Leptomeningeal Schistosomiasis: A Case Report of an Atypical Location of Neuroschistosomiasis Presenting as Adult-Onset Seizure

We report a case of a 19-year-old male, single, right-handed, student, Filipino currently living in Novaliches, Quezon City who consulted for the first time at our institution due to stiffening of extremities with a pertinent travel history from the Island of Samar. Evaluation and diagnostics showed a leptomeningeal enhancement and thereafter, a biopsy was made revealing deposition of schistosoma ova at the leptomenineal area. Schistosomiaisis (also known as Bilharzia or Blood Fluke Disease) is widely distributed in the Philippines affecting 24 provinces in Luzon, Visayas, and Mindanao, with 5 million people at risk and approximately 1 million affected in the year 2003. Cerebral schistomiasis is a severe and neglected complication which occurs in less than 5% of infected individuals. Symptoms are non-specific such as headache, vomiting, confusional states, and focal seizures. Typical neuroimaging findings are expected at the spinal cord, cerebellum, and the subcortical area, however leptomeningeal involvement is rarely reported. We report this case to the medical community to give light on the different presentations of the said diseas

A Haunting Tremor: A Rare Presentation of an Unruptured Arteriovenous Malformation and Review of Related Literature

Tremor is a common phenomenology characterized by an involuntary rhythmic and oscillatory movement. These are formed from any disruption in the dentate-olivary and the basal ganglia-cerebello-thalamic circuits due to neurodegenerative disease, stroke, head injuries, toxins, drugs, systemic illness, or metabolic disorders, and rarely, arteriovenous malformations (AVMs). Brain AVMs, as compared to AVMs in other anatomic locations, are less commonly studied. The pathophysiology, symptomatic correlation, and etiology of these brain AVMs are less reported, hence, current literature reviewed presented patients with a wide spectrum of signs and symptoms which were linked with AVMs of differing risk based on their diagnostic grading. This case report narrates the experience of a 29-year-old female physician presenting with fine high frequency hand tremors later found out to have a parietal AVM. We will discuss AVMs and their consequent course of diagnosis, treatment, and management.</p

COVID-19 Pandemic vs. Pre-Pandemic Period: Changes in Hospital Admission Rates, Length of Stay, and In-Hospital Mortality of Common Neurologic Conditions

Background and Objective: COVID-19 pandemic caused massive adjustments to healthcare systems in the country. This study determined the change in hospital admission rates, length of hospital stay and in-hospital mortality of common (non-COVID related) neurologic conditions during the COVID-19 pandemic and pre-pandemic period. Methods: The study utilized a retrospective cross-sectional study of patients admitted under the Department of Neurology at Jose R. Reyes Memorial Medical Center from the period of March 2019 to March 2020 (pre-pandemic group), and April 2020 to April 2021 (COVID-19 pandemic). Admission rates, length of stay and in-hospital mortality were calculated for cerebrovascular diseases, CNS infections, CNS neoplasms and Seizure disorders. Results: There were 1090 admissions from April 2019 to March 2020 and 393 admissions from April 2020 to March 2021 with an over-all decline of 63%. During the pandemic, the duration of hospital stay was longer for CNS neoplasms. Duration of hospital stay for cerebrovascular disease, CNS infection, and seizure disorders were not significantly different. There was an increase in over-all in hospital mortality from 22.75% to 26.46% with significant increase in the case fatality rate of cerebrovascular diseases. Conclusion: We observed a large decline in the over-all admission rate and longer hospital stays. The over-all in-hospital mortality rate also increased during the pandemic period.</p

COVID-19 Pandemic vs. Pre-Pandemic Period: Changes in Hospital Admission Rates, Length of Stay, and In-Hospital Mortality of Common Neurologic Conditions

Background and Objective: COVID-19 pandemic caused massive adjustments to healthcare systems in the country. This study determined the change in hospital admission rates, length of hospital stay and in-hospital mortality of common (non-COVID related) neurologic conditions during the COVID-19 pandemic and pre-pandemic period. Methods: The study utilized a retrospective cross-sectional study of patients admitted under the Department of Neurology at Jose R. Reyes Memorial Medical Center from the period of March 2019 to March 2020 (pre-pandemic group), and April 2020 to April 2021 (COVID-19 pandemic). Admission rates, length of stay and in-hospital mortality were calculated for cerebrovascular diseases, CNS infections, CNS neoplasms and Seizure disorders. Results: There were 1090 admissions from April 2019 to March 2020 and 393 admissions from April 2020 to March 2021 with an over-all decline of 63%. During the pandemic, the duration of hospital stay was longer for CNS neoplasms. Duration of hospital stay for cerebrovascular disease, CNS infection, and seizure disorders were not significantly different. There was an increase in over-all in hospital mortality from 22.75% to 26.46% with significant increase in the case fatality rate of cerebrovascular diseases. Conclusion: We observed a large decline in the over-all admission rate and longer hospital stays. The over-all in-hospital mortality rate also increased during the pandemic period.</jats:p

Abstract W MP60: Prevalence Of Post Stroke Daytime Sleepiness

Background of the study: In patients with stroke, the most common Sleep Disorder are sleep apnea, insomia (30%), and excessive daytime sleepiness. Ischemic stroke patients had 76.8% sleep disorder and hemorrhagic stroke patients had 82.5% sleep disorder. There were several postulated mechanisms on the pathophysiologic effects of sleep disorders on stroke which includes: acute hemodynamic changes during episodes of apnea, decreased cerebral blood flow, and paradoxical embolization, hypercoagulability, hypoxia-related cerebral ischemia, and atherosclerosis. With these several mechanisms, post stroke recovery among patients with post stroke sleep disorder can be altered. Methodology: A cross sectional study was conducted in Jose Reyes Memorial Medical Center from July 2013 to June 2014. All Medical records and neuroimaging of post stroke patients (≥ 6 months) were reviewed. Those patients with cognitive dysfunction, unable to give consent or unable to understand the study protocol and whose neuroimaging cannot be retrieved were excluded in the study. The interviewer assisted Epworth Sleepiness Scale (ESS) was used in this study to determine daytime sleep propensity. Results: A total of 130 subjects were included. There were 82 (63%) male and 48(37%) female. The mean age is 58. The variables shown to be significantly associated with ESS were duration of stroke, number of risk factor and type of stroke. The more recent the stroke (specifically shorter than 2.7 years which is the mean), the higher the ESS score. A patient with two risk factors was 4.6x more likely to have an ESS of 10-14 compared to one who has only 1 risk factor. Those who had intracranial bleeding were 2.5 times more likely to have an ESS of 10-14. Conclusion: Among post stroke patients, the more recent the stroke, the more risk factors present, and those who had intracerebral hemorrhage have higher propensity for daytime sleepiness. </jats:p

Priorities in Movement Disorders Research

Objectives: To analyze the patterns of movement disorders prospectively using the registry of movement disorders in our institution and to identify some research priorities.Background and purpose: Movement disorders are common reasons for consultation and referrals in our hospital. They are often thought to affect movement only. However, most patients also experience psychiatric, cognitive, and other non-motor symptoms, either from the disease itself, or as a side-effect of medications. No data has been obtained regarding movement disorders in our institution. With the use of our registry, we aim to document findings prospectively, for use as data mining to support a variety of researches in the future, and to guide us as to priorities in services, teaching and research.Methods: Starting April 2014, all adult patients seen at the Department of Neurology and the Department of Behavioral Medicine both inpatients and outpatients, presenting with movement disorders, were included in our IRB-approved Movement Disorder Registry. With signed consent from these patients, the motor manifestations were documented by recording with a video camera. All verified movement disorders were included in this registry. These patients were then characterized as to their demographic and clinical profile, and were reviewed as to the pattern of movement disorders.Discussion: Since April 2014, we have registered about 41 patients, with a mean age of 51 years for male and 67 years for female. The most commonly seen movement disorder was Parkinson’s disease (70%). Other movement disorders were dystonia, hemichorea, hemifacial spasm, tardive dyskinesia, and tic disorder. This was in keeping with other studies in Asian countries. As a national health institution, and the second institution locally with a registry of movement disorders, we hope to continue this registry so that we could obtain a substantial data for future researches, to establish a hospital prevalence and incidence of common movement disorders, and to be able to answer the possible natural course of movement disorders.Conclusion: Creating a registry of movement disorders is beneficial to be able to document findings from a prospective analysis the patterns of movement disorders in our institution and to help us construct research questions following research priorities in movement disorders. Among patients registered, Parkinson’s disease remains the most common disease seen in our institution.</p