Browsing by Author "Ziemele, Dace"

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    Clinical Impact and Relevance of Antiganglioside Antibodies Test Results
    (2015-09-01) Ķēniņa, Viktorija; Gālzere, Ieva; Ziemele, Dace; Jaunalksne, Inta; Department of Neurology and Neurosurgery
    Autoantibodies most commonly found in association with neuropathies are those against the ganglioside family antigens-GM1, GQ1b, asialo-GM1, GM2, GD1a, and GD1b. The major diagnostic role is set for two of antibodies-anti-GM1 and anti-GQ1b. This retrospective study was designed to evaluate the status of antiganglioside antibodies in patients with possible autoimmune neuropathy. The study included 85 patients tested for antiganglioside antibodies during their hospitalization. Clinical information such as demographic data and antecedent illness was collected for all patients, and paraclinical studies including results from cerebrospinal fluid and neuroelectrophysiological examination were analyzed. In our study, a total of 27 patients (32%) were found positive for at least one antiganglioside antibody. The most commonly found antibodies were against asialoGM1 (n=13) and GM1 (n=10) gangliosides. Eight patients were diagnosed with a disease where antiganglioside antibodies are used as a diagnostic marker: five patients-Guillain-Barré syndrome (GBS), 1 patient-Miller-Fisher syndrome (MFS), two patients-multifocal motor neuropathy (MMN). Three out of five patients diagnosed with GBS and one of two patients diagnosed with MMN were seronegative. The acute course of disease, positive antiganglioside antibodies and cytoalbuminologic dissociation in cerebrospinal fluid-induced patients is preference for a specific immune therapy. The results of our study support the previously described immunological association between antiganglioside antibodies and GBS, MFS, and MMN.
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    A fatal case of COVID-19-associated acute necrotizing encephalopathy
    (2021-11) Ziemele, Dace; Ķauķe, Gundega; Skrējāne, Krista; Jaunozoliņa, Līga; Karelis, Guntis; Rīga Stradiņš University
    Introduction: An increasing number of published reports on SARS-CoV-2 neurological manifestations have revealed a wide spectrum of symptoms, diagnostic features, and outcomes. We report a fatal case of a COVID-19-associated acute necrotizing encephalopathy (ANE). Case report: We report a 70-year-old man brought to the hospital after a generalized tonic-clonic seizure. He was confused and disoriented. Nasopharyngeal swab testing for SARS-CoV-2 was positive. A head computed tomography (CT) scan and cerebrospinal fluid (CSF) analysis showed no signs of acute pathology. After recurrent seizures, he was sedated and intubated. Throughout the days that followed he remained in a therapeutic coma. After discontinuation of sedatives, he remained unconscious. A repeated head CT scan showed signs of pontine edema, and brain magnetic resonance imaging (MRI) revealed inhomogeneous hyperintensities with microhemorrhages and small autonecrotic cavities in both thalami, brain stem, and cerebellar peduncles. With a high suspicion of a COVID-19-associated ANE, the patient was started on high-dose glucocorticoids; however, he died the next day. The CSF tested negative for SARS-CoV-2. Discussion: A variety of COVID-19 neurological manifestations have been reported to date, including various forms of encephalitis and encephalopathy. In our patient, encephalopathy with seizures was the presenting symptom of SARS-CoV-2 infection. The radiological findings on days 8 and 9 were consistent with an ANE. The precise pathogenesis of ANE remains unclear; however, an immune-mediated mechanism is suspected. Early diagnostics with prompt administration of immunomodulators may be lifesaving. Suspicion of a COVID-19-related encephalopathy/encephalitis should be raised in all patients with altered mental status, seizures, and/or coma.