Background: Chagas disease, resulting from the protozoan Trypanosoma cruzi, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical diseas...

Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association.

Importance The COVID-19 pandemic continues to affect millions of people globally, with increasing reports of neurological manifestations but limited data on their incidence and associations with outcome. Objective To determine the neurological phenotypes, incidence, and outcomes among adults hospitalized with COVID-19. Design, Setting, and Participants This cohort study included patients with clinically diagnosed or laboratory-confirmed COVID-19 at 28 centers, representing 13 countries and 4 continents. The study was performed by the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) from March 1 to September 30, 2020, and the European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY) from March to October 2020. Three cohorts were included: (1) the GCS-NeuroCOVID all COVID-19 cohort (n = 3055), which included consecutive hospitalized patients with COVID-19 with and without neurological manifestations; (2) the GCS-NeuroCOVID COVID-19 neurological cohort (n = 475), which comprised consecutive patients hospitalized with COVID-19 who had confirmed neurological manifestations; and (3) the ENERGY cohort (n = 214), which included patients with COVID-19 who received formal neurological consultation. Exposures Clinically diagnosed or laboratory-confirmed COVID-19. Main Outcomes and Measures Neurological phenotypes were classified as self-reported symptoms or neurological signs and/or syndromes assessed by clinical evaluation. Composite incidence was reported for groups with at least 1 neurological manifestation. The main outcome measure was in-hospital mortality. Results Of the 3055 patients in the all COVID-19 cohort, 1742 (57%) were men, and the mean age was 59.9 years (95% CI, 59.3-60.6 years). Of the 475 patients in the COVID-19 neurological cohort, 262 (55%) were men, and the mean age was 62.6 years (95% CI, 61.1-64.1 years). Of the 214 patients in the ENERGY cohort, 133 (62%) were men, and the mean age was 67 years (95% CI, 52-78 years). A total of 3083 of 3743 patients (82%) across cohorts had any neurological manifestation (self-reported neurological symptoms and/or clinically captured neurological sign and/or syndrome). The most common self-reported symptoms included headache (1385 of 3732 patients [37%]) and anosmia or ageusia (977 of 3700 patients [26%]). The most prevalent neurological signs and/or syndromes were acute encephalopathy (1845 of 3740 patients [49%]), coma (649 of 3737 patients [17%]), and stroke (222 of 3737 patients [6%]), while meningitis and/or encephalitis were rare (19 of 3741 patients [0.5%]). Presence of clinically captured neurologic signs and/or syndromes was associated with increased risk of in-hospital death (adjusted odds ratio [aOR], 5.99; 95% CI, 4.33-8.28) after adjusting for study site, age, sex, race, and ethnicity. Presence of preexisting neurological disorders (aOR, 2.23; 95% CI, 1.80-2.75) was associated with increased risk of developing neurological signs and/or syndromes with COVID-19. Conclusions and Relevance In this multicohort study, neurological manifestations were prevalent among patients hospitalized with COVID-19 and were associated with higher in-hospital mortality. Preexisting neurological disorders were associated with increased risk of developing neurological signs and/or syndromes in COVID-19.

/pdf/global-incidence-of-neurological-manifestations-among-cdqt0gk8qc.pdf

Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19-A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium.

The diagnostic evaluation and multidisciplinary management of neurofibromatosis 1 and neurofibromatosis 2

Stroke Unit Care for Acute Stroke Patients: An Observational Follow-up Study

Muscle-Specific Tyrosine Kinase and Myasthenia Gravis Owing to Other Antibodies.

Chiari malformation type I (CM1) is defined as the extrusion of the cerebellar tonsils through the foramen magnum and into the spinal canal. It can be confirmed by a radiograph showing descent of brain tissue 5 mm or more, lending a pointed appearance to the cerebellar tonsils and decreasing the subarachnoid space at the craniocervical junction. The clinical manifestations of CM-I are associated with direct compression of the brainstem and cervical spinal cord, or with changes in cerebrospinal fluid. A 38-year-old man with no relevant medical history described headaches occurring throughout the preceding year. Pain was dull and moderately intense (VAS score 6) and located in the occipital region radiating to the frontal region. Headache was triggered by laughing, but not by Valsalva manoeuvres or physical exercise. Episodes lasted 10 to 30 minutes and were not accompanied by focal neurological signs. In the preceding month, pain had grown more intense (VAS 8) and was triggered not only by laughing, but also by minimal exertion and Valsalva manoeuvres such as coughing or defecating. Lateral and rotational movements of the head also caused headache episodes. The general examination was normal; a neurological examination revealed left-beating horizontal nystagmus with no other relevant findings. Brain and cervical MRI (Fig. 1) showed that cerebellar tonsils had descended 16 mm below the foramen magnum, forming a point. The medulla had taken on an angled shape and the subarachnoid space at the craniocervical junction was reduced. Signs were consistent with a diagnosis of type I Chiari malformation. The patient was initially treated with 600 mg ibuprofen every 8 hours but did not respond. Treatment was changed to

Cefalea desencadenada por la risa como forma de presentación de una malformación de CHIARI tipo I

COVID-19 y neuroinfecciones concomitantes./ COVID-19 y neuroinfecciones concomitantes./ [COVID-19 and concomitant neurological infections].

Introduction Arteriosclerosis of the extra-cranial arteries is believed to be responsible for almost one-third of all ischaemic strokes. The sound diagnosis of the degree of stenosis is essential in deciding the best therapeutic strategy. Although cerebral angiography is considered the reference technique, ultrasound study (UST) is a more readily available, non-invasive and well-established procedure for quantifying carotid stenosis. However, on being a dependent exploratory technique, it is recommended that each laboratory validates its results against angiography. Objectives To establish the validity of the neuro-ultrasound study in our laboratory for use in the diagnosis of extracranial atheromatous disease, and determine its capacity to quantify the degree of stenosis in the internal carotid artery. Material and methods A retrospective study of patients with extracranial carotid atheromatous disease, in whom the diagnostic process was carried out with carotid ultrasound as well as supra-aortic trunk digital-subtraction angiography. Results A total of 254 carotids were evaluated and the degree of stenosis being classified into >50%, 70–99% and 100%. The UST for the fi rst group had a sensitivity (Se) of 97%, a specificity (Sp) of 90%, a positive predictive value (PPV) of 94.6% and a negative predictive value (NPV) of 94.2%. The second group had a Se of 96.4%, Sp 93%; PPV 94.4% and NPV 95.4%. The respective values for carotid occlusion were, 85%, 96.8%, 80% and 97.8%. Conclusions Our data validates the ability of UST performed in our Laboratory to diagnose the degree of carotid stenosis.

[Validation of supra-aortic trunks ultrasound in the diagnosis of atherosclerotic disease of the internal carotid artery. Comparison of the results with angiography].

Enfermedades de la médula espinal. Síndromes medulares

Infarto cerebral en paciente joven de etiología poco habitual

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