Severe Fever with Thrombocytopenia Syndrome Accompanied by Invasive Pulmonary Aspergillosis: An Autopsy Case

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease in China, Korea, and Japan caused by the SFTS virus (SFTSV). SFTS has a high mortality rate due to multiorgan failure. Recently, there are several reports on SFTS patients with mycosis. Here, we report a middle-aged Japanese SFTS patient with invasive pulmonary aspergillosis (IPA) revealed by an autopsy. A 61-year-old man with hypertension working in forestry was bitten by a tick and developed fever, diarrhea, and anorexia in 2 days. On day 4, consciousness disorder was appearing, and the patient was transferred to the University of Miyazaki Hospital. A blood test showed leukocytopenia, thrombocytopenia, as well as elevated levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. The SFTSV gene was detected in serum using a reverse-transcription polymerase chain reaction. On day 5, respiratory failure appeared and progressed rapidly, and on day 7, the patient died. An autopsy was performed that revealed hemophagocytosis in the bone marrow and bleeding of several organs. IPA was observed in lung specimens. SFTSV infection may be a risk factor for developing IPA. Early diagnosis and treatment of IPA may be important in patients with SFTS.

Neuropsychological Tests in Post-operative Cognitive Dysfunction: Methods and Applications

Post-operative cognitive dysfunction (POCD) is a neurological complication that relatively frequently occurs in older people after anesthesia/surgery, with varying durations and significant differences in the severity of cognitive impairment. POCD is mainly characterized by memory loss mostly without consciousness disorders, accompanied by abnormal emotions, behaviors, and language, mostly without consciousness disorder. The clinical performance of POCD lacks specificity but can reflect the severity of cognitive impairment in patients. The diagnosis of POCD cannot be separated from the evaluation of perioperative cognitive function of patients, and the more popular and accepted method is neuropsychological tests (NPTs).

Self-Related Stimuli Decoding With Auditory and Visual Modalities Using Stereo-Electroencephalography

Name recognition plays important role in self-related cognitive processes and also contributes to a variety of clinical applications, such as autism spectrum disorder diagnosis and consciousness disorder analysis. However, most previous name-related studies usually adopted noninvasive EEG or fMRI recordings, which were limited by low spatial resolution and temporal resolution, respectively, and thus millisecond-level response latencies in precise brain regions could not be measured using these noninvasive recordings. By invasive stereo-electroencephalography (SEEG) recordings that have high resolution in both the spatial and temporal domain, the current study distinguished the neural response to one's own name or a stranger's name, and explored common active brain regions in both auditory and visual modalities. The neural activities were classified using spatiotemporal features of high-gamma, beta, and alpha band. Results showed that different names could be decoded using multi-region SEEG signals, and the best classification performance was achieved at high gamma (60–145 Hz) band. In this case, auditory and visual modality-based name classification accuracies were 84.5 ± 8.3 and 79.9 ± 4.6%, respectively. Additionally, some single regions such as the supramarginal gyrus, middle temporal gyrus, and insula could also achieve remarkable accuracies for both modalities, supporting their roles in the processing of self-related information. The average latency of the difference between the two responses in these precise regions was 354 ± 63 and 285 ± 59 ms in the auditory and visual modality, respectively. This study suggested that name recognition was attributed to a distributed brain network, and the subsets with decoding capabilities might be potential implanted regions for awareness detection and cognition evaluation.

Acute Percheron Infarction: A Precision Learning

Background: So far, the diagnosis of acute AOP infarction is uncommon. The purpose of our study was to characterize the relationship between the imaging spectrum of acute AOP infarction and its clinical manifestations and prognosis on the basis of 23 cases.Methods: A total of 23 patients with acute AOP infarction in our institution from 2014 to 2019 were reviewed retrospectively. All cases were evaluated with computed tomography (CT), magnetic resonance imaging (MRI), detailed clinical and evaluated prognosis used a modified Rankin scale (mRs), blood studies, electrocardiogram and transthoracic echocardiography. All standard risk factors were recorded in these patients. mRs scores 90 days after discharge. Results: We identified 4 various patterns of acute AOP infarction: (1) bilateral paramedian thalamic infarction (BPTI, 52%), (2) bilateral paramedian thalamic with rostral midbrain infarction (BPTRMI, 30%), (3) bilateral paramedian and anterior thalamic infarction (BPATI, 13%), and (4) bilateral paramedian thalamic with red nuclei infarction (BPTRNI, 4%). These patients had consciousness disorder, memory dysfunctions, vertical gaze paresis, mesencephalothalamic syndrome and so on. The 65% patients with BPTI and BPATI who experienced a good functional recovery and could carry out daily life activities (mRS score ≤ 2). However, patients with BPTRMI who have an unfavorable outcome.Conclusion: Although the clinical feature of patients with AOP infarction is variable, DWI or ADC map can improve the diagnosis of acute AOP infarction patterns. Acute AOP occlusion requires immediate diagnosis and treatment initiation for a more favorable outcome and additional unnecessary procedures.

Consciousness Emanates from the Neuronal Network of Coordination, A Fact Endorsed by Preserved Consciousness in Focal Ischemic Infarctions

Background: Consciousness has remained a difficult problem for the scientists to explore its relationship to the brain activity. This is the first paper that presents the significance of focal areas of the cerebral cortex for consciousness. Objectives: To determine if consciousness is produced by the activity of the whole brain or one of its focal areas. Methods: We have performed a prospective cross-sectional study in eighty patients of acute ischemic stroke. The neurovascular territory of the middle cerebral artery (MCA) was sectioned into four similar areas. The association of any of these focal areas to consciousness was observed after their dysfunction with ischemic strokes. Results: Of the eighty patients, 57.5 % were males and 42.5 % were females. Mean age was 63 years ± 7 SD. The righthanded patients were 90 % (72) of the whole sample. Focal areas of the right MCA were generally less prone to consciousness disorder. Average statistics of the focal infarctions of the right MCA showed no tendency for consciousness disorder on the Glasgow coma scale (GCS) [Mean GCS of all focal areas; 14.5, SD; 0.71, 95 % CI; 14.27 to 14.72, P= 0.0000004]. Altered consciousness with focal infarctions of the territory of left MCA was also less likely [Mean GCS of all focal areas; 14.2, SD; 1.01, 95 % CI; 13.88 to 14.51, P= 0.0004]. Conclusion: Consciousness is not determined by the activity of a focal area of the cerebral cortex. Perhaps, we get our consciousness from the activity of “Neuronal Network of Coordination”.

PR interval as a predictor of syncope in tilt-up testing in adolescents and young adults

Background Syncope, as the most frequent consciousness disorder, is very common in young individuals. The aim of this study was to analyze ECG parameters and clinical properties obtained during tilt-up testing in 12 to 30-year-old subjects. We enrolled a total of 142 patients from our outpatient clinic (39 males, 103 females) with a true positive tilt-up test and analyzed ECG records obtained during tilt-testing. Data were stratified according to the age, gender, and type of syncope. Results PR interval shortening preceding syncope was found in all syncope types, irrespective of the gender. All types of syncope were more frequent in women (72.5%). Mixed syncope type was found to be the most common (47.18%). Male and female subjects differed in initial heart rate (71.56 vs 76.23/min, p=0.05), as well as heart rate dynamics during tilt-up testing. A gender difference was also found in systolic blood pressure (116.92 vs 110.44 mmHg, p<0.01), time to syncope onset (20.77 vs. 16.44 min, p=0.03), and the total number of syncopal episodes in patient history (2.79 vs. 4.62, p<0.05). Subjects with cardioinhibitory syncope had the longest PR interval (average 154.3 ms). PR interval prolongation and loss of variability during tilt-up testing positively correlated with aging (r=0.22, p<0.05). Nodal rhythm was found in 8 patients. Conclusion PR interval shortening on ECG tracings during a tilt-up test can be found in all subtypes of vasovagal syncope, thereby contrasting previous reports that these changes are a hallmark of the cardioinhibitory type of syncope. PR shortening, if observed during ECG monitoring, could be a potential predictor of syncope.

The effectiveness of therapy correction in children with paroxysmal disorders of consciousness based on the results of video electroencephalographic monitoring

Background. An important condition for adequate drug therapy is the early differential diagnosis of paroxysmal conditions in children, the estab lishment or clarification of their epileptic or non-epileptic nature.Objective: to demonstrate the necessity, effectiveness and safety of the correction therapy in children with paroxysmal disorders of consciousness according to results of complex investigation, including video-electroencephalographic monitoring.Materials and methods. A comprehensive examination with the inclusion of video-electroencephalographic monitoring was carried out in 527 pa tients referred by neurologists to clarify the nature of paroxysmal consciousness disorder, clarify the form of epilepsy, and select an adequate treatment.Results. Based on the results obtained during the comprehensive examination of children with video-electroencephalographic monitoring, in all the examined children the diagnosed was corrected. According to the results of the survey, it was found that 210 children had non-epileptic paroxysms. In the overwhelming majority of cases, the treatment was changed.Conclusions. The presented results of treatment of children with epileptic and non-epileptic paroxysms after correction of treatment indicate the need for careful analysis of all data (clinical and anamnestic, electroencephalographic, laboratory) for correct diagnosis, identification of causes of resistance and reasonable selection of therapy in each patient.

Evaluation of IL-8 level in cerebrospinal fluid in acute bacterial meningitis in adults

Background: Interleukin 8 increases in various types of meningitis, specifically acute bacterial meningitis inflammation, and it is important in the distinction between types of meningitis. The present paper aims at evaluation of the level of interleukin 8 in cerebrospinal fluid in acute adult bacterial meningitis. Methods: All adult patients’ with diagnosis of suspected meningitis with symptoms of fever, headache, neck stiffness, and consciousness disorder. Lumbar puncture was taken in between the third and fourth vertebra by a specialist physician for all patients suspected with meningitis. To determine the level of consciousness, the GCS of the patients was determined and the cerebrospinal fluid was cultured and sent to the laboratory for the analyses of cell count, diffraction, CSF fluid glucose, CSF fluid protein, LDH, or lactate dehydrogenase, and the level of interleukin 8. Results: The mean of IL-8 protein was 296.17±48.57Pg/ml in patients with aseptic meningitis and 1088.96±526.55Pg/ml in the group of patients with septic meningitis. There was a significant difference between the two groups in terms of the amount of interleukin 8 (p = 0.009). Cutoff was 297.6 Pg/ml for the detection of positive bacterial meningitis with a sensitivity of 92% and the specificity of 83.1% was 297.6 pg/ml. Conclusion: Interleukin 8 has a high sensitivity and specificity in the diagnosis of bacterial meningitis from aseptic meningitis, and along with the measurement of cerebrospinal fluid protein, it can be a good criterion for differentiation of bacterial from aseptic meningitis.

Effect of COVID-19 on Epidemiological Characteristics of Road Traffic Injuries in Suzhou:A Retrospective Study

Background: To present the new trends in epidemiology of road traffic injuries (RTIs) in Suzhou under the impact of Coronavirus disease 2019 (COVID-19) and control measures.Methods: Pre-hospital care records of RTIs in January-May 2020 and January-May 2019 were collected from the database of Suzhou emergency center, Jiangsu, China， and relevant clinical data were extracted for a retrospective study. RTIs in 2020 and 2019 were defined as observation group and control group respectively.Results: There were 7288 RTIs in the observation group, accounting for 82.17% of the control group. The number of RTIs per month from January to May in the observation group were 79.72%, 47.69%, 79.30%, 85.72% and 99.39% of the control group, respectively. Subgroup analysis showed that the number and composition ratio of electric bicycle related RTIs in the observation group were significantly higher than those in the control group (2641, 36.24% vs 2380, 26.84%, P<0.001). We observed a statistically significant increase in proportion of RTIs with consciousness disorder in the observation group compared to the control group (7.22% vs 6.13%, P = 0.006).Conclusions: Under the impact of COVID-19, the total number of RTIs in Suzhou from January to May 2020 decreased obviously. Nevertheless, there was an obvious rise in electric bicycle related RTIs, and the proportion of RTIs with consciousness disorder also increased. It is necessary for electric bicycle riders to wear helmets.

Nonconvulsive status epilepticus associated with Alzheimer’s disease mimicking symptomatic focal epilepsy following the resection of a frontal parasagittal meningioma

Background: Epilepsies are frequent in patients with Alzheimer’s disease (AD); however, epilepsies in AD can easily go unrecognized because they usually present as focal impaired awareness seizures or nonconvulsive status epilepticus (NCSE) and can overlap with other symptoms of AD. Case Description: We performed an epilepsy surgery in a 69-year-old woman with progressive cognitive impairment and consciousness disorder, who was diagnosed with focal NCSE related to the resected meningioma in the right frontal parasagittal region. Intraoperative electrocorticography revealed localized periodic paroxysmal discharges with beta and gamma activities in the neighboring cortex where the meningioma existed. The histopathological diagnosis of AD was first made from the resected epileptogenic cortex. Conclusion: Even when there is a suspected epileptogenic lesion that could cause focal NCSE, AD should be ruled out in elderly patients with progressive cognitive decline.