Pathophysiology, diagnosis, and management of neuroinflammation in covid-19

Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome. Physicians should be aware of the pathophysiology underlying these presentations to diagnose and treat patients rapidly and appropriately. Although good evidence has been found for neurovirulence, the neuroinvasive and neurotropic potential of SARS-CoV-2 is limited. The pathophysiology of most complications is immune mediated and vascular, or both. A significant proportion of patients have developed long covid, which can include neuropsychiatric presentations. The mechanisms of long covid remain unclear. The longer term consequences of infection with covid-19 on the brain, particularly in terms of neurodegeneration, will only become apparent with time and long term follow-up

Neurology and the histiocytoses: a case of Rosai-Dorfman-Destombes disease

The histiocytoses are a group of rare disorders characterised by the accumulation of neoplastic or non-neoplastic activated histiocytes in various tissues. Phenotypes vary widely from cutaneous lesions or lymphadenopathy that regress spontaneously to disseminated disease with poor prognosis. Neurological symptoms can be a presenting feature or appear during the course of disease. We present a challenging diagnostic and management case of Rosai-Dorfman-Destombes disease in a 48-year-old woman with a relapsing, partially steroid-responsive syndrome comprising patchy, non-length-dependent radiculoneuropathy with diffuse pachymeningitis and widespread systemic disease, and recent dramatic response to novel mitogen-activated kinase pathway inhibition. We discuss the clinical characteristics, diagnosis, recent breakthroughs in pathogenesis and emerging treatment options for Rosai-Dorfman disease and for the histiocytoses with neurological sequelae, including Langerhans cell histiocytosis and Erdheim-Chester disease

Learning to see the invisible:A data-driven approach to finding the underlying patterns of abnormality in visually normal brain magnetic resonance images in patients with temporal lobe epilepsy

OBJECTIVE: To find the covert patterns of abnormality in patients with unilateral temporal lobe epilepsy (TLE) and visually normal brain magnetic resonance images (MRI-negative), comparing them to those with visible abnormalities (MRI-positive). METHODS: We used multimodal brain MRI from patients with unilateral TLE and employed contemporary machine learning methods to predict the known laterality of seizure onset in 104 subjects (82 MRI-positive, 22 MRI-negative). A visualization approach entitled "Importance Maps" was developed to highlight image features predictive of seizure laterality in both the MRI-positive and MRI-negative cases. RESULTS: Seizure laterality could be predicted with an area under the receiver operating characteristic curve of 0.981 (95% confidence interval [CI] =0.974-0.989) in MRI-positive and 0.842 (95% CI = 0.736-0.949) in MRI-negative cases. The known image features arising from the hippocampus were the leading predictors of seizure laterality in the MRI-positive cases, whereas widespread temporal lobe abnormalities were revealed in the MRI-negative cases. SIGNIFICANCE: Covert abnormalities not discerned on visual reading were detected in MRI-negative TLE, with a spatial pattern involving the whole temporal lobe, rather than just the hippocampus. This suggests that MRI-negative TLE may be associated with subtle but widespread temporal lobe abnormalities. These abnormalities merit close inspection and postacquisition processing if there is no overt lesion

Political Regime Types and Varieties of Post-Socialist Capitalism in the Era of Globalization

For the former state socialist countries 1989 was the year of the starting of the simultaneous transformation of their political regimes and economic systems. This entailed attempts at remaking simultaneously the political and economic institutions of these countries under the conditions of opening up their economies and entering the ‘era of globalization’. These countries have ended a developmental model that was built upon the combination of authoritarian political regime, state control of the economy combined with limited links to the global markets. In 1989 they started their pathways towards some uncertain something else, away from autocracy, command economy and autarchy. The goal of this chapter is to provide a description of and an explanation for the diverging pathways of the post-socialist countries that have combined different political regime types with specific varieties of capitalism and have ended up with dramatically different patterns of insertion into the global markets