RESUMEN
Marchiafava Bignami disease (MBD) is a neurological disorder characterized by myelin degeneration and tissue necrosis within the central nervous system. This condition predominantly afflicts individuals with chronic alcohol abuse and malnutrition. The most distinctive pathological feature of MBD is the necrotic degeneration specifically observed in the corpus callosum; however, emerging evidence also indicates the potential involvement of other brain regions. The main pathophysiological mechanisms involve alcohol consumption, which leads to thiamine depletion and disrupts various metabolic pathways. This, in turn, hinders myelin synthesis and impairs signal transmission, resulting in a wide range of symptoms and signs. MBD can manifest in different stages, including acute, subacute, and chronic, each with varying severity. Diagnosing MBD can be challenging due to its presenting symptoms being nonspecific. In the era preceding the development of sophisticated imaging methodologies, the diagnosis of MBD was primarily established through postmortem examination conducted during autopsies. However, with a detailed medical history and imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT), it is now possible to diagnose MBD and differentiate it from other diseases with similar clinical presentations. MRI is considered the gold standard for visualizing lesions in the corpus callosum and other affected areas. Also, positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS) could show brain damage in the corpus callosum associated with MBD. MRI-diffusion-weighted imaging (DWI) detects early lesions, while diffusion tensor imaging (DTI) investigates clinical manifestations and recovery. Poor prognostic indicators for MBD include extensive cerebral cortex involvement and severe disturbances in consciousness. Differential diagnosis involves ruling out other alcohol-related disorders, such as neoplastic conditions, Wernicke's encephalopathy, and multiple sclerosis, among others, through careful evaluation. The therapeutic strategies for the management of MBD are currently lacking definitive establishment; however, available evidence indicates that targeted interventions have the potential to induce amelioration. Corticosteroids offer prospective advantages in addressing brain edema, demyelination, and inflammation; research findings present a heterogeneous outcome pattern. Notably, thiamine treatment reduces the likelihood of unfavorable consequences, particularly when administered promptly, and thus is endorsed as the primary therapeutic approach for MBD. This review will highlight this rare disease that many healthcare providers might not be familiar with. By understanding its clinical presentation, differential diagnosis, imaging, and management, medical providers might better identify and diagnose MBD. Raising awareness about this condition can lead to better prevention, early detection, and timely intervention.
RESUMEN
Coronavirus disease 2019 (COVID-19) has been primarily linked to respiratory complications, including acute respiratory distress syndrome (ARDS). However, several systemic manifestations of the disease may also occur. One of the emerging complications that is being increasingly reported in the literature is the hypercoagulable and intense inflammatory state in COVID-19 patients, which leads to venous and/or arterial thrombosis, vasospasm, and ischemia. Despite the recent advances in diagnostic and treatment modalities, the diagnosis and management of vascular ischemia in this patient population remain a challenge, resulting in increased morbidity and mortality. In this case report, we highlight the etiology and potential treatment of limb ischemia in COVID-19 patients.
RESUMEN
We present a case of an 80-year-old female with a past medical history of rheumatoid arthritis (RA) who was incidentally found to have severe circumferential thoracic aortic calcification detected on chest X-ray and computed tomography (CT) scan of the chest. This case highlights the chronic inflammatory state and immunological vascular damage as key mechanisms for the accumulation of dystrophic calcification in the blood vessels and soft tissues of patients with autoimmune and inflammatory diseases. It also emphasizes the importance of coordinated multidisciplinary care and management between different specialties including primary care physician (PCP), cardiology, and rheumatology to address all the challenges related to disease control and optimize cardiovascular risk factors in this patient population.
RESUMEN
BACKGROUND: COVID-19 infection has spread so fast in both low- and high-income countries. In December 2019, an outbreak of a respiratory disease occurred in China, and later, it involved different countries. Acute neurological insults are more likely to occur in severely infected patients. METHODS: We tried to evaluate patients with selective criteria including, the age of participants 18 and older with a confirmed diagnosis of SARS-CoV-2, and developed neurological complications post COVID-19 infection. An overall data of 1500 patients were collected from neurological and primary health care departments. About 970 of them had neurological problems. Patients-related data were gathered and assembled from the patients' records at participating hospitals from the Ministry of Health and university hospitals. RESULTS: We presented the results according to several variables including, regional distribution, reasons of presentation, neurological complications, follow-ups, and survival outcome. CONCLUSIONS: To our knowledge, we conducted the first retrospective analysis for neurological problems related to COVID-19 infection in Egypt. COVID-19 patients present with a variety of central and peripheral neurological symptoms, the pathogenic mechanisms of which have not been explained. Robust investigations of the neurological presentations of COVID-19 infection should be recruited for better understanding of the possible association. Moreover, further explaining the pathophysiologic mechanisms will help in designing proper treatment plans.