Occurrence Of Neurological Sequelae Research Articles

Neurological abnormalities among pediatric patients with sickle cell disease in Saudi Arabia: a single-center retrospective study.

Sickle cell disease (SCD) is a common inherited blood disorder characterized by the production of abnormal sickle-shaped red blood cells. SCD can lead to various complications including neurological issues. Early detection and treatment are crucial for preventing these complications. This study aimed to describe the neurological manifestations, radiological findings, and neurological diagnosis related to SCD in Saudi children with the aim of contributing to the formulation of population-based guidelines for screening and treating SCD-related neurological complications. This descriptive retrospective study included pediatric patients aged < 14 years diagnosed with SCD who were regularly followed up at the hematology clinic in KAMC, Jeddah, Saudi Arabia, from January 2008 to January 2022. Demographic and clinical data were collected from the clinical charts of 101 participants. This study included 101 patients with SCD with a mean age of 23 months at diagnosis. Among these, 59% had SCD and high fetal hemoglobin (HbF) levels. Neurological sequelae, including seizures, stroke, and other abnormalities, were observed in 26.7% of patients. There were no significant differences in the onset of neurological issues between the patients with SCD-high HbF and those with other SCD phenotypes. This study highlights the increased risk of brain injury and neurocognitive deficits in children with SCD. The occurrence of neurological sequelae in many patients emphasizes the need for early detection and intervention. Some patients experience neurological complications despite having high HbF levels, suggesting that further interventions are needed. This study has some limitations, including its small sample size and retrospective nature. Early detection and intervention are crucial for neurological complications in patients with SCD. This study emphasizes the need for further research and effective treatment strategies considering the presence of neurological complications despite the presence of high HbF levels. Large-scale studies and population-specific guidelines are warranted for better understanding and management of SCD-related neurological complications in the Saudi population.

A reappraisal of the role of fever in the occurrence of neurological sequelae following lithium intoxication: a systematic review

ABSTRACT Introduction We aimed to review cases of Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) characterized by neurological sequelae following acute lithium toxicity and to explore whether cerebellar sequelae are more frequent in cases presenting with fever and/or infection. Areas covered Case reports were identified from: (i) 6 reviews published up to 2005; (ii) MEDLINE, Web of Sciences, Cochrane Library and PsycINFO search. Expert opinion We identified 123 SILENT cases published from 1965 to 2019, in which cerebellar sequelae were observed in an overwhelming proportion (79%). SILENT may occur at any time during lithium treatment. This complication is most frequently observed during routine lithium treatment, with fewer than 10% of cases occurring after accidental or intentional overdoses. SILENT may occur even when lithium plasma levels are within the therapeutic range: 63% of cases had lithium plasma level <2.5 mEq/l (low/mild toxicity). Fever and/or infection were reported in nearly half of the patients (48%). The likelihood of presenting with cerebellar vs. other neurological sequelae was independently increased by elevated plasma lithium level (≥ 2.5 mEq/l) and by a history of fever and/or infection. Lithium users should be warned of the need to consult in case of fever to adjust their lithium dosage.

PD-L1 Expression in Patients with Primary Central Nervous System Diffuse Large B-Cell Lymphoma: Its Correlation with Serum Levels of Soluble Programmed Death-Ligand 1 (sPD-L1)

Background: The genetic evaluation of primary central nervous system lymphoma (PCNSL) demonstrated frequent copy-number alterations of 9p24.1/PD-L1/PD-L2 increasing the expression of programmed cell death protein 1 (PD-1) ligands, PD-L1 and PD-L2 in PCNS. Given the role of immune escape in the development of neoplasm, the expression of PD-L1/PD-L2 might play a role in the biology of PCNSL. Indeed, the PD-1 blockade by nivolumab, an immune checkpoint inhibitor has shown a single-agent activity in relapsed and refractory patients with PCNSL, implying its role as a salvage treatment for relapsed or refractory PCNSL. Moreover, tissue biopsy of brain is not always possible due to the risk of post-biopsy complications including bleeding or the occurrence of neurologic sequelae. Thus, liquid biopsy such as blood sampling might be more feasible and useful if a marker obtained from liquid biopsy could reflect biologic characteristics of tumor cells. Thus, serum sPD-L1 could be potentially used as a biomarker for representing tissue expression of PD-L1. Therefore, we measured the level of sPD-L1 in patients with PCNSL and analyzed its clinical relevance as a prognostic marker. Also, its correlation with PD-L1 expression of tumor cells are evaluated. Material and Methods: The study population was from patients who were diagnosed with PCNSL between January 2009 and February 2017. 68 patients who had archived serum samples available for measurement of sPD-L1 were analyzed. The measurement of sPD-L1 was performed using archived serum samples at diagnosis, and the sPD-L1 values in blood serum specimens of healthy controls were determined by the same method. Also, tissue expression of PD-L1 was also analyzed using archived paraffin-embedded tissue blocks. The extent of PD-L1 expression on tumor cell was defined as the proportion of tumor cells showing PD-L1 expression with any intensity in tumor area. Macrophages and lymphocytes infiltrating tumor area were considered non-tumor immune cells and the proportion of PD-L1 expression was assessed in a same manner as tumor cells. PD-L1-positive tumor cell was defined as positively stained for PD-L1 with distinct pattern of membranous and/or cytoplasmic or punctate/granular of any intensity because the immunostaining pattern of PD-L1 was reported to be membranous, cytoplasmic, or/and punctate/granular. Disease relapse, progression-free survival (PFS) and overall survival (OS) were analyzed according to the extent of sPD-L1 in serum and PD-L1 expression in tissue. Results: The median level of patients' serum sPD-L1 (n = 68) was 0.429 ng/mL (range: 0.324 - 0.757 ng/mL), and it was significantly higher than that of healthy control group (0.364 ng/mL; range: 0.329 - 0.390 ng/mL, P &amp;lt; 0.01). The optimal cutoff for predicting OS was determine as 0.432 ng/mL (the area under curve of sPD-L1 for OS was 0.739). The OS and PFS of high group were significantly lower than that of low group. The occurrence of relapse or progression was more frequent in the high sPD-L1 group (78%, 25/32) than low sPD-L1 (50%, 18/36) group (P = 0.023). PD-L1-positive tumor cells were found in 35 patients (67%), the median percentage was 0.7% and 20 patients (57%) had less than 1% of positivity. the extent of PD-L1-postive tumor cells showed modest associated with serum levels of sPD-L1 (r = 0.299, P = 0.031). However, the median percentage of positively stained immune cells including macrophages was 2.7% (Q1: 1.2% - Q3: 6.3%), and the percentage of PD-L1-postive immune cells was not correlated with serum levels of sPD-L1. Survival analysis revealed a trend of poor OS and PFS in patients with ≥ 1% of PD-L1-positive tumor cells. Conclusion: Our study demonstrated serum levels of sPD-L1 could reflect the expression of PD-L1 in tumor cells of PCNSL, and predict poor survival outcomes of patients. The studied results suggest the importance of PD-L1-positive tumor cells contributing to serum level of sPD-L1 compared to immune cells' PD-L1 expression. In line with these findings, the survival analysis based on the extent of PD-L1 expression of tumor cells showed better association with tumor cells' PD-L1 expression rather than immune cells. Thus, sPD-L1 in serum could be a feasible biomarker for determining the risk-adapted treatment strategy of PCNSL patients. Figure Disclosures No relevant conflicts of interest to declare.

The role for osmotic agents in children with acute encephalopathies: a systematic review

BackgroundRaised intracranial pressure (ICP) is known to complicate both traumatic and non-traumatic encephalopathies. It impairs cerebral perfusion and may cause death due to global ischaemia and intracranial herniation. Osmotic agents are widely used to control ICP. In children, guidelines for their use are mainly guided by adult studies. We conducted this review to determine the current evidence of the effectiveness of osmotic agents and their effect on resolution of coma and outcome in children with acute encephalopathy.MethodsWe searched several databases for published and unpublished studies in English and French languages, between January 1966 and March 2009. We considered studies on the use of osmotic agents in children aged between 0 and 16 years with acute encephalopathies. We examined reduction in intracranial pressure, time to resolution of coma, and occurrence of neurological sequelae and death.ResultsWe identified four randomized controlled trials, three prospective studies, two retrospective studies and one case report. Hypertonic saline (HS) achieved greater reduction in intracranial pressure (ICP) compared to mannitol and other fluids; normal saline or ringer's lactate. This effect was sustained for longer when it was given as continuous infusion. Boluses of glycerol and mannitol achieved transient reduction in ICP. Oral glycerol was associated with lower mortality and neurological sequelae when compared to placebo in children with acute bacterial meningitis. HS was associated with lower mortality when compared to mannitol in children with non-traumatic encephalopathies.ConclusionHS appears to achieve a greater reduction in ICP than other osmotic agents. Oral glycerol seems to improve outcome among children with acute bacterial meningitis. A sustained reduction in ICP is desirable and could be achieved by modifying the modes and rates of administration of these osmotic agents, but these factors need further investigation.

Pneumococcal Meningitis in Taiwanese Children: Emphasis on Clinical Outcomes and Prognostic Factors

Pneumococcal meningitis causes high morbidity or mortality in childhood despite the progress in medicine. Children with pneumococcal meningitis were identified and retrospectively reviewed. Forty-nine children were eligible, with mortality in 24.5% of all and neurological sequelae in 40.5% of survivors. In the analysis of clinical profiles, ventilator support (p = 0.001), septic shock (p < 0.001), multiple organ failure (p < 0.001) and lower cerebrospinal fluid (CSF) leukocyte count (p = 0.001) were more frequently found in non-survivors. Besides, CSF protein (p = 0.006) was higher in survivors with neurological sequelae. Initial dexamethasone usage and disease severity did not affect the occurrence of neurological sequelae. Multivariate logistic regression analysis revealed that CSF leukocyte count <or=200 mm(-3) (p = 0.013) and protein level >or=330 g l(-1) (p = 0.022) were significantly risk factors associated with poor outcomes, and physicians should be cautious if such conditions occur.

Postpartum neurologic symptoms following single‐shot spinal block for labour analgesia

As part of a quality assurance program, we investigated the incidence of postpartum neurologic symptoms in multiparous parturients receiving spinal block for labour analgesia, now in routine use in our labour ward. Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting spinal analgesia were asked to participate in this prospective study. All parturients received our standard intrathecal analgesia (ITA): 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) using a 27-gauge Quincke-type needle. The patients filled in a questionnaire on the first day after delivery and again upon discharge. Complaints typical of neurologic sequelae were noted and a neurologic examination was performed, if necessary. All patients with postdural puncture headache (PDPH) and transient neurologic symptoms (TNSs) were interviewed by telephone 2 weeks after discharge to determine the course of the symptoms. Two hundred and twelve parturients were included in the study. Eighteen (8.5%) parturients complained of PDPH, the severity of which was mild in eight (4%), moderate in seven (3%), and severe in three (1%) patients, respectively. Fifteen (7%) mothers were treated with analgesics or bedrest only. Three (1%) patients were given an epidural blood patch. The paramedian approach was associated with the development of PDPH (P = 0.04). Transient neurologic symptoms were experienced by nine (4.2%) mothers, lasting 1-3 days, mostly presenting as bilateral pain in the buttocks or thighs. One parturient suffered from paraesthesia of the left foot lasting for 3 days. Forty (19%) mothers complained of non-postural headache and 28 (13%) of new-onset back pain. Three mothers (1%) would not want to receive a further spinal block. Transient neurologic symptoms (TNSs) after spinal block occurred infrequently. The incidence of PDPH was higher than in the obstetric population in general and calls for re-evaluation of our spinal block methods. Despite the occurrence of neurologic sequelae, patient acceptability was high.

Ultrasound detection of micro-emboli in the middle cerebral artery during cardiopulmonary bypass surgery.

The occurrence of neurological sequelae following cardiopulmonary bypass (CBP) surgery has stimulated interest in refining the techniques of extracorporeal circulation. Air micro-emboli originating from the oxygenator have been postulated as one source of cerebral damage. Since controversy still exists regarding the merits of bubble versus membrane oxygenators, this has prompted investigators to devise methods to determine the amount of micro-emboli produced during CPB. In this study, 27 patients undergoing CPB surgery for coronary artery disease (21) or valve replacement (6) were examined. The surgical and anaesthetic techniques were standardised in all patients except for the type of oxygenator used. A bubble oxygenator was used in 17 patients (Bentley Bio-10, William Harvey or Dideco) and a membrane oxygenator with a 25 microns filter in the remaining 10 patients (Bentley BOS CM50). Transcranial pulsed Doppler ultrasound was used to obtain blood velocity signals from the middle cerebral artery throughout CPB. A flow disturbance index (FDI) was defined which provided a representative index of the number of micro-emboli passing the ultrasound transducer. The FDI indicated the presence of gaseous micro-emboli during insertion of the aortic cannula in 22 of the 27 patients. In the 17 patients with a bubble oxygenator, the FDI ranged from 4-39. In the 10 patients with a membrane oxygenator, the FDI was always 0. Variation of gas flow rates in 3 patients with bubble oxygenators showed a change in the FDI from 4 +/- 4 at a flow rate of 2 l/min to 17 +/- 9 at 5 l/min.(ABSTRACT TRUNCATED AT 250 WORDS)