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The sudden worldwide outbreak of Coronavirus Disease 2019 (COVID-19) has certainly provided new challenges in the management of acute ischaemic stroke, and the risk-benefit ratio of intravenous thrombolysis in COVID-19 positive patients is not well known. We describe four COVID-19 patients treated with intravenous thrombolysis for acute ischaemic stroke. Although rt-PA administration is the main therapeutic strategy, our patients experienced unpredictable complications and showed atypical features: the overall mortality was very high. In conclusion, in this article, we provide information about these cases and discuss the possible explanation behind this trend.

IntroductionContrast-induced encephalopathy is a rare and usually reversible entity due to the administration of iodinated contrast. Clinical manifestations include cortical blindness, encephalopathy, seizures and focal neurological deficits.MethodsWe report the case of a 56-year-old woman who developed global aphasia and right hemiplegia after a cerebral angiography performed for a subarachnoid haemorrhage. A prompt brain MRI resulted negative, while CT scan revealed left cerebral oedema with the cerebral sulci effacement. Complete recovery was observed in 10 days.DiscussionDiagnosis of contrast-induced encephalopathy requires a temporal correlation between neurological dysfunction and administration of iodinated contrast. Usually, the symptomatology is transient with a full recovery within 48–72 h. The most common symptom is cortical blindness, while other symptoms have been rarely reported. Only 20 cases previously reported global aphasia and/or hemiplegia or mimed anterior circulation strokes. Prompt brain neuroimaging is essential in order to exclude an alternative diagnosis that requires a distinct therapeutic approach.

Background/Objectives: Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a rare neurological disorder primarily affecting pediatric patients but also observed in adults. The radiological hallmark of MERS is a reversible lesion in the splenium of the corpus callosum. Although MERS generally has a favorable prognosis, its variable presentation poses diagnostic challenges. This study examines the clinical variability, diagnostic hurdles, and outcomes of pediatric MERS cases. Methods: Our retrospective study included 19 pediatric patients (11 female and 8 males with an average age of 8.41 years) diagnosed with MERS between 2016 and 2024. Clinical data, including demographic characteristics, prodromal symptoms, neurological features, MRI findings, laboratory results, treatments, and outcomes, were analyzed. Results: Among the 19 patients, 84% were previously healthy, with the remaining 16% having pre-existing medical conditions. The most common prodromal symptoms were fever (68%), vomiting (47%), and diarrhea (32%). Neurological manifestations included seizures (26%), headache (21%), and drowsiness (21%), among others. In terms of etiology, infections were identified in 52% of the patients, with viral agents, particularly rotavirus, being the most common (40%). Hyponatremia was present in 63% of the cohort. The typical MRI splenial lesion underwent complete resolution in all patients. Treatment varied, with 53% of patients receiving electrolyte rehydration, and 21% receiving intravenous immunoglobulin or corticosteroids. All patients, but one, achieved full recovery. Discussion: This study reinforces the clinical heterogeneity of MERS in pediatric patients, emphasizing its favorable prognosis independently of presentation. Viral infections and hyponatremia were the most frequent etiologies.

The above article was published online with inverted given and family names. The correct presentation has been corrected above.

IntroductionMutations of the skeletal muscle sodium channel gene SCN4A are associated with several neuromuscular disorders including hyper/hypokaliemic periodic paralysis, paramyotonia congenita and sodium channel myotonia. These disorders are distinguished from dystrophic myotonias by the absence of progressive weakness and extramuscular systemic involvement.MethodsWe present an Italian family with 2 subjects carrying a p.Asn1180Ile mutation in SCN4A gene showing a peculiar clinical picture characterized by the association of myopathic features and myotonia.ResultsThe clinical, electromyographic and histological findings of these patients are reported. The possible pathogenicity of the mutation was tested by three different software, all giving positive results.DiscussionThis is the first report of a dominant, heterozygous mutation in SCN4A causing a complex phenotype of non-congenital myopathy and myotonic syndrome. We suggest that, in patients with myotonia and myopathy not related to dystrophic myotonias, the sequence analysis of SCN4A gene should be performed.