Good recovery of immunization stress-related responses presenting as a cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations.

BACKGROUND: Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand. METHODS: We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site. RESULTS: Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28-42) years in patients receiving CoronaVac and 46 (33.5-60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16-960) min and 30 (8.8-750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability). CONCLUSIONS: Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.

Acute Calcific Discitis or Symptomatic Calcified Schmorl's Node of the Upper Thoracic Spine in an Adult: A Case Report and Literature Review.

We describe a patient with acute calcific discitis following symptomatic Schmorl's node (SN) of upper thoracic spine. A 28-year-old female suffered from sudden severe pain in mid-thoracic, left scapular area, radiating to her chest. Plain radiography of the thoracic spine showed calcification in T3-4 intervertebral disc space. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the spine demonstrated calcification of the T3-T4 nucleus pulposus, migrating into the inferior of T3 vertebral body with reactive bone marrow edema. By conservative treatment with multidrug therapy, the pain subsided and disappeared in 3 months. Follow-up CT scan and MRI of the thoracic spine confirmed complete resolution of calcified SN and reactive bone marrow edema.

An Outbreak of Peripheral Neuropathy in a Prison.

Prisoners are at risk for both physical and psychological diseases. Here, we report an outbreak of peripheral neuropathy in a prison in northeast Thailand. Between July and December 2014, there were 88 male prisoners at Bueng Kan Provincial Prison in Bueng Kan, Thailand suffering from peripheral neuropathy out of a total of 1,464 prisoners (6.01%). The common age range was 20-39 years (58 patients; 65.91%). The three most common features were hyporeflexia/areflexia of the lower extremities (36 patients; 83.72%). On laboratory vitamin B1 deficiency was detected in 4/5 patients, positive rhinovirus polymerase chain reaction in 3/4 patients, positive Mycoplasma pneumoniae IgM in 1/12 patients, and positive urinary arsenic in 4/7 patients. A dT vaccination was given on October 14 during the outbreak. This was a large outbreak of peripheral neuropathy in male prisoners. There are several possible causes of this outbreak including vitamin B1 deficiency, dT vaccination, arsenic toxicity, rhinovirus, and Mycoplasma infection.

Polyneuropathies and chronic inflammatory demyelinating polyradiculoneuropathy in multiple sclerosis.

BACKGROUND: Polyneuropathies co-occurring with multiple sclerosis (MS) may be underdiagnosed while causing additional disability burden. OBJECTIVE: To determine polyneuropathy presence and type in MS and compare MS with chronic inflammatory demyelinating polyradiculoneuropathy (MS-CIDP) versus MS with other non-inflammatory polyneuropathies. METHODS: Retrospective chart review of Mayo Clinic cases diagnosed with MS and polyneuropathy. Serum from MS-CIDP for pan-IgG autoantibodies to neurofascin-155 were tested when available. RESULTS: From 1980-2013, 133 co-existing MS/ polyneuropathy cases were identified. Twenty-eight MS patients had inflammatory neuropathy (11 CIDP, 5 plexopathy, 2 vasculitis, 4 monoclonal gammopathy-associated, 6 other), 15 inherited neuropathy (8 axonal, 7 demyelinating), 32 diabetic sensorimotor polyneuropathy, and 58 other. 109 had neuropathy beginning simultaneous to or after MS diagnosis (82%). Compared to MS cases with other polyneuropathy subtypes, MS-CIDP cases had absent or reduced ankle reflexes (100 vs. 70%, p = 0.04), earlier age of neuropathy recognition (52 vs. 58 years, p = 0.048), worse impairment (NIS 27 vs. 22 points, p < 0.03), and more acquired demyelinating electrophysiology features (46% vs. 9%, p < 0.003). Of MS-CIDP cases with available serum, 1-in-3 had IgG4 autoantibodies to neurofascin-155. CONCLUSION: (1) Polyneuropathies occurring in MS contribute to neurological disability. (2) Diagnosing polyneuropathies in people with MS is challenging and, likely, under-diagnosed. Recognition is important as some polyneuropathies (e.g., CIDP) are treatable. (3) The probable over-representation of inflammatory neuropathy (especially CIDP) in MS suggests a shared dysimmune pathogenesis, supported by autoantibodies to neurofascin-155.

Clinical Characteristics and Treatment Response of Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

Background: The incidence, prevalence, clinical phenotypes, and treatment response of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are varying in the world literature. There have been no epidemiologic studies of CIDP in Thai adult patients. Objective: To determine clinical characteristics, phenotypes, electrophysiological tests, and treatment response of CIDP in Thai adult patients and to find factors associated with disease outcome after treatment. Material and Method: Retrospective chart review of Prasat Neurological Institute patients diagnosed of CIDP between January 1, 2008 and December 31, 2014. Results: Sixty-three CIDP patients were identified. Patients were slightly male predominant (1.3:1), age at onset was 47.7 years, disease duration prior to first evaluation was 5.0 months, follow-up duration was 26.8 months, and 19% of patients had diabetes. Clinical phenotypes were classic CIDP (76.2%), 19% DADS, and 4.8% MADSAM. Fifteen point nine percent presented as AIDP and 12.7% as SIDP. Symmetrical, sensorimotor polyneuropathy with hyporeflexia were the common presentation. Autonomic symptoms, respiratory failure, bulbar involvement, ophthalmoparesis, ptosis, and muscle atrophy were rarely presented. The treatment response was generally favorable. Patients in disease relapsing group had shorter disease onset (2 vs. 6 months) and 40% had disease duration less than four weeks. Conclusion: Clinical characteristics, phenotypes, electrophysiological findings, and treatment response of CIPD in Thai patients were not different from previously published studies in western and oriental populations. Mode of disease onset may predict a response to immunosuppressive treatment in CIDP patients.

Rapid progression of familial amyloidotic polyneuropathy: a multinational natural history study.

OBJECTIVES: To assess the association between severity of neuropathy and disease stage, and estimate the rate of neuropathy progression in a retrospective cross-sectional analysis of a multinational population of patients with familial amyloidotic polyneuropathy (FAP). METHODS: We characterize neuropathy severity and rate of progression in available patients with FAP in France, the United States, Portugal, and Italy. Neuropathy Impairment Scores (NIS), time from symptom onset to NIS measurement, polyneuropathy disability (PND) scores, FAP disease stage, and manual grip strength data were collected. We estimated neuropathy progression using Loess Fit and Gompertz Fit models. RESULTS: For the 283 patients studied (mean age, 56.4 years), intercountry genotypic variation in the transthyretin (TTR) mutation was observed, with the majority of patients in Portugal (92%) having early-onset Val30Met-FAP. There was also marked intercountry variation in PND score, FAP stage, and TTR stabilizer use. NIS was associated with PND score (NIS 10 and 99 for scores I and IV, respectively; p < 0.0001) and FAP stage (NIS 14 and 99 for stages 1 and 3, respectively; p < 0.0001). In addition, there was an association between NIS and TTR genotype. The estimated rate of NIS progression for a population with a median NIS of 32 was 14.3 points/year; the corresponding estimated rate for the modified NIS+7 is 17.8 points/year. CONCLUSIONS: In a multinational population of patients with FAP, rapid neuropathic progression is observed and the severity of neuropathy is associated with functional scales of locomotion.

Chronic meralgia paresthetica and neurectomy: a clinical pathologic study.

OBJECTIVE: To understand the pathologic and clinical correlates of patients with chronic meralgia paresthetica (MP) undergoing lateral femoral cutaneous nerve (LFCN) neurectomy. METHODS: A retrospective cohort approach was utilized to identify 7 patients undergoing LFCN neurectomy for intractable pain. Control autopsied LFCN was obtained. Clinical, radiologic, and electrophysiologic features were reviewed. RESULTS: In identified cases, preoperative symptoms included severe lateral thigh pain and numbness. The duration of symptoms prior to surgery ranged from 2 to 15 years. Body mass index (BMI) varied from 20 kg/m(2) to 44.8 kg/m(2) (normal-morbidly obese), with 6 out of 7 patients being obese. No patients were diabetic. Focal nerve indentation at the inguinal ligament was seen intraoperatively and on gross pathology in 4 of 7 cases. Multifocal fiber loss, selective loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema were seen. None of these features were observed in control nerve. Morphometric analysis confirmed loss of large myelinated fibers with small and intermediate size fiber predominance. Five patients had varying degrees of intraneural and epineurial inflammation. Six of 7 reported improved pain after neurectomy, sometimes dramatic. CONCLUSIONS: Patients with chronic MP and intractable pain have an LFCN mononeuropathy with loss of nerve fibers. Pathologic and clinical study supports a compressive pathogenesis as the primary mechanism. Abnormal nerve inflammation coexists and may play a role in pathogenesis. These selected patients typically benefited from neurectomy at a site of inguinal ligament compression. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that patients with chronic MP LFCN neurectomy experience improvement in MP-related pain.

Aspirin non-responder in Thai ischemic stroke patients.

BACKGROUND: An important cause of recurrent ischemic stroke is failure to prevent secondary stroke due to poor control of important stroke risk factors. One of the proposed important risk factor is aspirin resistance. The prevalence of aspirin resistance varied widely. It depended on heterogeneity in studied populations and methods of platelet functional assessment. OBJECTIVE: To describe the prevalence of aspirin resistance based on optical platelet aggregometry in stroke patients who attended the Neurological Institute and investigate the clinical risk factors associated with aspirin resistance. MATERIAL AND METHOD: Three hundred stable ischemic stroke patients, whose aspirin dosage varied between 60 to 325 mg/day for at least 14 days before enrollment were recruited in the present study. Demographic data, modifiable risk factors, and treatment were collected by interview and from medical records. Aspirin resistance was determined by optical platelet aggregation technique, using arachidonicacid (AA) and adenosine diphosphate (ADP) as agonists. RESULTS: The patients were classified into two groups based on their platelet aggregatometry tests (PAT). The cases group (n = 40, 13.3%) included both patients with aspirin resistance (n = 2, 0.6%) and aspirin semi-responsiveness (n = 38, 12.7%). The control group was aspirin non-resistance (n = 260, 86.7%). The cases were older (64.8 year vs. 61.26 year, p = 0.049), higher proportion of females (60% vs. 41.5%, p = 0.029), and shorter in height (159.9 CM vs. 164.1 CM, p = 0.007) than the control group. Dosage and duration of the aspirin therapy were the same in both groups. The multivariate analysis showed old age was associated with aspirin resistance. CONCLUSION: The prevalence of aspirin resistance in the present study is 0.6% (95% CI, 0.18%-1.38%). The risk factor for aspirin resistance in post stroke patients is aging. No association between duration and aspirin dosage with aspirin resistance was found. The proportion of aspirin resistance was similar to a previous study done in post myocardial infarction patients.

Impact of risk factors for recurrent ischemic stroke in Prasat Neurological Institute.

BACKGROUND: Recurrent strokes are more likely to be more disabling or fatal than first-even strokes. The high frequency of recurrences underscores the importance ofsecondary prevention. OBJECTIVE: Investigate risk factors of recurrent ischemic stroke and to compare the outcomes after treatment following the Thai stroke guideline between patients with recurrent ischemic stroke and patients without recurrent ischemic stroke. MATERIAL AND METHOD: Sixty-seven patients with recurrent ischemic stroke and 167 patients without recurrent ischemic stroke were included in the present study. All patients were evaluated for demographic data, modifiable risk factors, and treatment. RESULTS: Patients without recurrent ischemic stroke had better controlled level of systolic blood pressure, diastolic blood pressure, and higher high-density lipoprotein level than patients with recurrent ischemic stroke. Carotid stenosis was higher in patients with recurrent ischemic stroke (43.3% vs. 28.7%, p = 0.032). Patients with recurrent ischemic stroke received statin therapy (67.2% vs. 86.8%, p = 0.001) and folic acid (61.2% vs. 78.4%, p = 0.007) less than patients without recurrent ischemic stroke. The multivariate analysis showed that well controlled diastolic blood pressure (p = 0.014), higher level of high-density lipoprotein (p = 0. 010), and receiving of statin (p = 0.002) were associated with decreased incidence of recurrent ischemic stroke. CONCLUSION: Well-controlled risk factors including blood pressure, fasting blood sugar, high-density lipoprotein, and low-density lipoprotein were crucial for the protection of recurrent ischemic stroke. Furthermore, the benefits of statin and folic acid therapies for the protection of recurrent ischemic stroke were emphasized