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Abstract This letter to the Editor discusses the case of a 73-year-old male with mild SARS-CoV-2 infection who one month later developed rapidly progressive cognitive decline, and imaging findings suggestive of Creutzfeldt–Jakob disease (CJD). The diagnosis of sporadic CJD was made on the basis of clinical presentation (rapidly progressive decline, depression, gait disturbance, incontinence, mutism), cerebral MRI (small infarcts, atrophy), hybrid FDG-PET (putaminal and thalamic diffusion restriction, bifrontal hypometabolism), and elevated 14-3-3 in the cerebrospinal fluid (CSF). Despite administration of glucocorticoids, the patient died three months after the onset of symptoms. No autopsy was performed. This case raises the question of a possible link between SARS-CoV-2 infection and the subsequent development of CJD-like syndromes, which warrants further investigation.

I was interested to read the article by Quadrelli et al. on a study on the prevention of sarcopenia using daily "Home Gym Bed" training for 30 minutes per day over 10 years in a 70-year-old man who was examined using 3D CT imaging.1 It was found that muscle mass did not change over the 10 years despite ageing.1 It was concluded that whole-body exercise in bed can help preserve muscle mass and density in older people,1 and that advanced imaging techniques can quantify the effectiveness of non-pharmacological interventions against sarcopenia.1 The study is excellent, but some points should be discussed.[...]

No abstract available.

Background Left ventricular hypertrabeculation/noncompaction (LVHT) is a cardiac abnormality of unknown pathogenesis, frequently associated with neuromuscular disorders. The relevance of coronary artery disease (CAD) in LVHT is largely unknown. This study aimed to assess the role of CAD as a prognostic marker in LVHT. Methods Data from patients with LVHT were collected from an echocardiographic laboratory. The hospital information system was retrospectively screened for coronary angiography. The association of CAD with clinical, echocardiographic, and neurologic baseline parameters was assessed. End points were all-cause death and heart transplantation. Results A total of 154 patients (mean [SD] age, 57 [13.7] years; 31% female) who had undergone coronary angiography between 1995 and 2020 were included in the study. Coronary angiography disclosed CAD in 53 of 154 patients. Patients with CAD were older (mean [SD] age of, 64.2 [12.9] years vs 52.7 [12.4] years; P < .001); more frequently had angina pectoris (P = .05), diabetes (P = .002), and hypertension (P = .03); and more frequently had 3 or more electrocardiographic abnormalities (P = .04) than patients without CAD. During a median (IQR) follow-up period of 6.48 (2.44-11.20) years, 39% of patients reached an end point (death, n = 56; heart transplantation, n = 4). Mortality was 4.5% per year, and the rate of death or heart transplantation did not differ between patients with and without CAD (P = .26). Patients with 3-vessel disease had a worse prognosis than patients with 1- or 2-vessel disease (P = .046). Conclusion: In patients with LVHT, CAD does not appear to be associated with an increased rate of death or heart transplantation.

New hippocampal neurons are continuously generated in the adult human brain. Several studies have demonstrated that the proliferation of hippocampal cells is strongly influenced by a variety of stimuli, including pesticides exposure. These effects are particularly important because neurogenesis dysregulation could be associated with the decline of neuronal and cognitive functions and the possible development of neuropsychiatric disorders.

SARS-CoV-2 vaccines are often promoted as safe. However, real world data tell a different story. The aim of this study is to investigate the type and frequency of adverse reactions to SARS-CoV-2 vaccination in a randomly selected cohort of unrelated individuals. Adverse reactions to the first/second dose of a SARS-CoV-2 vaccine were recorded using an online reporting system called “Pabbly”. Patients were asked via social media to report any symptoms temporarily associated with vaccination. One hundred subjects were enrolled. The mean age was 42.6 years (range: 12–74 years). Ninety-one percent were female. The latency period between vaccination and onset of symptoms ranged from zero to 18 days. The most commonly reported symptoms were tingling/vibration/tremor (79%), numbness (57%), heart problems (53%), muscle weakness/muscle pain (45%), dizziness (44%), headache (44%) and fatigue (43%). Three patients developed small fiber neuropathy. Three patients had COVID-19 prior to vaccination. Of the included subjects, 37% had to be hospitalized. Overall, SARS-CoV-2 vaccination is not without side effects, regardless of the product used. In most cases, the reported side effects were not life-threatening, but one third of study participants experienced serious side effects requiring hospitalization and intensive care. Manufacturers of SARS-CoV-2 vaccines should respond appropriately to reports of adverse reactions associated with SARS-CoV-2 vaccination.

Objectives new-onset relapsing-remitting multiple sclerosis (RRMS) has rarely been communicated as a side effect of SARS-CoV-2 vaccination (SC2V). Here we report a patient with new-onset RRMS shortly after the second BNT162b2 vaccine dose, which was diagnosed only after a relapse after the third vaccine dose. Case report the patient is a 31 year-old male who developed eye problems 48 days after the second dose of BNT162b2. The symptoms were attributed to eye strain and gradually disappeared without treatment. Further workup was negative. Three months after the third BNT162b2 dose, urinary urgency developed. Eleven months after the third BNT162b2 dose, he developed sensory and visual disturbances that were noticeable post-exercise and progressed and worsened with alcohol and heat. MRI showed typical lesions that met the Barkhof/Tintore criteria for RRMS. Cerebrospinal fluid (CSF) studies revealed elevated kappa free light chains and positive oligoclonal bands. Because the revised McDonalds criteria were met, RRMS was diagnosed and ocrelizumab was started. Conclusions this case shows that SARS-CoV-2 vaccination can trigger new-onset RRMS, the clinical presentation of SC2V-induced multiple sclerosis is similar to multiple sclerosis due to other triggers, and the severity of the relapses may increase with the number of boosters given. Although, rare, a neurologist should be aware of the presumably rare event in which SC2V triggers new-onset multiple sclerosis.

Objectives: Whether infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be complicated by immune suppression is under debate, but the following case suggests decreased immune competence during and after a SARS-CoV-2 infection. Case Report: The patient is a 50-year-old woman with a previous history of transient hyperthyroidism, allergy against ambrosia, and burn-out syndrome, who experienced a mild infection with SARS-CoV-2 during which she developed candida pharyngitis, which was successfully treated with miconazole. Twenty-eight days after clinical recovery from the SARS-CoV-2 infection, she developed right-sided zoster oticus with vestibular neuronitis and was successfully treated with acyclovir. Conclusions: The case suggests that infection with SARS-CoV-2 can weaken immune competence and precipitate the development of candidiasis and focal infection with the zoster virus. Even mild infections with SARS-CoV-2 may be complicated by immune-compromise and immune-concomitant superinfections, which is why coronavirus disease 2019 (COVID-19) patients should strengthen their immune system not only during but also after the infection.

Key Clinical Message Takotsubo syndrome and transient global amnesia can occur simultaneously, not only in the context of acute but also long‐standing emotional stress. Probably, hypothyroidism and migraine make the patient more susceptible to both of these disorders.

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Letter to the Editor