Manifestaciones neurológicas en una paciente con lupus eritematoso sistémico / Neurological manifestations in a patient with systemic lupus erythematosus

El lupus eritematoso sistémico es una enfermedad inflamatoria sistémica cuyo proceso inflamatorio genera un importante número de manifestaciones clínicas articulares y extraarticulares. Entre las manifestaciones extraarticulares destaca la afectación neurológica, y el compromiso puede ser tanto a nivel del sistema nervioso central o periférico. El objetivo de la presente investigación es presentar el caso de una paciente de 56 años de edad, con diagnóstico de lupus eritematoso sistémico de 18 años de evolución quien presentó un cuadro crónico de cefalea, neuropatía periférica y miastenia gravis como manifestaciones neurológicas de la enfermedad. Con el tratamiento de ciclofosfamida y el aumento de la dosis de esteroide, en la actualidad la paciente se encuentra estable. El reporte de este caso hace hincapié en la importancia que revisten las manifestaciones neurológicas como parte de las manifestaciones extraarticulares de esta enfermedad, ya que este tipo de afección es determinante en el curso del lupus eritematoso sistémico y en la calidad de vida de los pacientes(AU)

Systemic lupus erythematosus is a systemic inflammatory disease whose inflammatory process generates a significant number of articular and extra-articular clinical manifestations. Within the extra-articular manifestations, neurological involvement stands out, among others, the commitment can be both at the level of the central or peripheral nervous system. The objective of the present investigation is to present the case of a 56-year-old patient, diagnosed with systemic lupus erythematosus of 18 years of evolution and who has presented chronic symptoms of headache, peripheral neuropathy and myasthenia gravis as neurological manifestations of the illness. The report of this case is considered important to publicize the importance of neurological manifestations as part of the extra-articular manifestations of this disease; this type of condition is decisive in the course of the disease and in the quality of life of patients(AU)

Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

Clinico-hematological profile of children with Dengue and co-infection with Malaria: a hospital based study

Background: The two most common vector borne diseases in the world are malaria and dengue. Co-infection infection is not unusual in a geographical region such as India, wherein both the vectors coexist. This study aimed to determine whether simultaneous malaria and dengue infection is serious in children than mono infection alone.Methods: In this study all children with fever of less than 7 days duration were included in the study. Clinical inspection and laboratory analysis were performed in all instances, following a detailed history. Children were categorized under 3 categories, malaria (M), dengue (D) and coinfection (DM). For any statistical difference between groups, their clinical as well as hematological parameters were analyzed. SPSS software was used for the statistical studies.Results: Malarial chills fever was also found in a substantial percentage of children with dengue. Superficial as well as profound bleeding were seen more often in the coinfected DM groups than D or M alone. In M group alone, jaundice and diarrhea were noted. In the segregated M and DM groups, the neurological indication, neurological involvement such as altered sensorium and seizure was noted at the same rate, whereas, there had been no occurrence in D group. Anemia was reported in all children, but M group showed the highest drop.Conclusions: Severity criteria, neurological involvement such as altered sensorium and seizures were reported at same rate both in malaria and coinfection, whereas, none of the patients with dengue showed signs of seizure. Anemia relative to hematologic parameters, was considerably more prevalent in the malaria patients. Presence of bleeding in malaria and jaundice in dengue patients, should be considerably investigated for a coinfection.

Pediatric risk of mortality III score in predicting mortality in children with altered sensorium in pediatric intensive care unit

Background: The Pediatric Risk of Mortality (PRISM) Score has been devised to predict outcome and risk of mortality. The PRISM III score is one of the most recent scoring systems of pediatric mortality. This was developed involving 32 PICUs. Physiological data included the most abnormal values from the first 12 and second 12 hours of the PICU stay. To evaluate the mortality rate in children with altered sensorium by applying PRISM III (pediatric risk of mortality) score.Methods: This study was done in the paediatric intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India on 100 children of both sexes aged between 1 month and 13 years. The study was carried out for a period from December 2017 to July 2018. PRISM III scoring scale was applied for every child in his/her first 24 hours of PICU admission and their calculated score was recorded into the proforma. The clinical details at admission, laboratory data were recorded into the proforma.Results: Three major groups that contributed to the bulk of the admissions were acute CNS infection, seizure disorder and, bites and stings. They constituted to around 54% of our total admissions. As PRISM III Score increases there is a steady increase in the mortality rate. This table shows that the mortality rate is 0% for the 0-9 group and that it increases to 100% for 20-29 and 30 and above groups as the PRISM III score increase.Conclusions: PRISM III score provides an objective assessment of the severity of illness. PRISM III, when performed well, is good to predict mortality in an Indian PICU. Scoring systems with fewer laboratory parameters will be more useful in author's context. Larger studies are needed to develop/validate a mortality prediction score for our country.

Evaluation of the utility of IMNCI algorithm in predicting illness, hospitalization, and management of children aged 2 months to 5 years in a tertiary referral centre

Background: India has around 240 million under-five children and contributes close to 25% of under-five mortality. About 70% of such deaths are due to diarrhea, pneumonia, measles, malaria or malnutrition and often a combination of these conditions. These are also the diseases that are seen to afflict three out of every four sick children seeking care at a health facility. Aim of the study: To evaluate the utility of the WHO / UNICEF guidelines for “Integrated Management of Neonatal and Childhood Illness” among children aged two months to five years attending an Urban center. Materials and methods: This Prospective observational study was did in the outpatient department and emergency room, The Institute of child Health and Hospital for Children, Egmore, Chennai. Children attending the outpatient department and emergency room aged between 2 months and 5 years for the first time for a fresh complaint due to any illness were included in the study. Each study subject was assessed and classified according to IMNCI guidelines and the treatment options were identified and recorded in a proforma. Each child was evaluated using IMNCI algorithms for high Venkatesh Periasami, Senthilkumar Palanivelu. Evaluation of the utility of IMNCI algorithm in predicting illness, hospitalization, and management of children aged 2 months to 5 years in a tertiary referral centre. IAIM, 2019; 6(3): 73-82. Page 74 malaria risk areas and low malaria risk areas. The IMNCI algorithm was split into four modules dealing with specific complaints (cough/breathing difficulty, diarrhea, fever, ear problems) and the classification and treatment options arrived at for each child on applying the specific split algorithms guided by the presenting complaints were also noted. Results: 517 complaints were reported by the parents/other caregivers accompanying the children enrolled in the study; an average of 1.72 complaints per child. depicts the frequency of these symptoms. Over 43% (227) of such complaints comprised of respiratory problems such as cough or difficulty in breathing. One-fourth of all presenting complaints (125) were fever and another 10% (56) consisted of loose or bloody/mucoid stools. Other complaints frequently reported were convulsions (15, 2.9%), vomiting everything (14, 2.7%), lethargy/unconsciousness (11, 2.1%), not being able to drink/breastfeed (11, 2.1%) and ear problems (9, 1.7%). Conclusion: Multiple diagnoses are the rule than an exception in under five sick children. Hence vertical, disease-specific algorithms are inappropriate in the evaluation and management of a sick child. Integrated approaches must be preferred. The IMNCI algorithm can address most complaints that sick children present with. When implemented by health workers with appropriate training, the referral criteria of IMNCI are fairly good predictors of serious illness which requires medical attention.

Behçet’s Disease: A Case Series of 5 Patients in the Department of Dermatology, Hospital Kuala Lumpur, Malaysia

Behcet’s disease (BD) is a variant of systemic vasculitides characterized by recurrent oral aphthous ulcers, recurrent genital ulcers with eyes, cutaneous, gastrointestinal, joints, neurological and others organ involvement. Here we aim to describe the demography, clinical patterns and the treatment of 5 cases of BD presented to the Department of Dermatology Hospital Kuala Lumpur between 2002 and 2016. All the patients had a delay in their diagnosis. The clinical characteristics and the choices of treatment in our patients did not differ greatly compared to the reports from other countries. BD could be under-diagnosed in Malaysia as the presenting symptoms are non-specific. Therefore, a high index of suspicion is needed.

Epilepsy and Other Neuropsychiatric Manifestations in Children and Adolescents with 22q11.2 Deletion Syndrome

BACKGROUND AND PURPOSE: 22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome. Epilepsy and other neuropsychiatric (NP) manifestations of this genetic syndrome are not uncommon, but they are also not well-understood. We sought to identify the characteristics of epilepsy and other associated NP manifestations in patients with 22q11.2DS. METHODS: We retrospectively analyzed the medical records of 145 child and adolescent patients (72 males and 73 females) with genetically diagnosed 22q11.2DS. The clinical data included seizures, growth chart, psychological reports, development characteristics, school performance, other clinical manifestations, and laboratory findings. RESULTS: Of the 145 patients with 22q11.2DS, 22 (15.2%) had epileptic seizures, 15 (10.3%) had developmental delay, and 5 (3.4%) had a psychiatric illness. Twelve patients with epilepsy were classified as genetic epilepsy whereas the remaining were classified as structural, including three with malformations of cortical development. Patients with epilepsy were more likely to display developmental delay (odds ratio=3.98; 95% confidence interval=1.5-10.5; p=0.005), and developmental delay was more common in patients with structural epilepsy than in those with genetic epilepsy. CONCLUSIONS: Patients with 22q11.2DS have a high risk of epilepsy, which in these cases is closely related to other NP manifestations. This implies that this specific genetic locus is critically linked to neurodevelopment and epileptogenesis.

Parkinsonism and brain mri findings in a relapsed culture-proven Salmonella typhi infection: a case report in Malaysia

Typhoid fever is a systemic infection caused by Salmonella typhi, which may be associated with extra-intestinal complications. Neurological manifestations, particularly Parkinsonism, are rarely reported. We report a 17-year-old patient with relapsed culture-proven Salmonella typhi infection who developed septic shock and subsequently Parkinsonism. Lumbar puncture revealed acellular cerebrospinal fluid with raised protein level. Magnetic resonance imaging revealed cerebral petechial haemorrhages resulted from small vessels vasculitis. His symptoms resolved spontaneously after 3 months.

Dengue encephalitis-A rare manifestation of dengue fever

The clinical spectrum of dengue fever ranges from asymptomatic infection to dengue shock syndrome. Dengue is classically considered a non-neurotropic virus. Neurological complications are not commonly seen in dengue. The neurological manifestations seen in dengue are encephalitis, meningitis, encephalopathy, stroke and Guillain-Barré syndrome. Dengue encephalitis is a rare disease. We report an interesting case of dengue encephalitis from Southern India. A 49-year-old gentleman presented with fever, altered sensorium and seizures. Dengue NS-1 antigen test was reactive. Dengue IgM was also positive. CSF PCR was negative for herpes simplex 1 & 2. Dengue encephalitis should be considered in the differential diagnosis of fever with altered sensorium, especially in countries like India where dengue is rampant.

Ankylosing Spondylitis Associated with Acute Transverse Myelitis / 대한내과학회지

Neurological manifestations as extra-articular features of ankylosing spondylitis (AS) have not been reported often, and present as root lesions, cauda equina syndrome, and compression of the spinal cord. We report a 31-year-old man who complained of back pain and claudication of both lower extremities. The patient showed typical inflammatory back pain and significant sacroiliitis, consistent with AS. He also had mechanical back pain and unexplained neurological symptoms. A neurological evaluation, including spinal magnetic resonance imaging and a cerebrospinal fluid study, revealed that the patient had acute transverse myelitis (ATM). ATM can be associated with connective tissue diseases. The pathophysiology of ATM consists primarily of inflammatory disorders, similar to the neurological complications of AS. We suggest that ATM is a possible extra-articular manifestation of AS.

T CD4+ cells count among patients co-infected with human immunodeficiency virus type 1 (HIV-1) and human T-cell leukemia virus type 1 (HTLV-1): high prevalence of tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM)

INTRODUCTION: HIV positive patients co-infected with HTLV-1 may have an increase in their T CD4+ cell counts, thus rendering this parameter useless as an AIDS-defining event. OBJECTIVE: To study the effects induced by the co-infection of HIV-1 and HTLV-1 upon CD4+ cells. MATERIAL AND METHODS: Since 1997, our group has been following a cohort of HTLV-1-infected patients, in order to study the interaction of HTLV-1 with HIV and/or with hepatitis C virus (HCV), as well as HTLV-1-only infected asymptomatic carriers and those with tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM). One hundred and fifty HTLV-1-infected subjects have been referred to our clinic at the Institute of Infectious Diseases "Emílio Ribas", São Paulo. Twenty-seven of them were also infected with HIV-1 and HTLV-1-infection using two ELISAs and confirmed and typed by Western Blot (WB) or polymerase chain reaction (PCR). All subjects were evaluated by two neurologists, blinded to the patient's HTLV status, and the TSP/HAM diagnostic was based on the World Health Organization (WHO) classification. AIDS-defining events were in accordance with the Centers for Disease Control (CDC) classification of 1988. The first T CD4+ cells count available before starting anti-retroviral therapy are shown compared to the HIV-1-infected subjects at the moment of AIDS defining event. RESULTS: A total of 27 HIV-1/HTLV-1 co-infected subjects were identified in this cohort; 15 already had AIDS and 12 remained free of AIDS. The median of T CD4+ cell counts was 189 (98-688) cells/mm³ and 89 (53-196) cells/mm³ for co-infected subjects who had an AIDS-defining event, and HIV-only infected individuals, respectively (p = 0.036). Eight of 27 co-infected subjects (30 percent) were diagnosed as having a TSP/HAM simile diagnosis, and three of them had opportunistic infections but high T CD4+ cell counts at the time of their AIDS- defining event. DISCUSSION: Our results indicate that...

INTRODUÇÃO: A possibilidade que a co-infecção pelo vírus da leucemia de células T humana do tipo 1 (HTLV-1) em indivíduos infectados pelo vírus da imunodeficiência humana do tipo 1 poderia falsamente elevar o número de linfócitos T CD4+ no momento do evento definidor de aids, inferindo que essa contagem poderia ser um marcador laboratorial incompleto nos pacientes com a co-infecção HIV-1/HTLV-1. OBJETIVO: Estudar a interação entre o HIV-1 e a co-infecção como o HTLV-1. MATERIAL E MÉTODO: Desde 1997, nosso grupo tem seguido uma coorte de pacientes para estudar a interação entre HIV e/ou vírus da hepatite C (HCV), como também pacientes assintomáticos ou com TSP/HAM. 150 pacientes infectados pelo HTLV-1, encaminhados à clínica de HTLV do Instituto de Infectologia Emilio Ribas, São Paulo, Brasil, foram estudados. Vinte e sete deles estavam co-infectados pelo HIV-1 e HTLV-1, usando dois ELISAs e confirmados tipados pelo WB ou PCR. Todos os pacientes foram avaliados por dois neurologistas, cegos para o status de HTLV e o diagnóstico de TSP/HAM foi baseado na classificação da Organização Mundial de Saúde, 1988. A primeira contagem de células T disponível antes da terapia anti-retroviral foi mostrada para comparar com os pacientes infectados pelo HIV no momento do evento definidor de aids de acordo com Classificação do Centro de controle de Doenças, 1988. RESULTADOS: Um total de 27 HIV-1/HTLV-1 co-infectados foram identificados na coorte, 15 já apresentavam aids e 12 permaneceram sem evento de aids. A mediana de células T CD4 foi de 189 (98-688) células/mm³ e 89 (53-196) células/mm³ nos co-infectados que tinham evento definidor de aids e naqueles com a infecção somente pelo HIV, respectivamente (p = 0,036). Oito dos 27 co-infectados (30 por cento) foram diagnosticados tendo TSP/HAM símile, e três deles mostraram elevada contagem de células T CD4 e apresentaram infecções oportunistas no momento do evento definidor de aids. DISCUSSÃO: Nossos resultados...

Neurological Manifestations and Image Findings in Patients with Exercise-induced Heat Stroke

BACKGROUND: Heat stroke is a thermal insult to the cerebral thermo-regulatory system that controls heat production and heat dissipation. Heat stroke occurs in all age groups and in different parts of the world. In the Korean army heat stroke can occur during marching or any other military training. This study was intended to reveal the pattern of neurological manifestations and brain images of heat stroke. METHODS: All patients who were transferred to one army hospital from March 2000 to September 2002 were included in this study and their neurological manifestations were recorded. A brain MRI was taken in 13 patients. PET images were taken in 6 patients. RESULTS: A total of nineteen patients were included in the study. The mean age was 20.2 (19~23) years. In the acute stage, all patients showed altered mentality and 11 patients showed seizure. During the subacute to chronic stage, the patients showed various neurological statuses ranging from normal to severe neurologic deficits such as abulia, cerebellar ataxia and so on. Brain MRI also showed various findings from normal to severe cerebellar atrophy. In one patient who showed persistent severe cerebellar dysfunction, the MRI showed progressive cerebellar atrophy. A PET image showed cerebellar hypometabolism in 5 patients and frontal hypometabolism in one patient. CONCLUSIONS: Heat stroke can cause various neurological deficits. Brain images can also vary. In the acute stage, the MRI may not correlate with clinical findings and may need a follow-up study. Additionally, a PET may explain neurological findings better in some cases.