With the progress of medical and health conditions, the incidence and mortality of encephalitis and meningitis caused by traditional pathogens have decreased. However, due to the change of pathogen spectrum of neurological infection, the improvement of detection methods of neurological infection pathogens and the emergence of new evidence of pathogens causing neurodegenerative diseases, it is necessary to rethink the clinical characteristics and diagnosis and treatment of neurological infectious diseases (NID). At the same time, post-infectious/para-infectious nervous system diseases (PPINDs) that do not directly enter the central nervous system are increasing after the SARS-CoV-2 epidemic. Therefore, we propose to attach importance to the disciplinary characteristics and discipline construction of Infectious Neurology with NID and PPINDs as the two major themes, and to improve the diagnosis and treatment of NID and PPINDs through multi-disciplinary cooperation and specialized training.
Since 2017, human encephalitis caused by pseudorabies virus (PRV) has been reported in 28 cases in China. The clinical symptoms include fever, headache, seizures, focal neurological loss, disturbance of consciousness, etc.. This disease has the high disability rate and fatality rate. PRV is mainly transmitted through close contact with infected pigs or their excrement, or spread via blood - borne. Patients are mostly practitioners in the live pig industry chain. Early diagnosis and treatment are critical to the prognosis of patients. Therefore, this article reviews the progress on diagnosis and treatment of human encephalitis caused by PRV, in order to improve the clinical diagnosis and treatment of this disease.
Objective: To summarize the clinical features of infection-associated autoimmune encephalitis (IAE) with different antibodies in Xinjiang region, and to explore the diagnostic value of relevant laboratory indicators for IAE. Methods: A total of 47 patients with IAE diagnosed and treated in People's Hospital of Xinjiang Uiger Autonomous Region from January 2018 to October 2023 were enrolled, including 18 cases (38.30%) of anti-leucine-rich glioma-inactivated 1 (LGI1) antibody-associated encephalitis, 16 cases (34.04%) of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, 8 cases (17.02%) of anti-myelin oligodendrocyte glycoprotein (MOG) antibody- associated encephalitis, and 5 cases (10.64%) of anti-γ-aminobutyric acid receptor type B (GABABR) encephalitis. Social demographic data, clinical manifestations, laboratory and other examinations were collected, and receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of relevant laboratory indicators for IAE. Results: The age of onset (χ2 = 9.500, P = 0.023), myasthenia (χ2 = 9.967, P = 0.019), vision loss (χ2 = 9.967, P = 0.019) and seizures (χ2 = 8.046, P = 0.045), cerebrospinal fluid (CSF) white blood cell count (χ2 = 15.237, P = 0.002) and chloride (F = 4.156, P = 0.011) in patients with anti-LGI1 antibody-associated encephalitis, anti-NMDAR encephalitis, anti-MOG antibody-associated encephalitis and anti-GABA BR encephalitis were statistically significant. The age of onset in patients with anti-LGI1 antibody- associated encephalitis was larger than that in patients with anti-NMDAR encephalitis (Z =-2.384, P = 0.017) and anti- MOG antibody-associated encephalitis (Z =-2.420, P = 0.016). The CSF white blood cell count in patients with anti-NMDAR encephalitis was higher than that in patients with anti-LGI1 antibody-associated encephalitis (Z =-3.307, P = 0.001) and anti-MOG antibody-associated encephalitis (Z =-2.835, P = 0.005). CSF chloride was higher in patients with anti-NMDAR encephalitis (t = 3.159, P = 0.007) and anti-GABABR encephalitis (t =-4.592, P = 0.007) than in patients with anti-LGI1 antibody-associated encephalitis. ROC curve showed that the area under the curve (AUC) of age of onset for diagnosis of anti-LGI1 antibody-associated encephalitis was 0.722 (95%CI: 0.569-0.875, P = 0.012), the sensitivity was 0.556, the specificity was 0.821, and the cut-off value was 54.50 years old. The AUC of CSF white blood cell count in the diagnosis of anti-LGI1 antibody-associated encephalitis was 0.706 (95%CI: 0.558-0.855, P = 0.019), the sensitivity was 0.889, the specificity was 0.571, and the cut- off value was 4.50 × 106/L. The AUC in the diagnosis of anti-NMDAR encephalitis was 0.790 (95%CI: 0.643-0.937, P = 0.002), the sensitivity was 0.600, the specificity was 0.967, and the cut-off value was 13.50 × 106/L. The AUC of CSF chloride for the diagnosis of anti-LGI1 antibody-associated encephalitis was 0.748 (95%CI: 0.598-0.898, P = 0.005), with a sensitivity of 0.722 and a specificity of 0.714, and a cut- off value of 122.70 mmol/L. Conclusions: IAE with different antibodies in Xinjiang region has specific clinical features. Age of onset, CSF white blood cell count and chloride have important value in the diagnosis of anti-LGI1 antibody-associated encephalitis, and CSF white blood cell count has important value in the diagnosis of anti-NMDAR encephalitis.
Objective: To summarize the clinical characteristics of Vogt-Koyanagi-Harada syndrome (VKHS) combing with meningitis/encephalitis patients. Methods and Results: The clinical data of the inpatients of Beijing Tongren Hospital, Capital Medical University from January 2009 to December 2022 with VKHS combing with meningitis/encephalitis were retrospectively analyzed. A total of 23 patients were included in the study, of which 20 patients (86.96%) had neurological symptoms, with headache being the most common (19 cases, 82.61%), 11 patients (47.83%) had increased cerebrospinal fluid (CBF) pressure, 14 patients (60.87%) had increased CBF white blood cells, and 11 patients (47.83%) had increased CBF protein. The brain MRI mainly showed white matter demyelination (8/14 cases). Optic nerve MRI showed inflammatory lesions of optic nerve and optic papilla (12/14 cases). The visual evoked potential (VEP) mainly showed prolonged latency (10/16 cases). The optical coherence tomography (OCT) showed retinal exudation (8/15 cases) and retinal neurocortical detachment (7/15 cases). The main results of fundus photography were disc edema (17/18 cases). The main manifestation of fundus fluorescein angiography (FFA) was uveitis (9/15 cases). After intravenous hormone and intravenous immunoglobulin (IVIg) treatment, 14 patients were followed up, and neurological symptoms were completely relieved, 11 patients had good visual prognosis, and 3 patients had no obvious visual improvement. Conclusions: VKHS might present with meningitis/encephalitis symptoms, and the CSF characteristics of these patients were similar to those of viral meningitis. For those with early suspicions of VKHS, CBF examination and imaging examination might assist in early diagnosis and treatment.
Objective: To analyze the clinical features and prognostic factors of herpes simplex virus type 1 (HSV-1) encephalitis. Methods: A total of 51 patients with HSV-1 encephalitis hospitalized in He'nan Provincial People's Hospital from January 2018 to September 2023 were selected, and their clinical data, laboratory and imaging examination results were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis of patients and the recovery of neurological function after brain injury. Univariate and multivariate stepwise Logistic regression analyses were screened for risk factors of adverse prognosis of HSV-1 encephalitis. Results: The main symptoms of 51 cases were fever and headache. The serological examination results showed increased white blood cell count (14 cases), increased neutrophil count (14 cases), decreased lymphocyte count (8 cases), and decreased serum sodium level (17 cases). Cerebrospinal fluid (CSF) examination by lumbar puncture showed increased CSF pressure (18 cases), increased white blood cell count (28 cases), increased protein (32 cases), and increased glucose (15 cases). There were 48 patients who underwent head MRI examination, and 43 patients (89.58%) showed obvious brain region involvement on head MRI, among which 35 patients (72.92%) with positive MRI showed typical unilateral or bilateral temporal and frontal lobe involvement, and 8 cases (16.67%) with increased cerebral pia mater enhancement. 66.67% (34/51) of the patients recovered completely within 6 months after discharge, 21.57% (11/51) of the patients had sequelae, and the fatality rate was 11.76% (6/51). There were 34 (66.67%) patients with good prognosis and 17 (33.33%) patients with adverse prognosis. Multivariate Logistic regression analysis showed age increased (OR = 1.090, 95%CI: 1.020-1.200; P = 0.023) and increased CSF glucose level (OR = 23.800, 95%CI: 23.800-1250.000; P = 0.030) were risk factors for adverse prognosis in HSV-1 encephalitis patients. Conclusions: Increased aging and CSF glucose level are risk factors for the adverse prognosis in HSV-1 encephalitis patients. In clinical practice, it is necessary to master the clinical characteristics of patients with HSV-1 encephalitis, so as to achieve early detection, diagnosis and treatment.
Objective: To analyze the risk factors for dismal prognosis in patients with cryptococcal meningitis and construct a prediction scoring system Nomogram model. Methods: A total of 100 patients with cryptococcal meningitis who treated with anticryptococcal therapy admitted to Affiliated Hospital of Zunyi Medical University from January 2010 to August 2022 were selected. The patients were divided into favorable prognosis group (n = 19) and dismal prognosis group (n = 81) according to the results of cerebrospinal fluid (CSF) cryptococcal culture during hospitalization and clinical symptoms and signs at the time of discharge. Risk factors were screened by using univariate and multivariate stepwise Logistic regression analyses. A Nomogram model was constructed based on the risk factors, the receiver operating characteristic (ROC) curve and calibration curves of the model were plotted, and Hosmer-Lemeshow goodness-of-fit test was performed. Results: The proportion of patients in the dismal prognosis group with Nutritional Risk Screening 2002 (NRS 2002) score (Z = -3.898, P = 0.000), CSF pressure > 250 mm H2O (χ2 = 9.512, P = 0.002) and duration of antifungal treatment < 14 d (χ2 = 17.847, P = 0.000) on admission were higher than those in the favorable prognosis group, and the blood routine red blood cell count (t = -2.802, P = 0.006) and lymphocyte count (Z = -2.878, P = 0.004), plasma albumin (t = -4.332, P = 0.000), and the proportion of amphotericin B application (χ2 = 4.597, P = 0.032) were lower than those in the favorable prognosis group. Logistic regression analysis showed the admission high NRS 2002 score (OR = 3.258, 95%CI: 1.337-7.940; P = 0.009), CBF pressure > 250 mm H2O (OR = 0.108, 95%CI: 0.018-0.659; P = 0.016), and the duration of antifungal treatment < 14 d (OR = 0.092, 95%CI: 0.011-0.742; P = 0.025) were risk factors for dismal prognosis of cryptococcal meningitis. A Nomogram model was constructed based on the above 3 risk factors, and the area under the ROC curve was 0.927 (95%CI: 0.873-0.980, P = 0.000), which predicted a cut-off value of 53.50 points for dismal prognosis in cryptococcal meningitis; the calibration curve (with good consistency), and the Hosmer-Lemeshow goodness-of-fit test (χ2 = 2.694, P = 0.912) indicated that the model had good discrimination, calibration and stability. Conclusions: Patients with cryptococcal meningitis with a high NRS 2002 score, CSF pressure > 250 mm H2O, and antifungal treatment < 14 d had a dismal prognosis, and the Nomogram model constructed accordingly has a high predictive value of dismal prognostic risk.
Background: Para-infectious encephalopathy is an acute inflammatory encephalopathy secondary to a systemic infectious disease, including acute necrotizing encephalopathy (ANE) and mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). This paper reports on 3 cases of SARS-CoV-2 related to para-infectious encephalopathy diagnosed and treated in The Ordos Central Hospital of Inner Mongolia Autonomous Region from December 2022 to February 2023, and reviews relevant literature to summarize the clinical characteristics of the disease. Methods and Results: The 3 patients with SARS-CoV-2 related to para-infectious encephalopathy, including 2 cases of SARS-CoV-2 related to ANE and one case of SARS-CoV-2 related to MERS were reported. Three patients developed consciousness disorder 2-4 d after fever, and still had aphasia, mental abnormality, convulsions, etc.. SARS-CoV-2 throat swab was positive. Head MRI showed one abnormal signal of brain stem and bilateral thalamus, one abnormal signal of bilateral thalamus, and one abnormal pressure of corpus callosum. All received hormone shock therapy and (or) intravenous immunoglobulin. One died, and 2 cases were recovered. Conclusions: SARS-CoV-2 related to para-infectious encephalopathy including SARS-CoV-2 related to ANE and MERS and other clinical subtypes, the former has rapid progress, severe disease, high disability rate and fatality rate and poor prognosis, while the latter has relatively mild symptoms and better prognosis.
Background: Central nervous system aspergillosis is clinically rare. We present one case of central nervous system aspergillosis diagnosed by pathology, analyze its clinical features, review the literature, and summarize key diagnostic and therapeutic points. Methods and Results: The patient, a 50-year-old woman, presented clinically with progressive weakness in limbs, epileptic seizures, and cognitive decline. Systemic inflammation-immune markers and cerebrospinal fluid (CSF) analysis showed no significant abnormalities. Head MRI revealed abnormal signals in both frontal and parietal lobes with patchy and ring-enhancing lesions and meningeal enhancement. Neuropathology suggested vasculitis and brain tissue necrosis with hemorrhage. Periodic acid methenamine staining revealed fungal hyphae with apparent septation and branching at 45° angles. The final diagnosis was central nervous system aspergillosis. Following antifungal and other symptomatic treatments, the patient's symptoms improved, and follow-up brain MRI showed reduction in lesion size. Conclusions: Patients with central nervous system aspergillosis may not have a clear underlying immunodeficiency, and clinical manifestations are lack of specificity. CSF may show no inflammatory changes, and metagenomic next-generation sequencing (mNGS) may be negative. Brain biopsy is the primary diagnostic method. Early, adequate and full-course antifungal treatment with voriconazole can improve the prognosis.
Objective: To evaluate the reliability, validity and diagnostic accuracy of the Canadian Longitudinal Study on Aging Epilepsy Algorithm (CLSA - EA) questionnaire (Chinese version) in screening Chinese adult epilepsy. Methods: From August to October 2022, a total of 384 subjects and patients were included, who were respectively screened from urban and rural communities in Chengdu, Sichuan, and Department of Neurology of West China Hospital, Sichuan University. The CLSA - EA questionnaire (Chinese version) was used for the survey. Epilepsy was diagnosed according to 2014 International League Against Epilepsy (ILAE) criteria. Kappa coefficient and Cronbach's α coefficient were used to evaluate test- retest reliability and internal consistency, respectively. Construct validity was used to test validity. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic consistency κ value were calculated by confusion matrix method to evaluate the effect of screening. Results: Finally, 348 questionnaires were obtained, including 190 epileptic cases (54.60%) and 158 non-epileptic cases (45.40%), of which 244 were retested subjects, including 123 epileptic cases (50.41%) and 121 non-epileptic cases (49.59%). Retest reliability analysis in epileptic cases showed that the consistency of items Q3a, Q3b ⅲ, Q3b ⅳ, Q4a and Q4b in CLSA - EA questionnaire (Chinese version) had moderate consistency (0.400 ≤ κ < 0.750; P = 0.000, for all). Items Q1, Q2, Q3bⅰ, Q3bⅱ, Q3bⅴ, Q3bⅵ and Q3bⅶ had poor consistency (0.000 ≤ κ < 0.400;P < 0.05, for all). In non-epileptic cases, the consistencies of items Q2, Q3a, Q3bⅰ, Q4a and Q4b were moderate (P = 0.000, for all), Q3bⅴ and Q3bⅵ were poor (P = 0.000, for all), and no consistencies of Q3b ⅱ, Q3b ⅲ and Q3b ⅳ were found (P > 0.05, for all). The internal consistency evaluation in epileptic cases showed that the internal consistency of all items and the sum of all items in the CLSA -EA questionnaire (Chinese version) were poor (Cronbach's α coefficient < 0.700). The internal consistency of items Q4a and Q4b for non-epileptic patients was also poor, but other items and the sum of all items were acceptable (Cronbach's α coefficient 0.700-0.800). The structural validity analysis showed that the cumulative variance contribution rate of the four factors was only 43%, and items Q1 and Q3a were not incorporated into the factors. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and consistency of CLSA - EA2 epilepsy determination algorithm were higher (> 0.900, for all). Conclusions: The CLSA - EA questionnaire (Chinese version) has high sensitivity and specificity, which can guide the preliminary screening of epilepsy in China. However, the applicability, reliability and validity still need to be further considered.
Objective: To investigate the rehabilitation effects of vestibular rehabilitation in acute brainstem infarction patients with subjective visual vertical (SVV) tilting, and the correlation between the SVV, balance confidence, dizziness/vertigo and walking function. Methods: All 45 acute brainstem infarction patients with SVV tilting who were hospitalized in Tianjin Huanhu Hospital from July 2022 to July 2023 were collected. Patients were divided into vestibular rehabilitation group (n = 25) and general rehabilitation group (n = 20), Bucket Test was used to test SVV tilting angle, Activities - Specific Balance Confidence Scale (ABC) was used to evaluate balance confidence, Visual Analog Scales (VAS) was used to evaluate dizziness/vertigo and Functional Ambulation Category Scale (FAC) was used to evaluate walking function before and after 2 weeks of treatment. Results: The SVV tilting angle (F = 4.356, P = 0.043), ABC score (F = 4.389, P = 0.042), dizziness/vertigo VAS score (F = 4.138, P = 0.048) were significantly different between vestibular rehabilitation group and general rehabilitation group. After treatment, the SVV tilting angle (t = - 2.139, P = 0.038) and the dizziness/vertigo VAS score (t = - 2.952, P = 0.005) in vestibular rehabilitation group were lower than those in general rehabilitation group, and the ABC score was higher than that in general rehabilitation group (t = 2.920, P = 0.006). SVV tilting angle (F = 196.923, P = 0.000), ABC score (F = 89.050, P = 0.000), dizziness/vertigo VAS score (F = 81.803, P = 0.000), FAC grade (F = 72.866, P = 0.000) were statistically significant. The SVV tilting angle (t = 0.763, P = 0.000; t = 0.972, P = 0.000) and dizziness/vertigo VAS score (t = 8.815, P = 0.000; t = 5.107, P = 0.000) after treatment were lower than those before treatment of 2 groups, and the ABC score (t = 0.689, P = 0.001; t = 0.703, P = 0.001) and FAC grade (t = - 6.721, P = 0.000; t = - 5.772, P = 0.000) were higher than those before treatment of 2 groups. Correlation analysis showed a positive correlation between SVV tilting angle and dizziness/vertigo VAS score in acute brainstem infarction patients with SVV tilting (r = 0.627, P = 0.000). Conclusions: Vestibular rehabilitation can effectively improve the SVV tilting, balance confidence and dizziness/vertigo symptoms of acute brainstem infarction patients with SVV tilting, and the SVV tilting angle is closely related to the degree of dizziness/vertigo.
Delayed hyponatremia is a common endocrinologic complication after transsphenoidal surgery, also the most frequent cause of hospital readmissions post surgery. It usually occurs in the 5th to 7th day post operation. Patients can present without symptoms when they encounter mild or moderate hyponatremia, sometimes presenting symptoms such as nausea, headache and vomiting, etc.. In patients with severe hyponatremia, neuropsychiatric symptoms, cerebral edema and even death can occur. The risk factors related to this condition is various and complicated, and yet lack of standard procedures for prevention and monitoring. This article aims to provide a review of the literatures regarding pathophysiology, patient characteristics, monitoring and diagnosis, prevention and intervention of delayed hyponatremia after transsphenoidal surgery, thus enhancing acknowledgement on this condition and providing evidence for clinical practice.