Firas Kaddouh

Interests

Teaching

I am passionate about cross-Speciality education in both undergraduate and graduate medical education.

Research

I am interested in clinical trials in neurology as an essential cornerstone of advancing neurology and neurological care for our patients. I lead clinical trials in acute brain injury which includes ischemic stroke, intracerebral hemorrhage and anoxic brain injury

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Espinosa, J., Rehman, U., & Kaddouh, F. (2023). A case of intravenous iron administration resulting in cerebral edema expansion. BMC neurology, 23(1), 209.
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  Iron plays an important role in the development of perihematomal edema (PHE) in the setting of intracerebral hemorrhage (ICH). Cerebral iron is increased via direct hemoglobin release in ICH, and several studies have investigated the use of iron-chelating agents to mitigate its toxicity. However, the effect of systemic iron administration, corroborating the reverse concept, has never been investigated or reported clinically. We report the first case of systemic iron administration in the setting of hemorrhagic traumatic brain injury (TBI).
• Margo, T. E., McMullin, P. R., & Kaddouh, F. (2023). An interval of clinically silent gastrointestinal bleed in dysautonomic spinal cord injury: a case report. BMC neurology, 23(1), 70.
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  Gastrointestinal bleed (GIB) has high incidence in traumatic spinal cord injured (tSCI) patients and can frequently be life-threatening, especially early post-injury. Several risk factors often compound bleeding risk, some are unique to this patient population. Normally, clinical suspicion for GIB arises from symptoms like coffee-ground emesis, hematemesis, melena or even hematochezia. A hemoglobin drop may be a late sign. Due to tSCI, however, patients often experience neurogenic bowels and dysautonomia, which may delay symptom presentation and complicate timely diagnosis of GIB. We report a case of an almost clinically silent GI bleed in the context of acute cervical tSCI.
• Mozumder, A., Luo, A., Ramaswamy, D., Mozumder, S. S., & Kaddouh, F. (2023). Single Center Experience of Intrathecal Nicardipine Use in The Treatment of Vasospasm-Lessons Learned (P7-5.022). Stroke. doi:10.1212/wnl.0000000000204318
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  Objective: NA Background: Cerebral vasospasm and delayed cerebral ischemia (DCI) following aneurysmal SAH leads to significant morbidity and mortality. Intrathecal (IT) nicardipine has been shown to improve outcome and reduce DCI. We sought to study our limited experience with this treatment modality, in order to potentially inform our practice in treating vasospasm. Design/Methods: Retrospective case series of all patients who received IT nicardipine for the treatment of cerebral vasospasm from 2016 to 2021 at our University Hospital. Demographics, risk factors, clinical course and outcomes were analyzed. Results: 12 patients received intrathecal nicardipine. Linear regression analysis showed that IT nicardipine was associated with a reduction of the mean cerebral blood flow velocity of 16%. 5 patients had in-hospital mortality; 4 out of these 5 patients developed in-hospital DCI. Age (p 0.017), history of hypertension(HTN) (p 0.0007) were significant predictors for in-hospital mortality. 6 patients developed DCI: mFisher scale (p 0.03), admission GCS (p 0.000998), vasopressor requirement to maintain target pressure (p 0.04) were significant predictors for DCI. 1 patient was diagnosed with bacterial ventriculitis. 80% patients had a favorable functional outcome (mRS≤2) at 90 days. Conclusions: The choice of this treatment on a case-by-case basis somewhat has led to rendering it as a salvage treatment at our center. In our cohort, we found significant mortality rate, with age and HTN as predictive factors for in-hospital mortality, and mFisher scale, admission GCS and vasopressor usage as predictors for DCI. These results can be difficult to interpret, especially that we used it in only few selected patients with initial comorbidities potentially confounding the high mortality and morbidity. Intrathecal nicardipine treatment without a well-vetted protocol can potentially misinform the practice style and lead to early abandonment of this promising therapy as part of our armamentarium. Thus, it is important to develop a standardized protocol before deploying in clinical practice. Disclosure: Dr. Mozumder has nothing to disclose. Dr. Luo has nothing to disclose. Dr. Ramaswamy has nothing to disclose. Mr. Mozumder has nothing to disclose. Dr. Kaddouh has nothing to disclose.
• Shojaei, F., Chi, G., Memar Montazerin, S., Najafi, H., Lee, J. J., Marszalek, J., Kaddouh, F., & Seifi, A. (2022). Clinical outcomes of pharmacological thromboprophylaxis among patients with intracerebral hemorrhage: Systematic review and meta-analysis. Clinical neurology and neurosurgery, 212, 107066.
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  Efficacy and safety of pharmacologic thromboprophylaxis after an episode of intracerebral hemorrhage remains unclear. This meta-analysis aimed at comparing the clinical outcomes of intracerebral hemorrhage patients with or without pharmacologic thromboprophylaxis.
• Ammar, A. A., Ammar, M. A., Owusu, K. A., Brown, S. C., Kaddouh, F., Elsamadicy, A. A., Acosta, J. N., & Falcone, G. J. (2021). Andexanet Alfa Versus 4-Factor Prothrombin Complex Concentrate for Reversal of Factor Xa Inhibitors in Intracranial Hemorrhage. Neurocritical care, 35(1), 255-261.
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  There are limited data on the risks and benefits of using andexanet alfa (AA) in comparison with four-factor prothrombin complex concentrate (4F-PCC) to reverse factor Xa inhibitors (FXi) associated intracranial hemorrhage (ICH). We sought to describe our experience with AA or 4F-PCC in patients with oral FXi-related traumatic and spontaneous ICH.
• Brown, S. C., Cormier, J., Tuan, J., Lier, A. J., McGuone, D., Armstrong, P. M., Kaddouh, F., Parikh, S., Landry, M. L., & Gobeske, K. T. (2021). Four Human Cases of Eastern Equine Encephalitis in Connecticut, USA, during a Larger Regional Outbreak, 2019. Emerging infectious diseases, 27(8), 2042-51.
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  During 3 weeks in 2019, 4 human cases of Eastern equine encephalitis (EEE) were diagnosed at a single hospital in Connecticut, USA. The cases coincided with notable shifts in vector–host infection patterns in the northeastern United States and signified a striking change in EEE incidence. All 4 cases were geographically clustered, rapidly progressive, and neurologically devastating. Diagnostic tests conducted by a national commercial reference laboratory revealed initial granulocytic cerebrospinal fluid pleocytosis and false-negative antibody results. EEE virus infection was diagnosed only after patient samples were retested by the arbovirus laboratory of the Centers for Disease Control and Prevention in Fort Collins, Colorado, USA. The crucial diagnostic challenges, clinical findings, and epidemiologic patterns revealed in this outbreak can inform future public health and clinical practice.
• Mazurek, M. H., Yuen, M. M., Cahn, B. A., Rosen, M. S., Gobeske, K. T., Gilmore, E. J., Hwang, D. Y., Kaddouh, F., Kim, J., Falcone, G. J., Petersen, N., Siner, J., Spudich, S., Sze, G., Kimberly, W. T., & Sheth, K. N. (2021). Low-Field, Portable Magnetic Resonance Imaging at the Bedside to Assess Brain Injury in Patients with Severe COVID-19. Neurology.
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  Objective: To obtain neuroimaging on patients with COVID-19 using a low-field, portable magnetic resonance imaging (MRI) device. Background: Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional MRI systems operate at high-strength magnetic fields (1.5–3T) that require patient transportation to access-controlled environments. During the COVID-19 pandemic, critically ill patients have had limited neuroimaging due to infection control and safety concerns. We report neuroimaging in patients with severe COVID-19 using a portable MRI device. Design/Methods: A 64mT point-of-care (POC) MRI was used to acquire neuroimaging in Yale New Haven Hospital ICUs from April 2020 through August 2020. COVID-19 patients with neurological symptoms and no MRI contraindications were scanned. Exams were acquired using a standard 110V/15A power outlet. Hospital rooms included vital signs monitors, ventilators, dialysis machines, and intravenous infusion pumps. Images were acquired by trained research staff, without the need for an MRI technician. POC MRI exams were interpreted by two board-certified physicians (one neuroradiologist and one neurologist). Results: POC MRI exams were obtained on 22 ICU COVID-19 patients (19% female, ages 42–74 years, 86% mechanically ventilated). Glasgow Coma Scale and Richmond Agitation-Sedation Scale at time of scan were 7±3 and −3±2, respectively. T1-weighted (T1W), T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) sequences were obtained for all patients. Axial scan times were 4:54 minutes, 7:03 minutes, 9:31 minutes, and 9:04 minutes, respectively. Examination time was 35:40 minutes. Abnormal neuroimaging findings were observed in 10 patients: intracranial hemorrhage (n=2), cerebral infarction (n=4), diffuse cerebral edema (n=1), and leukoencephalopathy (n=3). The device did not interfere with ICU equipment, and no significant adverse events occurred. Conclusions: We report the acquisition of neuroimaging using a low-field, portable MRI at the bedside of patients with severe COVID-19. This approach may hold promise for bedside assessment of neurological injury in settings with imaging access constraints. Disclosure: Miss Mazurek has nothing to disclose. Mr. Yuen has nothing to disclose. Mr. Cahn has nothing to disclose. Matthew Rosen has received stock or an ownership interest from Hyperfine Research. Matthew Rosen has received stock or an ownership interest from BlinkAI. Matthew Rosen has received stock or an ownership interest from Vizma Life Sciences. Matthew Rosen has received stock or an ownership interest from Intact Data Services. The institution of Matthew Rosen has received research support from GE HealthCare. Matthew Rosen has received intellectual property interests from a discovery or technology relating to health care. Dr. Gobeske has nothing to disclose. Dr. Gilmore has nothing to disclose. Dr. Hwang has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Portola Pharmaceuticals. The institution of Dr. Hwang has received research support from Apple Pickers Foundation. The institution of an immediate family member of Dr. Hwang has received research support from National Institute of Health. The institution of an immediate family member of Dr. Hwang has received research support from American Diabetes Association. The institution of an immediate family member of Dr. Hwang has received research support from General Electric. Dr. Hwang has received publishing royalties from a publication relating to health care. Dr. Hwang has received personal compensation in the range of $5,000-$9,999 for serving as a Principal Investigator with Society of Critical Care Medicine. Dr. Hwang has a non-compensated relationship as a Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities. Dr. Kaddouh has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Falcone has nothing to disclose. Dr. Petersen has received research support from NIH. The institution of Jonathan Siner has received research support from NHLBI. The institution of Dr. Spudich has received research support from NIH. Gordon Sze has nothing to disclose. Dr. Kimberly has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for NControl Therapeutics. Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. The institution of Dr. Kimberly has received research support from Biogen. The institution of Dr. Kimberly has received research support from NControl Therapeutics. Dr. Kimberly has received intellectual property interests from a discovery or technology relating to health care. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
• Sheth, K. N., Mazurek, M. H., Yuen, M. M., Cahn, B. A., Shah, J., Ward, A., Kim, J. A., Gilmore, E. J., Falcone, G. J., Petersen, N., Gobeske, K. T., Kaddouh, F., Hwang, D. Y., Schindler, J., Sansing, L. H., Matouk, C., Rothberg, J. M., Sze, G., Siner, J., , Rosen, M. S., et al. (2021). Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients. JAMA Neurology. doi:10.1001/jamaneurol.2020.3263
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  Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional magnetic resonance imaging (MRI) systems operate at high-strength magnetic fields (1.5-3 T) that require strict, access-controlled environments. Limited access to timely neuroimaging remains a key structural barrier to effectively monitor the occurrence and progression of neurological injury in intensive care settings. Recent advances in low-field MRI technology have allowed for the acquisition of clinically meaningful imaging outside of radiology suites and in the presence of ferromagnetic materials at the bedside.To perform an assessment of brain injury in critically ill patients in intensive care unit settings, using a portable, low-field MRI device at the bedside.This was a prospective, single-center cohort study of 50 patients admitted to the neuroscience or coronavirus disease 2019 (COVID-19) intensive care units at Yale New Haven Hospital in New Haven, Connecticut, from October 30, 2019, to May 20, 2020. Patients were eligible if they presented with neurological injury or alteration, no contraindications for conventional MRI, and a body habitus not exceeding the scanner's 30-cm vertical opening. Diagnosis of COVID-19 was determined by positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction nasopharyngeal swab result.Portable MRI in an intensive care unit room.Demographic, clinical, radiological, and treatment data were collected and analyzed. Brain imaging findings are described.Point-of-care MRI examinations were performed on 50 patients (16 women [32%]; mean [SD] age, 59 [12] years [range, 20-89 years]). Patients presented with ischemic stroke (n = 9), hemorrhagic stroke (n = 12), subarachnoid hemorrhage (n = 2), traumatic brain injury (n = 3), brain tumor (n = 4), and COVID-19 with altered mental status (n = 20). Examinations were acquired at a median of 5 (range, 0-37) days after intensive care unit admission. Diagnostic-grade T1-weighted, T2-weighted, T2 fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences were obtained for 37, 48, 45, and 32 patients, respectively. Neuroimaging findings were detected in 29 of 30 patients who did not have COVID-19 (97%), and 8 of 20 patients with COVID-19 (40%) demonstrated abnormalities. There were no adverse events or complications during deployment of the portable MRI or scanning in an intensive care unit room.This single-center series of patients with critical illness in an intensive care setting demonstrated the feasibility of low-field, portable MRI. These findings demonstrate the potential role of portable MRI to obtain neuroimaging in complex clinical care settings.
• Sheth, K., Mazurek, M., Yuen, M., Cahn, B., Shah, J., Ward, A., Kim, J., Gilmore, E., Falcone, G., Petersen, N., Gobeske, K., Kaddouh, F., Hwang, D., Schindler, J., Sansing, L., Matouk, C., Rothberg, J., Sze, G., Siner, J., , Rosen, M., et al. (2021). Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients. JAMA Neurology, 78(1). doi:10.1001/jamaneurol.2020.3263
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  Importance: Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional magnetic resonance imaging (MRI) systems operate at high-strength magnetic fields (1.5-3 T) that require strict, access-controlled environments. Limited access to timely neuroimaging remains a key structural barrier to effectively monitor the occurrence and progression of neurological injury in intensive care settings. Recent advances in low-field MRI technology have allowed for the acquisition of clinically meaningful imaging outside of radiology suites and in the presence of ferromagnetic materials at the bedside. Objective: To perform an assessment of brain injury in critically ill patients in intensive care unit settings, using a portable, low-field MRI device at the bedside. Design, Setting, and Participants: This was a prospective, single-center cohort study of 50 patients admitted to the neuroscience or coronavirus disease 2019 (COVID-19) intensive care units at Yale New Haven Hospital in New Haven, Connecticut, from October 30, 2019, to May 20, 2020. Patients were eligible if they presented with neurological injury or alteration, no contraindications for conventional MRI, and a body habitus not exceeding the scanner's 30-cm vertical opening. Diagnosis of COVID-19 was determined by positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction nasopharyngeal swab result. Exposures: Portable MRI in an intensive care unit room. Main Outcomes and Measures: Demographic, clinical, radiological, and treatment data were collected and analyzed. Brain imaging findings are described. Results: Point-of-care MRI examinations were performed on 50 patients (16 women [32%]; mean [SD] age, 59 [12] years [range, 20-89 years]). Patients presented with ischemic stroke (n = 9), hemorrhagic stroke (n = 12), subarachnoid hemorrhage (n = 2), traumatic brain injury (n = 3), brain tumor (n = 4), and COVID-19 with altered mental status (n = 20). Examinations were acquired at a median of 5 (range, 0-37) days after intensive care unit admission. Diagnostic-grade T1-weighted, T2-weighted, T2 fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences were obtained for 37, 48, 45, and 32 patients, respectively. Neuroimaging findings were detected in 29 of 30 patients who did not have COVID-19 (97%), and 8 of 20 patients with COVID-19 (40%) demonstrated abnormalities. There were no adverse events or complications during deployment of the portable MRI or scanning in an intensive care unit room. Conclusions and Relevance: This single-center series of patients with critical illness in an intensive care setting demonstrated the feasibility of low-field, portable MRI. These findings demonstrate the potential role of portable MRI to obtain neuroimaging in complex clinical care settings.
• Yuen, M. M., Mazurek, M. H., Cahn, B. A., Prabhat, A. M., By, S., Hu, H. H., Welch, E. B., Sacolick, L., O’Halloran, R., Ward, A., Timario, N., Falcone, G. J., Gilmore, E. J., Hwang, D. Y., Kim, J., Kaddouh, F., Sharma, R., Amin, H., Schindler, J., , Matouk, C., et al. (2021). Abstract 33: Qualitative Description of Ischemic Stroke Appearance on Low-Field, Point-Of-Care Magnetic Resonance Imaging. Stroke. doi:10.1161/str.52.suppl_1.33
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  Background and Aims: Advances in low-field MRI have enabled image acquisition at the point-of-care (POC). We aim to characterize ischemic lesions in low-field, POC MRI and assess its relationship with stroke severity in ischemic stroke patients. Methods: We performed POC MRI exams on ischemic stroke patients. T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) exams were acquired with a 64mT, portable bedside MRI system. Three raters computed signal intensity ratios (SIR) for each sequence. For every slice showing an infarct, an SIR was generated by dividing the mean signal intensity of the lesion by the mean signal intensity of the contralateral hemisphere. Infarct volumes were obtained by multiplying the lesion area of each slice by the slice thickness (5mm) and summing the cross-sectional areas. Volumes were correlated with National Institutes of Health Stroke Scale (NIHSS) scores at the time of scan. Results: We studied 18 ischemic stroke patients (50% women; ages 30-95 years). Two patients were studied at two and three serial timepoints, respectively. POC exams were obtained 2.7 ± 2.2 days after symptom onset. A total of 18 T2W, 17 FLAIR, and 18 DWI exams were obtained. Three exams (1 T2W; 1 FLAIR; 1 DWI) were excluded due to motion degradation. High field MRI exams (19 ± 16 hours from POC exams) demonstrated ischemic infarcts in 15 of the 18 patients. All POC T2W and FLAIR exams revealed infarcts in these patients, and 14 of the 17 DWI exams showed infarcts. Ischemic infarcts were seen as hyperintense lesions (SIR: T2W = 1.19 ± 0.10, FLAIR = 1.15 ± 0.08, DWI = 1.36 ± 0.17). Infarct volume significantly correlated with NIHSS scores (T2W: r = 0.71, p < 0.01; FLAIR: r = 0.65, p < 0.05; DWI: r = 0.65, p < 0.05). Conclusions: These preliminary data suggest that low-field, POC MRI may be useful in the clinical evaluation of ischemic stroke. Further work in larger cohorts is needed to elucidate the appearance of infarction on low-field imaging.
• , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , , ., et al. (2020). Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial. The Lancet, 395(10227). doi:10.1016/S0140-6736(20)30258-0
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  Background: Nerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, is a neuroprotectant that is effective in preclinical stroke models of ischaemia-reperfusion. In this trial, we assessed the efficacy and safety of nerinetide in human ischaemia-reperfusion that occurs with rapid endovascular thrombectomy in patients who had an acute ischaemic stroke. Methods: For this multicentre, double-blind, randomised, placebo-controlled study done in 48 acute care hospitals in eight countries, we enrolled patients with acute ischaemic stroke due to large vessel occlusion within a 12 h treatment window. Eligible patients were aged 18 years or older with a disabling ischaemic stroke at the time of randomisation, had been functioning independently in the community before the stroke, had an Alberta Stroke Program Early CT Score (ASPECTS) greater than 4, and vascular imaging showing moderate-to-good collateral filling, as determined by multiphase CT angiography. Patients were randomly assigned (1:1) to receive intravenous nerinetide in a single dose of 2·6 mg/kg, up to a maximum dose of 270 mg, on the basis of estimated or actual weight (if known) or saline placebo by use of a real-time, dynamic, internet-based, stratified randomised minimisation procedure. Patients were stratified by intravenous alteplase treatment and declared endovascular device choice. All trial personnel and patients were masked to sequence and treatment allocation. All patients underwent endovascular thrombectomy and received alteplase in usual care when indicated. The primary outcome was a favourable functional outcome 90 days after randomisation, defined as a modified Rankin Scale (mRS) score of 0–2. Secondary outcomes were measures of neurological disability, functional independence in activities of daily living, excellent functional outcome (mRS 0–1), and mortality. The analysis was done in the intention-to-treat population and adjusted for age, sex, baseline National Institutes of Health Stroke Scale score, ASPECTS, occlusion location, site, alteplase use, and declared first device. The safety population included all patients who received any amount of study drug. This trial is registered with ClinicalTrials.gov, NCT02930018. Findings: Between March 1, 2017, and Aug 12, 2019, 1105 patients were randomly assigned to receive nerinetide (n=549) or placebo (n=556). 337 (61·4%) of 549 patients with nerinetide and 329 (59·2%) of 556 with placebo achieved an mRS score of 0–2 at 90 days (adjusted risk ratio 1·04, 95% CI 0·96–1·14; p=0·35). Secondary outcomes were similar between groups. We observed evidence of treatment effect modification resulting in inhibition of treatment effect in patients receiving alteplase. Serious adverse events occurred equally between groups. Interpretation: Nerinetide did not improve the proportion of patients achieving good clinical outcomes after endovascular thrombectomy compared with patients receiving placebo. Funding: Canadian Institutes for Health Research, Alberta Innovates, and NoNO.
• Radcliffe, C., Lier, A., Doilicho, N., Parikh, S., & Kaddouh, F. (2020). Bordetella bronchiseptica: a rare cause of meningitis. BMC infectious diseases, 20(1), 922.
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  Bordetella bronchiseptica is a gram-negative, obligate aerobic coccobacillus known to cause disease in domesticated animals and pets. In humans, B. bronchiseptica commonly leads to respiratory infections like pneumonia or bronchitis, and animal contact usually precedes the onset of symptoms.
• Sheth, K. N., Mazurek, M. H., Yuen, M. M., Cahn, B. A., Shah, J. T., Ward, A., Kim, J. A., Gilmore, E. J., Falcone, G. J., Petersen, N., Gobeske, K. T., Kaddouh, F., Hwang, D. Y., Schindler, J., Sansing, L., Matouk, C., Rothberg, J., Sze, G., Siner, J., , Rosen, M. S., et al. (2020). Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients. JAMA neurology, 78(1), 41-7.
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  Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional magnetic resonance imaging (MRI) systems operate at high-strength magnetic fields (1.5-3 T) that require strict, access-controlled environments. Limited access to timely neuroimaging remains a key structural barrier to effectively monitor the occurrence and progression of neurological injury in intensive care settings. Recent advances in low-field MRI technology have allowed for the acquisition of clinically meaningful imaging outside of radiology suites and in the presence of ferromagnetic materials at the bedside.
• Ghasemi, M., Kaddouh, F., Deb, A., & Owegi, M. A. (2018). Delayed-onset MRI findings in acute chorea related to anoxic brain injury. Clinical imaging, 48, 22-25.
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  Anoxic brain injury can manifest with various abnormal movements. We describe acute chorea in a young patient with anoxic brain injury due to chlordiazepoxide toxicity who had delayed radiographic lesions in bilateral globus pallidus. Although brain MRI 8days after the anoxic event was unremarkable, repeat brain MRI 15days after the event showed T2 hyperintensities and enhancement within the bilateral globus pallidi. It is possible that MRI brain findings of bilateral basal ganglia lesions may appear later than onset of chorea in anoxic brain injury. However, given the normal brain MRI in between, other etiologies cannot be excluded entirely.
• Li, Y., Kaddouh, F., Lozano, J., Jun-O’Connell, A. H., & Ramzan, M. (2016). Intracerebral Hemorrhage Due to Reversible Cerebral Vasoconstriction Syndrome in the Setting of Antipsychotic Medication (P4.340). Neurology.
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  Objective: To report a rare case of reversible cerebral vasoconstriction syndrome (RCVS) causing large intraparenchymal hemorrhage (IPH) in the setting of luradisone. Background: RCVS is a syndrome characterized by thunderclap headache and diffuse segmental vasoconstriction of the cerebral arteries evident on imaging of the cerebral vasculature. Only 50[percnt] of cases occur after exposure to recognized triggers, among those are sympathomimetics, serotonergic substances etc.. Lurasidone is a new antipsychotic medication and has potential D2 and 5HT2A receptor antagonism effects. The association between RCVS and lurasidone has not been reported before. Methods: Case report Results: A 40 year-old woman with history of hypertension, depression, fibromyalgia, and remote migraines 20 years ago presented with severe headache and vision change for 1 week. She had been taking Latuda recently to help her depression, and the dose had been gradually titrated from 20mg daily to 100mg daily. She drank socially and used marijuana occasionally, and has not been drinking or using recreational drug for at least one month. Physical exam showed left homonymous inferior quadrantanopia. Blood pressure was within normal range. CT revealed large IPH in the right parieto-occipital region with intraventricular extension and slight midline shift. No subarachnoid hemorrhage was seen. Cerebral angiography showed multiple segmental areas of vasoconstriction involving the anterior and posterior circulation with significant improvement after the intra-arterial administration of Verapamil. Significant improvement of her headache was noted after intra-arterial verapamil. She continued to take Nimodipine 60mg Q4h with improvement of her headache upon discharge. Conclusions: RCVS has not been reported following lurasidone use previously. Physicians should be aware of this occurrence as a potential precipitant and recommend avoiding this exposure as secondary prevention, especially in patients with higher risk of RCVS including middle age females and migraines. Disclosure: Dr. Li has nothing to disclose. Dr. Kaddouh has nothing to disclose. Dr. Lozano has nothing to disclose. Dr. Jun-O9Connell has nothing to disclose. Dr. Ramzan has nothing to disclose.
• Kaddouh, F., Tunguturi, A., Patel, A., DeGrush, E., Mandelbaum, M., Eleftheriou, E., & Goddeau, R. (2015). Bilateral Common Carotid Artery Thrombi Following Cisplatin-Based Chemotherapy (P1.027). Neurology.
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  OBJECTIVE: To report a unique case of bilateral carotid thrombi following Cisplatin-based chemotherapy. BACKGROUND: Cisplatin-based chemotherapy has been implicated in venous and arterial thromboembolic events. These events typically occur with the second or third cycles of chemotherapy. Arterial thrombi involving the aortic arch secondary to Cisplatin-based chemotherapy have been reported to occur very rarely. Occurrence of bilateral carotid artery thrombi after Cisplatin-based chemotherapy has not, to our knowledge, been described. CASE DESCRIPTION: A 54 year-old man with a recent diagnosis of testicular cancer on chemotherapy with Cisplatin and Etoposide presented with severe headache and nausea. Physical exam was notable for left upper extremity weakness and left homonymous hemianopia. A CT scan of the head without contrast showed no abnormality. An MRI of the brain showed multiple acute and subacute infarcts involving both cerebral hemispheres. A CT angiogram of the head and neck revealed large thrombi causing near complete occlusion of the bilateral common carotid arteries. No thrombus was seen in the aortic arch. There was no evidence of venous sinus thrombosis. The patient was treated with parenteral anticoagulation. A week later, the left-sided weakness improved but the patient continued to have left homonymous hemianopia. A repeat CT angiogram of the head and neck revealed partial resolution of the thrombus. DISCUSSION AND CONCLUSION: Bilateral carotid thrombi after Cisplatin-based chemotherapy has never been reported before and physicians should be aware of this possibility. The mechanism of such events is thought to be related to vascular toxicity, endothelial damage, vasospasm and release of prothrombotic particles causing platelet aggregation and activation of coagulation cascade. Early diagnosis and treatment are important for good clinical outcome. Disclosure: Dr. Kaddouh has nothing to disclose. Dr. Tunguturi has nothing to disclose. Dr. Patel has nothing to disclose. Dr. DeGrush has nothing to disclose. Dr. Mandelbaum has nothing to disclose. Dr. Eleftheriou has nothing to disclose. Dr. Goddeau has nothing to disclose.