Common Neurological Symptoms Research Articles

Investigation of Neurological Symptoms Caused by COVID-19 in Intensive Care Unit

We examined the neurological symptoms of patients treated in intensive care for COVID-19 in this study. We obtained the study data retrospectively from data records of 1,699 patients treated in the COVID-19 clinics of a training and research hospital. The study is a descriptive and cross-sectional study. Sociodemographic and Disease Information Form were used for data collection. Statistical Packed for the Social Sciences 25.0 IBM was used in Data analysis. It was observed that 37% of the COVID-19 patients were between the ages of 66-80 years and 55.6% of the COVID-19 patients were male. The most common neurological symptoms in the disease process and their rates were as follows: insomnia 74.6%, taste loss 74%, smell loss 75.6%, muscle pain 83.2%, headache 45.1%, dizziness 32.2%, weakness 20.2%, and agitation 34.7%. Assessment of neurological symptoms of patients followed up for COVID-19 is of great importance. We suggest that neurological problems should be tried to be cured with appropriate treatment protocols and therapy support before they progress further and the neurological prognosis progresses.

Frequency of Common Neurological Manifestations among Patients Presenting with Human Immunodeficiency Virus Positivity

Background: Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003.HIV/AIDS has a wide range of clinical manifestations, and it affects a variety of organ systems. It is neuro-invasive, neurotropic and neurovirulent, and can directly induce nervous system diseases due to its preference for the nervous system.Objective: To determine the frequency of common neurological symptoms in patients who have tested positive for the human immunodeficiency virus.Material and Methods: This descriptive cross-sectional study was conducted on 131 patients for 6 months in the Department of Medicine, Lady Reading Hospital, Peshawar (9/7/2019 to 8/1/2020). Routine examinations, CSF cultures, monofilament tests, detailed histories, and ICD-9 criteria inspection were performed on all patients to detect the existence of common neurological symptoms such as TBM, cryptococcal meningitis, peripheral neuropathy, headache, seizures, and dementia. A pre-designed proforma was used to record the data. The data was analyzed us SPSS version 20. Results: The current study showed that 66% of the patients were men and 34% were women with a mean age of 36±10.51 years. Mean duration of the disease was 1±7.33 years. TBM (45%), cryptococcal meningitis (15%), peripheral neuropathy (16%), headache (26%), seizures (28%), and dementia were the most common neurological symptoms (5%).Conclusion: TBM (45%), cryptococcal meningitis (15%), peripheral neuropathy (16%), headache (26%), seizures (28%), and dementia (5%) were the most prevalent neurological symptoms in patients with human immunodeficiency virus positive, according to our findings.Key Words: Neurological manifestations, HIV /AIDS infection.

Demographic, clinical, and laboratory findings of mushroom-poisoned patients in Kermanshah province, west of Iran.

BackgroundMushroom poisoning can cause gastrointestinal, renal, and hepatic symptoms and even death. This descriptive study examined the demographic, clinical, and laboratory findings of patients with fungal poisoning, a type of fungus causing the poisoning, and the incidence and mortality rates of fungal poisoning in Kermanshah province, western Iran, from 2014 to 2018.MethodsThe medical records of 193 patients with mushroom poisoning from 2014 to 2018 were evaluated. The liver and kidney function tests, electrolytes, abdominal and pelvic ultrasound, chest x-ray, coagulation tests, and coagulation factors (fibrinogen, prothrombin) were assessed. Data were collected from the medical records of patients admitted to the Poisoning Center of Imam Khomeini Hospital in Kermanshah, Iran using a researcher-made checklist. Data were analyzed by SPSS (version 16) using descriptive statistics, including mean, standard deviation, and frequency distribution tables. Trend analysis for proportion was done by chi-square statistics in STATA-14 software (ptrend command).ResultsOf cases, ‌51.3% were male, 92.6% were city dwellers, 38.3% were aged 21–40 years, and 92.5% were poisoned during the spring. The fungus that caused poisoning was Amanita virosa. The gastrointestinal, nervous, and visual systems were the most common systems involved. The most common gastrointestinal symptoms included nausea and vomiting (72.0%) and abdominal pain (71.0%). Vertigo (11.9%) and headache (9.3%) were the most common neurological symptoms. The most common visual manifestation was blurred vision (7.8%). Of cases, 23.7% had metabolic acidosis. The increased alkaline phosphatase level was the most common liver disorder in 98.7% of the cases. Increased blood urea nitrogen and creatinine levels were also reported in 21.0% and 17.7% of the cases, respectively. The serum lactic dehydrogenase and creatine phosphokinase levels also increased in 99.3% and 30.2% of the patients, respectively. The mortality rate was 1.6% (n = 3).ConclusionThe fungal poisoning diagnosis should always be considered in young patients referred to the emergency department with gastrointestinal complaints, a history of consuming wild self-picked mushrooms, and high liver and kidney test values. Since most fungal poisonings occur in the spring, it is necessary to inform the community of the dangers of consuming self-picked wild mushrooms, especially in this season.

Clinical Observation of Botulinum Toxin Injection in the Treatment of Focal Dystonia and Muscle Spasm.

Dystonia and muscle spasms are a group of common and unfavorable clinical neurological symptoms. The use of botulinum toxin (BTX-A) abroad has achieved good results in the treatment of various movement disorders characterized by involuntary or abnormal muscle contractions. It is expected to open up a new field for the treatment of myelodysplastic syndromes (MDs) such as focal dystonia and muscle spasm. There are theoretical and practical implications for the diagnosis and development of some effective neurological treatments. The efficacy of BTX-A in the treatment of various focal dystonia and muscle spasm disorders is as follows: symptoms were improved to varying degrees after injection of Botox or botulinum toxin type A (CBTX-A), but Botox or CBTx. There was no significant difference in the efficacy of A. 30.4% of patients had complete remission, 57.8% had significant remission, and 8.9% had partial remission. Among them, HFS and BS had the best curative effect, and the symptoms were significantly improved by 95.3% and 89.4%, respectively. The efficacy of CD was also satisfactory, with 75.5% of the patients showing significant improvement in symptoms, followed by Meg/OMD (OMD) with 73.3% and SD with 3.3%. The efficacy of WC is poor, and functional improvement is uncertain. Other forms of focal dystonia and spasticity also showed significant functional improvement in 60% of patients. Most patients start to see effects within 1 week after BTX-A injection, symptoms gradually improve, and the bridge of curative effect is reached in 2-4 weeks, and the healing effect lasts for about 3-5 months on average. The overall severity of adverse effects was not severe and resolved spontaneously within a few days to ten weeks, with the most concerning complications being ptosis and dysphagia.

Neurological Manifestations and Their Effect on Outcome in Second Wave of COVID-19 Pandemic: A Retrospective Cohort Study.

There is a need for a better understanding of the relation of various neurological symptoms and complications with manifestations and outcomes of coronavirus disease 2019 (COVID-19). Hence, we planned this study to get an insight into the relation of neurological manifestations and COVID-19. This was a retrospective study. All patients ≥18 years in age, admitted with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 were included in the study. Their clinical records were accessed for collecting demographic and laboratory data. The data collected were analyzed for prevalence and pattern of neurological symptoms at admission and neurological complications developed during hospitalization. It was also analyzed to find the relation of neurological manifestations with duration of hospital stay, requirement of bilevel positive airway pressure (BiPAP) or ventilator, severity of disease, development of neurological complications, and mortality. A total of 440 patients were included. The mean age was 59.28 ± 13.28 years. The most common neurological symptom at presentation was headache while the most common neurological complications were altered sensorium, cerebrovascular stroke, seizure, and encephalitis. Significantly, more patients with neurological complications than those without had severe disease and needed ventilation. Duration of hospitalization was significantly longer (16.26 ± 5.15 vs 12.73 ± 4.89, p = 0.0173) and mortality was also significantly higher (OR 6.59, 95% CI 2.23-19.43; p = 0.0006) in patients with neurological manifestations. The presence of neurological manifestations is associated with greater morbidity and mortality in patients with COVID-19 and thus warrants more aggressive treatment. However, a study of association of individual neurological manifestation with severity of COVID-19 will provide a more meaningful insight regarding the approach to the management of such patients.

Neurological and Neuroradiological Patterns with COVID-19 Infection in Children: A Single Institutional Study.

Background Varied neurological manifestations in pediatric patients with coronavirus disease 2019 (COVID-19) have been increasingly reported from all across the world in the scientific literature. Objective We aimed to evaluate pediatric cases with neurological symptoms and neuroimaging findings with COVID-19 infection in our hospital. Materials and Methods Children from 0 to 12 years with laboratory evidence of COVID-19 infection and acute neurological manifestations within 3 months, who have undergone magnetic resonance imaging (MRI) were included in the study. We categorized them based on neurological findings into four groups: acute encephalitis syndrome (AES), acute flaccid paralysis (AFP), cerebrovascular event/stroke, and miscellaneous consisting of acute seizures without encephalopathy. Results A total of 19 children with neurological manifestations related to COVID-19 infection were included in the study. AES was the most common neurological syndrome seen in 47.36%, followed by AFP in 26.31% and cardiovascular event/stroke in 21.05%. Seizure was the most common neurological symptoms in 62.15%, followed by encephalopathy in 42.10% and AFP in 26.31%. On neuroimaging, pattern observed were immune-mediated cauda equina nerve roots enhancement in 26.31% or acute disseminated encephalitis in 5.26%, small acute infarcts, hippocampal, and bilateral thalamic signal changes seen in 21.05% each, microhemorrhages and leukoencephalopathy in 15.78%, and coinfection in 5.26%. Conclusion In our study, seizures and encephalopathy were the most common neurological symptoms with COVID-19 infection. Postinfectious immune-mediated cauda equina nerve root enhancement or acute demyelinating encephalomyelitis-like brain imaging, followed by small acute infarcts and hippocampal/thalamic signal changes were most common imaging patterns. We found overlapping neurological and MRI patterns in many children, suggesting that various pathophysiological mechanisms act individually or synergistically.

COVID-19 and Central Nervous System Diseases

We reviewed the influence of coronavirus disease 2019 (COVID-19) on the central nervous system reported in the literature since its prevalence. Common neurological symptoms of COVID-19 include altered or impaired consciousness, headache, dizziness, cerebrovascular accidents, and seizures, etc. Encephalopathy caused by or related to COVID-19 includes stroke, acute encephalitis, and Guillain-Barre syndrome. Concomitant COVID-19 in patients with vascular risk factors increased the risk of stroke; the hypercoagulable state and vascular dysfunction caused by COVID-19 also led to stroke. Acute encephalitis was usually accompanied by a history of headache, fever, and altered mental status, and shown hemorrhagic lesions or high signal on MRI. In Guillain-Barre syndrome, there was a time lag between infection with the primary pathogen and the onset of neurological symptoms, which generally manifest as limb paralysis and various sensory abnormalities. The review illustrated that COVID-19 lead to serious consequences of brain and brought difficulties to the treatment. Exploring the neural mechanisms of COVID-19 to better understand the activity of the virus in the brain and to prevent further viral damage to the brain is an urgent issue.

Neurological Disorders of Patients Living with HIV Hospitalized in Infectious Departments of the Specialist Hospital in Lower Silesia in Poland.

Background and Objectives: Central nervous system (CNS) disorders are estimated to occur in approximately 10–20% of people living with HIV (PLWH). They are more commonly observed in newly diagnosed patients and in previously untreated patients or those refusing to undergo antiretroviral treatment. CNS diseases can also be the first manifestation of HIV/AIDS infection. The most common HIV-related central nervous system diseases (CNS-D) are CNS toxoplasmosis, CNS cryptococcosis, progressive multifocal leukoencephalopathy (PML), and HIV-associated encephalopathy treated as a neurocognitive disorder. Materials and Methods: A retrospective analysis of available medical records was performed on 476 patients hospitalised over a period from 2016 to 2021 and diagnosed with HIV/AIDS infection at the department of infectious diseases at the Provincial Specialist Hospital in Wroclaw. An additional criterion for selecting patients for the analysis was the performance of head imaging using computed tomography or magnetic resonance imaging on prospective patients. Results: Neurotoxoplasmosis, neurocryptococcosis, progressive multifocal leukoencephalopathy (PML), and neurosyphilis were the most common CNS diseases among the analysed group of patients. Based on radiological descriptions, other abnormalities, such as vascular changes or cortical and subcortical atrophy of multifactorial origin, not exclusively related to HIV infection, were also frequently observed. The most common neurological symptoms reported in the study group were headaches, limb paresis, and gait and balance disturbance. Conclusions: The clinical picture and epidemiology of neurological manifestations in the group of HIV-infected patients under assessment were similar to the results of other authors. Given the current epidemiological situation, diagnosis for HIV infection should be considered in patients admitted to neurological departments.

Management and outcome of gestational trophoblastic neoplasia patients with brain metastasis: Ten years’ experience in a trophoblastic referral center (460)

<b>Objectives:</b> To determine the clinical outcome of gestational trophoblastic neoplasia patients with brain metastasis. <b>Methods:</b> A review of records of all women with brain metastasis from gestational trophoblastic neoplasia from January 1, 2010, to December 31, 2019, was done. Patients' sociodemographic and clinical-pathologic profiles were described. Using the Kaplan-Meier survival curve, the survival time was determined. <b>Results:</b> A total of 19 patients were included; 13(68.42%) patients had neurological symptoms upon diagnosis and one (5.26%) patient had these symptoms during treatment. The most common neurological symptom was headache. Sixteen patients had the World Health Organization (WHO) prognostic score of >12, two had >7, and one had 3 (A case of tumor recurrence ten years after remission from her low-risk GTN). Nine patients (47.36%) had single brain metastasis, three (15.78%) had two, three (15.78%) had three, one (5.26%) had five, and two (10.52%) were reported to have multiple lesions. The location for brain metastasis was known in eighteen patients and was not identifiable in one due to massive hemorrhage. The location of the brain metastases were as follows: parietal (<i>n</i> = 3), frontal (<i>n</i> = 2), occiput (<i>n</i> = 2), temporal (<i>n</i> = 1), frontotemporal (<i>n</i> = 1), frontoparietal (<i>n</i> = 1), frontal and parietal (<i>n</i> = 2), cerebral and cerebellar (<i>n</i> = 1), parietal and occipital (<i>n</i> = 1), parietal, posterior, and occiput (<i>n</i> = 1), frontal and medial (<i>n</i> = 1), frontoparietal, frontal and thalamus (<i>n</i> = 1), and parietal and superior sagittal sinus (<i>n</i> = 1). The size of brain metastasis ranged from 0.2 to 4.0 cm. All received EMACO with an increase in the Methotrexate infusion to 1 g/m² as first-line treatment. Three (15.78%) patients were given induction chemotherapy with Etoposide 100 mg/m² and Cisplatin 20 mg/m². Fifteen (78.94%) patients underwent concomitant whole brain radiation at a dose of 2,000-3,000 cGy (in 10 fractions of 200-300 cGy), and two were given intrathecal Methotrexate 12.5 mg. The most common tox- icities from EMACO chemotherapy were infections in 84.21% (16/19), hypokalemia in 73.68% (14/19), and anemia grade 2-4 in 69.42% (13/19). Nine out of thirteen (69.23%) patients diagnosed with neurological symptoms achieved biochemical remission. One patient who had neurological symptom during the course of treatment was given palliative care. Four out of four (100%) patients who had no neurological symptoms achieved biochemical remission. Three (15.78%) patients had resistance to EMACO and were given EP-EMA. Four (21.05%) patients underwent an adjunctive hysterectomy. Two patients had a histopathologic result of choriocarcinoma, and one had an invasive mole. Two (10.52%) patients died of cerebral hemorrhage during treatment. One patient (5.26%) could not continue her chemotherapy because she got pregnant before her first consolidation course. The median follow-up was 25.35 months. Six patients were contacted, and five (83.33%) had resumed a normal life. There were fourteen early deaths. Causes of death were cerebral hemorrhage in nine (64.28%) patients, gastrointestinal hemorrhage in two (14.28%) patients, pulmonary embolism in two (14.28%) patients and pulmonary hemorrhage in one (7.14%) patient. After excluding early deaths, the proportion of patients surviving between 1 to 3 years was at 84% and those surviving past 3 years was 76%. The median survival was approximately 2.5 years. <b>Conclusions:</b> Brain metastasis continues to bear a poor prognosis despite the early institution of chemotherapy.

Neurocognitive and Psychosocial Characteristics of Pediatric Patients With Post-Acute/Long-COVID: A Retrospective Clinical Case Series.

ObjectiveStudies suggest a large number of patients have persistent symptoms following COVID-19 infection—a condition termed “long COVID.” Although children and parents often report cognitive difficulties after COVID, very few if any studies have been published including neuropsychological testing.MethodsA retrospective chart review was completed for the first 18 patients referred for a neuropsychological evaluation from a multidisciplinary pediatric post-COVID clinic. The neuropsychological screening battery assessed verbal fluency and category switching, attention, working memory, processing speed, and verbal learning and memory. Patients’ caregivers also completed standardized questionnaires regarding day-to-day mood and behavior.ResultsAt intake, the most common neurologic symptoms reported by caregivers were attention problems (83.3%), fatigue/lethargy (77.7%), sleep disturbance (77.7%), dizziness/vertigo (72.2%), and headaches (72.2%). On rating scales, most caregivers endorsed concerns for depressed mood and anxiety (14/15 and 12/15). A large proportion of patients had difficulties with attention (9/18) and depressed mood/anxiety (13/18) before COVID. On cognitive testing, the majority of the patients performed within or above broad average range (≥16th percentile) across most domains. However, a little over half of the patients performed below average on auditory attention measures.ConclusionsWithin our clinically referred sample, children who reported lingering cognitive symptoms after COVID-19 often had a preexisting history of attention and/or mood and anxiety concerns. Many of these patients performed below average in attention testing, but it remains to be seen whether this was due to direct effects of COVID, physical symptoms, and/or preexisting difficulties with attention or mood/anxiety.

Neurological Symptoms of SARS-CoV-2 Infection in Pediatric Patients

Purpose: Coronavirus disease 2019 (COVID-19) causes various neurological symptoms in children, as well as respiratory symptoms, and the number of reported cases is increasing with the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. This study aimed to investigate the neurological symptoms and incidence in pediatric patients hospitalized with COVID-19.Methods: We retrospectively analyzed the medical records of patients under the age of 18 diagnosed with COVID-19 and admitted to National Health Insurance Service Ilsan Hospital using real-time reverse transcription–polymerase chain reaction from December 2020 to March 2022. We reviewed data on the age of confirmed COVID-19 patients, fever, and respiratory, gastrointestinal, and neurological symptoms. We evaluated the chief complaints of hospitalization and classified them as non-neurological or neurological, according to the chief complaints that caused the most discomfort.Results: Among 376 patients, 63 (16.8%) and 313 (83.2%) patients were classified as having neurological and non-neurological symptoms, respectively. The most common neurological symptoms were headache (49, 13.0%), followed by seizures (39, 10.4%), myalgia (24, 6.4%), and dizziness (14, 3.7%). Additionally, there were patients with anosmia (nine, 2.4%), ageusia (four, 1.1%), and visual disturbance (twi, 0.5%). Of the 39 patients who experienced seizures, 15 (15/39, 51.7%) had no symptoms except fever, and seizures were the only main presenting symptom of SARS-CoV-2 infection.Conclusion: Neurological symptoms are common in pediatric COVID-19 patients. Seizures can be an early symptom of SARS-CoV-2 infection and should not be underestimated during the COVID-19 pandemic.

Longitudinal evaluation of neurologic-post acute sequelae SARS-CoV-2 infection symptoms.

ObjectiveTo assess the initial features and evolution of neurologic Postacute Sequelae of SARS‐CoV‐2 infection (neuro‐PASC) in patients with and without prior neurologic disease.MethodsParticipants with neurologic symptoms following acute SARS‐CoV‐2 infection were recruited from October 9, 2020 to October 11, 2021. Clinical data included a SARS‐CoV‐2 infection history, neurologic review of systems, neurologic exam, Montreal cognitive assessment (MoCA), and symptom‐based self‐reported surveys at baseline (conducted after acute infection) and 6‐month follow‐up assessments.ResultsFifty‐six participants (69% female, mean age 50 years, 29% with prior neurologic disease such as multiple sclerosis) were enrolled, of which 27 had completed the 6‐month follow‐up visit in this ongoing study. SARS‐CoV‐2 infection severity was largely described as mild (39.3%) or moderate (42.9%). At baseline, following acute infection, the most common neurologic symptoms were fatigue (89.3%) and headaches (80.4%). At the 6‐month follow‐up, memory impairment (68.8%) and decreased concentration (61.5%) were the most prevalent, though on average all symptoms showed a reduction in reported severity score at the follow‐up. Complete symptom resolution was reported in 33.3% of participants by 6 months. From baseline to 6 months, average MoCA scores improved overall though 26.3% of participants’ scores decreased. A syndrome consisting of tremor, ataxia, and cognitive dysfunction (PASC‐TAC) was observed in 7.1% of patients.InterpretationEarly in the neuro‐PASC syndrome, fatigue and headache are the most commonly reported symptoms. At 6 months, memory impairment and decreased concentration were most prominent. Only one‐third of participants had completed resolution of neuro‐PASC at 6 months, although persistent symptoms trended toward improvement at follow‐up.

Inactivated COVID-19 vaccine induced acute stroke-like focal neurologic symptoms: a case series

BackgroundA subgroup of individuals experienced stroke-like symptoms after receiving an inactivated COVID-19 vaccine. We present clinical characteristics, neuroimaging, and outcome of these patients.MethodsMedical personals who had neurological symptoms after receiving inactivated COVID-19 vaccine were enrolled. Clinical, laboratory investigation and neuroimaging were collected. Subjects were prospectively followed-up on clinical and neuroimaging to detect brain parenchymal or cerebrovascular abnormality.ResultsNineteen out of 385 subjects (4.9%) developed neurological symptoms after vaccination. There was a female predominance (89.5%) with mean age of 34 ± 7.5 years. Majority of patients (52.6%) had symptoms within 60 min after vaccination. The most common neurological symptoms were numbness (94.7%) followed by headache (52.6%) and weakness (47.4%). The most common neurological signs were sensory deficit (79%) followed by motor weakness (52.6%) and tongue deviation (26.3%). Recurrent headache was observed in most patients (89.5%) during followed up. Serial brain imaging was done in all patients with median follow-up interval of 18 days. There was no evidence of acute brain infarction in any of the patients, 84.2% had no vascular abnormality, 15.8% had transient focal narrowing of cerebral vessels. Outcome was favorable, modified ranking scale 0–1 for all patients at 4 weeks after vaccination.ConclusionsTransient focal neurological symptoms and deficits can be found after COVID-19 vaccination. However, benefit to stop COVID-19 pandemic by vaccination is outweighed by these seemingly reversible side effects. The pathophysiology underlined these phenomena should be further investigated.

Neurological long-COVID in the outpatient clinic: Two subtypes, two courses

IntroductionSymptoms referable to central and peripheral nervous system involvement are often evident both during the acute phase of COVID-19 infection and during long-COVID. In this study, we evaluated a population of patients with prior COVID-19 infection who showed signs and symptoms consistent with neurological long-COVID. MethodsWe prospectively collected demographic and acute phase course data from patients with prior COVID-19 infection who showed symptoms related to neurological involvement in the long-COVID phase. Firstly, we performed a multivariate logistic linear regression analysis to investigate the impact of demographic and clinical data, the severity of the acute COVID-19 infection and hospitalization course, on the post-COVID neurological symptoms at three months follow-up. Secondly, we performed an unsupervised clustering analysis to investigate whether there was evidence of different subtypes of neurological long COVID-19. ResultsOne hundred and nine patients referred to the neurological post-COVID outpatient clinic. Clustering analysis on the most common neurological symptoms returned two well-separated and well-balanced clusters: long-COVID type 1 contains the subjects with memory disturbances, psychological impairment, headache, anosmia and ageusia, while long-COVID type 2 contains all the subjects with reported symptoms related to PNS involvement. The analysis of potential risk-factors among the demographic, clinical presentation, COVID 19 severity and hospitalization course variables showed that the number of comorbidities at onset, the BMI, the number of COVID-19 symptoms, the number of non-neurological complications and a more severe course of the acute infection were all, on average, higher for the cluster of subjects with reported symptoms related to PNS involvement. ConclusionWe analyzed the characteristics of neurological long-COVID and presented a method to identify well-defined patient groups with distinct symptoms and risk factors. The proposed method could potentially enable treatment deployment by identifying the optimal interventions and services for well-defined patient groups, so alleviating long-COVID and easing recovery.

Post COVID-19 Multisystemic Inflammatory Syndrome Revealed by Seizures: A Case Report

The Covid-19 infection disrupts various organs, including the liver, kidney, and nervous system. Common neurological symptoms of the Covid-19 infection include delirium, confusion, headache, and loss of sense of smell and taste. In rare cases it can cause seizure. The virus enters the nervous system either directly through nerve pathways or indirectly through the ACE2 receptor. Understanding the potential mechanisms is necessary to gain better insight into COVID-19 induced seizure pathogenesis and to design the correct treatment strategies to achieve appropriate treatment for seizure and epilepsy. We report the case of a child with post covid syndrome with multisystemic inflammatory syndrome damage, and we explain the mechanisms of the damage to the nervous system.

COVID-19 and neurologic manifestations: a synthesis from the child neurologist's corner.

BackgroundSince December 2019, the SARS-CoV-2 virus has been a global health issue. The main clinical presentation of this virus is a flu-like disease; however, patients with diverse neurologic manifestations have also been reported. In this review, we attempt to summarize, discuss and update the knowledge of the neurologic manifestations in the pediatric population affected by SARS-CoV-2 infection and the pandemic’s effects in children with neurologic diseases.Data sourcesThis review analyzes studies found on the PubMed database using the following keywords: Neurologic manifestations COVID-19, Neurological COVID-19, coronavirus, SARS-CoV-2, pediatric COVID-19, COVID-19 in children, MIS-C, Pediatric Inflammatory Multisystem Syndrome, Guillain Barré Syndrome, Stroke, ADEM, and Anti-NMDA encephalitis. All studies cited were published between 2004 and 2022, and represent the most relevant articles in the field. The World Health Organization COVID-19 online dashboard was assessed to obtain updated epidemiological data.ResultsThe most common neurologic symptoms in the pediatric population are headache, seizures, encephalopathy, and muscle weakness. These can be present during COVID-19 or weeks after recovering from it. Children who presented with multi-system inflammatory syndrome had a higher incidence of neurologic manifestations, which conferred a greater risk of morbidity and mortality. Several neuro-pathophysiological mechanisms have been proposed, including direct virus invasion, hyper-inflammatory reactions, multi-systemic failure, prothrombotic states, and immune-mediated processes. On the other hand, the COVID-19 pandemic has affected patients with neurologic diseases, making it challenging to access controls, treatment, and therapies.ConclusionsVarious neurologic manifestations have been associated with children’s SARS-CoV-2 infection. It is important to identify and give them proper and opportune treatment because they can be potentially grave and life-threatening; some can lead to long-lasting sequelae. Different neuro-pathophysiological mechanisms have been proposed, however, a causal relationship between SARS-CoV-2 infection and neurologic manifestations remains to be proven. Patients with neurologic diseases are especially affected by COVID-19, not only by the disease itself but also by its complications and pandemic management measures.

Ischemic Stroke and SARS-CoV-2 Infection: The Bidirectional Pathology and Risk Morbidities.

Stroke is a fatal morbidity that needs emergency medical admission and immediate medical attention. COVID-19 ischemic brain damage is closely associated with common neurological symptoms, which are extremely difficult to treat medically, and risk factors. We performed literature research about COVID-19 and ischemia in PubMed, MEDLINE, and Scopus for this current narrative review. We discovered parallel manifestations of SARS-CoV-19 infection and brain ischemia risk factors. In published papers, we discovered a similar but complex pathophysiology of SARS-CoV-2 infection and stroke pathology. A patient with other systemic co-morbidities, such as diabetes, hypertension, or any respiratory disease, has a fatal combination in intensive care management when infected with SARS-CoV-19. Furthermore, due to their shared risk factors, COVID-19 and stroke are a lethal combination for medical management to treat. In this review, we discuss shared pathophysiology, adjuvant risk factors, challenges, and advancements in stroke-associated COVID-19 therapeutics.

Brain Tumor Infodemiology: Worldwide Online Health-Seeking Behavior Using Google Trends and Wikipedia Pageviews.

BackgroundSearching the internet for information on common neurologic symptoms and diseases has been increasing in recent times. It is postulated that online search volume data could be utilized to gauge public awareness and real-world epidemiological data regarding brain tumors.ObjectivesThe goal of this study was to describe the pattern of online search queries of keywords related to neoplasms of the central nervous system (CNS).MethodsUsing Google Trends, search activity from January 2004 – January 2021 was quantified using relative search volume (RSV). The average RSV for the first 3 years was compared with the final 3 years to account for percent change. Wikipedia article views from July 2007 – January 2021 were generated using Pageviews. Peaks in RSV and page views were then matched for related news.Results“Brain tumor”, “brain cancer”, “glioblastoma”, and “glioma” had the highest search volume. RSV from Google Trends and views of Wikipedia pages reflected comparable data in terms of known prevalence rankings of tumor subtypes. There were no observable trends that could correlate to the rising numbers of brain tumor cases worldwide. However, headlines of personalities being diagnosed with glioblastomas were mostly responsible for temporary increases in public interest.ConclusionsTransient rises in online search volume mirror public awareness of more aggressive CNS neoplasms that have a high burden of disease. Worldwide interest in brain tumors may not necessarily correspond to clinical occurrence, but may signify an unmet gap in providing accurate online information to neuro-oncologic patients.

Familial cold autoinflammatory syndrome and multiple sclerosis

AbstractBackgroundCryopyrin‐associated periodic syndrome (CAPS) is an autoinflammatory disorder with a spectrum ranging from the milder familial cold auto‐inflammatory syndrome (FCAS) phenotype to the more severe Muckle–Wells Syndrome. Although headaches are the most common neurological symptoms, neuroinflammatory diseases such as multiple sclerosis (MS) have only been reported in the more severe phenotypes.Case PresentationWe describe a 43‐year‐old male diagnosed with relapse‐remitting MS who developed cold‐induced arthralgias and urticaria. He initially presented with facial numbness and arthralgias in his late teenage years, and brain magnetic resonance imaging (MRI) demonstrated multiple lesions with periventricular white matter extension. Oligoclonal bands were detected in the cerebrospinal fluid (CSF). Symptoms gradually improved, and a decade later he presented with numbness at upper limbs and tongue. Brain and spine MRI showed new lesions, but CSF was unremarkable. He was started on interferon β‐1a with symptomatic improvement until another flare around 13 years later. Treatment was changed to dimethyl fumarate. During this hospitalization, urticaria was problematic and particularly associated with cold temperatures. This raised suspicion for possible CAPS and subsequently confirmed with an A439V mutation in the NLRP3 gene, consistent with FCAS. Anakinra was started but was not tolerated because of localized reactions despite desensitization. His serum amyloid A was mildly elevated at 9 mg/L (reference range 0–6). He remains stable from a neurological perspective, including imaging, and continues dimethyl fumarate.ConclusionsTo date, FCAS and possible association with MS has not been described. The case raises challenges in the diagnosis of concurrent disease processes. It also highlights that neurological sequelae should be considered in all spectrums of CAPS, and distinctions with MS should be made where possible.

Behavioral aspect of Wilson Disease: Diagnostic &amp; Management Challenge

Wilson disease (WD) is a multisystem disease of defective copper metabolism. Excess copper is accumulated in different organ of body including liver, brain, kidney, eyes etc. Accumulated copper causes dysfunction of different parts of brain and produce signs and symptoms of neurological disease. Epidemiological data suggested psychiatric symptoms may be the presenting problem in 30% of WD patients. Psychiatric symptoms developed almost 100% cases of WD patients at any time of the disease course. Psychiatrc symptoms are affective mood disorder, psychotic behavioral, personality changes, anxiety &amp; depression as well cognitive deterioration. Common neurologic symptoms are dystonia, hypertonia &amp; rigidity, tremors and dysarthria. Rarely patients may present with polyneuropathy or dysautonomia. So both neurologic and psychiatric evaluation and specific treatment is essential for both the conditions. Diagnostic evaluations of Wilson disease include estimation of serum ceruloplasmin, 24 hours urinary copper, MRI of brain. Magnetic resonance (MR) imaging of the brain or computed tomography (CT) may detect structures involved like basal ganglia. Knowledge of behavioral problem of WD is helpful for early diagnosis of many cases and overall management. Mainstay of treatment of Wilson disease is dietary restriction of copper-rich diet, copper-chelating agents, symptomatic treatment for dystonia &amp; rigidity as well as behavioral psychiatric therapy. For dystonia trihexy phenidyl, tetrabenazine, codopa &amp; clonidine can be used. Neurologic as well as psychiatric symptoms would be reduced where chelation therapy is effective. More over sometimes pharmacologic treatment for psychiatric symptoms is required. J Bangladesh Coll Phys Surg 2022; 40: 121-127