Juan Carlos López-Hernández

Introduction: Creutzfeldt-Jakob disease (CJD) is a fatal prion disorder marked by rapidly progressive dementia and neuropsychiatric features. Epidemiological data in Latin America are limited, and no incidence studies exist in Mexico. This study sought to quantify CJD incidence in a neurological reference center. Methods: A cross-sectional study was conducted at the National Institute of Neurology and Neurosurgery, Mexico City, during 2023-2024. Clinical and paraclinical findings were reviewed. Incidence was calculated per 1000 emergency visits, with relative risk (RR) and 95% confidence intervals. Results: Among 19 003 patients, 15 fulfilled probable CJD criteria. Incidence was 0.55/1000 in 2023 and 1.01/1000 in 2024 (RR 1.83; 95% CI 0.63-5.35; P = .309). Cognitive and behavioral symptoms predominated (psychosis in 68%). MRI revealed abnormalities in all cases, most often cortical ribboning (93%). Conclusion: This first incidence study highlights the presence of CJD in specialized Mexican centers, underscoring the need for systematic surveillance and improved diagnostic access.

Antecedentes: Existe escasa información sobre los factores de riesgo y los microorganismos relacionados con la neumonía asociada a los cuidados de la salud en pacientes con síndrome de Guillain-Barré (SGB). Objetivo: Analizar los factores clínicos relacionados con la neumonía asociada a los cuidados de la salud e identificar los principales microorganismos. Material y métodos: Estudio de casos y controles de pacientes con SGB atendidos en el periodo de marzo de 2020 a junio de 2022. Se definió neumonía asociada a los cuidados de la salud como hallazgos clínicos, radiológicos o de laboratorio de neumonía tras 48 horas de hospitalización. Los factores de riesgo se analizaron con un modelo multivariable, expresados en razón de momios (RM) con intervalos de confianza al 95% (IC 95%); el rendimiento del modelo se evaluó mediante análisis del área bajo la curva (AUC). Resultados: Se incluyeron 134 pacientes, el 75.4% hombres, con una edad promedio de 44.7 años. El 28.4% requirieron ventilación mecánica invasiva (VMI) y el 18.6% presentaron neumonía nosocomial. Se encontraron como factores de riesgo significativos una puntuación MRC ≤ 20 (RM: 5.5; IC 95%: 1.5-20.1; p = 0.009) y el uso de VMI (RM: 95; IC 95%: 12-749; p < 0.001). El modelo mostró un AUC de 0.94 (IC 95%: 0.90-0.98; p < 0.001). Los microorganismos más frecuentes fueron Staphylococcus aureus (52%) y Pseudomonas aeruginosa (13%). Conclusiones: La puntuación MRC ≤ 20 y el uso de VMI son factores de riesgo para neumonía asociada a los cuidados de la salud en pacientes con SGB. S. aureus fue el microorganismo predominante.

A 73-year-old patient presented with sudden double vision and left-sided hemiparesis. A physical exam revealed palsy of the right VI cranial nerve and left arm/leg paresis. A magnetic resonance imaging (MRI) scan showed an acute stroke in the right pons ([Figure 1A]), with the initial workup suggesting intracranial atherosclerosis ([Figure 1B–D]).[1] Other causes were ruled out. The patient was treated with aspirin and clopidogrel and then discharged. He returned the day after with dysarthria and gait instability. A follow-up MRI scan revealed a left cerebellar stroke, creating a chessboard pattern ([Figure 2]). Conceptualization: RMR, BDG; Funding acquisition: RMR; Supervision: RMR; Writing - original draft: RMR, EPR; Writing – review & editing: AMP, CLH. The data that support the findings of the present study are available upon reasonable request from the corresponding author. Editor-in-Chief: Ayrton Roberto Massaro 0000-0002-0487-5299. Associate Editor: Antonio José da Rocha 0000-0003-2591-9171. Received: 09 February 2025 Accepted: 13 April 2025 Article published online: 21 June 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil

Introduction: Low levels of Vitamin D are associated with severe manifestations of autoimmune or inflammatory diseases; there is limited information regarding Guillain-Barré Syndrome (GBS). Objective: To determine the serum levels of vitamin D in patients with GBS compared with healthy controls. Materials and Methods: A prospective observational study of consecutive patients with GBS based on EAN/PNS criteria over a year, from a single center was conducted. Clinical and paraclinical characteristics were obtained from the included patients upon admission; we determined the serum levels of Vitamin D (ng/ml) at admission and categorized them according to Vitamin D levels: sufficient >30 ng/mL, insufficient 20-30 ng/mL, and deficient P < 0.001]. Only 9% (95% CI 1-19%) of the GBS patients had sufficient levels of vitamin D. In correlation analysis, significant differences were found between Vitamin D levels and glucose levels (r2 = −.36, P = 0.007) and the glucose-leukocyte index (GLI) (r2 = −.42, P =<0.001). In comparative analysis (Vitamin D levels ≤15 ngs/ml/ vs ≥ 16 ng/mL), the presence of dysautonomias, facial diparesis, leukocytes, glucose-leukocyte index (GLI), and glucose levels were significant; in the Kaplan-Meier survival analysis, patients with Vitamin D levels ≤15 ngs/ml showed lesser recovery in independent walking at 3 months (log-rank = 0.047). Conclusion: Patients with GBS and low levels of Vitamin D exhibit a higher frequency of dysautonomias, higher GLI, and lesser recovery of independent walking.

Introduction: Autoimmune encephalitis (AE) represents a severe neuropsychiatric disorder that requires early diagnosis. This study describes the frequency, clinical characteristics, and paraclinical findings in patients with possible autoimmune encephalitis treated in a neurological emergency department, as well as factors associated with poor functional prognosis at discharge. Material and Methods: This was an observational ambispective cohort study including patients diagnosed with AE who were treated in a neurological emergency department in 2022. Demographic, clinical, and paraclinical characteristics were evaluated, along with functional outcomes using the modified Rankin scale (mRS); ≤2 points, was considered as good prognosis. In the statistical analysis we used the chi-squared test, Fisher’s exact test, Student’s T-test, and Mann-Whitney U test. Results: Out of 9046 patients, 31 (0.3%) met the criteria for probable autoimmune encephalitis (PAE). The average age was 28.4 ± 12.1 years and 51.6% were female. Cognitive alterations (90.3%), psychosis (74.2%), abnormal movements (71%), catatonia (67.7%), seizures/status epilepticus (64.5%, 19.4%), and dysautonomia (58.1%) were observed; 58.1% had a good functional prognosis. Factors associated with poor prognosis included older age (24.8 ± 5.0 vs. 33.4 ± 16.8, p = 0.049), status epilepticus (0% vs. 46.2%, p = 0.002), and lower frequency of headache (61.1% vs. 15.4%, p = 0.025). Conclusions: AE represents a rare diagnosis even in a neurological emergency center; older age, status epilepticus and absence of headache were associated with poor functional prognosis at discharge.

We present the case of a 60-year-old male patient with Guillain-Barré syndrome (GBS) who experienced treatment-related fluctuations (TRF) with a history of ayahuasca consumption. The patient presented to the neurological emergency department without a history of infection (upper respiratory tract or diarrhea) or vaccination in the past four weeks, but 14 days prior, the patient had consumed ayahuasca. Upon admission, the patient exhibited progressive weakness in all four limbs, with no cranial nerve involvement, a muscle strength Medical Research Council (MRC) score of 36/60, and generalized areflexia. Cerebrospinal fluid analysis showed slightly elevated protein levels at 50 mg/dL and a cell count of 2 (lumbar puncture was performed three days after the onset of symptoms). Neurophysiological studies met the criteria for the acute motor-sensory axonal neuropathy (AMSAN) variant. A diagnosis of GBS was established, Brighton criteria grade 1. The patient received treatment with intravenous human immunoglobulin, resulting in improvement with an MRC score of 48/60 at discharge. However, on day 10, he returned with worsening muscle strength (MRC score of 20/60), necessitating ventilatory support. TRF was considered, and retreatment with human immunoglobulin was initiated.

Dear Editor We recently reported the experience at our center in the care of Guillain-Barré syndrome (GBS) in the years of the pandemic (2020 and 2021), comparing it with that of previous years (2018 and 2019). 1 We thank your readers for their interest in our published work, and reply to the observations we have been asked to clarify. Firstly, the 56% increase in GBS cases during the pandemic in our center was due to the concentration effect our hospital had for the care of neurological patients in Mexico City. We cannot conclude that the population that was provided care could have had SARS-CoV-2 infection and that, for this reason, there was an increase in the number of cases. 1 Regarding the treatment received by the patients, the COVID-19 period group was made up of 123 patients, out of whom 84 received treatment with intravenous human immunoglobulin (IV IgG), 21 with plasma exchanges (five sessions on alternate days), with no treatment overlaps, and 19 patients were not treated because they were regarded as having mild forms (Hughes ≤ 2 points at admission, no disease progression, no lower cranial nerve involvement). Treatment with IV IgG was more often used in the COVID-19 period due to its rapid administration and because it shortened the days of hospital stay. 1 Cases of SARS-CoV-2 vaccine-associated GBS (20 patients)

Recientemente reportamos la experiencia de nuestro centro en la atención del síndrome de Guillain- Barré (SGB) en los años de la pandemia (2020 y 2021) comparándola con la de años previos (2018 y 2019).1

Background: During the COVID-19 pandemic, an increase in the number of Guillain-Barre syndrome (GBS) cases has been reported. Objective: To describe the clinical characteristics and prognosis of patients with GBS before and during the COVID-19 pandemic. Material and methods: Prospective cohort of GBS patients divided in two subgroups: before (2018-2019) and during (2020-2021) the COVID-19 pandemic. Clinical and paraclinical characteristics, as well as deaths, were recorded. A good prognosis was defined as independent ambulation recovery at three months. Results: Two-hundred and one patients were included (123 during and 78 before the pandemic), out of whom 69 % were males; age was 45 ± 16 years, and there was 2.5 % of in-hospital deaths. During the pandemic, a higher frequency of the demyelinating variant (50 %), bulbar cranial nerves involvement (44 % vs. 28 %), prior history of vaccination (16 % vs. 0 %), and a lower MRC score (30 ± 16.7 vs. 34.3 ± 17.7) were documented. An increase in the number of cases was observed from July to September (38 vs. 13). There were no significant differences in independent ambulation recovery or in the number of deaths. Conclusions: During the COVID-19 pandemic, a higher number of GBS cases were treated, out of which 16 % were associated with the SARS-CoV-2 vaccine; patients treated during the pandemic did not have a worse prognosis.