Current Issue : January-March Volume : 2023 Issue Number : 1 Articles : 5 Articles
One third of ischemic strokes have no known cause, and basic understanding of the mechanisms of these “cryptogenic” strokes is lacking. However, observational studies are increasingly bringing to light an etiology that has long remained hidden, the carotid web. The authors report a case of carotid web in a 32-year-old patient, gardener, from sub-Sharan Africa, with no medical history or known cerebrovascular risk factors. Indeed, due to a sudden weakness of his left limbs, the MRI was performed and revealed an ischemic stroke positive on diffusion-weighted within the territory of the right middle cerebral artery. FLAIR sequences were normal, while T2* sequences revealed an M1 thrombus ipsilateral to the brain lesion. After thrombolysis and thrombectomy, the patient’s weakness improved significantly. Digital subtraction angiography of supra-aortic trunks revealed the carotid web, which was incriminated as the etiology of this ischemic stroke in the absence of any abnormality on the other ancillary examinations that were performed. To prevent a recurrence, the patient was given Aspegic 250 mg/day and received physical therapy. The clinical course was improved and at 3 months, there was no new cerebrovascular event and his Rankin score was 1....
Introduction. COVID-19 has been a sudden public health crisis since January 2020, spreading from the city of Wuhan, China, to the whole country within a month and posing serious threats to lives. The pandemic has a profound effect on all aspects of society, including mental health and physical health. The actual effect of the virus on the brain and possible psychiatric manifestations is still an area of study and further investigation. There are also several case reports showing manic like symptoms after COVID-19 infection. We describe the case of a 55-year-old patient who presented with behavioral and mood symptoms after a COVID-19 infection. Case Presentation. The patient presented with behavioral disturbance after a diagnosis of COVID-19. He exhibited symptoms including irritability, verbal and physical aggressiveness, increased goal-directed activity, elated and expansive mood, increased energy, grandiosity and inflated self-esteem, and decreased need for sleep. Findings on psychiatric evaluation encompassing detailed history and mental state examination suggested bipolar disorder due to COVID-19 infections. For this, he was put on sodium valproate 1000 mg per day and later, and he was discharged after 21 days with improvement. Conclusions. This case highlights the importance of paying attention to psychiatric symptoms in patients with COVID-19 and the early intervention and involvement of psychiatrists especially in critically ill patients. In the present scenario, we urge physicians to pay attention to those cases and be open-minded for such a possible new diagnosis. We also recommend performing antibody tests for CSF and RNA tests for patients with mental abnormalities following COVID-19. Further studies can be performed to identify the relationship between COVID-19 and bipolar disorders....
Purpose: To examine the optical coherence tomography (OCT) features of the retina in patients with chronic relapsing inflammatory optic neuropathy (CRION) and compare them with those of neuromyelitis optica spectrum disorder (NMOSD), relapsing-remitting multiple sclerosis (RRMS) with and without optic neuritis (ON), and healthy controls (HC). Methods: In this retrospective cross-sectional study, we used spectral domain OCT to evaluate the retinal structure of 14 participants with CRION, 22 with NMOSD, 40 with RRMS with unilateral ON, and 20 HC. The peripapillary retinal nerve fiber layer (pRNFL), total macular volume (TMV), and papillomacular bundle (PMB) were measured, and intra-retinal segmentation was performed to obtain the retinal nerve fiber (RNFL), ganglion cell (GCL), inner plexiform (IPL), inner nuclear (INL), outer plexiform (OPL) and outer nuclear (ONL) layer volumes. Results: The global pRNFL [39.33(±1.8) μm] and all its quadrants are significantly thinner in CRION compared with all other groups (p < 0.05). CRION patients have decreased volumes of TMV, RNFL, GCL, and IPL compared with all other groups (p < 0.05). Conclusion: Severe thinning in pRNFL and thinning in intra-retinal segments of IPL, GCL, RNFL, and TMV could be helpful in differentiating CRION from NMOSD and RRMS....
Brain metastases (BMs) account for a disproportionately high percentage of cancer morbidity and mortality. Historically, studies have focused on improving survival outcomes, and recent radiation oncology clinical trials have incorporated HRQOL and cognitive assessments. We are now equipped with a battery of assessments in the radiation oncology clinic, but there is a lack of consensus regarding how to incorporate them in modern clinical practice. Herein, we present validated assessments for BM patients, current recommendations for future clinical studies, and treatment advances that have improved HRQOL and cognitive outcomes for BM patients....
Dysregulated host response to infection, which cause life-threatening organ dysfunction, was defined as sepsis. Sepsis can cause acute and long-term brain dysfunction, namely, sepsis-associated encephalopathy (SAE) and cognitive impairment. SAE refers to changes in consciousness without direct evidence of central nervous system infection. It is highly prevalent and may cause poor outcomes in sepsis patients. Cognitive impairment seriously affects the life quality of sepsis patients and increases the medical burden. The pathogenesis of sepsis-induced brain dysfunction is mainly characterized by the interaction of systemic inflammation, blood-brain barrier (BBB) dysfunction, neuroinflammation, microcirculation dysfunction, and brain dysfunction. Currently, the diagnosis of sepsis-induced brain dysfunction is based on clinical manifestation of altered consciousness along with neuropathological examination, and the treatment is mainly involves controlling sepsis. Although treatments for sepsis-induced brain dysfunction have been tested in animals, clinical treat sepsis-induced brain dysfunction is still difficult. Therefore, we review the underlying mechanisms of sepsis-induced brain injury, which mainly focus on the influence of systemic inflammation on BBB, neuroinflammation, brain microcirculation, and the brain function, which want to bring new mechanism-based directions for future basic and clinical research aimed at preventing or ameliorating brain dysfunction....
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