Co-occurrence of ipsilateral partial Horner's syndrome in a patient with monomelic amyotrophy.

Monomelic amyotrophy (MMA) is a lower motor neuron predominant disorder affecting an upper limb, which can mimic amyotrophic lateral sclerosis (ALS). It often presents with unilateral, distal upper limb weakness and atrophy, whose trajectory is one of an initial period of progression followed by a prolonged plateau, as opposed to the typically relentless progression as is seen in ALS. This case report describes a novel observation of a patient with MMA with an unexplained ipsilateral partial Horner's syndrome (miosis and ptosis).

Improvement of Confidence and Knowledge Retention for Stroke Management Among Internal Medicine Trainees During an Institution-Specific, Protocol-Oriented Lecture Based Intervention.

Background: Acute stroke management is an essential component of neurology residency education. Internal medicine trainees are less likely to receive dedicated training in acute stroke care despite having to care for hospitalized patients with a stroke diagnosis.

Objective: The objectives of this survey-based quality improvement study were to: 1) assess pre-existing confidence and knowledge about acute stroke care among internal medicine trainees and 2) measure change after an institution-specific, protocol-oriented "value added lecture" (intervention).

Occipital intermittent rhythmic delta activity (OIRDA) in pediatric focal epilepsies: A case series.

In this case series, we have identified an atypical pattern of OIRDA (Occipital intermittent rhythmic delta activity) on the electroencephalograms (EEGs) of three pediatric patients with self-limited focal epilepsies, including Childhood Epilepsy with Centrotemporal Spikes (CECTS), and Panayiotopoulos syndrome (PS). Previously, OIRDA was described as a symmetric sinusoidal occipital-maximal activity, often associated with childhood idiopathic generalized epilepsies, although it was also reported among other physiologic or pathological entities including focal epilepsy. We have observed in our case series that OIRDA, without prominent field effect, is lateralized or maximal on the hemispheric side ipsilateral to the more defining epileptiform discharges in these focal epilepsies.

Partial Recanalization of a Large Vessel Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator, Followed by Systemic Anticoagulation, in the Setting of COVID-19-Induced Hypercoagulability: A Case Report.

We report on the use of systemic heparinization following thrombolysis with intravenous tissue plasminogen activator (t-PA) for acute ischemic large vessel stroke, in the setting of COVID-19-induced hypercoagulability, with partial recanalization of the internal carotid artery. Off-label systemic heparinization was used within 12 hours of t-PA administration, after extensive multidisciplinary collaboration and family discussion, given evidence of severe hypercoagulability. We conclude that thrombolysis should be considered for all eligible patients with suspected or confirmed COVID-19 and acute ischemic stroke, and systemic anticoagulation, although with inherent risks, may be a useful adjunct treatment modality in selected patients who have received intravenous thrombolysis.

Central Disorders of Hypersomnolence, Restless Legs Syndrome, and Surgery With General Anesthesia: Patient Perceptions.

The importance of obstructive sleep apnea in patients undergoing surgery with general anesthesia is well-defined, but the surgical and anesthetic implications of other sleep disorders are less clear. We sought to evaluate response to surgery with general anesthesia in patients with central disorders of hypersomnolence or restless legs syndrome. We surveyed patients on their most recent surgical procedure with general anesthesia, querying about procedure, recovery, and any changes in sleep disorder symptomatology following the procedure.

Flumazenil for the Treatment of Refractory Hypersomnolence: Clinical Experience with 153 Patients.

Study Objectives: Patients with central disorders of hypersomnolence sometimes do not achieve satisfactory symptom control with currently available wake-promoting medications. Based on the finding that the cerebrospinal fluid from some patients with hypersomnolence demonstrates potentiation of gamma-aminobutyric acid (GABA)-A receptors in excess of that of controls, a finding that reverses with flumazenil, we initiated prescribing compounded flumazenil to carefully selected, treatment-refractory hypersomnolent patients.

Methods: This retrospective chart review evaluated the first 153 consecutive patients treated with transdermal and/or sublingual flumazenil by physicians at our center from 2013 through January 2015.

Interaction between troponin and myosin enhances contractile activity of myosin in cardiac muscle.

Ca(2+) signaling in striated muscle cells is critically dependent upon thin filament proteins tropomyosin (Tm) and troponin (Tn) to regulate mechanical output. Using in vitro measurements of contractility, we demonstrate that even in the absence of actin and Tm, human cardiac Tn (cTn) enhances heavy meromyosin MgATPase activity by up to 2.5-fold in solution.