Systemic lupus erythematosus (SLE) can affect the nervous system at multiple levels, among which SLE-associated transverse myelitis is an infrequent but potentially severe complication affecting around 1% of SLE population. To assist a timely diagnosis and optimal outcome, the clinical and radiological features, differential diagnosis (particularly with other central nervous system inflammatory demyelinating disorders), current therapeutic approach and the prognosis of SLE-associated myelitis are presented based on recent data and progress.

Background & Objectives: The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on clinical practice worldwide with severe consequences for acute stroke care. We aimed to evaluate our institution’s experience and measure the impact of the COVID-19 pandemic on acute stroke care in a single-center in Varna, Bulgaria. Methods: We conducted a retrospective study, including all the patients presented with acute stroke to a tertiary care referral center for neurological disorders in Eastern Bulgaria. We compared the data aboutstroke incidence, patient characteristics, treatment details, logistics, mortality rate, and general qualitative parameters in two periods - July to September 2020 (COVID) and the corresponding period in 2019 (pre-COVID). Results: There was a 17.29% increase in all admissions in the COVID period compared with 2019, as there were more patients with firstever ischemic stroke (p=0.031) and more severe cases in comatose state during admission (p=0.0001). During the pandemic, the time from onset to arrival in the hospital was significantly prolonged from 231 ± 233 minutes in 2019 to 615 ± 1179 minutes (p=0.0001), intravenous thrombolysis rates were decreased (p=0.014), mortality from acute ischemic stroke was two-fold higher, and stroke-survivors had a higher disability (p=0.0001). A decrease in the rehabilitation assessment was noted (p=0.002), while door-to-needle time for thrombolysis and other major qualitative parameters of acute stroke care did not significantly differ. Conclusion: During the COVID pandemic, we found an increase in stroke cases and a substantial delay from stroke onset to hospital presentation. These logistics changes could be one reason that led to more severe cases with worse functional outcomes and higher mortality rates.

Background: Among the morbid neurological complications, stroke has been frequently observed in COVID-19 but there are limited reports, especially in the Philippines. This study aims to determine the clinical characteristics of COVID-19 patients with cerebrovascular disease (CVD). Methods: We performed a single-center retrospective analysis of stroke patients with COVID-19 from March to August 2020. Results: Of the 584 COVID-19 cases, 27 patients have cerebrovascular disease, with rate of COVID-19 related CVD at 4.62%. COVID-19 with CVD were younger than those without COVID-19 (58.23 vs 61.53 years). The median admitting NIHSS was mild for both groups (4 vs 5) and the vascular risk factors of these groups were similar. The median time of onset of CVD at 7 days from onset of COVID-19. Deranged levels of procalcitonin, D-dimer, ferritin, CRP, and LDH were elevated and greater in the large artery atherothrombosis. Anti-platelet therapy was given in 4 (20%) while 16 (80%) received anticoagulation. For intracranial hemorrhage, 6 out of 7 (86 %) were admitted without prior COVID-19 symptom; hence, a causal relationship is difficult to establish. Conclusion: Less than 5 % of the COVID-19 patients present with CVD. They are younger but share similar vascular risk factors with COVID-19 negative stroke patients. There is a possible association between COVID-19 and acute ischemic stroke. Large artery atherothrombosis are more common in patients with COVID-19 this type showed more deranged laboratory investigation. A causal relationship between intracranial hemorrhage and COVID-19 is difficult to establish; thus, further study regarding this is merited.

Objective: This investigation sought to evaluate the safety outcomes after thrombolysis for acute ischemic stroke in patients with prior recent stroke through meta-analysis. Methods: The databases were systematically searched for were observational studies of intravenous thrombolysis for stroke in patients with prior stroke in the past 3 months, the risk of intracranial hemorrhage and mortality. Data from eligible studies were analyzed using RevMan5.3. Results: A total of 7 studies were included in the analysis. The adjusted OR of the analysis indicated that prior stroke within 3 months of receiving intravenous thrombolysis for acute ischemic stroke would not increase the risk of intracranial hemorrhage (6 studies, the treatment group contains 1,037 and the control group 51,788) and mortality at three months (4 studies, the treatment group contains 977 and the control group 51,361 subjects). Based on the number of events, we could conclude that thrombolysis does not increase the risk of intracranial hemorrhage (3 studies, the treatment group contains 834 and the control group 48,452 subjects) and mortality at three months (3 studies, the treatment group contains 834 and the control group 48,452 subjects). Conclusion: A review of the current published literature indicates that prior stroke within 3 months of receiving intravenous thrombolysis for acute ischemic stroke does not increase the risk of intracranial hemorrhage and the 3-month mortality of patients.

Background & Objectives: Stroke mimics are conditions that simulate the signs and symptoms of a stroke. These conditions pose a clinical challenge as they need to be distinguished from actual strokes based on neurologic findings, laboratory tests, and imaging studies in order to minimize the adverse effects of acute stroke therapies as well as hospital costs. The study aims to determine the rate and the most common etiologies of stroke mimics in a private tertiary care hospital in the Philippines and calculate the average cost incurred for diagnostics. Methods: We conducted a retrospective review of medical records of adult patients assessed by the hospital’s Brain Attack Team from 1 January 2014 to 31 December 2017. The diagnosis of stroke mimic was based on negative neuroimaging findings and laboratory results that showed an alternate diagnosis, in consultation with the stroke neurologist on call. Results: A total of 1,485 patient records were analyzed; 448 patients (30.2%) were diagnosed as stroke mimics. The most common etiologies were encephalopathy (83 cases, 18.5%), seizures (77 cases, 17.2%), headache (31 cases, 6.9%), hypertensive emergency (31 cases, 6.9%), and radiculopathy (27 cases, 6.0%). The average cost for diagnostics for each patient diagnosed as a stroke mimic was PHP 24,629.53 (approximately US$500). Conclusion: Stroke mimics are often encountered in the emergency setting. Due to the wide range of medical conditions that mimic stroke, early recognition is important in order to avoid the potential adverse effects of acute stroke therapies and minimize diagnostic costs, particularly in countries with limited resources.

Background: Lacunar stroke accounts for a quarter of all acute ischemic infarction. Insufficient information is available with respect to the pattern and risk factor profiles of patients with lacunar stroke from developing countries. We undertook this study to define the clinical features, imaging characteristics, and risk factors in a group of patients with image proven lacunar stroke from southern India, and contrast them with those described from developed countries. Methods: We retrospectively reviewed the demographic, risk factor profiles (presence of hypertension, diabetes mellitus, dyslipidemia, smoking) and CT/MRI brain findings (microbleeds, small vessel ischemic changes, old infarcts) and CV Doppler/CT or MR angiography of brain and neck vessels of 132 consecutive patients diagnosed with image proven acute infarct measuring 2-20mm in subcortical white matter, basal ganglia, thalamus or pons, presumed to result from the occlusion of a single small perforating artery(lacunar infarct), in Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India. Results: Males comprised 63.6%, with 56% between the ages of 55-75 years. Hypertension was present in 98 (74.2%) and 50 (37.8%) had diabetes mellitus. Pure motor hemiparesis was the most common clinical syndrome 79 (59.8%), followed by ataxic hemiparesis in 32 (24.2%). Chronic lacunar infarct was detected in 68 (51.5%) patients MRI; however, past history of stroke was present only in 10 (7.6%). Small vessel ischemic changes were present in 100 (75.8%), and cerebral micro-bleeds in 10 (7.6%) patients. Angiography showed symptomatic side carotid stenosis of over 50% in 6 (4.5%), intracranial major vessel stenosis in 12.61% of patients. Conclusion: Lacunar stroke, although less dramatic in its clinical presentation, is frequently associated with modifiable risk factors like hypertension and diabetes. It should be regarded as a warning sign of underlying diffuse small vessel disease; hence, portends recurrent stroke and vascular dementia. Our findings are in accordance with most studies from developed countries.

Individual values and beliefs vary according to cultural and social factors. To better understand clinical decision-making and inform future research, we undertook a survey of preferences in treatment goals for managing patients with acute ischemic stroke among medical professionals in China. We designed a web-based survey through literature search, face-to-face interviews, pilot questionnaire development, and focus group meetings. Key outcomes explored were death, disability, quality of life, neurological impairments, cognitive dysfunction, and hemorrhagic transformation. Participants were asked to rate the importance of each outcome on a 5-point Likert scale to allow calculation of a weighted score of importance: higher scores indicating greater importance. A total of 1,189 participants completed the survey. For established therapies with bleeding risk (e.g. thrombolysis and thrombectomy), death was the most important outcome (weighted score 4.60), followed by disability (4.45), quality of life (4.45), neurological impairments (4.34), cognitive dysfunction (4.03), and hemorrhagic transformation (3.99). For other acute therapies without bleeding risk, quality of life ranked first (4.08), followed by disability (4.03), neurological impairment (3.92), death (3.79), cognitive dysfunction (3.78), and hemorrhagic transformation (3.51). From the perspective of Chinese medical staff, death is the most important outcome measure for patients with acute ischemic stroke. When reduction of death or disability were less likely to be achievable, the improvement in quality of life is an acceptable outcome measure. In contrast to the previously perceived high fear of bleeding in practice, hemorrhagic transformation was the least concerned even for therapies with a potential bleeding risk.

Background & Objective: Nonsense mutations in SMC1A have been reported only in females with cluster seizures, all of whom have been described as drug-resistant epilepsy. Here, we aim to explore the use of ketogenic diet treatment. Methods: The clinical data of female patients with de novo nonsense mutations in SMC1A were collected and analyzed. The clinical data was recruited and analyzed. The peripheral blood of children and their parents was collected. The next generation sequencing was used to find suspected pathogenic mutations and all the confirmed mutations were verified by Sanger sequencing. Results: Three patients with heterozygous de novo mutations in SMC1A gene were reviewed. All patients were females, presenting with seizure onset at age between 2.5 to 11 months old. One patient had mild developmental delay. One had moderate developmental delay. Another had severe developmental retardation. None of the patients had a clinical diagnosis of Cornelia de Lange syndrome. All three patients had prominent clinical features of cluster seizures. All the nonsense mutations were predicted damaging SMC1A protein by PolyPhen-2 HVAR. All the patients were treated with multiple antiepileptic drugs but their seizures remained refractory. When initiated with ketogenic diet, they became seizure free within 3 to 4 weeks. Conclusion: SMC1A nonsense mutations can cause early onset epilepsy only in females with cluster seizures. These patients are characterized by drug-resistant epilepsy, but all our three patients have good effect on ketogenic diet add-on therapy.

Background & Objective: Although the clinical manifestations and outcomes of lumbosacral plexopathy have been reported, the long-term outcomes are unclear. Therefore, we investigated clinical manifestations and long-term outcomes in patients with lumbosacral plexopathy in terms of the extent and etiology of the injury. Methods: We evaluated the clinical and electrodiagnostic data and outcomes of 23 patients with lumbosacral plexopathy in a retrospective longitudinal observational study. The enrolled subjects were divided into groups according to the etiology and extent of their injuries, and the clinical outcomes of each group 1 year after onset were investigated. Outcomes were classified as full recovery, able to walk, unable to walk, and follow-up loss. Results: The right lumbosacral plexus was involved in 11 patients, left lumbosacral plexus in 8, and both in 4. Among the 27 lumbosacral plexus lesions (4 patients had bilateral lesions), the upper lumbar plexus was involved in 6 cases, lower lumbosacral plexus in 12, and the entire lumbosacral plexus in 9. Thirteen cases arose from traumatic events, and the rest were non-traumatic. When the clinical outcomes of the groups were compared, non-traumatic cases had higher rates of full recovery than did traumatic cases. Those with lesions in the upper lumbar plexus had a higher rate of full recovery than the other groups. Conclusions: Non-traumatic etiology and upper lumbar plexus injury were associated with better outcomes. These results will be useful when planning treatment strategies and will increase our understanding of the prognosis for lumbosacral plexopathy

Objective: This study aimed to determine the correlation of glycemic load (GL) and glycemic index (GI) with Parkinson’s disease (PD) in terms of the serum levels of methylglyoxal (MGO), oligomeric α-synuclein (α-syn), and DJ-1. Methods: In this case-control study (40 PD and 40 healthy individuals) dietary intake of the participants was assessed for a 4-day period (24-hour dietary recall questionnaire and three-day food record). Serum levels of MGO, oligomeric α-syn, and DJ-1 were measured by ELISA. Adjusted odds ratios (ORs) for PD were estimated according to quantiles of dietary factors and serum factors. Results: Serum levels of oligomeric α-syn (p = 0.003) and DJ-1 (p < 0.001) were significantly higher in the patients compared to the healthy participants. The participants with PD had higher GI levels (p = 0.02) compared to healthy individuals. A positive correlation emerged between the risks of PD and GI (OR: 10.05; [95%CI: 1.94, 51.95] for the highest vs. the lowest quintile, p for trend 0·028). In the patients, level of GI, but not GL, correlated with MGO [β (95% CI): 0.27 (0.02, 1.98); p = 0.04], oligomeric α-syn [β (95% CI): 0.34 (0.01, 0.17); p = 0.03], and DJ-1 [β (95% CI):0.39 (0.04, 0.30); p = 0.01] positively and significantly. Moreover, serum levels of MGO, oligomeric α-syn, and DJ-1 were associated with each other significantly and positively (p < 0.05). Conclusions: It can be concluded that high GI diets are positively correlated with PD, more possibly by the increased α-syn oligomerization and advanced glycated end products (AGEs) formation.