Common Neurological Symptoms Research Articles

ATP1A3 dysfunction causes motor hyperexcitability and afterhyperpolarization loss in a dystonia model.

Mutations in the gene encoding the alpha3 Na+/K+-ATPase isoform (ATP1A3) lead to movement disorders that manifest with dystonia, a common neurological symptom with many different origins, but for which the underlying molecular mechanisms remain poorly understood. We have generated an ATP1A3 mutant mouse that displays motor impairments and a hyperexcitable motor phenotype compatible with dystonia. We show that neurons harboring this mutation are compromised in their ability to extrude raised levels of intracellular sodium, highlighting a profound deficit in neuronal sodium homeostasis. We show that the spinal motor network in ATP1A3 mutant mice has a reduced responsiveness to activity-dependent rises in intracellular sodium and that this is accompanied by loss of the Na+/K+-ATPase-mediated afterhyperpolarization in motor neurons. Taken together, our data support that the alpha3 Na+/K+-ATPase is important for cellular and spinal motor network homeostasis. These insights suggest that it may be useful to consider ways to compensate for this loss of a critical afterhyperpolarization-dependent control of neuronal excitability when developing future therapies for dystonia.

Neurological symptoms in pediatric abusive head trauma: Multi-center data for clinical forensic medicine

Central nervous system-associated lesions can frequently be found in abusive head trauma (AHT) cases. Since there are frequently no visible signs of injury on the body surface, the diagnosis of AHT can be challenging. In particular, if the affected child shows only isolated neurological symptoms, these are often misinterpreted as a minor illness. Using a retrospective study design at three university hospitals, 72 medico-legal cases of “shaken baby syndrome” – a common variant of AHT – were analyzed. A comparison between confession cases (n=15) and non-confession cases was used in order to reduce the risk of circular reasoning. The most common neurological symptoms in the present cases were: epileptic seizures (44 %), pallor (37 %), somnolence (31 %), reduced muscle tone (25 %), vomiting (20 %) and unconsciousness (15 %). There were also no statistically significant differences between confession and non-confession cases, nor when comparing the simultaneous presence of skin or skeletal lesions. The combination of several symptoms serves as an indicator for the presence of AHT and should lead to further diagnostic measures under the hypothesis of the presence of an AHT in clinical observation.

Lyme disease in UK primary care: a knowledge, attitude and practice survey.

Lyme disease (LD) cases in the UK most commonly present within the primary care setting. Despite an upward trend of incidence, little is known regarding general practitioner (GP) experience with diagnosis and treatment. This study aims to describe baseline primary care clinician Knowledge, Attitude and Practice (KAP) in Scotland and England. Online KAP survey on Lyme disease for UK based practising GPs. An online KAP questionnaire was developed for use in UK primary care. The survey was distributed through UK based research networks, professional societies and via social media. 191 complete responses were analysed (England n=130, Scotland n=61). The Scotland-based respondent group had more relevant consultations in the previous 3 years. Respondents from Scotland demonstrated a greater awareness that erythema migrans (EM) is pathognomonic for Lyme disease and that serological testing of this patient group is not indicated. Less common cardiac and neurological symptoms were not as well associated with Lyme disease by both respondent groups for the former and England-based respondents for the latter. Prescribing according to the National institute for Health and Care Excellence (NICE) guidance was identified in 70% of Scotland and 42% of England-based GP responses. Targeted resources may improve clinician confidence on exposure risk, symptom recognition, testing limitations and treatment dose and duration. Scotland-based respondents' better survey performance potentially reflects greater clinical exposure and public awareness of the disease, due to high endemicity within the nation.

The Multiple Sclerosis Prodrome in a Retrospective Pediatric Cohort

BackgroundEvidence suggests a prodromal phase in multiple sclerosis (MS), with increased health care use preceding the first demyelinating event (FDE). Although prior studies have explored this in adults, limited data exist for pediatric cases. We aimed to analyze health care utilization and prodromal symptoms in the two years before FDE in patients with pediatric-onset MS (POMS). MethodsFrom 122 patients at the Pediatric Multiple Sclerosis & Demyelinating Diseases Center at Washington University School of Medicine from 2011 to 2021, 37 POMS cases were identified. Of these, 21 with at least two years of records preceding FDE were included. Retrospective analysis covered symptoms and health care utilization in the two-year period before FDE, including ambulatory visits, hospital admissions, and office calls. ResultsPatients showed increased health care utilization in the year preceding FDE (period B; 96 interactions) compared with the prior year (period A; 77 interactions) and an increase in the percentage of neurology-related encounters (P < 0.001). There was an increase in all office calls from period A to period B (P = 0.01). Neurological complaints included headaches (28.6%), visual (19.0%), sensory (14.3%), and balance (14.3%) in the two years before FDE, and 28.6% of patients presented for psychiatric complaints. Common non-neurological complaints included infection, dermatologic, and musculoskeletal issues and injury. ConclusionsOur POMS cohort showed increased health care use before FDE, consistent with population-based data. This study emphasizes diverse symptoms in prodromal POMS, with headaches being the most common neurological symptom in the two-year period before FDE.

PFC/M1 activation and excitability: a longitudinal cohort study on fatigue symptoms in healthcare workers post-COVID-19

BackgroundFatigue is one of the most common neurological symptoms reported post coronavirus disease 2019 (COVID-19) infection. In order to establish effective early intervention strategies, more emphasis should be placed on the correlation between fatigue and cortical neurophysiological changes, especially in healthcare workers, who are at a heightened risk of COVID-19 infection.MethodsA prospective cohort study was conducted involving 29 COVID-19 medical workers and 24 healthy controls. The assessment included fatigue, sleep and health quality, psychological status, and physical capacity. Functional near-infrared spectroscopy (fNIRS) was employed to detect activation of brain regions. Bilateral primary motor cortex (M1) excitabilities were measured using single- and paired-pulse transcranial magnetic stimulation. Outcomes were assessed at 1, 3, and 6 months into the disease course.ResultsAt 1-month post-COVID-19 infection, 37.9% of patients experienced severe fatigue symptoms, dropping to 10.3% at 3 months. Interestingly, the remarkable decreased activation/excitability of bilateral prefrontal lobe (PFC) and M1 were closely linked to fatigue symptoms after COVID-19. Notably, greater increase in M1 region excitability correlated with more significant fatigue improvement. Re-infected patients exhibited lower levels of brain activation and excitability compared to single-infection patients.ConclusionsBoth single infection and reinfection of COVID-19 lead to decreased activation and excitability of the PFC and M1. The degree of excitability improvement in the M1 region correlates with a greater recovery in fatigue. Based on these findings, targeted interventions to enhance and regulate the excitability of M1 may represent a novel strategy for COVID-19 early rehabilitation. Trial registration: The Ethics Review Committee of Xijing Hospital, No. KY20232051-F-1; www.chictr.org.cn, ChiCTR2300068444.

Neurologic Symptoms After 177Lu-Prostate-Specific-Membrane Antigen-617 Therapy: A Single-Center Experience.

Treatment with 177Lu-prostate-specific membrane antigen (PSMA)-617 (177Lu-vipivotide tetraxetan [Pluvicto]) prolongs both progression-free and overall survival in advanced PSMA-positive metastatic castration-resistant prostate cancer. Data examining specifically neurologic symptoms after 177Lu-PSMA-617 treatment are scarce. In this study, we aimed to review the neurologic findings in a large cohort of metastatic castration-resistant prostate cancer patients undergoing 177Lu-PSMA-617 therapy. Methods: The clinical records and imaging data of patients who received their initial dose of 177Lu-PSMA-617 between March 2022 and November 2022 were retrospectively reviewed. All patients presenting for medical evaluation, regardless of specific specialty appointments, with new or worsening neurologic symptoms were included in the study. Results: A total of 185 patients underwent 177Lu-PSMA-617 therapy. The median age was 70 y (range, 58-90 y). The mean follow-up time was 12.04 ± 2.87 mo. Fifty-five new or worsening neurologic symptoms were observed in 50 patients (27%, 50/185). Of these, 27 (11.9%, 27/185) reported altered taste. Eleven patients (6%, 11/185) experienced dizziness with no other clear etiology; 2 of these patients were admitted to the emergency department (ED). Paresthesia symptoms were reported in 6 patients (3.2%, 6/185). Five patients (2.7%, 5/185) reported headaches, 3 of these patients were admitted to the ED because of the severity of the symptoms. Two patients (1.08%, 2/185) presented with extremity weakness. Two patients (1.08%, 2/185) had an ischemic stroke and were admitted to the ED. One patient (0.05%, 1/185) exhibited gait disturbances. In total, 7 patients (3.78%, 7/185) were admitted to the ED because of neurologic symptoms. None of the patients discontinued or failed to complete the 177Lu-PSMA-617 therapy because of neurologic symptoms. Conclusion: After 177Lu-PSMA-617 treatment, the most common neurologic symptoms were dysgeusia and dizziness. In this study, our follow-up period and population size might not have been sufficient to detect delayed or uncommon neurologic symptoms. In patients without neurologic symptoms or central nervous system metastases before treatment, we found the development of severe neurologic problems to be rare and unlikely to require discontinuation of treatment.

Neuro-molecular perspectives on long COVID-19 impacted cerebrovascular diseases - a role for dipeptidyl peptidase IV

The coronavirus disease 2019 (COVID-19) has caused immense devastation globally with many outcomes that are now extending to its long-term sequel called long COVID. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects not only lungs, but also the brain and heart in association with endothelial cell dysfunction, coagulation abnormalities, and thrombosis leading to cardio-cerebrovascular health issues. Fatigue, cognitive decline, and brain fog are common neurological symptoms in persisting long COVID. Neurodegenerative processes and SARS-CoV-2 infection manifest overlapping molecular mechanisms, such as cytokine dysregulation, inflammation, protein aggregation, mitochondrial dysfunction, and oxidative stress. Identifying the key molecules in these processes is of importance for prevention and treatment of this disease. In particular, Dipeptidyl peptidase IV (DPPIV), a multifunctional peptidase has recently drawn attention as a potential co-receptor for SARS-CoV-2 infection and cellular entry. DPPIV is a known co-receptor for some other COVID viruses including MERS-Co-V. DPPIV regulates the immune responses, obesity, glucose metabolism, diabetes, and hypertension that are associated with cerebrovascular manifestations including stroke. DPPIV likely worsens persisting COVID-19 by disrupting inflammatory signaling pathways and the neurovascular system. This review highlights the neurological, cellular and molecular processes concerning long COVID, and DPPIV as a potential key factor contributing to cerebrovascular dysfunctions following SARS-CoV-2 infection.

Study of Clinical Spectrum of Neurological Manifestations in HIV/AIDS Seen at Tertiary Referral Hospital in India

Objectives: The pandemic caused by human immunodeficiency virus (HIV) is one of the fastest growing health problems in the world today. Neurological manifestations of HIV infection and acquired immunodeficiency syndrome (AIDS) are being seen in a frequency that is parallel to the increasing number of new cases seen the world over. The World Health Organisation (WHO) estimates that 36.7 million people in the world are infected with HIV. Neurological manifestations of HIV disease can be seen in 20% of outpatients in HIV clinics and almost half of HIV patients being treated as in-patients. Of the various subtypes of HIV, subtype C is responsible for more than 50% of HIV1 infections causing rapidly growing epidemics in India. The objectives of this study were as follows: (1) To evaluate the prevalence of neurological manifestation in HIV-positive patients admitted to a tertiary referral Hospital in India. (2) To describe the neurological manifestations documented. (3) To find the possible predictors of neurological manifestations. Material and Methods: This study was a single centre prospective cross-sectional study in which out of 200 HIV/AIDS patients, 40 patients with neurological manifestations were analysed over a period of 18 months. They were interviewed and evaluated with particular reference to neurological manifestations, and were classified using the WHO staging system. Results: Amongst the studied population of 40 patients, 16 patients (40%) manifested as tuberculous meningitis (TBM) with or without brain tuberculomas, followed by seven patients (18%) presented with peripheral neuropathy and six patients (15%) presented with central nervous system (CNS) vasculitic or multi-infarct state. Cryptococcal meningitis was seen in five patients (12%), efavirenz-induced psychosis/seizure seen in one patient, while HIV-induced polymyositis, progressive multifocal leukoencephalopathy progressive multifocal leukoencephalopathy, acute inflammatory demylinating polyradiculoneuropathy, AIDS dementia complex and CNS toxoplasmosis were seen in one patient each respectively. One patient presented with dual opportunistic infection with coexistence of cryptococcal and tuberculous meningitis. Conclusion: Headache with or without vomiting, seizures and altered sensorium were the most common neurological symptoms. Fundus abnormalities, meningeal signs, gait abnormalities, cranial nerve dysfunction and hemiplegia were the most common neurological signs. New-onset headache was a significant predictor of the occurrence of neurological complications. Opportunistic infections such as TBM and Cryptococcal meningitis were most commonly observed.

Profile of HIV/AIDS Patients with Neurological Manifestations in The Tertiary Referral Hospital in Bali

Background: Neurological manifestations in approximately half of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients are related to high morbidity and mortality worldwide. Therefore, there is a need for epidemiological data on HIV/AIDS patients with neurological manifestations in Bali, as an international tourism destination. Objective: This study aimed to describe the clinical profile of neurological manifestations among patients with HIV/AIDS in the tertiary referral hospital for Bali and Nusa Tenggara region. Methods: A descriptive-retrospective study was conducted on HIV/AIDS patients presenting with neurological manifestations hospitalized in the Neurology Department of Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar from January 2018 to December 2021. Results: Among the 227 subjects included in this study, the majority were male (69.9%) and HIV positive newly diagnosed (69.2%). Furthermore, out of 126 subjects who had CD4 data, the majority were with CD4 &lt;200 cells/mm3 (85.7%) and 53.1% were &lt;50 cells/mm3, with ages ranging from 18 to 67 years old, at a median of 36 years old. The most common neurological signs and symptoms found were paresis/paralysis (61.7%), headache (54.6%), decreased consciousness (52.9%), and cranial nerve palsy (52%). Cerebral toxoplasmosis (67.4%) and tuberculous meningoencephalitis (20.3%) were the prevalent opportunistic infections, while the mortality rate was 39.6% with sepsis as the major cause. Conclusions: Neurological manifestations are common initial symptoms in diagnosing HIV infection. Therefore, better awareness and earlier detection are required among people with risk factors of HIV transmission, particularly in groups of young and productive age with signs of immunocompromised condition as well as neurological manifestations.

Neuropsychiatric Manifestations of Monkeypox: A Retrospective Cross-Sectional Study

Abstract Objective: The World Health Organization declared monkeypox (MPX), a global health crisis, in July 2022. Its symptoms include fever, rash, lymphadenopathy, myalgias, and fatigue; there have also been the reports of neurological manifestations and no data on psychiatric manifestations. In our study, we aimed to study neurologic and psychiatric manifestations in MPX patients. Methodology: Our study used the TriNetX database to identify MPX patients along with their age, gender, race, ethnicity, and geographic location data. Using International Classification of Diseases, tenth revision codes for neurological, psychiatric symptoms, and diagnoses, we identified 331 individuals on November 22, 2022, who had neuropsychiatric signs within a month of diagnosis with MPX (n = 1,006). Results: The most common neurological symptom was pain (17.3%) followed by headache (10.3%), while the most frequent psychiatric symptoms were mood disorders (11.9%), emotional issues (10.5%), and anxiety (9.4%). Conclusion: In this study, neuropsychiatric symptoms were present in about one-third of MPX patients. Physicians, neurologists, and psychiatrists should be aware of the potential for neuropsychiatric side effects associated with MPX infection in patients.

Case Report: EEG Picture in a Patient with Post-Stroke Epilepsy

Introduction: Epilepsy is a chronic brain disorder that affects people all over the world. Seizures are the most common neurologic symptom in stroke patients. Approximately 10% of all stroke patients have experienced seizures, and post-stroke seizures generally begin several years after the stroke. Case Illustration: A male patient, 55 years old, Balinese, Kinan, came to the emergency room of Prof. Dr. I.G.N.G. Ngoerah General Hospital with complaints of seizures. The first seizure occurred on December 19, 2021, with a pattern of glancing at the left eye then, followed by full-body twitching, which lasted approximately 5 minutes and stopped on its own. The patient said that before the seizure, the patient was well conscious; during the seizure, the patient was unconscious, and after the seizure, the patient regained consciousness as before the seizure. Then, the seizure repeated the next day (December 20, 2021) with the same pattern and duration, but the patient was not taken for treatment. On physical examination, the patient was alert with vital signs and general physical examination within normal limits. Neurologic examination revealed no focal neurologic deficits. Electroencephalography (EEG) examination showed intermittent slow activity in the left and right fronto-centro-occipital areas. Computed tomography scan (CT-Scan) examination of the head without contrast revealed a hypodense image in the right temporo-parietal lobe. The patient then received anti-epileptic drug (OAE) therapy, OAE therapy given Phenytoin 200 mg every 12 hours intra-orally, Folic Acid 1 mg every 24 hours intra-orally, and anti-platelet and anti-hypertension continued. Discussion: Post-stroke seizure (PSS) is an episode of convulsion that occurs either single or multiple after a stroke, which is thought to be due to irreversible or reversible brain damage. At the same time, post-stroke epilepsy is convulsions after a stroke that occur at least two revivals without provocation with a distance between revivals of more than 24 hours. PSS classification is divided into early post-stroke seizure, where seizures occur onset two weeks early post-stroke, and late (delayed) post-stroke seizure if seizures occur onset after two weeks post-stroke. Post-stroke seizures' most common electroencephalography (EEG) waves are generalized slow waves, focal slowing, focal sharp and slow waves, and periodic lateralized epileptiform discharges (PLEDs). However, 5.1% of patients have normal EEG. The administration of anti-convulsants to prevent recurrent seizures is recommended by the European Guidelines of The European Stroke Organization. In comparison, prophylaxis is not recommended for patients with post-stroke. Keywords: Post-stroke Epilepsy, Stroke, Electroencephalography

The Syndrome of Irreversible Lithium-Effectuated Neurotoxicity: A Scoping Review.

The Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) is a rare but concerning neurological complication resulting from lithium intoxication. Despite being reported since the 1960s, SILENT remains poorly understood and previous reviews on this topic commonly have been narrative. We therefore conducted a scoping review to assess the nature and scope of the research literature on the long-term neurological sequelae of lithium toxicity and determine the current knowledge of SILENT. A comprehensive and systematic literature search, using the MEDLINE, Embase, and Web of Science databases (from inception to July 2023), was conducted for English and Dutch articles, assessing the long-term neurological sequelae of lithium intoxication. Key information concerning clinical manifestations, risk factors, therapeutic approaches, or preventive measurements was extracted. We reviewed 91 articles, extracting information from 117 cases of SILENT. The prevailing outcome observed was persistent cerebellar dysfunction (77% of cases), often in combination with other sequelae. Other common sequelae included cognitive problems, parkinsonism, choreoathetosis, tardive dyskinesia, and peripheral neuropathy. The most common (61.4%) acute neurological symptom in the development of SILENT is an altered level of consciousness ranging from confusion to comatose states. Cerebellar sequelae were mentioned in 77% of cases as most common persistent sequelae. Antipsychotic use was mentioned in 59% of cases and fever was reported in 37.6% of cases. Scientific knowledge about this phenomenon has not advanced much since its initial reports in the 1960s and 1970s. While the use of lithium has become much more stringent than it had been in years past, and the occurrence of SILENT is rather exceptional, raising awareness about SILENT nevertheless remains crucial to avoid deleterious neurological consequences. Comprehensive, high-quality research in a systematic and standardized manner is therefore urgently needed to better understand this phenomenon.

COVID-19 Infection-related Headache: A Narrative Review

Severe acute respiratory syndrome coronavirus 2 is the virus responsible for coronavirus disease 2019 (COVID-19), which caused a global pandemic and then became an endemic condition. COVID-19 infection may be associated with clinical manifestations such as respiratory symptoms and systemic diseases, including neurological disorders, notably headaches. Headaches are a common neurological symptom in individuals infected with COVID-19. Furthermore, with the transition to endemicity, COVID-19 infection-related headaches may reportedly persist in the acute phase of COVID-19 infection and in the long term after COVID-19 infection resolves. Persistent headaches after COVID-19 infection can be a significant concern for patients, potentially leading to disability. The present review discusses the clinical characteristics and potential underlying mechanisms of COVID-19 infection-related headaches.

Evaluación de la calidad y manejo de la cefalea en un paciente ingresado en el área de Neurociencia. Estudio CALMA

IntroductionHeadache is a very common neurological symptom. It is the first reason for consultation in neurology. About hospitalized patients, we do not have epidemiological data on the global prevalence of headaches in hospitalized patients. ObjectiveTo describe the prevalence of headaches in hospitalized patients, their triggers, and the level of compliance with nursing records. MethodologyThis is a descriptive, observational, and cross-sectional study at the Vall d’Hebron University Hospital (HUVH). The data collected were sociodemographic, related to the reason for admission and pain during admission. Statistical analysis was performed with R v4.1.1. ResultsOf the 45 admitted patients, 55% (25/45) participated, 55% (25/45) participated, 64% (16/25) were women. 60% (15/25) had presented headaches during admission, of which 73.3% (11/15) occurred in the last 24hours. The 33.3% (5/15) recognized stress as the most frequent trigger, noise (5/15), and income derivatives (3/15). During the daily follow-up by the nurse, 100% (25/25) of the patients answered that they had been asked about pain in general and 32% (8/25) specifically about headaches. No records were obtained due to the computer program's non-existence of nursing clinical variables. ConclussionHeadache is a symptom that occurs prevalently in hospitalized patients. Stress and noise seem to be triggers of this situation. Certain behaviors on the part of health centers and professionals could help improve the care of these patients.

A Study on Neurological Manifestations in Coronavirus Disease 2019 Patients Admitted to a Tertiary Care Hospital.

The coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, the involvement of other organs needs to be explored. Thus, this study is undertaken to analyze the neurological manifestations in patients with COVID-19 infection. To analyze the neurological manifestations in patients with COVID-19 infection. All COVID-19-positive patients who got neurology referrals from March 2020 to June 2021 were included in the study. Laboratory confirmation of COVID-19 infection was done by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of throat swabs in patients who present with symptoms suggestive of COVID-19. Demographic characteristics, neurological complaints, comorbid conditions, neurological examination, and requisite investigations were analyzed. Among 160 patients, 107 (67%) were men, and the mean age was 61 years. Comorbidities included diabetes mellitus (51%) of subjects followed by hypertension (28%), chronic kidney disease (10%), and coronary artery disease (5%). Considering the COVID-19 severity, 28.75% had mild; 8.75% had moderate; and 62.5% had severe disease. The most common neurological symptoms included altered sensorium (62.5%), focal neurological symptoms (29.4%), anosmia (13.1%), headache (10.6%), and seizures (7.5%). The most prevalent neurological signs and/or syndromes were acute encephalopathy (62.5%), stroke (21.3%%), and mucormycosis (12.5%). The mortality rate in our study population was 16.3%, encephalopathy being the most common cause. In our study, encephalopathy was the major cause of morbidity and mortality among the COVID-19-related neurological manifestations. Encephalopathy was most seen in severe COVID-19 infection and was associated with increased neutrophil-to-lymphocyte (NL) ratio raised inflammatory markers. Stroke constituted 29.4% of the neurology referrals in COVID-19 patients confirming COVID-19 infection predisposes to thrombotic events. We found an increased incidence of Mucormycosis in COVID-19 patients, but early debridement and timely treatment with antifungal medications had reduced the mortality.

The effect of salt substitution on frequency and severity of headache: results from the SSaSS cluster-randomised controlled trial of 20,995 participants

BackgroundHeadache is one of the most common neurological symptoms. Headache disorders are associated with a high global burden of disease. Prior studies indicate that short-to-medium term sodium reduction reduces headache symptom. This study evaluated the effects of long-term reduced-sodium, added-potassium salt on headache frequency and severity in rural China.MethodsThe Salt substitute and stroke study (SSaSS) was an open-label cluster-randomised trial in rural China designed to evaluate the effect of salt substitution on mortality and cardiovascular events. Participants included adults with a history of prior stroke and those aged ≥60 years with uncontrolled high blood pressure (BP). Villages were randomly assigned in a 1:1 ratio either to intervention with salt substitute (75% sodium chloride and 25% potassium chloride by mass) or to control with continued use of regular salt (100% sodium chloride). In this pre-specified analysis, between-group differences in headache frequency and severity were evaluated. The study was registered with ClinicalTrials.gov (identifier number: NCT02092090).ResultsA total of 20,995 participants were included in the trial (mean age 64.3 years, 51% female, mean follow-up 4.7 years). At final follow-up at the end of the study, headache outcome data including frequency and severity of headaches was available for 16,486 (98%) of 16,823 living participants. Overall, 4454/16,486 (27%) individuals reported having headache: 27.4% in the intervention group (2301/8386) vs 26.6% in the control group (2153/8100) (RR 1.04, 95% CI: 0.93, 1.16, p = 0.48). There was no difference in headache severity between intervention and control groups (p = 0.90).ConclusionLong term salt substitution did not reduce the frequency or severity of headaches in this population.

Exploring the link between pediatric headaches and environmental noise exposure

BackgroundHeadaches are the most common neurologic symptoms in the pediatric population. Most primary headache in children and adolescents focuses on associated factors, including noise. Auditory discomfort is related to recognizing the pain. We aimed to analyze the headache profile of pediatric populations and the connection between noise exposure and head pain in children and adolescents.MethodsWe reviewed retrospectively medical records of the pediatric population with headaches in Gyeongsang National University Changwon Hospital from January 2022 to April 2023. Personal headache profiling from self-questionnaires and environmental noise data from the National Noise Information System (NNIS) were used to analyze each variable, and chi-square tests and linear regression models by SAS were used to analyze the statistical correlation.ResultsOf the 224 participants, 125 were clinically diagnosed with headaches. Of the 104 pubertal subjects, 56.7% were diagnosed with headaches, compared to 60% in the prepubertal group. Both daytime and nighttime noise was significantly higher in the diagnosed headache group than in the non-diagnosed group. Headache duration increased by daytime and nighttime noise with statistical significance in age-adjusted models.ConclusionWe found that noise exposure is correlated to headaches in children and adolescents. Daytime and nighttime environmental noise exposure was significantly associated with the duration of headaches through our data. Therefore, we assume that noise exposure is vitally relevant to prolonged headaches in the pediatric population. Further research is needed to improve our data.

Abstract TP121: Using Visual Cues to Improve Dysphagia Screening Compliance in Acute Stroke Patients

Introduction: Dysphagia or difficulty swallowing after a stroke is a common neurological symptom which occurs in 35-67% of all acute stroke patients. Dysphagia can lead to complications such as aspiration, pneumonia, dehydration, weight loss or death. National guidelines recommend dysphagia screening before oral intake in stroke patients to reduce hospital acquired pneumonia. A dysphagia screening tool used by nurses at the bedside that allows for the direct observation of the patient’s ability to swallow is the Water Swallow Test. Upon analysis of patient data, a practice gap was identified in which the dysphagia screening was not performed prior to first oral intake of medication. With collaboration of our multi-disciplinary stroke team to identify opportunities for improvements in the dysphagia performance measure, we hypothesized that if a visual cue was in place prior to first oral administration of medication, we can improve our compliance in the dysphagia performance measure. Method: When a patient presents with stroke symptoms, a purple dot sticker will be placed on the patient’s identification band. This purple dot sticker will serve as a visual cue that will trigger a reminder to the nurse when scanning the patient’s identification band prior to administration of the first oral medication to perform the dysphagia screening. If screening has been performed and the patient passed, the purple sticker will be removed. If the patient fails the screening, the nurse will notify the provider and the patient will be kept NPO (no meds) pending a speech/swallow consult. Upon admission, SBAR handoff to the floor will include failure of dysphagia screening / NPO status and an order for a speech/swallow consult. Result: In 2022, the dysphagia screening compliance was 67%. Following the visual cue implementation, our compliance improved to 100% in June 2023 and 92% in July 2023. Conclusion: Preliminary metrics indicate that this tool has positively impacted our compliance rate. Education to the staff is ongoing. Integration of the visual tool into our hospital guidelines for care of the acute stroke patient is under consideration pending additional analysis of compliance rates.

Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta-analysis.

The clinical features of central nervous system (CNS) sporotrichosis are derived from case reports and a limited series of cases. Our objective was to carry out a systematic review and meta-analysis of CNS sporotrichosis. We searched PubMed/MEDLINE, Embase, Scopus, and LILACS on 9 September 2023. Our inclusion criteria were documentation of Sporothrix and demonstrated CNS involvement. A metaproportion or metamean analysis was performed to estimate a summary proportion with 95% confidence intervals. We included 52 cases of CNS sporotrichosis published from 1966 to 2023. Forty-six patients were male (88%, 95% CI: 77-95), and the mean age was 39 years (95% CI: 36-43). Close contact with cats was reported in 55% of cases (95% CI: 37-72). Thirty-two (61.5%) patients were from Brazil, 18 patients from the United State of America (34.6%). Only two Sporothrix species were reported: S. schenckii (26/41, 63%), and S. brasiliensis (15/41, 37%). The most common neurological symptom was headache. Meningitis was chronic in approximately 80% of cases. A significant majority of the patients were immunocompromised. HIV infection was the primary cause of immunosuppression (85%, 95% CI: 61-95). Overall mortality was 56% (22/39). The comparison of Kaplan-Meier survival curve showed a higher mortality with a statistically significant difference in immunosuppressed patients (p = .019). CNS sporotrichosis represents a notable cause of chronic meningitis, especially in individuals living in the Americas with HIV infection and concurrent skin lesions.

Juvenile dermatomyositis with central nervous system involvement: two case reports from a retrospective single-center cohort, with literature review.

Juvenile dermatomyositis (JDM) is a systemic autoimmune disease primarily involving the muscles and skin; it can also affect the central nervous system (CNS). The relevant literature provides limited information regarding the characteristics of JDM with CNS involvement. We reviewed patients with JDM who were hospitalized at our center between January 2016 and August 2023, with a focus on those with CNS involvement. The aim was to provide detailed case reports on these patients, and to summarize the relevant literature about the characteristics of similar cases. Among 193 hospitalized patients with JDM, two (1.03%) had CNS involvement. Two patients, a 5.5-year-old girl and an 11-year-old boy, were admitted with severe proximal muscle weakness and seizures, and presented with active cutaneous vasculitis. Both were ultimately diagnosed with JDM, with CNS involvement. Both patients had confirmed presence of anti-NXP2 antibody through myositis-specific antibody analysis. Additionally, they all exhibited hyperferritinemia and thrombocytopenia. Salvage therapies like intravenous methylprednisolone (IVMP) pulse therapy and/or plasma exchange were administered successfully. At final follow-up, both patients had achieved complete clinical response and full neurological recovery. Our literature review identified nine similar case studies. CNS involvement usually occurred within the first 10 months of the disease course, and most of these patients had fatal outcomes, with a mortality rate of 66.6% (6/9). Including the two patients described herein, the median age for disease onset is 10.5 years (range 4-17 years), and the male: female ratio is 6:5. Seizures are the most common neurological symptom, accompanied by active cutaneous vasculitis. The brain biopsies showed two distinct pathological presentations: one was central nervous system vasculitis, and the other was cerebral macrophage activation syndrome. CNS involvement is a rare but life-threatening JDM complication. Herein, our cases and the literature indicate that it typically occurs within the first 10 months of the disease course and manifests as seizures, often accompanied by active cutaneous vasculitis, with fatal outcomes. Timely implementation of salvage therapies, like IVMP pulse therapy and plasma exchange, may significantly impact patient outcomes.