Clinical Neuroscience

[COVID-19 with strange hallucinations and focal EEG abnormalities: Two case reports]

CLEMENS Béla 1

JULY 30, 2022

Clinical Neuroscience - 2022;75(07-08)

DOI: https://doi.org/10.18071/isz.75.0284

Case Reports

[Scientific literature about the ongoing COVID-19 disease and pandemic is considerable, though articles concentrate on the severe cases and their central nervous system manifestations. This article demonstrates two cases: middle-aged female patients who had serologically proven SARS-CoV-2 infection with mild upper airway and central nervous system symptoms. The patients reported vivid, strange, simple, and complex visual and auditory hallucinations. A characteristic element of these complex hallucinations was a talking human-shaped figure. Only three similar cases have been published; this article discusses common features of all five patients. This summary highlights that in COVID-19 cases, minor central nervous system symptoms can accompany mild or even missing upper respiratory symptoms. The cranial MRIs of the presented patients were normal, but the EEG showed focal abnormalities in localizations related to hallucinations, which emphasizes the importance of EEG in differential diagnostic procedures. ]

AFFILIATIONS

  1. Debreceni Egyetem Klinikai Központ, Kenézy Gyula Campus, Neurológiai Osztály, Debrecen

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

A cross-sectional study on the quality of life in migraine and medication overuse headache in a Hungarian sample: understanding the effect of headache characteristics

MAGYAR Máté , KÖKÖNYEI Gyöngyi , BAKSA Dániel, GALAMBOS Attila, ÉDES Edit Andrea , SZABÓ Edina , KOCSEL Natália , GECSE Kinga , DOBOS Dóra , GYÜRE Tamás , JUHÁSZ Gabriella , ERTSEY Csaba

Previous studies using generic and disease specific instruments showed that both migraine and medication overuse headache are associated with lower health-related quality of life (HRQoL). The aim of our study was to assess HRQoL differences in migraineurs and in patients with MOH and to examine how headache characteristics such as years with headache, aura symptoms, triptan use, headache pain severity and headache frequency are related to HRQoL. In this cross-sectional study 334 participants were examined (248 were recruited from a tertiary headache centre and 86 via advertisements). The Comp­rehensive Headache-related Quality of life Questionnaire (CHQQ) was used to measure the participants’ HRQoL. Data showed normal distribution, therefore beside Chi-squared test parametric tests (e.g. independent samples t-test) were used with a two-tailed p<0.05 threshold. Linear regression models were used to determine the independent effects of sex, age, recruitment method, headache type (migraine vs. MOH) and headache characteristics (presence of aura symptoms, years with headache, headache pain severity, headache frequency and triptan use) separately for each domain and for the total score of CHQQ. Significance threshold was adopted to p0.0125 (0.05/4) to correct for multiple testing and avoid Type I error. Independent samples t-tests showed that patients with MOH had significantly lower scores on all CHQQ domains than migraineurs, except on the social subscale. Results of a series of regression analyses showed that triptan use was inversely related to all the domains of HRQoL after correction for multiple testing (p<0.0125). In addition, headache pain severity was associated with lower physical (p=0.001) and total scores (p=0.002) on CHQQ subscales. Based on the results, different headache characteristics (but not the headache type, namely migraine or MOH) were associated with lower levels of HRQoL in patients with headache. Determining which factors play significant role in the deterioration of HRQoL is important to adequately manage different patient populations and to guide public health policies regarding health service utilization and health-care costs.

Clinical Neuroscience

Neonatal brachial plexus palsy – early diagnosis and treatment

BERÉNYI Marianne , SZEREDAI Márta , CSEH Ágnes

The incidence of brachial plexus palsy (BPP) has decreased recently, but the indivi­d­ual’s quality of life is endangered. To provide better chan­ces to BPP neonates and infants, the Department of Developmental Neurology worked out, introduced, and applied a complex early therapy, including nerve point stimulation. After diagnosing the severity of BPP, early intensive and complex therapy should be started. Appro­x­imately after a week or ten days following birth, the slightest form (neurapraxia) normalizes without any intervention, and signs of recovery can be detected around this period. The therapy includes the unipolar nerve point electro-stimulation and the regular application of those elemen­tary sensorimotor patterns, which activate both extremities simultaneously. With the guideline worked out and applied in the Department of Developmental Neurology, full recovery can be achieved in 50% of the patients, and even in the most severe cases (nerve root lesion), functional upper limb usage can be detected with typically developing body-scheme. Immediately starting complex treatment based on early diagnosis alters the outcome of BPP, providing recovery in the majority of cases and enhancing the everyday arm function of those who only partially benefit from the early treatment.

Clinical Neuroscience

An endoscope-assisted craniometric cadaveric study for the brain stem and the cisternal segment of the trochlear nerve

BAŞAK Tulgar Ahmet , ÇAKICI Nazlı

This study analyzed the relationship of trochlear nerve with neurovascular structures using craniometric measurements. The study was aimed to understand the course of trochlear nerve and minimize the risk of injury during surgical procedures. Twenty trochlear nerves of 10 fresh cadavers were studied bilaterally using endoscopic assistance through the view afforded by the lateral infratentorial-supracerebellar, and the combined presigmoid-subtemporal transtentorial approaches. Trochlear nerves were exposed bilaterally taking seven parameters into consideration: the distance between the cisternal segment of trochlear nerve and vascular structures (superior cerebellar artery/SCA; posterior cerebral artery/PCA), the origin of the trochlear nerve in the brain stem, the angle in the level of tentorial junction, length, diameter, and length of nerve in the cisternal segment. We identified the brain stem and cisternal segments of the trochlear nerve. The lateral infratentorial supracerebellar approach allowed the exposure of the cisternal segments (crural and ambient cisterns), including the origin of the nerve in the brain stem. The combined presigmoid-subtemporal transtentorial approaches provided visualization of the cisternal segment of the nerve and the free edge of the tentorium. In this study, the mean length and width of the trochlear nerve in the cisternal segment were 30.3 and 0.74 mm, respectively. Length of the trochlear nerve from its origin to its dural entrance was 37.2 mm, tentorial dural entrance angle of the trochlear nerve and exit angle of the trochlear nerve from the brain stem were 127.0 degrees and 54 degrees, PCA to trochlear nerve in mid ambient cistern and SCA to trochlear nerve in mid ambient cistern were 7.3 mm and 6.8mm. Trochlear nerve is vulnerable to injury during the surgical procedures. Therefore, it is necessary to have a sufficient knowledge of the anatomy of cisternal segment and its relationship with adjacent neurovascular structures. The anatomical and craniometric data can be helpful in middle and posterior fossa surgery in minimizing the potential injury of the trochlear nerve.

Clinical Neuroscience

A case study of acute oropharyngeal palsy concomitant with diabetic ketoacidosis

LANTOS Judit , BARTA Zsanett , NAGY Albert , VINCZE Rita , FÜLE Kálmán , BIHARI Katalin

Acute oropharyngeal palsy is a rare variant of Guillain-Barré syndrome. In our study we present the case of a 63-year-old man with general symptoms who was diagnosed with diabetic ketoacidosis and prescribed insulin therapy. Two weeks later, the patient complained of paraesthesia of the perioral region and the tip of the tongue, dysphagia, and dysarthria. These symptoms were initially thought to be complications of the patient’s type-1 diabetes. Due to rapidly developing paraparesis, the patient became bedridden. Clinical symptoms, cerebrospinal fluid analysis and a nerve conduction study resulted in a diagnosis of acute oropharyngeal palsy, a variant of Guillain-Barré syndrome. After five consecutive days of intravenous immunoglobulin treatment, neurological symptoms improved and the need for insulin ceased. One year later, the patient’s only remaining neurological symptom was loss of tendon reflexes in the lower extremities. Furthermore, the patient’s blood glucose level was normal without the use of medications or a special diet. Here, we report that oropharyngeal palsy can co-occur with diabetic ketoacidosis, and that immuntherapy is effective in treating both oropharyngeal palsy and type-1 diabetes. To our knowledge, this is the first description of a patient presenting with acut oropharyngeal palsy concomitant with diabetic ketoacidosis.

Clinical Neuroscience

Comparison of orexin-A and neurofilament light chain levels in patients with relapsing-remitting multiple sclerosis: a pilot study

SARUHAN Ercan , KORKMAZ Muammer , ALTIPARMAK Basak , TOSUN Kursad , KUTLU Gulnihal

Multiple sclerosis is an autoimmune disease of the central nervous system, with myelin degeneration and Relapsing-Remitting Multiple Sclerosis (RRMS) as the most common type. The aim of this study was to determine the levels of Neurofilament Light Chain (NFL) and Orexin-A (OXA) in patients with RRMS and compare it with healthy control subjects’ data. In this case-control study of 61 subjects, serum and cerebrospinal fluid samples were collected from 23 RRMS patients and 38 healthy control subjects. NFL and OXA levels were determined in cerebrospinal fluid and serum samples using enzyme-linked immunosorbent assay kits. Self-reported questionnaires were also administered to evaluate fatigue severity and impact. Receiver operating characteristic curve analysis was used to determine the optimal cut-off value of NFL and OXA. The NFL and OXA concentrations in cerebro­spinal fluid of RRMS patients were significantly higher than those of the control group (p < 0.001), but no sig­nificant difference was found in the serum concentrations (p = 0.842, p = 0.597, respectively). The cut-off values were found to be 1.194 ng/ml for NFL and 77.81 pg/ml for OXA in cerebrospinal fluid. A positive correlation was found between the Expanded Disability Status Scale and Epworth Sleepiness Scale in RRMS patients (ρ = 0.49, p = 0.045). These results suggest that increased levels of both NFL and OXA in cerebrospinal fluid reflect neuronal destruction in RRMS. Further research of neurodegeneration should focus on neuropeptides to determine the possible roles in RRMS pathogenesis.

All articles in the issue

Related contents

Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

Journal of Nursing Theory and Practice

[Correlations Between Burnout and Socio-demographic and Workplace Related Factors Among Health-care Workers During The Covid-19 Pandemics]

NÉMETH Anikó, IRINYI Tamás

[The present study aimed to assess the level of burn-out among health-care workers in 2020 and its correlations with socio-demographic and workplace related factors. The cross-sectional study was conducted by the means of a self-constructed online survey in the beginning of 2021. The responses of 1965 people were analysed with the help of SPSS 23.0. Descriptive statistics, chi-square and Kruskal-Wallis probes were run (p<0.05). Severe burnout was present in 46.7% of the responders. Age, marital status, type of health-care provided and years spent in the health-care system didn’t show any correlation with burnout. Unsure vision, opinion about salary raise and uncertainty at the workplace influenced the level of burnout significantly (p<0.000). The mental health of health-care workers is in continuous decline, in which the COVID-19 pandemic might play a big role. People with worse mental health feel more uncertain regarding their future and job; this might make providing health-care more and more difficult.]

Clinical Neuroscience

Acute transverse myelitis after inactivated COVID-19 vaccine

ERDEM Şimşek Nazan, DEMIRCI Seden, ÖZEL Tuğba , MAMADOVA Khalida, KARAALI Kamil , ÇELIK Tuğba Havva , USLU Ilgen Ferda, ÖZKAYNAK Sibel Sehür

Vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been rapidly developed to prevent coronavirus disease 2019 (COVID-19) pandemic. There is increasing safety concerns regarding COVID-19 vaccines. We report a 78-year old woman who was presented with tetraparesis, paresthesias of bilateral upper extremities, and urinary retention of one-day duration. Three weeks before these symptoms, she was vaccinated with CoronaVAC vaccine (Sinovac Life Sciences, China). Spine magnetic resonance imaging showed longitudinally extensive transverse myelitis (TM) from the C1 to the T3 spinal cord segment. An extensive diagnostic workup was performed to exclude other possible causes of TM. We suggest that longitudinally extensive TM may be associated with COVID-19 vaccination in this case. To the best of our knowledge, this is the first report of longitudinally extensive TM developing after CoronaVac vaccination. Clinicians should be aware of neurological symptoms after vaccination of COVID-19.

Clinical Neuroscience

The effect of starting a meal with salt and date palm on taste impairment caused by COVID-19

ALTUN Yasar , BULBULOGLU Semra

This study was conducted to examine the effect of starting a meal with salt and date palm on the sense of taste in COVID-19 patients. This study was conducted using a randomized controlled method. Patient and disease information forms and Visual Analog Scale were used for data collection. Salt and date palm were used to stimulate the sense of taste in two different experimental groups. No procedure was made in the control group except for the practice of the clinic. The results were analyzed using SPSS version 25. The mean ages of all groups were between 43.42 ± 8.60 and 47.22 ± 12.04 years. Fever, sore throat, dry mouth, cough, muscle weakness, and similar symptoms were present in all groups. Significant improvements were found in patients with hypoageusia and ageusia after date palm and salt application (p<0.01). For taste impairment caused by COVID-19, consumption of date palm and tasting very little salt for therapeutic purposes may help to alleviate taste impairment. Based on the data obtained from this study, the pathophysiology of the effects of date palm and salt on taste complications should be investigated.

Clinical Neuroscience

The effect of sniffing Turkish coffee on olfactory disorders in COVID-19 patients: An experimental clinical study

BULBULOGLU Semra, ALTUN Yasar

The current study aimed to examine the effect of sniffing Turkish coffee on the sense of smell in COVID-19 patients. This study utilized the experiment-control method. Data were collected using a patient and disease information form and the Connecticut Chemosensory Clinical Research Center (CCCRC) Test. An experimental group of patients sniffed Turkish coffee, and the coffee’s effect on the patients’ sense of smell was examined. All data were analyzed using SPSS version 25 (IBM). Of the patients in the experimental group, 25% had moderate hyposmia, 58.3% had severe hyposmia, and 16.7% had anosmia prior to sniffing Turkish coffee. After sniffing the Turkish coffee, 13.3% of these patients regained their ability to smell normally, while 18.3% had mild hyposmia, 45% had moderate hyposmia, 6.7% had severe hyposmia, and 16.7% had anosmia. There was no difference in the control group between first and second measurement. COVID-19 patients who sniffed Turkish coffee intermittently regained some of their sense of smell for one hour. Turkish coffee is cheap, fragrant, widely available, and easy to access. Therefore, results of this study suggest that it may be recommended for treating olfactory disorder in COVID-19 patients.