ABSTRACT
Post-malaria neurological syndrome (PMNS) is a rare complication of malaria. It follows recovery from an episode of Plasmodium falciparum malaria and is characterised by symptoms and signs of encephalopathy. Patients usually improve without any specific treatment. The pathogenesis is unknown, but it is probably immunologically mediated. The objective of this case study is to describe the first Italian patient with PMNS. A 60-year-old Italian man developed acute P. falciparum malaria after a stay in French Guinea. Twenty days after recovering from malaria, he became confused, developed generalised weakness, limb tremors, shivering and dizziness. These symptoms continued for three days, then resolved spontaneously. Neuroimaging was normal. Cerebrospinal fluid analysis revealed breakdown of the blood/brain barrier, without oligoclonal bands and normal IgG index. Our patient presented a mild diffuse encephalopathy suggestive of a generic activation of the immune system without any specific reaction against antigens within the CNS.
Subject(s)
Cerebellar Ataxia/etiology , Malaria, Falciparum/complications , Nervous System Diseases/etiology , Plasmodium falciparum/isolation & purification , Animals , Cerebellar Ataxia/diagnosis , Cerebellar Ataxia/immunology , Humans , Immunoglobulin G/blood , Malaria, Falciparum/diagnosis , Malaria, Falciparum/immunology , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/immunologyABSTRACT
BACKGROUND: Artery dissection is an unusual cause of ischemic stroke, particularly frequent among young patients. The aim of this study was to collect epidemiological data on artery dissection in a hospital-based community, set up a diagnostic protocol and discover outcome predictors. METHODS: Among patients suffering from cerebral infarction resident in our country, those with clinical and radiological features suggestive of artery dissection were selected. Risk factors, investigative techniques and treatment were evaluated. Patients were subjected to clinical examinations and were regularly tested neuradiologically. RESULTS: Out of 895 ischemic stroke patients, 10 patients with cervical artery dissection (1.1%) were found. Seven patients were treated with anticoagulants and 3 received antiplatelet agents. One posttraumatic artery dissection patient died within a few days of the stroke. None of the patients suffered from a recurrence, while serious disability occurred in 4 of them. CONCLUSIONS: Artery dissection should be suspected in any cerebral infarction patient, especially in young patients without risk factors for cerebrovascular diseases. The treatment of choice consists of anticoagulants. An early clinical diagnosis, strongly supported by radiological tests, is mandatory to start the proper treatment and achieve the best possible outcome.
Subject(s)
Stroke/epidemiology , Vertebral Artery Dissection/epidemiology , Adult , Anticoagulants/therapeutic use , Demography , Female , Follow-Up Studies , Humans , Italy/epidemiology , Male , Middle Aged , Prospective Studies , Residence Characteristics , Risk Factors , Stroke/complications , Stroke/drug therapy , Vertebral Artery Dissection/drug therapy , Vertebral Artery Dissection/etiologyABSTRACT
Antithyroid antibodies and circulating immune complexes (CIC) were found in the CSF of six patients with Hashimoto's encephalopathy (HE) but not in the CSF of 21 controls. The synthesis of autoantibodies and CIC was intrathecal and their titers were independent of the patients' clinical status or therapy. Their presence in the CSF of patients with acute or subacute encephalopathy may be useful in diagnosing HE.
