Guillain-Barré Syndrome Following the BNT162b2 mRNA COVID-19 Vaccine.

PURPOSE: The onset of the COVID-19 (SARS-CoV-2) pandemic in December 2019 created the need for multiple scientific research activities and clinical trials in an attempt to find solutions to mitigate the impact of the virus. One of the important tools to combat the virus is the development of vaccination programs. All types of vaccines have been associated with a mild to severe risk of neurological adverse events. One of these severe adverse events is Guillain-Barré syndrome. CASE REPORT: Here, we describe a case of Guillain-Barré syndrome after the first dose of the BNT162b2 mRNA COVID-19 vaccine and review the literature to increase the current knowledge regarding this complication. CONCLUSION: Guillain-Barré syndrome after COVID-19 vaccination is responsive to treatment. The benefits of administering the vaccine outweigh the risks. Due to the negative impact of COVID-19, it is essential to recognize the development of neurological complications that are potentially associated with vaccination, including Guillain-Barré syndrome.

Rapid implementation of telemedicine in Neurology during the COVID-19 pandemic: Challenges in King Abdulaziz Medical City-Jeddah.

Telemedicine is defined as the remote medical practice of delivering healthcare services to the underserved using information and communication technology. It encompasses a wide range of medical activities, including diagnosis, treatment, disease prevention, and education. The coronavirus disease of 2019 (COVID-19) pandemic has caused significant social dislocation, negative economic impact, and a major change in medical practice in Saudi Arabia. Telemedicine has rapidly moved to the frontline of healthcare practice due to the demand for prevention and mitigation strategies. It has been encouraged and facilitated with huge government support. Herein, we describe the virtual clinical practice of the neurology department at King Abdulaziz Medical City-Jeddah in response to the COVID-19 pandemic. This narrative review is an urgent call to improve the perception and knowledge of both medical personnel and patients concerning telemedicine and to support the utilization of advanced information and communication technology.

The spectrum of muscle pathologies: Three decades of experience from a reference laboratory in Saudi Arabia.

BACKGROUND: When investigating patients with a suspected neuromuscular disorder, a muscle biopsy is considered an instrumental tool to reach a definitive diagnosis. There is a paucity of publications that assess the diagnostic utilization and yield of muscle biopsies. We intend to present our experience in this regard over an extended period of more than three decades. METHODS: This is an observational retrospective cohort study in which we collected pathology reports for muscle biopsies diagnosed at our reference lab between 1986 and 2017. RESULTS: We identified a total of 461 cases of muscle biopsy performed, which fulfilled the inclusion criteria. Pediatric cases defined as ≤14 years of age constituted a significant proportion of cases (n = 275, 60%). Normal biopsies were reported in 27% of cases (n = 124), and in 4%, the biopsies were non-diagnostic. The most common pathologies reported were non-specific myopathy (n = 72, 16%), dystrophy (n = 71, 15%), and neurogenic disorders (n = 60, 13%). CONCLUSION: In conclusion, the muscle biopsy will continue to play a crucial role, as a gold standard or as a complementary investigation, in the diagnosis of certain neuromuscular disorders. Increasing the yield and accuracy of muscle pathology should be the main concern and priority to neuropathologists reporting muscle biopsies. In addition, utilizing next-generation sequencing and other molecular techniques have changed the location of muscle biopsy in the algorithm of the diagnosis of neuromuscular disorders. This paper is an urgent call to establish the Saudi Neuropathology Society and the muscle pathology and neuromuscular disorders registry.

Hashimoto`s Encephalopathy Presenting with Progressive Cerebellar Ataxia.

Hashimoto`s encephalopathy is a rare neurological syndrome occurring in patients with autoimmune thyroid disease. The diagnosis of Hashimoto`s encephalopathy is based on the clinical picture with the presence of serum anti-thyroid antibodies regardless of the thyroid disorder. Acquired cerebellar ataxia associated with Hashimoto`s disease is a rare occurrence. In this article, we present a case who had progressive non-familial autoimmune pancerebellar disease in association with an increased level of thyroid peroxidase and thyroglobulin antibodies. The patient was managed aggressively with both intravenous immunoglobulins and plasma exchange, which stopped the progression of the disease and allowed for slow improvement. Early diagnosis of Hashimoto`s encephalopathy with autoimmune cerebellar ataxia and intervention with immunomodulatory therapy are of paramount importance. Close monitoring after steroid therapy is important since some patients with this rare disease might be resistant to steroid therapy and require aggressive immunomodulatory therapy.

Quality of life among multiple sclerosis patients in Saudi Arabia.

OBJECTIVE: To assess quality of life in multiple sclerosis (MS) patients and determine the factors associated with levels of quality of life in MS patients in a public hospital in Saudi Arabia. METHODS: A cross-sectional study was conducted from June 2016 to April 2017 in King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia. Multiple sclerosis patients attending the outpatient and inpatient services were approached and recruited to participate in the study. The Arabic version of EuroQOL-5 Dimensions instrument (EQ-5D) was utilized for the assessment of MS patients quality of life. RESULTS: Data on quality of life were obtained from 292 patients. The reported quality of life of MS patients as measured by the EQ-5D index value score was 0.31+/-0.51 and the EQ-VAS score was 73.87+/-23.41, respectively. It was found that quality of life determined numerically in the EQ-5D index value and EQ-VAS deteriorates proportionally according to the disease duration. CONCLUSION: Multiple sclerosis is associated with a considerable effect on the patients quality of life. It continues to be challenging to manage both medically and psychosocially. Clinicians should consider the assessment of quality of life as routine practice along with the other important measures including symptomatic evaluation, laboratory tests, and neuroimaging to provide a holistic care of their MS patients.

Neurological complications of bariatric surgery.

OBJECTIVE: To review and analyze the neurological complications from bariatric surgery in Kingdom of Saudi Arabia. METHODS: This cross sectional study was carried out in King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia from January 2009 to December 2015. Important personal and clinical data were collected from the charts of the patients who underwent bariatric surgery. Data on follow up visit and remote complication if present, was also collected. All patients with neurological complications were reviewed in detail. The significant difference was calculated by using T-test and p-value<0.05 was considered significant. RESULTS: A total of 451 patients underwent bariatric surgery, 15 cases had neurological complications (3%). Axonal polyneuropathy was the most frequent neurological complication, but cases of Wernicke syndrome, vitamin B12 deficiency, Guillain-Barre syndrome and copper deficiency were also identified. Fourteen patients (93.3%) had full recovery from the neurological signs and symptoms; one patient died. CONCLUSION: Bariatric surgery is not free of potential neurological complications. Complications may affect both central and peripheral nervous system and death is a possibility. Multidisciplinary care including consultation of different teams is highly recommended.

Neurophobia among medical students.

OBJECTIVE: To assess the attitude of medical students and junior physicians toward neurology. METHODS: A self-administered, previously validated, questionnaire was distributed among 422 students and junior physicians at King Abdulaziz University, Jeddah, Saudi Arabia from September to December 2012. In this cross-sectional study, the questionnaire included demographic data and 12 statements to examine attitudes toward neurology using a Likert scale. RESULTS: The response rate among participants was 70.3%. The mean age was 22.35 (SD+/-1.28) years. Males comprised 46.2%. While 31.3% of students had not decided regarding their future career, 11.8% selected neurology as their first possible choice. Whereas 29.6% of students were not satisfied with their neurology teaching experience, 84.4% found neurology difficult, and 42.7% of the whole group thought that their neuroscience knowledge was insufficient. Advanced clinical year students (namely, interns) were less likely to consider neurology as a career choice (p=0.001). CONCLUSION: Most of the students had an unfavorable attitude toward neurology on the Likert scale. New strategies are needed to change students` attitude toward this demanding specialty.

Cerebral venous sinus thrombosis.

Cerebral venous thrombosis is a rare serious neurological disorder that may cause vital or morbid consequences if not diagnosed and treated promptly. It is a unique cerebrovascular disorder that predominantly affects adults in their third and fourth decades. The incidence of CVST in adults is estimated to be 4 cases per million of the population, and 7 cases per million in children. In the last 2 decades, the awareness and prognosis of the disease have improved due to development of sophisticated neuroimaging techniques and effective treatment. This comprehensive review of the topic aims to improve knowledge among neurologists and internists who are involved in the management of these patients.

Memory boosting effect of Citrus limon, Pomegranate and their combinations.

Memory is greatly influenced by factors like food, stress and quality of sleep, hence present study was designed to evaluate the effect of Citrus limon and Pomegranate juices on memory of mice using Harvard Panlab Passive Avoidance response apparatus controlled through LE2708 Programmer. Passive avoidance is fear-motivated tests used to assess short or long-term memory of small animals, which measures latency to enter into the black compartment. Animals at MCLD showed highly significant and significant increase in latency to enter into the black compartment after 3 and 24 hours respectively than control, animals at HCLD showed significant increase in latency only after 3hours. Animals both at low and moderate doses of pomegranate showed significant increase in test latency after 3 hours, while animals at high dose showed highly significant and significant increase in latency after 3 and 24 hours respectively. There was highly significant and significant increase in latency in animals at CPJ-1 combination after 3 and 24 hours respectively; however animals received CPJ-2 combination showed significant increase in latency only after 3 hours as compare to control. These results suggest that Citrus limon and Pomegranate has phytochemicals and essential nutrients which boost memory, particularly short term memory. Hence it may be concluded that flavonoids in these juices may be responsible for memory enhancing effects and a synergistic effect is observed by CPJ-1 and CPJ-2 combinations.

A child with leukemia and behavioral changes.

A 12-year-old Saudi girl, known case of T-cell leukemia with CNS relapse. She was diagnosed 2 years ago. Multiple cycles of chemotherapy had been used (Fludarabine, Cytarabine, Methotrexate, Cyclosporine, and Mercaptopurine). She was admitted electively for cord blood transplantation. Afterward, she developed visual, and behavioral change followed by seizure.

Acute paraplegia caused by Schistosoma mansoni.

Schistosomiasis affects over 200 million people worldwide. Involvement of the CNS is a rare occurrence. We report 2 young males who presented with rapidly progressing paraparesis associated with urinary incontinence. In both cases, MRI of the spine demonstrated a diffusely enhancing mass at the conus medullaris with extensive spinal cord edema. Laboratory investigations revealed mild peripheral eosinophilia and abnormal, but non-specific, CSF analysis. In one patient, the diagnosis was made based on a rising schistosomal titer with a positive rectal biopsy. In the other patient, spinal cord biopsy revealed a granuloma. Both cases were caused by Schistosoma mansoni and patients were treated with praziquantel and steroid therapy. They both made a remarkable neurological recovery. We emphasize that a high index of suspicion should be raised in the differential diagnosis of transverse myelitis in endemic areas.

Crossed cerebro-cerebellar atrophy with Dyke Davidoff Masson syndrome.

Dyke Davidoff Masson syndrome (DDMS) refers to atrophy or hypoplasia of one cerebral hemisphere following a prior fetal or childhood insult. It has characteristics of clinical and radiological changes. These changes include hemiparesis, seizures, facial-asymmetry, and mental retardation. We present a 25-year-old man with crossed cerebrocerebellar atrophy and DDMS. His seizures were well controlled using a combination of antiepileptic drugs.

Posterior fossa teratoma.

Germ cell tumors comprise approximately 2-5% of all childhood brain tumors. They arise predominantly in the pineal and suprasellar region, but may occur throughout the brain. Teratomas are generally divided into gonadal and extragonadal types. A posterior fossa teratoma is a rare occurrence. The focus of this discussion is a 5-year-old boy with posterior fossa teratoma who recovered completely after medical and surgical intervention. We also present his interesting imaging and pathological findings.

Reversible Parkinsonism caused by deep cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis (CVST) is an uncommon but serious disorder with highly variable clinical presentation. Over the past decade, more cases of CVST have been diagnosed more frequently and at an early stage of the disease process. This is mainly attributed to increased awareness by neurologists and the availability of sensitive non-invasive neuro-imaging techniques. Cerebral venous sinus thrombosis often affects children, adolescents, and young adults with female preponderance. We report a case of Parkinsonism secondary to deep CVST (DCVST), which recovered completely following treatment. Recognition of DCVST as a cause for Parkinsonism is of paramount importance due to its reversibility and favorable outcome when appropriately managed.

Cerebral fat embolism syndrome: diagnostic challenges and catastrophic outcomes: a case series.

Fat embolism syndrome is a rare but alarming, life-threatening clinical condition attributed to fat emboli entering the circulation. It usually occurs as a complication of long-bone fractures and joint reconstruction surgery. Neurological manifestations usually occur 12 to 72 hours after the initial insult. These neurological complications include cerebral infarction, spinal cord ischemia, hemorrhagic stroke, seizures, and coma. Other features include an acute confusional state, autonomic dysfunction, and retinal ischemia. In this case series, we describe three patients with fat embolism syndrome who presented with atypical symptoms and signs and with unusual neuroimaging findings. Cerebral fat embolism may occur without any respiratory or dermatological signs. In these cases, diagnosis is established after excluding other differential diagnoses. Neuroimaging using brain magnetic resonance imaging is of paramount importance in establishing a diagnosis. Aggressive hemodynamic and respiratory support from the beginning and consideration of orthopedic surgical intervention within the first 24 hours after trauma are critical to decreased morbidity and mortality.

Delirium. A comprehensive review.

Delirium is among the most common potentially preventable neurological disorders encountered in diverse patient populations, especially in critical care units and the elderly. It may present with highly variable clinical features, prolong hospital stay, and herald a poor prognosis. It is also a source of distress for patients and their caregivers. A high degree of clinical suspicion is required for detecting delirium and a detailed history, physical examination, and targeted investigations are necessary to determine the underlying etiology and ensure proper management. The following article is a comprehensive review outlining the various aspects of delirium.

Acute cervical dystonia following the BNT162b2 mRNA COVID-19 vaccine.

The coronavirus disease of 2019 (COVID-19) pandemic is caused by a novel coronavirus SARS-Cov-2. Four major vaccine types are being used to fight against this deadly pandemic and save precious human lives. All types of vaccines have been associated with a risk of neurological complications ranging from mild to severe. Cervical dystonia occurring after a COVID-19 vaccine was not previously reported in the literature. In this article, we describe a case of acute cervical dystonia occurring after the first dose of the BNT162b2 COVID-19 vaccine. We attribute the occurrence of cervical dystonia to the vaccine due to the temporal relationship. This report adds to the literature a possible rare side effect of a COVID-19 vaccine and contributes to the limited literature on potential neurological side effects of mRNA-based vaccines. The likely mechanism is autoimmune. Further research is needed to probe and study the exact mechanism.