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Kalafatakis K, Margoni A, Liakou ME, Stenos C, Toulas P, Korkolopoulou P, Lakiotaki E, Lafazanos SA, Zekiou K, Kardara P, Terentiou A, Nikolaou G, Stouraitis G. Acute hemorrhagic leukoencephalitis following the first dose of BNT162b2 vaccine against SARS-CoV-2: A case report. Heliyon 2024; 10:e25545. [PMID: 38356507 PMCID: PMC10865252 DOI: 10.1016/j.heliyon.2024.e25545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
Acute hemorrhagic leukoencephalitis (AHLE), is a rare inflammatory demyelinating disorder, variant of acute disseminated encephalomyelitis. The diagnosis of AHLE remains challenging due to the rarity of the disease and the lack of a reliable biomarker. We report here a case of a 73-year-old male patient with a progressive, low-grade febrile confusional syndrome 20 days after receiving the first dose of BNT162b2 vaccine against SARS-CoV-2. Evidence indicative of the underlying condition by an extensive panel of imaging (brain magnetic resonance imaging, computed tomography and digital subtraction angiography), laboratory (complete blood count, biochemistry, coagulation, tests for autoimmune or infectious disorders, tumor markers, hormonal levels, cerebrospinal fluid analysis) and electrodiagnostic tests were scarce, and mainly non-specific. Sequential neuroimaging revealed the appearance of extensive T2 lesions (signs of gliosis) along with multiple hemorrhagic lesions at various cortical sites. The patient was treated with corticosteroids, discontinued due to severe adverse effects, and subsequently with sessions of plasmapheresis and monthly intravenous administration of cyclophosphamide. Considering the rapid aggravation of the patient's neurological status, the MRI findings of cortical lesions and the lack of response to any treatment, a biopsy of a frontal lobe lesion was conducted, confirming the presence of confluent, inflammatory-edematous lesions with scattered areas of necrosis and hemorrhage, and ultimately areas of demyelination, thus confirming the diagnosis of AHLE. After more than 5 months of hospitalization the patient was transferred in a primary care facility and remained in a permanent vegetative state until his death, more than 2 years later.
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Affiliation(s)
- Konstantinos Kalafatakis
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
- Faculty of Medicine & Dentistry (Malta Campus), Queen Mary University of London, Victoria, Malta
| | - Anna Margoni
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | | | - Christos Stenos
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Panagiotis Toulas
- Research Unit of Radiology, Second Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Penelope Korkolopoulou
- First Department of Pathology, LAIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Lakiotaki
- First Department of Pathology, LAIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Katerina Zekiou
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Panagiota Kardara
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Aspasia Terentiou
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Georgios Nikolaou
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
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Stenos C, Kalafatakis K, Constantoulakis P, Zekiou K, Margoni A, Kardara P, Terentiou A, Stouraitis G, Nikolaou G. A case of cerebrotendinous xanthomatosis with brain and spinal involvement without tendon xanthomas: identification of a novel mutation of the CYP27A1 gene. J Clin Lipidol 2022; 16:281-285. [DOI: 10.1016/j.jacl.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/22/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
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Bairactaris C, Stouraitis G, Papalias E, Fakas N, Papatheodorou G, Gourtzelidis P. Early neurophysiological evolution of chronic inflammatory demyelinating polyneuropathy in a patient with Hashimoto's thyroiditis. Muscle Nerve 2008; 38:1518-1522. [DOI: 10.1002/mus.21138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Spengos K, Sameli S, Stouraitis G, Kolias A, Koulouri O, Kokkinos Z, Makrylou I, Tsivgoulis A, Tsivgoulis G, Vassilopoulos D. Seasonal variation of Bell's palsy in Athens, Greece - a hospital-based retrospective evaluation over fifteen years. Eur Neurol 2006; 55:84-8. [PMID: 16636553 DOI: 10.1159/000092779] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 02/27/2006] [Indexed: 11/19/2022]
Abstract
Epidemiological data on the incidence of Bell's palsy (BP) are conflicting. The aim of this retrospective study was to evaluate the variation of cases of BP acutely presented in the emergency room of our department over a 15-year period (January 1990 to December 2004). We examined the monthly and seasonal distribution of BPs among 36,312 patients who came to our emergency services and compared it with the assumed equal distribution of cases over the year (null hypothesis) using chi(2) techniques. During the observation period 1,252 of all patients (3.45%) presented due to BP. A decline during the summer was observed, in contrast to a peak documented during the autumn and winter. January and July were the months with the highest and lowest frequency of BP, respectively. Statistical analysis revealed a significantly different seasonal (chi(2) = 10.569; d.f. = 3; p = 0.014) and monthly (chi(2) = 25.445; d.f. = 11; p = 0.008) pattern of BP cases. The distribution of cases of BP shows a significant variation with a decline during the summer and an increase during the colder period of the year. A similar pattern has been described for reactivated herpetic ocular infections. Since a similar pathogenetic mechanism is regarded as the main cause of BP, the chronobiological aspects and the influence of meteorological factors on the reactivation of latent infections deserves further prospective evaluation.
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Affiliation(s)
- Konstantinos Spengos
- University of Athens School of Medicine, Department of Neurology, Eginition Hospital, Greece.
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Spengos K, Stouraitis G, Voumvourakis K, Zambelis T, Karandreas N. Motor and sensory polyneuritis with distal conduction failure as uncommon complication of an acute Rickettsia conorii infection. J Neurol Sci 2005; 234:113-6. [PMID: 15923013 DOI: 10.1016/j.jns.2005.03.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Revised: 01/07/2005] [Accepted: 03/31/2005] [Indexed: 10/25/2022]
Abstract
Rickettsia conorii is endemic in the Mediterranean region. Infections are mostly benign and neurological involvement is unusual. We describe a case of a man who presented with acute facial nerve palsy followed by flaccid tetraparesis due to an electrophysiologically established polyneuritis with distal conduction failure. Elevated IgM antibody titres for R. conorii were documented by indirect immunofluorescent antibody test. After doxycycline therapy, the patient presented a rapid clinical improvement. Repeated electrophysiological examinations revealed significantly restored compound muscles, and sensory action potentials, corresponding to the clinical course after treatment and ex juvantibus, indicate the causative relation between R. conorii infection and the described clinical syndrome.
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Spengos K, Wohrle JC, Tsivgoulis G, Stouraitis G, Vemmos K, Zis V. Bilateral paramedian midbrain infarct: an uncommon variant of the "top of the basilar" syndrome. J Neurol Neurosurg Psychiatry 2005; 76:742-3. [PMID: 15834041 PMCID: PMC1739622 DOI: 10.1136/jnnp.2004.050146] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Occlusion of the rostral portion of the basilar artery can result in ischaemia of the midbrain and thalami, as well as of the temporal and occipital lobes. The so called "top of the basilar" syndrome manifests clinically as numerous combinations of abnormalities of alertness, sleep-wake cycle, and behaviour and oculomotor or pupillomotor functions. A 67 year old man presented with bilateral internuclear ophthalmoplegia, rubral tremor, and daytime somnolence. He was awake during the night and mostly agitated and aggressive. An ischaemic lesion was visible on the magnetic resonance (MR) image in the central portion of the midbrain just ventral to the aqueduct, clearly affecting the paramedian structures bilaterally. MR angiographic images demonstrated a hypoplastic basilar artery ending in both superior cerebellar arteries. Both posterior cerebral arteries were seen to arise from the corresponding internal carotid arteries via the posterior communicating branches. This unique case of an acute bilateral paramedian infarct represents a highly uncommon variant of the "top of the basilar" syndrome and was due to the affected ischaemic territory--that is, the "distal field" of the variant basilar artery.
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Affiliation(s)
- K Spengos
- Department of Neurology, University of Athens, Vas. Sofias 82, 11528 Athens, Greece.
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