27 research outputs found
Immundiagnostik der Tuberkulose mittels rascher durchflusszytometrischer Detektion antigenspezifischer T-Zellen bei latenter Infektion und aktiver Erkrankung
PLWH treated with modern ART and high CD4 T cell counts: no evidence of HIV-associated vasculopathy measured by extra- and intracranial ultrasound
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Is It Lupus? Is It Neuromyelitis Optica Spectrum Disorder (NMOSD)? : Why Not Both?
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are among
the commonly considered differential diagnoses in patients with inflammatory central nervous system (CNS)-diseases. Formerly diagnosed competing autoimmune diseases might impair diagnostics
and treatment. Here, we report on a 41-year-old woman admitted to our hospital with primary
manifestation of NMOSD (paresthesia, paralysis of the lower extremities, and urinary incontinence)
while undergoing treatment for a diagnosed systemic lupus erythematosus (SLE) with hydroxychloroquine. CNS manifestation of the disease was considered. Magnetic resonance imaging (MRI)
of the cranium and spinal cord showed multiple supratentorial lesions of the white matter and
massive intramedullary lesions with contrast enhancement. Cerebrospinal fluid (CSF) showed pleocytosis (20/µL), positive antinuclear antibodies (ANA), antiphospholipid antibodies, and SSA/Ro
antibodies, while formerly positive dsDNA antibodies were negative. Further diagnostics revealed
a 1:10,240 serum titer of Aquaporine-4 antibodies. The patient received intravenous methylprednisolone for three days (2 g per day), which led to an escalation to plasmapheresis and to an improved
EDSS from 8.0 to 4.0. Because of the comorbidity, a combined relapse prophylaxis with satralizumab
and mycophenolate mofetil was established. Rehabilitation and continued treatment improved
EDSS to 1.0 with no impairment of mobilization. Although formerly diagnosed SLE could have
explained the symptoms, it is important to reconsider competitive diseases in order to establish
adequate immunotherap
Acute stroke treatment and outcome in the oldest old (90 years and older) at a tertiary care medical centre in Germany-a retrospective study showing safety and efficacy in this particular patient population
Background
Stroke is among the most common causes of death and disability worldwide. Despite the relevance of stroke-related disease burden, which is constantly increasing due to the demographic change in industrialized countries with an ageing population and consecutively an increase in age-associated diseases, there is sparse evidence concerning acute stroke treatment and treatment-related outcome in the elderly patient group. This retrospective study aimed at analysing patient characteristics, therapy-related complications and functional outcome in stroke patients aged 90 years or older who underwent acute stroke treatment (i.e. intravenous thrombolysis, mechanical thrombectomy, or both).
Methods
We identified files of all inpatient stays at the Department of Neurology at Saarland University Medical Center (tertiary care level with a comprehensive stroke unit) between June 2011 and December 2018 and filtered for subjects aged 90 years or older at the time of admission. We reviewed patient files for demographic data, symptoms upon admission, (main) diagnoses, comorbidities, and administered therapies. For patients admitted due to acute stroke we reviewed files for therapy-related complications and functional outcome. We compared the modified Rankin scale (mRS) scores upon admission and at discharge for these patients.
Results
We identified 566 inpatient stays of subjects aged 90 years or older. Three hundred sixty-seven of the 566 patients (64.8%) were admitted and discharged due to symptoms indicative of stroke. Two hundred eleven patients received a diagnosis of ischaemic stroke. These 211 patients were analysed subsequently. Sixty-four patients qualified for acute stroke treatment (intravenous thrombolysis n = 22, mechanical thrombectomy n = 26, intravenous thrombolysis followed by mechanical thrombectomy n = 16) and showed a significant improvement in their functional status as measured by change in mRS score (admission vs. discharge, p 0.001) with 7 (10.9%) observed potentially therapy-related complications (relevant drop in haemoglobin n = 2, subarachnoidal haemorrhage n = 1, cerebral haemorrhage n = 3, extracranial bleeding n = 1). One intravenous thrombolysis was stopped because of an uncontrollable hypertensive crisis. Patients who did not qualify for these treatments (including those declining acute treatment) did not show a change of their functional status between admission and discharge (p 0.064).
Conclusion
Our data indicate that acute stroke treatment is effective and safe in the oldest old. Age alone is no criterion to withhold an acute intervention even in oldest old stroke patients
Consecutive Eyeball Pressure Tests Reflect Clinically Relevant Vagal Dysfunction and Recovery in a Patient With Guillain-Barré-Syndrome With Tenacious Cardiac Dysautonomia
Cardiac dysautonomia is a potentially life-threatening complication of Guillain-Barré
syndrome (GBS). Proper and prompt recognition of patients at risk and subsequent
intensive care unit (ICU) monitoring are mandatory to prevent fatal outcome. Eyeball
pressure testing (EP) has been suggested as an easy applicable bedside test for vagal
overreactivity in GBS and thus identifying patients at risk. Yet, there is only sparse
follow-up data concerning the course of EP findings in GBS. We report a 25 years-old
male patient with GBS who underwent consecutive EP (n = 11) during his ICU stay over
a period of 11 weeks. The series of tests performed in this patient (and corresponding
clinical events) show that EP data might represent an approximation of vagal dysfunction
and vagal recovery in GBS. Interestingly, we observed a much longer duration of
pathological EP compared to a previous report. The tenacious cardiac dysautonomia in
this patient necessitated long-term application of a transvenous temporary pacemaker
Short-chain fatty acids and intestinal inflammation in multiple sclerosis: modulation of female susceptibility by microbial products?
Background: Multiple Sclerosis (MS) is an autoimmune-mediated disease of the central nervous system. Experi mental data suggest a role of intestinal microbiota and microbial products such as short-chain fatty acids (SCFAs) in
the pathogenesis of MS. A recent clinical study reported benefcial efects (mediated by immunomodulatory mecha nisms) after oral administration of the SCFA propionate in MS patients. Based on available evidence, we investigated
whether SCFAs and the fecal infammation marker calprotectin are altered in MS.
Methods: 76 subjects (41 patients with relapsing–remitting MS and 35 age-matched controls) were investigated in
this case–control study. All subjects underwent clinical assessment with established clinical scales and provided fecal
samples for a quantitative analysis of fecal SCFA and fecal calprotectin concentrations. Fecal markers were com pared between MS patients and controls, and were analyzed for an association with demographic as well as clinical
parameters.
Results: Median fecal calprotectin concentrations were within normal range in both groups without any group-spe cifc diferences. Fecal SCFA concentrations showed a non-signifcant reduction in MS patients compared to healthy
subjects. Female subjects showed signifcantly reduced SCFA concentrations compared to male subjects.
Conclusions: In our cohort of MS patients, we found no evidence of an active intestinal infammation. Yet, the vast
majority of the investigated MS patients was under immunotherapy which might have afected the outcome meas ures. The sex-associated diference in fecal SCFA concentrations might at least partially explain female predominance
in MS. Large-scale longitudinal studies including drug-naĂŻve MS patients are required to determine the role of SCFAs
in MS and to distinguish between disease-immanent efects and those caused by the therapeutic regime
Neurologic Consultations and Headache during Pregnancy and in Puerperium : A Retrospective Chart Review
Headache is a common symptom during pregnancy and in puerperium that requires careful
consideration, as it may be caused by a life-threatening condition. Headaches in pregnant women
and women in puerperium are classified as primary or secondary; acute, severe and newly diagnosed
headaches should prompt further investigation. We aimed to further characterise the demographic
features, symptoms, examination findings, and neuroimaging results of cases of headache during
pregnancy and in puerperium. All pregnant women or women in postpartum conditions who
attended neurological consultations at the emergency department of the clinic for Gynaecology,
Obstetrics and Reproductive Medicine of Saarland University/Germany between 2001/2015 and
2012/2019 were enrolled in this retrospective chart review. Data collected from the charts included
demographic/pregnancy characteristics, clinical features and imaging findings. Descriptive statistics
as well as binary logistic regression were performed. More than 50% of 97 patients had abnormal
findings in their neurological examination. Magnetic resonance imaging findings were pathological
for almost 20% of patients—indicating conditions such as cerebral venous thrombosis, reversible
posterior leukoencephalopathy, brain tumour and intracranial bleeding. The odds of abnormal
neuroimaging results were 2.2-times greater among women with abnormal neurological examination
findings than among those with normal examination results. In cases of headache during pregnancy
and in puerperium, neuroimaging should be indicated early on. Further research is needed to
determine which conditions indicate a need for immediate neuroimaging
Case report: cerebral sinus vein thrombosis in two patients with AstraZeneca SARS-CoV-2 vaccination
SARS-CoV-2 infection is associated with an increased rate of thromboembolic events and mortality. Diferent vaccines are
globally used to limit the pandemic. In this report, we present the case of two young female patients with newly diagnosed
cerebral sinus vein thrombosis occurring after injection of the vector-based ChAdOx1 vaccine. Both patients presented
with unusual headache only. The two of them used an estrogen-containing contraception, had had a history of deep venous
thrombosis, and both had MTHFR mutations. Both patients developed SARS-CoV-2 specifc humoral and cellular immunity
including both CD4 and CD8 T cells. This rare, but serious complication needs to be considered after vaccination of young
females, even if there is no evidence of heparin-induced thrombocytopenia
Identification of Neural Mechanisms in First Single-Sweep Analysis in oVEMPs and Novel Normative Data
Background: Bone-conducted (BC) VEMPs provide important tools for measuring otolith
function. However, two major drawbacks of this method are encountered in clinical practice—small
n10 amplitude and averaging technique. In this study, we present the results of a new VEMP setup
measuring technique combined with a novel single-sweep analysis. Methods: The study included
BC oVEMP data from 92 participants for the evaluation of normative data using a novel analysis
technique. For evaluating test-retest reliability, the intraclass correlation coefficient (ICC) was used.
Results: We found significant n10 amplitude differences in single-sweep analyses after the first and
second measurements. Thereby, mathematical analyses of the head movement did not show any
differences in the first or second measurements. The normative n10 amplitude was 20.66 µV with
an asymmetric ratio (AR) of 7%. The new value of late shift difference (LSD) was 0.01 ms. The test
retest-reliability showed good to excellent ICC results in 9 out of 10 measurements. Conclusions:
Our results support a phenomenon in single-sweep analysis of the first stimuli independent of head
movement and signal morphology. Furthermore, the values obtained with the new measurement
method appear to be more sensitive and may allow an extended diagnostic range due to the new
parameter LSD
Alterations in pathogen-specific cellular and humoral immunity associated with acute peripheral facial palsy of infectious origin
Background Peripheral facial palsy (PFP) is a common neurologic symptom which can be triggered by pathogens, autoimmunity, trauma, tumors, cholesteatoma or further local conditions disturbing the peripheral section
of the nerve. In general, its cause is often difcult to identify, remaining unknown in over two thirds of cases. As we
have previously shown that the quantity and quality of pathogen-specifc T cells change during active infections, we
hypothesized that such changes may also help to identify the causative pathogen in PFPs of unknown origin.
Methods In this observational study, pathogen-specifc T cells were quantifed in blood samples of 55 patients
with PFP and 23 healthy controls after stimulation with antigens from varicella-zoster virus (VZV), herpes-simplex
viruses (HSV) or borrelia. T cells were further characterized by expression of the inhibitory surface molecule CTLA-4,
as well as markers for diferentiation (CD27) and proliferation (Ki67). Pathogen-specifc antibody responses were analyzed using ELISA. Results were compared with conventional diagnostics.
Results Patients with PFP were more often HSV-seropositive than controls (p=0.0003), whereas VZV- and borreliaspecifc antibodies did not difer between groups. Although the quantity and general phenotypical characteristics
of antigen-specifc T cells did not difer either, expression of CTLA-4 and Ki67 was highly increased in VZV-specifc
T cells of 9 PFP patients, of which 5 showed typical signs of cutaneous zoster. In the remaining 4 patients, a causal
relationship with VZV was possible but remained unclear by clinical standard diagnostics. A similar CTLA-4- and Ki67-
expression profle of borrelia-specifc T cells was also found in a patient with acute neuroborreliosis.
Discussion In conclusion, the high prevalence of HSV-seropositivity among PFP-patients may indicate an underestimation of HSV-involvement in PFP, even though HSV-specifc T cell characteristics seem insufcient to identify HSV
as a causative agent. In contrast, striking alterations in VZV- and borrelia-specifc T cell phenotype and function may
allow identifcation of VZV- and borrelia-triggered PFPs. If confrmed in larger studies, antigen-specifc immune-phenotyping may have the potential to improve specifcity of the clinical diagnosis