A Rare Case of Varicella-Zoster Virus Meningitis With High Intracranial Pressure in an Immunocompetent Adult.

Varicella-zoster virus (VZV) is an alphaherpesvirus causing varicella (chickenpox) and herpes zoster. While varicella typically presents with a vesicular rash, latent VZV may reactivate within the sensory ganglia causing shingles, characterized by painful vesicular rash, which may lead to neurologic complications such as aseptic meningitis. This case explores an atypical presentation in an immunocompetent young man with VZV meningitis lacking the characteristic skin rash but featuring elevated intracranial pressure. A literature review revealed rare instances of VZV-related neurologic disease without typical skin manifestations, suggesting the virus's potential to affect the central nervous system directly. Treatment with intravenous acyclovir is recommended, with ganciclovir as an alternative treatment option. This case emphasizes the importance of considering VZV meningitis in the differential diagnosis of patients presenting with viral meningitis symptoms, with or without dermatomal rash or immunocompromised conditions.

Stroke intervention and pharmacotherapy guidelines: Knowledge-to-practice translation gaps among the emergency resident physicians in Riyadh, Saudi Arabia.

Translating the updated medical guidelines into routine clinical practice is an important initiative to improve the population's health and decrease disease outcomes. A cross-sectional survey-based study was conducted in Riyadh City, Saudi Arabia, to evaluate the knowledge and degree of application (practice) of the stroke management guidelines among emergency resident physicians. An interview-based self-administered questionnaire was used to survey the emergency resident doctors in Riyadh hospitals from May 2019 to January 2020. Of 129 participants, 78 valid, complete responses were obtained (60.5% response rate). Descriptive statistics, principle component, and correlation analyses were used. Most resident doctors were men(69.4%) with a mean age of 28.4±3.37 years. More than 60% of the residents were satisfied with their knowledge of the stroke guidelines; meanwhile, 46.2% were satisfied with their application of the guidelines. Both Knowledge and practice compliance components were significantly and positively correlated. Also, both components were significantly correlated with being updated, aware of, and strictly following these guidelines. The mini-test challenge showed a negative result with a mean knowledge score of 1.03±0.88. Even though the majority of participants utilized different tools of education and were aware of the American Stroke Association Guidelines. It was concluded that a considerable gap in the residents' knowledge regarding the current stroke management guidelines was present in Saudi hospitals. Also, it was reflected on their actual implementation and application into clinical practice. Continuous medical education, training, and follow-up of the emergency resident doctors, administered as a part of the government health programs, are crucial to improve the health care delivery for acute stroke patients.

Sleep patterns and awareness of the consequences of sleep deprivation in Saudi Arabia.

PURPOSE: Sleep deprivation is a growing challenge in modern society and places a burden on people's physical and mental well-being. However, only a few studies have investigated sleep patterns and awareness of the associated risks of sleep deprivation in Middle Eastern countries. This study aimed to explore these issues in adults in Saudi Arabia. METHODS: This was a quantitative cross-sectional study. We collected information on the participants' demographic characteristics, sleep hours, and sense of feeling sleep-deprived over the previous 3 months regardless of sleep duration. Current knowledge of the health consequences associated with chronic sleep deprivation and attitudes toward seeking in-person health care for sleep deprivation symptoms were additionally assessed. RESULTS: Among 1449 adults, only 41% of the participants slept for the recommended duration for adults of 7 h or more. However, 70% reported feeling sleep-deprived at least some of the time regardless of their sleep duration. Smokers, students, and those on sleep medications were more likely to report feeling sleep-deprived. Most participants (strongly) agreed that chronic sleep deprivation had a negative effect on their health (92%) and social (88%) and professional lives (91%), yet only 10% of our sample had visited a doctor for their sleep deprivation symptoms. CONCLUSIONS: We found a high level of sleep deprivation among residents of Saudi Arabia and a strong awareness of the association between chronic sleep deprivation and negative consequences, yet a lower awareness of the association with specific medical comorbidities. Our findings also suggested a lack of health care engagement among sleep-deprived participants.

Swallowing Apraxia Post Ischemic Stroke.

A 55-year-old male patient with a known medical history of diabetes mellitus type 2 and treated lymphoma was first admitted with a sudden left-sided facial asymmetry and mouth deviation to the left side with no other neurological symptoms. A Computerized Tomography (CT) scan of the brain showed acute infarct and small left basal ganglia old lacunar infarction. He was discharged on a dual antiplatelet. One week later, the patient's condition had worsened and, therefore, was admitted with an impression of ischemic stroke. A bedside swallowing assessment, VFSS, and FEES study were conducted to diagnose this case. The bedside assessment did not reveal any sensory or motor deficits in his oral cavity and the FEES examination was also unable to rule out pharyngeal dysphagia. However, a videofluoroscopic swallowing study (VFSS) revealed a significant dysfunction of oral preparation and oral phases and presented difficulty initiating the pharyngeal phase. Given these features, we believe that this swallowing difficulty is caused by swallowing apraxia. This case provides additional information and understanding on management from the swallowing side.