Reader Response: CSF Biomarkers in Patients With COVID-19 and Neurologic Symptoms: A Case Series

ABSTRACTOBJECTIVETo study the neurological manifestations of patients with coronavirus disease 2019 (COVID-19).DESIGNRetrospective case seriesSETTINGThree designated COVID-19 care hospitals of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China.PARTICIPANTSTwo hundred fourteen hospitalized patients with laboratory confirmed diagnosis of severe acute respiratory syndrome from coronavirus 2 (SARS-CoV-2) infection. Data were collected from 16 January 2020 to 19 February 2020.MAIN OUTCOME MEASURESClinical data were extracted from electronic medical records and reviewed by a trained team of physicians. Neurological symptoms fall into three categories: central nervous system (CNS) symptoms or diseases (headache, dizziness, impaired consciousness, ataxia, acute cerebrovascular disease, and epilepsy), peripheral nervous system (PNS) symptoms (hypogeusia, hyposmia, hypopsia, and neuralgia), and skeletal muscular symptoms. Data of all neurological symptoms were checked by two trained neurologists.RESULTSOf 214 patients studied, 88 (41.1%) were severe and 126 (58.9%) were non-severe patients. Compared with non-severe patients, severe patients were older (58.7 ± 15.0 years vs 48.9 ± 14.7 years), had more underlying disorders (42 [47.7%] vs 41 [32.5%]), especially hypertension (32 [36.4%] vs 19 [15.1%]), and showed less typical symptoms such as fever (40 [45.5%] vs 92 [73%]) and cough (30 [34.1%] vs 77 [61.1%]). Seventy-eight (36.4%) patients had neurologic manifestations. More severe patients were likely to have neurologic symptoms (40 [45.5%] vs 38 [30.2%]), such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]) and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]).CONCLUSIONCompared with non-severe patients with COVID-19, severe patients commonly had neurologic symptoms manifested as acute cerebrovascular diseases, consciousness impairment and skeletal muscle symptoms.

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The Behavioral/Dysexecutive Variant of Alzheimer’s Disease: A Case Series with Clinical, Neuropsychological, and FDG-PET Characterization

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000511210 ◽

2020 ◽

pp. 1-8

Author(s):

David Bergeron ◽

Leila Sellami ◽

Stéphane Poulin ◽

Louis Verret ◽

Rémi W. Bouchard ◽

...

Keyword(s):

Behavioral Problems ◽

Fdg Pet ◽

Visual Analysis ◽

Inferior Frontal Gyrus ◽

Case Series ◽

Cingulate Cortex ◽

Anterior Cingulate ◽

Cortical Atrophy ◽

Csf Biomarkers ◽

Imaging Features

Introduction: It is well known that some patients with Alzheimer’s disease (AD) have atypical, nonamnestic presentations. While logopenic aphasia and posterior cortical atrophy are well-characterized atypical variants of AD, the behavioral/dysexecutive variant remains a controversial entity, lacking consensus regarding its distinctive clinical and imaging features. Methods: We present a case series of 8 patients with biomarker confirmation of AD (cerebrospinal fluid [CSF] analysis or amyloid positron emission tomography [PET]) and a progressive frontal syndrome, defined as prominent behavioral and/or executive deficits at initial presentation. We characterize the cohort based on clinical features, cognitive performance in 4 domains (memory, visuospatial, executive, and language) as well as behavior on the Dépistage Cognitif de Québec (DCQ), and regional brain metabolism using 18F-fluorodeoxyglucose PET (FDG-PET). We compare these features with 8 age-matched patients diagnosed with the behavioral variant of frontotemporal dementia (bvFTD) and 37 patients with typical amnestic AD. Results: Patients with the behavioral/dysexecutive variant of AD presented with early-onset (mean age: 59 years old) progressive executive and behavioral problems reminiscent of bvFTD, including disinhibition, loss of social conventions, and hyperorality. Patients scored higher on the Memory Index and lower on the Behavioral Index than patients with amnestic AD on the DCQ, yet they were indistinguishable from patients with bvFTD on each of the cognitive indices. Visual analysis of FDG-PET revealed half of patients with behavioral/dysexecutive AD presented with frontal hypometabolism suggestive of bvFTD and only 3/8 (37.5%) presented significant hypometabolism of the posterior cingulate cortex. Group-level analysis of FDG-PET data revealed that the most hypometabolic regions were the middle temporal, inferior temporal, and angular gyri in behavioral/dysexecutive AD and the inferior frontal gyrus, anterior cingulate cortex, caudate nucleus, and insula in bvFTD. Conclusion: The behavioral/dysexecutive variant of AD is a rare, atypical young-onset variant of AD defined clinically by early and prominent impairments in executive and behavioral domains. While behavioral/dysexecutive AD is hardly distinguishable from bvFTD using clinical and cognitive features alone, CSF biomarkers and temporoparietal hypometabolism help predict underlying pathology during life.

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Abstract TP399: Hemodynamic Imaging in Children with Transient Neurologic Symptoms

Stroke ◽

10.1161/str.48.suppl_1.tp399 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Laura L Lehman ◽

Amy R Danehy ◽

Miya E Bernson-Leung ◽

Cameron C Trenor ◽

Christopher F Calahan ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Case Series ◽

Imaging Findings ◽

Diagnostic Challenge ◽

Stroke Treatment ◽

Neurologic Symptoms ◽

Clinical Criteria ◽

Hyperacute Stroke ◽

Diffusion Weighted ◽

Stroke Mimic

Children who present with transient neurologic symptoms raise concern for stroke as the underlying etiology. The rapid differentiation of stroke mimic from stroke in order to determine eligibility for hyperacute stroke treatment constitutes a unique and important diagnostic challenge in children. We used perfusion, diffusion, and magnetic resonance angiography (MRA) imaging to identify key imaging findings that together indicated a stroke mimic. We present a case series of 17 children who had transient neurologic symptoms and had MRA, perfusion, and diffusion weighted imaging in the acute period. The children ranged in age from 2 to 17 years of age. Among 17 children, 13 (76%) had headache at presentation. Thirteen (76%) children had focal MRA evidence of arterial pruning without occlusion, all had negative diffusion weighted imaging, and all showed evidence of hemispheric decreased perfusion by susceptibility-weighted imaging and/or arterial spin label perfusion imaging. Thirteen of 17 had left sided imaging findings. In all children who had repeat imaging (6/17;35%) these findings had reversed. No patient met clinical criteria for familial hemiplegic migraine. Only 6 (35%) had recurrence of transient neurologic symptoms since initial presentation; none had stroke. Use of combined MR imaging to include perfusion, diffusion and angiography can help to distinguish rapidly children who present with stroke mimics whose symptoms are likely to be transient and who do not require hyperacute stroke treatment.

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American Society of Clinical Oncology 2021 Annual Meeting updates on primary brain tumors and CNS metastatic tumors

Future Oncology ◽

10.2217/fon-2021-0955 ◽

2021 ◽

Author(s):

Archit B Baskaran ◽

Priya Kumthekar ◽

Amy B Heimberger ◽

Rimas V Lukas

Keyword(s):

Annual Meeting ◽

Clinical Oncology ◽

Case Series ◽

Primary Brain Tumor ◽

Phase Iii ◽

Future Research ◽

Csf Biomarkers ◽

Phase Ii Trials ◽

Tumor Management ◽

American Society

In this report, select key studies presented at the American Society of Clinical Oncology (ASCO) 2021 annual meeting are reviewed. Two major phase III randomized controlled trials were presented at the meeting: GEINO 1401 and EORTC 1709/CCTG CE.8. Both are reviewed in this report. Moreover, important phase II trials, including Alliance A0716701, and key phase I trials are included. All trials presented cover important advances in the understanding of primary brain tumor management. In addition, case series papers, trials in progress and select work on exploratory CSF biomarkers are reviewed. Altogether, research presented at ASCO 2021 highlights important advances in neuro-oncologic topics that may inform future research and practice.

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Correlation between CSF biomarkers and COVID-19 meningoencephalitis: A case series

Respiratory Medicine Case Reports ◽

10.1016/j.rmcr.2020.101335 ◽

2020 ◽

pp. 101335

Author(s):

Minoosh Moghimi ◽

Amirhossein Moghtader ◽

Manijeh Jozpanahi ◽

Kasra Khodadadi ◽

Mohammad Jafarzade ◽

...

Keyword(s):

Case Series ◽

Csf Biomarkers

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Neurologic Features Associated With SARS-CoV-2 Infection in Children: A Case Series Report

Journal of Child Neurology ◽

10.1177/0883073821989164 ◽

2021 ◽

pp. 088307382198916

Author(s):

Francisca Sandoval ◽

Katherine Julio ◽

Gastón Méndez ◽

Carolina Valderas ◽

Alejandra C. Echeverría ◽

...

Keyword(s):

Pediatric Population ◽

Case Series ◽

Neurologic Manifestations ◽

Retrospective Case ◽

Neurologic Symptoms ◽

Clinical Presentations ◽

Wide Range ◽

Neurophysiological Studies ◽

Case Series Report ◽

Series Report

Introduction: Although multiple neurologic manifestations associated with SARS-CoV-2 infection have been described in adults, there is little information about those presented in children. Here, we described neurologic manifestations associated with COVID-19 in the pediatric population. Methods: Retrospective case series report. We included patients younger than 18 years, admitted with confirmed SARS-CoV-2 infection and neurologic manifestations at our hospital in Santiago, Chile. Demographics, clinical presentations, laboratory results, radiologic and neurophysiological studies, treatment, and outcome features were described. Cases were described based on whether they presented with predominantly central or peripheral neurologic involvement. Results: Thirteen of 90 (14.4%) patients admitted with confirmed infection presented with new-onset neurologic symptoms and 4 patients showed epilepsy exacerbation. Neurologic manifestations ranged from mild (headache, muscle weakness, anosmia, ageusia), to severe (status epilepticus, Guillain-Barré syndrome, encephalopathy, demyelinating events). Conclusions: We found a wide range of neurologic manifestations in children with confirmed SARS-CoV-2 infection. In general, neurologic symptoms were resolved as the systemic presentation subsided. It is essential to recognize and report the main neurologic manifestations related to this new infectious disease in the pediatric population. More evidence is needed to establish the specific causality of nervous system involvement.

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Alzheimer's Dementia in People Living With HIV

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001060 ◽

2021 ◽

pp. 10.1212/CPJ.0000000000001060

Author(s):

Andrea Calcagno ◽

Luigi Celani ◽

Mattia Trunfio ◽

Giancarlo Orofino ◽

Daniele Imperiale ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Case Series ◽

Alzheimer’S Dementia ◽

Csf Biomarkers ◽

People Living With Hiv ◽

Alzheimer's Dementia ◽

Imaging Results ◽

Living With Hiv

ObjectiveGiven the ageing of people living with HIV (PLWH) and the high prevalence of HIV-associated neurocognitive disorders we aimed at describing the clinical, instrumental and CSF features of PLWH diagnosed with Alzheimer's dementia (AD).MethodsThe databases of 3 large Italian outpatient clinics taking care of more than 9,000 PLWH were searched for the diagnosis of AD. After obtaining patients' or their next of kin's consent for publication, anonymous data were collected in an excel spreadsheet and described. Routinely collected CSF biomarkers and radiologic imaging results were recorded whether available.ResultsFour patients were included in this case series that were diagnosed with AD aged between 60 and 74 years. All participants were on highly active antiretroviral therapy and showed non-detectable serum HIV RNA. Memory impairment was the most prominent cognitive feature. The diagnosis was obtained considering the exclusion of other potential causes, magnetic resonance imaging and fluorodeoxyglucose-PET features and, in (in 2/4), CSF AD biomarkers levels. In one patient, longitudinal CSF tau/p-tau increased and beta-amyloid1–42 decreased over time despite antiretroviral therapy containing nucleotide reverse transcriptase inhibitors.ConclusionsIn older PLWH with cognitive symptoms may represent the onset of AD: a multidisciplinary team may be needed for reaching a likely in vivo diagnosis.

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