scholarly journals New onset neurologic events in people with COVID-19 in 3 regions in China

Neurology ◽  
2020 ◽  
Vol 95 (11) ◽  
pp. e1479-e1487 ◽  
Author(s):  
Weixi Xiong ◽  
Jie Mu ◽  
Jian Guo ◽  
Lu Lu ◽  
Dan Liu ◽  
...  
Keyword(s):  
Previous History ◽  
Muscle Cramp ◽  
Cns Infection ◽  
Occipital Neuralgia ◽  
Impaired Consciousness ◽  
Multicenter Cohort Study ◽  
Brain Ct ◽  
New Findings ◽  
Acute Insult ◽  
New Onset

ObjectiveTo investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19).MethodsA retrospective multicenter cohort study was conducted between January 18 and March 20, 2020, including people with confirmed COVID-19 from 56 hospitals officially designated in 3 Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination, and investigations were noted, in which critical events included disorders of consciousness, stroke, CNS infection, seizures, and status epilepticus.ResultsWe enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new-onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n = 25) or stroke (n = 10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurologic conditions. Noncritical events were seen in fewer than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic, and tremor. Brain CT in 28 people led to new findings in 9. Findings from lumbar puncture in 3 with suspected CNS infection, unexplained headache, or severe occipital neuralgia were unremarkable.ConclusionsPeople with COVID-19 aged over 60 and with neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of severe acute respiratory syndrome coronavirus 2 to the CNS is lacking.

Paroxysmal Stabbing Headache in The Multiple Dermatomes of The Head and Neck: A Variant of Primary Stabbing Headache or Occipital Neuralgia?

Cephalalgia ◽  
2007 ◽  
Vol 27 (10) ◽  
pp. 1101-1108 ◽  
Author(s):  
JH Shin ◽  
HK Song ◽  
JH Lee ◽  
WK Kim ◽  
MK Chu
Keyword(s):  
Medical Center ◽  
Previous History ◽  
Headache Disorder ◽  
Acute Onset ◽  
Occipital Neuralgia ◽  
Cervical Nerve ◽  
Primary Stabbing Headache ◽  
History Of ◽  
Stabbing Headache

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2nd Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.

scholarly journals The relationship between antihypertensive medications and mood disorders: analysis of linked healthcare data for 1.8 million patients

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Richard J. Shaw ◽  
Daniel Mackay ◽  
Jill P. Pell ◽  
Sandosh Padmanabhan ◽  
David S. Bailey ◽  
...  
Keyword(s):  
Mood Disorder ◽  
Mood Disorders ◽  
Cox Regression ◽  
Previous History ◽  
Area Deprivation ◽  
Antihypertensive Medications ◽  
Healthcare Data ◽  
Increased Risk ◽  
History Of ◽  
New Onset

Abstract Background Recent work suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders. Using large-scale linked healthcare data we investigated whether certain classes of antihypertensive, such as angiotensin antagonists (AAs) and calcium channel blockers, were associated with reduced risk of new-onset major depressive disorder (MDD) or bipolar disorder (BD). Method Two cohorts of patients treated with antihypertensives were identified from Scottish prescribing (2009–2016) and hospital admission (1981–2016) records. Eligibility for cohort membership was determined by a receipt of a minimum of four prescriptions for antihypertensives within a 12-month window. One treatment cohort (n = 538 730) included patients with no previous history of mood disorder, whereas the other (n = 262 278) included those who did. Both cohorts were matched by age, sex and area deprivation to untreated comparators. Associations between antihypertensive treatment and new-onset MDD or bipolar episodes were investigated using Cox regression. Results For patients without a history of mood disorder, antihypertensives were associated with increased risk of new-onset MDD. For AA monotherapy, the hazard ratio (HR) for new-onset MDD was 1.17 (95% CI 1.04–1.31). Beta blockers' association was stronger (HR 2.68; 95% CI 2.45–2.92), possibly indicating pre-existing anxiety. Some classes of antihypertensive were associated with protection against BD, particularly AAs (HR 0.46; 95% CI 0.30–0.70). For patients with a past history of mood disorders, all classes of antihypertensives were associated with increased risk of future episodes of MDD. Conclusions There was no evidence that antihypertensive medications prevented new episodes of MDD but AAs may represent a novel treatment avenue for BD.

scholarly journals Incidence of and Factors Associated with New-Onset Insomnia Among Lebanese Hospitalised Patients

2021 ◽  
Vol 21 (2) ◽  
pp. e210-220
Author(s):  
Nour Sakr ◽  
Souheil Hallit ◽  
Hanna Mattar
Keyword(s):  
Tertiary Care ◽  
Previous History ◽  
Severity Index ◽  
Cardiac Monitoring ◽  
Sleep Wake Disorders ◽  
Tertiary Care Centre ◽  
Post Discharge ◽  
Hospitalised Patients ◽  
History Of ◽  
New Onset

Objectives: This study aimed to determine the incidence and post-discharge resolution of new-onset insomnia in hospitalised patients with no previous history of insomnia, as well as to define major correlates of in-hospital insomnia. Methods: This prospective observational study was conducted between November 2019 and January 2020 at a tertiary care centre in Lebanon. All hospitalised patients >18 years of age with no history of insomnia were screened for new-onset insomnia using the Insomnia Severity Index (ISI) scale. Subsequently, patients were re-assessed two weeks after discharge to determine insomnia resolution. Results: A total of 75 patients were included in the study. Of these, nine (12%) had no insomnia, 34 (45.3%) had subthreshold insomnia, 22 (29.3%) had moderate insomnia and 10 (13.3%) had severe insomnia. The mean ISI score was 14.95 ± 6.05, with 88% of patients having ISI scores of >7 (95% confidence interval: 0.822–0.965). The frequency of new-onset insomnia was significantly higher among patients who shared a room compared to those in single-bed rooms (95.7% versus 75%; P = 0.011). Other factors were not found to be associated with new-onset insomnia, including the administration of medications known to cause insomnia, in-hospital sedative use, overnight oxygen, cardiac monitoring and self-reported nocturnal toilet use. Overall, insomnia resolution occurred in 78.7% of patients two weeks after discharge. Conclusion: There was a high incidence of acute new-onset insomnia among hospitalised patients at a tertiary centre in Lebanon. Additional research is recommended to further examine inhospital sleep disturbance factors and to seek convenient solutions to limit insomnia. Keywords: Sleep Wake Disorders; Insomnia; Hospitalization; Incidence; Risk Factors; Lebanon.

scholarly journals Thyrotoxic periodic paralysis in new-onset hyperthyroidism – a case report and review of the literature

2014 ◽  
Vol 12 (4) ◽  
pp. 531
Author(s):  
Joaquim Custódio da Silva Junior ◽  
Helton Estrela Ramos
Keyword(s):  
Case Report ◽  
Previous History ◽  
Rare Condition ◽  
Periodic Paralysis ◽  
Emergency Physicians ◽  
Review Of The Literature ◽  
Font Size ◽  
Thyrotoxic Periodic Paralysis ◽  
History Of ◽  
New Onset

<p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><em><span style="font-size: 10.0pt; font-family: ";Times New Roman";,";serif";; mso-ansi-language: EN-US;" lang="EN-US">Thyrotoxic periodic paralysis (TPP) is a rare condition related to hyperthyroidism, with specific clinical and physiopathological features. In this article, we discuss a case report of a patient that develops TPP with no previous history of thyroid illness, highlighting semiological characteristics that can help Emergency physicians to suspect of this condition. Subsequently, we review the recent articles about TPP, with focus in the molecular basis of ion channelopathies and predisposing factors, and discuss the therapeutic approach at acute phase of TPP and prevention of crisis recurrence.</span></em></p>

Abstract W P186: Usefulness of the New Prehospital Cerebrovascular Disease Triage Score for Patients With Impaired Consciousness by Emergency Medical Services

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
katsufumi kajimoto ◽  
Hideaki Kanki ◽  
Kazuyuki Nagatsuka
Keyword(s):  
Emergency Medical Services ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Vital Signs ◽  
Medical Services ◽  
Impaired Consciousness ◽  
Characteristic Analysis ◽  
Emergency Medical ◽  
Stroke Group ◽  
New Onset

Background and Purpose: Early stroke recognition optimizes patients’ opportunities to benefit from therapeutic options; however, accurate stroke recognition by emergency medical services (EMS) is difficult in patients with impaired consciousness. Here we attempted to establish a new prehospital stroke triage score for such patients. Methods: In 2010, 713 patients (average age, 71 years; 421 men) presenting with impaired consciousness (score of <15 on the Glasgow coma scale) on EMS arrival, who were brought to our hospital, were included. We compared the relation between the symptoms and the vital signs on EMS arrival and the final diagnosis. Results: A final hospital diagnosis of stroke was made for 353 in 713 patients (49.5%). Systolic and diastolic blood pressure (SBP, DBP) on EMS arrival were significantly higher in the stroke group than in the non-stroke group (SBP: 172 mmHg vs 143 mmHg, p < 0.01, DBP: 93 mmHg vs 78 mmHg, p < 0.01). In contrast, the pulse rate (PR) was lower in the stroke group (84 bpm vs 88 bpm, p < 0.05). Receiver operating characteristic analysis showed that the optimum SBP, DBP, and PR cutoffs for stroke were 150 mmHg (sensitivity 76%, specificity 59%), 90 mmHg (63%, 70%), and 90 bpm (70%, 42%), respectively. Using univariate analysis, SBP of >150 mmHg, DBP of >90 mmHg, PR of <90 bpm and an arrhythmia case in addition to new-onset hemiparesis were significantly associated with stroke, whereas a case with cold sweat was not significantly associated. Using multivariable analysis, new onset hemiparesis (Odds ratio 11.0; 95% CI, 5.76-22.7), SBP of >150 mmHg (2.21, 1.26-3.87), DBP of >90 mmHg (2.88, 1.65-5.09), and PR of <90 bpm (2.25, 0.80-3.80) were significantly associated with stroke. The prehospital stroke triage score was calculated for each patient with 1 point assigned to patients with SBP of >150 mmHg, DBP of >90 mmHg, PR of <90 bpm, and 2 points for new onset hemiparesis. The triage score of >2points revealed stroke with relatively high sensitivity and specificity (sensitivity 63%, specificity 87%, AUC = 0.809). Conclusion: The new prehospital stroke triage score was calculated on the basis of vital signs in addition to new onset hemiparesis. This score is very useful for triage of stroke presenting with impaired consciousness.

scholarly journals Evidence-based clinical practice guidelines for Liver Cirrhosis 2020

2021 ◽  
Author(s):  
Hitoshi Yoshiji ◽  
Sumiko Nagoshi ◽  
Takemi Akahane ◽  
Yoshinari Asaoka ◽  
Yoshiyuki Ueno ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Hepatopulmonary Syndrome ◽  
International Standards ◽  
Muscle Cramp ◽  
Future Research ◽  
Alcoholic Steatohepatitis ◽  
New Findings

AbstractThe first edition of the clinical practice guidelines for liver cirrhosis was published in 2010, and the second edition was published in 2015 by the Japanese Society of Gastroenterology (JSGE). The revised third edition was recently published in 2020. This version has become a joint guideline by the JSGE and the Japan Society of Hepatology (JSH). In addition to the clinical questions (CQs), background questions (BQs) are new items for basic clinical knowledge, and future research questions (FRQs) are newly added clinically important items. Concerning the clinical treatment of liver cirrhosis, new findings have been reported over the past 5 years since the second edition. In this revision, we decided to match the international standards as much as possible by referring to the latest international guidelines. Newly developed agents for various complications have also made great progress. In comparison with the latest global guidelines, such as the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD), we are introducing data based on the evidence for clinical practice in Japan. The flowchart for nutrition therapy was reviewed to be useful for daily medical care by referring to overseas guidelines. We also explain several clinically important items that have recently received focus and were not mentioned in the last editions. This digest version describes the issues related to the management of liver cirrhosis and several complications in clinical practice. The content begins with a diagnostic algorithm, the revised flowchart for nutritional therapy, and refracted ascites, which are of great importance to patients with cirrhosis. In addition to the updated antiviral therapy for hepatitis B and C liver cirrhosis, the latest treatments for non-viral cirrhosis, such as alcoholic steatohepatitis/non-alcoholic steatohepatitis (ASH/NASH) and autoimmune-related cirrhosis, are also described. It also covers the latest evidence regarding the diagnosis and treatment of liver cirrhosis complications, namely gastrointestinal bleeding, ascites, hepatorenal syndrome and acute kidney injury, hepatic encephalopathy, portal thrombus, sarcopenia, muscle cramp, thrombocytopenia, pruritus, hepatopulmonary syndrome, portopulmonary hypertension, and vitamin D deficiency, including BQ, CQ and FRQ. Finally, this guideline covers prognosis prediction and liver transplantation, especially focusing on several new findings since the last version. Since this revision is a joint guideline by both societies, the same content is published simultaneously in the official English journal of JSGE and JSH.

scholarly journals Hashimoto’s Encephalopathy Presenting with Acute Behavioral Disturbances: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 309
Author(s):  
Rozi NR ◽  
RM Yousuf ◽  
Kok HT ◽  
Mohd Unit H ◽  
Ibrahim KA ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Previous History ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Cns Infection ◽  
Behavioural Disturbance ◽  
Behavioral Disturbances ◽  
Hashimoto’S Encephalopathy ◽  
Intravenous Acyclovir ◽  
History Of

Hashimoto’s encephalopathy (HE) is a rare and poorly understood neuropsychiatric illness of presumed autoimmune origin, with elevated titres of anti-thyroid antibodies. Its clinical presentation is highly variable that mimic a variety of neurologic and/or psychiatric disorders. Clinical presentation often suggests an infectious etiology which often leads to a mistaken diagnosis. We present the case of 35 year-old female who presented with acute onset behavioural disturbance of one day duration. On examination she was unkempt, emotionally labile, appeared withdrawn and unable to respond to questions. She had no focal neurological deficits. CNS infection was suspected and lumbar puncture was suggested, which the family members refused.She was empirically treated with intravenous acyclovir and ceftriaxone.Metabolic disorder, infectious and toxic issues were ruled out through laboratory testing.In view of her previous history of hyperthyroidism, suspicion of Hashimoto encephalopathy arose.The diagnosis was supported by the elevated level of anti-thyroglobulin (TG) antibody.We report this case to increase its awareness as it is one of the few treatable and easily reversible causes of acute encephalopathy. It should be considered in the differential diagnoses in any patient who presents with acute behavioural disturbance and has concurrent thyroid disorder.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 309-312

scholarly journals Association between Risk Factors and New-Onse Seizures in Old Age Population

2021 ◽  
pp. 47-58
Author(s):  
Samee Jatoi ◽  
Dayo Abdullah ◽  
M. Z. Jilani ◽  
Soomro Fatima
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Disease ◽  
Brain Tumor ◽  
Old Age ◽  
Cns Infection ◽  
Control Group ◽  
Onset Seizure ◽  
And Control ◽  
New Onset

Objective: To determine the association between risk factors and new-onset seizures in old age population at a tertiary care hospital, Karachi. Methods: A case control study on old age patients of > 60 years visited emergency department (ED) either with new onset seizure or without seizure were conducted at ED of Ziauddin University Hospital Karachi. 154 consecutive old age patients were distributed into two groups i.e., case group (77 old age patients of new onset seizure) and control group (77 old age patients without seizure). Risk factors including stroke, dementia, head trauma, metabolic causes, brain tumor, infection of central nervous system (CNS), depression and anxiety were evaluated. Results: Out of 154 old age patients, male was 32 (41.6%) and 40 (51.9%) and female was 45 (58.4%) and 37 (48.1%) in case and control group respectively. Type of seizure in control group was generalized tonic–clonic seizure (GTCS) in 51 (66.2%) patients and focal seizure in 26 (33.8%) patients. Comorbidities were diabetes mellitus (DM) in 76 (98.7%) and 59 (76.6%) patients, hypertension (HTN) in 72 (93.5%) and 63 (81.8%) patients and ischemic heart disease (IHD) in 39 (50.6%) and 25 (32.5%) patients. Risk factors were stroke in 23 (29.9%) and 16 (20.8%) patients, dementia in 3 (3.9%) and 0 (0.0%) patients, head trauma in 0 (0.0%) and 33 (42.9%) patients, metabolic causes in 27 (35.1%) and 27 (35.1%) patients, brain tumor in 6 (7.8%) and 0 (0.0%) patients, CNS infection in 17 (22.1%) and 1 (1.3%) patients and depression in 2 (2.6%) and 0 (0.0%) patients. Conclusion: New-onset seizures are significantly associated with age, diabetes mellitus, hypertension, ischemic heart disease, brain tumor and CNS infection.

C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome

2011 ◽  
Vol 15 (1) ◽  
pp. 3-8 ◽  
Author(s):  
D. Kojo Hamilton ◽  
Justin S. Smith ◽  
Charles A. Sansur ◽  
Aaron S. Dumont ◽  
Christopher I. Shaffrey
Keyword(s):  
Patient Satisfaction ◽  
Elderly Patients ◽  
Intraoperative Complications ◽  
Present Series ◽  
Consecutive Series ◽  
Occipital Neuralgia ◽  
Lateral Mass ◽  
Instrumented Fusion ◽  
New Onset

Object The originally described technique of atlantoaxial stabilization using C-1 lateral mass and C-2 pars screws includes a C-2 neurectomy to provide adequate hemostasis and visualization for screw placement, enable adequate joint decortication and arthrodesis, and prevent new-onset postoperative C-2 neuralgia. However, inclusion of a C-2 neurectomy for this procedure remains controversial, likely due in part to a lack of studies that have specifically addressed whether it affects patient outcome. The authors' objective was to assess the surgical and clinical impact of routine C-2 neurectomy performed with C1–2 segmental instrumented arthrodesis in a consecutive series of elderly patients with C1–2 instability. Methods Forty-four consecutive patients (mean age 71 years) underwent C1–2 instrumented fusion, including C-1 lateral mass screw insertion. Bilateral C-2 neurectomies were performed. Standardized clinical assessments were performed both pre- and postoperatively. Numbness or discomfort in a C-2 distribution was documented at follow-up. Fusion was assessed using the Lenke fusion grade. Results Among all 44 patients, mean blood loss was 200 ml (range 100–350 ml) and mean operative time was 129 minutes (range 87–240 minutes). There were no intraoperative complications, and no patients reported new postoperative onset or worsening of C-2 neuralgia postoperatively. Outcomes for the 30 patients with a minimum 13-month follow-up (range 13–72 months) were assessed. At a mean follow-up of 36 months, Nurick grade and pain numeric rating scale scores improved from 3.7 to 1.0 (p < 0.001) and 9.4 to 0.6 (p < 0.001), respectively. The mean postoperative Neck Disability Index score was 7.3%. The fusion rate was 97%, and the patient satisfaction rate was 93%. All 24 patients with preoperative occipital neuralgia reported relief. Seventeen patients noticed C-2 distribution numbness only during examination in the clinic, and 2 patients reported C-2 numbness, but it did not affect their daily function. Conclusions In this series of C1–2 instrumented arthrodesis in elderly patients, excellent fusion rates were achieved, and patient satisfaction was not negatively affected by C-2 neurectomy. In the authors' experience, C-2 neurectomy enhanced surgical exposure of the C1–2 joint, thereby facilitating hemostasis, placement of instrumentation, and decortication of the joint space for arthrodesis. Importantly, with C-2 neurectomy in the present series, no cases of new onset postoperative C-2 neuralgia occurred, in contrast to a growing number of reports in the literature documenting new-onset C-2 neuralgia without C-2 neurectomy. On the contrary, 80% of patients in the present series had preoperative occipital neuralgia and in all of these patients this neuralgia was relieved following C1–2 instrumented arthrodesis with C-2 neurectomy.

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