Browsing by Author "Arsenijević, Mirjana (57357620400)"

Herpes simplex encephalitis (HSVE), manifesting with non-convulsive status epilepticus (NCSE), normocellular CSF findings and CT features of acute ischemic stroke, is a rare finding that can be hard to diagnose accurately. We present a case of HSVE and compare our results to those of previously published cases with the same pathology, in order to provide information to support more rapid and effective diagnosis and treatment. A Pubmed search of reported cases was conducted and five cases of HSVE manifesting with NCSE were found. Each of the cases, including ours, was compared in terms of clinical manifestations and CSF, CT and EEG findings. The clinical manifestations in our patient correlated with those of the other cases. EEG showing sharp fronto-temporo-centro-parietal waves was only observed in our patient. Similar CT manifestations were found in one other patient, normocellular CSF was registered in three other cases and positive PCR for HSV in four patients. Information about the possible clinical manifestations and CT, EEG and CSF findings in patients with HSVE manifesting with NCSE is crucial for a fast diagnosis and successful treatment, leading to higher survival rates and fewer complications and neurological deficits. © 2021 Epileptic Disorders

Herpes simplex encephalitis (HSVE), manifesting with non-convulsive status epilepticus (NCSE), normocellular CSF findings and CT features of acute ischemic stroke, is a rare finding that can be hard to diagnose accurately. We present a case of HSVE and compare our results to those of previously published cases with the same pathology, in order to provide information to support more rapid and effective diagnosis and treatment. A Pubmed search of reported cases was conducted and five cases of HSVE manifesting with NCSE were found. Each of the cases, including ours, was compared in terms of clinical manifestations and CSF, CT and EEG findings. The clinical manifestations in our patient correlated with those of the other cases. EEG showing sharp fronto-temporo-centro-parietal waves was only observed in our patient. Similar CT manifestations were found in one other patient, normocellular CSF was registered in three other cases and positive PCR for HSV in four patients. Information about the possible clinical manifestations and CT, EEG and CSF findings in patients with HSVE manifesting with NCSE is crucial for a fast diagnosis and successful treatment, leading to higher survival rates and fewer complications and neurological deficits. © 2021 Epileptic Disorders

Background: Central nervous system involvement is rarely described in eosinophilic granulomatosis with polyangiitis (EGPA) and occurs in 5–9% of patients. Among central nervous system manifestations, cerebral infarctions are the most common. To the best of our knowledge, a recurrent stroke in patients with EGPA without cardiac risk factors during maintenance therapy so far has not been described. Case presentation: A previously healthy 57-year-old female during the course of 1 year developed asthma, sinusitis, polyneuropathy, muscle weakness, and rash followed by fatigue, myalgia, arthralgia, and fever. After an initial diagnostic evaluation, elevated values of eosinophils, liver enzymes, creatine kinase, lactate dehydrogenase, and inflammatory markers (sedimentation rate and C-reactive protein) were found, and renal impairment was detected. On the third day of hospitalization, she developed left-sided hemiparesis due to an ischemic stroke in the right basal ganglia. She has been diagnosed with EGPA, and oral corticosteroid, immunosuppressive, and antiplatelet therapy were applied. Despite potent treatment and initial recovery, a few weeks later, she developed recurrent ischemic stroke in the left hemisphere and pulmonary embolism as rare and potentially severe complications of EGPA. Assuming that complete disease remission had not been established previously, oral prednisone was initially substituted with intravenous methylprednisolone pulses. During follow-up, immunosuppressive therapy was slowly discontinued, oral corticosteroid therapy was reduced to a maintenance dose, and thromboembolic events were well controlled by oral anticoagulant therapy. Conclusion: Anticoagulant therapy, in addition to immunosuppressive maintenance therapy, should be considered in any EGPA patient who has had an ischemic stroke even without cardiac risk factors. © 2021, The Author(s).

Background: Central nervous system involvement is rarely described in eosinophilic granulomatosis with polyangiitis (EGPA) and occurs in 5–9% of patients. Among central nervous system manifestations, cerebral infarctions are the most common. To the best of our knowledge, a recurrent stroke in patients with EGPA without cardiac risk factors during maintenance therapy so far has not been described. Case presentation: A previously healthy 57-year-old female during the course of 1 year developed asthma, sinusitis, polyneuropathy, muscle weakness, and rash followed by fatigue, myalgia, arthralgia, and fever. After an initial diagnostic evaluation, elevated values of eosinophils, liver enzymes, creatine kinase, lactate dehydrogenase, and inflammatory markers (sedimentation rate and C-reactive protein) were found, and renal impairment was detected. On the third day of hospitalization, she developed left-sided hemiparesis due to an ischemic stroke in the right basal ganglia. She has been diagnosed with EGPA, and oral corticosteroid, immunosuppressive, and antiplatelet therapy were applied. Despite potent treatment and initial recovery, a few weeks later, she developed recurrent ischemic stroke in the left hemisphere and pulmonary embolism as rare and potentially severe complications of EGPA. Assuming that complete disease remission had not been established previously, oral prednisone was initially substituted with intravenous methylprednisolone pulses. During follow-up, immunosuppressive therapy was slowly discontinued, oral corticosteroid therapy was reduced to a maintenance dose, and thromboembolic events were well controlled by oral anticoagulant therapy. Conclusion: Anticoagulant therapy, in addition to immunosuppressive maintenance therapy, should be considered in any EGPA patient who has had an ischemic stroke even without cardiac risk factors. © 2021, The Author(s).

Introduction: There are no many data on association between progression rate of Guillain-Barré syndrome (GBS) and disease outcome. Aim: The aim of our study was to analyze short-term outcome of GBS in relation to the rate of disease progression. Methods: Our retrospective study included patients diagnosed with GBS in seven tertiary healthcare centers from 2009 to 2014. According to the rate of disease progression from onset of symptoms to the nadir, patients were divided in three groups: rapid-onset GBS (nadir reached in maximum 48 h), gradual-onset (nadir reached in three to 14 days), and slow-onset (nadir in 15 to 28 days). GBS disability scale (GDS) was used to assess functional disability at nadir and on discharge. Results: Among 380 patients included in the study, 24 (6.3%) patients had rapid-onset, 274 (72.1%) gradual-onset, and 82 (21.6%) slow-onset GBS. Time from the onset of the disease to the hospital admission was much shorter in faster-onset forms (3.0 ± 4.1 days in rapid-onset vs. 6.8 ± 9.5 days in gradual-onset and 21.0 ± 9.6 days in slow-onset GBS, p < 0.01). Preceding events were less commonly identified in slow-onset forms. Patients with rapid-onset GBS were more likely to have axonal variants (p < 0.05). All three groups of patients were treated in a similar way, and there were no differences in GDS score at nadir (p > 0.05) and on discharge (p > 0.05) and no differences in the duration of hospital stay. Conclusion: Faster progression of GBS does not imply a poorer short-term functional outcome of the disease. © 2020, Royal Academy of Medicine in Ireland.