Neurological Complaints Research Articles

Neurology of Aging : adapting neurology provision for an aging population.

Background Over the past few decades, advances in neurology of aging have been considerable and have led to a better understanding of the science of age-related neurological disorders. Likewise, it changed the perception of classical neurology practice, research and the way of looking at age-related conditions. Neurological disorders are the most frequent cause of major disability in the elderly and account for almost half of the incapacitation occurring beyond age 65 and more than 90% of serious dependency. However, a number of neurological changes occur also in the absence of a specific disease, making the assessment and management of neurological complaints and findings a specific expertise. Summary Maximizing success in clinical care of the elderly requires expertise in geriatric neurology, which includes an understanding of current research regarding aging and age-related neurological dysfunctions, and the ability to work with other geriatric health care providers. Although current therapies for neurodegenerative diseases mainly offer symptomatic relief without slowing progression, the landscape is evolving. Biomarkers of pathology and neuroimaging have continued to develop, with a significant impact on diagnosis and treatment. These advances have helped to improve our knowledge of disease pathophysiology but also disease stages, guiding symptomatic monitoring, and possible therapeutic options at a pre-symptomatic stage. Key Messages Neurological disorders are a leading cause of major disability and dependency in the elderly, underscoring the need for expertise in geriatric neurology for effective clinical care of this population. Although current therapies for neurodegenerative diseases primarily provide symptomatic relief without slowing disease progression, advancements in biomarkers and neuroimaging are significantly evolving. These advancements enhance our understanding of disease pathophysiology and stages, guiding symptomatic monitoring and potential therapeutic options at a pre-symptomatic stage. As knowledge about age-associated conditions is steadily rising and geriatric medicine gains further recognition, this article argues for a new focus on the role of neurologists in geriatric medicine, emphasizing the importance of integrating current research and collaborative care approaches in the management of elderly patients.

Admission characteristics of patients with short term hospitalization

BackgroundSheba Medical Center (SMC) is the largest hospital in Israel and has been coping with a steady increase in total Emergency Department (ED) visits. Over 140,000 patients arrive at the SMC's ED every year. Of those, 19% are admitted to the medical wards. Some are very short hospitalizations (one night or less). This puts a heavy burden on the medical wards. We aimed to identify the characteristics of short hospitalizations.MethodsWe retrospectively retrieved data of consecutive adult patients admitted to our hospital during January 1, 2013, to December 31, 2019. We limited the cohort to patients who were admitted to the medical wards. We divided the study group into those with short, those with non-short hospitalization and those who were discharged from the ED.ResultsOut of 133,126 admissions, 59,994 (45.0%) were hospitalized for short term. Patients in the short hospitalization group were younger and had fewer comorbidities. The highest rate of short hospitalization was recorded during night shifts (58.4%) and the rate of short hospitalization was associated with the ED daily patient load (r = 0.35, p < 0.001). The likelihood of having a short hospitalization was most prominent in patients with suicide attempt (80.0% of those admitted for this complaint had a short hospitalization), followed by hypertension (68.6%). However, these complaints accounted for only 0.7% of the total number of short hospitalizations. Cardiac and neurological complaints however, made up 27.4% of the short hospitalizations. The 30-days mortality rate was 7.0% in the non-short hospitalization group, 4.3% in the short hospitalization group and 0.9% in those who were discharged from the ED.ConclusionsShort hospitalizations in medical wards have special characteristics that may render them predictable. Increasing the rate of treating personnel per patient during peak hours and referring subsets of patients with cardiac and neurological complaints to ED-associated short term observation units may decrease short admissions to medical departments.

Myxomatous cause of multiple intracranial aneurysms and cognitive decline: a case report

BackgroundThe occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature.Case presentationA young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma.ConclusionIntracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical.Learning PointsIntracranial aneurysms are rare complications of cardiac myxoma that may present before, concurrent or many years after diagnosis of the myxoma.Special attention must be given to nonspecific neurological complaints with a low threshold for neuroimaging in those with a prior history of cardiac myxoma.Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-up including conventional angiography and/or magnetic resonance imaging is critical.

The Multiple Sclerosis Prodrome in a Retrospective Pediatric Cohort

BackgroundEvidence suggests a prodromal phase in multiple sclerosis (MS), with increased health care use preceding the first demyelinating event (FDE). Although prior studies have explored this in adults, limited data exist for pediatric cases. We aimed to analyze health care utilization and prodromal symptoms in the two years before FDE in patients with pediatric-onset MS (POMS). MethodsFrom 122 patients at the Pediatric Multiple Sclerosis & Demyelinating Diseases Center at Washington University School of Medicine from 2011 to 2021, 37 POMS cases were identified. Of these, 21 with at least two years of records preceding FDE were included. Retrospective analysis covered symptoms and health care utilization in the two-year period before FDE, including ambulatory visits, hospital admissions, and office calls. ResultsPatients showed increased health care utilization in the year preceding FDE (period B; 96 interactions) compared with the prior year (period A; 77 interactions) and an increase in the percentage of neurology-related encounters (P < 0.001). There was an increase in all office calls from period A to period B (P = 0.01). Neurological complaints included headaches (28.6%), visual (19.0%), sensory (14.3%), and balance (14.3%) in the two years before FDE, and 28.6% of patients presented for psychiatric complaints. Common non-neurological complaints included infection, dermatologic, and musculoskeletal issues and injury. ConclusionsOur POMS cohort showed increased health care use before FDE, consistent with population-based data. This study emphasizes diverse symptoms in prodromal POMS, with headaches being the most common neurological symptom in the two-year period before FDE.

Neurological long-term consequences of COVID-19

The COVID-19 pandemic faced the public health sector with unprecedented challenges. While the immediate impact on society seems to diminish, reports of long-term health consequences persist. Among the most frequently reported symptoms are neurological complaints such as persistent fatigue and cognitive impairments. Scientific understanding is evolving rapidly, and first therapeutic approaches are emerging. However, many questions still remain unanswered.

Mode of Transport and Patient Status Upon Arrival at a Tertiary Pediatric Emergency Department in a Developing Country: A Prospective Observational Study.

Introduction In children with acute illness or injury, timely access to healthcare is crucial for optimal outcomes, including early identification, prompt stabilization, and appropriate referral. Prehospital transport practices often represent a weak link in the system and are frequently underreported. Enhancing these practices could greatly benefit pediatric care. This study aims to analyze the mode of transport and condition upon arrival of children at our hospital's pediatric emergency department. Methods This hospital-based prospective observational study was conducted from August 2019 to March 2020. Data on referral status, mode of transport, vital parameters at admission, and final outcomes in terms of survival were collected prospectively from patient admission records. Results Out of 1,658 children, 1,326 (80%) were referred from another health facility. Among these, only 10.8% received prior notification about their arrival. The most common mode of transport was a bus (39.3%), followed by locally available ambulances (24.4%), two-wheelers (15.6%), and cars (10.9%). In terms of medical conditions, 47.5% of the children had respiratory infections, 15.8% had renal ailments, and 14.1% had neurological complaints. Upon arrival, 1,214 (73.2%) were in stable condition, while 444 (26.8%) were unstable. Common alterations in vital parameters included hypothermia (16.6%), SpO2 <92% (9.9%), abnormal heart rate (32.5%), and abnormal respiratory rate (56%). Additionally, 111 (6.6%) children required CPR upon arrival. Conclusions The data highlights the need for improvements in our referral systems and the modes of transport for sick children within our population.

Definitions and symptoms of the post-COVID syndrome: an updated systematic umbrella review.

Post-COVID syndrome (PCS) describes a persistent complex of symptoms following a COVID-19 episode, lasting at least 4 to 12 weeks, depending on the specific criteria used for its definition. It is often associated with moderate to severe impairments of daily life and represents a major burden for many people worldwide. However, especially during the first two years of the COVID-19 pandemic, therapeutic and diagnostic uncertainties were prominent due to the novelty of the disease and non-specific definitions that overlooked functional deficits and lacked objective assessment. The present work comprehensively examines the status of PCS definitions as depicted in recent reviews and meta-analyses, alongside exploring associated symptoms and functional impairments. We searched the database Pubmed for reviews and meta-analysis evaluating PCS in the period between May 31, 2022, to December 31, 2023. Out of 95 studies, 33 were selected for inclusion in our analyses. Furthermore, we extended upon prior research by systematically recording the symptoms linked with PCS as identified in the studies. We found that fatigue, neurological complaints, and exercise intolerance were the most frequently reported symptoms. In conclusion, over the past eighteen months, there has been a notable increase in quantity and quality of research studies on PCS. However, there still remains a clear need for improvement, particularly with regard to the definition of the symptoms necessary for diagnosing this syndrome. Enhancing this aspect will render future research more comparable and precise, thereby advancing and understanding PCS.

The Low Back Pain - Looking For a Physiotherapeutic Approach

BACKGROUND: Low back pain (LBP) is one of the most common neurological complaints. It affects young people but has a slow progression even at a later age. LBP is a condition with a rich clinical picture – pain, severely limited range of motion in the spinal column (especially in the area of the L4-L5 segment) and sacro-iliac joints, difficulty walking. Physiotherapy has an essential role in maintaining the general condition and improving the quality of life for this contingent of patients. AIM: The aim of the present study is to create and approve a physiotherapy methodology for pain reduction in patients diagnosed by a neurologist – radiculitis of the lumbo-sacral plexus. METHODS: 20 clinically proven patients divided into two groups were included in the study. After signing informed consent declarations and assessment of anthropometric data (age, height, and weight), the subjects were evaluated with neurological tests such as Lasegue test and dolorimetry. Results were also reported on the Barthel index scale. RESULTS: The dynamics of dolorimetry results, quality of life, and mobility in the spine area (especially the lumbar segment) were monitored in the two studied groups, with the results in the experimental group demonstrating better values (p &lt; 0.0001). CONCLUSION: There is no unified system for pain reduction in patients with LBP. As a result of applied physiotherapy, including modern techniques for myofascial massage, a faster increase in joint mobility in the area of the spine and sacroiliac joints, an improvement in muscle strength and, above all, a reduction in pain symptoms were found.

Biallelic NDC1 variants that interfere with ALADIN binding are associated with neuropathy and triple A-like syndrome

Nuclear pore complexes (NPC) regulate nucleocytoplasmic transport and are anchored in the nuclear envelope by the transmembrane nucleoporin NDC1. NDC1 is essential for post-mitotic NPC assembly and the recruitment of ALADIN to the nuclear envelope. While no human disorder has been associated to one of the three transmembrane nucleoporins, biallelic variants in AAAS, encoding ALADIN, cause Triple-A syndrome (Allgrove syndrome). Triple A syndrome, characterized by alacrima, achalasia and adrenal insufficiency, often includes progressive demyelinating polyneuropathy and other neurological complaints. In this report, diagnostic exome and/or RNA-sequencing was performed in 7 individuals from 4 unrelated consanguineous families with AAAS negative triple A syndrome. Molecular and clinical studies followed to elucidate the pathogenic mechanism. The affected individuals presented with intellectual disability, motor impairment, severe demyelinating with secondary axonal polyneuropathy, alacrima and achalasia.. None of the affected individuals has adrenal insufficiency. All individuals presented with biallelic NDC1 in-frame deletions or missense variants, that affect amino acids and protein domains required for ALADIN binding. No other significant variants associated with the phenotypic features were reported. Skin fibroblasts derived from affected individuals show decreased recruitment of ALADIN to the NE and decreased post-mitotic NPC insertion, confirming pathogenicity of the variants. Taken together, our results implicate biallelic NDC1 variants in the pathogenesis of polyneuropathy and a Triple-A-like disorder without adrenal insufficiency, by interfering with physiological NDC1 functions, including the recruitment of ALADIN to the NPC.

Primary care provider approach to patients with neurologic complaints 1

Primary care provider approach to patients with neurologic complaints 1

Primary care provider approach to patients with neurologic complaints 2

Primary care provider approach to patients with neurologic complaints 2

Increased Prevalence of Antibodies to Hepatitis E Virus in Patients with Neurocysticercosis.

We explored the association between serological status for hepatitis E and neurocysticercosis (NCC) in neurologic patients attending a national neurological referral center in Lima, Perú, between the years 2008 and 2012. Anti-hepatitis E antibodies were evaluated in patients with and without NCC, and a control group of rural general population. Anti-hepatitis E IgG was found in 23.8% of patients with NCC, compared with 14.3% in subjects without NCC from a general rural population (P = 0.023) and 14.4% in subjects with neurological complaints without NCC (P = 0.027). Seropositive patients had a median age of 44 years compared with 30 years in seronegative patients (P <0.001). No significant differences in sex, region of residence, or liver enzyme values were found. Seropositivity to hepatitis E was frequent in this Peruvian population and higher in patients with NCC, suggesting shared common routes of infection.

Evaluation of neuroimaging findings in children who admitted to pediatric emergency clinic with acute neurologic complaints

Aim: Acute neurological complaints are one of the reasons why children present to pediatric emergency departments. Neuro-imaging techniques gain more importance in children since physical examination and anamnesis do not provide sufficient information due to insufficient cooperation. We aimed to determine the distribution of patients who applied to the pediatric emergency department with non-traumatic acute neurological complaints and underwent neu-roimaging, and the clinical benefit of neuroimaging in these patients. Methods: The information and records of the patients who applied to the Konya City Hospital Pediatric Emergency Clinic between January 1 and October 1, 2022, due to acute neurological complaints and underwent neuroimaging were retrieved and analyzed retrospectively. Acute neurological complaints of the patients were classified according to the International Classifi-cation of Diseases-10 diagnostic coding. Results: This study included 180 (50.5% male) patients. The median age of the patients was 120 (interquartile range: 45-180) months. Afebrile convulsion was the most common reason for admission in 69 patients (38.3%). Cranial computed tomography (CCT) was performed in all 180 patients. Of the patients, 68 (37.8%) only underwent CCT scan, while 90 (50%) had diffusion magnetic resonance imaging (MRI), 20 (11.1%) had brain+diffusion MRI, and 2 (1.1%) had brain+diffusion+spinal MRI. Neuroimaging abnormalities were statistically higher in patients with abnormal physical examination findings than in patients with normal physical examination findings (p&lt;0.001). Conclusion: Neuroimaging results are mostly normal even in the presence of symptoms such as seizures, headaches, and impaired consciousness. Therefore, neuroimaging should be planned by considering not only the acute neurological complaint on admission but also the physical examination findings.

Profile of Multisystem Inflammatory Syndrome in Children (MIS-C) in Infants in North India during the Second Wave of SARS-CoV-2 Pandemic

Abstract Background: Multisystem inflammatory syndrome in children (MIS-C) secondary to severe acute respiratory syndrome coronavirus-2 has affected not only older children, adolescents, and adults but also infants, more so during the second wave of the global pandemic. Materials and Methods: All sequentially admitted infants hospitalized during 6 months who fulfilled the World Health Organization criteria for MIS-C or American Heart Association 2017 criteria for Kawasaki disease (KD) (and positive coronavirus disease-2019 [COVID-19] serology) were included in the present study. Results: A total of 19 infants were studied. Thirteen (68.3%) had evidence of recent COVID-19 infection. The median age of presentation was 2 months (interquartile range 25–75th, 0.5–3). The most common presenting symptoms were fever (68.4%), gastrointestinal complaints (63.1%), and edema (36.8%). Other predominant signs were shock (78.9%), myocarditis (52.6%), and neurological complaints (26.3%). Incomplete KD was present in 21% of patients. Elevated C-reactive protein, ferritin, D-Dimer, N-terminal prohormone of brain natriuretic peptide, and reduced fibrinogen were markers of severe illness. All subjects received intravenous immunoglobulin (IVIG) (100%), 31.5% received a second dose of IVIG, and 63.1% received pulse intravenous methylprednisolone. A total of 5 (26.3%) died as a result of the disease process. Conclusion: The spectrum of MIS-C in infants can be varied and is different from older children. A high index of suspicion is therefore needed in infants who present with critical illness and do not respond appropriately to conventional antibiotics and supportive care. The addition of IVIG and corticosteroids to the treatment regimen leads to a favorable outcome.

Peduncular Hallucinosis: Clinical characteristics, etiology, and a case report

IntroductionVisual hallucinations are a relatively common neurological complaint. Peduncular hallucinosis (PH) stands out as a distinct entity, characterized by complex visual hallucinations resulting from structural lesions in the brainstem or diencephalon.ObjectivesWe aim to provide an overview of the clinical features, etiological factors, and management strategies associated with PH, incorporating a unique case study.MethodsClinical case report and brief literature review.ResultsClinical Characteristics: PH is marked by detailed, colorful, vivid, and occasionally emotionally charged visual hallucinations. These hallucinations encompass people, animals, or objects and may be mistaken for reality. While primarily visual, they may occasionally involve other sensory modalities. Crucially, patients with PH maintain insight, distinguishing it from primary psychotic disorders.Etiological Factors: PH is most commonly associated with structural brainstem lesions, particularly in the midbrain. Potential instigators encompass ischemic strokes, vascular anomalies, tumors and infections. Disruption of the reticular activating system in the brainstem is implicated in the pathogenesis. Advanced imaging techniques have unveiled cases with subtle presentations, broadening our comprehension of PH.Pathogenesis: PH may involve the disturbance of serotonergic inhibitory pathways and the reticular activating system. A plausible link with hypnagogic hallucinations hints at a mechanism related to rapid REM sleep transitions.Case Report: Mr. J., a 30-year-old patient, suffered recurrent mesencephalic strokes attributed to Sneddon’s syndrome, ADA-2 deficiency, and protein C deficiency, leading to malacic lesions in the hemimesencephalon and right hemipons. He experienced complex visual hallucinations, primarily geometric patterns and animals, mainly at night. Importantly, he maintained insight into their hallucinatory nature. Mr. J. also had diplopia, visual impairment, recurrent headaches, and left hemiparesis.Reactive anxiety and depression due to functional loss followed his recurrent strokes. Initially, antipsychotics were used to manage sensory-perceptual disturbances, but were later discontinued due to reduced interference with daily functioning. Antidepressant and psychological therapy was continued throughout the follow-up to address mood symptoms.Conclusions Peduncular hallucinosis is an intriguing phenomenon characterized by complex visual hallucinations. Understanding its clinical features, etiology, and possible mechanisms is essential for accurate diagnosis and management. This case report emphasizes PH’s clinical aspects and the importance of a multidisciplinary approach, including pharmacological intervention and psychological support. Understanding its features, causes, and management is essential for accurate care. Further research is needed to improve our comprehension and optimize treatment strategies.Disclosure of InterestNone Declared

Clinical features of post-COVID syndrome in patients with carbohydrate metabolism disorders

Objective: clinical characteristics of patients with carbohydrate metabolism disorders (CDM) in the post-COVID period. Material and methods. 72 people with CDM in the post-COVID period were examined. Results. When detailing complaints, the incidence of respiratory symptoms in patients with impaired glucose tolerance (IGT) and diabetes mellitus (DM) was comparable. In both groups, nonspecific (general weakness) and neurological (memory deterioration, sleep disturbances, decreased vital activity) symptoms predominated. The development of NUD in the post-COVID period was facilitated by such risk factors as age &gt;45 years, body mass index &gt;25 kg/m2, family history of type 2 diabetes, hypertension. The most common concomitant diseases were overweight and obesity — in 64 (88.9%) patients, dyslipidemia — in 44 (61.1%), hypertension — in 32 (44.4%). In the group of patients with IGT, the frequency of re-infection with SARS-CoV-2 was higher compared to the group of patients with diabetes, and there was a tendency for the course to become more severe with re-infection. Conclusion. In the post-COVID period, patients with IGT and diabetes are more likely to have nonspecific and neurological complaints, while identified NDEs can aggravate the course of concomitant diseases and lead to re-infection with SARS-CoV-2.

Microfluidic Isolation of Neuronal-Enriched Extracellular Vesicles Shows Distinct and Common Neurological Proteins in Long COVID, HIV Infection and Alzheimer's Disease.

Long COVID (LongC) is associated with a myriad of symptoms including cognitive impairment. We reported at the beginning of the COVID-19 pandemic that neuronal-enriched or L1CAM+ extracellular vesicles (nEVs) from people with LongC contained proteins associated with Alzheimer's disease (AD). Since that time, a subset of people with prior COVID infection continue to report neurological problems more than three months after infection. Blood markers to better characterize LongC are elusive. To further identify neuronal proteins associated with LongC, we maximized the number of nEVs isolated from plasma by developing a hybrid EV Microfluidic Affinity Purification (EV-MAP) technique. We isolated nEVs from people with LongC and neurological complaints, AD, and HIV infection with mild cognitive impairment. Using the OLINK platform that assesses 384 neurological proteins, we identified 11 significant proteins increased in LongC and 2 decreased (BST1, GGT1). Fourteen proteins were increased in AD and forty proteins associated with HIV cognitive impairment were elevated with one decreased (IVD). One common protein (BST1) was decreased in LongC and increased in HIV. Six proteins (MIF, ENO1, MESD, NUDT5, TNFSF14 and FYB1) were expressed in both LongC and AD and no proteins were common to HIV and AD. This study begins to identify differences and similarities in the neuronal response to LongC versus AD and HIV infection.

Risk Factors for Cognitive Impairment in Multiple Sclerosis Patients

Cognitive impairment is one of the most significant burdens among the many neurological complaints in multiple sclerosis patients. Cognitive deficits negatively impact these patients’ quality of life, leading to partial or total loss of several mental functions, such as learning, memory, perception, or problem-solving. While the precise mechanisms involved in the onset and evolution of cognitive decline remain unknown, several risk factors have been associated with intellectual disability. With increasing data on this topic in recent years, the main aim of this review is to summarize the most relevant risk factors correlated with cognitive impairment in multiple sclerosis patients. Firstly, the authors demonstrate the importance of mental disability based on epidemiological data from multiple sclerosis patient cohorts. Subsequently, the intensely debated major risk factors for cognitive decline are discussed, with brief insights into the pathophysiology and possible underlying mechanisms. Finally, the authors describe the impact of medication on cognitive impairment in multiple sclerosis patients, highlighting the main research directions for future studies.

Hippocampal neurometabolic and structural changes from pre-to post-COVID-19: A case-series study

BackgroundNeurological complications of the COVID-19 infection may be caused in part by local neurochemical and structural abnormalities that could not be detected during routine medical examinations. We examined within subject neurometabolic and structural brain alterations from pre-to post-COVID-19 in the hippocampal region of three elderly individuals (aged 63–68 years) who had a COVID-19 infection with mild symptoms. Patients were participating in an interventional study in which they were closely monitored at the time they were diagnosed with COVID-19. Patients 1 and 2 just completed 18–20 resistance training sessions prior to their diagnosis. Patient 3 was assigned to a non-training condition in the same study. MethodsWhole brain magnetic resonance imaging (MRI) images and proton magnetic resonance spectroscopy (1H-MRS) of the left hippocampus were collected before and after infection. Structural and spectroscopic imaging measures post-COVID-19 were contrasted to the pre-COVID-19 measures and were compared with values for Minimal Detectable Change at 95% (MDC95) and 90% (MDC90) confidence from a group of six elderly (aged 60–79 years) without COVID-19 that participated in the same study. ResultsAfter SARS-COV-2 infection, we observed a reduction of glutamate-glutamine (Glx) in Patients 1 and 2 (≥ 42.0%) and elevation of myo-inositol (mIns) and N-acetyl-aspartate (NAA) in Patient 3 (≥ 36.4%); all > MDC90. MRI findings showed increased (Patients 1 and 2) or unchanged (Patient 3) hippocampal volume. ConclusionsOverall, findings from this exploratory study suggest that mild COVID-19 infection could be associated with development of local neuroinflammation and reduced glutamate levels in the hippocampus. Our 1H-MRS findings may have clinical value for explaining chronic neurological and psychological complaints in COVID-19 long-haulers.

Trends in non-focal neurological chief complaints and CT angiography utilization among adults in the emergency department.

Prudent imaging use is essential for cost reduction and efficient patient triage. Recent efforts have focused on head and neck CTA in patients with emergent concerns for non-focal neurological complaints, but have failed to demonstrate whether increases in utilization have resulted in better care.The objective of this study was to examine trends in head and neck CTA ordering and determine whether a correlation exists between imaging utilization and positivity rates. This is a single-center retrospective observational study at a quaternary referral center. This study includes patients presenting with headache and/or dizziness to the emergency department between January 2017 and December 2021. Patients who received a head and neck CTA were compared to those who did not. The main outcomes included annual head and neck CTA utilization and positivity rates, defined as the percent of scans with attributable acute pathologies. Among 24,892 emergency department visits, 2264 (9.1%) underwent head and neck CTA imaging. The percentage of patients who received a scan over the study period increased from 7.89% (422/5351) in 2017 to 13.24% (662/5001) in 2021, representing a 67.4% increase from baseline (OR, 1.14; 95% CI 1.11-1.18; P < .001). The positivity rate, or the percentage of scans ordered that revealed attributable acute pathology, dropped from 16.8% (71/422) in 2017 to 10.4% (69/662) in 2021 (OR, 0.86; 95% CI 0.79-0.94; P = .001), a 38% reduction in positive examinations. Throughout the study period, there was a 67.4% increase in head and neck CTA ordering with a concomitant 38.1% decrease in positivity rate.