scholarly journals Is the Frontal Lobe the Primary Target of SARS-CoV-2?

2021 ◽  
pp. 1-7
Author(s):  
Sofia Toniolo ◽  
Francesco Di Lorenzo ◽  
Marta Scarioni ◽  
Kristian Steen Frederiksen ◽  
Flavio Nobili
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Diagnostic Procedures ◽  
Frontal Lobes ◽  
Clinical Findings ◽  
Acute Encephalopathy ◽  
Biological Mechanisms ◽  
Primary Target ◽  
Clinical Biomarkers ◽  
18F Fdg ◽  
Standardized Diagnostic

Acute delirium and other neuropsychiatric symptoms have frequently been reported in COVID-19 patients and are variably referred to as acute encephalopathy, COVID-19 encephalopathy, SARS-CoV-2 encephalitis, or steroid-responsive encephalitis. COVID-19 specific biomarkers of cognitive impairment are currently lacking, but there is some evidence that SARS-CoV-2 could preferentially and directly target the frontal lobes, as suggested by behavioral and dysexecutive symptoms, fronto-temporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET imaging. We suggest that an inflammatory parainfectious process targeting preferentially the frontal lobes (and/or frontal networks) could be the underlying cause of these shared clinical, neurophysiological, and imaging findings in COVID-19 patients. We explore the biological mechanisms and the clinical biomarkers that might underlie such disruption of frontal circuits and highlight the need of standardized diagnostic procedures to be applied when investigating patients with these clinical findings. We also suggest the use of a unique label, to increase comparability across studies.

scholarly journals A Clinical Diagnostic System for Late-Stage Neuropsychiatric Lyme Borreliosis Based upon an Analysis of 100 Patients

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 13 ◽  
Author(s):  
Robert C. Bransfield ◽  
Dylan M. Aidlen ◽  
Michael J. Cook ◽  
Sagar Javia
Keyword(s):  
Lyme Disease ◽  
Clinical Assessment ◽  
Late Stage ◽  
Post Infection ◽  
Neuropsychiatric Symptoms ◽  
Light Sensitivity ◽  
Clinical Findings ◽  
Infection Prevalence ◽  
Memory Impairments ◽  
Infection Pattern

Many late-stage chronic Lyme disease clinical findings are neuropsychiatric. A total clinical assessment is critical in diagnosis, especially since controversy surrounds the reliability of laboratory testing. The clinical findings of one hundred Lyme disease patients with chronic neuropsychiatric symptoms were entered into a database. The prevalence of each clinical finding pre-infection and post-infection was compared and calculated within the 95% confidence interval. Patients had minimal symptoms pre-infection, but a high post-infection prevalence of a broad spectrum of acquired multisystem symptoms. These findings included impairments of attention span, memory, processing, executive functioning, emotional functioning, behavior, psychiatric syndromes, vegetative functioning, neurological, musculoskeletal, cardiovascular, upper respiratory, dental, pulmonary, gastrointestinal, genitourinary, and other symptoms. The most prevalent symptoms included sustained attention impairments, brain fog, unfocused concentration, joint symptoms, distraction by frustration, depression, working memory impairments, decreased school/job performance, recent memory impairments, difficulty prioritizing multiple tasks, fatigue, non-restorative sleep, multitasking difficulties, sudden mood swings, hypersomnia, mental apathy, decreased social functioning, insomnia, tingling, word finding difficulties, name retrieval, headaches, sound hypersensitivity, paresis, anhedonia, depersonalization, cold intolerance, body temperature fluctuations, light sensitivity and dysfluent speech. The average patient had five symptoms pre-infection and 82 post-infection. Pattern recognition is critical in making a diagnosis. This study was used to develop three clinical assessment forms.

Surgical treatment of syringomyelia

1984 ◽  
Vol 61 (3) ◽  
pp. 531-538 ◽  
Author(s):  
Nicholas M. Barbaro ◽  
Charles B. Wilson ◽  
Philip H. Gutin ◽  
Michael S. B. Edwards
Keyword(s):  
Operative Therapy ◽  
Diagnostic Procedures ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Sensory Loss ◽  
Content Type ◽  
Neurological Improvement ◽  
Leg Stiffness ◽  
Fine Print

✓ The authors reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia. Syringoperitoneal (SP) shunting was used in 15 patients and other procedures were used in 24 patients. Follow-up periods ranged from 1½ to 12 years. During the period of this study, metrizamide myelography in conjunction with early and delayed computerized tomography scanning replaced all other diagnostic procedures in patients with syringomyelia. Preoperative accuracy for the two procedures was 87%. The most common symptoms were weakness (79%), sensory loss (67%), pain (38%), and leg stiffness (28%). Surgery was most effective in stabilizing or alleviating pain (100%), sensory loss (81%), and weakness (74%); spasticity, headache, and bowel or bladder dysfunction were less likely to be reversed. Approximately 80% of patients with idiopathic and posttraumatic syringomyelia and 70% of those with arachnoiditis improved or stabilized. Better results were obtained in patients with less severe neurological deficits, suggesting the need for early operative intervention. A higher percentage of patients had neurological improvement with SP shunting than with any other procedure, especially when SP shunting was the first operation performed. Patients treated with SP shunts also had the highest complication rate, most often shunt malfunction. These results indicate that SP shunting is effective in reversing or arresting neurological deterioration in patients with syringomyelia.

scholarly journals CT, [18F]FDG-PET/CT and clinical findings before and during early Covid-19 onset in a patient affected by vascular tumour

2020 ◽  
Vol 47 (7) ◽  
pp. 1769-1770 ◽  
Author(s):  
Margarita Kirienko ◽  
Barbara Padovano ◽  
Gianluca Serafini ◽  
Alfonso Marchianò ◽  
Alessandro Gronchi ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Clinical Findings ◽  
Vascular Tumour ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals Nationwide questionnaire data of 229 Williams-Beuren syndrome patients using WhatsApp tool

2021 ◽  
Vol 79 (11) ◽  
pp. 950-956
Author(s):  
Lucas Vieira Lacerda Pires ◽  
Rogério Lemos Ribeiro ◽  
Adriana Modesto de Sousa ◽  
Bianca Domit Werner Linnenkamp ◽  
Sue Ellen Pontes ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Learning Difficulties ◽  
Failure To Thrive ◽  
Clinical Findings ◽  
First Year ◽  
Medical Specialties ◽  
Abdominal Colic ◽  
Age Of Diagnosis ◽  
Tract Infections ◽  
Emotional Dependence

ABSTRACT Background: Williams-Beuren syndrome is a multisystemic disorder caused by a microdeletion of the 7q11.23 region. Although familial cases with autosomal dominant inheritance have been reported, the vast majority are sporadic. Objective: To investigate the main complaints and clinical findings of patients with Williams-Beuren syndrome. Methods: A total of 757 parents of patients registered in the Brazilian Association of Williams-Beuren Syndrome (ABSW) received a questionnaire via WhatsApp from March to July 2017. Results: In total, 229 parents answered the survey. Age of diagnosis ranged from 2 days to 34 years (median: 3 years). The main clinical findings reported by the parents were abdominal colic (83.3%), failure to thrive (71.5%), feeding difficulty in the first year (68.9%), otitis (56.6%), urinary tract infections (31.9%), precocious puberty (27.1%) and scoliosis (15.9%). Cardiac defects were present in 66% of patients, and the most frequent defect was supravalvular aortic stenosis (36%). Arterial hypertension was reported in 23%. Hypercalcemia was reported in 10.5% of patients, mainly during the first year of life. Hyperacusis and hypersociability were common complaints (both present in 89%). Other behavioral and neuropsychiatric symptoms reported by the parents included attention deficit (89%), anger crises (83%), excessive fear (66%), depression (64%), anxiety (67%) and hypersexuality (33%). The most common complaints were hypersensitivity to sounds, talkative personality, emotional dependence and learning difficulties. In 98.3%, the parents denied family history. Conclusions: Williams-Beuren syndrome requires close follow-up with different medical specialties due to their variable clinical comorbidities, including language and school learning difficulties, behavioral and psychiatric problems.

scholarly journals Multiple Intraoral Venous Malformations In A Geriatric Patient- A Rare Case Report

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Case Report ◽  
Venous Malformation ◽  
Dorsal Surface ◽  
Diagnostic Procedures ◽  
Ventral Surface ◽  
Clinical Findings ◽  
Clinical Aspects ◽  
Venous Malformations ◽  
Arteriovenous Anastomosis ◽  
Rare Case Report

Venous malformation (VM) is defined as a simple malformation with slow flow and an abnormal venous network. This is caused by a disturbance in the late stages of angiogenesis (trunal stage) resulting in the persistence of arteriovenous anastomosis present during embryonic life. This case report describes an unusual case of multiple intraoral venous malformations with questionable augmentation. A 65 year-old female had reported with a complaint of discomfort in mouth since 8 years. Intraoral examination revealed presence of six spherical swellings (three on dorsal surface of tongue, one on ventral surface of tongue and two on left buccal mucosa) with bluish-violet hue, approximately 2 to 3 cm in diameter each. On the basis of history and clinical findings, vascular malformation was provisionally suspected. Adequate imaging established the diagnosis. A review of clinical aspects, diagnostic procedures as well as therapeutic options currently available for venous malformations are discussed in this article.

scholarly journals Impact of 18F-FDG PET/CT in Predicting Recurrence in Neurolymphomatosis

Hemato ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 596-606
Author(s):  
Megumi Uemichi ◽  
Kota Yokoyama ◽  
Junichi Tsuchiya ◽  
Toshiki Terao ◽  
Youichi Machida ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Medical Center ◽  
Clinical Findings ◽  
University Hospital ◽  
Nerve Lesions ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Tokyo Medical

To clarify the prognostic value of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in Neurolymphomatosis (NL), we retrospectively reviewed medical records of all NL patients who had undergone 18F-FDG PET/CT from 2007 to 2020 at Kameda Medical Center and Tokyo Medical and Dental University Hospital. The clinical data of patients were compared with 18F-FDG PET/CT findings of number of nerve lesions and presence of non-nerve extranodal lesions (ENL). Subsequently, we calculated recurrence-free survival (RFS) and overall survival (OS) using the Kaplan–Meier method. A total of 28 patients (mean age 70.1 years, range 44–87 years; 15 women) were included in the study and 7 patients (25.0%) relapsed NL. The number of nerve lesions detected by 18F-FDG PET/CT ranged from 1 to 5, with an average of 2.02. ENL was observed in 18 cases (64.3%). The comparison between the findings revealed that the more the lesions detected by 18F-FDG PET/CT, the higher the probability of recurrence (χ2 = 13.651, p = 0.0085) and there was significantly shorter RFS for the patients with 3 or more nerve lesions (p = 0.0059), whereas the presence of ENL was not significantly associated with any clinical findings. The present study revealed that the more nerve lesions detected by 18F-FDG PET/CT, the poorer the recurrence rate and RFS.

Antioxidant therapy in a patient with Hyperprolinemia type I presented with mild neuromotor retardation and speech disturbance

2020 ◽  
Author(s):  
Melike Ersoy ◽  
Semra Yılmaz ◽  
Serdar Ceylaner
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Clinical Findings ◽  
Antioxidant Therapy ◽  
Screening Tests ◽  
Psychomotor Development ◽  
Type I ◽  
Speech Disturbance ◽  
Chromosome 22Q11 ◽  
Long Term Follow Up

Abstract Background: Hyperprolinemia type 1 (HPI) is an autosomal recessive inborn disease caused by mutations/deletions of PRODH gene, which is located on chromosome 22q11. The clinic spectrum involves mainly delayed psychomotor development, mild-to-severe mental retardation, neuropsychiatric symptoms and epilepsy. Although HPI can easily be diagnosed in patients undergoing metabolic screening tests, there is no effective therapy protocol in use. There are studies showing that it does most of its clinical findings by disrupting mitochondria function. Case report: We present a long-term follow-up of a four-year-old girl with mild neuromotor retardation and speech disturbance, diagnosed with HPI and treated with antioxidant therapy (vitamin C, CoenzymeQ10, vitamin B complex and L-carnitine) for six years. It has been shown that antioxidant therapy decreases proline levels properly and provides clinical improvement.

scholarly journals CREST Syndrome - a Limited Form of Systemic Scleroderma: a Case Report and Literature Review

2015 ◽  
Vol 7 (3) ◽  
pp. 97-114 ◽  
Author(s):  
Mirjana Paravina ◽  
Milenko Stanojević ◽  
Ljiljana Spalević ◽  
Dragana Ljubisavljević ◽  
Zorana Zlatanović ◽  
...  
Keyword(s):  
Literature Review ◽  
Raynaud’S Phenomenon ◽  
Clinical Manifestations ◽  
Diagnostic Procedures ◽  
Raynaud's Phenomenon ◽  
Clinical Findings ◽  
Systemic Scleroderma ◽  
Crest Syndrome ◽  
Multisystem Disease ◽  
Therapeutic Modalities

Abstract Systemic scleroderma (SSc) is a multisystem disease with microvascular abnormalities, autoimmune disorders, excessive collagen production and deposition, and fibrosis of the skin and internal organs. According to the simplest, though incomplete classification, there are two forms of SSc: diffuse and limited (formerly acrosclerosis). CREST syndrome is a subtype of limited SSc, characterized by: calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. We present a patient with all the features of the CREST syndrome, which appeared at the age of 43 and lasted for 23 years. The patient presented with a gradual development of symptoms during the first ten years, from Raynaud’s phenomenon, skin sclerosis, calcinosis, telangiectasia, and esophageal dysmotility. The diagnosis was based on clinical findings and relevant diagnostic procedures. The article presents a literature review on the epidemiology, etiology, pathophysiology, clinical manifestations, various attempts at classification, diagnostic criteria, and therapeutic modalities. When classifying systemic scleroderma into two main types — diffuse and limited, with CREST syndrome as a variant of the latter, it should be pointed out that both types represent clinical forms of systemic sclerosis, share similar visceral involvement, laboratory abnormalities and course which is variable, as was the case in our patient.

scholarly journals Stroke-Like Hemiparesis During Acute Lymphoblastic Leukemia Treatment

Acta Medica ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 43-48
Author(s):  
İnci Yaman Bajin ◽  
Barış Kuşkonmaz ◽  
Şule Ünal ◽  
Selin Aytaç ◽  
Mualla Çetin ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Lymphoblastic Leukemia ◽  
Altered Mental Status ◽  
Clinical Findings ◽  
Restricted Diffusion ◽  
High Dose ◽  
Acute Encephalopathy ◽  
Mri Findings ◽  
Blurred Vision ◽  
Leukemia Treatment

In this case report; a 12-year-old male with ALL who developed transient left hemiparesis associated with dysphasia and central facial paralysis 14 days after high dose methotrexate (5g/m2) and intrathecal MTX (12 mg, according to age) treatment has been reported. Cranial magnetic resonance imaging (MRI) revealed restricted diffusion in bilateral centrum semiovale compatible with MTX-induced acute encephalopathy. All clinical symptoms resolved completely without any treatment. Clinical findings including headache, nausea, emesis, lethargy, altered mental status, blurred vision, aphasia, dysphasia, hemiparesis and cranial MRI findings of restricted diffusion that does not comply with the territory of ​​any artery seizure should alert the physician for MTX-induced acute encephalopathy.

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