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Objective@#This study aimed to determine the incidence of encephalopathy among hospitalized patients with COVID-19. @*Methods@#This was a retrospective observational study conducted in a tertiary hospital in Cebu City, Philippines. This study is a complete enumeration of all records of adult patients admitted for COVID-19 detected through polymerase chain reaction from March 1, 2020 to September 30, 2021. The cases were then classified as to the presence or absence of encephalopathy. @*Results@#The study determined that 6 in every 1000 admitted COVID-19 patients developed encephalopathy. The clinico-demographic profile of patients with encephalopathy were mostly elderly with a mean age of 67, males (55.7%), and obese stage I (61.1%). Encephalopathy was more likely to develop in patients with type 2 diabetes mellitus (80.1%) and coronary artery disease (40.0%). Most patients who did not have encephalopathy however had a history of CVD. Most patients (66.7%) who developed encephalopathy were dyspneic on presentation. Laboratory examination results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients (66.7%) with encephalopathy were intubated. Taking into consideration the stage of infection and the incidence of encephalopathy, most patients (66.6%) were in the hyperinflammatory stage. The number of hospitalization days and severity of illness did not have any association with developing encephalopathy. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with 66.7% of patients with encephalopathy expiring during their course of hospitalization.@*Conclusion@#The incidence of encephalopathy among admitted COVID-19 patients was 6 in every 1000 patients. Encephalopathy was more common in elderly males who were obese with type 2 diabetes mellitus and coronary artery disease. The most common presentation of patients who developed encephalopathy was dyspnea. Collated laboratory results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients with encephalopathy were intubated and were in the hyperinflammatory stage of COVID-19 infection. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with most patients with encephalopathy expiring during their course of hospitalization.
Subject(s)
COVID-19 , Brain Diseases , Brain , SARS-CoV-2ABSTRACT
Resumen El síndrome de Leriche es una enfermedad poco frecuente, con gran morbilidad y mortalidad, que ocurre debido a oclusión de las ramas principales de la aorta abdominal por debajo de la bifurcación de las arterias renales. Clínicamente, se caracteriza por la tríada de claudicación, impotencia y disminución de los pulsos femorales. El diagnóstico se confirma por ecografía Doppler abdominal o angiografía por tomografía computarizada y el tratamiento se basa en el restablecimiento del flujo por debajo del nivel de la oclusión. Se presenta el caso de un paciente con cuadro clínico atípico de dolor lumbar, paraparesia y livideces de miembros inferiores de inicio súbito, con rápido deterioro de su estado general que requirió intervención endovascular urgente. En esta ocasión, los síntomas neurológicos pueden ser explicados por la reducción del flujo sanguíneo de la arteria espinal magna, que en el 25 % de la población se origina en L1 o por debajo de ella y puede generar isquemia de la médula espinal. La presentación atípica de este reporte lo convierte en un desafío clínico de gran importancia.
Abstract Leriche syndrome is a rare disease with high morbidity and mortality that occurs due to occlusion of the main branches of the abdominal aorta below the bifurcation of the renal arteries. Clinically, it is characterized by the triad of claudication, impotence and decreased femoral pulses. Diagnosis is confirmed by abdominal Doppler ultrasound or computed tomography angiography and treatment is based on restoration of arterial flow below the level of occlusion. We present the case of a patient with an atypical clinical presentation of sudden onset of low back pain, paraparesis and lividity of the lower limbs, with rapid deterioration of his general condition that required urgent endovascular intervention. On this occasion, the neurological symptoms can be explained by reduced blood flow in the magna spinal artery, which in 25% of the population originates at or below L1 and can generate spinal cord ischemia. The atypical presentation of this report makes it a clinical challenge of great importance.
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Background@#Acute respiratory viral infection caused by human new coronavirus that was reported in last December of 2019, is becoming the most serious issue worldwide. During human coronavirus infection, upper and lower respiratory symptoms are common. However, other systemic symptoms, especially neurological signs were reported previously. It is further noted that sometimes the neurological manifestations can precede the typical features like fever and cough and later on typical manifestations develop in these patients. Purpose: to analyze information of neurological manifestations related to COVID-19 disease and possible way of affection of nervous system by SARS-CoV-2 virus.@*Material and Methods@#We searched Medline, PubMed, Central and Google Scholar, Web of Science for related published articles and case reports, using keywords such as “COVID-19”, “Coronavirus”, “pandemic”, “SARS-CoV-2”, “Neurological manifestations”; “Complications”; “Clinical characteristics”. There were found and considered few articles of clinical characteristics and case series reports related to COVID-19 with neurological manifestations and complications, also articles of SARS-CoV-2 virus affection to nervous system.@*Results@#Neurological manifestations including headache, dizziness, myalgia, confusion, and hyposmia were observed during COVID-19 in 6-36.4% cases. A few cases with COVID-19 showed more severe symptoms such as stroke, polyneuropathy, encephalopathy, myelitis and acute necrotizing encephalitis. SARS-CoV-2 viral infection pathway may be two different ways, namely, a) binding ACE-2 receptor on capillary endothelium and causing inflammation where then can cross blood-brain barrier and to emerge brain tissue damage; b) entering via nasal epithelium where the bipolar cells locate, from there directs to central nervous system to cause neuronal injury through olfactory bulb. </br> Conclusion: neurological manifestations are relatively common in COVID-19, however, there is lack of evidence-based study. There may have two possible pathways of SARS-CoV-2 to affect nervous system, but is required necessary further elaborately study
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@#Background: This study aims to investigate the prevalence of neurological symptoms in cancer patients followed up in a palliative care centre and the relation of these symptoms to the diagnosis, length of stay, discharge status and presence of metastasis. Methods: The records of inpatients with cancer diagnosed in a palliative care centre in Ankara, Turkey were retrospectively reviewed. The neurological symptoms observed in patients were classified as pain, insomnia, seizures, paresis, delirium and depression. Age, gender, length of stay, presence of metastasis, discharge status and diagnosis of patients who were included in the study were compared to the symptoms. Results: The mean age of 192 patients was 68.41 ± 14.15 years and length of stay in the Centre was 18.12 ± 17.64 days. The most common neurological symptoms were pain, insomnia, delirium, seizures, depression and paresis (27.1%, 17.2%, 15.1%, 13.5%, 11.5%) respectively. Pain was most commonly observed in genitourinary and gynecologic cancers (72.4%), and gastrointestinal cancers (69.3%). Pain was significantly higher in patients with metastasis (p < 0.005) and patients who have passed away (p < 0.032). Paresis and seizures were significantly higher in patients with head and neck cancers (p < 0.001 and 0.001, respectively). The number of days under palliative care was significantly higher in patients who were diagnosed with head and neck cancers (p < 0.007) and patients who experienced seizures (p < 0.004). Conclusion: Except for pain, the other neurological symptoms were not as prevalent as the nonneurological symptoms such as breathlessness, nausea and vomiting, fatigue, anorexia and constipation as reported in the literature.
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Abstract Background Borderline intelligence function (BIF) and specific learning disorder (SLD) are common diagnoses in children who are brought up for learning problems and school failure. Objective The aim of our study was to determine whether there were distinctive aspects of cognitive testing routinely used in evaluating SLD and BIF and investigate emotion regulation skills and minor neurologic symptoms. Method Sixty children (30 SLD and 30 BIF) who are currently attending primary school are selected for study. Visual Aural Digit Span Test - Form B, Gessel Figure Drawing Test, Bender Gestalt Visual Motor Perception Test, WISC-R, Emotion Regulation Scale (ERS) and Neurological Evaluation Scale (NES) was administered. Results There was no statistically significant difference between groups in cognitive tests. The emotional regulation ability measured by the emotional regulation subscale was better in the SLD group than the BIF group (p = 0.014). In the NES, sensory integration (p = 0.008), motor coordination (p = 0.047) and other (p < 0.001) subscales showed higher scores in the BIF group. Discussion It has been shown that cognitive tests don't have distinguishing features in the evaluation of SLD and BIF. Emotion regulation subscale score of ERS and sensory integration, motor coordination, and total scores of NES can be used in both discrimination of groups.
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Introduction: Migraine is a syndrome of recurrent headaches which commonly affects the most productive age group. The clinical presentation of a migraine varies is from the patient. The drug treatment needs to be selected by grouping into different categories based on the clinical profile. In this study, an attempt has been made to study the clinical spectrum EEG changes and therapeutic response in patients with a migraine. Aim of the study: To study the clinical spectrum of a migraine, to study the EEG changes in migraine patient, to assess the therapeutic response in patients treated with prophylactic drugs. Materials and methods: In this study, patient with age between 12 years and 60 years who attended the headache clinic and satisfied the international headache society criteria for a migraine included the patients were evaluated in the following way: Detailed History taking, Physical examinations, laboratory investigations. Results: In the present study, most of the patients were in the age group of 30 to 35 years in both migraine with aura (MA) and migraine without aura (MO) (MA 48% and MO 52%). The minimum age in this study was 14 years maximum age was 54 and the mean age was 33.2. Prevalence of a migraine varies with age peaking between age of 30 to 45 years. Overall prevalence was highest from 25 to 55 years of being productive age. The family history of a migraine was present in 32% of the total patients (MA 62% to 32%) seen predominantly in first degree relatives. The present rating factors were found in 76% of patients in the study group. Stress was commonest precipitating factor for migraine (MA 33%, MO 50%). Other precipitating factors were menses (MA 17%, MO 20%) hunger (MA 17%, MO 15%), sleep deprivation (MA17%, MO15%), food (MA 5%), head trauma (MA11%). In this study group, 61 patients had followed up for more than 3 months. Among them, 26 patients 42.6% were treated with three propranolol 33 patients 54% were treated which combination J. A. Vasanthakumar, K. Ganesamoorthi. A study on migraine in tertiary care centre at Dharmapuri IAIM, 2018; 5(3): 8-14. Page 9 of Beta blocker and amitriptyline and 2 patients 3.2%were treated with sodium valproate. At the end of 3 months, response to therapy was assessed by MIDAS score. Conclusion: Prodrome symptoms were present in 38% of patients and postdrome symptoms were present 50% of the patients. Visual Aura was the commonest aura. A headache was predominantly unilateral 72% pulsatile 95% moderate-to-severe intensity of pain 83% with the main duration of 16.5 hours. Nausea and vomiting were commonest associated symptoms. Stress was a commonest precipitating factor.
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INTRODUCTION: Eccrine carcinoma is an extremely rare skin tumor where only 1/13000 specimens have been submitted to dermatopathological laboratories in the United States.There is no data yet to compare the Philippines with the international incidence of eccrine carcinoma. This is a case of a 69-year-old Filipino female who presented with a recurring invasive indolent tumor at the right fronto-parietal area who presented with left sided hemiparesis and seizure.CASE: The patient was presented with a recurrent invasive indolent mass on her right front-parietal area, grossly measuring five by four centimeters, nodular flesh colored,which extended intracranially.This was associated with left sided hemiparesis and due to the extent of the tumor encroaching through the brain parenchyma, patient was noted to have seizure episodes. The patient was given surgical and radiologic options however, she did not comply and died last December 2015.RESULTS: A cranial MRI with MRA showed a heterogenous enhancing intracranial mass with extracranial component with compressed entrapped and depressed superior sagittal sinus by the axial mass witin calvarial penetration and scalp involvement compressing on the right parietal lobe with parenchyma edema. Biopsy was eventually done and findings were consistent with an eccrine carcinoma.CONCLUSION: This is the first case of eccrine carcinoma in our institution. Due to the paucity of data, there are no guidelines to the management of an eccrine carcinoma. Hence the imperative need to raise awareness regarding this rare tumor because, without a high index of suspicion this rare entity may be overlooked or misdiagnosed. When presented with an indolent invasive recurrent tumor a high index of suspicion that an eccrine Carcinoma may be suspected.Excision biopsy may be done for correct identification of the tumor.
Subject(s)
Humans , Female , Aged , Scalp , Superior Sagittal Sinus , Seizures , Sweat Gland Neoplasms , Biopsy , Skin Neoplasms , Carcinoma, Skin Appendage , Brain , Edema , Paresis , Parietal LobeABSTRACT
@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Eccrine carcinoma is an extremely rare skin tumor where only 1/13000 specimens have been submitted to dermatopathological laboratories in the United States.There is no data yet to compare the Philippines with the international incidence of eccrine carcinoma. This is a case of a 69-year-old Filipino female who presented with a recurring invasive indolent tumor at the right fronto-parietal area who presented with left sided hemiparesis and seizure.<br /><strong>CASE:</strong> The patient was presented with a recurrent invasive indolent mass on her right front-parietal area, grossly measuring five by four centimeters, nodular flesh colored,which extended intracranially.This was associated with left sided hemiparesis and due to the extent of the tumor encroaching through the brain parenchyma, patient was noted to have seizure episodes. The patient was given surgical and radiologic options however, she did not comply and died last December 2015.<br /><strong>RESULTS:</strong> A cranial MRI with MRA showed a heterogenous enhancing intracranial mass with extracranial component with compressed entrapped and depressed superior sagittal sinus by the axial mass witin calvarial penetration and scalp involvement compressing on the right parietal lobe with parenchyma edema. Biopsy was eventually done and findings were consistent with an eccrine carcinoma.<br /><strong>CONCLUSION:</strong> This is the first case of eccrine carcinoma in our institution. Due to the paucity of data, there are no guidelines to the management of an eccrine carcinoma. Hence the imperative need to raise awareness regarding this rare tumor because, without a high index of suspicion this rare entity may be overlooked or misdiagnosed. When presented with an indolent invasive recurrent tumor a high index of suspicion that an eccrine Carcinoma may be suspected.Excision biopsy may be done for correct identification of the tumor.</p>
Subject(s)
Humans , Female , Aged , Scalp , Superior Sagittal Sinus , Seizures , Sweat Gland Neoplasms , Biopsy , Skin Neoplasms , Carcinoma, Skin Appendage , Brain , Edema , Paresis , Parietal LobeABSTRACT
Cranial vault haemangiomas are benign vascular lesions having capillaries, venous and cavernous channels. Histopathologically, these are almost like soft tissue haemangiomas. These are slow growing tumors and very rarely bleed. Cranial vault is uncommon site for the occurrence as compared to the vertebral. Cross sectional imaging like Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in delineation of the vault pathologies. We present a 38-years old male who presented with slow growing swelling over the frontal bone without any neurological symptoms. CT and MRI imaging clinched the diagnosis which was confirmed subsequently by histopathological examination.
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Objective:To study the neurological symptoms of psoriasis patients who used infliximab. Methods: We studied psoriasis patients who used infliximab in two referral general hospitals in Tehran from January 2013 to January 2014. We completed neurological symptoms checklists by questioning the patients. Results: Sixty patients with psoriasis were included in this study. Among them, 3 patients had sensory symptoms as side effect and one patient showed motor symptoms as side effect. There was no statistically significant difference between age, gender, and session count with the sensory and motor side effects (P > 0.05). Conclusions: Neurological symptoms can be detected among 6% of patients under treatment with infliximab and there is no significant association between symptoms and gender, duration of drug use as well as age.
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Objective: To study the neurological symptoms of psoriasis patients who used infliximab. Methods: We studied psoriasis patients who used infliximab in two referral general hospitals in Tehran from January 2013 to January 2014. We completed neurological symptoms checklists by questioning the patients. Results: Sixty patients with psoriasis were included in this study. Among them, 3 patients had sensory symptoms as side effect and one patient showed motor symptoms as side effect. There was no statistically significant difference between age, gender, and session count with the sensory and motor side effects ( P > 0.05). Conclusions: Neurological symptoms can be detected among 6% of patients under treatment with infliximab and there is no significant association between symptoms and gender, duration of drug use as well as age.
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Scorpion envenomations are a major public health problem in Brazil, whose most dangerous cases are attributable to the genus Tityus. This study was designed to compare the clinical and demographic features of envenomations by 77tyus obscurus in two areas of the state of Pará located in the Amazon basin. Were compared demographic findings, local and systemic signs and symptoms of human envenomations caused by T. obscurus that occurred in western and eastern areas of the state.
Subject(s)
Animals , Poisoning/complications , Neurology , Poisons/analysis , Scorpions/physiologyABSTRACT
Scorpion envenomations are a major public health problem in Brazil, whose most dangerous cases are attributable to the genus Tityus. This study was designed to compare the clinical and demographic features of envenomations by 77tyus obscurus in two areas of the state of Pará located in the Amazon basin. Were compared demographic findings, local and systemic signs and symptoms of human envenomations caused by T. obscurus that occurred in western and eastern areas of the state.
Subject(s)
Animals , Poisoning/complications , Neurology , Poisons/analysis , Scorpions/physiologyABSTRACT
Visceral leishmaniasis is a severe and potentially fatal vector-borne disease. The most typical symptoms are fever, hepatosplenomegaly, weight loss, bleeding and bacterial infections. Neurological changes are rarely reported. This paper describes a child who presented with neurological signs as the first symptoms of leishmaniasis; tone was diminished and tremors in the extremities were observed. A diagnosis of visceral leishmaniasis was confirmed by parasite detection in the bone marrow. Symptoms were reversed by specific treatment. The nature of a possible mechanism of neurological involvement in visceral leishmaniasis remains unexplained.
A leishmaniose visceral é uma doença severa e potencialmente fatal transmitida pela picada de flebótomos infectados pelo parasita. Os sintomas mais comuns incluem febre, hepatoesplenomegalia, perda de peso, sangramentos e infecções bacterianas. Alterações neurológicas têm sido raramente descritas nesses pacientes. Descrevemos aqui o caso de uma criança que desenvolveu um quadro de infecção pela Leishmania, tendo como principal sintoma tremor de extremidades. O diagnóstico da doença foi confirmado pela demonstração do parasita no aspirado de medula. Os sintomas foram revertidos pelo tratamento específico. A natureza do possível mecanismo do envolvimento neurológico na leishmaniose visceral permanece duvidoso.
Subject(s)
Humans , Infant , Male , Bone Marrow/parasitology , Brain Diseases/diagnosis , Central Nervous System Protozoal Infections/diagnosis , Leishmaniasis, Visceral/diagnosis , Brain Diseases/parasitology , Central Nervous System Protozoal Infections/parasitology , Tomography, X-Ray ComputedABSTRACT
RESUMEN Se reportan cuatro pacientes con diagnóstico de lupus eritematoso sistémico (LES), con manifestaciones neurológicas, internados en el Hospital Nacional en el periodo 2010. Las manifestaciones fueron: psicosis lúpica, micro infartos cerebrales secundarios a la presencia de anticuerpos antifosfolipídicos y encéfalo mielitis Todos eran del sexo femenino. Dos de ellas debutaron la enfermedad con las manifestaciones neurológicas y dos en el curso de la evolución del LES. Tres pacientes respondieron al tratamiento con pulsos de metilprednisolona y de ciclofosfamida, con regresión de la sintomatología neurológica, sin embargo, una de las pacientes con manifestaciones neuropsiquiátricas no tuvo recuperación satisfactoria, persistiendo la sintomatología a pesar del tratamiento.
ABSTRACT We report four patients diagnosed with systemic lupus erythematosus (SLE) with neurological manifestations, placed in the National Hospital in the period 2010. Two patients had lupus psychosis, micro stroke secondary to antiphospholipid antibodies and encephalomyelitis. All were female. Two of them debuted the disease with neurological manifestations and two in the course of evolution of SLE. Three patients responded to treatment with methylprednisolone and cyclophosphamide pulses, with regression of neurologic symptoms. However, one of the patient was not satisfactory recovery and the symptoms persist despite treatment.
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Delleman Oorthuys syndrome (oculocerebrocutaneous syndrome) is a rare, congenital sporadic disorder affecting the skin and central nervous system. We present the case of a one-month-old male who presented with an orbital cyst in the left eye since birth along with other manifestations of this syndrome. The manifestations of this syndrome resemble other developmental disorders like Goldenhar and Goltz syndrome. Conservative management of the orbital cyst in these cases have been described. The need to diagnose this rare congenital anomaly with cerebral malformations as a separate entity is crucial in the management of these children.
Subject(s)
Abnormalities, Multiple/diagnosis , Diagnosis, Differential , Eye Abnormalities/diagnosis , Follow-Up Studies , Humans , Infant, Newborn , Male , Nervous System Malformations/diagnosis , Skin Abnormalities/diagnosis , Syndrome , Tomography, X-Ray ComputedABSTRACT
Erythropoietic protoporphyria is a genetic disorder due to a deficiency of ferrochelatase resulting in excessive accumulation and excretion of protoporphyrin. The predominant clinical feature is photosensitivity. Severe hepatic failure occurs in a small percentage of patients, and neurological symptoms are very rare. We report a case of erythropoietic protoporphyria associated with severe hepatic dysfunction and neurological symptoms. A 9-year-old girl presented with severe abdominal pain, nausea, weakness and pain of extremities, and urinary retention. Ultrasonogram and abdominal CT scanning revealed a diffuse infiltrated and enlarged liver. Liver biopsy showed deposition of dense dark brown pigment within the bile, hepatocytes and Kupffer cells. Plus, dense dark brown deposits gave a red birefringent under polarize light. Porphyrin studies demonstrated markedly elevated serum free erythrocyte protoporphyrin. This girl was diagnosed as erythropoietic protoporphyria with severe liver dysfunction and neurological symptoms.