Cranial Nerve Lesions Research Articles

A Systematic Review of Traumatic Brain Injury in Modern Rodent Models: Current Status and Future Prospects.

According to the Centers for Disease Control and Prevention (CDC), the national public health agency of the United States, traumatic brain injury is among the leading causes of mortality and disability worldwide. The consequences of TBI include diffuse brain atrophy, local post-traumatic atrophy, arachnoiditis, pachymeningitis, meningocerebral cicatrices, cranial nerve lesions, and cranial defects. In 2019, the economic cost of injuries in the USA alone was USD 4.2 trillion, which included USD 327 billion for medical care, USD 69 billion for work loss, and USD 3.8 trillion for the value of statistical life and quality of life losses. More than half of this cost (USD 2.4 trillion) was among working-age adults (25-64 years old). Currently, the development of new diagnostic approaches and the improvement of treatment techniques require further experimental studies focused on modeling TBI of varying severity.

Bilateral vocal cord palsy as complication of CNS tuberculosis

BackgroundTuberculous meningitis, a rare but severe form of extrapulmonary tuberculosis, frequently affects cranial nerves. While nerves III, VI and VII are commonly involved, involvement of caudal cranial nerves is rarely described. Here, we report a rare case of bilateral vocal cord palsy secondary to caudal cranial nerve involvement in tuberculous meningoencephalitis, that occurred in Germany, a country with low tuberculosis incidence.Case presentationA 71-year-old woman was transferred for further treatment of hydrocephalus as a complication of presumed bacterial meningitis with unknown pathogen at that time. Because of decreased consciousness, intubation was performed and an empiric antibiotic therapy with ampicillin, ceftriaxone and acyclovir was initiated. Upon admission to our hospital, an external ventricular drainage was placed. Cerebrospinal fluid analysis revealed Mycobacterium tuberculosis as the causative pathogen, and antitubercular treatment was initiated. Extubation was possible one week after admission. Eleven days later, the patient developed inspiratory stridor that worsened within a few hours. Flexible endoscopic evaluation of swallowing (FEES) revealed new-onset bilateral vocal cord palsy as the cause of respiratory distress, which required re-intubation and tracheostomy. The bilateral vocal cord palsy persisted despite continued antitubercular therapy on the follow-up examination.ConclusionConsidering the aetiology of infectious meningitis, cranial nerve palsies may be suggestive for tuberculous meningitis as underlying disease given their rarity in other bacterial forms of meningitis. Nevertheless, intracranial involvement of inferior cranial nerves is rare even in this specific entity, as only extracranial lesions of inferior cranial nerves have been reported in tuberculosis. With this report of a rare case of bilateral vocal cord palsy due to intracranial involvement of the vagal nerves, we emphasize the importance of timely initiation of treatment for tuberculous meningitis. This may help to prevent serious complications and associated poor outcome since the response to anti-tuberculosis therapy may be limited.

Transaxillary Branch-to-Branch-to-Branch Carotid Catheterization Technique for Triple-Branch Arch Repair.

To describe the transaxillary branch-to-branch-to-branch carotid catheterization technique (tranaxillary 3BRA-CCE IT) for cannulation of all supra-aortic vessels using only 1 femoral and 1 axillary access during triple-branch arch repair. After deployment of the triple-branch arch device, catheterization and bridging of the innominate artery (IA) should be performed through a right axillary access (cutdown or percutaneous). Then, the retrograde left subclavian (LSA) branch should be catheterized (if not preloaded) from a percutaneous femoral access, and a 12×90Fr sheath should be advanced to the outside of the endograft. Subsequently, catheterization of the left common carotid artery (LCCA) antegrade branch should be performed, followed by snaring of a wire in the ascending aorta which was inserted through the axillary access, creating a branch-to-branch-to-branch through-and-through guidewire. Over the axillary access, a 12×45Fr sheath should be inserted into the IA branch and looped in the ascending aorta using a push-and-pull technique so that it faces the LCCA branch, allowing for stable catheterization of the LCCA. The retrograde LSA branch should then be bridged following the standard fashion. This series of 5 patients demonstrates that triple-branch arch repair can be performed with the transaxillary 3BRA-CCE IT, allowing catheterization of the supra-aortic vessels without manipulation of the carotid arteries. The transaxillary 3BRA-CCE IT allows catheterization and bridging of all supra-aortic vessels in triple-branch arch repair through only 2 vascular access points, the femoral artery and the right axillary artery. This technique avoids carotid surgical cutdown and manipulation during these procedures, reducing the risk of access site complications, including bleeding and reintervention, reintubation, cranial nerve lesions, increased operating time, and so on, and has the potential to change the current vascular access standard used during triple-branch arch repair.

Timing of Heparin Administration During Carotid Endarterectomy Affects Wound Hematoma Evacuation Rate

The aim of this study was to investigate whether timing of heparin administration during carotid endarterectomy (CEA) could affect postoperative outcomes. Consecutive elective CEAs in two tertiary hospitals were enrolled for asymptomatic carotid stenosis ≥70% performed between 2011 and 2020. We grouped patients according to timing of heparin administration during CEA: (Group A) Heparin was given immediately before skin incision in the first group, whereas in the second group (Group B), heparin was given 2 minutes before internal carotid artery clamping. Primary outcomes were 24-hour postoperative major adverse events (MAEs: myocardial infarction, major and minor stroke, death), surgical site hematoma, and wound hematoma evacuation rate. Secondary outcomes were 30-day MAEs and cranial nerves lesions rate. A total of 2167 patients underwent CEA: 1191 patients (55%) were treated in group A, whereas 979 (45%) were treated in group B with a similar mean operation time of 79 minutes. Weight-adjusted (70 IU/kg) heparin was administered in both groups. A higher number of patients under dual antiplatelet (7% vs 15%) and anticoagulation (4.5% vs 11%) therapy were recorded in group B due to the presence of a higher rate of coronary heart disease (P < .001). Eversion CEA was 89% and 56% in group A and B, respectively. Protamine was administered in 3% vs 90% of patients in group A and B, respectively. Primary and secondary outcomes are summarized in Table. After multivariate analysis, just wound hematoma evacuation rate was affected by the timing of heparin administration during CEA. The strategy of heparin administration before skin incision during CEA protects against wound hematoma evacuation without increasing the procedural risk.TableOutcomesGroup A, n = 1191 n (%)Group B, n = 979 n (%)P24-hour postoperative outcomes: primary outcomes Myocardial infarction5 (0.4%)4 (0.4%)1 Major stroke1 (0.1%)4 (0.4%).18 Minor stroke0 -2 (0.2%).2 Death0 (0%)1 (0.1%).45 Major adverse events6 (0.5)11 (1.1%).14 Surgical site hematoma48 (4%)29 (3%).2 Wound hematoma evacuation1 (0.1%)15 (1.5%).000130-day outcomes: secondary outcomes Myocardial infarction0 -4 (0.4%).04 Major stroke1 (0.1%)1 (0.1%)1 Minor stroke0 -2 (0.2%).2 Death00– Major adverse events1 (0.1%)7 (0.7%).02 Cranial nerve lesion1 (0.1%)1 (0.1%)1Boldface P values indicate statistical significance. Open table in a new tab

E015 A case of ocular myasthenia gravis seen by rheumatology as suspected mononeuritis multiplex in an adult male shortly after Pfizer-BioNTech SARS-CoV-2 vaccination

Abstract Background/Aims Myasthenia gravis (MG) is an antibody-mediated autoimmune disease targeting proteins at the postsynaptic membrane of the neuromuscular junction. MG is thought to occur in genetically susceptible individuals following an environmental trigger. SARS-CoV-2 infection has been associated with new-onset autoimmune disease, new-onset MG, and exacerbations of pre-existing MG, with molecular mimicry between SARS-CoV-2 epitopes and autoantigen-induced autoreactivity thought to be part of the underlying mechanism. We report a case of new-onset ocular MG following first dose Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination which was referred to rheumatology as suspected mononeuritis multiplex. Methods A 53-year-old man of East Asian ethnicity presented to the emergency department (ED) with sudden onset diplopia and left lateral gaze restriction 7 days after receiving his first dose of the Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination. He had longstanding myopia and dry eyes but no other medical history, no regular medications or significant family history. He was a current smoker, with a 50-pack year history. He did not drink alcohol or use any recreational drugs. He was found to have an isolated left VI cranial nerve (CN) palsy with an otherwise normal ocular and physical examination. Blood tests were unremarkable apart from raised cholesterol, and he was discharged with a suspected self-limiting microvascular CN lesion. Three weeks later he presented to ED with worsening diplopia, increasingly restricted eye movements, headache, nausea, vomiting and blurred vision. Ophthalmology assessment noted new right sided CN III and VI palsy, persistent left CN VI palsy, and vertical diplopia in all fields of gaze. Neurological and physical examination were normal. Bloods including an autoimmune screen were unremarkable. SARS-CoV-2 Spike antibodies were positive consistent with SARS-CoV-2 vaccination but not infection. Intracranial and thoracic imaging were unremarkable. He was referred to and seen by both rheumatology and neurology as a case of suspected mononeuritis multiplex. Results A diagnosis of ocular MG was confirmed with positive serum acetylcholine receptor antibodies, and he was started on prednisolone, and pyridostigmine to good effect. Daily forced vital capacity (FVC) showed no respiratory muscle involvement, and nerve conduction studies and electromyography were normal, excluding secondary generalisation. Conclusion A review of the literature found 14 reported cases of new-onset MG all within 4 weeks following SARS-CoV-2 vaccine. Whilst these cases provide interesting insights into the pathogenesis of autoimmune conditions such as MG, they are not epidemiological studies to inform vaccine safety. Ultimately, current evidence suggests that the risks of SARS-COV-2 infection outweigh the risk of vaccine-related adverse events, therefore we suggest clinicians should be aware of potential new-onset autoimmune conditions, but support the safety of SARS-COV2 vaccination. Further, research into possible immunological mechanisms behind this phenomenon, including identifying potential epitopes inducing molecular mimicry, could help establish the likelihood of a causative link. Disclosure A. Storrie: None. R.M. Hum: None. J. Lilleker: None. P. Ho: None.

Association of Tumor Volumetry with Postoperative Outcomes for Cervical Paraganglioma

Objectives: To analyze the association of tumor volume with outcome after surgery for cervical paraganglioma. Materials and Methods: This retrospective study included consecutive patients undergoing surgery for cervical paraganglioma from 2009-2020. Outcomes were 30-day morbidity, mortality, cranial nerve injury, and stroke. Preoperative CT/MRI was used for tumor volumetry. An association between the volume and the outcomes was explored in univariate and multivariable analyses. A receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated. The study was conducted and reported according to the STROBE statement. Results: Volumetry was successful in 37/47 (78.8%) of included patients. A 30-day morbidity occurred in 13/47 (27.6%) patients with no mortality. Fifteen cranial nerve lesions occurred in eleven patients. The mean tumor volume was 6.92 cm3 in patients without and 15.89 cm3 in patients with complications (p = 0.035) and 7.64 cm3 in patients without and 16.28 cm3 in patients with cranial nerve injury (p = 0.05). Neither the volume nor Shamblin grade was significantly associated with complications on multivariable analysis. The AUC was 0.691, indicating a poor to fair performance of volumetry in predicting postoperative complications. Conclusions: Surgery for cervical paraganglioma bears a relevant morbidity with a particular risk of cranial nerve lesions. Tumor volume is associated with morbidity, and MRI/CT volumetry can be used for risk stratification.

Oral health and oral health-related quality of life in patients with chronic peripheral facial nerve palsy with synkineses-A case-control-study.

Facial nerve palsy (FP) is the most common cranial nerve lesion, leading to partial or complete immobility of the affected half of face. If food residues on tooth surfaces cannot be removed by natural self-cleaning mechanisms that this is likely to lead to an increase dental plaque formation and the risk of dental, periodontal and general diseases. It was the aim of this study to assess oral health, oral hygiene with the influence of handedness and oral health related quality of life in patients with chronic peripheral FP. This study included 86 people. Patients with FP (n = 43) in an FP-group (FPG) were matched with 43 participants without ever diagnosed FP in a control group (CG). Oral health and oral hygiene were assessed in a clinical examination performed in hospital. Decayed-missing-filled-teeth-index, periodontal-screening-index, approximal plaque index and sulcus bleeding index were used to evaluate dental caries and periodontal health status. Oral health-related quality of life data (OHQoL) was collected with the Oral health impact profile (Germany-14) by interview. Oral health parameters in the FPG were significantly worse than in the CG. The median revealed 14.3% more proximal plaque (p = 0.014), 20.8% more sulcus bleeding (p = 0.002) and more than twice as much caries (p = 0.024). The paretic side compared to the non-paretic side of patients was significantly more affected by inflammatory periodontal diseases (p = 0.032) and had a higher prevalence of caries (p = 0.163). Right-handed patients with right-sided FP performed worse than right-handed patients with left-sided FP (p = 0.004). Patients with FP described a greater limitation of OHQoL than patients without this disease (p &lt; 0.001). In conclusion, facial nerve palsy affects oral health, oral hygiene and OHQoL of patients while handedness influences oral hygiene and oral health.

Patterns of facial and blink reflex abnormalities in type 2 diabetes mellitus patients with short disease duration: a clue to subclinical cranial neuropathy

Abstract Background Cranial neuropathies occur in 3 to 14% of diabetic patients. Motor conduction study of the facial nerve and blink reflex study are electrophysiologic techniques used to assess the facio-trigeminal pathway in diabetic patients. The patterns of facial and blink reflex abnormalities are inconsistent among studies. This study aimed to assess the subclinical facial nerve and blink reflex abnormalities patterns in short-duration type 2 diabetes mellitus patients. This cross-sectional study included 30 type 2 diabetic patients with disease duration ≤ 5 years. We included only patients with the Toronto clinical neuropathy score ≤ 5. We enrolled 30 age- and sex-matched healthy subjects as a control group. We performed facial nerve motor conduction and blink reflex studies. Patients with prior history of cranial nerve lesions, stroke, or any other disease-causing polyneuropathy or drug-induced neuropathy were excluded from the study. Results Thirty diabetic patients were included, 20 females (66.7%) and ten males (33.3%). Their mean age was 52.63 ± 8.94 years. None of the patients had clinical evidence of neuropathy. There were significant differences between patients and controls in the distal latencies and amplitudes of facial nerve compound muscle action potentials and contralateral R2 late response latencies of the blink reflex. We detected subclinical cranial abnormalities in 6 diabetic patients (20%). One of them (3.3%) had facial nerve conduction abnormalities, four of them (13.4%) had blink reflex abnormalities, and one of them (3.3%) had both facial nerve and blink reflex abnormalities. Conclusion Subclinical cranial neuropathy can occur in short-duration type 2 diabetes mellitus patients. We detected different blink reflex patterns and facial conduction study abnormalities. We recommend blink reflex and facial nerve conduction studies as simple tests for the early evaluation of neurological subclinical affection in patients with short disease duration of T2DM as they may appear in the absence of peripheral neuropathy.

Flipping the Anatomy Classroom with Clinical Cases and Teamwork at a Large Medical School

Students participating in active and collaborative learning understand concepts better, perform better in coursework, and have better attitudes toward teamwork. But, the rise of the digital age has had a negative effect on classroom engagement—a topic of international concern. At UT Southwestern Medical School, voluntary attendance at didactic anatomy sessions is at an all‐time low. Because we believe contact time with students is a valuable commodity, our objective is to develop an anatomy teaching approach that will improve student engagement and teamwork. As content hours are limited, time‐efficiency is essential to the approach we seek to develop. In a pilot study, we developed two face‐to‐face case‐based active learning sessions that were conducted within the time slots formerly scheduled for two face‐to‐face anatomy lecture sessions. Content formerly covered in these didactic sessions was converted into video format and offered on‐demand through our institution’s learning management system. Students were given instructions for pre‐session preparation (i.e., review of the videos and other course materials) several days prior to each session. Due to computer technology limitations in our cadaver lab, a virtual cadaver model (Complete Anatomy, 3D4Medical from Elsevier) was used in place of human cadavers for the two case‐based sessions. During the sessions, each laboratory dissection team of 6‐7 students worked at a table outfitted with a 42‐inch monitor capable of wireless connection to student laptops. The exercises focused on the anatomical basis for several clinical cases involving cranial nerve lesions (Session 1) and abdominal hernias (Session 2). Students were allotted 45 minutes for each mandatory session at the end of which teams were required to electronically submit a completed worksheet for credit. Following each session, students were invited to participate in a brief survey with two open‐ended questions that asked them to name one thing about the exercise they would change and one thing they would keep the same. Results of the surveys revealed that the two most commonly perceived benefits of the exercises were 1) application of anatomy to real cases (41 of 131 responses) and 2) opportunity to work in teams with other students (28 of 131 responses). The most commonly perceived challenge was insufficient time to work through the exercises as a team (95 of 131 responses). Student performance on exam questions directly related to the content of the pilot sessions was higher than in years prior to the pilot; however, this difference was not statistically significant in this high‐performing group of students. The survey results demonstrate that our students perceive value in teamwork and the opportunity to practice applying their theoretical knowledge to real‐world problems. The results also highlight the importance of carving out adequate time in the curriculum for these experiences. In the future, we aim to increase opportunities, outside of dissection and didactic sessions, for our students to practice these important, career‐relevant skills.

Management of traumatic isolated unilateral oculomotor nerve palsy in the emergency department and literature review

Cranial nerve (CN) lesions are observed due to congenital, infectious, neoplastic formations, migraine and head trauma. Along with the patient's age, clinical findings and neuroradiological imaging studies guide the diagnosis. A 57-year-old female patient was brought to the emergency room (ER) by Emergency Medical Services (EMS) due to a motor vehicle accident. No medical history. She was conscious, cooperative and orientated. Vital findings were normal. She had ptosis in the left eye, loss in the direct light reflex, restricted medial movements and mydriasis were determined. Radiological examination is normal. The patient was hospitalized with the diagnosis of isolated 3rd cranial nerve palsy (OCNP). Isolated OCNP is a rare condition usually secondary to major trauma. In addition to, there may be isolated unilateral OCNP without any evidence of neuroimaging abnormality. Emergency physicians should be vigilant in such cases that should perform detailed neurological examination and clinical follow-up for the patient's complaints.

Complications after stereotactic radiosurgery in patients with brain disorders

Objective: to analyze complications after stereotactic radiosurgery for various diseases performed using the Elekta Leksell Gamma Knife Perfexion.Materials and methods. This retrospective study of stereotactic radiosurgery outcomes included 3,148 patients with different brain lesions, including 1,621 individuals with metastases (51.5 %), 732 with meningiomas (23.3 %), 359 with neurinomas (11.4 %), 71 with arteriovenous malformations (2.3 %), 118 with cavernomas (3.7 %), 114 with neuroepithelial tumors (3.6 %), 46 with pituitary adenomas (1.5 %), 54 with functional diseases (1.7 %), and 33 with other diseases (1 %).The diagnosis was based on the results of neurological examination, magnetic resonance imaging, computed tomography, and positron emission tomography.The severity of radiation complications was evaluated using the Eastern Cooperative Oncology Group (ECOG) scale.Results. Among all patients who underwent stereotactic radiosurgery, 96 individuals developed 97 different complications. The most common complications included radionecrosis (n = 43) and perifocal edema (n = 38). Alopecia (n = 3) and increased frequency of epileptic seizures (n = 3) were less common. We observed very few specific complications, such as non-obstructive hydrocephalus (n = 3), cranial nerve lesions (n = 3), and endocrine disorders (n = 1). The total rate of radiation-induced complications was 3.08 %.Conclusion. Our findings suggest that stereotactic radiosurgery is a safe treatment for various brain diseases and is characterized by a low rate of postoperative complications. The incidence of postoperative complications in this study did not exceed that reported in Russian and foreign literature.

Unilateral occlusion of the vertebral artery as a cause of bilateral paresis of the abducens nerve - case report

Paresis/paralysis of the abducens nerve can be unilateral or bilateral. So far, several causes of unilateral paresis/paralysis of the abducens have been described: stroke, tumors, demyelinating diseases, infections and above all trauma. In this manuscript we present a 47-year-old lady with bilateral paresis of the abducens nerve. We described all the diagnostic procedures we have done in order to determine the etiology of this disorder (laboratory, radiological and other analyzes). The only pathological deviation that was discovered in our patient was unilateral occlusion of the vertebral artery. This is the first time that the unilateral occlusion of the vertebral artery has been correlated with a mentioned lesion of the sixth cranial nerves.

P-OT027. Approach and management of suspected encephalitic patients in omdurman teaching hospital

Introduction . The aim of this study was to assess the approach and management of suspected encephalitic patients in Omdurman teaching hospital. Methods . This was a cross-sectional descriptive study, conducted on 84 patients who are suspected of encephalitis in neurology department. The data was analyzed using SPSS. Results . The commonest group of age affected (21–40) representing about 66.7% with 84.5% female predominant and most of the patients from Khartoum state (58.3%). Regarding the main presenting symptoms, 100% presented with fever and headache, 36.9% with seizure and 28.6% with agitation, other symptoms like abnormal behavior, memory disturbance, photophobia, neck stiffness and nausea / vomiting ranging from (22.6–8.3%). 1.2% has a history of SLE and also 1.2% presented with bilateral 6th cranial nerve lesion. 28.6% presented with unconsciousness and disoriented. 13.1% comatose with 20.2% had personality changes and memory disturbance. Regarding upper and lower limbs examination 13.1% hemiparesis, 4.8% quadriparesis and 1.2% paraparesis. 100% did a CBC showed lymphocyte predominant about 70.2%, 100% elevation in ESR. 71 patients did a CSF analysis with 83.1% showed abnormality, increasing lymphocyte cells, others were normal. MRI/CT scan was done in 50 patients;, in 63.2% MRI showed temporal hyperintense lesion, whereas CT scan was normal in majority of cases (71%). EEG was abnormal in 3.6% of cases. Most of the cases were managed empirically with antiviral and antibiotics, 100% and 94% respectively. About 85.7% received antiepileptic. The most common complication was seizure (85.7%). 26.2% ended up with motor deficit. Fortunately, most of the cases completely recovered (65.5%). Conclusion . The diagnostic approach to patients with encephalitis must include CSF, neuroimaging (MRI) plus or minus EEG. Empirical antimicrobial therapy for patients with suspected encephalitis should include rapid administration of intravenous acyclovir at appropriate dosages if clinically suspected despite unobtainable CSF result. We must identify the exact etiology and once an etiologic agent of encephalitis is identified, antimicrobial therapy should be targeted to that infectious agent, or therapy should be discontinued if treatment directed against the etiologic agent is not available.

Outcome after cervical debranching for proximal landing zone extension in thoracic endovascular aortic repair

Abstract Objective Aim of this study was to assess perioperative and long-term outcome after cervical debranching for proximal landing zone extension in thoracic endovascular aortic repair (TEVAR). Methods Retrospective analysis of all patients undergoing left-sided carotid-subclavian bypass (CSB) and subclavian-carotid transposition (SCT) with simultaneous or staged TEVAR between 2010 and 2019. Endpoints were patency and re-intervention due to the debranching, postoperative stroke, cranial nerve injury and mortality at 30 days and during follow-up. Results Forty-eight patients (66 ± 12 years, 81 % male) had 25 (52%) CSB and 23 (48%) SCT. TEVAR was performed simultaneously in 39 (81%). Eleven (23%) patients had simultaneous emergency debranching and TEVAR. There were eight (17%) re-interventions within 30 days: four due to local hematoma, one for bypass occlusion, two for stenosis (of which one was not confirmed intraoperatively), and one after initially abandoned SCT with subsequent CSB on the next day. Thirty-day mortality was 2 %; one patient died on the first postoperative day after combined CABG surgery and multiorgan failure. Four (8%) patients suffered postoperative strokes; three occurred after simultaneous emergency procedures and none was fatal. Seven (15%) patients had postoperative ipsilateral cranial nerve lesions: two occurred after CSB and five after SCT. Two patients had recurrent laryngeal nerve palsy, two had phrenic nerve injury and three had Horner syndrome. All patients had mild symptoms and recovered mostly. During a mean follow-up of 31±29 months with a Follow-up Index of 0.77, there were no reinterventions or occlusions, and no graft infections. Primary patency was 94%, primary assisted patency 96%, and secondary patency 100%. 9 patients died during follow-up after a mean of 30±29 months (range 0-82) all of them with patent cervical debranching. Conclusion Cervical debranching for proximal landing zone extension in TEVAR is a safe procedure with an acceptable rate of early re-interventions. There is a higher risk for postoperative stroke during simultaneous emergency debranching and TEVAR. Cranial nerve injuries and hematomas remain relevant periprocedural complications. During follow-up, excellent patency can be expected.

MR Imaging Features of COVID-19-related Cranial Nerves Lesions (4748)

MR Imaging Features of COVID-19-related Cranial Nerves Lesions (4748)

NEUROLOGICAL COMPLICATIONS OF COVID-19

After the first cases of the new disease COVID-19 (caused by the SARS-CoV-2 coronavirus) were registered in Wuhan, China in December 2019, its spread rapidly became a pandemic and within a few months it covered almost 200 countries [6]. The global COVID-19 pandemic has infected more than 79 million people around the world and claimed more than 1.7 million lives as of December 24, 2020 (according to the Center for Systems Science and Engineering at Johns Hopkins University). Thus, the mortality rate is 2.2%, which significantly exceeds the mortality rate for influenza. It is believed that the peak of the COVID-19 pandemic will continue in the next few months, after which the pandemic will decline. Although the predominant manifestations of COVID-19 are respiratory symptoms, more and more attention is paid to neurological complications. Some neurological complications are potentially life-threatening and can lead to death. The most common neurological complications of acute phase of COVID-19 are impairments of olfaction and taste, which are observed in 33-88% of patients [3]. These symptoms are important for differential diagnosis with influenza and ARVI viruses. Headaches, dizziness, fatigue, and myalgia according to different studies can be observed in 6.5-16.8% of patients. Other neurological complications of COVID-19 often develop in severe and very severe disease (although there are exceptions). Apparently, such neurological complications as ischemic stroke, transient ischemic attack, encephalopathy, delirium can be observed in approximately 0.5-3% of patients. Even less common are hemorrhagic stroke, venous sinus thrombosis, meningitis, encephalitis, encephalomyelitis, cerebral vasculitis, III, V, VI, VII, VIII, IX cranial nerves lesions, Guillain-Barre syndrome, Miller-Fisher syndrome, polyneuropathy, acute dysautonomia, myopathy, myoclonus, epileptic seizures and status epilepticus [2, 4-8]. Awareness of the neurological complications of COVID-19 can influence treatment strategies and simultaneously improve the prognosis for critically ill patients [5]. Keywords: COVID-19, SARS-CoV-2, coronavirus, neurological complications

Severe Behçet's disease equally affects both genders in Egyptian patients: A multicentre retrospective follow-up study.

Behçet's disease is a relapsing multisystemic disease. Its highest prevalence is seen along the Silk Road. While several studies reported gender disparities, others didn't. Scarce data are available about the Arabs and the gender differences detected in some ethnicities could not be applied to others. Our study aimed to detect gender differences among a cohort of adult Egyptian patients with Behçet's disease. Medical files of 255 adult patients diagnosed with Behçet's disease at the Rheumatology and Rehabilitation Department of Kasr Al-Aini Hospital, Cairo University and the Internal Medicine Department of Tanta University, between 2002 and 2018, were retrospectively reviewed. The demographic features, the cumulative clinical features, the use, if any, of an intravenous pulse of methylprednisolone and immunosuppressive/biological drugs, and the frequency of the cumulative damage to the different organ systems were described. The disease severity score was calculated as well. The study revealed a prominent male predominance; the male to female ratio was 6.7:1. Acne/pseudofolliculitis was more common in males (28.6% vs 13.2%, p=0.046); the same was observed regarding any vascular involvement and peripheral venous disease (36.3% vs 18.4%, p=0.03 and 30.4% vs 13.2%, p=0.03, respectively). On the other hand, encephalitis and cranial nerve lesions were more prevalent in females (15.8% vs 6%, p=0.03 and 10.5% vs 3.2%, p=0.04, respectively). Severe Behçet's disease equally affects Egyptian males and females. BD should not be considered a benign disease in Egyptian females. The same quality of medical care should be equally offered to both genders.

Maxillofacial manifestations in children and adolescents with neurofibromatosis 1

The aim of the study was to summarize literature data on oral and maxillofacial manifestations of neurofibromatosis I (NFI) and to analyze clinical case in with dentist had the leading role in proper diagnosis of the disease. Literature review showed main oral alterations in NFI to be: neurofibroma formation seen in 8-14% of children and adolescents, dysplastic «orthodontic» phenotype with shortened mandible, maxilla and sphenoid bones; radiologic signs including alveolar nerve canal and mental foramen widening in almost one third of patients; lesions of cranial nerves (mainly trigeminal, facial and glossopharyngeal), with non-specific paralysis clinic. These symptoms, however, develop gradually throughout the life and may be evident only in late adolescents. The most pathagnomic sigh is café-au-lait spots as they present in 95% of children at birth. The described clinical case demonstrates the difficulties in diagnostic of NFI in children in the absence of mutilating plexiform neurofibromas. The disease provoked significant functional disorders in maxillofacial area which resulted not only in lower quality of life but also mimicked iatrogenic complications of routine dental treatment.

Интратемпоральные поражения лицевого нерва

The article analyzes the literature data on intratemporal lesions of the facial nerve of various etiologies. According to the WHO, facial nerve lesions ranks second in frequency among peripheral nervous system pathologies and first among cranial nerve lesions (incidence varies from 13 to 24 patients per 100,000 population), equally among men and women. Any damage to the temporal bone affecting the canal of the facial nerve can cause facial paralysis. Common causes of damage to the facial nerve are: injuries resulting from an external traumatic agent (traffic accidents, catastrophes, domestic injuries); iatrogenic resulting from medical interventions; infections (Bell palsy); tumor lesions. Despite the rather large number of facial nerve repair methods proposed in the literature for paresis and paralysis, today there is no optimal algorithm for surgical treatment for large defects in the middle ear. Given that the number of such patients does not decrease from year to year, the search for a solution to this issue is currently relevant.

Ramsay hunt syndrome: case report

Ramsay-Hunt Syndrome is an uncommon disease caused by the reactivation of latent Varicella zoster virus in the geniculate ganglion. It is characterized with a herpes zoster oticus associated with an acute peripheral facial nerve paralysis, and possible other cranial nerve lesions. We describe the case of a 27-year-old man who presented with severe ear pain for two days, with vesicular eruptions on the external ear and ipsilateral peripheric facial paralysis. He was treated with the association of intravenous steroids and acyclovir for 7 days. The evolution showed gratifying results. The one-year follow-up showed no relapse of the syndrome. The purpose of this report is to highlight the importance of a thorough clinical examination and early treatment of the Ramsay-Hunt syndrome.