Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: First Described Complication after Gam-COVID-Vac Vaccine.

BACKGROUND: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe, debilitating chronic disease characterized by marked tiredness and fatigue, cognitive dysfunction, sleep disturbances, pain, and autonomic, immunological, and metabolic dysfunctions, in which all symptoms are usually exacerbated by physical and/or psychological stress. SUBJECTS AND METHODS: We report a case of ME/CFS with severe myalgia and severe locomotor disorders in a 25-year-old female after Gam-COVID-Vac vaccine (Sputnik V) ten days before the manifestation of the symptoms. RESULTS: This is the first report of such a complication from the Gam-COVID-Vac vaccine.

Clinical Features in Russian Patients with COVID-Associated Parosmia/Phanthosmia.

BACKGROUND: Olfactory dysfunction is a typical symptom of COVID-19 infection. While COVID-associated anosmia is well-described, knowledge of parosmia (olfactory distortions) and phanthosmia (olfactory hallucinations) is relatively lacking. We undertook a clinical study of the parosmia/phanthosmia phenotype, aiming to support improved prediction and management of these symptoms. SUBJECTS AND METHODS: In a cross-sectional study between September 2020 and May 2021, we recruited 187 COVID-19 patients with parosmia/phanthosmia via social media and a matched healthy control group from neurologists. The patients received an online video-consultation with a neurologist trained in olfactory research and completed a questionnaire to assess the nature of their subjective olfactory disorder. RESULTS: In the acute period of COVID-19 parosmia/phanthosmia, patients often experienced comorbid manifestations such as fatigue, fever, headache, myalgia, and "brain fog". Isolated phanthosmia was observed in 13.9% of acute COVID-19 patients, as compared to 34.2% in the long term. Parosmia was described in 89.8% of patients in the long-term course of the disease. COVID-associated parosmia/phanthosmia was more common in women (81.3%) than men (18.7%). Almost all parosmia/phanthosmia patients had an acute history of anosmia, which often progressed to hyposmia. A third of the patients had a history of taste disturbance The long-term COVID-19 sequelae such as fatigue, brain fog, and dizziness are significantly more common among patients with parosmia/phanthosmia, as were autonomic symptoms such as awareness of heartbeat and rapid pulse. The incidence of migraine with aura was significantly higher in the parosmia/phanthosmia group than in the control group (8% versus 0.9%). The allergy was reported significantly more frequent in the study group compared to the control group. CONCLUSIONS: Qualitative olfactory disorders occur frequently in COVID-19 patients. Those with the parosmia/phanthosmia phenotype have a higher risk for other symptoms, notably headache (including migraine with aura), fatigue, brain fog, dizziness, and cardiovascular/autonomic manifestations, as well as allergy. We suppose that further investigation of this phenomenon will reveal phenotypic variants depending on particular symptoms cluster; improved nosology of qualitative olfactory disorders in COIVD-19 is a prerequisite for establishing appropriate treatments.

Survey of diagnostic and treatment practices for multiple sclerosis in Russian Federation in comparison to European data.

INTRODUCTION: The data of the survey of European (EU) neurologists on the methods of diagnosis and treatment of multiple sclerosis in Europe were compared with the data of the similar survey of neurologists of the Russian Federation (RF). METHOD: Seventy-five neurologists specialized in MS from RF completed questionnaires on radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting (RRMS), secondary progressive (SPMS), and primary progressive (PPMS) multiple sclerosis. RESULTS: In the case of RIS, only 46% of neurologists from the RF recommended CSF analysis for oligoclonal IgG and only 54.3% performed magnetic resonance imaging (MRI) of the spinal cord, which is significantly lower than in the EU (78% and 80%, respectively). In the case of CIS, significantly more neurologists from the Russian Federation would have tested for antibodies to disorders of the optical spectrum of neuromyelitis (57% in the EU and 94% in the RF). In case of typical RRMS, more neurologists from the RF preferred to start with the second line of disease-modifying therapy (DMT), a lower percentage would choose dimethyl fumarate as the first line DMT (9% in the RF and 25% in the EU). In case of escalating therapy, the majority of EU respondents (68%) indicated that one relapse would be sufficient (only 28% in RF), while in RF, 58% indicated that two relapses would be sufficient (22% in EU). Fewer neurologists from RF would use fingolimod, natalizumab or mitoxantrone for SPMS. 91% of neurologists in RF would like to prescribe ocrelizumab for PPMS. CONCLUSION: MS specialists from RF are less active in monitoring RIS than MS specialists from EU. CIS is not indication to use any DMT in RF. MS specialists in RF are more conservative in changing DMT as escalation in cases with breakthrough RRMS. The products without indication to be used in SPMS are rarely prescribed in RF in comparison to EU. Most cases of PPMS in RF would be treated with ocrelizumab.

Clinical variants of limbic encephalitis.

The clinical picture of immunomediator disorders of the central nervous system resulting from autoimmune or paraneoplastic processes is often represented by the limbic symptom complex or limbic encephalitis. The article gives a brief description of these conditions, allocated to a separate nosological group in 2007. The symptoms of limbic encephalitis include mental disorders and epileptic seizures of both convulsive and non-convulsive spectrum, up to epileptic status. Four clinical cases representative of different variants of limbic encephalitis are presented in this study, along with the discussion of epidemiology, differential diagnostics, and generally accepted patient management strategies. The diagnosis of limbic encephalitis was made on clinical grounds alone in three cases and on the presence of antibodies to N-Methyl-d-aspartic acid receptors in one case. A combination of glucocorticoid pulse therapy with prolonged use of valproic acid was successfully applied for the treatment of limbic encephalitis with non-convulsive epileptic status. Plasmapheresis was used for the treatment of limbic encephalitis with recurrent focal non-motor attacks with and without loss of consciousness, as well as for limbic encephalitis with focal motor attacks. Presented cases emphasize the need to increase the awareness of physicians of various specialties to autoimmune disorders of the nervous system. In addition, it highlights the necessity of complete diagnostic workup for a patient with impaired consciousness of unclear etiology.

Case Report of a New Headache Developed by a Combat Soldier after an Episode of Exertional Heat Illness.

Only a few authors have reported about a new-onset headache among patients who sustained an episode of an exertional heat illness (EHI). This report presents a healthy and physically fit 20-year-old male who developed a completely new headache after an EHI event. The new headache could be aggravated or called by exertion or exposure to sun and environmental heat. It was severe enough to interfere with even moderate physical activity, but reacted well to a few hours' rest and OTC pain medications. An extensive work-up including laboratory blood tests, lumbar puncture, head CT, and CT angiogram was negative. The patient remained symptomatic on the 6-month follow-up. Continued abstinence from physical activity and waiting for spontaneous resolution were recommended. We suggest that the headache may be secondary to the hyperthermia brain damage during the EHI event and differs from exertional headache by its association with exposure to sun and environmental heat.