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Guillain-Barre syndrome (GBS) in pregnancy may be a serious disease associated with high maternal and perinatal morbidity and mortality. Herein, we present the long-term maternal and fetal outcomes of five pregnant GBS patients from our center. The mean age of pregnant GBS patients was 29.8 ± 3.1. Two patients had a severe disability at admission. Three patients were treated with intravenous immunoglobulins, while the remaining two were treated with symptomatic therapy. One year after disease onset, one patient had a mild disability, while the remaining four had normal neurological findings. All babies born were healthy and developed normally. GBS in pregnancy may affect both maternal and neonatal outcomes. Early diagnosis and treatment are essential for the outcome. Most patients and their babies have a favorable long-term outcome.

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly used surgical method to treat a variety of disorders in the cervical spine. Although, the incidence of complication related to ACDF is low, hematomas can be confronted after surgery. We report a 52-year-old male patient presented with complaints of paraesthesia and sensory loss in the upper extremities. Magnetic resonance imaging (MRI) showed a large central-right paracentral protrusion resulting in narrowing of the spinal channel at the level of C5-C6 accompanied by spinal cord compression and bilateral foraminal stenosis. ACDF was performed at this level. Five hours after surgery, sudden onset paraesthesia and tetraparesis developed. Urgent cervical MRI depicted acute filling half of the discectomy cavity, compressing the dural sac and spinal cord. The patient underwent revision surgery and the symptoms improved postoperatively. The patient received conservative therapy and was discharged without any nerological problem. Despite being a rare condition, sudden onset of neurological symptoms such as tetraparesis after ACDF surgery should remind the presence of hematoma at the surgical site., NA

The first objective was to assess the role of vascular inflammatory factors in the pathogenesis of deficiency of adenosine deaminase 2 (DADA2) and to compare these markers among DADA2 patients with different phenotypes. We also aimed to investigate differences between DADA2 patients with vasculitic features and classic polyarteritis nodosa (PAN) for the aforementioned markers.The study included eighteen DADA2 patients, ten PAN patients, and eight healthy controls. Plasma levels of sST2, sRAGE, Tie-2, sCD40L, Tie-1, sFlt-1, LIGHT, TNF-α, PlGF, IL-6, IL-18, IL-10, MCP-1 were studied by cytometric bead-based multiplex assay panel.Among the DADA2 patients, five had hematological manifestations, 13 had vasculitic findings, and accompanying immunological findings were present in seven patients. Nine patients had neurological findings, five of whom had neuropathy. Plasma levels of Tie-1 and sFlt-1 were higher in the overall DADA2 patients compared to healthy controls and PAN patients (p0.001 and p = 0.004, respectively). DADA2 patients with PAN-like features had higher sRAGE, Tie-2, and TNF-α levels compared to PAN patients (p = 0.013, p = 0.003, and p = 0.001, respectively). In DADA2 patients with hematological findings, plasma IL-18 levels were higher than those with PAN-like phenotype (p = 0.001). Finally, DADA2 patients with neuropathy had higher sRAGE concentrations than patients without neuropathy and healthy controls (p = 0.03 and p = 0.008, respectively).We suggest that the high plasma IL-18 levels observed in DADA2 patients with hematologic manifestations may be associated with an activated IFNγ pathway, and lack of response to anti-TNF treatment. We identified sRAGE as a potential biomarker of neuropathy in DADA2 patients. Higher concentrations of Tie-1, Tie-2, sFlt-1, sRAGE, and TNF-α distinguished DADA2 patients with PAN-like features from PAN patients.

Aim:The aim of this study is to analyze children with acute carbon monoxide (CO) poisoning and to present two patients with rare neuroradiological findings.Materials and Methods:We identified and reviewed the medical records of pediatric patients diagnosed with acute CO intoxication who were hospitalized in our department during a 10-year period. Epidemiologic and clinical data were collected and analyzed.Results:A total of 326 children (166 girls, 160 boys; age range 1 to 17.8 years) with CO poisoning were identified. Their ages ranged from 1 to 17.8 years, with a mean of 8.3±4.8 years. Improperly vented coal or wood stoves were the most common (80.7%) cause of intoxication. The most common presenting symptoms were nausea/vomiting and headache. Seizure was seen in 32 patients (9.8%). Two patients died and the mortality was 0.6%. All patients received normobaric oxygen therapy until their carboxyhemoglobin (COHb) levels were decreased below 2% and their symptoms resolved. One hundred of the 326 patients (30.7%) also were treated with hyperbaric oxygen (HBO) therapy as indicated by the signs and symptoms or COHb levels. Brain imaging was performed in 19 patients (thirteen magnetic resonance imaging and six computerized tomography), and was normal in 15. Acute brain stem demyelination related to water pipe smoking developed in one patient. All patients showed complete recovery without neurological sequelae except one who had mild right hemiparesis at discharge.Conclusion:Acute CO intoxication is an important health problem in our country, especially in winter, because of poorly functioning heating systems. The clinical spectrum including neurological findings varies during childhood. We suggest that HBO therapy could be used safely in children. We believe that the combined administration of pulse methylprednisolone and HBO treatment might reduce cerebral damage caused by CO poisoning in selected pediatric patients.

OBJECTIVES: Our study aimed to investigate neurological symptoms in patients with COVID-19 and contribute to this area of limited knowledge. BACKGROUND: Increasing evidence shows that neurotropism is a common feature of Coronaviruses (CoVs). Like the other CoVs, SARS-CoV 2 uses angiotensin-converting enzyme 2 (ACE2). The brain is thought to express ACE2 receptors detected on glial cells and neurons. There are also ACE2 receptors in skeletal muscles. Our study aimed to investigate neurological symptoms in patients with COVID-19 and contribute to this area of limited knowledge. METHODS: A total of 51 patients, presented to hospitalized in our hospital between March 23, 2020 and April 16, 2020 were included in the study. The diagnosis of all patients included in the study was made according to the WHO interim guideline. The patients were divided into two subgroups as mild and severe course according to the severity of the disease. RESULTS: Neurological symptoms were detected in 16 (31.37 %) patients. Muscle injury was detected in 10 (19.61 %) patients. The most common neurological symptom was headache (n: 9, 17.65 %). When the frequency of all neurological symptoms was compared in those with severe and mild disease, no significant differences were found between the groups. When the frequency of muscular involvement was compared in patients with severe and mild course, no significant differences were found between the groups. CONCLUSION: The nervous system and skeletal muscle system may be among viral targets. Detection of some neurological findings may be valuable in predicting the course of the disease. Some laboratory values can allow predicting disease severity and neurological symptoms (Tab. 5, Ref. 23) Keywords: COVID-19, neurotropism, muscle injury, headache.

Ajay Kumar Mishra,1 Harshad Arvind Vanjare,2 Anu Anna George,1 Kamal Kant Sahu1 1Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA; 2Department of Radiology, Christian Medical College, Vellore, IndiaCorrespondence: Kamal Kant SahuDepartment of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USAEmail drkksahu85@gmail.comAbstract: Individuals presenting with sudden and focal neurological findings are usually suspected to have stroke. However, there are other conditions that can simulate stroke, which are often referred to as stroke mimics. Awareness and understanding these stroke-like disorders are of extreme importance as the treatment of each of them might be variable. We hereby briefly discuss these stroke mimics, common differentials, and key features to differentiate amongst the various causes of acute neurological event. Stroke is one of the neurological emergencies that needs urgent intervention to prevent significant mortality and morbidity. At the same time, it is important to realize the importance of other conditions which may mimic to stroke. In this letter, we aim to discuss a few key features that could probably help to distinguish stroke from mimickers thereby helping emergency doctors, neurologists, and hospitalists in streamlining the correct treatment at the earliest.Keywords: COVID-19, stroke, virus, SARS-CoV-2, neurology

A 54-year-old female patient was admitted to our outpatient clinic with back and low back pain. There were no remarkable physical or neurological findings in the two-year followup period of the patient. There were 39 lesions at 17 levels (mean diameter: 5.93 +/- 2.77 [range, 1.00 to 12.2] mm) in entire vertebra in magnetic resonance imaging and more than one perineural cysts were observed adjacent to the same nerve root at several vertebrae levels. In this patient, conservative treatment was preferred.

Methyl mercury (MeHg) poisoning or Minamata disease (MD) from fish consumption is a public health concern throughout the world because all fish contain small amounts. The lowest exposure level needed to impair children's development is controversial. Actual poisoning with MeHg from fish consumption has been reliably reported only two times. It occurred in Minamata, Japan in the 1950s and then in Niigata, Japan in the 1960s. On each occasion, massive industrial pollution led to local fish having mercury levels as high as 40 ppm. In Niigata the pollution was on the Agano River and there were over 2000 commercial fishermen active at that time. We studied adult subjects who had been exposed perinatally to MeHg from fish consumption during the Niigata poisoning to determine the long-term impact of exposure. We identified mothers with elevated levels of exposure during the epidemic and those diagnosed with MeHg poisoning. The subjects of the study were their adult children, born during the epidemic. The evaluation consisted of a questionnaire (administered by interview) focusing on development, symptoms, and current function and a standard medical and neurological examination. The subjects were divided into four groups based upon prenatal levels of mercury in maternal hair or the presence of MD. For Group A the hair mercury levels were 50 ppm or more, for Group B the mercury levels were 25-49 ppm, and for Group C 10-24 ppm. The subjects in Group D were born to mothers diagnosed with MD, but their mercury levels were not measured. Exposure was predominantly prenatal, but some mothers also breast fed their infants. Group A included 13 subjects among whom two were diagnosed with congenital MeHg poisoning and in two others it was suspected. Group B included 10 subjects, of whom three had symptoms compatible with MeHg poisoning. Group C had nine subjects including one with intellectual deficit and another with hearing loss. Group D had eight subjects of whom four had symptoms compatible with MeHg exposure, but only one had abnormal neurological findings. Among the subjects thought to have congenital or childhood MeHg poisoning, intelligence did not appear to have declined over time. More children were affected by prenatal and postnatal MeHg exposure at Niigata than was previously reported.

Coronavirus disease 2019 (COVID-19) disease has spread worldwide since it was first discovered in China's Hubei province in December 2019. Respiratory illness is the primary manifestation of COVID-19 disease, and its pathophysiology as well as the clinical and cross-sectional imaging manifestations has been adequately reported. However, there is emerging evidence of its multisystemic nature, with associated extrapulmonary manifestations including gastrointestinal, cardiovascular, renal, and neurological findings. There is still limited understanding with regard to the extrapulmonary involvement in this disease. This review aims to put together the prevalence, proposed pathophysiology, and the spectrum of clinical and cross-sectional imaging manifestations of associated extrapulmonary findings in COVID-19 disease.

Background and Purpose Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19.Methods Three authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables.Results We identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase.Conclusions The association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.

Cerebral Palsy (CP) is a gathering of irreversible sicknesses of the improvement of development and stance that happens because of restrictions in useful exercises and are ascribed to non-progressive disorderwhich happen in an infant or fetal brain. CP is a chronic disorder distinguished worldwide in children.

We report the case of a 60-year-old female patient with a history of hypertension and dyslipidemia, who suddenly presented with a clinical picture of emotional lability, disorientation, complex visual hallucinations and persecutory delusions. There were no associated neurological findings in her initial physical examination. At a local hospital she was initially diagnosed with late-onset bipolar disorder and a manic episode with psychotic features, then referred to the mental health unit, where nuclear magnetic resonance (NMR) imaging of the brain revealed an acute ischemic stroke in the territory of the left posterior cerebral artery (PCA) with haemorrhagic reperfusion to the occipital cortex. Complete and spontaneous resolution of her clinical condition was achieved after approximately 15 days.

Purpose of review The current review covers recent advances in vascular vertigo in terms of diagnostic strategies, clinical/laboratory features, pathophysiology, and differential diagnosis. Recent findings Acute strokes presenting with isolated dizziness/vertigo without other obvious symptoms or signs of central nervous system involvements may be easily mistaken as peripheral vestibulopathy. For correct diagnosis of vascular vertigo, the importance of clinical history (timing and triggers) and targeted bedside examination cannot be overemphasized. In addition to Head Impulse-Nystagmus-Test of Skew, several differential strategies have been advanced by adopting a combination of clinical history, bedside or laboratory examination, and imaging for diagnosis of vascular vertigo. Circumscribed cerebellar and brainstem lesions may cause isolated central vestibular syndromes with characteristic vestibular and ocular motor manifestations. Recognition of these findings would aid in localizing the lesions and understanding the function of each central vestibular structure. Central positional nystagmus (CPN) may mimic benign paroxysmal positional vertigo (BPPV), but additional oculomotor or neurological findings mostly permit differentiation of CPN from BPPV. Summary In acute vestibular syndrome, discriminating vascular causes is still challenging especially when other central symptoms and signs are not evident. An integrated approach based on understanding of clinical features, laboratory findings, speculated mechanisms, and limitations of current diagnostic tests will lead to better clinical practice.

OBJECTIVES. Cervical mobilization and manipulation are two therapies commonly used for chronic neck pain (CNP). However, the safety, especially of cervical manipulation, is controversial. This study identifies the clinical scenarios for which an expert panel rated cervical mobilization and manipulation as appropriate and inappropriate. METHODS. An expert panel, following a well-validated modified-Delphi approach, used an evidence synthesis and clinical acumen to develop and then rate the appropriateness of cervical mobilization and manipulation for each of an exhaustive list of clinical scenarios for CNP. Key patient characteristics were identified using decision tree analysis (DTA). RESULTS. Three hundred seventy-two clinical scenarios were defined and rated by an 11-member expert panel as to the appropriateness of cervical mobilization and manipulation. Across clinical scenarios more were rated inappropriate than appropriate for both therapies, and more scenarios were rated inappropriate for manipulation than mobilization. However, the number of patients presenting with each scenario is not yet known. Nevertheless, DTA indicates that all clinical scenarios that included red flags (e.g., fever, cancer, inflammatory arthritides or vasculitides), and some others involving major neurologic findings, especially if previous manual therapy was unfavorable, were rated as inappropriate for both cervical mobilization and manipulation. DTA also identified the absence of cervical disc herniation, stenosis, or foraminal osteophytosis on additional testing as the most important patient characteristic in predicting ratings of appropriate. CONCLUSIONS. Clinical guidelines for CNP should include information on the clinical scenarios for which cervical mobilization and manipulation were found inappropriate, including those with red flags, and others involving major neurologic findings if previous manual therapy was unfavorable.

Cerebral air embolism (CAE) is a serious disease, often underdiagnosed due to nonspecific neurological findings and clinical and imaging unawareness. Early diagnosis is crucial for a prompt specific treatment, which differs from other types of brain infarcts. Immediate computed tomography (CT) scan is the imaging technique of choice, allowing to depict acute intracranial air, most commonly seen in the high convexity along cortical grooves, in a sulcal subarachnoid gyriform pattern. The use of thin-slice (thickness of 5 mm or smaller) and the measurement of air attenuation coefficient can reduce false-negative studies. Hyperbaric oxygen therapy (HBOT) is the first-line treatment for CAE and may affect the outcome. We report four cases of iatrogenic CAE and review the literature.

The global burden of neurologic disorders are a leading cause of disability and death worldwide and has increased the demand for treatments and rehabilitation. Our proposed integrated Osteopathic-Neurological Examination (ONE) provides the physician with expanded diagnostic and point of care treatment modalities while allowing the physician to make a more tangible impact in patient care. By incorporating the osteopathic structural somatic examination with the complete neurological evaluation, somatic dysfunction, occurring as a consequence or independent of neurologic injury, can be identified and treated using osteopathic manipulative techniques at time of visit. Utilizing the proposed integrated examination, the physician can determine the interplay between structural and neurological findings to identify patterns of change that coincide with more specific diagnoses and the chronicity of a condition. Tangible benefits from the ONE approach translate to more accurate clinical assessment and enhanced patient and physician satisfaction.

Neurological involvement in the coronavirus disease 2019 (COVID-19) infection is increasing all over the world. Neurological manifestations include headache, dizziness, stroke, seizure, encephalopathy, neuropathy, and skeletal muscle injury. While many patients with central nervous system involvement have normal neuroimaging, some show significant abnormalities. In this article, we report five patients with neurological manifestations of COVID-19 infection and its relevant abnormalities in brain magnetic resonance imaging.

Background The conventional methods for teaching neurological examination with real patients to medical students have some limitations if the patient with the symptom or disease is not available. Therefore, we developed a Virtual Reality-based Neurological Examination Teaching Tool (VRNET) and evaluated its usefulness in in teaching neurological examinations for the medical students. Methods In this prospective, randomized, single-blind study, we recruited 98 medical students and divided them into two groups: 1) A standardized patient(SP) group that received the clinical performance examination utilizing standard patients complaining of dizziness was provided neurological findings using conventional method such as verbal description, photographs, and video clips; 2) A SP with VRNET group that was provided the neurological findings using the newly developed tool. Among the 98 students, 3 did not agree to participate, and 95 were enrolled in this study. The SP group comprised 39 students and the SP with VRNET group had 56 students. Results There were no statistical differences in VRNET’s realness and student satisfaction between the SP and SP with VRNET groups. However, a statistically significant difference was found in the Neurologic Physical Exam (NPE) score (p = 0.043); the SP with VRNET group had higher NPE scores (3.81 ± 0.92) than the SP group (3.40 ± 1.01). Conclusions VRNET is useful in teaching senior (graduating) medical students with SP with a neurologic problem.

AIM There is no clear consensus on whether a cranial MRI should be performed in all cases of central precocious puberty(CPP). In this study, we aimed at evaluating the incidence of intracranial lesions and analyzing cranial imaging results in females with CPP. METHODS In the retrospective study medical records of the case, the age at the time of admission, anthropometric measurements, bone age, Tanner stages, serum follicle-stimulating hormone (FSH), serum luteinizing hormone(LH), serum estradiol (E2) levels, the peak LH level during the gonadotropin-releasing hormone (GnRH) stimulation test and the cranial MRI findings at the time of the diagnosis of CPP were collected. RESULTS The mean age diagnosis of the 154 girls included in the study was 6.9 ±1.08. Nine (5.8%) of 154 patients were diagnosed with organic-caused CPP. Four of the nine cases diagnosed with organic CPP had a previously known CNS pathology. The other five cases did not have any neurological findings at the time of diagnosis. Incidental lesions were detected at cranial MRI of nine of the 145 cases diagnosed with idiopathic CPP. The basal E2, basal LH, basal FSH, peak LH and peak LH/FSH levels of the cases with organic CPP were higher than those with idiopathic CPP. CONCLUSIONS In our study, approximately 90% of organic CPP due to intracranial lesions were between 6-8 years. Therefore, we believe that cranial imaging should be performed in all females with CPP.

Background: Brain imaging in psychiatry, especially by first-episode psychiatric symptoms, is unfortunately not a standard procedure in psychiatric clinics and is recommended only if indicated by history or if associated with neurological findings. As a result, the most serious diagnoses can be delayed or missed. Case Description: We describe a patient who presented with psychiatric symptoms admitted initially to a psychiatric clinic. Thanks to routine imaging the diagnosis of a brain tumor could be made with prompt transfer to neurosurgery. Conclusion: Brain imaging should be a mandatory procedure upon admission to a psychiatric clinic also in patients who present with exclusive psychiatric symptoms.

Sarcoidosis is a granulomatous condition with diverse clinical presentations, including neurological findings. It was previously hypothesized that perineural sarcoidal granulomas in the skin may be an explanation of small-fiber neuropathy. Herein, we present a case of a 55 year old female with anesthetic cutaneous lesions mimicking leprosy clinically and histopathologically and discuss the importance of this differential diagnosis.

Introduction: Prematurity, low birth weight and multiple births are risk factors for structural changes in the brain, as well as deviations in motor, cognitive, social and language development. Objective: To describe language findings and investigate the presence of neurological changes in preterm twins born at two years of age. Method: This is a cross-sectional study based on data analysis of the medical records of six pairs of low birth weight preterm twins, of both sexes, at two years of age, attended to at the State Center for the Prevention and Rehabilitation of Persons withDisabilities - CEPRED, in Salvador-Bahia-Brazil. To this end, information regarding birth was collected; the clinical history; the imaging exams; and the speech, neurological and interdisciplinary assessments. Results: preterm twins had atypical language development and neurological changes that may compromise oral language development. From the neurological point of view, abnormalities common to the premature newborn, such as peri-intraventricular hemorrhage, were observed. Conclusion: Multiple births associated with prematurity and low birth weight may pose risks to the childs language acquisition.

Rationale Adams-Oliver syndrome (AOS) is a genetic disorder characterized by the association of aplasia cutis congenita (ACC), terminal transverse limb defect (TTLD), congenital cardiac malformation (CCM), and minor features, such as cutaneous, neurological, and hepatic abnormalities (HAs). The aim of the study is to emphasize phenotype-genotype correlations in AOS. Methods We studied 29 AOS patients. We recorded retrospectively detailed phenotype data, including clinical examination, biological analyses, and imaging. The molecular analysis was performed through whole exome sequencing (WES). Results Twenty-nine patients (100%) presented with ACC, the principal inclusion criteria in the study. Seventeen of twenty-one (81%) had cutis marmorata telangiectasia congenita, 16/26 (62%) had TTLD, 14/23 (61%) had CCM, 7/20 (35%) had HAs, and 9/27 (33%) had neurological findings. WES was performed in 25 patients. Fourteen of twenty-five (56%) had alterations in the genes already described in AOS. CCM and HAs are particularly associated with the NOTCH1 genotype. TTLD is present in patients with DOCK6 and EOGT alterations. Neurological findings of variable degree were associated sometimes with DOCK6 and NOTCH1 rarely with EOGT. Conclusion AOS is characterized by a clinical and molecular variability. It appears that degrees of genotype-phenotype correlations exist for patients with identified pathogenic mutations, underlining the need to undertake a systematic but adjusted multidisciplinary assessment.

Determining the optimal surgical method for cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. The surgical indication should be made based on not only radiological findings, but also the patient’s age, preoperative neurological findings, social background, activities of daily life, and the presence or absence of comorbid diseases. Anterior resection for OPLL with or without wide corpectomy and fusion, posterior decompression with or without relatively long fusion, or anterior and posterior combined surgery may be considered. When evaluating the clinical condition of patients with cervical OPLL before surgery, various radiological parameters should be carefully considered, including the number of spinal segments involved, the cervical alignment or tilt angle, the relationship between OPLL and the C2–7 line (termed the “K-line”), the occupying ratio of OPLL, and the involvement of dural ossification. The objective of this article is to review the radiological parameters in current use for deciding upon the optimal surgical strategy and for predicting surgical outcomes, focusing on cervical OPLL.

Objective: The correlation between the progression of spinal cord lesions using spinal cord evoked potentials (SCEPs) and neurological findings are unclear. The purpose is to electrophysiologically evaluate relative vulnerability of spinal cord in patients with compressive cervical myelopathy (CCM) at C4–C5 intervertebral level using SCEPs and correlate the progression of spinal cord lesions with neurological findings. Design: Retrospective study. Setting: Yamaguchi University Hospital. Participants: 36 patients. Methods: SCEPs following median nerve stimulation (MN-SCEPs), ulnar nerve stimulation (UN-SCEPs), transcranial electric stimulation (TCE-SCEPs), and spinal cord stimulation (SC-SCEPs) were intraoperatively recorded. MN-SCEPs are mediated by posterior horns (4, 5 layers), UN-SCEPs by the Burdach tract, TCE-SCEPs by the lateral corticospinal tract, and SC-SCEPs by the Goll tract. We evaluated the neurological findings (numbness, tactile sense and pain sense in the C6 area, tactile sense in the lower extremities, and triceps tendon reflex [TTR]). Results: The incidence of electrophysiological and clinical abnormalities decreased in the order of UN-SCEPs (100%), TCE-SCEPs (94.4%), MN-SCEPs (77.8%), and SC-SCEPs (69.4%), and in the order of numbness (100%), pain sense (97.2%), TTR (91.7%), tactile sense in the C6 area (83.3%), and tactile sense in the lower extremities (70.0%), respectively. Conclusions: The relative vulnerability of spinal cord occurred in the order of the Burdach tract, the lateral corticospinal tract, posterior horns (4, 5 layers), and the Goll tract in most patients with CCM at the C4–C5 intervertebral level.

Background and objective: Globally, diastematomyelia accounts for 5% of all congenital spinal cord defects. Clinically, symptoms of diastematomyelia are non-specific, can be progressive, and can become symptomatic at any age. This study was carried out to describe neurological, radiological and surgical findings of diastematomyelia cases reported in Erbil city of Iraq. Methods: A retrospective review of diastematomyelia was carried out in three neurosurgical centers in Erbil city of Kurdistan region of Iraq between 1st January 2003 and 1st January 2013. Diagnosis of this anomaly was based on CT and MRI with surgical dissection in one case. In patients with contraindication for MRI and CT scan, the diagnosis was based on lumbar myelography. Surgical interventions included surgical decompression and laminectomy with timely follow-up at every six months to assess the outcomes after the surgical intervention. Results: A total of 27 cases were included in this study with a mean age of 13 years (ranging from 1-19 years) and a female to male ratio of 2.9:1. Spinal deformities (66.7 %) were the main complaints for patients to seek medical advice. Clinically, 89 % of the patients had a huge spinal disfigurement, and 74% had a mid-line thoracic or lumbar cutaneous variation from the norm. Neurologically, 59 % of the patients had a least neurological disability. Radiologically, 96 % showed inter-pedicular separation and spina bifida, 59% scoliosis, and 55.6% boney spicule. Intra-operatively, around 63% of the cases had boney septum separating the dissected hemi-cords; 70 % of the septa located in the lumbar region. Post-operatively, none of the patients experienced decay in their neurologic status after surgery. Over the long term, two patients were slightly improved, and another two had an increased neurological deficit, one patient had better reflexes, but increasing deformity of the foot and 14 patients were unchanged. None of the patients had contamination, pseudoarthrosis, or loss of remedy amid the subsequent visit. Conclusion: Despite the slight postoperative improvement, all patients with the established preoperative deficit still had residual neurological postoperative deficits and only a low proportion of them slightly improved.

To understand the typical presentation, risk factors, location and size, treatment, neurological recovery and survival of spontaneous spinal epidural haematomas (SSEH) in children. A systematic review of the English literature from 1 January 1960 to 1 March 2018 was performed on children aged 18 years and younger. Individual patient data were extracted and collated. Outcome measures were mode of presentation, risk factors, initial neurological findings, initial presumed diagnosis, diagnostic investigations, site and size of the SSEH, treatment, neurological recovery and survival. Thirty-one publications and 36 patients were reviewed. All age groups were affected. 83% of patients did not have a known risk factor. Back pain was reported in 61% and neurological dysfunction in 97% of patients, although not all articles defined these parameters. Initially 28% of patients were suspected of having an alternative diagnosis. All patients had an MRI and/or CT scan confirming the diagnosis. The cervical-thoracic region was most commonly affected, and the average haematoma size extended across 6.3 vertebral levels. Surgical decompression was performed in 72% of patients. Neurological function improved in 83% of patients. Two patients died as a consequence of their SSEH. SSEHs affect all paediatric age groups and typically present with neurological dysfunction and/or back pain. The initial diagnosis is incorrect in up to 28% of cases, but cross-sectional spinal imaging is diagnostic. Most SSEHs are located in the cervico-thoracic region and affect multiple spinal levels. The treatment depends on whether the patient has a bleeding disorder and their neurological status. These slides can be retrieved under Electronic Supplementary Material.

There is a special concern regarding substance using pregnant women due to the possible adverse effects on the infant. While the immediate effects of prenatal substance exposure are well known, the long-term data on the infants' neurodevelopment is inconclusive.The purpose of this study was to assess early neurobehavior of infants of mothers with substance use using the Dubowitz examination and to follow their neuromotor development until one year of age.Ninety-five pregnant women with a recent history of substance use were recruited and followed up at the maternity outpatient clinic. Follow-up data was collected from hospital records and maternal interviews. The Dubowitz neurological examination was performed to the 54 clinically healthy term infants. The results were converted into optimality scores and compared to normative values from clinically healthy term infants derived from a separate normative population. The infant's neuromotor development was followed up to one year of age.Only 7% of the infants born to women with recent or current substance use reached optimal scores (30.5) in the Dubowitz neurological examination compared to 95% reported in normative population. Sixty-three percent of the newborns needed follow-up based on physiotherapeutic assessment of neurobehavior. By 12 months of age, the neuromotor status of 88% (n = 30) of these infants was found normal.A high percentage of infants of mothers who were referred prenatally to hospital due to substance use showed suboptimal neurological findings during their first days of life.

Case The authors present a case of syringobulbia in a setting of elbow arthropathy due to syringomyelia. The patient had painless elbow instability with subtle neurological findings such as ulnar neuropathy, palatal palsy, and dysphonia. As she denied surgery, she was managed with physiotherapy and orthosis. At 24 months of follow-up, she had good clinical outcome without neurological or functional worsening. Conclusion Many patients with neuropathic joints due to syringomyelia present to an orthopaedician before a neurologist. A high index of suspicion and thorough neurological examination is essential. Conservative management of such a joint provided good results in this patient.

Objective: To investigate the usefulness of the combination of neurological findings and magnetic resonance imaging (MRI) as a prognostic predictor in patients with motor complete cervical spinal cord injury (CSCI) in the acute phase. Design: A cross-sectional analysis Setting: Department of Orthopaedic Surgery, Spinal Injuries Center Participants/Methods: Forty-two patients with an initial diagnosis of motor complete CSCI (AIS A, n = 29; AIS B, n = 13) within 72 h after injury were classified into the recovery group (Group R) and the non-recovery group (Group N), based on the presence or absence of motor recovery (conversion from AIS A/B to C/D) at three months after injury, respectively. The Neurological Level of Injury (NLI) at the initial diagnosis was investigated and the presumptive primary injured segment of the spinal cord was inferred from MRI performed at the initial diagnosis. We investigated whether or not the difference between the presumptive primary injured segment and the NLI exceeded one segment. The presence of a difference between the presumptive primary injured segment and the NLI was compared between Groups R and N. Results: The number of cases with the differences between the presumptive primary injured segment and the NLI was significantly higher in Group N than in Group R. Conclusion: The presence of differences between the presumptive primary injured segment and the NLI might be a poor improving prognostic predictor for motor complete CSCI. The NLI may be useful for predicting the recovery potential of patients with motor complete CSCI when combined with the MRI findings.

Objective Cerebral Blood Flow (CBF) change after Subarachnoid Hemorrhage (SAH) is strongly associated with brain injuries such as early brain injury and delayed cerebral ischemia. We evaluated the correlation between CBF using Laser Speckle Flow Imaging (LSFI) after SAH and neurological findings in the sub-acute phase. Method An SAH was induced by endovascular perforation in male mice. CBF was quantitatively measured by using LSFI at six time points, immediately to 14 days after SAH induction. Behavior tests and survival rate were evaluated. The mice were divided into recovery and hypo-perfusion groups according to their CBF at 1 day after the procedure. Result Forty mice were included in this study. Five mice (20%) were included in the hypo-perfusion group, and the remaining 20 (80%) mice were classified as the recovery group. The decrease of CBF in the recovery group was observed until 1 day after the procedure. However, the decrease of CBF in the hypo-perfusion group was prolonged until 7 days after the procedure. Neurological findings and survival rates in the hypo-perfusion group were significantly worse than those in the recovery group. The low alternation cases (≤ 50%) in the Y-maze test in the recovery group (n = 5) had significantly lower CBF at 1 day after the procedure. Conclusion Low blood flow at 1 day after SAH was associated with worse survival rate, neurological findings, and memory disturbance. Early improvement in CBF may be associated with an improved prognosis after SAH.

Ultrasonography (US) is the first-line imaging modality for screening neonates and young infants with suspected spinal abnormalities. Whether performed for a suspicious congenital skin lesion, such as a lumbosacral tract or lipomatous mass, or abnormal neurological findings, US can help define spinal anatomy, characterize congenital spine malformations, and direct further work-up and management. The purpose of this article is to review the diagnostic imaging approach to infant spine US, including technique and indications, normal anatomy and variants with a focus on embryological origins, and classification and diagnosis of congenital spine malformations.

Idiopathic Intracranial Hypertension is a rare occurrence in young, physically fit male and a diagnosis of exclusion among most patients presenting with signs and symptoms of raised intracranial pressure. Here we describe a case of a young male in the ideal weight range with no previous exposure to offending chemicals presented with a history of headache, obscuration of vision, and photopsia. On examination, there were no positive neurological findings. Increased opening pressure was found on the lumbar puncture. Ophthalmological examination revealed bilateral papilledema. Humphrey’s Visual field test showed peripheral field loss. Magnetic resonance imaging scan of the brain and orbits were normal. The patient was diagnosed and managed in primary care setting after neurosurgical consultation. Though rare, we should suspect idiopathic intracranial hypertension in ideal body weighted male if the headache is persistent after other causes of headache have been ruled out.

Introduction The SARS-CoV-2/COVID-19 may produce neurological manifestations, including its occurrence in children, and newborns, which has been little reported so far in newborns with COVID-19. Case We present a case in Colombia, of community-acquired neonatal infection of SARS-CoV-2, with suggestive symptoms, such as fever, and showing neurological findings, such as drowsiness, poor suction and mild hypotonia for a short time. Discussion The clinical manifestations of SARS-COV-2 in neonates are beginning to be described in detail. We report a case of SARS-COV-2-associated neurological compromise in a newborn, with features of drowsiness, poor suction and hypotonia.

Dietary consumption of arsenic is considered the largest source of toxicosis for nonoccupationally exposed individuals as it can be ingested through contaminated underground water, seafood, animal products, and crops irrigated with polluted water. We present a case of a 45-year-old Caucasian male who had headaches and peripheral neuropathy for more than two months. He suspected arsenic poisoning as he has a regular heavy consumption of seafood and canned sardines. Analysis of urinary arsenic concentration confirmed his intoxication with arsenic. Yet, since it was of an inorganic form, he was prescribed with symptomatic treatments only. A symmetrical sensory or motor polyneuropathy featuring more distal impairment is among the most common neurological findings induced by arsenic toxicosis. Hence, a presenting history of heavy seafood diet should raise the differential diagnosis of arsenic or heavy metal poisoning and to investigate accordingly. This case illustrates the importance of taking the dietary regime of any patient presenting with neuropathy. In addition, the authorities must impose further rigorous surveillance and strict safety measures on food products and staples to minimize any sources of contamination of any sorts.

Opsoclonus-myoclonus-ataxia syndrome is a heterogeneous constellation of symptoms ranging from full combination of these three neurological findings to varying degree of isolated individual sign. Since the emergence of coronavirus disease 2019 (COVID-19), neurological symptoms, syndromes and complications associated with this multi-organ viral infection have been reported and the various aspects of neurological involvement are increasingly uncovered. As a neuro-inflammatory disorder in nature, one would expect to observe opsoclonus-myoclonus syndrome after a prevalent viral infection in a pandemic scale, as it has been the case for many other neuro-inflammatory syndromes. We report seven cases of opsoclonus-myoclonus syndrome presumably para-infectious in nature and discuss their phenomenology, their possible pathophysiological relationship to COVID-19 and diagnostic and treatment strategy in each case. Finally we review the relevant data in the literature regarding the opsoclonus-myoclonus syndrome and possible similar cases associated with COVID-19 and its diagnostic importance for clinicians in various fields of medicine encountering COVID-19 patients and its complications.

Back pain is very common in children and even more common in adults. Back pain is a symptom, not a diagnosis, so seek a deeper understanding of the condition. Always evaluate the child’s development and growth. Be very concerned about a young child with a stiff spine, night pain, or abnormal neurological findings. Seek the underlying diagnosis in evaluating back pain or scoliosis. For the child under age 10 years, consider inflammation and the common pitfalls to avoid—especially tumors and infections. Stiffness can be a sign of inflammation. This inflammation can show up as night pain, limp, or refusal to walk. For the child older than age 10 years, think of mechanical origins, spondylolysis, spondylolisthesis, or Scheuermann kyphosis, but don’t forget the possible pitfalls. After a thorough evaluation, there may be no specific diagnosis, and you then need to reassure the family and provide comfort.

Parkinsonian disorders, including Parkinson’s disease (PD) and atypical parkinsonian disorders (APD), are characterized by shared clinical features of parkinsonism and although there are distinct clinical and pathological diagnostic criterion for PD and APD, patients present in the clinic with overlapping clinical features, which evolve with a great deal of variability and complexity over time. This leads to high level of uncertainty in the prediction of diagnosis and progression for an individual patient on clinical grounds. There have been recent initiatives to make available large-scale datasets from multiple research studies such as Accelerating Medicines Partnership for Parkinson’s Disease (AMP PD). However, these is a clear lack of a common terminological system or ontology that can support query analysis of datasets in AMP PD and map across multiple instruments used in the assessment of PD as well as APD. To address these challenges, we developed the Movement Disorder Ontology (MDO) that used a systematic analysis of movement disorder instruments, extensive review of literature led by a movement disorder specialists, and the AMP PD knowledge portal with an iterative ontology engineering process. The current version of MDO is focused on parkinsonian disorders with 203 concepts modeled in three broad categories of: (1) neurological findings, (2) treatment plans, and (3) instruments used to evaluate various traits of PD. MDO holds potential for use in clinical research especially in the context of large-scale phenotypic data available in public repositories such AMP PD with support for concept-based data analysis and potentially correlating with genotypic data.

Background Acute neurological deficit upon emergence from general anesthesia is a serious emergency. Conversion disorder, previously known as hysteria, is a somatoform disorder that causes neurological deficits without anatomical or physiological explanations. It is particularly rare after general anesthesia. Case presentation A 28-year-old healthy Japanese woman presented tetraplegia with normal sensory function upon waking from general anesthesia. She was evaluated for the causes of tetraplegia. There were no abnormal findings, and her symptoms were inconsistent with any anatomical or neurological pathology. Although she could not flex her knee actively, she could maintain the passive flexed position, suggesting that her paralysis was nonorganic. The most likely diagnosis was conversion disorder. After a 12-h observation, the patient fully recovered. Conclusions In patients with neurological deficits not correlating with neurological findings after general anesthesia, the presence of somatic disorders, such as conversion disorder, should be considered.

Background Since March 2020, during the Coronavirus disease 2019 (COVID-19) pandemic, it has been observed that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has neurological involvement with various clinical tables. Methods We present 3 new cases admitted to our clinic with various neurological findings which were affected by SARS-CoV-2. Results Imaging studies have shown that inflammatory/demyelinizing lesions appeared in different areas of the central nervous system which were accepted as an atypical demyelinating spectrum associated with Covid 19. Conclusions With increasing experience, it has been suggested that SARS-CoV-2 may also have a neurotrophic effect. The spectrum of neurological involvement is also expanding as the pandemic continues. These 3 cases suggest that the virus plays a role in the clinical onset of the inflammatory/demyelinating disease.

Objective To achieve an accurate quantification in diabetic polyneuropathy (DPN), we developed a new electrophysiological index that we called the DPN index. The relationship between the DPN index and the neurological findings in diabetic patients was assessed. Methods The DPN index was calculated by the mean value of percentages of four parameters (tibial compound muscle action potential amplitude / F wave minimum latency, sural sensory nerve action potential amplitude / sensory nerve conduction velocity) against the mean normal values. Twenty healthy subjects were recruited as a control group. Patients A total of 348 diabetic patients who were hospitalized in our hospital during the period from December 2016 to August 2019 were retrospectively studied. The correlations between the DPN index and five neurological findings (subjective sensory symptoms, diminished or absent Achilles tendon reflex, impaired tactile and vibration sense, low coefficient of variation of R-R interval) were evaluated. Results The DPN index in healthy subjects was 129.3±32.7%. The DPN index in diabetic patients with one or more neurological findings was significantly lower than that in diabetic patients without any neurological findings (p

Since the emerging of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in Wuhan, China at the end of 2019, the coronavirus disease 2019 (COVID-19) has become pandemic for months. Due to fast increased number of the positive patients with COVID-19, SARS-CoV-2 is considered highly pathogenic virus with various clinical presentations. Apart from the typical respiratory symptoms, neurological complains in COVID-19 involving central and peripheral nervous systems have been reported. This paper aimed to review the neurological findings reported in patients with COVID-19. We qualitatively reviewed studies reporting COVID-19 patient(s) with neurological manifestations according to the recommendations of PRISMA statement.There were twelve studies included in this brief review. We found that patients with neurological findings were reported ranging from symptomatic complain of headache and dizziness to specific neurological diseases/syndromes, such as meningitis/encephalitis, acute cerebrovascular diseases, Guillain-Barré syndrome, and Miller Fisher syndrome. This review suggests the possible neurological involvement in COVID-19. We hope to raise the awareness of the health workers in taking care of the patients with COVID-19 and neurological diseases.

In this review, we discuss the current implications of the changing genomic epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), etiological agent of the Coronavirus Disease 2019 (COVID-19) and its potential relationship with the change of clinical manifestations in patients with confirmed infection. Over the course of the current pandemic, the virus has been found more diverse in new countries. Simultaneously, also new clinical manifestations are observed, particularly more prominent gastrointestinal and neurological findings. SARS-CoV-2/COVID-19 is changing not only its epidemiology, but also its genomic diversity and clinical manifestations, both aspects coupled, needs to be considered in the study of this ongoing pandemic.

Summary Human Coronaviruses (HCoVs) have long been known as respiratory viruses. However, there are reports of neurological findings in HCoV infections, particularly in patients infected with the novel severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) amid Coronavirus disease 2019 (COVID‐19) pandemic. Therefore, it is essential to interpret the interaction of HCoVs and the nervous system and apply this understanding to the COVID‐19 pandemic. This review of the literature analyses how HCoVs, in general, and SARS‐CoV‐2, in particular, affect the nervous system, highlights the various underlying mechanisms, addresses the associated neurological and psychiatric manifestations, and identifies the neurological risk factors involved. This review of literature shows the magnitude of neurological conditions associated with HCoV infections, including SARS‐CoV‐2. This review emphasises, that, during HCoV outbreaks, such as COVID‐19, a focus on early detection of neurotropism, alertness for the resulting neurological complications, and the recognition of neurological risk factors are crucial to reduce the workload on hospitals, particularly intensive‐care units and neurological departments.

Cutis laxa is a heterogeneous group of diseases, characterized by abundant and wrinkled skin and a variable degree of intellectual disability. Cutis laxa, autosomal recessive, type IIIA and autosomal dominant 3 syndromes are caused by autosomal recessive or de novo pathogenic variants in ALDH18A1. Autosomal recessive variants are known to lead to the most severe neurological phenotype, and very few patients have been described.We describe a 13-month-old patient with cutis laxa, autosomal recessive, type IIIA, with an extremely severe phenotype, including novel neurological findings. This description enlarges the neurological spectrum associated to cutis laxa, autosomal recessive, type IIIA, and provides an additional description of this syndrome.

TRPV4, a nonselective calcium permeable ion channel, is expressed broadly in many organs including bone and neurons. Pathogenic variants in TRPV4 are known to cause both a spectrum of skeletal dysplasias and neuropathies. Recent publications have documented a few patients who have a combined phenotype of skeletal dysplasia and neuropathy secondary to TRPV4 pathogenic variants. We present an additional patient who has an overlapping neuromuscular and skeletal phenotype secondary to a TRPV4 pathogenic variant. The patient has spondylometaphyseal dysplasia-Kozlowski type and Charcot-Marie-Tooth disease type 2C. This and prior reports illustrate that TRPV4-related skeletal dysplasias and TRPV4-related neuropathies are not fully distinct disorders secondary to unique sets of pathogenic variants as originally postulated, but rather are 2 phenotypes on the same spectrum that may or may not overlap. We suggest that evaluation for patients presenting with any TRPV4-related disorder include assessment for both skeletal and neurological findings.

Introduction Carotid artery dissections may occur in severe trauma such as motor vehicle accidents or may also develop due to minor trauma. We aimed to present a case with internal carotid artery dissection that referred to the pediatric neurology department due to speech impairment after minor shoulder trauma. Case A previously healthy 10-year-old male patient was admitted to the pediatric emergency clinic due to headache, vomiting and speech impairment. In his story, we learned that he had bumped shoulder to shoulder with his friend about 6 h ago. He did not fall or hit his head. On his admission he could not speak and had right central facial paralysis. There was no infarct or diffusion limitation in MRI but MR angiography showed thinning in left internal carotid artery calibration. Fat-suppressed, non-contrast T1-weighted MRI showed that the left carotid artery had ring-shaped pathological signal changes. Low-molecular-weight heparin therapy was initiated with the diagnosis of carotid artery dissection (CAD). No hemiparesis or hemiplejia occurred in the follow-up of the patient. Within a few days, his speech improved. At the end of the first month, facial paralysis completely recovered. Conclusion In carotid artery dissections, prodromal symptoms such as transient ischemic attack, like in our patient, are rarely present in children. For good long term outcomes, it is very important to suspect, diagnose and initiate appropriate treatment in a rapid manner in carotid artery dissection before severe neurological findings such as acute ischemic stroke develops.

Cherry red spot is a known sign of retinal occlusive disease. However, when it occurs bilaterally in a young patient with neurological findings, a diagnosis of retinal occlusive disease becomes farfetched, and the possibility of a storage disorder is raised. We report multimodal retinal imaging findings in a case of cherry-red spot myoclonus syndrome. This form of imaging helps in the ophthalmological diagnosis and management of these patients.

We describe here a patient diagnosed with multiple loose bodies in the lumbar facet joint. The patient was a 52-year-old woman who presented with left sciatic pain. Neurological findings indicated L5 radiculopathy. Radiological findings revealed lateral recess stenosis at the L4–L5 level, and loose bodies in the left L4–L5 facet joint were noted that compressed the left L5 nerve root. We performed laminotomy at the left L4–L5 level, and removed five loose bodies located on the dorsal side of the ligamentum flavum. Following removal of the loose bodies and flavectomy, the L5 nerve root was decompressed. Postoperatively, the patient’s symptoms improved markedly. Symptomatic multiple loose bodies in the lumbar facet joint are very rare, and can cause lumbar radiculopathy. It is important for spine surgeons to recognize this pathology.