Sakusic, Amra

Abstract We present the case of a 61-year-old woman with a history of orthotopic heart transplant who was hospitalized with new-onset headache. Magnetic resonance imaging (MRI) of the brain revealed T2 hyperintense signal involving the left occipital lobe with leptomeningeal enhancement and mild vasogenic edema. Initial neurologic examination was normal; however, after 7 days she developed imbalance, visual disturbances, night sweats, bradyphrenia, alexia without agraphia, and right hemianopsia. Brain MRI showed enlargement of the left occipital mass and worsening edema. Stereotactic needle biopsy showed nondiagnostic necrosis. The patient continued to deteriorate despite dexamethasone. Cerebrospinal fluid (CSF) suggested infection, and cytomegalovirus CSF polymerase chain reaction (PCR) was positive. The patient received vancomycin, imipenem, and ganciclovir. After obtaining a positive serum beta-D-glucan (Fungitell), amphotericin was added. Despite best medical efforts, the patient died. Postmortem broad-range PCR sequencing of the brain tissue was positive for rare amoeba Balamuthia mandrillaris.

AbstractNeurological complications after heart transplantation are common and include cerebrovascular events (ischemic strokes, hemorrhagic strokes, and transient ischemic attacks), seizures, encephalopathy, central nervous system (CNS) infections, malignancies, and peripheral nervous system complications. Although most neurological complications are transient, strokes and CNS infections can result in high mortality and morbidity. Early recognition and timely management of these serious complications are crucial to improve survival and recovery. Diagnosing CNS infections can be challenging because their clinical presentation can be subtle in the setting of immunosuppression. Immunosuppressive medications themselves can cause a broad spectrum of neurological complications including seizures and posterior reversible encephalopathy syndrome. This article provides a review of the diagnosis and management of neurological complications after cardiac transplantation.

Background and Purpose: To describe the neurological and cerebrovascular findings in patients who tested positive for SARS-CoV-2 and underwent head imaging in ambulatory and inpatient settings. Methods: Consecutive patients aged ≥18 years with SARS-CoV-2 infection diagnosed or treated at Mayo Clinic sites from 3/11/2020 to 7/23/2020 with head CT or brain MRI within 30 days of SARS-CoV-2 diagnosis were included. Demographics, medical history, indication for SARS-CoV-2 testing, neurologic symptoms, indication for brain imaging, neuroimaging findings, etiology of cerebrovascular events, and hospital course were abstracted from medical records. Results: Of 8,675 patients with SARS-CoV-2, 180 (2.07%) had head imaging. Mean age of the entire cohort was 42 ± 18 years, whereas mean age of those with head imaging was 62 ± 19 years. Common indications for imaging were headache (34.4%), encephalopathy (33.4%), focal neurologic symptom (16.7%), and trauma (13.9%). While 86.1% of patients who underwent head imaging had normal exams, cerebrovascular events occurred in 18 patients (0.21% of the total cohort). Of patients with cerebrovascular events, 8 (44.5%) had acute infarct; 6 (33.3%), acute intracranial hemorrhage; 5 (2.8%), subacute infarct; and 1 (0.6%) posterior reversible encephalopathy syndrome. In the thirteen patients with ischemic stroke, 6 (46.2%) had cryptogenic stroke; 3 (23.1%), other defined causes; 2 (15.4%), small vessel stroke; 1 (7.7%), large vessel stroke; and 1 (7.7%) cardioembolic stroke. Conclusion: In ambulatory and hospitalized patients with SARS-CoV-2 infection, the rate of head imaging is low, with common indications of encephalopathy and headache. Cerebrovascular events occurred rarely, and cryptogenic stroke was the most common stroke mechanism.

Abstract Background Since the outbreak of COVID-19 pandemic, clinical data from various parts of the world have been reported. Until now, there has been no clinical data with regards to COVID-19 from Bosnia and Herzegovina (B&H). The aim was to report on the first cohort of patients from B&H and to analyze clinical factors of COVID-19 patients that have influenced the length of hospitalization (LOH) of COVID-19 infected patients.Methods This retrospective cohort study was conducted at Tuzla University Clinical Center (UKC). It included 25 COVID-19 positive patients that were hospitalized between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Factors analyzed induced age, BMI, presence of known comorbidities, serum creatinine and O2 saturation upon admission.Results The mean age was 52.92±19.15 years and BMI 28.80±4.22. LOH for patients with BMI <25 was 9± SE2.646 days (CI 95% 3.814-14.816) vs 14.182 ±SE .937 (CI 95% 12.346-16.018 p<0.05; HR 5.148 CI95% 1.217 to 21.772 p=0.026) for ≥25 BMI. The mean LOH of patients with normal levels of O2 ≥95% was 11.667 ±SE1.202 (CI95% 8.261 to 13.739; p=0.046), while LOH for patients with <95% was 14.625 ±SE 1.231 CI95% 12.184 to 16.757 p=0.042; HR 3.732 CI95%1.137-12.251 p=0.03). Patients without known comorbidities had a mean LOH of 11.700± SE1.075 (CI 95% 9.592-13.808), while those with comorbidities had a mean of 14.8±1.303 (CI 95% 12.247-17.353; p=0.029) with HR2.552Conclusion LOH varied among COVID-19 patients and was prolonged when clinical characteristics such as BMI, known comorbidities, elevated creatinine, and O2 saturation <95% were present. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from those reported in other countries.

Abstract Background Since the outbreak of COVID-19 pandemic clinical data from various parts of the world have been reported; until now, there has been no clinical data with regards to COVID-19 from Bosnia and Herzegovina (B&H). The aim was to report on the first cohort of patients from B&H and to analyze clinical factors of COVID-19 patients that may influence the length of hospitalization (LOH) of COVID-19 infected patients.Methods Retrospective cohort study was conducted at Tuzla University Clinical Center (UKC). It included 25 COVID-19 positive patients that were hospitalized between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Factors analyzed induced age, BMI, presence of comorbidities, serum creatinine and oxygen saturation upon admission.Results The mean age was 52.92±19.15 years and BMI 28.80±4.22. LOH for patients with normal BMI was 9±SE2.646 days (CI 95% 3.814-14.816) vs 14.182 ±SE .937 (CI 95% 12.346-16.018; p<0.05) for ≥25 BMI. Patients without underlying diseases had a LOH of 11.70 ±SE1.075 (CI 95% 9.592-13.808), while those with comorbidities 14.8 ±SE1.303 (CI95% 12.247-17.353; p<0.05). Conclusion LOH varied among COVID-19 patients and was prolonged when clinical characteristics such as elevated BMI, presence of comorbidities, elevated creatinine and low oxygen saturation levels were taken into consideration. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from data reported in other countries.

Abstract Background Since outbreak of COVID-19 pandemic clinical data from various parts of the world have been reported, until now there has been no provide data from Bosnia and Herzegovina (B&H) about COVID-19. Aim was to report on the first cohort of patients from B&H and to analyze clinical factors of COVID-19 patients that influence the length of hospitalization. Methods Retrospective cohort study conducted at UKC Tuzla. The study included 25 COVID-19 positive patients that were hospitalized between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Hospitalization greater than 10 days was considered as prolonged. Factors analyzed induced age, BMI, comorbidities, serum creatinine and oxygen saturation upon admission.Results The mean age was 52.92±19.15 years and BMI 28.80±4.22. LOH for patients with normal BMI was 9±SE2.646 days (CI 95% 3.814-14.816) vs 14.182 ±SE .937 (CI 95% 12.346-16.018; p<0.05) for ≥25 BMI. Patients without underlying diseases had a LOH of 11.70 ±SE1.075 (CI 95% 9.592-13.808), while those with comorbidities 14.8 ±SE1.303 (CI95% 12.247-17.353; p<0.05). Conclusion LOH varied among COVID-19 patients and was prolonged when clinical characteristics such as elevated BMI, comorbidities, elevated creatinine and low oxygen saturation levels were taken into consideration. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from data reported in other countries.