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Background During COVID-19 pandemic, a lot of newly discovered symptoms and presentations are emerging. Neurological symptoms of corona virus disease 19 (COVID19) have been reported including central nervous symptoms (CNS), peripheral nervous symptoms (PNS), and skeletal muscular symptoms; however, data are scarce about the exact occurrence of neurological affection during COVID-19 infection. Case presentation We present a case of a 67-year-old male patient with proven COVID-19 infection who developed acute confusion state, behavioral changes, agitation, and one attack of loss of consciousness 8 days following the infection. Laboratory profile, computed tomography (CT) brain, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis all were normal, and the patients were highly suspicion of autoimmune encephalitis due to COVID-19 infection. The patient received pulse steroid therapy with complete regaining the conscious level. Conclusion This clinical case emphasizes the possible relationship between COVID-19 infection and autoimmune encephalitis.

BackgroundAcute bilateral painless visual loss is an uncommon presentation and poses a significant diagnostic challenge. Without overt neurological deficits or significant vascular risk factors, stroke may not be the initial consideration. However, infarctions in the occipitoparietal regions can result in profound visual impairment, despite normal early CT head findings.Case presentationWe present the case of a 59-year-old male with no known comorbidities who developed acute bilateral painless visual loss, reducing his vision to hand motion in one eye and finger counting at 30 cm in the other. His neurological and ophthalmological examinations were otherwise unremarkable, and initial CT head and cerebral CT angiography were normal. Due to the absence of vascular risk factors and normal early neuroimaging, bilateral retrobulbar neuritis was suspected. However, a delayed MRI obtained the next day revealed bilateral occipitoparietal ischemic infarctions. The patient was treated with dual antiplatelet therapy and statins. He showed slight improvement in visual acuity, although significant deficits remained.ConclusionThis case highlights the importance of considering posterior circulation strokes in patients with acute bilateral painless visual loss, even in the absence of traditional stroke risk factors. It emphasizes the role of advanced neuroimaging, particularly MRI, in diagnosing cortical strokes when initial CT head is unremarkable.

BackgroundOn 11 March 2020, WHO declared COVID-19 has become a pandemic. This had an impact on everyday activity for every person. For special groups such as multiple sclerosis patients, the situation is a little bit confusing. In this study, COVID-19 infection impact on MS patients, willingness for vaccination, percentage of vaccinated patients and adverse effects of different vaccines were investigated. This cross-sectional descriptive study included 160 Egyptian MS patients. Demographic and clinical characteristics of all patients were extracted from their files MS unit archives. All these patients were contacted either by telephone and an oral informed consent was taken or in-person on their scheduled follow-up and informed written consent was taken to join this study. Patients were asked about: COVID-19 infection, severity of infection, and vaccination using a special questionnaire developed by the authors.ResultsOnly 39 (24.3%) patients have had COVID-19 infection with confirmed diagnosis. Most of infected patients (84.6%) were treated at home with no need for hospital admission. Five patients (12.8%) reported symptom suggestive of relapses after COVID-19 infection. Sixty-five patients (40.6%) were vaccinated against COVID-19. Out of these vaccinated patients, 22 patients (33%) developed adverse events from vaccine. These adverse events were self-limiting and related to local injection site and general manifestations. MS relapse after vaccination was reported in 7.7% of the vaccinated group.ConclusionPrevalence of COVID-19 infection and severity of infection were equal to general population. Risk of relapse is low either with infection or vaccination. No severe adverse events were reported after vaccination.

BackgroundCorpus callosum infarctions are rare due to the region’s dual vascular supply and often present with nonspecific or atypical symptoms. The resulting diagnostic delay may impact management and outcomes.Case presentationWe report a case of a female patient in her early sixties with a background of hypertension, diabetes mellitus, and stage IV chronic kidney disease. She presented with acute coronary syndrome and pulmonary edema. During hospitalization, she developed a new-onset cognitive decline, with a Mini-Mental State Examination (MMSE) score of 16/30. Neurological examination revealed no focal deficits but marked cognitive slowing. MRI of the brain showed acute infarction involving the entire corpus callosum. Workup for embolic sources and alternative diagnoses was unremarkable. The patient was managed conservatively due to comorbidities and gradually improved. Her MMSE improved to 24/30 at 1-week follow-up.ConclusionThis case highlights the importance of considering corpus callosum infarction in patients presenting with unexplained cognitive changes, especially in the presence of vascular risk factors. Neuroimaging, particularly MRI, plays a pivotal role in diagnosis. Early identification and neurorehabilitation may improve cognitive outcomes.

BackgroundBrain abscess is a potentially life-threatening condition typically developing shortly after head trauma or neurosurgery. Delayed onset, particularly more than a decade after the original insult, is exceedingly rare.Case presentationWe present the case of a 29-year-old male with a history of frontal bone fractures and cranioplasty in 2011, complicated by a persistently discharging forehead sinus. Fourteen years later, he presented with new-onset seizure and neuropsychiatric symptoms. Imaging revealed a large right frontal abscess with mass effect and midline shift, likely originating from the chronic sinus tract. He underwent urgent surgical drainage, with Staphylococcus aureus isolated from the abscess. The patient improved postoperatively and was managed with long-term intravenous antibiotics and coordinated craniofacial care. ConclusionThis case illustrates a rare but serious delayed complication of craniofacial trauma and emphasizes the importance of long-term surveillance in patients with chronic sinus tracts. Clinicians should maintain high suspicion for intracranial pathology in patients with subtle neuropsychiatric symptoms and prior neurosurgical history.

BackgroundGuillain–Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy often triggered by preceding infections. It typically presents with ascending weakness, but variants such as Miller Fisher Syndrome (MFS) manifest with descending paralysis, ophthalmoplegia, and ataxia. Viral infections, including respiratory pathogens and COVID-19, are known triggers for GBS, but relapses associated with successive infections are rare. Our case demonstrates a rare presentation of relapsing GBS with ophthalmoplegia as the main presenting symptom.Case presentationWe present a 46-year-old Middle Eastern man with no chronic illnesses who experienced recurrent episodes of Guillain–Barré Syndrome (GBS) triggered by viral infections, presenting in an unusual form. In 2017, he developed acute dysphagia, diplopia, and limb weakness following an upper respiratory tract infection, diagnosed as Miller Fisher variant GBS and treated successfully with IVIg. In 2022, after COVID-19 infection and ICU admission, he experienced a relapse with similar symptoms and responded well to IVIg. In 2024, he presented again with dysphagia, diplopia, and facial weakness with minimal limb involvement following an Influenza A infection. Despite initial deterioration requiring NGT insertion, gradual improvement occurred after 5 days of IVIg treatment. Nerve conduction studies confirmed demyelinating neuropathy.ConclusionThis case highlights the association between viral infections and recurrent GBS, presenting with descending weakness—an uncommon feature—emphasizing the importance of early recognition and management, even when clinical presentations deviate from typical patterns.

BackgroundThe incidence estimates for intracranial subdural empyema are 0.1 per 100,000 individuals, making it a rare clinical condition. It is a highly morbid and fatal illness that is most commonly the result of a primary infection somewhere else.Case presentationThe authors present a young male patient 15 years presented with 1 week history of headache, fever, confusion and seizure attack with initial negative CT head and nearly negative CSF analysis. With few days he developed left sided weakness. MRI brain showed right temporoparietal subdural fluid collection with midline shift. Urgent neurosurgical evacuation was made and revealed subdural empyema. The boy received combination therapy of vancomycin, ceftriaxone, and metronidazole. The culture of the pus was negative but 16S rRNA gene sequencing (bacterial) revealed streptococcus intermedius. He made a good recovery with no recollection or neurological deficit on follow up.ConclusionThis case highlights the possibility of occurrence of this rare infection in otherwise healthy individuals without obvious precipitating factor. It also indicates the superiority of MRI brain over CT head in detection of subdural collection. The rapid diagnosis and intervention improve the outcome of the patient.

Background Academic thriving encompasses students’ cognitive engagement, emotional well-being, and sense of belonging. The educational environment plays a vital role in supporting thriving, particularly in the demanding context of medical education. Limited multinational data exists on how educational environments influence thriving in MENA region. This study was designed to investigate the relationship between the educational environment and academic thriving among medical students across Arabic-speaking countries, using validated assessment tools. Methods A cross-sectional, descriptive-correlational design was employed. A total of 1,246 undergraduate medical students from five Arab countries participated in an online survey conducted between February and March 2025. The Dundee Ready Education Environment Measure (DREEM) assessed perceptions of the educational environment, while the Thriving Quotient (TQ) evaluated students’ academic engagement and well-being. Data were analyzed using descriptive statistics, inferential tests, correlation, and regression analyses. Results Participants reported generally positive perceptions of their educational environment (mean DREEM score: 113.79 ± 27.76) and moderate levels of thriving (Overall TQ mean was 95.38 ± 18.22). Strongest correlations with academic thriving were found in the domains of academic self-perception and social self-perception. Regression analysis revealed that educational environment variables explained 38.7% of the variance in thriving outcomes ( p  < 0.001). Socio-demographic variables, including gender, financial status, and awareness of student support services, significantly influenced both DREEM and TQ scores. Conclusions The educational environment plays a significant role in shaping academic thriving among medical students. Institutions should focus on improving academic support, fostering inclusive environments, and strengthening student-centered teaching strategies to enhance both learning and psychological outcomes. Clinical trial number Not applicable.

Background Acute quadriplegia due to compressive myelopathy is a rare but reversible neurological emergency, especially when diagnosed early. In patients with comorbidities such as diabetes and end-stage renal disease (ESRD), clinical presentations may be atypical, and elevated cardiac biomarkers like troponin may not reflect true myocardial ischemia. This can lead to diagnostic delays when spinal cord compression mimics cardiac conditions. Case presentation A 56-year-old male with diabetes and ESRD on hemodialysis presented with progressive quadriplegia. Three weeks prior, he had experienced chest pain and shortness of breath, prompting a diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) based on mildly elevated troponin (145 pg/mL), despite a normal ECG. He was treated for volume overload and sepsis secondary to a central line-associated bloodstream infection (CLABSI) and discharged in stable condition. One week later, he developed a weakness of his right leg, progressing to complete quadriplegia by the following week. Neurological examination revealed a sensory level at C6–C7 and motor weakness in all limbs. MRI of the spine showed compressive myelopathy at C8–T1, prompting urgent neurosurgical referral. Retrospective analysis suggested that his initial chest pain was referred pain from spinal cord compression rather than cardiac in origin. Conclusion This case highlights the importance of maintaining a broad differential diagnosis in patients with complex comorbidities. Elevated troponin in ESRD may be misleading, and clinicians must consider spinal pathology in the presence of neurological deficits, even when symptoms mimic cardiac events. Early recognition and intervention are key to preventing irreversible neurological damage.

BackgroundChitinase -3-like 1-protein (CHI3L1) is a glycoside secreted by monocytes, microglia, and activated astrocytes. Its distribution in inflammatory lesions denotes its role in astrocytic response to modulate CNS inflammation. In multiple sclerosis (MS), CHI3L1 levels have been found to be influenced by disease severity, activity, and progression. We aimed to measure CSF level of CHI3L1 in patients with MS and correlate its level with disability measures for a possible role as a biomarker for disease progression.MethodsFifty-two MS patients (30 relapsing-remitting MS and 22 progressive MS) and thirty-five age and sex-matched healthy controls were included. They all underwent full clinical assessment (including disability and cognitive scales), radiological assessment, and CSF level of CHI3L1.ResultsPatients with MS had higher CSF level of CHI3L1 than controls. Patients with progressive forms had higher levels than relapsing forms. There were positive correlations between disease duration, number of attacks, total EDSS, and CSF level of CHI3L1. Patients who had higher level of CSF CHI3L1 showed worse performance in MMSE and BICAMS and more lesions in T2 MRI brain. A cut off value of 154 ng/mL was found between patients with RRMS and PMS patients.ConclusionCHI3L1 can be considered as a biomarker of disease progression. CHI3L1 level increases in progressive MS more than RRMS. Also, high CSF level of CHI3L1 was associated with more disability including motor, cognitive, and radiological aspects.