Disturbance Of Consciousness Research Articles

Congenital disorders of glycosylation type 1A associated with cerebral hemorrhagic infarction: illustrative case.

Cases of congenital disorders of glycosylation (CDGs) are rare, and the occurrence of hemorrhagic infarction is also rare. The etiology is unclear. A 3-year-old Asian boy with CDG type 1A was hospitalized with pneumonia. Consciousness disturbance and hemiplegia appeared after high fever and were associated with disseminated intravascular coagulation. Magnetic resonance (MR) images showed subcortical hemorrhagic infarction due to anterior superior sagittal sinus occlusion. Follow-up computed tomography revealed the enlargement of a right frontal lobe hematoma with a midline shift. The authors performed emergency craniotomy for hematoma evacuation. The postoperative course was favorable, with improvements in consciousness and hemiplegia. Patients with CDG type 1A have various types of coagulation disorders and sometimes develop several thrombotic and bleeding events; however, there has only been one reported case of CDG with concomitant intracranial hemorrhagic infarction. The authors detected sinus thrombosis on MR images for the first time in a patient with CDG. In patients with CDGs, abnormalities in the coagulation-fibrinolysis system can cause various neurological symptoms, such as intracranial bleeding, cerebral ischemia, and stroke-like episodes. In Asian infants with suspected cerebral venous sinus thrombosis, it is advisable to conduct examinations that include imaging modalities, such as MR venography and/or contrast-enhanced T1-weighted imaging, to confirm complications. https://thejns.org/doi/10.3171/CASE23729.

Assessment of acute toxicity cases with disturbed consciousness in Tanta University poison treating center

Background Patients with disturbed consciousness due to poisoning are considered neurologic emergencies that represent a challenge for clinicians. Aim The aim of this study was to assess acute poisoned cases with disturbed consciousness regarding sociodemographic data, toxicological data, consciousness level, and outcome. Patients and methods This cohort study was conducted on 241 cases of acute toxicity with disturbed consciousness admitted to Tanta University Poison Treating Center (TUPTC) from January 2017 to the end of December 2018. Results Acute poisoned cases with disturbed consciousness represented 9.5% of total admitted cases. Most of the cases were in the age group less than 30 years with male predominance. Poisoning was mainly suicidal. Psychotropic drugs were the most common finding. Most of the cases were discharged after improvement and did not need intensive care unit (ICU) admission or mechanical ventilation. A significant association was found between consciousness level, mortality, need for ICU admission and mechanical ventilation. Survivors and nonsurvivors showed a significant difference regarding consciousness level. A significantly higher percentage of the nonsurvivors showed a lower GCS (≤8) and a high need for ICU admission and mechanical ventilation. In addition, a significant negative correlation between consciousness level and the time passed till complete regaining of consciousness, normalization of vital signs and hospital stay was found. Conclusion The mortality rate among cases of the study was 10.8%. The non-survivors showed a marked reduction in consciousness level and a high need for ICU admission and mechanical ventilation. Pesticides were the most frequently consumed poison among them.

Anti-Tr/DNER Antibody-associated Paraneoplastic Neurological Syndrome Presenting Limbic Encephalitis with Anaplastic Large Cell Lymphoma: A Case Report.

An 82-year-old man presented with acute progressive disturbance of consciousness. We suspected autoimmune limbic encephalitis because of abnormal magnetic resonance imaging findings in the bilateral temporal lobes and cerebrospinal fluid pleocytosis. The patient tested positive for anti-Tr/Delta/Notch-like epidermal growth factor-related receptor (DNER) antibodies, and a tissue biopsy revealed complications of anaplastic large cell lymphoma. Typically, anti-Tr/DNER antibody-associated paraneoplastic neurological syndrome presents with cerebellar ataxia and is complicated by Hodgkin lymphoma (HL). However, there are rare cases that present only with LE and are complicated by tumors other than HL; therefore, aggressive antibody measurement and search for tumors are important.

Non-convulsive Status Epilepticus as a Potentially Under-recognised Cause of Consciousness Disturbance Following Mechanical Thrombectomy: A Case Report

Non-convulsive Status Epilepticus as a Potentially Under-recognised Cause of Consciousness Disturbance Following Mechanical Thrombectomy: A Case Report

COX Regression Analysis and Mortality Risk Prediction Model of 85 Adult Patients with Secondary Hemophagocytic Lymphohistiocytosis

Aims/Background Secondary hemophagocytic lymphohistiocytosis (sHLH) is a rare, rapidly progressive and highly lethal disease. This retrospective cohort study aims to analyze the factors influencing the mortality risk in adult patients with sHLH, which are instrumental to improving our understanding of the high mortality risks associated with sHLH. Methods This study included 85 patients diagnosed with sHLH who were admitted and treated in the Department of Emergency, Peking University People’s Hospital between April 2015 and July 2023. Participants were classified based on prognosis into two groups: the death group and the survival group. We collected demographic data, routine blood tests, comprehensive biochemical profiles, coagulation analyses, serum ferritin levels, natural killer (NK) cell counts, soluble interleukin-2 receptor (sCD25) levels, and potential etiological factors upon admission. The mortality risk factors influencing the prognosis of sHLH were analyzed with univariate and multivariate COX regression. Additionally, a mortality risk prediction model was established, and its accuracy was validated and optimized using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curve, calibration curves and clinical decision curve analysis (DCA). Results A total of 85 patients were included in this study, the male-to-female ratio is 1:1.4. The median age at diagnosis of sHLH was 56.00 (33.00–69.00) years. Clinical symptoms were atypical, with fever being the most prevalent symptom (81 cases, 95.3%), followed by disturbance of consciousness (10 cases, 11.8%). Univariate COX analysis and Multivariate COX regression analysis revealed that age (hazard ratio (HR) [95% confidence interval (CI)], 1.098 [1.025–1.177], p = 0.008), Alanine transaminase (ALT) (HR [95% CI], 1.016 [1.001–1.031], p = 0.034), Aspartate transaminase (AST) (HR [95% CI], 1.005 [1.001–1.008], p = 0.004), and Troponin I (TNI) levels (HR [95% CI], 1.196 [1.011–1.414], p = 0.037) were independent risk factors affecting prognosis. Specifically, sHLH patients aged ≥63.5 years (sensitivity 82.8%, specificity 85.7%), with AST levels ≥111 U/L (sensitivity 82.8%, specificity 82.1%), ALT ≥41 U/L (sensitivity 58.6%, specificity 64.3%) and TNI levels ≥2.15 ng/mL (sensitivity 62.1%, specificity 100%), faced a higher risk of mortality. We established a mortality risk prediction model for sHLH patients, which yielded a C-index of 0.848 (0.773–0.901), indicating strong agreement between predicted and observed outcomes. The ROC curves of the 28-day, 60-day, and 90-day mortality risk prediction model for sHLH patients were drawn, and the results showed that the 28-day, 60-day, and 90-day area under the curve (AUC) were 0.900 (0.829–0.971), 0.940 (0.882–0.998), and 0.930 (0.874–0.986), respectively. The predictive effect of the prediction model is satisfactory. Additionally, the clinical decision curve analysis for 28, 60 and 90 days in sHLH patients indicated that the net benefit of the nomogram model was higher than that line of extremes models (treat all and treat none). Conclusion Patients with sHLH have frequently atypical clinical presentation, with early death risk and notably elevated mortality rate. Independent risk factors influencing mortality risk in sHLH patients include age ≥63.5 years, AST ≥111 U/L, ALT ≥41 U/L, and TNI ≥2.15 ng/mL. With high accuracy and efficacy, the risk prediction model constructed can facilitate timely identification of sHLH patients at elevated risk of mortality, which is critical for optimizing clinical interventions.

A Rare Case of Recurrent Disturbed Consciousness with Alternating Hemiplegia Associated with 46,XX,der(18)t(12;18)(p11.2;p11.2)

AbstractTrisomy of the short arm of chromosome 12 (trisomy 12p) is a rare chromosomal abnormality causing dysmorphic features, congenital anomalies, intellectual disabilities, developmental delays, and seizures. Detailed information regarding the types of seizures is scarce owing to the low incidence of seizures. In contrast, 18p deletions and seizures are rare. Previous reports on trisomy 12p or monosomy 18p are limited, and little is known about epilepsy in children with trisomy 12p or monosomy 18p. Here, we report a case of 46,XX,der(18)t(12;18)(p11.2;p11.2) with repeatedly disturbed consciousness accompanied by alternating hemiplegia, corresponding to the electroencephalogram findings. G-banding of the parents showed balanced translocation of the mother. The last hospitalization occurred when the patient was 12 years old and presented with disturbed consciousness and left-sided hemiplegia. Electroencephalogram showed continuous 1 to 2 Hz slow waves in the right hemisphere and a theta burst in the left hemisphere. Based on the genes on chromosomes 12 and 18, the symptoms seemed to be related to partial trisomy 12p. Our case suggests the possibility of a novel seizure phenotype associated with trisomy 12p.

Posterior reversible encephalopathy syndrome after COVID-19 in a patient with chronic renal failure

A 61-year-old man with chronic renal failure had an embolic stroke of undetermined source that was treated with warfarin. Five weeks later, the patient contracted coronavirus disease (COVID-19). Six days after the onset of COVID-19, high blood pressure (>200 ‍mmHg) and consciousness disturbance were reported. CT demonstrated symmetrical hypodensity areas in the bilateral cerebellar hemispheres. MRI revealed hyperintensity lesions in the bilateral cerebellar hemispheres and pons on the T2-weighted and fluid-attenuated inversion recovery images. Moreover, cerebellar lesions appeared as hyperintensity areas on apparent diffusion coefficient mapping. Based on these findings, a diagnosis of posterior reversible encephalopathy syndrome (PRES) was made. The patient was treated with antihypertensive drugs, and the consciousness level improved gradually. MRI after one month showed that the lesions had disappeared. PRES should be considered if the brain CT of patients with COVID-19 shows a low-density lesion, especially in patients with risk factors for PRES such as chronic renal failure or hypertension.

Morbilidad de la infección por el SARS-CoV-2 en adultos jóvenes en la altura en un centro de salud militar

Introduction: In the face of this debutant disease generated by SARS-CoV-2 the clinical and epidemiological characteristics are new in each region, city or hospital environment in which patients with this infection occur. Objective: Determine the morbidity of SARS-CoV-2 infection in young adults living at high altitudes. Method: Descriptive, quantitative, observational, retrospective, cross-sectional study, carried out at 3,259 meters above sea level, identified the clinical-epidemiological characteristics of patients with a positive result for SARS-CoV-2 with immunochromatography, a sample of 97 patients hospitalized at the Military Health Center No. 31 Chilca-Huancayo of the 31st Infantry Brigade in the period from May to June 2020. Results: A total of 97 male patients (100%) were studied, with a mean age of 21,5 ± 3. The employment status was: active (49,5%), reservist (50,5%). Grade: soldier (25.8%), corporal (23,7%), sergeant 1st. (14,4%), 2nd Sergeant (35,1%), non-commissioned officer (1,0%). The rapidtest was positive (100.0%), IgM–IgG immunoglobulin positive (96.9%), IgG positive (3,1%). Respiratory rate: normal (96,9%), tachypnea (3,1%). Heart rate: normal (63,9%), tachycardia (32,0%), bradycardia (4,1%). Temperature: normal (89,7%), low-grade fever (10,3%). Oxygensaturation: mild hypoxia (56,7%), normal (40,2%), moderate hypoxia (3,1%). Conclusions: The epidemiological profile of the study are young adults, reservists predominate, Sergeant 2nd.; symptomatic with mild hypoxia and diarrhea; oligosymptomatic in respiratory rate, heart rate, body temperature, sore throat, general discomfort, nausea, vomiting, headache, skin rash; and asymptomatic in cough, nasal congestion, smell and consciousness disturbances.

Analysis of the clinical features and prognosis of neuro-Behcet's syndrome in 5 children

Objective: To investigate the clinical features and prognosis of neuro-Behçet's syndrome (NBS) in children. Method: The clinical, brain magnetic resonance imaging and laboratory data of 5 children with NBS diagnosed in the Department of Pediatrics, General Hospital of Ningxia Medical University and Department of Rheumatology and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics from April 2014 to April 2024 were analyzed retrospectively. The follow-up method was retrospective outpatient or inpatient visit to evaluate the treatment effect of NBS. Result: Among the 5 NBS cases, 2 were male and 3 were female. The age of admission ranged from 8 to 17 years, the time from onset to diagnosis was 2 days to 4 years. Two patients had dizziness, headache and convulsions during the treatment of NBS, 1 patient had disturbance of consciousness, 1 patient gradually developed aphasia, limb movement disorder, dysphagia and muscle weakness after 4 years of Behcet's syndrome, and 1 patient had no clinical symptoms. C-reactive protein and erythrocyte sedimentation rate were increased in 4 cases, and cerebrospinal fluid white blood cells and immunoglobulin G were increased in 1 case. Brain magnetic resonance imaging of 4 children showed multiple lesions, including bilateral frontal lobe, occipital lobe, parietal lobe, periventricular and corpus callosum lesions. Brain magnetic resonance imaging showed multiple demyelinating diseases in 1 case, and cervical and thoracic magnetic resonance imaging showed slender cervical and thoracic spinal cord. All patients were treated with corticosteroids combined with immunosuppressants or biological agents. The children were followed up for 6 months to 4 years, and 4 cases had good treatment results, and 1 case finally gave up treatment. Conclusions: The clinical manifestations of NBS are not specific, and brain magnetic resonance imaging shows that the lesion location and morphology are not specific. NBS children treated with corticosteroids combined with immunosuppressive agents or biological agents have a good prognosis.

Incidence and associated factors of pre-hospital care-seeking delay in people with acute ischemic stroke: a systematic review and meta-analysis.

Despite decades of educational efforts, patients with acute ischemic stroke (AIS) remain delayed in seeking medical care, which becomes the greatest obstacle to the successful management of the condition. To systematically explore the incidence and influencing factors of pre-hospital care-seeking delay in acute ischemic stroke patients. We systematically searched the PubMed, Embase, Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature from database inception to September 30, 2023. Meta-analysis was conducted using the Stata 15.0 software package. The pooled incidence was calculated using a random-effects model. The quality of studies reporting incidence data was assessed using Joanna Briggs Institute's Critical Appraisal Checklist and Newcastle-Ottawa Scale. Subgroup analyses were performed according to study location, country income, recruitment date, and age. Finally, 30 related articles were included, involving a total of 287,102 people. The estimated incidence of pre-hospital care-seeking delay was 68%,and there were differences in this incidence in different countries (P= 0.035). Meta-analysis results showed that the delay rate was highest in low-income countries (85%) and lowest in high-income countries (62%). Patients who live farther from hospitals, have a lower level of education, diabetes, hyperlipidemia, or a history of stroke are more likely to experience delays (all P <0.05). Conversely, those who can recognize stroke symptom , perceive the severity of early symptom, understand thrombolysis treatment, atrial fibrillation, consciousness disturbance, visual disturbance, and symptom score at admission, Emergency Medical Services use, and immediate help-seeking have a lower risk of delay (all P < 0.05). Pre-hospital care-seeking delays are common among patients with AIS, especially in low-income countries. To reduce delays, it is crucial to increase public awareness of stroke symptoms, improve education levels, and optimize healthcare accessibility.

Disturbances in higher order consciousness encountered in neuropsychological rehabilitation and assessment.

The purpose of this invited paper was to summarize my clinical research on disturbances of higher order consciousness (i.e., primarily on self-awareness but including anosognosia and impaired awareness of another person's cognitive/emotional state) that contributed to my receiving the Distinguished Career Award from the International Neuropsychology Society. I reviewed my early clinical encounters with disturbances in higher order consciousness and then a series of studies performed with various colleagues over the last 45 years to better understand the nature of these disturbances. The findings obtained are also discussed within the context of other researchers' observations during this time frame. Disturbances in higher order consciousness include classic anosognosia, impaired self-awareness, denial of disability, and denial of ability. Proposed diagnostic features of each of these disturbances are outlined and a model for understanding their complex relationships suggested. Different treatment/rehabilitation approaches for these disturbances are also summarized. Disturbances in higher order consciousness are often revealed when exploring with the person their subjective experiences of their neurological and neuropsychological functioning following different brain disorders. These subjective experiences have diagnostic value and lead to different rehabilitation approaches. The neuropsychological investigation of disturbances in higher order consciousness should include integrating knowledge from the neurosciences with nonbiological understandings of how cultural and personality features of the person may also influences their subjective experiences associated with a known or suspected brain disorder.

Effect of different durations of preoperative computerised cognitive training on postoperative delirium in older patients undergoing cardiac surgery: a study protocol for a prospective, randomised controlled trial

IntroductionPostoperative delirium (POD) is a common neurological complication after surgery among older patients, characterised by acute disturbances in consciousness, attention and cognition, usually occurring within 24–72 hours after surgery. POD...

Clazosentan-induced reversible focal brain edema in basal ganglia following aneurysmal subarachnoid hemorrhage treatment: illustrative case.

Clazosentan, a selective endothelin A receptor antagonist, effectively prevents cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Although various adverse effects have been reported, there have been no specific case reports of clazosentan-associated focal brain edema. This report highlights a rare complication associated with clazosentan treatment. A female in her 70s with a subarachnoid hemorrhage underwent surgical clipping of a ruptured middle cerebral artery aneurysm and received clazosentan postoperatively. Six days after surgery, magnetic resonance imaging revealed high-intensity signals in the left basal ganglia on fluid-attenuated inversion recovery and apparent diffusion coefficient sequences without changes on diffusion-weighted imaging. The patient's right-sided hemiparesis and disturbance of consciousness gradually progressed. On day 9, clazosentan was discontinued because of suspected adverse effects. Within approximately 2 weeks of discontinuation, both imaging findings and neurological symptoms improved. The temporal relationship between clazosentan administration, symptom onset, and improvement after discontinuation strongly suggested clazosentan-induced vasogenic edema. Clazosentan can cause reversible localized vasogenic brain edema in the basal ganglia following subarachnoid hemorrhage treatment. This rare but significant complication underscores the importance of careful neurological monitoring and timely imaging in patients receiving clazosentan. Further research is required to understand the risk factors and mechanisms underlying this phenomenon. https://thejns.org/doi/10.3171/CASE24567.

Caloric requirement targets for nutritional support in adult autoimmune encephalitis: a retrospective cohort study.

Autoimmune encephalitis (AE) is a severe neurological disease often accompanied by consciousness disturbances, severe swallowing difficulties, and gastrointestinal dysfunction, increasing the risk of malnutrition. However, the optimal caloric intake target during the acute phase of AE remains unclear. This study aims to evaluate the impact of caloric intake on short-term clinical outcomes in AE patients, specifically focusing on the improvement in Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores, to provide recommendations for nutritional support during the acute phase. A retrospective study analyzed clinical data from 128 adult AE patients requiring nutritional support, admitted to West China Hospital, Sichuan University, from January 2020 to January 2024. Patients were categorized into low-calorie intake (below 70% of requirements), standard-calorie intake (70-100% of requirements), and high-calorie intake (above 100% of requirements) groups. Multivariate linear and logistic regression models were used to quantify the associations. Higher caloric intake was significantly associated with improved CASE scores (β = 8.58, SE = 3.75, 95% CI = 1.14 to 16.03, p = 0.02). Low caloric intake negatively impacted the improvement of CASE scores (p = 0.049), particularly in seizures and speech problems. The low-calorie intake group had significantly longer hospital stays and nutrition therapy durations (45.79 ± 30.98 days, p < 0.01; 40.39 ± 31.92 days, p = 0.02). Adequate caloric intake has a significant positive impact on the short-term clinical outcomes of AE patients, suggesting that meeting or exceeding caloric requirements may promote neurological recovery in AE patients. Future prospective studies are needed to validate these findings and further optimize nutritional support strategies.

Research Progress in the Construction of Delirium Risk Warning Model for ICU Patients Based on Decision Tree: A Review of the Literature

Intensive Care Unit (ICU) delirium is a cerebral syndrome characterized by acute disturbance of consciousness, with an incidence of 38%-87%. The occurrence of delirium can lead to prolonged hospital stay, accidental extubation rate, mortality and other adverse consequences. Therefore, early identification of delirium and active correction of reversible causes appear to be particularly important. At present, the risk prediction models for delirium in ICU constructed at home and abroad mainly use logistic regression to build delirium risk prediction models for patients admitted to ICU≥24h. However, studies have found that as many as 25% of critically ill patients will develop delirium within 24h of admission to ICU. Therefore, it is particularly important to construct a delirium early warning model for patients entering ICU24h. Logistic regression model has low processing efficiency for non-linear and interactive data, and can not intuitively show the importance of each variable in the predicted result. As a non-parametric statistical method, decision tree can overcome the disadvantages of Logistic regression model and build a better prediction model. Therefore, this study used 24h after admission to ICU as the segmentation point to build a decision tree model for predicting early and late delirium in ICU patients, forming a corresponding risk level system, and compared it with similar delirium models to verify the predictive value of the decision tree model for early and late delirium in ICU patients, providing a basis for the formulation of further intervention and nursing plans. Thereby reducing the incidence of ICU delirium.

Construction and external validation of a non-invasive pre-hospital screening model for stroke patients: a study based on artificial intelligence DeepFM algorithm

To construct a non-invasive pre-hospital screening model and early based on artificial intelligence algorithms to provide the severity of stroke in patients, provide screening, guidance and early warning for stroke patients and their families, and provide data support for clinical decision-making. A retrospective study was conducted. The clinical information of stroke patients (n = 53 793) were extracted from the Yidu cloud big data server system of the Second Affiliated Hospital of Dalian Medical University from January 1, 2001 to July 31, 2023. Combined with the results of single factor screening and the opinions of experts with senior professional titles in neurology, the input variable was determined, and the output variable was the National Institutes of Health Stroke Scale (NIHSS) representing the severity of the disease at admission. Python 3.7 was used to build DeepFM algorithm model, and five data mining models including Logistic regression, CART decision tree, C5.0 decision tree, Bayesian network and deep neural network (DNN) were built at the same time. The original data were randomly divided into 80% training set and 20% test set, which were used to train and test the models, adjust the parameters of each model, respectively calculate the accuracy, sensitivity and F-index of the six models, carry out the comprehensive comparison and evaluation of the model. The receiver operator characteristic curve (ROC curve) and calibration curve were drawn, compared the prediction performance of DeepFM model and the other five algorithms. In addition, the data of stroke patients (n = 1 028) were extracted from Dalian Central Hospital for external verification of the model. A total of 14 015 stroke patients with complete information were selected, including 11 212 in the training set and 2 803 in the testing set. After univariate screening, 14 indicators were included to construct the model, including gender, age, recurrence, physical impairment, facial problems, speech disorders, head reactions, disturbance of consciousness, visual disorders, abnormal cough and swallowing, high risk factor, family history, smoking history and drinking history. DeepFM model adopted the two-order crossover feature. The number of hidden layers in DNN layer was 3. Dropout was used to discard the neurons in the neural network. Rule was used as the activation function. Each layer used Dense full connection. The objective function was random gradient descent. The number of iterations was 15. There were 133 922 training parameters in total. Comparing the predictive value of the six models showed that the accuracy of DeepFM model was 0.951, the sensitivity was 0.992, the specificity was 0.814, the F-index was 0.950, and the area under the curve (AUC) was 0.916. The accuracy of the other five data mining models was between 0.771-0.780, the sensitivity was between 0.978-0.987, the F-index was between 0.690-0.707, and the AUC was between 0.568-0.639. The calibration curve of the DeepFM model was more aligned with the ideal curve than the other five data mining models. Suggesting that the prediction performance of DeepFM model was the best. External validation was conducted on the DeepFM model, and its accuracy was 0.891, indicating good generalization performance of the model. The pre-hospital non-invasive screening prediction model based on DeepFM can accurately predict the severity grading of stroke patients, and has potential application value in rapid screening and early clinical decision-making of stroke.

Survival in hostile environments: The fight to understand and protect against acceleration-induced visual disturbance and loss of consciousness in pilots of powered, heavier-than-air aircraft.

Survival in hostile environments: The fight to understand and protect against acceleration-induced visual disturbance and loss of consciousness in pilots of powered, heavier-than-air aircraft.

ApoE: The Non-Protagonist Actor in Neurological Diseases.

Apolipoprotein E (APOE = gene, ApoE = protein) is a glycoprotein involved in the biological process of lipid transportation and metabolism, contributing to lipid homeostasis. APOE has been extensively studied for its correlation with neurodegenerative diseases, in particular Alzheimer's disease (AD), where the possession of the epsilon 4 (E4) allele is established as a risk factor for developing AD in non-familiar sporadic forms. Recently, evidence suggests a broad involvement of E4 also in other neurological conditions, where it has been shown to be a predictive marker for worse clinical outcomes in Parkinson's disease (PD), brain trauma, and disturbances of consciousness. The mechanisms underlying these associations are complex and involve amyloid-β (Aβ) peptide accumulation and neuroinflammation, although many others have yet to be identified. The aim of this review is to overview the current knowledge on ApoE as a non-protagonist actor in processes underlying neurodegenerative diseases and its clinical significance in AD, PD, acquired brain trauma, and Disorders of Consciousness (DoC). Ethical implications of genetic testing for APOE variants and information disclosure will also be briefly discussed.

Successful Management of Progressive Multifocal Leukoencephalopathy in an HIV/AIDS Patient: A Therapeutic Case Report

Background: Progressive multifocal leukoencephalopathy (PML), a rare and devastating opportunistic infection caused by JC virus reactivation, typically carries a poor prognosis in immunocompromised individuals, particularly those with HIV. Aim: To report a remarkable case of full recovery in an HIV-positive patient with PML and highlight the significance of prompt recognition, diagnosis, and combination antiretroviral therapy (cART). Case Summary: A 34-year-old HIV-positive male presented with progressive disturbances of consciousness and movement. MRI revealed multifocal white matter lesions, and JC virus DNA was detected in cerebrospinal fluid. Despite initial deterioration, the patient achieved full recovery with cART. Conclusion: This exceptional outcome emphasizes the critical importance of vigilant monitoring, prompt diagnosis, and effective management strategies for PML in HIV patients, highlighting the potential for full recovery with optimal cART.

Clinical data and MRI features-based nomogram for differentiation of central nervous system infection and central nervous system involvement in hematological malignancy.

Central nervous system leukemia (CNSL) and central nervous system infection (CNSI) are the most important complications in patients with acute leukemia (AL). However, the differential diagnosis could represent a major challenge since the two disorders are all heterogeneous entities with overlapping clinical characteristics and radiological appearances. In this paper, we conduct a retrospective study to develop a model based on clinical data and magnetic resonance imaging (MRI) to distinguish CNSL from CNSI. A total of 108 patients with AL who underwent cranial MRI between January 2020 and December 2023 in our hospital were included. Univariate and multivariate logistic regression analyses were used to determine the independent predictors. A nomogram was developed based on the predictors, and the performance of the nomogram was evaluated by the area under the receiver operating characteristic (ROC) curve. The validation cohort was used to test the predictive model. Hyperleukocytosis at initial diagnosis, marrow state, fever, conscious disturbance, coinfection in other sites and MRI (parenchyma type) were identified as independent factors. A nomogram was constructed and the discrimination was presented as AUC = 0.947 (95% CI 0.9105-0.984). Calibration of the nomogram showed that the predicted probability matched the actual probability well.