{"title":"Diagnostic Dilemma of Aspergillus Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series","authors":"Joseph Seemiller, M. T. Malik","doi":"10.14740/jnr706","DOIUrl":"https://doi.org/10.14740/jnr706","url":null,"abstract":"","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74440038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khaled Al-Robaidi, M. Loganathan, L. Alhuneafat, Samir S. Al-Ghazawi, K. Vogt, P. Thirumala
{"title":"Reported Incidences of Postoperative Delirium in State and National Hospital Claims Databases","authors":"Khaled Al-Robaidi, M. Loganathan, L. Alhuneafat, Samir S. Al-Ghazawi, K. Vogt, P. Thirumala","doi":"10.14740/jnr675","DOIUrl":"https://doi.org/10.14740/jnr675","url":null,"abstract":"","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84340374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Diagnostic Mimicker: A Sixty-Year-Old Male With Ptosis and Left Arm Weakness","authors":"Connie G. Tang, S. Dehbashi","doi":"10.14740/jnr605","DOIUrl":"https://doi.org/10.14740/jnr605","url":null,"abstract":"","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90453105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Long-term microgravity in spaceflight has been demonstrated with induction of multi-organ damage and dysfunction, including the dorsal root ganglia (DRG) injury. Present studies investigated protective effects of oral pyruvate in drinking water on lumbar 5 (L5) DRG tissues in rats subjected with hindlimb unweighting (HU). Methods: Sprague-Dawley male rats were randomly divided into four groups (N = 10): the control (CON) group, the suspension (SUS) group, the normal saline (SAL) group and the sodium pyruvate (PYR) group, respectively. Rats in the SUS, SAL and PYR groups were treated with simulated microgravity by HU with tail suspension for an 8-week period. Rats in the SAL and PYR groups were fed with normal saline and pyruvate saline, respectively. Histopathological hematoxylin-eosin (H&E) staining and Nissl-stained neurons as well as myelin sheath immunofluorescence examinations in L5 DRG tissues were carried out. The protein expression of glial cell line-derived neurotrophic factor (GDNF), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) as well as the levels of adenosine triphosphate (ATP) and adenosine triphosphatase (ATPase) were also determined after HU procedures. Results: Data showed that nerve tissues’ structure and function were robustly altered in L5 DRG of the SUS and SAL groups, whereas morphological changes were not significantly different between the PYR group and the CON group; levels of GDNF, GFAP, NSE and S100B were significantly changed in the SUS and SAL groups, but mostly preserved or overexpressed in group PYR following the HU injury. However, levels of ATP and ATPase were significantly retained, but still worse in the PYR group than in the CON group. The significance of oral pyruvate protection against DRG injury following the HU and the dose and formula of oral pyruvate solutions were discussed for the use of astronauts in space missions. Conclusions: This study indicates that oral pyruvate can effectively protect L5 DRG against the damage of pathological alterations and dysfunction induced by the HU in rats. Further investigations are needed.
{"title":"Oral Pyruvate Effects on Dorsal Root Ganglia in Simulated Weightlessness Rats","authors":"Yuan Li, Heng Zhang, Ning-tao Ren, Chao Chen, Peng Qi, Fang-Qiang Zhou, Geng Cui","doi":"10.14740/jnr709","DOIUrl":"https://doi.org/10.14740/jnr709","url":null,"abstract":"Background: Long-term microgravity in spaceflight has been demonstrated with induction of multi-organ damage and dysfunction, including the dorsal root ganglia (DRG) injury. Present studies investigated protective effects of oral pyruvate in drinking water on lumbar 5 (L5) DRG tissues in rats subjected with hindlimb unweighting (HU). Methods: Sprague-Dawley male rats were randomly divided into four groups (N = 10): the control (CON) group, the suspension (SUS) group, the normal saline (SAL) group and the sodium pyruvate (PYR) group, respectively. Rats in the SUS, SAL and PYR groups were treated with simulated microgravity by HU with tail suspension for an 8-week period. Rats in the SAL and PYR groups were fed with normal saline and pyruvate saline, respectively. Histopathological hematoxylin-eosin (H&E) staining and Nissl-stained neurons as well as myelin sheath immunofluorescence examinations in L5 DRG tissues were carried out. The protein expression of glial cell line-derived neurotrophic factor (GDNF), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) as well as the levels of adenosine triphosphate (ATP) and adenosine triphosphatase (ATPase) were also determined after HU procedures. Results: Data showed that nerve tissues’ structure and function were robustly altered in L5 DRG of the SUS and SAL groups, whereas morphological changes were not significantly different between the PYR group and the CON group; levels of GDNF, GFAP, NSE and S100B were significantly changed in the SUS and SAL groups, but mostly preserved or overexpressed in group PYR following the HU injury. However, levels of ATP and ATPase were significantly retained, but still worse in the PYR group than in the CON group. The significance of oral pyruvate protection against DRG injury following the HU and the dose and formula of oral pyruvate solutions were discussed for the use of astronauts in space missions. Conclusions: This study indicates that oral pyruvate can effectively protect L5 DRG against the damage of pathological alterations and dysfunction induced by the HU in rats. Further investigations are needed.","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90554087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kurukumbi, J. Castillo, T. Shah, Joanne Lau, Bhumi P. Patel, Soumil Narayan, Laura Madarasz, Yun Fang, Caroline Shadowen, Divya Sahajwalla
Background: Of the 2.7 - 3.4 million Americans estimated to have some form of epilepsy, approximately 25-30% of these individuals do not have adequate seizure control and suffer from intractable epilepsy. The objective of this study was to report outcomes of patients with epilepsy monitoring unit (EMU) admissions using data from a level 4 epilepsy center. Methods: We performed a retrospective review of electronic medical records for 433 EMU patient visits between January 2016 and May 2019 at a level 4 comprehensive epilepsy center. The EMU protocols followed in these admissions were those listed in the guidelines by the National Association of Epilepsy Centers (NAEC). Patients were monitored by a medical team that included electroencephalogram technicians, neurophysiologists, and epileptologists. Results: Of the 433 patients assessed, 384 met inclusion criteria. Mean length of stay in the EMU was 4 days. Of the patients, 73.4% had EMU stays resulting in new information which led to interventions including further diagnostic testing, surgical treatment, and medication changes. The most frequent intervention was a change in medication (68.8% of patients). Of the patients, 90.1% received a definitive diagnosis at the conclusion of their admission, with the most common diagnosis being epileptic seizures (66.7%), followed by non-epileptic physiologic events (14.3%) and psychogenic non-epileptic seizures (8.6%). Conclusions: This study sought to describe outcomes from patients who stayed in our level 4 epilepsy center’s EMU after the implementation of the revised NAEC guidelines made in 2010. We investigated patient demographics as well as diagnosis and/or treatment changes after the EMU stay. We conclude that under the new NAEC guidelines, an EMU admission remains diagnostically useful in identifying if a patient has epilepsy or not. Our goal for this retrospective review is to inform future prospective outcomes studies and add to the body of literature demonstrating an EMU evaluation as a valuable diagnostic tool for epilepsy patients. J Neurol Res. 2021;11(5):87-93 doi: https://doi.org/10.14740/jnr703
{"title":"An Observational Study of an Epilepsy Monitoring Unit in a Level 4 Epilepsy Center, Post-Implementation of the National Association of Epilepsy Centers 2010 Revised Guidelines","authors":"M. Kurukumbi, J. Castillo, T. Shah, Joanne Lau, Bhumi P. Patel, Soumil Narayan, Laura Madarasz, Yun Fang, Caroline Shadowen, Divya Sahajwalla","doi":"10.14740/jnr703","DOIUrl":"https://doi.org/10.14740/jnr703","url":null,"abstract":"Background: Of the 2.7 - 3.4 million Americans estimated to have some form of epilepsy, approximately 25-30% of these individuals do not have adequate seizure control and suffer from intractable epilepsy. The objective of this study was to report outcomes of patients with epilepsy monitoring unit (EMU) admissions using data from a level 4 epilepsy center. Methods: We performed a retrospective review of electronic medical records for 433 EMU patient visits between January 2016 and May 2019 at a level 4 comprehensive epilepsy center. The EMU protocols followed in these admissions were those listed in the guidelines by the National Association of Epilepsy Centers (NAEC). Patients were monitored by a medical team that included electroencephalogram technicians, neurophysiologists, and epileptologists. Results: Of the 433 patients assessed, 384 met inclusion criteria. Mean length of stay in the EMU was 4 days. Of the patients, 73.4% had EMU stays resulting in new information which led to interventions including further diagnostic testing, surgical treatment, and medication changes. The most frequent intervention was a change in medication (68.8% of patients). Of the patients, 90.1% received a definitive diagnosis at the conclusion of their admission, with the most common diagnosis being epileptic seizures (66.7%), followed by non-epileptic physiologic events (14.3%) and psychogenic non-epileptic seizures (8.6%). Conclusions: This study sought to describe outcomes from patients who stayed in our level 4 epilepsy center’s EMU after the implementation of the revised NAEC guidelines made in 2010. We investigated patient demographics as well as diagnosis and/or treatment changes after the EMU stay. We conclude that under the new NAEC guidelines, an EMU admission remains diagnostically useful in identifying if a patient has epilepsy or not. Our goal for this retrospective review is to inform future prospective outcomes studies and add to the body of literature demonstrating an EMU evaluation as a valuable diagnostic tool for epilepsy patients. J Neurol Res. 2021;11(5):87-93 doi: https://doi.org/10.14740/jnr703","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76960378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Fitzsimons, Michael C Li, A. Ravichandran, R. Apolo, Erafat Rehim, H. Yacoub
Several neurological manifestations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported, including cerebral venous sinus thrombosis (CVST). In this report, we discuss two cases of cerebral venous thrombosis in young patients with a recent SARS-CoV-2 infection and otherwise unrevealing workup. Case 1 was a 35-year-old man who was found unresponsive with urinary incontinence and vomitus on the floor. Computed tomography (CT) angiogram of the head revealed evidence of extensive venous thrombosis. Extensive workup for thrombotic disease was unrevealing and SARS-CoV-2 was detected via polymerase chain reaction. Anticoagulation was immediately initiated, and the patient made a good clinical recovery. Case 2 was a 31-year-old man who presented with severe decreased level of consciousness and was found to have extensive cerebral sinus thrombosis. Past medical history was significant for a recent SARS-CoV-2 infection diagnosed 12 days prior. The patient was treated with intravenous heparin and eventually oral anticoagulation with good clinical outcome. CVST is a potential cerebrovascular complication of SARS-CoV-2. We advise clinicians to consider this diagnosis in patients with a recent SARS-CoV-2 infection in the appropriate clinical setting.
{"title":"Cerebral Venous Sinus Thrombosis in Patients With SARS-CoV-2","authors":"M. Fitzsimons, Michael C Li, A. Ravichandran, R. Apolo, Erafat Rehim, H. Yacoub","doi":"10.14740/jnr697","DOIUrl":"https://doi.org/10.14740/jnr697","url":null,"abstract":"Several neurological manifestations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported, including cerebral venous sinus thrombosis (CVST). In this report, we discuss two cases of cerebral venous thrombosis in young patients with a recent SARS-CoV-2 infection and otherwise unrevealing workup. Case 1 was a 35-year-old man who was found unresponsive with urinary incontinence and vomitus on the floor. Computed tomography (CT) angiogram of the head revealed evidence of extensive venous thrombosis. Extensive workup for thrombotic disease was unrevealing and SARS-CoV-2 was detected via polymerase chain reaction. Anticoagulation was immediately initiated, and the patient made a good clinical recovery. Case 2 was a 31-year-old man who presented with severe decreased level of consciousness and was found to have extensive cerebral sinus thrombosis. Past medical history was significant for a recent SARS-CoV-2 infection diagnosed 12 days prior. The patient was treated with intravenous heparin and eventually oral anticoagulation with good clinical outcome. CVST is a potential cerebrovascular complication of SARS-CoV-2. We advise clinicians to consider this diagnosis in patients with a recent SARS-CoV-2 infection in the appropriate clinical setting.","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"4044 1 1","pages":"94 - 101"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86729166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Zhang, Ai-yuan Zhang, L. Gao, Li Zhou, Anke Wang
Vestibular migraine (VM) is the most common etiology of vertigo in the adults. VM accompanied by brainstem symptoms is not uncommon, but underrecognized so far. It is often misdiagnosed as brainstem infarction. Earlier correct diagnosis could help avoid thrombolysis, intravascular intervention, excessive auxiliary examination, panic and fear, repeated hospitalization, waste of medical resources, early and short-term use of steroid hormone, and antioxidant. Family or sporadic hemiplegic migraine (HM) is a kind of encephalopathy instead of simple hypoperfusion; the pathogenesis, which was not well described, might also account for the neurological symptoms in VM patients. The genomic identification of the migraine could facilitate better understanding on molecular pathogenesis of familial HM. Genetic mutations are believed to be associated with more susceptible alterations of cortical spreading depression in the brain. J Neurol Res. 2021;11(5):77-86 doi: https://doi.org/10.14740/jnr651
{"title":"Vestibular Migraine With Brainstem Auras: A Review of Pathogenesis, Clinical Varieties, Abortive and Prophylactic Treatment","authors":"A. Zhang, Ai-yuan Zhang, L. Gao, Li Zhou, Anke Wang","doi":"10.14740/jnr651","DOIUrl":"https://doi.org/10.14740/jnr651","url":null,"abstract":"Vestibular migraine (VM) is the most common etiology of vertigo in the adults. VM accompanied by brainstem symptoms is not uncommon, but underrecognized so far. It is often misdiagnosed as brainstem infarction. Earlier correct diagnosis could help avoid thrombolysis, intravascular intervention, excessive auxiliary examination, panic and fear, repeated hospitalization, waste of medical resources, early and short-term use of steroid hormone, and antioxidant. Family or sporadic hemiplegic migraine (HM) is a kind of encephalopathy instead of simple hypoperfusion; the pathogenesis, which was not well described, might also account for the neurological symptoms in VM patients. The genomic identification of the migraine could facilitate better understanding on molecular pathogenesis of familial HM. Genetic mutations are believed to be associated with more susceptible alterations of cortical spreading depression in the brain. J Neurol Res. 2021;11(5):77-86 doi: https://doi.org/10.14740/jnr651","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90042154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Poursadeghfard, Maryam Sharifian-Dorche, Ali Nemati, A. Mowla
Coronavirus disease 2019 (COVID-19) pandemic greatly impacted many aspects of life in the world. Both neurological and ophthalmologic presentations after COVID-19 have been reported. Herein, we present a case of both neuroretinitis and encephalitis after COVID-19 in a young adult. Both presentations are among the rare presentations of COVID-19. Similar manifestations were not reported previously. The 18-year-old previously healthy girl initially presented with low-grade fever, nausea, vomiting, body pain, and headache. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction (PCR) by using a nasal swab. Two days after the onset of COVID-19 symptoms, she reported blurred vision in both eyes, progressing to only light perception in 3 days. Based on the ophthalmological evaluation, she was diagnosed with neuroretinitis. A few days later, she gradually became drowsy, so she was referred for neurological evaluation. Brain magnetic resonance imaging (MRI) showed bilateral medial temporal T2 and fluid-attenuated inversion recovery (FLAIR) hyper-signal lesions suggestive of encephalitis. A low-dose steroid was started to treat the neuroretinitis. After about 2 weeks, significant improvement in visual acuity and resolution of retinitis patches were observed. Our case is rare in respect of both neurological and ophthalmic involvement.
{"title":"Simultaneous Encephalitis and Neuroretinitis After COVID-19 in a Young Adult: A Case Report","authors":"M. Poursadeghfard, Maryam Sharifian-Dorche, Ali Nemati, A. Mowla","doi":"10.14740/jnr698","DOIUrl":"https://doi.org/10.14740/jnr698","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) pandemic greatly impacted many aspects of life in the world. Both neurological and ophthalmologic presentations after COVID-19 have been reported. Herein, we present a case of both neuroretinitis and encephalitis after COVID-19 in a young adult. Both presentations are among the rare presentations of COVID-19. Similar manifestations were not reported previously. The 18-year-old previously healthy girl initially presented with low-grade fever, nausea, vomiting, body pain, and headache. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction (PCR) by using a nasal swab. Two days after the onset of COVID-19 symptoms, she reported blurred vision in both eyes, progressing to only light perception in 3 days. Based on the ophthalmological evaluation, she was diagnosed with neuroretinitis. A few days later, she gradually became drowsy, so she was referred for neurological evaluation. Brain magnetic resonance imaging (MRI) showed bilateral medial temporal T2 and fluid-attenuated inversion recovery (FLAIR) hyper-signal lesions suggestive of encephalitis. A low-dose steroid was started to treat the neuroretinitis. After about 2 weeks, significant improvement in visual acuity and resolution of retinitis patches were observed. Our case is rare in respect of both neurological and ophthalmic involvement.","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"38 1","pages":"102 - 107"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78667375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Aghabaklou, S. Razavi, Pegah Mohammadi, S. Gholamin, A. Mowla
Emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak identified in late 2019 in Wuhan, China, was declared a pandemic in March 2020. High fatality rate in afflicted patients prompted scientists and physicians to develop various vaccines against the virus. While administration of millions of doses of the adenoviral vector vaccines (e.g., Oxford-AstraZeneca (ChAdOx1 nCoV-19) and Janssen/Johnson & Johnson (Ad26.COV2. S)) has helped control the disease, numerous cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia have been reported in vaccinated individuals. In this article, we aim to review the cases reported thus far and further discuss the association between the vaccine administration and subsequent cerebral thromboembolic events. Our study was performed and reported based on the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Google Scholar and Norris Medical Library databases were searched using the following terms: coronavirus disease 2019 (COVID-19) vaccines (“AstraZeneca” or “AZD1222 COVID vaccine” or “ChAdOx1 nCoV-19 COVID-19 vaccine” or “Janssen” or “Johnson & Johnson COVID vaccine” or “Ad26.COV2 COVID vaccine”), coagulopathy (“cerebral venous sinus thrombosis (CVST)” and “vaccine-induced immune thrombotic thrombocytopenia (VITT)” or “cerebral venous thrombosis (CVT)”) and thrombocytopenia. All the relevant studies within the English literature up to August 1, 2021, were included. Fourteen most recent articles reporting on 66 patients with CVST and VITT after adenoviral vector vaccination were reviewed by two independent authors. Age of the patients ranged from 18 to 60 years. The majority of cases were women (43 females versus 14 males). Platelet count was between 5 and 127 × 109/L. Above-normal D-dimer was found in 86% of the patients. A total of 68% of the patients had positive platelet factor 4 IgG assay in the absence of prior exposure to heparin. Among CVST cases following COVID vaccination, 44% succumbed to death. Early diagnosis and treatment of CVST plays a fundamental role in decreasing morbidity and mortality. Health care professional should be familiar with this rare complication post vaccination against COVID-19. Given the rarity of CVST after the COVID-19 vaccine, the benefit of vaccination outweighs the potential harm.
2019年底在中国武汉发现的新型冠状病毒——严重急性呼吸综合征2型(SARS-CoV-2)疫情，于2020年3月被宣布为大流行。患者的高致死率促使科学家和医生开发各种针对该病毒的疫苗。同时施用数百万剂腺病毒载体疫苗(例如牛津-阿斯利康(ChAdOx1 nCoV-19)和杨森/强生(Ad26.COV2))。S))有助于控制疾病，在接种疫苗的个体中报告了许多脑静脉窦血栓形成(CVST)伴血小板减少的病例。在本文中，我们旨在回顾迄今为止报道的病例，并进一步讨论疫苗接种与随后的脑血栓栓塞事件之间的关系。我们的研究是根据系统评价和荟萃分析首选报告项目(PRISMA)中概述的指南进行和报告的。PubMed、谷歌Scholar和Norris Medical Library数据库使用以下术语进行检索:2019冠状病毒病(COVID-19)疫苗(“AstraZeneca”或“AZD1222 COVID疫苗”或“ChAdOx1 nCoV-19 COVID疫苗”或“Janssen”或“Johnson & Johnson COVID疫苗”或“Ad26”)。COV2 COVID疫苗”)、凝血功能障碍(“脑静脉窦血栓形成(CVST)”和“疫苗诱导的免疫性血栓性血小板减少(VITT)”或“脑静脉血栓形成(CVT)”)和血小板减少症。纳入截至2021年8月1日的所有英国文献中的相关研究。两位独立作者对最近报道66例腺病毒载体疫苗接种后CVST和VITT患者的14篇文章进行了综述。患者年龄18 ~ 60岁。大多数病例为女性(43名女性对14名男性)。血小板计数在5 ~ 127 × 109/L。86%的患者发现d -二聚体高于正常水平。在没有肝素暴露的情况下，共有68%的患者血小板因子4 IgG检测呈阳性。在COVID疫苗接种后的CVST病例中，44%死于死亡。早期诊断和治疗CVST对降低发病率和死亡率具有重要作用。卫生保健专业人员应该熟悉这种罕见的COVID-19疫苗接种后并发症。鉴于COVID-19疫苗后CVST的罕见性，疫苗接种的好处超过了潜在的危害。
{"title":"Cerebral Coagulation Complications Following COVID-19 Adenoviral Vector Vaccines: A Systematic Review","authors":"Sara Aghabaklou, S. Razavi, Pegah Mohammadi, S. Gholamin, A. Mowla","doi":"10.14740/jnr700","DOIUrl":"https://doi.org/10.14740/jnr700","url":null,"abstract":"Emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak identified in late 2019 in Wuhan, China, was declared a pandemic in March 2020. High fatality rate in afflicted patients prompted scientists and physicians to develop various vaccines against the virus. While administration of millions of doses of the adenoviral vector vaccines (e.g., Oxford-AstraZeneca (ChAdOx1 nCoV-19) and Janssen/Johnson & Johnson (Ad26.COV2. S)) has helped control the disease, numerous cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia have been reported in vaccinated individuals. In this article, we aim to review the cases reported thus far and further discuss the association between the vaccine administration and subsequent cerebral thromboembolic events. Our study was performed and reported based on the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Google Scholar and Norris Medical Library databases were searched using the following terms: coronavirus disease 2019 (COVID-19) vaccines (“AstraZeneca” or “AZD1222 COVID vaccine” or “ChAdOx1 nCoV-19 COVID-19 vaccine” or “Janssen” or “Johnson & Johnson COVID vaccine” or “Ad26.COV2 COVID vaccine”), coagulopathy (“cerebral venous sinus thrombosis (CVST)” and “vaccine-induced immune thrombotic thrombocytopenia (VITT)” or “cerebral venous thrombosis (CVT)”) and thrombocytopenia. All the relevant studies within the English literature up to August 1, 2021, were included. Fourteen most recent articles reporting on 66 patients with CVST and VITT after adenoviral vector vaccination were reviewed by two independent authors. Age of the patients ranged from 18 to 60 years. The majority of cases were women (43 females versus 14 males). Platelet count was between 5 and 127 × 109/L. Above-normal D-dimer was found in 86% of the patients. A total of 68% of the patients had positive platelet factor 4 IgG assay in the absence of prior exposure to heparin. Among CVST cases following COVID vaccination, 44% succumbed to death. Early diagnosis and treatment of CVST plays a fundamental role in decreasing morbidity and mortality. Health care professional should be familiar with this rare complication post vaccination against COVID-19. Given the rarity of CVST after the COVID-19 vaccine, the benefit of vaccination outweighs the potential harm.","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"6 1","pages":"69 - 76"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90188946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Assunção, Beth Chauncey Evers, C. Martins, K. Remmel
Background: In stroke, timeliness of care is essential for optimal patient outcomes. While opportunities for code response time improvements have been extensively documented in the medical literature, this retrospective study aimed at providing data and insights for the development of a quality improvement project in the same hospital, with the ultimate goal of increasing code stroke response speeds without compromising the quality of care. Methods: This was a retrospective cohort study. Data were collected from weekly code stroke review meetings between January and December 2020 from both the emergency department (ED), and inpatient settings from one Joint Commission certified Primary Stroke Center. All code stroke cases with a computed tomography (CT) scan were included. For cases that received tissue plasminogen activator (tPA), variables collected were time from code-to-CT scan start, code-to-tPA, from CT scan start to tPA, and from CT scan completion to tPA. For code stroke cases that did not receive tPA, variables collected were code-to-CT scan start, code-to-CT scan read, from CT scan start to CT scan read, and from CT scan completion to CT scan read. Then, the ED’s code stroke response times were compared with those in the inpatient setting by using a two-tailed t -test and a 95% confidence interval. Results: From a sample of 206 code stroke activations in 2020, 157 activations met the study’s criteria. For cases that received tPA, the difference in the mean code-to-CT start times between ED and the inpatient settings (9.01 and 24.99 min, respectively) was statistically significant with a P-value < 0.05. For cases that did not receive tPA, the differences between ED and the inpatient settings in the mean code-to-CT start times (14.25 and 30.74 min, respectively) and code-to-CT read times (34.25 and 54.95 min, respectively) were also statistically significant with a P-value < 0.05. Conclusion: This study highlights the urgent need to improve code-to-CT times in this hospital’s inpatient setting since ED code stroke times were markedly better from a statistical viewpoint. Improving the quality of care will have to address the evident delay in transporting inpatients to the CT scanner after a code stroke has been activated. J Neurol Res. 2021;11(3-4):47-53 doi: https://doi.org/10.14740/jnr688
{"title":"Comparison of Code Stroke Response Times Between Emergency Department and Inpatient Settings in a Primary Stroke Center","authors":"C. Assunção, Beth Chauncey Evers, C. Martins, K. Remmel","doi":"10.14740/jnr688","DOIUrl":"https://doi.org/10.14740/jnr688","url":null,"abstract":"Background: In stroke, timeliness of care is essential for optimal patient outcomes. While opportunities for code response time improvements have been extensively documented in the medical literature, this retrospective study aimed at providing data and insights for the development of a quality improvement project in the same hospital, with the ultimate goal of increasing code stroke response speeds without compromising the quality of care. Methods: This was a retrospective cohort study. Data were collected from weekly code stroke review meetings between January and December 2020 from both the emergency department (ED), and inpatient settings from one Joint Commission certified Primary Stroke Center. All code stroke cases with a computed tomography (CT) scan were included. For cases that received tissue plasminogen activator (tPA), variables collected were time from code-to-CT scan start, code-to-tPA, from CT scan start to tPA, and from CT scan completion to tPA. For code stroke cases that did not receive tPA, variables collected were code-to-CT scan start, code-to-CT scan read, from CT scan start to CT scan read, and from CT scan completion to CT scan read. Then, the ED’s code stroke response times were compared with those in the inpatient setting by using a two-tailed t -test and a 95% confidence interval. Results: From a sample of 206 code stroke activations in 2020, 157 activations met the study’s criteria. For cases that received tPA, the difference in the mean code-to-CT start times between ED and the inpatient settings (9.01 and 24.99 min, respectively) was statistically significant with a P-value < 0.05. For cases that did not receive tPA, the differences between ED and the inpatient settings in the mean code-to-CT start times (14.25 and 30.74 min, respectively) and code-to-CT read times (34.25 and 54.95 min, respectively) were also statistically significant with a P-value < 0.05. Conclusion: This study highlights the urgent need to improve code-to-CT times in this hospital’s inpatient setting since ED code stroke times were markedly better from a statistical viewpoint. Improving the quality of care will have to address the evident delay in transporting inpatients to the CT scanner after a code stroke has been activated. J Neurol Res. 2021;11(3-4):47-53 doi: https://doi.org/10.14740/jnr688","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80846637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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