Neurological Syndrome Research Articles

Infectious Diseases.

Microglia, brain-resident innate immune cells, have been extensively studied in neurodegenerative contexts like Alzheimer's disease. The Coronavirus disease 2019 (COVID-19) pandemic highlighted how peripheral infection and inflammation can be detrimental to the neuroimmune milieu and initiate microgliosis driven by peripheral inflammation. Microglia can remain deleterious to brain health by sustaining inflammation in the central nervous system even after the clearance of the original immunogenic agents. In this chapter, we discuss how pulmonary infection with Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) can lead to neurovascular and neuroimmune inflammation causing the neurological syndrome of post-acute sequelae of COVID-19 (PASC). Further, we incorporate lessons from the Human Immunodeficiency Virus' (HIV's) effects on microglial functioning in the era of combined antiretroviral therapies (cART) that contribute to HIV-1 associated neurocognitive disorders (HAND). Finally, we describe roles for mixed lineage kinase 3 (MLK3) and leucine-rich repeat kinase (LRRK2) as key regulators of multiple inflammatory and apoptotic pathways important to the pathogenesis of PASC and HAND. Inhibition of these pathways provides a therapeutically synergistic method of treating both PASC and HAND.

Cancer-associated neuromyelitis optica spectrum disorder: a case report with literature review.

Neuromyelitis optica spectrum disorders (NMOSD) is one of autoimmune inflammatory diseases and is characterized by area postrema syndrome, brainstem syndrome, optic neuritis, and/or myelitis. Typical myelitis is longitudinally extended transverse myelitis (LETM) which extends over three vertebral bodies. Several previous case reports have suggested association between cancer and NMOSD. A 50-year-old woman had breast cancer and underwent mastectomy and, 10 months later, she had developed acutely progressive dysbasia. Spine MRI showed LETM in 13 vertebrae length and blood test revealed positive anti-aquaporin 4 (anti-AQP4) antibody based on enzyme-linked immunosorbent assay with index of over 40. She was treated by intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulin, followed by oral prednisolone. The condition had mostly recovered after the treatment. A small population of NMOSD has the aspect of paraneoplastic neurological syndrome. The age of onset in patients with cancer-associated NMOSD tends to be higher than that in individuals with NMOSD due to any causes of NMOSD.

Evaluation of potential prevalence of onconeural antibodies in women with breast cancer.

Aim: To analyse onconeural antibodies in the blood serum of breast cancer patients without neurological symptoms.. Materials and Methods: The study included 48 women with breast cancer. Paraneoplastic Neurologic Syndromes 12 Ag (IgG) Euroline by EUROIMMUN test was used to determine onconeural antibodies: anti-Hu, anti-Yo, anti-Ri, anti-CV2, anti-Ma/anti-Ta, anti-amphiphysin, anti-recoverin, anti-SOX1, anti-tytin, anti-zic4, anti-GAD65 and anti-Tr (DNER). Results: The conducted analysis revealed the presence of onconeural antibodies such as: anti-recoverin, anti-CV2, anti-Zic4, anti-SOX1, anti-MA2/Ta and antititin in blood serum of women with breast cancer. Conclusions: Further analysis may allow the assessment of the possible clinical usefulness of these determinations.

Paraneoplastic syndromes in patients with melanoma.

Paraneoplastic syndromes are a group of rare clinical conditions characterized by a diverse array of systemic manifestations that arise in association with malignant tumours, often due to the production of bioactive substances by the tumour or an autoimmune response to the tumour. Melanoma, a malignant skin neoplasm originating from melanocytes, has been associated with various paraneoplastic syndromes. This paper provides an overview of the key paraneoplastic syndromes observed in patients with melanoma. Paraneoplastic syndromes in melanoma can manifest with neurological, dermatological, endocrine, haematological, and rheumatological symptoms, among others. Melanoma-associated retinopathy was the most reported paraneoplastic syndrome; this entity is characterized by a spectrum of retinal abnormalities. Paraneoplastic neurological syndromes, such as paraneoplastic encephalitis and paraneoplastic cerebellar degeneration, are among the most frequently reported. The pathophysiology of paraneoplastic syndromes often involves the production of autoantibodies against neuronal or tumour antigens, immune-mediated reactions, or the release of cytokines and growth factors from the tumour. Management strategies for paraneoplastic syndromes associated with melanoma primarily focus on treating the underlying malignancy, which may lead to resolution or improvement of the paraneoplastic manifestations. Immune-modulating therapies, including corticosteroids, intravenous immunoglobulins, and plasmapheresis, may be considered in selected cases to ameliorate symptoms and suppress the autoimmune response. In conclusion, paraneoplastic syndromes in patients with melanoma are a complex and diverse group of clinical entities with a broad range of presentations. Further research is needed to enhance our understanding of the mechanisms and therapeutic options for paraneoplastic syndromes associated with melanoma.

Neuromodulatory pharmacotherapy individualization in prolonged and chronic consciousness disorders after severe traumatic brain injury

One of the most probable causes of effective therapy for post-comatose disorders of consciousness is the lack of individualization of drug prescriptions. In this observational study, we analyzed 48 courses of neuromodulatory therapy in 28 patients with prolonged and chronic disorders of consciousness following severe traumatic brain injury. Comparison of 24 effective and 24 ineffective courses demonstrated higher effectiveness of pharmacotherapy through its individualization, i.e. the choice of a drug whose neuromodulatory spectrum would correspond to neurological syndromes of neurotransmitter dysfunction. In this approach, 74% of therapy courses were effective while opposite management resulted only 34% of effective courses.

“Migrânea” or “enxaqueca”: A historical and semantic review

IntroductionHeadache is as old as the emergence of man on earth. A classification for headaches has been suggested for many centuries. After the invention of writing, numerous words were created to designate different types of headache.ObjectiveThe objective of this review was to discuss the historical and etymological aspects of the terms “migrânea” and “enxaqueca”.MethodsThis study was an integrative review using articles with historical data on the etymology of the terms “migrânea” and “enxaqueca” and their evolution over the years.ResultsThe terms “migrânea” and “enxaqueca” have Greek and Arabic origins, respectively. Both describe a neurological syndrome characterized by headache and other associated symptoms. Usually, sufferers of this disease are more familiar with the term “enxaqueca” and confuse it with headache, while health professionals prefer the term “migrânea”. ConclusionsAfter so many years that the term "migrânea" has been used, it would be a step backwards to use the term "enxaqueca" again, especially because "migrânea" has been adopted by young neurologists, including those from other specialties.

Paraneoplastic Neurological Syndrome as an Initial Presentation of Occult Breast Cancer: A Case Report

Paraneoplastic Neurological Syndrome as an Initial Presentation of Occult Breast Cancer: A Case Report

Mesenchymal Stem Cell-Based Therapies in the Post-Acute Neurological COVID Syndrome: Current Landscape and Opportunities.

One of the main concerns related to SARS-CoV-2 infection is the symptoms that could be developed by survivors, known as long COVID, a syndrome characterized by persistent symptoms beyond the acute phase of the infection. This syndrome has emerged as a complex and debilitating condition with a diverse range of manifestations affecting multiple organ systems. It is increasingly recognized for affecting the Central Nervous System, in which one of the most prevalent manifestations is cognitive impairment. The search for effective therapeutic interventions has led to growing interest in Mesenchymal Stem Cell (MSC)-based therapies due to their immunomodulatory, anti-inflammatory, and tissue regenerative properties. This review provides a comprehensive analysis of the current understanding and potential applications of MSC-based interventions in the context of post-acute neurological COVID-19 syndrome, exploring the underlying mechanisms by which MSCs exert their effects on neuroinflammation, neuroprotection, and neural tissue repair. Moreover, we discuss the challenges and considerations specific to employing MSC-based therapies, including optimal delivery methods, and functional treatment enhancements.

“Worse than hell”: Complex Neuraxial Lesions Resulting in Tetraplegia and Blindness after Polytrauma - Case presentation

Background. Lesions of the vertebral artery (VA) may develop spontaneously or as a result of severe traumatic cervico-cephalic injuries. Most frequent VA injuries (VAI) result from blunt trauma to the spine or may be due to penetrating lesions. VAI plays a significant role in the broader context of cervical spine trauma by providing insights into the vascular aspects of spinal cord injury (SCI). Upper cervical spine fractures and accompanying subluxation, as well as transverse process fractures extending into the artery bone foramen, are associated with an elevated risk of VAI. Clinical case. A 63-year-old female patient with flaccid C4 AIS-A quadriplegia (global motor score 3/100), vertebral myelopathy, neurogenic bladder, sacral pressure sore, and blindness was transferred from the spinal neurosurgical department. The patient fell from the same level and suffered a mild brain concussion and, apparently, a minor cervical SCI on October 1, 2022. She was asymptomatic, then quickly became tetraplegic, and then blindness added on in a few days. She was operated on on October 7, 2022, for a C6 vertebral body fracture and a C5-6 dislocation. The surgical protocol consisted of anterior spinal cord decompression, dislocation reduction, and mixed anterior fusion with bone grafts and fixation screws. Following the traumatic event, a bilateral posterior cerebral artery (PCA) stroke subsequently produced blindness and partial optic atrophy in both eyes. Serial clinical and imaging examinations confirmed the diagnosis: a subacute bilateral occipital stroke and a chronic lacunar lesion in the right thalamus associated with a severe spinal cord lesion. Anticoagulation has partially improved the neurological outcomes of stroke in the PCA territory. Ethical considerations. The patient's next of kin has given written consent to the case study and to use the radiological images related to the case for academic purposes. The personal identity data was anonymized. The presentation of this clinical case has the approval of the ethics commission of TEHBA (no. 40205/01.09.2023). Discussion. The clinical example is notable for the concurrent development of two severely devastating neurological syndromes, quadriplegia, and blindness, which occurred after an initially minor cervical trauma and progressed gradually over a few days. VA lesions after cervical trauma are considered rare, and the diagnosis is difficult because the vast majority of individuals do not exhibit cerebral neurological symptoms (due to the collateral compensatory blood supply from the circle of Willis). Most of the patients with bilateral or dominant VA occlusions are symptomatic, with rapid (and possibly fatal) ischemic damage to the encephalon, cerebellum, or brainstem. The detection and tracking of evolutionary tendencies required a series of clinical tests, including fundoscopy, and imaging procedures, including native CT, MRI, and MR angiography scans of the brain and spine. Conclusions. Although VAI is a rare complication, in every polytrauma patient with head and neck trauma, VA damage should be suspected. Careful clinical and imaging monitoring through detailed serial imaging procedures must be performed for every person with severe cranio-cervical trauma. The clinical example emphasizes the importance of the interprofessional team's participation in the patient's care.

Post-malaria neurological syndrome (PMNS): a rare case report with brain biopsy findings

Post-malaria neurological syndrome (PMNS) is a rare, self-limiting condition that presents with a wide range of neurological manifestations after clearance of malarial infection, especially \U0001d617\U0001d62d\U0001d622\U0001d634\U0001d62e\U0001d630\U0001d625\U0001d62a\U0001d636\U0001d62e f\U0001d622\U0001d62d\U0001d624\U0001d62a\U0001d631\U0001d622\U0001d633\U0001d636\U0001d62e, most patients recover without residual deficits. Here we present a case of a 29-year-old, male with a recent history of malaria treated successfully, who presented due to a generalized tonic-clonic seizure, without any other neurological symptoms, the examination and labs were unremarkable, he underwent a computer tomography (CT) scan and Magnetic resonant imaging (MRI) which both showed two areas of vasogenic edema involving the subcortical white matter of left frontal and right posterior parasagittal regions, all autoimmune screens, infection workup from blood and CSF were negative, he underwent a brain biopsy that showed intense perivascular inflammation with neuronal loss and gliosis, findings are nonspecific and can be seen in a variety of condition. The patient’s condition improved, and he was discharged without any complications.

ELV-N34 or RvD6-isomer Counteracts Damaging Astrocyte Phenotypes Protecting the Brain from Omicron BA.5 Sequelae

Neurodegenerative diseases induce astrocyte phenotypes that trigger inflammation and cell damage. This cell induction also takes place in post-acute neurological syndrome from SARS-CoV-2 infection. We found that the secretome from Omicron BA.5 infected human nasal epithelial or human lung cells induced the activation of human astrocytes to a reactive pro-inflammatory phenotype as defined by nuclear translocation of NF-kB/p65. Remarkably, the secretome from these cells incubated with Elovanoid (ELV)-N34 or Resolvin D6 (RvD6)-isomer (500nM) did not trigger the formation of reactive astrocytes. One of the factors involved is CXCL1, secreted by Omicron BA.5-infected nasal epithelial cells. So, when CXCL1 was administered intranasally to mice along with Interferon type I, the infiltration of fluorescein indicated a permeabilization of the neurovascular unit. Astrocytes are close to this barrier and contribute to restricting the access of damaging molecules to the brain parenchyma. Together, these results point to a specific way of entry of chemokines and cytokines as part of the secretome from infected cells that may play a role in long COVID brain sequelae.

Overactivity of the Less Affected Side as a Possible Pattern of Asymmetry in Sitting in Patients Suffering from First-Time Ischemic Stroke-An Observational Study.

It has been observed that in some people in the acute phase of ischemic stroke (IS) there is a tendency to shift the body weight towards the side more affected by the disease and a tendency to spontaneous movements of the upper and/or lower limbs (not covered by the neurological syndrome). The purposes of this study were: to define the kind of behavior observed, and to select symptoms which can predict its occurrence. Participants (n = 222) hospitalized due to first-time IS were assigned to three groups. A: 78 patients with no lateralization of the neurological syndrome (lateralization of the neurological syndrome-LoNS); B: 109 patients with LoNS; O+ group: 35 patients, who at the beginning of hospitalization presented, apart from LoNS, characteristic motor symptoms performed by the less affected side. Patients underwent therapy depending on the neurological symptoms. If the patient showed potential symptoms of a new phenomenon, overactivity of the less affected side (OLAS), a trial therapy (focused on this behavior) was used to confirm it. The predictive symptoms, selected among these from the index day, for the occurrence of OLAS in sitting were distinguished: asymmetry in supine posture and simple, repetitive movements of the nonparetic upper extremity.

Role of NMDA Receptor in High-Pressure Neurological Syndrome and Hyperbaric Oxygen Toxicity.

Professional divers exposed to pressures greater than 11 ATA (1.1 MPa) may suffer from high-pressure neurological syndrome (HPNS). Divers who use closed-circuit breathing apparatus and patients and medical attendants undergoing hyperbaric oxygen therapy (HBOT) face the risk of CNS hyperbaric oxygen toxicity (HBOTx) at oxygen pressure above 2 ATA (0.2 MPa). Both syndromes are characterized by reversible CNS hyperexcitability, accompanied by cognitive and motor deficits, and N-methyl-D-aspartate receptor (NMDAR) plays a crucial role in provoking them. Various NMDAR subtypes respond differently under hyperbaric conditions. The augmented currents observed only in NMDAR containing GluN2A subunit increase glutamatergic synaptic activity and cause dendritic hyperexcitability and abnormal neuronal activity. Removal of the resting Zn2+ voltage-independent inhibition exerted by GluN2A present in the NMDAR is the major candidate for the mechanism underlying the increase in receptor conductance. Therefore, this process should be the main target for future research aiming at developing neuroprotection against HPNS and HBOTx.

Neurological syndromes as the first manifestation of SARS-COV-2 in patients hospitalized in a second level hospital

Neurological syndromes as the first manifestation of SARS-COV-2 in patients hospitalized in a second level hospital

Risk factor of suicidal thoughts in caregivers of dementia patients: a systematic review and meta‐analysis

AbstractBackgroundDementia is a neurologic syndrome that affects several domains of daily life. However it does not exclusively affect the patient, but relatives, friends and caregivers, who are people constantly in contact with the patient. Deterioration of cognition and daily life activities may affect mental health of the caregiver. In this systematic review, we collected evidence regarding risk factors of suicidal thoughts among caregivers of patients with dementia.MethodA search was carried out in PubMed, Scopus, and Web of Science up to January 2023. Observational studies that analyzed factors associated with suicidal thoughts in caregivers were selected and revised. Meta‐analyses were performed with R Studio.ResultFour studies were selected for this systematic review. Only one study assessed caregivers of dementia and non‐dementia patients. Total sample size was 2224. Mean age was approximately 60 years. We did not find significant differences between caregivers with and without suicidal thoughts in age, educational level, religious status, being a woman, being spouse or caring one year or more. However, we found that CES tool score for depression was higher in those caregivers who reported suicidal thoughts (MD: 8.03, 95% CI: 6.26‐9.80).ConclusionDepression is a risk factor of suicidal thoughts, however more efforts should be done to assess non‐typical risk factors of suicidal thoughts among caregivers. We highly recommend increasing the sample size for future studies.

Utility of the 2021 paraneoplastic neurologic syndromes diagnostic criteria

Utility of the 2021 paraneoplastic neurologic syndromes diagnostic criteria

Risk Factors Associated with Epilepsy Related to Cerebrovascular Disease: A Systematic Review and Meta-Analysis.

Stroke is one of the most frequent neurological syndromes in the adult population and the cause of 10% of all diagnosed epilepsies. It is attributed to the origin of up to 50% of them in adults >60 years of age. Although a few risk factors have been described and considered when modeling predictive tools, this aspect is still clinically complex. The objective of this study is to describe and compare predictor scales of post stroke epilepsy (PSE) in adult patients with better performance. A systematic review and meta-analysis were performed of studies published between 2010 and 2020 and found in PubMed, Scopus, EMBASE, LILACS, BVS, Google Scholar, and CENTRAL databases. Sixteen studies were included with a total of 298,694 patients with a diagnosis of stroke, 5590 presented late seizures (LS). Hemorrhage, cortical involvement, and early seizure were the elements most associated with the risk of presenting late seizures. The SeLECT score demonstrated a low risk of bias with a high predictive ability in patients with ischemic stroke (AUC: 0.77 [95% CI: 0.71-0.82]). In patients with hemorrhagic stroke, the CAVE score demonstrated adequate predictive ability (AUC: 0.81 [95% CI: 0.76-0.86]), but an uncertain risk of bias. Research has established risk factors for post ictal epilepsy; however, the numerous ways of assessing data in studies and the difference in their designs make the task of producing a predictive scale that covers the most important risk factors and is reliable for application in the clinical setting, regardless of stroke etiology, very arduous. Hemorrhage, cortical involvement, and early seizure are associated with an increased risk of post ictal epilepsy. Also, elements such as age, traditional vascular risk factors, and functional assessment failed to reflect statistical significance. Finally, further research is required to refine the available predictive tools.

Epidemiological analysis of paraneoplastic neurological syndromes and autoimmune encephalitides in Vilnius County, Lithuania

Epidemiological analysis of paraneoplastic neurological syndromes and autoimmune encephalitides in Vilnius County, Lithuania

Atypical neurological syndromes in anti-MA2 associated encephalitis: Two case reports

Atypical neurological syndromes in anti-MA2 associated encephalitis: Two case reports

Paraneoplastic Neurologic Syndromes.

Progress is ongoing in understanding paraneoplastic neurologic disorders, with new syndromes and antibodies being described and more detailed evidence available to guide workup for diagnosis and treatment to improve outcomes. Many excellent reviews have summarized the molecular features of different antibodies, but this article emphasizes the clinical features of each syndrome that may help guide initial diagnosis and treatment, which often should occur before an antibody or cancer is found to confirm the diagnosis. Recent findings include updated diagnostic criteria with validated sensitivity and specificity, discovery of novel antibodies, and clinical findings that increase the likelihood of an underlying paraneoplastic disorder. Suggestive syndromes that have been recently identified include faciobrachial dystonic seizures and pilomotor auras in anti-leucine-rich glioma inactivated protein 1 encephalitis, extreme delta brush on EEG in N-methyl-d-aspartate (NMDA)-receptor encephalitis, déjà vu aura in anti-glutamic acid decarboxylase 65 (GAD65) encephalitis, and sleep disturbances in several disorders. In addition, there is confirmed utility of brain positron emission tomography (PET) and CSF markers, including carcinoembryonic antigen and oligoclonal bands, as well as improved tests for the presence of leptomeningeal cancer cells in CSF. Associations of cancer immunotherapies with paraneoplastic syndromes and herpes simplex virus encephalitis (and COVID-19) with NMDA-receptor encephalitis have been described. All neurologists should be aware of advances regarding paraneoplastic neurologic syndromes, as patients can present with a wide variety of neurologic symptoms and earlier diagnosis and treatment can improve outcomes.