eNeurologicalScieNeurologicalSci Vol 25

December 2021

Original Articles

Healthcare professionals' knowledge of modifiable stroke risk factors: A cross-sectional questionnaire survey in greater Gaborone, Botswana

Ookeditse Ookeditse, Thusego R. Motswakadikgwa, Kebadiretse K. Ookeditse, Gosiame Masilo, ... Stein H. Johnsen

  • Article 100365
  • https://doi.org/10.1016/j.ensci.2021.100365
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  • Abstract

    Stroke remains the second leading cause of deaths and disability globally, with highest mortality in Africa (low- and middle-income countries). It is crucial for healthcare professionals to have sufficient stroke risk factors' knowledge in order to reduce the stroke burden

    We investigated healthcare professionals' knowledge of modifiable stroke risk factors, and identified demographic factors influencing this knowledge

Cerebral perfusion changes in chronic dizziness: A single-photon emission computed tomography study

Ken Johkura, Koji Takahashi, Yosuke Kudo, Tsutomu Soma, ... Kiyokazu Kurihara

  • Article 100367
  • https://doi.org/10.1016/j.ensci.2021.100367
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  • Abstract

    Dizziness may persist even after the causative vestibular imbalance subsides. Although the precise mechanism of chronic dizziness is unknown, various cerebral activity changes associated with it have been reported. To understand its mechanism in the absence of the causative vestibular imbalance, we compared cerebral changes in chronic dizziness with and without persistent vestibular imbalance.

    This is the first study to highlight the difference in rCBF changes between patients having chronic dizziness with and without active vestibular imbalance.

Circulatory 25(OH)D and 1,25(OH)2D as differential biomarkers between multiple system atrophy and Parkinson's disease patients

Hiromu Ogura, Izzettin Hatip-Al-Khatib, Midori Suenaga, Funda Bolukbasi Hatip, ... Yoshio Tsuboi

  • Article 100369
  • https://doi.org/10.1016/j.ensci.2021.100369
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  • Abstract

    There is sufficient evidence to support vitamin D's noncalcemic effects and the role of vitamin D deficiency in the development of a wide range of neurological disorders. This study aimed to evaluate whether serum 25(OH)D and 1,25(OH) 2 D could be used as biomarkers to differentiate between healthy subjects (HS), multiple system atrophy (MSA) and Parkinson's disease (PD) patients of both genders.

Fluctuating pain in Parkinson's disease: Its prevalence and impact on quality of life

Kanako Kurihara, Shinsuke Fujioka, Miki Kawazoe, Takayasu Mishima, ... Yoshio Tsuboi

  • Article 100371
  • https://doi.org/10.1016/j.ensci.2021.100371
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  • Abstract

    Pain is a common non-motor symptom in Parkinson's disease (PD) patients, and the incidence of fluctuating pain may be improved by taking levodopa. There are only a few detailed reports regarding fluctuating pain. In this study, 331 PD patients were classified into three groups: no-pain group (67.4%), non-fluctuating pain group (22.1%), and fluctuating pain group (10.6%). We evaluated patients' background and its impact on the quality of life (QOL) of each group.

Clinical presentation of posterior cerebral artery occlusions – Clinical rationale for a more aggressive therapeutic strategy?

Volker Maus, Sophia Rogozinski, Jan Borggrefe, Utako Birgit Barnikol, ... Anastasios Mpotsaris

  • Article 100368
  • https://doi.org/10.1016/j.ensci.2021.100368
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  • Abstract

    A proximal occlusion of the posterior cerebral artery (PCA) can affect patients severely and clinical outcome might be poor. Aim of this paper is to describe clinical presentation, diagnostic findings and outcome of patients suffering from ischemia in the PCA territory.

    We conducted a retrospective analysis of clinically affected patients with imaging-based evidence of ischemia within in the PCA territory at a comprehensive stroke center over a six-year period. Clinical (including demographics, National Institutes of Health Stroke Scale, NIHSS, modified Rankin Sclae, mRS), imaging (including occlusion site and brain infarction) and therapeutic data were evaluated. A favorable outcome was defined as an mRS ≤2.

Cross-sectional area of the vagus nerve on carotid duplex ultrasound and atrial fibrillation in acute stroke: A retrospective analysis

Kazumasa Oura, Ryo Itabashi, Mao Yamaguchi Oura, Tetsuro Kiyokawa, ... Tetsuya Maeda

  • Article 100378
  • https://doi.org/10.1016/j.ensci.2021.100378
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  • Abstract

    The autonomic nervous system, including the vagus nerve, is associated with the development of atrial fibrillation (AF). However, the association between the cross-sectional area (CSA) of the vagus nerve on ultrasound and the presence of AF has not been fully clarified. This study investigated the association between vagus nerve CSA and the presence of AF in patients with acute stroke.

    We retrospectively reviewed 150 consecutive patients with ischemic stroke or transient ischemic attack. Vagus nerve CSA was evaluated by carotid ultrasonography on the axial view at the thyroid gland level. Univariate and multivariable analyses were performed to examine the association between vagus nerve CSA and AF.

Efficacy of botulinum toxin type B (rimabotulinumtoxinB) in patients with cervical dystonia previously treated with botulinum toxin type A: A post-marketing observational study in Japan

Ryuji Kaji, Akira Endo, Michiko Sugawara, Mika Ishii

  • Article 100374
  • https://doi.org/10.1016/j.ensci.2021.100374
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  • Abstract

    To date, efficacy data on botulinum toxin type B (rimabotulinumtoxinB) in patients with cervical dystonia (CD) previously treated with botulinum toxin type A in a large population are lacking; thus, we aimed to evaluate type B efficacy in this patient population. In a post-marketing observational cohort study, 150 patients previously treated with botulinum toxin type A were enrolled, of whom 138 were followed up for 1 year after the initial type B injection. Final observation data were available for 122 patients.

Alterations of the serum and CSF ferritin levels and the diagnosis and prognosis of amyotrophic lateral sclerosis

Parastou Paydarnia, Mahsa Mayeli, Mahan Shafie, Elmira Agah, ... Payam Sarraf

  • Article 100379
  • https://doi.org/10.1016/j.ensci.2021.100379
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  • Abstract

    The ALS diagnostic challenges necessitate more robust diagnostic and prognostic methods. A potential biomarker in this regard is the alterations of ferritin levels in the serum and CSF of patients compared to controls.

Cholesterol crystal embolism-related cerebral infarction: Magnetic resonance imaging and clinical characteristics

Yuko Kondo, Mami Kanzaki, Daisuke Ishima, Ryo Usui, ... Tsugio Akutsu

  • Article 100388
  • https://doi.org/10.1016/j.ensci.2021.100388
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  • Abstract

    Cholesterol crystal embolism-related cerebral infarction (CCE-CI) is frequently misdiagnosed due to the lack of specific symptoms. To aid in differential diagnosis, this study comprehensively characterized the magnetic resonance imaging (MRI) and clinical manifestations of CCE-CI and compared these features to those of atherothrombotic cerebral infarction (ACI).

    This single-center, retrospective, observational study was conducted at Kitasato University Hospital, Kanagawa, Japan. We identified 37 clinically or histopathologically confirmed CCE-CI cases and 110 ACI cases treated from January 2006 to May 2020. Groups were compared for mean age, sex ratio, clinical presentations, imaging manifestations, precipitating factors, comorbid conditions, medications, and smoking history.


Case Reports

Isolated progression of miliary brain metastasis in a patient with stable lung adenocarcinoma successfully treated with whole-brain radiotherapy: A case report

Satomi Hiya, Satoru Fujiwara, Atsushi Nakagawa, Yuki Sato, ... Michi Kawamoto

  • Article 100366
  • https://doi.org/10.1016/j.ensci.2021.100366
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  • Abstract

    Miliary brain metastasis is a rare form of metastasis commonly associated with advanced stages of cancer. In this article, we report a case of a 38-year-old male with solitary progression of miliary brain metastasis originating from stage 4 EML-ALK-positive lung adenocarcinoma.

Autoimmune basal ganglia encephalitis associated with anti-recoverin antibodies: A case report

Yuki Kitazaki, Norimichi Shirafuji, Naoko Takaku, Tomohisa Yamaguchi, ... Tadanori Hamano

  • Article 100382
  • https://doi.org/10.1016/j.ensci.2021.100382
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  • Abstract

    Autoimmune basal ganglia encephalitis causes neurological symptoms such as parkinsonism associated with basal ganglia lesions. Here, we report a case of autoimmune basal ganglia encephalitis without retinal lesions or malignancy harboring anti-recoverin antibodies.

Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign

Akira Hanazono, Yoshiko Takahashi, Yui Sanpei, Sachiko Kamada, Masashiro Sugawara


Letters to the Editor

Hashimoto's encephalopathy with gait disturbance caused by sensory ganglionopathy: A case report and review of the literature

Tomoyo Shimada, Sho Nakajima, Ryota Nakamura, Naohide Kurita, ... Takao Urabe

  • Article 100370
  • https://doi.org/10.1016/j.ensci.2021.100370
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  • Abstract

    Hashimoto's encephalopathy (HE) is a steroid-responsive encephalopathy characterized by several neurological symptoms. HE mainly involves the central nervous system; the peripheral nervous system is rarely involved. We treated a previously healthy elderly man showing mild cognitive decline and subacute progressive gait disturbance due to severe sensory deficits, including sensation of touch and deep sensation with elevated anti-NH2 terminal of α-enolase and anti-thyroid antibodies. His sensory disturbance symptoms improved after steroid therapy, suggesting that the neuropathy was related to HE. His disease was characteristic of HE in that his sensory deficits responded well and rapidly to steroid therapy. A nerve conduction study showed reduced sensory nerve action potentials in all limbs, indicating that his neuropathy was not "axonopathy", but "sensory ganglionopathy", which can occur concurrently with autoimmune disorders. Dysautonomia may be the responsible pathomechanism because of the vulnerability of the blood–nerve barrier at the ganglia. Although the pathophysiology of HE has not been clearly elucidated, autoimmune inflammation has been reported in a number of autopsy cases, indicating that sensory ganglionopathy can develop with HE. Therefore, HE should be recognized as one type of "treatable neuropathy".

Palinopsia as an initial symptom of cerebral amyloid angiopathy-related inflammation

Hitomi Onomura, Takahiro Shimizu, Rei Kobayashi, Junichiro Suzuki, ... Yasuhiro Ito

Intraoral alveolar submucosal injections of Incobotulinumtoxin A: Relief of therapy-refractory trigeminal neuropathy after tooth extraction

Lars Wojtecki, Oliver Maierhofer, Philipp Albrecht

"COVID arm" detected by MR neurography

Hiroyasu Komiya, Kohei Harada, Ryoji Morishita, Shunta Hashiguchi, ... Fumiaki Tanaka


A Japanese family with P102L Gerstmann–Sträussler–Scheinker disease with a variant Creutzfeldt-Jakob disease-like phenotype among the siblings: A case report

Kazumichi Ota, Yoshihiko Nakazato, Ryu Yokoyama, Hitoshi Kawasaki, ... Toshimasa Yamamoto

An 88-year-old woman with acute disseminated encephalomyelitis following messenger ribonucleic acid-based COVID-19 vaccination

Mai Shimizu, Kotaro Ogaki, Ryota Nakamura, Eriko Kado, ... Takao Urabe

  • Article 100381
  • https://doi.org/10.1016/j.ensci.2021.100381
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  • Abstract
  • A global pandemic has resulted from the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19). To control the spread of SARS-CoV-2 infection, several SARS-CoV-2 vaccines have been developed and administered in a wide range of age groups. Messenger ribonucleic acid (mRNA)-based COVID-19 vaccines are the most widely used. We present the case of an 88-year-old woman who was diagnosed with acute disseminated encephalomyelitis (ADEM) following her second mRNA COVID-19 vaccination.

Nivolumab treatment followed by atezolizumab induced encephalitis and neuropathy with antiganglioside antibodies

Shohei Watanabe, Kazuki Yoshizumi, Sayaka Moriguchi, Tomoki Higashiyama, ... Takashi Kimura

Levodopa-carbidopa intestinal gel therapy may cause "Supra-ON freezing of gate" in patients with Parkinson's disease with diphasic dyskinesia

Saki Oshiro, Toru Baba, Atsushi Takeda

Indirect effects of the lockdown for the COVID-19 pandemic: Comparative study of fibular palsies from prolonged sitting posture

F. Castellani, M. Cacciavillani, A. Salvalaggio, M. Campagnolo, C. Briani

Transient Horner syndrome associated with COVID-19: A case report

Mika S. Naor, Paul G. Mathew, Roni Sharon

  • Article 100349
  • https://doi.org/10.1016/j.ensci.2021.100349
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  • Abstract

    The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has spread as a global pandemic with significant morbidity and mortality. As the prevalence of COVID-19 has risen, so has the diversity of its clinical presentation. SARS-CoV-2 is considered to have neuroinvasive and neurotropic qualities that can lead to central and peripheral nervous system manifestations. We describe a 65-year-old woman who developed new-onset unilateral ptosis and mitosis following a diagnosis of COVID-19. To our knowledge, this is the first reported case describing transient Horner syndrome in association with COVID-19.

Immune checkpoint inhibitor-induced encephalitis with dostarlimab in two patients: Case series

Sina Marzoughi, Tychicus Chen

  • Article 100356
  • https://doi.org/10.1016/j.ensci.2021.100356
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  • Abstract

    Immune checkpoint inhibitors (ICIs) are being used increasingly in the treatment of several cancers and have been associated with neurological complications including immune checkpoint inhibitor-induced encephalitis (ICI-iE). We present two cases of ICI-iE with the novel agent dostarlimab, which to our knowledge are the first reported with this agent. These cases add to the growing body of literature on ICI-iE, demonstrating two cases of meningoencephalitis associated with the novel agent dostarlimab treated successfully with prednisone.

Pathological evidence of demyelination in the recurrent laryngeal, phrenic, and oculomotor nerves in Charcot-Marie-Tooth disease 4F

Kengo Maeda, Yutaka Yamamoto, Masatsugu Ohuchi, Takuto Sakashita, ... Hiroshi Takashima

  • Article 100358
  • https://doi.org/10.1016/j.ensci.2021.100358
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  • Abstract

    We present pathology of the peripheral nerves of a patient with Adult-onset Charcot-Marie-Tooth disease 4F caused by periaxin gene mutation p.D651N. The patient was a 72-year-old woman. She had hoarseness and underwent continuous positive airway pressure therapy at night due to sleep apnea. The patient died abruptly.



Corrigendum to "Encephalopathy in COVID-19 patients; viral, parainfectious, or both?" [eNeurologicalScic(Volume 21), December 2020, 100275]

Thirugnanam Umapathi, Wei Ming Jason Quek, Jia Min Yen, Hnin Su Wai Khin, ... Wai-Yung Yu