Neurological Manifestations of Vitamin B12 Deficiency: About a Case

The authors report a case of deficient sensory neuropathy secondary to vitamin B12 deficiency, diagnosed in the neurology department of the Sino-Central African Friendship University Hospital in Bangui. The diagnosis was made possible by electroneuromyography which showed subclinical neurological damage associated with hematological damage (anemia). Through this observation, we recall the diagnostic criteria of the disease in a context of difficult medical practice. .

Neurological manifestations of hepatitis E virus infection:An overview

Hepatitis E virus(HEV)is an important cause of repeated waterborne outbreaks of acute hepatitis.Recently,several extrahepatic manifestations(EHMs)have been described in patients with HEV infection.Of these,neurological disorders are the most common EHM associated with HEV.The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation.Patients can present with normal liver function tests,which can often be misleading for physicians.There is a paucity of data on HEV-related neurological manifestations;and these data are mostly described as case reports and case series.In this review,we analyzed data of 163 reported cases of HEV-related neurological disorders.The mechanisms of pathogenesis,clinico-demographic profile,and outcomes of the HEV-related neurological disorders are described in this article.Nerve root and plexus disorder were found to be the most commonly reported disease,followed by meningoencephalitis.

Neurological Manifestations of Takayasu Arteritis

Objective To investigate the clinical neurological manifestations of Takayasu arteritis (TA). Methods A retrospective study was conducted with 63 consecutive TA cases admitted to Peking Union Medical College Hospital from January 2009 to May 2010. All the patients fulfilled the diagnostic criteria of TA by the American College of Rheumatology. Among the 63 TA patients, 27 with neurological manifestations were included in the present study. All the patients were evaluated using standardized neurological examination, sonography, computed tomography (CT) angiography, and cerebral CT or magnetic resonance imaging. Results Dizziness and visual disturbance were the most common symptoms, which occurred in 20 (74.1%) and 16 (59.3%) patients respectively. Another common symptom was headache, observed in 15 (55.6%) patients. Six (22.2%) patients had suffered from ischemic stroke; 7 (25.9%) patients had epileptic seizures. Two (7.4%) patients were diagnosed as reversible posterior encephalopathy syndrome (RPES) based on typical clinical and imaging manifestations. Conclusions Neurological manifestations are common symptoms in TA patients in the chronic phase, including dizziness, visual disturbance, headache, ischemic stroke, seizures, and some unusual ones such as RPES. We suggested RPES be included into the differential diagnosis of acute neurological changes in TA.

A Systematic review on the Neurological manifestations of COVID-19

Background:Background:The unprecedented virus(COVID-19)has claimed the lives of humans worldwide since the onset of the current pandemic.The virus which commonly starts as mild symptoms most often progresses to severe cases.Healthcare workers have reported that some patients present with atypical symptoms such as cerebrovascular accidents,taste disorders and nerve disorders.Hence,patients with neurological involvement following the infection may be easily misdiagnosed and mismanaged.In order to assess the occurrence,development and prognosis of this novel infection for a better understanding and management,a systematic review of the published cases was done which gives an insight into the possibility that some infected patients may not manifest with the primary symptoms of the respiratory system.Methods:A systematic review of literature searches were conducted in three databases:PubMed,EMBASE and google scholar between December 01,2019 to July 16,2020 for published articles related to the neurologic symptoms of COVID-19.The screening of articles was conducted by two reviewers independently.Results:Thirty-five relevant articles comprising of a total of 543 patients which met the inclusion criteria were carefully selected and included in this review.Headache and dizziness were the most commonly reported symptoms followed by impaired conscious level,olfactory disorders(Anosmia and hyposmia)and taste disorders(Ageusia).In severe cases,acute cerebrovascular accidents,cerebral hemorrhage and Guillain Barre Syndrome were also significantly reported.Conclusion:Some of the neurologic manifestations may occur at the onset of SARS-CoV-2 infection or independently of the respiratory symptoms.Hence,the health care providers need to be prepared and unusually alert in the management of patients in order to avoid delayed or misdiagnosis.This will help in reducing the morbidities and mortalities associated with the infection.

Neurological manifestations of patients with COVID-19:potential routes of SARS-CoV-2 neuroinvasion from the periphery to the brain

Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has caused a global pandemic in only 3 months.In addition to major respiratory distress,characteristic neurological manifestations are also described,indicating that SARS-CoV-2 may be an underestimated opportunistic pathogen of the brain.Based on previous studies of neuroinvasive human respiratory coronaviruses,it is proposed that after physical contact with the nasal mucosa,laryngopharynx,trachea,lower respiratory tract,alveoli epithelium,or gastrointestinal mucosa,SARS-CoV-2 can induce intrinsic and innate immune responses in the host involving increased cytokine release,tissue damage,and high neurosusceptibility to COVID-19,especially in the hypoxic conditions caused by lung injury.In some immunecompromised individuals,the virus may invade the brain through multiple routes,such as the vasculature and peripheral nerves.Therefore,in addition to drug treatments,such as pharmaceuticals and traditional Chinese medicine,non-pharmaceutical precautions,including facemasks and hand hygiene,are critically important.

Insights into Plasmodium and SARS-CoV-2 co-infection driven neurological manifestations

In malaria-endemic regions,people often get exposed to various pathogens simultaneously,generating coinfection scenarios.In such scenarios,overlapping symptoms pose serious diagnostic challenges.The delayed diagnosis may lead to an increase in disease severity and catastrophic events.Recent coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has affected various areas globally,including malaria-endemic regions.The Plasmodium and SARS-CoV-2 co-infection and its effect on health are yet unexplored.We present a case report of a previously healthy,middle-aged individual from the malaria-endemic area who suffered SARS-CoV-2 and Plasmodium falciparum co-infection.The patient developed severe disease indications in a short time period.The patient showed neurological symptoms,altered hematological as well as liver-test parameters,and subsequent death in a narrow time span.We hereby discuss the various aspects of this case regarding treatment and hematological parameters.Further,we have put forward perspectives related to the mechanism behind severity and neurological symptoms in this fatal parasite-virus co-infection case.In malaria-endemic regions,due to overlapping symptoms,suspected COVID-19 patients should also be monitored for diagnosis of malaria without any delay.The SARS-CoV-2 and Plasmodium co-infection could increase the disease severity in a short time span.In treatment,dexamethasone may not help in severe cases having malaria as well as COVID-19 positive status and needs further exploration.

Neurological manifestations related to Crohn’s disease:a boon for the workforce

The neurological manifestations of Crohn’s disease and its prevalence are not well known.Here,we report five patients of confirmed Crohn’s disease with different neurological presentations.The neurological presentations include anterior ischemic optic neuropathy,myelopathy,posterior reversible encephalopathy syndrome,chronic inflammatory demyelinating polyneuropathy,and chronic axonal sensory and motor polyneuropathy.These manifestations should be kept in mind in the assessment of Crohn’s disease.

Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke

BACKGROUND: Cerebrovascular accident(CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't signi? cant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients.METHODS: A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale(GCS), agitation were analyzed in this study.RESULTS: In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had signi? cantly higher prevalence in hemorrhagic stroke patients(P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients(P<0.001).CONCLUSION: Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.

Dengue fever leading to acute dengue hemorrhagic leukoencephalitis:A case report

Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome.Patient’s concerns:A 20-year-old male presented with a 2-day history of fever,multiple episodes of vomiting,and altered sensorium.Diagnosis:Dengue fever leading to acute hemorrhagic leukoencephalitis.Interventions:Multiple transfusions of single donor platelets,intravenous methylprednisolone,intravenous immunoglobulin,anti-seizure prophylaxis,and broad-spectrum antibiotics.Outcomes:Repeat brain magnetic resonance imaging showed resolution of lesions.The patient was subsequently discharged from the hospital in a healthy state.Lessons:This report helps us to gain a better understanding of the patient’s presentation,which will help to improve the timely recognition and prevention of this rare devastating presentation.

Clinical efficacy and safety of Gandouling plus low-dose D-penicillamine for treatment of Wilson's disease with neurological symptoms

OBJECTIVE： To investigate the effect and safety of Gandouling plus low-dose D-penicillamine for treating patients with Wilson＇s disease （WD） who have neurological symptoms. METHODS： WD patients with neurological symptoms were divided into two groups： a treatment group （n = 53） and a control group （n = 50）. The treatment group received anti-copper therapy with a combination of Gandouling and low-dose D-peni- cillamine （10 mglkg）, whereas the control group was with conventional dose D-penicillamine （20 rag/ kg） monotherapy. The clinical efficacies, adverse re- actions, and results of the various hematological and biochemical investigations were recorded and analyzed statistically. RESULTS： Overall, 98.11% of the WD patients treated with the combined therapy experienced alleviation of their neurological condition （paralleled by a significantly improved Global Assessment Scale score or remained stable）. Their white blood cell and platelet counts stabilized, and their liver function was improved or remained stable. The combined therapy also obviously promoted improved 24-h urinary copper excretion. Only 15.09% of the WD patients with the combined therapy experienced adverse reactions, including neurological deterioration in one case （1.89%） and hepatic worsening in one case （1.89%）, which was less frequent than that in the control group given conventional-dose D-penicillamine monotherapy. CONCLUSION： Treating WD patients with neurological symptoms using Gandouling plus low-close D-penicillamine is effective and safe.

Emerging neurotropic features of SARS-CoV-2

The prevailing coronavirus disease-19(COVID-19)caused by a novel severe acute respiratory syndrome coronavirus(SARS-CoV-2)has presented some neurological manifestations including hyposmia,hypogeusia,headache,stroke,encephalitis,Guillain-Barre syndrome,and some neuropsychiatric disorders.Although several cell types in the brain express angiotensin-converting enzyme-2(ACE2),the main SARS-CoV-2 receptor,and other related proteins,it remains unclear whether the observed neurological manifestations are attributed to virus invasion into the brain or just comorbidities caused by dysregulation of systemic factors.Here,we briefly review the neurological manifestations of SARS-CoV-2,summarize recent evidence for the potential neurotropism of SARS-CoV-2,and discuss the potential mechanisms of COVID-19-associated neurological diseases.

Effect of electro-scalp acupuncture on acute ischemic stroke: a randomized, single blind, trial

OBJECTIVE： To determine the clinical efficacy and safety of electro-scalp acupuncture in the treatment of patients with acute ischemic stroke. METHODS： Totally 74 patients with acute ischemic stroke were enrolled and divided into either body acupuncture （Control） or electro-scalp acupuncture （ESA） groups according to randomized controlled principle. The patients in the control group were given body acupuncture treatment once daily for 28 d, whereas except for the body acupuncture, electro-scalp acupuncture was additional treatment given to the ESA group. Neurological deficits, everyday motor function and muscle strength were evaluated at baseline and the 28th d by NIH Stroke Scale （NIHSS）, FugI-Meyer Assessment （FMA） and Modified Barthel Index Score （MBI）, respectively. RESULTS： There were not obvious between-group differences in the baseline efficacy parameters （NI- HSS, FMA and MBI） （all P 〉 0.05）, whereas signifi- cant between-group differences were found in post-treatment NIHSS, FMA-UE and MBI scores （all P 〈 0.05）. After acupuncture treatment, systematic within-group improvements were found in the two groups for any of the efficacy parameters assessed （all P 〈 0.01）, and the ESA group showed higher significant improvements in NIHSS, FMA-UE and MBI scores （all P 〈 0.05）. CONCLUSION： Electro-scalp acupuncture was efficacious in the treatment of acute ischemic stroke, which resulted in meaningful improvements in neurologic function, motor function and activities of daily living of patients.

Improvement effect of acupuncture on locomotor function in Parkinson disease via regulating gut microbiota and inhibiting inflammatory factorrelease

Objective To observe the effect of acupuncture on the intestinal flora in Parkinson disease(PD)model mice and explore the mechanism of acupuncture in improving the locomotor function in PD.Methods Thirty-two C57BL/6 mice were randomly divided into a control group,a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)group,a MPTP+acupuncture group(MPTP+A),and a MPTP+madopar group(MPTP+M),with 8 mice in each group.Except for the control group,the other groups were intraperitoneally injected[25 mg/(kg·bw)]with MPTP to establish PD mouse models.After successful modeling,the MPTP group received no intervention,the MPTP+A received acupuncture at Tianshu(ST25),Guanyuan(CV4),and Zusanli(ST36),and the MPTP+M was given madopar[125 mg/(kg·bw)]by intragastric gavage.After consecutive 10-day interventions,the intestinal function and behaviors of the mice were detected.The 16S rRNA gene sequence was used to analyze the composition of fecal intestinal flora in each group.Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)and enzyme-linked immunosorbent assay were used to detect the expression levels of inflammatory cytokines in the brain and serum.The expression levels of tyrosine hydroxylase(TH)andα-synuclein in the substantia nigra(SN)were detected by immunohistochemical staining.Toll-like receptor(TLR)2 and lipopolysaccharide receptor CD14(CD14)in the SN were determined by RT-qPCR.Myeloid differentiation factor(MyD)88,nuclear factor kappa-B(NF-κB)and Akt1 in the SN were detected by Western blotting.Results After the intervention,compared with the control group,the intestinal motility,fecal water content,and the expression of TH in the SN were significantly decreased in the MPTP group(P<0.05),along with an increasedα-synuclein expression(P<0.05).Additionally,the results of the fecal microflora test showed that the alpha diversity of the MPTP decreased,and the levels of inflammatory cytokines[tumor necrosis factor(TNF)-α,inducible nitric oxide synthase(iNOS),interleukin(IL)-1β,and IL-6]in the serum and SN,and the expression of NF-κB in the SN were significantly increased(P<0.05).Compared with the MPTP group,acupuncture intervention significantly enhanced the autonomous horizontal movement and coordination ability of PD mice(P<0.05);acupuncture and madopar interventions significantly reduced the levels ofα-synuclein,inflammatory cytokines(TNF-α,iNOS,IL-1β,and IL-6)in the serum and SN,and the NF-κB expression in the SN,along with significantly increased alpha diversity richness index(P<0.05).In addition,the relative abundance of Bacteroides increased significantly in the MPTP+A(P<0.05),while the relative abundance of Firmicutes and Cyanobacteria decreased significantly(P<0.05).Conclusion Acupuncture intervention can improve locomotor function,reduceα-synuclein aggregation and inflammatory factors expression,and increase the Akt signaling pathway in PD mice.In addition,acupuncture intervention can benignly regulate the intestinal flora of PD mice.Therefore,it suggests that acupuncture intervention can protect PD model mice probably by regulating intestinal flora and activating Akt signaling pathway.

A rabbit model of graded primary mechanical injury to brainstem

Objective： To introduce a new animal model of graded mechanical primary brainstem injury （BSI）. Methods： Altogether 45 rabbits were subjected to BSI by type II biological impact machine designed by the Third Military Medical University. The animals were divided into 4 experimental groups （n=10） and 1 control group （n=5） ac- cording to different magnitudes of impact pressure imposed on the occipital nodule： Group 1,500-520 kPa; Group 2, 520- 540 kPa; Group 3,540-560 kPa; Group 4, 560-580 kPa and Group 5, 0 kPa with 20 kPa increase in each grade. The im- pact depth was a constant 0.5 cm. After injury, the clinical symptoms and signs as well as pathological changes were observed. Results： Rabbits in Group 1 revealed mild physiologi- cal reaction of BSI. They had localized cerebral contusion with punctate hemorrhage and subarachnoid hemorrhage （SAH） was limited to the peripheral tissues at the impact area. In Group 2, obvious physiological reaction was observed. Local pathological lesions reached the superfi- cial layer of brainstem tissues; focal hemorrhage and girdle- shaped SAH in basilar pon were observed under microscope. In Group 3, BSI was more severe with a long respiratory depression. Pathological lesions reached the inner portionof brainstem with massive hemorrhage and the whole brainstem was wrapped by subarachnoid hematoma. In Group 4, most rabbits died due to severe BSI. Pathological lesions deepened to the central brainstem with wide patho- logical change, rapture of the medulla oblongata central canal. Group 5 was the control group, with normal brainstem structure and no lesion observed. Conclusion： This model successfully simulates differ- ent levels ofbrainstem mechanical injury and clearly shows the subsequent pathological changes following injury. It takes two external parameters （impact pressure and depth） and has a similar injury mechanism to clinical accelerating BSI. Moreover it is reproducible and stable, thus being be- neficial for exploring pathophysiological mechanism, diag- nosis and forensic identification of various degrees of BSI.