Postvaccinal Encephalopathy Presenting with Amnesia and Seizure After ChAdOx1 nCov-19 Vaccination: A Case Report.

PURPOSE: Because of the COVID-19 pandemic and resulting widespread vaccination, many related neurological disorders, including autoimmune encephalopathy, have emerged. The pathophysiological mechanism underlying the COVID-19 vaccination and autoimmune encephalopathy remains unclear; more case reports and further investigation are required. CASE REPORT: We report a clinical case of a 38-year-old woman who presented with acute-onset amnesia, language disturbance, and seizure. We suspected autoimmune encephalopathy triggered by the ChAdOx1 nCoV-19 vaccine. Brain magnetic resonance imaging revealed a subacute infarction at the right internal capsule and irregular vascular contour, which indicated a vasculopathy, such as vasculitis. Cerebrospinal fluid analysis revealed inflammation without pleocytosis, and electroencephalography detected diffuse background slowing with sharp transients at the right temporal region. Although autoantibody tests were negative, we initiated steroid pulse therapy. The patient's symptoms improved rapidly. The patient was discharged without neurological deficit or sequelae. CONCLUSION: Clinicians should be mindful of postvaccinal encephalopathy and suspect this condition in patients with acute onset of psychosis or mental change, higher cortical dysfunction, and seizure within 2 weeks of vaccination. Early diagnosis is key, and immune treatment, such as steroid pulse therapy or immunosuppressants, may dramatically improve patients'symptoms.

Efficacy of Scalp Acupuncture in Patients With Post-stroke Hemiparesis: Meta-Analysis of Randomized Controlled Trials.

Objectives: To conduct a meta-analysis to assess the efficacy of scalp acupuncture (SA) in patients with stroke and consequent hemiparesis regardless of brain infarction or intracerebral hemorrhage. Methods: A literature search of randomized controlled trials (RCTs) on SA for stroke was performed in five databases up to May 10, 2021. We investigated three types of outcome: motor function, sequelae of poststroke hemiparesis, and adverse effects. Methodological quality was assessed using the revised Cochrane risk of bias tool version 2.0. Results: Of 1,063 papers, 30 RCTs involving Fugl-Meyer Assessment were selected, among which 10 and four RCTs were selected for evaluation of courses lasting of 1 and 3 months, respectively. The meta-analysis of 1- and 3-month courses revealed significant differences in the motor function of the SA plus Western standard treatment group vs. Western standard treatment only (medication plus rehabilitation; P < 0.001). A 3-month course tended to result in better outcomes than a 1-month course. Conclusions: Our meta-analysis results reveal that SA improves motor function in patients with acute to chronic stroke, regardless of brain infarction or intracerebral hemorrhage. However, because of a lack of methodological quality, thoroughly planned clinical studies are still required.

Chronic Immune Sensory Polyradiculoneuropathy-Plus With Diffuse Enlarged Dorsal Root Ganglion and Positive Serum Human Leukocyte Antigen (HLA)-B27.

The peripheral nerve is usually spared in chronic immune sensory polyradiculoneuropathy (CISP) according to a literature review; however, an extended-spectrum of CISP, CISP-plus, was introduced recently. Here we report a 29-year-old Taiwanese man who presented with numbness and hypoesthesia in all distal extremities, tightness sensation in the left posterior thigh, and sensory ataxia for three months. The clinical and neurophysiological examinations revealed proximal sensory abnormalities along with sural nerve involvement. The elevated protein level of cerebrospinal fluid (CSF) was noted and enlarged dorsal root ganglia were seen on the magnetic resonance imaging (MRI) of the whole spine. Autoimmune workup showed only positive human leukocyte antigen (HLA)-B27. Biopsy of the sural nerve revealed inflammatory demyelinating neuropathy. Only mild improvement was noted after methylprednisolone pulse therapy (1,000mg/day) for three days, and he was then treated with intravenous immunoglobulin with the dosage of 2g/kg-BW followed by azathioprine, and objective improvements were reported. Different from the previous case reports, CISP may also associate with peripheral nerve involvements. A sural nerve biopsy could assist the diagnosis. Further investigation is needed for the possible immune association between CISP-plus and HLA-B27.

Time-Varying Effects of Psychological Distress on the Functional Recovery of Stroke Patients.

OBJECTIVE: To explore the temporal effects of psychological distress on the functional recovery of stroke survivors. DESIGN: A longitudinal follow-up study. All participants were interviewed at 5 days after stroke onset, and at 1, 2, 3, and 6 months after discharge from acute care hospitals. SETTING: Neurology inpatient and outpatient departments and rehabilitation clinics. PARTICIPANTS: First-time stroke participants (N=62) without cognitive impairment, psychiatric disorders, or cancer were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements consisted of demographic characteristics, disease severity, social support, the Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ_C), and the Barthel Index. RESULTS: Our findings showed that psychological distress had a dynamic effect on functional recovery over time, and as the total ESDQ_C score increased by 1 point, the concurrent functional recovery decreased by .23 points (P<.001). Additionally, 5 subscales of the ESDQ_C including anger, emotional dyscontrol, helplessness, indifference, and euphoria also had dynamic effects on functional recovery over time (P<.05). Regardless of when a single form or various forms of psychological distress occurred over time from stroke onset, the functional recovery over time was simultaneously affected. CONCLUSIONS: The time-varying effect of psychological distress on functional recovery was significant. Adopting comprehensive instruments and regular assessments for the early detection of various psychological distresses while under clinical care is needed. Effective interventions targeting both physical and mental functions would further improve the functional recovery and overall health of stroke patients.

Nitrous Oxide-induced Subacute Combined Degeneration Presenting with Dystonia and Pseudoathetosis: A Case Report.

PURPOSE: Nitrous oxide (N2O) is neurotoxic by interfering with vitamin B12 bioavailability. The clinical picture is indistinguishable to that of subacute combined degeneration (SCD). A movement disorder might occur though it is not a characteristic feature. We report a patient with N2O-induced SCD, exhibiting a combination of different involuntary movements. CASE REPORT: A 20-year-old woman presented with one month of progressive unsteady gait, involuntary movements and tingling sensation in a stocking-glove distribution. She had used N2O and ketamine intermittently for recreational purposes for about two years. Neurological examination demonstrated normal cranial nerve functions except for dystonia in the facial muscle and tongue. Her muscle strength was full, but there were bilateral hyperreflexia and extensor plantar response. She exhibited dystonia in four limbs with athetoid movement in fingers and toes, worsened by eye closure. Vibration and proprioception were impaired. Laboratory tests revealed anemia (Hb: 9.9 g/dl) with normal mean corpuscular volume (85.7 fL) and decreased iron level (22 µg/dl) while other results were normal including serum vitamin B12 level (626 pg/ml). Magnetic resonance imaging showed a hyperintense lesion from C1 to C6 level in the posterior column. She was diagnosed as having SCD caused by N2O abuse, presenting with generalized dystonia and pseudoathetosis. The involuntary movements disappeared with vitamin B12 supplementation. CONCLUSION: Movement disorders may be the rare manifestations of SCD associated with N2O abuse. Early recognition of the etiology is vital because it is treatable with vitamin B12 and methionine.

CHA2DS2-VASc Score and Heart Rate Predict Ischemic Stroke Outcomes in Patients withAtrial Fibrillation.

PURPOSE: To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF). METHODS: Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate. RESULTS: Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of ≥ 8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 ± 24 versus 84 ± 20 beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 ± 23 versus 11 ± 12 days, p < 0.001) and a higher mortality rate (11.0% versus 0.0%, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of ≤ 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR 2-4.75 versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity. CONCLUSIONS: Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke. KEY WORDS: Atrial fibrillation; CHA2DS2-VASc score; Heart rate; Ischemic stroke.

Leptomeningeal metastasis of malignant lymphoma with negative results in magnetic resonance imaging: a case report.

PURPOSE: Non-Hodgkin's lymphoma which occasionally involves the central nervous system, occurs more often in high-grade cases and implicates a poor prognosis. Leptomeningeal metastases may present as multiple cranial nerve involvements. Diagnosis is achieved by recognizing the clinical manifestations, followed by neuroradiologic studies and laboratory examination of the cerebrospinal fluid. But normal studies of either method do not exclude such a diagnosis. CASE REPORT: We present one female patient with non-Hodgkin's lymphoma, who had multiple cranial nerve palsies as signs of central nervous system involvement, but who had negative results in her neuroimaging studies. CONCLUSION: Patients with multiple cranial nerve palsies should receive cytological examinations of the cerebrospinal fluid in spite of the negative neuroimaging results.