Mayo Clinic Cases in Neuroimmunology

Andrew McKeon, Mark Keegan, and Oliver Tobin are Mayo Clinic-based neuroimmunologists. They provide care for patients with diverse immune-mediated CNS diseases 'from cortex to c-fibers', including MS, NMO, and paraneoplastic disorders, both in the Multiple Sclerosis and Autoimmune Neurology Clinics, and diagnostic Neuroimmunology Laboratory. Educational accomplishments include being current or former fellowship program directors at Mayo Clinic, and in research have characterized a number of inflammatory CNS diseases (CLIPPERS and Autoimmune GFAP astrocytopathy).

Section I
CNS Demyelinating Disease (Cases 1-21)

Case 1 A Woman With Subacute Painful Vision Loss
Jiraporn Jitprapaikulsan, MD, M. Tariq Bhatti, MD, Eric R. Eggenberger, DO, and Marie D. Acierno, MD

Case 2 Rapidly Progressive Numbness and Weakness After Soft-Tissue Abscess
Elia Sechi, MD, and Dean M. Wingerchuk, MD

Case 3 Weakness With Neck Flexion
Brian G. Weinshenker, MD

Case 4 New-Onset Right-Sided Numbness and Double Vision
W. Oliver Tobin, MB, BCh, BAO, PhD

Case 5 Progressive Left Lower Extremity Weakness and Thoracic Spinal Cord Lesion
B. Mark Keegan, MD

Case 6 Progressive Spasticity With a Single Magnetic Resonance Imaging Lesion
Samantha A. Banks, MD, and Eoin P. Flanagan, MB, BCh

Case 7 Fluctuating Vision Loss, Seizures, and Left Parieto-Occipital Mass
Alicja Kalinowska-Lyszczarz, MD, PhD, W. Oliver Tobin, MB, BCh, BAO, PhD, Yong Guo, MD, PhD, and Claudia F. Lucchinetti, MD

Case 8 Diffuse Pain and Abnormal Brain MRI Findings
Andrew McKeon, MB, BCh, MD

Case 9 Lesions Found by Chance
Dean M. Wingerchuk, MD

Case 10 Encephalopathy and Quadriparesis After an Upper Respiratory Tract Infection
A. Sebastian Lopez Chiriboga, MD

Case 11 Severe Monocular Vision Loss Followed by Gait Difficulty
Brian G. Weinshenker, MD

Case 12 Multiple Sclerosis and Cognitive Impairment
Cristina Valencia-Sanchez, MD, PhD, and Jonathan L. Carter, MD

Case 13 New-Onset Gait Difficulty With Kappa Free Light Chains in Cerebrospinal Fluid
Maria Alice V. Willrich, PhD, and Ruba S. Saadeh

Case 14 A Girl With Back Pain, Paresthesias, and Painful Vision Loss
Cecilia Zivelonghi, MD, and Andrew McKeon, MB, BCh, MD

Case 15 A Septuagenarian With Progressive Hemiparesis
Roman Kassa, MD, and B. Mark Keegan, MD

Case 16 Recurrent Demyelinating Episodes
I. Vanessa Marin Collazo, MD

Case 17 Breakthrough Disease While on Multiple Sclerosis Immunomodulatory Therapy
Jonathan L. Carter, MD

Case 18 Highly Active Multiple Sclerosis
Roman Kassa, MD, and W. Oliver Tobin, MB, BCh, BAO, PhD

Case 19 Progressive Gait Difficulties
I. Vanessa Marin Collazo, MD

Case 20 Progressive Cerebellar Ataxia After Natalizumab Treatment
Michel Toledano, MD

Case 21 Weakness and Dysarthria After Radiosurgery
Andrew McKeon, MB, ChB, MD

Section II
Autoimmune Neurologic Disorders (Cases 22-52)

Case 22 Fatigue, Blurry Vision, and Swollen Optic Nerves
Marie D. Acierno, MD, M. Tariq Bhatti, MD, John J. Chen, MD, PhD, and Eric R. Eggenberger, DO

Case 23 Progressive, Symmetrical, Painless Visual Loss in an Elderly Woman
Eric R. Eggenberger, DO, Marie D. Acierno, MD, M. Tariq Bhatti, MD, and John J. Chen, MD, PhD

Case 24 Personality Changes, Cognitive Decline, and Jerking Movements
A. Sebastian Lopez Chiriboga, MD

Case 25 Rapidly Progressive Memory Loss, Mood Change, Mutism, and Abnormal Movements
Shailee S. Shah, MD, and Marie F. Grill, MD

Case 26 Behavioral and Cognitive Changes Followed by Coma
Anastasia Zekeridou, MD, PhD

Case 27 Episodic Hemiparesis, Cognitive Decline, and Seizures in a Woman With Pernicious Anemia
Cristina Valencia-Sanchez, MD, PhD, and Andrew McKeon, MB, BCh, MD

Case 28 Rapidly Progressive Dementia and Thyroid Antibodies
Amy C. Kunchok, MBBS, MMED, and Eoin P. Flanagan, MB, BCh

Case 29 Goosebumps and Memory Loss
Jeffrey W. Britton, MD, Bhavya Narapureddy, MBBS, and Divyanshu Dubey, MBBS

Case 30 A Patient With Headache and Progressive Tremor
Anastasia Zekeridou, MD

Case 31 A Man With Flulike Symptoms and Hemorrhagic Brain Lesions
Michel Toledano, MD

Case 32 Hearing Loss, Imbalance, and Diplopia in a 44-Year-Old Man
Michelle F. Devine, MD, Divyanshu Dubey, MBBS, and Sean J. Pittock, MD

Case 33 Chorea, Ataxia, and Disturbed Sleep
John C. Feemster, and Erik K. St. Louis, MD, MS

Case 34 Rapidly Progressive Gait and Coordination Difficulties
Andrew McKeon, MB, BCh, MD

Case 35 Dancelike Movements in a Patient With a History of Rash
Andrew McKeon, MB, BCh, MD

Case 36 Body Spasms in a Woman With Thyroid Disease
Andrew McKeon, MB, BCh, MD

Case 37 Stiffness, Spasms, and Frequent Falls in a 41-Year-Old Man
Michelle Devine, MD, and A. Sebastian Lopez Chiriboga, MD

Case 38 Rapid-Onset Weakness and Numbness in a Patient With Systemic Lupus Erythematosus
Floranne C. Ernste, MD

Case 39 Progressive Quadriparesis and Cancer
Elia Sechi, MD, and Eoin P. Flanagan, MB, BCh

Case 40 Progressive Numbness, Burning Pain, Imbalance, and Dryness
Shahar Shelly, MD, and Divyanshu Dubey, MBBS

Case 41 Ascending Painful Paresthesias, Progressive Ataxia, and Bilateral Foot Drop
Rocio Vazquez Do Campo, MD, and Divyanshu Dubey, MBBS

Case 42 Painless, Symmetric, Ascending Weakness and Sensory Loss
Christopher J. Klein, MD

Case 43 Difficult-to-Treat Polyradiculoneuropathy
Marcus V. R. Pinto, MD, MS, and P. James B. Dyck, MD

Case 44 Autoimmune Peripheral Nervous System Hyperexcitability
Christopher J. Klein, MD

Case 45 Orthostatism, Constipation, and Early Satiety
Kamal Shouman, MD, and Eduardo E. Benarroch, MD

Case 46 Constipation and Syncope
Michelle F. Devine, MD, and Sean J. Pittock, MD

Case 47 Bulbar-Predominant Weakness
Jennifer A. Tracy, MD, and Vanda A. Lennon, MD, PhD

Case 48 Difficulty Climbing the Stairs
Anastasia Zekeridou, MD, PhD, and Vanda A. Lennon, MD, PhD

Case 49 Rapidly Progressive Proximal Weakness
Teerin Liewluck, MD, and Margherita Milone, MD, PhD

Case 50 Progressive Weakness and Rash
Margherita Milone, MD, PhD, and Teerin Liewluck, MD

Case 51 "Restlessness" After Cancer Diagnosis and Treatment
Anastasia Zekeridou, MD, PhD

Case 52 Sudden Onset of Diplopia and a Skeletal Muscle Antibody
John R. Mills, PhD

Section III
Other Inflammatory CNS Disorders and Neuroimmunologic Mimics (Cases 53-83)

Case 53 Diplopia, Orbital Pain, and Vision Loss in a Middle-Aged Woman
Lauren M. Webb, and Eoin P. Flanagan, MB, BCh

Case 54 A Young Man With Visual Field Loss, Decreased Hearing, and Confusion
M. Tariq Bhatti, MD, Eric R. Eggenberger, DO, Marie D. Acierno, MD, and John J. Chen, MD, PhD

Case 55 A Woman With Progressive Gait Difficulty and White Matter Abnormalities
Adrian Budhram, MD, and Ralitza H. Gavrilova, MD

Case 56 Progressive Asymmetrical Limb Impairment and Cognitive Decline With Leukoencephalopathy
B. Mark Keegan, MD

Case 57 A Woman With Fever, Confusion, and Seizures
Michel Toledano, MD

Case 58 Encephalopathy With Alternating Hemispheric MRI Abnormalities
Andrew McKeon, MB, BCh, MD

Case 59 Rapid-Onset Hemibody Sensory Loss, Incoordination, and Muscle Jerking
Andrew McKeon, MB, BCh, MD, and Nicholas L. Zalewski, MD

Case 60 A History of Sarcoidosis and a New Brain Lesion
Andrew McKeon, MB, BCh, MD, and Julie E. Hammack, MD

Case 61 Headache and Hemiparesis in Middle Age
Catalina Sanchez Alvarez, MD, and Kenneth J. Warrington, MD

Case 62 Subacute Cognitive Decline in an 86-Year-Old Woman With Prior Lobar Intracerebral Hemorrhage
Stephen W. English Jr, MD, MBA, and James P. Klaas, MD

Case 63 A 75-Year-Old Man With 5 Days of Progressive Gait Difficulties and Confusion
Julie E. Hammack, MD

Case 64 Night Sweats and Paraparesis
David N. Abarbanel, MD, and Ivan D. Carabenciov, MD

Case 65 A Woman With Headaches and a Tumefactive Brain Lesion
Andrew McKeon, MB, BCh, MD

Case 66 Behavioral Change, Seizures, and Temporal Lobe Lesion
Stuart J. McCarter, MD, and Andrew McKeon, MB, BCh, MD

Case 67 A Young Woman With Vessel Dissection and Brainstem Lesions
Burcu Zeydan, MD, and Orhun H. Kantarci, MD

Case 68 Headache, Uveitis, and Leptomeningeal Enhancement
Orhun H. Kantarci, MD

Case 69 Weakness and Punctate Enhancement
W. Oliver Tobin, MB, BCh, BAO, PhD

Case 70 Bilateral Paresthesias in Crohn Disease
Amy C. Kunchok, MBBS, and Andrew McKeon, MB, BCh, MD

Case 71 Seizures and Enhancing Brain Lesions
Josephe Archie Honorat, MD, PhD, and Andrew McKeon, MB, BCh, MD

Case 72 A Man With Recurrent Headache and Focal Neurologic Deficits
Jaclyn R. Duvall, MD, and Jerry W. Swanson, MD, MHPE

Case 73 Headache, Radicular Pain, and Enhancing Lesions
W. Oliver Tobin, MB, BCh, BAO, PhD

Case 74 Seizures 3 Months After Endarterectomy
Andrew McKeon, MB, BCh, MD, and Robert D. Brown Jr, MD, MPH

Case 75 Progressive Bilateral Arm Pain, Gait Disturbance, Constipation, and Urinary Retention
Ivan D. Carabenciov, MD, and Michael W. Ruff, MD

Case 76 A Woman With Subacute Numbness of the Trunk, Arms, and Legs
Eoin P. Flanagan, MB, BCh

Case 77 A Septuagenarian With Progressive Lower Extremity Weakness and Pain
Nicholas L. Zalewski, MD

Case 78 Acute Quadriparesis in a Smoker
Nicholas L. Zalewski, MD

Case 79 A 25-Year-Old Man With Recurrent Back Pain and Rapid-Onset Paraplegia
Nicholas L. Zalewski, MD

Case 80 Progressive Myelopathy After Neck Pain
Eoin P. Flanagan, MB, BCh

Case 81 Progressive Imbalance and Visual Impairment in a Patient With Diabetes
Neeraj Kumar, MD

Case 82 Progressive Myelopathy After Spine Surgery
Andrew McKeon, MB, BCh, MD, and Nicholas L. Zalewski, MD

Case 83 Altered Mental Status During the COVID-19 Pandemic
Sara Mariotto, MD, Silvia Bozzetti, Maria Elena De Rui, Fulvia Mazzaferri, Andrew McKeon, MB, BCh, MD, and Sergio Ferrari

Section IV
Questions and Answers

Section I: Questions, Answers, Suggested Reading
Section II: Questions, Answers, Suggested Reading
Section III: Questions, Answers, Suggested Reading