Reinfection, reactivation or delayed complication of the initial SARS-CoV-2 infection

OBJECTIVEStenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy.METHODSEligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019.RESULTSThirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8–35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6–61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8–54.0 months) from the date of the first catheter angiogram to last clinic visit.CONCLUSIONSAll children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.

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Holmes tremor: a delayed complication after resection of brainstem cavernomas

Journal of Neurosurgery ◽

10.3171/2020.7.jns201352 ◽

2020 ◽

pp. 1-11

Author(s):

Marco Cenzato ◽

Davide Colistra ◽

Giorgia Iacopino ◽

Christian Raftopoulos ◽

Ulrich Sure ◽

...

Keyword(s):

Statistical Analysis ◽

Neurophysiological Monitoring ◽

Strict Adherence ◽

Surgical Access ◽

Holmes Tremor ◽

Neurophysiological Studies ◽

Metropolitan Hospital ◽

Delayed Complication ◽

Brainstem Cavernoma ◽

Predicting Factor

OBJECTIVEIn this paper, the authors aimed to illustrate how Holmes tremor (HT) can occur as a delayed complication after brainstem cavernoma resection despite strict adherence to the safe entry zones (SEZs).METHODSAfter operating on 2 patients with brainstem cavernoma at the Great Metropolitan Hospital Niguarda in Milan and noticing a similar pathological pattern postoperatively, the authors asked 10 different neurosurgery centers around the world to identify similar cases, and a total of 20 were gathered from among 1274 cases of brainstem cavernomas. They evaluated the tremor, cavernoma location, surgical approach, and SEZ for every case. For the 2 cases at their center, they also performed electromyographic and accelerometric recordings of the tremor and evaluated the postoperative tractographic representation of the neuronal pathways involved in the tremorigenesis. After gathering data on all 1274 brainstem cavernomas, they performed a statistical analysis to determine if the location of the cavernoma is a potential predicting factor for the onset of HT.RESULTSFrom the analysis of all 20 cases with HT, it emerged that this highly debilitating tremor can occur as a delayed complication in patients whose postoperative clinical course has been excellent and in whom surgical access has strictly adhered to the SEZs. Three of the patients were subsequently effectively treated with deep brain stimulation (DBS), which resulted in complete or almost complete tremor regression. From the statistical analysis of all 1274 brainstem cavernomas, it was determined that a cavernoma location in the midbrain was significantly associated with the onset of HT (p < 0.0005).CONCLUSIONSDespite strict adherence to SEZs, the use of intraoperative neurophysiological monitoring, and the immediate success of a resective surgery, HT, a severe neurological disorder, can occur as a delayed complication after resection of brainstem cavernomas. A cavernoma location in the midbrain is a significant predictive factor for the onset of HT. Further anatomical and neurophysiological studies will be necessary to find clues to prevent this complication.

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Delayed complication secondary to unsuccessful deployment of the StarClose device

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.03.031 ◽

2021 ◽

Author(s):

Miss E Afify ◽

Dr R Patel ◽

Mr A Elmetwally ◽

Mr H Al-Khaffaf

Keyword(s):

Delayed Complication

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Cerebral vasoconstriction following CEA and the role of conventional cerebral angiography

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000941 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000000941

Author(s):

Azam S. Tolla ◽

Muhammad U. Farooq ◽

Bradly Haveman-Gould ◽

Ghassan Naisan ◽

Philip B. Gorelick

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Cerebral Hyperperfusion Syndrome ◽

Carotid Revascularization ◽

Cerebral Vasoconstriction ◽

Cerebral Hyperperfusion ◽

Delayed Complication ◽

Reduce Risk ◽

Revascularization Procedures

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established cerebrovascular procedures to reduce risk of stroke. Complications include stroke, myocardial infarction, and death. A delayed complication following carotid revascularization is cerebral hyperperfusion syndrome (CHS), which can manifest as intracerebral hemorrhage (ICH)[1]. A less common delayed complication of carotid revascularization procedures is reversible cerebral vasoconstriction syndrome (RCVS).

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Reversible hearing impairment: delayed complication of murine typhus or adverse reaction to azithromycin?

Journal of Medical Microbiology ◽

10.1099/jmm.0.013813-0 ◽

2010 ◽

Vol 59 (5) ◽

pp. 602-606 ◽

Cited By ~ 5

Author(s):

Shang-Yi Lin ◽

Ya-Ling Wang ◽

Hsiu-Fen Lin ◽

Tun-Chieh Chen ◽

Yen-Hsu Chen ◽

...

Keyword(s):

Adverse Reaction ◽

Hearing Loss ◽

Male Patient ◽

Immunofluorescence Assay ◽

Murine Typhus ◽

Bilateral Hearing Loss ◽

Delayed Onset ◽

Fever Onset ◽

Initial Symptoms ◽

Delayed Complication

Delayed and reversible hearing loss occurred in a 55-year-old male patient with murine typhus infection. The patient had the initial symptoms of headache, fever and chills, followed by the occurrence of bilateral hearing loss on day 9 from fever onset. Murine typhus was diagnosed with a high IgM titre by indirect immunofluorescence assay. After treatment with azithromycin and prednisolone, the fever and other symptoms subsided gradually and bilateral hearing loss improved 3 weeks later. Though an adverse reaction to azithromycin could not be ruled out, delayed onset of hearing loss was more likely a complication of murine typhus, mainly because the hearing loss did not occur during the azithromycin usage period. Although hearing loss due to murine typhus is rare, clinicians should be alert to the existence of such a delayed complication.

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