scholarly journals Acute psychosis in COVID-19: Is it due to favipiravir treatment or acute viral illness?

2021 ◽  
Author(s):  
Murat Duyan ◽  
Ibrahim Ulas Ozturan
Keyword(s):  
Emergency Department ◽  
Psychiatric Ward ◽  
Antipsychotic Treatment ◽  
Loading Dose ◽  
Acute Psychosis ◽  
Cerebrospinal Fluid Analysis ◽  
Case Presentation ◽  
Fluid Analysis ◽  
Viral Illness ◽  
Disorganized Speech

Abstract Introduction: In this report, we present a case of acute psychosis that occurred after the loading dose of favipiravir, one of the most prescribed antiviral drugs in many countries, in a patient with COVID-19. Case presentation: A 31-year-old female was readmitted to the emergency department after three days of sleep disturbance, intermittent paranoid delusions, auditory hallucinations, and agitation that started after the favipiravir treatment was initiated. A physical examination revealed disorganized speech, distorted orientation, and agitation. All laboratory tests, including drug screening and cerebrospinal fluid analysis, were normal. After excluding all the other causes of acute psychosis, favipiravir treatment was discontinued, antipsychotic treatment was started, and the patient was admitted to the psychiatric ward. The symptoms resolved on the second day of hospitalization. Although acute viral illness does seldomly cause psychosis in patients with increased inflammatory response, in the presented case, none of the inflammatory markers were positive and acute psychosis was attributed to the loading dose of favipiravir. Conclusion In conclusion, emergency department physicians should be aware of this rare adverse effect and prescribe cautiously to patients at a high risk of psychosis.

scholarly journals CompartmentalizedHistoplasma capsulatumInfection of the Central Nervous System

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Albert J. Eid ◽  
John D. Leever ◽  
Kathrin Husmann
Keyword(s):  
Histoplasma Capsulatum ◽  
Brain Mri ◽  
Cerebrospinal Fluid Analysis ◽  
Case Presentation ◽  
Fluid Analysis ◽  
Disseminated Histoplasmosis ◽  
Progressive Neurological Deficit ◽  
The Central Nervous System ◽  
Progressive Weakness ◽  
Immunocompetent Patients

Background. Histoplasmosis is a common fungal infection in the southeastern, mid-Atlantic, and central states; however, its presentation can be atypical.Case Presentation. We report a case ofHistoplasma capsulatuminfection presenting as slowly progressive weakness in the lower extremities, followed by the development of numbness below the midthoracic area, urinary incontinence, and slurred speech. Brain MRI showed leptomeningeal enhancement, predominantly linear, involving the basal cisterns, the brainstem, and spinal cord. Cerebrospinal fluid analysis showed lymphocytic pleocytosis.Discussion. CNS histoplasmosis is usually seen in patients with disseminated histoplasmosis. Isolated CNS histoplasmosis is rarely seen, especially in immunocompetent patients.Conclusions. Histoplasmosis should be considered in the differential diagnosis of patients experiencing slowly progressive neurological deficit.

Immunoglobulin-Induced Aseptic Meningitis in Juvenile Dermatomyositis: A Case Report

2021 ◽  
Author(s):  
Oi Man CHAN ◽  
Chon In Kuok ◽  
Hoi Man Roanna Yeung ◽  
Winnie Kwai Yu Chan
Keyword(s):  
Adverse Effect ◽  
Cerebrospinal Fluid ◽  
Aseptic Meningitis ◽  
Juvenile Dermatomyositis ◽  
Cerebrospinal Fluid Analysis ◽  
Ivig Infusion ◽  
Case Presentation ◽  
Neurological Sequelae ◽  
Fluid Analysis ◽  
Chinese Girl

Abstract Background: Aseptic meningitis is a known but unusual serious adverse effect of intravenous immunoglobulin (IVIG). It usually resembles infectious meningitis which makes diagnosis challenging. Case presentation: We report a five-and-a-half-year-old Chinese girl with juvenile dermatomyositis presented with signs of meningismus 21 hours after the initiation of IVIG infusion. Her blood work at diagnosis showed neutrophilia and lymphopenia. The cerebrospinal fluid analysis demonstrated neutrophilic pleocytosis, hyperproteinorrachia and normoglycorrhachia. All microbiological tests were negative. The child recovered fully within 72hours without neurological sequelae.Conclusion: IVIG-induced aseptic meningitis remains a diagnosis of exclusion. Although it is rare, paediatricians should be aware of this complication and avoid unnecessary investigation or treatment.

scholarly journals Miller Fisher syndrome following BNT162b2 mRNA coronavirus 2019 vaccination

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yamato Nishiguchi ◽  
Hirofumi Matsuyama ◽  
Kuniko Maeda ◽  
Akihiro Shindo ◽  
Hidekazu Tomimoto
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Miller Fisher Syndrome ◽  
Cerebrospinal Fluid Analysis ◽  
Fisher Syndrome ◽  
Case Presentation ◽  
Fluid Analysis ◽  
Positron Emission ◽  
Limb Ataxia ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. One of the vaccines approved against COVID-19 is the BNT162b2 mRNA COVID-19 vaccine (Pfizer/BioNTech). Case presentation We present the case of a 71-year-old man with no history of the SARS-CoV-2 infection or any recent viral or bacterial illnesses who presented with bilateral oculomotor palsy and limb ataxia after BNT162b2 mRNA COVID-19 vaccination. The diagnosis of Miller Fisher syndrome (MFS) was established based on physical examination, brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis (CSF), and positron emission tomography (PET). There was no evidence of other predisposing infectious or autoimmune factors, and the period from COVID-19 vaccination to the appearance of neurological symptoms was similar to that of other vaccines and preceding events, such as infection. Conclusion Guillain–Barré syndrome (GBS) and its variants after COVID-19 vaccination are extremely rare. Note that more research is needed to establish an association between MFS and COVID-19 vaccines. In our opinion, the benefits of COVID-19 vaccination largely outweigh its risks.

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.

A Clinical Study of Violence in Patients Referred on a Form I to a General Hospital Psychiatric Unit

1988 ◽  
Vol 33 (8) ◽  
pp. 711-715 ◽  
Author(s):  
A.J. Cooper
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Clinical Study ◽  
Hospital Stay ◽  
General Hospital ◽  
Alcohol Misuse ◽  
Psychiatric Ward ◽  
Violent Behaviour ◽  
Initial Management ◽  
Retrospective Examination

A retrospective examination of all patients referred by the emergency department of a medium sized general hospital for a mandated Form I psychiatric assessment during a 12 month period was conducted. The principal aim was an analysis of the clinical phenomena and especially the antecedents and course of violent behaviour (following admission and throughout the hospital stay) which in the majority of cases was the reason for the referral. Thirty percent had behaved violently prior to admission but within 24 hours all had settled and during the remainder of their hospital stay were indistinguishable from the generality of the ward population (for example, non-violent). Two-thirds of the patients were non-psychotic; that is, not suffering from a major mental illness; nevertheless, they required a disproportionate amount of time and effort in initial management. A high proportion had several prior admissions to the psychiatric ward, particularly for alcohol misuse and/or a personality disorder.

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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