Cranial nerve involvement among COVID-19 survivors.

Introduction: COVID-19 was first reported in November 2019 in China and rapidly spread across the globe. COVID-19 causes neurologic symptoms and complications, which may persist even after recovery in patients. The objective of this research was to determine the involvement of cranial nerves in COVID-19 survivors. Method: This was a retrospective study. The study was conducted between March and July of 2022. The analysis included 98 patients with a certain positive polymerase chain reaction. SPSS software version 19 was utilized for data analysis. Results: The average age of the participants was 40.47 years (8.81). The olfactory nerve was found to be the most frequently involved cranial nerve (36.7%). Over 20% of participants had a taste disorder. The findings from the regression analysis indicated that lung involvement and age have a direct and significant relationship with cranial nerve involvement and can serve as its predictors (p = 0.001). Conclusion: It seems that cranial nerve involvement was sustained in COVID-19 patients who survived. In addition, elderly patients and patients with severe illnesses were more likely to show cranial symptoms. It is necessary to monitor COVID-19 survivors for neurological symptoms.

Infantile Neuroaxonal Dystrophy in Two Cases: Siblings with Different Presentations.

Infantile neuroaxonal dystrophy (INAD) is a rare recessive neurodegenerative disorder manifested by symptoms like hypotonia, extrapyramidal signs, spastic tetraplegia, vision problems, cerebellar ataxia, cognitive complications, and dementia before the age of three. Various reports evaluated the relationship between the incidence of INAD and different mutations in the PLA2G6 gene. We described cases of two children with INAD whose diagnoses were challenging due to misleading findings and a mutation in the C.2370 T>G (p. Y790X) in the PLA2G6 gene based on NM_001349864, which has been reported previously.

Spontaneous intracerebral hemorrhage, initial computed tomography (CT) scan findings, clinical manifestations and possible risk factors.

Intracerebral hemorrhage is one of the types of stroke in patients with risk factors. In this study, we aimed to evaluate the initial computed tomography (CT) scan findings, clinical manifestations and possible risk factors of patients with intracerebral hemorrhage. This is a cross-sectional study that was performed in 2015-2022 on 900 patients with definite diagnosis of intracerebral hemorrhage. Data of patients were evaluated for patient's age, gender, clinical manifestations, primary radiologic signs in CT scan and possible risks factors for stroke. Lobar hemorrhage was the most common site of involvement (324 patients, 36%) followed by lenticular (putamen) (294 patients, 32.7%) and thalamus (135 patients, 15%). Among patients, 543 patients (60.3%) had hypertension, 81 patients (9%) had histories of anticoagulant. Hemorrhages in putamen were significantly more common in patients with hypertension (P<0.001) and lobar hemorrhages were significantly more common in patients with the use of anticoagulant drugs (P=0.033). The most common presentation of hemorrhagic stroke was decreased consciousness level (428 patients, 47.5%) followed by headache (343 patients, 38.1%), coma (81 patients, 9%) and seizure (48 patients, 5.4%). Evaluation of the relationships between patient's main symptoms and sites of involvement showed that patients with decreased consciousness as their most common symptom had more frequently diagnosed with lobar hemorrhage (54%) and putamen hemorrhage (30.4%) (P<0.001). Hypertension was the most common past medical history that was significantly related to hemorrhage in basal nuclei. Hemorrhages in putamen were common in hypertensive patients and lobar hemorrhages were common in patients with anticoagulant use.

Predictive value of number and volume of demyelinating plaques in treatment response in patients with multiple sclerosis treated with INF-B.

BACKGROUND: Multiple Sclerosis (MS) is an autoimmune, inflammatory disease of the central nervous system. Magnetic resonance imaging (MRI) findings are associated with disease clinical activity and response to treatment. This study aimed to evaluate the future value of plaque number and volume in MRI as radiological criteria in determining the treatment response to INF-B in patients with MS. METHODS: This is a cross-sectional study performed in 2016-2021 in Iran on patients with the newly diagnosed (less than one year) relapsing-remitting MS. Brain MRI was taken for all patients. The number and volumes of the MS plaques were evaluated from FLAIR images by the two radiologists. Patients were treated with INF-B1a with a dosage of 12 million units equal to 44 micrograms subcutaneously, three times per week. Patients were visited monthly by neurologists to examine their clinical status. After one year, the brain MRI was conducted with the similar characteristics to the beginning of the study, and the number and volume of MS plaques were measured again. RESULTS: The study population consisted of 33 males and 90 females with a mean age of 28.37 ± 6.29 years. The mean Expanded Disability Status Scale (EDSS) of the patients was 3.16 ± 0.23 at the beginning of the study. The specificity for a 50% reduction in the number and volume of plaques as two separate criteria was the same and equal to 100%. The sensitivity of the number and volume of plaques were 65.5% and 90.6%, respectively. In addition, considering 10% as the cut-off point of the number of plaques, the sensitivity of the number of plaques as a criterion was equal to the sensitivity of the plaque volume. CONCLUSION: The results of this study showed that imaging criteria provide a more objective tool for evaluating the effectiveness of treatment. These findings indicate that the number and volume of plaques could be two reliable MRI imaging criteria for assessing therapy response. The number of plaques was less accurate than the volume of plaques.

Contrast-enhanced weighted-T1 and FLAIR sequences in MRI of meningeal lesions.

Magnetic resonance imaging (MRI) is widely used in meningeal lesions due to rapid and accurate diagnosis and prevention of serious complications. The aim of the present study was to compare these two sequences after injection of a contrast agent into meningeal lesions. This is a descriptive-analytical study that was performed in 2018-2020 on patients referred to the radiology ward with detection of any meningeal involvements in the MRI images. In addition to T1-W, FLAIR sequence imaging was also performed. Images were initially evaluated by two expert radiologists and a neurologist. The diagnostic values of the sequences were compared. Overall, a total number of 147 patients with meningeal lesions in their brain MRI entered the study. 57.1% of cases (84 patients) had an infectious etiology and 42.9% (63 patients) had a tumoral etiology. T1-W images without contrast were able to diagnose 78 cases of meningitis (92.8% of them), and FLAIR sequences could diagnose 82 patients (97.6% of them). Without contrast injection on MRI, the diagnostic value of T1-W sequence was higher than FLAIR sequence for tumoral lesions (P < 0.01). The enhancement degree of T1-W was higher for tumoral findings (P < 0.01). In contrast, the enhancement degree of the FLAIR sequence was higher for infectious findings, which was also statistically significant (P = 0.015). FLAIR sequences had 92% sensitivity and 85% specificity for diagnosis of brain inflammatory diseases. Similar analysis showed that T1 sequence had 82% sensitivity and 73% specificity for diagnosis of brain inflammatory diseases.

The risk of confusion between AstraZeneka COVID-19 vaccine side effects and signs of COVID-19 infection: a case report.

Post-vaccination side effects of AstraZeneca (AZ) coronavirus disease 2019 (COVID-19) vaccine are common. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection immediately after the first dose of AZ COVID-19 vaccine has not been reported. In this case, a 30-year-old female without a past medical history of SARS-CoV2 infection presented to an outpatient clinic with lightheadedness and weakness 2 hours after getting the first dose of the AZ COVID-19 vaccine. Blood pressure (BP) was 80/60 mm Hg, and oxygen saturation (SpO2) was 98%. After administering normal saline intravenous fluid, the BP was 110/80 mm Hg. On the first day, fever (oral temperature of 39℃), sweating, dry cough, sore throat, and injection-site pain were presented. On the second day, diarrhea, productive cough, and hypotension occurred in addition to fever (oral temperature of 39.9℃). The fever did not stop and productive cough, change in smell, and fatigue were reported. SpO2 was 96%. On the third day, no abnormality of the spiral lung computed tomography and the positive reverse transcriptase-polymerase chain reaction (RT-PCR) test were reported. Simultaneously, two out of three members of the family became symptomatic on the second day and their RT-PCR tests were positive. Dexamethasone ampule, Cefixime tablet, Acetaminophen tablet, and Diphenhydramine syrup were prescribed. After a week, fever subsided and SpO2 was 98%. After 3 weeks of self-quarantine at home, her general condition improved. Despite the similarity between SARS-CoV2 infection signs and symptoms and AZ COVID-19 vaccine side effects, none of the approved vaccines contain the live virus that causes disease. Therefore, any unusual post-vaccination signs and symptoms should not be attributed to the vaccine itself and need to be considered for further evaluations and early actions in order to prevent the spread of the disease in society.

Assessment of fingolimod versus dimethyl fumarate for the treatment of multiple sclerosis; a 24-month follow-up study.

BACKGROUND: Oral treatment of multiple sclerosis (MS) using disease-modifying therapies (DMTs) is a challenge worldwide. Fingolimod (FTY) and dimethyl fumarate (DMF) are two approved agents for oral treatment of MS with remarkable efficacy for relapse control and deceleration of disability progression. Therefore, the current study was done to compare disability control, lesions in magnetic resonance imaging (MRI), and adverse effects between the patients treated with FTY and DMF. METHODS: This randomized clinical trial (IR.MUI.REC.1396.3.786) was conducted on 60 patients who were randomly divided into two groups of treatment with 0.5 mg daily dose of FTY (n = 30) and 240 mg dose of DMF twice daily (n = 30). Disability of patients was assessed using the expanded disability status scale (EDSS) within 6 weeks, 12, and 24 months following treatment initiation and MRI was performed for all the patients prior to study initiation and within 24 months. Obtained data were compared between two study groups. RESULTS: There was no significant difference between two treatment groups based on EDSS scores, brain lesions in MRI, and newly formed plaques (P>0.05). Skin and gastrointestinal-related complaints were the most common adverse effects of DMF while the increase in liver enzyme level and thrombocytopenia were the most common complications of FTY, respectively (P-value = 0.22). CONCLUSION: According to our findings, within 24-month follow-up, DMF was neither superior nor inferior to FTY comparing MRI lesions, EDSS scores, and adverse effects. Although, further evaluations with larger sample size are recommended.

The relationship between menstrual disorders and education in women with intractable epilepsy.

OBJECTIVE: The study aimed to investigate the relationship between menstrual disorders and education in women with intractable epilepsy. METHOD: This was a descriptive-analytical study. Statistical population consisted of all female patients with intractable epilepsy in 15-45 age group who visited the third department of epilepsy in Ayatollah Kashani Hospital. The sample size was 380. They were selected using simple random sampling. A questionnaire was distributed among the patients to collect information on education, incidence and type of current menstrual disorder (each type of menstrual disorder was explained to the participants). Then, the relationship between education and prevalence of menstrual disorders in these women was investigated. FINDINGS: Analysis of Spearman correlation coefficient showed a significant and negative correlation between education and menstrual disorder (P≤0.05). Analysis of multivariate logistic regression also showed a significant relationship between education and types of menstrual disorders. There was also a significant relationship between education and regular and irregular menstruation (P≤0.05). CONCLUSION: There is a significant relationship between education and menstrual disorders in women with intractable epilepsy, and the higher education level indicates less prevalent menstrual irregularities.

Clinical and radiologic manifestation B-cell mediated autoimmune diseases of central nervous system.

B-cell mediated autoimmune diseases of central nervous system (CNS) put a heavy burden on different aspects of society and economy. Taken together, there are different types of autoimmune diseases in which B-cells play an important role and affect CNS in a pattern of inflammation. These diseases have some similarities in clinical presentations and radiological findings and some similarities with other diseases in different aspects such as treatments with each disease having its own characteristics. In this review article, we had a survey on some different types of B-cell mediated autoimmune diseases of CNS and explained how they can be distinguished from each other and how distinct they are according to radiological findings. The aim of this study is to distinguish B-cell mediated autoimmune diseases of CNS from other non-B-cell diseases in order to choose the best anti-B-cell treatments. At the end of this article we briefly explain different types of treatments being utilized and the role of corticosteroids in acute phases of different diseases.

Effects of fingolimod treatments on alanine transaminase and aspartate transaminase levels in patients with multiple sclerosis.

INTRODUCTION: Multiple Sclerosis (MS) is a chronic neurological disorder with no known cause or cure. Fingolimod (FTY720) is an oral medication recently approved for the treatment of MS as well as other diseases with autoimmune aspects. However, the drug is not without side effects. The severity and prevalence of these side effects are not completely understood. One of the most common causes for the patient cessation of fingolimod is an increase in liver enzymes, indicating possible inflammation or damage to liver cells. Alanine transaminase (ALT) and aspartate transaminase (AST) are the most common liver enzymes used as indicators of hepatic health. OBJECTIVES: This three-month prospective cohort study selected patients who were diagnosed with relapsing-remitting MS (RRMS) and who were not taking fingolimod oral treatment. ALT and AST levels were determined for these patients at baseline and then after three months of taking FTY720 to determine if these liver enzymes were changed. METHODS: 36 RRMS patients completed this study, which lasted three months. They were started on 0.5 oral FTY720 after approval from a physician and completion of an AST/ALT blood test. Baseline levels were determined and then taken again three months later. Statistical analysis of these values was performed using P<0.05 as a significance threshold. RESULTS: In this sample of patients, only ALT levels were significantly increased after fingolimod treatment in the general cohort (P=0.00). The general cohort showed an insignificant increase in AST levels. In male and female populations separately, AST was not significantly increased. ALT was only significantly increased in men (P=0.00) and insignificantly increased in women. CONCLUSION: This study further confirms our concerns about fingolimod's possible effects on the liver. While these numbers do support the claim that the drug does on average increase ALT in patient populations, it is important to note that most of these patients have no real hepatic side effects. In addition, previous studies have cited a return to normal ALT and AST levels after cessation of fingolimod, suggesting its effects are temporary and not severely damaged in the usual patient.

Alcohol and multiple sclerosis: an immune system-based review.

Multiple sclerosis is a chronic inflammatory disease of the central nervous system (CNS). Although the exact etiology of multiple sclerosis is unknown, researchers suggest that genetic, environmental, and microbial factors play a central role in causing multiple sclerosis. Pathology of multiple sclerosis is based on inflammation as T cells enter the brain via disruptions in the blood-brain barrier, recognizing myelin as foreign antigen; and as a result, the T cells attack myelin and start the inflammatory processes, enhancing inflammatory cytokines and antibodies. Since previous studies show ethanol can suppress the immune system such as innate, humoral, and cellular immunity and increases the production of anti-inflammatory cytokines, we hypothesized maybe ethanol also have ameliorating effects on multiple sclerosis symptoms. Although alcohol induces apoptosis in oligodendrocytes and neurons, causing demyelination and affects CNS directly, in this study we will investigate ethanol's effects on some aspects of the immune system in multiple sclerosis.

Frequency of Seizure Clusters and Their Associated Risk Factors in Adult Patients with Epilepsy Referred to Epilepsy Center of Kashani Hospital in Isfahan from 2011 to 2016.

BACKGROUND: Epilepsy is a chronic neurologic condition and affects people of all ages. Seizure clusters are generally referred to seizures that occur at close intervals with complete recovery between attacks. Various studies have reported a variety of frequencies and risk factors for this condition. METHODS: We designed a study to determine the frequency of seizure cluster and their associated risk factors in Iranian population for the first time. RESULTS: Among 40 variables analyzed, 18 of them were significantly associated with seizure clustering. Risk factors including educational level, age of onset, number of drugs, seizure types, perinatal complication, developmental delay, other illnesses, parental consanguinity, systemic diseases, number of drugs used, mentation, motor signs, sensory signs, cranial nerves signs, cerebellar signs, seizure duration, existence of magnetic resonance imaging (MRI) lesion, and type of MRI pathology are significantly associated with clustering of seizures. When associated risk factors were analyzed with multivariate analysis, age of onset of seizures, number of antiepileptic drugs currently used, lack of seizure-free periods, seizure frequency, and type of MRI pathology are significantly defining for anticipating clustering of seizures. CONCLUSIONS: Seizure cluster has a significant negative impact on the quality of life of patients. Important risk factors that are found to be associated are age of onset, parental consanguinity, frequency of seizure, lack of have seizure-free period or periods, pathologies in neurological examination, and MRI findings.

Clinical outcomes of transverse myelitis with myelin oligodendrocyte glycoprotein antibody versus negative cases among adults in Isfahan, Iran: A comparative study.

Background: The aim of this study was to evaluate the status of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with transverse myelitis (TM) and compare the clinical and imaging characteristics of MOG immunoglobulin G (IgG)-positive with negative cases. Methods: This cohort study enrolled 71 patients diagnosed with new-onset of TM who were being followed at a referral university clinic in Isfahan, Iran, from November 2016 to January 2019. Magnetic resonance imaging (MRI) images and blood samples for anti-MOG, anti-aquaporin 4 (anti-AQP4) (using the cell-based technique), and vasculitis-related antibodies were collected from patients. Outcomes were assessed by the evolution of the Expanded Disability Status Scale (EDSS) score and brain and spinal cord imaging findings within three months. All patients underwent imaging and clinical assessment during a mean period of one year as a follow-up. We compared the characteristics of clinical and radiological outcomes in MOG-IgG-positive and negative cases. Results: Of the total population studied, there were 26.8% men and 73.2% women, with a mean age of 33 ± 10 years. 12 (16.9%) patients were seropositive for MOG antibody and 17 (89.5%) were positive for anti-AQP4 antibodies. There was no significant association between anti-MOG antibody seropositivity and age, gender distribution, the presence of other autoimmune diseases, and number and interval of relapses. However, the involvement site of the spine at first imaging was significantly different between seronegative and seropositive patients. Conclusion: In patients with MOG antibody disease (MOG-AD) TM, the MRI findings suggest a preferential involvement of the cervical-thoracic section in seropositive cases which may help differentiate from non-MOG demyelination TM.