Neurological Manifestations of Medical Child Abuse

BackgroundMedical child abuse occurs when a child receives unnecessary and harmful, or potentially harmful, medical care at the instigation of a caretaker through exaggeration, falsification, or induction of symptoms of illness in a child. Neurological manifestations are common with this type of maltreatment.ObjectivesWe sought to review common reported neurological manifestations that may alert the clinician to consider medical child abuse. In addition, the possible sequelae of this form of child maltreatment is discussed, as well as practice recommendations for establishing the diagnosis and stopping the abuse once it is identified.MethodsA review of the medical literature was conducted regarding the reported neurological presentations of this entity.ResultsNeurological manifestations of medical child abuse include false reports of apparent life-threatening events and seizures and reports of induction of symptoms from poisoning. Failure to correlate objective findings with subjective complaints may lead to unnecessary and potentially harmful testing or treatment. This form of child maltreatment puts a child at significant risk of long-term morbidity and mortality.ConclusionsA wide variety of neurological manifestations have been reported in cases of medical child abuse. It is important for the practicing neurologist to include medical child abuse on the differential diagnosis.     

The Neurological Manifestations of Chronic Inhalation of Leaded Gasoline

Abnormal neurological signs were found in 46 of 50 children and adolescents chronically sniffing leaded gasoline. These abnormalities resolved within eight weeks in all but one case. Exaggerated deep reflexes, postural tremor and evidence of cerebellar dysfunction occurred in a highly significnat number of patients. Forty-nine had blood lead levels greater than or equal to 40ug/dl. The mean blood lead levels were significantly higher in those with (a) abnormally brisk deep reflexes and (b) with evidence of cerebellar dysfunction, than in those without these findings. Five optional treatment regimes were employed and a classification was used, based on clinical findings, initial blood lead levels and the response to the calcium disodium edatate mobilization test. 39 patients received chelation therapy. These data suggest that neurological manifestations occur frequently in those abusing leaded gasoline and that chelation therapy has an important place in their management.     

Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy

MethodsA retrospective database review of all patients with a diagnosis of APMPPE was performed. Clinical, ophthalmological, and neurological data were analyzed, and only cases of APMPPE with neurological complications were included. A literature review of several databases was also performed, and previous case reports were reviewed and analyzed in detail.ResultsIn total, 56 cases of APMPPE-associated neurological complications were included in the analyses: 54 from the literature and 2 from our own practice. The most common complication was cerebral vasculitis, which affected 28 patients (50%), followed by headaches in 15 patients (26.8%). The other complications include sixth-cranial-nerve palsy, transient hearing loss, meningoencephalitis, cavernous sinus thrombosis, and viral meningitis.ConclusionsThis report adds to the literature of a novel association of APMPPE with peripheral neuropathy, and comprehensively reviews the neurological manifestations of this disease. A high level of suspicion should be applied when dealing with a case of APMPPE. We recommend applying detailed clinical neurological examinations and magnetic resonance imaging to APMPPE patients, and then early steroid treatment if the examination is positive or even suspicious. Early treatment with steroids and long-term treatment with immunosuppressive azathioprine with interval neurological evaluations will contribute positively to the outcomes and avoid fatal complications, namely strokes.     

寨卡病毒感染引发神经系统表现的研究进展

寨卡病毒在巴西和美国等国家大规模爆发流行,而且是目前最大的一次爆发流行。寨卡病毒可引起非特异性的发热。然而,一系列合并神经系统并发症的病例报道如小头畸形和吉兰-巴雷综合征等显示与寨卡病毒感染有关,提示寨卡病毒是嗜神经性病毒。寨卡病毒感染后引发的神经系统疾病相继被报道,如脑膜脑炎、脊髓炎和视觉损害等。既往众多报道提示寨卡病毒感染和神经系统症状之间关系密切,但需对此次爆发流行进行长期的纵向研究和建立动物或活体外实验模型研究,才能更好的帮助临床医生了解该疾病的发病机制。     

Neurological Manifestations Associated with Cold Hemagglutinin Syndrome Report of Two Cases

Two cases of cold hemagglutinin syndrome associated with neurological manifestations were reported. One was a 52-year-old woman with acute hemolytic anemia which developed following grippe. Cold hemagglutinin titer was elevated to 1:1,024. Neurological manifestations were apathy, confusion, auditory hallucination and EEG abnormality. Steroid administration cleared these neurological abnormalities and EEG was reverted to normal. The other was a 77-year-old man with chronic hemolytic anemia. Cold hemagglutinin titer was extraordinarily elevated (1:32,768, 1:524,-288). Neurological abnormalities were almost confined to the cerebellar system. Hormonal therapy was completely unrewarding and the patient was incapacitated from his daily activity. From the literature some of the reported cases of hemolytic anemia associated with neurological abnormalities, particularly in reference to cold hemagglutinin syndrome, were briefly described. The present authors consider 2 reported cases fall in the category of “Syndromes neuro-hémolytiques” by French school.     

Neurological Manifestations of COVID-19: A systematic review and current update

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December of 2019 in the city of Wuhan, China. Since the outbreak, various reports detail its symptoms and outcomes, primarily focusing on respiratory complications. However, reports are emerging of the virus’ effects systemically, including that of the nervous system. A review of all current published literature was conducted, and we report that headache and anosmia were common neurological manifestations of SARS-CoV-2. Less common symptoms include seizure, stroke and isolated cases of Guillain-Barre syndrome. Further research is now warranted to precisely determine the relationship between those patients developing neurological sequelae, their clinical state and any subsequent morbidity and mortality.     

Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea

Background and PurposeTo investigate the incidence and characteristics of neurological manifestations associated with coronavirus disease 2019 (COVID-19).MethodsWe reviewed the medical records of the consecutive patients with COVID-19 who were admitted to the central infectious diseases hospital designated for the treatment of COVID-19 in South Korea between March 2020 and September 2020. Newly developed neurological manifestations associated with COVID-19 were investigated. The frequency and clinical features of the neurological manifestations were analyzed according to disease severity, which was classified according to World Health Organization interim guidance.ResultsOf the 306 symptomatic patients, 186 (60.8%) developed at least one neurological manifestation during hospitalization. The most common neurological symptom was headache (n=102, 33.3%), followed by myalgia (n=96, 31.4%) and anosmia/ageusia (n=54, 17.6%). Acute stroke (all ischemic stroke) occurred in three (1.0%) patients, and new-onset seizures occurred in two (0.7%). Neurological manifestation was a presenting symptom of COVID-19 in 72 (23.5%) patients, and was the only symptom of COVID-19 in 12 (3.9%). Stroke, seizure, and impaired consciousness were significantly associated with severe to critical COVID-19, whereas headache and anosmia/ageusia were frequently found in patients with mild to moderate disease.ConclusionsNeurological manifestations were commonly observed in patients with COVID-19. During the current pandemic, when patients present with new-onset neurological symptoms, COVID-19 may be considered as part of the differential diagnosis. Attention to severe neurological complications is needed, especially in patients with severe or critical COVID-19.     

一氧化碳中毒后迟发性脑病的影像学、电生理学临床分析

目的 :了解CO中毒后迟发性脑病 (DEACMP)的影像学、电生理及临床特点。方法 :对 184例DEACMP患者的假愈期、急性期、恢复期的临床表现和头部CT、MRI、EEG、BAEP、TCD、rCBF、智能等进行对比分析。结果 :CT异常率 91 3 % ,MRI异常率 97% ,EEG、TCD、BAEP均为 10 0 %异常 ,智力测验 10 0 %异常。结论 :影像学改变轻于临床表现 ,电生理改变与临床一致 ,EEG在假愈期有意义 ,脑血流检测能真实反映病情 ,智能恢复较慢 ,对判断患者真正痊愈有价值。及时、长期坚持治疗和锻炼有助于患者的恢复。     

Neurological Manifestations in Chagas Disease without Cardiac Dysfunction: Correlation between Dysfunction of the Parasympathetic Nervous System and White Matter Lesions in the Brain

Chagas disease (American Trypanosomyasis) is endemic in South America. It has been associated with autonomic dysfunction and increased stroke risk.  

OBJECTIVE

To correlate findings in neurological examination, autonomic nervous system function, and brain magnetic resonance imaging (MRI), in patients with chronic Chagas disease.  

METHODS

Neurological findings of 64 patients from a hospital cohort were correlated with disease stage (according to Los Andes classification) and with signs of autonomic nervous system function (respiratory sinus arrhythmia test). Also, 27 subjects with no cardiac dysfunction (phase IA) had MRI evaluation. Results were correlated with autonomic nervous system variables using Spearman correlation coefficient and Mann-Whitney test.  

RESULTS

There was a significant correlation between the presence and number of white matter hyperintensities in MRI and the respiratory sinus arrhythmia test. There was no correlation between disease stage and autonomic nervous system dysfunction.  

CONCLUSION

There is a significant correlation between parasympathetic nervous system dysfunction and the presence of white matter lesions in patients with chronic Chagas disease without cardiac dysfunction. The pathogenesis of such lesions is unknown, but cardiac arrhythmias could be involved. As hypertension was frequent in our sample and also correlated to MRI hyperintensities, studies excluding hypertensive patients are needed to confirm our results.     

Autoimmunity and inflammation in the peripheral nervous system

Peripheral Nerve Society Biennial Meeting, organized in conjunction with the Austrian Federal Ministry of Education, Research and Culture, held at Telfs, Tyrol, Austria from 8-12 September 2001.     

Neurological diseases in the aged

In this paper, I described clinical and basic problems on neurology of the aged patients. These studies have been done in various institutions with many co-workers. 1) A PET study revealed some age differences on CBF, CMRO2, or CMRgl. But these results are not so rigid in which much of individual variations should be considered in interpretation. Calendar age is not always compatible to biological age. 2) Saccular aneurysms in the brain artery were found in 7.3% of 1200 routine autopsy series of the aged subjects. Aneurysms with external diameter exceeding 6 mm had been fatally ruptured in 14 (78%) of 18 subjects. 3) Variations of the pyramidal crossing are found responsible for bizarre clinical manifestations. Non-crossing component was more prominent in the right pyramidal tract; consequently, right pyramidal tracts including ventral and lateral one seemed to have more extensive representation in the spinal cord level. 4) I123-IMP SPECT study showed a reduced uptake in the area 4 or area 4-6 of the ALS patients. 5) I introduced a new simplified Wartenberg's maneuver, which is useful for detection of subtle pyramidal dysfunctions. 6) Cases with central pontine myelinolysis and those of paraneoplastic syndrome were presented with an emphasis on their patho-chemical mechanisms. 7) Lewis-Sumner syndrome showing multifocal persistent conduction block is not rare in the aged, in which we have already had some useful therapeutic methods. 8) Dementia complicated with neurodegenerative disease was discussed on its clinical and chemical features of mental disturbances. In ALS-dementia, CSF-homovanilic acid reduced significantly than in the control and L-dopa was effective in some patients. 9) Vascular and Alzheimer-type dementias were presented and discussed on their pathogenetic mechanism according to our recent studies with review of literature.