Bilophila wadsworthia is a Gram-negative anaerobic bacterium. In current study, it was identified in the bloodstream of a 69-year-old man admitted to the Neurology Clinic at the University of Debrecen, Clinical Centre, Hungary, for internal carotid artery stent implantation. Bacteraemia caused by B. wadsworthia is extremely rare, with very few cases reported worldwide. This case is notable because it is the first instance in which whole-genome sequencing of B. wadsworthia derived from blood was performed. Moreover, the sequence data have been deposited in a public database.

Background: Intravenous thrombolysis (IVT) improves acute ischemic stroke (AIS) outcomes, but with limited success. In addition, ethanol potentiates the effect of r-tPA in ischemia models. Methods: The effect of acute alcohol consumption on IVT outcomes was investigated in a retrospective cohort study. AIS patients with detectable blood alcohol concentration (BAC) during IVT were included (alcohol group; n = 60). For each case, 3 control subjects who underwent IVT but denied alcohol consumption were matched in terms of age, sex, affected brain area, and stroke severity. Outcomes were determined using the NIHSS at 7 days and the modified Rankin scale (mRS) at 90 days. Results: Patients were younger and had a less severe stroke than in a standard stroke study. Favorable long-term outcomes (mRS 0–2) occurred significantly more frequently in the alcohol group compared to controls (90% vs. 63%, p < 0.001). However, the rates of hemorrhagic transformation were similar. Multiple logistic regression models identified elevated BAC as a significant protective factor against unfavorable short-term (OR: 0.091, 95% CI: 0.036–0.227, p < 0.001) and long-term outcomes (OR: 0.187, 95% CI: 0.066–0.535, p = 0.002). In patients with BAC > 0.2%, significantly lower NIHSS was observed at 3 and 7 days after IVT vs. in those with 0.01–0.2% ethanol levels. Conclusion: Elevated BAC is associated with improved outcomes in IVT-treated AIS without affecting safety.

Introduction The impact of acute alcohol consumption at the onset of spontaneous non-traumatic intracerebral hemorrhage (ICH) remains unclear. We evaluated the association between elevated blood alcohol concentration (BAC) at admission and clinical outcomes in patients with ICH. Methods This retrospective single-center cohort study analyzed 1081 patients admitted with ICH between 2000 and 2023. BAC was measured at admission when alcohol use was suspected. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS). Outcomes—7-day neurological deterioration (ND), mortality, 90-day modified Rankin Scale (mRS) scores—were analyzed using logistic and Cox regression models to assess associations with acute alcohol consumption. Results Patients that were BAC positive (alcohol group; n = 31, 2.9%) were younger, predominantly male, had larger hematoma volumes, showed significantly higher rates of 7-day ND (58.1% vs. 27.6%, p < 0.001) and mortality at 7, 30, and 90 days (51.6% vs. 23.7%, 71% vs. 37.6%, 71% vs. 43.3%, all p < 0.001) than patients with no clinical suspicion of alcohol consumption (control group; n = 1050, 97.1%). Multivariable Cox regression identified elevated BAC as an independent predictor of mortality at all time points (HR 2.089, 95% CI 1.091–3.997, p = 0.026 at 7 days; HR 2.133, 95% CI 1.220–3.728, p = 0.008 at 30 days; HR 2.096, 95% CI 1.214–3.622, p = 0.008 at 90 days). Multivariate logistic regression identified elevated BAC as an independent predictor of 7-day ND (OR 4.188, 95% CI 1.163–15.078, p = 0.028) and large ICH volume (≥ 30 cm³) (OR 3.67, 95% CI 1.388–9.704, p = 0.009). In a subgroup analysis of heavy-drinking patients, elevated BAC was associated with early ND, increased mortality, and large ICH volume. Conclusion Elevated BAC at ICH onset independently predicts early ND and increased mortality, indicating a potentially modifiable prognostic factor in acute ICH. These results underscore the importance of BAC measurement in patients with suspected alcohol consumption and warrant further research aimed at understanding and mitigating its potential detrimental effects.

Central nervous system (CNS) involvement is an extremely rare manifestation in eosinophilic granulomatosis with polyangiitis (EGPA), associated with a poor prognosis. Here we present a case of 50-year-old female patient previously long-lasting treated with asthma who presented initially with extreme eosinophilia (56%) and severe progressive ascending paresis similar to Guillain-Barré syndrome leading to tetraplegia. After navigating through diagnostic mazes; the diagnosis of EGPA was established based on eosinophilia, anti-neutrophil cytoplasmic antibody positivity (MPO-ANCA), asthma, eosinophil granulomatosis in the gastrointestinal tract, and severe peripheral nervous system involvement complicated with rare central nervous granulomatosis and ischaemia. With combined immunosuppressive and immunomodulatory treatment including high-dose corticosteroids, rituximab and intravenous immunoglobulin along with symptomatic treatment and planned rehabilitation over 6 months our patient recovered gradually from tetraplegia and adverse events such as severe infections and osteoporotic fractures. Now from a 2-year perspective we can conclude a successful treatment leading to decrease in all of her symptoms. Due to persistent eosinophilia after steroid tapering, she is currently on mepolizumab maintaining treatment and demonstating continuous improvement of motor and sensory functions. Thanks to periodically repeated rehabilitation, she became self-sufficient and returned to her previous job. Our case represents that EGPA patients should be treated in a centre of expertise due to the rarity of disease and complexity of diagnosis and treatment. Careful multidisciplinary cooperation, huge effort of the patient and supportive environment can show a way back from immune-mediated tetraplegia.

Central nervous system (CNS) involvement is an extremely rare manifestation in eosinophilic granulomatosis with polyangiitis (EGPA), associated with a poor prognosis. Here we present a case of 50-year-old female patient with long-term asthma treatment who presented initially with extreme eosinophilia (56%) and severe progressive ascending paresis, similar to Guillain–Barré syndrome, leading to tetraplegia. After navigating through diagnostic mazes, the diagnosis of EGPA was established based on eosinophilia, myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) positivity, asthma, eosinophil granulomatosis in the gastrointestinal tract, and severe peripheral nervous system involvement, complicated with rare central nervous granulomas and ischemia. With combined immunosuppressive and immunomodulatory treatment including high-dose corticosteroids, rituximab and intravenous immunoglobulin along with symptomatic treatment and planned rehabilitation over 6 months, our patient recovered gradually from tetraplegia and adverse events such as severe infections and osteoporotic fractures. Now, from a 2-year perspective, we can conclude a successful treatment leading to decrease in all of her symptoms. Due to persistent eosinophilia after steroid tapering, she was switched to mepolizumab maintenance treatment and demonstrated continuous improvement of motor and sensory functions. Thanks to periodically repeated rehabilitation, she became self-sufficient and returned to her previous job. Our case highlights that EGPA patients should be treated in a center of expertise due to the rarity of the disease and complexity of diagnosis and treatment. Careful multidisciplinary cooperation, the huge effort of the patient, and a supportive environment can show a way back from immune-mediated tetraplegia.