Nervous System Diseases Commons^™

Seeing The Pattern: Optic Neuritis, Multifocal Mri Lesions, And The Early Diagnosis Of Multiple Sclerosis, Jose J. Loayza Pintado, William Reckley, Aura Calderon, Luis Gaitan

Research Symposium

Background: Optic neuritis is a common neuro-ophthalmic emergency and may be the first clinical manifestation of inflammatory demyelinating disease. In the acute setting, clinicians must rapidly distinguish multiple sclerosis (MS) from important mimics, particularly when optic nerve involvement is accompanied by spinal cord lesions. A structured approach integrating phenotype, MRI lesion distribution and activity, and cerebrospinal fluid (CSF) markers can support timely diagnosis and guide counseling regarding long-term management. We report a young man presenting with unilateral optic neuritis and prior transient neurologic episodes, highlighting a practical diagnostic framework applicable to emergency and inpatient care.

Case Presentation: A 27-year-old man …

Age And Genotype-Dependent Baseline Characterization Of Spatial Learning And Memory In App/Ps1 Rats Using The Morris Water Maze, Thomas George, Mohammadreza Arbab, Nathanael Ricardo Alicea, Mahdie Kerdari, Christopher Janson

Rowan-Virtua Research Day

Background: Alzheimer’s disease (AD) is characterized by progressive cognitive decline. Transgenic APP/PS1 rat models offer improved translational relevance compared to mouse models due to closer similarity to human neurobiology.

Objective: To establish a baseline profile of spatial learning and memory across age and genotype in rate model.

Methods: The Morris Water Maze (MWM) was used to assess four groups of rats: young Wild Type (WT), young APP/PS1 (AD), middle-aged WT, and middle-aged AD. Spatial learning was evaluated during acquisition (Day 1–4) using cumulative proximity and escape latency. Memory was assessed using probe trials (Day 2–4). Swim velocity …

Incidence Of Stroke Post Pulmonary Thrombectomy: Implications For Periprocedural Management, Rohan Umrani, Rameez Shahid, Luai Tabaza

Rowan-Virtua Research Day

Background: The incidence of stroke after pulmonary thrombectomy (PT) remains unknown. Given the incidence of patent foramen ovale (PFO) of 25% in autopsy studies, the concern for paradoxical embolus in this patient population warrants evaluation of periprocedural management.

Methods: We queried the EPIC EHR at Virtua Health in New Jersey for all patients who underwent PT from 2021-2025, categorized by utilization of the Inari Flowtriever system or the Penumbra thrombectomy device. We assessed post-PT cerebrovascular accident (CVA), PFO presence by transthoracic echocardiogram (TTE), and gender via descriptive statistics. Age, average anesthesia time and procedure supply cost were assessed via two-sided …

Effect Of Parkinson’S Disease On The Lateralization Of The Digastric Muscle In A Rodent Model, Estelle Richardson, Francois Gould

Rowan-Virtua Research Day

In Parkinson’s disease, the loss of dopaminergic neurons in the substantia nigra can cause dysphagia, which affects all phases of swallowing. In swallowing, bilateral pairs of muscles under the control of independent unilateral neural mechanisms must simultaneously activate to coordinate their movements and produce a swallow. However it is unknown how Parkinson’s disease impairs the activation of the right and left sides of those muscles. In this study we tested how Parkinson’s disease impacts the lateralization of the digastric muscle in rats. We hypothesized that Parkinson’s disease will cause a difference in activation of the right and left digastric muscles …

Atypical Presentation Of Alpha-Gal Syndrome Identified During Evaluation Of Transient Neurologic Symptoms, Austin J. Wong, Todd Schachter

Rowan-Virtua Research Day

Alpha-gal syndrome (AGS) is an IgE-mediated hypersensitivity reaction to galactose-α-1,3-galactose, typically associated with tick exposure and delayed allergic reactions to mammalian meat products. While most commonly presenting with urticaria, gastrointestinal symptoms, or anaphylaxis, atypical and systemic manifestations remain poorly characterized.

We present the case of a 39-year-old male with minimal vascular risk factors who developed acute onset shortness of breath, chest pressure, and transient neurologic symptoms concerning for a transient ischemic attack. Extensive cardiac, vascular, and autoimmune evaluation was largely unremarkable aside from abnormalities in lupus anticoagulation screening and elevated homocysteine and protein C levels.

Further evaluation revealed elevated alpha-gal–specific …

Focal Status Epilepticus In A Patient With Responsive Neurostimulation: A Rare Complication And Management Insights, Ana Leticia Fornari Caprara Md, Jamir Pitton Rissardo, Pranaya Gade, Estefania Joselinne Alba-Rodriguez Md, Eric P. Nagele Md, Salman Assad Md, Islam Fayed Md, Evren Burakgazi-Dalkilic Md

Rowan-Virtua Research Day

Introduction: Responsive neurostimulation (RNS) is an established therapy for drug-resistant focal epilepsy, yet device-related complications during acute seizures remain underreported. We describe a case of focal status epilepticus in a patient with RNS, illustrating the interplay of possible device malfunction, systemic illness, and medication nonadherence. Case Report: A 39-year-old man with drug-resistant focal epilepsy and schizoaffective disorder, status post right frontal craniotomy and RNS implantation, presented with focal status epilepticus after several days of antiseizure medication (ASM) nonadherence, febrile illness, vomiting, and urinary tract infection (UTI). On admission, he was lethargic with frequent focal seizures (< 30 s) characterized by left head turn, left arm followed by bilateral arm tonic stiffening, and impaired awareness. Continuous EEG confirmed focal status epilepticus. Family declined intubation. A ketamine bolus (20 mg) followed by infusion (0.25–0.5 mg/kg/hr) for 24 hours achieved seizure cessation. Despite broad ASM therapy (phenytoin, zonisamide, perampanel, levetiracetam, clorazepate, cenobamate, carbamazepine, clonazepam, lacosamide), seizures persisted until RNS interrogation revealed high lead impedance; the device was deactivated. ASM doses were optimized, PEG tube placed for consistent delivery, and UTI treated. He stabilized and was discharged to rehabilitation. Conclusion: This case highlights the need for comprehensive evaluation in RNS patients presenting with focal status epilepticus. Device malfunction, systemic illness, and inconsistent ASM adherence can synergistically worsen seizure control. Multidisciplinary management including neurocritical care, device troubleshooting, and nutritional support was pivotal for recovery.

An Unusual Cause Of Generalized Weakness: Cns Toxoplasmosis, Christopher Dellmyer, Danielle Kusmaul, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

No abstract provided.

Case Report: Vertebral Artery Dissection After Cervical Manipulation, Devin Hoover, Emily Bolinger, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 22-year-old female who presented with dizziness and vomiting after recent cervical manipulation who was diagnosed with a dissection of the vertebral artery. Dizziness can have a variety of causes including vascular etiologies, cerebellar and brainstem lesions, ocular problems, trauma, and others. In the setting of a known trauma and acute vestibular symptoms, it is prudent to consider vascular injuries.

Air Quality, Atmospheric Pressure, And Migraine Presentations In The Emergency Department, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Migraine is a leading cause of Emergency Department (ED) visits and global disability. Weather has long been reported by patients as a trigger, yet the literature remains inconsistent. Prior ED-based data demonstrated an association between higher mean barometric pressure and increased migraine presentations, without a relationship to short-term pressure change. Because high-pressure systems are frequently associated with atmospheric stagnation and pollutant accumulation, air quality may represent a biologically plausible mediator.

Objective: To examine the relationship between air quality and ED migraine presentations within the existing body of literature and to explore whether air quality may help explain previously observed …

Unusual Etiology Of Cauda Equina Syndrome In An Aids Patient: A Case Report, Wesley Augustus Kim, Brandon Velazquez

Rowan-Virtua Research Day

Patients with advanced HIV/AIDS are at high risk for primary central nervous system (CNS) lymphoma due to impaired immune surveillance and HIV-driven B-cell proliferation. While intracranial lesions are well recognized, spinal involvement remains underrecognized due to the scarcity of well documented report cases in current literature. In this patient,we describe the case of a 35-year-old male with a new HIV diagnosis who experienced acute bilateral lower extremity weakness and urinary retention during hospitalization for fever, perianal abscess, and urinary tract infection. Initial CD4 count revealed profound immunosuppression with a CD4 count less than 20 cells/μL and a viral load of …

Efficacy Of Repetitive Transcranial Magnetic Stimulation In Reducing Pain Intensity In Chronic Neuropathic Pain: A Sham-Controlled Analysis, Aprupa Alahari, Nathan Nhan, Cindy Nguyen, Samnit Gill, Simran Parmar, Annelisse Zara

Rowan-Virtua Research Day

Background 

Chronic neuropathic pain (CNP) can be refractory to traditional pharmacologic therapies, giving rise to the investigation of non-invasive alternatives such as repetitive transcranial magnetic stimulation (rTMS). rTMS utilizes magnetic fields to modulate neuronal activity within specific brain regions, offering a targeted approach to analgesia without the side effects of systemic medication1,2,3,4.

Hypothesis 

rTMS produces a greater reduction in reported pain intensity compared to sham stimulation in adults diagnosed with CNP.

Methods 

A systematic review and analysis  were conducted, utilizing PubMed and Embase (2004–2025) for sham-controlled randomized controlled trials (RCTs) and relevant meta-analyses. The review focused on outcomes such as …

Health Disparities In Pediatric Epilepsy: A Narrative Review Of Barriers To Equitable Care, Nikhila Archakam, Akhila Archakam, Wesley Kim, Harshal Parmar

Rowan-Virtua Research Day

Epilepsy affects approximately 1% of children in the United States, representing over 456,000 pediatric patients with active seizure disorders. Despite advances in antiseizure medications and surgical interventions, the benefits of these developments are not distributed equally across racial, socioeconomic, and geographic groups. A narrative review of the literature was conducted using PubMed, Scopus, Embase, and Medline using search terms including "pediatric epilepsy," "health disparities," "health equity," "social determinants of health," "race," "socioeconomic status," and "access to care." Articles were included if they focused on pediatric populations aged 0 to 17, addressed at least one disparity domain, and were published between …

When Biomarkers Disagree: Diagnostic Challenges In Alzheimer’S Disease, Hayya Ali, Omar C. Chishti

Rowan-Virtua Research Day

Alzheimer’s disease (AD) is commonly diagnosed using a combination of clinical evaluation and biomarkers, including amyloid positron emission tomography (PET) imaging and tau protein levels. However, discordant biomarker findings can complicate diagnosis and clinical decision-making. We present a case study of a patient with progressive cognitive decline who demonstrated positive amyloid PET imaging but negative tau biomarkers. The objective of this case report is to demonstrate key diagnostic challenges in Alzheimer’s disease and highlight the need for a comprehensive, multimodal diagnostic approach. This case underscores the limitations of relying on a single biomarker modality and highlights the potential for overlap …

Sleep Architecture And Delirium In Patients With Intracerebral Hemorrhage: A Preliminary Observational Study, Lily Roessler, Kevin Eaise, Jamie Feinour Msn, Crnp, Jennifer Jond Ms, Pa-C, Vanessa Salasky Md, Mikel Shea Ehntholt Md, Bethany C. Young

Rowan-Virtua Research Day

Background: Delirium is common among ICU stroke patients and could possibly be associated with disrupted sleep. However, the relationship between specific sleep characteristics and delirium remains unclear.

Objective: To evaluate the association between sleep architecture and delirium in intracerebral hemorrhage (ICH) patients in the ICU.

Methods: We performed a primary analysis of 14 ICU ICH patients who underwent polysomnography. Sleep variables included total sleep time, sleep efficiency, sleep stages (N1, N2, N3, REM), arousal index, and sleep latency. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Patients were categorized by presence or absence of delirium. Continuous …

Prevalence And Clinical Correlates Of Restless Legs Syndrome In Neuromyelitis Optica Spectrum Disorder: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Restless legs syndrome (RLS) is increasingly recognized in neuromyelitis optica spectrum disorder (NMOSD), yet published prevalence estimates remain highly variable, largely because of small sample sizes and methodological heterogeneity. We sought to estimate the pooled prevalence of RLS in NMOSD using published observational studies. Methods: A systematic literature search of PubMed was performed using the terms “restless legs syndrome” AND “neuromyelitis optica spectrum disorder”, identifying all original studies reporting RLS prevalence in NMOSD. Seven studies (2016–2026) met inclusion criteria. Study‑level data on RLS events and NMOSD sample size were extracted. A proportion‑weighted fixed‑effect meta‑analysis was performed. Pooled prevalence estimates …

Wearable And Technology‑Assisted Gait And Balance Interventions In Parkinson’S Disease: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Nishant Patel, Jarvish Shah, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Wearable sensors and cue‑based technologies are increasingly used to augment rehabilitation in Parkinson’s disease (PD). However, the magnitude of benefit across clinical domains remains uncertain. Objective: This meta‑analysis aimed to quantify the effects of technology‑assisted interventions in PD. Methods: Randomized controlled trials evaluating wearable‑assisted interventions were systematically identified from PubMed. Outcomes included motor severity (Movement Disorders Society Unified Parkinson Disease Rating Scale Part III), balance (Berg Balance Scale, Mini‑BESTest, POMA balance), gait speed, walking endurance, freezing of gait (FOG‑Q/NFOG‑Q), fear of falling, and quality-of-life (PDQ‑39/PDQ‑8). Meta‑analyses were performed using random‑effects models to account for between‑study heterogeneity. Statistical heterogeneity was …

Trends And Disparities In Mortality Involving Epilepsy And Aspiration Pneumonia Among Older Adults In The United States, 1999–2020, Pranaya Gade, Jarvish Shah, Daarsh Goradia, Nishant Patel, Jamir Pitton Rissardo Md, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Introduction: Epilepsy in older adults is frequently complicated by swallowing dysfunction, increasing the risk of aspiration pneumonia. Despite its clinical relevance, national trends and demographic disparities in deaths involving these conditions remain poorly characterized. Methods: We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999–2020) for individuals aged ≥65 years with epilepsy (ICD-10 G40, G41) and aspiration pneumonia (J69) listed as causes. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percentage changes (APCs) with 95% confidence intervals were calculated using Joinpoint Regression. Analyses were stratified by sex, race/ethnicity, census region, and state. Results: From 1999 …

Cerebrospinal Fluid And Serum Manganese Levels In Parkinson’S Disease: A Method‑Stratified Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Manganese (Mn) exposure can cause parkinsonism, but circulating and cerebrospinal fluid (CSF) Mn levels in idiopathic Parkinson’s disease (PD) have been reported inconsistently. This study aims to determine whether Mn concentrations differ between patients with PD. Methods: A systematic review of PubMed/Medline studies reporting CSF/serum Mn concentrations in PD was done. Random‑effects models with inverse‑variance weighting were used to pool mean differences (MDs). Studies were stratified a priori by analytical method. Results: For CSF Mn, the overall pooled effect showed no significant difference between PD and controls (MD 0.08 μg/L, 95% CI −0.31 to 0.47; I2=85.7%). Subgroup analysis revealed …

Efficacy And Safety Of Levetiracetam For Essential Tremor: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo, Daarsh Goradia, Nishant Patel, Jarvish Shah, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Essential tremor (ET) is a common movement disorder with limited therapeutic options. Levetiracetam has been proposed as a potential treatment, but published studies report inconsistent efficacy and safety findings. We performed a meta‑analysis to quantify the efficacy and safety of levetiracetam in patients with essential tremor using pooled effect estimates. Methods: A systematic review of PubMed was performed to identify clinical studies evaluating levetiracetam for ET. Continuous efficacy outcomes were pooled using standardized mean differences (SMD) with inverse‑variance random‑effects models. Binary adverse events were pooled using risk ratios (RR) with Mantel–Haenszel random‑effects models. Heterogeneity was assessed using I2 statistics. …

Effects Of Subthalamic Nucleus Deep Brain Stimulation On Depressive Symptoms In Patients With Parkinson’S Disease: A Meta‑Analysis, Jamir Pitton Rissardo Md, Jarvish Shah, Nishant Patel, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Depression is a prevalent non‑motor symptom of Parkinson’s disease (PD) and may adversely affect quality-of-life and overall treatment outcomes. Subthalamic nucleus deep brain stimulation (STN‑DBS) is an established therapy for motor symptoms, yet its impact on depressive symptoms remains controversial. This meta‑analysis aimed to evaluate the effect of STN‑DBS on depressive symptoms in PD. Methods: PubMed‑indexed studies meeting predefined eligibility criteria were identified and included. Random‑effects meta‑analyses were performed using REML. Mean differences (MDs) between STN‑DBS and control conditions were pooled separately for Beck Depression Inventory (BDI) and its revision (BDI-II), and the Hamilton Depression Rating Scale (HAMD). Heterogeneity …

Collet–Sicard Syndrome Secondary To Internal Carotid Artery Dissection Following Cervical Self-Manipulation, Ryan K. Alali, James Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 40-year-old male presenting with progressive dysphagia who was ultimately diagnosed with Collet–Sicard syndrome secondary to internal carotid artery (ICA) dissection. While most reported cases are associated with trauma, this case highlights an atypical etiology following cervical self-manipulation. The patient presented with dysphagia to solids, liquids, and saliva, along with several days of ipsilateral headache and neck pain. Neurologic examination revealed tongue deviation, prompting advanced imaging. CTA demonstrated left ICA dissection, which was further characterized on MRI. The patient was managed with dual antiplatelet therapy and multidisciplinary care, including neurology, neurosurgery, and speech-language pathology, and …

High-Intensity Interval Training And Circulating Brain-Derived Neurotrophic Factor In Healthy Young Adults: A Scoping Review, Rikuto Abe, Safe Elhakeem, Mohamed Elhakeem

Rowan-Virtua Research Day

Abstract

Background: Brain-derived neurotrophic factor (BDNF) plays an important role in synaptic plasticity, neuronal survival, and cognitive function (1,2,3). High-intensity interval training (HIIT) has emerged as a time-efficient exercise modality capable of inducing neurotrophic adaptations (4,5). However, the magnitude and consistency of its effects on circulating BDNF remain unclear.

Objective: This scoping review evaluated the current evidence examining the effects of HIIT on circulating BDNF levels measured via enzyme-linked immunosorbent assay (ELISA) in healthy young adults.

Methods: A systematic search of PubMed, Embase, and Scopus was conducted for randomized and controlled clinical trials published between 2020 and 2025. Studies were …

Gut Microbiota Dysbiosis In Down Syndrome: Implications For Gastrointestinal And Neurological Health, Ashlyn Mcclelland, Jennifer Lecomte, Wendy Aita, Andrea Iannuzzelli

Rowan-Virtua Research Day

Down syndrome (DS) is the most common autosomal aneuploidy and has strong associations with increased gastrointestinal, neurological, and immune disorders. Emerging evidence suggests that gut microbiota dysbiosis may play a prominent role in disorders of gut-brain interaction, including constipation and irritable bowel syndrome affecting over half of individuals with DS. This review examines how gut microbiota alterations can contribute to chronic systemic inflammation and neurological manifestations in DS. Included articles were published between 2014 and 2025 and evaluated microbiota composition, inflammatory markers, and gastrointestinal or neurological outcomes in human or animal models of DS.

Across seven studies, characteristic microbiome shifts …

Holmes Tremor In A Patient With Multiple Sclerosis: A Case Report, Delaney Rowe

Rowan-Virtua Research Day

Multiple Sclerosis (MS) is a neurologic condition characterized by demyelination of motor neuron axons. About a third of MS patients experience tremor, typically postural or intention type. This case study details a patient with a history of Multiple Sclerosis-associated therapy-resistant severe rubral tremor. Reviewed literature demonstrates an increased need for diagnostic tools specific to MS patients with Holmes tremors, as well as further investigation of dopamine-based pharmacologic therapy for such patients.

Feasibility Of 90-Day Follow Up For Patients With Intracerebral Hemorrhage: Early Data From A Neuro Icu Sleep Quality And Delirium Study, Sierra Triolo, Bethany C. Young, Mikel Shea Ehntholt, Anuoluwapo Fadare, Jamie R. Feinour, Jennifer A. Jond, Jonathan Perumpail, Kevin Eaise, Lily Roessler, Shay Lynn Greco, Vanessa Salasky

Rowan-Virtua Research Day

Background. Neuro intensive care unit (ICU) patients often experience sleep deprivation due to serial neurologic assessments, among other factors. Subjective sleep disturbance has been associated with increased delirium risk in patients with intracerebral hemorrhage (ICH).¹ However, relationships between specific sleep features, delirium and subsequent outcomes in neurocritically ill patients have not been studied.¹ Additionally, ICH-related clinical research has not historically been conducted at Virtua Our Lady of Lourdes (VOLOL) Hospital. This study aimed to assess feasibility of obtaining quantitative sleep data, delirium assessments, and 90-day functional outcomes in neurocritical care patients with ICH.

Hypothesis. We hypothesized that 90-day …

Improving Anesthesia Provider Confidence In The Identification, Management, And Treatment Of Postoperative Delirium, Brittany M. Whistle, Charles Dustin Phelps

Scholars Week

Purpose: Postoperative Delirium (POD) is a potentially devastating complication of anesthesia that is poorly understood by clinical staff leading to poor outcomes for surgical patients. This study is meant to determine if a focused knowledge presentation accompanied by visual aids could increase anesthesia providers confidence in identifying, diagnosing, and treating Postoperative Delirium.

Methodology: Utilizing a statistical model to analyze respondents results on a standardized test administered before and after an informational presentation with visual aids on the topic of Postoperative Delirium.

Results: Results indicated a statistically significant difference between pretest and posttest scores, with a p-value of .002, t(11) = …

Bcl-2 Regulation As Seen In Alzheimer's Disease, Whitley Whitehead, Joseph Marek, Jack Lowry, Parker Shirley

Student Scholar Symposium

Alzheimer’s Disease (AD) is a degenerative and destructive disorder causing progressive impairment and loss of the nerve cells, eventually leading to further impairments of cognitive functions. Calcium ions (Ca2+) are vital for cell signaling and muscle contraction. The Bcl-2 protein family helps regulate cell death by controlling the release of Ca2+ from the ER. Bcl-2 can also block pro-apoptotic proteins from puncturing the mitochondria and causing intrinsic apoptosis. In AD, the presence of amyloid-beta plaques and neurofibrillary tangles downregulates Bcl-2 production. The loss of Bcl-2 leads to mitochondrial damage, heightened calcium levels, and oxidative stress. Although there is no cure …

Ocular Blood Flow And Retinal Vascular Reactivity In Alzheimer’S Disease: A Systematic Review Of Retinal Images, Tori Sayers, Alexa Nichols, Amin Ibrahim, Igor Zwir, Andrew Tsin, Lorena Flores-Hernandez, Gladys E. Maestre, Jesus D. Melgarejo

Research Colloquium

Background: Alzheimer’s disease (AD) is the most common form of dementia and one of the leading causes of disability and death in the United States¹. Research efforts aim to identify pathological changes that may help support earlier detection of AD and lead to more accessible tools for monitoring disease progression². The retina is being explored as a potential non-invasive marker of AD, reflecting the shared embryology and microvasculature features between the retina and the brain. Although research has focused on structural changes in retinal vessel diameters and density, few studies have evaluated functional markers of retinal …

Ischemic Stroke In A Patient With Atrial Fibrillation Despite Therapeutic Anticoagulation With Rivaroxaban: A Clinical Reminder, Ridwan Ademola Lawal, Angelica Lan Pham

Research Colloquium

Background: Atrial fibrillation is a well-established risk factor for cardioembolic stroke, with anticoagulation significantly reducing this risk. However, breakthrough ischemic strokes can still occur in anti-coagulated patients, with an estimated annual incidence of 1-2% despite appropriate direct oral anticoagulant (DOAC) therapy. These rare but consequential events challenge clinicians to maintain high diagnostic vigilance, especially in patients presenting with atypical or subtle neurological symptoms. Here, we present a case of an embolus in a patient on long-term rivaroxaban therapy, underscoring a vital clinical teaching point: therapeutic anticoagulation does not eliminate stroke risk, and homonymous hemianopsia may be the only presenting feature. …

A Unique Case Of Limbic Encephalitis In The Rio Grande Valley, A Case Report, Osiris Fernandez-Betances, Kevin A. Garcia Valdez

Research Colloquium

Background: Limbic encephalitis (LE) is a rare but increasingly recognized autoimmune subtype of encephalitis that primarily affects the limbic system, which includes the medial temporal lobe, hippocampus, frontobasal, and cingulate cortex. LE was initially believed to cause inflammation restricted to the limbic region; however, subsequent studies have shown that the disease process can extend to other brain areas, resulting in a wide range of neurological and psychiatric manifestations.

Case Presentation: We present the case of a 64-year-old Hispanic male with multiple emergency department visits due to progressive neurologic symptoms. From late November of 2023 to January of 2024, the patient …