Spectrum Of Neurological Complications Research Articles

Spectrum of Neurological Complications Following COVID-19 Vaccination in India.

According to WHO statistics, approximately 6.9 billion people worldwide had been vaccinated against SARS-CoV-2 as at October 27, 2021, including around 1.0 billion people in India. Most Indian recipients received the Covishield (ChAdOx1-S/nCoV-19) vaccine, followed by the Covaxin (an inactivated SARS-CoV-2 antigen) vaccine. This study was conducted to characterize the neurological phenotypic spectrum of patients with adverse events following immunization with any of the available COVID-19 vaccines in India (Covishield or Covaxin) during the study period and their temporal relationship with vaccination. This ambispective multicenter hospital-based cohort study covered the period from March to October 2021. The study included all cases suspected of having neurological complications following COVID-19 vaccination. We report a spectrum of serious postvaccination neurological complications comprising primary central nervous system demyelination (4 cases), cerebral venous thrombosis (3 cases), Guillain-Barre syndrome (2 cases), vaccine-induced prothrombotic immune thrombocytopenia syndrome (2 cases), cranial nerve palsies (2 cases), primary cerebral hemorrhage (1 case), vestibular neuronitis (1 case), chronic inflammatory demyelinating polyneuropathy (1 case), generalized myasthenia (1 case), and seizures (1 case). Although the benefits of vaccination far outweigh its risks, clinicians must be aware of possible serious adverse events associated with COVID-19 vaccinations.

Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus

Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.

COVID-19 and Central Nervous System Manifestations: A Systemic review on Therapeutic Outcome

A novel caused the outbreak of coronavirus disease (COVID-19) has spread to Wuhan city of China and has become a global health issue and severe concern of the international community. Elderly patients with comorbidities, such as hypertension, diabetes mellitus, heart and lung disease, are more prone to COVID-19 Infection. COVID-19 and neurological disorders are two conditions with a well-documented association recently. Studies have shown that Infection with COVID-19 can alter the clinical spectrum of manifested neurological disorders and plays a vital role as long-term consequences in the development of diseases in the future. The SARS-CoV-2 virus reaches the brain either by an olfactory or by a hematogenous route pathway. Angiotensin-converting enzyme-2 (ACE-2) receptors, present in cerebral vessel endothelial cells of a cerebral vessel, are a potential viral entry point. Several cases of neurological disease have been identified recently, including Alzheimer's disease, Multiple sclerosis, and Parkinson's disease in COVID-19 patients, and a post-infectious immune-mediated inflammatory pathway has been held responsible for this. In this study, we try to explore the effect of COVID-19 on central nervous system damage and treatment of these manifestations. COVID-19 pandemic spreads to different parts of the world, the spectrum of neurological complications can expand further.

Timing and Spectrum of Neurological Complications After Flow Diverter Implantation for Intracranial Aneurysms.

Background and Purpose: The aim of this study was to characterize neurological complications after flow diverter (FD) treatment on a long follow-up cohort and identify predictive factors associated with these complications.Methods: This study was conducted on a monocentric cohort of patients treated for intracranial aneurysms by FD.Results: Between September 2008 and July 2018, 413 patients were treated for 514 aneurysms: 18% of the patients presented with at least one neurological complication during a median follow-up of 446 days (IQR 186–1,210). Sixty-one patients presented with ischemic complications, 13 with hemorrhagic ones and 10 with compressive processes. Among 89 neurological complications 64.5% were peri-operative (occurring within the 30 days following the procedure) and 35.5% were delayed after 1 month.Conclusions: Overall, neurological complications after FD implantation were overrepresented by cerebrovascular ischemic events occurring during the peri-operative period, but also in a delayed manner after 1 year. Long-term follow-up is relevant after aneurysm intervention using FD.

Spectrum of Neurologic Complications in COVID-19: An Evidence-Based Review

AbstractThe world is facing an unprecedented crisis due to the pandemic of current coronavirus disease 2019 (COVID-19). Coronavirus (CoVs) infections not only are always involving the respiratory tract but also possess significant neuroinvasive potential. The literature regarding neuropathogenic potential of human CoVs is sparse. Thus, the number of COVID-19–related neurologic complications is likely to be underestimated. Awareness regarding the possible spectrum of neurologic complications is essential for therapeutic decision-making and individualized treatment and thereby limiting the COVID-19–related morbidity and mortality. The aim of this review is to address the neurologic manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Spectrum of Neurological Manifestations in Covid-19: A Review.

COVID-19, in most patients, presents with mild flu-like illness. Elderly patients with comorbidities, like hypertension, diabetes, or lung and cardiac disease, are more likely to have severe disease and deaths. Neurological complications are frequently reported in severely or critically ill patients with comorbidities. In COVID-19, both central and peripheral nervous systems can be affected. The SARS-CoV-2 virus causes the disease COVID-19 and has the potential to invade the brain. The SARS-CoV-2 virus enters the brain either via a hematogenous route or olfactory system. Angiotensin-converting enzyme two receptors, present on endothelial cells of cerebral vessels, are a possible viral entry point. The most severe neurological manifestations, altered sensorium (agitation, delirium, and coma), are because of hypoxic and metabolic abnormalities. Characteristic cytokine storm incites severe metabolic changes and multiple organ failure. Profound coagulopathies may manifest with ischemic or hemorrhagic stroke. Rarely, SARS-CoV-2 virus encephalitis or pictures like acute disseminated encephalomyelitis or acute necrotizing encephalopathy have been reported. Nonspecific headache is a commonly experienced neurological symptom. A new type of headache "personal protection equipment-related headache" has been described. Complete or partial anosmia and ageusia are common peripheral nervous system manifestations. Recently, many cases of Guillain-Barré syndrome in COVID-19 patients have been observed, and a postinfectious immune-mediated inflammatory process was held responsible for this. Guillain-Barré syndrome does respond to intravenous immunoglobulin. Myalgia/fatigue is also common, and elevated creatine kinase levels indicate muscle injury. Most of the reports about neurological complications are currently from China. COVID-19 pandemic is spreading to other parts of the world; the spectrum of neurological complications is likely to widen further.

Spectrum of Neurologic Complications after Allogeneic Hematopoietic Cell Transplantation for Hematologic Diseases in Adults: Systematic Review and Meta-Analysis

Introduction: Neurologic adverse events remain challenging complications with poor morbidity and mortality post adult allogeneic hematopoietic cell transplantation (alloHCT) for hematologic diseases. We conducted a systematic review and meta-analysis to determine their spectrum, incidence and impact on survival. Methods: We searched MEDLINE, COCHRANE, EMBASE through March 2019 for studies published in English. We deemed eligible all types of primary studies including randomized controlled trials (RCTs), controlled observational studies (both cohort and case control), case series and case reports. The eligibility criteria were: (a) adult population specified as patients fifteen years old or older, (b) alloHCT for hematologic diseases, (c) neurologic disorders' diagnosis. Two independent reviewers screened, extracted data and assessed risk of bias (RoB). The primary outcome being the incidence of neurologic complications was assessed in a form of a proportion of adult patients with the neurologic manifestation (n) from the total group of patients that received alloHCT for hematologic diseases (N). We performed a random-effects meta-analysis of proportions using the Freeman-Tukey double arcsine transformation, including only cohort studies. Secondary outcome was impact of neurologic complications on overall survival of patients presented with symptoms after allo-HCT. Pre-planned sensitivity analysis integrating the risk of bias assessment by excluding studies evaluated as high risk was performed as well as prespecified subgroup analyses according to the type of neurologic event. Results: We identified 552 eligible studies describing 57.972 patients; one randomized controlled trial, two case-control, 17 prospective, 86 retrospective cohort studies, 21 case-series and 425 case-reports (PRISMA flow diagram). RoB ranged from fair to high although case-series were of low-risk. The majority of studies traced infectious or drug-related neurologic manifestations. Incidence rates of neurologic complications varied, according to type of complications and studies, from 0.6% for immune-mediated disorders in retrospective cohorts to 13% for drug-related events in prospective cohorts. In meta-analysis of proportions, we included only cohort studies, retrospective or prospective, with homogenous population to estimate a proportion. Neurologic clinical signs or symptoms were detected in 1415 out of 37450 [6.2% (95%CI 4.8-7.7), Ι2= 96.1% (p<0.001)] patients described in 78 included cohort studies. Heterogeneity of results remained high, even after sensitivity analysis excluding studies of high RoB. Infectious complications were present in 2.7% (95%CI 1.9-3.6) and 3.3% (95%CI 0.8-7.1) of patients in retrospective and prospective cohort studies respectively. In retrospective studies, 3.4% (95%CI 2.1-4.9) of patients suffered from drug-related neurologic events. In prospective cohorts, the equivalent incidence was 13% (95%CI 4.2-24.8). Other neurologic complications included cerebrovascular events, thrombotic microangiopathy, immune-mediated complications, relapse and metabolic events. Regarding the severity of neurologic complications and death rate in patients with outcome of interest, data were too diverse to provide any safe conclusion. Neurologic complications had a detrimental impact on survival depending on type of complication in various studies. Based on study type, high RoB in most of the included studies, as well as significant heterogeneity in results from observational data, high imprecision and suspected publication bias, quality of evidence was very low applying the GRADE tool. Conclusion: Our study highlights the wide spectrum and significant impact of neurologic complications on survival post alloHCT. This systematic review summarizes existing data and provides the necessary background information for every physician involved in the management of these patients. Disclosures No relevant conflicts of interest to declare.

CEREBRAL VENOUS SINUS THROMBOSIS IN SCRUB TYPHUS INFECTION: A RARE PRESENTATION

Scrub typhus is an acute febrile infectious illness caused by Rickettsia species Orientia tsutsugamushi. Scrub typhus has diverse clinical manifestations ranging from a non-specific febrile illness to severe multiorgan dysfunction. A spectrum of neurological complications in scrub typhus includes aseptic meningitis, meningoencephalitis, cerebellitis, myelitis, cerebral hemorrhage, and cerebral infarction. This report describes the case of a scrub typhus with cerebral venous sinus thrombosis, an unreported complication of scrub typhus to the best of our knowledge.

Spectrum of neurological complications in chikungunya fever: experience at a tertiary care centre and review of literature.

Chikungunya (CHIK) has re-emerged as a potential neurotropic virus, with outbreaks recently being reported from many parts of India. The present study was conducted to study the spectrum and outcome of neurological complications in patients of CHIK during the 2016 outbreak in Delhi. A total of 42 cases seropositive for IgM CHIK antibodies by MAC-ELISA and developing neurological complications were enrolled. The male:female ratio was 1:2 (age range = 18-90 years). The neurological manifestations observed were encephalitis (n = 12), bulbar palsy (n = 3), acute disseminated encephalomyelitis (n = 1), cerebellitis (n = 1), myelopathy (n = 1), radiculoneuropathy (n = 3), carpal tunnel syndrome (n = 9) and tremors (n = 1). Ten patients reported worsening of pre-existing neuropathic symptoms of diabetic peripheral neuropathy (n = 4) and carpal tunnel syndrome (n = 6). One patient had aggravation of myasthenia gravis leading to respiratory failure. The majority of patients (n = 32) showed a good outcome; ten had a poor prognosis, out of which four died, all from the encephalitis group, particularly the elderly with co-morbidities.

Neurological complications associated with dengue virus infection

Dengue is an arboviral infection caused by the dengue virus. The neurological complications associated with this infection are reviewed. The neurotropic nature of dengue virus has been confirmed in epidemiological studies, case series and histopathological studies. The range of neurological complications is 5.6-14.6%, and they are more frequent in serotypes 1 and 3. Encephalopathy is the most common neurological syndrome (0.5-6%) and its prevalence is higher in children and adolescents. The detection of the viral antigen in brain tissue and the presence of pleocytosis or RNA in cerebrospinal fluid are evidence of the neurotropic nature of dengue virus, which manifests itself in the form of encephalitis. Neurological syndromes during convalescence (disseminated acute cerebellitis, opsoclonus-myoclonus syndrome, mononeuritis, poly-radiculoneuritis and plexitis) appear to be immunomediated. Myelitis can occur during acute dengue virus infection and through an immunomediated mechanism in the convalescence phase. Myalgias, myositis, rhabdomyolysis and hypokalemic paralysis are examples of muscular dysfunction associated with the dengue virus. The incidence of stroke is 0.26%, and may be ischaemic or haemorrhagic. Ophthalmological complications include maculopathy, retinal haemorrhage, optic neuropathy and vitritis. The spectrum of neurological complications from dengue virus is broad. There are no reliable data on its real incidence because most of the studies published to date are isolated series or cases.

Spectrum of Neurological Complications in Eclampsia in a Tertiary Care Hospital in India.

Preeclampsia or eclampsia is associated with significant maternal morbidity and mortality, and neurological complications are varied. This prospective observational study sought to collect data and push for early aggressive diagnostic evaluation for neurological complications in eclamptic women. The study was conducted in Lady Hardinge Medical College and associated Shrimati Sucheta Kriplani Hospital in New Dehli, India from July 2014 to July 2016. All women who underwent Caesarean delivery (CD) and had preeclampsia were identified, and eclamptic women who had CD and required critical care in the ICU were further followed up. A total of 741 women (of the 5564 women with CDs) had preeclampsia. Of the 63 women in whom eclampsia developed, 32 required ICU admission. The incidence of neurological complications associated with eclampsia was 20.63%, and it was 40.62% among patients admitted to the ICU. In the patients who developed neurological complications, the mortality rate was 46.15%. Neurological complications are not uncommon in eclampsia, and a high index of clinical suspicion is essential for early detection and proper management of these patients. All patients with eclampsia and neurological complications had raised systolic blood pressure, but not all had thrombocytopenia. Despite control of seizure with MgSO4, the incidence of neurological complications remains high.

Chapter 8 - NeuroAIDS in children

The human immunodeficiency virus-1 (HIV-1) enters the central nervous system compartment within the first few weeks of systemic HIV infection and may cause a spectrum of neurologic complications. Without combination antiretroviral therapy (cART), 50-90% of all HIV-infected infants and children develop some form of neuroAIDS. Of the estimated 2.3 million children less than 15 years of age who were living in sub-Saharan Africa at the end of 2014, only 30% were receiving cART, suggesting that there is a large burden of neuroAIDS among HIV-infected children in sub-Saharan Africa. There is complex interplay between the disease process itself, the child's immune reaction to the disease, the secondary complications, the side-effects of antiretroviral drugs, and inadequate antiretroviral drug uptake into the central nervous system. In addition there is the layering effect from the multiple socioeconomic challenges for children living in low- and middle-income countries. Adolescents may manifest with a range of neurocognitive sequelae from mild neurocognitive disorder through to severe neurocognitive impairment. Neuroimaging studies on white-matter tracts have identified dysfunction, especially in the frontostriatal networks needed for executive function. Psychiatric symptoms of depression, attention deficit hyperactivity disorder, and behavioral problems are also commonly reported in this age group. Antiretroviral drugs may cause treatment-limiting neurologic and neuropsychiatric adverse reactions. The following chapter addresses the neurologic complications known to be, and suspected of being, associated with HIV infection in children and adolescents.

Accident Vasculaire Cerebral Ischemique Post-Chimiotherapie Pour Cancer De La Langue Ischemic Stroke Induced by Chemotherapy for Tongue Cancer

Introduction: Cancer chemotherapy is a provider of a wide spectrum of neurological complications. Such complication ischemic strokes are an unusual event with an incidence of 0.14%. Objective: Report and comment on the observation of a patient who presented an ischemic stroke in the aftermath of chemotherapy for tongue cancer. Observation: 47 years old patient without cardiovascular risk factor is followed for tongue cancer. She presented the waning of chemotherapy ischemic stroke confirmed by brain scan. Heart explorations are normal, and the etiologic biological assessment. Discussion: The diagnosis of stroke after chemotherapy has been retained in our patient on the basis of the absence of vascular risk factor and negativity of etiological assessment, and the use of cisplatine and 5-fluorouracil, which have been implicated in the occurrence ischemic stroke. The occurrence of this complication depends on the type of drugs, and certain drug combinations and fall of several mechanisms that can be entangled.

Clinical Characteristics and Functional Motor Outcomes of Enterovirus 71 Neurological Disease in Children

Enterovirus 71 (EV71) causes a spectrum of neurological complications with significant morbidity and mortality. Further understanding of the characteristics of EV71-related neurological disease, factors related to outcome, and potential responsiveness to treatments is important in developing therapeutic guidelines. To further characterize EV71-related neurological disease and neurological outcome in children. Prospective 2-hospital (The Sydney Children's Hospitals Network) inpatient study of 61 children with enterovirus-related neurological disease during a 2013 outbreak of EV71 in Sydney, Australia. The dates of our analysis were January 1, to June 30, 2013. Clinical, neuroimaging, laboratory, and pathological characteristics, together with treatment administered and functional motor outcomes, were assessed. Among 61 patients, there were 4 precipitous deaths (7%), despite resuscitation at presentation. Among 57 surviving patients, the age range was 0.3 to 5.2 years (median age, 1.5 years), and 36 (63%) were male. Fever (100% [57 of 57]), myoclonic jerks (86% [49 of 57]), ataxia (54% [29 of 54]), and vomiting (54% [29 of 54]) were common initial clinical manifestations. In 57 surviving patients, EV71 neurological disease included encephalomyelitis in 23 (40%), brainstem encephalitis in 20 (35%), encephalitis in 6 (11%), acute flaccid paralysis in 4 (7%), and autonomic dysregulation with pulmonary edema in 4 (7%). Enterovirus RNA was more commonly identified in feces (42 of 44 [95%]), rectal swabs (35 of 37 [95%]), and throat swabs (33 of 39 [85%]) rather than in cerebrospinal fluid (10 of 41 [24%]). Magnetic resonance imaging revealed characteristic increased T2-weighted signal in the dorsal pons and spinal cord. All 4 patients with pulmonary edema (severe disease) demonstrated dorsal brainstem restricted diffusion (odds ratio, 2; 95% CI, 1-4; P = .001). Brainstem or motor dysfunction had resolved in 44 of 57 (77%) at 2 months and in 51 of 57 (90%) at 12 months. Focal paresis was evident in 23 of 57 (40%) at presentation and was the most common persisting clinical and functional problem at 12 months (observed in 5 of 6 patients), with 1 patient also requiring invasive ventilation. Patients initially seen with acute flaccid paralysis or pulmonary edema had significantly greater frequencies of motor dysfunction at follow-up compared with patients initially seen with other syndromes (odds ratio, 15; 95% CI, 3-79; P < .001). Enterovirus 71 may cause serious neurological disease in young patients. The distinct clinicoradiological syndromes, predominantly within the spinal cord and brainstem, enable rapid recognition within evolving outbreaks. Long-term functional neurological morbidity is associated with paresis linked to involvement of gray matter in the brainstem or spinal cord.

Spectrum of neurological complications in HELLP syndrome

Hemolysis (H), elevated liver enzymes (EL), and low platelets (LP), HELLP syndrome is the extended spectrum of severe preeclampsia and is associated with high mortality. A large proportion of mortality can be attributed to catastrophic central nervous system events. The purpose of this study was to access the clinical manifestations, radiological abnormalities and outcome in patients of HELLP syndrome with neurological manifestations. Obstetric unit and neurology intensive critical unit (ICU) of an academic medical center. Retrospective study. Case records of all obstetrical patients who were admitted between January 2012 and December 2012 were screened and data was collected from those patients who were diagnosed with HELLP syndrome with neurological complications. It was entered into a structured performa and analyzed using percentages . During the study period; 1,166 deliveries were conducted, 108 patients had pregnancy-induced hypertension (PIH); and of the 12 patients with HELLP, eight (66%) patients had neurological complications. The presenting neurological features were seizures (four), focal neurological deficits (two), and encephalopathy (two). Of the eight patients, in six patients neuroimaging showed features of posterior reversible encephalopathy syndrome (PRES), three of them had associated hemorrhage, and two patients had isolated intracranial hemorrhage. All except two were discharged home. Neurological complications are not uncommon in patients with HELLP syndrome and a high index of suspicion is essential. Aggressive multidisciplinary approach is the key to reduce the morbidity and mortality.

Similar Frequency and Types of Neurological Complications in Patients Undergoing Matched Related and Matched Unrelated Donor Stem Cell Transplantation for Hematological Malignancies

AbstractAbstract 4515 Background:Allogeneic hematopoietic stem cell transplantation (allo HSCT), exploiting donor T-cell activity against residual tumor cells, remains the treatment of choice in most patients with acute leukemia, and in those presenting with other advanced hematological malignancies. To overcome the lack of matched related donors (MRD) in many cases, stem cells from a match unrelated donor (MUD) or cord blood are used. However, this mode of therapy is associated with various clinical complications. While information regarding graft-versus-host disease (GvHD) and infections is abundant, there is paucity of data looking at post-HSCT neurological complications (NC). Objective:The current retrospective study was aimed to assess the frequency and types of NCs associated with allo HSCT in the settings of MRD versus MUD SCT. Methods:The study was approved by the IRB of the Rambam Health Care Campus, Haifa, Israel (Approval # 0269–12). The institutional electronic database was retrospectively searched for adult patients undergoing allo SCT as their first high-dose therapy, between January 2008 and December 2011. According to the institutional protocol, GvHD prophylaxis was identical for patients undergoing MRD and MUD transplants, including cyclosporine A and methotrexate. The following data were recorded: demographics, underlying hematological disease, time from diagnosis to SCT, disease status at transplantation, donor type, development of acute and chronic GvHD, NC features (vascular, infections, therapy-related, time of complication onset and management). Characteristics and risk factors of NC reported in patients undergoing MRD vs MUD SCT were compared. Results:One hundred and sixty one consecutive patients, undergoing an allo SCT, were analyzed. The median age at diagnosis was 43 years (range 17–71). Ninety six patients (60%) were males. The most common indication for HCT was acute myeloid leukemia (AML) (45.3 %), followed by acute lymphocytic leukemia (ALL) (16.8%), non-Hodgkin lymphoma (NHL) (17.4%) and others (20.5%). The median time from disease diagnosis to allo SCT was 224 days (range 37–5434). MRD accounted for 57.8% of transplants. There were no statistically significant differences in the characteristics of patients undergoing MRD versus MUD SCT. Within a year from SCT, 49 patients (30.4%) experienced 53 neurological events. The median time between SCT and occurrence of the first neurological complication was 66.5 days (range 1–349). Characteristics of neurological complications for the entire series and dependent on donor type are presented in Table 1. In a univariate analysis, diagnosis of ALL and a period longer than 9.5 months from diagnosis to transplant were found to be risk factors for neurologic insult occurrence (p= 0.015 and 0.031, respectively). In a multivariate analysis, only time between diagnosis and SCT remained a valid risk factor for the development of neurological complications (OR=1.977, CI 0.998–3.916). Conclusions:The data obtained suggest that in patients with hematological malignancies, the MUD transplant is not a risk factor for the development of NCs during the first year after alloSCT. The donor type has no impact on the spectrum of NCs in this clinical setting.Table 1Neurological complicationsEntire cohort (n=161) No (%)MRD (n=93) No (%)MUD (n=68) No (%)pPatients with neurological complications49 (30.4%)25 (27%)24 (35.8%)nsTime from SCT (days)66.576.546nsComplication type (n)Drug-related1486nsInfections927nsVascular642nsMetabolic202nsOther835nsNOS*1495ns*NOS - not otherwise specified. Disclosures:No relevant conflicts of interest to declare.

Acute transverse myelitis: an unusual complication of typhoid fever

Typhoid fever is associated with a wide spectrum of neurological complications. Acute transverse myelitis is a rare complication with only a few reports in adults and none in children. A 15-year-old boy with typhoid fever is reported who developed acute transverse myelitis in the 3rd week of illness. He was treated with antibiotics and corticosteroids and made a complete recovery.

Normal pressure hydrocephalus in the spectrum of neurological complications of systemic lupus erythematosus

Normal pressure hydrocephalus is an unusual manifestation of systemic lupus erythematosus and its pathogenesis is still unclear. We report the case of a 39-year-old white woman with systemic lupus erythematosus who developed magnetic gait, speech difficulties, progressive memory impairment, urinary incontinence and episodes of involuntary closure of the eyelids. Signs and symptoms, associated with ventriculomegaly and normal cerebrospinal fluid pressure, suggested normal pressure hydrocephalus, which as a complication of systemic lupus erythematosus believably develops due to the insidious inflammatory process that occurs in the meningeal tissues or to the vasculitis itself. Normal pressure hydrocephalus tends to develop secondary to trauma, infection or subarachnoid haemorrhage, but in 50 % of patients no aetiology is found. Shunt surgery is the only effective treatment, specifically for the gait disorder, which usually improves more than the cognitive symptoms. Since the tap-test showed a strongly positive result, a medium pressure ventriculoperitoneal shunt was inserted, further replaced by a high pressure one in view of the complications, with less than expected improvement. Subdural hematomas and empyemas developed, requiring surgery and antibiotic therapy. A new tap-test was positive, and the patient improved only after a programmable valve was finally placed. However, pressure regulation shall be continuously required, and shunt dysfunction might still develop in the long term. The few similar case reports in the literature are reviewed, confirming the rarity of this neurological complication of systemic lupus erythematosus.

Chronic Inflammatory Demyelinating Polyneuropathy in Common Variable Immunodeficiency

Common variable immunodeficiency comprises a heterogeneous group of primary antibody deficiencies with complex clinical and immunologic phenotypes. Immune dysregulation leads to the generation of multiple autoantibodies against various antigenic targets in patients with common variable immunodeficiency. Chronic inflammatory demyelinating polyneuropathy is a heterogeneous disorder that indicates an autoimmune response against peripheral nerve myelin. We describe a 7-year-old girl with common variable immunodeficiency who developed chronic inflammatory polyneuropathy. A 5-day course of intravenous immunoglobulin (500 mg/kg/day) improved her neurologic disorder. Chronic inflammatory demyelinating polyneuropathy should be added to the broadening spectrum of neurologic complications in common variable immunodeficiency. Early detection and consequent treatment may reverse the neurologic sequelae.

Spectrum of Neurologic Complications in Chronic Lymphocytic Leukemia

Neurologic disease is believed to be an unusual complication during the course of chronic lymphocytic leukemia. Nevertheless, it has already been proven in autopsy series that the incidence of occult nervous system infiltration is much higher than was previously expected. The advent of more potent drugs to treat this lymphoproliferative disorder has brought a new hope for a possible cure in the future. However, an appropriate systemic treatment for central nervous system infiltration of this disease is still lacking. Also, due to the potent immunosuppressive properties of the agents used in the up-front treatment, for example, the purine nucleoside analogues, we have witnessed an increase in the incidence of opportunistic infections, with progressive multifocal leukoencephalopathy being one of the most serious. The goal of this review is to summarize the spectrum of neurologic derangements linked to chronic lymphocytic leukemia and to raise clinicians' awareness to recognize the possibility of such associations.