Non-metastatic neurological manifestations of malignancy

Cns Infection ◽

Local Effects ◽

Immune Mediated ◽

Neuronal Proteins ◽

Systemic Malignancy

Neurological complications of systemic malignancy are frequent. They may reflect direct local effects of the tumour; CNS infection; side effects of chemotherapy or radiotherapy; nutritional or metabolic derangements; or a paraneoplastic syndrome. The paraneoplastic neurological syndromes are a group of disorders associated with a malignancy outside the nervous system. The pathophysiology is immune-mediated, with the tumour’s expression of neuronal proteins invoking antibody formation, which in turn results in neurological symptoms. This chapter will mainly focus on these syndromes.

Dengue Fever and Neurology: Well Beyond Hemorrhage and Strokes

10.20944/preprints202005.0421.v1 ◽

2020 ◽

Author(s):

Marco Antônio Machado Schlindwein ◽

Isabelle Pastor Bandeira ◽

Letícia Caroline Breis ◽

Júlia Machado Rickli ◽

Caio César Demore ◽

...

Keyword(s):

Nervous System ◽

Dengue Virus ◽

Dengue Fever ◽

The Body ◽

Common Disease ◽

Immune Mediated

Dengue virus an arbovirus is endemic in an area that comprise almost half of the world's population, contrary to past beliefs that dengue virus differentiate from other neuroinvasive arbovirus due to its lack of neurological invasion and disease related neurological complications excluding hemorrhagic and thromboembolic , the body of evidence have grown to demonstrate a series of neurological manifestations linked to dengue virus with possible mechanisms involving direct virus invasion of the nervous system or immune mediated complications. In this review we provide a wide approach to this neglect but not so rare manifestations of a very common disease.

SARS-CoV-2 and the Nervous System: From Clinical Features to Molecular Mechanisms

International Journal of Molecular Sciences ◽

10.3390/ijms21155475 ◽

2020 ◽

Vol 21 (15) ◽

pp. 5475 ◽

Cited By ~ 11

Author(s):

Manuela Pennisi ◽

Giuseppe Lanza ◽

Luca Falzone ◽

Francesco Fisicaro ◽

Raffaele Ferri ◽

...

Keyword(s):

Nervous System ◽

Molecular Mechanisms ◽

Neuronal Damage ◽

Wide Range ◽

Inflammatory State ◽

Acute Polyneuropathy ◽

The Central Nervous System ◽

The Impact

Increasing evidence suggests that Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) can also invade the central nervous system (CNS). However, findings available on its neurological manifestations and their pathogenic mechanisms have not yet been systematically addressed. A literature search on neurological complications reported in patients with COVID-19 until June 2020 produced a total of 23 studies. Overall, these papers report that patients may exhibit a wide range of neurological manifestations, including encephalopathy, encephalitis, seizures, cerebrovascular events, acute polyneuropathy, headache, hypogeusia, and hyposmia, as well as some non-specific symptoms. Whether these features can be an indirect and unspecific consequence of the pulmonary disease or a generalized inflammatory state on the CNS remains to be determined; also, they may rather reflect direct SARS-CoV-2-related neuronal damage. Hematogenous versus transsynaptic propagation, the role of the angiotensin II converting enzyme receptor-2, the spread across the blood-brain barrier, the impact of the hyperimmune response (the so-called “cytokine storm”), and the possibility of virus persistence within some CNS resident cells are still debated. The different levels and severity of neurotropism and neurovirulence in patients with COVID-19 might be explained by a combination of viral and host factors and by their interaction.

Neurological Complications of Biological Treatment of Psoriasis

Life ◽

10.3390/life12010118 ◽

2022 ◽

Vol 12 (1) ◽

pp. 118

Author(s):

Mateusz Kamil Ożóg ◽

Beniamin Oskar Grabarek ◽

Magdalena Wierzbik-Strońska ◽

Magdalena Świder

Keyword(s):

Nervous System ◽

Side Effects ◽

Biological Treatment ◽

Biological Therapy ◽

Tnf Alpha ◽

Biological Drugs ◽

Discontinuation Of Treatment ◽

The Relationship ◽

Alpha Therapy

In the available literature, little attention has been paid to the assessment of psoriasis and the biological therapy used for it and the nervous system. The purpose of this article is to discuss the relationship between psoriasis and the nervous system as well as to analyze the mechanisms that lead to neurological complications during anticytokine therapies in psoriasis. However, this connection requires further analysis. The use of biological drugs in psoriasis, although it yields positive therapeutic results, is not without numerous side effects. Serious neurological side effects of the therapy are most often visible with the use of anti-TNF-alpha, which is why patients should be monitored for their potential occurrence. Early detection of complications and rapid discontinuation of treatment with the drug may potentially increase the patient’s chances of a full recovery or improvement of his/her neurological condition. It also seems reasonable that, in the case of complications occurring during anti-TNF-alpha therapy, some of the drugs from other groups should be included in the therapy.

Neurological manifestations associated with SARS-CoV-2 infection: a narrative review

10.5327/1516-3180.442 ◽

2021 ◽

Author(s):

Poliana Rafaela dos Santos Araújo ◽

Kauan Alves Sousa Madruga ◽

Bruna Alves Rocha ◽

Lucas Oliveira Braga

Keyword(s):

Nervous System ◽

Meta Analysis ◽

Neurological Symptoms ◽

Narrative Review ◽

Common Symptom ◽

Cns Involvement ◽

Pubmed Database ◽

Critical Patients

Background: Coronavirus disease (COVID-19), once identified, soon spread globally, becoming a pandemic. Although patients present mainly with respiratory complaints, several neurological symptoms have been reported. Symptoms range from headache and nonspecific dizziness to seizures and cerebrovascular disease (CVD). It has also been shown that the severity of the infection is directly proportional to the development of neurological symptoms, especially CVD and changes in mental status. Objective: The present study aims to briefly review the neurological manifestations of COVID-19 and discuss the pathogenic mechanisms of Central Nervous System (CNS) involvement. Methods: This is an exploratory narrative review with a descriptive approach, consisting of an active search for scientific articles in the PubMed database. The descriptors “coronavirus infections”, “COVID-19” and “Nervous system” were used, with the Boolean operators “OR” and “AND”. Eighteen articles of systematic review and meta-analysis were included. Results: CNS manifestations included, among others: encephalitis, encephalopathy, consciousness decrease, headache, dizziness, acute myelitis, and stroke. As for the peripheral nervous system, skeletal muscle damage, chemosensory dysfunction, and Guillain-Barré syndrome were observed, with hyposmia being the most common symptom. CNS involvement may be related to a worse prognosis. Conclusion: The clinical involvement of the nervous system in COVID-19 is not uncommon, and can result in several neurological complications, especially in the most critical patients. The pathophysiological mechanisms of these events still need further investigation. In the meantime, physicians should value extra-respiratory symptoms ranging from hyposmia, to potentially fatal manifestations, such as stroke and encephalopathy.

Clinical Analysis of Intravenous and Oral Sequential Treatment With Voriconazole for Candida Central Nervous System Infection in Six Premature Infants

Frontiers in Pharmacology ◽

10.3389/fphar.2021.631293 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yingying Zhu ◽

Xiaohui Gong ◽

Zhiling Li ◽

Danni Wang ◽

Chongbing Yan

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Side Effects ◽

Blood Culture ◽

Kidney Function ◽

Premature Infants ◽

Sequential Treatment ◽

Cns Infection ◽

Significant Difference ◽

Liver And Kidney

Objective: The aim of the study was to observe the clinical efficacy and safety of intravenous and oral sequential treatment with voriconazole for Candida central nervous system (CNS) infection in premature infants.Methods: The study included retrospective analysis of the clinical data of six premature infants with Candida CNS infection admitted to the neonatology department in Shanghai Children’s Hospital between November 2016 and November 2019. By reviewing the characteristics of voriconazole based on the literature, it showed that infants without gastrointestinal dysfunction could be effectively treated by intravenous and oral sequential therapy with voriconazole (both 7 mg/kg/dose, every 12 h). Clinical manifestations, the time required for the cerebrospinal fluid (CSF), blood culture, nonspecific infection markers such as platelets and C-reactive protein (CRP) to turn normal, and drug-related side effects were observed and recorded in the process of treatment. All data were statistically analyzed by T test and Mann–Whitney U test.Results: A total of six premature infants were diagnosed with Candida CNS infection, two cases were diagnosed by a positive CSF culture and four cases were clinically diagnosed. Blood culture was positive for Candida in five cases. Among the 6 patients, 4 cases were Candida albicans and 2 cases were Candida parapsilosis. All the six cases were cured. After 3–5 days of treatment, symptoms such as lethargy, apnea, and feeding intolerance were improved and disappeared; a repeated blood culture turned negative in 3–7 days; CSF returned to normal in 15 ± 9 days on an average. Brain abscess, meningeal inflammation, and other infectious lesions were cleared on cranial magnetic resonance imaging (MRI) after treatment. The average total course of voriconazole was 61 ± 29 days, and the average oral treatment was 28 ± 15 days. No Candida recurrence was found during the treatment, and no drug-related side effects such as skin rash, liver and kidney function impairment, or visual abnormalities were found. The white blood cells, CSF glucose/plasma glucose ratio, and protein in CSF were significantly improved after the treatment (p < 0.05). No statistically significant difference was identified in the liver and kidney function indexes (p > 0.05).Conclusion: Voriconazole is a relatively safe and effective alternative treatment for Candida CNS infection in preterm infants. No severe drug-related side effects were detected.

Involvement of Nervous System in Kawasaki Disease

Journal of Pediatric Neurology ◽

10.1055/s-0037-1606615 ◽

2017 ◽

Vol 17 (01) ◽

pp. 001-007

Author(s):

Andreas Giannopoulos ◽

Maria Gogou

Keyword(s):

Nervous System ◽

Kawasaki Disease ◽

Hormone Secretion ◽

Cranial Nerves ◽

Medical Database ◽

Inappropriate Antidiuretic Hormone Secretion ◽

Central Nervous System Dysfunction ◽

Increased Risk

AbstractThe aim of this study was to summarize the published reports about neurological manifestations of Kawasaki disease and underlying mechanisms. PubMed was used as the source for medical database. The prevalence of neurological complications is estimated to range from 1.1 to 3.7% and can include strokes, inflammation of central nervous system, dysfunction of cranial nerves, behavioral disorders as well as syndrome of inappropriate antidiuretic hormone secretion. Their incidence is usually associated with an increased risk for coronary artery aneurysms. In particular, the involvement of facial nerve seems to be a marker of disease severity. Although prognosis is generally remarkable, serious complications may arise in some cases. The early initiation of appropriate therapy prevents the appearance of neurological manifestations in children with Kawasaki disease.

Isolated Chronic Aseptic Meningitis Due to SARS-COV-2 Unresponsive to Ordinary Treatments

Archives of Pediatric Infectious Diseases ◽

10.5812/pedinfect.113175 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Abdollah Karimi ◽

Sedigheh Rafiei Tabatabaei ◽

Ghazal Shariatpanahi ◽

Mohsen Javadzadeh ◽

Shahnaz Armin ◽

...

Keyword(s):

Nervous System ◽

Severe Acute Respiratory Syndrome ◽

Aseptic Meningitis ◽

Neurological Symptoms ◽

Adult Patients ◽

Immune Mediated

: Serious, and sometimes, deadly complications of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are devastating. Whereas most manifestations of COVID-19 are respiratory (fever, dry cough, fatigue, pneumonia), it is getting to be progressively recognized that numerous organ functions can be affected by this disease, and the nervous system is one of them as neurological complications can affect up to 36% of adult patients. However, the prevalence and pathophysiology of these complications have yet to be fully elucidated in children. Here, we discuss an infant with neurological symptoms manifested as chronic isolated aseptic meningitis associated with COVID-19, which was unresponsive to ordinary treatments and dramatically responsive to dexamethasone. Immune-mediated reactions may have had a major pathophysiologic role in this case.

COVID-19 Infection and Neurological Complications: Present Findings and Future Predictions

Neuroepidemiology ◽

10.1159/000508991 ◽

2020 ◽

Vol 54 (5) ◽

pp. 364-369 ◽

Cited By ~ 5

Author(s):

Ettore Beghi ◽

Valery Feigin ◽

Valeria Caso ◽

Paola Santalucia ◽

Giancarlo Logroscino

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Viral Infections ◽

Neurological Diseases ◽

Influenza Viruses ◽

Surveillance Systems ◽

Care Needs ◽

The Past ◽

Immune Mediated

The present outbreak caused by SARS-CoV-2, an influenza virus with neurotropic potential, presents with neurological manifestations in a large proportion of the affected individuals. Disorders of the central and peripheral nervous system are all present, while stroke, ataxia, seizures, and depressed level of consciousness are more common in severely affected patients. People with these severe complications are most likely elderly with medical comorbidities, especially hypertension and other vascular risk factors. However, postinfectious complications are also expected. Neurological disorders as sequelae of influenza viruses have been repeatedly documented in the past and include symptoms, signs, and diseases occurring during the acute phase and, not rarely, during follow-up. Postinfectious neurological complications are the result of the activation of immune mechanisms and can explain the insurgence of immune-mediated diseases, including the Guillain-Barré syndrome and other diseases of the central and peripheral nervous system that in the past occurred as complications of viral infections and occasionally with vaccines. For these reasons, the present outbreak calls for the introduction of surveillance systems to monitor changes in the frequency of several immune-mediated neurological diseases. These changes will determine a reorganization of the measures apt to describe the interaction between the virus, the environment, and the host in areas of different dimensions, from local communities to regions with several millions of inhabitants. The public health system, mainly primary care, needs to be strengthened to ensure that research and development efforts are directed toward right needs and directions. To cope with the present pandemic, better collaboration is required between international organizations along with more research funding, and tools in order to detect, treat, and prevent future epidemics.

Advances and new insights in the neuropathogenesis of dengue infection

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150074 ◽

2015 ◽

Vol 73 (8) ◽

pp. 698-703 ◽

Cited By ~ 14

Author(s):

Marzia Puccioni-Sohler ◽

Carolina Rosadas

Keyword(s):

Animal Model ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Dengue Virus ◽

Murine Model ◽

Vaccine Development ◽

Dengue Infection ◽

Viral Antigens

Dengue virus (DENV) infects approximately 390 million persons every year in more than 100 countries. Reports of neurological complications are more frequently. The objective of this narrative review is to bring up the advances in the dengue neuropathogenesis. DENV can access the nervous system through blood-brain barrier disturbance mediated by cytokine. The blood-cerebrospinal fluid (CSF) barrier seems to be also involved, considering the presence of the virus in the CSF of patients with neurological manifestations. As for neurotropism, several studies showed the presence of RNA and viral antigens in brain tissue and CSF in humans. In murine model, different virus mutations were associated to neurovirulence. Despite the advances in the dengue neuropathogenesis, it is still necessary to determine a more appropriate animal model and increase the number of cases of autopsy. The detection of neurovirulence markers may contribute to establish a prognosis, the disease control and vaccine development.

Neurological complications in COVID-19 – a diagnostic challenge

Journal of Medicine and Life ◽

10.25122/jml-2021-0045 ◽

2021 ◽

Vol 14 (2) ◽

pp. 216-224

Author(s):

Vitalie Vacaras ◽

◽

Sorina Frunze ◽

Adrian Mihai Cordos ◽

◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Exponential Growth ◽

Treatment Plan ◽

Motor Deficit ◽

Compelling Evidence ◽

Diagnostic Challenge ◽

Subarachnoid Hemorrhages

With the exponential growth of COVID-19 cases, the neurological complications reported during or after the infection became more common. There is limited knowledge regarding the pathophysiological mechanisms that are responsible for these complications. Recent data provides compelling evidence for the neurotropic nature of SARS-CoV-2, based on neurological manifestations reported during the current pandemic, as well as on previous experience with other coronaviruses. We present the case of a patient who developed headaches, motor deficit and dysphasia after respiratory COVID-19. Imaging tests showed heterogeneous central nervous system lesions (multiple subarachnoid hemorrhages and two ischemic strokes). Given the plethora of atypical neurological complications of COVID-19 described in the current literature, establishing a positive diagnosis and deciding on a treatment plan proved to be particularly challenging. We set to discuss some of the possible pathologies, hypothesized to be associated with COVID-19, that could lead to concomitant neurological lesions, similar to those noticed in our patient.