Bilateral Optic Neuritis Caused by Meningococcal Meningoencephalitis

In this article, we described a case of pathogen-induced bilateral optic neuritis accompanying meningococcal meningoencephalitis in an adolescent male. A 15-year-old boy presented to our emergency room due to progressive severe headache, stiff neck, diffuse extremity pain, fever, and nausea concerning meningoencephalitis. Intravenous ceftriaxone, metamizole, and ondansetron were started immediately. Due to acute autonomic dysregulation and development of petechiae, he was transferred to the pediatric intensive care unit. Next morning, the patient developed severe visual impairment. Investigations revealed elevated C-reactive protein, procalcitonin and leucocyte count, decreased platelet count, and clotting activation. Cerebrospinal fluid (CSF) analysis revealed increased leucocyte count, protein, and decreased glucose concentration with pathological CSF cytology. Brain magnetic resonance imaging revealed an increased contrast enhancement in the optic nerve sheath, consistent with acute bilateral optic neuritis. He was started on high-dose intravenous pulse methylprednisolone therapy. After treatment with ceftriaxone und pulse steroids, the patient was discharged in good condition without any visual sequel.

The Causes and Long-Term Consequences of Viral Encephalitis

Reports regarding brain inflammation, known as encephalitis, have shown an increasing frequency during the past years. Encephalitis is a relevant concern to public health due to its high morbidity and mortality. Infectious or autoimmune diseases are the most common cause of encephalitis. The clinical symptoms of this pathology can vary depending on the brain zone affected, with mild ones such as fever, headache, confusion, and stiff neck, or severe ones, such as seizures, weakness, hallucinations, and coma, among others. Encephalitis can affect individuals of all ages, but it is frequently observed in pediatric and elderly populations, and the most common causes are viral infections. Several viral agents have been described to induce encephalitis, such as arboviruses, rhabdoviruses, enteroviruses, herpesviruses, retroviruses, orthomyxoviruses, orthopneumovirus, and coronaviruses, among others. Once a neurotropic virus reaches the brain parenchyma, the resident cells such as neurons, astrocytes, and microglia, can be infected, promoting the secretion of pro-inflammatory molecules and the subsequent immune cell infiltration that leads to brain damage. After resolving the viral infection, the local immune response can remain active, contributing to long-term neuropsychiatric disorders, neurocognitive impairment, and degenerative diseases. In this article, we will discuss how viruses can reach the brain, the impact of viral encephalitis on brain function, and we will focus especially on the neurocognitive sequelae reported even after viral clearance.

P089 Meningeal syndrome revealing Kawasaki like syndrome: a case report

Background Multisystemic inflammatory syndrome in children is a new and rare hyperinflammatory disorder with a temporal link to the current coronavirus 2019 (COVID-19) pandemic; its main clinical signs are prolonged fever, typical features of Kawasaki disease; cardiac dysfunction; as well as gastrointestinal, renal, and/or neurological symptoms. However, the association between meningeal syndrome and the pediatric multisystemic inflammatory syndrome is poorly described in the literature. We will report the case of a boy who presented with meningeal syndrome revealing a Kawasaki-like syndrome. The objective of our work is to provide an update on this pathology which is very little known by clinicians. Observation Our patient is a male child aged 8 years, from a 2nd degree consanguineous marriage, with a history of the influenza-like syndrome in all family members one month before admission, He was admitted for the management of a febrile meningeal syndrome, the history of which goes back to seven days before his admission, with the onset of a non-calculated fever resistant to antipyretics, associated with peri-umbilical pain and stiffness of the neck with the notion of photophobia and constipation. The clinical examination revealed a conscious child, GCS 15/15, very asthenic, fever 39.3 degrees. The neurological examination revealed a stiff neck with a negative brudzinski and kerning sign and no sensory-motor deficit. The skin examination reveals a morbilliform exanthema with an interval of healthy skin made up of non-infiltrated erythematous macules, which fade away within vitro pressure, on the lower and upper limbs and the trunk, sparing the face, the palms, the soles, and the external genitals, associated with the presence of bilateral palmoplantar oedema without desquamation. The mucous membrane examination showed bilateral conjunctivitis, not purulent, and cheilitis with left cervical adenopathy measuring 2 cm, with an inflammatory appearance on ganglionic examination. The rest of the examination was unremarkable. In front of the meningeal syndrome, a lumbar puncture was performed and came back negative. The biological workup revealed a major inflammatory syndrome: the white blood cells were 25 000 with a predominance of PNN at 23 500, the lymphocytes at 1,000, the platelets at 278 000, the sedimentation rate at 100 and the CRP at 272, the ferritinemia at 725.12, the Pro-BNP was elevated at 1,834, the liver and kidney biological results were normal. Echocardiography revealed myocarditis with mitral leakage, slight hypokinesia of the left ventricle, ejection fraction at 50%, VGTG 40MM, dilated coronary arteries, left common trunk at 4 mm, and IVA at 3 mm with minimal pericardial effusion. Given the current epidemiological context of the clinical symptomatology in our child, the multisystemic inflammatory syndrome was strongly suspected, so a covid19 serology was performed: negative IgM, positive IgG. Conclusions Several recent studies have shown the presence of neurological signs in children with multisystemic inflammatory syndrome related to Covid 19 hence the interest in screening to have recommendations based on sound clinical data for better management of patients with this syndrome during this pandemic.

A Rare Case of Rathke’s Cleft Cyst Apoplexy

The occurrence of symptomatic Rathke's cleft cyst (RCC) apoplexy is extremely rare. This is often misdiagnosed due to similar presentations to subarachnoid haemorrhage and pituitary apoplexy. This case highlights an excellent example of similar clinical presentation and serves as a learning case for clinicians. A 40-year-old lady presented to a district hospital with 9 days of worsening severe headache associated with blurring of vision, photophobia, stiff neck, nausea and vomiting. Nuchal rigidity and Brudzinski’s positive. Blood test showed hyponatremia, raised inflammatory markers and normal dynamic pituitary function test. CT Head demonstrated no evidence of space-occupying lesion or intracranial haemorrhage. Lumbar puncture showed xanthochromia positive consistent with subarachnoid haemorrhage. MRI head advised by Neurosurgery team and revealed a focal lesion involving anterior pituitary macroadenoma with mass effect on optic chiasm with possible haemorrhage within. Further assessment in tertiary hospital confirmed loss of visual acuity and field deficit. Patient underwent emergency endoscopic transnasal transsphenoidal resection of apoplectic tumour and repair of CSF leak with graft from thigh. Histopathology report showed a Rathke’s cleft cyst with squamous metaplasia. Post operatively, the patient developed sinusitis which fully recovered, and MRI showed good decompression. The author demonstrated a rare case of symptomatic RCC which was initially presumed to be pituitary apoplexy. Radiology imaging and treatment approach for both conditions are quite similar and can only be differentiated by histopathology. Further research is required to identify the causes and risk factors of RCC apoplexy to aid early detection and diagnosis.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S23

Leptospirosis Case Report with Renal Insufficiency

Introduction: Leptospirosis is an international zoonotic condition relay and rising prevalencethe causes of the infection Leptospira spirochete with popular exhibition of polluted clean water.Most asymptomatic diseases, but the symptoms are moderate, autonomous, specific febrile and respiratory non-specific disorder high mortality rates of renal failure. Case: A 33-years-old woman from rural area came to the hospital in casualty with a history of high grade fever (40 degree Celsius), with chilling, headache, stiff neck. Urinary retention along with productive cough for three days. Intervention: The patient underwent inpatient management, which included tablet Ceftriaxone 1gm twice a day, Tablet Doxycycline 100 mg bd given and intravenous fluids 5% dextrose and dextrose/sodium chloride solution, Injection Furosemide20 mg intravenously twice a day were given to the patients. Nursing management: monitoring the vital sign, maintain the O2 levels as well as the consumption and output. All basic nursing care has been provided. Her symptoms cured after two weeks of treatment, she was discharged. Results: Fever has been minimized. The therapy is reacted to and restored. Conclusion: Management was mainly aimed at protecting patient wellbeing, preventing complications and improving the quality of life. The patient received all medical therapy and the results show that the therapy and care was effective.

Terapi Akupunktur Dan Pola Hidup Sehat Untuk Menurunkan Tekanan Darah Pada Penderita Hipertensi

Background: Hypertension is a disease that is a public health problem found in both developed and developing countries. It takes obedience and discipline and money to be able to control high blood pressure. Acupuncture can be applied to help control blood pressure by stimulating acupuncture points to deliver and smooth the Qi in an effort to balance Yin Yang which medically can improve the physiology of blood pressure. More than 20% of the Bibis Luhur RW XXI Nusukan Banjarsari Surakarta community complained of frequent dizziness and experiencing high blood pressure. Methods: Examination of blood pressure checks, counseling on healthy lifestyles and prevention of hypertension, as well as acupuncture therapy services located at Griya Sehat Prima Hati. The activity was carried out 12 times with a frequency of once a week with local health cadres. Blood pressure was checked at each visit and blood pressure comparisons were made from the first and last therapy. Results: There was an average decrease of 19 mmHg for systolic pressure and 10 mmHg for diastolic pressure. Patients, families and health cadres experienced an increase in knowledge about hypertension management and a healthy lifestyle by 80%. Acupuncture reduces comorbidities for people with hypertension such as dizziness, insomnia, stiff neck, and other complaints. Conclusion: With counseling, health care, and acupuncture therapy to help people understand and improve their daily life patterns, reduce complaints, and lower blood pressure.

Subarachnoid hemorrhage due to intradural cerebral aneurysm and simultaneous spinal subdural hematoma: illustrative case

BACKGROUND Spontaneous spinal subdural hematomas (SSDHs) are unusual. Among their probable etiologies, an association with ruptured brain aneurysms has been described in an extraordinary way. The underlying pathophysiological mechanism is not conclusively described in the literature. OBSERVATIONS The authors reported an exceptional case of a 59-year-old woman admitted for a condition that included sudden headache, stiff neck, and vomiting associated with pain in the left flank area that radiated to the leg. Computed tomography (CT) of the brain evidenced acute subarachnoid hemorrhage distributed in the bilateral posterior parieto-occipital fossa and occipital horns of the ventricles. CT angiography detected a dissecting aneurysm in the left vertebral artery (V4) that was treated urgently via the endovascular route. In the next hours, the patient’s symptoms worsened, with paraplegia of the lower extremities. Magnetic resonance imaging showed SSDH at T4–6 and extensive associated myelopathy. LESSONS The origin of the spinal hematoma may be the rupture of the aneurysm of the V4 segment in the dura mater of the foramen magnum and subsequent rostrocaudal migration of the hemorrhage to the spinal subdural space, enhanced by an intracranial pressure increase. This hypothesis is discussed, as is a brief literature review.

A Patient of Neurocysticercosis Misdiagnosed as Tuberculous Meningitis for 26 Years: a Case Report

Background: Neurocysticercosis (NCC) is a neurological infection caused by the larval stage of the tapeworm Taenia solium (T. solium). The diagnosis of NCC can be challenging because of heterogeneity in clinical manifestation. Neurocysticercosis is easily misdiagnosed as tuberculous meningitis (TBM).Case presentation: We describe a case of subarachnoid neurocysticercosis with 28 years illness course misdiagnosed as TBM for 26 years. The patient presented with symptoms of repeated headache, fever, serious low back and legs pain, and vomiting, occasional seizure and lose of consciousness. The neurological assessments revealed stiff neck and right plantar and saddle numbness. Lumbar puncture results revealed obvious intracranial hypertension, pleocytosis, elevated protein level, and decreased glucose level. Magnetic resonance imaging showed meningeal enhancement of brain, cystlike structure in the lumbosacral sac and the clumping of the nerve roots of the cauda equina. Five recurrent episodes occurred in twenty-eight years. TBM was considered as a probable etiology and was treated for tuberculosis empirically with adjunctive corticosteroids for 26 years. In the first three hospitalizations, During this period, the patient was hospitalized three times. In 2016, The local hypertrophic pachymeningitis were considered as a probable etiology. She was treated with steroid pulse therapy. At her fifth relapse, in 2018, next-generation sequencing of cerebrospinal fluid (CSF) identified the patient was NCC, T. solium infection. Her symptoms and CSF examination were relieved after etiological treatment. Conclusions: Neurocysticercosis is easily misdiagnosed as TBM. Meanwhile, adjunctive corticosteroids therapy can alleviate the symptom of TBM and NCC. So we suggest that NCC should be considered in the differential diagnosis of TBM. NGS of CSF is a promising tool for the diagnosis of NCC.

Balloon Assisted Endovascular Coiling in Wide Neck Basilar Tip Aneurysm

Basilar tip aneurysms are the commonest aneurysms of the posterior circulation and constitute around 5-8% of all cerebral aneurysms. Ruptured basilar tip aneurysms may present with signs and symptoms of subarachnoid hemorrhage (SAH) with sudden, extremely severe headache, nausea and vomiting, stiff neck, blurred or double vision, sensitivity to light, seizure, drooping eyelid and loss of consciousness. At times, the hemorrhage could be fatal, reaching mortality beyond 20%. Basilar tip aneurysms have complex anatomy and have always been considered difficult to treat. Two well-known options to treat basilar tip aneurysms include the microsurgical approach and the endovascular approach. Endovascular treatment is now a cost-effective, preferred and logical rationale for the management of intracranial aneurysms. This case reports the first ever coiling procedure that was performed at Ziauddin Hospital (North Campus) for a basilar tip aneurysm and the other major challenge faced at our center was that the neck was wide, hence requiring a supporting balloon.