neurological manifestations of H1N1 influenza infection; diagnostic challenges and recommendations

World Health Organization declared pandemic phase of human infection with novel influenza A [H1N1] in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection. The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of Shiraz, Iran from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay. Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillan-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy. The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1 influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms

Vasovagal syncope treated as epilepsy for 16 years

The differentiation of vasovagal syncope and epileptic seizure is sometimes problematic, since vasovagal syncope may mimic epileptic seizures in many ways. The present report describes a patient who had been diagnosed and treated as having epilepsy with medically-refractory seizures for 16 years. Often, unlike epileptic seizures, tonic-clonic convulsions and postical confusion are uncommon features of vasovagal syncope, but these may occur. Our patient was subjected to subcutaneous injection of one ml normal saline, which caused asystole leading to hypoxia and consequently a typical tonic-clonic convulsion. This patient was proved to have vasovagal syncope. The findings in the present case suggest that the possibility of vasovagal syncope should always be taken into consideration when evaluating patients with medically-refractory or unusual pattern of seizures. In such a circumstance, simultaneous video-electroencephalogram/electrocardiogram monitoring may help achieve the correct diagnosis

Investigation of Fc gamma RIIA and Fc gamma RIIIA polymorphism in multiple sclerosis: a case control study

Multiple Sclerosis [MS], the most common demyelinating disease of the CNS, is immunologically mediated in genetically susceptible individuals. Receptors for the Fc fragment of IgG [Fc gamma R] might induce inflammatory responses through linking the humoral and cellular immune responses by targeting immune complexes to effector cells. Polymorphisms in some Fc gamma R genes are associated with various infectious and autoimmune diseases, probably due to their effects on different binding capacities of encoded receptors for IgG containing immune complexes. To investigate the importance of Fc gamma R polymorphisms in susceptibility to MS. One hundred and fifty MS patients and 136 age and sex matched controls were genotyped for Fc gamma RIIA and Fc gamma RIIIA gene polymorphisms using PCR-RFLP method. The allelic and genotypic frequencies of the Fc gamma RIIA and Fc gamma RIIIA did not differ significantly between the MS patients and controls. There was no association between allelic polymorphism of Fc gamma RIIIA and severity of disease based on Expanded Disability Status Scale [EDSS] score. However, significant association between inherited Fc gamma RIIA genotype and disease activity [p=0.001] or progression index was revealed [p=0.014]. EDSS values showed that Fc gamma RIIA [H/H] and [H/R] genotypes were associated with a lower EDSS score in relapsing-remitting MS and in the total MS population [P=0.001] but not [R/R] genotype. Considering the detrimental role of autoantibodies in the pathogenesis of MS, our results suggest that the inherited Fc gamma RIIA alleles could affect the severity of MS by influencing the clearance rate of immune complexes and autoantibodies. The results of the present study add the Fc gamma RIIA gene to the gene networks which determine the severity of MS in southern Iran

Neurological manifestations of behcet's disease

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcet's disease. This prospective study was carried out in the Behcet's Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet's patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet's Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies

Neurological manifestations of Behcet's disease

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcets disease. This prospective study was carried out in the Behcets Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet s patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet s Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcets disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies