Neurological Signs Research Articles

Surgical strategies for hemorrhagic vestibular schwannoma with acute neurological decline: a case report with a literature review

Introduction and importance: Vestibular schwannomas (VSs) are benign tumors of cranial nerve VIII, comprising 8% of primary intracranial neoplasms. Hemorrhagic VSs, though rare, present unique clinical challenges due to their potential for rapid neurological decline. Case presentation: We present a case of a 68-year-old male with sudden severe headache, nausea, vomiting, and balance issues, initially diagnosed with a hematoma at the right cerebellopontine angle until an magnetic resonance imaging (MRI) scan verified a bleeding schwannoma. Due to deteriorating neurological status and signs of obstructive hydrocephalus on computed tomography (CT), urgent neurosurgical neuromonitoring, successfully managed the hemorrhagic VS, with postoperative recovery intervention required. Neurosurgical treatment, guided by intraoperative outcomes, restoring normal life. Urgent transfer to a medical center with a neurosurgical showing favorable outcomes. Clinical discussion: Cerebellopontine hematoma verified by CT mandates MRI to exclude tumorous bleeding, which is crucial in cases lacking prior MRI. Conclusion: Though rare, hemorrhagic VS must be considered in neurologically decompensated patients, especially with risk factors. Timely surgical intervention, despite precipitating a comatose state, can yield satisfactory results.

Respiratory Complications in the Inborn Errors of Metabolism

: Inborn Errors of Metabolism (IEMs) are a large heterogeneous group of monogenic disorders that affect specific metabolic pathways. Although the clinical picture is variable and shows a multisystemic impairment, most of these defects encompass neurologic symptoms and signs. The respiratory involvement may represent a late-onset feature of a complex multisystemic disease or the only manifestation of an underlying IEM. The severity of the respiratory disease can range from mild aspecific symptoms, such as tachypnea and respiratory distress in response to metabolic acidosis, to severe conditions, such as respiratory failure and restrictive disease. This review aims to offer an overview of the principal IEMs with neurologic and respiratory involvement, highlighting the significance of early recognition and multidisciplinary management for optimal patient care.

Investigating the Prevalence of Neurological Soft Signs in Children with Autism Spectrum Disorder and their Siblings: A Cross-Sectional Study.

Autism is determined by children's inability to communicate with others through language. More studies have shown that neurological soft signs (NSS) can be one of the symptoms of psychiatric disorders, including schizophrenia. However, complete and proven evidence regarding the role of NSS in the pathogenesis of autism has not been determined. For this purpose, this research investigated the prevalence of NSS in children with autism spectrum and their siblings and compared it with the control group. The current study was cross-sectional. In this study, thirty-two children aged 7-17 who had been referred to the pediatric psychiatry clinics of Imam Hossein Hospital and the Autism Charitable Association in Tehran, Iran, were entered; they were diagnosed with an autism disorder by a child and adolescent psychiatrist based on the DSM-5 diagnostic criteria. Furthermore, thirty-two siblings of children with autism in the age group of 7-17 years who did not have any neurological and mental disorders were included; thirty-two healthy individuals (controls) who did not have any disorders were evaluated with the K-SADS checklist. Gilliam Autism Rating Scale 3rd Edition (GARS-3) was also used to confirm the diagnosis and severity of the disease. The results showed that the incidence of NSS in the patient group was higher than in the other two groups, which was statistically significant (p<0.05). Furthermore, the results indicated that these signs had a high diagnostic value in identifying patients from healthy people. In general, using the NSS score in patients with autism can be considered a prediction factor compared to their siblings. In addition, the score had no effect on the prediction between sibling and control subjects.

Neurological Soft Signs in Type I Bipolar Disorder and Bipolar Spectrum Patients and Their Unaffected First-Degree Relatives: A Cross-Sectional Study.

This study aimed to compare neurological soft signs (NSSs) in type 1 bipolar disorder (BD), bipolar spectrum (BS) patients, and their unaffected first-degree relatives. This descriptive cross-sectional study involved participants referred to the Psychiatric Department of Imam Hossein Hospital. Five groups (n = 25): patients with type 1 BD, patients with BS, unaffected first-degree relatives of the two groups, and a control group were evaluated using the Neurological Evaluation Scale (NES). The analysis revealed that patients with bipolar I disorder had the highest NES scores, with significant group differences (F(4.120) = 10.36, p < 0.001). The Bonferroni correction identified bipolar I patients as the primary source of this difference, while other groups did not significantly differ. ANCOVA showed that age (F(1.123) = 3.92, p = 0.052) and gender (F(1.123) = 0.1, p = 0.75) had no significant influence on NES scores. However, all four NES subsets significantly contributed to the overall score, except for the sensory subset. Differences were significant between bipolar I patients and most other groups, except the BS group, which showed no significant differences from the rest. No correlation was found with age, gender, or age of disease onset. The higher NSS severity in type I BD compared to BS and control groups highlights its potential link to the genetic and neurodevelopmental differences in BD type I. Further research is recommended.

Higher Rate of Reinterventions After Transfemoral Carotid Artery Stenting in Symptomatic Patients: A Retrospective Stroke Center's Cohort Study between 2015-2024.

Carotid artery stenosis is a significant contributor to ischemic strokes, and its surgical management includes carotid artery endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and trans carotid artery revascularization (TCAR). CEA has traditionally been preferred, but TF-CAS and TCAR are also excellent alternative options if the anatomy of the vessels allows them. This study reports our short- and mid-term outcomes after carotid artery revascularization in symptomatic patients at a stroke center. This single-institution retrospective cohort study was conducted from 2015 to 2024. All patients with focal neurological symptoms attributable to ipsilateral carotid artery stenosis within 6 months before the intervention were included. Primary outcomes were stroke, myocardial infarction (MI), and death within 30 days. Secondary outcomes included mid-term stroke, MI, death, restenosis, and reinterventions. Statistical analyses were performed using R v 4.4.1, and Kaplan-Meier curves were used for sub-group analysis. A total of 183 interventions on 178 patients were analyzed (TF-CAS = 118, CEA = 55, and TCAR = 10), with a mean age of 71.5 ± 9.6 years. The cohort included 123 male (69.1%) and 55 female (30.9%) patients. Peripheral arterial disease (PAD) prevalence was higher in TCAR patients (30.0%) compared to CEA (5.5%) and TF-CAS (5.3%) (p = 0.04). TF-CAS patients had a higher rate of pre-operative stroke (68.6%) compared to CEA (50.9%) (p = 0.02); though there was no difference in stroke severity (NIHSS in TF-CAS: 6.8 ±7.2 vs CEA: 5.7 ± 7.1; p =0.86). CEA patients had a higher rate of TIAs (43.6%) than TF-CAS (25.0%) (p = 0.02); but their ABCD2 score did not differ (CEA 3.6 ± 1.6 vs. TF-CAS 3.4 ± 1.5, p = 0.92). Pre-operative amaurosis fugax rates were similar (TF-CAS:16.4% vs. CEA 14.4% p = 0.72) among groups. Carotid artery degree of stenosis measured by computed tomography angiography (CTA) was significantly higher in TF-CAS (75.1 ± 17.2) than in CEA (69.6 ± 18.3) (p = 0.01). A vulnerable plaque was found in 60% of CEA and 50% of TF-CAS patients (p = 0.42). TF-CAS had longer hospitalizations than CEA patients (TF-CAS median of 14.0 (IQR: 2.0-16.0) days vs. CEA median of 9.0 (IQR 2.0-15.0) days; p<0.01). Transient cranial nerve injuries occurred in 5.5% of CEA patients but none in TF-CAS patients (p = 0.03). Thirty-day combined ipsilateral stroke, MI and death were 0.0% for CEA and 5.0% for TF-CAS (p = 0.18). Two perioperative deaths occurred among TF-CAS patients, who were older than 70 years of age and with NIHSS of 19 and 8 on presentation. Mid-term follow-up was 1.2±1.4 years. Mid-term combined ipsilateral TIA, stroke, MI, and death were 21.8% for CEA and 22.9% for TF-CAS (p = 0.88). TF-CAS had a higher rate of restenosis (11.0%, p=0.01) and reintervention (12.7%, p< 0.01) compared to CEA. Reinterventions included cutting-balloon angioplasties, CEA, and TCAR. TF-CAS is associated with higher, but no significant perioperative mortality, particularly in patients over 70 years of age. Thirty-day and mid-term composite outcomes including ipsilateral stroke, MI, and death are similar in the CEA and TF-CAS groups. However, restenosis occurred more frequently in the TF-CAS group, leading to a higher rate of reintervention, the earliest occurring two months after initial intervention. Careful patient selection may mitigate the need for reinterventions in patients undergoing TF-CAS.

Resolution of Refractory Status Epilepticus With Ketamine Without Intubation in a Patient With Stroke‐Like Migraine Attacks After Radiation Therapy (SMART) Syndrome

Stroke‐like migraine attacks after radiation therapy (SMART) syndrome is an infrequently reported complication arising years after radiation therapy that manifests as a reversible syndrome marked by migraine‐like headaches, focal neurologic signs, and/or seizures. Refractory status epilepticus (RSE) associated with SMART syndrome is rare and can be challenging to treat. Valproic acid has been reported to improve seizures in RSE in SMART syndrome in a few case reports and may be ideal for SMART syndrome, given its use in the treatment of migraines and seizures. Ketamine has been used in RSE and a few instances in SMART syndrome. Here, we present a case of refractory focal status epilepticus in a patient with SMART syndrome who was treated with ketamine, which resolved seizures without the need for intubation.

Distinguishing Transient From Persistent Brain Structural Changes in Pediatric Patients With Acute Disseminated Encephalomyelitis.

Pediatric patients with acute disseminated encephalomyelitis (ADEM) are at risk of impaired brain growth, with long-term neuropsychiatric consequences. We previously reported transient expansions of cerebral ventricle volume (VV) in experimental autoimmune encephalomyelitis, which subsequently normalized. In this study, we investigated changes in VV in ADEM in relation to other brain structures and clinical outcomes. We investigated brain MRI scans acquired in routine clinical practice from a multicenter cohort of 61 pediatric patients with ADEM, of whom 39 were myelin oligodendrocyte glycoprotein (MOG) antibody-positive. Patients were compared with 1,219 pediatric healthy controls (HCs). Volumes of multiple brain structures were computed using a contrast-agnostic machine learning-based tool and analyzed with mixed-effect models regarding other clinical parameters. Patients with ADEM had larger VV than HCs at initial clinical presentation, before immune therapy. Most of the patients showed further VV increases within 2 months after disease onset. Patients had smaller brain volumes than HCs, with specific reductions in deep gray matter structures. These changes were more pronounced in MOG antibody-negative patients.Of the patients with more than 2 MRI scans, 12 of 22 resolved their VV expansion back to within 15% of baseline values while 10 of 22 had persistently increased VV at the last available MRI within 1 year from onset. Patients with persistent VV expansion had greater reductions in volumes of other brain structures at the last MRI than patients whose VV resolved and were more likely to have residual neurologic signs. The VV resolving and nonresolving patients did not differ regarding age, sex, elevated CSF cell counts at baseline, or occurrence of relapses. However, patients with a larger magnitude of VV expansion-≥90% of baseline volume-were more likely to be in the nonresolving group. We could distinguish between 2 outcomes of VV changes in ADEM: one in which the VV expanded but ultimately returned to normal and one in which the expansions continued after disease onset and treatment but failed to resolve. The latter was associated with reduced brain volume, particularly in deep gray matter structures. This highlights the necessity for patients with ADEM to undergo regular MRI scans to assess whether developing VV expansions indicate a greater risk of permanent brain atrophy.

West Nile Neuroinvasive Disease: Case Series and Review of the Literature

Background: West Nile virus (WNV), although underdiagnosed, is the most common mosquito-borne disease and the second most common cause of viral encephalitis in the United States. Fewer than 1% of those infected develop neuroinvasive disease. Methods: We present a cluster of 3 cases of neuroinvasive WNV that occurred between August and September 2023 and a review of the literature for neurologic involvement with this virus. Data Sources: Sunrise Electronic Health Record; PubMed; Google; Division of Infectious Disease Diagnostics, Northwell Health Laboratories, Little Neck, NY. Results: The patients in all 3 cases were admitted with acute encephalopathy and other neurologic impairment. All 3 patients had a serum serologic diagnosis consistent with WNV. However, only one of 3 of the patients underwent a lumbar puncture with cerebrospinal fluid confirmation of WNV. Areas of Uncertainty: Clinical and laboratory guidelines have been described for the diagnosis of neuroinvasive WNV infection. This is especially important in patients who do not have cerebrospinal fluid confirmation. Conclusions: WNV is underdiagnosed. Furthermore, although neuroinvasive WNV infection is uncommon, this diagnosis should be considered in patients presenting with abnormal neurologic signs and symptoms during the summer months in geographic areas where potential transmission is of concern.

Factors associated with true-positive and false-positive diagnoses of behavioural variant frontotemporal dementia in 100 consecutive referrals from specialist physicians.

The behavioural variant of frontotemporal dementia (bvFTD) is a challenging diagnosis due to overlapping symptoms with psychiatric and other neurological conditions. Accordingly, misdiagnosis is common. The present study aimed to identify clinical factors contributing to misdiagnoses of bvFTD by specialist physicians. We retrospectively analysed 100 consecutive referrals by specialist physicians (primarily psychiatrists, neurologists and geriatricians) to a tertiary cognitive disorders clinic specializing in frontotemporal lobar degenerative disorders. Patients were included if the referring specialist suspected bvFTD or if bvFTD was confirmed as the final diagnosis. Diagnostic factors were assessed by comparing the initial referral information with final clinical diagnoses. Of the 100 patients, 34 were true-positive and 66 were false-positive for bvFTD. False-positive diagnoses were often based on misinterpretation of neuroimaging, particularly nuclear imaging (FDG-PET and HMPAO-SPECT), where subjective interpretation errors led to incorrect bvFTD diagnoses in 32 patients. Cognitive testing also contributed to misdiagnosis, with formal neuropsychological testing incorrectly leading to a bvFTD diagnosis in 20 patients. Patients with prior psychiatric histories were more likely to be misdiagnosed. Observable behavioural features of bvFTD and physical neurological signs were significantly more prevalent in true-positive patients. Misinterpretation of neuroimaging and cognitive testing, in particular formal neuropsychological testing, significantly contributed to false-positive bvFTD diagnoses. Physicians should be cautious not to over-interpret neuroimaging and neuropsychology studies and be wary of patients with prior psychiatric histories. In contrast, greater weight should be placed on objective clinical observations of behavioural signs of bvFTD and the emergence of physical neurological signs.

A Novel Mutation Related to Aceruloplasminemia with Mild Clinical Findings: A Case Report

Background and Clinical Significance: Aceruloplasminemia (ACP), a member of the neurodegeneration with brain iron accumulation (NBIA) spectrum of disorders, is a rare disorder caused by mutations in the ceruloplasmin (CP) gene. Iron accumulation in various organs, including the brain, liver, eyes, and heart, can lead to a broad clinical spectrum. Here, we report the first case of ACP in Greece. Case Presentation: Our patient was a 53-year-old male who was referred to our movement disorders center for a 6-month history of mild, unspecific, episodic dizziness and postural instability, and attention and memory deficits. Brain MRI revealed significant iron accumulation in multiple brain regions, including the dentate nuclei, cerebellar cortex, basal ganglia, thalamus, brainstem nuclei, and hypothalamus. These findings were particularly evident in susceptibility-weighted images. Fundoscopy revealed a normal retina, optic nerve, and macula. Whole-exome sequencing revealed a novel homozygous frameshift mutation in the CP gene [NM_000096.3:p.Thr3232fs (c.9695delC)]. This mutation has not been previously reported and is predicted to result in premature protein termination, supporting its pathogenic nature. Laboratory tests showed no anemia but revealed significantly elevated serum ferritin and low serum iron. Subsequent testing revealed extremely low serum CP and low serum copper. Despite less involvement of the myocardium, our patient succumbed to cardiac arrest. Conclusions: ACP should be considered in cases with minor neurological signs and symptoms. Brain MRI plays a significant role in early diagnosis. Close cardiac monitoring is also important.

Cerebral Pseudoaneurysms: A review of the current literature

Cerebral pseudoaneurysms are focal dilatations of an artery that involve all three layers of the vessel wall, unlike true aneurysms. They typically arise after trauma, iatrogenic (ventricular drain insertion, transsphenoidal surgery, etc.), or infections. Common presentations include headache, subarachnoid hemorrhage, or focal neurological deficits depending on the location and size of the pseudoaneurysm. Diagnosis often involves imaging techniques such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Treatment options vary depending on the size, location, and clinical presentation and may include conservative observation, endovascular embolization, or surgical intervention.

Anesthesia Management For Brain Abcess And Hidrocephalus In Children During External Ventrikel Drainage With Tetralogy Of Fallot

Background: Congenital heart defects occur due to abnormal changes in the structure of the heart that occur early in pregnancy and are present at birth. This defect is the most common congenital anomaly, occurring in approximately 1 in 125 births. Tetralogy of Fallot (TOF) is a defect in which there is an obstruction of blood flow from the heart to the lungs, resulting in low blood oxygen levels. Brain abscess is a rare, fatal complication, accounting for 5%–18.7% of the population with cyanotic congenital heart disease. This condition is often accompanied by headache, fever, seizures, altered mental status, focal neurologic deficits, nausea, and vomiting. Case: A 10 year old girl with brain abcess and hydrocephalus who will undergo external ventrikel drainage with tetralogy of fallot. Disscussion: The Anaesthetic goals for a case of uncorrected Tetralogy of Fallot posted for a non-cardiac surgery are to avoid hypoxemia, ensure adequate hydration, maintain systemic arterial blood pressure (SVR), minimise additional resistance to pulmonary blood flow (pulmonary vascular resistance) and avoiding sudden increase in systemic oxygen demand (cry, inadequate depth of an aesthesia, seizure, pain, etc). Conclution: Anesthesia management of children with TOF presenting for non-cardiac surgery requires a thorough understanding of the pathophysiology of this condition and the altered haemodynamics.

The clinical and radiographic features of eastern equine encephalitis: A single-center retrospective case series

Rationale: This case series aims to describe the clinical and radiographic findings associated with eastern equine encephalitis (EEE) virus. Patient concerns: Patients in this series presented with a variety of neurological symptoms, including altered mental status, seizures, and focal neurological deficits. Common initial concerns included confusion, hemiparesis, fever, and flu-like symptoms. In all cases, the progression of neurological symptoms prompted urgent medical evaluation and hospitalization. Diagnoses: Diagnosis of EEE was confirmed in all 4 patients by detection of EEE-specific IgM antibodies in cerebrospinal fluid. Cerebrospinal fluid studies also showed elevated protein, red blood cells, normal or high glucose, and elevated white blood cells with lymphocytic or neutrophil predominance. Magnetic resonance imaging showed T2 hyperintensities in the basal ganglia, thalamus, and cortical regions. Two cases showed encapsulation as evidence by a hyperintense ring around the basal ganglia or thalamus. Electroencephalogram findings ranged from normal, focal irritability, and spikes to nonconvulsive status epilepticus. Clinical and/or electrographic evidence of seizure was seen in all 4 cases. Interventions: All patients received supportive care, including anticonvulsant therapy, often using levetiracetam. Two patients were treated with high-dose intravenous methylprednisolone and one with intravenous immunoglobulin (IVIG) to modulate the immune response. Empiric antibiotics and antivirals were initiated in most cases until the diagnosis of EEE was confirmed. Two patients required intubation and mechanical ventilation, one of which was due to seizure activity and nonconvulsive status epilepticus. Outcomes: We report a 1/4 (25%) mortality rate. The average hospital stay among survivors was 10 days. Two-fourth (50%) required intubation and mechanical ventilation. Two patients were discharged to rehabilitation facilities, one patient recovered fully with resolution of magnetic resonance imaging abnormalities at follow-up, and one patient experienced a fatal outcome after the family opted to withdraw care due to a poor prognosis. Lessons: This case series underscores the importance of maintaining a high clinical suspicion of EEE in patients with acute neurological symptoms, especially in endemic areas. Early diagnosis and treatment are crucial, but the variability in presentation and imaging findings complicates this process. Early use of high-dose steroids can improve outcomes.

Presentation, Management, and Outcome of Tick-Borne Encephalitis in Patients Referred to Infectious Diseases or Neurology

Background: In Slovenia, patients with suspected tick-borne encephalitis (TBE) were historically referred to infectious diseases (ID), but during the COVID-19 pandemic, there were increased referrals to neurology. This study compared the clinical management of TBE patients between ID specialists and neurologists and assessed patients’ outcomes. Methods: We retrospectively reviewed the clinical, laboratory, and imaging data of 318 adult patients with TBE managed by ID (n = 256; 80.5%) and neurology (n = 62; 19.5%) at a tertiary centre in Slovenia between March 2020 and September 2022 to explore variations in diagnostic and therapeutic approaches by specialty and to assess the severity and outcome of acute illness. Results: Patients referred to ID or neurology did not differ regarding their basic demographic and epidemiologic characteristics or basic laboratory parameters. However, patients referred to neurology more often presented with severe illness, including impaired consciousness and/or focal neurological signs (72.6% vs. 55.5%; p &lt; 0.001). ID specialists used head imaging before lumbar puncture (6.6% vs. 64.5%; p &lt; 0.001), performed microbiological tests other than for TBE (16.0% vs. 51.6%; p &lt; 0.001), and empirically prescribed antimicrobials less often than neurology (5.1% vs. 22.6%; p &lt; 0.001). When adjusting for age, sex, comorbidities, vaccination status, and the severity of acute illness, clinical outcomes were similar between the two groups of patients, but those with more severe acute illness had higher odds for incomplete recovery. Conclusions: Differences in clinical presentation between ID and neurology referrals could only partially explain the narrower diagnostic and therapeutic approach used by ID, which, given the study design, was not associated with adverse outcomes. Additionally, in patients with clinical characteristics suggestive of TBE in endemic areas, tremor in the absence of other focal neurological signs or impaired consciousness may not necessitate head imaging before lumbar puncture. Future prospective studies could help to optimise the management of this clinical syndrome.

Systemic food embolism in a case of atrio-esophageal fistula after alcohol ablation of the Marshall vein: A case report

Purpose: Ablation procedures are common and standard therapeutic interventions for symptomatic patients with persistent atrial fibrillation (AF). Various complications have been observed after the procedure, with one of the most fatal being atrio-esophageal fistula (AEF). Although rare, AEF has very high morality. Diagnosis of AEF is challenging, especially in emergency settings, because of its unspecific clinical signs, such as atypical neurological signs after food or air embolism. Case Presentation: A 46-year-old woman with a 10-year history of AF underwent ethanol infusion of the Marshall vein. Almost a month after the procedure, the patient collapsed and was brought to the emergency department with signs of right side hemiparesis. Occlusion of the left middle cerebral artery was identified with no ischemic change in brain parenchyma. During thrombectomy the patient had a sudden episode of hematemesis. After esophagogastroscopy, she was immediately transferred to the operating room for emergency surgery, but died on the operating table. Autopsy confirmed a clinical suspicion of AEF with massive gastrointestinal bleeding and systemic food embolism. We present this case to improve clinical recognition of the signs of AEF after alcohol ablation for AF. We also recommend active surveillance for patients who undergo similar procedures, including regular check-ups.

Striatal Dopaminergic Function and Motor Slowing in Essential Tremor Plus.

While previous imaging studies have generally shown normal striatal dopamine transporter (DAT) binding in essential tremor (ET), emerging evidence suggests a partial dopaminergic mechanism in this condition and an epidemiological link between ET and Parkinson's disease (PD). This link seems particularly meaningful in ET patients with additional neurological signs, such as slowness of movements, rigidity, or rest tremor (ET+). To investigate the potential dopaminergic pathophysiology of ET+ and to compare it to PD. Fourty-three ET+ patients, 115 PD patients and 40 healthy controls were studied using [123I]FP-CIT SPECT imaging and clinical examinations. A median follow-up of 3.0 years was carried out to confirm the diagnoses. ET+ patients underwent an extended follow-up with a median of 7.7 years (range 4.3-9.8 years). Region-specific binding ratios of striatal DAT binding were compared among the groups and correlated with the MDS-UPDRS motor scores. Bradykinesia scores were negatively associated with posterior putamen DAT binding in both the ET+ and PD groups, with the strongest correlation observed in finger tapping (F = 11.1, β = -0.10, 95%CI -0.16 to -0.04, P = 0.001). In ET+ patients, kinetic tremor asymmetry correlated with posterior putamen DAT binding asymmetry (r = 0.33, P = 0.043), indicating a relationship between more severe tremor and subtle contralateral DAT loss. In ET+, subtle increases in bradykinesia scores correlate with striatal dopaminergic dysfunction, while kinetic tremor asymmetry is associated with hemispheric DAT binding asymmetry. These findings support the concept of partial dopaminergic involvement in the pathophysiology of ET+.

Non-Stenotic Carotid Plaques and Rate of DWI-positive MRI in Patients with Lower-Risk Transient or Persistent Minor Neurologic Events: DOUBT Sub Study.

Non-stenotic (< 50%) carotid plaques are increasingly recognized as apotential mechanism for ischemic stroke. We assessed the prevalence of such plaques in patients with low-risk neurologic events and evidence of DWI (Diffusion Weighted Imaging)-positive ischemia. This is apost-hoc exploratory analysis from the DOUBT study, aprospective, observational, multicenter study of patients with low-risk transient or persistent minor focal neurological symptoms. Patients who had baseline CT angiography (CTA) and an MRI within 8days of their event were included in the study. We aimed to assess the prevalence of non-stenotic carotid disease in patients with versus without DWI-positive events, and in patients with ipsilateral DWI-positive events. Acarotid-level analysis with univariable logistic regression analysis was performed to assess whether any of the assessed plaque features were associated with ipsilateral stroke. Of the 334 patients (mean age 62.7 years, 50.4% females) with available vascular neuroimaging, 153 (45.9%) had non-stenotic carotid plaques (≤50% stenosis), 174 (52.1%) had no stenosis and 7 (2.1%) patients had >50% stenosis. Of those with non-stenotic carotid plaques, 31/153 (20.3%) had evidence of DWI-positive ischemia, approximately half (15/31; 48.4%) of which was in the territory of the carotid plaque. Amongst patients with DWI-positive ischemia, non-stenotic plaques were significantly more common on the side of DWI-positive lesions [31/49 (63.3%) versus 18/49(36.7%)]. Presence of non-stenotic plaque was arisk marker for DWI-positive events (RR 1.4, 95% CI 1.1-1.8, p 0.012). On matched analysis, non-stenotic plaques were more likely on the side of DWI+ ischemia (odds ratio 1.14, 95% CI 0.36-3.70, McNemar's p value 0.80). Plaque features, including hypodensity, irregularity and greater plaque thickness were significantly associated with ahigher likelihood of ipsilateral DWI+ ischemia. In patients with low-risk transient or persistent neurologic events, non-stenotic carotid plaques are more common in patients with DWI-positive ischemia. Plaque features like hypodense and irregular plaque were more common with DWI-positive changes in the territory of the affected carotid.

Case Report: Atypical post-COVID Cogan's syndrome

Background Cogan’s syndrome is a rare autoimmune disorder characterized by ocular inflammation, vestibulocochlear dysfunction, and systemic vasculitis. Case Presentation We report a 28-year-old female who experienced decreased visual acuity and ocular redness one month after a COVID-19 infection, with ophthalmological signs linked to keratitis, uveitis and retinal vasculitis. Two weeks later, she developed vertigo, tinnitus, and sudden hearing loss, leading to a diagnosis of Cogan’s disease. The patient received corticosteroid therapy, resulting in regression of ophthalmological signs, but progressed to complete deafness. One month later, she presented with lymphocytic meningitis and high intracranial pressure, which improved under treatment. The patient later received cochlear implants. Objective This case report aims to highlight an atypical presentation of Cogan’s syndrome with neurological involvement following a COVID-19 infection. This case contributes to the limited literature on such presentations. Conclusion Our case is one of only two reported instances of Cogan’s syndrome presenting with neurological signs post-COVID-19 infection, underscoring the rarity and complexity of this condition.

Epidemiology of Bovine Neosporosis in Relation to Socioeconomic, Demographic, and Transmissibility Factors in Dual-Purpose Production Systems in Colombia.

Bovine neosporosis represents a significant threat to reproduction and production in livestock systems worldwide. This disease is caused by the protozoan Neospora caninum, resulting in abortions of cows and neurological signs in newborn calves. This leads to significant economic losses, decreasing meat and milk production, especially in tropical regions. The infection has an endogenous and exogenous cycle of transmission involving dogs that shed the oocysts, with the highest transmission successes in humid areas. Similarly, there is a lack of knowledge about the epidemiological risk factors and management practices involved in the transmission success in tropical humid regions. In this sense, a cross-sectional epidemiological survey was conducted on 150 farms from 24 municipalities of the Huila area. A total of 360 cattle were sampled, and information about the production system was collected using a structured poll with 128 questions. In these cattle, 53% (191/360) were positive for antibodies against Neospora caninum using ELISA. The logistic regression analysis using the information collected from the poll identified the presence of flooring type, water access, production systems, and feed management as risk factors. Among the protective factors were identified the geographical area, molasses supplementation, and biosecurity practices such as animal separation and access control. This study identified for the first time the epidemiological risk factors associated mainly with the exogenous cycle of neosporosis. The present study contributes to the design of intervention strategies oriented to minimize the impact of parasitism in Colombian herds.

Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study

BackgroundWe aimed to investigate the association of intracranial complications diagnosed on neuroimaging with neurological outcomes of adults with severe pneumococcal meningitis.MethodsWe performed a retrospective multicenter study on consecutive adults diagnosed with pneumococcal meningitis requiring at least 48 h of stay in the intensive care unit (ICU) and undergoing neuroimaging, between 2005 and 2021. All neuroimaging were reanalyzed to look for intracranial complications which were categorized as (1) ischemic lesion, (2) intracranial hemorrhage (3) abscess/empyema, (4) ventriculitis, (5) cerebral venous thrombosis, (6) hydrocephalus, (7) diffuse cerebral oedema. The primary outcome was unfavorable outcome at 90 days after ICU admission, defined by a modified Rankin Scale (mRS) score > 2.ResultsAmong the 237 patients included, intracranial complications were diagnosed in 68/220 patients (31%, 95%CI 0.25–0.37) who underwent neuroimaging at ICU admission and in 75/110 patients (68%, 95%CI 0.59–0.77) who underwent neuroimaging during ICU stay. At 90 days, 103 patients (44%, 95%CI 37–50) had unfavorable outcome, including 71 (30%) deaths. The most frequent intracranial complications were ischemic lesion (69/237 patients, 29%), diffuse cerebral oedema (43/237, 18%) and ventriculitis (36/237, 15%). Through multivariable analysis, we found that intracranial complications (adjusted odds ratio (aOR) 2.88, 95%CI 1.37–6.21) were associated with unfavorable outcome, along with chronic alcohol consumption (aOR 3.10, 95%CI 1.27–7.90), chronic vascular disease (aOR 4.41, 95%CI 1.58–13.63), focal neurological sign(s) (aOR 2.38, 95%CI 1.11–5.23), and cerebrospinal fluid leukocyte count < 1000 cell/microL (aOR 4.24, 95%CI 2.11–8.83). Competing risk analysis, with persistent disability (mRS score 3–5) as the primary risk and ICU-death as the competing risk, revealed that chronic alcohol consumption was the sole significant variable associated with persistent disability at 90 days (cause-specific hazard ratio 4.26, 95%CI 1.83–9.91), whereas the remaining variables were associated with mortality.ConclusionsIn adults with severe pneumococcal meninigitis, intracranial complications were independently associated with a higher risk of poor functional outcome, in the form of persistent disability or death. This study highlights the value of neuroimaging studies in this population, and provides relevant information for prognostication.