The Safety Profile of Common COVID-19 Vaccines in Patients With Multiple Sclerosis.

Background and objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In light of the COVID-19 pandemic that emerged in late 2019, the World Health Organization (WHO) has endorsed mass immunization to enhance the population's immunity against the virus. However, certain concerns have been raised about the safety of COVID-19 vaccines among patients with autoimmune disorders, including those with multiple sclerosis (MS). Further research is required to address these concerns and to gain deeper insights into the possible complications of COVID-19 vaccines among MS patients. This study aimed to assess the side effects of COVID-19 vaccines among MS patients. Methods An observational cross-sectional study was conducted between May and November 2023 at the National Guard Hospital, Jeddah, Saudi Arabia. All MS patients enrolled in our local registry system and provided phone numbers were included in the study. A total of 208 MS patients were surveyed via phone interviews, and data were collected regarding their demographics, MS history, COVID-19 history, SARS-CoV-2 vaccination status, and their exposure to disease-modifying therapies (DMTs). All results were analyzed using Stata software. Statistical significance was set at a CI of 95% and a p-value <0.05. Results In our cohort, 128 (61.5%) patients had received three doses of the COVID-19 vaccine, while 68 (32.7%) had received two doses; four patients (2.0%) had received only one dose, five (2.4%) had not received the vaccine, and the number of doses was unknown for the remaining three patients (1.4%). The BNT162b2 mRNA COVID-19 Vaccine from Pfizer-BioNTech was the most commonly administered (n=136 patients, 66.0%), followed byChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca (n=47 patients, 22.8%), and mRNA-1273 SARS-CoV-2 Vaccine from Moderna (n=5 patients, 2.4%). Of note, 139 patients (69.5%) reported experiencing adverse events after receiving the vaccine, and the ChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca was significantly associated with higher rates of side effects, in 87.8% of the patients. Conclusion A sizable proportion of MS patients experienced self-limiting side effects from exposure to the COVID-19 vaccine. The rates and incidence of side effects were similar to those encountered in the general population. None of the adverse effects recorded in our population of MS patients were serious or life-threatening. We recommend that physicians encourage patients with MS who have never received COVID-19 vaccination to get promptly vaccinated as the risks of COVID-19 infection far outweigh the minor risks associated with COVID-19 vaccination.

Optic Neuritis Following the BNT162b2 mRNA COVID-19 Vaccine in a Patient with Systemic Lupus Erythematosus Uncovering the Diagnosis of Neuromyelitis Optica Spectrum Disorders.

COVID-19 vaccinations have been given worldwide to save the lives of millions. However, several complications following different types of COVID-19 vaccinations were reported previously in the literature. Previous articles have reported multiple ocular complications following different types of COVID-19 vaccinations. In this article, we report a unique case in which the diagnosis of neuromyelitis optica spectrum disorders (NMOSD) was unveiled following vaccination with BNT162b2 mRNA COVID-19 vaccine and manifesting as acute optic neuritis in a patient with systemic lupus erythematosus (SLE). The temporal association of acute optic neuritis after receiving the BNT162b2 mRNA COVID-19 vaccine along with the serological evidence of NMOSD support this theory. The risk of triggering an occult autoimmune disorder in patients with an overactive immune system such as this patient should be studied to calibrate the benefits and risks of vaccination against COVID-19. Screening for aquaporin-4 antibodies in patients with SLE prior to vaccination against COVID-19 may be considered to prevent potentially devastating neurological disability in patients with premorbid occult NMOSD.

Migraine Prevalence and Analysis of Dietary Habits in Relation to Headache in the Female Population: A Single-Center Study From Jeddah, Saudi Arabia.

Introduction Lifestyle-related factors including dietary intake can significantly increase the chances of developing migraine. Some components of food items are thought to induce the release of vasoactive substances leading to the dilation of blood vessels, which in turn results in migraine episodes. This research aimed to assess the prevalence of migraine and examine the relation of the headache to the dietary patterns of female students and employees of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) - Jeddah experiencing migraine attacks as well as to assess the relationship between the migraine attacks and the available dietary items served at the food outlets within the campus. Methods Two questionnaires were developed for this study. The first questionnaire was a short survey asking about the characteristics of headaches. This survey aimed to estimate the prevalence of migraine among female students and employees in KSAU-HS. Of the participants who filled the first questionnaire, those who met the International Classification of Headache Disorders (ICDH-III) criteria for migraine were given a second questionnaire to further understand the characteristics of their migraine headaches and to assess lifestyle and diet-related aggravating factors. Results The final sample size for the calculated prevalence was 410; 352 were students and 58 were faculty members. It has been found that 165 (40.24%) participants of the KSAU-HS female population met the criteria for migraine. Two (2.2%) reported an association between chocolate consumption and headaches and seven (7.8%) reported a significant association between caffeine and headaches. No specific association was perceived by the respondents between migraine attacks and the following food items: citrus fruits, pickles, cheese, and dairy products. Conclusion Our study revealed that the widespread trends for excessive consumption of coffee and caffeinated beverages at food outlets within the educational institution are occult triggers for headache attacks in a significant portion of students with migraine. The recent shift in dietary habits in our community for excessive consumption of coffee and other tyramine-rich food items has negative consequences on productivity and the economy. Our results can be conceivably extrapolated to reflect the effect of dietary habits on other streams of society, including companies, firms, schools, and workplaces that are driven by the new dietary trends.

Vertical One-and-a-Half Syndrome with Pseudoabducens Palsy and Midbrain Horizontal Gaze Paresis.

The rostral mesencephalon may influence ocular motility in the vertical, horizontal, and torsional trajectories through intricate supranuclear, internuclear, and infranuclear neural networks. Strategic unilateral midbrain lesions may result in contralateral horizontal gaze palsy with saccadic failure due to combined interruption of supranuclear corticofugal fibers from the frontal eye field and colliculofugal fibers from the superior colliculus. In this article, we report a patient who sustained combined vertical and horizontal gaze deficits after a single infarct involving the mesodiencephalic junction. The neural substrate for each deficit is briefly discussed in light of clinical findings. This case presented a triad of three distinct syndromes of horizontal gaze paresis, vertical one-and-a-half syndrome, and pseudoabducens palsy due to damage of nuclear and supranuclear projections within the rostral mesencephalon. This combination was due to a single embolic infarct in the territory of the posterior thalamosubthalamic artery (artery of Percheron) that arises at the basilar bifurcation. Coexistence of these phenomena exemplified how rostral midbrain lesions may affect ocular motility in the vertical, horizontal, and torsional planes, along with disruption of normal vergence control.

Space neuroscience: current understanding and future research.

Space exploration is crucial for understanding our surroundings and establishing scientific concepts to explore, monitor, and save our planet's environment. However, the response of the human nervous system in the environment of space poses numerous challenges. Brain complexity explains the vulnerability and intrinsic difficulty of recalibration after disturbance. Over the millennia, the brain has evolved to function at 1-G. Studying the brain and its physiology in different environments may shed light on multiple conditions encountered on Earth that are yet to be solved and dictate collaboration at international levels. The nervous system is affected by several stressors due to microgravity, radiation, isolation, disruption of circadian rhythm, impaired sleep dynamics, and hypercapnia associated with space travel. In this article, we aim to review several aspects related to the nervous system in weightless conditions, as well as the development and future of the emerging field of "space neuroscience." Space neuroscience is a fascinating, embryonic field that requires significant development. The establishment of frameworks for the strategic development of space neuroscience is vital, as more research and collaboration are required to overcome these numerous and diverse challenges, minimize risks, and optimize crew performance during planetary operations.

Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure.

Hashimoto's encephalopathy is a rare immune-mediated disorder characterized by subacute encephalopathy with elevated thyroid antibodies. Hashimoto's encephalopathy is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis. We report a rare presentation of Hashimoto's encephalopathy presenting with acute neuropsychiatric disturbances, rapidly progressive dementia, seizures, and extrapyramidal failure. Neuroimaging revealed multifocal vasculitides of major cerebral vessels that support the autoimmune vasculitic theory as the underlying pathogenesis for Hashimoto's encephalopathy. Unfortunately, permanent irreversible cerebral damage has already ensued before her presentation to our center, which rendered steroid therapy ineffective. Serological testing for Hashimoto's thyroiditis must be in the investigation of all rapidly progressive dementias as early diagnosis and timely management of autoimmune thyroiditis may salvage sizable and eloquent cerebral tissues. The rarity of the condition should not preclude the investigation of Hashimoto's disease even in the presence of normal levels of thyroid hormones. Delayed diagnosis may result in irreversibly catastrophic encephalopathy in patients who once presented with potentially curable dementia.

Vaccine-Induced Immune Thrombotic Thrombocytopenia with Disseminated Intravascular Coagulation and Death following the ChAdOx1 nCoV-19 Vaccine.

Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Although COVID-19 is primarily a disease of the lungs with florid respiratory manifestations, there are increasing reports of cardiovascular, musculoskeletal, gastrointestinal, and thromboembolic complications. Developing an effective and reliable vaccine was emergently pursued to control the catastrophic spread of the global pandemic. We report a fatal case of vaccine-induced immune thrombotic thrombocytopenia (VITT) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute this fatal thrombotic condition to the vaccine due to the remarkable temporal relationship. The proposed mechanism of VITT is production of rogue antibodies against platelet factor-4 resulting in massive platelet aggregation. Healthcare providers should be aware of the possibility of such fatal complication, and the vaccine recipients should be warned about the symptoms of VITT.

New-onset refractory status epilepticus following the ChAdOx1 nCoV-19 vaccine.

Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Developing an effective and reliable vaccine was emergently pursued to control the dramatic spread of the global pandemic. The standard stages for vaccine development were unprecedentedly accelerated over a few months. We report a case of new-onset refractory status epilepticus (NORSE) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute the occurrence of NORSE to the vaccine due to the temporal relationship and the lack of risk factors for epilepsy in the patient. This report adds to the literature a possible rare side effect of a COVID-19 vaccine and contributes to the extremely limited literature on potential neurological side effects of viral vector vaccines. Healthcare providers should be aware of the possibility of post-vaccination epilepsy. The patient had recurrent seizures that were refractory to conventional antiepileptic drug therapy with a dramatic response to immunotherapy with pulse steroids and plasmapheresis. This likely reflects an underlying autoimmune mechanism in the genesis of post-vaccination generalized seizures without fever. Further research is needed to probe and study the exact mechanism at a more molecular level.

Insulin Neuritis and Effect of Pregabalin.

INTRODUCTION: Insulin neuritis (IN) is a rare condition that results in acute painful neuropathy. It occurs classically in patients with diabetes mellitus with uncontrolled sugar levels who are started on insulin therapy leading to a precipitous normalization of blood sugar levels. The condition is heralded by severe and generalized burning pain along with significant weight loss and mood issues. The diagnosis is mainly clinical and the etiology of IN remains obscure. METHODS AND RESULTS: We report on 2 cases who developed acute and excruciating neuropathic pain after institution of insulin therapy for poorly controlled diabetes mellitus. Both showed elucidate classical features of IN. CONCLUSIONS AND RELEVANCE: IN is a self-limited condition. Early recognition can lead to institution of appropriate therapy, which includes pain control and withholding insulin. Most cases do not require any work-up and resolve spontaneously.

Real-time hemodynamic assessment of intracranial stenosis in a patient with orthostatic aphasia: potential applications of transcranial Doppler.

BACKGROUND: Intracranial atherosclerotic stenosis is thought to be responsible for 8% of all ischemic stroke subtypes. Transcranial Doppler (TCD) ultrasonography allows for noninvasive and dynamic evaluation of the cerebral circulation within the circle of Willis. We present a case of recurrent, orthostatic transient ischemic attacks in which, using TCD, we were able to correlate dynamically between the orthostatic symptomatology and a significant drop in the mean flow velocity (MFV) across the stenotic middle cerebral artery (MCA) segment. METHODS: A 56-year-old male presented with recurrent episodes of orthostatic right-sided weakness and expressive aphasia. Diagnostic TCD revealed a stenotic signal in the left internal carotid artery (ICA) siphon. Subsequent TCD monitoring of both MCAs demonstrated a significant orthostatic drop in MFV of the left MCA, which closely correlated with his symptoms. The cerebral angiogram confirmed a high-grade stenosis at the supraclinoid segment of the left ICA. CONCLUSION: TCD is a useful, noninvasive, and dynamic tool for assessment of the intracranial circulation, and should be considered in the workup of patients with hypoperfusion cerebrovascular events.

Pearls & Oy-sters: selective postictal aphasia: cerebral language organization in bilingual patients.

BACKGROUND: Ictal and postictal language dysfunction is common and strongly predictive of language laterality in monolingual patients. For bilingual patients, selective dysfunction has been reported for a single language with focal cerebral lesions, electrical brain stimulation, and intracarotid sodium amytal. METHODS: Two right-handed Ukrainian-English bilingual patients with left perisylvian structural lesions, late onset complex-partial seizures, and postictal aphasia for English are presented and discussed with regard to mechanisms of selective aphasia and factors contributory to language lateralization in bilingual patients. RESULTS: Ukrainian was the native language of both patients with English acquired after 7 years of age. Regular/video-EEG showed left temporal epileptogenesis. A 56-year-old man, who had a left hemorrhagic stroke at age 50 and had not spoken Ukrainian for 40 years, was unable to speak English for approximately 20 minutes postictally but had global preservation of Ukrainian. A 71-year-old woman, who had a left temporal epidermoid cyst and had not spoken Ukrainian since childhood, had 10- to 15-minute postictal expressive aphasia in English but not Ukrainian and preservation of comprehension in both languages. CONCLUSIONS: These cases are instructive and consistent with the literature on cerebral organization of language in bilingual individuals. For both patients, postictal aphasia with preservation of Ukrainian is consistent with findings from clinical and experimental studies indicating that later age of second language acquisition (>6 years) rather than language proficiency is a primary factor in language laterality. Second, global aphasia in the man with a late lesion vs expressive aphasia with preservation of comprehension of English in the woman with a prenatal/early lesion is consistent with the atypical language laterality described for individuals with left-sided lesions sustained prior to age 5. Although neither Wada test nor fMRI was done to assure left hemisphere laterality of spoken Ukrainian and English, this is probable, and the selective postictal aphasia observed for both patients is consistent with the differential intrahemispheric organization reported for the two languages of bilingual individuals. Possible mechanisms of selective postictal aphasia, e.g., active inhibition, and differences in language networks in bilingual patients are discussed.

Refractory status epilepticus during pregnancy secondary to cavernous angioma.

SUMMARY: First-time seizure and status epilepticus during pregnancy have been previously reported as the initial manifestation of intracranial cavernous hemangioma. We report a woman with no history of seizures who presented with refractory status epilepticus at 10 weeks gestation. Cranial MRI revealed a right frontal cavernous hemangioma. The seizures remained refractory to conventional anticonvulsant medications and 48 h of general anesthetic. Termination of the pregnancy resulted in almost immediate resolution of the seizures. The dramatic response of the seizures to termination of the pregnancy suggests that hormonal factors were primarily responsible for the precipitous presentation in this patient.