Acute Encephalomyelitis Research Articles

A Case Series of Scrub Meningoencephalitis from a Tertiary Care Center in North India

Abstract Scrub typhus infection is reemerging leading cause of acute febrile illnesses in post-rainy or monsoon season in Southeast Asia. It is caused by Orientia tsutsugamushi and spread by the bite of chiggers, larval forms of trombiculid mites. The clinical picture can range from simple acute febrile illness to multiorgan dysfunction. Neurological manifestations also vary from aseptic meningitis, meningoencephalitis, cerebral infarction, acute disseminated encephalomyelitis, transverse myelitis, and psychiatric manifestations. Here, we present a case series of eight cases of scrub meningoencephalitis diagnosed based on clinical, laboratory, and radiological criteria.

Post-COVID-19 acute disseminated encephalomyelitis in a 51–year-old female from Nepal: A case report with literature review

There have been a growing number of acute disseminated encephalomyelitis cases following coronavirus disease-19 (COVID-19) infection. Given the rare occurrence, studies eliciting the clinical features, treatment response, and outcomes are still limited. In patients recovering from COVID-19, multifocal neurologic symptoms in the presence or absence of encephalopathy must be closely evaluated by neurologists and physicians. Early radiographic evaluation using magnetic resonance imaging and timely administration of glucocorticoid-based treatment reduces mortality and leads to satisfactory outcomes.

Neurološke komplikacije teškog oblika Influenze A kod dece

Introduction: Neurological complications of Influenza infection in pediatric population vary in incidence and severity. The central nervous system is most often affected by encephalitis and encephalopathy. Acute necrotizing encephalopathy (ANE) is the most serious complication. The aim of this case study was to present a variety of severe cases of neuro-influenza in pediatric patients. Methods: The study presents five children who were hospitalized in the pediatric intensive-care unit due to neurological complications of Influenza A infection during the winter season of 2022/2023. The identification of the causative agent was carried out by the reversetranscription-polymerase chain reaction or by the detection of viral antigens in the samples of nasopharyngeal swabs. Results: Four out of five presented patients were male. The average age at admission was 6 years (min. 7 months, max. 11 years). All patients had an acute disturbance of consciousness at admission and four of them had seizures. Neurological complications of Influenza A infection presented as acute encephalitis, posterior reversible encephalopathy syndrome, acute disseminated encephalomyelitis, encephalopathy, and ANE. Neurological signs appeared approximately four days after the first symptoms. There were no lethal outcomes. Younger patients had more severe brain damage and took longer to recover. None of the children had been vaccinated against the flu. Conclusions: Children presenting with acute neurological deterioration during influenza season should be evaluated for influenza-associated central nervous system complications even if the respiratory involvement is mild or there are no respiratory signs at all. Magnetic resonance imaging is the most important tool for early diagnosis.

Spectrum of Neurological Disorders Related to Autoimmune Diseases in Brazzaville, Congo

Background: Autoimmune diseases, which are among the leading causes of morbidity and mortality in the world, are pathologies caused by a dysfunction of the immune system. They can affect the central nervous system, the peripheral nervous system or both nervous systems. Objectives: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutive aspects of neurological disorders related to autoimmune diseases. Methods: This was a prospective cohort study. It was carried out from 1 January 2015 to 31 December 2019 (5 years). It focused on patients aged 15 years and above, who were hospitalized or followed as ambulatory patients for neurological disorders related to autoimmune diseases in the neurology department of the university teaching hospital in Brazzaville. Results: Among the 41 patients who fulfilled inclusion criteria, there were 29 (70.73%) women and 12 (29.27%) men. The average age of patients was 38.3 ± 13.8 years. An increase in the frequency of neurological disorders related to autoimmune diseases was observed every year. The main neurological disorders were neuromyelitis optica spectrum disorders (n = 14; 34.15%), acute polyradiculoneuropathies (n = 13; 31.71%), chronic polyradiculoneuropathies (n = 4; 9.75%) and acute disseminated encephalomyelitis (n = 3; 7.31%). The treatments administered, which consisted of corticosteroids and immunosuppressive drugs, had significantly improved the vital prognosis and functional status of patients (p = 0.025). Conclusion: In our study population, neurological disorders related to autoimmune diseases are rare. The neurological clinico-pathological entities diagnosed are similar to those reported in the literature. The therapeutic approaches used improve the quality of life of patients.

Levamisole-associated multifocal inflammatory encephalopathy: clinical and MRI characteristics, and diagnostic algorithm.

Levamisole-associated multifocal inflammatory encephalopathy (LAMIE) is a devastating adverse effect of levamisole (LEV) treatment. In Russia, people often use LEV without a doctor's prescription for anthelmintic prophylaxis. LAMIE often misdiagnosed as the first episode of MS or acute disseminated encephalomyelitis (ADEM). The aim of our study was to describe clinical, laboratory and morphological characteristics of LAMIE, magnetic resonance imaging (MRI) patterns and create an algorithm for the differential diagnosis. This study was a prospective observational study with retrospective analysis of cases. It was performed at two hospitals with ambulatory service for MS. We included 43 patients with LAMIE with follow-up was from 1 year to 5 years. Age was 19-68 y.o. with female predominance. The most typical manifestations of LAMIE were cerebellar, pyramidal and cognitive symptoms, and majority of patients had biphasic course of the disease. Three main types of MRI patterns were described: ADEM-like, MS-like, atypical demyelination. About 40% of patients had CSF specific oligoclonal bands synthesis, but only 20 % of them converted to MS during the period from 1 month until 2 years. The CSF albumin levels and immunoglobulin G index were elevated in LAMIE patients compared to reference values. We described results of brain biopsy in two cases. Therefore LAMIE should be considered in patients with demyelinating or inflammatory conditions with biphasic onset of the disease and variable MRI presentation.

Neurological Complications After Covid 19 Vaccinations: Serial Case Report

Background: COVID-19 vaccination has been carried out worldwide, with more than 5 million dose of vaccine delivered. Although declared safe, there are cases of neurological disorders after the Covid 19 vaccination. Cases: In the first case, a 20-year-old male came with decrease level of consciousness, 4 days after receiving the first dose of COVID 19 vaccine with Sinovac vaccine. MRI Brain shows acute disseminated encephalomyelitis (ADEM). In the second case, a 50-year-old male with seizures and decreased consciousness after recieving first dose of COVID-19 vaccination with Sinovac vaccine, 10 days before admission. Non contrast CT Scan and brain contrast MRI Brain revealed cerebral edema. In the third case, an 18-year-old woman had seizures and decreased consciousness one month after the first dose of COVID 19 vaccination with Sinovac. Contrast Head MRI showing focal leptomeningitis. In the fourth case, a 30-year-old male with slurred speech and right-sided weakness. Three months before admission, he had fever, headache, and tingling of the right limbs a few days after the first dose of COVID 19 vaccination with Sinova MRI Brain Contrast shows ADEM lesion Discussion: The mechanism of neurological disorders concerning COVID 19 vaccination is still unclear. Neurological complications after vaccination weaken the effort of vaccination, but can be used as a precaution and assess prognosis while waiting for further confirmation from large epidemiological studies and meta-analyses. Until now, it is believed that the COVID-19 vaccine has important benefits and is a hope for ending the COVID-19 pandemic.

COVID-19 association in an unresponsive case of acute disseminated encephalomyelitis

COVID-19 association in an unresponsive case of acute disseminated encephalomyelitis

Transcortical sensory aphasia heralding SARS-Cov-2-induced autoimmune encephalitis with gyral restricted diffusion hyperintensities: a novel case report

BackgroundCoronavirus disease 2019 (CoVID-19), primarily thought of as a respiratory system disease is actually a multi-system disease with immunological implications. CNS involvement in COVID has been explained in recent literature mainly for stroke, encephalopathy, encephalitis, acute disseminated encephalomyelitis and myelopathy. There are few studies characterizing clinical spectrum of COVID autoimmune encephalitis. We present a unique case of post-COVID autoimmune encephalitis in a diabetic male presenting with language dysfunction and novel radiologic findings.Case presentationPatient admitted to inpatient department of a tertiary care hospital of India was evaluated by bedside clinical examination, routine blood tests, CSF study with intrathecal SARS-Cov-2 antibody detection, commercially available tests for autoimmune encephalitis, neuroviral panel with HSV PCR, EEG, 3-Tesla MRI and PET scan. Patient was found to have personality change and transcortical sensory aphasia in the outset of COVID encephalitis. MRI findings like temporal involvement and insular ribboning are also being reported. The patient was treated with IV immunoglobulin and is on an improving course.ConclusionsThis case reports dysphasia due to COVID-mediated injury to the language networks, with novel radiologic findings. Role of parainfectious versus immune etiology is also discussed. Further studies are needed to elucidate the mechanism and clinical spectrum of post-COVID autoimmune encephalitis.

Postvaccination acute disseminated encephalomyelitis with <i>area postrema</i> syndrome and quasi benign paroxysmal positional vertigo: a case report

Area postrema syndrome (APS) develops in patients with lesions found in the floor of the fourth ventricle and manifests with nausea, intractable vomiting, and hiccup. APS is most commonly associated with neuromyelitis optica spectrum disorders although it may develop in some other conditions as well.
 We have presented a case study of APS with positional vertigo developed in a 41-year-old woman caused by acute disseminated encephalomyelitis after COVID-19 vaccination. Quasi benign paroxysmal positional vertigo acutely manifested with nausea, vomiting, and vertigo that dramatically worsened with head movement. Physical examination revealed patchy hypesthesia on the left side of the face and decreased convergence of the left eye. MRI scan showed a lesion adjacent to the floor of the fourth ventricle (area postrema). The manifestations totally regressed on glucocorticoids without any relapse during 1-year follow-up.

Supratentorial Demyelinating Lesions Following Severe Acute Respiratory Syndrome Coronavirus-2 Infection: A Pediatric Case Report

Most coronavirus disease 2019 (COVID-19) pediatric patients are asymptomatic; however, several neurological manifestations associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection have been reported. Demyelinating events such as acute disseminated encephalomyelitis have been recently included among potential complications of COVID-19. We describe the case of a 12-year-old boy who developed central nervous system demyelinating lesions following SARS-CoV-2 infection. Two months prior he had been diagnosed with panuveitis but was otherwise healthy. Three weeks after testing positive for SARS-CoV-2, he started to complain of right temporal headache associated with right orbital pain without vision impairment. Brain magnetic resonance imaging showed large leukodystrophy-like demyelinating lesions. Standard electroencephalogram revealed a slow activity on the right hemisphere. His clinical and electroencephalographic course was favorable, with a good response to corticosteroid therapy and infusions of intravenous immunoglobulins. Delayed but complete resolution of brain lesions was noted on imaging. Our case contributes to broaden the knowledge regarding the spectrum of possible complications of SARS-CoV-2 infection. The relative lack of clinical manifestations in our patient can be seen as a warning not to underestimate even mild neurological symptoms correlated with COVID-19.

Successful treatment of post–COVID-19 acute disseminated encephalomyelitis with urgent immunotherapy and neurointensive management: a case report

Background: Acute disseminated encephalomyelitis (ADEM)-like white matter disease, a rare complication of coronavirus disease 2019 (COVID-19), is a potentially life-threatening neurological disorder. The objective of this study was to report the successful treatment of post–COVID-19 ADEM with urgent immunotherapy and neurointensive management.Case Report: A 53-year-old woman was referred to our hospital with a 2-day history of progressive mental deterioration and was diagnosed with ADEM after COVID-19. The patient's symptoms worsened despite the administration of high-dose steroids, and targeted temperature management was employed to manage brain edema. Additionally, the neurointensivist decided to use intravenous immunoglobulin early for intractable post–COVID-19 ADEM. Her mental status and neuroimaging findings showed rapid improvement at about 3 months after admission.Conclusion: This case highlights that if the patient's symptoms worsen despite high-dose steroid administration in the acute stage, early use of intravenous immunoglobulin is expected to have a positive effect on the prognosis of patients with post–COVID-19 ADEM.

Clinical and Brain Imaging Findings of Children with Acute Ataxia: Ten Years of Experience at a Major Pediatric Referral Center

Background: Ataxia is a symptom of a wide range of disorders, which manifests as a lack of coordinated movements. It is commonly associated with cerebellar disorders. Objectives: To evaluate the neuroimaging findings of children with acute ataxia (AA) and to identify the association between these findings and clinical results. Patients and Methods: This cross-sectional study was conducted using the electronic medical records of patients, presenting to a major pediatric referral center over 10 years from March 2009 to February 2020. Patients were included in the study if they were younger than 18 years, were diagnosed with AA (< 30 days), and underwent magnetic resonance imaging (MRI), computed tomography (CT) scan, or both. The exclusion criteria were as follows: A history of neurological or medical disorders, explaining ataxia; pseudo-ataxia; a traumatic brain injury; severe loss of consciousness; and missing key information in the medical records (e.g., no brain imaging findings). Patient data, including the demographic data, clinical history, laboratory findings, imaging results, and in-hospital outcomes, were collected. A P-value less than 0.05 was considered statistically significant, and the confidence interval was set at 95%. Results: A total of 119 patients were included in this study (51% female; mean age, 4.9 years). Clinically urgent neurological pathology (CUNP) was detected in 37 (31.09%) patients. The most common pathologies on images were tumors, acute disseminated encephalomyelitis (ADEM), and stroke. However, the most common diagnosis was acute post-infectious cerebellar ataxia (APCA) (24.4%), followed by brain tumors (16.8%) and Guillain-Barre syndrome (GBS) (15.1%), respectively. Overall, 11 variables were significantly different between patients with and without CUNP. Most notably, the duration of symptoms (P < 0.01), ophthalmoplegia (odds ratio [OR] = 13.93; 95% confidence interval [CI]: 3.5 - 54.7), focal neurologic deficit (OR = 7.26; 95% CI: 2.6 - 20.5), and fever (OR = 3.33; 95% CI: 1.1 - 9.8) were associated with a higher risk of CUNP. On the other hand, some features, such as a recent history of febrile illness (presence of fever or body temperature above 38°C in the last month) (OR = 0.36; 95% CI: 0.16 - 0.8) and hyporeflexia (P < 0.01), were associated with a lower risk of CUNP. Conclusion: Acute post-infectious cerebellar ataxia was the most common diagnosis of AA in children, undergoing neuroimaging studies in our center. Nevertheless, tumor was the most common pathology detected on the images of patients with CUNP. Some pathologies might not be detected by some imaging modalities. Considering the associations identified in this study, patients with risk factors, such as a longer duration of symptoms, ophthalmoplegia, focal neurologic deficit, and fever, need to undergo another imaging modality with higher sensitivity if there are no positive findings in the initial imaging study. On the other hand, patients with protective factors, such as hyporeflexia and a recent history of febrile illness, could benefit more from other diagnostic modalities.

Acute disseminated encephalomyelitis in a patient with monkeypox: a case report and radiological findings

Monkeypox is a zoonosis caused by a double-stranded DNA virus of the Poxviridae family. It currently represents a global epidemic given its contagion reported in more than 31 previously non-endemic countries. We present the case of a 30-year-old male patient from Peru with a diagnosis of monkeypox by PCR test, who manifested an initial clinical picture of asthenia, adynamia, and odynophagia, with the appearance of pustular lesions on the lower lip and in the genital region associated with motor and sensory deficit of the lower limbs with altered state of consciousness, with subsequent findings of acute disseminated encephalitis by brain magnetic resonance imaging. This entity corresponds to an infrequent complication with only one case reported in the literature. The importance lies in knowing the possible imaging findings to suspect the diagnosis and expand the knowledge about this current disease.

Acute Flaccid Paralysis in Australian Children from 2007 to 2017

Introduction: Acute flaccid paralysis (AFP) surveillance continues globally as part of the World Health Organization’s goal to eradicate poliomyelitis. The Australian Paediatric Surveillance Unit (APSU), Paediatric Active Enhanced Disease Surveillance (PAEDS) network, and National Enterovirus Reference Laboratory (NERL) collaborate in AFP surveillance in Australia, capturing and reviewing cases of AFP for all aetiologies in order to exclude poliovirus. We aimed to describe the AFP epidemiology in childhood over an 11 year period. Methods: Data were reported nationally by paediatricians via prospective APSU surveillance, PAEDS surveillance nurses at five tertiary paediatric hospitals and NERL from 2007 to 2017. Children aged 0–15 years with AFP were included. We combined APSU, PAEDS, and NERL datasets, analysed epidemiological trends, and described clinical features and investigations for major diagnoses. Results: Of 590 AFP-compatible cases, 49% were male; 47% were aged 0–4 years, 9% aged <1 year. Annual incidence of AFP was 1.3 cases per 100,000 children aged <15 years. Lower limb paralysis was the most frequent presenting symptom. The most frequent diagnoses were Guillain-Barre syndrome (GBS; 36%), transverse myelitis (TM; 17%), and acute disseminated encephalomyelitis (ADEM; 15%). No secular trend was seen in frequency of AFP cases nor amongst major diagnoses. Seasonality was observed with ADEM occurring more frequently in winter. We observed periods of increased AFP frequency in 2013 and 2016, coinciding with increased reporting of non-polio anterior horn cell disease (AHCD) and detection of non-polio enterovirus (NPEV). Conclusions: Estimated incidence of GBS, ADEM, and TM in Australian children was comparable with international rates. There was stable incidence of AFP in Australian children between 2007 and 2017. GBS, ADEM, and TM are the major causes of AFP. We observed clustering of cases associated with NPEV that emphasises a need for ongoing vigilance in surveillance given continue emerging infectious disease threats.

Anti-myelin Oligodendrocyte Glycoprotein Antibody-Associated Disorder (MOGAD) in a Pediatric Patient with Rare Presentation of a Cerebellar Tumefactive Lesion

Objective NA. Background Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies have been commonly associated with optic neuritis, myelitis, and acute disseminated encephalomyelitis but rarely with tumefactive lesions, especially in children. We report a young child with MOGAD presenting with a tumefactive cerebellar demyelinating lesion. Design/Methods A retrospective chart review Results A 3-year-old developmentally appropriate boy with fever for five days prior presented for gait changes and a self-resolved seizure lasting less than 5 minutes. Neurologic examination showed abnormal finger to nose on the left side, weakness of the left lower extremity and an ataxic gait. The differential at the time was Todd's paralysis versus an intracranial process. MRI showed a non-enhancing, ill-defined T2 hyperintense tumefactive lesion with mass effect within the left cerebellum concerning for tumor, abscess, or demyelination. On EEG, a lack of a well sustained and modulated posterior dominant rhythm and lack of a well-developed anterior to posterior gradient, with moderate background slowing was seen. Cerebrospinal fluid showed 8 white blood cells, 0 red blood cells, 55 mg/dl glucose, 31 mg/dl protein, 0.61 IgG index, and 0 oligoclonal bands. The Mayo Clinic cell-based assay detected anti-MOG IgG antibody in the serum with titer of 1:100. Neurological symptoms gradually improved after steroid pulse therapy. Conclusions This report highlights the novel spectrum of radiologic manifestations associated with MOGAD in pediatric patients and MOGAD should always be considered in the differential diagnosis of tumefactive lesions.

Recurrent Acute Necrotizing Encephalopathy with underlying RANBP2 mutation

Objective N/A. Background Acute necrotizing encephalopathy (ANE) is a rapidly progressive encephalopathy that can occur in otherwise healthy children after common viral infections such as influenza and parainfluenza. Most ANE is sporadic and nonrecurrent (isolated ANE). We report a case of recurrent acute necrotizing encephalitis in a boy with an identified RANBP2 mutation, which is known to account for the majority of recurrent ANE cases. Design/Methods CASE REPORT Our patient is a 13-year-old boy with no significant medical or developmental history and no family history of neurodevelopmental disorders.He had his first episode at 15 months of agewhich manifested as irritability, non-responsiveness and was diagnosed as acute disseminated encephalomyelitis (ADEM) and subsequently had 4 additional episodes of ANE at ages 4,4.5,5, and 10. After his third episode, testing for RANBP2 was performed and found to be positive. His typical presentation includes fever, staring spells, nystagmus and altered sensorium during these episodes typically within 24 hours of febrile-illness. He has had multiple triggering viral infections identified including adenovirus, influenza A and parainfluenza. Ultimately his ANE episodes were managed with iv pulse steroid therapy and IVIG.With treatment he has had a slow but nearcomplete recovery, including radiological resolution. He does have mild cognitive impairment and learning difficulties which have persisted. Results N/A. Conclusions This patient has had numerous episodes of ANE triggered by infection that have responded well to acute management without prophylactic immunomodulation. This is, to our knowledge, themost non-fatal recurrences that have been reported with this condition. Our case suggests that multiple relapses are possible in patients with ANE and early diagnosis and treatment of the episodic encephalopathy would result in improved outcomes. Our case raises the consideration of prophylactic immunotherapy but also demonstrates a relatively positive outcome with a watchful management approach. Keywords: acute necrotizing encephalopathy.

MOGAD in the Mountain West: Epidemiology and Outcomes in Pediatric and Adult Patients at Two Large Academic Referral Centers

Objective To describe the characteristics and outcomes in adult and pediatric patients diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) at the two major referral centers in the Mountain West of the United States, a geographic area encompassing roughly 15% of the land mass of the continental US. Background Since the development of commercial assays, MOGAD has become increasingly recognized as an etiologic diagnosis for several CNS demyelinating phenotypes, yet the epidemiological characteristics, relapse rates and outcomes of large populations are not well-described Design/Methods A retrospective chart review for patients within the health systems at the University of Utah and the University of Colorado, and affiliated children's hospitals, was conducted. To identify MOGAD patients, we queried the ICD10 codes corresponding to demyelinating disease of CNS, neuromyelitis optic spectrum disease, optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis. These patients were then cross matched against antibody testing results and existing research databases at each institution. Search dates included 1/1/2016-12/1/2021 to encompass the period of commercially available MOG IgG testing. Patients were cross referenced with a list of positive MOG IgG assays at each institution. Results We describe the characteristics of over 50 patients (adults and children) with MOGAD, including age of onset, gender, symptoms at onset, associated autoimmunity, antibody titers, response to therapies and relapse rates. Conclusions This is a comprehensive characterization of a diverse population of pediatric and adult MOGAD patients seen at the two major referral hospitals in the Mountain West. The treatment regimens and outcomes in this population may inform approaches to current management and future clinical trials.

Clinical spectrum of neuro‐ophthalmological manifestations associated in MOG antibodies in children

AbstractIntroduction: The discovery of the role of MOG antibodies over the last decade has tremendously modified our comprehension of inflammatory disorders of the central nervous system (CNS), especially in children.Objective: To describe the clinical spectrum of neuro‐ophthalmological manifestations associated in MOG antibodies in children.Methods: Literature review using Pubmed and Google Scholar and chosen clinical case series.Results: Three long known clinical entities affecting the optic nerve in children have been recently proven to be largely associated with MOG antibodies: optic neuritis in the context of acute disseminated encephalomyelitis (ADEM); monophasic optic neuritis; chronic relapsing inflammatory optic neuropathy (CRION). ADEM is a child's specificity. CRION often starts during late childhood. These entities can occur after one another in a same child.Conclusions: The absence of overlap between multiple sclerosis, aquaporine 4 antibodies (associated with neuromyelitis optica only) and MOG antibodies, allows for a new, clearer delineation of inflammatory disorders of the CNS in children, closer to the precise classical clinical descriptions than to the semi‐recent criteria‐based “spectra”.

Central nervous system autoimmune diseases associated with COVID-19: Comprehensive review

The first appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) named coronavirus disease 2019 (COVID-19) was reported from Wuhan in December 2019. While this virus displays several respiratory manifestations such as severe pneumonia and acute respiratory distress syndrome, there are several reports of nervous system involvement in the affected patients. Currently, there is a growing number of cases with central nervous system (CNS) autoimmune diseases (ADs) including autoimmune encephalitis (AE), neuromyelitis optica spectrum disorder (NMOSD), CNS vasculitis, acute disseminated encephalomyelitis (ADEM), and multiple sclerosis (MS) secondary to COVID-19 infection. Symptoms of these diseases vary from mainly drowsiness, delirium, and motor deficits in ADEM, MS, and AE and also visual impairment, and sensory problems in NMOSD and transverse myelitis patients. The severity of COVID-19 symptoms was also different from disease to disease. Based on the previous studies moderate corticosteroid therapy or other medication such as intravenous human immunoglobulins (IVIG), and plasma exchange (PLEX) is suggested for the treatment of CNS ADs in COVID patients. Also, patients with a previous history of ADs and other comorbidities such as hypertension, diabetes mellitus, hypercholesterolemia, and ischemic heart disease are at greater risk to develop severe complications of COVID compared to other patients. Current pieces of evidence demonstrated that CNS ADs can occur due to COVID-19 infection and the healthcare system should attention to CNS ADs as a complication of COVID-19. However, further investigations are strongly needed to confirm these findings.

Pediatric Optic Neuritis Post Vaccination: A Literature Review

Pediatric optic neuritis (PON) tend to have their differences with adult optic neuritis (ON). It might happen due to several etiologies such as neuromyelitis optica disorder, acute disseminated encephalomyelitis, multiple sclerosis and many more. While cases of post infectious and post vaccination rarely happened in adults compared to other etiologies, it works differently on pediatric cases. Pediatric ON caused a lot by post infectious and post vaccinations episode, and may or may not associated with other etiology. Vaccines are a must have thing to do in childhood period, therefore it is crucial to know more about post vaccinations PON. This article aims to review previous studies discussing pediatric optic neuritis especially the ones due to post vaccination.