Aphasia and confusion – influenza encephalopathy: atypical presentation of influenza

2020 ◽  
Vol 13 (10) ◽  
pp. e235559
Author(s):  
Reiichiro Obata ◽  
Kristina Ernst
Keyword(s):  
Influenza Infection ◽  
Adult Population ◽  
Acute Onset ◽  
Close Attention ◽  
Fatal Disease ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Rare Manifestation ◽  
Upper Respiratory ◽  
Upper Respiratory Symptoms

Influenza encephalopathy, a rare manifestation of influenza infection in the adult population which is not widely recognised, can present with confusion and focal neurological symptoms, including aphasia. The aim of this report is to illustrate the unique presentation of influenza encephalopathy and discuss the need for close attention to and monitoring of this rare but highly fatal disease.A 28-year-old woman was admitted with acute-onset confusion and incoherent speech. CT of the head was unremarkable. Cerebrospinal fluid analysis showed elevation of protein, but was otherwise unremarkable. A detailed history revealed recent upper respiratory symptoms which prompted a rapid influenza test which was positive and oseltamivir was started. The patient’s confusion and aphasia gradually improved and her speech was back to her baseline by the next day.

Haemiballism/haemichorea: an atypical presentation of ischaemic stroke

2021 ◽  
Vol 14 (6) ◽  
pp. e240439
Author(s):  
Raman Nohria ◽  
Stacey Bennett ◽  
Yasmin Ali O'Keefe
Keyword(s):  
Brain Mri ◽  
Acute Onset ◽  
Cerebral Peduncle ◽  
Atypical Presentation ◽  
Cerebrospinal Fluid Analysis ◽  
Medication Therapy ◽  
Fluid Analysis ◽  
Ct Head ◽  
The Right ◽  
Distressing Condition

A 76-year-old man was admitted to the hospital with acute onset of involuntary movements of the left side of his body. His neurological examination revealed he was oriented only to himself, and aforementioned movements of his left arm and leg. CT head demonstrated old infarcts in his right aspect of his pons and basal ganglia. Cerebrospinal fluid analysis was unremarkable. He initially had a normal blood glucose with an elevated anion gap and elevated creatine kinase. Brain MRI showed a small lacunar-type ischaemic infarct within the anteromedial aspect of the right cerebral peduncle, which localised to his haemiballism. To prevent worsening rhabdomyolysis associated with his haemiballism, the primary team initiated both tetrabenazine and diazepam. His movements improved after 1 week of medication therapy. This report discusses a thorough workup for this movement disorder and when to intervene for this distressing condition.

scholarly journals Benign Recurrent Aseptic Meningitis (Mollaret’s Meningitis) in an Elderly Male: A Case Report

2021 ◽  
Vol 59 (241) ◽  
pp. 916-918
Author(s):  
Swati Chand ◽  
Sangharsha Thapa ◽  
Khusal Gautam ◽  
Anu Radha Twayana ◽  
Maryrose R.Laguio-Vila ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Cerebrospinal Fluid ◽  
Aseptic Meningitis ◽  
Acute Onset ◽  
Chain Reaction ◽  
Elderly Male ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Polymerase Chain ◽  
Mollaret's Meningitis

Mollaret’s meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn’s criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviraldue to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.

scholarly journals Guillain-Barre Syndrome and COVID-19 Vaccine: A Report of Nine Patients

2021 ◽  
pp. 1-17
Author(s):  
Narges Karimi ◽  
◽  
Reza Boostani ◽  
Farzad Fatehi ◽  
Akram Panahi ◽  
...  
Keyword(s):  
Neuromuscular Disorder ◽  
Nerve Conduction Studies ◽  
Guillain Barre Syndrome ◽  
Upper Respiratory Tract ◽  
Cerebrospinal Fluid Analysis ◽  
Acute Inflammatory Demyelinating Polyneuropathy ◽  
Fluid Analysis ◽  
Guillain Barré Syndrome ◽  
Upper Respiratory ◽  
Guillain Barré

Background: Guillain-Barre syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy usually elicited by an upper respiratory tract infection. Several studies reported GBS associated with coronavirus-2019 (COVID-19) infection. In this study, we describe nine GBS patients following the COVID-19 vaccine. Methods: In this study, nine patients introduce from six referral centers of neuromuscular disorder in Iran between April 8 and June 20, 2021. Four patients received the Sputnik V, three patients administrated the Sinopharm, and two patients received the AstraZeneca vaccine. All patients were diagnosed with GBS, including nerve conduction studies and/or cerebrospinal fluid analysis. Results: The median age of the patients was 54.22 years (range, 26-87 years), and seven patients were male. The patients were treated with intravenous immunoglobulin (IVIg) or plasma exchange (PLEX). All patients were discharged with some improvement. Conclusion: The link between the COVID-19 vaccine and GBS is not well understood. Given the prevalence of GBS in the general population, this association may be coincidental. Therefore, more studies are needed to investigate a causal relationship.

scholarly journals Guillain-Barré syndrome associated with COVID-19 disease

2020 ◽  
Vol 13 (9) ◽  
pp. e237215 ◽  
Author(s):  
Sindhuja Korem ◽  
Haresh Gandhi ◽  
Decerie Baculi Dayag
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Guillain Barre Syndrome ◽  
Upper Respiratory Tract ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Guillain Barré Syndrome ◽  
Upper Respiratory ◽  
Guillain Barré

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.

scholarly journals Diagnostic tools for neurosyphilis: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gustavo Henrique Pereira Boog ◽  
João Vitor Ziroldo Lopes ◽  
João Vitor Mahler ◽  
Marina Solti ◽  
Lucas Tokio Kawahara ◽  
...  
Keyword(s):  
New Technologies ◽  
Clinical Suspicion ◽  
Risk Of Bias ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Test Accuracy ◽  
Cerebrospinal Fluid Analysis ◽  
Evaluation Methodologies ◽  
Fluid Analysis ◽  
Criteria For Diagnosis

Abstract Purpose Increasing incidences of syphilis highlight the preoccupation with the occurrence of neurosyphilis. This study aimed to understand the current diagnostic tools and their performance to detect neurosyphilis, including new technologies and the variety of existing methods. Methods We searched databases to select articles that reported neurosyphilis diagnostic methods and assessed their accuracy, presenting sensitivity and specificity values. Information was synthesized in tables. The risk of bias was examined using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy recommendations. Results Fourteen studies were included. The main finding was a remarkable diversity of tests, which had varied purposes, techniques, and evaluation methodologies. There was no uniform criterion or gold standard to define neurosyphilis. The current basis for its diagnosis is clinical suspicion and cerebrospinal fluid analysis. There are new promising tests such as PCR tests and chemokine measurement assays. Conclusions The diagnosis of neurosyphilis is still a challenge, despite the variety of existing and developing tests. We believe that the multiplicity of reference standards adopted as criteria for diagnosis reveals the imprecision of the current definitions of neurosyphilis. An important next step for the scientific community is to create a universally accepted diagnostic definition for this disease.

scholarly journals New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review

2021 ◽  
Vol 9 ◽  
pp. 232470962098630
Author(s):  
Riwaj Bhagat ◽  
Barbara Kwiecinska ◽  
Nolan Smith ◽  
Matthew Peters ◽  
Christopher Shafer ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Nasopharyngeal Swab ◽  
Onset Seizure ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Global Pandemic ◽  
Elevated Protein ◽  
T2 Hyperintensity ◽  
Elevated Protein Level ◽  
New Onset

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.

Autoimmune Encephalitis Related to Cancer Treatment With Immune Checkpoint Inhibitors: Systematic Review

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012122
Author(s):  
Vardan Nersesjan ◽  
Oskar McWilliam ◽  
Lars-Henrik Krarup ◽  
Daniel Kondziella
Keyword(s):  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Autoimmune Encephalitis ◽  
Cochrane Library ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Heterogenous Group ◽  
The Cochrane Library ◽  
Common Laboratory

OBJECTIVE:To determine the clinical and laboratory features of immune checkpoint inhibitor (ICPI)-associated autoimmune encephalitis (ICPI-AIE), an increasingly recognized adverse event with ICPI treatment.METHODS.We searched PubMed, The Cochrane Library and Embase for ICPI-AIE cases from the first description in 2015 until 01/2020 using standard bibliographic measures including PRISMA guidelines and pre-registration with PROSPERO (CRD42019139838).RESULTS.Thirty-nine studies met inclusion criteria, resulting in 54 ICPI-AIE patients (mean age 58.6 years; 43% females). Common cancers included melanoma (30%) and non-small cell lung cancer (30%). Brain metastases were found in 16 patients (30%). The most frequent ICPI was nivolumab (61%). Onset of ICPI-AIE occurred after a median of 3.5 treatment cycles, but very early and late presentations were common. Non-limbic AIE was roughly twice as frequent as limbic AIE (p<0.05). The most common laboratory abnormalities included bitemporal FLAIR lesions on MRI, continuous slow waves and diffuse slowing on EEG, and monocytic pleocytosis on cerebrospinal fluid analysis. Of note, intraneuronal antibodies were more frequent than neuronal surface antibodies, and a significant predictor for lack of improvement after 1st line immunotherapy (p<0.05).CONCLUSIONS.ICPI-AIE consists of a heterogenous group of conditions. Neurologists will likely encounter ICPI-AIE more often in the future, but important unresolved questions include the exact pathophysiological mechanisms, the epidemiology and the best treatment approaches associated with ICPI-AIE.

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