Neuroinfectious Diseases
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Potential chronic neurologic complications of COVID-19Cognitive function. Approximately one-third of hospitalized COVID-19 patients with severe clinical features who are subsequently discharged have deficits in executive function.4 The long-term outcomes for these patients are not clear. It also is unknown whether these patients are at risk for the development of a progressive dementia similar to that observed in HIV/AIDS.29Demyelinating disease. In experimental animal models, coronaviruses initiate the formation of CNS demyelinating lesions similar to those seen in multiple sclerosis.30 At this point in time, there has not been a reported increase in MS-like diseases in patients who have recovered from COVID-19. However, assessment of the long-term impact of COVID-19 on the development of neurologic and autoimmune diseases will require clinical monitoring over several years.
Diseases of the Nervous System
George Feuer, Felix A. de la Iglesia in Molecular Biochemistry of Human Disease, 2020
Myelin sheaths are highly specialized structures in the central nervous system interfascicular obligodendroglia and in the peripheral system Schwann cells. Myelin is very reactiveto ischemia or trauma and disintegrates if the axon is lost by injury. In some disease conditions, myelin-forming cells or myelin sheaths are primary targets and axonal alterations, gliosis, and phagocytosis follow secondarily. A wide variety of injuries can bring about destruction of the myelin sheath. Sometimes the demyelinating disease is secondary to damage of the neurons. Demyelinating diseases are relatively common disorders, but their etiology in most cases is unknown. Characteristic symptoms are scattered and localized areas show myelin breakdown and gliosis. The main locations of the demyelinated areas are the white matter of the brain, spinal cord, and optic nerves. Demyelination is considered to be the reaction of the nervous system to injury and the primary cause of this lesion can be, therefore, very different.
Neuroanatomy of the Functional Aging Brain
José León-Carrión, Margaret J. Giannini in Behavioral Neurology in the Elderly, 2001
In the transmission of information within the brain and between the central nervous system (CNS) and the periphery, myelin plays an important role related to velocity and reliability. Normally, when a demyelinating disease appears, neurobehavioral and cognitive deficits can be observed. Normal cognitive development requires normal myelination of the pathways of the CNS. One of the most frequent and easily observed abnormalities in MRI images is the well-known white matter hyperintensities (WMH) or leukoaraiosis (see Figure 4.1). A study by Salonen et al.6 found that signal intensity of the white matter increased concomitantly with widening of the cerebrospinal fluid spaces while basal ganglia remained stable. High-signal foci in white matter increased in number and size after the age of 50, and the periventricular high-signal foci were constant after the age of 65. They suggest that their visual impression of a decrease in signal intensity of the central gray matter with age seems to be mistaken. Pathological processes should be suspected if periventricular foci are found in middle-aged or young subjects.
Primary central nervous system lymphoma with no enhancement initially and no significant progression over a long term: a case report and review of the literature
Published in International Journal of Neuroscience, 2019
Ning-ning Hu, Man-man Zhang, Yan-yan Chen, Bei-lei Zhu
The patient was diagnosed as central nervous system demyelinating disease. Brain biopsy was suggested for the first time to exclude primary central nervous system lymphoma but was declined by the patient’s families. After quitting smoking, controlling blood glucose and blood pressure, and receiving antiplatelet, anxiolytic, and sleep-improving therapy, the patient’s symptoms improved substantially. Half a month later, re-examination of the cranial MRI indicated that the lesion was subsided than before, so hormone therapy was not administrated to the patient. A third cranial MRI scan was performed in June 2017, from which further subsidence of old lesions was suggested, while newly developed lesions were spotted in the left parietal lobe (Figure 1). The diagnosis of demyelinating disease seemed to be further supported. However, no special treatment was given as there was no complaint from the patient.
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
Definitions for neuropsychiatric manifestations, including a minimal set of investigation and attribution criteria, are the first step toward a standardization. Positive experience has been made in other autoimmune diseases, such as systemic lupus erythematosus. Therefore, we consider that an international, multidisciplinary study could significantly contribute and make an important step toward diagnostic and/or classification criteria for neuropsychiatric manifestations in pSS. So far, these have been classified as PNS, CNS (Diffuse, focal, and spinal cord involvement), and ANS. Some manifestations, such as demyelinating disease, have to be differentiated from multiple sclerosis and neuromyelitis optica. Definition criteria and attribution could significantly impact future studies allowing comparisons of different cohorts and validation of biomarkers.
Spinal cord involvement in COVID-19: A review
Published in The Journal of Spinal Cord Medicine, 2023
Ravindra Kumar Garg, Vimal Kumar Paliwal, Ankit Gupta
Acute transverse myelitis is clinically characterized by sensorimotor disturbances, bladder/bowel dysfunction, and/or autonomic dysfunction attributable to the spinal cord. Typically, it manifests as a rapid disease progression within a few hours to up to 21 days, with a sharp sensory affection level, bilateral pyramidal signs, and bladder/bowel dysfunction. While neuroimaging is not usually suggestive of compressive myelopathy, cerebrospinal fluid (CSF) examination may reveal inflammatory changes.1,2 Acute demyelinating diseases of the central nervous system, such as multiple sclerosis, neuromyelitis optica spectrum disorder, and acute disseminated encephalomyelitis are other frequently encountered causes of acute myelitis. Moreover, many viruses can be directly implicated in the etiopathogenesis of acute transverse myelitis, including varicella-zoster, herpes simplex, Epstein–Barr, West Nile, Dengue, Japanese encephalitis, Zika, influenza, echovirus & hepatitis B, mumps, measles, and rubella viruses. However, most often, it is difficult to differentiate between a viral-induced and immune-mediated transverse myelitis.2,3 Furthermore, there is an increasing number of reports that have linked the SARS-CoV-2 virus to the pathogenesis of acute transverse myelitis.4–6 The spinal cord involvement can result either from the direct invasion of the spinal cord, cytokine storm, or an autoimmune response.
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