Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries

Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20–37) versus 47 (IQR 32–58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11–40]) than in HICs (44/102 [43%, 95% CI 34–53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.</p

Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.</p

p.Gly743Val Mutation in COL4A1 Is Responsible for Familial Porencephaly and Severe Hypermetropia

COL4A1 is an essential component for basal membrane stability. Exon mutations of the COL4A1 genes are responsible for a broad spectrum of cerebral, ocular, and systemic manifestations. We describe here the phenotype of a likely pathogenic gene variant, p.Gly743Val, which is responsible for a missense mutation in the COL4A1 gene exon 30 in a three generation family with severe hypermetropia and highly penetrant porencephaly in the absence of systemic manifestations. This report highlights both the broad spectrum of COL4A1 mutations and the yield of testing the COL4A1 gene in familial ophthalmological and brain disorders.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Epileptic activity in neurological deterioration after ischemic stroke, a continuous EEG study

Objective: Despite improvement in acute stroke care, almost 40% of patients with ischemic stroke present neurological deterioration. Neurological deterioration is associated with higher death and dependency rates. Neurological deterioration mechanisms are unknown, and half of neurological deterioration remains unexplained. We postulate that a substantial proportion of neurological deterioration in ischemic stroke is associated with periodic discharges/non-convulsive seizures that negatively impact the recovery of ischemic stroke and worsen symptoms. Methods: Retrospective review of 24 h continuous EEG monitoring (cEEG) performed for neurological deterioration in the stroke unit of a tertiary academic centre. Results: Eighty-one patients were included. cEEG detected epileptic activities in 44% of cases (Non-convulsive seizures/non-convulsive status epilepticus: 10/81 (12%), periodic discharges: 17/81 (21%) and sporadic epileptiform discharges in 14/81 (17%)). The proportion of patients who did not receive recanalization therapy was significantly higher in the NCSE/NCSz/PDs group than in the group devoid of NCSE/NCSz/PDs: 17/22 (77%) vs 13/59 (22%); p < 0,001. Treatment of Non-convulsive seizures /non-convulsive status epilepticus and periodic discharges was followed by EEG improvement in respectively 7/8 and 10/16 of treated patients. Conclusions: Non-convulsive seizures /non-convulsive status epilepticus /periodic discharges are associated to neurological deterioration after ischemic stroke. Significance: Treatment of Non-convulsive seizures /non-convulsive status epilepticus and periodic discharges, if such patterns are detected, could help prevent adverse metabolic consequences of epileptic activities on ischemic brain tissue.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Céphalées, sténose bilatérale des carotides et parésie du XII isolés révélant une granulomatose avec polyangéite

INTRODUCTION La granulomatose avec polyang'eite (GPA/Wegener) est une vascularite n'ecrosante syst'emique des petits vaisseaux. L'atteinte neurologique centrale combine classiquement une m'eningite lymphocytaire et une atteinte multiple de nerfs cr^aniens. OBSERVATION Une patiente de 54 ans, sans ant'ec'edents m'edicaux notables, se pr'esente avec des c'ephal'ees d'apparition progressive depuis deux mois, centr'ees sur l'oreille gauche, irradiant dans toute l'h'emiface. Ces 'episodes r'ecidivants de c'ephal'ee avaient temporairement disparu gr^ace `a un traitement par cortico"ides prescrit pour hypoacousie aigu"e bilat'erale. La patiente a perdu 10 kilos en 8 mois dans un contexte d'odynophagie et asth'enie. L'examen neurologique est normal hormis une par'esie de l'h'emilangue gauche. Les examens biologiques r'ev`elent une hyperplaquettose et une vitesse de s'edimentation (VS) `a 92mm/H. Les ANCA sont titr'es `a 1/160, de sp'ecificit'e antig'enique anti-prot'einase 3. L'ARM d'emontre une st'enose de la portion pr'e-p'etreuse des deux art`eres carotides internes, associ'ee `a un processus infiltrant de l'espace carotidien et une pachym'eningite. Une l'esion nodulaire sous-pleurale apicale gauche et les espaces carotidiens sont hyperm'etaboliques en TEP-FEDG. L'art`ere temporale a un aspect histologique normal. La fibroscopie nasale retrouve des zones n'ecrotico-h'emorragiques au niveau du bourrelet tubaire gauche caract'eris'ees par la pr'esence de l'esions granulomateuses avec quelques cellules g'eantes (marquages CD68, CD34 positifs). Un diagnostic de GPA est pos'e. DISCUSSION Les c'ephal'ees unilat'erales et les st'enoses carotidiennes dans un contexte inflammatoire 'evoquent une maladie de Horton. Cependant, l'imagerie a mis en 'evidence non pas une atteinte vasculitique per se des carotides mais un infiltrat d'allure inflammatoire des espaces carotidiens et de l'apex pulmonaire finalement attribu'e `a une GPA sur base de la pr'esence de granulomes `a l'histopathologie et de cANCA anti-prot'einase 3. CONCLUSION Nous d'ecrivons un cas de GPA dont l'originalit'e consiste en une infiltration inflammatoire des espaces carotidiens responsable d'une par'esie isol'ee du XII gauche et de c'ephal'ees homolat'erales.info:eu-repo/semantics/publishe

Headache, bilateral carotid stenosis, and hypoglossal palsy revealing granulomatosis with polyangiitis: An innovative application of vessel-wall mri

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis

Background and purpose: Reports on the safety and efficacy of intraventricularly administered (IVT) colistin for the treatment of Acinetobacter baumannii ventriculomeningitis in adults are limited and no comparative studies of IVT colistin versus intravenous (IV) therapy alone have been published. This study compared outcomes of patients with postneurosurgical ventriculomeningitis caused by extensively drug-resistant A. baumannii treated with IV colistin or IV plus IVT colistin. Methods: In an 11-year period, information on 18 consecutive patients with extensively drug-resistant A. baumannii ventriculomeningitis was collected. Infection was defined on the basis of (i) isolation of A. baumannii from the cerebrospinal fluid (CSF); (ii) laboratory evidence of CSF infection; (iii) signs/symptoms of central nervous system (CNS) infection. Patients were divided into group 1 (nine patients, IV colistin alone) and group 2 (nine patients, IV plus IVT colistin). Results: Cerebrospinal fluid sterilization was documented for 12 of 18 patients (66.6%). The CSF sterilization rate was 33.3% in group 1 and 100% in group 2 (P = 0.009). The mean time to CSF sterilization was 21 days (range 8-48). Five patients died due to A. baumannii CNS infection (all in group 1), and five deaths were unrelated to A. baumannii ventriculomeningitis. Intensive care unit mean length of stay was shorter in group 2 (20.7 vs. 41.6 days, P = 0.046). Crude relative risk ratio of cumulative incidence of persistent CNS infection in group 1 versus group 2 was 13. No cases of chemical meningitis due to intrathecal colistin administration were encountered. Conclusions: Intraventricular colistin administration is much more effective than IV therapy alone and does not seem to add further toxicity

Presence of 'ghosts' and mortality after transvenous lead extraction

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