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.

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.

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.

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.

克罗恩病的神经系统表现:疾病诊治的有益补充

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.