SARS-CoV-2-related encephalitis with prominent parkinsonism: clinical and FDG-PET correlates in two patients

Considering the similarities with other pandemics due to respiratory virus infections and subsequent development of neurological disorders (e.g. encephalitis lethargica after the 1918 influenza), there is growing concern about a possible new wave of neurological complications following the worldwide spread of SARS-CoV-2. However, data on COVID-19-related encephalitis and movement disorders are still limited. Herein, we describe the clinical and neuroimaging (FDG-PET/CT, MRI and DaT-SPECT) findings of two patients with COVID-19-related encephalopathy who developed prominent parkinsonism. None of the patients had previous history of parkinsonian signs/symptoms, and none had prodromal features of Parkinson's disease (hyposmia or RBD). Both developed a rapidly progressive form of atypical parkinsonism along with distinctive features suggestive of encephalitis. A possible immune-mediated etiology was suggested in Patient 2 by the presence of CSF-restricted oligoclonal bands, but none of the patients responded favorably to immunotherapy. Interestingly, FDG-PET/CT findings were similar in both cases and reminiscent of those observed in post-encephalitic parkinsonism, with cortical hypo-metabolism associated with hyper-metabolism in the brainstem, mesial temporal lobes, and basal ganglia. Patient's FDG-PET/CT findings were validated by performing a Statistical Parametric Mapping analysis and comparing the results with a cohort of healthy controls (n = 48). Cerebrum cortical thickness map was obtained in Patient 1 from MRI examinations to evaluate the structural correlates of the metabolic alterations detected with FDG-PET/CT. Hypermetabolic areas correlated with brain regions showing increased cortical thickness, suggesting their involvement during the inflammatory process. Overall, these observations suggest that SARS-CoV-2 infection may trigger an encephalitis with prominent parkinsonism and distinctive brain metabolic alterations

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

BACKGROUND: Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. METHODS: We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. RESULTS: We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region. INTERPRETATION: Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis.

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

A new genus of indo-west pacific turridae (Gastropoda : Prosobranchia)

Volume: 48Start Page: 136End Page: 14

MAURO MORASSI & ANTONIO BONFITTO (2013) Four new African turriform gastropods (Mollusca: Conoidea). Zootaxa, 3710(3), 271-280.

Morassi, Mauro, Bonfitto, Antonio (2013): MAURO MORASSI & ANTONIO BONFITTO (2013) Four new African turriform gastropods (Mollusca: Conoidea). Zootaxa, 3710(3), 271-280. Zootaxa 3718 (2): 200-200, DOI: 10.11646/zootaxa.3718.2.

Horaiclavus ordinei Bonfitto & Morassi, 2014, sp. nov.

Horaiclavus ordinei sp. nov. Figures 1 M–T Type material. Holotype (MZB 60081) and paratype (MZB 60082). Type locality. Balicasag Island, Philippines trawled by local fishermen at about 200 m. Material examined. 2 dd from the type locality. Description. Shell broadly claviform (b/l 0.53–0.57; a/l 0.41–0.44) (Fig. 1.M–P) with a moderately high orthoconoid spire and a short, contracted and quite strongly tapering base. Protoconch papilliform of about 1 ½ smooth whorls (Fig. 1 S–T). Maximum protoconch diameter 0.57 mm. Teleoconch of up to about five whorls with deeply impressed, strongly wavy suture. Whorls strongly convex with an angled periphery just below mid-whorl height on earlier whorls, at middle on last two whorls. Subsutural ramp narrow, shallowly concave. Axial sculpture of strong, slightly arcuate and weakly opisthocline folds, extending from suture to suture, slightly weakening on subsutural ramp and extending on base but not on rostrum. Axial ribs of rounded triangular cross-section, interspaces concave, slightly broader to about the same width as ribs. There are nine axial folds on last two teleoconch whorls. Spiral sculpture commencing with a peripheral cord forming shoulder angle, joined on second whorl by a closely-spaced weaker cord below periphery, and a third cord near abapical suture on last two whorls (Fig. 1 Q); in the paratype of fourth rather weak spiral cord in the interspace between the two adapical cords and cord bordering abapical suture. Last whorl has three spiral threads on base and five threads on rostrum. Aperture oval, with a distinct, narrow, proportionally long (for genus) siphonal canal. Inner lip has a relatively thick callus forming a weak parietal tubercle. Fasciole is strong; a shallow but distinct false umbilicus is present. Outer lip has with heavy varicoid-rib behind thin lip edge. Anal sinus shallow but distinct. Shell pale buff colored. Dimensions: Holotype: 5.8 x 3.1 mm, aperture height 2.4 mm. Paratype: 4.9 x 2.8 mm, aperture height 2.2 mm. Etymology. Named after Professor Nuccio Ordine of the University of Calabria, Italy. Remarks. Horaiclavus ordinei sp. nov. is a rather peculiar species morphologically and is characterized by its small dimensions, relatively low spire, strong fasciole, relatively long siphonal canal and presence of few but distinct spiral cords. The southwestern Pacific species Horaiclavus phaeocercus Sysoev in Fedosov & Kantor, 2008 and H. anaimus Sysoev in Fedosov & Kantor, 2008 are superficially similar to the new species in proportions but attain a larger size (up to about 6 mm in length vs ca. 12 mm) and lack spiral sculpture on spire whorls. Among Horaiclavus species, H. multicostatus (Schepman, 1913) from Indonesia has a distinct spiral cord forming a peripheral angulation on spire whorls, but otherwise spiral sculpture in restricted to base and rostrum. Shuto proposed the monotypic subgenus Anguloclavus Shuto, 1983 for H. multicostatus (Schepman, 1913) but the status of this latter taxon, as well as of the two species here described, will remain uncertain until anatomical and/or molecular features become known.Published as part of Bonfitto, Antonio & Morassi, Mauro, 2014, Two new Horaiclavus (Horaiclavidae, Conoidea) species from the Indo-Pacific region, pp. 146-150 in Zootaxa 3821 (1) on page 149, DOI: 10.11646/zootaxa.3821.1.12, http://zenodo.org/record/22971

Cryptodaphne kilburni, a new species of bathyal turrid (Gastropoda : Prosobranchia) from the Gulf of Aden (Northwestern Indian Ocean)

Volume: 48Start Page: 230End Page: 23

New Indo-Pacific species of the genus Teretia Norman, 1888 (Gastropoda: Raphitomidae)

Four new species are assigned to the genus Teretia Norman, 1888 in the family Raphitomidae Bellardi, 1875 and herein described: Teretia neocaledonica sp. nov., T. sysoevi sp. nov., T. tongaensis sp. nov. from the southeastern Pacific and Teretia tavianii sp. nov. from the Gulf of Aden. The new species represent the first Indo-Pacific record of a genus previously known in the recent molluscan fauna by only two species from the Atlantic Ocean-Mediterranean Sea and Southern Africa. A possible Tethyan origin for the genus Teretia is suggested

New species of the genus Otitoma Jousseaume, 1898 (Pseudomelatomidae, Conoidea) from the Western Pacific Ocean

Twelve new species are assigned to the genus Otitoma Jousseaume, 1898 in the family Pseudomelatomidae Morrison, 1966 and herein described: O. hadra sp. nov., O. neocaledonica sp. nov., O. rubiginostoma sp. nov and O. tropispira sp. nov. from New Caledonia; O. boucheti sp. nov., O. nereidum sp. nov. and O. sororcula sp. nov. from the Fiji Islands; O. xantholineata sp. nov. from the Solomon to the Fiji Islands; O. crassivaricosa sp. nov. from Fiji to Hiva Oa Island (Marquesas Archipelago); O. philpoppei sp. nov. from the Philippines but also reported from the Fiji Islands; O. elegans sp. nov. from the Fiji Islands and O. philippinensis sp. nov. from the Philippines. New data on O. carnicolor (Hervier, 1896) are provided. Otitoma mitra (Kilburn, 1986), from Southern Mozambique, is here considered a synonym of O. cyclophora (Deshayes, 1863). Drillia batjanensis Schepman, 1913, previously assigned to the genus Maoritomella Powell, 1942 in the family Borsoniidae Bellardi, 1875, is here assigned to the genus Otitoma. Photographs of the holotype of Drillia batjanensis are provided for the first time. In addition, color photographs of the type specimens of the following species are provided: Drillia kwandangensis Schepman, 1913, D. timorensis Schepman, 1913 and Mitrellatoma mitra Kilburn, 1986

Dural Metastases of Advanced Prostate Cancer Detected by 18F-Fluorocholine

Prostate cancer with extensive dural metastases is very rare, with only few cases described in the literature. We report one such case of a 74-year-old man with advanced prostate cancer, and in relatively good clinical condition. The patient returned with complaints of headache and diplopia. Fluorocholine (18F) chloride (18F-FCH) is an analog of choline in which a hydrogen atom has been replaced by fluorine (18F). After crossing the cell membrane by a carrier-mediated mechanism, choline is phosphorylated by choline kinase to produce phosphorylcholine. 18F-FCH positron emission tomography–computed tomography (PET/CT) is widely used to stage and restage patients affected by prostate cancer with good sensitivity. 18F-FCH PET/CT showed disease progression with the onset of multiple skull lesions. Numerous suspicious dural hypermetabolic lesions indicating neoplastic involvement were detected along the fronto-parietal convexities, in the left fronto-orbital region and right lateral wall of the orbit, concerning for metastases in these regions. A contrast-enhanced computed tomography (CECT) scan was performed which showed corresponding enhancing tissue which correlated with the PET findings. The final imaging diagnosis was osteo-dural metastases from prostate cancer associated with poor outcome. Awareness of this pattern of metastases may be of clinical relevance in order to avoid unnecessary invasive diagnostic procedures in groups of patients with a dismal prognosis