Type Of Neurological Complications Research Articles

Investigating the possible neurological side effects follow the COVID-19 vaccine

Background: With the widespread of COVID-19 vaccination around the world, there are many case reports which referred to the neurological complications following vaccination. However, due to the lack of more information about this, especially in our country Iran, the aim of this study was to investigate the possible neurological side effects of the COVID-19 vaccine in patients. Methods: This cross-sectional study was conducted on 1046 people injecting various types of COVID-19 vaccines, including Sinopharm, AstraZeneca, Sputnik V, CovIran-Barekat, Covaxin, SpikoGen, and PastoCovac plus, who were registered in the health system due to vaccine complications. These people were evaluated in terms of the overall incidence rate of neurological complications, types of neurological complications, and the relationship between the occurrence of neurological complications and the type of vaccine. Results: Of all patients, 589 (56.3%) were female and 457 (43.7%) were male, and most of them were from the age group of 60 years and older (43.8%). 247 people (23.6%) had neurological complications that most of them related to the headache (16.6%). Conclusions: The results of this study showed that the neurological side effects associated with the covid-19 vaccination were in mild level and most of them were seen in AstraZeneca vaccine and so, in line with the recommendation of the European medicines agency, the injection of this vaccine should be done with caution.

Incidence and Distribution of Various Arterial Territories Involved in Postoperative Neurological Complications in Patients Undergoing Cardiovascular Surgery: A Single Centre Retrospective Analysis

Background: Neurological complications (NCs) (stroke) remain a devastating complication after cardiovascular surgical procedures despite advances in perioperative monitoring and management. The incidence of NC related to cardiovascular surgeries (CS) is comparatively very high and associated with high morbidity and mortality. The aim of this study is to evaluate the overall incidence of neurological complications in adult as well as pediatric patients and various pattern of neurological injury on noncontrast computed tomography head (NCCT) associated with various types of CS. Materials and Methods: We retrospectively analyzed all the NCCT heads of the postoperative cardiovascular surgery patients done in the immediate and early postoperative period (<7 days) who developed postoperative neurological deficits between April 2016 and February 2020. The medical records of all these cardiac surgery patients were analyzed for various variants such as the total number of patients who underwent CS, various types of cardiac surgery done during the study period, demographic information, associated comorbidities, various types of NC, postoperative data and various spectrum of computed tomography (CT) findings in the brain. Results: A total of 12,896 adult and pediatric cardiac surgeries were performed at our institute. Out of these, 1115 patients (8.6%) underwent CT brain for suspected neurological injury. A total of 215 patients (1.6%) had a positive finding on their NCCT head. Out of 215 patients, 148 (68.9%) were adult patients, whereas 67 (31.1%) were pediatric patients. A total of 156 (72.5%) patients had ischemic infarction (stroke), whereas hemorrhagic lesions were present in 59 patients (27.4%). The various types of positive CT scan findings were-156 ischemic infarcts (72.5%), 20 intraparenchymal hemorrhages (9.3%), 16 subdural hemorrhage (7.4%), 15 subarachnoid hemorrhage (6.9%), 01 cerebrovascular thrombosis (0.4%), and 07 intraventricular hemorrhage (3.2%). In an adult patient, pattern of ischemic infarct comprised middle cerebral artery (MCA) territory in 42 patients (41.5%), posterior territory in 34 patients (33.6%), anterior cerebral territory in seven patients (7.0%), multi-territory infracts in 11 patients (11.0%) and global ischemia in six patients (6.0%). Intraparenchymal hemorrhage was present in 17 patients (11.4%). In a pediatric subset of patient, the pattern of ischemic infarct included global hypoxic injury (GHI) in 30 patients (54.5%), posterior cerebral artery territory in nine patients (16.3%), MCA territory in eight patients (14.5%), multi-territory involvement in five patients (9.0%), and anterior cerebral artery territory in three patients (5.4%). In the hemorrhage group, five patients (7.4%) developed subarachnoid hemorrhage (SAH). Conclusion: In an adult patient, subset MCA territory infarcts were common in the infract group, whereas intra parenchymal haemorrhage (IPH) in the hemorrhage group. In the pediatric patient subset, GHI was common in infract group and SAH in hemorrhage group. Moreover, NCCT of the head is very useful in diagnosing early postoperative neurological complications in cardiovascular surgeries and managing the complications accordingly.

Neurological Manifestations of SARS-CoV-2 Infection: Protocol for a Sub-analysis of the COVID-19 Critical Care Consortium Observational Study.

IntroductionNeurological manifestations and complications in coronavirus disease-2019 (COVID-19) patients are frequent. Prior studies suggested a possible association between neurological complications and fatal outcome, as well as the existence of potential modifiable risk factors associated to their occurrence. Therefore, more information is needed regarding the incidence and type of neurological complications, risk factors, and associated outcomes in COVID-19.MethodsThis is a pre-planned secondary analysis of the international multicenter observational study of the COVID-19 Critical Care Consortium (which collected data both retrospectively and prospectively from the beginning of COVID-19 pandemic) with the aim to describe neurological complications in critically ill COVID-19 patients and to assess the associated risk factors, and outcomes. Adult patients with confirmed COVID-19, admitted to Intensive Care Unit (ICU) will be considered for this analysis. Data collected in the COVID-19 Critical Care Consortium study includes patients' pre-admission characteristics, comorbidities, severity status, and type and severity of neurological complications. In-hospital mortality and neurological outcome were collected at discharge from ICU, and at 28-days.Ethics and DisseminationThe COVID-19 Critical Care Consortium main study and its amendments have been approved by the Regional Ethics Committee of participating sites. No further approval is required for this secondary analysis.Trial Registration NumberACTRN12620000421932.

The Prevalence of Neurological Complication after Renal Transplantation.

Objective To evaluate the incidence of neurological complications (NCs) after renal transplantation by meta-analysis. Methods A broad literature search in PubMed, Embase, and Cochrane-Library was performed from inception to December 31, 2021, to collect published studies on the incidence of NCs after kidney transplantation. The R language meta-package was used to organize and analyze the data. Results 17 articles including 1,1119 participants were considered eligible. There were 3 studies that recorded unclassified NCs (249 participants), 6 that recorded nervous system CMV infection (1489 participants), 3 that recorded headache (243 participants), and 5 that recorded cerebrovascular events (9138 participants). There was significant heterogeneity (all I2 ≥ 75%) in all analyses, and random-effects models were selected. Meta-analysis results showed that the incidence of unclassified NCs was 0.29 (95% CI (0.16–0.48)), the incidence of nervous system CMV infection was 0.38 (95% CI (0.26–0.52)), the incidence of headache was 0.55 (95% CI (0.44–0.66)), and the incidence of stroke was 0.05 (95% CI (0.02–0.09)). Egger's test showed that there was no conspicuous publication bias in the included literature in each group. Conclusions Headache had the highest incidence (55%) in the nervous system after KT, followed by nervous system CMV infection (38%) and stroke (5%). Nevertheless, due to the inconsistencies in the types of NCs included and the follow-up time, our results might only serve as an epidemiological reference for the specific incidence differences.

Complete manuscript title: Neurological complications from sinugenic orbital cellulitis.

This study was undertaken with an aim to identify any common factors or trends among patients of orbital cellulitis that developed neurological complications. A 24-month retrospective review of patients was undertaken to include those showing clinical deterioration and neurological complications on radiological imaging, after being treated for orbital cellulitis at Manchester Royal Eye Hospital. The study specifically looked at the site of orbital collection, sinus involvement, types of neurological complications and whether these were detected at initial presentation, surgical input and microbiology findings. Nine patients (9/26) developed associated neurological complications during the study period. (February 2018 and January 2020) This included subdural empyema in six patients; leptomeningeal enhancement in two and septic emboli in one patient. All the patients had associated significant pan-sinusitis at initial presentation. Neurological complications were detected in three patients at the time of admission and after clinical deterioration and further investigations in the rest. A superior orbital abscess and Streptococcus mileri infection had higher risk of neurological complications. It is worth debating whether patients with chronic sinusitis who develop orbital cellulitis need earlier surgical input rather than a conservative treatment. Patients who fail to improve clinically need to be re-imaged to look for possible neurological complications.

Transmission dynamics of zika virus in presence of vertical transmission and some preventive measures

Zika virus (ZIKV) infection is a vector-born human disease which enhances the chance of various types of neurological complications in affected individual. In this work we have studied a mathematical model of ZIKV by incorporating vector, direct (sexual) and vertical transmission paths of the virus. In our model also we have considered different kind of preventive measures like as: protection of susceptible individuals from mosquito bites, isolation of infected individuals from mosquito, protection of susceptible individuals from sexual interaction with infected individuals, and mosquitoes control effort. We have found the analytical expression of basic reproduction number and studied the stability of the disease free equilibrium point. Existence of endemic equilibrium point and its stability are also studied. The proposed model exhibits a backward bifurcation when the virus transmission probability from infected human to mosquito crosses the crucial value. We have fitted the model to real data and estimated the key model parameters and their 95% confidence interval which depict the ZIKV outbreak in French Polynesia in 2013-14. We also have estimated the basic reproduction number using first nine epidemic weeks (EW) data and the estimated value is 2.87 with lower and upper values are 2.47 and 3.32 respectively. The effective reproduction number of the outbreak also has been studied and which decreases gradually from 5.404 to 0.2499 during the period 11th October, 2013 and 28th March, 2014. According to our sensitivity analysis, the basic reproduction number is the most sensitive with controllable parameters, biting rate, mosquito recruitment rate, mosquito death rate and recovery rate from infection. Finally, numerically we have studied the impact of different parameters on the basic reproduction number and on the number of infected human population.

Neurological complications during veno-venous extracorporeal membrane oxygenation: Does the configuration matter? A retrospective analysis of the ELSO database

BackgroundSingle- (SL) and double-lumen (DL) catheters are used in clinical practice for veno-venous extracorporeal membrane oxygenation (V-V ECMO) therapy. However, information is lacking regarding the effects of the cannulation on neurological complications.MethodsA retrospective observational study based on data from the Extracorporeal Life Support Organization (ELSO) registry. All adult patients included in the ELSO registry from 2011 to 2018 submitted to a single run of V-V ECMO were analyzed. Propensity score (PS) inverse probability of treatment weighting estimation for multiple treatments was used. The average treatment effect (ATE) was chosen as the causal effect estimate of outcome. The aim of the study was to evaluate differences in the occurrence and the type of neurological complications in adult patients undergoing V-V ECMO when treated with SL or DL cannulas.ResultsFrom a population of 6834 patients, the weighted propensity score matching included 6245 patients (i.e., 91% of the total cohort; 4175 with SL and 20,270 with DL cannulation). The proportion of patients with at least one neurological complication was similar in the SL (306, 7.2%) and DL (189, 7.7%; odds ratio 1.10 [95% confidence intervals 0.91–1.32]; p = 0.33). After weighted propensity score, the ATE for the occurrence of least one neurological complication was 0.005 (95% CI − 0.009 to 0.018; p = 0.50). Also, the occurrence of specific neurological complications, including intracerebral hemorrhage, acute ischemic stroke, seizures or brain death, was similar between groups. Overall mortality was similar between patients with neurological complications in the two groups.ConclusionsIn this large registry, the occurrence of neurological complications was not related to the type of cannulation in patients undergoing V-V ECMO.

Neurological complications in haematopoietic stem cell transplant patients

Neurological complications are some of the most important complications that can occur in a patient undergoing haematopoietic stem cell transplantation (HSCT), not only because of the high mortality rate, but also because of the sequelae that appear in survivors. The causes of such complications are manifold and very often coexist in the same patient: toxicity of the conditioning regimen, graft-versus-host disease and its treatment, infections and their treatment, platelets and coagulation disorders, liver failure or arterial hypertension with low platelet count. The aim of the present study is to provide a clinical description and to describe the risk factors for complications involving the central nervous system that may occur during the course of HSCT, in order to assist in the early detection of these disorders that may have a negative influence on the morbidity and mortality of these patients. The following types of neurological complications are described: central nervous system infections, vascular complications, pharmacological toxicity, metabolic complications, immune-mediated disorders and post-HSCT carcinogenesis, and effects of graft-versus-host disease and thrombotic microangiopathy on the nervous system. The patient undergoing HSCT is at particular risk for the development of neurological complications. Early diagnosis and treatment are needed to try to reduce the high morbidity and mortality in these patients.

Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients.

Purpose: The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available.Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry.Results: Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days, p < 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days, p < 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046–1.175, p = 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay.Conclusions: Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.

Neurologic complications after primary anatomic or reverse total shoulder arthroplasty

BackgroundThe incidence of the various types of neurologic complications that can occur after primary shoulder arthroplasty, as well as the factors associated with these complications, are unclear. MethodsWe reviewed 309 cases of primary anatomic total shoulder arthroplasty (TSA) and 504 cases of reverse TSA performed from 2003–2017 with minimum 1-year follow-up. We defined 3 types of neurologic complication: iatrogenic nerve injury, new-onset compressive peripheral neuropathy (CPN), and worsening of preexisting CPN. Multivariate analyses were performed to identify factors associated with each type of neurologic complication. ResultsThe overall rate of neurologic complication after primary shoulder arthroplasty was 16% (127/813) (95% confidence interval [CI]: 13%–19%). The rates by complication type were 10% (81/813) for iatrogenic nerve injury, 18% (39/216) for worsening of preexisting CPN, and 1.8% (15/813) for new-onset CPN. The incidence of the 3 complication types did not differ between anatomic and reverse TSA. All cases of iatrogenic nerve injury improved without operative treatment after 1 year, whereas 53% of cases of new-onset CPN and 36% of cases of worsening CPN required surgical release. We found no factors independently associated with iatrogenic nerve injury, but iatrogenic nerve injury was independently associated with new-onset CPN. Factors independently associated with worsening CPN were male sex and a history preexisting CPN not treated with previous surgery. ConclusionNearly 1 in 5 patients experienced neurologic complications after primary shoulder arthroplasty. Clinicians should be alert for neurologic symptoms because some patients develop CPN or worsening of CPN that may warrant surgical treatment. Level of EvidenceLevel IV; Retrospective Cohort; Treatment Study

72. Operation timing affects outcomes after adult spinal deformity surgery

BACKGROUND CONTEXT Adult spinal deformity (ASD) surgery can entail complex reconstructive procedures in patients with multiple comorbidities. Postoperative complications can range from minor complications such as ileus, to significant neurologic injury. ASD surgery is commonly scheduled for weekdays, with first start times. It is unclear if there is any effect of time-related performance impairment on the surgical team. PURPOSE To investigate the rate of complications based on day of the week, or time of day, that ASD surgeries are performed. STUDY DESIGN/SETTING Retrospective review of prospectively collected single center database. PATIENT SAMPLE 1040 ASD patients (Age: 46 ± 23; BMI 25 ± 7, ASA 2.5 ± 0.6, Levels fused 10 ± 4, Revision procedure: 9%, 3CO: 13%) were included in the analysis. OUTCOME MEASURES Overall complication rate, and 90-day readmission and reoperation rates. METHODS We collected start times and day of the week for ASD cases occurring at our institution from 2011-2018. First start was designated as any case starting at 7:30 AM; late start was designated as any case starting 11 am and after. Day of week was modelled as a categorical variable, with Monday as the reference group. RESULTS 1040 ASD patients (Age: 46 ± 23; BMI 25 ± 7, ASA 2.5 ± 0.6, Levels fused 10 ± 4, Revision procedure: 9%, 3CO: 13%) were included. After controlling for patient and case characteristics, there was no association between day of week and length of stay, or 90-day complication, readmission, or reoperation rates in the adjusted analyses. Late start cases (n=269) had higher rates of 90-day readmission (10.4% vs 6.0%, p=0.02), reoperation (11.9% vs 6.6%, p=0.008), and neurologic injury (5.2% vs 2.3%, 0.019). Sub-analysis of types of neurologic complications encountered demonstrated that in late start cases, there was a higher rate of postoperative radiculopathy (3.3% vs 0.9%, p=0.007), and residual central or foraminal stenosis (2.2% vs 0.6%, p=0.029). Late start cases were predictive of increased risk for 90-day readmission (OR 1.8, CI: 1.1-3.0, p=0.02), unplanned reoperation (OR 1.9, CI:1.2-3.1, p=0.009), and neurologic complication (OR 2.1, CI: 1.0-4.3, p=0.046). CONCLUSIONS Risk of morbidity after elective ASD surgery is not associated with day of the week, in an analysis of over 1000 cases. A late OR start time was predictive of increased risk for neurologic complication, and 90-day readmission and unplanned reoperation. Well-established protocols for first start OR times for elective ASD surgery may decrease outcome risk and reduce variability in complication rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis

Study DesignLongitudinal cohort. ObjectivesTo identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity. Summary of Background DataIncreasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient's health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity. MethodsThe data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events. ResultsOf 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071). ConclusionsFactors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient's quality of life. Level of EvidenceLevel II. Prospective cohort.

Neurological Complications Involving the Central Nervous System After Allogeneic Hematopoietic Stem Cell Transplantation During a Period of Evolution in Transplant Modalities: A Cohort Analysis.

Neurological complications (NC) after hematopoietic stem cell transplantation (HSCT) are rare events. The evolution of transplant procedures has resulted in improved survival and has allowed elderly patients or those with comorbidity to receive an HSCT. The risk of NC in these patients has still not been well defined. Therefore, we carried out an observational study to estimate the occurrence and identify the risks associated with NC. The study cohort included 452 adult-allogeneic HSCT recipients, transplanted from 1997 to 2012. The median follow up was 1.3 year (0-15.7). A myeloablative regimen was used in 307 patients. Two hundred patients were grafted from matched unrelated donor (MUD), of these, 129 (64.5%) received an in vivo T-cell depletion. Out of 452 patients, 30 (6.6%) developed NC. Infections were the most frequent causes of NC (30%). Overall survival decreased in patients developing NC (P < 0.001). Univariate survival regression on the cumulative incidence of NC identified period of transplant, linear trend between 4-year periods (1997-2012) (P < 0.001), MUD (P < 0.001), and recipient's age (P = 0.034) as significant risk factors. In multivariate analysis, period of transplant (P < 0.001) and MUD (P = 0.004) remained significant independent risk factors. Matched unrelated donor recipients showed a 3.8-fold elevated risk of developing NC. Analysis highlights a temporal trend of incidence of NC that progressively increased over time and confirms a strong association between donor type and risk of NC. Our observations suggest that, although relatively uncommon, NC after allo-HSCT, may become more frequent due to the improved overall survival in recent years.

Morbidity and mortality in a large number of Iranian patients with severe congenital factor XIII deficiency.

With 473 patients, Iran has about one third of the world's patients with severe congenital factor XIII (FXIII) deficiency. A considerable number of patients with FXIII deficiency (FXIIID) are affected by life-threatening bleeding episodes, such as central nervous system (CNS) bleeding or recurrent miscarriage and umbilical cord bleeding (UCB), that cause a high rate of morbidity and mortality in Iranian patients with FXIIID. Among 317 Iranian patients with FXIIID, 145 cases experienced 166 CNS bleeds (CNSBs) that recurred in 21 cases. CNSB caused different types of neurological complications in 69 patients. A total of 62 miscarriages were observed in 24 women of childbearing age, and 21 deaths were observed due to umbilical cord bleeding or mucosal bleeding. In fact, 49 deaths (15.4 %) were observed in these patients, which highlight the importance of early diagnosis and intensive health care among patients with FXIIID.

Neurological Complications after Renal Transplantation: A Retrospective Clinical Study.

The aim of this study was to evaluate the incidence and types of neurological complications (NCs) and associated factors in renal transplantation (RT) patients. Three hundred and forty-four patients who had RT performed at our institution between January 2005 and July 2014 were retrospectively evaluated. File records of the patients revealed 19 who experienced a total of 22 episodes of NCs, of whom three had more than one episode. The mean age of 19 patients included in the study, of whom eight were female, was 37.52±13.08 (range, 18-65) years. NCs were classified into central or peripheral depending on the location of involvement of the central nervous system (CNS). CNS involvement was found in 16 (84.2%) of the 19 patients. Tremor (36.8%) was the most common CNS complication in these patients. Encephalopathy, generalized tonic-clonic seizures, and status epilepticus were observed in two patients (10.5%). Delirium and dementia were observed in one patient (5.2%). Headache was experienced by one patient, and agitated depression was observed in one patient. Six patients (26.3%) had the peripheral nervous system involvement. One patient had the numbness of hands with normal electromyography findings, and four patients had polyneuropathy. In one patient, lumbar plexopathy was observed. Seventeen of the 22 NCs were considered to be caused by immunosuppressive agents. Each incidence of amyloidosis, infection, septic emboli, and hypoglycemia caused a neurological episode. The etiology of one episode was unknown. Different neurological disorders can be seen after RT, and most of them are caused by immunosuppressive drugs. NCs seen after RT can be treated by decreasing the dose or changing the immunosuppressive drug.

Neurologic Complications After Liver Transplant: Experience at a Single Center

Neurologic complications occur frequently after liver transplants. Up to 43% of patients experience severe postsurgical neurologic complications. These complications are significantly associated with longer hospital stay, morbidity, and mortality. The aim of this retrospective study was to evaluate the type and incidence of neurologic complications after liver transplants in adult patients. We retrospectively evaluated the medical records of 176 adult patients who had undergone liver transplants between 1995 and 2013. We recorded the demographic data, type of neurologic complications, type, and level of immunosuppressive treatment, and cause of liver failure. Our study sample consisted of 48 deceased-donor liver transplants and 128 living-donor transplants (n = 176). Fifty-three of the patients (30.1%) were female. The age range of the total sample was 18 to 66 years (mean age, 43.1 ± 13.7 y). As immunosuppressive treatment, most patients received tacrolimus alone (52%) or tacrolimus combined with mycophenolate mofetil (33%). Neurologic complications occurred in 74 of the patients (42%). The most common neurologic complications were diffuse encephalopathy (22.2%) and seizure (14.2%). Other neurologic complications were posterior reversible encephalopathy (1.7%), peripheral neuropathy (1.7%), cerebrovascular disease (1.1%), and central nervous system infection (1.1%). Age, cause of liver failure, and type of transplant were not associated with occurrence of neurologic complications. There was a high incidence of neurologic complications after liver transplants. Diffuse encephalopathy and seizure were common complications. Physicians should be aware of the high risk of neurologic complications after liver transplants. Factors such as immunosuppressive toxicity and metabolic imbalance that predispose patients to neurologic complications after liver transplants should be evaluated immediately, and treatment of postoperative neurologic complications should be initiated as early as possible.

Chapter 27 - Measles virus and the nervous system

Measles is a highly contagious viral disease caused by an enveloped negative-strand RNA virus in the Paramyxovirus family. Measles is associated with three different types of neurologic complications: acute disseminated encephalomyelitis (ADEM), measles inclusion body encephalitis (MIBE), and subacute sclerosing panencephalitis (SSPE). ADEM is a monophasic autoimmune demyelinating disease that has an incidence of 1:1000 and occurs primarily in children over the age of 4 years. Disease onset is acute and usually occurs within days to weeks after measles. Pathology is characterized by perivenular inflammation and demyelination. MIBE is due to progressive measles virus infection of the nervous system and occurs in immune-compromised individuals who are unable to clear virus after infection. Disease onset is subacute and usually fatal. Pathology shows nuclear and cytoplasmic viral inclusion bodies with little evidence of inflammation. SSPE is a fatal progressive neurologic disease with an onset many years after measles and an incidence of 1:10 000. The disease occurs primarily in immunologically normal children who developed measles under the age of 2 years. Pathology shows nuclear and cytoplasmic inclusion bodies and inflammation. All of these diseases can be prevented by measles vaccination.

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.

74 Pre- and Post-Operative Risk Factors Associated with Neurological Complications in Patients Supported by Ventricular Assist Device

Purpose Neurological complications (NC) are a major adverse event following left ventricular assist device (LVAD) surgery. Pre- and post-operative factors associated with NC were investigated. Methods and Materials We reviewed 287 consecutive patients who underwent LVAD surgery [167 Heart Mate (HM) I and 121 HM II] at Columbia University Medical Center between November 2000 and June 2010. Clinical characteristics, hemodynamic and laboratory indexes were analyzed. The NC was defined according to the INTERMACS definition of neurological dysfunction including transient ischemic attack (TIA) and ischemic or hemorrhagic stroke. Results In total, 43 (15.0%) patients developed NC at 145±218 days after surgery, including 28 infarcts, 5 hemorrhages, and 14 TIAs. Six patients developed multiple events. The type of NC was not different between HM I and HM II patients. Preoperative factors that were different between patients with and without NC included: serum albumin (pre-alb, 3.3±0.6 vs. 3.5±0.5 mg/dL; p=0.015); sodium (pre-Na, 127±9 vs. 132±8 mg/dL, p=0.001), and the history of stroke (pre-stroke, 37.2% vs. 17.1%, p=0.003). Postoperative factors associated with NC again included lower albumin (post-alb, 3.4±0.7 vs. 3.9±0.7 mg/dL, p=0.001); sodium (post-Na, 128±8 vs. 132±7 mg/dL, p=0.003) and hematocrit (post-Hct, 31.8±6.1 vs. 35.3±6.6 %, p=0.001). The incidence of LVAD-related infection (post-Inf) was higher (39.5% vs. 20.8%, p=0.008) in patients with NC than without NC. Multiple regression analysis revealed that pre-stroke [odds ratio (OR) 3.0, 95% confidential interval (CI), 1.2-7.3, p=0.002], post-Na (OR, 0.9, 95%CI, 0.90-0.99, p=0.002), and post-Infect (OR, 2.9, 95%CI, 1.24-6.67, p=0.001) were highly associated with NC development. The combination of pre-Alb, pre-stroke, post-Alb, post-Na, post-Hct and post-Inf could predict NC with a probability of 76.4%. Conclusions Persistent malnutrition, severity of heart failure, previous stroke and post LVAD infections were the key factors associated with NC development post LVAD.

Neurologic Varicella Complications Before Routine Immunization in Germany

Varicella is an acute febrile, highly infectious disease. We describe the incidence and types of neurologic complications in children up to 16 years old. Hospitalized varicella cases were prospectively captured by active nationwide surveillance through the German Pediatric Surveillance Unit for Rare Diseases from January 2003 to December 2004. Neurologic complications occurred in 232 (25.4%) of 918 hospitalized children with varicella, and were the most frequent reason for hospitalization. The median age was 4.2 years (interquartile range 2.5-5.9). The median duration of hospital stay was 6 days (interquartile range 3-11). Neurologic complications were more frequent (P=0.054) in immunocompetent (32%) than immunocompromised (4%) children. The most frequent diagnoses comprised acute cerebellar ataxia in 72 (31.0%), febrile convulsion in 69 (29.7%), meningoencephalitis in 52 (22.4%), cerebral convulsions in 21 (9.1%), syncope in 9 (3.9%), and cerebral vasculitis/infarction in 6 (2.6%) of all children with neurologic complications. Twenty-eight (12%) demonstrated sequelae (18 with ataxia, four with epilepsy, two with hemiparesis, three with cerebral nerve palsy, and one with dysesthesia). Three patients died. The yearly incidence of neurologic varicella-associated hospitalizations was estimated at 2.4 neurologic complications per 100,000 children, corresponding to about one neurologic complication in 2000 varicella cases.