COVID-19 Respiratory Illness and Subsequent Cerebrovascular Events, the Initial Iranian Experience.

OBJECTIVES: COVID-19 disproportionately affects older adults and individuals with cardiovascular co-morbidities. This report presents fifteen patients who had COVID-19 respiratory illness followed by cerebrovascular events. MATERIALS AND METHODS: A call by the Iranian Neurological Association gathered cases across the country who developed neurological symptoms attributed to hemorrhagic or ischemic stroke after a definite or probable Covid-19 respiratory illness. Definite cases were those with a typical respiratory illness, positive nasopharyngeal Covid-19 PCR test, and chest CT consistent with Covid-19 infection. Probable cases were defined by a typical respiratory illness, history of contacts with a Covid-19 case, and chest CT characteristic for Covid-19 infection. RESULTS: Fifteen patients (12 men and 3 women) with an age range of 38 to 93 years old (median: 65 years old) were included. Fourteen patients had a first-ever acute ischemic stroke and one patient had a subarachnoid hemorrhage. Eleven patients (73%) had previous cardiovascular comorbidities. The median time between respiratory symptoms and neurological symptoms was seven days (range 1-16 days). Stroke severity in two patients was mild (NIHSS ≤ 6), in six patients moderate (NIHSS: 7-12), and in seven patients severe (NIHSS ≥13). One patient received intravenous tissue plasminogen activator ( IV-tPA) with improved neurological symptoms. Six out of 15 patients (40%) died. All but one of those who survived had significant disability assessed by a modified ranking scale >2. The majority of patients in this case series had vascular risk factors and their stroke was associated with severe disability and death. CONCLUSION: This report highlights the need for further investigation of the links between Covid-19 and cerebrovascular events.

Inflammatory markers and functional outcome score in different subgroups of ischaemic stroke: a prospective cohort study.

Background: Acute ischaemic stroke (AIS) is a leading cause of disability and mortality worldwide. Determining subgroups and outcomes of AIS may lead to better treatment. We aimed to investigate the relationship between inflammatory markers and subgroups of AIS with further follow-up of patients in terms of functional outcome score. Methods: In this prospective cohort study, we examined white cell count (WCC), neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR) and qualitative C reactive protein (CRP), in the first 24 hours of patients' admission. Patients were assigned to AIS subgroups as defined by the TOAST criteria. Then patients' disability score was followed up after 3 and 6 months, using the modified Rankin Scale. Results: We included 217 patients with AIS. The mean age of participants was 72.07 years, and we included 92 women (42.4%). For the AIS subgroup, 83 (38.25%) patients had large artery atherosclerosis (LAA), 41 (18.89%) had cardioembolism and 62 (28.57) had small vessel obstruction. Neutrophil count and NLR showed a statistically significant difference in the subgroups of AIS and were highest in the 'other' subgroup of AIS (p<0.05). Lymphocyte count, ESR and qualitative CRP showed no statistically significant difference between subgroups (p>0.05). WCC, neutrophil count and NLR showed a positive correlation with functional outcomes (p<0.05), other markers did not correlate with outcomes (pp>0.05). Conclusion: We can conclude that neutrophil count and NLR are available inflammatory biomarkers for predicting outcomes and these two biomarkers are associated with AIS subgroups. However, ESR, qualitative CRP and lymphocyte count do not appear to be correlated with outcomes or subgroup of AIS.

Stiff-person syndrome revealing an occult gray zone lymphoma: A diagnostic challenge.

Key Clinical Message: Stiff-Person Syndrome (SPS) can be associated with various malignancies, including lymphomas. Therefore, clinicians should always remain vigilant for the presence of an underlying malignancy, especially in older patients presenting with SPS. Abstract: Stiff-person syndrome (SPS) is a rare neurological disorder characterized by painful muscle spasms. It can occur as a paraneoplastic syndrome associated with various malignancies. We present a case of an older male adult with a history of recurrent fever episodes and elevated inflammatory markers for 1 year who subsequently developed neurological symptoms. The presence of positive amphiphysin antibodies led to the diagnosis of SPS, which prompted further investigations revealing an underlying Gray Zone lymphoma (GZL). This case highlights the challenges in diagnosing lymphoma and emphasizes the importance of considering SPS as a paraneoplastic syndrome in guiding toward the final diagnosis. The diagnostic challenge in our case is summarized in Chart 1.

Guillain-Barré syndrome following COVID-19 vaccine: A case report.

Coronavirus disease is a viral infection affecting different organs with various morbidities and mortality. Vaccines are used to control the disease. COVID-19 vaccines have brought many benefits but their adverse effects should not be ignored. Here, we report a case of Guillain-Barré Syndrome Following Sinopharm COVID-19 Vaccine.

Frequency distribution of the first clinical symptoms in the Iranian population with multiple sclerosis.

BACKGROUND: Initial symptoms of multiple sclerosis (MS) may be varied and nonspecific. We tried to find the frequency distribution of the first clinical symptoms in Iranian patients with MS. METHODS: In a case series study, 1130 patients with definite diagnosis of MS who had been referred to three referral university hospitals of Tehran, Iran, were enrolled. The patients' medical records were reviewed for neurological history to find the first symptom at presentation. RESULTS: 884 (78.2%) patients were female and 246 (21.8%) were male. The mean ± SD age of patients was 31.4 ± 9.1 years. The most common initial symptoms were motor in 492 (43.5%), ocular in 366 (32.4%), cerebellar in 91 (8.1%), sensory in 76 (6.7%), cranial nerve involvement in 51 (4.5%), and fatigue in 23 (2%) patients. There was no difference between female and male patients in first clinical symptoms (P > 0.05). CONCLUSION: The motor symptoms were the most common finding at presentation in the Iranian population with MS. Complementary studies with larger sample sizes are needed to increase the external validity.