We explored the relationship between acute ischaemic stroke (IS) early functional outcome and serum levels of homocysteine, vitamin B12, and D in a noninterventional prospective clinical study. We enrolled 50 patients with first-ever IS and performed laboratory tests and functional assessment at three time points: on admission and three and six months after stroke. Modified Rankin Scale (mRS), NIHSS scale, and Barthel index (BI) scores were assessed in all participants by trained examiner blinded to laboratory data. Patients did not receive treatment that might alter laboratory data. Admission NIHSS correlated with homocysteine levels (r = 0.304, p < 0.05), B12 level (r = −0.410, p < 0.01), and vitamin D levels (r = −0.465, p < 0.01). Functional outcome measures (BI and mRS) did not significantly correlate with homocysteine and vitamin D3 levels at 3 and 6 months. However, a positive correlation with vitamin B12 levels was detected for BI both at 3 and 6 months and mRS at 6 months. Higher serum vitamin B12 levels were associated with better functional outcome at follow-up.

Beginning with its emergence in Wuhan, China, in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic that causes COVID-19, has spread and left profound consequences on the lives and health of people around the world. Although most patients who have COVID-19 recover after two to six weeks, research shows that 10–30% of people who have had COVID-19, even with a mild clinical picture, remain with persistent symptoms that have a devastating effect on their quality of life. These symptoms, which most often include fatigue, shortness of breath, chest pain, headache, and cognitive dysfunction, but also others that generally have an impact on everyday functioning, are recognized as a clinical condition called post-COVID syndrome (long COVID). In addition to physical disabilities in people recovering from COVID-19, mental health problems have also been observed, including problems with concentration (“brain fog”), anxiety, depression, sleep disorders, and symptoms of post-traumatic stress disorder (PTSD). In this chapter, we provide a comprehensive review of the current scientific findings identifying post-COVID conditions and their relationship with mental health status.

Vitamins are necessary factors in human development and normal brain function. Vitamin C is a hydrosoluble compound that humans cannot produce; therefore, we are completely dependent on food intake for vitamin C. Ascorbic acid is an important antioxidative agent and is present in high concentrations in neurons and is also crucial for collagen synthesis throughout the body. Ascorbic acid has a role in modulating many essential neurotransmitters, enables neurogenesis in adult brain and protects cells against infection. While SVCT1 enables the absorption of vitamin C in the intestine, SVCT2 is primarily located in the brain. Ascorbate deficiency is classically expressed as scurvy, which is lethal if not treated. However, subclinical deficiencies are probably much more frequent. Potential fields of vitamin C therapy are in neurodegenerative, cerebrovascular and affective diseases, cancer, brain trauma and others. For example, there is some data on its positive effects in Alzheimer’s disease. Various dosing regimes are used, but ascorbate is safe, even in high doses for protracted periods. Better designed studies are needed to elucidate all of the potential therapeutic roles of vitamin C.

We present a case of a young woman, age 34, who presented with recurrent Lyme neuroborreliosis (LNB). Her clinical profile consisted of a rare combination of two thirdstage manifestations, namely, progressive encephalomyelitis and peripheral neuritis, in both bouts of the disease. The epidemiological data were controversial, as she reported a tick bite only two months prior to the onset of symptoms. Negative magnetic resonance imaging (MRI) results excluded multiple sclerosis, vascular causes and tumours. Serological tests confirmed the Bb infection in the recommended twostep serological approach consisting of an enzyme-linked immunosorbent assay (ELISA) test for Borrelia burgdorferi (Bb) immunoglobulin G (IgG) and immunoglobulin M (IgM) and a Western blot (WB) as confirmatory analysis in the blood. Another controversial issue is the lack of pleocytosis. Atypical findings in our patient can be explained by a possible rare genotype of Bb. After treatment with oral doxycycline, she made an apparent remission, but after three months, she had another episode with signs of central and peripheral nervous system involvement, increased Bb antibodies and white matter changes on the MRI. This time, she was treated with intravenous ceftriaxone, 2 grams daily for four weeks. She showed no signs of LNB, both clinically and serologically, during a follow up lasting about a year. This case emphasises the importance of the clinical and serological findings and the use of ceftriaxone as the first line of treatment in LNB.