MENINGO-ENCEPHALITIS IN A MIDDLE-AGED WOMAN HOSPITALIZED FOR COVID-19.

OBJECTIVE: The aim: To pay attention of clinicians to possible lesions of the central nervous system (encephalitis) in patients with COVID-19. PATIENTS AND METHODS: Case presentation: A 44-year-old woman was admitted to our clinic because of 2-month-history of mild fever, bilateral lower lobe pneumonia, respiratory failure, generalized weakness, and some neurologic symptoms. SARS-CoV-2 RNA was detected in nasopharyngeal swab. Chest CT demonstrated bilateral pulmonary poly segmental consolidations in the mid and lower zones. Focal hyper intensive abnormalities in various parts of the left hemisphere were found at MR brain imaging in T2WI, and T2 FLAIR mode. Cerebrospinal fluid (CSF) examination showed a white cell count of 31/uL (normal <5/uL), protein 0.73 g/L (0.15-0.45), and glucose 1.4 mmole/L (2.2-3.9). Standard CSF neuroviral PCR panel and PCR for SARS-CoV-2 were negative. She was treated with ganciclovir, and dexamethasone. Due to suspected tuberculosis meningitis (cytosis, decreased level of protein and glucose), she also received ex juvantibus a course of anti-TB therapy (isoniazid, kanamycin, and levofloxacin) and made a steady improvement. CONCLUSION: Conclusion: This case shows that SARS-CoV-2 in association with other pathogens may cause various lesions of the CNS accompanied by severe neurological manifestations in adults.

A RARE BRAINSTEM INFLAMMATORY SYNDROME, CLIPPERS, MYTH OR FACT. CASE REPORT WITH CRITICAL REVIEW.

A very rare inflammatory disease of CNS, CLIPPERS syndrome, was recently described and only a few sporadic cases are reported in the medical literature. Its etiology and pathogenesis are unknown, that together with the polymorphic and sometimes confounding neurological manifestations, and radiological findings represent a real diagnostic and therapeutic challenge for clinicians. Aim: To highlight the importance of clear and specific diagnostic assessment. Here we present the case of a 40-year-old male with a subacute lymphocytic midbrain inflammation accompanied by vasculitis. We discuss the symptoms, imaging and treatment of this lesion.

Subacute enterovirus-associated encephalitis in a young adult coinfected with borrelia burgdorferI.

OBJECTIVE: The aim: To pay attention of clinicians to sterile encephalitis in adults, which in fact may be caused by EVs. RESULTS: Results: A young woman was admitted to our clinic because of 3-month-history of mild fever, left-sided soft facial paralysis, and generalized weakness. MR brain imaging in T2W, FLAIR, and T1W mode showed focal hyper intensive abnormalities in various parts of the left hemisphere. EV RNA was detected in the patient's CSF on admission. IgM class antibodies to B.burgdorferi were present in the blood. Antibiotics and ribavirin have been administrated with a good effect. CONCLUSION: Conclusion: This case shows that EV infection may cause brainstem encephalitis accompanied by severe neurological manifestations in adults.

A CASE OF MRI-NEGATIVE HERPES VIRUS ENCEPHALITIS PRESENTED BY RAMSAY HUNT SYNDROME.

Ramsay Hunt syndrome (RHS) occurs due to reactivation of latent Varicella Zoster Virus (VZV) infection in the geniculate ganglion of the facial nerve. Major clinical symptoms include ipsilateral facial paralysis, otic pain, and herpetic vesicles (rashes) along the nerve with accompanying ear pain. Rarely clinical findings include retrograde transaxonal spread of the virus from the ganglion into the brain parenchyma with developing the encephalitis or multiple cranial nerve involvement. We describe here a patient with both RHS along with complicating brainstem encephalitis developed due to the coinfection of VZV and EBV.

Varicella-zoster virus cns disease clinical features in ukrainian patients. prospective study.

OBJECTIVE: Introduction: Herpes zoster (HZ), or shingles, is localized disease characterized by unilateral radicular pain and a vesicular rash limited to the area of skin innervated by a single dorsal root or cranial sensory ganglion. Whereas varicella, or chickenpox, results from primary exogenous varicella-zoster virus (VZV) infection, HZ is caused by reactivation of endogenous VZV that has persisted in latent form within sensory ganglia following an earlier episode of chickenpox. The aim: To explore the clinical features, diagnosis, and treatment of CNS injury caused by VZV infection in a prospective single center study from January 2014 to January 2018. PATIENTS AND METHODS: Materials and methods: 117 adult patients, among which young women predominated with confirmed VZV infection were analyzed in the study. CSF and blood contents, antibody for herpes zoster M and G classes, and MRI scans have been studied, but the crucial diagnostic sign was the presence of specific viral DNA in the CSF or blood. The main clinical manifestations of the disease were ganglionitis and ganglioradiculoneuritis. Another brain lesion like uveitis, encephalitis and vasculitis were observed also. A clinical case of an unusual course of VZV-infection is given. RESULTS: Results and conclusions: The most common clinical variants of HZ were ganglionitis (69.7%). Cranial localization was observed in 31% of patients, spinal one - in 38.7%, injury to the meninges was found in 16.3% of patients.

HIV/AIDS in the guise of a demyelinating disease.

OBJECTIVE: Introduction: A significant part of patients with HIV / AIDS develops damage to the nervous system. There are also cases where opportunistic infections of the nervous system, especially herpes viral origin, can hide the underlying disease, making it difficult diagnosis. The aim: To show the possibility of HIV infection mimicry a neurological pathology. PATIENTS AND METHODS: Clinical case: A 41-years-old female presented to The Cеntег of Infectious disorders of the Nervous System (Kyiv, Ukraine) in August, 2018 after developing acute fever following by a left side hemiparesis, violation of coordination. Tuberculosis and HIV denied. Her physical examination showed tremor in her hands during a Barre-probe. She performed the coordination tests with intent, staggering in the Romberg pose. A small brain lesion was revealed at MRI. Antibodies to HSV1/2, CMV, Tox. gondii were found in the CSF and blood. Blood PCR was reported to be positive for EBV DNA, and HCV RNA. A rapid HIV test was negative. A repeated blood test performed 10 days after admission showed low level of CD4+ T cells (36 cells /1 µl), and HIV RNA (850,104 cp / ml). HIV antibodies were also revealed. As a result, patient was transferred to a specialized department for further treatment. CONCLUSION: Conclusion: Considering high clinical polymorphism of HIV/AIDS, physicians of all specialties should be alert for the possible neurologic manifestations of this disease to timely examine patients.