Sarfaraz Ahmad

The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I² = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I² = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.

Patients with systemic lupus erythematosus (SLE) experience neuropsychiatric symptoms. The term neuropsychiatric SLE (NPSLE) is a generic term that refers to a series of neurological and psychiatric symptoms directly related to SLE. In approximately 30% of patients with neuropsychiatric symptoms, SLE is the primary cause (NPSLE), and symptoms manifest more frequently around SLE onset. Neurovascular and psychotic conditions can also lead to NPSLE. Pathogenesis of NPSLE is implicated in both neuroinflammatory and ischemic mechanisms, and it is associated with high morbidity and mortality. After diagnosing and assigning causality, NPSLE treatment is individualized according to the type of neuropsychiatric manifestations, type of the predominant pathway, activity of SLE, and severity of the clinical manifestations. There are many problems to be addressed with regards to the diagnosis and management of NPSLE. Controlled clinical trials provide limited guidance for management, and observational cohort studies support symptomatic, antithrombotic, and immunosuppressive agents. The purpose of this review was to provide a detailed and critical review of the literature on the pathophysiology, diagnosis, and treatment of NPSLE. This study aimed to identify the shortcoming in diagnostic biomarkers, novel therapies against NPSLE, and additional research needs.

A 51-year-old woman with a past medical history of migraine presented with severe headache for the last three weeks. The pain was intermittent and throbbing in nature. She has not experienced any headaches in the past several years. She took her migraine pills and over-the-counter analgesics, but the pain did not resolve. Initial evaluation including physical exam and neurological exam was normal. Her serum chemistry was unremarkable and CT scan of the brain was nonsignificant. The patient was diagnosed with possible trigeminal neuralgia and the pain resolved after being started on tegral (carbamazepine). Unilateral headache is a typical presentation of atypical trigeminal neuralgia and is rarely reported in literature.

A 39-year-old-man presented to the emergency room with a complaint of febrile jaundice and diffuse arthralgia. The patient had a temperature of 100°F, severe jaundice, and scleral icterus. Laboratory workup showed severe hyperbilirubinemia and elevated serum creatinine, and the rest of the serum chemistry was unremarkable. The ultrasound and computed tomography (CT) of the abdomen was normal. The patient had a recent history of travel to an endemic area for Lyme disease. After an extensive workup, all other possible etiologies had been ruled out, and the patient was started on empirical doxycycline by considering the patient’s recent history of travel. Serum serologic test confirmed Lyme disease. His bilirubin and creatinine improved gradually. His fever subsided in three days, and he was discharged with outpatient follow-up. Although hyperbilirubinemia is rare in Lyme disease, it should be considered as a differential diagnosis in patients with severe jaundice and a recent history of travel.