Neuroimaging of Central Nervous System Infections.

Neuroimaging plays a key role in the diagnosis of central nervous system (CNS) infections, as well as common infectious mimics. Standard imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), as well as advanced techniques such as vessel wall imaging and MR spectroscopy, are becoming widely used in many areas of the world and are valuable tools to aid neurologists in clinical practice. This review seeks to elucidate patterns of infectious pathogen tropism in the brain and spine, detail key imaging features of specific neuroinfectious pathogens such as patterns of enhancement and formation of mass lesions, and improve understanding of the sequential development of CNS infections and their complications including stroke and hydrocephalus.

Evaluation of a flipped classroom approach to undergraduate neurology medical education in Zambia.

Background: Countries in sub-Saharan Africa, including Zambia, have few neurologists, and neurophobia is common amongst medical trainees. While neurology teaching initiatives and training programs are growing in the region, innovative teaching methods are needed to improve neurology knowledge, reduce neurophobia, and encourage medical students to pursue careers in neurology. Furthermore, studies formally evaluating the effectiveness of different neurology teaching methods are needed.

Emerging neuroinfectious diseases: public health implications.

Purpose Of Review: Direct neurological consequences from emerging and re-emerging infectious diseases such as poliomyelitis, West Nile virus and Zika virus, and those with indirect neurological effects such as COVID-19 and Influenza, are major contributors to the profound impact of infectious diseases on global human health. Here, we highlight select infections of the nervous system of public health significance and discuss some of the key factors of emergence. We focus on vector-borne infections including Oropouche virus and West Nile virus, those transmitted by other nonvector animal species including Nipah and Hendra virus, and vaccine preventable infections including neurological effects of Measles virus.

Brain health in HIV: pathogenesis, classification, and treatment.

Purpose Of Review: An update on brain health and cognitive function in persons living with HIV, with a focus on pathogenesis, classification and treatment.

Recent Findings: Criteria for HIV-associated neurocognitive disorders overestimate prevalence of cognitive impairment and should no longer be used. Instead, HIV-associated brain injury should be considered as one cause of cognitive impairment in persons living with HIV, along with other non-HIV factors.

Greater Accumulation of Brain White Matter Hyperintensities in People Diagnosed and Treated During Acute HIV Compared With People Without HIV.

Background And Objectives: People living with HIV (PWH) have increased rates of ischemic stroke even after antiretroviral therapy (ART) and viral suppression. Cerebral white matter hyperintensities (WMHs) on brain MRI are associated with an increased risk of stroke and cognitive impairment. This study sought to characterize and quantify brain WMHs during acute HIV infection and after early ART initiation compared with people without HIV.

Updates on the neurological manifestations of SARS-CoV-2 infection.

Purpose Of Review: Since its emergence in 2020, the COVID-19 pandemic has created a global surge of survivors experiencing neurologic effects from SARS-CoV-2 infection. This review aims to provide an updated synthesis of the acute and chronic neurological manifestations of COVID-19, and to outline the current therapeutic strategies for these conditions.

Recent Findings: Epidemiological studies have shown that COVID-19 patients with neurological symptoms during acute infection tend to have poorer hospital and functional outcomes.

Framingham risk score based vascular outcomes in acute versus chronic HIV cohorts after 6 years of ART.

Introduction: Immune dysregulation persists in people with HIV (PWH) on antiretroviral therapy (ART) and may lead to accelerated vascular ageing and cardiovascular disease (CVD). While delayed time to initiation of ART has been linked to worse cardiovascular outcomes, the effect of ART initiation during acute infection on these outcomes is not well understood.

Methods: Participants were enrolled from the SEARCH010/RV254 acute HIV (AHI) and HIV-NAT chronic HIV (CHI) cohorts in Thailand.

Metabolic and Toxic Myelopathies.

Objective: This article reviews the clinical presentation, diagnostic evaluation, and treatment of metabolic and toxic myelopathies resulting from nutritional deficiencies, environmental and dietary toxins, drugs of abuse, systemic medical illnesses, and oncologic treatments.

Latest Developments: Increased use of bariatric surgery for obesity has led to higher incidences of deficiencies in nutrients such as vitamin B12 and copper, which can cause subacute combined degeneration. Myelopathies secondary to dietary toxins including konzo and lathyrism are likely to become more prevalent in the setting of climate change leading to drought and flooding.

Impact of steatotic liver disease and non-alcoholic steatohepatitis on cognitive impairment in people living with HIV: A cross-sectional study.

Introduction: The link between fatty liver diseases and cognitive impairment among people living with HIV (PLWH) remains unclear. We investigated the association of steatotic liver disease (SLD), advanced liver fibrosis and non-alcoholic steatohepatitis (NASH) with significant activity and liver fibrosis with cognitive impairment in PLWH.

Methods: Cognitive performance was assessed for PLWH aged ≥50 years on stable antiretroviral therapy (ART) with the Thai-validated version of the Montreal Cognitive Assessment (MoCA), and a cut-off of <25/30 was used to define cognitive impairment.

Central Nervous System Neuroimmunologic Complications of COVID-19.

Autoimmune disorders of the central nervous system following COVID-19 infection include multiple sclerosis (MS), neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, autoimmune encephalitis, acute disseminated encephalomyelitis, and other less common neuroimmunologic disorders. In general, these disorders are rare and likely represent postinfectious phenomena rather than direct consequences of the SARS-CoV-2 virus itself. The impact of COVID-19 infection on patients with preexisting neuroinflammatory disorders depends on both the disorder and disease-modifying therapy use.

Historical Perspectives on the Neurologic Manifestations of Viral Pandemics.

Neurologic symptoms have been reported in over 30% of hospitalized patients with coronavirus disease 2019 (COVID-19), but the pathogenesis of these symptoms remains under investigation. Here, we place the neurologic complications of COVID-19 within the context of three historical viral pandemics that have been associated with neurologic diseases: (1) the 1918 influenza pandemic, subsequent spread of encephalitis lethargica, and lessons for the study of COVID-19-related neuroinflammation; (2) the controversial link between the 1976 influenza vaccination campaign and Guillain-Barré Syndrome and its implications for the post- and parainfectious complications of COVID-19 and COVID-19 vaccination; and (3) potential applications of scientific techniques developed in the wake of the human immunodeficiency virus pandemic to the study of postacute sequelae of COVID-19.

Quantifying the economic burden to patients of relapse events from neuromyelitis optica spectrum disorders: A cross-sectional survey.

We surveyed 103 adults (mean age 46 years; 85% female) with neuromyelitis optica spectrum disorders (NMOSD) through social media about their personal economic burden of NMOSD emergency department visits and hospitalizations ("relapse events"). The average number of relapse events over the prior 3 years was 5.3.

Use of Transcranial Doppler as a Biomarker of CAR T Cell-Related Neurotoxicity.

Background And Objectives: To examine the relationship between transcranial Doppler (TCD) mean flow velocity (MFV) and the severity and temporal onset of neurotoxicity after chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed lymphoma.

Methods: We identified a cohort of 165 patients with relapsed or refractory B-cell lymphoma who received CAR T-cell therapy. TCDs were performed at baseline, treatment day 5, and throughout hospitalization based on development of neurologic symptoms.

Neurologic disease activity in people with multiple sclerosis treated with immune checkpoint inhibitors.

Background: There is concern that immune checkpoint inhibitors (ICPIs) can provoke relapses in people with multiple sclerosis (pwMS).

Objective: Analyze outcomes of pwMS who received ICPI treatment for malignancy.

Methods: We electronically identified pwMS who received ICPI treatment at Mass General Brigham hospital system.

Humoral response to COVID-19 vaccination in MS patients on disease modifying therapy: Immune profiles and clinical outcomes.

Background: Patients with multiple sclerosis (MS) on some disease modifying therapies (DMTs), particularly anti-CD20 and sphingosine-1-phosphate (S1P) modulators, are at increased risk of severe Coronavirus Disease 19 (COVID-19) and death. COVID-19 vaccinations are effective in preventing infection and severe disease, but humoral response to vaccination and outcomes of COVID-19 infection after vaccination in MS patients on DMTs remain less understood.

Methods: In this retrospective single-center study, patients enrolled in the CLIMB (Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women's Hospital) study and biorepository who had been vaccinated against COVID-19 and had SARS-CoV-2 spike antibody (anti-SARS-CoV-2 S Roche-Elecsys) testing were identified and compared to healthy controls.

Disease modifying therapy management of multiple sclerosis after stem cell therapies: A retrospective case series.

Background: Stem cell therapies (SCT) have not received formal regulatory approval for the treatment of people with multiple sclerosis (PwMS), but PwMS may seek various options on their own accord. The current literature largely focuses on the efficacy and safety of SCT in PwMS in clinical trials, in particular autologous hematopoietic stem cell transplantation (aHSCT), in carefully selected participants. There is little reported on the MS disease modifying therapy (DMT) management of PwMS who choose to undergo SCT outside of these trials.

Intrathecal inflammatory responses in the absence of SARS-CoV-2 nucleic acid in the CSF of COVID-19 hospitalized patients.

Objective: Little is known about CSF profiles in patients with acute COVID-19 infection and neurological symptoms. Here, CSF was tested for SARS-CoV-2 RNA and inflammatory cytokines and chemokines and compared to controls and patients with known neurotropic pathogens.

Methods: CSF from twenty-seven consecutive patients with COVID-19 and neurological symptoms was assayed for SARS-CoV-2 RNA using quantitative reverse transcription PCR (RT-qPCR) and unbiased metagenomic sequencing.

Neurologic Complications in Patients with Cancer.

Neurologic symptoms are commonly seen in patients with cancer and can be among the most challenging to diagnose and manage. It is often difficult to determine if new neurologic symptoms are secondary to direct effects of a malignant lesion, systemic complications of disease, paraneoplastic disorders, or side effects of cancer treatment itself. However, early diagnosis and treatment of each of these conditions can improve patients' quality of life and long-term functional outcomes.

Neurologic Complications of Acute HIV Infection.

Purpose Of Review: This review focuses on the pathophysiology of acute HIV infection (AHI) and related central nervous system (CNS) pathology, the clinical characteristics of neurologic complications of AHI, and the implications of the CNS reservoir and viral escape for HIV treatment and cure strategies.

Recent Findings: Recent studies in newly seroconverted populations show a high prevalence of peripheral neuropathy and cognitive dysfunction in AHI, even though these findings have been classically associated with chronic HIV infection. HIV cure strategies such as the "shock and kill" strategy are currently being studied and even in small clinical trials, though the CNS as a reservoir for latent HIV poses unique barriers to these treatment strategies.

Update on neuromyelitis optica spectrum disorder.

Purpose Of Review: Neuromyelitis optica spectrum disorder is an autoimmune disease that causes optic neuritis and transverse myelitis. Attacks can cause severe neurological damage leading to blindness and paralysis. Understanding of the immunopathogenesis of this disease has led to major breakthroughs in diagnosis and treatment.

Light therapy for multiple sclerosis-associated fatigue: a randomized, controlled phase II trial.

Background: Bright white light therapy (LT) can improve fatigue in several disease states but has not been studied in multiple sclerosis (MS).

Objective: To determine whether controlled home-based LT is feasible, tolerable, and well-adhered to in MS-associated fatigue.

Methods: A randomized, controlled trial of twice-daily 1-h bright white LT (BWLT) (10,000 lx, active arm) versus dim red LT (DRLT) (< 300 lx, control arm) was performed.

Multiple Sclerosis, Anxiety, and Depression in the United Arab Emirates: Does Social Stigma Prevent Treatment?

Background: Depression rates in the multiple sclerosis (MS) population in the Arab world have rarely been reported despite people with MS generally having higher rates of depression. We examined depression rates in 416 people with MS versus the general population of Abu Dhabi, United Arab Emirates, and their treatment.

Methods: A retrospective medical record review of 416 people with MS (age range, 16-80 years) followed up at four large government hospitals in Abu Dhabi was conducted to determine the percentage of people with MS diagnosed as having depression or anxiety.

Prevalence and characteristics of transverse myelitis and neuromyelitis optica spectrum disorders in the United Arab Emirates: A multicenter, retrospective study.

Objective: To determine the epidemiology and characteristics of transverse myelitis (TM) and neuromyelitis optica spectrum disorders (NMOSD) in Abu Dhabi, United Arab Emirates.

Methods: Retrospective chart review at four large government-run hospitals in Abu Dhabi between 2010 and 2016. Data collected included year of onset, presentation, laboratory results including aquaporin-4 immunoglobulin G (IgG)/myelin oligodendrocyte glycoprotein IgG antibodies and the occurrence of any relapses.

Novel mutation in the KCNJ10 gene in three siblings with seizures, ataxia and no electrolyte abnormalities.

We report a consanguineous family with three affected siblings with novel mutation in the KCNJ10 gene. All three presented with central nervous system symptoms in the form of infantile focal seizures, ataxia, slurred speech with early developmental delay and intellectual disability in two siblings. None had any associated electrolyte abnormalities and no symptomatic hearing deficits were observed.