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Elshony H, Alzahrani M, Khafaji S, Almuhanna R, Khalil K, Mudassir R. Ischemic stroke as the initial presentation in acute myeloid leukemia vs. myelodysplastic syndrome: a case report and literature review with pathophysiological and clinical exploration. Neurol Sci 2024; 45:3297-3304. [PMID: 38351359 DOI: 10.1007/s10072-024-07367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/25/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) present intricate challenges due to their diverse clinical manifestations and thrombotic complications. Thromboembolism (TE) incidence in newly diagnosed AML patients is noteworthy, with arterial TE linked to poorer overall survival. Ischemic strokes, although relatively low in prevalence, carry significant clinical implications. CASE DESCRIPTION We report the case of an 84-year-old male with Type 2 Diabetes, Hypertension, and Chronic Kidney Disease, presenting with seizures, focal neurological deficits, and pancytopenia. An unexpected diagnosis of AML or MDS emerged during the investigation. Despite interventions, the patient's condition deteriorated, leading to a fatal outcome weeks later. CONCLUSION This case underscores the intricate relationship between hematologic malignancies and ischemic stroke. The rarity of this complication emphasizes the importance of understanding the multifaceted mechanisms at play, including hyperleukocytosis, pro-inflammatory cytokine release, coagulation cascade activation, and direct interactions with endothelial cells. In our literature review, analysis of 15 cases, including ours, revealed a wide age range (3-87 years) and a gender bias towards females. AML diagnosis was predominant, with uniformly low platelet counts. Cortical infarctions, especially in the anterior circulation, were common. Hyperleukocytosis, disseminated intravascular coagulation (DIC), and fatal outcomes were observed in a subset of cases. Despite the grim statistics and often poor prognosis, the identification of specific risk factors, such as thrombocytopenia and cytogenetic abnormalities, offers avenues for targeted prevention and management.
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Affiliation(s)
- Hosna Elshony
- Department of Neuropsychiatry, Faculty of Medicine, Menoufiya University, Shebin El-kom, Egypt.
| | - Meshari Alzahrani
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
| | - Salah Khafaji
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
| | - Rakan Almuhanna
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
| | - Khalid Khalil
- Department of Internal Medicine/Hematology, Security Forces Hospital, Makkah, Saudi Arabia
| | - Rabia Mudassir
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
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Loni R, Khushaym AH, Aldoseri AB, Alfehaid A, Fox G, Hasan S. Acute Viral Encephalitis Mimicking Idiopathic Intracranial Hypertension in an Immunocompetent Obese Adolescent Girl. Cureus 2024; 16:e51896. [PMID: 38205089 PMCID: PMC10776452 DOI: 10.7759/cureus.51896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/12/2024] Open
Abstract
Varicella zoster virus (VZV) is common worldwide and one of the main causes of infectious encephalitis. We report the case of a 13-year-old girl who presented to the emergency department with complaints of recurrent episodes of vague headaches associated with photophobia multiple times within three days before hospitalization. The patient had a history of morbid obesity without other metabolic complications as well as a history of chicken pox in childhood. Doctors subsequently diagnosed her with increased intracranial pressure owing to suspected VZV encephalitis. A lumbar puncture confirmed the presence of VZV in the cerebrospinal fluid. After admitting the diagnosis of VZV encephalitis, doctors treated the patient with intravenous acyclovir and discharged her with oral acyclovir. This case highlights the importance of considering VZV encephalitis in the differential diagnosis for patients presenting with headaches, especially in the presence of typical vesicular skin rashes. The case has an unusual complication associated with shingles, which doctors diagnosed early and treated appropriately.
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Affiliation(s)
- Ramaning Loni
- Pediatrics, King Hamad University Hospital, Busaiteen, BHR
| | | | | | - Ali Alfehaid
- Pediatrics, King Hamad University Hospital, Busaiteen, BHR
| | - Gabriel Fox
- Pediatrics, King Hamad University Hospital, Busaiteen, BHR
| | - Shatha Hasan
- Pediatrics, King Hamad University Hospital, Busaiteen, BHR
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Rodrigues F, Santos M, Macedo E, Rocha JM, Silva L, Oliveira AS, Alves J, Apolinário I. Varicella-Zoster Virus: A Case of Encephalitis. Cureus 2023; 15:e45378. [PMID: 37849585 PMCID: PMC10578968 DOI: 10.7759/cureus.45378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
Infection with the varicella-zoster virus (VZV) is very common worldwide and is one of the main causes of infectious encephalitis. Immunosuppressed patients are at increased risk of severe disease and central nervous system (CNS) involvement. We report the case of a 43-year-old man with HIV infection and poor adherence to antiretroviral therapy who presented to the emergency department (ER) with complaints of diplopia and a frontal headache, referring to having a child with chickenpox. Brain magnetic resonance imaging revealed three hyperintense T2-weighted lesions surrounded by edema in the right sublenticular, left occipital and left parietal regions, and VZV DNA was detected in the cerebrospinal fluid (CSF). After admitting the diagnosis of VZV encephalitis, the patient was treated with intravenous acyclovir, with clinical improvement and a favorable outcome.
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Affiliation(s)
| | | | | | | | - Luís Silva
- Internal Medicine, Hospital de Braga, Braga, PRT
| | | | - Joana Alves
- Infectious Disease, Hospital de Braga, Braga, PRT
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Li C, Xu BF, Zhang M, Song YM, Liu R. Severe Thrombocytopenia with Acute Cerebral Infarction: A Case Report and Literature Review. Niger J Clin Pract 2023; 26:1040-1044. [PMID: 37635593 DOI: 10.4103/njcp.njcp_844_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Common causes of thrombocytopenia include pseudo-thrombocytopenia, splenomegaly, decreased bone marrow production, and increased platelet destruction or depletion. The main clinical manifestation is bleeding, and thrombosis-related complications are rare. This article reports an 87-year-old woman with severe thrombocytopenia for more than 7 years. On day 6 in the hospital, the patient suddenly fell into a coma, and emergency head computed tomography (CT) displayed acute cerebral infarction of the left cerebellar hemisphere, brainstem, and left thalamus. Although thrombocytopenia is often associated with bleeding, there is still a need for vigilance against ischemic diseases. We analyzed the possible causes of acute cerebral infarction with thrombocytopenia and reviewed the literature. Our case is different from the causes of cerebral infarction reported in previous articles, so the relationship between thrombocytopenia and acute cerebral infarction needs further study. The patient, in this case, was not given anticoagulant or antiplatelet therapy but recovered well. It shows that individualized treatment is effective.
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Affiliation(s)
- C Li
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - B F Xu
- Department of Stroke Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - M Zhang
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Y M Song
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - R Liu
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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Hofstrand R, Portela R, Juneau R, Okafor C, Watts R. Hemorrhagic Stroke Due to Varicella Zoster Virus Vasculopathy. Cureus 2023; 15:e36604. [PMID: 37102032 PMCID: PMC10123232 DOI: 10.7759/cureus.36604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
Varicella-zoster virus (VZV) vasculopathy is a granulomatous vasculitis that has a wide variety of clinical presentations. It is most common in patients with HIV not on anti-retroviral therapy (ART) with low cluster of differentiation (CD)4 cell counts. This disease affects the central nervous system and can cause small intracranial bleeds. Our patient presented with stroke-like symptoms in the setting of recent VZV reactivation in the ophthalmic distribution with HIV on ART. Her MRI scan showed a small punctate bleed and the CSF workup was consistent with VZV vasculitis. She was treated with 14 days of acyclovir and five days of high-dose steroids with clinical improvement to baseline.
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Affiliation(s)
- Reese Hofstrand
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Rafael Portela
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Ryan Juneau
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Chika Okafor
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Ryan Watts
- Cardiothoracic Surgery, Campbell University School of Osteopathic Medicine, Lillington, USA
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Rodriguez-Pla A, Grill MF, Fletcher GP, Di Nome MA. Ischemic Optic Neuropathy Secondary to Varicella-Zoster Vasculitis Mimicking Giant Cell Arteritis: Case Report. Case Rep Neurol 2022; 14:483-490. [PMID: 36644003 PMCID: PMC9834640 DOI: 10.1159/000527876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
Differentiating GCA from its many mimickers remains a challenge in the daily clinical practice, especially in patients presenting with unspecific manifestations. We present the case of an 82-year-old woman who presented with a 3-week history of left eye vision loss secondary to bilateral edema and hemorrhage of the optic discs. Despite negative bilateral temporal artery biopsies, the elevation of the inflammatory markers and brain MRA findings suggestive of temporal arteritis as well as stenosis of the basilar artery led us to initiate treatment with high-dose steroids. Inflammatory markers remained elevated despite high-dose steroids which prompted additional work leading to a diagnosis of varicella-zoster encephalitis. Steroid treatment was quickly tapered off and treatment with acyclovir resulted in the normalization of the acute phase reactants. The persistence of elevated inflammatory markers despite high-dose steroids should prompt additional work up for the search of an alternative diagnosis of GCA mimickers.
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Affiliation(s)
- Alicia Rodriguez-Pla
- Division of Rheumatology, University of California San Fracisco (UCSF) in Fresno, Fresno, California, USA,*Alicia Rodriguez-Pla,
| | - Marie F. Grill
- Mayo Clinic Arizona, Department of Neurology, Scottsdale, Arizona, USA
| | | | - Marie A. Di Nome
- Mayo Clinic Arizona, Division of Neuro-ophthalmology, Scottsdale, Arizona, USA
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Matthews E, Beckham JD, Piquet AL, Tyler KL, Chauhan L, Pastula DM. Herpesvirus-Associated Encephalitis: an Update. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:92-100. [PMID: 36186545 PMCID: PMC9510386 DOI: 10.1007/s40475-022-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review Recent Findings Summary
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Yang Z, Wei F, Zhang B, Luo Y, Xing X, Wang M, Chen R, Sun G, Sun X. Cellular Immune Signal Exchange From Ischemic Stroke to Intestinal Lesions Through Brain-Gut Axis. Front Immunol 2022; 13:688619. [PMID: 35432368 PMCID: PMC9010780 DOI: 10.3389/fimmu.2022.688619] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 03/16/2022] [Indexed: 12/24/2022] Open
Abstract
As a vital pivot for the human circulatory system, the brain-gut axis is now being considered as an important channel for many of the small immune molecules’ transductions, including interleukins, interferons, neurotransmitters, peptides, and the chemokines penetrating the mesentery and blood brain barrier (BBB) during the development of an ischemic stroke (IS). Hypoxia-ischemia contributes to pituitary and neurofunctional disorders by interfering with the molecular signal release and communication then providing feedback to the gut. Suffering from such a disease on a long-term basis may cause the peripheral system’s homeostasis to become imbalanced, and it can also lead to multiple intestinal complications such as gut microbiota dysbiosis (GMD), inflammatory bowel disease (IBD), necrotizing enterocolitis (NEC), and even the tumorigenesis of colorectal carcinoma (CRC). Correspondingly, these complications will deteriorate the cerebral infarctions and, in patients suffering with IS, it can even ruin the brain’s immune system. This review summarized recent studies on abnormal immunological signal exchange mediated polarization subtype changes, in both macrophages and microglial cells as well as T-lymphocytes. How gut complications modulate the immune signal transduction from the brain are also elucidated and analyzed. The conclusions drawn in this review could provide guidance and novel strategies to benefit remedies for both IS and relative gut lesions from immune-prophylaxis and immunotherapy aspects.
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Affiliation(s)
- Zizhao Yang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Program in Neuroscience and Behavioral Disorders, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Fei Wei
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun Luo
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Xing
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Wang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongchang Chen
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guibo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Guibo Sun, ; Xiaobo Sun,
| | - Xiaobo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Guibo Sun, ; Xiaobo Sun,
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