Encephalopathy and encephalitis during acute SARS-CoV-2 infection. Spanish Society of Neurology COVID-19 Registry. / Encefalopatías y encefalitis durante la infección aguda por SARS-CoV2. Registro de la Sociedad Española de Neurología SEN COVID-19.

OBJECTIVES: Since the beginning of the COVID-19 pandemic, the Spanish Society of Neurology has run a registry of patients with neurological involvement for the purpose of informing clinical neurologists. Encephalopathy and encephalitis were among the most frequently reported complications. In this study, we analyse the characteristics of these complications. PATIENTS AND METHODS: We conducted a retrospective, descriptive, observational, multicentre study of patients with symptoms compatible with encephalitis or encephalopathy, entered in the Spanish Society of Neurology's COVID-19 Registry from 17 March to 6 June 2020. RESULTS: A total of 232 patients with neurological symptoms were registered, including 51 cases of encephalopathy or encephalitis (21.9%). None of these patients were healthcare professionals. The most frequent syndromes were mild or moderate confusion (33%) and severe encephalopathy or coma (9.8%). The mean time between onset of infection and onset of neurological symptoms was 8.02 days. Lumbar puncture was performed in 60.8% of patients, with positive PCR results for SARS-CoV-2 in only one case. Brain MRI studies were performed in 47% of patients, with alterations detected in 7.8% of these. EEG studies were performed in 41.3% of cases, detecting alterations in 61.9%. CONCLUSIONS: Encephalopathy and encephalitis are among the complications most frequently reported in the registry. More than one-third of patients presented mild or moderate confusional syndrome. The mean time from onset of infection to onset of neurological symptoms was 8 days (up to 24hours earlier in women than in men). EEG was the most sensitive test in these patients, with very few cases presenting alterations in neuroimaging studies. All patients treated with boluses of corticosteroids or immunoglobulins progressed favourably.

[Bilateral facial palsy due to Epstein-Barr virus Infection]. / Parálisis facial bilateral secundaria a infección por virus de Epstein-Barr.

Two young patients with bilateral facial palsy are described. They initially presented unilateral facial palsy, followed by contralateral facial nerve involvement a few days later, together with clinical and serologic evidence of acute Epstein-Barr virus infection. The outcome was favourable in one patient but severe sequels persisted in the second. These two cases show that this infrequent complication of Epstein-Barr virus infection may not always have a good outcome. The pathogenic mechanism of bilateral facial palsy is discussed.

[Cocaine-induced brain stem stroke associated to craneal midline destructive lesions]. / Ictus de tronco asociado a lesiones destructivas de línea media craneal inducidas por cocaína.

INTRODUCTION: Abuse of cocaine and other sympathomimetic drugs has been reported as a significant risk factor for stroke. The physiopathologic mechanisms implicated are multifactorial. Chronic cocaine use leads to extensive destruction of osteocartilaginous structures of nose, sinuses and palate. CASE REPORT: We report the case of a 56 years-old woman with hypertension and smoke abuse who was admitted with a pontine paramedian infarction. Cranial resonance findings of midline destructive lesions lead to the suspicion of chronic cocaine consumption. The initial outcome was good but she was re-admitted nine months later with an extent pontomesencephalic infarction. CONCLUSIONS: Abuse of cocaine is a risk factor for stroke that should be considered not only in young patients. The pathogenic relationship between stroke and midline cocaine related destructive lesions is discussed.

Ictus de tronco asociado a lesiones destructivas de línea media craneal inducidas por cocaína / Cocaine-induced brain stem stroke associated to craneal midline destructive lesions

Introducción. La asociación entre enfermedad cerebrovascular y consumo de cocaína y otras drogas simpaticomiméticas ha sido ampliamente reflejada en la literatura y son múltiples los mecanismos fisiopatológicos que pueden explicar esta asociación. Por otro lado, el consumo crónico de cocaína produce lesiones destructivas de estructuras osteocartilaginosas de nariz, senos nasales y paladar. Caso clínico. Se describe el caso de una paciente de 56 años, hipertensa y fumadora que ingresa por un infarto pontino paramediano y en la que fue el hallazgo en neuroimagen de lesiones destructivas de línea media craneal lo que hizo sospechar el consumo crónico de cocaína. Tras una evolución inicial satisfactoria, sufrió una recurrencia a los 9 meses en forma de extenso infarto pontomesencefálico. Conclusiones. El consumo de cocaína debe tenerse en cuenta como factor de riesgo de enfermedad cerebrovascular, no sólo entre la población joven. Discutimos la relación fisiopatológica entre las lesiones destructivas de línea media craneal y los infartos de tronco recurrentes

Introduction. Abuse of cocaine and other sympathomimetic drugs has been reported as a significant risk factor for stroke. The physiopathologic mechanisms implicated are multifactorial. Chronic cocaine use leads to extensive destruction of osteocartilaginous structures of nose, sinuses and palate. Case report. We report the case of a 56 years-old woman with hypertension and smoke abuse who was admitted with a pontine paramedian infarction. Cranial resonance findings of midline destructive lesions lead to the suspicion of chronic cocaine consumption. The initial outcome was good but she was re-admitted nine months later with an extent pontomesencephalic infarction. Conclusions. Abuse of cocaine is a risk factor for stroke that should be considered not only in young patients. The pathogenic relationship between stroke and midline cocaine related destructive lesions is discussed