Zubeda Sheikh

Pearls & Oy-sters: Hemicrania epileptica Unfolding the mystery of an unremitting migraine

A 38-year-old woman presented with a right-sided throbbing headache associated with visual symptoms, nausea, vomiting, photophobia, and phonophobia. She had experienced migraines since her teenage years characterized by monthly unilateral headache associated with nausea and photophobia. The current headache had started with symptoms she recognized as her regular monthly migraine, but it had uncharacteristically persisted for 3 days. She also described a persistent aura of “pixelated 3-dimensional objects” and “colored pinwheels,” which she had not experienced with her previous headaches. Two days into the headache, she had developed a defect in her left visual field and had narrowly missed hitting a tree on that side while driving. At the time of presentation to us, she had already undergone a head CT, which was reported normal, and she was prescribed prednisone, sumatriptan, and oxycodone for management of status migrainosus, without benefit.

Clinical Reasoning: Corpus callosum lesion with multiple strokes

A 71-year-old woman with hypertension, diabetes, and recent stroke presented with acute left hemiparesis, which started 3.5 hours earlier but improved by the time of emergency department evaluation. Examination showed mild left-sided pronator drift and sensory extinction. Her history was significant for resection of a right frontoparietal meningioma for which she had received adjuvant radiation therapy 3 years previously.

Acute retinal necrosis in multiple sclerosis: A neuroimmunologic challenge!

We report a case of a 32-year-old woman with a 2-year history of multiple sclerosis (MS) who presented to the ophthalmology clinic 1 week after the completion of pulse steroids with complaints of blurred vision associated with pain in the left eye. She was treated with 3 courses of high-dose methylprednisolone (1,000 mg a day for 3 days) for recurrent relapses in the 5 months before presentation (brain MRI, figure, A). Her symptoms during these relapses were left hemiparesis, right hemiparesis, and worsening right hemiparesis, in that order. She was started on glatiramer acetate 1 month before presentation. Given the frequent relapses, changing her disease-modifying therapy to natalizumab was being considered.

Ictal water-seeking in nondominant temporal lobe seizures

A 40-year-old woman with complex partial seizures and right hippocampal atrophy (figure, A and B) had persistent seizures after epilepsy surgery. One of her seizures is shown in the video on the Neurology® Web site at Neurology.org. She pushes the event button during the aura (rising epigastric sensation), rubs her mouth, reaches for water, and holds onto it through the seizure.

Trends in Outcome and Hospitalization Charges of Adult Patients Admitted with Botulism in the United States.

Background: To assess the impact of new therapeutic strategies on outcomes and hospitalization charges among adult patients with botulism in the United States. Methods: We determined in-hospital outcomes and charges for patients with botulism hospitalized in 1993–1994 and compared them with those observed among patients hospitalized in 2006–2007. Mortality, length of stay, and hospitalization charges were calculated. Age, sex, race, ethnicity, and discharge status were also reported. Results: There were 66 and 132 admissions of adult patients with botulism in 1993–1994 and 2006–2007, respectively. Men predominance was observed in 2006–2007 compared to women predominance during the 1993–1994 time period. There was no significant difference in the average length of stay and in-hospital mortality rate between the two groups studied. However, in the 2006–2007 group, there was a significant increase in the mean hospitalization charges (USD 126,092 ± 120,535 vs. USD 83,623 ± 82,084; p = 0.0107) and in the proportion of patients requiring mechanical ventilation when compared to 1993–1994 (34 vs. 13.6%; p < 0.0001). Conclusion: Botulism continues to be an infrequent cause of hospitalization, with a significant increase in the average hospitalization charges in 2006–2007 when compared to 1993–1994, despite a nonsignificant change in the mortality rate and average length of hospitalization.

Contents Vol. 38, 2012

196 Regional North American Annual Meeting of the World Federation of Neurology – Research Group on Neuroepidemiology Louisiana State University, New Orleans, La., April 27, 2012 Guest Editors: England, J. (New Orleans, La.); Franklin, G. (Seattle, Wash.) Leimpeter, A. (Oakland, Calif.) Van Den Eeden, S.K. (Oakland, Calif.) (available online only)