Peripheral blood cell count ratios as a predictor of poor functional outcome in patients with acute ischemic stroke.

BACKGROUND AND AIMS: Acute ischemic stroke (AIS) is a leading cause of death and long-term disability worldwide. Thromboinflammation plays an important role in the pathophysiology of stroke. The peripheral blood cell count ratios (PBCCR): neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), are global inflammatory indicators with prognostic value for the clinical outcome after stroke. We aimed to determine the relationship between NLR, PLR, or LMR and the functional outcome three months post-stroke. METHODS: A prospective, hospital-based study, including 141 participants with AIS, was conducted at a referral stroke center in North-Eastern Bulgaria. The PBCCRs were obtained during the first 24 hours after stroke onset. Stroke severity was measured using the NIHSS scale, and functional outcome was assessed with the modified Rankin Scale (mRS) at discharge and 3 months post-stroke. RESULTS: We found significantly lower total lymphocyte counts, and higher NLR, PLR, and C-reactive protein in the poor-outcome group (mRS>3) three months post-stroke. A positive correlation was found between the NIHSS score and mRS score on discharge, NLR, and PLR with the worse outcome on the third month. The receiver operating characteristic (ROC) curves showed the predictability of NLR (AUC, 0.626, 95%CI: 0.524-0.724, p = 0.018), and for PLR- (AUC, 0.613, 95%CI: 0.510-0.716, p = 0.031). The optimal cutoff value for NLR was 2.68 (sensitivity 77.8% and specificity 60.4%), and for PLR - 122.6 (sensitivity 77.8% and specificity 61.5%). CONCLUSION: Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are simple, widely available, and cost-effective biomarkers with high prognostic value for the clinical outcome three months post-stroke.

Streptococcus Agalactiae Meningitis Presented with Cerebral Infarction in Adult Patient - Clinical Case and Review.

Background: Bacterial meningitis (BM) is an inflammation of the meninges, associated with the invasion of bacteria. The etiologic agents vary by age group. BM because of Group B streptococcus (GBS) is common for the neonatal period but considered as rare in adult patients. Acute BM can have various presentations and adverse effects, such as ischemic stroke in 10% to 29% of the cases. Objective: This study aimed to present a rare case of GBS meningitis presented with cerebral infarction (CI) in an adult patient and to make a brief review of the etiology and incidence of GBS infections in adults. Case Report: We present a case of a 62-year-old female who presented with acute onset of central lesion of the right facial nerve, mild hemiparesis on the right, and partial sensorimotor aphasia. There were no signs of meningoradicular irritation. The pupils were equal, with slow reaction to light, and unaffected eye movements. There was a central lesion of the right facial nerve and mild hemiparesis on the right. Tendon reflexes were unremarkable and Babinski's sign was negative bilaterally. Discussion: This review shows an increasing incidence of cases in elderly patients. A higher risk of GBS is found in adults with more medical comorbidities. CI, as a rare adverse effect in BM, is both a sign for severity and a predictor of a poor clinical outcome with a high lethal rate. GBS infections are a growing problem in older adults and those with chronic medical conditions. The involvement of the central nervous system as meningitis is a less common manifestation with a high lethal rate. Conclusions: CI is a rare adverse effect of neuro infections leading to an even worse clinical outcome. Early recognition of the infection and appropriate antimicrobial therapy are the crucial moments of successful management of GBS disease.

Hyperglycemic hemichorea due to diabetic striatopathy: case-based review.

Diabetic Striatopathy (DS) is a rare complication of diabetes mellitus (DM) with poor glycemic control and typical neuroimaging findings. DS predominantly leads to a unilateral reversible injury of the basal ganglia resulting in various movement disorders such as hemichorea and hemibalismus. We present a rare case of DS with left-sided hemichorea as a first presentation for a newly diagnosed Diabetes Mellitus (DM) type II and to make a thorough review of this disorder and to provide a practical approach to its management. A 63-year-old female was admitted to the neurology ward with symptoms of involuntary hyperkinetic movements for the left limbs and the left half of the face. The blood samples revealed random serum glucose of 30.8 mmol/l and an HbA1c of 15.13%. The computed tomography of the brain showed asymmetric, unilateral hyperdensity in the right basal ganglia (BG) - the putamen and nucleus caudatus. The patient was managed with Insulin and Haloperidol as the symptoms entirely resolved on the tenth day. In conclusion (DS) is a condition with a good prognosis and reversible clinical and neuroimaging findings after a prompt diagnosis and management. DS should be considered a possible differential diagnosis in patients with abrupt onset of hyperkinetic movement disorders.

Neuro-Behcet´s disease - case report and review.

INTRODUCTION: Behcet's disease (BD) is a multisystem autoimmune relapsing vasculitis with almost unknown etiology, which involves both large and small vessels. The involvement of the central nervous system (CNS) is rare, divided into two main sub-types- parenchymal nad and non-parenchymal. The peripheral nervous system is generally preserved or involved in very rare cases. CASE REPORT: We present a rare case of neuro-Behcet's Disease (NBD) in a young 25-year-old female. The patient presented to our clinic with sudden onset complaints of general weakness, quadriparesis more prevalent for the right limbs, slurred speech, and swallowing disorders. Initially, a clinical diagnosis of cerebral infarction was made, but later the condition was defined as parenchymal Neuro-Behcet disease and the patient underwent corticosteroid and immunosuppressive treatment. DISCUSSION: NBD remains a difficult diagnosis to establish as other diseases and conditions may have a similar clinical presentation. The diagnosis is based on the clinical presentation and the typical lesions in brain magnetic resonance imaging (MRI). The development and disappearance of lesions at MRI in relation with disease-specific treatment may correlate with the course of clinical neurologic deficits. CONCLUSIONS: Differential diagnosis of NBD should be considered in cerebrovascular disease, brain tumors, and demyelinating processes.