Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019. Neurologic symptoms have been reported as part of the clinical spectrum of the disease. We aimed to determine whether neurologic manifestations are common in hospitalized patients with COVID-19 and to describe their main characteristics. METHODS: We systematically reviewed all patients diagnosed with COVID-19 admitted to the hospital in a Spanish population during March 2020. Demographic characteristics, systemic and neurologic clinical manifestations, and complementary tests were analyzed. RESULTS: Of 841 patients hospitalized with COVID-19 (mean age 66.4 years, 56.2% men), 57.4% developed some form of neurologic symptom. Nonspecific symptoms such as myalgias (17.2%), headache (14.1%), and dizziness (6.1%) were present mostly in the early stages of infection. Anosmia (4.9%) and dysgeusia (6.2%) tended to occur early (60% as the first clinical manifestation) and were more frequent in less severe cases. Disorders of consciousness occurred commonly (19.6%), mostly in older patients and in severe and advanced COVID-19 stages. Myopathy (3.1%), dysautonomia (2.5%), cerebrovascular diseases (1.7%), seizures (0.7%), movement disorders (0.7%), encephalitis (n = 1), Guillain-Barré syndrome (n = 1), and optic neuritis (n = 1) were also reported, but less frequent. Neurologic complications were the main cause of death in 4.1% of all deceased study participants. CONCLUSIONS: Neurologic manifestations are common in hospitalized patients with COVID-19. In our series, more than half of patients presented some form of neurologic symptom. Clinicians need to maintain close neurologic surveillance for prompt recognition of these complications. The mechanisms and consequences of severe acute respiratory syndrome coronavirus type 2 neurologic involvement require further studies.

Propranolol reduces viability and induces apoptosis in hemangioblastoma cells from von Hippel-Lindau patients.

BACKGROUND: Von Hippel-Lindau (VHL) disease is a rare oncological disease with an incidence of 1:36,000, and is characterized by the growth of different types of tumors: hemangioblastomas in the central nervous system (CNS) and retina, renal carcinoma, pheochromocytomas, pancreatic serous cystadenoma, and endolymphatic sac tumors. These tumors do not express VHL protein (pVHL). pVHL ubiquitinates hypoxia inducible factor (HIF) protein for degradation by the proteasome; in the absence of VHL, HIF translocates to the nucleus to activate the expression of its target genes. Targeting VHL-derived tumors with drugs that have reduced side effects is urgent to avoid repeat CNS surgeries. Recent reports have shown that propranolol, a ß-blocker used for the treatment of hypertension and other cardiac and neurological diseases, is the best option for infantile hemangioma (IH). Propranolol could be an efficient treatment to control hemangioblastoma growth in VHL disease because of its antiangiogenic effects demonstrated in IH and the hypothetical impact on HIF levels. METHODS: HeLa 9X (HRE) hypoxia responsive element cell line and primary hemangioblastoma-derived cells were subjected to propranolol treatment and cell viability and apoptosis were evaluated. HIF1-α and Hif-2α expression after propranolol treatment was analyzed by western blotting. Quantitative PCR was performed to study the mRNA expression of HIF target genes. Vascular endothelial growth factor (VEGF) was measured in culture supernatants by immunoassay. RESULTS: Propranolol downregulated HIF-dependent transcription in HeLa 9XHRE cells. Under hypoxic conditions, propranolol decreased the expression of HIF target genes in hemangioblastoma cells, which stopped proliferating and died following long-term treatment. These results suggests that propranolol treatment promoted reduced HIF protein expression and corresponding downregulation of HIF target genes, and inhibited cell proliferation in parallel with induction of cell death by apoptosis. CONCLUSIONS: Our results suggest that propranolol could reduce the growth of HIF-dependent tumors and may thus be a promising treatment to delay surgery in VHL patients.

[Contribution made by sonography in a patient with motor neuropathy with conduction blocks]. / Aportación de la sonografía en un paciente con neuropatía motora con bloqueos.

TITLE: Aportacion de la sonografia en un paciente con neuropatia motora con bloqueos.

Aportación de la sonografía en un paciente con neuropatía motora con bloqueos / Contribution made by sonography in a patient with motor neuropathy with conduction blocks

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Focalidad neurológica en paciente anticoagulado / Focal neurologic signs in an anticoagulated patient

Presentamos el caso de una mujer de 63 años que acude a urgencias por dificultad en la emisión del lenguaje y debilidad en extremidades derechas de instauración súbita. Entre sus antecedentes personales encontramos una fibrilación auricular (FA) crónica insuficientemente anticoagulada. El primer diagnóstico a tener en cuenta es el de ictus isquémico agudo de origen cardioembólico. La enfermedad vascular cerebral es la segunda causa de mortalidad en el mundo. El tiempo entre el inicio del ictus y el tratamiento de revascularización, bien sea farmacológico (intravenoso o intraarterial) o mecánico, nos marcará la evolución y pronóstico del paciente (AU)

We report the case of a 63 year old woman who came to the emergency department due to difficulty in expressing herself linguistically and right limb weakness of sudden onset. She had a history of chronic atrial fibrillation (AF) and being insufficiently anticoagulated. The first diagnosis to consider is acute ischemic stroke of cardioembolic origin. Cerebrovascular disease is the second cause of death worldwide. The time between the onset of stroke and revascularization, either pharmacological (intravenous or intraarterial) or mechanical, will determine the patient's evolution and prognosis (AU)

Síncopes de Repetición como presentación de Encefalopatía de Wernicke-Korsakov / Repeated syncope as a sign of Wernicke-Korsakoff Syndrome

La encefalopatía de Wernicke-Korsakov (EWK) es un cuadro neuropsiquiátrico agudo que cursa con la clínica clásica de paresia oculomotora, nistagmus, ataxia y alteraciones mentales. Se produce de forma secundaria a un déficit de tiamina (vitamina B1) y se da con frecuencia en alcohólicos crónicos, desnutrición, diálisis y otros desórdenes sistémicos. En ocasiones puede cursar con síntomas atípicos, lo que retrasa de forma significativa el diagnóstico. Presentamos el caso de un varón de 61 años, no bebedor y sin antecedentes de vómitos, que consulta en varias ocasiones por una clínica inespecífica, consistente en varios episodios de pérdida transitoria de conocimiento, acompañada de malestar general y parestesias difusas. Con la evolución del proceso aparecieron los síntomas típicos de esta entidad, así como la afectación de la memoria, produciendo un síndrome amnésico de Korsakov. La ausencia de los antecedentes típicos contribuyó al retraso diagnóstico. Tras confirmar el diagnóstico, se procedió a un estudio etiológico completo, sin encontrar ningún factor subyacente. El tratamiento con tiamina parenteral produjo la recuperación parcial del cuadro. Aunque el diagnóstico de esta entidad es fundamentalmente clínico, es preferible recurrir a pruebas diagnósticas para confirmarlo, como el análisis de vitamina B1 en suero y especialmente la Resonancia Magnética craneal (RM), que muestra hallazgos característicos. Además es necesario realizar un adecuado estudio etiológico. Su diagnóstico precoz es fundamental para evitar secuelas neurológicas (AU)

Wernicke-Korsakoff syndrome (WKS) has neuropsychiatric signs and symptoms and typically presents with ophthalmoparesis, nystagmus, ataxia and mental disturbances. It results from a lack of thiamine (vitamin B1) and often occurs in chronic alcoholics, people with malnutrition, on dialysis or with other systemic disorders. It may also develop with atypical symptoms, which can considerably delay diagnosis. We present a case of a 61 year old man, non-drinker with no history of vomiting, who came to the primary care centre on several occasions due to several episodes of temporary loss of consciousness accompanied by general malaise and diffuse paraesthesia. Typical symptoms began to appear as the syndrome developed, such as memory loss producing Korsakoff’s amnesia. The lack of a typical history contributed to a delayed diagnosis. After confirming the diagnosis, a complete aetiological study was conducted that did not reveal any underlying factor. Parenteral thiamine produced partial recovery. Although diagnosis is mainly by clinical impression, diagnostic tests should be conducted such as analysis of vitamin B1 in serum and especially Magnetic Resonance Imaging (MRI) which reveals characteristic signs. An aetiological study should also be conducted. Early diagnosis is essential in order to prevent neurological sequel (AU)

Trastornos no motores de la enfermedad de Parkinson: introducción y generalidades / Non-motor disorders in Parkinson’s disease: introduction and general features

Introducción. Hace ya casi 200 años, James Parkinson describió con detalle la enfermedad que hoy lleva su nombre, centrándose no sólo en los trastornos motores sino también en los síntomas no motores que sufren estos pacientes. Desarrollo. Los síntomas no motores en enfermos parkinsonianos son prevalentes e interfieren en su calidad de vida. En los últimos años se ha intentado resolver el problema de su infradiagnóstico mediante cuestionarios y escalas. Asimismo, algunos de estos síntomas se postulan como predictores de la enfermedad y se plantea que individuos asintomáticos desde el punto de vista motor que sufran alguno de estos síntomas no motores podrían ser dianas de estrategias neuroprotectoras cuando se disponga de ellas. Conclusiones. Los síntomas no motores son frecuentes y tienen gran impacto en la calidad de vida de los enfermos parkinsonianos, por lo que es necesario reconocerlos y tratarlos. Su papel como predictores de la enfermedad a día de hoy aún no está aclarado (AU)

Introduction. Two hundred years ago James Parkinson accurately described the disease that bears his name today, focusing not only on motor aspects but also on non-motor symptoms suffered by these patients. Development. Non-motor symptoms are prevalent and decrease the quality of life of the patients with Parkinson’s disease. In recent years, some non-motor scales have been developed to avoid the problem of underdiagnosis. Moreover, some of them have been proposed as clinical predictors for Parkinson’s disease and it is has been suggested that individuals with any of these non-motor symptoms and without motor manifestations of the disease could be the aim for neuroprotective therapies when they become available. Conclusions. Non-motor symptoms are prevalent and have a great impact in the quality of life of patients. Therefore, it is important to detect and treat them. Their role as predictors of the disease is unclear yet (AU)