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2. Fever and Therapeutic Hypothermia

Author

Subramaniam, Thanujaa, Parasram, Melvin, Barnes, Erin C., Picard, John M., Sheth, Kevin N., Mahanna Gabrielli, Elizabeth, editor, O'Phelan, Kristine H., editor, Kumar, Monisha A., editor, Levine, Joshua, editor, Le Roux, Peter, editor, Gabrielli, Andrea, editor, and Layon, A. Joseph, editor

Published
2024
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5. Assessing Effects of Intrathecal Nicardipine on Cerebral Autoregulation and Cortical Activity in Aneurysmal Subarachnoid Hemorrhage (P10-5.019)

Author

Jayasundara, Sithmi, primary, Kim, Jennifer, additional, Choi, Rachel, additional, Rapuano, Amedeo, additional, Barnes, Erin, additional, Parasram, Melvin, additional, Moura, Michele, additional, Uppal, Puneet, additional, Chen, Yilun, additional, Top, Ilayda, additional, Olexa, Madelynne, additional, Maarek, Rafael, additional, Yan, Jennifer, additional, Beekman, Rachel, additional, Magid-Bernstein, Jessica, additional, Hebert, Ryan, additional, Bahrassa, Farhad, additional, Matouk, Charles, additional, Sheth, Kevin, additional, Gilmore, Emily, additional, and Petersen, Nils, additional

Published
2024
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7. Curriculum Innovations: A Social Media–Based Educational Curriculum Improves Knowledge for Trainees in Neurocritical Care

Author

Alvarado-Dyer, Ronald, primary, Saleh Velez, Faddi G., additional, Kamdar, Hera A., additional, Niznick, Naomi, additional, Carroll, Elizabeth, additional, Castillo-Pinto, Carlos, additional, Parasram, Melvin, additional, Kelly, Dearbhla, additional, Goswami, Shweta, additional, Ehntholt, Mikel S., additional, Dangayach, Neha S., additional, Babi, Marc-Alain, additional, Ramadan, Ahmad Riad, additional, Lazaridis, Christos, additional, Albin, Catherine, additional, and Morris, Nicholas A., additional

Published
2023
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8. Acute and subacute neurovascular impact of cryptogenic air emboli

Author

Gummerson, Christine E., primary, Parasram, Melvin, additional, Peng, Teng J., additional, Picard, John M., additional, Kahn, Peter A., additional, Angelus, Evan, additional, Bhatt, Shivani, additional, Havenon, Adam de, additional, Jasne, Adam S., additional, and Magid-Bernstein, Jessica, additional

Published
2023
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20. Supplemental Material, sj-docx-1-nho-10.1177_19418744211026709 - Risk of Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors

Author

Parasram, Melvin, Parikh, Neal S., Merkler, Alexander E., Falcone, Guido J., Sheth, Kevin N., Navi, Babak B., Kamel, Hooman, Zhang, Cenai, and Murthy, Santosh B.

Subjects
FOS: Clinical medicine, 110306 Endocrinology, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental Material, sj-docx-1-nho-10.1177_19418744211026709 for Risk of Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors by Melvin Parasram, Neal S. Parikh, Alexander E. Merkler, Guido J. Falcone, Kevin N. Sheth, Babak B. Navi, Hooman Kamel, Cenai Zhang and Santosh B. Murthy in The Neurohospitalist

Published
2021
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21. HaNDL Syndrome Presenting with Thunderclap Headache

Author

Parasram, Melvin, Malhotra, Ashwin, Yoo, Andrea S., and Mir, Saad A.

Subjects
Article Subject
Abstract

Introduction. Transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) is defined as a secondary, nonvascular headache disorder characterized by the findings described in its name. Patients with HaNDL syndrome typically present with gradual onset migrainous headaches of moderate to severe intensity with transient neurological symptoms. Case Report. We discuss a patient who presented with thunderclap headache, recent transient neurologic deficits, and was ultimately diagnosed with HaNDL after an extensive neurologic evaluation. Conclusion. Thunderclap headache has very rarely been described in patients with HaNDL. After excluding emergent and secondary causes, HaNDL should be considered in patients with thunderclap-quality headaches, particularly when there is a history of transient neurological symptoms.

Published
2021
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32. Long-Term Risk of Ischemic Stroke among Elderly Survivors of Non-Traumatic Subarachnoid Hemorrhage.

Author

Parasram, Melvin, Parikh, Neal S., Merkler, Alexander E., Ch'ang, Judy H., . Navi, Babak B, Kamel, Hooman, Zhang, Cenai, and Murthy, Santosh B.

Subjects
*STROKE, *SUBARACHNOID hemorrhage, *ISCHEMIC stroke, *DISEASE risk factors, *OLDER patients, *OLDER people
Abstract

Introduction: Non-traumatic subarachnoid hemorrhage (SAH) is associated with poor long-term functional outcomes, but the risk of ischemic stroke among SAH survivors is poorly understood. Objectives: The aim of this study was to evaluate the risk of ischemic stroke among survivors of SAH. Methods: We performed a retrospective cohort study using claims data from Medicare beneficiaries from 2008 to 2015. The exposure was a diagnosis of SAH, while the outcome was an acute ischemic stroke, both identified using previously validated ICD-9-CM diagnosis codes. We used Cox regression analysis adjusting for demographics and stroke risk factors to evaluate the association between SAH and long-term risk of ischemic stroke. Results: Among 1.7 million Medicare beneficiaries, 912 were hospitalized with non-traumatic SAH. During a median follow-up of 5.2 years (IQR, 2.7–6.7), the cumulative incidence of ischemic stroke was 22 per 1,000 patients per year among patients with SAH, and 7 per 1,000 patients per year in those without SAH. In adjusted Cox models, SAH was associated with an increased risk of ischemic stroke (HR, 2.0; 95% confidence interval, 1.4–2.8) as compared to beneficiaries without SAH. Similar results were obtained in sensitivity analyses, when treating death as a competing risk (sub HR, 3.0; 95% CI, 2.8–3.3) and after excluding ischemic stroke within 30 days of SAH discharge (HR, 1.5; 95% CI, 1.1–2.3). Conclusions: In a large, heterogeneous national cohort of elderly patients, survivors of SAH had double the long-term risk of ischemic stroke. SAH survivors should be closely monitored and risk stratified for ischemic stroke. [ABSTRACT FROM AUTHOR]

Published
2022
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33. Risk of Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors

Author

Parasram, Melvin, Parikh, Neal S., Merkler, Alexander E., Falcone, Guido J., Sheth, Kevin N., Navi, Babak B., Kamel, Hooman, Zhang, Cenai, and Murthy, Santosh B.

Abstract

Background and Purpose: The impact of arterial ischemic events after intracerebral hemorrhage (ICH) on outcomes is unclear. This study aimed to evaluate the risk of death among ICH survivors with and without an incident arterial ischemic event.Methods: We performed a retrospective cohort study using claims data from Medicare beneficiaries with a non-traumatic ICH from January 2008 to October 2015. Our exposure was an arterial ischemic event, a composite of acute ischemic stroke or myocardial infarction (MI), identified using validated ICD-9-CM diagnosis codes. The outcome was mortality. We used marginal structural models to analyze the risk of death among ICH patients with and without an arterial ischemic event, after adjusting for confounders as time-varying covariates.Results: Among 8,804 Medicare beneficiaries with ICH, 2,371 (26.9%) had an arterial ischemic event. During a median follow-up time of 1.9 years (interquartile range, 0.7-3.9), ICH patients with an arterial ischemic event had a mortality rate of 21.7 (95% confidence interval [CI], 20.4-23.0) per 100 person-years compared to a rate of 15.0 (95% CI, 14.4-15.6) per 100 person-years in those without. In the marginal structural model, an arterial ischemic event was associated with an increased risk of death (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.6-1.9). In secondary analyses, the mortality risk was elevated after an ischemic stroke (HR, 1.7; 95% CI, 1.5-1.8), and MI (HR, 3.0; 95% CI, 2.4-3.8).Conclusions: We found that elderly patients who survived an ICH had an increased risk of death after a subsequent ischemic stroke or MI.

Published
2022
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34. A Case of Lyme Carditis Presenting with Atrial Fibrillation

Author

Kennel, Peter J., Parasram, Melvin, Lu, Daniel, Zisa, Diane, Chung, Samuel, Freedman, Samuel, Knorr, Katherine, Donahoe, Timothy, Markowitz, Steven M., and Halazun, Hadi

Subjects
Article Subject, cardiovascular system, cardiovascular diseases, bacterial infections and mycoses
Abstract

We report a case of a 20-year-old man who presented to our institution with a new arrhythmia on a routine EKG. Serial EKG tracings revealed various abnormal rhythms such as episodes of atrial fibrillation, profound first degree AV block, and type I second degree AV block. He was found to have positive serologies for Borrelia burgdorferi. After initiation of antibiotic therapy, the atrial arrhythmias and AV block resolved. Here, we present a case of Lyme carditis presenting with atrial fibrillation, a highly unusual presentation of Lyme carditis.

Published
2018
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35. Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis

Author

Gopal, Mangala, Parasram, Melvin, Patel, Harsh, Ilorah, Chike, and Nersesyan, Hrachya

Subjects
Article Subject
Abstract

Central pontine myelinolysis (CPM) is an acute demyelinating neurological disorder affecting primarily the central pons and is frequently associated with rapid correction of hyponatremia. Common clinical manifestations of CPM include spastic quadriparesis, dysarthria, pseudobulbar palsy, and encephalopathy of various degrees; however, coma, “locked-in” syndrome, or death can occur in most severe cases. Rarely, CPM presents with neuropsychiatric manifestations, such as personality changes, acute psychosis, paranoia, hallucinations, or catatonia, typically associated with additional injury to the brain, described as extrapontine myelinolysis (EPM). We present a patient with primarily neuropsychiatric manifestations of CPM, in the absence of focal neurologic deficits or radiographic extrapontine involvement. A 51-year-old female without significant medical history presented with dizziness, frequent falls, diarrhea, generalized weakness, and weight loss. Physical examination showed no focal neurological deficits. Laboratory data showed severe hyponatremia, which was corrected rather rapidly. Subsequently, the patient developed symptoms of an acute psychotic illness. Initial brain magnetic resonance imaging (MRI) was unremarkable, although a repeat MRI two weeks later revealed changes compatible with CPM. This case demonstrates that acute psychosis might represent the main manifestation of CPM, especially in early stages of the disease, which should be taken into consideration when assessing patients with acute abnormalities of sodium metabolism.

Published
2017
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38. A Case of Lyme Carditis Presenting with Atrial Fibrillation

Author

J. Kennel, Peter, Parasram, Melvin, Lu, Daniel, Zisa, Diane, Chung, Samuel, Freedman, Samuel, Knorr, Katherine, Donahoe, Timothy, M. Markowitz, Steven, and Halazun, Hadi

Abstract

We report a case of a 20-year-old man who presented to our institution with a new arrhythmia on a routine EKG. Serial EKG tracings revealed various abnormal rhythms such as episodes of atrial fibrillation, profound first degree AV block, and type I second degree AV block. He was found to have positive serologies for Borrelia burgdorferi. After initiation of antibiotic therapy, the atrial arrhythmias and AV block resolved. Here, we present a case of Lyme carditis presenting with atrial fibrillation, a highly unusual presentation of Lyme carditis.

Published
2018
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