Determining the optimal timing for the initiation of early rehabilitation in pediatric non-traumatic acquired brain injury (ABI) remains challenging, largely because the onset of injury is often difficult to identify, particularly in infancy. We report the case of a 1-year-old boy with non-traumatic ABI of uncertain onset, in whom mobilization was initiated more than 24 hours after an imaging-based diagnosis. Neurorehabilitation, consisting primarily of active practice, was implemented safely, with no adverse events or neurological deterioration during the intervention. This case suggests that imaging-based assessment may serve as an adjunctive objective reference for determining the timing of early rehabilitation in pediatric non-traumatic ABI.
Hypersensitivity reactions to fibrin sealants used in microvascular decompression (MVD) are rare, and delayed eosinophilic meningoencephalitis with progressive brainstem injury has been scarcely reported. We present a case of severe delayed immune-mediated brainstem injury following fibrin-sealant application during MVD for trigeminal neuralgia, with an emphasis on its neurorehabilitation implications. A male patient with long-standing trigeminal neuralgia underwent MVD using a Teflon pledget secured with Beriplast® fibrin sealant. Immediately after surgery, he developed profound quadriplegia (Medical Research Council [MRC] grade 1 in all extremities). Magnetic resonance imaging on postoperative day (POD) 0 revealed ventral medullary and pontine T2/FLAIR hyperintensity without diffusion restriction, consistent with acute vasogenic edema. Despite complete surgical material removal on POD 1, deficits persisted. By POD 8, new diffusion-restricted lesions appeared, indicating secondary cytotoxic injury. Delayed eosinophilia peaked at 21.0% on POD 62, accompanied by a diffuse rash. Comprehensive workup excluded vascular, infectious, autoimmune, and drug-related causes. On transfer to our rehabilitation center (POD 251), motor strength was MRC 3+ in upper and 2- in lower extremities; the patient remained wheelchair-dependent with severe functional limitation and required assistance for all activities of daily living. Markedly prolonged somatosensory evoked potential and motor evoked potential latencies confirmed irreversible corticospinal and sensory pathway disruption, suggesting a potential ceiling for neuroplasticity-driven recovery in this case. Despite one month of structured inpatient neurorehabilitation, no meaningful functional gain was achieved. This case underscores the importance of early immune-mediated injury recognition and highlights the critical role of neurophysiological assessment in prognostication and rehabilitation goal-setting following catastrophic brainstem injury.
This case report describes an 82-year-old man with a right parasagittal motor cortex intracerebral hemorrhage who presented with visuospatial neglect disproportionate to the primary lesion. Quantitative diffusion tensor imaging analysis revealed white matter damage suggestive of underlying cerebral amyloid angiopathy. These findings highlight the importance of considering underlying conditions such as cerebral amyloid angiopathy and premorbid cognitive function when diagnosing visuospatial neglect in elderly stroke patients. Furthermore, assessing the microstructural integrity of non-lesioned white matter tracts may help identify causes of post-stroke cognitive impairment or unexplained symptoms and provide insight into premorbid cognitive function.
Meningiomas involving the supplementary motor area (SMA) are known to cause motor deficits, but acquired narcissistic personality changes following such lesions rarely described. We report a rare case of a 63-year-old woman who developed acquired narcissistic personality traits following the resection of a right frontal parasagittal meningioma involving the SMA, complicated by postoperative hemorrhage. Although previously cooperative, she manifested transient grandiosity, entitlement, and lack of empathy, temporarily meeting Diagnostic and Statistical Manual of Mental Disorders-5 criteria. Her symptoms improved with pharmacotherapy and rehabilitation. We hypothesize that while the SMA is not a canonical hub in the triple network model, this focal damage induced connectional diaschisis, disrupting functional connectivity to distant Salience and Default Mode Network hubs implicated in social cognition. This case suggests that acquired narcissistic personality traits can emerge from lesions in non-hub regions through remote network dysfunction, highlighting the importance of evaluating functional connectivity in acquired personality disorders.
Transcutaneous auricular vagus nerve stimulation (taVNS) is a promising non-invasive neuromodulation approach for addressing gait impairments in Parkinson's disease (PD). However, evidence regarding its effects on daily-life gait remains limited. We report a case of a 67-year-old woman with PD and freezing of gait (FOG), based on the hypothesis that taVNS may enhance gait automaticity under daily-life conditions. A single-case A-B-C design was used, consisting of baseline, sham stimulation, and taVNS phases. Gait performance was assessed using wearable accelerometry in both experimental and daily-life settings. While no significant changes were observed in gait parameters during experimental assessments, daily-life walking measures-step velocity, step length, variability, and asymmetry-showed improvements during the taVNS phase. Importantly, no falls or FOG episodes were observed during the taVNS phase. These findings support the feasibility of taVNS and provide preliminary support for its potential therapeutic role in enhancing gait automaticity in daily life. Further controlled studies are warranted.
