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In this case report, a 9-month Swiss brown calf has been reported with neurological symptoms including seizures, opisthotonus, hyperesthesia, nystagmus, convulsions of the head and extremity muscles, watery brown faeces and mild blood in faeces. Eimeria spp. oocyst was found in the parasitological examination of the faeces, and it was suspected of nervous coccidiosis. When the brain tissue was examined, the numerous different forms of Eimeria spp were histopathologically detected in the brain parenchyma and brain capillaries. Eimeria spp which were found in the brain and large intestinal tissues were confirmed as Eimeria zuernii using specific primers with qRT-PCR. This case report emphasizes that Eimeria zuernii is located in the brain tissue of cattle for the first time in the world. We suspect that these agents may travel to the brain through the enteric blood vessels, and all the neurological symptoms detected in this calf may be due to the presence of these agents in the brain tissue. Therefore, this could be crucial knowledge on the pathogenesis of nervous coccidiosis.

Deltamethrin is a synthetic type II pyrethroid insecticide that is widely used to protect vegetables, fruits and agricultural crops against pests such as mites, ants, beetles and weevils. Moreover, it is used in veterinary practice as an ectoparasiticide, but it is not approved for feline use. To my knowledge, deltamethrin intoxication in cats has never been reported before. For the first time, this report aimed to report clinical, haematological and biochemical changes due to deltamethrin intoxication in a cat. The cat had complaints of involuntary movements and difficulty in standing because the owner sprayed his kittens to treat lice infestation with a watery solution of a pesticide containing deltamethrin, and the mother cat licked its kittens. In the clinical examination of the cat – incoordination, spontaneous contractions, ataxia, hyperesthesia, hypothermia (T: 37.2°C), bradycardia (128/bpm), tachypnea, mydriasis and erosive lesions in the tongue – were detected. Hematologic examination revealed leukocytosis and neutrophilia. Biochemical analysis showed an increase in AST, LDH and CK-MB activities and potassium levels. Given that there is no specific antidote to deltamethrin toxicity, symptomatic treatment was given. Fluid therapy (0.9% NaCl and 5% dextrose solution at a dose of 40 ml/kg, IV) was administered for the elimination of the toxin from the body and coping with septic shock. Diazepam (0.5 mg/kg, IV) was administered to alleviate neurological signs. Enrofloxacin (5 mg/ kg, SC) was administered for three days due to sepsis, leukocytosis and neutrophilia. In the treatment of hypothermia, blankets and hot water bottles were used. After this treatment, the cat recovered. This case report, confirms that deltamethrin, like other pyrethroids, is quite toxic to cats, the clinical findings appeared in a short time, and neurological findings, especially choreoathetosis, were dominant. Consequently, this study demonstrated that deltamethrin causes neutrophilia, leukocytosis, hyperkalaemia, and heart and skeletal muscle damage in cats., Deltametrin je sintetički piretrodni insekticid tipa II koji se široko upotrebljava u zaštiti bilja, voća i poljoprivrednih usjeva protiv štetočina kao što su grinje, mravi, kornjače i korov. U veterinarskoj se praksi upotrebljava kao ektoparaziticid, ali nije odobren za primjenu u mačaka. Prema podacima autora članka intoksikacija deltametrinom u mačaka do sada nije zabilježena i u ovom se članku prvi put bilježe kliničke, hematološke i biokemijske promjene uzrokovane trovanjem deltametrinom u te vrste životinja. U mačke su primijećeni nevoljni pokreti i poteškoće u stajanju nakon što je liznula svoje mačiće koje je vlasnik tretirao vodenastom otopinom pesticida koji je sadržavao deltametrin kako bi ih zaštitio od infestacije ušima. Kliničkim pregledom mačke ustanovljena je inkoordinacija, spontane kontrakcije, ataksija, hiperestezija, hipotermija (37,2 °C), bradikardija (128/otkucaja u minuti), tahipneja, midrijaza i erozivne lezije na jeziku. Hematološki pregled otkrio je leukocitozu i neutrofiliju. Biokemijska analiza pokazala je porast aktivnosti AST-a, LDH-a te CK-MB-a i razine kalija. S obzirom na to da ne postoji specifični antidot toksičnosti deltametrina, primijenjena je simptomatska terapija. Terapija tekućinama (0,9 %-tni NaCl i 5 %-tna otopina glukoze dekstroze u dozi od 40 mL/kg, iv.) primijenjena je kako bi se iz tijela uklonio toksin i spriječio septički šok. Diazepam (0,5 mg/kg, iv.) primijenjen je za ublažavanje neuroloških znakova. Enrofloksacin (5 mg/ kg, sk.) primjenjivan je tri dana zbog sepse, leukocitoze i neutrofilije. U liječenju hipotermije upotrijebljene su deke i termofori. Nakon primjene navedenih terapijskih postupaka mačka se oporavila. Ovaj prikaz slučaja potvrđuje da je deltametrin, kao i drugi piretroidi, prilično toksičan za mačke, da su se klinički znakovi pojavili vrlo brzo i da su dominirali neurološki znakovi, posebno koreoatetoza. Ovo istraživanje također pokazuje da deltametrin uzrokuje neutrofiliju, leukocitozu, hiperkalemiju te oštećenje srca i skeletnih mišića u mačaka.

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.

Resumen: El virus del Zika fue el responsable en Colombia de la segunda epidemia más grande del continente después de Brasil durante el período 2015-2017. Con 100.000 casos reportados, 19.963 gestantes infectadas y 248 casos de niños nacidos con microcefalia, la epidemia fue declarada como finalizada en el país en 2016. Es el causal del Síndrome Congénito por Zika (SCZ), sospechado por primera vez en Río de Janeiro donde se estableció la relación entre la infección por Zika en gestantes y el aumento en la incidencia de microcefalias. Posteriormente se plantearía toda una serie de alteraciones congénitas en el feto a nivel neurológico, sensorial y osteomuscular confirmando así el efecto teratogénico del virus. Se presenta el caso de un paciente de cuatro meses y veinte días de edad que procede del área rural de Ibagué y que acude al programa madre canguro de la Unidad Materno Infantil del Tolima (UMIT); presenta diagnóstico de microcefalia asociada a neuroinfección congénita por Zika con prueba confirmatoria RT-PCR de la madre por parte del Instituto Nacional de Salud. Presenta hallazgos imagenológicos, físicos y clínicos como un perímetro cefálico que persiste por debajo de -3SD, trastorno del tono y un Retardo en el Desarrollo Psicomotor (RDPM) severo con una edad neurológica de tres meses persistente en todos los controles. Atrofia cortical, microcalcificaciones periventriculares y gangliobasales, y ventriculomegalia. Se trata del primero de veintiún pacientes con sospecha clínica y confirmación con hallazgos similares a los presentados en la literatura. La importancia de la detección de estos casos radica en el riesgo neurológico que se presenta por el compromiso motor, cognitivo y sensorial. También en la diferenciación con las secuelas neurológicas por TORCH y de alteraciones cromosómicas. Abstract: The Zika virus was responsible in Colombia for the second largest epidemic on the continent after Brazil during the 2015-2017 period. With 100,000 reported cases, 19,963 infected pregnant women and 248 cases of children born with microcephaly, the epidemic was declared to have ended in the country in 2016. It is the cause of the Congenital Zika Syndrome (CZS), suspected for the first time in Rio de Janeiro where the relationship between Zika infection in pregnant women and the increase in the incidence of microcephaly was established. Subsequently, a whole series of congenital disorders in the fetus would be considered at the neurological, sensory, and musculoskeletal levels, thus confirming the teratogenic effect of the virus. The case of a four-month and twenty-day old patient coming from the rural area of Ibagué and attending the kangaroo mother program of the Maternal and Child Unit of Tolima (UMIT) is presented. The child was diagnosed with microcephaly associated with congenital Zika neuroinfection confirmed by RT-PCR test to the mother by the National Institute of Health. It presents imaging, physical, and clinical findings such as a head circumference persistently below -3SD, tone disorder, and a severe Psychomotor Development Retardation (PDR) with a persistent neurological age of three months in all controls. Cortical atrophy, periventricular and basal ganglia micro-calcification, and ventriculomegaly. This is the first of twenty-one patients with clinical suspicion and confirmation with findings similar to those presented in the literature. The importance of detecting these cases lies in the neurological risk presented by motor, cognitive and sensory involvement and also in the differentiation with TORCH neurological sequelae and chromosomal abnormalities. Resumo: O vírus do Zika foi o responsável na Colômbia pela segunda maior epidemia do continente depois do Brasil entre 2015 e 2017. Com 100.000 casos relatados, 19.963 gestantes infectadas e 248 casos de recém-nascidos com microcefalia, a epidemia foi declarada como finalizada no país em 2016. É a causa da síndrome congênita pelo vírus Zika, suspeita pela primeira vez no Rio de Janeiro, Brasil, onde foi estabelecida a relação entre a infecção pelo vírus Zika em gestantes e o aumento da incidência de mi-crocefalias. Em seguida, são apresentadas alterações congénitas no feto em nível neurológico, sensorial e osteomuscular, o que confirma o efeito teratogênico do vírus. É apresentado o caso de um paciente de quatro meses e vinte dias de idade que procede da área rural de Ibagué, Colômbia, e que recorre ao programa "mãe canguru" da Unidade Materno-Infantil de Tolima; apresenta diagnóstico de microcefalia associada à neuroinfecção congênita pelo vírus Zika com teste confirmatório RT-PCR da mãe, realizado pelo Instituto Nacional de Saúde da Colômbia. Apresenta achados imagenológicos, físicos e clínicos como um perímetro cefálico que persiste abaixo de -3SD, transtorno do tom e um atraso no desenvolvimento psicomotor agudo com uma rede neurológica de três meses persistente em todas as revisões. Atrofia cortical, microcalcificações periventriculares e dos gânglios da base, e ventriculomegalia. Trata-se do primeiro de 21 pacientes com suspeita clínica e confirmação com achados semelhantes aos apresentados na literatura. A importância da detecção desses casos está no risco neurológico apresentado pelo comprometimento motor, cognitivo e sensorial. Também na diferenciação com as sequelas neurológicas por TORCH e alterações cromossômicas.

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.

The common co-occurrence of psychiatric diagnoses and neurological diagnoses has important implications. Subtle abnormalities on the neurological examination are often present and are referred to as “neurological soft signs.” Overt movement disorders are more common as well. The purpose of this chapter is to review common movement disorders and subtle neurological findings in developmental psychiatric disorders attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and autism spectrum disorder (ASD).

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.

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.