Neurological Signs Research Articles

Postanesthetic neurologic signs progressing to seizures in 2 dogs and 1 cat with unoperated congenital portosystemic shunts after non-shunt-related surgery.

To describe the development of neurologic signs progressing to seizures in 2 dogs and 1 cat with unoperated single congenital portosystemic shunts (CPSSs) after general anesthesia for non-shunt-related surgery and no intraoperative shunt manipulation. 2 dogs (dog 1 [a 5-year-old 7.1-kg castrated male Bichon Frise] and dog 2 [a 10-year-old 7.3-kg castrated male Bichon Frise]) and 1 cat (cat 1 [a 2-year-old 3.8-kg castrated male Ragdoll]). Medical records from the University College Dublin Veterinary Hospital and Royal Veterinary College Queen Mother Animal Hospital were searched for dogs and cats with unoperated CPSSs that developed neurologic signs progressing to seizures after general anesthesia for non-shunt-related surgery between January 1, 2015, and June 31, 2024. 3 animals were identified. Dogs 1 and 2 both underwent cholecystectomy, whereas cat 1 underwent jejunal enterectomy. None had known preoperative seizures, although both dogs had experienced prolonged anesthetic recovery after previous surgery and the cat had a 3-day history of ataxia, walking into walls, and generalized weakness. All 3 animals developed severe neurologic signs including seizures within 48 hours postoperatively. Both dogs were euthanized before hospital discharge: dog 1 for suspected aspiration pneumonia coupled with severe neurologic signs and dog 2 for refractory neurologic signs. Cat 1 survived to hospital discharge and underwent 2 subsequent CPSS attenuation surgeries. Postanesthetic neurologic signs can occur in animals with CPSSs without intraoperative shunt manipulation. This possible complication should be discussed with owners of animals with unoperated CPSSs that require general anesthesia for non-shunt-related surgery.

Shiga toxin-producing Escherichia coli infection-related acute encephalopathy.

Shiga toxin-producing Escherichia coli (STEC) poses a significant global health threat, contributing to gastrointestinal involvement and, rarely, systemic illnesses. In particular, the toxin's pathogenic mechanisms primarily target the kidneys and the central nervous system, leading to severe consequences. We present a rare case of STEC-related acute encephalopathy in a 34-year-old female without concurrent kidney involvement. The patient presented with hemorrhagic diarrhea and subsequent neurological symptoms, including seizures, cortical blindness, and left hemiparesis. Diagnostic evaluations, including blood tests, imaging studies, and cerebrospinal fluid analysis, suggested STEC infection-related encephalopathy. Central nervous system involvement in STEC infections, although more commonly observed in children, can manifest in various neurological symptoms, including altered mental status, seizures, and focal neurological deficits. Neuroimaging and electrophysiological findings often demonstrate non-specific abnormalities, reflecting diffuse brain dysfunction. The pathogenesis of STEC-related encephalopathy involves direct neuronal cytotoxicity mediated by Shiga toxin, leading to acute cerebrovascular events and neuroinflammation. Therapeutic strategies primarily focus on anti-inflammatory interventions, such as high-dose steroid therapy, with variable prognosis influenced by age, sex, disease severity, and response to treatment. This case underscores the importance of recognizing STEC infection-related encephalopathy as a rare but potentially severe complication, highlighting the need for prompt diagnosis and appropriate management to optimize patient outcomes.

Acute outbreak of polioencephalomalacia in adult beef cows on pasture associated with feeding broiler litter.

Polioencephalomalacia (PEM) is a neurologic disorder of ruminants that can affect cattle as a result of high levels of sulfur in the diet. Sulfur can be ingested by an animal through feed or water, and the mineral status of the animal can affect how much sulfur is ultimately absorbed. Broiler (poultry) litter is sometimes used in cattle diets as an economical protein source, although it runs the risk of supplying too much sulfur to the bovine diet. Here we report a case in which 15 cows had neurologic signs before death. Initial testing ruled out other causes of acute death, and histologic findings confirmed a diagnosis of PEM. The sulfur concentration was ~0.70% of the total mixed ration (TMR), which is above the maximum tolerable dietary concentration of sulfur. The broiler litter contributed nearly all of the sulfur to this ration and was the cause of the PEM experienced in this herd. When feeding by- and co-products as part of a TMR, it is important for producers to analyze the feed to mitigate risk and ensure good health.

Tremor tales: A cohort study of general and neurological signs in pigs with atypical porcine pestivirus-induced congenital tremor.

Congenital tremor (CT) caused by atypical porcine pestivirus (APPV) is a widespread disease in the swine industry. It is characterized by tremors in newborn piglets, but tremor description and association to other clinical signs are not well documented. This study's objectives were to characterize general and neurological clinical signs of APPV-induced CT and describe the progression and associations between the different signs. A cohort study was conducted including 37 pigs from litters with APPV-confirmed CT and 27 control pigs from healthy litters. All pigs were examined five times from birth to slaughter, including general and neurological parameters, and detailed tremor characterization. All levels of tremor, from grave severity to no tremor, were seen within litters. Tremor persisted throughout the suckling period for all, to weaner age for 60 % and to slaughter age for 40 %, unrelated to the initial degree of tremor (P = 0.9). Tremors were consistent with intention tremor and typically went from affecting the whole body to smaller regions as the pig aged, while frequency increased, and amplitude decreased. Tremor was associated with hypermetria (P = 0.0018) and a broad stance (P = 0.0198) during the suckling period. No other neurological signs, or splay leg, were observed. Severe tremor inhibited voluntary movement and was associated with reduced general condition (P = 0.0017), lower body condition score (P = 0.0044), more carpal lesions (P = 0.0163) and arthritis (P = 0.0198). Intention tremor and hypermetria corresponds to cerebellar diseases, although other typical signs of this were absent. Both the tremor observed, and the associated clinical manifestations appear to have severe animal welfare implications.

Tuberculous meningitis-related ischemic stroke: A retrospective study from a tertiary care hospital.

Patients with tuberculous meningitis (TBM) are at high risk of ischemic stroke, and stroke is a poor prognosticator of TBM. However, reports regarding the predictors of stroke in TBM patients are scanty. The aim of this study was to investigate the clinical characteristics and predictors of tuberculous meningitis-related ischemic stroke (TBMRIS). This retrospective study was conducted among TBM patients without traditional vascular risk factors from a tertiary care hospital between January 2017 and November 2022. Patients were divided into TBMRIS group and TBM-only group according to presence of stroke. Clinical, laboratory and radiological variables were compared between the two groups. Predictors of stroke were identified using binary logistic regression analysis. A total of 176 TBM patients were included in the study. Forty-nine patients with stroke were classified as TBMRIS group and 127 patients without stroke were classified as TBM-only group. In TBMRIS group, 41 (83.7%) patients experienced stroke within 3months after the onset of meningitis symptoms and 10 (20.4%) patients presented silent stroke. Stroke occurred in basal ganglia in 57.1% of patients. About 73.5% of patients showed multiple stroke lesions and 38.8% of patients had stroke involving multiple vascular territories. There were significant differences in focal neurological deficit, stage of meningitis, short-term outcome, serum sodium, cerebrospinal fluid (CSF) white cell count, CSF adenosine deaminase (ADA), CSF protein, leptomeningeal enhancement, tuberculoma between TBMRIS group and TBM-only group. Binary logistic regression analysis revealed that focal neurological deficit, CSF white cell count and leptomeningeal enhancement were the independent risk factors for stroke, and tuberculoma was negatively correlated with stroke. Most of TBMRIS develop within 3months after the onset of meningitis symptoms and basal ganglia is the most frequent site. Multiple stroke lesions and involvement of multiple vascular territories are commonly observed. Focal neurological deficit, CSF white cell count and leptomeningeal enhancement are the predictors of stroke in patients with TBM.

Community acquired bacterial meningitis in adults

Bacterial meningitis is arare but severe disease with ahigh mortality. The most frequent pathogens in adults are pneumococcus, meningococcus and Listeria. The most important key symptoms are headache, meningism and fever; however, the absence of individual cardinal symptoms does not exclude the diagnosis. The empirical treatment consists of ceftriaxone and ampicillin, supplemented with dexamethasone as needed. It should be initiated without delay if bacterial meningitis is suspected. Before this, two pairs of blood cultures should be obtained followed by alumbar puncture. An elevated intracranial pressure must be excluded via cerebral computed tomography before performing alumbar puncture only in patients with confirmation of impaired consciousness, focal neurological deficits or epileptic seizures. In such cases treatment is initiated immediately after obtaining blood cultures but before the lumbar puncture. The identification and management of a focus are essential and should be conducted on the day of admission.

Genetic characteristics and pathogenesis of clade 2.3.4.4b H5N1 high pathogenicity avian influenza virus isolated from poultry in South Korea, 2022-2023.

During the 2022-2023 winter season in South Korea, a novel clade 2.3.4.4b H5N1 HPAIV was first detected in wild birds, which then subsequently caused multiple outbreaks in poultry farms and wild birds. This study aimed to investigate the genetic characteristics of H5N1 HPAIVs isolated during the 2022-2023, along with their pathogenicity and transmissibility in chickens and ducks. The clade 2.3.4.4b H5N1 HPAIV viruses caused outbreaks in 75 poultry farms and detected in 174 wild bird cases. Phylogenetic analysis of hemagglutinin genes revealed that the South Korean H5N1 HPAIV isolates were closely related to Eurasian and American HPAIVs isolated between 2022 and 2023. In total, 21 diverse genotypes (22G0-22G20) were identified in virus isolates from poultry and wild birds, among which 22G7 was the dominant genotype. The 22G1 genotype (A/duck/Korea/H493/2022(H5N1)) caused high virulence and pathogenicity, with a 100% mortality rate in specific-pathogen-free chickens. Ducks inoculated with genotypes 22G1 or 22G7 (A/duck/Korea/H537/2022(H5N1)) showed neurological signs, with 60%-80% mortality rate. In the contact groups of ducks, 100% of transmissibility was observed. Notably, in the 22G7-inoculated group, viral shedding via the cloacal route was longer, and viral replication in the cecal tonsil was higher than that in the 22G1-inoculated group, which may have contributed to the dominancy of the 22G7 genotype. Therefore, better understanding of the genetic and pathogenic features of HPAI viruses is important for effective virus control in the field.

Inpatient Implementation of Portable Ocular Fundus Photography Among Neurology Residents.

Background: Nonmydriatic ocular fundus photography has been studied with demonstrated benefit in the evaluation of emergency department neurological complaints, particularly in triaging headache and focal neurological deficits. Likewise, portable fundus camera usage may be practical for inpatients with neurological complaints, although feasibility has not been studied in a neurology teaching service. Purpose: The objective of this study is to determine if a portable, nonmydriatic fundus camera could be integrated into routine clinical care by neurology inpatient housestaff at a tertiary medical center. Research Design: Housestaff were asked to obtain fundus photographs for patients with specific indications for fundoscopy. Study Sample: During a 1-month pilot period, housestaff were successfully able to upload images from 21 patients, which were reviewed by a neuro-ophthalmology attending, with input from on-call ophthalmology if desired. Results: Surveys of housestaff before (n = 13) and after (n = 12) implementation demonstrated increased confidence in camera operation and in ocular structure identification, description, and interpretation. Thematic analysis on qualitative feedback suggested benefits in clinical (improving fundus visualization, aiding in triage, sharing images with offsite staff), health systems (reducing length of stay, reducing ophthalmology consultations, reduced unnecessary testing), and educational domains (facilitating group discussions of images, sharing photographs with patients). Conclusions: Overall, inpatient portable fundus photography was shown to be feasible and effective for rapid fundus visualization for neurological inpatients, enhancing the ability to share, document, and compare examinations among neurology housestaff. Further work is needed to confirm clinical and educational benefits of portable fundus photography usage by neurology residents, as suggested by this healthcare quality improvement pilot study.

P-919. Epidemiology of Cerebral Sinovenous Thrombosis in Children with Acute Bacterial Intracranial Infection: a Single-Institution Retrospective Study

Abstract Background Cerebral sinovenous thrombosis (CSVT) is a known complication of acute bacterial intracranial infection. The objective of this study is to determine the annual proportion of, risk factors for, and outcomes in children with CSVT secondary to acute bacterial intracranial infection.Figure 1:Annual proportion of CSVT in children with acute bacterial intracranial infection between Jan 1, 2015 and December 31, 2022 Methods Retrospective single-center cohort study of children age 1-18 years hospitalized at a tertiary care children’s hospital for acute bacterial intracranial infection between 01/01/2015 and 02/01/2023. Cases were identified by discharge ICD codes for “meningitis,” “meningoencephalitis,” “subdural empyema,” “epidural abscess,” and “brain abscess.” Medical charts were manually screened to ascertain the diagnosis and to abstract relevant clinical data. Multivariate models were built to examine risk factors for CSVT. Results One hundred and three patients were included. Median age was 10.2 [5.9,12.7] years. 31/103 (30%) had CSVT. Annual proportion of CSVT did not vary; however, the total number of cases of intracranial infection rose during the study period. Patients with CSVT were no different from those without CSVT by demographics, vaccination status, neurologic signs or symptoms at presentation, or causative organisms. Non-pneumococcal streptococcus species were the most common causative organisms, found in 37/103 (36%) children. Need for neurosurgical intervention (aOR=11.6, p=0.027), need for ENT intervention (aOR=6.1, p=0.013), temporal location of infection (aOR=7.9, p=0.004), and concurrent mastoiditis (aOR=29.5, p=0.004) were associated with CSVT. The sigmoid sinus (55%, 17/31), transverse sinus (42%, 13/31), jugular vein (45%, 14/31), and superior sagittal sinus (45%, 14/31) were the most common locations for CSVT. Two patients (6%) had venous infarction; one (3%) had venous hemorrhage. A higher proportion of children with CSVT had behavioral concerns (p=0.020) and learning concerns (p=0.025) than children without CSVT. Conclusion CSVT is common in acute bacterial intracranial infection. Consider empiric surveillance in children with acute bacterial intracranial infection with mastoiditis, temporal location of infection, and/or those who require surgical intervention. Outcomes in this population should be further explored. Disclosures All Authors: No reported disclosures

A TTPA deletion is associated with Retinopathy with Vitamin E Deficiency (RVED) in the English Cocker Spaniel Dog.

Retinopathy with Vitamin E Deficiency (RVED) is a familial disease in the English Cocker Spaniel (ECS) dog breed. Ophthalmic abnormalities observed in RVED-affected ECS include lipofuscin granule deposition within the tapetal fundus and subsequent retinal degeneration resulting in visual deficits. Affected dogs may also exhibit neurological signs that include ataxia and hindlimb proprioceptive deficit. In all cases, circulating plasma concentrations of α-tocopherol are low. This study sought to investigate the genetic basis of RVED in the ECS breed. We undertook a genome-wide association study comprising 30 ECS with normal fundic examinations aged 6 years or older (controls) and 20 diagnosed with RVED (cases) and identified a statistically associated signal on chromosome 29 (Praw = 1.909×10-17). Whole genome sequencing (WGS) of two cases identified a 102bp deletion in exon 1 of the Alpha Tocopherol Transfer Protein gene (TTPA), truncating the protein by 34 amino acids. The c.23_124del variant segregated with RVED in a total of 30 cases and 43 controls. Variants in TTPA are causal for Ataxia with Vitamin E Deficiency (AVED) in humans which is a phenotypically similar disease to RVED. The identification of the canine variant is extremely significant as the availability of a DNA test will allow for identification of presymptomatic dogs and early therapeutic intervention which may prevent development of retinopathy and improve neurological signs. Breeders can also use the DNA test to efficiently eradicate the disease from this breed.

Central Nervous System Infection by Free-Living Nematode Cephalobus cubaensis in a Human Host in Africa

Background: Human central nervous system infections due to free-living nematodes, although extremely rare, are usually fatal. Immunodeficiency has not been a feature of most of these cases, unlike the situation pertaining to disseminated Strongyloides stercoralis infection. Case report: An elderly immunocompetent man presented with a history of tinnitus and otalgia, progressing to central nervous system involvement with confusion, weakness, and other neurological signs. Examination revealed a unilateral external auditory canal soft tissue mass and radiological evidence of ipsilateral temporal bone destruction and brain parenchymal disease. A biopsy of the ear canal mass revealed the presence of an unidentified nematode species, and treatment with anthelminthics was started. The patient’s clinical condition deteriorated and he died shortly after admission to the intensive care unit. The immediate cause of death was bronchopneumonia. During the autopsy, an extensive involvement of the right middle cranial fossa was found, with destruction of the squamous and petrous parts of the temporal bone. Results: We identified adult, larval, and egg stages of a free-living nematode in the antemortem external auditory canal tissue mass and the post-mortem brain samples. Polymerase chain reaction assays, with Sanger and whole-genome sequencing, identified Cephalobus cubaensis. This is a free-living species not previously known to be pathogenic to humans, although nematodes of the same genus have caused mastitis in horses. Conclusions: Microscopic appearance and the invasive behaviour of the pathogen evoked a putative diagnosis of Halicephalobus gingivalis, the most frequently reported free-living nematode infecting humans. However, this nematode’s size and anatomical features, and the clinical presentation and duration of illness, prompted the consideration of an alternative species. We speculate that an initial bacterial otitis externa provided the opportunity for colonization by the nematode from an environmental source and subsequent invasion.

Meningioma in the fourth ventricle in 2 cats.

Feline meningiomas typically arise on the surface of the brain but can occur in the third ventricle. Meningiomas in the fourth ventricle have not been reported in cats, to our knowledge. Here, we describe the clinical and pathologic findings of meningioma in the fourth ventricle in 2 cats. Both affected patients (1 castrated male, 1 spayed female) were 15-y-old. Case 2 had neurologic signs, including absent menace response, head tilt, and ataxia. Grossly, both tumors were well-demarcated and firm, expanded the fourth ventricle, and compressed the adjacent neuroparenchyma. Cytology of the ventricular mass in case 1 revealed a spindle-cell neoplasm. Based on histology, the neoplasms were classified as WHO grade 1 fibrous meningioma (case 1) and transitional meningioma (case 2). Immunohistochemistry revealed diffuse, robust cytoplasmic E-cadherin and vimentin immunolabeling in both cases and multifocal, weak cytoplasmic pan-cytokeratin AE1/AE3 immunolabeling in case 2. Our findings indicate that meningiomas should be included as a differential diagnosis for tumors of the fourth ventricle in cats.

P-46 A CASE OF PITUITARY APOPLEXY PRESENTING WITH OPHTHALMOPLEGIA

Abstract Introduction Pituitary apoplexy is a rare endocrinological emergency that may be life-threatening due to pituitary hormone deficiency or compression effect, if not treated appropriately. It usually develops secondary to acute ischemia or hemorrhage in the pituitary gland and presents with headache, vomiting, ophthalmoplegia, vision loss. In this case, we aim to present a case of pituitary apoplexy who applied to the emergency service with a complaint of vomiting, and developed ophthalmoplegia while hospitalized. Clinical Case A 76-year-old male patient applied to the emergency department with complaints of nausea and vomiting that had been continuing for the last week. At admission, physical examination, blood pressure and neurologic examination were normal. The laboratory tests were as follows: Glu:141 mg/dl, Cre:0,7 mg/dl, AST:25 U/L, ALT:13 IU/L, Na:118 mmol/L, K:3.0 mmol/L. He was admitted to the service in order to investigate hyponatremia and hypokalemia. On the first day of his hospitalization, restriction of upward sight in the right eye and ptosis developed. Cranial imaging with computerized tomography revealed a contrast-enhancing mass at the level of pituitary gland. A well-frameworked, 20 mm in diameter, hyperintens at T1-weighted images, with heterogeneous contrast enhancing lesion was reported in the contrast-enhanced pituitary MRI. Preliminary diagnosis were considered to be a bleeding cyst or pituitary apoplexy. Pituitary hormone tests were as follows: TSH:0.5 mIU/L (0.27-4.8), sT4: 1,38 ng/dL (0,79-1,59), sT3: 2.1 ng/L (2,04-4,4), FSH: 2.6 IU/L (1,5-12,4), LH: 0.87 IU/L (1,7-8,6), Total Testosterone: 0.4 ng/ml (2,8-8), PRL: 1 µg/dl (4,6-21,4), ACTH: 1,5 ng/L (7-63,2), Cortisol: 1.8 µg/dl (6-19), İGF-1: 53 mg/L (50-184). Hormone replacement with methylprednisolone 2x20 mg intravenous was started with the diagnosis of anterior pituitary insufficiency. The patient underwent to transphenoidal pituitary surgery for decompression, under a steroid cover. Hemodynamics remained stable following surgical intervention. Postop urinary output was also normal. But, right side ptosis continued after surgery. The patient was discharged with oral prednisolone 5 mg 1*1. Steroid was discontinued at the second week following surgery. The entire pituitary axis was determined to be intact at the first month. Pathology was reported as a large hemorrhagic infarction of the pituitary gland compatible with pituitary apoplexy. Consultations with Neurology and ophthalmology departments were done because of the persistence of right ptosis. No additional intervention was planned, follow-up was recommended. A significant improvement of ptosis was observed after a two months period. Conclusion Although the neurological signs and symptoms of pituitary apoplexy usually improves following accurate medical or surgical interventions in majority of patients, it should be kept in mind that it may take time for ptosis to recover after surgical decompression as in our case.Figure 1:Improvement in ptosis in the second month after surgery

Giant, unruptured, partially thrombosed right MCA aneurysm treated with 2 bypasses and excision.

Aneurysms of the middle cerebral artery (MCA) account for up to 40% of all unruptured intracranial aneurysms [1-3] and 14% to 20% of ruptured ones. [4-5] Giant MCA aneurysms are rare, representing 10% of cases [6], but carry an aggressive natural history, with the UCAS Japan study reporting an annual rupture rate of ∼ 17%. [7]. Additionally, unruptured giant MCA aneurysms can present with neurological symptoms including headache, focal neurological deficit, seizure, or ischemia infarcts. Here we report a 58-year-old male with a history of alcohol abuse, hypertension, diabetes, and smoking that presented after a first-time seizure. Imaging revealed an unruptured, giant (2.9 cm), partially thrombosed right MCA aneurysm. A microsurgical approach using clipping and bypass was planned due to the aneurysm's complexity. Six weeks later, the patient underwent a right frontotemporal craniotomy with radial artery graft (RAG) extraction, followed by two bypasses: an M2-M2 intracranial bypass and a right external carotid to M2 bypass using the RAG. The aneurysm was successfully excised. Otolaryngology assisted with the RAG extraction during the craniotomy and neck dissection. This case highlights the technical complexities involved in managing giant aneurysms via microsurgical technique, including appropriate pre-operative strategy development. Informed consent from next of kin as well as IRB approval (IRB #23.0720) was obtained for this retrospective study of patients with cerebrovascular disease.

Initial surgical management of spinal injuries in patients with multiple and/or severe injuries- the 2022 update of the German clinical practice guideline.

Our aim was to update evidence-based and consensus-based recommendations for the initial surgical management of spinal (cord) injuries in patients with multiple and/or severe injuries based on current evidence. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. MEDLINE and Embase were systematically searched to May 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions and the timing of interventions for the initial surgical management of spinal (cord) injuries in patients with polytrauma and/or severe injuries. We considered patient-relevant clinical outcomes such as mortality, complication rates, and lengths of stay. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Seven new studies were identified. All studies compared different moments for the initial surgical management of spinal injuries. Three recommendations were modified, and three additional recommendations were developed. All achieved strong consensus. The following key recommendations are made. (1) Patients with spinal injuries or deformities with confirmed or assumed neurological deficits which can be treated operatively should undergo surgery as soon as possible (ideally on day 1) if their other medical conditions permit. (2) If suggested by fracture morphology with spinal canal compression or translational injury and if spinal neurological damage cannot be ruled out, assume the presence of spinal neurological damage until it can be ruled out. (3) In the absence of neurological signs and/or symptoms, unstable spinal injuries should be treated by early surgical stabilization based on the patient's overall condition. (4) Depending on the injury, an anterior and/or posterior approach or, in exceptional cases, a halo fixation device can be used to stabilize the cervical spine. (5) Posterior internal fixation should be used as the primary surgical technique for stabilizing injuries to the thoracic and lumbar spine.

A Closed Reduction of Cervical Spine Subluxation in an Arabian Foal with an External Neck Stabilizer

Cervical spine injuries that impact young horses and foals can result in mild to severe neurological signs or even result in sudden death. There are only a few reports on conservative treatment options for this condition in the scientific literature. If the condition is left untreated, it can lead to the development of degenerative joint disease, resulting in chronic neurological symptoms and discomfort. We present the case of a two-day-old Arabian foal that showed signs of ataxia following a neck injury, being the result of cervical spine subluxation. Radiological examination revealed a dislocation between the second and third cervical vertebrae. At admission to the clinic on the seventh day of life, the foal’s clinical examination parameters were within physiological ranges. The head posture at the presentation was consistently low, the foal could not lift its head above the shoulder joint throughout the whole examination, the neck muscles were spastically tensed and clinical signs of ataxia were present. The foal underwent a closed reduction in the subluxation under general anesthesia and a fiberglass semicircular gutter was created to stabilize the neck in the desired position. The ataxia symptoms began to improve around day 12 post manipulation, and the fiberglass stabilizer was removed after 16 days post manipulation, followed by radiographs. The dislocation of C2/C3 was no longer visible on the radiographs, and the foal was able to assume a normal neck posture after the removal of the fixator.

Human Herpesvirus 6 Encephalitis in a Patient with a History of Psychotropic Drug Use: A Case Report

Human herpesvirus 6 (HHV-6) is a beta-herpesvirus typically associated with asymptomatic infections but can cause severe encephalitis, especially in immunocompromised individuals. This report details a case of HHV-6 encephalitis in an immunocompetent 35-year-old male with recent cocaine use. The patient initially presented with confusion and focal neurological deficits, with MRI showing bihemispheric demyelinating lesions. Acyclovir was initiated as empirical antiviral therapy, resulting in partial improvement. However, the patient was readmitted following discharge due to recurrent neurological symptoms, with MRI findings showing extensive, periventricular white matter lesions consistent with acute disseminated encephalomyelitis (ADEM) secondary to HHV-6. Given the atypical response to the treatment, this case highlights the need for further research on optimal antiviral therapies and the role of psychoactive substance use in neurological infections such as HHV-6 encephalitis.

Challenges and effectiveness of remote neurological follow-up of children with concussion following TBI using telemedicine.

Traumatic brain injury (TBI) in children, including concussion, is one of the major causes of emergency department (ED) registration and a significant burden on the health system. The primary goal of this study was to evaluate the outcomes of a telemedicine strategy for remotely monitoring thechildren with traumatic brain concussions, focusing on their neurological symptoms and signs. The secondary goal was to explore socioeconomic and educational differences among the participating families. This study was conducted in a prospective and observational fashion. It included children aged between 6 and 18years who presented in the ED with head trauma and were subsequently diagnosed with a brain concussion. Enrolled patients split into telemedicine-only and telemedicine + readmission groups according to their concussion symptoms during video-call visits. We recruited 29 children and performed 75 telehealth visits. Four children were called for readmission, and they comprised the telemedicine + readmission group. The telemedicine-only group included 25 children whose follow-ups were completed remotely. The median PECARN score was 1 (IQR = 0.75), and the most common reason for head trauma was simple falls from the same level (n = 18, 62%); 22 (76%) children were suffering from headaches; 55% of the families were in very low-income status. During the video-call visit sessions, three children stated worse headaches, and one child's parents reported consistent sleepiness. This study demonstrates the potential effectiveness of telemedicine in monitoring children with concussions, especially in regions with diverse socioeconomic backgrounds and overcrowded metropolitan hospitals.

Article Review : Peran Hipertensi terhadap Patomekanisme Stroke Iskemik dan Hemoragik

Stroke is a syndrome characterized by sudden focal neurological deficits caused by vascular injury, either hemorrhage or infarction in the central nervous system. According to the World Health Organization, approximately 15 million people experience stroke worldwide each year, with 5 million resulting in death and another 5 million suffering permanent disability. Hypertension is a major risk factor for both ischemic and hemorrhagic stroke, mediated by complex pathophysiological mechanisms. This review aims to explore the mechanisms by which hypertension contributes to the pathophysiology of stroke based on current evidence. The study adopts a literature review approach, utilizing data sources from journal articles, books, and other relevant documents accessible online via search engines such as Google Scholar®, PubMed®, and ScienceDirect®. The findings indicate that ischemic stroke occurs due to atherosclerosis and microvascular dysfunction induced by hypertension, whereas hemorrhagic stroke involves vessel rupture resulting from arterial wall weakening. Hypertension also affects the permeability of the blood-brain barrier through molecular pathways such as vascular endothelial growth factor (VEGF) release, leading to cerebral edema. Studies demonstrate that effective blood pressure control can significantly reduce the risk of stroke by up to 41%, underscoring hypertension as a primary target in stroke prevention.

Cocaine-Induced Limbic Encephalopathy Manifesting as Acute Amnesia: A Case Report

Background: Cocaine has been shown to cause cytotoxic neuronal damage, which has been implicated in cases of leukoencephalopathy. We present a case of cocaine-induced toxic encephalopathy resulting in predominant lesions to the gray matter on magnetic resonance imaging (MRI). Case Presentation: A 70-year-old female presented acutely with confusion, agitation, and disorientation. She was markedly hypertensive with other vital signs within normal range. On presentation to the emergency department, she was uncooperative and had an unsteady gait but showed no focal neurological deficits. Her lab work was positive for elevated cardiac troponins, elevated D-dimer, and a urine drug screen positive only for cocaine. Head computed tomography (CT) showed no hemorrhage and head CT angiogram showed no abnormalities and no significant vascular stenosis. Chest X-ray and CT showed diffuse ground glass opacities compatible with atypical pneumonia. Antibiotics were initiated to treat the pneumonia and antihypertensives were administered to manage her blood pressure. She was also given IV thiamine. Brain MRI showed restricted diffusion involving bilateral hippocampi, thalami, putamen, caudate, and right occipital lobe, findings suspicious for cytotoxic edema. After acute stabilization, the patient demonstrated profound anterograde and retrograde amnesia, which improved gradually over days to weeks. She was eventually discharged to a skilled nursing facility. Conclusion: To our knowledge, this is the first reported case of profound amnesia secondary to cocaine-induced toxic encephalopathy with bilateral hippocampal involvement. These symptoms correlate with the implicated neuroanatomical structures. This case demonstrates that cocaine may be implicated in toxic encephalopathy affecting the brain’s gray matter and highlights a unique presentation of these findings.