Central Nervous System Syndromes Research Articles

High Frequency of Autoantibodies in COVID-19 Patients with Central Nervous System Complications: a Multicenter Observational Study.

We present a panel of central nervous system (CNS) complications associated with coronavirus disease 2019 (COVID-19) and their clinical characteristics. We aim to investigate associations between neurological autoantibodies and COVID-19 patients with predominant CNS complications. In this retrospective multi-center study, we analyze neurologic complications associated with COVID-19 patients from Dec. 2022 to Feb. 2023 at four tertiary hospitals in China. CSF and/or serum in the enrolled patients were tested for autoantibodies using tissue-based assays (TBAs) and cell-based assays (CBAs). A total of 34 consecutive patients (median age was 40.5 years [range 15-83], 50% were female) were enrolled. CNS syndromes included encephalitis (n=15), encephalopathies (n=6), meningoencephalitis (n=3), ADEM (n=2), depression (n = 2), Alzheimer's disease (n=2), Parkinson disease (n=1), and central nervous system vasculitis (n=1). Twenty-eight specimens (of 44 tested; 11/27 [40.7%] CSF, 13/17 [76.5%] serums) were confirmed by TBAs to be autoantibodies positive. However, only a few autoantibodies (1 with MOG and 1 with NMDAR) were detected by CBAs assays. Twenty-four patients received immunotherapy. After a mean time of 7.26 months of follow-up, 75.8% (25/33) of patients had good outcome (mRS score ≤2). Although no significant difference was observed between the two groups, the proportion of positive CSF autoantibodies in the poor outcomes group was higher than that in the good outcomes group (57.1% vs 31.5%, P = 0.369). Autoantibodies were frequently observed in COVID-19-associated CNS complications. The identification of these autoantibody-positive COVID-19 cases is important as they respond favorably to immunotherapy.

Evaluation of research trends in the incidence of postoperative neurocognitive disorders in patients undergoing cardiac surgery

Postoperative neurocognitive disorders (PNDs) are a kind of acute central nervous system syndrome, which is a common postoperative complication in cardiac elderly patients. The two most commonly used terms for PNDs are postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). POD often leads to a series of adverse clinical outcomes and even death, so its prevention and treatment has become an important part of perioperative management in elderly patients. In the past decades, research has focused on the mechanism and progress of the pathogenesis of PNDs. Nonetheless, little research has been conducted on the research trends in the relevant field.

Abstract 13261: Global T Wave Inversion: Incidence and Implications in Critically Ill Patients

Background: Symmetric global T-wave inversion (GTWI) occurs in 0.3% of general hospital admits. As reported by Walder and Spodick, GTWI exhibited a 4:1 female preponderance and was often associated with ACS or central nervous system (CNS) disorders; in-hospital mortality was not affected. Anecdotally we have observed this ECG pattern in critically-ill medical ICU (MICU) patients. We hypothesized that GTWI is more prevalent among MICU patients and may be associated with adverse outcomes. Methods: We reviewed the ECGs, demographic, clinical, and physiological data of 1652 consecutive patients admitted to 2 medical ICUs. Those admitted to CCU and Neuro ICU were excluded as were MICU patients with a primary diagnosis of ACS, acute CNS syndrome, LBBB, ventricular pacing, pre-excitation, and uninterpretable ECG. ECGs performed within 48 hours of ICU admit were reviewed by 2 blinded readers. GTWI was defined by the criteria of Walder and Spodick. The GTWI group was compared to 95 matched patients without GTWI. Results: See Table. GTWI occurred in 75 patients (4.5%); 56% of whom were female. Significant differences between GTWI vs control included history of CAD (p=0.03), cardiomyopathy (p=0.035), CKD (p=0.046), and prior EP procedure (p=0.023). In addition, QT-interval (p<0.0001), QTc (p<0.0001) and BNP (1433±1725 vs 750±978 pg/mL; p=0.032) were greater in the GTWI group. LVEF (52.7±16.2% vs 55.6±14.1%) and cTnI (1.35±2.52 vs 1.25±4.15 pg/mL) were similar. MICU days and APACHE II score were greater in those with GTWI. Total length of stay and in-hospital mortality were similar. Conclusions: In this critically-ill MICU cohort, GTWI was more prevalent compared to previously reported general hospital admits. A distinct female preponderance was not found. This ECG pattern was associated with underlying cardiac disease, greater length of MICU stay and higher illness severity, but was not associated with higher in-hospital morality.

Перинатальні наслідки інноваційної тактики лікування звичного невиношування вагітності при істміко-цервікальній недостатності

Purpose - to improve the effectiveness of the treatment of miscarriage due to isthmic-cervical insufficiency (ICI) by using improved management tactics for women at high risk of ICI. Materials and methods. A two-stage innovating tactic for the treatment of miscarriage caused by ICI was proposed, including the prediction of the ineffectiveness of vaginal cerclage and the implementation of transabdominal cerclage in certain groups of patients. Starting from the pregravid stage, 30 women at risk of ICI were examined, which were conducted according to the developed scheme. 2 patients with a history of failed vaginal cerclage had abdominal cerclage prior to pregnancy and had not yet become pregnant at the time of writing. In 28 remaining women, the course and results of pregnancy were monitored. 3 patients after trachelectomy for cervical cancer were given abdominal cerclage in early pregnancy. 23 pregnant women were subjected to vaginal cerclage prophylactically or for sonographic or physical indications, these women constituted the main group for evaluating the effectiveness of the proposed treatment regimen for miscarriage in ICI. The comparison group consisted of 80 women with intravaginal cerclage, who were managed according to the protocols of the Ministry of Health of Ukraine. Results. The effectiveness of the proposed tactics for the treatment of miscarriage caused by ICI reflects the frequency of miscarriage and its structure. No cases of late miscarriages were observed. The rate of preterm birth significantly decreased from 37.5% to 21.7% (p<0.05), while no cases of early preterm birth (before 28 weeks) were observed. In the structure of miscarriage, 80.0% is the proportion of preterm births at 34-36 weeks of gestation (against 35.5%; p<0.05). The frequency of premature rupture of membranes decreased by 4 times (8.7% vs. 36.3%; p<0.05). The frequency of birth of children in a state of asphyxia decreased by more than 2 times (17.4% vs. 43.4%; p<0.05), and there was not a single case of birth in a state of severe asphyxia. The incidence of complications in the early neonatal period decreased by 20% (43.5% vs. 63.2%; p<0.05), mainly due to a decrease in the frequency of such dangerous complications as respiratory distress syndrome (13.0% vs. 31.6%; p<0.05) and disorders of central nervous system (17.4% vs. 44.7%; p<0.05). Conclusions. The use of the proposed tactics for the treatment of miscarriage caused by CI made it possible to significantly reduce the frequency of miscarriage and improve its structure, avoid cases of spontaneous miscarriages and neonatal deaths, improve the condition of newborns, which makes it possible to recommend the introduction of this tactic in the practical work of obstetric and gynecological institutions. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The effect of acute topiramate administration on morphine withdrawal syndrome and brain-derived neurotrophic factor in central nervous system

ABSTRACT Objectives Nucleus accumbens plays an important role in opioid addiction. Topiramate, increases postsynaptic gamma-aminobutyric acid receptor activity and antagonizes glutamatergic activity. Brain-derived neurotrophic factor (BDNF), which plays a key role in synaptic plasticity, is produced from proBDNF. The aim of this study is to investigate the effects of 100 µM topiramate applied into the lateral ventricle or nucleus accumbens on naloxone-induced morphine withdrawal and the BDNF/proBDNF ratio in the frontal cortex. Methods In the study, 36 adult male Wistar rats weighing 250–350 g were used. Morphine dependence was created with morphine pellets following guide cannula implantations. Withdrawal findings were evaluated in naloxone-induced morphine withdrawal syndrome following topiramate administration, and locomotor activity measurements were performed simultaneously. The brains of sacrificed animals were removed for determination of BDNF/proBDNF ratio. Results Topiramate administered by either route significantly suppressed the number of jumps in morphine withdrawal. Topiramate applied into the nucleus accumbens significantly reduced stereotypical behavior in morphine withdrawal, but did not cause any changes in other locomotor activity behaviors. Topiramate applied into the lateral ventricle significantly decreased the BDNF/proBDNF ratio, whereas administered into the nucleus accumbens significantly increased this ratio. Conclusion The findings of this study indicate that topiramate administered into the lateral ventricle and nucleus accumbens reduces naloxone-induced morphine withdrawal symptoms, stereotypical locomotor activity, and changes the BDNF/proBDNF ratio.

Paraneoplastic neurological syndromes of the central nervous system: a single institution 7-year case series.

Paraneoplastic neurological syndromes (PNSs) are nonmetastatic complications of malignancy, defined by the presence of onconeural antibodies (ONAs). ONAs may be found in 60% of patients with central nervous system (CNS) involvement, and they are directed against intraneuronal antigens or channels, receptors or associated proteins located at the synaptic or extra-synaptic neuronal cell membrane. Given its rare incidence, there are few epidemiological case series on CNS-PNS. We aim to discuss the variability of CNS-PNSs etiology, clinical features, management and outcome, highlighting the importance of early recognition and appropriate treatment, leading to significant reduction of mortality and morbidity. We retrospectively reviewed our 7-years single-center experience, and specifically discussed the underlying etiology, parenchymal CNS involvement, and the acute treatment response. Only cases fulfilling PNS Euronetwork criteria for definitive PNS were included. A total of 26 probable PNSs cases involving CNS were identified. We reported medical records of eleven (42.3%) illustrative cases, meeting the criteria of definite PNS and presenting variable clinical spectrum and different radiological appearances. Our series has a relative paucity of the most common syndromes and larger portion of clinical diagnosis with ONAs. Well-characterized ONAs had been detected in CSF of six patients. Our case series supports the utmost importance of early recognition of CNS-PNSs. Screening for occult malignancies should not be limited to patients with classical CNS syndrome. Empiric immunomodulatory therapy may be considered before the diagnostic evaluation is completed, in order to prevent unfavorable outcome. Late presentations should not discourage initiation of treatment.

Central nervous system syndrome associated with Marek’s disease in Hubbard broilers

Marek’s disease (MD) has a high economic impact in poultry production worldwide. MD consists of several pathologic syndromes of which the most commonly encountered are lymphoproliferative syndromes such as acute MD. Sporadically, MD leads to central nervous system syndromes characterized by non-neoplastic brain pathology. In this case report, an onset of neurological signs on two different broiler farms, housing ‘slow-growing’ Hubbard JA 757 broilers, is described. On the first farm, clinical signs were observed from 42 days of age onwards and on the second farm, respectively from 42 (stable 1) and 30 days (stable 2) of age onwards. The neurological symptoms consisted of acute central nervous system signs, which started with flaccid neck paralysis. Histopathological examination revealed multifocal perivascular cuffing of CD3 positive mononuclear cells in the brain tissues. These findings pointed towards the development of transient paralysis. qPCR analysis confirmed the diagnosis. In broiler flocks, which only have a limited life span, vaccination is not common practice. In flocks of slow-growing breeds, outbreaks of MD might become more important again. Therefore, vaccination of slow-growing broilers against MD seems recommended.

Mielitis transversa aguda asociada con infección por SARS-CoV-2

In addition to causing respiratory problems, SARS-CoV-2 can cause a wide spectrum of neurological complications such as headaches, ageusia, anosmia, encephalopathy, cerebrovascular disease, Guillain-Barré syndrome and other polyneuropathies, meningoencephalitis, acute necrotizing hemorrhagic encephalopathy, and central nervous system syndromes associated with inflammation. In this review we present 39 cases of acute transverse myelitis (ATM) associated to SARS-CoV-2 infection. All cases had a positive polymerase chain reaction (PCR) nasopharyngeal swab and/or antigen test. Biochemical analyses confirmed the absence of other pathogens and autoantibody-mediated neuroinflammatory disease, except for two cases, one with autoantibodies against the oligodendrocyte myelin glycoprotein (anti-MOG IgG) and another with anti-MOG IgG and anti-glutamic acid decarboxylase (anti-GAD65). Magnetic Resonance Imaging (MRI) studies confirmed the diagnosis of ATM. Although causality cannot be inferred, it is likely that isolated cases of ATM are the consequence of a para or post-infectious process in SARS-CoV-2. In this work, the probable causes of ATM associated with SARS-CoV-2 are discussed. The understanding of the mechanisms behind these neurological disorders triggered by a viral infection will help to optimize the therapeutic strategies for patient management. Keywords: SARS-CoV-2; COVID-19; transverse myelitis; long COVID; demyelination; nervous system.

Retrospective Study of Marek’s Disease in Commercial Broilers in France: Focus on Central Nervous System Syndromes

Retrospective Study of Marek’s Disease in Commercial Broilers in France: Focus on Central Nervous System Syndromes

Topical Administration of a Marine Oil Rich in Pro-Resolving Lipid Mediators Accelerates Wound Healing in Diabetic db/db Mice through Angiogenesis and Macrophage Polarization.

Impaired wound healing in patients with type 2 diabetes (DM2) is characterized by chronic inflammation, which delays wound closure. Specialized pro-resolving lipid mediators (SPMs) are bioactive molecules produced from essential polyunsaturated fatty acids (PUFAs), principally omega-3 docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). SPMs are potent regulators of inflammation and have been used to suppress chronic inflammation in peripheral artery disease, non-alcoholic fatty liver disease, and central nervous system syndromes. LIPINOVA® is a commercially available safe-grade nutritional supplement made from a fractionated marine lipid concentrate derived from anchovy and sardine oil that is rich in SPMs and EPA, as well as DHA precursors. Here, we assessed the effect of LIPINOVA® in wound dressing applications. LIPINOVA® showed biocompatibility with keratinocytes and fibroblasts, reduced the abundance of pro-inflammatory macrophages (Mφ1), and promoted in vitro wound closure. Daily application of the marine oil to open wounds made by punch biopsy in db/db mice promoted wound closure by accelerating the resolution of inflammation, inducing neoangiogenesis and Mφ1/Mφ2 macrophage polarization. In conclusion, LIPINOVA® displays pro-resolutive properties and could be exploited as a therapeutic agent for the treatment of diabetic ulcers.

Predicting the Risk of in-Hospital Mortality in Patients with HIV-Associated Talaromyces Marneffei Infection

Disseminated Talaromyces marneffei infection (formerly termed penicilliosis) is the third most common microbiologically confirmed opportunistic infection in Southeast Asia, with mortality of up to 30% despite antifungal therapy. There are restrictive clinical algorithms to predict treatment outcomes. A total of 513 patients with microbiology-confirmed HIV-associated talaromycosis were included in the analysis. Poor outcome was observed in 143/513 patients (27.9%). In the univariate logistic regression analysis, hepatomegaly and splenomegaly were protective factors. Shorter duration of illness, higher respiratory rates, dyspnea, AIDS-associated central nervous system syndromes, platelet counts <50,000 cells/mL, aspartate transaminase (AST) >300 U/L, alanine transaminase (ALT) >150 U/L, serum creatinine >110 µmol/L were predictors of poor outcome. In the multivariate logistic regression analysis, shorter days of illness, higher respiratory rates, platelet counts <50,000 cells/mL, AST >300 U/L and serum creatinine >110 µmol/L, active tuberculosis (TB) and/or ongoing TB induction treatment and AIDS-associated central nervous system syndromes were independent predictors of poor outcome. The prognostic scores ranged from 0 to 19, corresponding to a mortality risk of 0% to 100%. The internal validation showed acceptable discrimination (AUC=0.68) and calibration slope (0.93). The Brier score for model performance was 0.14. We developed a simple scoring system that can predict the risk of death in patients with HIV-associated talaromycosis based on routinely measured characteristics on admission. The scoring system will be further externally validated using other cohorts in the region.

SARS-CoV-2 Infection and Possible Neonatal Neurological Outcomes: A Literature Review.

The virus responsible for COVID-19 is designated “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), a highly transmissible and pathogenic coronavirus. Although people of all ages are susceptible to SARS-CoV-2 infection, clinical manifestations may vary with age. The response of neonates to SARS-CoV-2 infection or exposure differs from that of children and adults. Encephalitis due to viral infections in the central nervous system (CNS) and childhood multisystem inflammatory syndrome (MIS-C) are some of the possible neonatal consequences of SARS-CoV-2 infection. This review aims to verify possible neonatal neurological outcomes after SARS-CoV-2 infection. Overall, the cellular and molecular basis of the neurological sequelae of SARS-CoV-2 in neonates remains unclear, and attempts to elucidate the pathophysiology of COVID-19 involve a comparison with the mechanism of other viral diseases. There are a considerable number of case reports in the literature exploring neurological outcomes in the neonatal period. In this review, we present possible effects of SARS-CoV-2 in neonates, emphasizing the importance of monitoring this group. The mechanisms of SARS-CoV-2 entry into the CNS have not yet been fully elucidated, and the potential severity of SARS-CoV-2 infection in neonates, as well as the possible short- and long-term neurological sequelae, remain unclear.

P248 Tuberculosis is still a major contributor to serious infection in juvenile SLE

Abstract Background/Aims Infections are a major cause of morbidity and mortality in juvenile systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in juvenile SLE. Methods We carried out a retrospective review of 175 patients of juvenile SLE (ACR 1997 criteria) with age <18 years visiting the rheumatology clinic at a single centre between 2010 and 2020. Clinical details were retrieved from clinical case records and supplemented with data from the hospital's electronic health records. Major infections (defined as need for hospitalization, prolonged antibacterial therapy >1 week, resulting in disability or death) were recorded. Predictors of infection and their outcomes were determined using multivariate logistic regression and Kaplan Meier survival analysis. Results Among 175 patients (154 were girls) with a mean age of 14.79±3.1 years, there were a total of 52 major infections in 43 patients with an incidence rate of 8.83 per 100 person-years. The respiratory tract (19) was the most commonly involved site followed by skin and soft tissue (10), gastrointestinal tract (6), systemic bacteremia (5), ear nose and throat (4), disseminated infection (3), urinary tract (2), central nervous system (1), joint (1) and dengue shock syndrome (1). Organisms isolated were Mycobacterium tuberculosis (11) which was the most common and predominantly extrapulmonary, followed by enterobacteria (12), Staphylococcus aureus (5), cytomegalovirus (3), Herpes zoster (2), Herpes simplex (1), MRSA (1), and Candida (1). Gastrointestinal involvement (OR 4.21), major organ involvement (OR 2.5), use of cyclophosphamide (OR 7.63), higher baseline SLEDAI (16[11.5-21] vs 12[8.75-16.25]) and a higher daily dose of prednisolone (16.1±15.1mg vs 6.1±5.8mg) at the time of the infection were predictors of a major infection. On multivariate analysis, only higher daily doses of corticosteroids (OR1.09, 95% CI 1.05-1.14) and gastrointestinal involvement (OR 4.98, 1.05-23.65) were significant predictors. Major infection-free survival at 1 year and 5 years was 82.5% (95% CI 76.8-88.7) and 72.5% (95% CI 65-80.9) respectively. There were eight deaths with five directly attributable to infection. Overall survival was worse in those who had an episode of major infection. Conclusion The risk of major infections in juvenile SLE is significant and associated with higher daily corticosteroid use and gastrointestinal involvement at baseline. Disclosure R. Chatterjee: None. S. Pattanaik: None. L. Gupta: None. D.P. Misra: None. V. Agarwal: None. A. Lawrence: None. A. Aggarwal: None.

Primary angiitis of the central nervous system and reversible cerebral vasoconstriction syndrome: analysis of the National Inpatient Sample.

Primary angiitis of the central nervous system (PACNS) and reversible cerebral vasoconstriction syndrome (RCVS) are two rare syndromes that affect the cerebral vasculature. Both conditions have been shown to cause severe neurologic complications. Distinguishing these two conditions in clinical practice is often challenging. Here, we compare the clinical features and outcomes of RCVS and PACNS hospitalizations against the general adult inpatient population. We conducted a retrospective review of hospitalizations with a diagnosis of PACNS or RCVS from 2016 to 2018 in the National Inpatient Sample (NIS) database. Multivariate analysis was performed to calculate adjusted odds ratios (ORadj) for hospital outcomes. In the NIS, 3305 hospitalizations had a diagnosis of RCVS and 6035 hospitalizations had a diagnosis of PACNS. RCVS hospitalizations had a significantly greater association with cerebral aneurysms (ORadj 23.80), hemiplegia/hemiparesis following subarachnoid hemorrhage (SAH) (ORadj 324.09), ischemic stroke (ORadj 7.59), and nontraumatic SAH (ORadj 253.61). PACNS hospitalizations had a significantly greater association with hemiplegia/hemiparesis following cerebrovascular accident (CVA) (ORadj 6.16), ischemic stroke (ORadj 11.55), nontraumatic SAH (ORadj 7.29), seizure (ORadj 2.49), and in-hospital mortality (ORadj 2.85). We performed an analysis of the NIS to better understand RCVS and PACNS hospitalizations. Severe neurologic events including CVA and SAH were elevated in both, but SAH and related hemiplegia/hemiparesis were extremely common among RCVS hospitalizations. In-hospital mortality was elevated in PACNS but not RCVS. This information can be used to help clinicians better understand, distinguish, and diagnose these conditions. Key Points • Despite clear description of RCVS and PACNS in the medical literature, there remains a scarcity of national population-based studies comparing these two entities against the general adult inpatient population. • This study aims to fill knowledge gaps in this area. • Here, we compare the clinical features and outcomes of RCVS and PACNS hospitalizations against the general adult inpatient population.

Cerebrospinal fluid analysis in patients with COVID-19-associated central nervous system manifestations: a systematic review.

Central nervous system (CNS) symptoms may occur in patients with acute COVID-19. The role of CSF examination in these patients remains to be established. A systematic review of CSF findings relating to COVID-19 was carried out. CSF parameters, including cytological and biochemical analyses, SARS-CoV-2 RT-PCR and other CSF markers, were recorded and analyzed among patients with acute COVID-19 and one of the following CNS syndromes: stroke, encephalopathy, encephalitis, inflammatory syndromes, seizure, headache and meningitis. Increased white blood cells and/or increased protein concentration were found in 52.7% of the patients with encephalitis, 29.4% of the patients with encephalopathy and 46.7% of the patients with inflammatory syndromes (P < 0.05). CSF RT-PCR for SARS-CoV-2 was positive in 17.35% of the patients with encephalitis and less than 3.5% of the patients with encephalopathy or inflammatory syndromes (P < 0.05). Intrathecal production of immunoglobulins was found in only 8% of the cases. More than 85% of the patients had increased CSF cytokines and chemokines. Increased CSF neurofilament light chain (NfL) and CSF Tau were found in 71% and 36% of the cases, respectively. Non-specific inflammatory CSF abnormalities were frequently found in patients with COVID-19 CNS syndromes. The increase in neurodegeneration biomarkers suggests that neuronal damage occurs, with long-term consequences that are still unknown.

Therapeutic Plasma Exchange using Continuous Flow Cell Separator Machine in a Neuromyelitis Optica Patient Outcome and Analysis

Neuromyelitis optica (NMO) is an inflammatory central nervous system syndrome, associated with serum aquaporin-4 immunoglobulin G antibodies. Autoantibodies against aquaporin-4 (AQP4-IgG), the principal water channel on astrocyte foot processes at the blood brain barrier, are pathogenic in NMO. Acute attacks are managed by high-dose intravenous methylprednisolone, if symptoms fail to resolve, plasma exchange is considered. Here, we present a case of NMO spectrum disorder in a 20 year old lady, failed to pharmacotherapy, was managed by plasma exchange using Spectra Optia Cell Separator machine. Detailed plasma exchange protocol, disease progression and outcome was analysed in this study.

Hospital-based observational study of neurological disorders in patients recently vaccinated with COVID-19 mRNA vaccines

PurposeWe describe the spectrum of acute neurological disorders among hospitalized patients who recently had COVID-19 mRNA vaccination. MethodWe performed a prospective study at 7 acute hospitals in Singapore. Hospitalized patients who were referred for neurological complaints and had COVID-19 mRNA vaccines, BNT162b2 and mRNA-1273, in the last 6 weeks were classified into central nervous system (CNS) syndromes, cerebrovascular disorders, peripheral nervous system (PNS) disorders, autonomic nervous system (ANS) disorders and immunization stress-related responses (ISRR). ResultsFrom 30 December 2020 to 20 April 2021, 1,398,074 persons (median age 59 years, 54.5% males) received COVID-19 mRNA vaccine (86.7% BNT162b2, 13.3% mRNA-1273); 915,344(65.5%) completed 2 doses. Four hundred and fifty-seven(0.03%) patients were referred for neurological complaints [median age 67(20–97) years, 281(61.5%) males; 95.8% received BNT162b2 and 4.2% mRNA-1273], classified into 73(16.0%) CNS syndromes, 286(62.6%) cerebrovascular disorders, 59(12.9%) PNS disorders, 0 ANS disorders and 39(8.5%) ISRRs. Eleven of 27 patients with cranial mononeuropathy had Bell's palsy. Of 33 patients with seizures, only 4 were unprovoked and occurred within 2 weeks of vaccination. All strokes occurred among individuals with pre-existing cardiovascular risk factors. We recorded 2 cases of cerebral venous thrombosis; none were vaccine-induced thrombotic thrombocytopenia. Five had mild flares of immune-mediated diseases. ConclusionOur observational study does not establish causality of the described disorders to vaccines. Though limited by the lack of baseline incidence data of several conditions, we observed no obvious signal of serious neurological morbidity associated with mRNA vaccination. The benefits of COVID-19 vaccination outweigh concerns over neurological adverse events.

Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil.

Virus-induced infections of the central nervous system (CNS) are among the most serious problems in public health and can be associated with high rates of morbidity and mortality, mainly in low- and middle-income countries, where these manifestations have been neglected. Typically, herpes simplex virus 1 and 2, varicella-zoster, and enterovirus are responsible for a high number of cases in immunocompetent hosts, whereas other herpesviruses (for example, cytomegalovirus) are the most common in immunocompromised individuals. Arboviruses have also been associated with outbreaks with a high burden of neurological disorders, such as the Zika virus epidemic in Brazil. There is a current lack of understanding in Brazil about the most common viruses involved in CNS infections. In this review, we briefly summarize the most recent studies and findings associated with the CNS, in addition to epidemiological data that provide extensive information on the circulation and diversity of the most common neuro-invasive viruses in Brazil. We also highlight important aspects of the prion-associated diseases. This review provides readers with better knowledge of virus-associated CNS infections. A deeper understanding of these infections will support the improvement of the current surveillance strategies to allow the timely monitoring of the emergence/re-emergence of neurotropic viruses.

Evoked Potential Studies (EP) P-EV001. Visual evoked potential findings in Neuromyelitis optica spectrum disorders

Introduction . Neuromyelitis optica is an inflammatory, demyelinating syndrome of central nervous system that is characterised by severe attacks of optic neuritis and myelitis. It has a high morbidity and mortality. Five years after initial presentation, more than 50% of patients with NMO will be blind in one or both eyes or require ambulatory help. Methods . A total of 68 patients with neuromyelitis optica spectrum disorders (NMOSD) admitted to neuromedical ward of Yangon General Hospital were prospectively studied for visual acuity, and visual evoked potential were performed. Results . Visual acuity was ranged from normal to blindness. Visual impairment were classified into mild, moderate, severe and blindness according to WHO classification. At admission, among 68 patients, 4.4% of the patients had moderate vision impairment, 1.5% had severe vision impairment, 50.0% had blindness, and 44.1% had no vision impairment. Among 136 eyes examined, 43 (31.6%) had no visually evoked response. Out of 93 eyes (68.4%) in which VEP responses were detected, 61 (65.6%) had P100 wave latency within normal limits, while remaining 32 (34.4%) had increased wave latency. Latency values among study population were found to be ranging between 84.7 ms and 164.6 ms and the average latency of P100 was 111.8 ± 19.5 ms. Among 93 eyes in which visual response was evoked, it was found that 14 eyes (15.1%) had reduced P100 wave amplitude with normal latency. Conclusion . In Neto et al. study (2013), reduced P100 wave amplitude with normal latency in 65% of the 20 eyes in which the visual response was evoked .This pattern was called the ‘NMO pattern’. So regarding these data, such an NMO pattern was not evident in present study. Because most of patients have severe vision impairment and latency is prolonged in most of the patients.

Dysautonomia in immune‐mediated neuropathies

AbstractIn Guillain‐Barré syndrome (GBS), severe dysautonomia is associated with a poor prognosis and may cause extraperipheral nervous system disorders such as posterior reversible encephalopathy syndrome and Takotsubo cardiomyopathy. Dysautonomia is associated with demyelination in vagal nerves with mononuclear cell infiltration, and demyelination is the predominant pathology. Approximately half of the cases of autoimmune autonomic ganglionopathy (AAG) are positive for antiganglionic acetylcholine receptor antibody. It is believed that there is no clinical difference between antibody‐positive and antibody‐negative cases, but a recent study indicated that seronegative AAG is a distinct clinical entity. Extra‐autonomic symptoms such as central nervous system disorder, amenorrhea, and syndrome of inappropriate secretion of antidiuretic hormone are also present in AAG. When accompanied by sensory impairment, it is difficult to distinguish AAG from acute autonomic sensory neuropathy (AASN). It is also often difficult to distinguish AASN from GBS, as two‐thirds of patients with AASN have antecedent infection, AASN often has a monophasic course, and there are also antiglycolipid antibody‐positive cases. Identification of biomarkers is required for evaluation of the pathophysiology of AASN and establishment of diagnostic criteria. There is an urgent need for biomarkers and for definition of highly sensitive diagnostic criteria for immune‐mediated dysautonomia.