Neurología general.artículos

Detection of sequelae from acute meningitis during clinical review by a healthcare provider : a systematic review and meta-analysis

2026-02-28T00:00:00Z

Detection of sequelae from acute meningitis during clinical review by a healthcare provider : a systematic review and meta-analysis Alviz, Luisa F.; Kim, Carla Y.; Monette, Lauren E.; Harrer, Caroline E.; Benevides Tadinac, Ana Claudia; Roberts, Jackson A.; Varela, Francisco José; Hwang, Soonmyung A.; Gebresilassie, Blen M.; Balcarce, Pilar; Prasad, Manya; Usseglio, John; Kothari, Kavita U.; Venuti, Francesco; Schiess, Nicoline; Binello, Nicolò; Brohan, Elaine; Dua, Tarun; Thakur, Kiran T. Background: Neurological sequelae from acute meningitis are estimated to affect more than 30% of survivors worldwide, though often underreported or undetected due to inadequate follow-up, limited access to healthcare services, and diagnostic challenges. The aim of this systematic review and meta-analysis is to assess the time of administered health assessments for the detection of meningitis-related sequelae associated with acute meningitis diagnosis in adult and pediatric populations. Methods: A literature review was conducted in three databases. Studies documenting the time frame of sequelae detection after an acute episode of all-cause meningitis were included. Descriptive analysis and meta-analysis of pooled prevalence for neurological outcomes were performed, with subgroup analysis per timepoint of healthcare assessment. Results: A total of 89 studies met inclusion criteria, reporting 9311 adult and 18,658 pediatric meningitis cases. Among adults, 7301 (78.4%) underwent sequelae assessment, with 1339 (18%) diagnosed. The most frequently reported sequelae were hearing loss, followed by focal neurological deficits, psychological after-effects, neurocognitive impairments, seizures, hydrocephalus, speech disorders, vision impairment, and limb loss. While more were assessed before discharge (5270 vs. 2711), the proportion of sequelae diagnoses was higher post-discharge. The pooled prevalence of sequelae was 24.8% (95% CI 20.5-29.2%) at discharge, compared to 41.5% (95% CI 25.7-57.3%) within 3 months and 31.9% (95% CI 18.5-45.3%) beyond 3 months post-discharge. In children, 14,826 (79%) were assessed, and 3484 (24%) had sequelae, with the most common sequelae being hearing loss, followed by focal neurological deficits, seizures, neurocognitive, and neurodevelopmental impairments. More were assessed post-discharge (8298 vs. 7180), with a higher pooled prevalence of sequelae diagnoses post-discharge. At discharge, the pooled prevalence of sequelae was 28.9% (95% CI 20.8-37%), compared to 29.9% (95% CI 19-40.8%) within 3 months and 38.2% (95% CI 30.3-46.1%) beyond 3 months after discharge. Conclusions: Meningitis-related sequelae significantly impact quality of life. This review highlights variability and critical gaps in their evaluation, detection, and management, underscoring the need for routine monitoring from discharge through consistent follow-up assessments, as recommended by the new WHO guidelines on meningitis diagnosis, treatment, and care.

Detection of hearing loss by formal audiological testing after acute infectious meningitis : a global systematic review and meta-analysis

2026-02-28T00:00:00Z

Detection of hearing loss by formal audiological testing after acute infectious meningitis : a global systematic review and meta-analysis Alviz, Luisa F.; Kim, Carla Y.; Benevides Tadinac, Ana Claudia; Roberts, Jackson A.; Monette, Lauren E.; Harrer, Caroline E.; Varela, Francisco José; Hwang, Soonmyung A.; Gebresilassie, Blen M.; Balcarce, Pilar; Prasad, Manya; Usseglio, John; Kothari, Kavita U.; Venuti, Francesco; Schiess, Nicoline; Gadama, Yohane; Binello, Nicolò; Chadha, Shelly; Dua, Tarun; Thakur, Kiran T. Background Acute community-acquired bacterial meningitis remains a significant global health concern with significant mortality and morbidity, including neurological sequelae such as sensorineural hearing loss (SNHL). Early detection of meningitis-associated SNHL mitigates permanent deafness and poor outcomes, including cognitive decline, social isolation, and mental health disorders. This systematic review evaluates the optimal time point(s) to perform formal audiological diagnostic testing and follow-up in adult and pediatric meningitis patients to effectively detect hearing loss (HL) outcomes. Methods A literature search was conducted across Medline, Embase, and Cochrane databases. Studies reporting the time frames for HL detection secondary to acute meningitis using formal audiological tests were included. Data were analyzed descriptively for continuous and categorical variables. A meta-analysis calculated the pooled prevalence of outcomes, with subgroup analyses stratified by the time frame of audiological diagnostic assessment. Results A total of 41 studies were included, with n=8105 meningitis patients comprising n=1397 (17.2%) adults and 6708 (82.8%) children. In adults, most audiological testing occurred post-discharge (n=530 vs. n=145), yet the proportion of hearing loss diagnoses was higher before discharge than after (45.5% vs. 42.5%). Similarly, more audiological assessments were administered post-discharge compared to pre-discharge (n=3340 vs. n=1975) in children, but HL diagnoses were more frequent before discharge (33.9% vs. 25.3%). The pooled prevalence of HL diagnoses during hospitalization or at discharge was 30.4% (95% CI 22.9–38%), compared to 22.9% (95% CI 12.6–33.1%) within 1 month post-discharge, 20.3% (95% CI 8.8–31.9%) between 30 and 60 days post-discharge, 22.7% (95% CI 12.1–33.4%) between 60 and 180 days post-discharge, and 10.8% (95% CI 5.9–15.7%) more than 180 days after discharge. Conclusions The considerable variability in the time frame of audiological test administration following an acute meningitis episode highlights the need for standardized auditory evaluations after meningitis diagnosis. Our findings emphasize that as hearing loss may occur and recover at different stages after an infectious meningitis episode, coordinated hearing assessments at discharge and during follow-up are important to ensure adequate detection and care.

Adult polyglucosan body disease: ultrarare but commonly misdiagnosed

2025-02-16T00:00:00Z

Adult polyglucosan body disease: ultrarare but commonly misdiagnosed Caiza-Zambrano, Francisco; Aldecoa, Mayra; Rugilo, Carlos; Taratuto, Ana Lía; Marchesoni, Cintia; León-Cejas, Luciana; Reisin, Ricardo; Bonardo, Pablo Adult polyglucosan body disease is a rare genetic condition caused by biallelic pathogenic variants in GBE-1 gene. Affected patients typically have urinary dysfunction, progressive gait disturbance and cognitive impairment. We report a 63-year-old woman with urinary incontinence, walking difficulty and episodes of forgetfulness. She had symmetrical limb weakness with upper motor neurone signs, distal sensory loss and a broad-based ataxic gait. MR scans of the brain and spine showed white matter changes with cerebellar and spinal cord atrophy. Sural nerve biopsy identified intra-axonal polyglucosan bodies. A multigene panel test identified a GBE-1 pathogenic variant, confirming the diagnosis of adult polyglucosan body disease. This case emphasises the importance of considering rare genetic disorders in people with autonomic dysfunction, mixed upper and lower motor neurone signs, peripheral neuropathy and cognitive impairment.

Validation of an Artificial Intelligence-Powered Virtual Assistant for Emergency Triage in Neurology

2025-02-06T00:00:00Z

Validation of an Artificial Intelligence-Powered Virtual Assistant for Emergency Triage in Neurology Alessandro, Lucas; Crema, Santiago; Castiglione, Juan Ignacio; Dossi, Daiana Elizabeth; Eberbach, Federico; Kohler, Alejandro Alfredo; Laffue, Alfredo Hernan; Marone, Abril; Nagel, Vanesa; Pastor Rueda, José Manuel; Varela, Francisco José; Fernández Slezak, Diego; Rodríguez Murúa, Sofía; Debasa, Carlos; Pensa, Claudio; Farez, Mauricio Franco Objectives: Neurological emergencies pose significant challenges in medical care in resource-limited countries. Artificial intelligence (AI), particularly health chatbots, offers a promising solution. Rigorous validation is required to ensure safety and accuracy. Our objective is to evaluate the diagnostic safety and effectiveness of an AI-powered virtual assistant (VA) designed for the triage of neurological pathologies. Methods: The performance of an AI-powered VA for emergency neurological triage was tested. Ten patients over 18 years old with urgent neurological pathologies were selected. In the first stage, 9 neurologists assessed the safety of the VA using their clinical records. In the second stage, the assistant's accuracy when used by patients was evaluated. Finally, VA performance was compared with ChatGPT 3.5 and 4. Results: In stage 1, neurologists agreed with the VA in 98.5% of the cases for syndromic diagnosis, and in all cases, the definitive diagnosis was among the top 5 differentials. In stage 2, neurologists agreed with all diagnostic parameters and recommendations suggested by the assistant to patients. The average use time was 5.5 minutes (average of 16.5 questions). VA showed superiority over both versions of ChatGPT in all evaluated diagnostic and safety aspects (P<0.0001). In 57.8% of the evaluations, neurologists rated the VA as "excellent" (suggesting adequate utility). Conclusions: In this study, the VA showcased promising diagnostic accuracy and user satisfaction, bolstering confidence in further development. These outcomes encourage proceeding to a comprehensive phase 1/2 trial with 100 patients to thoroughly assess its "real-time" application in emergency neurological triage.