Pradeep C Bollu

Salmonella brain abscess in a patient on chronic azathioprine therapy for myasthenia gravis: report of an unusual case and review of literature in the postantibiotic era

Focal intracranial infections caused by Salmonella species in adults are exceedingly uncommon. Structural brain injury with coexisting immunocompromised status appears to predispose adults to this rare manifestation of Salmonella infection. We report a case of Salmonella brain abscess in a patient with myasthenia gravis on chronic azathioprine therapy without any prior structural brain lesion. We reviewed world literature and discuss their analysis of Salmonella brain abscess in adult population in the postantibiotic era.

Trouble Shooting with Noninvasive Ventilation

With increasing awareness of sleep-related breathing disorders, more people are getting treated for these. Though positive airway pressure (PAP) therapies are an excellent treatment option, some patients won’t be able to tolerate them. In this chapter, we aim to highlight the various important and common obstacles patients may encounter during PAP treatment. We also attempted to address each of these challenges that can help with increased compliance or improved efficacy or both. A better understanding of these challenges will help with improved tolerance and better outcomes.

The Basics of Polysomnography

With advances in neurophysiology, the recording of electrical activity of brain became possible. Analysis of the brainwave activity during sleep helped in understanding the various different components of sleep and sleep disorders. Polysomnography nowadays gives us a great deal of information about sleep, respiratory, and limb movement characteristics. The modern day sleep physician relies heavily on polysomnography in understanding the sleep disorders of the patients. In this chapter, we go over the various different aspects of a typical sleep study including electrode arrangement, electroencephalogram, electrooculogram including audio and video recordings.

Sleep Issues in Motor Neuron Diseases

Motor neuron diseases (MND) are progressive neuromuscular disorders that affect lower motor neurons and sometimes, upper motor neurons. Some of the MNDs manifest early in life while some develop later. Sleep disordered breathing (SDB) is a very common association in these diseases and can present as sleep apnea or hypoventilation. Untreated, SDB contributes to morbidity and reduced quality of life. In this chapter, we discuss the different types of MNDs and then about the associated sleep issues in these disorders. Early recognition of these associated sleep disorders and appropriate therapeutic intervention is the key to improve quality of life and reduce morbidity and mortality in these patients.

Sleep Issues in Neuromuscular Junction Disorders

Disorders of the neuromuscular junction (NMJ) typically cause weakness. However, as a part of their full clinical presentation, patients with disorders of NMJ have a variety of sleep problems. Of them, Sleep-Related Breathing Disorders (SRBD) like sleep apnea and hypoventilation are the most common ones. Sometimes, the associated sleep disorder may be the presenting symptoms of the NMJ disorder. The associated sleep disorder can contribute to the fatigue that already exists due to the NMJ disorder. Identification of the associated sleep disorder and selection of appropriate treatment is critical to better patient outcomes. In this chapter, we go over the neuromuscular junction, the most common NMJ disorders, the associated sleep issues and discuss the therapeutic options.

Wernicke’s Encephalopathy as a Rare Complication of Hyperemesis Gravidarum: A Case Report and Review of Literature

Wernickes encephalopathy (WE) is a rare neurological syndrome that presents in the setting of thiamine deficiency. Though alcoholism is the most common cause of this condition, a few other etiologies include malnutrition from other causes, hemodialysis, and hyperemesis gravidarum. In this case report, we aim to report a case of a young woman who developed WE in the setting of hyperemesis gravidarum (HG) that improved with thiamine replacement. This manuscript details her presentation and clinical examination and includes a spontaneous upbeat nystagmus and goes over the condition along with a review of the literature.

Delayed Hypoxic Reversible Leukoencephalopathy Syndrome

We report a case of postanoxic leukoencephalopathy in a patient who started to have cognitive and behavioral changes weeks after the anoxic insult along with white matter lesions on neuroimaging and demyelination on brain biopsy. His disease course followed a steady decline initially both clinically and radiologically and assumed a steady plateau. Months after his decline, the patient was seen to be completely functional with substantially improved mental status examination and resolution of white matter changes on imaging. The course of this disease entity usually assumes a plateau after clinical worsening with little improvement subsequently. However, our patient showed a dramatic recovery to his baseline after a few months. In this article, we review mechanisms, presentation and the sequelae of hypoxic injury to the brain.

Rett Syndrome in Males: A Case Report and Review of Literature

Rett syndrome (RTT) is a neurodevelopmental disorder in which a period of normal development is followed by regression of previously acquired skills. RTT was originally thought to be present exclusively in females. However, advances in genetic testing and phenotypic identification revealed that it is not a female-only disorder as cases of males with similar phenotype were reported. RTT was considered lethal in males as it has an X-linked dominant inheritance. The purpose of this review is to report a case of RTT in young male and elaborate genetics and phenomenology of this disorder in males.

Mononeuropathy due to Entrapment of Dorsal Cutaneous Peroneal Nerve: Clinical, Electrophysiological, and Imaging Findings

Peroneal neuropathy is the most common mononeuropathy encountered in the lower extremities. Isolated injuries to the dorsal cutaneous peroneal nerve (DCPN) are uncommon, and most of the reported cases are due to trauma or iatrogenic causes. We report a case of a middle-aged woman who presented with a nine-month history of tingling sensation over the dorsum of her left foot with normal electromyography (EMG) findings and was subsequently diagnosed with entrapment of the DCPN at the ankle by ultrasonographic examination.

Multiple Cranial Neuropathies in a Patient with Diffuse Large B-cell Lymphoma: Case Report and Review of Literature

Neuropathies can occur in patients with diffuse large B-cell lymphoma (DLBCL) at any stage of the disease as a presenting symptom or during later stages of illness. A wide spectrum of neurological association is known to occur with DLBCL, ranging from cranial nerve palsies to peripheral neuropathies. Evaluation of cranial and peripheral neuropathies in patients with DLBCL requires meticulous clinical, imaging, and electrodiagnostic testing. A 75-year-old right-handed female with a known history of multiple cranial neuropathies and DLBCL presented with acute dysphagia and upper extremity weakness of one-week duration. On evaluation, she was found to have right vagal nerve palsy. Cerebrospinal fluid (CSF) analysis along with flow cytometry testing showed CD19 and CD20 positive B cells, confirming neoplastic infiltration of CSF. We describe the case and review the literature of the association of cranial nerve palsies with DLBCL.