scholarly journals 2587. Etiology and Outcome of Acute Neonatal Infectious Encephalitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S899-S899
Author(s):  
Craig Frankel ◽  
Hilary Whyte ◽  
Vann Chau ◽  
Daune MacGregor ◽  
Sanjay Mahant ◽  
...  
Keyword(s):  
Influenza A ◽  
Hemorrhagic Stroke ◽  
Peripheral Leukocyte ◽  
Eeg Abnormalities ◽  
Level Of Consciousness ◽  
Neurologic Sequelae ◽  
Csf Pleocytosis ◽  
Ischemic Encephalopathy ◽  
Infectious Encephalitis ◽  
Infectious Etiology

Abstract Background There are very few studies on acute encephalitis with onset during the neonatal period. The objectives of this study were to investigate the etiology and salient clinical features of neonatal encephalitis. Methods Neonates with possible infectious encephalitis (IE) were prospectively enrolled. Inclusion criteria included encephalopathy (altered/fluctuating level of consciousness ≥24 hours) plus ≥2 of: fever/temperature instability; seizure(s); focal neurologic findings; CSF pleocytosis; EEG abnormalities consistent with encephalitis; neuroimaging abnormalities consistent with encephalitis. Neonates with a clear diagnosis of post-perinatal asphyxial encephalopathy or culture proven bacterial meningitis were excluded. Results shown as absolute numbers, proportions or medians [interquartile range] as appropriate. Results Fifty-nine neonates fulfilled the inclusion/exclusion criteria (June 2013–November 2018). Empiric acyclovir was initiated in 49 (83.1%) cases. An infectious etiology was identified in 25 (42.4%): enteroviruses (n = 15), HSV (n = 5), HHV6 (n = 2), parainfluenza 3 (n = 1), influenza A (n = 1), CMV (n = 1). A noninfectious cause was confirmed in 20 (33.9%): missed hypoxic-ischemic encephalopathy (n = 10), genetic/metabolic disorders (n = 7), ischemic/hemorrhagic stroke (n = 3). No specific etiology was identified in 14 (23.7%). Thirteen (52%) neonates with IE either died (n = 7) or suffered neurologic sequelae (n = 6). Deaths were attributable to HSV (n = 4), enteroviruses (n = 2) and HHV6 (n = 1). Neurocognitive sequelae were documented in one case each of enterovirus, HSV2, HHV6, CMV, parainfluenza 3 and influenza A. Differences between neonates with and without IE, respectively, included age in days of symptom onset (7 [6, 10] vs. 1 [0, 3]; P < 0.001), gestational age (37.0 [36.0, 39.0] vs. 38.6 [37.6, 40.0]; P = 0.045), peripheral leukocyte count (10.5 [IQR 5.9, 14.6] vs. 14.3 [IQR 10.7, 21.7]; P = 0.008) and CSF glucose (2.80 [IQR 2.3, 3.2] vs. 3.10 [2.8, 3.8]; P = 0.003). Conclusion Enteroviruses and HSV are the predominant causes of neonatal IE. Outcome of neonatal IE is poor with approximately half dying or suffering neurologic sequelae. Disclosures All authors: No reported disclosures.

Pandemic Influenza A-Associated Acute Necrotizing Encephalopathy Without Neurologic Sequelae

2011 ◽  
Vol 45 (5) ◽  
pp. 344-346 ◽  
Author(s):  
Akira Kumakura ◽  
Chihiro Iida ◽  
Makiko Saito ◽  
Masashi Mizuguchi ◽  
Daisuke Hata
Keyword(s):  
Pandemic Influenza ◽  
Influenza A ◽  
Acute Necrotizing Encephalopathy ◽  
Neurologic Sequelae ◽  
Acute Necrotizing

Abstract W P313: Effects of Organized Stroke Care on In-Hospital Mortality and Morbidity of Patients With Ischemic and Hemorrhagic Stroke: J-ASPECT Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kunihiro Nishimura ◽  
Satoru Kamitani ◽  
Michikazu Nakai ◽  
Akiko Kada ◽  
Fumiaki Nakamura ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hemorrhagic Stroke ◽  
Strong Association ◽  
Stroke Care ◽  
Stroke Subtype ◽  
Mortality And Morbidity ◽  
Hierarchical Logistic Regression ◽  
Team Assessment ◽  
Stroke Team ◽  
Level Of Consciousness

Background and Purpose: The effectiveness of organized stroke care on stroke mortality and morbidity remains uncertain. We examined whether organized stroke care index (OCI), which graded 0-3 based on the presence of rehabilitation, stroke team assessment, and admission to a stroke unit developed by Saposnik (Neurology 2010) influence in-hospital mortality and morbidity of patients with ischemic and hemorrhagic stroke in a nationwide study. Methods: Of the 1369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding comprehensive stroke care capacities. Among the institutions that responded, data on patients hospitalized between April 1, 2010 and March 31, 2011, because of stroke were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality morbidity was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, and the number of OCI fulfilled in each component and in total.It was supported by Grants-in-Aid from the Ministry of Health, Labour and Welfare of Japan Results: Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Patients fulfilled the criteria for admission to a SCU, stroke team assessment and the presence of rehabilitation were 28.9%, 42.1% and 95.1%, respectively. Mortality adjusted for age, sex, and level of consciousness was significantly correlated with admission to a SCU (OR=0.87, p=0.039), SCU team assessment (OR=0.88,p=0.029), and OCI ( OR=0.93, p=0.031). Modified ranking scale 0 to 2 rate were also associated with significantly SCU admission (p=0.003) .These association holds for ischemic stroke and subarachnoid hemorrhage. Conclusion: A strong association between organized stroke care and lower mortality was apparent. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.

Acute Viral Meningitis

2015 ◽  
Author(s):  
Karen L. Roos ◽  
Jared R. Brosch
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Meningitis ◽  
Viral Pathogen ◽  
Meningeal Irritation ◽  
Nuchal Rigidity ◽  
Common Causes ◽  
Neurologic Sequelae ◽  
Control And Prevention ◽  
Csf Pleocytosis ◽  
The Brain

Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation. This chapter contains 4 highly rendered figures, 7 tables, 16 references, and 5 MCQs.

Acute Viral Meningitis

2018 ◽  
Author(s):  
Karen L. Roos ◽  
Jared R. Brosch
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Meningitis ◽  
Viral Pathogen ◽  
Meningeal Irritation ◽  
Nuchal Rigidity ◽  
Common Causes ◽  
Neurologic Sequelae ◽  
Control And Prevention ◽  
Csf Pleocytosis ◽  
The Brain

Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation. This review contains 4 highly rendered figures, 8 tables, and 17 references.

scholarly journals Subacute Cognitive Impairment in Individuals With Mild and Moderate COVID-19: A Case Series

2021 ◽  
Vol 12 ◽  
Author(s):  
Aline de Moura Brasil Matos ◽  
Flavia Esper Dahy ◽  
João Victor Luisi de Moura ◽  
Rosa Maria Nascimento Marcusso ◽  
Andre Borges Ferreira Gomes ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Case Series ◽  
Oligoclonal Bands ◽  
Clock Drawing Test ◽  
Neurologic Sequelae ◽  
Cognitive Disturbances ◽  
Csf Pleocytosis ◽  
The Mean ◽  
Antibody Dynamics ◽  
State Examination

Background: Previous reported neurologic sequelae associated with SARS-CoV-2 infection have mainly been confined to hospital-based patients in which viral detection was restricted to nasal/throat swabs or to IgM/IgG peripheral blood serology. Here we describe seven cases from Brazil of outpatients with previous mild or moderate COVID-19 who developed subacute cognitive disturbances.Methods: From June 1 to August 15, 2020, seven individuals 18 to 60 years old, with confirmed mild/moderate COVID-19 and findings consistent with encephalopathy who were observed &gt;7 days after respiratory symptom initiation, were screened for cognitive dysfunction. Paired sera and CSF were tested for SARS-CoV-2 (IgA, IgG ELISA, and RT-PCR). Serum and intrathecal antibody dynamics were evaluated with oligoclonal bands and IgG index. Cognitive dysfunction was assessed by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Clock Drawing Test (CDT).Results: All but one of our patients were female, and the mean age was 42.6 years. Neurologic symptoms were first reported a median of 16 days (IQR 15–33) after initial COVID-19 symptoms. All patients had headache and altered behavior. Cognitive dysfunction was observed mainly in phonemic verbal fluency (MoCA) with a median of six words/min (IQR 5.25–10.75) and altered visuospatial construction with a median of four points (IQR 4–9) (CDT). CSF pleocytosis was not detected, and only one patient was positive for SARS-CoConclusions: A subacute cognitive syndrome suggestive of SARS-CoV-2-initiated damage to cortico-subcortical associative pathways that could not be attributed solely to inflammation and hypoxia was present in seven individuals with mild/moderate COVID-19.

scholarly journals Psychogenic Non-Epileptic Status as Refractory, Generalized Hypertonic Posturing: Report of Two Adolescents

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 508
Author(s):  
Giangennaro Coppola ◽  
Grazia Maria Giovanna Pastorino ◽  
Lucia Morcaldi ◽  
Floriana D’Onofrio ◽  
Francesca Felicia Operto
Keyword(s):  
Social Withdrawal ◽  
Epileptic Seizures ◽  
Obsessive Compulsive ◽  
Eeg Abnormalities ◽  
Level Of Consciousness ◽  
Low Levels ◽  
High Doses ◽  
Dissociative Seizures ◽  
Non Motor Symptoms ◽  
Video Eeg

Psychogenic non-epileptic seizures (PNES) or dissociative seizures are found under the umbrella headings of functional/dissociative neurological disorders (FND) in psychiatric classifications (DSM-5; ICD-11). PNES are not characterized by any specific ictal or postictal EEG abnormalities. Patients with PNES can present with motor or non-motor symptoms, frequently associated with a change in the level of consciousness. PNES duration is variable, often longer than that of epileptic seizures. Prolonged PNES, sometimes termed PNES status, involve continuous or repetitive events that exceed 30 min. Prolonged PNES are often misdiagnosed as an epileptic event and are often inappropriately treated with high doses of antiseizure drugs. In this report, we describe two adolescent patients who presented with prolonged PNES characterized by generalized hypertonic posturing and low levels of consciousness. Despite multiple presentation to the Emergency department, and multiple normal video-EEG, the patients were misdiagnosed with epilepsy and were inappropriately treated with antiseizure medications. Both patients presented psychiatric comorbidity, consisting of a major depressive disorder, obsessive-compulsive symptoms, social withdrawal, difficulty of social interaction, and anxious-perfectionist personality traits. The episodes of prolonged PNES gradually declined within 18 months in both patients.

scholarly journals Correlation of Glasgow Coma Scale Score at Hospital Admission with Stroke Hemorrhagic Patient Mortality at Hasan Sadikin Hospital

2019 ◽  
Vol 2 (4) ◽  
Author(s):  
Ary Setio Hartanto ◽  
Andi Basuki ◽  
Cep Juli
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Admission ◽  
Hemorrhagic Stroke ◽  
P Value ◽  
Stroke Patients ◽  
Coma Scale ◽  
Risk Of Death ◽  
Increased Risk ◽  
Level Of Consciousness ◽  
Gcs Score

Stroke is the most common cause of death in Indonesia. Stroke is divided into ischemic and hemorrhagic stroke. Hemorrhagic stroke has a higher risk of death than ischemic stroke. Hemorrhagic stroke can disrupt patient’s consciousness. The Glasgow Coma Scale (GCS) is a scale that is widely used to assess level of consciousness. Accurate predictors can help doctors determine prognosis and treatment for stroke patient. This study was conducted to determine the correlation of GCS scores at the time of hospital admission and mortality of hemorrhagic stroke patients at Hasan Sadikin Hospital. This study is a retrospective cohort analytic study involving 134 subjects. Data were analyzed using Kolmogorov-Smirnov’s and Fisher's analysis test with significance of p <0.05. From the results of the study, the p value was 0.00, subjects with GCS score somnolence (12-14) had six times higher risk in mortality (P = 0.02, RR = 6.38) and subjects with GCS score sopor and coma (3 - 11) had twenty four times higher risk in mortality (P = 0.00, RR = 23.85). We concluded that decreased score of SKG at the time of hospital admission was associated with increased risk of death in hemorrhagic stroke patients at Hasan Sadikin Hospital.   Keywords: Glasgow Coma Scale, hemorrhagic stroke, mortality

scholarly journals Relation of Volume of Hemorrhage With Mortality Within First 48 Hours in Hemorrhagic Stroke

KYAMC Journal ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 127-132
Author(s):  
Sk Abdullah Al Mamun ◽  
Saiyeedur Rahman ◽  
Sayedur Rahman Sheikh ◽  
Abdul Wadud ◽  
Gobindo Gain
Keyword(s):  
Mortality Rate ◽  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Mortality Rates ◽  
Advanced Age ◽  
Coma Scale ◽  
Level Of Consciousness ◽  
Hemorrhage Volume ◽  
Scale 8

Background: Hemorrhagic stroke accounts for 10-15% of all strokes with higher mortality rates than cerebral infarction. Intracerebral hemorrhage has a reported 30-day mortality of 44% to 51%, with almost half of the death occurs within the first 48 hours. Advanced age, low level of consciousness, large volume of hemorrhage has been linked with poor outcome. Objectives: To predict early outcome of hemorrhagic stroke patient in relation with age, Glasgow Coma Scale, volume of hemorrhage and ventricular extension. Materials and Methods: Hospital based prospective study carried out in hundred hemorrhagic stroke patients. The formula of ABC/2 was used to calculate hemorrhage volume in bedside by using CT scan. Results: 1st month mortality rates of hemorrhagic stroke was 44% with 45.45% of patients died within the first 48 hours of onset. Mean age of patients of hemorrhagic stroke was 61.2 ± 13.88 years. Mortality rate of intracerebral hemorrhage after age of 60 was 51.06% in 1st month. Volume of intracerebral hemorrhage was the strongest predictor of both 48 hours and 30 days mortality. Using three categories of intracerebral hemorrhage (X for < 30 ml, Y for 30 - 50 ml and Z for > 50 ml group) calculated by ABC/2 formula showed 100% mortality rate in Z group, 50% in Y group and only 12% mortality rate in X group in 1st month. Among all death, 61.5% of Z group 25% of Y group and 16.67% of patients of X group died within 48 hours. Two categories of Glasgow Coma Scale (≤ 8 and ≥ 9) were used and shown death rates 80.77% in GCS ≤ 8 and 4.55% in GCS ≥ 9 in 1st month. Conclusion: Volume of intracerebral hemorrhage in combination with advanced age, initial Glasgow Coma Scale is a powerful and easy to use in both 48 hours and 1st month mortality in patients with spontaneous intracerebral hemorrhage. KYAMC Journal. 2021;12(3): 127-132

scholarly journals Cerebral near-infrared spectroscopy in term newborns: reference values and hypoxic-ischemic encephalopathy

2019 ◽  
Vol 19 (2) ◽  
pp. 58-63
Author(s):  
R Gumulak ◽  
L Nandraziova ◽  
L Tulejova ◽  
Z Pazicka
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Brain Dysfunction ◽  
Hypoxic Ischemic Encephalopathy ◽  
Daily Routine ◽  
Term Infants ◽  
Non Invasive ◽  
Level Of Consciousness ◽  
Ischemic Encephalopathy

Abstract Non-invasive measurement of cerebral tissue oxygenation (cStO2) using near-infrared spectroscopy (NIRS) is attracting an increasing attention not only in neonatology. The vast diversity of commercially available NIRS devices makes it difficult to compare in the published clinical studies. This review provides a view on the practical use of NIRS as a tool for cStO2 measurement, its limitations and pitfalls, with a focus on brain dysfunction caused by hypoxic-ischemic encephalopathy. This syndrome of disturbed neurologic function in the earliest days after the birth in the term infants is manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, subnormal level of consciousness, and often seizures. This fascinating technology has already proven accurate and has been recommended to use during daily routine tool to evaluate the level of oxygen saturation in brain in intensive care units worldwide.

scholarly journals Bilateral Hypertrophic Olivary Degeneration Following Brainstem Insult: A Retrospective Review and Examination of Causative Pathology

2021 ◽  
Vol 16 ◽  
pp. 263310552110074
Author(s):  
Fardad Behzadi ◽  
Peter J Fiester ◽  
Dinesh Rao
Keyword(s):  
Hemorrhagic Stroke ◽  
Inferior Olive ◽  
Rare Condition ◽  
Inferior Olivary Nucleus ◽  
Mri Imaging ◽  
Hypertrophic Olivary Degeneration ◽  
Synaptic Degeneration ◽  
Inferior Olivary ◽  
Infectious Etiology ◽  
Olivary Nucleus

Hypertrophic olivary degeneration is a rare condition caused by a lesion in the Guillain-Mollaret triangle which leads to trans-synaptic degeneration resulting in the degenerative hypertrophy of the inferior olivary nucleus. This condition presents clinically with palatal tremor but can also produce ocular myoclonus or cerebellar signs. While any lesion that occurs within the Guillian-Mollaret triangle and results in the deafferentation of the inferior olive can lead to hypertrophic olivary degeneration, the most common etiologies include ischemic and hemorrhagic stroke, vascular malformation, neoplasm, and iatrogenic injury related to surgery. We report a series of 7 patients who presented with this condition bilaterally on MRI imaging, including 1 case which represents the first report of toxoplasmosis leading to the development of bilateral hypertrophic olivary degeneration and only the third reported case, unilateral or bilateral, related to an infectious etiology.

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