Neurological Sequelae of Hypoglycaemia

Demyelinating peripheral neuropathy has been described in association with tumor necrosis factor (TNF) inhibitors. It is rarely developed after treatment discontinuation. We present the case of a child with juvenile idiopathic arthritis who developed peripheral neuropathy few months after TNF inhibitor withdrawal with clinical worsening of the neurological sequelae while undergoing treatment with abatacept.

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Neurobrucellosis associated with feral swine hunting in the southern United States

BMJ Case Reports ◽

10.1136/bcr-2020-238216 ◽

2020 ◽

Vol 13 (12) ◽

pp. e238216

Author(s):

Harry Ross Powers ◽

Jared R Nelson ◽

Salvador Alvarez ◽

Julio C Mendez

Keyword(s):

United States ◽

At Risk ◽

High Index ◽

Southern United States ◽

Endemic Country ◽

Feral Swine ◽

Neurological Sequelae ◽

Initial Symptoms ◽

The Usa ◽

High Index Of Suspicion

Although uncommon, Brucella infection can occur outside the areas of high endemicity, such as the USA. In the southern USA, hunters of wild swine are at risk for brucellosis. We present a case of a patient with fever, headache and constitutional symptoms that were ongoing for 11 months. He was diagnosed with neurobrucellosis. The patient was treated successfully with intravenous ceftriaxone, oral doxycycline and oral rifampin therapy. He had persistent neurological sequelae after completing treatment. This case illustrates the high index of suspicion needed to diagnose neurobrucellosis in a non-endemic country because initial symptoms can be subtle. The disease can be treated successfully, but long-lasting neurological sequelae are common.

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Extremely Elevated Cerebrospinal Fluid Protein and Glucose Level in a Neonate with Hypernatremic Dehydration

Journal of Pediatric Neurology ◽

10.1055/s-0040-1708496 ◽

2020 ◽

Author(s):

Arti Maria ◽

Tapas Bandyopadhyay

Keyword(s):

Cerebrospinal Fluid ◽

Neurodevelopmental Outcome ◽

Neurological Sequelae ◽

Glucose Levels ◽

Csf Analysis ◽

First Case ◽

Time Of Admission ◽

Cerebrospinal Fluid Protein ◽

Hypernatremic Dehydration

AbstractWe describe the case of a term newborn who presented with hypernatremic dehydration on day 19 of life. The baby was otherwise hemodynamically stable with no evidence of focal or asymmetric neurological signs. The laboratory tests at the time of admission were negative except for hypernatremia and the extremely elevated levels of cerebrospinal fluid (CSF) protein (717 mg/dL) and glucose levels (97 mg/dL). The hypernatremic dehydration was corrected as per the unit protocol over 48 hours. Repeat CSF analysis done after 5 days showed normalization of the protein and glucose levels. Serial follow-up and neuroimaging showed no evidence of neurological sequelae. Unique feature of our case is this is the first case reporting such an extreme elevation of CSF protein and glucose levels that have had no bearing on neurodevelopmental outcome at 1 month and 3 months of follow-up.

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Low Maternal Immunoglobulin G Avidity and Single Parity as Adverse Implications of Human Cytomegalovirus Vertical Transmission in Pregnant Women with Immunoglobulin M Positivity

Viruses ◽

10.3390/v13050866 ◽

2021 ◽

Vol 13 (5) ◽

pp. 866

Author(s):

Masatoki Kaneko ◽

Junsuke Muraoka ◽

Kazumi Kusumoto ◽

Toshio Minematsu

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Vertical Transmission ◽

Human Cytomegalovirus ◽

Multiple Logistic Regression Analysis ◽

Clinical Signs ◽

Immunoglobulin M ◽

Igg Antibody ◽

Neurological Sequelae ◽

Previous Pregnancy

Human cytomegalovirus (CMV) is the leading cause of neurological sequelae in infants. Understanding the risk factors of primary CMV infection is crucial in establishing preventive strategies. Thus, we conducted a retrospective cohort study to identify risk factors of vertical transmission among pregnant women with immunoglobulin (Ig) M positivity. The study included 456 pregnant women with IgM positivity. Information on age, parity, occupation, clinical signs, IgM levels, and IgG avidity index (AI) was collected. The women were divided into infected and non-infected groups. The two groups showed significant differences in IgM level, IgG AI, number of women with low IgG AI, clinical signs, and number of pregnant women with single parity. In the multiple logistic regression analysis, pregnant women with single parity and low IgG AI were independent predictors. Among 40 women who tested negative for IgG antibody in their previous pregnancy, 20 showed low IgG AI in their current pregnancy. Among the 20 women, 4 had vertical transmission. These results provide better understanding of the risk factors of vertical transmission in pregnant women with IgM positivity.

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Neurological Complications of COVID-19: Underlying Mechanisms and Management

International Journal of Molecular Sciences ◽

10.3390/ijms22084081 ◽

2021 ◽

Vol 22 (8) ◽

pp. 4081

Author(s):

Ghaydaa A. Shehata ◽

Kevin C. Lord ◽

Michaela C. Grudzinski ◽

Mohamed Elsayed ◽

Ramy Abdelnaby ◽

...

Keyword(s):

Neuromuscular Junctions ◽

Neurological Complications ◽

Cerebrovascular Diseases ◽

World Health ◽

Neurological Sequelae ◽

Global Pandemic ◽

Underlying Mechanisms ◽

Health Organization ◽

Demyelinating Disorders ◽

Taste And Smell

COVID-19 is a severe respiratory disease caused by the newly identified human coronavirus (HCoV) Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The virus was discovered in December 2019, and in March 2020, the disease was declared a global pandemic by the World Health Organization (WHO) due to a high number of cases. Although SARS-CoV-2 primarily affects the respiratory system, several studies have reported neurological complications in COVID-19 patients. Headache, dizziness, loss of taste and smell, encephalitis, encephalopathy, and cerebrovascular diseases are the most common neurological complications that are associated with COVID-19. In addition, seizures, neuromuscular junctions’ disorders, and Guillain–Barré syndrome were reported as complications of COVID-19, as well as neurodegenerative and demyelinating disorders. However, the management of these conditions remains a challenge. In this review, we discuss the prevalence, pathogenesis, and mechanisms of these neurological sequelae that are secondary to SARS-CoV-2 infection. We aim to update neurologists and healthcare workers on the possible neurological complications associated with COVID-19 and the management of these disease conditions.

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Successful Postnatal Cardiopulmonary Resuscitation Due to Defibrillation

Children ◽

10.3390/children8050421 ◽

2021 ◽

Vol 8 (5) ◽

pp. 421

Author(s):

Lukas Peter Mileder ◽

Nicholas Mark Morris ◽

Stefan Kurath-Koller ◽

Jasmin Pansy ◽

Gerhard Pichler ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiac Rhythm ◽

Neonatal Intensive Care ◽

Spontaneous Circulation ◽

Long Qt ◽

Neurological Sequelae ◽

Cardio Pulmonary Resuscitation ◽

Propranolol Treatment ◽

Qt Syndrome

An asphyxiated term neonate required postnatal resuscitation. After six minutes of cardio-pulmonary resuscitation (CPR) and two doses of epinephrine, spontaneous circulation returned, but was shortly followed by ventricular fibrillation. CPR and administration of magnesium, calcium gluconate, and sodium bicarbonate did not improve the neonate’s condition. A counter shock of five Joule was delivered and the cardiac rhythm immediately converted to sinus rhythm. The neonate was transferred to the neonatal intensive care unit and received post-resuscitation care. Due to prolonged QTc and subsequently suspected long-QT syndrome propranolol treatment was initiated. The neonate was discharged home on day 14 without neurological sequelae.

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A cardiopulmonary bypass strategy to support a patient with vein of Galen malformation

Perfusion ◽

10.1177/02676591211001534 ◽

2021 ◽

pp. 026765912110015

Author(s):

Alex Robertson ◽

Nagarajan Muthialu ◽

Mike Broadhead

Keyword(s):

Cardiopulmonary Bypass ◽

Surgical Repair ◽

Circulatory Arrest ◽

Ductus Arteriosus ◽

Venous Drainage ◽

Deep Hypothermic Circulatory Arrest ◽

Vein Of Galen ◽

Vein Of Galen Malformation ◽

Neurological Sequelae ◽

Ph Stat

We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation. Several strategies were employed to attenuate the cerebral shunt including pH-stat, high cardiac index, restrictive venous drainage, continuous ventilation and deep hypothermic circulatory arrest. The patient recovered from surgery with no apparent neurological sequelae.

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Ventriculitis: a severe complication of central nervous system infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab216 ◽

2021 ◽

Author(s):

David Luque-Paz ◽

Matthieu Revest ◽

François Eugène ◽

Sarrah Boukthir ◽

Loren Dejoies ◽

...

Keyword(s):

Brain Abscess ◽

Behavior Disorder ◽

Severe Complication ◽

Limited Attention ◽

Neurosurgical Procedures ◽

Imaging Features ◽

Neurological Sequelae ◽

Single Centre Study ◽

One Year ◽

Gait Disturbances

Abstract Background Ventriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature. Methods Retrospective single-centre study. We screened medical files of all patients who had a brain imaging report including the word “ventriculitis” during years 2005-2019. Only patients with clinical, microbiological and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire. Results Ninety-eight patients fulfilled inclusion criteria: 42 women and 56 men, median age 60 years [interquartile range 48-68]. Primary mechanism for ventriculitis was classified as follows: brain abscess (n=29, 29.6%), meningitis (n=27, 27.6%), intraventricular catheter-related (n=17, 17.3%), post-neurosurgery (n=13, 13.3%), and hematogenous (n=12, 12.2%). Main neuroimaging features were intraventricular pus (n=81, 82.7%), ependymal enhancement (n=70, 71.4%) and intraventricular loculations (n=15, 15.3%). Main pathogens were streptococci (n=44, 44.9%), Gram-negative bacilli (n=27, 27.6%), and staphylococci (n=15, 15.3%). In-hospital and one-year mortality rates were, respectively, 30.6% (n=30), and 38.8% (n=38). Neurological sequelae were reported in 34/55 (61.8%) survivors, including cognitive impairment (n=11), gait disturbances (n=9), paresis (n=7), behavior disorder (n=6), epilepsy (n=5). On multivariate analysis, age > 65 years, Glasgow Coma Scale score < 13 at initial presentation, status epilepticus, hydrocephalus and positive cerebrospinal fluid culture were associated with one-year mortality. We built a scoring system to stratify patients with ventriculitis into low-risk (12.5%), intermediate-risk (36.5%), and high-risk (71.4%) of death. Conclusion Ventriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with in-hospital mortality rate of 30%, and neurological sequelae in 60% of survivors.

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