A rare case of Streptococcus anginosus infectious intracranial aneurysm: Proper management of a poor prognosis

Background: Infectious intracranial aneurysms (IIAs), sometimes referred to as cerebral mycotic aneurysms, are an uncommon but feared compilation of bacterial endocarditis, occurring in up to 5% of all bacterial endocarditis cases. While IIAs carry a low risk of rupture, a ruptured mycotic aneurysm carries devastating neurologic consequences with up to an 80% mortality rate secondary to subarachnoid and intracerebral hemorrhage. Case Description: A 69-year-old man undergoing antibacterial therapy for Streptococcus anginosus endocarditis with aortic insufficiency and root abscess presented to the ED with multiple seizures and left-sided weakness. MRI of the head revealed right frontal and temporal abscesses with evidence of scattered septic emboli and subarachnoid hemorrhage. CTA of the head revealed a ruptured 1 mm distal middle cerebral artery mycotic aneurysm. Prior to undergoing surgery, the patient began to decline, becoming lethargic, and failing to respond to commands. The patient underwent endovascular Onyx embolization. After the procedure, the patient remained with partial status epilepticus and was discharged to rehabilitation. Over the following months, the patient made a great recovery and was able to undergo aortic and mitral valve replacement 5 months after neurosurgical intervention. Conclusion: This favorable outcome is the result of a tremendous deal of long-term coordination and efficient communication between neurosurgery, cardiology, neurology, physical medicine and rehabilitation, and primary care.

THE IMPACT OF STATUS ANONYMITY ON TEAM DYNAMICS IN CO-CREATION WORKSHOPS

This paper looks at the positive effects of partial status anonymity in face-to-face co-creation workshops. Results suggest that especially during the early phases of co-creation, i.e. idea generation, participants experience more freedom to express themselves without self-imposed barriers. We observed positive effects in terms of (1) lowering or even suspending the perceived status among team members, (2) increased motivation, (3) freedom to speak and positive disposition to listen, (4) willingness to consider perspectives from other team members.

К ВОПРОСУ О ЧАСТЕРЕЧНОЙ ПРИНАДЛЕЖНОСТИ МОДАЛЬНЫХ СЛОВ

Аннотация: В русском языке вопрос о количестве частей речи, их объеме, принципах их выделения до сих пор остается спорным, что составляет трудности в преподавании морфологического уровня русского языка и требует изучения данного вопроса с разных подходов. Разночтения в определении частеречной принадлежности некоторых лексических единиц объясняются многомерностью свойств слова. Статья посвящена одной из спорных проблем морфологии русского языка - частеречному статусу модальных слов, отличающихся от всех традиционно выделяемых частей речи по многим параметрам. В статье рассматриваются семантическая и синтаксическая природа, состав модальных слов, а также критерии их отграничения от других знаменательных частей речи. Ключевые слова: частеречный статус, модальность, субъективно-модальные значения, объективно-модальные значения, модальность достоверности/недостоверности, синкретичные единицы. Аннотация. Орус тилинде сөз түркүмдөрүнүн саны, алардын көлөмү, ажыратуу принциптери ушул убакка чейин талаштуу болуп эсептелүү менен орус тилинин морфологиялык деңгээлин окутууда кыйынчылыктарды жаратып, бул маселени ар башка өңүттөрдөн кароону талап кылат. Кээ бир лексикалык бирдиктердин сөз түркүмдөрүнүн айырмачылыгында сөздөр касиеттери менен шартталат. Макала орус тилинин морфологиясынын талаштуу проблемаларынын бири – салттуу түрдө ажыратылуучу бардык сөз түркүмдөрүнөн көптөгөн параметрлери менен айырмалануучу модалдык сөздөрдүн сөз түркүмдүк макамына арналган. Макалада модалдык сөздөрдүн семантикалык жана синтаксистик табияты, курамы, ошондой эле аны башка негизги сөз түркүмдөрүнөн ажыратуучу критерийлери каралат. Түйүндүү сөздөр: сөз түркүмдүк макам, модалдуулук, субъективдик-модалдык маанилер, объективдик-модалдык маанилер, модалдык аныктык/аныктык эмес, синкретивдик бирдик. Annotation: In the Russian language, the question of the number of parts of speech, their volume, the principles of their allocation is still controversial, which is difficult to teach the morphological level of the Russian language and requires the study of this issue from different approaches. The article is devoted to one of the controversial problems of the morphology of the Russian language - the partial status of modal words that differ from all traditionally allocated parts of speech in many ways. The article discusses the semantic and syntactic nature, the composition of modal words, as well as the criteria for their separation from other significant parts of speech. Key words: modality, subjective-modal values, objective-modal values, partial sta- tus.

Oral Perampanel for the Treatment of Super-Refractory Status Epilepticus

A 72-year-old man presented with a super-refractory partial status epilepticus following evacuation of a right subdural hematoma. He failed to respond to treatment with high doses of intravenous valproic acid, Levetiracetam, Lacosamide, Thiopental, and Midazolam. He was given 4 mg of Perampanel orally via nasogastric tube and the dose was rapidly increased to 8 mg after 12 hours with cessation of clinical and electrical seizures. Other antiepileptic drugs were tapered progressively with an excellent clinical outcome.

Periodic Slow Waves Presenting as Ictal Electroencephalography Findings in Complex Partial Status Epilepticus

The diagnosis of nonconvulsive status epilepticus (NCSE) largely relies on electroencephalography (EEG) findings, but the existing diagnostic criteria for EEG results are sometimes inconsistent. Much debate has centered on periodic epileptic discharges (PEDs) and their relationship with seizures. The recently published Salzburg Consensus Criteria for diagnosis of NCSE, which consider PEDs to be ictal findings under several conditions, have been proven to have high diagnostic accuracy. However, the criteria do not include periodic slow waves (PSWs) and do not consider these as overall ictal electrographic changes. Here, we report 2 cases of complex partial status epilepticus in which routine EEG showed PSWs without epileptiform activity during the clinical ictal phase. Both patients were elderly males who had histories of seizures and presented with impaired consciousness and signs such as aphasia or tongue automatism that indicated a temporal lobe origin. After we administered antiepileptic drugs (AED), the clinical signs and periodic EEG slow waves disappeared. These cases show that PSWs may appear as ictal electrographic changes in NCSE. When PSWs accompany clinical signs suggestive of NCSE, they should be considered ictal findings, and physicians should administer AED.