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1.
J Coll Physicians Surg Pak ; 30(1): S42-S45, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33650425

RESUMEN

The aim of this retrospective observational study was to describe the neuroimaging manifestations of patients with COVID-19. This study was conducted at Aga Khan University Hospital, Karachi, Pakistan from March to July 2020. COVID-19 patients with neurological symptoms and positive neuroimaging were included after confirmation of COVID-19 by polymerase chain reaction test (PCR). In the 12 included patients, seizures and altered mentation were predominant neurological manifestations. Three cases had acute watershed infarcts (25%), two cases had posterior cerebral artery territorial infarcts (16.7%), two cases had periventricular corona radiata infarcts (16.7%), three cases had hypoxic ischemic encephalopathy (25%), two cases had posterior reversible encephalopathy syndrome (16.7%), and there was one case each of cerebral venous sinus thrombosis, pontine infarct, and bithalamic lesions (8.3%). This study highlights the diagnostic approaches in COVID-19-associated encephalopathy and the variable imaging features that clinicians and neuroradiologists should be aware of, as the pandemic progresses.  Key Words: COVID-19, Neuroimaging, Encephalopathy, Magnetic resonance imaging, Coronavirus.


Asunto(s)
Encefalopatías/diagnóstico , Neuroimagen/métodos , Pandemias , Encefalopatías/epidemiología , Comorbilidad , Humanos
2.
Neurologia ; 36(2): 127-134, 2021 Mar.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33549369

RESUMEN

OBJECTIVES: Since the beginning of the COVID-19 pandemic, the Spanish Society of Neurology has run a registry of patients with neurological involvement for the purpose of informing clinical neurologists. Encephalopathy and encephalitis were among the most frequently reported complications. In this study, we analyse the characteristics of these complications. PATIENTS AND METHODS: We conducted a retrospective, descriptive, observational, multicentre study of patients with symptoms compatible with encephalitis or encephalopathy, entered in the Spanish Society of Neurology's COVID-19 Registry from 17 March to 6 June 2020. RESULTS: A total of 232 patients with neurological symptoms were registered, including 51 cases of encephalopathy or encephalitis (21.9%). None of these patients were healthcare professionals. The most frequent syndromes were mild or moderate confusion (33%) and severe encephalopathy or coma (9.8%). The mean time between onset of infection and onset of neurological symptoms was 8.02 days. Lumbar puncture was performed in 60.8% of patients, with positive PCR results for SARS-CoV-2 in only one case. Brain MRI studies were performed in 47% of patients, with alterations detected in 7.8% of these. EEG studies were performed in 41.3% of cases, detecting alterations in 61.9%. CONCLUSIONS: Encephalopathy and encephalitis are among the complications most frequently reported in the registry. More than one-third of patients presented mild or moderate confusional syndrome. The mean time from onset of infection to onset of neurological symptoms was 8 days (up to 24hours earlier in women than in men). EEG was the most sensitive test in these patients, with very few cases presenting alterations in neuroimaging studies. All patients treated with boluses of corticosteroids or immunoglobulins progressed favourably.


Asunto(s)
Encefalopatías/etiología , Encefalitis Viral/etiología , Pandemias , /patogenicidad , Corticoesteroides/uso terapéutico , Encefalopatías/epidemiología , Encefalopatías/virología , Trastornos del Conocimiento/epidemiología , Coma/epidemiología , Coma/etiología , Coma/virología , Comorbilidad , Electroencefalografía , Encefalitis Viral/epidemiología , Encefalitis Viral/virología , Epilepsia/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Inmunoglobulinas Intravenosas/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Sistema de Registros , /etiología , Estudios Retrospectivos , España/epidemiología , Accidente Cerebrovascular/epidemiología
3.
Rev Neurol (Paris) ; 177(1-2): 51-64, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33446327

RESUMEN

INTRODUCTION: The past two decades have been marked by three epidemics linked to emerging coronaviruses. The COVID-19 pandemic highlighted the existence of neurological manifestations associated with SARS-CoV-2 infection and raised the question of the neuropathogenicity of coronaviruses. The aim of this review was to summarize the current data about neurological manifestations and diseases linked to human coronaviruses. MATERIAL AND METHODS: Articles have been identified by searches of PubMed and Google scholar up to September 25, 2020, using a combination of coronavirus and neurology search terms and adding relevant references in the articles. RESULTS: We found five cohorts providing prevalence data of neurological symptoms among a total of 2533 hospitalized COVID-19 patients, and articles focusing on COVID-19 patients with neurological manifestations including a total of 580 patients. Neurological symptoms involved up to 73% of COVID-19 hospitalized patients, and were mostly headache, myalgias and impaired consciousness. Central nervous system (CNS) manifestations reported in COVID-19 were mostly non-specific encephalopathies that represented between 13% and 40% of all neurological manifestations; post-infectious syndromes including acute demyelinating encephalomyelitis (ADEM, n=13), acute necrotizing encephalopathy (ANE, n=4), Bickerstaff's encephalitis (n=5), generalized myoclonus (n=3) and acute transverse myelitis (n=7); other encephalitis including limbic encephalitis (n=9) and miscellaneous encephalitis with variable radiologic findings (n=26); acute cerebrovascular diseases including ischemic strokes (between 1.3% and 4.7% of COVID-19 patients), hemorrhagic strokes (n=17), cerebral venous thrombosis (n=8) and posterior reversible encephalopathy (n=5). Peripheral nervous system (PNS) manifestations reported in COVID-19 were the following: Guillain-Barré syndrome (n=31) and variants including Miller Fisher syndrome (n=3), polyneuritis cranialis (n=2) and facial diplegia (n=2); isolated oculomotor neuropathy (n=6); critical illness myopathy (n=6). Neuropathological studies in COVID-19 patients demonstrated different patterns of CNS damage, mostly ischemic and hemorrhagic changes with few cases of inflammatory injuries. Only one case suggested SARS-CoV-2 infiltration in endothelial and neural cells. We found 10 case reports or case series describing 22 patients with neurological manifestations associated with other human coronaviruses. Among them we found four MERS patients with ADEM or Bickerstaff's encephalitis, two SARS patients with encephalitis who had a positive SARS-CoV PCR in cerebrospinal fluid, five patients with ischemic strokes associated with SARS, eight MERS patients with critical illness neuromyopathy and one MERS patient with Guillain-Barré Syndrome. An autopsy study on SARS-CoV patients demonstrated the presence of the virus in the brain of eight patients. CONCLUSION: The wide range of neurological manifestations and diseases associated with SARS-CoV-2 is consistent with multiple pathogenic pathways including post-infectious mechanisms, septic-associated encephalopathies, coagulopathy or endothelitis. There was no definite evidence to support direct neuropathogenicity of SARS-CoV-2.


Asunto(s)
/complicaciones , Enfermedades del Sistema Nervioso/etiología , Encefalopatías/epidemiología , Encefalopatías/etiología , Infecciones por Coronavirus/complicaciones , Coronavirus Humano OC43 , Femenino , Síndrome de Guillain-Barré/epidemiología , Síndrome de Guillain-Barré/etiología , Humanos , Masculino , Coronavirus del Síndrome Respiratorio de Oriente Medio , Mielitis/epidemiología , Mielitis/etiología , Enfermedades del Sistema Nervioso/epidemiología , Síndrome Respiratorio Agudo Grave/complicaciones , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología
4.
Pediatr Cardiol ; 42(1): 1-18, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33373013

RESUMEN

Congenital heart defects (CHD) is one of the most common types of birth defects. Thanks to advances in surgical techniques and intensive care, the majority of children with severe forms of CHD survive into adulthood. However, this increase in survival comes with a cost. CHD survivors have neurological functioning at the bottom of the normal range. A large spectrum of central nervous system dysmaturation leads to the deficits seen in critical CHD. The heart develops early during gestation, and CHD has a profound effect on fetal brain development for the remainder of gestation. Term infants with critical CHD are born with an immature brain, which is highly susceptible to hypoxic-ischemic injuries. Perioperative blood flow disturbances due to the CHD and the use of cardiopulmonary bypass or circulatory arrest during surgery cause additional neurological injuries. Innate patient factors, such as genetic syndromes and preterm birth, and postoperative complications play a larger role in neurological injury than perioperative factors. Strategies to reduce the disability burden in critical CHD survivors are urgently needed.


Asunto(s)
Encefalopatías/epidemiología , Cardiopatías Congénitas/epidemiología , Complicaciones Posoperatorias/epidemiología , Adulto , Encéfalo/crecimiento & desarrollo , Lesiones Encefálicas/epidemiología , Puente Cardiopulmonar/métodos , Niño , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Hipoxia-Isquemia Encefálica/epidemiología , Lactante , Recién Nacido , Trastornos del Neurodesarrollo/epidemiología , Embarazo , Nacimiento Prematuro/epidemiología , Sobrevivientes
5.
Alzheimers Res Ther ; 12(1): 170, 2020 12 30.
Artículo en Inglés | MEDLINE | ID: mdl-33380345

RESUMEN

COVID-19 is primarily a respiratory disease but up to two thirds of hospitalised patients show evidence of central nervous system (CNS) damage, predominantly ischaemic, in some cases haemorrhagic and occasionally encephalitic. It is unclear how much of the ischaemic damage is mediated by direct or inflammatory effects of virus on the CNS vasculature and how much is secondary to extracranial cardiorespiratory disease. Limited data suggest that the causative SARS-CoV-2 virus may enter the CNS via the nasal mucosa and olfactory fibres, or by haematogenous spread, and is capable of infecting endothelial cells, pericytes and probably neurons. Extracranially, SARS-CoV-2 targets endothelial cells and pericytes, causing endothelial cell dysfunction, vascular leakage and immune activation, sometimes leading to disseminated intravascular coagulation. It remains to be confirmed whether endothelial cells and pericytes in the cerebral vasculature are similarly targeted. Several aspects of COVID-19 are likely to impact on cognition. Cerebral white matter is particularly vulnerable to ischaemic damage in COVID-19 and is also critically important for cognitive function. There is accumulating evidence that cerebral hypoperfusion accelerates amyloid-ß (Aß) accumulation and is linked to tau and TDP-43 pathology, and by inducing phosphorylation of α-synuclein at serine-129, ischaemia may also increase the risk of development of Lewy body disease. Current therapies for COVID-19 are understandably focused on supporting respiratory function, preventing thrombosis and reducing immune activation. Since angiotensin-converting enzyme (ACE)-2 is a receptor for SARS-CoV-2, and ACE inhibitors and angiotensin receptor blockers are predicted to increase ACE-2 expression, it was initially feared that their use might exacerbate COVID-19. Recent meta-analyses have instead suggested that these medications are protective. This is perhaps because SARS-CoV-2 entry may deplete ACE-2, tipping the balance towards angiotensin II-ACE-1-mediated classical RAS activation: exacerbating hypoperfusion and promoting inflammation. It may be relevant that APOE ε4 individuals, who seem to be at increased risk of COVID-19, also have lowest ACE-2 activity. COVID-19 is likely to leave an unexpected legacy of long-term neurological complications in a significant number of survivors. Cognitive follow-up of COVID-19 patients will be important, especially in patients who develop cerebrovascular and neurological complications during the acute illness.


Asunto(s)
Encefalopatías/epidemiología , Encefalopatías/virología , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/virología , Humanos
6.
Cell ; 183(1): 16-27.e1, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32882182

RESUMEN

Neurological complications have emerged as a significant cause of morbidity and mortality in the ongoing COVID-19 pandemic. Beside respiratory insufficiency, many hospitalized patients exhibit neurological manifestations ranging from headache and loss of smell, to confusion and disabling strokes. COVID-19 is also anticipated to take a toll on the nervous system in the long term. Here, we will provide a critical appraisal of the potential for neurotropism and mechanisms of neuropathogenesis of SARS-CoV-2 as they relate to the acute and chronic neurological consequences of the infection. Finally, we will examine potential avenues for future research and therapeutic development.


Asunto(s)
Encefalopatías/etiología , Infecciones por Coronavirus/complicaciones , Trastornos del Olfato/etiología , Neumonía Viral/complicaciones , Accidente Cerebrovascular/etiología , Animales , Encefalopatías/epidemiología , Reanimación Cardiopulmonar/efectos adversos , Infecciones por Coronavirus/terapia , Humanos , Trastornos del Olfato/epidemiología , Pandemias , Neumonía Viral/terapia , Accidente Cerebrovascular/epidemiología
7.
Anesth Analg ; 131(4): 1032-1041, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32925320

RESUMEN

BACKGROUND: Obstructive sleep apnea (OSA) patients are at increased risk for pulmonary and cardiovascular complications; perioperative mortality risk is unclear. This report analyzes cases submitted to the OSA Death and Near Miss Registry, focusing on factors associated with poor outcomes after an OSA-related event. We hypothesized that more severe outcomes would be associated with OSA severity, less intense monitoring, and higher cumulative opioid doses. METHODS: Inclusion criteria were age ≥18 years, OSA diagnosed or suspected, event related to OSA, and event occurrence 1992 or later and <30 days postoperatively. Factors associated with death or brain damage versus other critical events were analyzed by tests of association and odds ratios (OR; 95% confidence intervals [CIs]). RESULTS: Sixty-six cases met inclusion criteria with known OSA diagnosed in 55 (83%). Patients were middle aged (mean = 53, standard deviation [SD] = 15 years), American Society of Anesthesiologists (ASA) III (59%, n = 38), and obese (mean body mass index [BMI] = 38, SD = 9 kg/m); most had inpatient (80%, n = 51) and elective (90%, n = 56) procedures with general anesthesia (88%, n = 58). Most events occurred on the ward (56%, n = 37), and 14 (21%) occurred at home. Most events (76%, n = 50) occurred within 24 hours of anesthesia end. Ninety-seven percent (n = 64) received opioids within the 24 hours before the event, and two-thirds (41 of 62) also received sedatives. Positive airway pressure devices and/or supplemental oxygen were in use at the time of critical events in 7.5% and 52% of cases, respectively. Sixty-five percent (n = 43) of patients died or had brain damage; 35% (n = 23) experienced other critical events. Continuous central respiratory monitoring was in use for 3 of 43 (7%) of cases where death or brain damage resulted. Death or brain damage was (1) less common when the event was witnessed than unwitnessed (OR = 0.036; 95% CI, 0.007-0.181; P < .001); (2) less common with supplemental oxygen in place (OR = 0.227; 95% CI, 0.070-0.740; P = .011); (3) less common with respiratory monitoring versus no monitoring (OR = 0.109; 95% CI, 0.031-0.384; P < .001); and (4) more common in patients who received both opioids and sedatives than opioids alone (OR = 4.133; 95% CI, 1.348-12.672; P = .011). No evidence for an association was observed between outcomes and OSA severity or cumulative opioid dose. CONCLUSIONS: Death and brain damage were more likely to occur with unwitnessed events, no supplemental oxygen, lack of respiratory monitoring, and coadministration of opioids and sedatives. It is important that efforts be directed at providing more effective monitoring for OSA patients following surgery, and clinicians consider the potentially dangerous effects of opioids and sedatives-especially when combined-when managing OSA patients postoperatively.


Asunto(s)
Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Apnea Obstructiva del Sueño/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/efectos adversos , Anestesia General , Encefalopatías/inducido químicamente , Encefalopatías/epidemiología , Enfermedad Crítica/epidemiología , Femenino , Humanos , Hipnóticos y Sedantes/efectos adversos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Obesidad/complicaciones , Obesidad/mortalidad , Polisomnografía , Respiración con Presión Positiva , Complicaciones Posoperatorias/mortalidad , Sistema de Registros
8.
Crit Care ; 24(1): 491, 2020 08 08.
Artículo en Inglés | MEDLINE | ID: mdl-32771053

RESUMEN

BACKGROUND: Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. We aimed at describing delirium and neurological symptoms of COVID-19 in ICU patients. METHODS: We conducted a bicentric cohort study in two French ICUs of Strasbourg University Hospital. All the 150 patients referred for acute respiratory distress syndrome due to SARS-CoV-2 between March 3 and May 5, 2020, were included at their admission. Ten patients (6.7%) were excluded because they remained under neuromuscular blockers during their entire ICU stay. Neurological examination, including CAM-ICU, and cerebrospinal fluid analysis, electroencephalography, and magnetic resonance imaging (MRI) were performed in some of the patients with delirium and/or abnormal neurological examination. The primary endpoint was to describe the incidence of delirium and/or abnormal neurological examination. The secondary endpoints were to describe the characteristics of delirium, to compare the duration of invasive mechanical ventilation and ICU length of stay in patients with and without delirium and/or abnormal neurological symptoms. RESULTS: The 140 patients were aged in median of 62 [IQR 52; 70] years old, with a median SAPSII of 49 [IQR 37; 64] points. Neurological examination was normal in 22 patients (15.7%). One hundred eighteen patients (84.3%) developed a delirium with a combination of acute attention, awareness, and cognition disturbances. Eighty-eight patients (69.3%) presented an unexpected state of agitation despite high infusion rates of sedative treatments and neuroleptics, and 89 (63.6%) patients had corticospinal tract signs. Brain MRI performed in 28 patients demonstrated enhancement of subarachnoid spaces in 17/28 patients (60.7%), intraparenchymal, predominantly white matter abnormalities in 8 patients, and perfusion abnormalities in 17/26 patients (65.4%). The 42 electroencephalograms mostly revealed unspecific abnormalities or diffuse, especially bifrontal, slow activity. Cerebrospinal fluid examination revealed inflammatory disturbances in 18/28 patients, including oligoclonal bands with mirror pattern and elevated IL-6. The CSF RT-PCR SARS-CoV-2 was positive in one patient. The delirium/neurological symptoms in COVID-19 patients were responsible for longer mechanical ventilation compared to the patients without delirium/neurological symptoms. Delirium/neurological symptoms could be secondary to systemic inflammatory reaction to SARS-CoV-2. CONCLUSIONS AND RELEVANCE: Delirium/neurological symptoms in COVID-19 patients are a major issue in ICUs, especially in the context of insufficient human and material resources. TRIAL REGISTRATION: NA.


Asunto(s)
Encefalopatías/epidemiología , Infecciones por Coronavirus/terapia , Delirio/epidemiología , Neumonía Viral/terapia , Anciano , Estudios de Cohortes , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Índice de Severidad de la Enfermedad
9.
Rev Med Virol ; 30(5): e2118, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32687681

RESUMEN

Human Coronaviruses (HCoVs) have long been known as respiratory viruses. However, there are reports of neurological findings in HCoV infections, particularly in patients infected with the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) amid Coronavirus disease 2019 (COVID-19) pandemic. Therefore, it is essential to interpret the interaction of HCoVs and the nervous system and apply this understanding to the COVID-19 pandemic. This review of the literature analyses how HCoVs, in general, and SARS-CoV-2, in particular, affect the nervous system, highlights the various underlying mechanisms, addresses the associated neurological and psychiatric manifestations, and identifies the neurological risk factors involved. This review of literature shows the magnitude of neurological conditions associated with HCoV infections, including SARS-CoV-2. This review emphasises, that, during HCoV outbreaks, such as COVID-19, a focus on early detection of neurotropism, alertness for the resulting neurological complications, and the recognition of neurological risk factors are crucial to reduce the workload on hospitals, particularly intensive-care units and neurological departments.


Asunto(s)
Encefalopatías/epidemiología , Infecciones por Coronavirus/epidemiología , Encefalitis Viral/epidemiología , Pandemias , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Betacoronavirus/patogenicidad , Encefalopatías/fisiopatología , Encefalopatías/virología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Encefalitis Viral/fisiopatología , Encefalitis Viral/virología , Humanos , Coronavirus del Síndrome Respiratorio de Oriente Medio/patogenicidad , Sistema Nervioso/fisiopatología , Sistema Nervioso/virología , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Virus del SRAS/patogenicidad , Síndrome Respiratorio Agudo Grave/mortalidad , Síndrome Respiratorio Agudo Grave/fisiopatología , Síndrome Respiratorio Agudo Grave/virología , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
11.
AJNR Am J Neuroradiol ; 41(7): 1251-1255, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32499246

RESUMEN

BACKGROUND AND PURPOSE: Cephaloceles are relatively rare conditions caused by a congenital and/or acquired skull defect. The incidence of associated venous brain anomalies with regard to cephaloceles remains to be fully elucidated. Accordingly, we sought to assess the prevalence of sigmoid sinus dehiscence and diverticula in patients with spontaneous skull base cephaloceles. MATERIALS AND METHODS: Our institutional data base was retrospectively queried from 2005 to 2018. Patients in whom spontaneous skull base cephaloceles were identified were ultimately included in the study cohort. These patients subsequently had their sigmoid sinuses re-evaluated with focused attention on the possible presence of dehiscence and/or diverticula. RESULTS: We identified 56 patients: 12 men and 44 women. After re-evaluation of the sigmoid sinuses, evidence of dehiscence and/or diverticula was noted in 21 patients. The right sigmoid sinus was involved in 11 patients, and the left sigmoid sinus was involved in 7 patients, including 3 cases of diverticulum. In 3 patients, evidence of bilateral sigmoid sinus dehiscence and diverticula was noted. Female sex was associated with sigmoid sinus dehiscence and diverticula by univariate analysis (P = .019). By linear regression, cephalocele volume was negatively associated with sigmoid sinus dehiscence and diverticula (coefficient, -2266, P value < .007, adjusted R 2 = 0.1077). By univariate logistic regression using average cephalocele volume as a cutoff, we demonstrate a statistically significant finding of lower volumes being associated with sigmoid sinus dehiscence and diverticula with an odds ratio of 3.58 (P = .05). CONCLUSIONS: The prevalence of sigmoid sinus dehiscence and diverticula in patients with cephalocele is high. Female sex is associated with sigmoid sinus dehiscence and diverticula. The cephalocele volume appears to be inversely proportional to sigmoid sinus dehiscence and diverticula.


Asunto(s)
Encefalopatías/epidemiología , Senos Craneales/patología , Encefalocele/complicaciones , Adulto , Encefalopatías/patología , Divertículo/epidemiología , Encefalocele/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Base del Cráneo
12.
Radiology ; 297(1): E232-E235, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32384020
14.
J Neurol ; 267(9): 2485-2489, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32458197

RESUMEN

Coronavirus disease 2019 (COVID-19) has become a pandemic disease globally. While it mostly presents with respiratory symptoms, it has already been found that it could manifest with a series of neurological symptoms as well, either at presentation or during the course of the disease. Symptoms vary from non-specific such as headache or dizziness to more specific such as convulsions and cerebrovascular disease (CVD). This study aims to give an overview of the neurological manifestations of COVID-19 and discuss the potential pathogenetic mechanisms of central nervous system (CNS) involvement. Clinicians and especially internists, neurologists, and infectious disease specialists should be aware of these symptoms and able to recognize them early. Prompt diagnosis and immediate management of the neurological manifestations of the novel coronavirus will not only improve the prognosis of COVID-19 patients but will also prevent the dissemination of the disease due to misdiagnosed cases.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/fisiopatología , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Encefalopatías/sangre , Encefalopatías/epidemiología , Encefalopatías/fisiopatología , Trastornos Cerebrovasculares/sangre , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/fisiopatología , Infecciones por Coronavirus/sangre , Humanos , Enfermedades del Sistema Nervioso/sangre , Pandemias , Neumonía Viral/sangre
15.
Hosp Pract (1995) ; 48(3): 145-160, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32343632

RESUMEN

INTRODUCTION: Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives. METHODS: Multi-centered, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population. RESULTS: 57,664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population. CONCLUSIONS: There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.


Asunto(s)
Encefalopatías/tratamiento farmacológico , Encefalopatías/epidemiología , Fármacos del Sistema Nervioso Central/uso terapéutico , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antipsicóticos/uso terapéutico , Fármacos del Sistema Nervioso Central/administración & dosificación , Niño , Preescolar , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Pautas de la Práctica en Medicina , Prevalencia , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Adulto Joven
16.
Eur J Cancer ; 129: 32-40, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32120273

RESUMEN

BACKGROUND: 5-Fluorouracil (5-FU)-induced hyperammonaemic encephalopathy is a rare but serious 5-FU adverse drug reaction (ADR). Given the growing number of cancers treated with 5-FU and the paucity of data regarding this ADR, we performed a retrospective national survey to better characterise 5-FU-induced hyperammonaemic encephalopathy. PATIENTS AND METHODS: Since inception of the French pharmacovigilance database, we identified all patients who experienced 5-FU-induced hyperammonaemic encephalopathy. Variables regarding demographics, characteristics, management and outcome of patients were collected. RESULTS: From 1986 to 2018, 30 patients were included. 5-FU-induced hyperammonaemic encephalopathy started 2 [1-4] days after 5-FU infusion onset. Most common neurological disorders were consciousness impairment, seizures and confusion. hyperammonaemia tended to be higher in patients with the lowest Glasgow score and admitted in intensive care unit (ICU) compared to non-ICU patients (250 [133-522] versus 139 [68-220] µmol/L respectively, p = NS). Dihydropyrimidine dehydrogenase deficiency was found in 27% of tested patients (n = 3/11). Encephalopathy-induced mortality was 17%, 57% of patients were admitted in ICU and 70% had a complete neurological recovery within 5 [2-10] days. A 5-FU rechallenge was considered in 14 (67%) patients with neurological recovery and a relapse was observed in 57% of them. No 5-FU-induced hyperammonaemic encephalopathy relapse was observed as long as 5-FU rechallenge was performed with decreased 5-FU dosage. CONCLUSION: We report the largest cohort of 5-FU-induced hyperammonaemic encephalopathy cases so far. This ADR should be suspected and ammonaemia measured in all patients experiencing neurological disorders after 5-FU administration. In patients with complete neurological recovery, a 5-FU rechallenge could be cautiously considered.


Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Encefalopatías/epidemiología , Fluorouracilo/efectos adversos , Hiperamonemia/epidemiología , Neoplasias/tratamiento farmacológico , Anciano , Amoníaco/sangre , Antimetabolitos Antineoplásicos/administración & dosificación , Encefalopatías/sangre , Encefalopatías/inducido químicamente , Encefalopatías/terapia , Ciclo del Ácido Cítrico/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Fluorouracilo/administración & dosificación , Francia/epidemiología , Humanos , Hiperamonemia/sangre , Hiperamonemia/inducido químicamente , Hiperamonemia/terapia , Incidencia , Masculino , Persona de Mediana Edad , Farmacovigilancia , Estudios Retrospectivos , Resultado del Tratamiento , Urea/metabolismo
17.
J Assoc Physicians India ; 68(3): 63-66, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138487

RESUMEN

Background: Diagnosis and delay in management of encephalopathy in elderly patients is challenging due to the paucity of presenting symptoms and signs. Methods: This was an observational study conducted over a period of one year (1.2.2016 to 31.1.2017) on all elderly patients presenting with encephalopathy. Their demographic profile along with clinical presentation, laboratory, imaging results and final outcome were recorded and analysed. Results: There were 251 elderly patients who presented with encephalopathy, 110 (43.82%) of whom were females. Majority of these patients i.e. 186(74.10%) were in the age group of 60-75 years with a mean age of 70.78 years. There were 112 (44.62%) patients who presented to the hospital within 6 hours of commencement of the altered mental status (AMS). Multiple etiologies for encephalopathy were present in 75 (29.88%) patients with the commonest being neurological in 97 (38.65%) patients, infection/sepsis in 92 (36.65%) patients and metabolic in 84 (33.47%) patients. Hyponatremia was the commonest cause of metabolic encephalopathy present in 38(45.24%) patients followed by hypoglycemia in 25 (29.76%) patients. Pneumonia was the commonest infection present in 41 (44.57%) patients. There were 48(19.12%) deaths with 38(79.17%) of them having one or more co-morbidities. Early presentation to hospital (within 6 hours of commencement of symptoms), higher GCS and conscious level at presentation were the good prognostic markers of outcome in these elderly patients. However patients with septic encephalopathy were found to have worst prognosis. Conclusion: The common etiologies of encephalopathy in the elderly were neurological (38.65%) followed by infection (36.65%) and metabolic (33.47%). The mortality rate was 19.12%. Seeking medical aid within 6 hours of commencement of altered sensorium along with timely diagnosis could reduce the mortality and improve outcomes.


Asunto(s)
Encefalopatías/etiología , Anciano , Encefalopatías/epidemiología , Trastornos de la Conciencia , Femenino , Humanos , Hiponatremia , Persona de Mediana Edad , Neumonía , Sepsis
18.
Lancet Child Adolesc Health ; 4(5): 378-387, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32199080

RESUMEN

BACKGROUND: Congenital Zika syndrome causes a spectrum of neurological symptoms with varying effects on function that require different therapeutic strategies. To date, this spectrum of effects and its clinical implications have not been completely described. We describe the neurological examination findings in toddlers and preschoolers, including predominant symptom complexes and comorbidities. METHODS: This study is a case-series neurological evaluation of 75 children with congenital Zika syndrome in Campina Grande, Brazil. The study is part of a cohort of children with congenital Zika syndrome that started in 2015 and is still ongoing. Children with Zika virus infection detected during pregnancy (mothers exhibited rash and were followed and diagnosed by fetal ultrasound abnormalities or RT-PCR) or through microcephaly screening after birth, using Intergrowth 21 guidelines, were selected by laboratory and radiological criteria. Children were examined during a 10-day period in September, 2018, and underwent neurological interview, examination, and assessment of functional outcomes and comorbidities. Children were divided in groups of predominant corticospinal or neuromuscular clinical signs and the associations between these groups and clinical comorbidities were assessed. FINDINGS: All of the children recruited to the study from Nov 29, 2015 to Nov 30, 2017 had imaging correlates of congenital Zika syndrome. Children were assigned to groups depending on the signs exhibited, either corticospinal or neuromuscular, with or without dyskinetic signs. 75 children completed the evaluation, 38 (51%) girls and 37 (49%) boys. Median age was 33 months (range 26-40 months; IQR 29-34). Microcephaly was present at birth in 56 (75%) children, and 19 (25%) children were born with normal head circumference, 15 of whom later developed microcephaly. Neurological examination grouped four children as having isolated dyskinetic signs, 48 children were assigned to the corticospinal group and 23 into the neuromuscular group. Dyskinetic findings were present in 30 (40%) children, either alone (four [5%]) or combined with corticospinal (19 [40%] of 48) or neuromuscular (seven [30%] of 23) findings. Comorbidities were highly prevalent, and the neuromuscular group had worse functional outcomes, evaluated by gross motor function (p=0·026), manual abilities (p=0·0013), and communication function (p<0·0005) classification scales, than the corticospinal group, whereas pneumonia (p<0·0005) and urinary tract infections (p<0·0005) were more frequent in the corticospinal group. Cortical hyperexcitability was supported by several clinical correlates, such as early onset epilepsy, persistence of primitive reflexes, and dystonia. INTERPRETATION: We describe distinct neurological profiles in the congenital Zika syndrome spectrum, with functional outcomes tending to correlate with these groups. The clinical division of children based on the disease signs proposed here is supported by the literature on central and peripheral nervous system pathology in congenital Zika syndrome. The high prevalence of dyskinetic symptoms merits special attention. FUNDING: Brazilian National Council for Scientific and Technological Development and by the Coordination for the Improvement of Higher Education Personnel.


Asunto(s)
Discinesias/fisiopatología , Enfermedades Neuromusculares/fisiopatología , Infección por el Virus Zika/fisiopatología , Encéfalo/diagnóstico por imagen , Encefalopatías/diagnóstico por imagen , Encefalopatías/epidemiología , Brasil/epidemiología , Calcinosis/diagnóstico por imagen , Calcinosis/epidemiología , Preescolar , Comorbilidad , Trastornos de Deglución/epidemiología , Discinesias/epidemiología , Epilepsia/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Malformaciones del Desarrollo Cortical/diagnóstico por imagen , Malformaciones del Desarrollo Cortical/epidemiología , Malformaciones del Desarrollo Cortical/fisiopatología , Microcefalia/epidemiología , Microcefalia/fisiopatología , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/fisiopatología , Examen Neurológico , Enfermedades Neuromusculares/epidemiología , Neumonía/epidemiología , Tractos Piramidales/fisiopatología , Trastornos del Sueño-Vigilia/epidemiología , Tomografía Computarizada por Rayos X , Infecciones Urinarias/epidemiología , Infección por el Virus Zika/congénito , Infección por el Virus Zika/diagnóstico por imagen , Infección por el Virus Zika/epidemiología
19.
Curr Opin Nephrol Hypertens ; 29(2): 213-220, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31904619

RESUMEN

PURPOSE OF REVIEW: The topic of hyponatremia is in a state of flux. We review a new approach to diagnosis that is superior to previous methods. It simplifies identifying the causes of hyponatremia, the most important issue being the differentiation of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) from cerebral/renal salt wasting (RSW). We also report on the high prevalence of RSW without cerebral disease in the general wards of the hospital. RECENT FINDINGS: We applied our new approach to hyponatremia by utilizing sound pathophysiologic criteria in 62 hyponatremic patients. Seventeen (27%) had SIADH, 19 (31%) had a reset osmostat, 24 (38%) had RSW with 21 having no evidence of cerebral disease, 1 had Addison's disease, and 1 was because of hydrochlorothiazide. Many had urine sodium concentrations (UNa) less than 30 mmol/l. SUMMARY: RSW is much more common than perceived in the general wards of the hospital. It is important to change the terminology from cerebral to RSW and to differentiate SIADH from RSW. These changes will improve clinical outcomes because of divergent therapeutic goals of water-restricting in SIADH and administering salt and water to a dehydrated patient with RSW. The present review will hopefully spur others to reflect and act on the new findings and different approaches to hyponatremia.


Asunto(s)
Encefalopatías/etiología , Hiponatremia/etiología , Síndrome de Secreción Inadecuada de ADH/etiología , Sodio/metabolismo , Encefalopatías/epidemiología , Humanos , Hiponatremia/epidemiología , Síndrome de Secreción Inadecuada de ADH/epidemiología , Prevalencia
20.
Chin J Traumatol ; 23(1): 45-50, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31982270

RESUMEN

PURPOSE: To introduced our experience with progressive extra-axial hematoma (EAH) in the original frontotemporoparietal (FTP) site after contralateral decompressive surgery (CDS) in traumatic brain injury patients and discuss the risk factors associated with this dangerous situation. METHODS: This retrospective study was conducted on 941 patients with moderate or severe TBI treated in Daping Hospital, Army Medical University, Chongqing, China in a period over 5 years (2013-2017). Only patients with bilateral lesion, the contralateral side being the dominant lesion, and decompressive surgery on the contralateral side conducted firstly were included. Patients were exclude if (1) they underwent bilateral decompression or neurosurgery at the original location firstly; (2) although surgery was performed first on the contralateral side, surgery was done again at the contralateral side due to re-bleeding or complications; (3) patients younger than 18 years or older than 80 years; and (4) patients with other significant organ injury or severe disorder or those with abnormal coagulation profiles. Clinical and radiographic variables reviewed were demographic data, trauma mechanisms, neurological condition assessed by Glasgow coma scale (GCS) score at admission, pupil size and reactivity, use of mannitol, time interval from trauma to surgery, Rotterdam CT classification, type and volume of EAH, presence of a skull fracture overlying the EAH, status of basal cistern, size of midline shift, associated brain lesions and types, etc. Patients were followed-up for at least 6 months and the outcome was graded by Glasgow outcome scale (GOS) score as favorable (scores of 4-5) and unfavorable (scores of 1-3). Student's t-test was adopted for quantitative variables while Pearson Chi-squared test or Fisher's exact test for categorical variables. Multivariate logistic regression analysis was also applied to estimate the significance of risk factors. RESULTS: Initially 186 patients (19.8%) with original impact locations at the FTP site and underwent surgery were selected. Among them, 66 met the inclusion and exclusion criteria. But only 50 patients were included because the data of the other 16 patients were incomplete. Progressive EAH developed at the original FTP site in 11 patients after the treatment of, with an incidence of 22%. Therefore the other 39 patients were classified as the control group. Multivariate logistic regression analysis showed that both the volume of the original hematoma and the absence of an apparent midline shift were significant predictors of hematoma progression after decompressive surgery. Patients with fracture at the original impact site had a higher incidence of progressive EAH after CDS, however this factor was not an important predictor in the multivariate model. We also found that patients with progressive EAH had a similar favorable outcome with control group. CONCLUSION: Progressive EAH is correlated with several variables, such as hematoma volumes ≥10 mL at the original impact location and the absence of an apparent midline shift (<5 mm). Although progressive EAH is devastating, timely diagnosis with computed tomography scans and immediate evacuation of the progressive hematoma can yield a favorable result.


Asunto(s)
Encefalopatías/etiología , Lesiones Encefálicas/cirugía , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Lóbulo Frontal , Hematoma/etiología , Lóbulo Parietal , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Encefalopatías/epidemiología , Progresión de la Enfermedad , Femenino , Hematoma/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Índices de Gravedad del Trauma
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