A Comparison of Patients' and Neurologists' Assessments of their Teleneurology Encounter: A Cross-Sectional Analysis
Neurologists' Evaluations of Experience and Effectiveness of Teleneurology Encounters
Neurosarcoidosis Presenting as Ophthalmoplegic Headache Managed With Acetazolamide
Botulinum Toxin Therapy in Writer's Cramp and Musician's Dystonia
Task-specific focal dystonia is characterized by muscle contraction(s) during a specific task, resulting in abnormal postures or movements. Specifically, writer's cramp involves the upper extremity during the act of writing. Musician's dystonia has a highly variable presentation, and thus makes therapeutic options more limited. Treatments include oral pharmacologic agents, neuromodulation, surgery and, most often, botulinum toxin (BoNT) injection. Selection of target muscles for toxin injection continues to be an area of active research for these task-specific movements. We present a review of the literature selected from a predefined search of the MEDLINE and ClinicalTrials.gov databases. We include six controlled studies of botulinum toxin for the management of writer's cramp and focal task-specific dystonia (FTSD), including musician's dystonia. Overall, 139 patients were included across all studies, with 99 individuals injected for writer's cramp and the remaining 40 individuals with FTSD. The age range of all patients was 18-80 years old. We included studies that utilized only the BoNT-A serotype. These studies utilized various severity scales to quantify response to toxin injection, with ratings of instrument or pen control included as subjective ratings. Of the included 139 patients in this review, pooled data for toxin response show that 73% of patients who received the drug demonstrated improvement. Specific techniques for muscle localization and targeting were difficult to study as variable methods were employed. This remains an area of ongoing exploration.
Immunotherapy for Peripheral Nerve Disorders
Inflammatory peripheral neuropathies can be disabling for any patient. Selecting the most appropriate agent for treatment, especially in the elderly, is no simple task. Several factors should be considered. Herein, we discuss immunotherapeutic options for peripheral nerve diseases and the important considerations required for choosing one in the geriatric population.
Acute Transverse Myelitis as a Parainfectious Manifestation of SARS-CoV-2 Infection (4933)
We present a case of acute transverse myelitis associated with presumed Covid-19 infection.Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a single-stranded RNA virus that causes coronavirus disease 2019 (COVID-19). The full spectrum of neurological involvement of Covid-19 has not been characterized.Design/Methods: Case report and review of literature.Results: A 52-year-old man from New York City with hypertension, diabetes, and diabetic peripheral neuropathy presented after two days of progressive bilateral leg weakness and urinary retention. He reported fever, cough, and low back pain that started three weeks prior to this presentation. On arrival, he was febrile and hypoxic on room air (SpO2 88%). Neurological examination showed bilateral hip flexion weakness (Medical Research Council grade 3/5), stable length-dependent sensory loss in the lower extremities, and generalized hyporeflexia. Laboratory studies were notable for leukocytosis (15.9 103/uL), lymphopenia (13%), hyponatremia (126 mmol/L), and elevated inflammatory markers: Lactate dehydrogenase (390 IU/L), erythrocyte sedimentation rate (120 mm/hr), C-reactive protein (195 mg/L), and interleukin-2 receptor (1383 pg/mL). Chest radiography revealed interstitial opacities in both lungs. Magnetic resonance imaging of the total spine revealed increased T2 signal in the spinal cord at the level of the T3 vertebra (Figure 1Bâ€“D). Cerebrospinal fluid (CSF) analysis revealed normal cell count (1 cell/mL) with elevated protein (91 mg/dL) and negative RT-PCR for SARS-COV-2. Early mobility was encouraged and antipyretics successfully controlled the patientâ€™s fever. Spontaneous voiding returned on day three of hospitalization. His respiratory status also improved, and he was discharged home.Conclusions: Neuroinvasion has been demonstrated to be a common feature of many coronaviruses. This case provides insight into the potential mechanisms by which SARS-CoV-2 can affect the central nervous system, highlights acute transverse myelitis as a neurological manifestation of Covid-19, and demonstrates an example of an affected individual with good potential for neurologic recovery.Disclosure: Dr. Valdes has nothing to disclose. Dr. Zakin has nothing to disclose.
POST-PARTUM CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY WITH EXCELLENT RESPONSE TO THERAPEUTIC PLASMA EXCHANGE [Meeting Abstract]
Hypertrophic Olivary Degeneration and Movement Disorder in a Patient with Familial Creutzfeldt-Jakob Disease [Case Report]
A 38-year-old male presented with a three-week history of bilateral lower extremity choreiform movements. History included sleep abnormalities, rushed and unintelligible speech, with delusions two to six months prior to presentation. He also developed mild dysphagia, staring spells, and anterograde amnesia. On examination, he had pressured speech, asynchronous cycling movements of the bilateral lower extremities persisting during sleep, occasional ballistic movements of the upper extremities, and ataxia. Magnetic resonance imaging (MRI) of the brain showed high cortical signal change in bilateral parieto-occipital cortices with evidence of medullary olive hypertrophy bilaterally. Electroencephalography showed generalized slowing without periodic spikes. Cerebrospinal fluid was positive for protein 14-3-3 and real-time quaking-induced conversion. Genetic testing was positive for autosomal dominant prion protein gene (PRNP) genetic mutation. The patient passed away three months after discharge. This case provides previously undescribed imaging and movement abnormalities in a patient with familial Creutzfeldt-Jakob disease (CJD), and suggests that CJD should not be removed from the differential in patients with these atypical findings.
SARS-CoV-2-Associated Guillain-Barre Syndrome With Good Response to Plasmapheresis
Keeping the team together: Transformation of an inpatient neurology service at an urban, multi-ethnic, safety net hospital in New York City during COVID-19
The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital's expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.