Hemorrhagic Encephalopathy Research Articles

Hemorrhagic encephalopathies and myelopathies in dogs and cats: a focus on classification.

The prevalence of hemorrhagic diseases of the central nervous system of dogs and cats is low compared to other diseases such as neoplasia and inflammation. However, the clinical consequences can be devastating. Several etiological and localization-based classification systems have been reported for intracerebral and spinal cord hemorrhage or hematomyelia in humans but similar systems do not exist in veterinary medicine. The authors propose an etiologic classification system for both intraparenchymal hemorrhagic encephalopathy and myelopathy following a review of the literature detailing the presentation, diagnosis, therapy, and prognosis of these diseases. A summary of the investigative and therapeutic approach to these cases is also provided.

Hypernatremic hemorrhagic encephalopathy as an unexpected critical complication in children: a case report from a tertiary hospital

Introduction: Hypernatremic hemorrhagic encephalopathy (HHE) is one of the complications of hypernatremic dehydration which is relatively uncommon in patients with hypernatremia. Severe hypernatremia might lead to brain shrinkage resulting in intracranial bleeding which can increase morbidity and mortality, especially in children. Hypernatremic hemorrhagic encephalopathy is harmful, but only limited cases are reported. This case highlights the role of cautious management of hypernatremic dehydration and the need for intense monitoring due to the unexpected complication of HHE. Case presentation: A 4 months old female infant presented with a decreased consciousness. She showed signs of shock along with acute diarrhoea and severe dehydration. Laboratory findings revealed severe hypernatremia and high septic marker. Rehydration and correction of hypernatremia were done, but during the process, several episodes of general tonic-clonic seizure occurred. A Head CT scan was done and showed subdural hemorrhage in the posterior interhemispheric fissure and intraventricular hemorrhage in the posterior horn of the right lateral ventricle. Conservative management was undertaken and the patient was clinically improved progressively. On the 11th day of hospitalization, the patient's condition had been significantly improved without neurological sequelae and was later discharged on the 11th day of hospitalization. Conclusion: Close monitoring of clinical, neurological, and laboratory examination is essential in the management of hypernatremic dehydration due to the possibility of HHE, even when on the right procedure. Once neurological complication is suspected, an immediate imaging study should be performed and modifying therapy is required.

The regulation of host cytoskeleton during SARS-CoV-2 infection in the nervous system

The global economy and public health are currently under enormous pressure since the outbreak of COVID-19. Apart from respiratory discomfort, a subpopulation of COVID-19 patients exhibits neurological symptoms such as headache, myalgia, and loss of smell. Some have even shown encephalitis and necrotizing hemorrhagic encephalopathy. The cytoskeleton of nerve cells changes drastically in these pathologies, indicating that the cytoskeleton and its related proteins are closely related to the pathogenesis of nervous system diseases. In this review, we present the up-to-date association between host cytoskeleton and coronavirus infection in the context of the nervous system. We systematically summarize cytoskeleton-related pathogen-host interactions in both the peripheral and central nervous systems, hoping to contribute to the development of clinical treatment in COVID-19 patients.

Mielitis transversa aguda asociada con infección por SARS-CoV-2

In addition to causing respiratory problems, SARS-CoV-2 can cause a wide spectrum of neurological complications such as headaches, ageusia, anosmia, encephalopathy, cerebrovascular disease, Guillain-Barré syndrome and other polyneuropathies, meningoencephalitis, acute necrotizing hemorrhagic encephalopathy, and central nervous system syndromes associated with inflammation. In this review we present 39 cases of acute transverse myelitis (ATM) associated to SARS-CoV-2 infection. All cases had a positive polymerase chain reaction (PCR) nasopharyngeal swab and/or antigen test. Biochemical analyses confirmed the absence of other pathogens and autoantibody-mediated neuroinflammatory disease, except for two cases, one with autoantibodies against the oligodendrocyte myelin glycoprotein (anti-MOG IgG) and another with anti-MOG IgG and anti-glutamic acid decarboxylase (anti-GAD65). Magnetic Resonance Imaging (MRI) studies confirmed the diagnosis of ATM. Although causality cannot be inferred, it is likely that isolated cases of ATM are the consequence of a para or post-infectious process in SARS-CoV-2. In this work, the probable causes of ATM associated with SARS-CoV-2 are discussed. The understanding of the mechanisms behind these neurological disorders triggered by a viral infection will help to optimize the therapeutic strategies for patient management. Keywords: SARS-CoV-2; COVID-19; transverse myelitis; long COVID; demyelination; nervous system.

The disquietude of clozapine continuation during the COVID-19 pandemic.

The disquietude of clozapine continuation during the COVID-19 pandemic.

Abstract 49: Elevation Of Blood Viscosity In Acute Ischemic Stroke

Objectives: The blood viscosity would quantify the physiological state of abnormal blood flow and hypercoagulability, which are crucial predisposing factors of ischemic stroke. It investigated whether the viscosity increase in the stroke. Methods: It enrolled a series of patients who visited the hospital with any neurologic symptom or sign within 24 h of last well-being. Blood was immediately sampled at the time of hospital arrival as a routine clinical practice along the acute stroke clinical pathway. The viscosity was investigated in a point-of-care test manner using ARS M-200, Rheology Solutions, Korea. It placed the whole blood between the two plates and measured the viscosity by applying a torque of 10 Hz within 5 minutes of taking the blood sample. The primary outcome was an ischemic stroke and other diseases, and the difference in blood viscosity between the two groups was compared. Results: In 2021, it enrolled 47 subjects (age, 69.5 ± 12.9 years-old, male, 51.0%) of whose were diagnosed as ischemic stroke (n = 18) and other diseases (n = 29) consisted of hemorrhagic stroke, metabolic encephalopathy, vertigo, seizure, drug intoxication, and peripheral neuropathy. The viscosity of ischemic stroke with 10 Hz torque was significantly higher than those of non-stroke (22.7 ± 7.4 vs. 18.4 ± 7.0 Ps, P = 0.02). In stroke, the viscosity was significantly different between direct visits (25.5 ± 6.6 Ps) and transferred subjects with intravenous fluids (14.3 ± 1.4) (P = 0.003). In the case of hemorrhagic stroke, traumatic hemorrhage presented the highest values (27.1 ± 5.8), which was different from intracerebral hemorrhage (22.1 ± 7.3 Ps, Figure). Conclusion: The blood viscosity increased in acute ischemic stroke, which would be used as an auxiliary factor in the emergency setting. Also, it may be warranted the following studies for investigating their prognostic roles.

Neuroradiologic Imaging of Neurologic and Neuro-Ophthalmic Complications of Coronavirus-19 Infection.

Background:To review the literature and provide a summary of COVID-19–related neurologic and neuro-ophthalmic complications.Methods:The currently available literature was reviewed on PubMed and Google Scholar using the following keywords for searches: CNS, Neuro-Ophthalmology, COVID-19, SARS-CoV-2, coronavirus, optic neuritis, pseudotumor cerebri, Acute Disseminated Encephalomyelitis, posterior reversible encephalopathy syndrome (PRES), meningitis, encephalitis, acute necrotizing hemorrhagic encephalopathy, and Guillain–Barré and Miller Fisher syndromes.Results:Neuroradiologic findings of neurologic and neuro-ophthalmologic complications in relationship to COVID-19 infection were reviewed. Afferent visual pathway–related disorders with relevant imaging manifestations included fundus nodules on MRI, papilledema and pseudotumor cerebri syndrome, optic neuritis, Acute Disseminated Encephalomyelitis, vascular injury with thromboembolism and infarct, leukoencephalopathy, gray matter hypoxic injury, hemorrhage, infectious meningitis/encephalitis, acute necrotizing hemorrhagic encephalopathy, and PRES. Efferent visual pathway–related complications with relevant imaging manifestations were also reviewed, including orbital abnormalities, cranial neuropathy, Guillain–Barré and Miller Fisher syndromes, and nystagmus and other eye movement abnormalities related to rhombencephalitis.Conclusion:COVID-19 can cause central and peripheral nervous system disease, including along both the afferent and efferent components of visual axis. Manifestations of disease and long-term sequela continue to be studied and described. Familiarity with the wide variety of neurologic, ophthalmic, and neuroradiologic presentations can promote prompt and appropriate treatment and continue building a framework to understand the underlying mechanism of disease.

Possible mechanisms involved in neurological manifestation of COVID-19: A short review

COVID-19 resulted in a pandemic causing respiratory infection due to the SARS-CoV-2 virus. It started from the Wuhan city of China in mid-December 2019 and then spread all over the world in a very short time. COVID19 is mainly responsible for acute respiratory syndrome however, there are reports of involvement of some neurological symptoms and conditions wise; headache, dizziness, fatigue, insomnia, confusion and myalgia, encephalitis etc. The severe neurological effects consist of acute ischemic stroke, cerebral hemorrhage, cerebral venous sinus thrombosis, subarachnoid hemorrhage, acute necrotizing hemorrhagic encephalopathy, meningitis/encephalitis, and acute Guillain-Barre Syndrome. Neurological conditions could be due to the entrance of the virus into the brain via nasal passage through the olfactory bulb or the initiation of a storm of cytokines that cross the blood-brain barrier (BBB). It can also have a long-term effect in the form of demyelination of neurons which can lead to neurodegenerative diseases. This review deals with the general mechanisms which might be involved in the entrance of COVID-19 into the brain and its possible effects.

The progress of research on histone methylation in ischemic stroke pathogenesis.

Stroke, also known as cerebral stroke or cerebrovascular accident, refers to acute ischemic or hemorrhagic encephalopathy caused by a disturbance to cerebral blood flow. Ischemic stroke is the most common type of cerebral stroke, accounting for approximately 80% of the total incidence of clinical stroke. High morbidity, disability, and mortality rates place heavy burdens on the families of patients and society. An increasing number of studies have shown that histone modification plays an important role in the pathogenesis of ischemic stroke, but most studies on histone modification focus on acetylation, and studies on the role of histone methylation in the pathogenesis of ischemic stroke are limited. Here, we review the role of histone methylation and related histone methyltransferase (HMT) inhibitors in the pathogenesis of ischemic stroke and related HMT inhibitors in the treatment of ischemic stroke, which may open up a new avenue to the study of ischemic stroke.

The Biosafety and Risk Management in Preparation and Processing of Cerebrospinal Fluid and Other Neurological Specimens With Potential Coronavirus Infection.

The recent outbreak of coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2, has become a global threat. Due to neurological manifestations presented throughout the coronavirus disease process, the potential involvement of COVID-19 in central nervous system has attracted considerable attention. Notably, the neurologic system could be widely affected, with various complications such as acute cerebrovascular events, encephalitis, Guillain-Barré syndrome, and acute necrotizing hemorrhagic encephalopathy. However, the risk assessment of exposure to potential biohazards in the context of the COVID-19 pandemic has not been clearly clarified regarding the sampling, preparation, and processing neurological specimens. Further risk managements and implantations are seldom discussed either. This article aims to provide current recommendations and evidence-based reviews on biosafety issues of preparation and processing of cerebrospinal fluid and neurological specimens with potential coronavirus infection from the bedside to the laboratory.

Covid-19 associated acute encephalopathy features on computed tomography: A case report

More than 83,000,000 individuals have encountered Covid-19 disease, caused by novel severe acute respiratory syndrome - Coronavirus-2 (SARS-CoV-2). Besides systemic and respiratory symptoms, neurologic involvement has begun to be discussed recently. As severe involvement, only a few meningoencephalitis and encephalopathy cases were reported in the literature. We herein present a 65-year-old male Covid-19 patient with signs of hemorrhagic encephalopathy, along with literature review.

Neurological Damage by Coronaviruses: A Catastrophe in the Queue!

Neurological disorders caused by neuroviral infections are an obvious pathogenic manifestation. However, non-neurotropic viruses or peripheral viral infections pose a considerable challenge as their neuropathological manifestations do not emerge because of primary infection. Their secondary or bystander pathologies develop much later, like a syndrome, during and after the recovery of patients from the primary disease. Massive inflammation caused by peripheral viral infections can trigger multiple neurological anomalies. These neurological damages may range from a general cognitive and motor dysfunction up to a wide spectrum of CNS anomalies, such as Acute Necrotizing Hemorrhagic Encephalopathy, Guillain-Barré syndrome, Encephalitis, Meningitis, anxiety, and other audio-visual disabilities. Peripheral viruses like Measles virus, Enteroviruses, Influenza viruses (HIN1 series), SARS-CoV-1, MERS-CoV, and, recently, SARS-CoV-2 are reported to cause various neurological manifestations in patients and are proven to be neuropathogenic even in cellular and animal model systems. This review presents a comprehensive picture of CNS susceptibilities toward these peripheral viral infections and explains some common underlying themes of their neuropathology in the human brain.

Hemorrhagic encephalopathy associated with COVID-19

The mechanisms for neurological complications of COVID-19, the disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), are not yet well understood. We present a critically ill man with a COVID-19-associated hemorrhagic encephalopathy. SARS-CoV-2 RNA was not detected in cerebrospinal fluid (CSF) or blood. CSF analyses suggested dysregulation of pro-inflammatory cytokine pathways, particularly tumor necrosis factor-α and interleukin-6, consistent with a cytokine release syndrome. The patient gradually recovered with supportive care and neurological rehabilitation. Awareness of this clinical entity may facilitate the identification of patients with a potentially remediable cause of encephalopathy in COVID-19.

Neurologic Manifestations and Complications of SARS-CoV-2 Infection

Abstract The SARS-CoV-2 pandemic originated in China has caused a severe impact on worldwide health. Respiratory symptoms accompanied by unspecific systemic complaints are the most common presentation. However, neurological symptoms and complications could be found in a patient, and this might confer a poor prognosis. In this view, we aim to present a narrative review of neurological manifestations and complications of SARS-CoV-2 infection by performing literature research. We found nonspecific neurological symptoms such as headache, lethargy, anosmia, and dysgeusia reported in a few cohorts. Case reports of encephalitis, acute necrotizing hemorrhagic encephalopathy, and Guillain-Barré syndrome have also been published. Finally, cerebrovascular complications resulting from a hypercoagulation state, reported in some cases of SARS-CoV-2 infected patients, confers higher morbidity, especially in younger patients. Future studies should address the implications of the nervous system manifestations and the possibility of virus permanence in nervous tissue.

A review of pathophysiology and neuropsychiatric manifestations of COVID-19.

IntroductionThe outbreak of coronavirus disease 2019 (COVID-19) has become one of the most serious pandemics of the recent times. Since this pandemic began, there have been numerous reports about the COVID-19 involvement of the nervous system. There have been reports of both direct and indirect involvement of the central and peripheral nervous system by the virus.ObjectiveTo review the neuropsychiatric manifestations along with corresponding pathophysiologic mechanisms of nervous system involvement by the COVID-19.BackgroundSince the beginning of the disease in humans in the later part of 2019, the coronavirus disease 2019 (COVID-19) pandemic has rapidly spread across the world with over 2,719,000 reported cases in over 200 countries [World Health Organization. Coronavirus disease 2019 (COVID-19) situation report-96.,]. While patients typically present with fever, shortness of breath, sore throat, and cough, neurologic manifestations have been reported, as well. These include the ones with both direct and indirect involvement of the nervous system. The reported manifestations include anosmia, ageusia, central respiratory failure, stroke, acute inflammatory demyelinating polyneuropathy (AIDP), acute necrotizing hemorrhagic encephalopathy, toxic–metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. These data were derived from the published clinical data in various journals and case reports.ConclusionThe neurological manifestations of the COVID-19 are varied and the data about this continue to evolve as the pandemic continues to progress.

Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms.

Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus (SARS-CoV-2), has become a global pandemic threat. The potential involvement of COVID-19 in central nervous system (CNS) has attracted considerable attention due to neurological manifestations presented throughout the disease process. In addition, SARS-CoV-2 is structurally similar to SARS-CoV, and both bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. Thus, cells expressing ACE2, such as neurons and glial cells may act as targets and are thus vulnerable to SARS-CoV-2 infection. Here, we have reviewed the neurological characteristics of COVID-19 and summarized possible mechanisms of SARS-CoV-2 invasion of the CNS. COVID-19 patients have presented with a number of different neurological symptoms such as headache, dizziness, hyposmia, and hypogeusia during the course of illness. It has also been reported recently that some cases of COVID-19 have presented with concurrent acute cerebrovascular disease (acute ischemic stroke, cerebral venous sinus thrombosis, cerebral hemorrhage, subarachnoid hemorrhage), meningitis/encephalitis, acute necrotizing hemorrhagic encephalopathy, and acute Guillain–Barré syndrome. Furthermore, SARS-CoV-2 RNA detected in a cerebrospinal fluid specimen of a patient with COVID-19 have provided direct evidence to support the theory of neurotropic involvement of SARS-CoV-2. However, the underlying neurotropic mechanisms of SARS-CoV-2 are yet to be established. SARS-CoV-2 may affect CNS through two direct mechanisms (hematogenous dissemination or neuronal retrograde dissemination) or via indirect routes. The underlying mechanisms require further elucidation in the future.

Features of neurological manifestations of the COVID-19 in children and adults

The number of COVID-19 patients is increasing worldwide and the number of patients with neurological manifestations of a new coronavirus infection is increasing as well. Pathognomonic for COVID-19 is the presence of cephalgic syndrome, infectious-toxic encephalopathy, hypo- and anosmia and ageusia. Inducing of pathological autoimmune response contributes to the development of Miller Fischer and Guillain-Barré syndrome. Hyperergic reaction with the generation of the so-called «cytokine storm» provokes multisystem hemorrhagic complications such as Kawasaki disease and acute necrotizing hemorrhagic encephalopathy. There is also a special form of COVID-19-associated stroke. Almost all post-COVID-19 patients complain of severe fatigue, emotional lability, and sometimes have features of asthenic-neurotic, anxiety-phobic disorders and apato-abulic syndromes, which require rehabilitation measures, as well as courses of restorative neurotrophic and nootropic therapy.

Neurological complications of coronavirus and COVID-19.

Clinical and experimental studies have shown that the coronavirus family has a certain tropism for the central nervous system. Seven types of coronavirus can infect humans. Coronaviruses are not always confined to the respiratory tract, and under certain conditions they can invade the central nervous system and cause neurological pathologies. The potential for neuroinvasion is well documented in most human coronaviruses (OC-43, 229E, MERS and SARS) and in some animal coronaviruses (porcine haemagglutinating encephalomyelitis coronavirus). Neurological symptoms have been reported in patients affected by COVID-19, such as headache, dizziness, myalgia and anosmia, as well as cases of encephalopathy, encephalitis, necrotising haemorrhagic encephalopathy, stroke, epileptic seizures, rhabdomyolysis and Guillain-Barre syndrome, associated with SARS-CoV-2 infection. Future epidemiological studies and case records should elucidate the real incidence of these neurological complications, their pathogenic mechanisms and their therapeutic options.

Defects of Red Blood Cell Membranes in Patients with Brain Dysfunction (Pilot Study)

The aimof the paper: to identify promising diagnostic and prognostic biomarkers of pathological processes development based on the red blood cell membrane morphology and nanostructure in patients with brain disorders in the Intensive Care Unit.Materials and methods. The study included 24 patients from the anesthesiology and resuscitation ward of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. Blood was acquired from the patients for standard tests, and all further tests were performed in vitro. The images of red blood cells were obtained using the atomic force microscope «NTEGRA Рrima» (NT-MDT, Russia) in semi-contact mode.Results. Patients from the anesthesiology and intensive care ward with traumatic brain injury, ischemic and hemorrhagic stroke, cerebral edema, and post-hypoxic encephalopathy had different blood cell shapes and localized defects of different topology on the surface of erythrocyte membranes including defects of pallor, torus, and nanostructure.Conclusion. In this pilot study we have shown that several defects represent the trigger mechanisms for the development of a total membrane damage. Local topographic defects of nanostructures and abnormalities of erythrocyte morphology are irreversible. The number and quality of these abnormalities may eventually be used as a diagnostic and prognostic biomarker of pathological processes.

Diagnosis and treatment of hemorrhagic shock and encephalopathy syndrome

Hemorrhagic shock and encephalopathy syndrome(HSES) is an acute-onset disease whose clinical manifestations are fever, shock, diarrhea, severe disseminated intravascular coagulation and liver and kidney dysfunction, with rapid progression, poor prognosis and high mortality rate.At present, the etiology of HSES is unknown, and it is widely believed that the pathogenesis of HSES is related to infection, high fever, cytokine storm and genetics.There is lack of specific diagnostic markers for the diagnosis of HSES, which mainly depends on some specific clinical features and the exclusion of other diseases.All patients are provided given fluid therapy, intracranial pressure reduction and supportive treatments.It is essential to improve the recognition of HSES, and early diagnosis and early intervention may improve efficacy, and reduce mortality rate and disability rate. Key words: Hemorrhagic shock; Encephalopathy syndrome; Diagnosis; Treatment