Acute ptotic myelopathy: cervical compressive myelopathy resulting from prolonged head ptosis after alcohol intoxication.

A 28-year-old man was brought to the emergency department with quadriparesis of acute onset after a bout of binge drinking. Evaluation revealed a mid-cervical myelopathy and magnetic resonance imaging (MRI) showed an acute compressive cervical myelopathy. He also developed rhabdomyolysis, and cervical paraspinal muscles showed MRI hyperintensities. After resolution of rhabdomyolysis and acute kidney injury, he underwent cervical spine fixation. He was found to have acute dropped head syndrome with secondary compressive myelopathy.

Screening Power of Short Tau Inversion Recovery Muscle Magnetic Resonance Imaging in Critical Illness Myoneuropathy and Guillain-Barre Syndrome in the Intensive Care Unit.

Introduction: Critical illness myoneuropathy (CIMN) or intensive care unit (ICU)-acquired weakness (AW) is a common cause of weakness in ICU patients. Guillain-Barre syndrome (GBS) is also a common cause of acute neurological weakness in the ICU. It is diagnosed by clinical features, nerve conduction studies (NCS), and muscle/nerve biopsies. Methods: The short tau inversion recovery (STIR) muscle magnetic resonance (MR) images of seven patients with suspected CIMN and seven GBS patients over a 5-year period from February 2015 till May 2020 were analyzed. Results: All seven patients with CIMN showed diffuse muscle edema, predominating in the lower limbs. Only one patient with GBS showed abnormal magnetic resonance imaging (MRI) changes (14%) and MRI was normal in 86%. The sensitivity of MRI to detect CIMN was 100%, whereas the specificity was 85.7%. Thus, the positive predictive value (PPV) of MRI in this situation was 87.5% and the negative predictive value (NPV) was 100%. Conclusion: Muscle STIR imaging may help to differentiate between CIMN and GBS. How to cite this article: Maramattom BV. Screening Power of Short Tau Inversion Recovery Muscle Magnetic Resonance Imaging in Critical Illness Myoneuropathy and Guillain-Barre Syndrome in the Intensive Care Unit. Indian J Crit Care Med 2022;26(2):204-209.

Cortical unihemispheric brain edema (CUBE) due to a multi-system inflammatory syndrome in adults (MIS-A).

Unilateral hemispheric edema may occur with or without seizures. It is a rare entity, found more often in children, than in adults. As many of these patients develop pronounced unilateral complete cortical hemispheric (uni-hemispheric) edema on MRI, we have used the term "cortical unihemispheric brain edema" (CUBE) to describe this entity. We describe a case of CUBE occurring along with a post COVID multi-system inflammatory syndrome in adults (MIS-A). A 30-year-old man was admitted with status epilepticus. He was found to have CUBE and features of MIS-A. He had a history of mild COVID-19 illness one month earlier. He was noted to have persistently elevated inflammatory markers and multiorgan dysfunction compatible with MIS-A. We review the cases of CUBE in the literature and describe the features and etiology of this uncommon syndrome. Furthermore, we discuss the differences between two types of CUBE;cytotoxic CUBE (CUBE-C) and vasogenic CUBE (CUBE-V).

Great balls of fire! The basal ganglia on fire.

A 76-year-old man presented to the hospital with intermittent dizziness, memory impairment and jerky movements. Evaluation revealed them to be faciobrachial dystonic seizures and antibodies to voltage-gated potassium channel complexes were found. He was treated with intravenous methylprednisolone and rituximab, and made a remarkable recovery. Magnetic resonance imaging of the brain was normal, although positron emission tomography - computed tomography showed striking basal ganglia changes.

Understanding and Managing Autonomic Disorders in the Neurocritical Care Unit: A Comprehensive review.

Background: For a favorable outcome, patients admitted to critical care units require continuous monitoring and swift decision-making ability regarding management. One of the biggest challenges in neurocritical care units is the identification and management of autonomic dysfunction and in the worst-case scenario, autonomic storms. Objective: Most of the literature available focuses mainly on autonomic storms following traumatic brain injury. However, due to the myriad neurological presentations in a critical care setting, it is particularly important for physicians and intensivists to suspect and manage autonomic dysfunction in various neurological scenarios. Methods: Understanding the mechanism of paroxysmal sympathetic hyperactivity (PSH) is essential for early recognition and treatment. PSH-AM is an assessment measurement scale to diagnose and assess the severity of PSH in traumatic brain injury. However, this is not yet standardized across all neurological settings. Conclusion: We present a comprehensive report on understanding the mechanism of autonomic storms across various neurological disorders and outline the management.