Comment on "Paraneoplastic encephalomyelitis revealing burned-out seminoma": confirmed case of anti-Kelch-like protein-11 encephalomyelitis.

No abstract availabl

Acute stroke care during the COVID-19 pandemic: difficult, but not impossible!

Amid the coronavirus disease 2019 (COVID-19) pandemic, neurologists have been confronted with unprecedented situations, among which acute stroke management in COVID-19 patients. To the best of our knowledge, this is the first report of protected code stroke in Belgium. [...

Levodopa-responsive Holmes head titubation caused by midbrain cavernoma hemorrhage

Herein we report a patient with a rare delayed-onset Holmes head titubation after midbrain cavernoma hemorrhage that dramatically responded to levodopa treatment. To our knowl- edge, the levodopa responsiveness of a Holmes head titubation has not yet been reported with accompanying video footage

Levodopa-responsive Holmes head titubation caused by midbrain cavernoma hemorrhage

Herein we report a patient with a rare delayed-onset Holmes head titubation after midbrain cavernoma hemorrhage that dramatically responded to levodopa treatment. To our knowl- edge, the levodopa responsiveness of a Holmes head titubation has not yet been reported with accompanying video footage

SARS-CoV-2-associated Guillain-Barré syndrome in four patients: what do we know about pathophysiology?

A growing number of Guillain-Barré syndrome (GBS) and Miller Fisher Syndrome (MFS) cases following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are reported. Nevertheless, this association is still debated, and pathophysiology remains unclear. Between April and December 2020, in three hospitals located in Brussels, Belgium, we examined four patients with GBS following SARS-CoV-2 infection.  Neurological onset occurred 3 weeks after SARS-CoV-2 symptoms in all patients. Three patients presented with acute inflammatory demyelinating polyneuropathy (AIDP) and had negative anti-ganglioside testing: two suffered from a severe SARS-CoV-2 infection and had good clinical outcome after intravenous immunoglobulin (IVIG) treatment; one with mild SARS-CoV-2 infection had spontaneously favorable evolution without treatment. The fourth patient had critical SARS-CoV-2 infection and presented acute motor and sensory axonal neuropathy (AMSAN) with clinical features highly suggestive of brainstem involvement, as well as positive anti-ganglioside antibodies (anti-GD1b IgG) and had partial improvement after IVIG. We report four cases of SARS-CoV-2-associated GBS. The interval of 3 weeks between SARS-CoV-2 symptoms and neurological onset, the clinical improvement after IVIG administration, and the presence of positive anti-ganglioside antibodies in one patient further support the hypothesis of an immune-mediated post-infectious process. Systematic extensive antibody testing might help for a better understanding of physiopathology

Assessing thermal sensitivity using transient heat and cold stimuli combined with a Bayesian adaptive method in a clinical setting: a proof of concept study.

BACKGROUND: Quantitative sensory testing of thermal detection abilities is used as a clinical tool to assess the function of pain pathways. The most common procedure to assess thermal sensitivity, the "method of limits", provides a quick but rough estimate of detection thresholds. Here, we investigate the potential of evaluating not only the threshold but also the slope of the psychometric functions for cold and warm detection. METHOD: A convenience sample of 15 patients with diabetes mellitus (DM) and 15 age-matched healthy controls (HC) was tested. Thirty brief (100 ms) stimuli of each modality were applied to the volar wrist and foot dorsum. Cold and warm stimuli were delivered with a Peltier thermode and a temperature-controlled CO2 laser, respectively. Stimulus intensities were dynamically selected using an adaptive Bayesian algorithm (psi method) maximizing information gain for threshold and slope estimation. ROC analyses were used to assess the ability of slopes, thresholds and the combination of both to discriminate between groups. RESULTS: Assessment of the slope and threshold of the psychometric function for thermal detection took about 10 minutes. The ability to detect warmth was not reduced in DM patients as compared to HC. Cold detection performance assessed using slope or threshold parameters separated DM from HC with good discriminative power. Discrimination was further increased when both parameters were used together (93% sensitivity and 87% specificity), indicating that they provide complementary information on patient status. CONCLUSION: The psi method may be an interesting alternative to the classical method of limits for thermal QST

Intravenous immunoglobulin-induced aseptic meningitis in a patient with Miller Fisher syndrome.

Dear Editor, Intravenous immunoglobulin (IVIG) is an established treatment for multiple conditions, including Miller Fisher syndrome (MFS). Although IVIG is considered safe, serious adverse efects may occur during or shortly after IVIG administration. Herein, we report a case of aseptic meningitis following IVIG treatment for MFS. To the best of our knowledge, no such association has been previously reported in a patient with MFS. [...

Focal status epilepticus may trigger relapse of primary angiitis of the CNS.

The role of neuroinflammation in epileptogenesis is extensively investigated, but short-term effects of seizures on established CNS pathologies are less studied and less predictable. We describe the case of a woman with previous recurrent episodes of focal cerebral haemorrhage of unknown cause who developed a pseudo-tumoural oedema triggered by provoked focal status epilepticus. A brain biopsy revealed that the underlying condition was primary angiitis of the CNS. Ictal-induced blood-brain barrier dysfunction allows the entry of water and inflammatory molecules that, in the context of CNS inflammatory diseases, may trigger a self-reinforcing process. Caution should be observed when tapering antiepileptic drugs in patients with such conditions