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Objective: Many clinicians are unfamiliar with a diagnosis of lacertus syndrome (LS). We investigated the value of the lacertus notch sign in diagnosing LS. Methods: We included 56 consecutive patients (112 upper extremities) who had neuropathic pain and neurological symptoms of the hand. The presence of LS and the lacertus notch sign in each upper extremity was assessed. Results: Of the 83 upper extremities with LS, 54 (65.1%) had a lacertus notch sign, whereas 29 (34.9%) did not. Of the 29 upper extremities without LS, 9 (31.0%) and 20 (69.0%) had and did not have a lacertus notch sign, respectively. The rates of lacertus notch presence in upper extremities with and without LS were significantly different. Of the 63 upper extremities with a lacertus notch sign, 54 (85.7%) were diagnosed with LS, whereas 9 (14.3%) were not. Of the 49 upper extremities without a lacertus notch sign, 20 (40.8%) were diagnosed with LS, and 29 (59.2%) were not. We observed significant differences in the rates of LS in upper extremities with and without lacertus notch. Conclusions: The presence of the lacertus notch sign is useful for diagnosing LS. When patients with neuropathic pain and neurological symptoms present with a lacertus notch sign, clinicians should consider the possibility of LS. [ABSTRACT FROM AUTHOR]

Background: New-onset neurological symptoms such as numbness and pain in lower extremities might appear immediately after conventional lumbar interbody fusion (LIF) surgery performed in patients with lumbar spinal stenosis. Methods and analysis: This is a multicenter, randomized, open-label, parallel-group, active-controlled trial investigating the clinical outcomes of modified LIF sequence versus conventional LIF sequence in treating patients with lumbar spinal stenosis. A total of 254 eligible patients will be enrolled and randomized in a 1:1 ratio to either modified LIF sequence or conventional LIF sequence group. The primary outcome measure is the perioperative incidence of new-onset lower extremity neurological symptoms, including new adverse events of pain, numbness, and foot drop of any severity. Important secondary endpoints include visual analogue scale (VAS) pain score and lumbar Japanese Orthopaedic Association (JOA) recovery rate. Other safety endpoints will also be evaluated. The safety set used for safety data analysis by the actual surgical treatment received and the full analysis set for baseline and efficacy data analyses according to the intent-to-treat principle will be established as the two analysis populations in the study. Conclusion: This study is designed to investigate the clinical outcomes of modified LIF sequences in patients with lumbar spinal stenosis. It aims to provide clinical evidence that the modified "fixation-fusion" sequence of LIF surgery is effective in treating lumbar spinal stenosis. Trial registration: http://www.chictr.org.cn/index.aspx ID: ChiCTR2100048507. [ABSTRACT FROM AUTHOR]

Background: Thirty-two-day-old broiler chickens at a farm located in northwestern South Korea displayed adverse neurological symptoms including limping, lying down, and head shaking. Approximately 2.1% of chickens died or were culled due to severe symptoms. Five carcasses were submitted to the Avian Disease Division of the Animal and Plant Quarantine Agency (APQA) for disease diagnosis. Results: Broilers displayed severe pericarditis and perihepatitis associated with gross lesions. Broilers also displayed microscopic lesions in the cerebrum and in the granular layer of the cerebellum, which were associated with multifocal perivascular cuffing and purulent necrosis in the cerebrum, and severe meningitis with heterophil and lymphocyte infiltration. Staphylococcus spp. were identified in the liver and heart using bacteriological culture. PCR/RT-PCR assays revealed that broilers were negative for avian Clostridium botulinum, Newcastle disease virus, and avian encephalomyelitis virus. Bacterial and viral metagenomic analysis of brain sample further revealed the presence of Pseudomonas spp. and Marek's disease virus, which are known etiological agents of chicken meningoencephalitis. Conclusions: This study reports a diagnostic analysis of gross and histopathological lesions from 32-day-old broilers displaying unique neurological symptoms that revealed the presence of the several neurological diseases including meningoencephalitis. The causative agents associated with meningoencephalitis of broilers that had not been identified by routine diagnostic methods could be diagnosed by metagenomics, which proves the usefulness of metagenomics as a diagnostic tool for unknown neurological diseases in broilers. [ABSTRACT FROM AUTHOR]

Background: Thirty-two-day-old broiler chickens at a farm located in northwestern South Korea displayed adverse neurological symptoms including limping, lying down, and head shaking. Approximately 2.1% of chickens died or were culled due to severe symptoms. Five carcasses were submitted to the Avian Disease Division of the Animal and Plant Quarantine Agency (APQA) for disease diagnosis. Results: Broilers displayed severe pericarditis and perihepatitis associated with gross lesions. Broilers also displayed microscopic lesions in the cerebrum and in the granular layer of the cerebellum, which were associated with multifocal perivascular cuffing and purulent necrosis in the cerebrum, and severe meningitis with heterophil and lymphocyte infiltration. Staphylococcus spp. were identified in the liver and heart using bacteriological culture. PCR/RT-PCR assays revealed that broilers were negative for avian Clostridium botulinum, Newcastle disease virus, and avian encephalomyelitis virus. Bacterial and viral metagenomic analysis of brain sample further revealed the presence of Pseudomonas spp. and Marek's disease virus, which are known etiological agents of chicken meningoencephalitis. Conclusions: This study reports a diagnostic analysis of gross and histopathological lesions from 32-day-old broilers displaying unique neurological symptoms that revealed the presence of the several neurological diseases including meningoencephalitis. The causative agents associated with meningoencephalitis of broilers that had not been identified by routine diagnostic methods could be diagnosed by metagenomics, which proves the usefulness of metagenomics as a diagnostic tool for unknown neurological diseases in broilers. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the neurological involvement in Coronavirus 19 (COVID-19) patients with laboratory findings with these cost-free, practical tests. Materials and Methods: Of the 170 patients diagnosed COVID-19, 103 patients could be reached by phone, and neurological symptoms were recorded as three categories. Laboratory tests of the patients and 103 controls whose real-time polymerase chain reaction (RT-PCR) test negative without any chronic disease history and drug use were obtained from the hospital software. Results: White blood cell, neutrophil, lymphocyte, eosinophil, basophil, platelet were lower, monocyte to lymphocyte ratio and platelet to lymphocyte ratio higher in patients than controls. In the group with central nervous system findings, red blood cell and hematocrit counts, in the group with peripheral nervous system findings, lymphocyte and platelet counts and with sleep disturbances and muscle pain group eosinophil counts were lower in patients than those without. Conclusion: COVID-19 patients with neurological symptoms have some hematological abnormalities. The presence of certain hematological findings may be a clue to the emergence of neurological symptoms, and early detection and correction of these hematological abnormalities may be the solution to prevent the development of neurological symptoms in COVID-19. [ABSTRACT FROM AUTHOR]

Some respiratory viruses have long been known to cause neurological involvement. A novel coronavirus, leading to severe acute respiratory syndrome, also called coronavirus disease 19 (COVID-19), seems to be a new member of neuroinvasive viruses. While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) keeps on spreading around the world rapidly, reports about the neurological manifestations associated with SARS-CoV-2, increases day by day. It is reported that a variety of symptoms and syndromes such as headache, dizziness, confusion, ataxia, epilepsy, ischemic stroke, neuropathic pain and myopathy are common especially in more severe COVID-19 patients. It is also suggested that the development of neurological complications is strongly associated with a poor outcome. On the other hand, hyposmia can be the unique symptom in COVID-19 carriers and this can serve as a marker for identifying the otherwise asymptomatically infected patients. It is thought that SARSCoV- 2 may cause neurological symptoms through direct or indirect mechanisms. Nevertheless, neuroinvasion capability of SARS-CoV2 is confirmed by the presence of the virus, in the cerebrospinal fluid of a COVID-19 patient with encephalitis, and this is proven by gene sequencing. In conclusion, during the COVID-19 pandemic, it is crucial to be aware of the possible neurological complications of the disease. Therefore, in this review, we aimed to report neurological manifestations associated with SARS-CoV-2 and possible underlying pathophysiological mechanisms. Due to the high homology of SARS-CoV-2 with other human coronaviruses such as SARS-CoV or Middle East Respiratory Syndrome (MERS)-CoV, reviewing the neurological involvement also associated with these coronaviruses will provide an idea about the longterm complications of COVID-19. [ABSTRACT FROM AUTHOR]

Objective: In this study, the relationship between preoperative risk factors and operative outcomes in patients undergoing unilateral carotid endarterectomy was compared in the light of literature reviews. Method: 223 patients who underwent unilateral carotid endarterectomy in Dr.Siyami Ersek Breast Heart and Vascular Surgery Training and Research Hospital in the years between 2007 and 2009 were included in the study. The mean age of the patients was 68.13 ± 5,25 and 29,5% of them were women (n=66) while 70,5% of them were men (n=157). 43.5% of patients (n=97) had hypertension and 61.2% of patients (n = 136) had diabetes mellitus. 76.1% of patients (n = 170) had a history of smoking while 29.3% of patients (n = 65) had hyperlipidemia. In 5.4% (n = 12) of patients experienced perioperative stroke, 10.8% (n = 24) of patients had a history of prolonged neurologic disease and 6.8% (n = 15) of patients had experienced transient ischemic attacks. Results: Patients undergoing carotid endarterectomy in the postoperative period were followed under 3 main headings: early neurologic complications, early cardiac arrhythmias and other complications (multiple organ failure, respiratory problems and hypertension). Early neurologic complications in patients were followed by the frequency of stroke, transient ischemic attack (TIA), and prolonged reversible ischemic neurological disease (PRIND). In this group, the rate of stroke patients in the postoperative period was 2.2% (n = 5) while the rate of TIA or PRIND patients was 4.1% (n = 9). Conclusions: Reducing mortality and morbidity after carotid artery endarterectomy is possible with a good analysis of preoperative risks and a good preoperative preparation. Cardiovascular surgeons have a great role and responsibility to reduce the risk and complications of carotid artery endarterectomy in preoperative, intraoperative and postoperative periods. [ABSTRACT FROM AUTHOR]

Although emerging evidence suggests that PM 2.5 is linked to neurological symptoms (NSs) via neuroinflammation, relevant studies are scarce. This study aimed to investigate the risks and excess costs of hospital admission for five NSs—fatigue, headache, dizziness, convulsion, and paralysis—attributable to long-term exposure to PM 2.5 in New York State, USA. We analyzed the New York Statewide Planning and Research Cooperative System (SPARCS) from 2010 to 2016. A Bayesian hierarchical model with integrated nested Laplace approximations was performed to estimate the risks and excess costs of hospital admission for NSs due to long-term exposure to PM 2.5 at the county level. A 1 μg/m3 increase in lag 0–1 years PM 2.5 was associated with an increased risk of headache and convulsion by 1.06 (1.01, 1.11) and 1.04 (1.01, 1.06), respectively. The excess hospital admission cost for five NSs attributable to lag 0–1 years PM 2.5 above the new World Health Organization guideline (annual standard: 5 μg/m3) was $200.24 (95% CI: 6.00, 376.96) million during 2011–2016, recording the highest for convulsion ($153.73 [95% CI: 63.61, 244.19] million). This study provides quantitative estimates of risks and excess costs for NSs attributable to long-term PM 2.5 and suggests that policies that reduce long-term PM 2.5 concentration in accordance with the new WHO air quality guidelines can yield substantial health and economic benefits related to NSs in the New York State population. • Hospital admissions for neurological symptoms are positively associated with PM 2.5. • The association was higher in female than male, despite the absence of statistical significance. • The association was higher in Other races than non-Hispanic White and Black. • The excess cost due to noncompliance with the WHO air quality guideline is substantial. [ABSTRACT FROM AUTHOR]

Background: Isolated adrenocorticotropic hormone (ACTH) deficiency is a pituitary disorder characterized by reduction only in the secretion of ACTH. Although the underlying mechanism remains to be elucidated, numbers of cases with this entity have been increasing. We experienced a case presenting with gait disturbance necessitating differential diagnosis from idiopathic normal pressure hydrocephalus (iNPH). Case presentation: A 69-year-old female with a complaint of difficulty walking and suspected to have iNPH at a prior hospital was referred to our department. For the prior three years, she had suffered from a progressive gait disturbance. Magnetic resonance imaging (MRI) revealed global ventricular dilatation. The typical features of the gait in iNPH cases were all identifiable. Neuropsychological dementia scale tests showed deterioration. However, the major feature of a disproportionately enlarged subarachnoid-space on MRI was not obvious. The patient developed progressively worsening fatigue during hospitalization. Her symptoms resembled those of hypothalamic-pituitary tumor patients. Serum ACTH and cortisol levels were low. While corticotrophin releasing hormone stress tests showed no response, other stress tests using thyrotropin releasing hormone, luteinizing hormone releasing hormone, and growth hormone releasing hormone yielded normal responses, indicating a diagnosis of isolated ACTH deficiency. We initiated corticosteroid therapy, and her gait disturbance improved promptly. Conclusion: Isolated ACTH deficiency may have major significance to the differential diagnosis of iNPH. Early consideration of this entity is anticipated to facilitate making an early diagnosis. [ABSTRACT FROM AUTHOR]

Background: Isolated adrenocorticotropic hormone (ACTH) deficiency is a pituitary disorder characterized by reduction only in the secretion of ACTH. Although the underlying mechanism remains to be elucidated, numbers of cases with this entity have been increasing. We experienced a case presenting with gait disturbance necessitating differential diagnosis from idiopathic normal pressure hydrocephalus (iNPH). Case presentation: A 69-year-old female with a complaint of difficulty walking and suspected to have iNPH at a prior hospital was referred to our department. For the prior three years, she had suffered from a progressive gait disturbance. Magnetic resonance imaging (MRI) revealed global ventricular dilatation. The typical features of the gait in iNPH cases were all identifiable. Neuropsychological dementia scale tests showed deterioration. However, the major feature of a disproportionately enlarged subarachnoid-space on MRI was not obvious. The patient developed progressively worsening fatigue during hospitalization. Her symptoms resembled those of hypothalamic-pituitary tumor patients. Serum ACTH and cortisol levels were low. While corticotrophin releasing hormone stress tests showed no response, other stress tests using thyrotropin releasing hormone, luteinizing hormone releasing hormone, and growth hormone releasing hormone yielded normal responses, indicating a diagnosis of isolated ACTH deficiency. We initiated corticosteroid therapy, and her gait disturbance improved promptly. Conclusion: Isolated ACTH deficiency may have major significance to the differential diagnosis of iNPH. Early consideration of this entity is anticipated to facilitate making an early diagnosis. [ABSTRACT FROM AUTHOR]

Background: Neurological symptoms influence health and well-being among older adults. However, Chinese older adults are underrepresented in most studies on neurological symptoms. This study aims to examine the prevalence of neurological symptoms among U.S. Chinese older adults. Methods: Data were drawn from the PINE study, a population-based survey of U.S Chinese older adults in the greater Chicago area. Guided by a community-based participatory research approach, a total of 3,159 Chinese older adults aged 60 and above were surveyed. Clinical review of system (ROS) was used to assess the presence of dizziness, syncope/fainting, fall, seizures, weakness, numbness, tingling, tremor, and stiffness. Results: Neurological symptoms were commonly experienced by U.S Chinese older adults (50.6%). Symptoms as dizziness (31.0%), numbness (19.0%), and falls (14.8%) were commonly reported. Participants were more likely to report any neurological symptom if they were older, female, with lower education, lower income, poorer self-perceived health status, poorer quality of life, and worsened health change over last year. Conclusions: Neurological symptoms are common among Chinese older adults in the U.S. Future longitudinal research is needed to examine risk factors and health outcomes associated with neurological symptoms. [ABSTRACT FROM AUTHOR]

With increasing experience, it has been suggested that the SARS-CoV-2 virus has a neurotropic effect. Here, we present a case of a tonic pupil who developed after COVID-19 infection. A 36-year-old woman presented with progressive photophobia and blurred vision. On neurological examination, loss of deep tendon reflexes accompanying a tonic pupil was detected and brain MR imaging was normal. With this case, we aimed to describe a rare pattern of neurological involvement caused by the possible SARS-CoV-2 virus. [ABSTRACT FROM AUTHOR]

• Higher levels of inflammatory cytokines might promote the expression of adhesion molecules on BCSFB. • Upregulation of adhesion molecules results in facilitation of monocyte recruitment. • Increased levels of CSF chemokines help to the trafficking of monocytes to CSF. • Inflammatory cytokines enhance production of MMPs from monocytes. • Increased level of MMPs disrupts BCSFB in COVID-19 patients with neurological syndrome. Evidence show that Matrix metalloproteinases (MMPs) have been associated with neurological complications in the viral infections. Here in the current investigation, we intended to reveal if MMPs are potentially involved in the development of neurological symptoms in the patients with Coronavirus disease 2019 (COVID-19). The levels of MMPs, inflammatory cytokines, chemokines, and adhesion molecules were evaluated in the serum and cerebrospinal fluid (CSF) samples from 10 COVID-19 patients with neurological syndrome (NS) and 10 COVID-19 patients lacking NS. Monocytes from the CSF samples were treated with TNF-α and the secreted levels of MMPs were determined. The frequency of monocytes were increased in the CSF samples of COVID-19 patients with NS compared to patients without NS. Levels of inflammatory cytokines IL-1β, IL-6, and TNF-α, chemokines CCL2, CCL3, CCL4, CCL7, CCL12, CXCL8, and CX3CL1, MMPs MMP-2, MMP-3, MMP-9, and MMP-12, and adhesion molecules ICAM-1, VCAM-1, and E-selectin were significantly increased in the CSF samples of COVID-19 patients with NS compared with patients without NS. Treatment of CSF-derived monocytes obtained from COVID-19 patients with NS caused increased production of MMP-2, MMP-3, MMP-9, and MMP-12. Higher levels of inflammatory cytokines might promote the expression of adhesion molecules on blood-CSF barrier (BCSFB), resulting in facilitation of monocyte recruitment. Increased levels of CSF chemokines might also help to the trafficking of monocytes to CSF. Inflammatory cytokines might enhance production of MMPs from monocytes, leading to disruption of BCSFB (and therefore further infiltration of inflammatory cells to CSF) in COVID-19 patients with NS. [ABSTRACT FROM AUTHOR]

Mastocytosis is a rare disease of clonal hematological disorders characterized by a pathological accumulation of Mast Cells (MCs) in different tissues, with variable symptomatology and prognosis. Signs and symptoms of Systemic Mastocytosis (SM) are due to pathological infiltration of MCs and to the release of chemical mediators, mainly histamine. Patients with SM may also present with neurological symptoms or complications. The pathophysiology of these neurological disorders remains uncertain to this day, but it can be associated with the infiltration of tissue mastocytes, release of mastocytes' mediators or both. Moreover, there is a lot to understand about the role of neurological symptoms in SM and knowing, for example, what is the real frequency of neurological disorders in SM and if is present a relation between other SM subtypes, because it has been noted that the alteration of the histamine expression may be an initiating factor for susceptibility, gravity and progression of the epigenetic disease. In this review we explain the possible pathophysiological mechanism about neurological symptomatology found in some patients affected by SM, describing the role of histamine and its receptors in the nervous system and, in light of the results, what the future prospects may be for a more specific course of treatment. • Patients with SM may also present with neurological symptoms or complications • The pathophysiology can be associated with the infiltration of mastocytes and/or release of mastocytes' mediators • Developing histamine receptor ligands and acquiring a more profound comprehension of potential mechanisms may become a milestone to application in clinical settings. [ABSTRACT FROM AUTHOR]

The main objective of this study was to analyse neurological symptoms during a Covid-19 infection and determine the pattern of symptoms by comparing outpatients with inpatients. A further goal was to identify possible predictors, such as pre-existing conditions and neurological symptoms. We recorded the clinical data of 40 inpatients and 42 outpatients in this retrospective, cross sectional study. Of them, 68 patients (83%), evenly distributed between the two groups, suffered from neurological symptoms. We identified the onset of neurological symptoms and the related time ranges in 41 patients (36 outpatients and 5 inpatients). Of these, 63.4% reported neurological symptoms on the first or second day of illness. 49 patients (72%) showed combinations of at least two to a maximum of seven different neurological symptoms. A more severe course of disease was correlated with age and male sex, but age was not identified as a predictor for the occurrence of neurological symptoms. Women suffered from central and neuromuscular symptoms more often than men (p = 0,004). The most common symptoms were fatigue (54%), headache (31%), loss of taste (31%), and loss of smell (27%). Pre-existing dementia was associated with increased lethality; similarly, pre-existing stroke was associated with a more severe course of Covid-19 infection. Hallucinations and confusion were related to an increased likelihood of death. The present data demonstrate the importance of comprehensive neurological support of inpatients and outpatients affected by Covid-19. • Dementia and stroke, as a pre-existing condition, are predictors for a severe course of Covid-19. • Hallucination is related to an increased lethality. • In outdoor patients a variety of neurological symptoms and combinations of those occur. • The number of neurological symptoms is related to a prolonged Covid-19 course of disease. [ABSTRACT FROM AUTHOR]

• Frequency of pesticide exposure was linked to urinary dialkylphosphate metabolites. • Farmers had higher comet tail lengths and tail moments than non-farmers. • Measurement of DNA damage is useful as a biomarker of exposure to organophosphates. • Electromyography is not sensitive to detect farmers' nerve conduction effects. Garlic farmers used organophosphate pesticides to control insects, resulting in an increased risk for adverse health outcomes. Thus, we investigated exposure to organophosphate pesticides, DNA damage, nerve conduction, and neurological symptoms among 134 garlic farmers. They were interviewed, measured nerve conduction, and collected blood and urine for determining DNA damage and dialkylphosphate metabolites. Total dialkylphosphate levels of farmers who began cultivating garlic in October were significantly higher than those of non-farmers and the farmers who began cultivating in November and December. Farmers showed significantly longer comet tail lengths and tail moments than non-farmers. However, their mean compound motor and sensory nerve action potential amplitudes of the median, ulnar, and common peroneal nerves were within normal ranges. Measurement of DNA damage is useful as a biomarker of long-term and low-level exposure to organophosphate pesticides; however, electromyography might be not sufficiently sensitive to detect nerve conduction effects in farmers exposed to pesticides. [ABSTRACT FROM AUTHOR]

Hiccups as the only presenting symptom in neurosurgical practice is uncommon. We report a case of a 22-year-old man who was evaluated for a 9-month history of intractable hiccups. He was diagnosed with a case of Chiari malformation type I. Surgical decompression improved the symptoms of the patient. The cause and pathogenesis of hiccups are discussed. Chiari malformation should be considered in patients with intractable hiccups, who are otherwise asymptomatic for any neurological problems. [ABSTRACT FROM AUTHOR]