Author Of 2 Presentations
LB1203 - Neuromyelitis optica spectrum disorders (NMOSD) attack triggered by COVID-19 infection (A case report) (ID 2044)
Abstract
Background
Neurological presentations of SARS-CoV-2 infection (COVID-19) are now increasingly reported, however some specific presentations as well as the neurological para or post infectious sequels are still under recognized. Here, we report a patient with acute bilateral diminution of vision and acute diencephalic syndrome wiith clinical and imaging findings consistent with NMOSD, 2 weeks following a COVID-19 infection.
Objectives
We would report a case of female patient with COVID-19 who had clinical and radiological disease consistent with NMOSD 2 weeks after her COVID-19 infection
Methods
A 56 years old female patient who was completely healthy without any previous history of neurologic disease except past history of left temporal meningioma which removed surgically successfuly 12 years ago. The patient had developed fever (up to 39 C), associated with respiratory symptoms, easy fatigability, anorexia and generalized body aches. Her Blood picture showed lymphopenia with normal other labs, CT chest showed bilateral ground glass appearance highly suggestive of Covid -19 infection. SARS-CoV-2 PCR sample from nasopharyngeal swab was positive. Patient recieved treatment for her COVID-19 infection at her home according to the treatment protocl. Her fever as her other symptoms gradually improved within 2 weeks. At the end of 2 weeks,the patient presented to the emergency department with acute bilateral loss of vision, lethargy and disorientation.Her tvital signs were within normal refrences, Oxygen saturation was 95% and the patient metabolic profile was within normal range. Neurological examination showed disorientation to time, place and person. All extremities moved spontaneously equal with normal tone, intact deep tendon reflexes and positive planter response. Brain MRI showed abnormal signal intensity seen involving diencephalic, medial thalamic, optic chiasm, optic tracts and radiation, being hyper intense inT2W1 and FLAIR, no DW restriction, no perilesional edema or mass effect. According to examination and imaging findings, NMOSD diagnosis was postulated. Methylprednisolone 1 g IV daily was administered for the presumed acute demyelinating event. Later on patient developed bradycardia (50 b/min), became shocked, uncorrected hypothermia (35 c). At the end she developed central diabetes insipidus complicated by hypernatremia (160 mmol/L).A follow up MRI with contrast was done and showed no significant changes from baseline MRI with partial enhancement of the chiasm and diencephalic region. Patient developed 2 attacks of generalised tonic clonic convulsions, aspirated, arrested respiratory, mechanicaly ventilated and died few hours later.
Results
The diagnosis of the patient as NMOSD was established according to patient clinical scenario and radiological findings.
Conclusions
NMOSD could be a possible complication to COVID-19 infection, In addition to its previously known neurologic complications
P0680 - The role of gut microbiota in the Egyptian relapsing remitting multiple sclerosis patients. (ID 1599)
Abstract
Background
The gut microbiota assumed to play an essential role in the pathogenesis of MS. It is thought to be involved in modulating the host’s immune system, modifies the integrity and function of the blood brain barrier, triggers autoimmune response, and interacts directly with different cell types present in the CNS, which lead to demyelination at the end. MS has several clinical variants, among which the most frequent is relapsing–remitting MS (RRMS).
Objectives
to assess the role of gut microbiota among the Egyptian RRMS patients and to discover the abundance and diversity of gut microbiota in the patients and healthy age- and sex- matched control group.
Methods
In our cross-sectional study, 40 cases of RR-MS patients (diagnosed according to the McDonald criteria 2017), were consecutively recruited from inpatients ward at the department of Neurology, Assiut University Hospitals, Assiut, Egypt. Together with 30 age and sex matched healthy control subjects. Detailed history, thorough neurologic examinations, MRI brain and whole spine with contrast, CSF analysis, Evoked potentials, complete Laboratory investigations and Expanded Disability Status Scale (EDSS) were carried out for each patient. Stool sample processing and DNA extraction, concentration and copy number of bacterial organisms were estimated for Patients and control groups.
Results
The mean age of the patients was 31.4 ± 8.8, 75% of them were women. The mean disease duration was 29.90 ± 25.79 months. The mean EDSS score was 3.43 ±1.35. There were significant increased Copy number of Desulfovibrio, Actinobacteria, Firmcutes, and Lactic acid bacteria in the patients with RRMS in comparison with control group, in the contrary a significant lower level of Copy number of Clostridium cluster IV group in RR-MS in comparison with control group were found. The other species of gut microbiota showed no significant differences between groups. Patients who had EDSS ≤ 3.5 had significant higher copy number of Actinobacteria, Bacteroidetes, and Bifidubacterium, in comparison with patients who had EDSS > 3.5. A significant correlation between EDSS scoring and copy number of Bifidubacterium only with P= 0.04. There was a significant negative correlation between duration of illness and copy number of three species; Firmcutes, Akkermansia, and Lactic acid bacteria (r= - 0.42; P = 0.01, r= - 0.33; P = 0.04, r= - 0.64; P = 0.004 respectively)
Conclusions
The present study demonstrated that the Egyptian RRMS patients had a distinct fecal microbiome compared to healthy controls, with specific changes in certain gut microbes richness among RRMS patients compared to controls.
Presenter Of 2 Presentations
LB1203 - Neuromyelitis optica spectrum disorders (NMOSD) attack triggered by COVID-19 infection (A case report) (ID 2044)
Abstract
Background
Neurological presentations of SARS-CoV-2 infection (COVID-19) are now increasingly reported, however some specific presentations as well as the neurological para or post infectious sequels are still under recognized. Here, we report a patient with acute bilateral diminution of vision and acute diencephalic syndrome wiith clinical and imaging findings consistent with NMOSD, 2 weeks following a COVID-19 infection.
Objectives
We would report a case of female patient with COVID-19 who had clinical and radiological disease consistent with NMOSD 2 weeks after her COVID-19 infection
Methods
A 56 years old female patient who was completely healthy without any previous history of neurologic disease except past history of left temporal meningioma which removed surgically successfuly 12 years ago. The patient had developed fever (up to 39 C), associated with respiratory symptoms, easy fatigability, anorexia and generalized body aches. Her Blood picture showed lymphopenia with normal other labs, CT chest showed bilateral ground glass appearance highly suggestive of Covid -19 infection. SARS-CoV-2 PCR sample from nasopharyngeal swab was positive. Patient recieved treatment for her COVID-19 infection at her home according to the treatment protocl. Her fever as her other symptoms gradually improved within 2 weeks. At the end of 2 weeks,the patient presented to the emergency department with acute bilateral loss of vision, lethargy and disorientation.Her tvital signs were within normal refrences, Oxygen saturation was 95% and the patient metabolic profile was within normal range. Neurological examination showed disorientation to time, place and person. All extremities moved spontaneously equal with normal tone, intact deep tendon reflexes and positive planter response. Brain MRI showed abnormal signal intensity seen involving diencephalic, medial thalamic, optic chiasm, optic tracts and radiation, being hyper intense inT2W1 and FLAIR, no DW restriction, no perilesional edema or mass effect. According to examination and imaging findings, NMOSD diagnosis was postulated. Methylprednisolone 1 g IV daily was administered for the presumed acute demyelinating event. Later on patient developed bradycardia (50 b/min), became shocked, uncorrected hypothermia (35 c). At the end she developed central diabetes insipidus complicated by hypernatremia (160 mmol/L).A follow up MRI with contrast was done and showed no significant changes from baseline MRI with partial enhancement of the chiasm and diencephalic region. Patient developed 2 attacks of generalised tonic clonic convulsions, aspirated, arrested respiratory, mechanicaly ventilated and died few hours later.
Results
The diagnosis of the patient as NMOSD was established according to patient clinical scenario and radiological findings.
Conclusions
NMOSD could be a possible complication to COVID-19 infection, In addition to its previously known neurologic complications
P0680 - The role of gut microbiota in the Egyptian relapsing remitting multiple sclerosis patients. (ID 1599)
Abstract
Background
The gut microbiota assumed to play an essential role in the pathogenesis of MS. It is thought to be involved in modulating the host’s immune system, modifies the integrity and function of the blood brain barrier, triggers autoimmune response, and interacts directly with different cell types present in the CNS, which lead to demyelination at the end. MS has several clinical variants, among which the most frequent is relapsing–remitting MS (RRMS).
Objectives
to assess the role of gut microbiota among the Egyptian RRMS patients and to discover the abundance and diversity of gut microbiota in the patients and healthy age- and sex- matched control group.
Methods
In our cross-sectional study, 40 cases of RR-MS patients (diagnosed according to the McDonald criteria 2017), were consecutively recruited from inpatients ward at the department of Neurology, Assiut University Hospitals, Assiut, Egypt. Together with 30 age and sex matched healthy control subjects. Detailed history, thorough neurologic examinations, MRI brain and whole spine with contrast, CSF analysis, Evoked potentials, complete Laboratory investigations and Expanded Disability Status Scale (EDSS) were carried out for each patient. Stool sample processing and DNA extraction, concentration and copy number of bacterial organisms were estimated for Patients and control groups.
Results
The mean age of the patients was 31.4 ± 8.8, 75% of them were women. The mean disease duration was 29.90 ± 25.79 months. The mean EDSS score was 3.43 ±1.35. There were significant increased Copy number of Desulfovibrio, Actinobacteria, Firmcutes, and Lactic acid bacteria in the patients with RRMS in comparison with control group, in the contrary a significant lower level of Copy number of Clostridium cluster IV group in RR-MS in comparison with control group were found. The other species of gut microbiota showed no significant differences between groups. Patients who had EDSS ≤ 3.5 had significant higher copy number of Actinobacteria, Bacteroidetes, and Bifidubacterium, in comparison with patients who had EDSS > 3.5. A significant correlation between EDSS scoring and copy number of Bifidubacterium only with P= 0.04. There was a significant negative correlation between duration of illness and copy number of three species; Firmcutes, Akkermansia, and Lactic acid bacteria (r= - 0.42; P = 0.01, r= - 0.33; P = 0.04, r= - 0.64; P = 0.004 respectively)
Conclusions
The present study demonstrated that the Egyptian RRMS patients had a distinct fecal microbiome compared to healthy controls, with specific changes in certain gut microbes richness among RRMS patients compared to controls.