scholarly journals Otoneurological presentations of COVID-19

2021 ◽  
Vol 14 (9) ◽  
pp. e241893
Author(s):  
Kiran J Shinde ◽  
Tulasi Karanth ◽  
Aditya M Yeolekar
Keyword(s):  
Facial Nerve ◽  
Neurological Deficit ◽  
Medical Management ◽  
Respiratory Symptoms ◽  
Viral Encephalitis ◽  
Neurological Impairment ◽  
Toxic Encephalopathy ◽  
Neurological Injury ◽  
Immune Mediated ◽  
Primary Presentation

COVID-19 usually begins with respiratory symptoms but may also cause neurological disturbances by direct (viral invasion) or indirect (immune-mediated) mechanism. Common neurological injury described in the literature include infectious toxic encephalopathy, viral encephalitis and Guillain-Barré syndrome. We present two cases diagnosed with COVID-19 who presented with isolated neurological deficit along facial nerve and vestibular nerve. Both recovered with medical management and rehabilitative exercises. Isolated neurological impairment in otorhinolaryngological practice may be the primary presentation or delayed feature of COVID-19.

scholarly journals Inflammatory Skin Lesions in Three SARS-CoV-2 Swab-Negative Adolescents: A Possible COVID-19 Sneaky Manifestation?

2021 ◽  
Vol 13 (2) ◽  
pp. 181-188
Author(s):  
Giuseppe Ingravallo ◽  
Francesco Mazzotta ◽  
Leonardo Resta ◽  
Sara Sablone ◽  
Gerardo Cazzato ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Respiratory Symptoms ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Sweat Glands ◽  
Histological Findings ◽  
Immune Mediated ◽  
Nodular Lesions ◽  
Immunohistochemical Evidence ◽  
Eccrine Sweat Glands

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with various clinical manifestations, including skin lesions. In particular, during the COVID-19 pandemic lock-down period numerous chilblain-like lesions, mainly located on the feet, were observed in adolescents. The latter were often asymptomatic or associated with very mild respiratory symptoms. Here, we report three cases of acral nodular lesions in SARS-CoV-2 swab-negative adolescents with histological findings of chronic immune-mediated inflammation and immunohistochemical evidence of SARS-CoV-2 spike glycoproteins in endothelial cells and eccrine sweat glands. In one of these cases, the virus presence was confirmed by electron microscopy.

scholarly journals Informed Consent for the Human Research Subject with a Neurologic Disorder

2018 ◽  
Vol 38 (05) ◽  
pp. 539-547 ◽  
Author(s):  
Neil Vaishnav ◽  
Winston Chiong
Keyword(s):  
Informed Consent ◽  
Neurological Impairment ◽  
Neurological Injury ◽  
Neurologic Disorder ◽  
Legal Principles ◽  
Human Research Subject ◽  
Neurological Patients ◽  
Dementia Research ◽  
To Come

AbstractThe doctrine of informed consent sits at the intersection of law, ethics, and neuroscience, posing unique challenges for human subject research involving neurological patients. These challenges are compounded by the variegated nature of both neurological injury and the law governing research consent. This article provides a framework for investigators likely to encounter subjects with some degree of neurological impairment, whose capacity to consent requires scrupulous assessment prior to enrollment in research trials. We consider several researches and disease contexts—from emergency epilepsy research to long-term dementia research—and clarify the ethical and legal principles governing consent for participation in each. We additionally explore empirical research on consent capacity and survey several areas of emerging ethical import that will require the attention of investigators in decades to come.

scholarly journals Edaravone Combined with Clopidogrel Is Beneficial to Improve Efficacy, Neurological Impairment, and Life Function in Acute Cerebral Infarction Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Liao Wu ◽  
Ying Sun ◽  
Guihua Ni ◽  
Bo Sun ◽  
Xiaoyu Ni ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Neurological Deficit ◽  
Daily Living ◽  
Adverse Reactions ◽  
Neurological Impairment ◽  
Acute Cerebral Infarction ◽  
Control Group ◽  
Nihss Score ◽  
Cerebral Hemodynamic ◽  
Life Function

Objective. This research aimed at investigating the efficacy of edaravone combined with clopidogrel on acute cerebral infarction (ACI) and its influence on the neurological deficit and life function. Methods. Totally, 154 ACI cases were included and then divided into the control group (CG) (n = 71) and research group (RG) (n = 83) according to the treatment methods. Patients in the CG were treated with clopidogrel alone, and those in the RG were under edaravone-clopidogrel combination therapy. The efficacy, adverse reactions, NIHSS score, cerebral hemodynamic indexes, and Fugl-Meyer scale (FMA) and Barthel index (BI) of activities of daily living (ADL) scores were observed. Results. Compared with before treatment, the symptoms of both groups were improved after treatment: the NIHSS scores decreased, FMA and ADL scores increased, and cerebral hemodynamic indexes were improved. Compared with the CG, the efficacy and cerebral hemodynamic indexes of the RG were better, the adverse reactions were equivalent, the NIHSS score was lower, and the ADL and FMA scores were higher. Conclusion. Edaravone combined with clopidogrel can effectively treat ACI and improve the neurological deficit and life function of patients.

scholarly journals Continuous Visual Focal Status Epilepticus as the Primary Presentation of NMDA-R and GAD65-R Autoimmune Epilepsy

2020 ◽  
Vol 11 ◽  
Author(s):  
Elma M. Paredes-Aragón ◽  
Héctor E. Valdéz-Ruvalcaba ◽  
Andrea Santos-Peyret ◽  
Marcela Cisneros-Otero ◽  
Raúl Medina-Rioja ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Early Identification ◽  
Acid Decarboxylase ◽  
Visual Aura ◽  
Epilepsia Partialis Continua ◽  
Autoimmune Epilepsy ◽  
Immune Mediated ◽  
Focal Status Epilepticus ◽  
Patients With Epilepsy ◽  
Primary Presentation

Epilepsia partialis continua (EPC) has changed in its clinical and pathophysiological definition throughout time. Several etiologies have been described in addition to classic causes of EPC. The following case depicts a young woman who had a peculiar onset of epilepsy with a continuous visual aura becoming a form of chronic recurrent and non-progressive EPC. The patient was initially misdiagnosed as a non-neurological entity (assumed psychiatric in origin), but finally, an immune-mediated epilepsy was diagnosed, and EEG showed focal status epilepticus during evolution. Once the diagnosis was achieved and immune treatment was established, the patient is seizure free. Early identification of an immune basis in patients with epilepsy is important because immunotherapy can reverse the epileptogenic process and reduce the risk of chronic epilepsy. To date, this is the only case reported with EPC manifesting as a continuous visual aura associated with antiglutamic acid decarboxylase 65 (anti-GAD65) and anti-N-methyl-d-aspartate (anti-NMDA) antibodies.

scholarly journals Neurological deficit of the facial nerve after root canal treatment

2009 ◽  
Vol 108 (2) ◽  
pp. e46-e48 ◽  
Author(s):  
Astrid Kruse ◽  
Nadja Hellmich ◽  
Heinz Theo Luebbers ◽  
Klaus W. Grätz
Keyword(s):  
Facial Nerve ◽  
Neurological Deficit ◽  
Root Canal ◽  
Root Canal Treatment

Spinal Metastasis

Neurosurgery ◽  
1979 ◽  
Vol 5 (6) ◽  
pp. 726-746 ◽  
Author(s):  
Perry Black
Keyword(s):  
Neurological Deficit ◽  
Spinal Metastasis ◽  
Neurological Status ◽  
Neurological Impairment ◽  
Radicular Pain ◽  
Current Status ◽  
Spinal Instability ◽  
Patients At Risk ◽  
Pain Symptoms ◽  
High Index Of Suspicion

Abstract An overview of the current status of various aspects of spinal metastasis, including pathology, diagnosis, and management, is presented. The cell type of the tumor, particularly with reference to its radiosensitivity, seems to be positively correlated with treatment outcome, regardless of the treatment modality. Because pretreatment neurological status also seems to influence prognosis, early identification of spinal involvement in patients at risk is important; therefore, a high index of suspicion in patients known to have cancer is necessary. The most useful warning of impending spinal cord or nerve root compression is spinal or radicular pain, which usually precedes neurological deficit by days to years. An aggressive diagnostic evaluation of pain symptoms is therefore warranted; this should include plain spine films and, in questionable cases, radioisotope bone scan. Myelography should also be considered in any cancer patient with persistent spinal or radicular pain, even in the absence of neurological deficit and certainly if there is any neurological impairment. Therapeutically, radiation and surgery continue as the mainstays of management, whereas steroids and chemotherapy serve as adjuvants. The guidelines for management recommended in this paper are to be viewed as tentative because the ideal treatment for spinal metastasis has not been established. The proposed guidelines are based on an analysis of retrospective studies that suggest that radiotherapy should be the primary mode of treatment and that surgery should be reserved for situations in which radiotherapy fails or where there is bony compression or spinal instability. Cases are presented to illustrate the application of these guidelines.

Neurological injury and patterns of sacral fractures

1990 ◽  
Vol 72 (6) ◽  
pp. 889-893 ◽  
Author(s):  
Kevin J. Gibbons ◽  
Donald S. Soloniuk ◽  
Nizam Razack
Keyword(s):  
Neurological Deficit ◽  
Medical Center ◽  
Treatment Options ◽  
Central Canal ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Erie County ◽  
Content Type ◽  
Canal Zone ◽  
Sacral Fractures

✓ To evaluate the morphological and neurological findings in sacral spine injuries, a retrospective study was conducted of all patients admitted to Erie County Medical Center over a 2-year period with the diagnosis of pelvic or sacral injury. Of these 253 patients, 44 were found to have sacral fractures and form the basis of this study. The type of fracture, neurological deficit, treatment, and outcome in these patients were analyzed. The patient population consisted of 25 males and 19 females, with a mean age of 34 years (range 15 to 80 years). The fractures were classified by the degree of involvement of the foramina and central canal. Fractures through the ala sacralis only (Zone I, 25 cases) or involving the foramina but not the central canal (Zone II, seven cases) were less likely to cause nerve injury (24% and 29%, respectively). Fractures involving the central canal (Zone III), both vertical (five cases) and transverse (seven cases), were more likely to cause neurological injury (60% and 57%, respectively). Neurological deficits in Zone I and II injuries were usually unilateral lumbar and sacral radiculopathies. Zone III deficits were usually bilateral and severe; bowel and/or bladder incontinence was present in six of the 12 patients in this group. Deficits generally improved with time; however, operative reduction and internal fixation may have been useful, particularly in patients with unilateral root symptoms. The treatment options are discussed, and previously published series of sacral fractures are reviewed. The authors conclude that the classification of sacral fractures described is useful in predicting the incidence and severity of neurological deficit.

scholarly journals Microglia and monocytes in inflammatory CNS disease: integrating phenotype and function

2021 ◽  
Author(s):  
Alanna G. Spiteri ◽  
Claire L. Wishart ◽  
Roger Pamphlett ◽  
Giuseppe Locatelli ◽  
Nicholas J. C. King
Keyword(s):  
Viral Encephalitis ◽  
Neurological Diseases ◽  
Cell Types ◽  
Cell Type ◽  
Neuroinflammatory Disease ◽  
Experimental Systems ◽  
Immune Mediated ◽  
Experimental Approaches ◽  
And Function ◽  
Disease Specific

AbstractIn neurological diseases, the actions of microglia, the resident myeloid cells of the CNS parenchyma, may diverge from, or intersect with, those of recruited monocytes to drive immune-mediated pathology. However, defining the precise roles of each cell type has historically been impeded by the lack of discriminating markers and experimental systems capable of accurately identifying them. Our ability to distinguish microglia from monocytes in neuroinflammation has advanced with single-cell technologies, new markers and drugs that identify and deplete them, respectively. Nevertheless, the focus of individual studies on particular cell types, diseases or experimental approaches has limited our ability to connect phenotype and function more widely and across diverse CNS pathologies. Here, we critically review, tabulate and integrate the disease-specific functions and immune profiles of microglia and monocytes to provide a comprehensive atlas of myeloid responses in viral encephalitis, demyelination, neurodegeneration and ischemic injury. In emphasizing the differential roles of microglia and monocytes in the severe neuroinflammatory disease of viral encephalitis, we connect inflammatory pathways common to equally incapacitating diseases with less severe inflammation. We examine these findings in the context of human studies and highlight the benefits and inherent limitations of animal models that may impede or facilitate clinical translation. This enables us to highlight common and contrasting, non-redundant and often opposing roles of microglia and monocytes in disease that could be targeted therapeutically.

scholarly journals A rare case of unilateral hemifacial spasm and facial palsy associated with an abnormal anatomical variant of the posterior basilar circulation

2019 ◽  
Vol 101 (6) ◽  
pp. e1-e3
Author(s):  
J Chan ◽  
K Jolly ◽  
A Darr ◽  
DJ Bowyer
Keyword(s):  
Facial Nerve ◽  
Basilar Artery ◽  
Hemifacial Spasm ◽  
Neurological Deficit ◽  
Facial Palsy ◽  
Rare Case ◽  
Focal Neurological Deficit ◽  
Anatomical Variant ◽  
Vertebral Arteries ◽  
Facial Spasm

Tortuous vertebral arteries are a rare anatomical variant. Mild tortuosity is usually asymptomatic whereas severe tortuosity may present with ischaemic symptoms or compressive symptoms (focal neurological deficit). While a resulting hemifacial spasm has been previously described, sparse literature exists for its association with facial palsy. We present a rare case of facial spasm along with facial palsy in a 67-year-old woman who was found to have an anatomical variant in the posterior basilar circulation with an ectatic basilar artery and significantly displaced posterior vertebral artery impinging on the facial nerve.

scholarly journals Subacute cerebellar ataxia following respiratory symptoms of COVID-19: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jana Werner ◽  
Ina Reichen ◽  
Michael Huber ◽  
Irene A. Abela ◽  
Michael Weller ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Neurological Deficits ◽  
High Dose ◽  
Upper Airways ◽  
Fisher Syndrome ◽  
Cerebral Magnetic Resonance Imaging ◽  
Cell Counts ◽  
Immune Mediated ◽  
High Dose Methylprednisolone ◽  
Post Infectious

Abstract Background Severe acute respiratory syndrome virus 2 (SARS-CoV-2) is spreading globally and causes most frequently fever and respiratory symptoms, i.e. Coronavirus disease 2019 (COVID-19), however, distinct neurological syndromes associated with SARS-CoV-2 infection have been described. Among SARS-CoV-2-infections-associated neurological symptoms fatigue, headache, dizziness, impaired consciousness and anosmia/ageusia are most frequent, but less frequent neurological deficits such as seizures, Guillain-Barré syndrome or ataxia may also occur. Case presentation Herein we present a case of a 62-year-old man who developed a subacute cerebellar syndrome with limb-, truncal- and gait ataxia and scanning speech 1 day after clinical resolution of symptomatic SARS-CoV-2 infection of the upper airways. Apart from ataxia, there were no signs indicative of opsoclonus myoclonus ataxia syndrome or Miller Fisher syndrome. Cerebral magnetic resonance imaging showed mild cerebellar atrophy. SARS-CoV-2 infection of the cerebellum was excluded by normal cerebrospinal fluid cell counts and, most importantly, absence of SARS-CoV-2 RNA or intrathecal SARS-CoV-2-specific antibody production. Other causes of ataxia such as other viral infections, other autoimmune and/or paraneoplastic diseases or intoxication were ruled out. The neurological deficits improved rapidly after high-dose methylprednisolone therapy. Conclusions The laboratory and clinical findings as well as the marked improvement after high-dose methylprednisolone therapy suggest a post-infectious, immune-mediated cause of ataxia. This report should make clinicians aware to consider SARS-CoV-2 infection as a potential cause of post-infectious neurological deficits with an atypical clinical presentation and to consider high-dose corticosteroid treatment in case that a post-infectious immune-mediated mechanism is assumed.

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