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The SARS-CoV-2 virus that led to COVID-19 is associated with significant and long-lasting neurologic symptoms in many patients, with an increased mortality risk for people with Alzheimer's disease (AD) and/or Down syndrome (DS). However, few studies have evaluated the neuropathological and inflammatory sequelae in postmortem brain tissue obtained from AD and people with DS with severe SARS-CoV-2 infections. We examined tau, beta-amyloid (Aβ), inflammatory markers and SARS-CoV-2 nucleoprotein in DS, AD, and healthy non-demented controls with COVID-19 and compared with non-infected brain tissue from each disease group (total n = 24). A nested ANOVA was used to determine regional effects of the COVID-19 infection on arborization of astrocytes (Sholl analysis) and percent-stained area of Iba-1 and TMEM 119. SARS-CoV-2 antibodies labeled neurons and glial cells in the frontal cortex of all subjects with COVID-19, and in the hippocampus of two of the three DS COVID-19 cases. SARS-CoV-2-related alterations were observed in peri-vascular astrocytes and microglial cells in the gray matter of the frontal cortex, hippocampus, and para-hippocampal gyrus. Bright field microscopy revealed scattered intracellular and diffuse extracellular Aβ deposits in the hippocampus of controls with confirmed SARS-CoV-2 infections. Overall, the present preliminary findings suggest that SARS-CoV-2 infections induce abnormal inflammatory responses in Down syndrome.

Background: Recent advances in childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) management provide higher survival rates at the cost of increased toxicities. Acute neurotoxicity affects up to 10% of patients, requiring rapid recognition and treatment. Methods: A retrospective observational study was performed to determine the frequency, clinical manifestations, radiological characteristics, treatment options and outcome of acute neurological adverse events in pediatric patients with lymphoid malignancies at the Department of Oncology and Hematology, Children’s Hospital Zagreb, Croatia. Results: A total of 56 patients (48 ALL and 8 LL, male/female ratio 1:1, average age 5.4 years) were treated mainly according to the ALL-IC BFM 2009 protocol. The B-immunophenotype was the most frequent (85.7%). Most patients were stratified to the intermediate risk group (39.3%), and two were initially diagnosed with central nervous system infiltration. Acute neurotoxic events were registered in 11 patients (19.6%), most commonly in the 6–10-year age group (66.7%), predominately in females (72.7%) and high-risk group (54.5%). The most frequent clinical presentation was seizures (83.3%), with status epilepticus in four cases. We detected electroencephalogram (EEG) irregularities in almost all patients and various morphological changes in the brain magnetic resonance imaging (MRI), most often consistent with posterior reversible encephalopathy syndrome and leukoencephalopathy. Approximately half the patients received prolonged antiepileptic therapy. No apparent residual neurologic manifestations have been observed. Conclusions: Acute neurotoxicity is a rather frequent treatment-related adverse event, associated with high-risk disease. Early recognition and timely management are essential for rapid recovery and optimal outcomes.

Obstructive hydrocephalus in adults can result from various etiologies, including rare cystic lesions such as tectal plate cysts. To depict a unique case of a tectal plate cyst causing hydrocephalus in an adult accompanied by persistent headaches, visual disturbances, and balance problems. In a clinical context, a 43-year-old female patient presented with a 2-week history of persistent headaches, accompanied by symptoms of dizziness, visual disturbances, and impaired balance. These headaches had exhibited a daily aggravation pattern over a year and were associated with concurrent manifestations of nausea, vomiting, and diplopia. Subsequent neuroimaging through a brain computed tomography (CT) scan disclosed the presence of hydrocephalus. Consultation with a neurologist and brain magnetic resonance imaging (MRI) yielded a diagnosis implicating a tectal plate cyst as the causative agent behind the obstructive hydrocephalus. The patient subsequently underwent surgical excision of the cyst. A follow-up assessment postoperation unveiled a marked improvement in the patient's clinical condition, characterized by the resolution of visual and gait impairments, as well as a notable reduction in the frequency and severity of headaches. This case highlights the importance of considering tectal plate cysts as an uncommon cause of hydrocephalus in the differential diagnosis of patients with persistent headaches and neurological symptoms. Early diagnosis and treatment with surgical removal of the cyst can significantly improve the patient's symptoms and prevent further complications such as hydrocephalus.

We evaluated outcomes of AML patients with central nervous system (CNS) involvement at two academic institutions. Fifty-two adult patients were identified. Neurologic symptoms were reported in 69% of patients, with headache the most common (33%). 84% (n = 42) of patients cleared their cerebrospinal fluid (CSF), with a median number of one dose of intrathecal (IT) chemotherapy. Of these patients, 21% (n = 9) had a CSF relapse, with 67% (n = 6) of those experiencing CSF relapse also having concurrent bone marrow relapse. Of the 36 patients with baseline neurologic symptoms, 69% had improvement in symptoms post-IT therapy. The median overall survival was 9.3 months and 3.5 months for patients with CNS involvement diagnosed before/during induction and at relapse, respectively. In this study, IT therapy was rapidly effective in clearing CSF blasts and improving neurologic symptoms in most patients. Few patients experienced CSF relapse, which predominantly occurred in the setting of concomitant bone marrow relapse. [ABSTRACT FROM AUTHOR]

• Neuro-PASC patients show plasma proteomic alterations 3–9 months post infection. • Plasma proteome differences are identified based on PASC symptoms. • Proteomic differences suggest inflammation and mitochondrial involvement in Neuro-PASC. Persistent symptoms of COVID-19 survivors constitute long COVID syndrome, also called post-acute sequelae of SARS-CoV-2 infection (PASC). Neurologic manifestations of PASC (Neuro-PASC) are particularly debilitating, long lasting, and poorly understood. To gain insight into the pathogenesis of PASC, we leveraged a well-characterized group of Neuro-PASC (NP) patients seen at our Neuro-COVID-19 clinic who had mild acute COVID-19 and never required hospitalization to investigate their plasma proteome. Using the SomaLogic platform, SomaScan, the plasma concentration of >7000 proteins was measured from 92 unvaccinated individuals, including 48 NP patients, 20 COVID-19 convalescents (CC) without lingering symptoms, and 24 unexposed healthy controls (HC) to interrogate underlying pathobiology and potential biomarkers of PASC. We analyzed the plasma proteome based on post-COVID-19 status, neurologic and non-neurologic symptoms, as well as subjective and objective standardized tests for changes in quality-of-life (QoL) and cognition associated with Neuro-PASC. The plasma proteome of NP patients differed from CC and HC subjects more substantially than post-COVID-19 groups (NP and CC combined) differed from HC. Proteomic differences in NP patients 3–9 months following acute COVID-19 showed alterations in inflammatory proteins and pathways relative to CC and HC subjects. Proteomic associations with Neuro-PASC symptoms of brain fog and fatigue included changes in markers of DNA repair, oxidative stress, and neutrophil degranulation. Furthermore, we discovered a correlation between NP patients lower subjective impression of recovery to pre-COVID-19 baseline with an increase in the concentration of the oxidative phosphorylation protein COX7A1, which was also associated with neurologic symptoms and fatigue, as well as impairment in QoL and cognitive dysfunction. Finally, we identified other oxidative phosphorylation-associated proteins correlating with central nervous system symptoms. Our results suggest ongoing inflammatory changes and mitochondrial involvement in Neuro-PASC and pave the way for biomarker validation for use in monitoring and development of therapeutic intervention for this debilitating condition. [ABSTRACT FROM AUTHOR]

Cardiac myxoma is a rare etiology of ischemic stroke, especially in young people. We report a case of multiple myxomas in left atrium and right ventricle inducing acute cerebral infarction. No significant abnormalities were detected in the patient's preoperative laboratory examination. Following emergency surgery, the patient's prognosis was satisfactory, providing valuable empirical insight for the surgical management of acute cerebral infarction in individuals diagnosed with cardiac myxoma. Our objective is to heighten awareness regarding the evaluation and treatment of patients with acute cerebral infarction subsequent to early diagnosis of cardiac myxoma.

The occurrence of neurological manifestations and complications in pregnant women compared to non-pregnant women with COVID-19 is unclear. This cross-sectional study included women aged over 18 years hospitalized with SARS-CoV-2 infection confirmed by RT-PCR from March to June 2020 in Recife, Brazil. We evaluated 360 women, including 82 pregnant patients who were significantly younger (27.5 vs. 53.6 years; p < 0.01) and less frequently obese (2.4% vs. 15.1%; p < 0.01) than the non-pregnant group. All pregnancies were confirmed using ultrasound imaging. Abdominal pain was the only more frequent COVID-19 manifestation during pregnancy (23.2% vs. 6.8%; p < 0.01), but was not associated with the outcomes. Almost half the pregnant women presented neurological manifestations, including anosmia (31.7%), headache (25.6%), ageusia (17.1%), and fatigue (12.2%). However, neurological manifestations occurred similarly in pregnant and non-pregnant women. Four (4.9%) pregnant women and 64 non-pregnant women (23%) presented delirium, but the frequency with age-adjustment was similar in the non-pregnant group. Pregnant women with COVID and preeclampsia (19.5%) or eclampsia (3.7%) were older (31.8 vs. 26.5 years; p < 0.01), and epileptic seizures occurred more often in association with eclampsia (18.8% vs. 1.5%; p < 0.01) regardless of previous epilepsy. There were three maternal deaths (3.7%), one dead fetus, and one miscarriage. The overall prognosis was good. There was no difference in prolonged hospital stay, the need for ICU and mechanical ventilation, or death when comparing pregnant and non-pregnant women. [ABSTRACT FROM AUTHOR]

Objective: The pandemic coronavirus disease-2019 (COVID-19) is caused by a novel type of coronavirus named severe acute respiratory syndrome coronavirus-2 and is rapidly spreading all over the world. In addition to various neurological symptoms, acute facial palsy was diagnosed as the main neurological symptom in some COVID-19 patients. The current study aimed to analyze the variation and any possible association in the case numbers or medical symptoms of patients with facial palsy before and during the COVID-19 pandemic. Methods: The clinical files of patients who were diagnosed with facial palsy in the Neurology Department of Medicalpoint Hospital, University of Economics Faculty of Medicine, İzmir were retrospectively investigated. To compare the facial palsy cases according to different periods, two patient groups were formed: before the COVID-19 pandemic and during the COVID-19 pandemic. The pandemic group was further divided into two subgroups as COVID-19-positive and COVID-19-negative patients to compare the effects of COVID-19 on facial palsy. Results: During the specified COVID-19 period (May 2020-January 2021) of the study, 38 patients were admitted to the hospital for facial palsy; 34 facial palsy patients were admitted in the same calendar period as the two previous years (May 2018-January 2019). There was no significant difference in the frequency of facial palsy between these two time periods. There were significant differences between before and during the COVID-19 pandemic groups regarding response to cortisone therapy (p<0.001), facial palsy grade (p<0.001), electromyography findings (p=0.005), denervation (p<0.001), and 6 months recovery (p<0.001) data. There were also significant differences between the COVID- 19-positive and COVID-19-negative subgroups regarding response to cortisone therapy (p=0.015) and facial palsy grade (p=0.001). Conclusion: The current study findings support the possible association between the severity of the clinical course of facial palsy and COVID-19. Further studies are needed to prove a direct association between facial palsy and COVID-19. [ABSTRACT FROM AUTHOR]

Electrical burn injuries are injuries that can be of high or low voltage and result in variety of injuries ranging from skin burns to damage to internal organs including neurologic complications. Tissue damage can result directly from the current passing through the body or conversion of the electrical energy to heat energy as it is met with various levels of resistance within the different tissues in the body. Neurologic complications can be of early or late onset in electrical injuries and show variable levels of recovery over long period of time. We have presented here a patient that sustained high voltage electrical burn and developed late onset quadriparesis that significantly improved within a period of one week following the initiation of dexamethasone. Multidisciplinary approach and long term follow up of such patients is necessary to achieve best possible outcome

Objective: To characterize the cognitive profile following COVID‐19 infection and its possible association to clinical symptoms, emotional disturbance, biomarkers, and disease severity. Methods: This was a single‐center cross‐sectional cohort study. Subjects between 20‐ and 60‐year old with confirmed COVID‐19 infection were included. Evaluation was performed between April 2020 and July 2021. Patients with previous cognitive impairment and other neurological or severe psychiatric disorders were excluded. Demographic and laboratory data were extracted from the medical records. Results: Altogether 200 patients were included, 85 subjects were female (42.3%), and mean age was 49.12 years (SD: 7.84). Patients were classified into four groups: nonhospitalized (NH, n = 21), hospitalized without intensive care unit (ICU) nor oxygen therapy (HOSP, n = 42), hospitalized without ICU but with oxygen therapy (OXY, n = 107), and ICU (ICU, n = 31) patients. NH group was younger (p =.026). No significant differences were found in any test performed attending severity of illness (p >.05). A total of 55 patients reported subjective cognitive complaints (SCC). Subjects with neurological symptoms (NS) performed worse in trail making test B (p =.013), digits backwards (p =.006), letter&numbers (p =.002), symbol digit modalities test (p =.016), and Stroop color (p =.010) tests. Conclusions: OXY patients and females referred more SCC associated with symptoms of anxiety and depression. Objective cognitive performance was unrelated to SCC. No cognitive impairment was found regarding the severity of COVID‐19 infection. Results suggest that NS such as headache, anosmia, and dysgeusia during infection were a risk factor for later cognitive deficits. Tests assessing attention, processing speed, and executive function were the most sensitive in detecting cognitive changes in these patients. [ABSTRACT FROM AUTHOR]

It has been widely reported that the farmers were at increased risk of neurologic disorders, which probably be related with agricultural risk factors. The intensity of agricultural risk factors was rather high in the solar greenhouse than those in the agricultural farm, while the risk and prevalence of neurologic symptoms among solar greenhouse workers are unclear, which may provide evidence of neurologic dysfunction before clinically measurable signs are evident. This study aimed to evaluate the association among solar greenhouse working, field working, and neurologic symptoms. A cross-sectional study was conducted in China, and 986 Chinese Han population consisting 711 solar greenhouse workers (greenhouse worker group) and 275 field farmers (field worker group) were included. Participants provided information on demographic information, number of solar greenhouses owned (only solar greenhouse workers), working lifetime, and neurologic symptoms through an established questionnaire Q16 to assess the impact of occupational exposure to neurotoxicants, and the total scores were calculated. Multiple linear regression models were used to analyze the association among solar greenhouse working, field working, and neurologic symptoms. The total scales of the neurologic symptoms were higher in the solar greenhouse worker group (20.29 ± 4.79) than those in the field worker group (19.44 ± 4.22) (p < 0.05). Multivariate multiple linear regression showed that solar greenhouse working was positively associated with the scales of the neurologic symptoms (β = 0.248, 95% CI: (0.112, 0.383)). And the age, working lifetime, and current smoking were also positively associated with the scores of the neurologic symptoms, β = 0.007, 0.006 and 0.485 respectively (All p < 0.05). Solar greenhouse workers probably be at an increased risk of neurologic symptoms scores, and the age, working lifetime, and current smoking were also risk factors. [ABSTRACT FROM AUTHOR]

Metachromatic leukodystrophy is a rare inherited disorder of the nervous system with great clinical variability characterized by loss of both cognitive and motor functions upon extensive white matter damage by the accumulation of sulfatides. Although metachromatic leukodystrophy usually affects children, many cases of adult leukodystrophy have been reported in the literature in the last few years. Adult-onset leukodystrophy typically presents with a progressive syndrome that includes various combinations of cognitive impairment, spasticity, apraxia, ataxia, and upper motor neuron manifestations. In this article, we decided to present this case to draw attention to the fact that the adult form of metachromatic leukodystrophy, which presents with psychotic symptoms and behavioural problems, should be considered in the differential diagnosis of psychotic pictures. In a 48-year-old male patient who did not have any psychiatric or neurological problems before, symptoms such as meaningless shouting, running away from home, restlessness, and audio-visual hallucinations were added to the clinical picture that started with confusion and disorganized behaviour in a short time. MRI, plasma aryl sulfatase A level (ARSA) and gene analysis were performed for differential diagnosis in the patient. It is known that the patient has a sibling who died before the age of one, and two nephews diagnosed with an autism spectrum disorder. Heterozygous c.1283C>A (p P428Q) mutation was detected in the patient, which was not previously reported in the literature or mutation databases. The chromosomal region-22q13.33- in which the ARSA gene with this mutation is located is also a candidate region for autism. In this respect, it was thought that this mutation might be related to disorganized behavioural problems. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study is to evaluate the results of liver transplantation (LT) in pediatric Wilson disease (WD) with a specific sub-analysis in patients with neuropsychiatric symptoms. Materials and Methods: Demographic, operative, laboratory and neurologic findings of 23 pediatric patients with WD that underwent LT were analyzed by examining the patient charts. Results: Median age of the patients was 13 (7 to 17) years. Median Wilson's Index scores of the patients were 7 (5-13). Median Child-Pugh Score, MELD-Na and PELD scores of the patients were 10 (5-12), 19 (8-34) and 25.4 (8.4-30.7); respectively. Eight patients (34.8%) had Kayser-Fleischer rings on examination. Five patients (21.7%%) presented with acute decompensated Wilson's disease. Fifteen patients (65.2%) received living donor liver transplantation. Totally, 10 patients (43.4%) had nervous system involvement in the preoperative period. Two patients fully recovered; 2 patients showed partial recovery. On the other hand, 4 patients showed no improvement and 2 patients had progression of their disease in the postoperative period. Conclusion: The results of the present study show that LT is an effective and safe alternative in end-stage liver failure in WD. However, in these patients, nervous system involvement may not improve despite successful LT. [ABSTRACT FROM AUTHOR]

Background: COVID-19 was declared as a pandemic by World Health Organization on March 11, 2020, and still constitutes a serious health problem affecting millions of people across the world. The evaluation and follow-up of ongoing and/or newly developing neurological involvement after recovery from COVID-19 are important. This study aims to reveal post-COVID-19 neurological symptoms and risk factors for their development. Methods: Patients over the age of 18 years who applied to centers, at least 4 weeks after COVID-19 infection and agreed to participate in the study were included in this cross-sectional study between January 20 and March 15, 2021. The patients were evaluated face to face, and their sociodemographic data, medical history, post-COVID-19 neurological symptoms, treatments, and Beck Depression Inventory scores were recorded. All statistical analyses were performed using SPSS 23 for Windows software package (SPSS Inc., Chicago, IL). Results: Four hundred patients were included in this study, an average of 108+5.12 days had passed after the onset of COVID-19. The rate of post-COVID-19 neurological involvement was 73.3%, and the top 3 most common symptoms were headache (47%), myalgia (43%), and sleep disturbance (39%). Having depression (OR: 4.54, 95% Cl :1.88-10.96), female gender (OR:2.18, 95% Cl :1.36-3.49), hospitalization (OR: 2.01, 95% Cl :103-3.64), and usage of favipiravir (OR:2.07 95 Cl :1.15-3.72) were determined as independent predictors of developing prolonged neurological symptoms. Conclusion: The long-term consequences of COVID-19 remain uncertain. It should be remembered that neurological symptoms are very common in post-infectious patients and long-term follow-up may be required in the management of this condition. [ABSTRACT FROM AUTHOR]

Opinion statement: Brain metastases (BM) are rare in gynecologic cancers. Overall BM confers a poor prognosis but other factors such as number of brain lesions, patient age, the presence of extracranial metastasis, the Karnofsky Performance Status (KPS) score, and the type of primary cancer also impact prognosis. Taking a patient's whole picture into perspective is crucial in deciding the appropriate management strategy. The management of BM requires an interdisciplinary approach that frequently includes oncology, neurosurgery, radiation oncology and palliative care. Treatment includes both direct targeted therapies to the lesion(s) as well as management of the neurologic side effects caused by mass effect. There is limited evidence of when screening for BM in the gynecology oncology patient is warranted but it is recommended that any cancer patient with new focal neurologic deficit or increasing headaches should be evaluated. The primary imaging modality for detection of BM is MRI, but other imaging modalities such as CT and PET scan can be used for certain scenarios. New advances in radiation techniques, improved imaging modalities, and systemic therapies are helping to discover BM earlier and provide treatments with less detrimental side effects. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 is a new coronavirus that has affected the world since 2019. Interstitial pneumonia is the most common clinical presentation, but additional symptoms have been reported, including neurological manifestations. Severe forms of infection, especially in elderly patients, present as an excessive inflammatory response called "cytokine storm", which can lead to acute respiratory distress syndrome (ARDS), multiorgan failure and death. Little is known about the relationship between symptoms and clinical outcomes or the characteristics of virus–host interactions. The aim of this narrative review is to highlight possible links between neurological involvement and respiratory damage mediated by pathological inflammatory pathways in SARS-CoV-2 infection. We will focus on neuro–immune interactions and age-related immunity decline and discuss some pathological mechanisms that contribute to negative outcomes in COVID-19 patients. Furthermore, we will describe available therapeutic strategies and their effects on COVID-19 neurological symptoms. [ABSTRACT FROM AUTHOR]

A case of myoclonic status treated with plasmapheresis in a patient of 63 years of age who was admitted to a Spanish intensive care unit is reported. The patient showed clinical and radiological evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; molecular tests did not verify this.

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HoBi-like pestivirus (HoBiPeV) has been reported in several biological samples from cattle worldwide, but there are no descriptions of this virus associated with neurological symptoms. This report described the first occurrence of neurological disease associated with HoBiPeV in a newborn dairy calf. A mixed-breed Holstein calf had severe neurological symptoms at birth and died at 21 days old. The tissue fragments (central nervous system (CNS), myocardium, liver, kidney, lung, intestine, and spleen) were submitted to reverse transcription (RT)–PCR assay for the partial 5'-untranslated region (5'UTR) and N-terminal autoprotease (Npro) gene of the pestivirus genome, and the CNS tissue fragments were submitted to histopathological and immunohistochemical evaluation. The RT–PCR assay indicated that the kidney, CNS, and intestinal tissue fragments were positive for the pestivirus 5'UTR, and the CNS and intestinal tissue fragments were positive for the pestivirus Npro gene. Amplicons with high DNA quantification in the 5'UTR (CNS—cerebral cortex) and Npro (CNS—cerebral cortex and intestine) RT–PCR assays were sequenced. The nucleotide (nt) sequence and phylogenetic analysis of the 5'UTR strain exhibited 93.6 to 99.4%, 85%, 89.4 to 89.9%, 85.1%, and 90.5 to 91.5% nt identity with HoBiPeV strains from clades a, b, c, d, and e, respectively. The Npro amplicons showed 99.7% nt identity to each other and 90.4 to 96.5%, 85.1 to 85.3%, 79.2 to 79.7%, and 85.8 to 86.5% nt identity with HoBiPeV strains from clades a, c, d, and e, respectively. A histopathology revealed neuronal necrosis at the cerebrum, cerebellum, and brain stem. An immunohistochemical assay designed to identify antigens of bovine viral diarrhea virus revealed positive intracytoplasmic immunoreactivity within neurons at the cerebral cortex, cerebrum, cerebellum, and spinal cord. Thus, this report provides information about the first identification of HoBiPeV in tissues of the CNS in a newborn dairy calf with neurological symptoms.

Multiple Sclerosis is a chronic inflammatory disease. It is characterized by demyelinating lesions throughout the central nervous system. Patients suffering from multiple sclerosis constitute a vulnerable population to coronavirus disease-2019. This review focuses on the effects of coronavirus disease-2019 on relapse and symptom exacerbation in multiple sclerosis patients and their treatment. It highlights how the blood-brain barrier may be compromised by severe acute respiratory syndrome coronavirus 2, allowing inflammatory mediators and lymphocytes to infiltrate the central nervous system. This may increase the risk of relapse in multiple sclerosis patients. Also, in patients who did not have a prior history of multiple sclerosis, coronavirus disease-2019 has been found to impact multiple sclerosis onset and pathogenesis. However, more comprehensive research is required to fully understand the interplay between multiple sclerosis and coronavirus disease-2019.

BACKGROUND: Since the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV2) in December 2019, there have been some case reports of Coronavirus disease 19 (COVID 19) associated Guillain-Barré Syndrome (GBS). GBS is an inflammatory polyradiculoneuropathy associated with numerous viral and bacterial infections. Here we describe the case of an Ethiopian man with a typical clinical and electrophysiological manifestation of GBS. CASE PRESENTATION: A 70-year-old male presented with four days history of progressive and ascending bilateral limbs weakness which end up with respiratory failure. He had an antecedent headache, loss of appetite, and generalized fatigue. Electrophysiological studies showed Acute Motor and Sensory Axonal Neuropathy whereas and cerebrospinal fluid analysis revealed albuminocytologic dissociation with positive preintubation SARS CoV2 test. He was treated with supportive care and recovered successfully. CONCLUSION: This case illustrates one of the few occasions when patients with mild COVID-19 develop severe neurologic manifestations. Seemingly, early identification and management can improve clinical outcomes. We would like to emphasize the need to consider screening for SARS CoV-2 in patients presenting with GBS. [ABSTRACT FROM AUTHOR]

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Interscalene brachial plexus block has been widely used in shoulder surgery. We report one case of long-term phrenic palsy following ultrasound-guided interscalene brachial plexus block and we will discuss the possible etiology and mechanism of this disability. For painful shoulder surgery, ultrasound-guided interscalene brachial plexus block remains topical. Alternative blocks, such as suprascapular and axillary blocks, may be reserved for patients with pre-existing respiratory pathology.

A case of recurrent coronavirus disease 2019 (COVID-19) with neurovestibular symptoms was reported. In March 2020, a physician working in an Italian pediatric hospital had flu-like symptoms with anosmia and dysgeusia, and following a reverse transcription PCR (RT/PCR) test with a nasopharyngeal swab tested positive for SARS-CoV-2. After home quarantine, 21 days from the beginning of the symptoms, the patient tested negative in two subsequent swabs and was declared healed and readmitted to work. Serological testing showed a low level of immunoglobulin G (IgG) antibody title and absence of immunoglobulin M (IgM). However, 2 weeks later, before resuming work, the patient complained of acute vestibular syndrome, and the RT/PCR test with mucosal swab turned positive. On the basis of the literature examined and reviewed for recurrence cases and vestibular symptoms during COVID-19, to our knowledge this case is the first case of recurrence with vestibular impairment as a neurological symptom, and we defined it as probably a viral reactivation. The PCR retest positivity cannot differentiate re-infectivity, relapse, and dead-viral RNA detection. Serological antibody testing and viral genome sequencing could be always performed in recurrence cases.

Delirium is a common presenting symptom among older patients. Patients who presented with delirium may have a higher morbidity and mortality rate due to older age, other comorbidities, and atypical COVID-19 presentation. Currently, the evidence supporting delirium as one of the predictors of poor outcome of COVID-19 is still insufficient. This study aims to explore the potential association between delirium and poor outcomes from COVID-19. We systematically searched the PubMed and Google Scholar databases using specific keywords related to our aims until January 30th, 2021. All articles published on COVID-19 and delirium were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for case-series studies. Statistical analysis was done using Review Manager 5.4 software. Our meta-analysis of 20 studies showed that delirium symptoms on admission was associated with poor outcomes from COVID-19 [OR 2.36 (95% CI 1.80–3.09), p < 0.00001, I 2 = 76%, random-effect models] and its subgroup which consist of severe COVID-19 [OR 3.89 (95% CI 1.72–8.75), p = 0.001, I 2 = 91%, random-effect models], and mortality from COVID-19 [OR 1.90 (95% CI 1.55–2.33), p < 0.00001, I 2 = 36%, random-effect models]. Meta-regression showed that the association was influenced by age (p = 0.005). Our study suggests delirium as an important marker to identify patients at higher risk for developing poor COVID-19 outcomes. The physicians should add delirium as one of the common presenting symptoms of COVID-19 in older populations. • Currently, evidence supporting delirium as the predictors for poor COVID-19 is still lacking. • Our meta-analysis showed that delirium are associated with poor outcomes from COVID-19. • The relationship between delirium and poor COVID-19 outcomes is influenced by age. • Physicians should consider delirium as important markers of poor COVID-19 in older populations. [ABSTRACT FROM AUTHOR]

Aims: To determine if neurologic symptoms at admission can predict adverse outcomes in patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods: Electronic medical records of 1053 consecutively hospitalized patients with laboratory‐confirmed infection of SARS‐CoV‐2 from one large medical center in the USA were retrospectively analyzed. Univariable and multivariable Cox regression analyses were performed with the calculation of areas under the curve (AUC) and concordance index (C‐index). Patients were stratified into subgroups based on the presence of encephalopathy and its severity using survival statistics. In sensitivity analyses, patients with mild/moderate and severe encephalopathy (defined as coma) were separately considered. Results: Of 1053 patients (mean age 52.4 years, 48.0% men [n = 505]), 35.1% (n = 370) had neurologic manifestations at admission, including 10.3% (n = 108) with encephalopathy. Encephalopathy was an independent predictor for death (hazard ratio [HR] 2.617, 95% confidence interval [CI] 1.481–4.625) in multivariable Cox regression. The addition of encephalopathy to multivariable models comprising other predictors for adverse outcomes increased AUCs (mortality: 0.84–0.86, ventilation/ intensive care unit [ICU]: 0.76–0.78) and C‐index (mortality: 0.78 to 0.81, ventilation/ICU: 0.85–0.86). In sensitivity analyses, risk stratification survival curves for mortality and ventilation/ICU based on severe encephalopathy (n = 15) versus mild/moderate encephalopathy (n = 93) versus no encephalopathy (n = 945) at admission were discriminative (p < 0.001). Conclusions: Encephalopathy at admission predicts later progression to death in SARS‐CoV‐2 infection, which may have important implications for risk stratification in clinical practice. [ABSTRACT FROM AUTHOR]

A case of recurrent coronavirus disease 2019 (COVID-19) with neurovestibular symptoms was reported. In March 2020, a physician working in an Italian pediatric hospital had flu-like symptoms with anosmia and dysgeusia, and following a reverse transcription PCR (RT/PCR) test with a nasopharyngeal swab tested positive for SARS-CoV-2. After home quarantine, 21 days from the beginning of the symptoms, the patient tested negative in two subsequent swabs and was declared healed and readmitted to work. Serological testing showed a low level of immunoglobulin G (IgG) antibody title and absence of immunoglobulin M (IgM). However, 2 weeks later, before resuming work, the patient complained of acute vestibular syndrome, and the RT/PCR test with mucosal swab turned positive. On the basis of the literature examined and reviewed for recurrence cases and vestibular symptoms during COVID-19, to our knowledge this case is the first case of recurrence with vestibular impairment as a neurological symptom, and we defined it as probably a viral reactivation. The PCR retest positivity cannot differentiate re-infectivity, relapse, and dead-viral RNA detection. Serological antibody testing and viral genome sequencing could be always performed in recurrence cases. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 is a new coronavirus that has affected the world since 2019. Interstitial pneumonia is the most common clinical presentation, but additional symptoms have been reported, including neurological manifestations. Severe forms of infection, especially in elderly patients, present as an excessive inflammatory response called “cytokine storm”, which can lead to acute respiratory distress syndrome (ARDS), multiorgan failure and death. Little is known about the relationship between symptoms and clinical outcomes or the characteristics of virus–host interactions. The aim of this narrative review is to highlight possible links between neurological involvement and respiratory damage mediated by pathological inflammatory pathways in SARS-CoV-2 infection. We will focus on neuro–immune interactions and age-related immunity decline and discuss some pathological mechanisms that contribute to negative outcomes in COVID-19 patients. Furthermore, we will describe available therapeutic strategies and their effects on COVID-19 neurological symptoms.

Exposure to infectious disease increases in tandem with international travel rates. Globally, up to 70% of travelers to developing countries report health problems while traveling, most being self-limiting. Few travelers are ill enough to seek medical care while abroad or upon returning home. Although fever is one of the more common symptoms in these travelers, little attention has been paid to those who return with fever and neurologic symptoms. This article describes conditions that can present with fever and neurologic changes and how to evaluate patients in a timely manner to prevent progression of neural dysfunction and spread of disease in local communities. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) infection is a worldwide disease and the primary cause of acute viral hepatitis with an estimated 3.3 million symptomatic cases every year and 44,000 related deaths. It is a waterborne infection in the developing countries. In these countries, HEV genotypes 1 and 2 cause large outbreaks and affect young subjects resulting in significant mortality in pregnant women and patients with cirrhosis. In developed countries, HEV genotypes 3 and 4 are responsible for autochthonous, sporadic hepatitis and transmission is zoonotic. Parenteral transmission by the transfusion of blood products has been identified as a potential new mode of transmission. HEV can also cause neurological disorders and chronic infections in immunocompromised patients. The progression of acute hepatitis E is usually asymptomatic and resolves spontaneously. Diagnosis is based on both anti‐HEV IgM antibodies in serum and viral RNA detection in blood or stools by PCR in immunocompetent patients, while only PCR is validated in immunocompromised individuals. Ribavirin is the only validated treatment in chronic infection. A vaccine has been developed in China. [ABSTRACT FROM AUTHOR]

The actual Coronavirus Disease 2019 (COVID-19) infection is an ongoing pandemic, characterized by high morbidity and mortality produced by SARS-CoV-2 virus. Studies reported a stroke frequency around 5-20% in infected patients; however, SNC invasion and pathophysiological mechanisms related to stroke in COVID-19 patients are still unknown. Several studies have demonstrated that SARS-CoV-2 infection is linked to a prothrombotic state causing venous and arterial thromboembolism. Also, an overstated inflammatory response with recruitment of blood cells and disproportioned secretion of proinflammatory cytokines has been reported. Finally, cardioembolism and hypoxia have been proposed as surrogate mechanisms. It is essential to define the pathophysiological mechanisms of stroke during the infection in order to apply more specific treatments to avoid further stroke complications.

Background: Coronavirus disease 2019 (COVID-19) is a new viral respiratory disease and has become a pandemic. Fever, weakness, and dry cough are the main clinical manifestations. However, little is known about neurological symptoms of non-critically ill COVID-19 patients.Objective: To investigate the neurological symptoms and implications of patients with non-critically ill COVID-19 patients.Materials and Methods: This retrospective cohort study investigated all COVID-19 patients admitted to Wuhan East-West Lake Fangcang shelter hospital. Demographic data, clinical manifestations, comorbidities, radiological data, the result of nucleic acid test, and treatments were collected and analyzed.Results: Among 1,682 patients with confirmed non-critically ill COVID-19, 509 patients (30.3%) had neurological symptoms, including myalgia (311, 18.5%), headache (216, 12.8%), fatigue (83, 4.9%), and dizziness (15, 0.9%). One hundred and fourteen patients (6.8%) were the expansion of pulmonary infection according to their chest CT images and medical history. Compared with patients without neurological symptoms, patients with neurological symptoms had a significantly longer length of hospital stay, time of nucleic acid turning negative, and the mean time from onset of symptom to hospital admission (p < 0.05). Patients with neurological symptoms were more likely to occur the expansion of pulmonary infection compared with the patients without neurological symptoms (46/509 [9.0%] vs. 68/1,173 [5.8%]).Conclusions: Non-critically ill COVID-19 patients commonly have neurological symptoms. Neurological symptoms are significantly associated with the processes of COVID-19. Early identification and aggressive treatment are particularly important for COVID-19 patients with neurological symptoms.

QuestionDo steroids improve neurologic symptoms in patients with metastatic brain tumors compared to no treatment? If steroids are given, what dose should be used? Comparisons include: (1) steroid therapy versus none. (2) comparison of different doses of steroid therapy.Target populationThese recommendations apply to adults diagnosed with brain metastases.RecommendationsSteroid therapy versus no steroid therapy Asymptomatic brain metastases patients without mass effect Insufficient evidence exists to make a treatment recommendation for this clinical scenario. Brain metastases patients with mild symptoms related to mass effect Level 3 Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brain metastases. It is recommended for patients who are symptomatic from metastatic disease to the brain that a starting dose of 4-8 mg/day of dexamethasone be considered. Brain metastases patients with moderate to severe symptoms related to mass effect Level 3 Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brain metastases. If patients exhibit severe symptoms consistent with increased intracranial pressure, it is recommended that higher doses such as 16 mg/day or more be considered. Choice of Steroid Level 3 If corticosteroids are given, dexamethasone is the best drug choice given the available evidence. Duration of Corticosteroid Administration Level 3 Corticosteroids, if given, should be tapered slowly over a 2 week time period, or longer in symptomatic patients, based upon an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy. Given the very limited number of studies (two) which met the eligibility criteria for the systematic review, these are the only recommendations that can be offered based on this methodology. Please see "Discussion" and "Summary" section for additional details.

Infection by the severe acute respiratory syndrome (SARS) coronavirus-2 (SARS-CoV-2) is the cause of the new viral infectious disease (coronavirus disease 2019; COVID-19). Emerging evidence indicates that COVID-19 may be associated with a wide spectrum of neurological symptoms and complications with central nervous system (CNS) involvement. It is now well-established that entry of SARS-CoV-2 into host cells is facilitated by its spike proteins mainly through binding to the angiotensin-converting enzyme 2 (ACE-2). Preclinical studies have suggested that neuropilin-1 (NRP1), which is a transmembrane receptor that lacks a cytosolic protein kinase domain and exhibits high expression in the respiratory and olfactory epithelium, may also be implicated in COVID-19 by enhancing the entry of SARS-CoV-2 into the brain through the olfactory epithelium. In the present study, we expand on these findings and demonstrate that the NRP1 is also expressed in the CNS, including olfactory-related regions such as the olfactory tubercles and paraolfactory gyri. This furthers supports the potential role of NRP1 as an additional SARS-CoV-2 infection mediator implicated in the neurologic manifestations of COVID-19. Accordingly, the neurotropism of SARS-CoV-2 via NRP1-expressing cells in the CNS merits further investigation. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) is a new viral respiratory disease and has become a pandemic. Fever, weakness, and dry cough are the main clinical manifestations. However, little is known about neurological symptoms of non-critically ill COVID-19 patients. Objective: To investigate the neurological symptoms and implications of patients with non-critically ill COVID-19 patients. Materials and Methods: This retrospective cohort study investigated all COVID-19 patients admitted to Wuhan East-West Lake Fangcang shelter hospital. Demographic data, clinical manifestations, comorbidities, radiological data, the result of nucleic acid test, and treatments were collected and analyzed. Results: Among 1,682 patients with confirmed non-critically ill COVID-19, 509 patients (30.3%) had neurological symptoms, including myalgia (311, 18.5%), headache (216, 12.8%), fatigue (83, 4.9%), and dizziness (15, 0.9%). One hundred and fourteen patients (6.8%) were the expansion of pulmonary infection according to their chest CT images and medical history. Compared with patients without neurological symptoms, patients with neurological symptoms had a significantly longer length of hospital stay, time of nucleic acid turning negative, and the mean time from onset of symptom to hospital admission (p < 0.05). Patients with neurological symptoms were more likely to occur the expansion of pulmonary infection compared with the patients without neurological symptoms (46/509 [9.0%] vs. 68/1,173 [5.8%]). Conclusions: Non-critically ill COVID-19 patients commonly have neurological symptoms. Neurological symptoms are significantly associated with the processes of COVID-19. Early identification and aggressive treatment are particularly important for COVID-19 patients with neurological symptoms. [ABSTRACT FROM AUTHOR]

Background: The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm).Methods: The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro-oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis.Results: Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15-76 months). After multivariate analysis, age <50 years at the time of BC diagnosis (odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8-3.5 [P < .0001]), human epidermal growth factor receptor 2 (HER2)-positive status (HER2+) (OR, 3.6; 95% CI, 2.1-6.1 [P < .0001]), luminal B/HER2+ subtype (OR, 3.1; 95% CI, 1.9-5.3 [P < .001]), triple-negative subtype(OR, 2.4; 95% CI, 1.5-4 [P = .001]), and Karnofsky performance status ≤70 (OR, 6.6; 95% CI, 4.5-9.6 [P < .0001]) were associated with a higher frequency of CNSm. Brain parenchyma was the most common site of CNSm. The median overall survival after a diagnosis of CNSm was 12.2 months (95% CI, 9.3-15.1 months).Conclusions: CNSm is not uncommon among patients with BC, particularly in those with neurologic symptoms who require neuro-oncology evaluation and are aged <50 years at the time of diagnosis, have HER2+ or triple-negative subtypes, have a poor Karnofsky performance status, and/or have ≥2 non-CNS metastases. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is a virus pandemic. According to the first obtained data, COVID-19 has defined with findings such as cough, fever, diarrhea, and fatigue although neurological symptoms of patients with COVID-19 have not been investigated in detail. This study aims to investigate the neurological findings via obtained face-to-face anamnesis and detailed neurological examination in patients with COVID-19. Methods: Two hundred thirty-nine consecutive inpatients with COVID-19, supported with laboratory tests, were evaluated. Detailed neurological examinations and evaluations of all patients were performed. All evaluations and examinations were performed by two neurologists who have at least five-year experience. Results: This study was carried out 239 patients (133 male + 106 female) with diagnosed COVID-19. Neurological findings were present in 83 of 239 patients (34.7%). The most common neurological finding was a headache (27.6%). D-dimer blood levels were detected to be significantly higher in patients with at least one neurological symptom than patients without the neurological symptom (p < 0.05). IL-6 level was found to be significantly higher in patients with headache than without headache (p < 0.05). Creatine kinase (CK) level was detected to be significantly higher in patients with muscle pain (p < 0.05). Conclusion: Neurological symptoms are often seen in patients with COVID-19. Headache was the most common seen neurological symptom in this disease. Dizziness, impaired consciousness, smell and gustation impairments, cerebrovascular disorders, epileptic seizures, and myalgia were detected as other findings apart from the headache. It is suggested that determining these neurological symptoms prevents the diagnosis delay and helps to prohibit virus spread. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the rate and magnitude of neurologic symptom change during radiation therapy (RT) and impact of symptom change on survival outcomes in patients with diffuse intrinsic pontine glioma (DIPG). Methods: From 2006 to 2014, 108 patients with newly diagnosed DIPG were treated with conventionally fractionated radiation therapy (RT) to 54 Gy (median) at our institution. The presence and severity of neurologic symptoms related to cranial neuropathy (CN) and cerebellar (CB) and long-tract (LT) signs was reviewed before and weekly during RT for each patient. The rate and magnitude of change for each symptom category was evaluated according to accumulated RT dose. The impact of clinical factors and radiation dose-volume parameters was determined using Cox proportional hazards models. Results: Median dose to first sign of symptomatic improvement was 16.2 Gy (CN), 19.8 Gy (LT) and 21.6 Gy (CB). Most patients showed an improvement by 20 Gy. Larger uninvolved brainstem volume, alone or normalized to total brain (TB) or posterior fossa volume (PF), was associated with shorter time to LT sign improvement (P = 0.044, P = 0.033, and P = 0.05, respectively). Patients with any improvement in CN experienced significantly, yet modestly, prolonged progression-free survival (PFS) and overall survival (OS) (P = 0.002 and P = 0.008, respectively). Tumor volume, with or without normalization to TB or PF, was not significantly associated with PFS or OS. Conclusions: Low cumulative RT doses resulted in neurologic improvement in most patients with DIPG. The volume of brainstem spared by tumor influenced time to symptomatic improvement. Neurologic improvement during RT was associated with superior survival. [ABSTRACT FROM AUTHOR]

Hepatitis E Virus (HEV) infection is a worldwide disease and the primary cause of acute viral hepatitis in the world with an estimated 20 million cases every year and 70 000 deaths. Hepatitis E is a waterborne infection in the developing countries. In these countries, HEV genotypes 1 and 2 cause large outbreaks and affect young subjects, resulting in significant mortality in pregnant women and patients with cirrhosis. In the developed countries, HEV genotypes 3 and 4 are responsible for autochthonous, sporadic hepatitis and transmission is zoonotic. Parenteral transmission by the transfusion of blood products has been identified as a potential new mode of transmission. The prevalence of positive HEV viraemia in blood donors in Europe ranges from 1/600 to 1/2500 in highly endemic European countries. HEV can cause neurological disorders and chronic infections in immunocompromised patients. The progression of acute hepatitis E is usually asymptomatic and resolves spontaneously. Diagnostic tools include anti‐HEV IgM antibodies in serum and/or viral RNA detection in the blood or the stools by PCR. Ribavirin is used to treat chronic infection. A vaccine has been developed in China. [ABSTRACT FROM AUTHOR]

• CSF-VZV renders VZV either the pathogenic culprit or a stress-related epiphenomenon. • We studied the significance of CSF-VZV coupled with neurological manifestations. • Of 125 CSF-VZV-positive patients, only 9(7 %) had alternative attributable diagnoses. • High VZV viral load and rash correlated with a greater risk of stroke. • Empiric antiviral treatment was not associated with superior prognosis. Varicella zoster virus (VZV) is among the leading pathogens causing meningitis and encephalitis. While VZV-PCR-positive CSF is considered a gold-standard for diagnosis, it is not-uncommon to detect VZV-DNA in CSF of patients with other acute or chronic illness. Our goal was to determine the clinical relevance of VZV-PCR-positive CSF when investigating patients with neurological symptoms. In this retrospective cohort from the largest hospital in Israel, we collected demographic, clinical and laboratory data of patients with VZV-PCR-positive CSF, analyzing the significance of various parameters. During a 5-years study, 125 patient-unique VZV-PCR-positive CSFs were recorded, in which only 9 alternative diagnoses were noted. The commonest symptoms were headache (N = 104, 83 %) and rash (N = 96, 76 %). PCR-cycle-threshold (Ct), a surrogate of viral burden, did not significantly vary across the clinical manifestations; however, patients with rash and Ct<35 were prone to develop stroke in the following year (N = 6, 7 %). Empiric nucleoside-analogue treatment was not associated with a better outcome compared to treatment administered upon a positive-PCR result. Our findings suggest that in patients with neurological symptoms, detection of VZV-DNA in CSF renders VZV the probable culprit. Nevertheless, a systematic evaluation of treatment and follow-up algorithms of patients with suspected or proved VZV meningitis and encephalitis is needed. The benefits of a prompt treatment should be weighed against the potential complications of nucleoside-analogue. Conversely, the propensity for stroke in patients with higher viral-burden, necessitates further studies assessing VZV causal role, directing additional workup, treatment and monitoring policy. [ABSTRACT FROM AUTHOR]

Objectives: To document if manganese from welding causes health effects including neurological symptoms associated with manganese exposure. Material and Methods: An anonymous questionnaire survey for a total of 505 welders at 3 welding facilities in Qingdao City, China was administered and analyzed. Results: Numerous symptoms were reported by the welders including difficulty with eyes for 43% of them, sore throat for 30% of them, and tremors were reported by over 18% of them. Tremors were associated with longer periods of work as a welder and correlated with the relative cleanliness at the 3 different facilities. Tremors did not correlate with smoking. Conclusions: Manganese-exposed welders reported a variety of symptoms related to work and showed neurological disturbances that correlated with amount of exposure. Int J Occup Med Environ Health 2017;30(2):241–247

Background and Purpose: Reperfusion therapy is typically performed in cases with acute cerebral infarction. Mechanical thrombectomy (MT) achieves superior recanalization and favorable outcomes. However, some patients have poor functional prognosis despite successful recanalization. We investigated factors affecting functional prognosis after MT with good reperfusion., Methods: Among the 205 consecutive cases with ischemic stroke treated with MT at our center from January 1, 2019 to March 31, 2021, 168 with successful recanalization were included. Factors affecting early neurological improvement (ENI) and modified Rankin Scale (mRS) scores were reviewed retrospectively., Results: There were 93 (55%) cases with ENI and 75 (45%) without ENI. The times from onset to recombinant tissue-type plasminogen activator administration and recanalization in ENI cases were shorter than those in non-ENI cases. However, non-ENI cases had significantly higher Fazekas grades for white matter lesions. In multivariate analysis, the Fazekas grade was related to ENI (odds ratio [OR]=0.572, 95% confidence interval [CI]=0.345-0.948). The mRS score at discharge was 0-2 in 64 cases (good outcome) and 3-6 in 104 cases (poor outcome). Patients with a poor outcome had a significantly higher age, National Institutes of Health Stroke Scale (NIHSS) score, and Fazekas grade. Multivariate analysis revealed that the NIHSS score (OR=1.073, 95% CI=1.020-1.129) and Fazekas grade (OR=2.162, 95% CI=1.458-3.205) at hospitalization affected the mRS score at discharge., Conclusion: There is a correlation of greater severity of white matter lesions with poorer ENI and clinical outcomes at discharge post-MT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Deguchi et al.)

Background: Acquired hepatocerebral degeneration (AHD) is now widely recognized by physicians. Although hyperintensity in the bilateral globus pallidus in T1-weighted magnetic resonance images (MRIs) are characteristic neuroimaging findings, accumulating reports indicate that atypical neuroimaging findings are not rare. This study aimed to describe the spectrum of atypical neuroimaging findings and related factors in patients with AHD.Methods: From February 2017 to January 2019, a retrospective study was conducted of 28 patients with AHD in the Shengjing Hospital of China Medical University. The neurological manifestations, clinical parameters, and biochemical and neuroimaging findings were analyzed.Results: Among 28 patients, 14 patients were diagnosed with viral hepatitis-caused hepatocirrhosis, which was the most common cause of AHD. Resting tremor, cognitive impairment, and parkinsonian gait were the most common neurologic symptoms. Bilateral globus pallidus T1-weighted hyperintensity was detected in 26 patients (26/28, 92.9%). Ten patients (10/28, 35.7%) were determined to have an atypical neuroimaging finding. Binary logistic regression analysis indicated that age at onset of neurologic symptoms (odds ratio = 1.29, 95% confidence interval [CI] 1.03-1.61; p = 0.030) and Child-Pugh scores (odds ratio = 2.52, 95% CI, 1.01-6.31; p = 0.048) were independently associated with atypical neuroimaging findings in AHD.Conclusion: The clinical manifestations of AHD are diverse; resting tremor, cognitive impairment, and parkinsonian gait were the most common. More than one third of patients had atypical neuroimaging findings. Age at onset of neurologic symptoms and Child-Pugh scores may be important predictors of atypical neuroimaging findings in patients with AHD. [ABSTRACT FROM AUTHOR]