A case of COVID-19 with multiple cranial neuropathies.

Various neurological manifestations involving the central and peripheral nervous system have been reported in association with COVID-19. Most common associations reported are encephalopathy, headache, ischemic, hemorrhagic stroke and transient ischemic attack, Miller Fisher syndrome, cranial neuropathies and Guillain-Barre syndrome. Of the cranial neuropathies, anosmia, and dysgeusia are the most common reported symptoms. This is a case of COVID-19 with ipsilateral fifth and seventh cranial nerve involvement with complete resolution of symptoms over a period of 3 weeks. The neurological symptoms started within 5 days of respiratory symptoms. We conclude that isolated cranial neuropathies can be the manifestations of SARS-CoV-2 infection.

Use of noninvasive induction techniques in the diagnosis of PNES.

The diagnosis of psychogenic nonepileptic seizures (PNES) remains challenging. In the correct clinical setting with prolonged electroencephalography (EEG) monitoring, the specificity of provocative techniques to distinguish induced epileptic event from a nonepileptic event approaches 90%. We report our epilepsy monitoring unit (EMU) experience with the use of noninvasive verbal suggestion (VS) during hyperventilation (HV), photic stimulation (PS) as induction technique in making the diagnosis of PNES. In total, 189/423 patients were diagnosed with PNES during the EMU evaluation. Of the 189, 20 had mixed disorder and 169 patients had only PNES, 80 patients (47.3%) had a PNES with induction, and the remaining 89 of 169 patients (52.7%) had a spontaneous PNES episode that did not require induction. Verbal suggestion during HV and PS confirmed the diagnosis of PNES in 47% of the patients who otherwise did not have spontaneous events. Within the group who was diagnosed with PNES following induction, antiepileptic drugs (AEDs) were stopped in 53% of the patients. We believe that this is a large proportion of patients that would possibly remain undiagnosed if no induction were performed.

Tumefactive multiple sclerosis (TMS): A case series of this challenging variant of MS.

BACKGROUND: Tumefactive MS is a rare variant of multiple sclerosis that poses a diagnostic and a therapeutic challenge due to its close resemblance to central nervous neoplasms on MRI. TMS is defined as acute large >2 cm, tumour like demyelinating lesion in the CNS that may occur with surrounding edema, mass effect and ring enhancement. Some of the known mimickers are CNS lymphoma, metastasis, primary brain tumour such as glioblastoma, brain abscesses. The prevalence of TMS is estimated to be 1-3/1000 cases. There are also reported cases of drug induced TMS cases especially with fingolimod and natalizumab therapy. We report the occurrence of tumefactive MS at our institution. METHODS: We retrospectively reviewed the chart of the patients with multiple sclerosis including initial visits, hospitalizations, clinic follow up notes and collected data on demographic, ethnicity, presenting signs and symptoms, imaging modalities, cerebrospinal fluid analysis results, disease progression. After reviewing the charts, we isolated the patients with tumefactive multiple sclerosis from the group and summarized the cases. Four of these patients were managed with Glatiramer acetate, 2 on dimethyl fumarate and 1 on beta interferon with 0-2 clinical flare ups on subsequent years. RESULTS: Out of 323 patients reviewed with multiple sclerosis or possible multiple sclerosis, 7 carried a diagnosis of tumefactive MS. The age range of these patients were 19 to 62 years old with 4 females and 3 males. Five patients were Caucasian and 2 were Hispanic. Out of seven patients, 6 were newly diagnosed MS following biopsy of the lesion. The histological findings in 3 patients who underwent biopsy demonstrated include reactive gliosis and inflammatory cells predominantly macrophages and lymphocytes while 1 patient showed hypercellular brain tissue with perineuronal satellosis. CONCLUSION: Tumefactive MS remains a challenging disease to diagnosis and often times requires a biopsy for definitive diagnosis or to exclude neoplasms, other inflammatory conditions such as neurosarcoidosis. The demographic of the patients in this case series is no different than patients with relapsing remitting multiple sclerosis (RRMS). However, based on our experience, the patients with TMS do respond to disease modifying agents such as Glatiramer acetate and Dimethyl fumarate with similar progression as of RRMS.

Anti-hyperglycaemic potential of Psidium guajava raw fruit peel.

BACKGROUND & OBJECTIVE: This study was undertaken to evaluate the glycaemic potential of aqueous extract of Psidium guajava unripe fruit peel on blood glucose level (BGL) of normal and streptozotocin induced mild and severely diabetic rats as an extension of our previous work carried out on Psidium guajava ripe fruit peel. METHODS: The aqueous extract of P. guajava unripe fruits was prepared. Male 6-8 wk old albino Wistar rats were selected for the experiments. Diabetes was induced by streptozotocin infection. Blood glucose levels were measured by glucose oxidase method. Antihyperglycaemic activity of the extract was assessed in mild and severely diabetic rats. RESULTS: The maximum fall of 21.2 per cent (P<0.01) and 26.9 per cent (P<0.01) after 3 h of glucose administration during glucose tolerance test (GTT) was observed in BGL from a dose of 400 mg/kg, identified as the most effective dose, in normal and mild diabetic rats respectively. In severely diabetic rats the maximum fall of 20.8 and 17.5 per cent in fasting blood glucose (FBG) and post prandial glucose (PPG) levels, and 50 per cent (P<0.01) in urine sugar levels was observed with the same dose. Haemoglobin level increased by 5.2 per cent (P<0.05) and body weight by 2.5 per cent (P<0.05) after 21 days treatment. INTERPRETATION & CONCLUSION: Normal, mild and severely diabetic rat models had shown hypoglycaemic as well as antidiabetic effect of the unripe guava fruit peel aqueous extract. Further studies need to be done to characterize the active components of the peel.

Carbofuran-induced toxicity in rats: protective role of vitamin C.

Erythrocytes are prone to oxidative stress due to the presence of hemoglobin and polyunsaturated fatty acids. Oxidative stress (OS) is associated with increased osmotic fragility (OF) of erythrocytes. Organophosphate and organocarbamate pesticides are known to cause OS in erythrocytes. We have investigated the effect of a single sub-acute dose of carbofuran (CF), an organocarbamate pesticide and ameliorating role of vitamin C on OF and OS in erythrocytes of Wistar rats. OF and OS were assessed by determining membrane stability in terms of erythrocyte OF and the activities of free radicals scavenging enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione-S-transferase (GST). We observed a significant alteration in the mean erythrocyte fragility (MEF) at relatively higher NaCl concentration (0.67%) as compared to MEF at 0.55%, 0.58% and 0.56% of NaCl in control, vitamin C- and vitamin C + CF-treated groups, respectively. The activities of CAT and SOD were observed to be elevated by 74.35% and 85.56%, respectively, with significance level of p < or = 0.001, whereas GST activity got significantly (p < or = 0.001) diminished by 46.30% in the erythrocytes of CF-treated rats. Vitamin C treatment exhibited marked (p < or = 0.05) prevention of carbofuran-induced oxidative stress as well as erythrocyte osmotic fragility in the Wistar rats. These results suggest that CF treatment induces OF and OS in the erythrocytes of rats, and pretreatment with vitamin C can mitigate these toxic effects.