Welcome to the WCN 2021 Interactive Program
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Please note that all sessions will run at their scheduled time and be followed by a LIVE Q&A/Discussion at the end
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- Marco Medina (Honduras)
THE NEUROLOGIC COMPLICATIONS OF COVID-19
- Gustavo C. Roman (United States of America)
Abstract
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Human infection with SARS-CoV-2, the agent of COVID-19, affects both the central nervous system (CNS) and the peripheral nervous system (PNS) including the muscle (Román GC, SpencerPS, Reis J, et al. The Neurology of COVID-19 Revisited. J Neurol Sci 414 (2020) 116884). This virus is neurogenic and invades the CNS via cranial nerve I, progressing into rhinencephalon and brainstem respiratory centers resulting in irreversible respiratory failure responsible for most of the 6.9 million excess deaths due to this coronavirus (Institute for Health Metrics and Evaluation, University of Washington [www.healthdata.org]). Early CNS manifestations include headache and decreased responsiveness, anosmia and ageusia. Viral attachment to ACE2 receptors in endothelium cause widespread endotheliitis, coagulopathy, small-vessel disease, arterial and venous thromboses responsible for large-vessel ischemic strokes, cerebral venous thrombosis, intracerebral hemorrhage and subarachnoid hemorrhage along with a thrombotic state. Acute hemorrhagic necrotizing encephalopathy is associated to the cytokine storm. There are isolated reports of seizures, encephalopathy, meningitis, and encephalitis. Acute transverse myelitis is more frequent than expected and has also been reported as a complication of the Oxford AstraZeneca vaccine (Román GC, Gracia F, Torres A, et al. SARS-CoV-2-associated acute transverse myelitis: Clinical review of 43 cases and 3 post-vaccination reports. Front Immunol 26 April 2021). Guillain-Barré syndrome is the most common neurological disorder affecting the PNS but Miller Fisher syndrome and polyneuritis cranialis may also occur. There are rare instances of viral myopathy with rhabdomyolysis. International neuroepidemiological collaboration has helped to define the natural history of the COVID-19 neurology during this pandemic.
EPILEPSY IMAGING: NEW CHALLENGES ON THE DIAGNOSIS
- Fernando Cendes (Brazil)
Abstract
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Imaging is pivotal in the evaluation and management of patients with epilepsies. High-resolution structural neuroimaging with magnetic resonance imaging (MRI) plays a vital role in defining the etiology, epilepsy syndrome, and prognosis of seizure disorders. The type of lesion identified by MRI is associated with different probabilities of pharmacoresistance. It is essential that structural MRIs are optimally acquired, including 3D T1-weighted and FLAIR sequences, and carefully reviewed by trained experts within the context of all available clinical and EEG data. Multiplanar reformatting of high-resolution MRI and correlation with functional multimodal imaging improves the detection of subtle lesions. Detection of a lesion on a previous negative MRI has a substantial impact on determining the etiology of epilepsy, reducing the need for invasive investigations, and planning surgical treatment in patients with pharmacoresistant seizures and for the postoperative outcome. The high diagnostic yield of MRI to identify the common pathological findings in individuals with focal seizures, including mesial temporal sclerosis, vascular anomalies, low-grade glial neoplasms, and malformations of cortical development (MCD), has been well established. Quantitative postprocessing may help to complement the evaluation of subtle MCDs. Positron emission tomography (PET) is the most performed interictal functional neuroimaging technique that may reveal a focal hypometabolic region concordant with seizure onset. Single-photon emission computed tomography (SPECT) studies may assist the performance of ictal neuroimaging in patients with pharmacoresistant focal epilepsy. Emerging functional imaging modalities, such as functional MRI (fMRI), and EEG-fMRI, may help to reduce the need for invasive investigations and predict prognosis.
TROPICAL NEUROLOGY AND CLIMATE CHANGE: THE IMPACT IN LATIN AMERICA
- Marco Medina (Honduras)