, paresthesias, and gait difficulties 14 days after having received the Johnson & Johnson COVID-19 vaccination. MRI of the lumbar spine with and without contrast revealed enhancement of the cauda equina nerve roots suggestive of acute inflammatory demyelinating polyradiculoneuropathy. Cerebrospinal fluid (CSF) analysis reported mildly elevated protein low white blood cells (WBCs). Ganglioside (GM1 and GQ1b) antibodies were reported as negative. After intravenous immunoglobulin (IVIg), the patient had significant improvement in her weakness and paresthesia and was discharged home. The case was reported to the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System. Guillain-Barré syndrome after COVID-19 immunization remains a rare complication. A clear mechanism of disease has not been clarified; however, it is believed that there could be some type of molecular mimicry between the spike glycoprotein produced with the help of the vaccines and proteins in the myelin sheath.

Combined Transradial and Upper Extremity Transvenous Accesses in the Treatment of Carotid-Cavernous Fistulae: Two Case Reports and a Literature Review.

The expansion of indications for neurointerventional procedures, combined with the need to treat a diverse patient population, has driven a need for broader access options. Concurrent arterial and venous access is often necessary for the diagnosis and treatment of various neurovascular diseases. Although complication rates are low, life-threatening severe complications have been reported with these access methods. Moreover, venous access through traditional routes can be challenging in patients with large body habitus. There is a growing trend of utilizing radial artery access for neuroendovascular procedures due to the increased ease of access and similar efficacy. Nevertheless, the use of upper limb veins in neurointerventional procedures is still rare. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for neurointerventionalists, but data are limited. This study reports two cases of successful combined upper extremity transvenous access (TVA) and transradial access (TRA) in the treatment of carotid artery-cavernous fistulae. Combined TRA and UETV is a feasible, promising access strategy for patients and may also confer the same safety and patient satisfaction outcomes that have been seen with TRA. Further studies are needed to elucidate the exact impact this strategy has on patient outcomes and satisfaction.