Publications by authors named "Lindsey Gurin"

9 Publications

  • Page 1 of 1

Neuropsychiatric Complications after Stroke.

Semin Neurol 2021 Feb 28;41(1):85-100. Epub 2021 Jan 28.

Departments of Neurology, Psychiatry, and Rehabilitation Medicine, NYU Langone Health, New York, New York.

Neuropsychiatric disturbances represent a common and uniquely challenging consequence of stroke. These disorders arise at the intersection of lesion-related brain dysfunction and psychological distress related to the event and its aftermath, making it difficult to identify what symptom is a direct physiological consequence of the stroke. Depression, anxiety, fatigue, apathy, emotionalism, and anger are the most common of these syndromes, and posttraumatic stress disorder related to the stroke event has become increasingly recognized as a relevant entity. Mania, obsessive-compulsive disorder, and psychosis are less commonly encountered but potentially highly debilitating conditions that may be underrecognized. Early identification and treatment may mitigate functional impairment and improve quality of life. Evidence-based guidelines from the general population are often relied upon to guide treatment. Further research is needed to understand and tailor treatment of these disorders in the poststroke population.
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http://dx.doi.org/10.1055/s-0040-1722723DOI Listing
February 2021

Successful Use of Electroconvulsive Therapy for Catatonia After Hypoxic-Ischemic Brain Injury.

Psychosomatics 2020 Sep 2. Epub 2020 Sep 2.

Departments of Psychiatry, Neurology, and Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY.

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http://dx.doi.org/10.1016/j.psym.2020.08.009DOI Listing
September 2020

Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2.

J Neurol Sci 2020 10 8;417:117087. Epub 2020 Aug 8.

NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States of America.

Introduction: The coronavirus disease 2019 (Covid-19) pandemic has led to challenges in provision of care, clinical assessment and communication with families. The unique considerations associated with evaluation of catastrophic brain injury and death by neurologic criteria in patients with Covid-19 infection have not been examined.

Methods: We describe the evaluation of six patients hospitalized at a health network in New York City in April 2020 who had Covid-19, were comatose and had absent brainstem reflexes.

Results: Four males and two females with a median age of 58.5 (IQR 47-68) were evaluated for catastrophic brain injury due to stroke and/or global anoxic injury at a median of 14 days (IQR 13-18) after admission for acute respiratory failure due to Covid-19. All patients had hypotension requiring vasopressors and had been treated with sedative/narcotic drips for ventilator dyssynchrony. Among these patients, 5 had received paralytics. Apnea testing was performed for 1 patient due to the decision to withdraw treatment (n = 2), concern for inability to tolerate testing (n = 2) and observation of spontaneous respirations (n = 1). The apnea test was aborted due to hypoxia and hypotension. After ancillary testing, death was declared in three patients based on neurologic criteria and in three patients based on cardiopulmonary criteria (after withdrawal of support (n = 2) or cardiopulmonary arrest (n = 1)). A family member was able to visit 5/6 patients prior to cardiopulmonary arrest/discontinuation of organ support.

Conclusion: It is feasible to evaluate patients with catastrophic brain injury and declare brain death despite the Covid-19 pandemic, but this requires unique considerations.
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http://dx.doi.org/10.1016/j.jns.2020.117087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414304PMC
October 2020

Multiple Administrations of Intravenous Thrombolytic Therapy to a Stroke Mimic.

J Emerg Med 2020 Mar 3;58(3):e133-e136. Epub 2019 Dec 3.

Department of Neurology, New York University School of Medicine, New York, New York.

Background: Patients who present emergently with focal neurological deficits concerning for acute ischemic stroke can be extremely challenging to diagnose and treat. Unnecessary administration of thrombolytics to potential stroke patients whose symptoms are not caused by an acute ischemic stroke-stroke mimics-may result in patient harm, although the overall risk of hemorrhagic complications among stroke mimics is low.

Case Report: We present a case of a stroke mimic patient with underlying psychiatric disease who was treated with intravenous alteplase on four separate occasions in four different emergency departments in the same city. Although he did not suffer hemorrhagic complications, this case highlights the importance of rapid exchange of health information across institutions to improve diagnostic quality and safety. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Increased awareness of stroke mimics by emergency physicians may improve diagnostic safety for a subset of high-risk patients. Establishing rapid cross-institutional communication pathways that are integrated into provider's workflows to convey essential patient health information has potential to improve stroke diagnostic decision-making and thus represents an important topic for health systems research in emergency medicine.
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http://dx.doi.org/10.1016/j.jemermed.2019.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200287PMC
March 2020

Clinical Reasoning: A 41-year-old man with thunderclap headache.

Neurology 2018 07;91(1):e87-e91

From the Departments of Neurology (S. Grossman, A.R., J.C., L.G., S. Galetta) and Psychiatry (L.G.), New York University, New York.

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http://dx.doi.org/10.1212/WNL.0000000000005738DOI Listing
July 2018

Delusions and the Right Hemisphere: A Review of the Case for the Right Hemisphere as a Mediator of Reality-Based Belief.

J Neuropsychiatry Clin Neurosci 2017 28;29(3):225-235. Epub 2017 Mar 28.

From the Departments of Neurology and Psychiatry, New York University Langone Medical Center, New York (LG); and the Departments of Neurology and Rehabilitation Medicine, New York University Langone Medical Center, New York (SB).

Delusions are beliefs that remain fixed despite evidence that they are incorrect. Although the precise neural mechanism of delusional belief remains to be elucidated, there is a predominance of right-hemisphere lesions among patients with delusional syndromes accompanied by structural pathology, suggesting that right-hemisphere lesions, or networks with key nodes in the right hemisphere, may be playing a role. The authors discuss the potential theoretical basis and empiric support for a specific right-hemisphere role in delusion production, drawing on its roles in pragmatic communication; perceptual integration; attentional surveillance and anomaly/novelty detection; and belief updating.
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http://dx.doi.org/10.1176/appi.neuropsych.16060118DOI Listing
April 2018

Predictors of Recovery From Posttraumatic Amnesia.

J Neuropsychiatry Clin Neurosci 2016 25;28(1):32-7. Epub 2015 Sep 25.

From the Depts. of Neurology (LG, SB), Psychiatry (LG), and Rehabilitation Medicine (LR, SB), New York University Langone Medical Center, New York.

This study examined the predictive value of variables known early in the course of posttraumatic amnesia (PTA) on length of PTA and functional outcome of acute rehabilitation. Forty patients with traumatic brain injury who had PTA at admission for acute inpatient rehabilitation were included (29 men and 11 women; aged 18-91 years). This article presents the characteristics of the patients who came out of PTA and those who did not emerge during the acute inpatient rehabilitation stay. These data suggest that the location of the lesion (specifically, parietal lobe lesions) and initial cognitive scores are helpful in prognosticating patient trajectories.
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http://dx.doi.org/10.1176/appi.neuropsych.15040081DOI Listing
December 2016

A case of systemic lupus erythematosus associated with longitudinal extensive transverse myelitis, cerebral neutrophilic vasculitis, and cerebritis.

Bull Hosp Jt Dis (2013) 2014 ;72(4):294-300

Systemic Lupus erythematosus (SLE) is an autoimmune disease with multiple clinical presentations and manifestations. Here, we report an intriguing case of a 30-year-old female with full-blown SLE, associated with longitudinal extensive transverse myelitis (LETM) on Magnetic Resonance Imaging (MRI) manifested by lower extremity weakness, neurogenic bladder and bowel, and central nervous system (CNS) lupus clinically manifested by changes in mood and behavior as well as neutrophilic vasculitis and cerebritis on pathology. LETM is a rare complication of SLE; however, what makes this case even more intriguing is that it additionally had cerebral lesions consistent with neutrophilic vasculitis and cerebritis, and that it may all have started at least 10 years prior with nonspecific musculoskeletal manifestations subsequently followed by a rash as well as intractable fevers of unknown etiology—much later attributed to her lupus. Although she had a most concerning and dramatic presentation, she, so far, had responded very well to therapy including pulse dose steroids, plasmapheresis, intravenous immunoglobulins (IVIG), cyclophosphamide, and related medications.
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December 2015

Pain syndrome with stress fractures in transplanted patients treated with calcineurin inhibitors.

Clin Kidney J 2012 Feb 28;5(1):13-6. Epub 2012 Jan 28.

Division of Musculoskeletal Radiology, Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA.

Bone disease remains a major cause of morbidity after renal transplantation. Post-transplant osseous complications include osteoporosis and osteonecrosis, both historically associated with glucocorticoids, and a newer syndrome of bone pain associated with calcineurin inhibitors. Calcineurin inhibitor-induced pain syndrome (CIPS) is a reversible etiology of lower extremity bone pain and bone marrow edema reported in patients receiving cyclosporine or tacrolimus after solid organ or bone marrow transplantation. While the syndrome's pathophysiology is unclear, bone insufficiency and epiphyseal impaction may play a role. We review the literature on this increasingly important post-transplant entity and describe a case illustrating the syndrome's key features.
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http://dx.doi.org/10.1093/ndtplus/sfr156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400457PMC
February 2012