Hastanede Yatan COVID-19 Tanılı Hastalarda Görülen Nörolojik Semptomlar ve Hastalık Şiddeti ile İlişkisi

Introduction: Coronavirus disease 2019 (COVID-19) spread rapidly all over the world, causing a pandemic. Neurological findings have also been reported in patients since the beginning of the pandemic. Recent data suggest that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has both neurotropic and neurovirulent effects. This study aimed to evaluate the presence of neurological findings in hospitalized patients with the diagnosis of COVID-19 and the relationship of these findings with the severity of COVID-19. Material and Methods: Patients, positive for SARS-CoV-2 and had an indication of hospitalization were included in the study. Demographic characteristics, systemic symptoms, laboratory values and computed chest tomography findings of the patients were recorded. Neurological findings of the patients were evaluated by an experienced neurologist, and the relationship between these findings and the disease severity was analyzed. Results: The median age of 66 patients (33 females, 33 males) included in the study was 34.5. Of the patients, 33 (50%) had mild, 28 (42.4%) had moderate, 5 (7.6%) had severe COVID-19. The most common symptom was fever (48.5%). At least one neurologic symptom was detected in 43 patients (65.2%). Dysgeusia (27.3%), hyposmia-anosmia (27.3%), headache (25.8%) and muscle pain (24.2%) were the most common neurological symptoms. Among mild COVID-19 patients, individuals with neurological symptoms had longer hospitalization periods, than the patients without neurological symptoms (p=0.017). Conclusion: Neurological symptoms were observed in the majority of patients with COVID-19 in this study. Besides this study revealed that neurological symptoms may occur not only in aged intensive care patients with COVID-19, but also in young patients, with mild COVID-19. Therefore the hospitalization period may be prolonged in this patient group. In conclusion, regardless of its severity, physicians should keep in mind that COVID-19 may be a potential risk factor for neurological disorders. Keywords: COVID-19, pandemic, neurological symptoms, nervous system invasion

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN A POSTPARTUM NORMOTENSIVE POST CESAREAN PATIENT - A CASE REPORT

Posterior reversible encephalopathy syndrome { PRES } is a reversible neurological entity characterised by seizures , headaches , visual symptoms , impaired consciousness and other focal neurological findings . There are a variety of causes behind this syndrome but eclampsia takes the lead and preeclampsia also significantly contributes . We present here a case of young postpartum woman with atypical findings and imaging results leading to diagnosis of PRES .

Incidence of Stroke and Other Brain Imaging Findings in Adult Patients with Sickle Cell Disease: A Retrospective Study

Background: Vaso-occlusion and hemolytic anemia are the main features of sickle cell disease. Central Nervous system complications of sickle cell disease (SCD) can include silent cerebral infarcts (SCI), hemorrhagic or ischemic strokes, seizures and Moyamoya syndrome. SCI is the most common neurological complications in SCD. SCI patients have abnormal Magnetic Resonance Imaging (MRI) of the brain with normal neurological examination and no history of stroke. More precisely, Casella et al in the Silent Cerebral Infarct Multi-Center Clinical trial (SIT) defined infarct as MRI signal abnormality that was at least 3 mm in one dimension and that was visible in two planes on fluid-attenuated inversion recovery T2 -weighted images, as determined by agreement of two of the three study neuroradiologists. SCI in children is associated with lower Intelligence Quotient and increased risk of stroke. Methods: In this retrospective study we reviewed 100 adult patients at our Comprehensive Sickle Cell Center. We looked at the incidence of documented stroke and other neurological complications in SCD patients. We reviewed the hospital records of SCD patients for any incidental brain imaging (MRI brain or Computed Tomography(CT) brain) findings, done as inpatient or in the emergency room as part of hospital visits. Results: Out of the 100 patients, 14 patients had documented stroke. On the review of other 86 patients, 10 patients had MRI brain, 23 patients had CT brain, and 53 patients had no brain imaging record. Out of the 10 patients with MRI brain, 7 patient had significant findings- 3 patients had small vessel ischemic changes, 1 patient with chronic petechial hemorrhage of cerebellar vermis, 1 patient with ischemic changes and Chiari malformation type 1 (CTM 1), 1 patient with CTM 1 and non-specific white matter changes and 1 patient with CTM 1 alone. Out of the 22 CT of the brain and 1 CT angiogram of brain, 2 imaging showed ischemic changes and the angiogram showed large cerebral vessel narrowing. Therefore, on our review, 19 patients out of 100 were found to have stroke and 24 out of 100 had significant neurological findings. However, only 14 out of 19 patients had documented stroke. 7 out the 10 patients with MRI brain had significant incidental neurological findings. The number of adult SCD patients with neurological findings in our cohort could have been higher, if we had brain imaging record for the 53 other patients. Conclusion: This study shows that there is a heavy burden of neurological complications in SCD patients and SCI is under-diagnosed. MRI brain is superior to CT brain in detecting neurological complications in SCD patients. SIT showed that regular blood-transfusion significantly reduced the recurrence of cerebral infarct in children with SCI. Finding of SCI in adults also warrants consideration for follow up brain imaging, neurology referral and discussion of treatment modalities including chronic blood transfusion and hydroxyurea therapy. CTM 1 can also be associated with SCD. In CTM 1, tonsil herniates 5 millimeter or below foramen magnum. SCD may cause increased thickness of calvarium from extramedullary hematopoiesis in skull, which can result in cranio-cephalic disproportion with cerebellar ectopia and subsequent CTM 1. Because of high incidence of neurological complications in SCD patients, routine screening with MRI brain should be considered in adult SCD patients. Disclosures Idowu: Forma Therapeutics, Inc.: Research Funding; Pfizer: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Ironwood: Research Funding.

Virtual reality-based neurological examination teaching tool(VRNET) versus standardized patient in teaching neurological examinations for the medical students: a randomized, single-blind study

Background The conventional methods for teaching neurological examination with real patients to medical students have some limitations if the patient with the symptom or disease is not available. Therefore, we developed a Virtual Reality-based Neurological Examination Teaching Tool (VRNET) and evaluated its usefulness in in teaching neurological examinations for the medical students. Methods In this prospective, randomized, single-blind study, we recruited 98 medical students and divided them into two groups: 1) A standardized patient(SP) group that received the clinical performance examination utilizing standard patients complaining of dizziness was provided neurological findings using conventional method such as verbal description, photographs, and video clips; 2) A SP with VRNET group that was provided the neurological findings using the newly developed tool. Among the 98 students, 3 did not agree to participate, and 95 were enrolled in this study. The SP group comprised 39 students and the SP with VRNET group had 56 students. Results There were no statistical differences in VRNET’s realness and student satisfaction between the SP and SP with VRNET groups. However, a statistically significant difference was found in the Neurologic Physical Exam (NPE) score (p = 0.043); the SP with VRNET group had higher NPE scores (3.81 ± 0.92) than the SP group (3.40 ± 1.01). Conclusions VRNET is useful in teaching senior (graduating) medical students with SP with a neurologic problem.

The need for neuroimaging in first manifestations of psychiatric symptoms

Background: Brain imaging in psychiatry, especially by first-episode psychiatric symptoms, is unfortunately not a standard procedure in psychiatric clinics and is recommended only if indicated by history or if associated with neurological findings. As a result, the most serious diagnoses can be delayed or missed. Case Description: We describe a patient who presented with psychiatric symptoms admitted initially to a psychiatric clinic. Thanks to routine imaging the diagnosis of a brain tumor could be made with prompt transfer to neurosurgery. Conclusion: Brain imaging should be a mandatory procedure upon admission to a psychiatric clinic also in patients who present with exclusive psychiatric symptoms.

DreamSenseMemory - a Gestalt-based dream-work approach embracing all our senses

Gestalt therapists believe that their task is to help their clients to experience repressed, ambivalent, and unpleasant things in order to accept and implement them in their whole self. To implement those ‘things’, those elements of the self, they need to be uncovered first, which is a process that often is achieved by dream work, as messages from the unconscious that are stuck in our dreams can be revealed by certain Gestalt-therapy methods. The method in focus is the newly developed DreamSenseMemory technique which is based on neurological findings on how the senses at play influence memory processing. Dream work with the DreamSenseMemory method has the advantage that by using this method on a regular basis, dream content will not only be remembered more often but also in more detail. Thus, effectively supporting dream work and its process of understanding the message of the unconscious, accepting the elements withing and implementing them in the self.

The associations between radiological and neurological findings of degenerative cervical myelopathy: radiological analysis based on kinematic CT myelography and evoked potentials of the spinal cord

OBJECTIVE Neurological and imaging findings play significant roles in the diagnosis of degenerative cervical myelopathy (DCM). Consistency between neurological and imaging findings is important for diagnosing DCM. The reasons why neurological findings exhibit varying sensitivity for DCM and their associations with radiological findings are unclear. This study aimed to identify associations between radiological parameters and neurological findings in DCM and elucidate the utility of concordance between imaging and neurological findings for diagnosing DCM. METHODS One hundred twenty-one patients with DCM were enrolled. The Japanese Orthopaedic Association (JOA) score, radiological parameters, MRI and kinematic CT myelography (CTM) parameters, and the affected spinal level (according to multimodal spinal cord evoked potential examinations) were assessed. Kinematic CTM was conducted with neutral positioning or at maximal extension or flexion of the cervical spine. The cross-sectional area (CSA) of the spinal cord, dynamic change in the CSA, C2–7 range of motion, and C2–7 angle were measured. The associations between radiological parameters and hyperreflexia, the Hoffmann reflex, the Babinski sign, and positional sense were analyzed via multiple logistic regression analysis. RESULTS In univariate analyses, the upper- and lower-limb JOA scores were found to be significantly associated with a positive Hoffmann reflex and a positive Babinski sign, respectively. In the multivariate analysis, a positive Hoffmann reflex was associated with a higher MRI grade (p = 0.026, OR 2.23) and a responsible level other than C6–7 (p = 0.0017, OR 0.061). A small CSA during flexion was found to be significantly associated with a positive Babinski sign (p = 0.021, OR 0.90). The presence of ossification of the posterior longitudinal ligament (p = 0.0045, OR 0.31) and a larger C2–7 angle during flexion (p = 0.01, OR 0.89) were significantly associated with abnormal great toe proprioception (GTP). CONCLUSIONS This study found that the Hoffmann reflex is associated with chronic and severe spinal cord compression but not the dynamic factors. The Babinski sign is associated with severe spinal cord compression during neck flexion. The GTP is associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.