Acute Demyelinating Encephalomyelitis (ADEM) in COVID-19 infection: A Case Series

AbstractObjectiveTo report three patients infected with COVID-19 with severe respiratory syndrome requiring intubation, who developed acute demyelinating encephalomyelitis (ADEM).MethodPatient data were obtained from medical records from the North Memorial Health Hospital, Robbinsdale, MN, USAResultsThree patients (two men and one woman, aged 38 - 63) presented with fatigue, cough and fever leading to development of acute respiratory distress syndrome secondary to COVID-19 infection requiring intubation and ventilatory support. Two patients were unresponsive, one with strong eye deviation to the left and the third patient had severe diffuse weakness. MRI in all patients showed findings consistent with ADEM. CSF showed elevated protein in all patients with normal cell count and no evidence of infection, including negative COVID-19 PCR. All three of the patients received Convalescent plasma therapy for COVID-19. All patients were treated with intravenous corticosteroids and improved, although two responded minimally. Two patients treated with IVIG showed no further improvement.ConclusionNeurological complications from COVID-19 are being rapidly recognized. Our three cases highlight the occurrence of ADEM as a postinfectious/immune mediated complication of COVID-19 infection, which may be responsive to corticosteroid treatment. Early recognition of this complication and treatment is important to avoid long term complications.

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P14.123 Neurological complications related to checkpoints inhibitors

Neuro-Oncology ◽

10.1093/neuonc/noz126.358 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii97-iii98

Author(s):

I Esparragosa ◽

R Valenti-Azcarate ◽

D Moreno-Ajona ◽

J Gallego Perez de Larraya

Keyword(s):

Cerebrospinal Fluid ◽

Checkpoint Inhibitors ◽

Early Recognition ◽

Oral Prednisone ◽

Fatal Outcome ◽

Case Series ◽

Neurological Complications ◽

Ovarian Adenocarcinoma ◽

Inflammatory Myositis ◽

Oncological Treatment

Abstract BACKGROUND Currently, immunotherapy is part of the therapeutic arsenal for oncological treatment. Indeed, the need for new medications has led to the development of immune checkpoint inhibitors. Despite favourable oncological outcomes, these treatments have been associated with immune-related adverse events. Although infrequent, neurological toxicities have been reported. Early recognition is crucial for improvement of functional outcome and requires a multidisciplinary approach. OBJECTIVE To describe a case series of patients with neurological complications related to checkpoint inhibitors. PATIENTS AND METHODS We identified six oncological patients who presented immunomediated neurological complications, derived from the use of checkpoints inhibitors. Five cases were men. Ages ranged from 58 to 73 years. Nivolumab, alone or combined, was the most commonly associated drug (4/6). Underlying diseases included lung carcinoma (2/6), melanoma (2/6), renal carcinoma (1/6) and ovarian adenocarcinoma (1/6). An acute demyelinating sensory-motor polyneuropathy and an acute axonal sensory polyneuropathy were documented in two and one case, respectively. In these, the cerebrospinal fluid analysis revealed albuminocytologic dissociation. All three cases improved after treatment with intravenous immunoglobulins (0.4 g/Kg a day for five days). The latter and another case were diagnosed of aseptic meningitis after cerebrospinal fluid lymphocytic pleocytosis was found. High fever was also associated with lower extremities areflexia, weakness and ataxia. Methylprednisolone (1g/day for five days) was administered. One case of necrotizing inflammatory myositis with high levels of creatine kinasa, confirmed by muscular biopsy, involving cervical weakness and ptosis, was effectively treated with Methylprednisolone (1g/day for five days) follow by oral prednisone tapering. An anti-Yo related pancerebellar syndrome was the only case with a fatal outcome despite treatment. CONCLUSION The increasingly frequent use of immunotherapy in the treatment of cancer may lead to an increase in neurological complications. These include a broad spectrum of syndromes with peripheral nervous system predominantly susceptible. Early identification of these and appropriate management of drug-related toxicity are required. Immune-modulating therapies are particularly beneficial.

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Atlantoaxial Stabilization by Posterior C1 and C2 Screw-Rod Fixation for Various Pathologies: Case Series and Comprehensive Review of Literature

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1722838 ◽

2021 ◽

Author(s):

Chandramohan Unni ◽

Vijayan Pettakkandy ◽

Abdul Jaleel P. ◽

Subrat Kumar Soren ◽

Vineeth K. K.

Keyword(s):

Early Recognition ◽

Case Series ◽

Neurological Complications ◽

Os Odontoideum ◽

Atlantoaxial Joint ◽

Chronic Inflammatory Condition ◽

History Of ◽

Atlantoaxial Stabilization ◽

C2 Fixation ◽

Harms Technique

AbstractWe retrospectively analyzed atlantoaxial dislocation (AAD) of various pathologies, namely, rheumatoid arthritis (RA), os odontoideum, and trauma. Various techniques were discussed in relation to C1-C2 stabilization. The study aims to share our clinical experience in a series of six cases of C1-C2 instability that underwent posterior C1-C2 fusion, with free hand technique and limited fluoroscopy. The clinicoradiological presentation for each patient is described. We reviewed different literatures related to our case vividly and focused on the basic neuroanatomy involved in the atlantoaxial joint. All patients of AAD had evidence of severe canal compromise and chronic compressive spinal cord changes. In our study, the patients age ranged from 28 to 52 years. The study included four males and two females. Out of six patients of AAD, three had history of trauma, two had os odontoideum, and one had chronic inflammatory condition (RA). From our case series, we concluded that the Goel–Harms technique is the most versatile and surgeon friendly technique for C1-C2 fixation. Early recognition and surgical intervention of atlantoaxial joint instability is essential to prevent catastrophic neurological complications.

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Convalescent Plasma Therapy for pregnant patients with COVID-19: Case Series

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol06-i11/1230 ◽

2021 ◽

Vol 6 (11) ◽

pp. 800-807

Author(s):

Mariam Ayed ◽

Farah Alshammari ◽

Amal Ayed ◽

Ibrahim Gadalla ◽

Fawaz Aldoohan ◽

...

Keyword(s):

Adverse Events ◽

Extracorporeal Membrane Oxygenation ◽

Oxygen Saturation ◽

Pregnant Women ◽

Respiratory Rate ◽

Gestational Age ◽

Ventilatory Support ◽

Case Series ◽

Plasma Therapy ◽

In Pregnancy

Aim: The objective of this study is to report the effect of COVID-19 convalescent plasma (CCP) therapy in pregnant women with moderate or severe COVID-19 infection. Methods: This study is a case series of 9 pregnant women with moderate or severe COVID-19 infection. All the patients (N=9) received two doses (400 mL) of ABO compatible CCP. The median gestational age at the time of confirmed COVID-19 diagnosis was 31 weeks (range: 16-39 weeks). Results: No adverse events with CCP were reported. On day 3 post-CCP administration, there was a significant improvement in oxygen saturation (p=0.032), decrease in the respiratory rate from baseline (p=0.041), and improvement in the lymphocyte counts (p=0.043). None of the patients required invasive ventilatory support or extracorporeal membrane oxygenation and all were discharged home (median time from CCP administration to discharge was 6 days). All the patients gave birth to healthy newborns. The newborns had negative SARS-CoV-2 PCR on days 2 and 5 of ages. Conclusion: Our case series demonstrated CCP therapy to be safe with improved clinical outcomes during moderate and severe COVID-19 infection in pregnancy. However, extensive studies are still needed to recommend the routine use of CCP in the pregnant population with COVID-19 disease.

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TBE in Italy

Tick-borne encephalitis - The Book ◽

10.33442/978-981-14-0914-1_12b-15 ◽

2019 ◽

Cited By ~ 1

Author(s):

Valentina Tagliapietra ◽

Flavia Riccardo ◽

Giovanni Rezza

Keyword(s):

Case Series ◽

East Part ◽

Mountainous Regions ◽

North East ◽

The North ◽

Tick Borne Encephalitis ◽

Low Incidence

Italy is considered a low incidence country for tick-borne encephalitis (TBE) in Europe. Areas at higher risk for TBE in Italy are geographically clustered in the forested and mountainous regions and provinces in the north east part of the country, as suggested by TBE case series published over the last decade.

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TBE in Italy

Tick-borne encephalitis - The Book ◽

10.33442/26613980_12b15-3 ◽

2020 ◽

Keyword(s):

Surveillance System ◽

Ad Hoc ◽

National Level ◽

Case Series ◽

Incidence Rates ◽

Mountainous Regions ◽

North East ◽

The North ◽

Tick Borne Encephalitis ◽

Low Incidence

Italy is considered a low-incidence country for tick-borne encephalitis (TBE) in Europe.1 Areas at higher risk for TBE in Italy are geographically clustered in the forested and mountainous regions and provinces in the north east part of the country, as suggested by TBE case series published over the last decade.2-5 A national enhanced surveillance system for TBE has been established since 2017.6 Before this, information on the occurrence of TBE cases at the national level in Italy was lacking. Both incidence rates and the geographical distribution of the disease were mostly inferred from endemic areas where surveillance was already in place, ad hoc studies and international literature.1

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The novel use of convalescent plasma in patients with COVID 19 in Basra governorate, Case series review

Iraqi National Journal of Medicine ◽

10.37319/iqnjm.2.csi.1 ◽

2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Saad Hammadi ◽

Ali Hashim ◽

Abbas Ali ◽

Rafid Abbood ◽

Hassanein Ali ◽

...

Keyword(s):

Plasma Exchange ◽

Case Series ◽

Passive Immunity ◽

The Novel ◽

Efficacy And Safety ◽

Off Label Use ◽

Plasma Therapy ◽

Off Label ◽

Plasma Donation ◽

Patient Series

Background: The idea of convalescent plasma usage is to give passive immunity to the patients, so their immune system stands a good chance of combating the virus.this study will review 6 cases of eligible covid 19 patients that had been treated with convalescent plasma therapy in Basra covid 19 quarantine Objectives: to demonstrate efficacy and safety of convalescent plasma in the patient series that had been enrolled . Method: this study had pioneered a new method to collect up to 3,000 mL in one session by an off-label use of Spectra Optia Apheresis systems by TerumoBCT /Exchange set to collect convalescent plasma. In this study 250 mL convalescent plasma had been given each of the 6 patients, from one donor. respose in spo2,dyspnoea and tachypnoea was observed ,any reaction to plasma also had been monitored . Result: Our case series have demonstrated both safety and effectiveness of convalescent plasma. This study was successful in reaching our primary and secondary outcomes in all 6 patients (improvement in SpO2 and symptoms). With negligible difference in time of post transfusion response Conclusion: convalescent plasma is apperantly safe and effective, In this study 250 mL convalescent plasma had been given each of the 6 patients, from one donor using Therapeutic Plasma Exchange (TPE) protocol by Spectra Optia Apheresis system/TerumoBCT. Keywords: convalescent plasma, COVID-19, SARS CoV-2, apheresis, plasma exchange, plasma donation

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Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

Journal of Neurology ◽

10.1007/s00415-021-10406-y ◽

2021 ◽

Author(s):

Biyan Nathanael Harapan ◽

Hyeon Joo Yoo

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Case Reports ◽

Case Series ◽

Altered Mental Status ◽

Neurological Complications ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Fisher Syndrome ◽

Novel Coronavirus ◽

The Impact

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and was first identified in Wuhan, China in December 2019. It is evident that the COVID-19 pandemic has become a challenging world issue. Although most COVID-19 patients primarily develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with COVID-19 have been observed. In this narrative review, we elaborate on proposed neurotropic mechanisms and various neurological symptoms, manifestations, and complications of COVID-19 reported in the present literature. For this purpose, a review of all current published literature (studies, case reports, case series, reviews, editorials, and other articles) was conducted and neurological sequelae of COVID-19 were summarized. Essential and common neurological symptoms including gustatory and olfactory dysfunctions, myalgia, headache, altered mental status, confusion, delirium, and dizziness are presented separately in sections. Moreover, neurological manifestations and complications that are of great concern such as stroke, cerebral (sinus) venous thrombosis, seizures, meningoencephalitis, Guillain–Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome (PRES) are also addressed systematically. Future studies that examine the impact of neurological symptoms and manifestations on the course of the disease are needed to further clarify and assess the link between neurological complications and the clinical outcome of patients with COVID-19. To limit long-term consequences, it is crucial that healthcare professionals can early detect possible neurological symptoms and are well versed in the increasingly common neurological manifestations and complications of COVID-19.

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Autoimmune Hemolytic Anemia as a Complication of Congenital Anemias. A Case Series and Review of the Literature

Journal of Clinical Medicine ◽

10.3390/jcm10153439 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3439

Author(s):

Irene Motta ◽

Juri Giannotta ◽

Marta Ferraresi ◽

Kordelia Barbullushi ◽

Nicoletta Revelli ◽

...

Keyword(s):

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Case Series ◽

Intravenous Immunoglobulins ◽

Point Of View ◽

First Line ◽

Human Erythropoietin ◽

Immune Mediated ◽

Hemolytic Crisis ◽

Life Threatening

Congenital anemias may be complicated by immune-mediated hemolytic crisis. Alloantibodies are usually seen in chronically transfused patients, and autoantibodies have also been described, although they are rarely associated with overt autoimmune hemolytic anemia (AIHA), a serious and potentially life-threatening complication. Given the lack of data on the AIHA diagnosis and management in congenital anemias, we retrospectively evaluated all clinically relevant AIHA cases occurring at a referral center for AIHA, hemoglobinopathies, and chronic hemolytic anemias, focusing on clinical management and outcome. In our cohort, AIHA had a prevalence of 1% (14/1410 patients). The majority were warm AIHA. Possible triggers were recent transfusion, infection, pregnancy, and surgery. All the patients received steroid therapy as the first line, and about 25% required further treatment, including rituximab, azathioprine, intravenous immunoglobulins, and cyclophosphamide. Transfusion support was required in 57% of the patients with non-transfusion-dependent anemia, and recombinant human erythropoietin was safely administered in one third of the patients. AIHA in congenital anemias may be challenging both from a diagnostic and a therapeutic point of view. A proper evaluation of hemolytic markers, bone marrow compensation, and assessment of the direct antiglobulin test is mandatory.

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76 FECAL MICROBIOTA TRANSPLANTATION (FMT) FOR THE TREATMENT OF IMMUNE-MEDIATED DIARRHEA AND COLITIS: A CASE SERIES

Gastroenterology ◽

10.1016/s0016-5085(21)00791-5 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-17

Author(s):

Arielle Elkrief ◽

Jonathan U. Peled ◽

Matthew D. Hellmann ◽

Jamie E. Chaft ◽

Juliana Eng ◽

...

Keyword(s):

Fecal Microbiota Transplantation ◽

Case Series ◽

Fecal Microbiota ◽

Immune Mediated

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Cochlear Implant Outcomes in Patients with Neurosarcoidosis

Audiology and Neurotology ◽

10.1159/000514479 ◽

2021 ◽

pp. 1-7

Author(s):

Dario Ebode ◽

Fleur Cohen-Aubart ◽

Stéphanie Trunet ◽

Evelyne Ferrary ◽

Ghizlène Lahlou ◽

...

Keyword(s):

Hearing Loss ◽

Cochlear Implantation ◽

Case Series ◽

Corticosteroid Treatment ◽

Auditory Neuropathy ◽

Disease Exacerbation ◽

Profound Hearing Loss ◽

Hearing Recovery ◽

Speech Performance

Introduction: Audiovestibular symptoms are rare in sarcoidosis, but they may also be the first manifestation of the disease. Sudden or progressive bilateral hearing loss is usually associated with vestibular impairment. The mechanism of hearing loss remains unclear, but clinical presentation and magnetic resonance imaging suggest a retrocochlear site for the lesion in most patients. Several cases of hearing recovery after corticosteroid treatment have been reported. In patients with severe or profound hearing loss, the benefit of cochlear implantation is challenging to predict in the case of auditory neuropathy and is rarely described. We present a case series of cochlear implantation in patients with documented neurosarcoidosis. Results: Seven cases of cochlear implantation in 4 patients with neurosarcoidosis are reported. All of the patients showed a great improvement very quickly in both quiet and noise. Speech performance remained stable over time with a follow-up ranging from 4 to 11 years, even in patients who had disease exacerbation. Conclusion: Cochlear implantation is possible in deaf patients with neurosarcoidosis. The excellent benefit obtained in our patients suggests a particular type of neuropathy, but endocochlear involvement cannot be entirely ruled out.

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