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Despite a well characterized mechanism, myasthenia gravis (MG) remains a dilemma in terms of etiology. Several case reports and series of cases suggest a potential cause-effect relation between SARS-CoV-2 infection or vaccination and MG. We present the case of an autoimmune MG occurring post Covid-19 in an elderly male, vaccinated with three doses of the BNT162b2/Pfizer-BioNTech vaccine. The 78-year-old male was admitted in the Neurology Clinic in early November 2021 with double vision, bilateral ptosis, dysphonia and dysphagia, 16 days after receiving a third dose of the BNT162b2/Pfizer-BioNTech SARS-CoV-2 vaccine and 12 days after testing positive for SARS-CoV-2 infection. The symptoms began to emerge at 9 days after COVID-19 diagnosis. Clinical neurological examination included ice-pack test and intramuscular neostigmine, both with positive results. Myasthenia gravis positive diagnosis was confirmed by slow repetitive nerve stimulation and abnormally increased serum levels of antibodies against acetylcholine receptors. Due to patient's refusal of further hospitalization, he was discharged with therapy recommendations. Under treatment with oral pyridostigmine, but no oral corticosteroid due to therapeutic noncompliance, the patient was readmitted two months later with aggravated symptoms. The myasthenic crisis was successfully treated with intravenous immunoglobulins, corticosteroid therapy and oral pyridostigmine. The novelty of the current case resides in the fact that, to the best of our knowledge, appears to be the first case of MG clinically manifested after COVID-19 infection in a fully vaccinated patient. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is clinically manifested by motor and non-motor symptoms, including neuropsychiatric changes, which can occur both in the early and advanced stages of PD. Objectives. The study evaluated cognitive and behavioral changes in patients with PD. Material and methods. Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr scale were used to assess the neurological status of 112 patients with PD. Clinical neuropsychological tests were applied to all patients. Outcomes. The longer the duration of the disease is, the more critical impulse-control disorders are, especially shopping, hobbyism, and punding. Hypersexual behavior appears to be age and gender-dependent. Depression and impulse-control disorders seem interconnected: subjects tested with severe depression on the Hamilton Depression Rating Scale have more shopping compulsions. Antiparkinsonian treatment influences the Montreal Cognitive Assessment score. When specific cognitive domains are tested, subjects treated only with levodopa have lower scores at temporal and spatial orientation testing. Dopamine agonists appear to be associated with less cognitive dysfunctions. Conclusions. Neuropsychiatric symptoms impact the quality of life in Parkinson's disease patients and must be systematically assessed. [ABSTRACT FROM AUTHOR]

Ambient temperature can modulate neurotransmission in the peripheral nervous system. Transmission at the neuromuscular junction is also influenced by ambient temperature. Myasthenia Gravis (MG) is an autoimmune disease of the neuromuscular junction characterized by impaired transmission of the nerve impulses to the muscle fibers. The aim of the study was to determine if there is in fact a statistically significant correlation between environmental fluctuations and MG exacerbations among myasthenic patients. Also, the authors intended to find candidate variables for validation in a future prospective study. The subjects included in the study were hospitalized in I Neurology Clinic of “Prof. Dr. N. Oblu” Emergency Clinical Hospital Iasi, Romania during a five years period. The authors performed a binary logistic regression on 195 hospital admissions from which 144 were from Iasi County. P values<0.05 were considered significant. The risk of myasthenic aggravation appeared to be higher when the extremes of temperature from the week before hospitalization were greater with a p < 0.001 and Exp(B) of 1.143 (95%CI: 1.1 - 1.187). This statistically significant correlation maintained when a subgroup analysis of 144 admissions from Iasi county was performed. Also, apparently females had a greater risk of exacerbation when ambient temperature fluctuations were higher. These are promising remarks that represent a hypothesis for a prospective study. In addition, further studies are mandatory in order to establish a link between myasthenic aggravations and other environmental parameters such as atmospheric pressure and humidity. [ABSTRACT FROM AUTHOR]

Introduction. Bullous dermatoses are a group of skin-specific autoimmune diseases with systemic involvment that have a molecular basis related to the development of IgG autoantibodies targeted against desmosome proteins. The purpose of this report consists in marking the association between an acute cerebrovascular event and an active phase blistering dermatosis, at a pacient with no other known risk factors. Case presentation. Female patient, 46 years old, diagnosed with pemphigus vulgaris one year before, was admitted to the emergency room with left hemiparesis. The general physical examination shows multiple fragile blisters with serocitrin content and well-defined painful skin erosion, localized on the limbs, thorax and abdomen. The neurological examination revealed a conscious, cooperative, right-handed pacient with left proportional flaccid hemiparesis, and homonimous hemianopya. Native cranio-cerebral computed-tomography described acute infarction in the right sylvian arterial territory. Extensive paraclinical tests did not reveal an evident pathogenesis of acute ischemic stroke. Conclusions. Patients with bullous dermatosis have a two-folded increased risk of stroke, particularly ischemic stroke and this risk remains high even after controlling modifiable cardiovascular risk factors. The neurologist should consider implementing primary ischemic stroke prevention in patients diagnosed with bullous dermatosis. [ABSTRACT FROM AUTHOR]