Pauci-symptomatic foodborne botulism due to Clostridium botulinum type B with predominant ophthalmologic presentation possibly after consumption of honey.

Foodborne botulism, a toxin-mediated illness caused by Clostridium botulinum, is a public health emergency, and rarely reported in France. We report herein the case of two family members (a father and his son) from Franche-Comté, France, presented with ophthalmological symptoms which occurred after non-specific gastro-intestinal symptoms after a trip to Serbia with a recent consumption of artisanal honey, and suggestive of botulism. The suspected intoxication appeared to be caused by a type B strain of C. botulinum, as demonstrated by toxin-neutralization in the lethal mouse bioassay. Regarding the mild-to-moderate form, the patients were treated symptomatically with monitoring, against antitoxins, with no evidence of relapse afterwards. We want to highlight the importance of recognizing clinical ophthalmologic botulism symptoms as unreactive bilateral mydriasis with lack of accommodation to contribute to earlier diagnosis in case of pauci-symptomatic botulism.

Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020.

We describe 2 cases in coronavirus disease patients in France involving presumed thrombotic stroke that occurred during ongoing anticoagulation treatment for atrial fibrillation stroke prophylaxis; 1 patient had positive antiphospholipid antibodies. These cases highlight the severe and unique consequences of coronavirus disease-associated stroke.

Fibrocartilaginous embolism after mountain cycling: a case report with clinical and radiological follow-up and almost complete recovery.

Introduction: Fibrocartilaginous embolism (FCE) is a rare spinal cord infarction due to embolism of fibrocartilaginous material with consecutive arterial infarction of the anterior spinal artery. Physical activity with increased axial pressure is the underlying mechanism of the retrograde migration of primarily nucleus pulposus material into the arterial system of the spinal cord. The initial severity of the clinical symptoms is supposed to be a prognostic predictor of recovery and so far, no specific treatment recommendation exists. Methods: We present a case of spinal cord infarction due to FCE after long and sporty mountain cycling (during 6 hours and 2500 altitude difference) with detailed clinical and radiological follow-up. Results: The clinical and radiological follow-up at month 4 showed an unexpected almost complete recovery despite the extensive initial clinical impairment. Conclusion: Mountain cycling has not yet been described as a specific trigger of FCE with spinal cord infarction. Further observation is necessary to show if the prolonged bent posture and core muscle imbalance in cycling, in addition to the Valsalva manoeuvre during physical effort, may contribute to FCE. It is unknown if prognosis of spinal cord infarction due to FCE differs from other causes of spinal ischaemia and if anticoagulation treatment presents a therapeutic option.

Posterior reversible encephalopathy syndrome in early lyme neuroborreliosis.

We report a case of posterior reversible encephalopathy syndrome in an adult patient fulfilling criteria for proven early Lyme neuroborreliosis.

Acute Cerebellitis Following COVID-19: Alarming Clinical Presentation Challenged by Normal Paraclinical Findings.

We report the case of an acute cerebellitis following COVID-19 in 32-year-old man who presented with a life-threatening critical cerebellar syndrome contrasting with normal paraclinical findings. Despite this fulminant critical presentation, the patient fully recovered in 37 days after early treatment with high-dose steroids and intravenous immunoglobulins. This case highlights the need for clinicians to be aware of acute cerebellitis following COVID-19, despite normal laboratory, imaging and electroencephalography findings and the importance to start appropriate treatment as soon as possible.

Atypical miller-fisher syndrome after COVID-19 and sleeve gastrectomy: Contribution of neurochemical markers to early diagnosis.

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. More recently, there have been sporadic case reports on development of Miller-Fisher Syndrome , a rare variant of Guillain-Barré Syndrome in COVID-19 patients. Case report: We reported herein the case of a French young women presenting with ophtalmoplegia, cerebellar ataxia, and universal areflexia following a bariatric surgery (sleeve gastrectomy). A concomitant COVID-19 diagnosis was retained based on microbiological testing. The patient was successfully treated after high-dose intravenous thiamine, but areflexia persisted. Underlying COVID-19 related Miller-Fisher Syndrome was established on physical examination and confirmed by pathologic neurophysiological findings and elevated level of phosphorylated neurofilament heavy chain protein in cerebrospinal fluid analysis. Conclusions: Guillain-Barré Syndrome and its variants after SARS-CoV-2 infection are extremely rare. The measurement of phosphorylated neurofilament heavy chain protein should be considered as an easy tool to detect an early affection of the peripheral nervous system.

Post malaria acute motor axonal neuropathy.

We report herein the first case of acute motor axonal neuropathy syndrome after severe Plasmodium falciparum malaria in a traveller, diagnosed through neurophysiological findings and high level of neurofilaments light chain in cerebrospinal fluid analysis, with negative testing for anti-ganglioside antibodies.