Acta Neurologica Taiwanica[JOURNAL]
Sun
200 papers
Evidence-Based Taiwan Consensus Recommendations for the treatment of Parkinson's disease.
Treatment Guideline Subcommittee of Taiwan Movement Disorder Society
Acta Neurol Taiwan · 2023 Sep · PMID 37674429
Parkinson's disease (PD) is a common and disabling neurodegenerative disorder with a prevalence set to double by 2030. People with PD present both motor symptoms (such as tremor, rigidity, slowness of movements, and post...
Parkinson's disease (PD) is a common and disabling neurodegenerative disorder with a prevalence set to double by 2030. People with PD present both motor symptoms (such as tremor, rigidity, slowness of movements, and postural instability) and non-motor symptoms (such as dementia, psychiatric symptoms, and sleep disturbances). The treatment of PD is challenging and is highly individualized. The Taiwan Movement Disorder Society (TMDS) has published its treatment recommendations for PD in 2017. Since then, because the advent of medical and device-aided therapy has developed rapidly, the TMDS has recognized the need to disseminate the updated knowledge about the management of PD. The TMDS acknowledges the importance of evidence-based medicine (EBM) in clinical practice. Therefore, we strive to align our treatment recommendations with EBM principles. Nevertheless, it still needs to be emphasized that therapeutic recommendations should always be tailored to the individual patient, based not only on an accurate understanding of the efficacy and side effect profile of available treatments (the primary focus of guidelines), but also the physician's judgment, patient's preference, and the regulations of national health insurance. To ensure that the updated Taiwan treatment suggestions are appropriate and feasible, the treatment guideline subcommittee of TMDS referred to the guidelines from the International Movement Disorder Society and other treatment suggestions from United States and Europe concerning the level of evidence, recommendation levels, clinical efficacy, and potential adverse reactions of therapeutics for the treatment of motor and non-motor symptoms of PD. By incorporating the latest research, international guidelines, and treatment suggestions, the TMDS aims to provide comprehensive and up-to-date recommendations for the management of PD in Taiwan. These recommendations serve as a valuable resource for healthcare professionals to enhance their understanding of PD treatment options and optimize patient care. Key Words: Parkinson's disease; treatment; guidelines; evidence-based medicine.
Clinical Updates on Antiplatelet Therapy for Secondary Prevention in Acute Ischemic Stroke.
Lee TL, Chang YM, Sung PS
Acta Neurol Taiwan · 2023 Sep · PMID 37674428
Antiplatelet therapy is the first-line management for noncardioembolic transient ischemic attack (TIA) and acute ischemic stroke (IS). Herein, we review the safety and efficacy of antiplatelet therapies in patients with...
Antiplatelet therapy is the first-line management for noncardioembolic transient ischemic attack (TIA) and acute ischemic stroke (IS). Herein, we review the safety and efficacy of antiplatelet therapies in patients with IS and TIA, primarily focusing on the acute stage. We discuss current antiplatelet monotherapy and the factors influencing efficacy and continuation rate according to clinical trial data. Aspirin remains the most commonly used first-line antiplatelet agent for preventing noncardioembolic stroke recurrence, and clopidogrel, cilostazol, and ticagrelor are feasible alternatives. Various short-term dual antiplatelet therapies (including clopidogrel-aspirin and ticagrelor-aspirin combination therapy) for minor stroke and high-risk TIA are also reviewed. For selected patients with specific stroke etiologies, short-term dual antiplatelet therapy with aspirin combined with clopidogrel or ticagrelor can significantly reduce the risk of stroke. However, insufficient evidence supports the benefits of triple antiplatelet therapy for recurrent noncardioembolic stroke prevention, and this treatment substantially increases the rate of bleeding complications. Keyword: antiplatelet therapy, acute ischemic stroke, secondary prevention, transient ischemic attack.
Hemorrhagic shock due to retroperitoneal hemorrhage: a rare complication of lumbar puncture.
Valentin RS, Noemi AF, Lucia GA … +6 more , Maria Del Mar RA, Ziortza EM, Jose Pablo CM, Alfonso EA, Jose Alberto SO, Carlos MC
Acta Neurol Taiwan · 2023 Sep · PMID 37674427
Lumbar puncture is a routine procedure frequently done in hospitalized patients. This tecnique is not free from complications. Here we bring a case of active bleeding from a lumbar arterie after a lumbar puncture that le...
Lumbar puncture is a routine procedure frequently done in hospitalized patients. This tecnique is not free from complications. Here we bring a case of active bleeding from a lumbar arterie after a lumbar puncture that leads to hemorrhagic shock and retroperitoneal hematoma. Furthermore, we focus on developing non-surgical alternatives to cease active bleeding. Keyword: Lumbar puncture, Hemorrhagic shock, Retroperitoneal hemorrhage.
Coexistence of IgLON5-IgG and SOX1-IgG in a Patient with Progressive Brainstem Dysfunction.
Teekaput C, Teekaput K, Tanprawate S … +2 more , Kittisares A, Apiwattanakul M
Acta Neurol Taiwan · 2023 Sep · PMID 37674426
PURPOSE: The coexistence of IgLON5-IgG and SOX1-IgG is rare. Previous reports have shown that patients with IgLON5-IgG spectrum disease present with sleep disorders, bulbar involvement, and autonomic abnormality, while S...
PURPOSE: The coexistence of IgLON5-IgG and SOX1-IgG is rare. Previous reports have shown that patients with IgLON5-IgG spectrum disease present with sleep disorders, bulbar involvement, and autonomic abnormality, while SOX1-IgG positive patients present with peripheral nervous system symptoms such as the Lambert-Eaton Myasthenic Syndrome (LEMS). CASE REPORT: We report a patient who presented with progressive ophthalmoplegia, ptosis, oropharyngeal dysphagia, gait instability, and sleep disorders. The paraneoplastic antibody screening tested doublepositive for IgLON5-IgG and SOX1-IgG. However, there was no clinical sign of LEMS in this patient. After extensive cancer screening, only lung nodules with hilar adenopathy were noted. CONCLUSION: The coexistence of IgLON5-IgG with onconeuronal SOX1-IgG would suggest an underlying immune-mediated paraneoplastic process rather than secondary autoimmunity because of neurodegeneration. This is the first IgLON5-IgG case reported in Thailand, with a case of doublepositive IgLON5-IgG and SOX1-IgG as well. Keyword: IgLON5-IgG, SOX1-IgG, Paraneoplastic process, case report.
Ross syndrome with chronic cough and RF positivity: a case report.
Tosunoğlu B, İnan LE
Acta Neurol Taiwan · 2023 Sep · PMID 37674425
Ross syndrome is a rare disorder of unknown etiology, characterized by the triad of segmental anhidrosis, tonic pupil, and areflexia/hyporeflexia. Ross syndrome is thought to be a limited and selective ganglioneuropathy....
Ross syndrome is a rare disorder of unknown etiology, characterized by the triad of segmental anhidrosis, tonic pupil, and areflexia/hyporeflexia. Ross syndrome is thought to be a limited and selective ganglioneuropathy. Its etiology has not been fully elucidated. Autonomic findings may also accompany. We wanted to present our 25-year-old patient who was diagnosed with Ross syndrome and presented with complaints of inability to sweat, heat intolerance, headache, diarrhea and chronic cough. Keyword: cough, tonic pupil, anhidrosis, compensatory.
Non-Hodgkin's Lymphoma with Intraspinal Involvement Mimics Bilateral Thoracolumbar Plexopath.
Lin WH, Wu MN
Acta Neurol Taiwan · 2023 Sep · PMID 37674424
PURPOSE: Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma, and its extranodal manifestation is rare. Skeletal muscle involvement is noted in only 1.1% of patients with NHL. Here, we present a case of high-g...
PURPOSE: Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma, and its extranodal manifestation is rare. Skeletal muscle involvement is noted in only 1.1% of patients with NHL. Here, we present a case of high-grade B-cell lymphoma (HGBL); it infiltrated the left neural foramina from the left psoas muscle before encroaching on the whole spinal canal and subsequently invading the contralateral neural foramina from T12 to L3. CASE REPORT: A 43-year-old man with HGBL who could function independently presented with numbness and weakness of the left thigh 2 months after a diagnosis of infiltrative lymphoma in the left psoas muscle. His symptoms were urine incontinence and unsteady gait. A neurological examination revealed weakness in the left psoas and quadriceps with hyporeflexia and hypesthesia. Lumbar spine magnetic resonance imaging (MRI) revealed intraspinal extradural invasion from T12 to L3 with multiple left-sided root compression despite the resolution of primary psoas lymphoma. At 6 weeks after symptom onset, his symptoms progressed to weakness, numbness, and hyporeflexia of the bilateral lower extremities with preserved anal sensation. Follow- up MRI revealed the progression of intraspinal invasion, which spread through the spinal canal and invaded the contralateral neural foramina from T12 to L3. The patient was finally bound to a wheelchair. CONCLUSION: Clinicians must check for possible intraspinal involvement in patients with HGBL, particularly patients with known paraspinal soft-tissue involvement. The resolved infiltration of the soft tissue does not preclude the possibility of further neurological involvement. Additionally, MRI may provide higher resolution findings for clarifying the structure of the neural foramina and thecal sac. Keyword: Non-Hodgkin's Lymphoma, high-grade B-cell lymphoma, plexopathy.
Cranial nerve Palsy following COVID-19 Vaccination Responsive to Plasma Exchange.
Liu Y, Sung YF, Yen SY
Acta Neurol Taiwan · 2023 Sep · PMID 37674423
BACKGROUND: Globally, mass COVID-19 vaccine administration has revealed various adverse effects of the vaccine, such as various neurological symptoms, which are currently identified as a result of an excessive immune res...
BACKGROUND: Globally, mass COVID-19 vaccine administration has revealed various adverse effects of the vaccine, such as various neurological symptoms, which are currently identified as a result of an excessive immune response. CASE REPORT: A 70-year-old woman presented with progressive unilateral oculomotor nerve palsy and decreased visual acuity 12 days after receiving the Moderna COVID-19 vaccine. In adults, such palsy is typically caused by microvascular disease (ischemia) or compressive tumors. Given the temporal relationship between vaccination and symptoms and the exclusion of other possible causative factors, the patient's oculomotor nerve palsy and optic nerve involvement was considered to be related to the vaccination. Cranial nerve palsy following COVID-19 vaccination was diagnosed, and after pulse steroid and plasma exchange, the patient showed steady recovery. CONCLUSION: Our patient with cranial nerve palsy following COVID-19 vaccination responded well to plasma exchange after limited improved toward steroid. This case highlights the importance of early identification and treatment of the immunological effects of COVID-19 vaccines on cranial nerves.
Acute Asymmetric Sensorimotor Variant of Chronic Inflammatory Demyelinating Polyneuropathy Triggered by mRNA-1273 COVID-19 Vaccination.
Cheng CJ, Lu CJ
Acta Neurol Taiwan · 2023 Sep · PMID 37674422
PURPOSE: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) developing in the postvaccination period was distinctly unusual and its course was rarely well described. We aimed to clearly depict the clinical...
PURPOSE: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) developing in the postvaccination period was distinctly unusual and its course was rarely well described. We aimed to clearly depict the clinical features of acute-onset multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) caused by mRNA-1273 COVID-19 vaccination. CASE REPORT: A 74-year-old man noticed weakness of hands 2-3 days after he accepted the second dose of mRNA-1273 COVID-19 vaccine. He soon became unable to walk within one week. Initially, muscle power of bilateral hand grasping was most severely affected. He had stayed on at the nadir for 3.5 months until the diagnosis of CIDP was made. Nerve conduction studies showed typical evidences of acquired demyelinating, but no sural spare pattern. He was treated with intermittent pulse steroid therapy. Two weeks after treatment, INCAT disability score improved from 10 to 4, but remained at 4 thereafter: arm disability score was 3 and that of leg was 1, which suggested muscles of upper limbs were more severely affected. CONCLUSION: Diagnosis of acute-onset MADSAM was challenging at the beginning of this disease. For vaccine-triggered CIDP, time to symptom onset could be as short as 2-3 days. Delay in recognition may influence the remission of this disease. Muscles of upper limbs were more affected than those of lower limbs. Intermittent steroid pulse therapy would be an alternative to daily oral steroid therapy. Keyword: chronic inflammatory demyelinating polyradiculoneuropathy, COVID-19 vaccination.
Intra-Arterial Thrombectomy for Acute Ischemic Stroke Related to the Procoagulant Effect of Warfarin in A Patient with Atrial Fibrillation and Bioprosthetic Valve Replacement.
Huang HT, Huang YT, Chen DY … +3 more , Chan L, Hong CT, Chung CC
Acta Neurol Taiwan · 2023 Sep · PMID 37674421
PURPOSE: Warfarin is associated with paradoxical procoagulant effect that leads to a transient hypercoagulable state and acute ischemic stroke (AIS). This clinical dilemma is further confounded when the patient has multi...
PURPOSE: Warfarin is associated with paradoxical procoagulant effect that leads to a transient hypercoagulable state and acute ischemic stroke (AIS). This clinical dilemma is further confounded when the patient has multiple comorbidities and the optimal treatment strategies are unclear. CASE REPORT: We report a 78-year-old male with valvular heart disease, congestive heart failure, and atrial fibrillation, who received bioprosthetic valve replacement and developed AIS related to the paradoxical procoagulant effect of warfarin. Emergent cerebral angiography with mechanical thrombectomy was performed, and recanalization was successfully achieved. After shifting warfarin to nonvitamin K oral anticoagulant (NOAC), the paradoxical procoagulant effect ameliorated. CONCLUSION: This report describes the roles of endovascular therapy and NOAC in patients with similar highly complex conditions and has clinical relevance for therapeutic plans in the clinical setting.
Curcumin Attenuates Nonylphenol-Induced Toxicity In Brain Development; An Experimental Study.
Suna PA, Gergin OO, Baran M … +3 more , Ulger M, Goc R, Yay A
Acta Neurol Taiwan · 2023 Sep · PMID 37674420
OBJECTIVE: Nonylphenol is an alkylphenol compound that has been widely used in the industry. It has endocrine-disrupting properties. The effect of alkylphenol compounds on development has been the subject of a limited nu...
OBJECTIVE: Nonylphenol is an alkylphenol compound that has been widely used in the industry. It has endocrine-disrupting properties. The effect of alkylphenol compounds on development has been the subject of a limited number of studies. Herein, we aimed to examine curcumin's effect against nonylphenol toxicity on brain development. METHODS: For this study, 30 pregnant female Wistar albino rats from the Animal Laboratory of Erciyes University, Faculty of Medicine, were used. The rats were randomly divided into the following 5 groups; the control group, corn oil group (150μl/kg/day), nonylphenol group (50μl/kg/day), curcumin group (100mg/kg/day) and curcumin+nonylphenol group (100mg/kg/day+50 μl/kg/day). After the sacrification, histological and immunohistochemical evaluations were made. RESULTS: Histopathologically, vascular congestion, increased GFAP, and p-tau immunoreactivity intensity was found in the developing brain of the nonylphenol group. Moreover, co-treatment of nonylphenol administrated with curcumin showed slight pathological alterations with vascular congestion. CONCLUSIONS: These data suggest that nonylphenol-induced increase in GFAP and p-tau immunoreactivity contributes to toxicity caused impairment in the rat brain. Additionally, curcumin had a neuroprotective effect against nonylphenol-induced neurotoxicity.
The impact of SARS-CoV-2 on neuromuscular disorders.
Wu MJ, Sun YT
Acta Neurol Taiwan · 2023 Sep · PMID 37674419
The emergence of SARS-CoV-2 has profoundly impacted global society and various aspects of human life. While the pandemic has resulted in disruptions and challenges, it has also accelerated scientific research on viruses...
The emergence of SARS-CoV-2 has profoundly impacted global society and various aspects of human life. While the pandemic has resulted in disruptions and challenges, it has also accelerated scientific research on viruses and immunology, leading to remarkable progress in vaccine technology and immunization strategies. This review examines the impact of SARS-CoV-2 on pre-existing neuromuscular disorders, and neuromuscular events following SARS-CoV-2 infection, including immune-mediated and critical illness status-related disorders. Furthermore, the review discusses the relationship between SARSCoV- 2 vaccination and neuromuscular complications. The findings highlight the need for further research and understanding to improve patient outcomes. Keywords: SARS-CoV-2, neuromuscular diseases, vaccine.
2022 Taiwan Guidelines for Acute and Preventive Treatment of Cluster Headaches.
Yang FC, Tsai CL, Lin GY … +1 more , Treatment Guidelines Subcommittee of the Taiwan Headache Society
Acta Neurol Taiwan · 2022 Dec · PMID 37431108
The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated Taiwan's guidelines for the acute and preventive treatment of cluster headaches on the basis of the principles of evidence-based medicine. The...
The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated Taiwan's guidelines for the acute and preventive treatment of cluster headaches on the basis of the principles of evidence-based medicine. The subcommittee assessed the quality of clinical trials and levels of evidence and referred to the treatment guidelines of other countries. Over the course of several panel discussions, the subcommittee members reached a consensus regarding the major roles of, recommended levels of, clinical efficacy of, adverse events in, and clinical precautions for the acute and preventive treatment of cluster headaches. Thus, the subcommittee updated the previous version of the guidelines published in 2011. Most cluster headaches occurring in Taiwan are episodic, and very few patients develop chronic cluster headaches. Cluster headaches cause extreme pain over a short period and are accompanied by ipsilateral autonomic symptoms; therefore, immediate treatment can provide considerable relief. Treatment options can be categorized into acute and preventive types. Among the treatment methods currently available in Taiwan for cluster headaches, high-flow pure oxygen inhalation has demonstrated the best evidence and effectiveness for acute attacks, followed by triptan nasal spray; therefore, these are recommended as first-line treatments. Oral steroids and suboccipital steroid injections can be used as transitional preventative treatments. Verapamil is recommended as a first-line treatment for maintenance prophylaxis. Drugs such as lithium, topiramate, and calcitonin gene-related peptide (CGRP) monoclonal antibodies are recommended as secondline treatments. Noninvasive vagus nerve stimulation is the recommended instrumental therapy. The effectiveness of surgical treatment, such as sphenopalatine ganglion stimulation, is supported by a high level of evidence; nevertheless, because few patients have chronic cluster headaches in Taiwan, no clinical records are available for use as a reference. Transitional prophylaxis and maintenance prophylaxis can be used simultaneously according to the individual condition of the patient, and the transitional prophylaxis can be gradually discontinued once the maintenance prophylaxis takes effect. Steroids should not be used for more than 2 weeks as transitional prophylaxis. Maintenance prophylaxis should be administered until the end of the bout period (no attacks for 2 weeks) and then gradually tapered off. Key words: cluster headaches, oxygen therapy, triptans, steroids, CGRP monoclonal antibodies, noninvasive vagus nerve stimulation.
Neuroimaging of central nervous system tuberculosis.
Morais CG, Reis-Melo A, Oliveira J … +3 more , Ribeiro A, Pinto-Carvalho I, Tavares M
Acta Neurol Taiwan · 2023 Jun · PMID 37198514
A 20-month-old female, not immunized with Bacillus Calmette-Guérin (BCG) vaccine, was admitted due to a four-day history of fever and cough. In the past three months, she presented respiratory infections, weight loss and...
A 20-month-old female, not immunized with Bacillus Calmette-Guérin (BCG) vaccine, was admitted due to a four-day history of fever and cough. In the past three months, she presented respiratory infections, weight loss and enlarged cervical lymph nodes. On day two of admission, she displayed drowsiness and positive Romberg's sign; cerebrospinal fluid (CSF) workout revealed 107/ul cells, low glucose and high protein levels. Ceftriaxone and acyclovir were initiated, and she was transferred to our tertiary hospital. Brain magnetic resonance imaging showed punctiform focal areas of restricted diffusion in left capsular lenticular region suggestive of vasculitis secondary to infection. Tuberculin skin test and interferon-gamma release assay were positive. She started tuberculostatic therapy, but two days later she presented tonic-clonic seizures and impaired consciousness. Cerebral computed tomography (CT) revealed tetrahydrocephalus (Figure 1), needing external ventricular derivation. She had a slow clinical improvement, requiring several neurosurgical interventions and developing a syndrome of inappropriate antidiuretic secretion alternating with cerebral salt wasting. Positive results for Mycobacterium tuberculosis were obtained by CSF culture and by polymerase chain reaction in CSF, bronchoalveolar lavage and gastric aspirate specimens. Repeated brain CT showed a large-vessel vasculitis with basal meningeal enhancement, typical of central nervous system (CNS) tuberculosis (Figure 2). She completed one month of corticosteroids and maintained antituberculosis treatment. At two years of age, she has spastic paraparesis and no language skills. Portugal had 1836 cases of tuberculosis (17.8 per 100000) in 2016 and was considered a low-incidence country; consequently, BCG vaccination is not universal (1). We present a severe case of CNS tuberculosis with intracranial hypertension, vasculitis and hyponatremia, associated with poorer outcomes (2). A high index of suspicion allowed prompt start of antituberculosis treatment. Diagnosis was corroborated by microbiological positivity and a typical triad in neuroimaging (hydrocephalus, vasculitis and basal meningeal enhancement) (3), which we wish to emphasize.
Guillain-Barré Syndrome Following the BNT162b2 mRNA COVID-19 Vaccine.
Algahtani HA, Shirah BH, Albeladi YK … +1 more , Albeladi RK
Acta Neurol Taiwan · 2023 Jun · PMID 37198513
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 vir...
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.
Myositis developing after Covid-19 mRNA vaccine: Case Report.
Tosunoğlu B, Güneş HN, Çokal BG … +1 more , Yoldaş TK
Acta Neurol Taiwan · 2023 Jun · PMID 37198512
Vaccine-related side effects are common. Usually, pain, edema, redness and tenderness may be seen at the injection site. Symptoms such as fever, fatigue, myalgia may occur. The coronavirus 2019 disease (Covid-19) has aff...
Vaccine-related side effects are common. Usually, pain, edema, redness and tenderness may be seen at the injection site. Symptoms such as fever, fatigue, myalgia may occur. The coronavirus 2019 disease (Covid-19) has affected many people around the world. Although the vaccines that have been used play an active role in the fight against the pandemic, adverse events still continue to be reported. We present a 21-year-old patient who was diagnosed as having myositis after receiving covid vaccine with complaints of pain in her left arm two days after the 2nd dose of BNT162b2 mRNA Covid-19 vaccine, followed by inability to stand up from sitting and squatting and difficulty in going up and down stairs. Keywords: vaccine, myositis, creatine kinase, IVIG.
The Possible Role of COVID-19 in the Triggering of Underlying Mitochondrial Dysfunction in MELAS Syndrome, A Brief Report of three cases.
Ramezani M, Rabiei MM, Cheraghi Z … +1 more , Simani L
Acta Neurol Taiwan · 2023 Jun · PMID 37198511
BACKGROUND: During corona virus pandemic, various neurological complications of COVID-19 have been reported. Recent studies demonstrated different pathophysiology for neurological manifestations of COVID-19 such as mitoc...
BACKGROUND: During corona virus pandemic, various neurological complications of COVID-19 have been reported. Recent studies demonstrated different pathophysiology for neurological manifestations of COVID-19 such as mitochondrial dysfunction and damage to cerebral vasculature. In addition, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a mitochondrial disorder with a variety of neurological symptoms. In this study, we aim to assess a potential predisposition in mitochondrial dysfunction of COVID-19, leading to MELAS presentation. METHODS: We studied three previously healthy patients with the first presentation of acute stroke-like symptoms, following COVID-19 infection. We analyzed the patients' clinical data and brain magnetic resonance imaging (MRI) lesions that presented to the neurological center of a university-affiliated hospital in Tehran, Iran, from September 2020 to August 2021. RESULTS: All cases are characterized by a temporoparietal abnormality in imaging studies and electroencephalogram (EEG). Based on electrodiagnostic tests, three patients were diagnosed with myopathy. In two brothers with relatively the same symptoms, one performed muscle biopsy finding myopathic process, and genetic testing confirmed a 3243A>G point mutation in a heteroplasmic state in one of our patients. CONCLUSION: Although MELAS is not a prevalent condition, the recent increase in the number of these patients in our center might indicate the potential role of COVID-19 in triggering the silent pre- existing mitochondrial dysfunction in these patients.
Fulminant Extra- And Intracranial Arteriovenous Thrombosis And Non-aneurysmal Subarachnoid Hemorrhage Following COVID-19 Infection.
Furtado SV, Hegde N, Prabhu VMD
Acta Neurol Taiwan · 2023 Jun · PMID 37198510
PURPOSE: Coronavirus disease of 2019 (COVID-19) is associated with increased risk of stroke and intracranial hemorrhage. This first report of fulminant panvascular arteriovenous thrombosis with subarachnoid hemorrhage (S...
PURPOSE: Coronavirus disease of 2019 (COVID-19) is associated with increased risk of stroke and intracranial hemorrhage. This first report of fulminant panvascular arteriovenous thrombosis with subarachnoid hemorrhage (SAH) in a post-COVID-19 infection is attributed to extensive arteriovenous inflammation leading to arterial rupture following vasculitis. CASE REPORT: We report a rare case of extensive extra- and intra-cranial cerebral arteriovenous thrombosis following COVID-19 infection, presenting as fatal non-aneurysmal subarachnoid hemorrhage. The clinical course, biochemical and radiological evaluation is discussed. The other possible etiological differentials which were analysed and ruled out during case management are also detailed. CONCLUSION: A high degree of suspicion for COVID-19 induced coagulopathy leading to extensive non- aneurysmal, non-hemispheric SAH and malignant intracranial hypertension should be entertained. Our experience and previous reports on non-aneurysmal SAH in such patients show a poor prognosis.
A case with prolonged headache after COVID-19 vaccination and later developed Bell's palsy.
Hsiao YY, Liu LJ, Lin YL
Acta Neurol Taiwan · 2023 Jun · PMID 37198509
PURPOSE: During COVID-19 pandemic, the authorization of emergent usage of new vaccine has raised suspicions and doubts about potential adverse events related to vaccination. Among the reported adverse events related to C...
PURPOSE: During COVID-19 pandemic, the authorization of emergent usage of new vaccine has raised suspicions and doubts about potential adverse events related to vaccination. Among the reported adverse events related to ChAdOx1/nCoV-19 vaccine, facial paralysis did not have an incident rate higher than natural occurrence like mRNA vaccines. However, temporal association between vaccination and facial palsy have been documented in several studies. Here, we report a case of an otherwise healthy 23-year-old Taiwanese female who experienced prolonged headache since the second day postvaccination and developed facial palsy on the tenth day. CASE REPORT: A 23-year-old Taiwanese female who was previously healthy experienced intermittent right side throbbing headache, general malaise, myalgia and fever. Headache, transient ear pain and right scalp numbness developed in the next few days but quickly resolved. On day ten after vaccination, signs of facial palsy on the right side of her face was noticed. The results of brain Magnetic Resonance Imaging (MRI) with contrast displayed no abnormality. Facial stimulation and blink reflex tests were compatible with right facial neuropathy. CONCLUSION: Reactivation of latent herpes virus has been suggested as one of the possible mechanisms underlying the phenomenon, but the causal pathophysiology related to the symptom needs further validation. Moreover, in the event of facial palsy post-vaccination, alternative diagnoses such as Guillain-Barre syndrome (GBS), Ramsey-Hunt syndrome, Lyme disease, trauma, central nervous system infection (CNS) infection, or stroke should also be considered.
Headache Associated with PPE During COVID-19 Pandemic in Health Care Workers.
Chaudhary SK, Prasad N, Verma C … +2 more , Jaiswal S, Jaiswal A
Acta Neurol Taiwan · 2023 Jun · PMID 37198508
PURPOSE: In the pandemic coronavirus disease 2019 (COVID-19), health care workers (HCWs) are at very high risk. Personal protective equipment (PPE) and masks are not only difficult to wear while working but also causes v...
PURPOSE: In the pandemic coronavirus disease 2019 (COVID-19), health care workers (HCWs) are at very high risk. Personal protective equipment (PPE) and masks are not only difficult to wear while working but also causes various complications. The present self-administered questionnaire- based study aimed to explore the headache and complications in HCWs on wearing PPE during the COVID-19 pandemic. METHODS: The present study was performed by obtaining a self-administered questionnaire from HCWs, which provides evidence of various complications due to the use of a PPE and mask. RESULTS: Out of a total of 329 respondents, 189(57.45%), 67(20.36%), 238(72.34%), 213(64.74%), 177(53.80%), and 34(10.33%) reported headache, breathlessness, suffocation, nose pain, ear pain, and leg pain respectively. Out of 329 respondents, 47(14.29%) had pre-existing headaches. Headache was significantly high for those who wore PPE for 4-6h (121/133; 87.05%) than that of those who wore up to 4h (18/26; 69.23%). Of the 34(24.46%) required medication who reported headaches wearing PPE. Acetaminophen is quite helpful in most health care workers to decrease headaches. Nose-related complications occur frequently in health care workers after regular shifts for more than 6 days. Gelatinous adhesives patch was a wonderful prophylactic remedy as it was helpful to prevent nose- related complications in 24 HCWs out of 25(96%). CONCLUSIONS: More than half of the HCWs reported headache, suffocation, nose pain, and ear pain. Duration of PPE use of more than 4h is significantly associated with headache. Short duration PPE use prevent HCWs from headache and various ill effects.
Endovascular Treatment for Spontaneous bilateral carotid artery dissection with acute ischemic stroke: A Case Report with automated postprocessing CT perfusion findings and Review of the Literature.
Yen PS, Lin YH, Chang TW … +1 more , Yang CP
Acta Neurol Taiwan · 2023 Jun · PMID 37198507
Carotid artery dissection (CAD) is a common cause of stroke, accounting for up to 25% of all ischemic strokes in young and middle-aged patients. CAD should be considered in young patients with unexplained head and neck p...
Carotid artery dissection (CAD) is a common cause of stroke, accounting for up to 25% of all ischemic strokes in young and middle-aged patients. CAD should be considered in young patients with unexplained head and neck pain, with or without focal neurological symptoms and signs. While the clinical features may raise suspicion for CAD, the diagnosis is confirmed by its typical neuroimaging findings. Meanwhile, simultaneous spontaneous dissection of the bilateral carotid artery has rarely been reported. We herein describe a clinically challenging case of a simultaneous bilateral CAD that was successfully treated with bilateral carotid artery stenting (CAS). The patient recovered satisfactorily after completing the whole course of treatment. Keywords: Acute stroke, Bilateral Spontaneous carotid artery dissection, Endovascular treatment.
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