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Mina Y, Enose-Akahata Y, Hammoud DA, Videckis AJ, Narpala SR, O'Connell SE, Carroll R, Lin BC, McMahan CC, Nair G, Reoma LB, McDermott AB, Walitt B, Jacobson S, Goldstein DS, Smith BR, Nath A. Deep Phenotyping of Neurologic Postacute Sequelae of SARS-CoV-2 Infection. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/4/e200097. [PMID: 37147136 PMCID: PMC10162706 DOI: 10.1212/nxi.0000000000200097] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/04/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVES SARS-CoV-2 infection has been associated with a syndrome of long-term neurologic sequelae that is poorly characterized. We aimed to describe and characterize in-depth features of neurologic postacute sequelae of SARS-CoV-2 infection (neuro-PASC). METHODS Between October 2020 and April 2021, 12 participants were seen at the NIH Clinical Center under an observational study to characterize ongoing neurologic abnormalities after SARS-CoV-2 infection. Autonomic function and CSF immunophenotypic analysis were compared with healthy volunteers (HVs) without prior SARS-CoV-2 infection tested using the same methodology. RESULTS Participants were mostly female (83%), with a mean age of 45 ± 11 years. The median time of evaluation was 9 months after COVID-19 (range 3-12 months), and most (11/12, 92%) had a history of only a mild infection. The most common neuro-PASC symptoms were cognitive difficulties and fatigue, and there was evidence for mild cognitive impairment in half of the patients (MoCA score <26). The majority (83%) had a very disabling disease, with Karnofsky Performance Status ≤80. Smell testing demonstrated different degrees of microsmia in 8 participants (66%). Brain MRI scans were normal, except 1 patient with bilateral olfactory bulb hypoplasia that was likely congenital. CSF analysis showed evidence of unique intrathecal oligoclonal bands in 3 cases (25%). Immunophenotyping of CSF compared with HVs showed that patients with neuro-PASC had lower frequencies of effector memory phenotype both for CD4+ T cells (p < 0.0001) and for CD8+ T cells (p = 0.002), an increased frequency of antibody-secreting B cells (p = 0.009), and increased frequency of cells expressing immune checkpoint molecules. On autonomic testing, there was evidence for decreased baroreflex-cardiovagal gain (p = 0.009) and an increased peripheral resistance during tilt-table testing (p < 0.0001) compared with HVs, without excessive plasma catecholamine responses. DISCUSSION CSF immune dysregulation and neurocirculatory abnormalities after SARS-CoV-2 infection in the setting of disabling neuro-PASC call for further evaluation to confirm these changes and explore immunomodulatory treatments in the context of clinical trials.
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Affiliation(s)
- Yair Mina
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Yoshimi Enose-Akahata
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Dima A Hammoud
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Anthony J Videckis
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sandeep R Narpala
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sarah E O'Connell
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Robin Carroll
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Bob C Lin
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Cynthia Chen McMahan
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Govind Nair
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Lauren B Reoma
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Adrian B McDermott
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Brian Walitt
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Steven Jacobson
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - David S Goldstein
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Bryan R Smith
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Avindra Nath
- From the National Institute of Neurological Disorders and Stroke (Y.M., Y.E.-A., A.J.V., C.C.M., G.N., L.B.R., B.W., S.J., D.S.G., B.R.S., A.N.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel-Aviv University, Israel; Center for Infectious Disease Imaging (D.A.H.), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health; and Vaccine Immunology Program (S.R.N., S.E.O.C., R.C., B.C.L., A.B.M.), Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
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Calvier L, Drelich A, Hsu J, Tseng CT, Mina Y, Nath A, Kounnas MZ, Herz J. Circulating Reelin promotes inflammation and modulates disease activity in acute and long COVID-19 cases. Front Immunol 2023; 14:1185748. [PMID: 37441066 PMCID: PMC10333573 DOI: 10.3389/fimmu.2023.1185748] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Thromboembolic complications and excessive inflammation are frequent in severe COVID-19, potentially leading to long COVID. In non-COVID studies, we and others demonstrated that circulating Reelin promotes leukocyte infiltration and thrombosis. Thus, we hypothesized that Reelin participates in endothelial dysfunction and hyperinflammation during COVID-19. We showed that Reelin was increased in COVID-19 patients and correlated with the disease activity. In the severe COVID-19 group, we observed a hyperinflammatory state, as judged by increased concentration of cytokines (IL-1α, IL-4, IL-6, IL-10 and IL-17A), chemokines (IP-10 and MIP-1β), and adhesion markers (E-selectin and ICAM-1). Reelin level was correlated with IL-1α, IL-4, IP-10, MIP-1β, and ICAM-1, suggesting a specific role for Reelin in COVID-19 progression. Furthermore, Reelin and all of the inflammatory markers aforementioned returned to normal in a long COVID cohort, showing that the hyperinflammatory state was resolved. Finally, we tested Reelin inhibition with the anti-Reelin antibody CR-50 in hACE2 transgenic mice infected with SARS-CoV-2. CR-50 prophylactic treatment decreased mortality and disease severity in this model. These results demonstrate a direct proinflammatory function for Reelin in COVID-19 and identify it as a drug target. This work opens translational clinical applications in severe SARS-CoV-2 infection and beyond in auto-inflammatory diseases.
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Affiliation(s)
- Laurent Calvier
- Department of Molecular Genetics, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
- Center for Translational Neurodegeneration Research, UT Southwestern Medical Center, Dallas, TX, United States
| | - Aleksandra Drelich
- Department of Biochemistry, Cellular, and Molecular Biology, University of Texas Medical Branch (UTMB) Health, Galveston, TX, United States
| | - Jason Hsu
- Department of Biochemistry, Cellular, and Molecular Biology, University of Texas Medical Branch (UTMB) Health, Galveston, TX, United States
| | - Chien-Te Tseng
- Department of Biochemistry, Cellular, and Molecular Biology, University of Texas Medical Branch (UTMB) Health, Galveston, TX, United States
| | - Yair Mina
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | | | - Joachim Herz
- Department of Molecular Genetics, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
- Center for Translational Neurodegeneration Research, UT Southwestern Medical Center, Dallas, TX, United States
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX, United States
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, United States
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Bierman-Chow S, Holland SM, Hsu AP, Palmer C, Lynch J, Mina Y, Joo (Sophie) Cho H. Clinical, Imaging, and Laboratory Findings in Patients With GATA2 Deficiency Presenting With Early-Onset Ischemic Stroke. Neurology 2023; 100:338-341. [PMID: 36357187 PMCID: PMC9969925 DOI: 10.1212/wnl.0000000000201569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to characterize the clinical, laboratory, and imaging findings of 10 patients with GATA2 deficiency who presented with early-onset ischemic stroke. METHODS A retrospective chart review was conducted on a 127-patient cohort enrolled in the Natural History Study of GATA2 Deficiency and Related Disorders protocol at NIH between 2013 and 2021. All patients had a genetically confirmed GATA2 deficiency. Patients were included if they had evidence of an ischemic stroke through clinical evaluation and neuroimaging. Stroke diagnosis was confirmed through brain magnetic resonance imaging and/or CT. RESULTS Ten patients between the ages of 15 and 38 years (4 males and 6 females) were identified with at least one ischemic stroke while 6 patients experienced recurrent strokes (7.9% overall, 10/127). Stroke etiology varied and included small vessel (n = 4), large vessel (n = 1), cardioembolic (n = 1), and undetermined (n = 4). Nine patients had lupus anticoagulant, and 2 patients had a history of recurrent deep vein thrombosis. DISCUSSION We describe the clinical, laboratory, and imaging findings of 10 patients with GATA2 deficiency younger than 40 years who suffered one or more ischemic strokes , suggesting a link between GATA2 deficiency and stroke. This report emphasizes the need for further research to understand this unique vulnerability within this patient population.
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Affiliation(s)
- Shaia Bierman-Chow
- From the National Institute of Neurological Disorders and Stroke (S.B.-C., J.L., Y.M., H.J.(S.)C.), National Institutes of Health, Bethesda, MD; National Institute of Allergy and Infectious Diseases (S.M.H., A.P.H.), National Institutes of Health, Bethesda, MD; National Institutes of Health Bethesda (C.P.), Maryland; and Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel.
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Enose-Akahata Y, Wang L, Almsned F, Johnson KR, Mina Y, Ohayon J, Wang XW, Jacobson S. The repertoire of CSF antiviral antibodies in patients with neuroinflammatory diseases. Sci Adv 2023; 9:eabq6978. [PMID: 36598996 PMCID: PMC9812372 DOI: 10.1126/sciadv.abq6978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). Although various viruses have been proposed to contribute to MS pathology, the etiology of MS remains unknown. Since intrathecal antibody synthesis is well documented in chronic viral infection and neuroinflammatory diseases, we hypothesized whether the patterns of antigen-specific antibody responses associated with various viral exposures may define patients with CNS chronic immune dysregulation. The pan-viral antibody profiling in cerebrospinal fluid (CSF) and serum of patients with MS showed significant differences from those in healthy volunteers and a pattern of antibody responses against multiple viruses, including the previously identified Epstein-Barr virus. These findings demonstrate that virus-specific antibody signatures might be able to reflect disease-associated inflammatory milieu in CSF of subjects with neuroinflammatory diseases.
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Affiliation(s)
- Yoshimi Enose-Akahata
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Limin Wang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Fahad Almsned
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kory R. Johnson
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Yair Mina
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Xin Wei Wang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Dieckhaus H, Meijboom R, Okar S, Wu T, Parvathaneni P, Mina Y, Chandran S, Waldman AD, Reich DS, Nair G. Logistic Regression-Based Model Is More Efficient Than U-Net Model for Reliable Whole Brain Magnetic Resonance Imaging Segmentation. Top Magn Reson Imaging 2022; 31:31-39. [PMID: 35767314 PMCID: PMC9258518 DOI: 10.1097/rmr.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Automated whole brain segmentation from magnetic resonance images is of great interest for the development of clinically relevant volumetric markers for various neurological diseases. Although deep learning methods have demonstrated remarkable potential in this area, they may perform poorly in nonoptimal conditions, such as limited training data availability. Manual whole brain segmentation is an incredibly tedious process, so minimizing the data set size required for training segmentation algorithms may be of wide interest. The purpose of this study was to compare the performance of the prototypical deep learning segmentation architecture (U-Net) with a previously published atlas-free traditional machine learning method, Classification using Derivative-based Features (C-DEF) for whole brain segmentation, in the setting of limited training data. MATERIALS AND METHODS C-DEF and U-Net models were evaluated after training on manually curated data from 5, 10, and 15 participants in 2 research cohorts: (1) people living with clinically diagnosed HIV infection and (2) relapsing-remitting multiple sclerosis, each acquired at separate institutions, and between 5 and 295 participants' data using a large, publicly available, and annotated data set of glioblastoma and lower grade glioma (brain tumor segmentation). Statistics was performed on the Dice similarity coefficient using repeated-measures analysis of variance and Dunnett-Hsu pairwise comparison. RESULTS C-DEF produced better segmentation than U-Net in lesion (29.2%-38.9%) and cerebrospinal fluid (5.3%-11.9%) classes when trained with data from 15 or fewer participants. Unlike C-DEF, U-Net showed significant improvement when increasing the size of the training data (24%-30% higher than baseline). In the brain tumor segmentation data set, C-DEF produced equivalent or better segmentations than U-Net for enhancing tumor and peritumoral edema regions across all training data sizes explored. However, U-Net was more effective than C-DEF for segmentation of necrotic/non-enhancing tumor when trained on 10 or more participants, probably because of the inconsistent signal intensity of the tissue class. CONCLUSIONS These results demonstrate that classical machine learning methods can produce more accurate brain segmentation than the far more complex deep learning methods when only small or moderate amounts of training data are available (n ≤ 15). The magnitude of this advantage varies by tissue and cohort, while U-Net may be preferable for deep gray matter and necrotic/non-enhancing tumor segmentation, particularly with larger training data sets (n ≥ 20). Given that segmentation models often need to be retrained for application to novel imaging protocols or pathology, the bottleneck associated with large-scale manual annotation could be avoided with classical machine learning algorithms, such as C-DEF.
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Affiliation(s)
- Henry Dieckhaus
- qMRI Core Facility, NINDS, National Institutes of Health, Bethesda, MD, USA
| | | | - Serhat Okar
- Translational Neuroradiology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- Clinical Trials Unit, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Prasanna Parvathaneni
- Translational Neuroradiology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Yair Mina
- Viral Immunology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Daniel S. Reich
- Translational Neuroradiology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Govind Nair
- qMRI Core Facility, NINDS, National Institutes of Health, Bethesda, MD, USA
- Corresponding Author: Govind Nair, Room 5C440, 10 Center Drive, Bethesda MD 20892, ; 301-402-6391
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Safavi F, Gustafson L, Walitt B, Lehky T, Dehbashi S, Wiebold A, Mina Y, Shin S, Pan B, Polydefkis M, Oaklander AL, Nath A. Neuropathic symptoms with SARS-CoV-2 vaccination. medRxiv 2022:2022.05.16.22274439. [PMID: 35611338 PMCID: PMC9128783 DOI: 10.1101/2022.05.16.22274439] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Background and Objectives Various peripheral neuropathies, particularly those with sensory and autonomic dysfunction may occur during or shortly after acute COVID-19 illnesses. These appear most likely to reflect immune dysregulation. If similar manifestations can occur with the vaccination remains unknown. Results In an observational study, we studied 23 patients (92% female; median age 40years) reporting new neuropathic symptoms beginning within 1 month after SARS-CoV-2 vaccination. 100% reported sensory symptoms comprising severe face and/or limb paresthesias, and 61% had orthostasis, heat intolerance and palpitations. Autonomic testing in 12 identified seven with reduced distal sweat production and six with positional orthostatic tachycardia syndrome. Among 16 with lower-leg skin biopsies, 31% had diagnostic/subthreshold epidermal neurite densities (≤5%), 13% were borderline (5.01-10%) and 19% showed abnormal axonal swelling. Biopsies from randomly selected five patients that were evaluated for immune complexes showed deposition of complement C4d in endothelial cells. Electrodiagnostic test results were normal in 94% (16/17). Together, 52% (12/23) of patients had objective evidence of small-fiber peripheral neuropathy. 58% patients (7/12) treated with oral corticosteroids had complete or near-complete improvement after two weeks as compared to 9% (1/11) of patients who did not receive immunotherapy having full recovery at 12 weeks. At 5-9 months post-symptom onset, 3 non-recovering patients received intravenous immunoglobulin with symptom resolution within two weeks. Conclusions This observational study suggests that a variety of neuropathic symptoms may manifest after SARS-CoV-2 vaccinations and in some patients might be an immune-mediated process.
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Affiliation(s)
- Farinaz Safavi
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Lindsey Gustafson
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Brian Walitt
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Tanya Lehky
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Sara Dehbashi
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA
| | - Amanda Wiebold
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Yair Mina
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Baohan Pan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Polydefkis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anne Louise Oaklander
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA
- Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, MA
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Beck ES, Maranzano J, Luciano NJ, Parvathaneni P, Filippini S, Morrison M, Suto DJ, Wu T, van Gelderen P, de Zwart JA, Antel S, Fetco D, Ohayon J, Andrada F, Mina Y, Thomas C, Jacobson S, Duyn J, Cortese I, Narayanan S, Nair G, Sati P, Reich DS. Cortical lesion hotspots and association of subpial lesions with disability in multiple sclerosis. Mult Scler 2022; 28:1351-1363. [PMID: 35142571 DOI: 10.1177/13524585211069167] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dramatic improvements in visualization of cortical (especially subpial) multiple sclerosis (MS) lesions allow assessment of impact on clinical course. OBJECTIVE Characterize cortical lesions by 7 tesla (T) T2*-/T1-weighted magnetic resonance imaging (MRI); determine relationship with other MS pathology and contribution to disability. METHODS Sixty-four adults with MS (45 relapsing-remitting/19 progressive) underwent 3 T brain/spine MRI, 7 T brain MRI, and clinical testing. RESULTS Cortical lesions were found in 94% (progressive: median 56/range 2-203; relapsing-remitting: 15/0-168; p = 0.004). Lesion distribution across 50 cortical regions was nonuniform (p = 0.006), with highest lesion burden in supplementary motor cortex and highest prevalence in superior frontal gyrus. Leukocortical and white matter lesion volumes were strongly correlated (r = 0.58, p < 0.0001), while subpial and white matter lesion volumes were moderately correlated (r = 0.30, p = 0.002). Leukocortical (p = 0.02) but not subpial lesions (p = 0.40) were correlated with paramagnetic rim lesions; both were correlated with spinal cord lesions (p = 0.01). Cortical lesion volumes (total and subtypes) were correlated with expanded disability status scale, 25-foot timed walk, nine-hole peg test, and symbol digit modality test scores. CONCLUSION Cortical lesions are highly prevalent and are associated with disability and progressive disease. Subpial lesion burden is not strongly correlated with white matter lesions, suggesting differences in inflammation and repair mechanisms.
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Affiliation(s)
- Erin S Beck
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josefina Maranzano
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada; Department of Anatomy, University of Quebec in Trois-Rivières, Trois-Rivières, QC, Canada
| | - Nicholas J Luciano
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Prasanna Parvathaneni
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Stefano Filippini
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Mark Morrison
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Suto
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Peter van Gelderen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jacco A de Zwart
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Samson Antel
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Dumitru Fetco
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Joan Ohayon
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Frances Andrada
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Yair Mina
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chevaz Thomas
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Steve Jacobson
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jeff Duyn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Irene Cortese
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pascal Sati
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Mina Y, Azodi S, Dubuche T, Andrada F, Osuorah I, Ohayon J, Cortese I, Wu T, Johnson KR, Reich DS, Nair G, Jacobson S. Cervical and thoracic cord atrophy in multiple sclerosis phenotypes: Quantification and correlation with clinical disability. Neuroimage Clin 2021; 30:102680. [PMID: 34215150 PMCID: PMC8131917 DOI: 10.1016/j.nicl.2021.102680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/01/2022]
Abstract
Spinal cord atrophy is prevalent across multiple sclerosis phenotypes. It correlates with disability, especially in relapsing-remitting patients. This correlation can be demonstrated both cross-sectionally and longitudinally. Cervical atrophy is highly associated with disability and disease progression. Thoracic atrophy contributes to improved correlation and radiological subgrouping.
Objective We sought to characterize spinal cord atrophy along the entire spinal cord in the major multiple sclerosis (MS) phenotypes, and evaluate its correlation with clinical disability. Methods Axial T1-weighted images were automatically reformatted at each point along the cord. Spinal cord cross‐sectional area (SCCSA) were calculated from C1-T10 vertebral body levels and profile plots were compared across phenotypes. Average values from C2-3, C4-5, and T4-9 regions were compared across phenotypes and correlated with clinical scores, and then categorized as atrophic/normal based on z-scores derived from controls, to compare clinical scores between subgroups. In a subset of relapsing-remitting cases with longitudinal scans these regions were compared to change in clinical scores. Results The cross-sectional study consisted of 149 adults diagnosed with relapsing-remitting MS (RRMS), 49 with secondary-progressive MS (SPMS), 58 with primary-progressive MS (PPMS) and 48 controls. The longitudinal study included 78 RRMS cases. Compared to controls, all MS groups had smaller average regions except RRMS in T4-9 region. In all MS groups, SCCSA from all regions, particularly the cervical cord, correlated with most clinical measures. In the RRMS cohort, 22% of cases had at least one atrophic region, whereas in progressive MS the rate was almost 70%. Longitudinal analysis showed correlation between clinical disability and cervical cord thinning. Conclusions Spinal cord atrophy was prevalent across MS phenotypes, with regional measures from the RRMS cohort and the progressive cohort, including SPMS and PPMS, being correlated with disability. Longitudinal changes in the spinal cord were documented in RRMS cases, making it a potential marker for disease progression. While cervical SCCSA correlated with most disability and progression measures, inclusion of thoracic measurements improved this correlation and allowed for better subgrouping of spinal cord phenotypes. Cord atrophy is an important and easily obtainable imaging marker of clinical and sub-clinical progression in all MS phenotypes, and such measures can play a key role in patient selection for clinical trials.
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Affiliation(s)
- Yair Mina
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shila Azodi
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Tsemacha Dubuche
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Frances Andrada
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Ikesinachi Osuorah
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Tianxia Wu
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Kory R Johnson
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Govind Nair
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Quantitative MRI Core Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
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Mina Y, Wu T, Hsieh HC, Hammoud DA, Shah S, Lau CY, Ham L, Snow J, Horne E, Ganesan A, Rapoport SI, Tramont EC, Reich DS, Agan BK, Nath A, Smith BR. Association of White Matter Hyperintensities With HIV Status and Vascular Risk Factors. Neurology 2021; 96:e1823-e1834. [PMID: 33637630 PMCID: PMC8105972 DOI: 10.1212/wnl.0000000000011702] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/09/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To test the hypothesis that brain white matter hyperintensities (WMH) are more common in people living with HIV (PLWH), even in the setting of well-controlled infection, and to identify clinical measures that correlate with these abnormalities. METHODS Research brain MRI scans, acquired within longitudinal studies evaluating neurocognitive outcomes, were reviewed to determine WMH load using the Fazekas visual rating scale in PLWH with well-controlled infection (antiretroviral therapy for at least 1 year and plasma viral load <200 copies/mL) and in sociodemographically matched controls without HIV (CWOH). The primary outcome measure of this cross-sectional analysis was increased WMH load, determined by total Fazekas score ≥2. Multiple logistic regression analysis was performed to evaluate the effect of HIV serostatus on WMH load and to identify MRI, CSF, and clinical variables that associate with WMH in the PLWH group. RESULTS The study included 203 PLWH and 58 CWOH who completed a brain MRI scan between April 2014 and March 2019. The multiple logistic regression analysis, with age and history of tobacco use as covariates, showed that the adjusted odds ratio of the PLWH group for increased WMH load is 3.7 (95% confidence interval 1.8-7.5; p = 0.0004). For the PLWH group, increased WMH load was associated with older age, male sex, tobacco use, hypertension, and hepatitis C virus coinfection, and also with the presence of measurable tumor necrosis factor α in CSF. CONCLUSION Our results suggest that HIV serostatus affects the extent of brain WMH. This effect is mainly associated with aging and modifiable comorbidities.
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Affiliation(s)
- Yair Mina
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Tianxia Wu
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Hsing-Chuan Hsieh
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Dima A Hammoud
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Swati Shah
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Chuen-Yen Lau
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Lillian Ham
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Joseph Snow
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Elizabeth Horne
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Anuradha Ganesan
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Stanley I Rapoport
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Edmund C Tramont
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Daniel S Reich
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Brian K Agan
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Avindra Nath
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD
| | - Bryan R Smith
- From the National Institute of Neurological Disorders and Stroke (Y.M., T.W., E.H., D.S.R., A.N., B.R.S.), Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center (D.A.H., S.S.), National Institute of Allergy and Infectious Diseases (C.-Y.L., E.C.T.), National Institute of Mental Health (L.H., J.S.), and National Institute on Alcohol Abuse and Alcoholism (S.I.R.), National Institutes of Health, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (H.-C.H., A.G., B.K.A.), Uniformed Services University of the Health Sciences; and Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. (H.-C.H., A.G., B.K.A.), Bethesda, MD.
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Droby A, Omer N, Gurevich T, Kestenbaum M, Mina Y, Cedarbaum JM, Aizenstein O, Giladi N, Mirelman A, Thaler A. Low cerebrospinal fluid volume and the risk for post-lumbar puncture headaches. J Neurol Sci 2020; 417:117059. [DOI: 10.1016/j.jns.2020.117059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022]
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Anis S, Fahoum F, Korczyn AD, Sverdlov D, Abramovici S, Mina Y, Neufeld MY, Kipervasser S. Atypical duration of epileptic and psychogenic nonepileptic events. Epilepsy Behav 2020; 111:107145. [PMID: 32693371 DOI: 10.1016/j.yebeh.2020.107145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We aimed to estimate the frequency of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) with atypical duration in our epilepsy monitoring unit (EMU), in order to raise awareness of atypical durations of both types of events. MATERIALS & METHODS We retrospectively reviewed all consecutive video-electroencephalogram (vEEG) recordings in our medical center's EMU from January 2013 to December 2017 and identified patients with seizures with atypical duration. Short PNES were defined as those lasting fewer than 2 min and long ES as those lasting for more than 5 min. RESULTS The files of 830 adult (age >16 years) patients were reviewed, of whom 26 patients (3.1%, mean age: 33.3 ± 9.8 years, 12 females) were diagnosed as having an unusual seizure duration. Among 432 patients with ES during monitoring, fourteen patients [3.2% (95% confidence interval (CI): 1.5%-5.0%), mean age: 33.0 ± 12.2, 5 females [had long ES durations (exceeding 5 min). In 64% of patients with long ES, the events were provoked by antiepileptic drug (AED) withdrawal during vEEG, 62% had focal lesion on brain imaging, and 64% had a frontotemporal or a temporal seizure focus. Among 223 patients diagnosed with PNES, 12 patients [5.4% (95% CI: 2.2%-8.6%), mean age: 33.6 ± 6.6, 7 females] had short PNES durations (less than 2 min) and demonstrated motor (9/12, 75%), altered responsiveness (6/12, 50%), and vocalization (5/12, 42%) as the most prominent clinical features. CONCLUSIONS The data from our case files highlight two main considerations in the diagnosis of paroxysmal events: prolonged event can be due to ES, while short events can be psychogenic.
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Affiliation(s)
- Saar Anis
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Firas Fahoum
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Amos D Korczyn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Diana Sverdlov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sergiu Abramovici
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yair Mina
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Miri Y Neufeld
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Svetlana Kipervasser
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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12
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Mina Y, Fahoum F, Abramovici S, Anis S, Kipervasser S. Clinical correlates and electroencephalographic features of FIRDA in a tertiary center. Acta Neurol Scand 2019; 140:405-413. [PMID: 31420976 DOI: 10.1111/ane.13157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to explore the diagnostic value, clinical correlates and electroencephalographic features of FIRDA (Frontal intermittent rhythmic delta activity). MATERIALS AND METHODS We retrospectively reviewed reports from EEG studies done in adults at our tertiary center between January 2015 and May 2018. For cases demonstrating FIRDA, medical files were reviewed and each case was given a diagnostic category. EEG recordings were reviewed and electrophysiologic data were extracted including FIRDA characteristics (frequency, location, duration, and symmetry). Then, a statistical analysis was done to evaluate the relationship between the diagnostic categories and EEG variables. RESULTS Ninety-four cases of FIRDA were found, with a frequency of 1.6% among inpatients. EEG recordings were available for review in 84 cases. FIRDA was asymmetric in 43 of these cases (49%), usually more prominent on the left (36/43, 84%). The diagnostic category groups included epilepsy (n = 39, 41%), other central nervous system (CNS) disease (n = 33, 35%), and systemic illness (n = 22, 23%). A significant difference in FIRDA location was found, as patients with epilepsy or other CNS disease, had a significantly higher probability for the delta activity to involve the temporal areas (frontotemporal location in 27/64 in these groups compared with 3/20 in the systemic illness group, P-value = .033). CONCLUSIONS This study provides insights to the diagnosis underlying FIRDA, especially the high rate of epilepsy patients, and calls for further neurologic investigation of cases in which FIRDA involves the temporal areas since most of these cases were due to epilepsy or other CNS disease and not a systemic illness.
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Affiliation(s)
- Yair Mina
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Firas Fahoum
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Sergiu Abramovici
- Neurology Department UPMC Hamot Medical Center Pittsburgh Pennsylvania
| | - Saar Anis
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Svetlana Kipervasser
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
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13
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Mina Y, Schechner V, Savion M, Yahav D, Bilavsky E, Sorek N, Ben-Zvi H, Adler A. Clinical benefits of FilmArray meningitis-encephalitis PCR assay in partially-treated bacterial meningitis in Israel. BMC Infect Dis 2019; 19:713. [PMID: 31409318 PMCID: PMC6693273 DOI: 10.1186/s12879-019-4348-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
Background Management of partially-treated, community-acquired bacterial meningitis (PCBM) is commonly compromised by lack of microbiological diagnosis. We aimed to analyze the impact of FilmArray Meningitis-Encephalitis (FA-ME) PCR on the management of PCBM. Methods Comparison of treatment variables of PCBM cases between two periods, before (6.5 years, control group) and after (2 years, study group) the application of FA-ME PCR assay. Results The total duration of antimicrobial treatment in the study group (n = 8) was significantly shorter than the control group (n = 23) (9.5 ± 3.7 days vs. 15.2 ± 5 days, p = 0.007). The percentage of narrow-spectrum regimens was significantly higher in the study group (78 ± 11% vs. 40 ± 9%, p = 0.03). There was a significant difference in implementation of antimicrobial chemoprophylaxis for close contacts (4/8 (50%) vs. 1/23 (4%), p = 0.01). Conclusions The use of FA-ME PCR provides significant benefits in the management of PCBM by shortening duration of antibiotic treatment, increasing the use of narrow-spectrum regimens, and allowing proper administration of antimicrobial chemoprophylaxis. Trial registration The study was approved and retrospectively registered by the Tel-Aviv Sourasky Medical Center (0378–17-TLV, 10/17/2017) and Rabin Medical Center (0270–18-RMC, 11/11/2018) Ethics committees and conforms to recognized standards.
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Affiliation(s)
- Yair Mina
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Neurological Institute, Tel-Aviv Sourasky Medical Center, 6th Weizman street, Tel-Aviv, Israel.
| | - Vered Schechner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Division of Epidemiology and Preventive Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Savion
- Tel-Aviv District, Israel Ministry of Health, Tel-Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Efraim Bilavsky
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Nadav Sorek
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Adler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Abstract
Neurosyphilis is a rare disease that until the 2000s was almost eradicated due to population awareness of HIV and efficient treatment. Since then, the prevalence of the entity is rising due to risk-associated behaviour such as unprotected intercourse. Neurosyphilis is still a difficult entity to diagnose especially when combined with acute HIV infection which can influence the usual clinical course of disease. In rare occasions, both acute HIV and early syphilis infection can present as mono or multiple cranial nerve palsies. This case demonstrates a rare manifestation of misdiagnosed early syphilis infection combined with acute HIV infection in a 34-year-old man with prior history of unprotected sex with men.
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Affiliation(s)
- Yoav Piura
- Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yair Mina
- Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orna Aizenstein
- Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Avi Gadoth
- Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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15
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Anis S, Sharabi A, Mina Y, Klein A, Cagnano E, Elkayam O, Gurevich T. Rituximab as a Second-Line Treatment for Lymphocytic Vasculitis of the Central Nervous System. Isr Med Assoc J 2016; 18:630-632. [PMID: 28471627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Saar Anis
- Department of Neurology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sharabi
- Departments of Rheumatology Institute, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Mina
- Department of Neurology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ainat Klein
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emanuela Cagnano
- Institute of Pathology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- Departments of Rheumatology Institute, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Gurevich
- Department of Neurology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mina Y, Rinkevich-Shop S, Konen E, Goitein O, Kushnir T, Epstein FH, Feinberg MS, Leor J, Landa-Rouben N. Mast cell inhibition attenuates myocardial damage, adverse remodeling, and dysfunction during fulminant myocarditis in the rat. J Cardiovasc Pharmacol Ther 2013; 18:152-61. [PMID: 23172937 PMCID: PMC3968541 DOI: 10.1177/1074248412458975] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myocarditis is a life-threatening heart disease characterized by myocardial inflammation, necrosis, and chronic fibrosis. While mast cell inhibition has been suggested to prevent fibrosis in rat myocarditis, little is known about its effectiveness in attenuating cardiac remodeling and dysfunction in myocarditis. Thus, we sought to test the hypothesis that mast cell inhibition will attenuate the inflammatory reaction and associated left ventricular (LV) remodeling and dysfunction after fulminant autoimmune myocarditis. Methods and RESULTS To induce experimental autoimmune myocarditis, we immunized 30 rats with porcine cardiac myosin (PCM) twice at a 7-day interval. On day 8 animals were randomized into treatment with either an intraperitoneal (IP) injection of 25mg/kg of cromolyn sodium (n = 13) or an equivalent volume (∼0.5 mL IP) of normal saline (n = 11). All animals were scanned by serial echocardiography studies before treatment (baseline echocardiogram) and after 20 days of cromolyn sodium (28 days after immunization). Furthermore, serial cardiac magnetic resonance was performed in a subgroup of 12 animals. After 20 days of treatment (28 days from first immunization), hearts were harvested for histopathological analysis. By echocardiography, cromolyn sodium prevented LV dilatation and attenuated LV dysfunction, compared with controls. Postmortem analysis of hearts showed that cromolyn sodium reduced myocardial fibrosis, as well as the number and size of cardiac mast cells in the inflamed myocardium, compared with controls. CONCLUSIONS Our study suggests that mast cell inhibition with cromolyn sodium attenuates adverse LV remodeling and dysfunction in myocarditis. This mechanism-based therapy is clinically relevant and could improve the outcome of patients at risk for inflammatory cardiomyopathy and heart failure.
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Affiliation(s)
- Yair Mina
- Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel-Aviv University, Sheba Medical Center, Tel-Hashomer, Israel
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17
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Abstract
BACKGROUND In vitro studies have demonstrated that ciprofloxacin suppresses Escherichia coli attachment on stents, and ciprofloxacin has been shown to prolong stent patency in cats. However, clinical studies with antibiotic prophylaxis have produced conflicting results. The aim of this study was to isolate and identify the bacteria that attach early on unblocked stents removed from patients and to study their enzyme activities. METHODS Eighteen unblocked biliary stents were removed from 17 patients (benign obstruction in 14 and malignant obstruction in 4). All patients received antibiotic prophylaxis (mean of 6 days). Stents were in place for a mean of 33 days. The inside of stents was scraped and sludge was cultured aerobically and anaerobically. Identification of isolated bacteria and measurement of beta-glucuronidase and phospholipase C activities were performed by using standard techniques. Gastric and duodenal juice from 18 patients with no biliary diseases was used as control samples. RESULTS All stents were patent and only 6 had visible sludge. There were 19 anaerobes isolated from 16 stents (Clostridium perfringens 13, Clostridium bifermentans 4 and Bacteroides fragilis 2). Phospholipase C was detected in all Clostridium species. beta-Glucuronidase was produced only by 12 of 13 C perfringens isolates. Sixteen aerobes including Enterococcus species and Bacillus species were isolated but none produced beta-glucuronidase or phospholipase C. There were no aerobic gram-negative bacteria isolated from stents. Clostridium species and B fragilis were not recovered from the control samples. CONCLUSIONS In patients who had received antibiotic prophylaxis against gram-negative bacterial infection, anaerobic bacteria may play a role in initiating stent blockage.
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Affiliation(s)
- J W Leung
- Divisions of Gastroenterology and Infectious Diseases, Mr. & Mrs. C. W. Law Biofilm Research Laboratory, University of California, Davis Medical Center, Sacramento, CA 95817, USA
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Affiliation(s)
- M Stein
- Department of Radiology, University of California Davis Medical Center, Sacramento 95817, USA.
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