Internal Medicine Commons^™

Longitudinal Cognitive Performance Of Alzheimer's Disease Neuropathological Subtypes, Madeline Uretsky, Laura E. Gibbons, Shubhabrata Mukherjee, Emily H. Trittschuh, David W. Fardo, Patricia A. Boyle, C. Dirk Keene, Andrew J. Saykin, Paul K. Crane, Julie A. Schneider, Jesse Mez

Sanders-Brown Center on Aging Faculty Publications

Introduction: Alzheimer's disease (AD) neuropathological subtypes (limbic predominant [lpAD], hippocampal sparing [HpSpAD], and typical [tAD]), defined by relative neurofibrillary tangle (NFT) burden in limbic and cortical regions, have not been studied in prospectively characterized epidemiological cohorts with robust cognitive assessments.

Methods: Two hundred ninety-two participants with neuropathologically confirmed AD from the Religious Orders Study and Memory and Aging Project were categorized by neuropathological subtype based on previously specified diagnostic criteria using quantitative regional NFT counts. Rates of cognitive decline were compared across subtypes using linear mixed-effects models that included subtype, time, and a subtype-time interaction as predictors and four cognitive …

Rupture Of A Superficial Temporal Artery Pseudoaneurysm Following Craniotomy, Jessica A. Shields, Jared M. Robichaux, Kevin Morrow, Clifford Crutcher, Gabriel Tender

School of Medicine Faculty Publications

Pseudoaneurysm of the superficial temporal artery (STA) is a rare entity that has been reported in the literature after trauma or iatrogenic injuries. We describe a unique case of STA pseudoaneurysm rupture and the clinical sequelae associated with its rupture. We report a case of pseudoaneurysm rupture of the STA that occurred 14 days after craniotomy for cerebrospinal fluid leak repair. We also review the literature, diagnosis and treatment of external carotid artery aneurysms. Rupture of a STA pseudoaneurysm is a previously unreported and serious complication that must be quickly recognized in order to control hemorrhage that may have life …

Takayasu Arteritis: A Rare Cause Of Chronic Headache, Linda Barasa, Adil Salyani, Jillo Bika, Fred Otieno, Dilraj Sokhi

Internal Medicine, East Africa

Chronic headache can be a presenting manifestation of Takayasu arteritis, although patients usually have other characteristic features. A thorough clinical assessment remains key in the evaluation of chronic headache.

Chronic Inflammatory Demyelinating Polyneuropathy As A Paraneoplastic Manifestation Of Colorectal Carcinoma: What Do We Know?, Talal Almas, Muhammad Ali Niaz, Yasar Sattar, Tarek Khedro, Ali Kanawati, Katia Yazji, Reema Alsufyani, Yousef Al-Khatib, Absam Akbar, Emad Mansoor

Medical College Documents

No abstract provided.

Correlation Of Serum Calcium With Severity Of Acute Ischaemic Stroke, Ainan Arshad, Saad Bin Zafar Mahmood, Ahmed Ayaz, Mehsa Hashim, Eisha Hanan

Section of Internal Medicine

Stroke results in the death of around 6.5 million people annually with a majority of these occurring in developing countries. Serum calcium has been hypothesised to play a significant role in causing ischaemic stroke. This retrospective observational study was conducted to determine the correlation, if any, between serum calcium and the severity of acute ischaemic stroke in our population. Two hundred and seventy-nine patients admitted with acute ischaemic stroke were enrolled in the study. Of the 279 patients 162 (58%) were male and mean age was 62.4 ± 3.8 years. Characteristics of stroke patients were compared with stroke severity. Mean …

Cushing’S Reflex And Bradycardic Arrest In Cryptococcal Meningitis, Scott Briggs, Trent Malcolm

Rowan-Virtua Research Day

Cushing’s reflex is a physiologic response to maintain cerebral perfusion pressure with elevated systolic blood pressure, widened pulse pressure, and bradycardia occurring in the setting of elevated intracranial pressure (ICP). The proposed mechanisms for reflexive bradycardia include ischemia to medullary brain tissue and compression of the intracranial segment of the vagus nerve leading to parasympathetic activation. (1) In acutely elevated ICP, bradycardia is a late finding of worsening intracranial pathology suggestive of impending herniation and cardiovascular collapse.

Cryptococcal meningitis has been identified by Infectious Disease Society of America for its association with elevated ICP. (2) Variety of pathogenic mechanisms occurring …

Guillain-Barré Syndrome In A Patient With Sickle Cell Anemia, Kunjan Udani, Pooja Patel, Dveet Patel, Hajra Awwab, Nino Balanchivadze

HCA Healthcare Journal of Medicine

A 24-year-old African American male with a history of sickle cell anemia (Hb S/S) presented to an outside hospital with acute colitis, acute renal failure and sickle cell crisis and was treated with supportive measures. On day 3 of hospitalization, he developed bilateral ascending paralysis with sacral numbness. Magnetic resonance imaging (MRI) demonstrated epidural lipomatosis, which was attributed as the cause of his paralysis. He was transferred to our facility for neurosurgery evaluation. Based on the physical examination, Guillain-Barré Syndrome (GBS) was suspected. This conclusion lead to a lumbar puncture with cerebrospinal fluid (CSF) analysis that confirmed the diagnosis. He …

CertL Reduces C16 Ceramide, Amyloid-Β Levels, And Inflammation In A Model Of Alzheimer’S Disease, Simone M. Crivelli, Qian Luo, Jo A. A. Stevens, Caterina Giovagnoni, Daan Van Kruining, Gerard Bode, Sandra Den Hoedt, Barbara Hobo, Anna-Lena Scheithauer, Jochen Walter, Monique T. Mulder, Christopher Exley, Matthew Mold, Michelle M. Mielke, Helga E. De Vries, Kristiaan Wouters, Daniel L. A. Van Den Hove, Dusan Berkes, María Dolores Ledesma, Joost Verhaagen, Mario Losen, Erhard Bieberich, Pilar Martinez-Martinez

Physiology Faculty Publications

BACKGROUND: Dysregulation of ceramide and sphingomyelin levels have been suggested to contribute to the pathogenesis of Alzheimer's disease (AD). Ceramide transfer proteins (CERTs) are ceramide carriers which are crucial for ceramide and sphingomyelin balance in cells. Extracellular forms of CERTs co-localize with amyloid-β (Aβ) plaques in AD brains. To date, the significance of these observations for the pathophysiology of AD remains uncertain.

METHODS: A plasmid expressing CERT_L, the long isoform of CERTs, was used to study the interaction of CERT_L with amyloid precursor protein (APP) by co-immunoprecipitation and immunofluorescence in HEK cells. The recombinant CERT_L protein …

Heidenhain Variant Of Sporadic Creutzfeldt-Jakob Disease: First Reported Case From East Africa, Dilraj Sokhi, Fazal Yakub, Karishma Sharma, Sheila Was, Peter Mativo

Internal Medicine, East Africa

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare prion disease that causes rapidly progressive fatal neurodegeneration. The rarer Heidenhain variant of sCJD presents with visual symptoms and is rarely reported in the literature from sub-Saharan Africa. We report the case of a 57-year-old male with a three-week history of losing direction when driving home and visual hallucinations described as seeing rainbows. Magnetic resonance imaging (MRI) of the brain revealed unilateral parieto-occipital sulcal hyperintensities with restriction on diffusion-weighted imaging (DWI), and electroencephalography (EEG) showed right para-central slowing leading to an initial diagnosis of non-convulsive status epilepticus. He was treated with anti-epileptic medication …

Encephalopathy And Complex Hyperkinesia In A Patient With Severe Acute Respiratory Syndrome Coronavirus-2 Infection, Wenyang Li, Elif Pinar Coskun, Rolando Berger, John T. Slevin, L. Creed Pettigrew

Neurology Faculty Publications

No abstract provided.

Antibodies Against Lysophosphatidic Acid Protect Against Blast-Induced Ocular Injuries, Peethambaran Arun, Franco Rossetti, James C. Demar, Ying Wang, Andrew B. Batuure, Donna M. Wilder, Irene D. Gist, Andrew J. Morris, Roger A. Sabbadini, Joseph B. Long

Internal Medicine Faculty Publications

Exposure to blast overpressure waves is implicated as the major cause of ocular injuries and resultant visual dysfunction in veterans involved in recent combat operations. No effective therapeutic strategies have been developed so far for blast-induced ocular dysfunction. Lysophosphatidic acid (LPA) is a bioactive phospholipid generated by activated platelets, astrocytes, choroidal plexus cells, and microglia and is reported to play major roles in stimulating inflammatory processes. The levels of LPA in the cerebrospinal fluid have been reported to increase acutely in patients with traumatic brain injury (TBI) as well as in a controlled cortical impact (CCI) TBI model in mice. …

Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum, Antonina Obayo, Sylvia Mbugua, Sayed Karar

Internal Medicine, East Africa

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Postinfectious Cerebellar Syndrome With Paraneoplastic Antibodies: An Association Or Coincidence?, Sajid Hameed, Mukesh Kumar, Pal Satyajit Singh Athwal, Sukhmanii Kahlon, Nimit Dalal

Section of Neurology

Cerebellar ataxia has a very broad differential diagnosis in adults, including paraneoplastic and postinfectious etiologies. We report a case of a 56-year-old male presented with right-sided cerebellar dysfunction preceded by fever and headache. He was diagnosed with subacute postinfectious cerebellar ataxia. Blood serology showed the presence of anti-amphiphysin and anti-Ri (ANNA-2, antineuronal nuclear autoantibody type 2) antibodies, which have a known association with cerebellar syndrome. The patient subsequently improved with the steroids. Although no evidence of an underlying tumor was found in the patient, the presence of the paraneoplastic antibodies remains a mystery. We suggest a probable association of these …

Out-Patient Neurological Disorders In Tanzania: Experience From A Private Institution In Dar Es Salaam, Philip Adebayo, Omar Aziz, Rose E. Mwakabatika, Mandela Makakala, Mugisha Clement, Shabbir Adamjee, Noureen Mushi, Ahmed Jusabani, Eric Aris

Internal Medicine, East Africa

Background and introduction: Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa.

Objective: To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD).

Materials and methods: The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively …

A Fatal Case Of Primary Amoebic Meningoencephalitis (Pam) Complicated With Diabetes Insipidus (Di): A Case Report And Review Of The Literature, Zain Mushtaq, Saad Bin Zafar Mahmood, Adil Aziz

Section of Internal Medicine

Naegleria fowleri is a highly infective free-living amoeba usually isolated from soil and fresh water and is primarily found to infect the central nervous system (CNS) resulting in primary amoebic meningoencephalitis (PAM). PAM as a cause of meningitis is often overlooked for other, more common causes of meningitis. Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries. We are presenting a case of a 44-year-old male with fever, worsening headache, and generalized weakness. Lumbar puncture showed a …

Impact Of Order Set Use On Stroke Care, Bilal Nadeem, Edward Waseleski, Meryem Maras-Casey, Sabih Alam, Adnan Faruqui, Michael Gutierrez, Maruthsakhi Molugu, Christina Oricompil, Ashar Mahmood, Katherine Torralba, Fatima Agha, Nour Tlimat, Olu Oyesanmi, Irina Davis, Salman Muddassir, Nikolay Mitzov

West Florida Division GME Research Day 2020

• A case control study on stroke patients was recently completed for a quality improvement (QI) investigation.
• The objective was to determine if the use of either Hemorrhagic or Ischemic Stroke Order Set had an effect on the length of stay (LOS) or adherence to current stroke guideline recommendations

The Β3-Adrenergic Receptor Agonist Mirabegron Improves Glucose Homeostasis In Obese Humans, Brian S. Finlin, Hasiyet Memetimin, Beibei Zhu, Amy L. Confides, Hemendra J. Vekaria, Riham H. El Khouli, Zachary R. Johnson, Philip M. Westgate, Jianzhong Chen, Andrew J. Morris, Patrick G. Sullivan, Esther E. Dupont-Versteegden, Philip A. Kern

Internal Medicine Faculty Publications

BACKGROUND. Beige adipose tissue is associated with improved glucose homeostasis in mice. Adipose tissue contains β3-adrenergic receptors (β3-ARs), and this study was intended to determine whether the treatment of obese, insulin-resistant humans with the β3-AR agonist mirabegron, which stimulates beige adipose formation in subcutaneous white adipose tissue (SC WAT), would induce other beneficial changes in fat and muscle and improve metabolic homeostasis.

METHODS. Before and after β3-AR agonist treatment, oral glucose tolerance tests and euglycemic clamps were performed, and histochemical analysis and gene expression profiling were performed on fat and muscle biopsies. PET-CT scans quantified brown adipose tissue volume and …

Acute Disseminated Encephalomyelitis, Ashan Hatharasinghe, Hossein Akhondi, Don Pepito

HCA Healthcare Journal of Medicine

Introduction: Acute Disseminated Encephalomyelitis (ADEM) is a rare autoimmune demyelinating disorder of the central nervous system. Clinical manifestations include encephalopathy, motor deficits, ataxia, and meningeal signs. In most cases, ADEM is preceded by either vaccination or viral illness. Here, we present a case with neither of the two predisposing elements.

Discussion: A 28-year-old Hispanic female presenting with substance use and suicidal ideation was placed on an involuntary psychiatric hold, started on olanzapine and scheduled for a psychiatric facility transfer. The following day, she was noted to have neurological deficits when ambulating. Computed tomography of the brain showed a right frontal …

Giant 75mm Intracranial Aneurysm Masquerading As Primary Malignancy, Andrew W. Hwang, Satvir Dhillon Md, Remus Popa

Internal Medicine

No abstract provided.

A Phantom Of The Past: Withdrawal From Meprobamate Presenting With Focal Seizures., Thomas M. Zink, John E. Erickson

Journal of Maine Medical Center

Introduction: Meprobamate (Miltown, Equinil) is a sedative-hypnotic medication that first gained popularity as an anxiolytic and later as a muscle relaxant. It is a major metabolite of the more commonly used muscle relaxant carisoprodol (Soma). In vitro and electroencephalogram studies demonstrated that meprobamate modulates gama-aminobutyric acid (GABA) receptors, similar to barbiturates. Withdrawal from meprobamate manifests in symptoms ranging from mild anxiety to severe autonomic instability and death. Meprobamate is rarely prescribed, but is still given to a small subset of elderly patients.

Clinical findings: In this case of meprobamate withdrawal, the patient initially displayed altered mental status and recurrent seizures …

Guillain Barre Syndrome In A Patient With Sickle Cell Anemia, Kunjan Udani Md, Pooja Patel, Dveet Patel, Hajra Awwab, Nino Balanchivadze

Internal Medicine

No abstract provided.

Moyamoya Disease Presenting With Stroke, Timothy Collins, Chimezie Ubbaonu, Phuong Vo

Internal Medicine

No abstract provided.

Multiple Sclerosis Outcomes After Cancer Immunotherapy, Catherine R. Garcia, Rani Jayswal, Val R. Adams, Lowell B. Anthony, John L. Villano

Markey Cancer Center Faculty Publications

INTRODUCTION: Neurological immune-related adverse events are a rare but potentially deadly complication after immune checkpoint inhibitor (ICI) treatment. As multiple sclerosis (MS) is an immune-mediated disease, it is unknown how ICI treatment may affect outcomes.

METHODS: We analyzed the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database for pembrolizumab, atezolizumab, nivolumab, ipilimumab, avelumab, and durvalumab 2 years prior their FDA approval until December 31, 2017, to include all cases with confirmed diagnosis/relapse of MS. We also included cases reported in the literature and a patient from our institution.

RESULTS: We identified 14 cases of MS …

Sensorimotor Polyneuropathy As The Initial Presentation Of Sarcoidosis: A Case Report Of A Rare Manifestation, Melanie Rojas, Lakshpaul Chauhan Md, Arshad M. Iqbal Md, Sadia Tufail, Nikolay Mitzov

Internal Medicine

No abstract provided.

Initial Management Of Meningiomas: Analysis Of The National Cancer Database, Catherine R. Garcia, Stacey A. Slone, Monica Chau, Janna H. Neltner, Thomas A. Pittman, John L. Villano

Neurology Faculty Publications

BACKGROUND: Meningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States.

METHODS: We analyzed the National Cancer Database from 2004 to 2014, for all patients with diagnosis of meningioma.

RESULTS: 201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Nilotinib-Associated Demyelinating Disease, Casey Judge Do, Negar Moheb Md, Christopher Melinosky Md

Department of Medicine

No abstract provided.

Stiff-Limb Syndrome: A Variant Of Stiff-Person Syndrome, Sagar Vadhar Do, Ethan S. Stern Do, Jaimin Patel Do, Keithan Sivakumar Md, Mba, N Shah Md

Department of Medicine

No abstract provided.