Common Neurological Symptoms Research Articles

Role of incompatible food and regimen in neurological disorders

Introduction: The burden of neurological disorders has gradually increased over last 30 years. Neurological disorders are becoming a leading cause of disability and mortality in worldwide population. Patients presenting with common neurological symptoms like headache, anxiety, behavioural changes, fatigue, unexplained pain, erectile dysfunction, have been increasing, most of which can be attributed to unhealthy lifestyle and dietary practices. Ayurveda is one of the oldest systems of medicine, evolved over 3 millennia through constant devotedness of its preachers & learners. Viruddha Ahara is mentioned to cause various metabolic disorders and may even lead to neurological diseases. Food-food interaction is a serious issue requiring much attention. Hence it is of importance to ascertain role of Viruddha Ahara in the manifestation of different neurological disorders. Aim: To study role of incompatible food and regimen in neurological disorders. Material and Methods: This is a conceptual study for which various Ayurveda texts, Modern texts and published Articles are referred. Discussion: Although food combinations in present era are different in nature, principles remain the same and it is required to identify such food incompatibilities that can cause neurological disorders based on basic Ayurvedic principles. Conclusions will be made on basis of mentioned concepts.

Alterations in pathogen-specific cellular and humoral immunity associated with acute peripheral facial palsy of infectious origin

BackgroundPeripheral facial palsy (PFP) is a common neurologic symptom which can be triggered by pathogens, autoimmunity, trauma, tumors, cholesteatoma or further local conditions disturbing the peripheral section of the nerve. In general, its cause is often difficult to identify, remaining unknown in over two thirds of cases. As we have previously shown that the quantity and quality of pathogen-specific T cells change during active infections, we hypothesized that such changes may also help to identify the causative pathogen in PFPs of unknown origin.MethodsIn this observational study, pathogen-specific T cells were quantified in blood samples of 55 patients with PFP and 23 healthy controls after stimulation with antigens from varicella-zoster virus (VZV), herpes-simplex viruses (HSV) or borrelia. T cells were further characterized by expression of the inhibitory surface molecule CTLA-4, as well as markers for differentiation (CD27) and proliferation (Ki67). Pathogen-specific antibody responses were analyzed using ELISA. Results were compared with conventional diagnostics.ResultsPatients with PFP were more often HSV-seropositive than controls (p = 0.0003), whereas VZV- and borrelia-specific antibodies did not differ between groups. Although the quantity and general phenotypical characteristics of antigen-specific T cells did not differ either, expression of CTLA-4 and Ki67 was highly increased in VZV-specific T cells of 9 PFP patients, of which 5 showed typical signs of cutaneous zoster. In the remaining 4 patients, a causal relationship with VZV was possible but remained unclear by clinical standard diagnostics. A similar CTLA-4- and Ki67-expression profile of borrelia-specific T cells was also found in a patient with acute neuroborreliosis.DiscussionIn conclusion, the high prevalence of HSV-seropositivity among PFP-patients may indicate an underestimation of HSV-involvement in PFP, even though HSV-specific T cell characteristics seem insufficient to identify HSV as a causative agent. In contrast, striking alterations in VZV- and borrelia-specific T cell phenotype and function may allow identification of VZV- and borrelia-triggered PFPs. If confirmed in larger studies, antigen-specific immune-phenotyping may have the potential to improve specificity of the clinical diagnosis.

Ką naujo sužinojome apie galvos skausmą per COVID-19 pandemiją? Literatūros apžvalga

Headache is one of the most common neurological symptoms associated with coronavirus disease 19 (COVID-19), which can mimic primary headache phenotypes. COVID-19 and quarantine have affected both the course of primary headache and patient care strategies. The safety of migraine treatment with anti-CGRP (calcitonin gene-related peptides) monoclonal drugs has become important. Another challenge posed by the introduction of mass vaccination is vaccine-related headache, the most common neurological adverse event, and a less common complication, cerebral venous thrombosis. The article provides a brief overview of COVID-19 induced headache and its features, vaccination-induced headache, the impact of COVID-19 and quarantine on primary headache, the safety of anti-CGRP monoclonals, and the advantages and disadvantages of remote consultations on primary headaches.

Correlation between Acute Phase Symptoms with Neurological Long Covid Symptoms on COVID-19 Survivors

Objective: To investigate prolonged neurological impacts of COVID-19 and establish a connection between initial COVID-19 symptom severity and chronic fatigue syndrome (CFS) development, poor sleep quality (PSQ), and cognitive impairment (CI) in individuals recovered from COVID-19.Methods: This cross-sectional study recruited COVID-19 survivors at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, between June and December 2021. All participants gave informed consent and underwent interviews on demography, clinical features, long-COVID questionnaire, and neurological examination. Participants underwent cognitive examination (MOCA-INA), Chalder Fatigue Scale and Pittsburgh Sleep Quality Index (PSQI) to assess CI, CFS, and PSQ variables. Chi-Square analysis was performed to determine the probability of neurological long COVID-19 syndrome manifestations using SPSS 24.0.Results: Of the 127 participants recruited, 67.7% were women, median (IQR) age of 33 (21-65) years, and time from hospitalization to examination of nine months (1-13). The most common neurological Long COVID symptoms were PSQ (59.8. %), CFS (51.2%), and CI (33.9%). Participants with more than five acute phase COVID-19 symptoms had a higher probability of CFS and CI (OR 2.38 (1, 16-4.9, CI 95%); OR 2.20 (1.01-4.79, CI 95%)) than those with less than five symptoms. The study did not find a significant correlation between sleep quality and number of acute-phase COVID-19 symptoms (OR 1.56 (0.76-3.20, CI 95%)).Conclusion: Almost two-thirds of the COVID-19 survivors experienced PSQ, more than half had CFS, and almost one-third had CI. The study revealed an increasing likelihood of CFS and CI in COVID-19 survivors as the number of acute COVID-19 symptoms increases.

Risk factors of Omicron variant associated acute encephalitis/encephalopathy in children

BackgroundOutbreak of Omicron BA.2 in Taiwan led to an increased number of acute encephalitis/encephalopathy cases in children and several fatal cases drew public attention. In pre-Omicron period, pediatric cases of COVID-19-associated acute encephalitis have been reported and during Omicron epidemic, febrile convulsions, encephalitis were mentioned more frequently. The outcome of patients with neurological complications was worse. However, few studies investigated the risk factors, pathophysiology and prognosis of COVID-19-associated encephalitis/encephalopathy. Here, we describe the presentation of pediatric cases of COVID-19-associated acute encephalitis/encephalopathy and explore the associated risk factors. MethodsPediatric patients with confirmed SARS-CoV-2 infections were prospectively enrolled at admission at Chang Gung Memorial Hospital between April and August 2022. Patients were categorized into groups of acute encephalitis/encephalopathy, febrile convulsions or mild disease. Demographic descriptions, clinical manifestations and laboratory data were collected. ResultsOf 288 acute COVID-19 patients, there were 38 (13.2%) acute encephalitis/encephalopathy, 40 (13.9%) febrile convulsions, and 210 (72.9%) mild disease. Among acute encephalitis/encephalopathy group, the mean age was 68.3 ± 45.0 months. The common neurological symptoms were lethargy (65.8%), seizures (52.6%), and impaired consciousness (34.2%). Over 3 years old (adjusted odds ratio [aOR]: 7.57, p < 0.001), absolute neutrophil count ≥3150/μL (aOR: 5.46, p = 0.008), and procalcitonin ≥0.5 ng/mL (aOR: 4.32, p = 0.021) were independent factors for acute encephalitis/encephalopathy. ConclusionsMost cases of COVID-19-associated acute encephalitis/encephalopathy showed no evidence of direct viral invasion but associations with older age, increased peripheral neutrophil, and serum procalcitonin. These findings may imply the neutrophil-mediated systemic inflammatory response plays an important role on central nerve system, leading to cerebral dysfunction.

Fabrication of Aptamer-based Field Effect Transistor Sensors for Detecting Mercury Ions

With the rapid development of industry, the pollution of the environment is becoming more and more serious. Among them, water pollution is one of the most serious problems, and polluted water sources often contain heavy metal ions such as mercury, chromium, lead, chromium, arsenic, etc. Which in turn affect our irrigation, breeding, food, and drinking, and finally cause physical harm. Mercury is still widely used today. For example, mercury and mercury compounds are used as catalysts in the plastics industry. Mercury is still widely used today. For example, mercury and mercury compounds are used as catalysts in the plastics industry. Some toxic pesticides also contain mercury. Mercury is used in daily life in fluorescent lamps, batteries, thermometers, medical amalgams, etc.Mercury pollution can be divided into two categories: organic mercury and inorganic mercury. Prolonged exposure to mercury can cause paralysis and a progressive loss of sense of touch, sight, hearing, or taste. Other more common neurological symptoms include memory and balance impairment, insomnia, hand tremors, and behavioral disturbances. Detecting the mercury content in water usually requires large-scale laboratory instruments for measurement, costing a lot of money and time.In this study, a specific aptamer is combined with a field-effect transistor to form an aptamer field-effect transistor by utilizing the properties of thymine-Hg(II)-thymine (T-Hg(II)-T) coordination chemical bonds. A highly selective and sensitive mercury ion sensor was achieved by using N-channel depletion-mode MOSFETs with APTAMER-modified gates. For the Aptamer-modified FET sensor, a detection limit of 0.2 PPM was achieved using a 500 μM × 500 μM gate sensing area. Biosensors realize reduced size, shorter detection speeds, cost savings, and high detection of limit sensors. Therefore, the determination of heavy metal ions in the environment by simple and easy-to-use instruments is of great significance for disease prevention. Figure 1

Relationship between alcohol and primary headaches: a systematic review and meta-analysis

BackgroundHeadache is one of the most common neurological symptoms. Many previous studies have indicated a relationship between primary headaches and alcohol. Drinking has been associated with increased risk of tension-type headache (TTH) and migraine. However, recently published studies have not confirmed this relationship. The existing literature is inconclusive; however, migraine patients avoid alcohol. Therefore, the primary objective was to provide a reliable assessment of alcohol intake in people with primary headaches; the secondary objective was to identify any potential relationship between alcohol consumption and headache risk.MethodsThis study was based on PubMed, Embase and Web of Science database searches performed on 11 July 2023. This systematic review was registered in PROSPERO (CRD42023412926). Risk of bias for the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were performed using Statistica software. The Risk Ratio (RR) was adopted as the measure of the final effect. Analyses were based on a dichotomous division of the respondents into "non-drinkers" and "drinkers" for headache patients and matched non-headache groups.ResultsFrom a total of 1892 articles, 22 were included in the meta-analysis. The majority demonstrated a moderate or high risk of bias. The first part of the meta-analysis was performed on data obtained from 19 migraine studies with 126 173 participants. The risk of migraine in alcohol drinkers is approximately 1.5 times lower than in the group of non-drinkers (RR = 0.71; 95% CI: 0.57–0.89). The second part involved 9 TTH studies with 28 715 participants. No relationship was found between TTH diagnosis and alcohol consumption (RR = 1.09; 95% CI: 0.93–1.27). Two of the included cluster-headache articles had inconclusive results.ConclusionsAlcohol consumption and migraine are inversely correlated. The exact mechanism behind this observation may indicate that migraine leads to alcohol-avoidance, rather than alcohol having any protective role against migraine. There was no relationship between TTH and drinking. However, further studies related to primary headaches and alcohol consumption with low risk of bias are required. Additionally, patients and physicians should consider the latest medical data, in order to avoid the myths about alcohol consumption and primary headaches.

Brain Renin-Angiotensin System: From Physiology to Pathology in Neuronal Complications Induced by SARS-CoV-2.

Angiotensin-converting enzyme 2 (ACE2), a key enzyme in the renin-angiotensin system (RAS), is expressed in various tissues and organs, including the central nervous system (CNS). The spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease-2019 (COVID-19), binds to ACE2, which raises concerns about the potential for viral infection in the CNS. There are numerous reports suggesting a link between SARS-CoV-2 infection and neurological manifestations. This study aimed to present an updated review of the role of brain RAS components, especially ACE2, in neurological complications induced by SARS-CoV-2 infection. Several routes of SARS-CoV-2 entry into the brain have been proposed. Because an anosmia condition appeared broadly in COVID-19 patients, the olfactory nerve route was suggested as an early pathway for SARS-CoV-2 entry into the brain. In addition, a hematogenous route via disintegrations in the blood-brain barrier following an increase in systemic cytokine and chemokine levels and retrograde axonal transport, especially via the vagus nerve innervating lungs, have been described. Common nonspecific neurological symptoms in COVID-19 patients are myalgia, headache, anosmia, and dysgeusia. However, more severe outcomes include cerebrovascular diseases, cognitive impairment, anxiety, encephalopathy, and stroke. Alterations in brain RAS components such as angiotensin II (Ang II) and ACE2 mediate neurological manifestations of SARS-CoV-2 infection, at least in part. Downregulation of ACE2 due to SARS-CoV-2 infection, followed by an increase in Ang II levels, leads to hyperinflammation and oxidative stress, which in turn accelerates neurodegeneration in the brain. Furthermore, ACE2 downregulation in the hypothalamus induces stress and anxiety responses by increasing corticotropin-releasing hormone. SARS-CoV-2 infection may also dysregulate the CNS neurotransmission, leading to neurological complications observed in severe cases of COVID-19. It can be concluded that the neurological manifestations of COVID-19 may be partially associated with changes in brain RAS components.

The relationship between the use of digital display devices and headphones and primary headaches in children.

Headache represents the most common neurologic symptom in children. In this study, we investigated the relationship between watching television, listening to music with headphones, smartphone, tablet, and computer use, and primary headaches in children. We aimed to determine whether primary headache in children is associated with excessive use of digital display devices and headphones and whether reducing the use of digital display devices and headphones affects primary headache. The study included 69 children with primary headaches and 64 with no headaches as a control group. All subjects were evaluated for demographic and headache characteristics and the use of digital display devices and headphones. Our recommendation for patients and families was to decrease the use of digital display devices and headphones, and the headache burden was re-evaluated after one month. Headache frequency was more common in patients who watched television and used smartphones or tablets for more than 6 hours per day. Using a smartphone or tablet for more than 3 hours daily was more common in the study group than the control group. Headache frequency decreased in all patients one month after the digital imaging device and headphones were restricted. Watching television and using a smartphone or tablet strongly associates with primary headaches during childhood.

Spotlight on Sturge-Weber Syndrome: Unraveling the Enigma of a Rare Neurocutaneous Disorder in Infants-An Overview

This article aims to provide a concise overview of the existing literature on Sturge-Weber syndrome in infants. This comprehensive review presents key information regarding the prevalence, clinical characteristics, diagnostic methods, and available treatments based on recent global research. Sturge-Weber syndrome is a rare congenital neurocutaneous disorder, affecting approximately 1 in 20,000 to 50,000 new-born, and is caused by a somatic mutation in the GNAQ gene. Its defining features include leptomeningeal angiomatosis, glaucoma, and a facial birthmark known as a port-wine stain. Seizures are the most common neurological symptom, typically appearing within the first few months of life. Glaucoma can either manifest at birth or emerge during later stages of life. The severity of symptoms associated with Sturge-Weber syndrome can vary. Common treatments include anticonvulsants, laser therapy for the port-wine stain, and medication and surgery for glaucoma. This article also discusses potential causes, contributing factors, and possible solutions for Sturge-Weber syndrome.

Neurological Manifestations of Coronavirus Disease 2019 and Mpox in Pediatric Patients and Their Management: A State-of-the-Art Systematic Review

BackgroundThere is an increasing number of cases being reported of neurological manifestations of Coronavirus disease 2019 (COVID-19) infection and Monkeypox (Mpox), both during the course of the infection and as a presenting symptom. We aim to review the neurological manifestations of COVID-19 and monkeypox in pediatric patients and their management. MethodsWe conducted a systematic review that included cohort studies and case series or reports involving a pediatric population of patients with a confirmed COVID-19 or Mpox infection and their neurological manifestations. We searched the following electronic databases: PubMed, EMBASE, and Scopus. ResultsFrom 1136 articles identified, 127 studies were included. Headache, stroke, Guillain-Barré syndrome, seizure, nerve palsies, and multisystem inflammatory syndrome in children were the most common neurological symptoms caused by COVID-19, whereas encephalitis was commonly seen in patients with Mpox. Rare neurological manifestations of COVID-19 included cerebral venous sinus thrombosis, plexopathies, demyelinating disorders, encephalitis, etc., and rare neurological manifestations of Mpox included headache. ConclusionsOur review highlights the importance of investigating possible neurological manifestations and closely monitoring these patients to develop a better understanding of the treatment strategies that can be adopted.

Neurological and imaging phenotypes of adults with untreated phenylketonuria: new cases and literature review.

Phenylketonuria (PKU) is the most prevalent congenital disease of amino acid metabolism. Neurological manifestations usually complicate PKU in untreated adult patients. This study describes neurological and imaging phenotypes of adult patients with untreated PKU. We investigated a cohort of 320 unrelated adult patients with suspected genetic leukoencephalopathies using whole-exome sequencing (WES). We analyzed the phenotypic features of adult PKU patients in our cohort and summarized cases reported in the literature. We identified 10 patients in our cohort and 12 patients in the literature, who presented with neurological manifestations and were diagnosed with PKU in adulthood. Approximately 60% of these patients had onset of clinical features in adulthood. The most common neurological symptoms of patients presenting in adulthood were cognitive disturbance and spastic paralysis, followed by vision loss, cerebellar ataxia, weakness of limbs, and seizure. This differed from that of patients presenting with PKU features in childhood, who consistently had mental retardation with various neurological complications emerging during a broad age range. Imaging findings were similar between patients presenting with clinical features in childhood compared with adulthood, comprising symmetric periventricular white matter hyperintense on T2-weighted imaging and diffusion-weighted imaging predominantly in the parietal and occipital lobes. Also, normal brain imaging and diffuse leukoencephalopathies were observed in both patient groups. PKU with clinical features presenting in adulthood is an atypical subtype and should be considered during diagnosis of adults with neurological symptoms and leukoencephalopathy. DWI seems to be most helpful to distinguish patients with PKU. Additionally, we demonstrate that PKU constitutes a part (3.1%) of adult genetic leukoencephalopathies.

A Case of Glossopharyngeal Schwannoma Protruding to the Larynx: A Case Report

Schwannoma is benign tumor that can occur in any part of the nerve that contains a Schwann cell. It is rare in the head and neck region and is characterized by common postoperative neurologic symptoms. We experienced a cervical schwannoma in a 22-year-old young man. Except for a foreign body sensation in the neck and a mass in the anterior region, there were no other complaints. A retropharyngeal schwannoma was most suspected considering neck computed tomography, magnetic resonance imaging, laryngoscopy and fine needle aspiration. Surgical treatment was performed, and the origin of the schwannoma was diagnosed as the tonsillar branch of the glossopharyngeal nerve. Histopathological examination confirmed the presence of a schwannoma with typical characteristics. After surgery, the patient recovered without any side effects. We report this case with a review of the literature.

QEEG findings in adolescents complaining of headache

BackgroundHeadache is one of the most common neurological symptoms reported in adolescence. The value of electroencephalography (EEG) in the diagnostics of patients with headache is controversial; however, quantitative EEG (QEEG) can clarify the pathophysiology of headache. Aim of the study was to assess QEEG and daily habits in adolescents with or without a clinical history of headache (according to answers of a screening questionnaire), to identify differences, attempt to explain them, and find possible correlations. This cross-sectional study included 89 adolescents; age 18–19 years at time of study, including 24 males. Headache was reported in 58 participant. All consenting subjects filled a questionnaire and underwent a conventional 30 min EEG examination. The mean frequency (Hz) and amplitude (µV) (absolute and relative) of beta (at F7and F8), theta (at C3 and C4), and alpha (at O1 and O2) band points were analyzed.ResultsA comparison of caffeine intake, and mobile phone use in cases versus controls showed no significant differences. QEEG showed statistically significant differences in the findings within alpha freq-O1, alpha freq-O2, and beta freq-F7 (P = 0.041, 0.003, and 0.05, respectively) in adolescents who had headache.ConclusionsThere were significant QEEG changes in the occipital regions and left frontal region in individuals with headache. It is recommended to perform more extensive statistical correlations between QEEG and clinical data should be targeted in future researches, to obtain a clearer view of the relationship between daily habits and the electrophysiology of headache.

Machine Learning Models to Predict Severity and Mortality of COVID-19 Using Neurological Symptoms (S21.002)

<h3>Objective:</h3> This study aimed to assess the correlation of neurological symptoms with the disease severity and mortality. Furthermore, different models were proposed to predict the severity and mortality using COVID-19 symptoms including neurological manifestations. <h3>Background:</h3> Coronavirus disease 2019 (COVID-19) was first described after many cases of pneumonia with unknown cause were reported in Wuhan, China in December, 2019. COVID-19 can present multiple non-respiratory symptoms and it was found to be associated with increased risk of different neurological manifestations. <h3>Design/Methods:</h3> This is a prospective cohort study conducted among hospitalized patients diagnosed with COVID-19 from April 7, 2020 to January 21, 2020. All manifestations were recorded and patients were examined by a neurologist to identify neurological symptoms. The severity was classified based on American Thoracic Society recommendations for community-acquired pneumonia. Data were analyzed and models were designed using IPython 7.22.0 in Jupyter notebook 6.3.0 from Anaconda. <h3>Results:</h3> There were 921 eligible participants (552 males and 369 females) in this study. The mean age of individuals was 61.58 ± 17.63 years. Smell and taste dysfunctions were the most common neurological symptom, reported in 619 patients (67.2%) and were associated with reduced odds of severe cases (OR: 0.63, 95%CI: 0.41 to 0.89) and death (OR: 0.61, 95%CI: 0.38 to 0.86). Myalgia (26.9%), headaches (14.8%), and dizziness (9.8%) were other common neurological symptoms. Headaches had negative correlation with severity (OR: 0.48, 95%CI: 0.34 to 0.85) and death due to COVID-19 (OR: 0.39, 95%CI: 0.77 to 0.94) but myalgia and dizziness were not correlated. The analysis of neurological and non-neurological symptoms showed that headaches and smell and taste dysfunction had the highest correlation with patients with mild severity and lower death rate. <h3>Conclusions:</h3> Neurological manifestations in hospitalized patients with COVID-19 can predict disease severity and mortality. <b>Disclosure:</b> Dr. Salehi has nothing to disclose. Dr. Garakani has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters-Kluwer. Mr. Amanat has nothing to disclose.

Neurotoxoplasmosis: a 5-year story in the Dominican Republic (P14-10.004)

<h3>Objective:</h3> To describe people living with HIV and neurotoxoplasmosis clinical presentation and common outcomes in the Dominican Republic. <h3>Background:</h3> Despite breakthroughs in HIV testing and ART access, advanced HIV is still a Latin American health concern. The Dominican Republic saw only a 4% reduction in HIV incidence rate during the last 5 years. Suboptimal disease control and opportunistic infections like neurotoxoplasmosis may occur from a lack of specialized healthcare facilities, limited resources, and information availability in remote areas. <h3>Design/Methods:</h3> Retrospective case series study of individuals with HIV and neurotoxoplasmosis diagnosis from 2017 to 2022. Characteristics included demographics, clinical presentation, laboratory, and imaging. Quantitative data was analyzed using dispersion and central tendency, whereas qualitative data was analyzed using frequencies and percentages. <h3>Results:</h3> 37 patients with HIV and neurotoxoplasmosis (mean[SD] age, 37.8[9.55] years; 70.2%[26] men) had a median CD4 count of 24 k/uL (IQR 53) and a mean viral load of 329.3 (SD 258). 64%(24) were noncompliant, not treated, or had uncertain HAART status. 29.7% (11) had anemia, 11.1%(4) myasthenia gravis, and 8.1%(3) hypertension. Oropharyngeal candidiasis 29.7%(11) and Tuberculosis 10.8%(4) were common coinfections. Headache (72.9%[27]), hemiparesis (54.1%[20]), and seizures (51.4%[19]) were the most common neurological symptoms. CT scans showed hypodense lesions (72.4%[21]), mass effect (48.6%[18]), patchy white matter hypodensities (32.4%[12]), and vasogenic edema (27.02%[10]). Within a year, 10.8%(4) had died. <h3>Conclusions:</h3> Although recent advances in HIV management, developing nations still face difficulties in accessing adequate care. HIV patients require continuous monitoring to avoid preventable conditions, such as neurotoxoplasmosis. Given the sociocultural context, what can we do to increase follow-up and HAART adherence? <b>Disclosure:</b> Dr. Cedeño has nothing to disclose. Dr. Agramonte has nothing to disclose. Mr. Rivas has nothing to disclose. Dr. Chacón has nothing to disclose. Dr. Medrano Heredia has nothing to disclose. Miss Montilla has nothing to disclose. Dr. Abreu Guaba has nothing to disclose. Mr. Acra-Tolari has nothing to disclose. Mrs. Rojas Fermin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Mrs. Rojas Fermin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Msd. Mrs. Rojas Fermin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Mejia has nothing to disclose.

Neuropsychiatric Presentations in Late-onset Inborn Errors of the Metabolism: A Systematic Review of the Literature (P2-12.008)

<h3>Objective:</h3> To review the clinical features of adult-onset inborn errors of metabolism (IEMs) presenting with neuropsychiatric symptoms. <h3>Background:</h3> Awareness of IEMs presenting in adulthood is increasing. The potentially treatable nature of some of these conditions warrants consideration during the evaluation of patients. However, the rarity and plentitude of individual IEMs make their inclusion in clinical practice cumbersome. <h3>Design/Methods:</h3> We conducted a retrospective systematic review of the literature on treatable adult-onset IEMs up to September 2022. We obtained the clinical features of each case, including presentation course, neuropsychiatric and neurological symptoms. <h3>Results:</h3> We identified 192 cases in 14 IEMs. We divided the IEMs into four categories based on their pathophysiology: 1) energy deficits 2) intoxications 3) metal storage disorders, and 4) lysosomal storage disorders. Energy deficits presented with an acute (53.1% of cases) or episodic (34.4%) course. Impaired arousal (18.7%) and seizures (37.5%) were the most common neurological symptoms. Intoxications had an acute onset in 44.1% of cases. The most common neuropsychiatric symptom was psychosis (26.5%) and acute polyneuropathy was present in 20.6% of cases. Metal storage disorders had a chronic time course (76.3%) with memory impairment (26.5%) as the most common neuropsychiatric symptom. Lysosomal storage disorders progressed over a chronic time course (84.1%). Multidomain cognitive presentations were seen in 43.2% of patients, memory and language dysfunctions were the most common deficits. Spasticity and weakness were noted in 28.4% of cases. <h3>Conclusions:</h3> Neuropsychiatric symptoms are common in IEM. Our retrospective showed that the time course, neuropsychiatric symptoms at onset, and associated systemic symptoms are informative in establishing the IEM subtype underlying a neuropsychiatric presentation. <b>Disclosure:</b> Dr. Rosso has nothing to disclose. An immediate family member of Dr. Rodriguez-Porcel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Anmeal. Dr. Rodriguez-Porcel has received publishing royalties from a publication relating to health care.

Neuropsychiatric manifestations and magnetic resonance spectroscopy of the brain in systemic lupus erythematosus patients

BackgroundNeuropsychiatric manifestations of lupus (NPSLE) are considered one of the major and most devastating lupus manifestations. The aim of this study was to assess the neuropsychiatric manifestations in systemic lupus erythematosus (SLE) patients and estimate the effectiveness of brain magnetic resonance spectroscopy (MRS) and anti-ribosomal P antibody test in early detection of NPSLE. This cross-sectional study was carried out on 50 SLE patients. Demographic, clinical, and therapeutic data were assessed. All patients were subjected to thorough rheumatological and neuropsychiatric evaluation. Serologic tests included antinuclear antibodies, anti-double-stranded DNA, and anti-ribosomal P protein antibodies. Radiologic evaluation included brain MRS.ResultsThe mean age was 26.9 ± 98.9 years; the median disease duration was 18 (0–108) months. Headache was the most common neurological symptom (40%). Depression was not detected in 29 patients (58%), mild in 15 patients (30%), and moderate in 6 patients (12%). Anti-ribosomal P antibody titer was significantly elevated in patients with active in comparison with those with inactive lupus disease (p = 0.026). Brain MRS showed a statistically significant reduction in N-acetylaspartate creatine ratio (NAA/Cr) among patients with active lupus disease (p = 0.015) with a statistically significant increase in choline creatine ratio (Cho/Cr) among patients with inactive lupus disease (p = 0.049). There was a statistically significant negative correlation between the level of NAA/Cr and anti-ribosomal P antibody titer among patients with active lupus disease (p < 0.001).ConclusionsHeadache is the most common neurological manifestation among SLE patients. Anti-ribosomal P antibody titer is elevated in active SLE patients. The changes of NAA/Cr and Cho/Cr in brain MRS can be of help to differentiate between the active and inactive SLE.

Myeloneuropathy with Bilateral Foot Pain after Scrub Typhus Infection: An Antibody-Proven Case Report

Scrub typhus is an acute febrile illness caused by &lt;i&gt;Orientia tsutsugamushi&lt;/i&gt;. The most common neurological symptoms are headaches presenting with meningitis, meningoencephalitis, or encephalitis; however, transverse myelopathy and polyneuropathy are rare in typhoid infections. Herein, we report a laboratory and electrodiagnostically proven case of subacute myelopathy and polyneuropathy with slow progression after scrub typhus infection. A 64-year-old man complained of truncal numbness and a burning sensation in both feet. Magnetic resonance imaging did not reveal any definite changes in the spinal cord; however, serological tests showed immunoglobulin G antibodies against O. tsutsugamushi by enzyme-linked immunosorbent assay. An electrophysiological study showed myelopathy concurrent with polyneuropathy. To the best of our knowledge, this is the first immunochemical detection of antibodies in a patient with delayed neurological manifestations after scrub typhus infection.

Effects of transcranial direct current stimulation on COVID-19 neurological symptoms: a mini-review

Introduction: COVID-19 patients can experience long-term effects including neurological symptoms as part of the long COVID syndrome. The most common neurological symptoms associated with this syndrome are cognitive impairments, such as brain fog, memory issues or loss of concentration, and mood changes, such as depression and anxiety. Non-invasive brain stimulation, for instance, transcranial direct current stimulation (tDCS), is a treatment currently being tested to improve cognitive deficits and mood disorders in long COVID. Methods: We performed a systematic literature search for articles on long COVID and non-invasive brain stimulation. Electronic searches were performed in MEDLINE (via PubMed) and Cochrane databases. The Joanna Briggs Institute Critical Appraisal tool was used for quality assessment. Data regarding population, intervention, outcomes, study design, and sources of funding were collected. Results: The search returned 21 articles, of which two case reports were included in the discussion. Three patients with long COVID and cognitive symptoms were treated with tDCS. Although these studies reported promising results, they had methodological differences, no control groups were used and the sample size is insufficient to draw definitive conclusions. Discussion: Neuromodulation treatments like tDCS are currently being considered to treat long COVID, since they have been found to improve cognition, but so far only in observational studies with few patients. In the future, randomized clinical trials using tDCS for long COVID patients with cognitive impairment might demonstrate the effectiveness of this intervention.