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1.
Med Clin North Am ; 105(3): 511-529, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926644

RESUMO

Neuro-ophthalmology is the study of the neurologic underpinnings of vision and includes a fascinating variety of disorders that span the broad spectrum of ophthalmic and neurologic disease. This subspecialty relies heavily on accurate neuroanatomic localization and examination. This article discusses neuro-ophthalmic complaints that frequently present to the internist, including acute vision loss, double vision, and unequal pupils. It focuses on pertinent clinical features of the most common causes of these chief complaints and additionally highlights salient points of history, diagnosis, examination, and management with special emphasis on the signs and symptoms that should prompt expedited evaluation.


Assuntos
Cegueira/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Anisocoria/diagnóstico , Anisocoria/etiologia , Cegueira/etiologia , Cegueira/terapia , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Diplopia/diagnóstico , Diplopia/etiologia , Humanos , Medicina Interna , Transtornos de Enxaqueca/complicações , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/diagnóstico , Oftalmologia , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/terapia
2.
Horm Mol Biol Clin Investig ; 42(1): 69-75, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33617700

RESUMO

COVID-19 caused by SARS CoV2 (The novel corona virus) has already taken lives of many people across the globe even more than anyone could have imagined. This outbreak occurred in China and since then it is expanding its devastating effects by leaps and bounds. Initially it appeared to be an outbreak of pneumonia but soon it was found to be much more than that and the infectivity was found to be very high. This is the reason that it has taken whole globe in its trap and become a pandemic in such a short span of time. Death is occurring because it is a new virus and human body has no specific antibodies for it. Presently there is no approved vaccine so everyone is susceptible but people with co-morbidities appear to be in more risk and the best way for protection is social distancing and increasing one's natural immunity by taking healthy diet and exercise. When a person is infected the clinical presentation ranges from asymptomatic to severe ARDS, sudden onset of anosmia, headache, cough may be the initial symptoms. This review is focused on immunopathology and effect of COVID-19 on neurological disorders and also the neurological manifestations and the treatment.


Assuntos
/complicações , Doenças do Sistema Nervoso , Pandemias , /imunologia , Comorbidade , Humanos , Sistema Imunitário/fisiologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/imunologia , Doenças do Sistema Nervoso/terapia , Neuroimunomodulação/fisiologia , /fisiologia
3.
BMJ Open ; 11(1): e045780, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436478

RESUMO

OBJECTIVES: Describing perceived limitations in everyday life, psychological burden and approval to easing of measures during the COVID-19 phases in elderly people with neurological disorders. DESIGN: Observational, prospective study SETTING: This is a monocentric study conducted at a university hospital in Germany. PARTICIPANTS: Overall, 452 elderly people participated in the NeuroGerAdh study (DRKS00016774) and were interviewed by telephone between 18 March and 30 August 2020. RESULTS: Overall, 307 (67.9%) patients had relevant limitations in daily life due to the measures. These limitations significantly decreased during the pandemic phases. At the beginning of the pandemic, people complained about restricted social contacts and mobility, which were the most common reasons for perceived limitations in daily life. Later, since June 2020, wearing a mouth-nose mask had become the main reason for perceived limitations. In the elastic net regularisation, model higher perceived limitations in daily life were among others associated with younger age and earlier pandemic phases. Higher psychological burden was mainly associated with early pandemic phase, younger age and depression.The perceived psychological burden decreased as the pandemic phases passed, even though the reasons for psychological burden (anxiety or fear of infection, insecurity and concerns) did not remarkably change during the phases. From 16 June 2020, the patients were asked whether they approve the easing of measures. Sixty-seven of 136 patients (49.3%) approved and 55 (40.4%) did not. The common reasons for disapproval were fear of increased risk of infection and irresponsible behaviour of other people. CONCLUSION: While limitations in daily life decreased during the study period, anxiety remains a common psychological burden in elderly sick people, and this needs special attention. Accordingly, most people do not approve easing of measures. Special strategies are needed to cope with changing measures during the COVID-19 pandemic.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/psicologia , Adaptação Psicológica , Idoso , Feminino , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Alemanha , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Máscaras , Pandemias , Estudos Prospectivos , Estresse Psicológico/complicações , Estresse Psicológico/psicologia
5.
Clin Nucl Med ; 46(1): e31-e33, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32657879

RESUMO

Three patients with neurological disorders (cerebral infarction, progressive multifocal leukoencephalopathy, and multiple sclerosis) underwent F-THK5351 and C-L-deprenyl PET on the same day to visualize lesions undergoing astrogliosis by measuring MAO-B activity. BPND map and SUV image with F-THK5351 as well as Ki map, Ki/K1 map and SUV image with C-L-deprenyl were created. F-THK5351 BPND maps and SUV images clearly identified the lesions undergoing astrogliosis. C-L-deprenyl Ki/K1 maps were close to F-THK5351 images, but very noisy. Ki maps and SUV images were likely affected by the effect of blood flow. Hence, F-THK5351 is superior to C-L-deprenyl for visualizing lesions undergoing astrogliosis.


Assuntos
Aminopiridinas/metabolismo , Radioisótopos de Carbono , Gliose/diagnóstico por imagem , Monoaminoxidase/metabolismo , Doenças do Sistema Nervoso/complicações , Tomografia por Emissão de Pósitrons , Quinolinas/metabolismo , Selegilina/metabolismo , Feminino , Gliose/complicações , Gliose/metabolismo , Humanos , Ligantes , Masculino
6.
Neurology ; 96(6): e876-e889, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33318164

RESUMO

OBJECTIVE: Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES). METHODS: A systematic literature review was conducted, searching MEDLINE from inception to May 2020 for FEES findings in neurologic diseases of interest. Based on a retrospective analysis of FEES videos in neurologic diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1,012 randomly selected FEES videos of patients with various neurologic disorders. Chi-square tests were used to compare the distribution of dysphagia phenotypes between the underlying neurologic disorders. RESULTS: A total of 159 articles were identified, of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) "premature bolus spillage" and (2) "delayed swallowing reflex" occurred mainly in stroke, (3) "predominance of residue in the valleculae" was most common in Parkinson disease, (4) "predominance of residue in the piriform sinus" occurred only in myositis, motoneuron disease, and brainstem stroke, (5) "pharyngolaryngeal movement disorder" was found in atypical Parkinsonian syndromes and stroke, (6) "fatigable swallowing weakness" was common in myasthenia gravis, and (7) "complex disorder" with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic lateral sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84). CONCLUSION: Neurogenic dysphagia is not a symptom, but a multietiologic syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.


Assuntos
Transtornos de Deglutição/classificação , Transtornos de Deglutição/diagnóstico , Doenças do Sistema Nervoso/complicações , Transtornos de Deglutição/etiologia , Humanos
7.
Rev. cuba. med ; 59(4): e1162, oct.-dic. 2020.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144507

RESUMO

Introducción: Los trastornos neurológicos asociados al dengue es un tema que cobra vital importancia en estos tiempos debido a que el espectro clínico del dengue ha cambiado y las manifestaciones atípicas están reportándose con mayor frecuencia. Los serotipos 2 y 3 son los más frecuentemente relacionados a manifestaciones neurológicas como la encefalitis, mielitis y síndrome de Guillain-Barré. Objetivo: Reportar una serie de casos con trastornos neurológicos asociados a la infección por DENV y sus variables clínicas, humorales e imagenológicas. Casos clínicos: Todos los pacientes cursaron en primera instancia con un cuadro clínico de dengue no complicado dado por fiebre de 38,5º C y escalofríos de aparición brusca, exantema maculo-papuloso céfalo-caudal que respeta palmas y plantas, artralgias, mialgias, cefalea frontal y retro-ocular, esta última a la contracción del músculo recto superior del globo ocular. Todos confirmados con anticuerpos específicos anti-virus del dengue. Un paciente desarrolló síndrome de Guillain-Barré, otro curso con encefalitis, bicitopenia y compromiso del nivel de conciencia. El resto cursó con mielitis transversa, meningoencefalitis y encefalitis autoinmune. Conclusiones: Los trastornos neurológicos asociados al virus del dengue deben ser sospechados en todo paciente que ingrese con esta infección y manifieste cualquiera de las alteraciones aquí descritas(AU)


Introduction: Neurological disorders associated with dengue is an issue of vital importance in these times because the clinical spectrum of dengue has changed and atypical manifestations are being reported much frequently. Serotypes 2 and 3 are the most frequently related to neurological manifestations such as encephalitis, myelitis and Guillain-Barré syndrome. Objective: To report a series of cases with neurological disorders associated with DENV infection and its clinical, humoral and imaging variables. Clinical case report: All patients had, in the first instance, uncomplicated dengue clinical status due to 38.5º C fever and chills of sudden appearance, Cephalo-caudal maculo-papular rash that spares palms and soles, arthralgias, myalgias, frontal and retro-ocular headache, the latter due to the contraction of the superior rectus muscle of the eyeball. All confirmed with specific anti-dengue virus antibodies. One patient developed Guillain-Barré syndrome, another had encephalitis, bicytopenia, and compromised level of consciousness. The rest had transverse myelitis, meningoencephalitis and autoimmune encephalitis. Conclusions: Neurological disorders associated with dengue virus should be suspected in every patient who is admitted with this infection and manifests any of the alterations described here(AU)


Assuntos
Humanos , Masculino , Feminino , Dengue/complicações , Doenças do Sistema Nervoso/complicações
8.
Wiad Lek ; 73(9 cz. 1): 1848-1852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33099528

RESUMO

OBJECTIVE: Introduction: Neurogenic dysphagia is a frequent disorder affecting people with neurological diseases. Many experts work together to diagnose and treat dysphagia. The aim: The article focuses on the specificity of neurogenic dysphagia, its symptoms and treatment possibilities. The speech pathologist can be included in the diagnostic process and can evaluate the intake of liquids and foods based on a variety of consistency tests. In clinical conditions, screening tests such as water swallowing test, multiple consistency tests: GUSS (Gugging Swallowing Screen), V-VST (Volume-Viscosity Swallow Test) and EAT-10 questionnaire can be used successfully. If you have limited ability to perform instrumental tests, they can help you to expand your diagnosis. PATIENTS AND METHODS: Review and Discussion:Treatment of swallowing disorders is based on a daily modification of the patient's posture and consistency of the eaten meals. Nursing staff are involved in this adaptation activity, which plays an invaluable role in the diagnosis and treatment of patients in neurological and rehabilitation departments. CONCLUSION: Conclusions: Despite the knowledge of the problem, difficulty swallowing is still unnoticed. The effects of this neglect are felt both for patients and from the perspective of management within treatment units For people suffering from neurological diseases, swallowing disorders should be diagnosed on a compulsory basis and their assessment should be a permanent part of the standard procedures for assessing patients with neurological deficits.


Assuntos
Transtornos de Deglutição , Doenças do Sistema Nervoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Humanos , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/diagnóstico , Sensibilidade e Especificidade , Inquéritos e Questionários
9.
Cells ; 9(11)2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33120941

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel human coronavirus that has sparked a global pandemic of the coronavirus disease of 2019 (COVID-19). The virus invades human cells through the angiotensin-converting enzyme 2 (ACE2) receptor-driven pathway, primarily targeting the human respiratory tract. However, emerging reports of neurological manifestations demonstrate the neuroinvasive potential of SARS-CoV-2. This review highlights the possible routes by which SARS-CoV-2 may invade the central nervous system (CNS) and provides insight into recent case reports of COVID-19-associated neurological disorders, namely ischaemic stroke, encephalitis, encephalopathy, epilepsy, neurodegenerative diseases, and inflammatory-mediated neurological disorders. We hypothesize that SARS-CoV-2 neuroinvasion, neuroinflammation, and blood-brain barrier (BBB) dysfunction may be implicated in the development of the observed disorders; however, further research is critical to understand the detailed mechanisms and pathway of infectivity behind CNS pathogenesis.


Assuntos
Betacoronavirus/metabolismo , Barreira Hematoencefálica/fisiopatologia , Barreira Hematoencefálica/virologia , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/complicações , Pneumonia Viral/complicações , Internalização do Vírus , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Citocinas/metabolismo , Humanos , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/imunologia , Pneumonia Viral/virologia
10.
PLoS One ; 15(9): e0238102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941484

RESUMO

OBJECTIVES: To assess neurological sequelae and growth in the first 12 months of life in a cohort of congenital cytomegalovirus (cCMV) infected infants compared to cCMV uninfected infants. STUDY DESIGN: This was a prospective matched cohort study conducted in Soweto, South Africa where forty-six confirmed cCMV cases were matched on HIV-exposure, gender and gestational age (±two weeks) to 84 cCMV-uninfected controls in a 1:2 ratio. Cases and controls were followed up until 12 months of age to assess anthropometry, hearing and neurodevelopmental outcomes. RESULTS: Thirty-four (73.9%) cCMV cases and 74 (88.1%) controls, completed all assessments at 12 months age. At 12 months, one cCMV case had died, none of the children in either group had SNHL and neurodevelopmental delay was present in a similar percentage of cCMV cases (n = 2; 6%) and controls (n = 1, 4%; OR 1.09, 95% CI 0.04-27.84, p = 0.958). Anthropometry did not differ between cases and controls overall throughout the follow up period. HIV-exposed cases had smaller head circumference for age at 6 and 12 months when compared with HIV-exposed controls. CONCLUSION: By 12 months of age, there was no evidence of a difference in neurological sequelae between cCMV infected South African children and cCMV uninfected children in this study. Further follow-up is warranted to detect late-onset hearing loss and neurodevelopmental delay beyond 12 months of age.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/fisiopatologia , Citomegalovirus/fisiologia , Crescimento e Desenvolvimento , Doenças do Sistema Nervoso/complicações , Adulto , Estudos de Casos e Controles , Criança , Estudos de Coortes , Infecções por Citomegalovirus/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , África do Sul , Ultrassonografia , Adulto Jovem
11.
Rev. neurol. (Ed. impr.) ; 71(6): 213-220, 16 sept., 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195514

RESUMO

INTRODUCCIÓN: Los problemas nutricionales son frecuentes en niños con enfermedades neurológicas, sobre todo si tienen una importante afectación motora. La disfagia orofaríngea es muy prevalente en estos pacientes y puede contribuir a empeorar el estado nutricional y a que se produzcan aspiraciones pulmonares. OBJETIVO: Evaluar de forma longitudinal el estado nutricional de una muestra de pacientes pediátricos con enfermedad neurológica moderada-grave y establecer la prevalencia de disfagia orofaríngea en dicha muestra. PACIENTES Y MÉTODOS: Estudio multicéntrico prospectivo observacional. Se incluyó a niños menores de 16 años controlados en cuatro centros hospitalarios. Se recogieron datos clínicos y antropométricos durante un año. Se realizaron preguntas dirigidas a realizar un cribado sistemático de disfagia orofaríngea. RESULTADOS: Se seleccionó a 68 pacientes, y el diagnóstico más frecuente fue la parálisis cerebral infantil. En la valoración antropométrica, 42 pacientes (62%) presentaron puntuaciones z de peso inferiores a 2, y 29 (43%), talla con puntuaciones z inferiores a 2, pero con un índice de masa corporal, un perímetro braquial y unos pliegues cutáneos mucho menos alterados. La prevalencia de disfagia orofaríngea fue del 73,5%, que aumentó a mayor afectación motora. CONCLUSIONES: Estos pacientes presentan un tamaño corporal menor que la población de su misma edad y sexo sin patología. Sin embargo, con un correcto seguimiento nutricional, mantienen estable su composición corporal. Es importante investigar de forma proactiva la presencia de disfagia orofaríngea, sobre todo en los que tienen mayor afectación motora, pues se presenta con mucha frecuencia y un adecuado diagnóstico puede mejorar la evolución clínica y prevenir complicaciones


INTRODUCTION: Nutritional problems are common in children with neurological diseases, especially if they have significant motor impairment. Oropharyngeal dysphagia is very prevalent in these patients, and can contribute to worsening nutritional status and produce pulmonary aspirations. AIM: Longitudinal assessment of the nutritional status of a sample of pediatric patients with moderate-severe neurological disease and establish the prevalence of oropharyngeal dysphagia in that sample. PATIENTS AND METHODS: An observational multicenter prospective study was conducted. We included children under 16 years of age with moderate-to-severe neurological impairment from four hospitals, with clinical and anthropometric monitoring for one year. Questions were asked to conduct oropharyngeal dysphagia screening. RESULTS: Sixty-eight children were included, the main diagnosis obtained was cerebral palsy. In the anthropometric assessment, 42 patients (62%) showed weight z scores below 2, and 29 (43%) height z scores below 2, while body mass index, mid upper arm circumference and triceps and subscapular skinfolds remained less affected. We found an oropharyngeal dysphagia prevalence of 73.5% in our sample, increasing with greater motor impairment. CONCLUSIONS: These patients showed lower weight and height than children without neurological impairment. However, with a correct follow-up they remain stable with an adequate body composition. It is important to proactively investigate the presence of oropharyngeal dysphagia, especially in those with greater motor impairment, as it occurs very frequently and an adequate diagnosis can improve clinical evolution and prevent complications


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Estado Nutricional/fisiologia , Transtornos de Deglutição/complicações , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/dietoterapia , Estudos Prospectivos , Antropometria/métodos , Transtornos de Deglutição/prevenção & controle , Gastrostomia
12.
Rev. cuba. invest. bioméd ; 39(3): e868, jul.-set. 2020.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1138946

RESUMO

Introducción: Los coronavirus infectan al ser humano y pueden causar manifestaciones neurológicas en individuos susceptibles. Objetivo: Describir la patogenia de las manifestaciones neurológicas en pacientes con la COVID-19. Estrategia de búsqueda y criterios de selección: Se realizó una revisión bibliográfica empleando la bibliografía nacional e internacional actualizada. Se realizó la búsqueda en Google Académico, se consultaron artículos de libre acceso en las bases de datos Pubmed y SciELO, desde enero de 2014 hasta el 6 de mayo de 2020. Fueron seleccionados 51 artículos (6 en idioma español, 45 en inglés) y un libro de neuroinmunología. Se utilizaron los términos de búsqueda COVID-19, coronavirus, SARS-CoV-2,manifestaciones neurológicas, sistema nervioso, patogénesis, según el descriptor de Ciencias de la Salud (DeCS). Análisis e integración de la información: El SARS-CoV-2 entra al sistema nervioso por la vía linfática, hematógena, transináptica retrógada, por diseminación local a través del etmoides o por disfunción de la barrera hematoencefálica. La patogenia puede ser por la acción directa del virus o inmunomediada. En la pandemia de COVID-19 se reportan pacientes con manifestaciones neurológicas centrales, periféricas y musculoesqueléticas. Los síntomas más frecuentes son los trastornos del gusto, el olfato, cefaleas, mialgias y mareos. En las formas graves se reportan meningitis, encefalitis, síndrome de Guillain-Barré, ictus y encefalopatías. Conclusiones: El SARS-CoV-2 puede afectar al sistema nervioso central y periférico. Causa principalmente manifestaciones leves y transitorias, aunque pueden ocurrir complicaciones neurológicas. Los mecanismos patogénicos principales son el daño citopático directo o mecanismos indirectos debido a una respuesta inflamatoria(AU)


Introduction: Coronaviruses infect humans and may cause neurological manifestations in susceptible individuals. Objective: Describe the pathogenesis of neurological manifestations in patients with COVID-19. Search strategy and selection criteria: A review was conducted of national and international updated bibliography. The search was carried out in Google Scholar and open access papers were consulted in the databases PubMed and SciELO from January 2014 to 6 May 2020. A total 51 papers (6 in Spanish and 45 in English) and a book on neuroimmunology were selected. The search terms used were COVID-19, coronavirus, SARS-CoV-2, neurological manifestations, nervous system and pathogenesis, in compliance with the Health Sciences Descriptors (DeCS). Data analysis and integration: SARS-CoV-2 enters the nervous system by lymphatic, hematogenous, transynaptic, retrograde routes, by local dissemination through the ethmoid, or by dysfunction of the hematoencephalic barrier. Pathogenesis may be due to direct action by the virus or immunomediated. During the COVID-19 pandemic patients have been reported with central, peripheral and musculoskeletal neurological manifestations. The most common symptoms are taste and smell disorders, headache, myalgia and dizziness. Meningitis, encephalitis, Guillain-Barré syndrome, stroke and encephalopathies have been reported in severe forms of the disease. Conclusions: SARS-CoV-2 may affect the central and the peripheral nervous system. It mainly causes mild, transient manifestations, but neurological complications may also occur. The main pathogenic mechanisms are direct cytophatic damage or indirect mechanisms resulting from an inflammatory response(AU)


Assuntos
Humanos , Virulência/imunologia , Doenças do Sistema Nervoso/complicações , Infecções por Coronavirus/transmissão
13.
Acta pediátr. hondu ; 11(1): 1136-1141, abr.- sept. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1145394

RESUMO

El nuevo coronavirus se origino en la ciudad de Wuhan, China, esta enfermedad afecta principalmente el sistema respiratorio, los síntomas pueden ir desde leves a severos, así también, existe otra variedad de presentaciones clínicas en otros sistemas, como es el sistema nervioso central, actualmente existe evidencia de gran cantidad de publicaciones de presentación neurológica como manifestaciones de COVID-19. Actualmente se ha descrito el potencial neurotrópico del coronavirus para invadir el sistema nervioso central y también se ha descrito diversos mecanismos de daño secundario. Las diferentes presentaciones neurológicas en niños como en adultos pueden ser variables, y estas incluyen manifestaciones del sistema nervios central, periférico y enfermedades musculares...(AU)


Assuntos
Humanos , Sistema Nervoso Central , Infecções por Coronavirus/diagnóstico , Sistema Nervoso Periférico , Doenças do Sistema Nervoso/complicações
14.
Indian J Med Res ; 152(1 & 2): 41-47, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32859864

RESUMO

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been predominantly a respiratory manifestation. Currently, with evolving literature, neurological signs are being increasingly recognized. Studies have reported that SARS-CoV-2 affects all aspects of the nervous system including the central nervous system (CNS), peripheral nervous system (PNS) and the muscular system as well. Not all patients have reverse transcription-polymerase chain reaction positive for the virus in the cerebrospinal fluid, and diagnosing the association of the virus with the myriad of neurological manifestations can be a challenge. It is important that clinicians have a high-index of suspicion for COVID-19 in patients presenting with new-onset neurological symptoms. This will lead to early diagnosis and specific management. Further studies are desired to unravel the varied neurological manifestations, treatment, outcome and long-term sequel in COVID-19 patients.


Assuntos
Sistema Nervoso Central/patologia , Infecções por Coronavirus/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Sistema Nervoso Periférico/patologia , Pneumonia Viral/epidemiologia , Betacoronavirus/patogenicidade , Sistema Nervoso Central/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Humanos , Músculo Esquelético/patologia , Músculo Esquelético/virologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/virologia , Pandemias , Sistema Nervoso Periférico/virologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Pneumonia Viral/virologia
15.
Medicine (Baltimore) ; 99(34): e21805, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846817

RESUMO

BACKGROUND: Impaired physical mobility, most often seen in people with neurological disorders (i.e., stroke and spinal cord injury survivors), musculoskeletal diseases or frailty, is a limitation in independent and purposeful physical movement of the body or one or more extremities. The physical restrictions result in negative consequences on an individual's physical and psychosocial functions. This proposal describes a systematic review protocol to determine the effectiveness and approaches of sitting Tai Chi intervention for individuals with impaired physical mobility. Our review would inform stakeholders' decisions in integrating this complementary therapy into current rehabilitation services. METHODS: Randomized controlled trials or quasi-experimental studies that compared an intervention group receiving sitting Tai Chi with a control group among adult participants with impaired physical mobility resulting from any health condition(s) will be included. Outcomes of interest will include physical and psychosocial health outcomes. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, Scopus, Web of Science, AMED, PsycINFO, SPORDiscus, PEDro, WanFang Data and China National Knowledge Infrastructure will be searched from their inception to January 2020. Additional searches will be performed to identify studies that are being refereed, to be published, unpublished or ongoing. Two reviewers will select the trials and extract data independently. The risk of bias of the included studies will be assessed using the Cochrane risk-of-bias tools. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess evidence quality for each review outcome. Data synthesis will be performed using Review Manager 5.3. When a meta-analysis is possible, we will assess the heterogeneity across the studies by computing the I statistics. RESULTS: A high-quality synthesis of current evidence of sitting Tai Chi for impaired physical mobility will be stated from several aspect using subjective reports and objective measures of performance. CONCLUSION: This protocol will present the evidence of whether sitting Tai Chi is an effective intervention for impaired physical mobility. PROSPERO REGISTRATION NUMBER: CRD 42019142681.


Assuntos
Fragilidade/reabilitação , Limitação da Mobilidade , Doenças Musculoesqueléticas/reabilitação , Doenças do Sistema Nervoso/reabilitação , Tai Ji , Fragilidade/complicações , Fragilidade/psicologia , Humanos , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/psicologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/psicologia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
16.
Clin Interv Aging ; 15: 907-914, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606632

RESUMO

Purpose: Cognitive impairment (CI) is one of the most significant post-stroke complications. The Montreal Cognitive Assessment (MoCA) is widely applied to the early screening of post-stroke CI (PSCI), and has good sensitivity and specificity, but needs a long time to administer. Clinicians and researchers need shorter, more effective cognitive testing tools. The purpose of this study was to detect the sensitivity and specificity of two different short-form versions of the MoCA (SF-MoCA) for screening of PSCI in a Chinese population. Methods: A total of 2,989 stroke participants were included from 14 hospitals in northern and southern China between June 2011 and September 2013. The sensitivity and specificity of the two SF-MoCA versions were compared. Results: Using an MoCA score <26 as the critical value, the National Institute of Neurological Disease and Stroke-Canadian Stroke Network SF-MoCA showed sensitivity of 91% and specificity of 63% (PPV 71%, BPV 87%) with scores ≤10 points. The sensitivity and specificity of the Bocti SF-MoCA were 92% and 69% (PPV 75%, BPV 89%) with scores ≤7, respectively. The area under the curve was 0.885 (95% CI 0.873-0.897) and 0.912 (95% CI 0.902-0.922), respectively. Conclusion: The Bocti SF-MoCA can be used as a briefer and more effective screening tool for PSCI in Chinese.


Assuntos
Disfunção Cognitiva/diagnóstico , Testes de Estado Mental e Demência/normas , Acidente Vascular Cerebral/complicações , Idoso , China , Disfunção Cognitiva/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Testes Neuropsicológicos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
17.
Genes (Basel) ; 11(7)2020 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-32635188

RESUMO

Angiotensin-converting enzyme 2 (ACE2) has been recognized as the entry receptor of the novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Structural and sequence variants in ACE2 gene may affect its expression in different tissues and determine a differential response to SARS-Cov-2 infection and the COVID-19-related phenotype. The present study investigated the genetic variability of ACE2 in terms of single nucleotide variants (SNVs), copy number variations (CNVs), and expression quantitative loci (eQTLs) in a cohort of 268 individuals representative of the general Italian population. The analysis identified five SNVs (rs35803318, rs41303171, rs774469453, rs773676270, and rs2285666) in the Italian cohort. Of them, rs35803318 and rs2285666 displayed a significant different frequency distribution in the Italian population with respect to worldwide population. The eQTLs analysis located in and targeting ACE2 revealed a high distribution of eQTL variants in different brain tissues, suggesting a possible link between ACE2 genetic variability and the neurological complications in patients with COVID-19. Further research is needed to clarify the possible relationship between ACE2 expression and the susceptibility to neurological complications in patients with COVID-19. In fact, patients at higher risk of neurological involvement may need different monitoring and treatment strategies in order to prevent severe, permanent brain injury.


Assuntos
Infecções por Coronavirus/patologia , Grupo com Ancestrais do Continente Europeu/genética , Variação Genética , Doenças do Sistema Nervoso/complicações , Peptidil Dipeptidase A/genética , Pneumonia Viral/patologia , Betacoronavirus/isolamento & purificação , Encéfalo/metabolismo , Biologia Computacional/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Genótipo , Humanos , Itália , Doenças do Sistema Nervoso/patologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Polimorfismo de Nucleotídeo Único , Locos de Características Quantitativas
18.
Radiology ; 297(3): E324-E334, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32729812

RESUMO

Background Neurologic complications in coronavirus disease 2019 (COVID-19) have been described, but the understanding of their pathophysiologic causes and neuroanatomical correlates remains limited. Purpose To report on the frequency and type of neuroradiological findings in COVID-19. Materials and Methods In this retrospective study, all consecutive adult hospitalized patients with polymerase chain reaction positivity for severe acute respiratory syndrome coronavirus 2 and who underwent neuroimaging at Karolinska University Hospital between March 2 and May 24, 2020, were included. All examinations were systematically re-evaluated by 12 readers. Summary descriptive statistics were calculated. Results A total of 185 patients with COVID-19 (62 years ± 14 [standard deviation]; 138 men) underwent neuroimaging. In total, 222 brain CT, 47 brain MRI, and seven spinal MRI examinations were performed. Intra-axial susceptibility abnormalities were the most common finding (29 of 39; 74%, 95% CI: 58, 87) in patients who underwent brain MRI, often with an ovoid shape suggestive of microvascular pathology and with a predilection for the corpus callosum (23 of 39; 59%; 95% CI: 42, 74) and juxtacortical areas (14 of 39; 36%; 95% CI: 21, 53). Ischemic and macrohemorrhagic manifestations were also observed, but vascular imaging did not demonstrate overt abnormalities. Dynamic susceptibility contrast perfusion MRI in 19 patients did not reveal consistent asymmetries between hemispheres or regions. Many patients (18 of 41; 44%; 95% CI: 28, 60) had leukoencephalopathy and one patient had a cytotoxic lesion of the corpus callosum. Other findings included olfactory bulb signal abnormalities (seven of 37; 19%), prominent optic nerve subarachnoid spaces (20 of 36; 56%), and enhancement of the parenchyma (three of 20; 15%), leptomeninges (three of 20; 15%), cranial nerves (two of 20; 10%), and spinal nerves (two of four; 50%). At MRI follow-up, regression of leukoencephalopathy and progressive leptomeningeal enhancement was observed in one patient each, respectively, which is suggestive of dynamic processes. Conclusion Patients with coronavirus disease 2019 had a wide spectrum of vascular and inflammatory involvement of both the central and peripheral nervous system. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Infecções por Coronavirus/complicações , Imagem por Ressonância Magnética/métodos , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/diagnóstico por imagem , Neuroimagem/métodos , Pneumonia Viral/complicações , Tomografia Computadorizada por Raios X/métodos , Betacoronavirus , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Humanos , Pandemias , Estudos Retrospectivos , Coluna Vertebral/diagnóstico por imagem
19.
Clin Nucl Med ; 45(9): 700-702, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32657874

RESUMO

Bing-Neel syndrome is a rare neurological complication of Waldenström macroglobulinemia. We present the case of a 71-year-old man who underwent prechemotherapy and postchemotherapy FDG PET/MRI scan for the evaluation of cerebrospinal disease. In light of limited literature and lack of consensus guidelines on the role of metabolic imaging, we aim to highlight the utility of FDG PET/MRI in the diagnosis and response assessment in Bing-Neel syndrome.


Assuntos
Fluordesoxiglucose F18 , Imagem por Ressonância Magnética , Imagem Multimodal , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/terapia , Tomografia por Emissão de Pósitrons , Macroglobulinemia de Waldenstrom/complicações , Idoso , Humanos , Masculino , Doenças do Sistema Nervoso/complicações
20.
Neuroscientist ; 26(5-6): 402-414, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32684080

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new pandemic infectious disease that originated in China. COVID-19 is a global public health emergency of international concern. COVID-19 causes mild to severe illness with high morbidity and mortality, especially in preexisting risk groups. Therapeutic options are now limited to COVID-19. The hallmark of COVID-19 pathogenesis is the cytokine storm with elevated levels of interleukin-6 (IL-6), IL-1ß, tumor necrosis factor-alpha (TNF-α), chemokine (C-C-motif) ligand 2 (CCL2), and granulocyte-macrophage colony-stimulating factor (GM-CSF). COVID-19 can cause severe pneumonia, and neurological disorders, including stroke, the damage to the neurovascular unit, blood-brain barrier disruption, high intracranial proinflammatory cytokines, and endothelial cell damage in the brain. Mast cells are innate immune cells and also implicated in adaptive immune response, systemic inflammatory diseases, neuroinflammatory diseases, traumatic brain injury and stroke, and stress disorders. SARS-CoV-2 can activate monocytes/macrophages, dendritic cells, T cells, mast cells, neutrophils, and induce cytokine storm in the lung. COVID-19 can activate mast cells, neurons, glial cells, and endothelial cells. SARS-CoV-2 infection can cause psychological stress and neuroinflammation. In conclusion, COVID-19 can induce mast cell activation, psychological stress, cytokine storm, and neuroinflammation.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Citocinas/imunologia , Mastócitos/imunologia , Doenças do Sistema Nervoso/imunologia , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Estresse Psicológico/fisiopatologia , Infecções por Coronavirus/complicações , Humanos , Mastócitos/virologia , Doenças do Sistema Nervoso/complicações , Pandemias , Pneumonia Viral/complicações
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