Case Report: Anti-LGI1 Encephalitis Following COVID-19 Vaccination.

Anti-leucine rich glioma inactivated 1 (LGI1) autoimmune encephalitis (AE) is characterized by cognitive impairment or rapid progressive dementia, psychiatric disorders, faciobrachial dystonic seizures (FBDS) and refractory hyponatremia. Since December 2020, millions of people worldwide have been vaccinated against COVID-19. Several soft neurological symptoms like pain, headache, dizziness, or muscle spasms are common and self-limited adverse effects after receiving the COVID-19 vaccine. However, several major neurological complications, despite the unproven causality, have been reported since the introduction of the COVID-19 vaccine. Herein, we describe a 48 years old man presenting with rapidly progressive cognitive decline and hyponatremia diagnosed with anti LGI1 AE, occurring shortly after the second dose of mRNA COVID -19 vaccine and possibly representing a severe adverse event related to the vaccination. Response to high dose steroid therapy was favorable. As millions of people worldwide are currently receiving COVID-19 vaccinations, this case should serve to increase the awareness for possible rare autoimmune reactions following this novel vaccination in general, and particularly of anti-LGI1 AE.

Migraine exacerbation during Ramadan fasting.

Fasting for approximately 1 month is an obligatory practice for Muslims during the month of Ramadan. We attempted to evaluate the effect of the Ramadan fasting on the frequency of migraine attacks among observant Muslim migraine sufferers using a cohort cross-over study. Thirty-two observant Muslim migraine sufferers filled a migraine diary during the Ramadan month and the following month (control). Two patients failed to complete the fast because of migraine suffering. During the Ramadan month, the patient expressed 9.4 ± 4.3 migraine days in average (range 3-20) when compared with 3.7 ± 2.1 migraine days in average (range 1-10) during the control month (p < 0.001). This phenomenon was associated with longer duration of migraine, lower frequency of migraine attacks, and migraine with aura. It seemed to be less pronounced in patients experiencing throbbing headaches and in married patients. Previous prophylactic therapy did not dampen this. Physicians treating Muslim migraine patients should discuss potential Ramadan month exacerbation with their patients and provide counseling regarding the prevention of dehydration and caffeine withdrawal. Pharmacological prophylactic treatment should be considered.

Soccer heading and subclinical neuropsychiatric symptomatology in professional soccer players.

OBJECTIVES: To evaluate the association between postconcussive symptomatology and heading in professional soccer players, overcoming the bias of self-reported exposure, we evaluated several clinical neuropsychiatric symptoms using questionnaires after a thorough objective follow-up of players' heading exposure throughout an entire season. METHODS: We collected heading data for all Israeli Premier League players for an entire season using a web-based platform for performance analysis, which enabled us to quantify the exact number of headers per player. Players filled out questionnaires regarding postconcussion symptoms, depression, anxiety, and sleep disorders. We tested the association between the number of headers and each outcome using a negative binomial regression corrected for the hours played. RESULTS: A total of 159 players were included, of whom 79 were considered in the high heading exposure group (49%), defined as more than median number of headings (1.34 per game hour). Among players without any past head injury, those with higher heading exposure were less likely to have postconcussion symptoms compared with players with low heading exposure (relative risk [RR] per heading per hour 0.94, 95% confidence interval [CI] 0.912-0.963). Players with high heading exposure had fewer depression symptoms (RR 0.98, 95% CI 0.961-0.997), anxiety (RR 0.98, 95% CI 0.958-0.997), and sleep disorders (RR 0.98, 95% CI 0.961-0.996). CONCLUSION: Professional soccer players with high heading rate do not display higher postconcussive symptomatology severity. Symptoms among players with low heading exposure might be explained by low resilience, possibly associated with an inferior heading technique. Alternatively, it can reflect heading-avoidant behavior.

Increase in Ischemic Stroke Incident Hospitalizations Among Bedouin Arabs During Ramadan Month.

BACKGROUND: Previous studies have not shown any significant effect on stroke incidence during Ramadan. We aimed to investigate the association between ischemic stroke incident hospitalizations and Ramadan, accounting for seasonality and temperature. METHODS AND RESULTS: This retrospective cohort study included all patients admitted with acute ischemic stroke to Soroka University Medical Center from June 2012 to June 2016. We obtained daily mean temperatures and relative humidity rates from 2 monitoring stations in South Israel. We analyzed the association between stroke incidence and Ramadan month, adjusting for weekly temperature and seasonality using Poisson regression models. We compared the first versus the last Ramadan fortnight. We performed an effect specificity analysis by assessing stroke incidence in the non-Bedouin population. We identified 4727 cases of ischemic stroke, 564 cases of which were Bedouin Arabs. Fifty-one cases occurred during Ramadan. Ramadan was significantly associated with an increased risk for ischemic stroke (RR 1.48; 95% confidence interval, 1.04-2.09), mainly during the first fortnight (RR 1.73, 95% confidence interval, 1.13-2.66) when compared with non-Ramadan periods. Mean weekly temperatures and the summer season were not associated with stroke incidence among Bedouin Arabs (RR 0.98; 95% confidence interval, 0.82-1.18 and RR 0.77; confidence interval 0.56-1.06 accordingly). Such association was not observed in the non-Bedouin population. CONCLUSION: The Ramadan month, particularly in its first 2 weeks, is an independent and ethnicity specific risk factor for ischemic stroke hospitalizations among the Bedouin Arab fasting population.

Do Gender and Season Modify the Triggering Effect of Ambient Temperature on Ischemic Stroke?

BACKGROUND: Ischemic stroke (IS) is a multifactorial disorder, a leading cause of long-term disability, and the second most common cause of death. Previous studies have examined the association between stroke and weather conditions with conflicting results. In this study we aimed to investigate the association between changes in ambient temperature and risk of IS onset. METHODS: We used a time-stratified case-crossover study design including all patients admitted to Soroka University Medical Center in southern Israel between 2012 and 2014 for IS. Exposure windows of 6, 12, 24, 48, 72, and 96 hours were examined. All patients were assessed and classified by a neurologist. Temperature (°C), and relative humidity (%) were obtained from monitoring stations located in Beer-Sheva. RESULTS: A total of 1,174 patients visited Soroka University Medical Center for admission for an IS during the study period. Among them, 56% were male, on average 69.8 ± 13.1 years old. IS incidence was associated with increase in temperature during the summer and autumn season over the 96 hours preceding symptoms onset; the odds ratio (OR) for an increase of 5°C was 3.10 (95% CI, 1.45-6.61) during the summer and 1.86 (95% CI, 1.15-2.99) in autumn. The association between temperature and stroke onset during the winter was negative (OR, 0.68; 95% CI, 0.48-0.97) for 96-hour moving average temperature exposure. Men were more sensitive to 96-hour exposure window temperature fluctuations (OR, 1.35; 95% CI, 1.01-1.80) than women (OR, 0.96; 95% CI, 0.68-1.36). We did not find any associations between IS onset and differences between the maximum and minimum measurements of temperature. CONCLUSIONS: Our findings showed that short-term exposure to high temperatures is associated with a higher risk of IS in men but not in women. Further study is needed to validate this observation and to understand its pathophysiology.