Search Results (55)

The majority of somatic symptoms have unexplained medical causes, and it is claimed that psychological factors are important in the initiation and exacerbation of somatic complaints. This study, cross-sectional and correlational in nature, investigated the mediating role of eudaimonic well-being on the relationship between self-determination and somatic symptoms. Mediations were examined at both the whole-construct and component levels to better understand these relationships. A total of 486 participants took part in this study, comprising 403 females (82.9%) and 83 males (17.1%), with an age range of 18 to 36 years (M = 22, SD = 2.27). Self-determination, eudaimonic well-being, and somatic symptoms were measured using questionnaires. Mediations were tested at the construct and component levels using the PROCESS macro. The results show that eudaimonic well-being mediates the relationship between self-determination and somatic symptoms (b = −0.21, SE = 0.03, 95% CI = [−0.32, −0.10]). Component-level analyses reveal that the relationship between controlling motives and somatic symptoms is mediated by negative affect (b = 0.39, SE = 0.08, 95% CI [0.23, 0.56]). These findings identify the variables that may explain the origin of somatic symptoms, emphasising self-determination as a starting point and eudaimonic well-being as a mechanism by which motivational factors affect health outcomes. Full article

Background and Clinical Significance: IgG4-related disease (IgG4-RD) is a chronic fibroinflammatory, immune-mediated multisystem disorder that can mimic neoplastic, infectious, or autoimmune conditions. Among its head-and-neck manifestations, IgG4-related dacryoadenitis and sialadenitis, historically referred to as Mikulicz disease, should be distinguished from the classical Mikulicz syndrome, which describes secondary lacrimal and salivary gland enlargement due to other systemic disorders. Renal involvement, most commonly in the form of IgG4-related tubulointerstitial nephritis (IgG4-TIN), is less frequent but carries major prognostic implications because delayed diagnosis may lead to irreversible kidney damage. Case Presentation: A 49-year-old man with no relevant past medical history presented with a 2-year history of intermittent polyuria and foamy urine. Laboratory testing revealed advanced kidney dysfunction, with serum creatinine of 4.2 mg/dL, estimated glomerular filtration rate of 16 mL/min/1.73 m², and proteinuria of 2874 mg/day. Physical examination showed bilateral parotid enlargement, upper eyelid edema, lacrimal gland enlargement, and sicca symptoms, raising suspicion for IgG4-related dacryoadenitis and sialadenitis (Mikulicz disease). Further work-up demonstrated marked eosinophilia, polyclonal hypergammaglobulinemia, and significantly elevated serum IgG4 levels (3180 mg/dL), while infectious serologies and autoimmune studies were negative. Kidney biopsy revealed plasma cell-rich tubulointerstitial nephritis with lymphoplasmacytic and eosinophilic infiltrates, interstitial fibrosis, tubular atrophy, and more than 40 IgG4-positive plasma cells per high-power field, supporting the diagnosis of IgG4-related tubulointerstitial nephritis in the setting of systemic IgG4-RD. Treatment with prednisone followed by mycophenolate mofetil led to improvement in glandular manifestations and a partial reduction in proteinuria, but renal recovery remained incomplete. The patient subsequently developed a severe pulmonary infection complicated by sepsis and oligoanuric acute kidney injury superimposed on chronic kidney disease, and ultimately progressed to end-stage kidney disease requiring chronic maintenance hemodialysis. Conclusions: This case highlights that a Mikulicz disease phenotype may represent the initial manifestation of systemic IgG4-RD and should prompt evaluation for extraglandular involvement, particularly renal disease. In patients with glandular enlargement, eosinophilia, hypergammaglobulinemia, and unexplained renal dysfunction, IgG4-RD should be actively considered. Kidney biopsy remains essential for diagnostic confirmation and prognostic assessment, as delayed recognition may result in irreversible renal damage and progression to end-stage kidney disease. Full article

Background and Clinical Significance: Autosomal dominant tubulointerstitial kidney disease caused by a mutation in the uromodulin gene (ADTKD-UMOD) is a rare kidney disorder characterized by progressive tubulointerstitial damage and a slowly progressive loss of renal function. ADTKD is often under-recognized in the clinical setting. Diagnosis of ADTKD-UMOD can be challenging due to its nonspecific symptoms and is confirmed by genetic testing alone. Case presentation: We report the case of a 42-year-old male patient referred for evaluation of renal dysfunction, which was accidentally discovered during routine laboratory checks. He had no significant medical history and no known family history of kidney disease or gout. Physical examination was unremarkable. Renal dysfunction was confirmed, with serum creatinine at 1.44 mg/dL and eGFR at 59.5 mL/min/1.73 m². Urinalysis was within physiological limits, proteinuria being 75 mg/day. Uric acid was mildly elevated (7.5 mg/dL) without a history of gout. Other laboratory findings, including autoantibodies, were in the normal range. The patient underwent a kidney biopsy, though it was not diagnostic, showing mild focal tubular atrophy and interstitial fibrosis without glomerular involvement. Immunofluorescence staining was negative for complement and immunoglobulins. Given the above nonspecific findings, the patient was suspected of having possible ADTKD. Genetic investigation using a clinical exome next-generation sequencing approach identified a novel heterozygous missense variant in the UMOD gene (c.409T>C; p.Cysteine137Arginine (p.Cys137Arg)) that is likely pathogenic. The patient is under regular clinical-laboratory monitoring. After one year, his overall health is good, renal function is stable with no proteinuria, and uric acid is mildly increased without gout attacks. Conclusions: Increased clinical awareness is crucial for detecting ADTKD-UMOD. Genetic testing can help to resolve clinical diagnostic challenges in patients with unexplained decreased kidney function. Full article

Background/Objectives: Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by acute neurological symptoms and vasogenic edema, usually affecting the posterior circulation. It is described in end-stage renal disease (ESRD), but its presentation in peritoneal dialysis (PD) is not well defined. We aimed to describe the clinical, radiological, and dialysis-related features of PRES in PD patients and highlight factors relevant for diagnosis and management. Materials and Methods: We conducted a retrospective descriptive case series of four ESRD patients on PD or recently transitioned from PD to hemodialysis (HD) who developed PRES at a single center. Clinical data, laboratory results, dialysis characteristics, and neuroimaging findings were obtained from medical records. PRES was diagnosed based on acute neurological symptoms in the setting of severe hypertension and uremia, with CT and/or MRI findings supportive of PRES when present and exclusion of alternative diagnoses. Results: All patients presented with acute neurological manifestations, including headache, visual disturbances, seizures, and/or altered consciousness, in the context of marked hypertension and uremia. Neuroimaging findings ranged from normal CT/MRI to subtle bilateral occipital hypodensities and, in one case, extensive supra- and infratentorial vasogenic edema with internal hydrocephalus and subependymal edema. In three patients, inadequate volume or solute control on PD prompted temporary or permanent transition to HD to improve blood pressure and fluid management. With antihypertensive therapy, seizure control when required, correction of metabolic disturbances, and optimization of dialysis, all patients recovered clinically, with time to PRES resolution ranging from 7 to 43 days. Conclusions: PRES should be considered in PD patients with new-onset seizures, visual symptoms, or unexplained changes in mental status, particularly during hypertensive crises and uremia. Early CT/MRI, prompt blood pressure control, and careful adjustment of dialysis modality appear important for achieving favorable neurological outcomes. Full article

Background: Tracheobronchial disease, including tracheomalacia (TM) and tracheobronchomalacia (TBM), is a spectrum of congenital and acquired airway disorders characterized by the collapse of the tracheal or mainstem bronchial walls during expiration, particularly when there are increased intrathoracic pressures. Traditional surgical approaches to treat severe medically refractory TM include anterior approaches, such as aortopexy or anterior tracheopexy. Recently, posterior tracheopexy has emerged to address the widened and mobile posterior tracheal membrane which can cause transient airway obstruction. Method: The National Institute of Health, National Library of Medicine, PubMed, and MEDLINE databases were queried for manuscripts related to posterior tracheopexy in the pediatric population. Preoperative diagnostics, anesthetic considerations, operative technique, clinical outcomes, and operative complications were analyzed in each manuscript. Results: Patients with severe medically refractory cases of TM who are being considered for posterior tracheopexy should undergo thorough preoperative workup by a multidisciplinary team. Cross-sectional, dynamic thoracic imaging and a “quadruple endoscopy”, incorporating laryngoscopy, dynamic bronchoscopy, distal bronchoscopy, and esophagogastroduodenoscopy (EGD) should be obtained as part of a standardized preoperative assessment. Posterior tracheopexy for pre-existing TM significantly improves respiratory symptoms, respiratory infection rates, brief resolved unexplained events, and ventilatory dependence. Recently, posterior tracheopexy during TEF/EA repair has been described and aims to reduce the risk of patients developing TM, the risk of TEF recurrence, and respiratory morbidity following TEF/EA repair. An ongoing randomized controlled trial may help to elucidate the efficacy of primary posterior tracheopexy in select neonates with TEF/EA. Conclusions: Posterior tracheopexy is a valuable surgical technique for the treatment of TM or the reduction in respiratory morbidity following TEF/EA repair in select neonates. Full article

Background and Objectives: Medically unexplained symptoms (MUS) represent a clinical syndrome encompassing conditions in which patients present with symptoms that cannot be adequately explained by identifiable organic pathology or do not meet established diagnostic criteria for organic disease. These symptoms pose a diagnostic and management challenge, particularly in acute care settings. The objective of this study was to determine the proportion of patients presenting with MUS to the Emergency Neurology Service of a tertiary care hospital. Materials and Methods: This retrospective study was conducted at the Emergency Neurology Service of Sveti Duh University Hospital. All patients who were triaged for neurological examination during the study period were included. Following clinical evaluation, attending neurologists assessed the extent to which each patient’s symptoms could be explained by organic disease (“organicity”). This assessment was recorded using a Likert scale ranging from “not at all explained” to “completely explained. Results: Out of 219 patients, 2.7% had symptoms that were rated as “not at all explained” by organic disease, 7.3% “somewhat explained”, 23.3% “largely explained” and 66.7% “completely explained” by organic disease. Conclusions: Approximately one-tenth of patients presenting to our Emergency Neurology Service have symptoms that are poorly explained by identifiable organic disease. Full article

Background: Cryoglobulinemia is a rare immune-mediated condition, in which abnormal proteins (cryoglobulins) precipitate at cold temperatures, leading to blood vessel inflammation. It affects approximately 1 in 100,000 individuals globally and often goes undiagnosed due to its overlapping symptoms with common conditions such as stroke. When the central nervous system (CNS) is involved—primarily in Type 2 cryoglobulinemia—it can cause serious neurological events, including seizures, confusion, and stroke-like episodes. Despite this, there is limited awareness and minimal research on this condition in South Africa. Objective: The aims of this study were to describe neurological manifestations of cryoglobulinemia using global case reports, evaluate outcomes associated with delayed diagnosis, and highlight the importance of early detection in patients with unexplained neurological symptoms. Methods: A qualitative systematic review of published case reports (2015–2024) was conducted. The study focused on adults (≥18 years) who were diagnosed with cryoglobulinemia involving CNS manifestations. Reports from hospital-based studies in Europe, North America, and Asia were retrieved from medical databases. Data on symptoms, diagnosis, treatment, and outcomes were summarized numerically and by identifying common patterns. Results: Seventeen relevant cases were identified. The most common neurological symptoms were ischemic stroke (35%), reversible posterior encephalopathy syndrome (24%), seizures (18%), and intracranial hemorrhage (12%). Most cases were associated with Type 2 cryoglobulinemia. Neuroimaging frequently revealed vasculitis, infarcts, or cerebral edema. All patients received immunosuppressive therapy, mainly corticosteroids. Outcomes showed that 76% improved, 12% partially recovered, and 12% died—mostly due to delayed diagnosis. Conclusions: Neurological involvement in cryoglobulinemia is uncommon but potentially fatal. Stroke-like presentations dominate due to vasculitis injury and vascular occlusion. Early diagnosis significantly improves outcomes, while delays can be deadly. Increased clinical awareness is essential in South Africa, where this condition is rarely reported. Clinicians should consider cryoglobulinemia as a possible cause in patients presenting with unexplained neurological symptoms. Full article

Background: Medically unexplained oral symptoms/syndromes (MUOS), such as Burning Mouth Syndrome and Persistent Idiopathic Facial Pain, present significant management challenges due to the lack of standardized treatments and high-level evidence. While pharmacotherapy is often employed, real-world data on treatment adherence—a pragmatic proxy for effectiveness and tolerability—remain sparse, especially in Japan. This study aimed to describe the real-world prescribing patterns of antidepressants and dopamine receptor partial agonists (DPAs) for MUOS and retrospectively investigate their association with treatment continuation. Methods: This retrospective observational study analyzed data from patients initiating pharmacotherapy for MUOS at a specialized clinic in Japan (April 2021–March 2023). We used Cox proportional hazards models to evaluate treatment continuation for amitriptyline monotherapy and antidepressant–aripiprazole adjunctive therapy. The primary outcome was the time to discontinuation. Dosage effects were modeled using B-splines to capture nonlinearity. Results: Among 702 MUOS patients who started pharmacotherapy, 493 received amitriptyline as the first prescription, and 108 received aripiprazole as an adjunctive therapy. For amitriptyline monotherapy, a nonlinear relationship was observed between dosage and discontinuation risk, with a relatively lower hazard around 25 mg/day across age groups. In the antidepressant–aripiprazole adjunctive group, the overall hazard ratio for discontinuation was higher (HR = 4.75, p < 0.0005) compared to non-adjunctive therapy, likely due to indication bias reflecting more treatment-resistant cases. However, within the aripiprazole adjunctive group, a U-shaped relationship was identified between maximum aripiprazole dosage and discontinuation risk, with the lowest hazard (HR ≈ 0.30) observed at approximately 1.7–1.8 mg/day. Mild side effects such as drowsiness, dry mouth, constipation, tremor, insomnia, and weight gain were noted, but no severe adverse events occurred. Conclusions: This real-world data analysis suggests specific dosage ranges (amitriptyline ≈ 25 mg/day; aripiprazole augmentation ≈ 1.7–1.8 mg/day) are associated with longer treatment continuation in MUOS patients. Treatment continuation reflects a crucial balance between symptom relief and tolerability, essential for managing these chronic conditions. It is critical to emphasize that these findings are descriptive and observational, derived from a specialized setting, and do not constitute prescriptive recommendations. They highlight the importance of individualized dosing. Definitive evidence-based strategies require validation through prospective randomized controlled trials. Full article

Among the leading etiologies of limb amputations are diabetes mellitus, alongside trauma and peripheral vascular disease conditions, whose complications are major indications for surgery, which can subsequently elicit chronic refractory postamputation pain. ‘Phantom limb pain’ (PLP) denotes pain that is perceived as occurring in an absent part of the limb following amputation. Even though it is a relatively common complication among amputees—with an estimated prevalence as high as ~80 percent—the underlying mechanisms of this puzzling condition remain poorly understood. Current theories predominantly emphasize the role of the nervous system and neuropsychopathology in the development of PLP. However, these neurocentric explanations are disputed and have not yet been translated into effective treatments or a definitive cure for the condition, nor have several notable anomalies been settled, which has prompted researchers to call for the exploration of alternative theories. The aim of this paper is to offer an alternative mechanical mechanism for explaining PLP and spontaneous phantom sensations. This work introduces a theoretical model for the mechanism of PLP, drawing on a recent study that proposed this model to explain fibromyalgia-type psychosomatic syndromes as disorders driven by overactive soft tissue myofibroblasts. The manuscript proposes a shift from purely neurocentric models of PLP to a framework where the extracellular matrix and connective tissue, specifically myofascial tissue and inflammatory myofibroblasts—which are often overlooked in research—take part in its pathogenesis. In this suggested model, surgical interventions disrupt the biomechanical stability of the fascio-musculoskeletal biotensegrity-like system, thus acting as a contributing factor in the chronic pain manifestation. The term ‘biotensegrity’ refers to the dynamic biomechanical behavior of a living system that is stabilized by compressive and tensile force elements, a characteristic quality of myofascial tissue. In this framework, abnormal extracellular matrix remodeling, driven by overactive peripheral myofibroblasts, and the concomitant mechanical effects exerted on sensory nerves embedded within the fascia and reaching the neuroma microenvironment contribute to the generation and perception of spontaneous PLP and phantom sensations. The interplay between abnormal extracellular matrix, the neuroma’s intrinsic excitability, as well as peripheral and central neurophysiological mechanisms, collectively provide a biophysical neuropathophysiological basis to help explain PLP. This offers a different unexplored perspective on a condition with poorly understood mechanisms. Full article

Background: Post-concussion syndrome (PCS) and Functional Neurological Disorder (FND), including Functional Cognitive Disorder (FCD), are two frequently encountered but diagnostically complex conditions. While PCS is conceptualized as a sequela of mild traumatic brain injury (mTBI), FND/FCD encompasses symptoms incompatible with recognized neurological disease, often arising in the absence of structural brain damage. Yet, both conditions exhibit considerable clinical overlap—particularly in the domains of cognitive dysfunction, emotional dysregulation, and symptom persistence despite negative investigations. Objective: This review critically examines the shared and divergent features of PCS and FND/FCD. We explore their respective epidemiology, diagnostic criteria, and risk factors—including personality traits and trauma exposure—as well as emerging insights from neuroimaging and biomarkers. We propose the “Functional Overlay Model” as a clinical tool for navigating diagnostic ambiguity in patients with persistent post-injury symptoms. Results: PCS and FND/FCD frequently share features such as subjective cognitive complaints, fatigue, anxiety, and heightened somatic vigilance. High neuroticism, maladaptive coping, prior psychiatric history, and trauma exposure emerge as common risk factors. Neuroimaging studies show persistent network dysfunction in both PCS and FND, with overlapping disruption in fronto-limbic and default mode systems. The Functional Overlay Model helps to identify cases where functional symptomatology coexists with or replaces an initial organic insult—particularly in patients with incongruent symptoms and normal objective testing. Conclusions: PCS and FND/FCD should be conceptualized along a continuum of brain dysfunction, shaped by injury, psychology, and contextual factors. Early recognition of functional overlays and stratified psychological interventions may improve outcomes for patients with persistent, medically unexplained symptoms after head trauma. This review introduces the Functional Overlay Model as a novel framework to enhance diagnostic clarity and therapeutic planning in patients presenting with persistent post-injury symptoms. Full article

Background/Objectives: Vague physical complaints with no corresponding organic disease background are called unidentified complaints. The symptoms of patients with unidentified complaints closely resemble medically unexplained or persistent physical symptoms, with the onset sometimes masked by mental disorders. Over the past 50 years, numerous studies have connected unfavorable eating habits to these symptoms; however, no study has systematically examined the association between the symptoms and specific nutrients or food items. Methods: We conducted a cross-sectional study of young Japanese women, using questionnaire surveys, to assess their nutritional intake, quantify unidentified complaints and depression, and identify nutrients/food items primarily associated with the severity of these conditions. Results: Our findings indicate that participants with high scores for unidentified complaints, depression, or both had lower intake levels of eicosapentaenoic acid, docosahexaenoic acid, vitamin D, and vitamin B₁₂ than those with low scores, alongside reduced fish and shellfish consumption. Notably, the median fish and shellfish intake in the group with high scores for both unidentified complaints and depression was less than one-fourth of that in the low-score group. Conclusions: The results align with previous findings, demonstrating a modest inverse association between fish intake and depression risk, and suggesting the involvement of fish and shellfish intake in the occurrence of unidentified complaints. Full article

Background: Somatic symptom disorder (SSD) involves physical symptoms that cannot entirely be explained by an organic medical cause, accompanied by persistent thoughts, feelings and behaviours relating to one’s health. SSD is common yet underdiagnosed in emergency departments (EDs). This study aimed to assess emergency physician (EP) readiness, attitudes and perceptions toward diagnosing SSD and explore demographic trends. Methods: In total, 1339 Canadian EPs were invited to respond to a survey collecting demographic information and assessing attitudes toward SSD in four domains: perceptions of SSD, attitudes toward patients, diagnostic confidence, and physician–patient communication. Data were analyzed using t-tests and ANOVA to determine associations with demographic information. Results: Of the 96 survey respondents, 75 met the eligibility criteria. In total, 44% estimated that emotional stress was the primary cause of symptoms in 11–20% of their patients. Most felt that SSD was underdiagnosed and that effective therapies exist. Concerns included medico-legal implications, managing patients’ emotions, and potential negative reactions to non-organic diagnoses. Most respondents felt prepared and confident broaching the diagnosis. More experienced EPs felt that there was time to broach the topic of SSD, while rural EPs were less concerned about patient offence than urban counterparts. Conclusions: EPs recognize SSD as common and underdiagnosed, acknowledging its diagnosis as part of their role. Challenges identified include managing patients’ emotions, time constraints, and reliance on only diagnosing SSD once an organic etiology is excluded. Training pathway, experience, and practice setting impact perceptions and attitudes around SSD. The findings suggest opportunities for improving SSD care through targeted interventions, communication training, and enhanced diagnostic education. Full article

Background/Objectives: Lower-extremity weakness in older adults is often overlooked, yet it can have reversible or medical causes that contribute to increased falls. Common factors include vision disturbances, impaired balance due to otolith dysfunction, arthritis-related immobility, and lower-extremity neuropathy. This case presents a unique diagnostic challenge in evaluating bilateral lower-extremity weakness and recurrent falls in an older adult, highlighting the complexity of diagnosing conditions with overlapping symptoms. Case Presentation: The patient, a woman with a history of a neuroendocrine tumor, experienced progressive weakness in her lower extremities, along with oculomotor and facial muscle involvement, despite extensive testing. Key clinical findings included elevated protein levels in cerebrospinal fluid, suggesting the possibility of an infectious or autoimmune process. A thorough investigation was conducted, including testing for both common and rare conditions such as Guillain–Barré syndrome, Lyme disease, and tuberculosis. Results: Despite comprehensive diagnostic efforts, no clear etiology was identified. The patient’s condition was eventually considered to be related to carcinomatosis meningoencephalitis, a rare complication from a previous cancer diagnosis. Given the progressive nature of her symptoms and lack of treatment options, she was transitioned to palliative care. Conclusions: This case highlights the importance of a comprehensive differential diagnosis in older patients with unexplained weakness and falls. Rare neurological conditions should not be overlooked, even when more common causes are suspected. Clinicians should remain aware that falls and weakness in older adults may stem from various pathologies, some of which are reversible if identified early, and rare causes must always be considered when standard treatments fail. Full article

Background: Persistent splenomegaly, often an incidental finding, can originate from a number of inherited metabolic disorders (IMDs). Variants of APOE are primarily known as risk factors in terms of cardiovascular disease; however, severe dysfunction of APOE can result in a disease phenotype with considerable overlap with lysosomal storage disorders (LSDs), including splenomegaly and gross elevation of N-palmitoyl-O-phosphocholine-serine (PPCS). Methods: A case study (deep phenotyping, genetic and FACS analysis) and literature study was conducted. Results: The index patient, with a family history of early-onset cardiovascular disease, presented with splenic infarctions in a grossly enlarged spleen. The identified genetic cause was homozygosity for two APOE variants (c.604C>T, p.(Arg202Cys) and c.512G>A, p.(Gly171Asp); ε1/ε1), resulting in a macrophage storage phenotype resembling an LSD that was also present in the brother of the index patient. A FACS analysis of the circulating monocytes showed increased lipid content and the expression of activation markers (CD11b, CCR2, CD36). This activated state enhances lipoprotein intake, which eventually converts these monocytes/macrophages into foam cells, accumulating in tissues (e.g., spleen and vascular wall). A literature search identified seven individuals with splenomegaly caused by APOE variants (deletion of leucine at position 167). The combined data from all patients identified male gender, splenectomy and obesity as potential modifiers determining the severity of the phenotype (i.e., degree of triglyceride increase in plasma and/or spleen size). Symptoms are (partially) reversible by lipid-lowering medication and energy restricted diets and splenectomy is contra-indicated. Conclusions: Inherited dyslipidemic splenomegaly caused by disruptive APOE variants should be included in the differential diagnoses of unexplained splenomegaly with abnormal lipid profiles. A plasma lipid profile consistent with dysbetalipoproteinemia is a diagnostic biomarker for this IMD. Full article

Background: Prenatal factors have been implicated in the likelihood of reporting sleep disorders in infants. The influence of prenatal and pregnancy-related factors on the incidence of brief resolved unexplained events (BRUEs) in infants has not been established. Objectives: This study aims to evaluate the prenatal and pregnancy-related factors that may contribute to the development of BRUEs in infants. Methods: A single-center, observational, and cross-sectional cohort study was conducted on mothers of children presenting to the Pediatric Clinic of the University of Insubria’s Center for the Study of Respiratory Sleep Disorders with BRUEs as infants. The mothers of typically developing children were enrolled as a control group consecutively at their respective outpatient clinics. All mothers were administered comprehensive questionnaires including demographics, past medical histories, and pregnancy-related issues (weight gain, Berlin sleep-disordered breathing score, and insomnia severity index), psychological symptoms, medical history, illnesses, and medications. Results: Infants with BRUEs were delivered at an earlier gestational age. Mothers of infants with BRUEs were more likely to snore during pregnancy and have lower extremity edema during the first trimester, uterine contractions and restless legs syndrome symptoms during the second trimester, and muscle aches and aspirin usage during the third trimester. The insomnia severity index composite score was not different between the control and BRUE groups. Mothers of infants with BRUEs were less likely to report leg cramps, pregnancy-related diarrhea, fatigue, and gastroesophageal reflux. Conclusions: Mothers of infants presenting with BRUEs had more symptoms during pregnancy of snoring and uterine contractions but not insomnia and were less likely to report leg cramps, pregnancy-related diarrhea, fatigue, and gastroesophageal reflux. The reporting of this study conforms with the STROBE statement. Full article