Case Report: Angiostrongylus cantonesis Myelitis in Thailand

A 67-year-old man presented with headache, middle back pain that radiated to both legs, and paresthesia in the right leg for 1 day. He had eaten raw shrimp 1 week previously. Over the next week after admission, he developed urinary retention and weakness in both legs. The numbness in his right leg expanded to below the umbilicus. Magnetic resonance imaging of the spinal cord showed myelopathy with minimal cord swelling at T9 to the conus medullaris and a hemorrhagic lesion from T10 to T11. A complete blood count on day 28 after the onset of symptoms revealed leukocytosis without eosinophilia and no white blood cells in his cerebrospinal fluid. Results of an immunochromatographic test kit were positive for Angiostrongylus cantonesis but negative for Gnathostoma spinigerum. After a 4-week course of albendazole combined with a tapering dose of dexamethasone, he achieved nearly complete recovery.

Unexpected intracranial location of a Cephenemyia stimulator larva in a roe deer, Capreolus capreolus, revealed by computed tomography

In this study we describe the finding of a Cephenemyia stimulator larva in the brain of a roe deer (Capreolus capreolus) after performing a computed tomography (CT) scan of its head. Despite this anatomical location of oestrid larvae could be relatively frequent in other genera, such as Oestrus, to our knowledge, this is the first reported case involving the genus Cephenemyia. Concretely, a second-instar C. stimulator larvae was found in the basis of the cranium. The location of a macroscopic hemorrhagic lesion involving the brain parenchyma peripheral to the location of the larva suggests that tissue colonization occurred before the animal was hunted. Since no detectable alterations or damage to the cranial bones were observed, we suggest a possible larval migration route drilling the skull bones. Finally, we propose the use of the term “neuromyiasis” to be referred to the invasion of the central nervous system by dipteran larvae, particularly oestrids.

Endosurgery Approach in a Dog with Thoracoabdominal Injury

Background: Chest trauma is one of the main thoracic injuries in dogs and cats, reaching a high morbidity and mortality. The tissue damage, in thoracic trauma, can be underappreciated by visual exam and traditional radiography. The thoracoscopy can provide information for a precise definitive diagnosis, by this technique bleeding or air leakage can be identified and corrected immediately and the diaphragm can be completely evaluated. The aim of this work was to describe the thoracoscopic approach in a case of diaphragmatic perforation caused by penetrating trauma in a dog.Case:A 6-year-old male dog mixed-breed dog, weighing 14 kg with thorax perforation was presented to the Veterinary Hospital. Clinical examination of the animal revealed the following: pale mucous membranes, moderate dyspnea, open pneumothorax, abdominal distension, heart rate of 108 beats per minute and respiratory rate of 64 breaths per minute. Physical examination confirmed a 3 cm perforation hemorrhagic lesion in the left ninth intercostal space. As an emergency treatment, oxygen therapy, tramadol hydrochloride [Cronidor® 2%, 4 mg/kg, i.v, TID], tranexamic acid [Transamin® 25 mg/kg, i.v, TID], ceftriaxone [Rocefin® 50 mg/kg, i.v, BID] and fluid therapy with lactated Ringer’s solution were administered. The hair was removed, and then, wound cleaning and obliteration of the wall injury with sterile gauze was performed. After the emergency stabilization, the animal was anesthetized, followed by preventive thoracocentesis by an approach close to thoracic perforation and thoracoscopy without pneumoperitonea through this thoracic perforation with 0-degree rigid endoscope. About 100 mL of blood and air was drained and diagnosed perforation in the diaphragm and pulmonary atelectasis in the caudal and left cranial lobes. the edges of the incisional wound were debrided, and the closure of thoracic incision was performed usual way. After that, the air was removed by a catheter and syringe system. A flexible plastic tube was inserted through the chest wall and into the pleural space for drainage every 2 h for 24 h. There were no intercurrences during the first 24 h after the surgical procedure. The patient was discharged 48 h after the surgery. Cephalexin [75 mg, 30 mg/kg, v.o, TID, during 5 days), Ketoprofen [20 mg, 2 mg/kg, v.o, SID, during 5 days], Tramadol Hydrochloride [50 mg, 4 mg/kg, v.o, SID, during 2 days] and Rifamycin spray at the wound site was prescribed. Ten days after surgery, the patient returned to the hospital for suture removal and reassessment.Discussion: The prognosis of chest perforation depends on the severity and number of internal and external thoracic lesions, as well as cardiovascular status at the time of initial patient care. In cases of penetrating chest trauma, it is essential to thoroughly examine the thoracic cavity for bleeding, tissue tears, and diaphragm perforation. The use of the endoscope allowed for a more detailed exploration of the chest without the need to increase the incision. When the diaphragm lesion was found, it was also possible to perform the abdominal examination by videoendoscopy, through this perforation. Laparotomy and thoracotomy cause postoperative pain and discomfort, in addition to increasing recovery time, however, even with trauma, not performing a larger incision favored the recovery of this patient, without any intercurrence in the first 24 h after the procedure. In conclusion, the endoscopic approach was efficient for diagnosis, avoiding greater trauma and contributing to a better clinical recovery of the patient.Keywords: dog, chest trauma, minimally invasive surgery, thoracocentesis, thoracoscopy.

Constraints of health management of commercially cultured high valued fishes

This study was performed to understand the constraints of health management of commerciallycultured high value fishes including gulsha (Mystus cavasius), shing (Heteropneustes fossilis) and koi (Anabastestudineus). One hundred farmers were interviewed through structured questionnaire in Mymensingh andJashore districts. Most of the farmers practiced polyculture of gulsha and shing with carps and monocultureof koi high densities. All the three species suffered from a number of serious diseases under farmingconditions. Most prevalent clinical signs of diseases were ulcerative hemorrhagic lesion, whitishappearance over body surface, ventral and mouth reddening and fin rot. The most susceptiblespecies to disease was shing with a higher average mortality of 43.33% followed by gulsha(36.71%) and koi (38.76%). Diagnosis of disease was the single most important constraints ofhealth management followed by lack of farmer’s knowledge on fish health and diseases, presence ofhuge number of poor quality medicine, ineffectiveness and indiscriminate use of such medicine,lack of farmer’s ability on application of medicine and absence of qualified fish health adviser.Lack of good quality fish seed, feed and water were identified as the main resource problemsassociated with fish health management. The study also identified a number of general constraintsof farming of high value fish which included low price of fish, higher feed cost, and outbreak ofdiseases, high land tax, electricity bill and marketing problem. Further studies should focus on thedevelopment of strategies for better health management practices for sustainable commercial cultureof high value fishes.

Bilingual aphasia after stroke. Case report

Context: With the largest number of bilingual individuals in the world, there is a growing need for understanding and studying language in different populations. In cases of bilingual aphasia, patterns of language recovery can vary. Parallel, or simultaneous, recovery in both languages is the most common type of language recovery, followed by differential recovery, where there is an improvement in one language compared to another. This case report was approved by the Ethics Committee of Universidade Metropolitana de Santos. Case Report: The present case refers to a male patient, 52 years old, righthanded, born in Arkansas-United States of America and resident for 20 years in the city of Santos, São Paulo. The patient is bilingual fluent in English and Portuguese and had a sudden deficit in strength and sensitivity in the right hemibody, associated with language disorders. Imaging exams showed a hemorrhagic lesion in the topography of the left lenticular nucleus. In the neurological evaluation, hemiparesis and proportioned and complete hemiparesis were shown on the right. In the language assessment, he presented an important impairment of fluency, compression and repetition in the Portuguese language and relative preservation, with slight dysfunction in fluency in the English language. Conclusions: Symptomatic treatment was instituted and after 12 months he had partial improvement of motor symptoms and complete aphasia.

Neonatal Cerebellar Hemorrhage and Facial Nerve Palsy: An Unusual Association

Cerebellar hemorrhage is rare in term newborns and is most often seen after traumatic birth. Lifelong sequelae include motor and cognitive impairment. We report the uncommon case of a late preterm infant born by spontaneous delivery who showed right peripheral facial palsy at 24 hours of life. Cranial ultrasound showed lateral ventricles dilatation and a diffuse hyperechoic round lesion in the right cerebellar hemisphere. The computed tomography scan confirmed a hemorrhagic lesion in the right cerebellar hemisphere and in the vermis with midline shift and intraventricular bleeding. Ommaya reservoir was inserted and used for a few days. The facial palsy gradually recovered to a complete remission after 6 weeks. Follow-up examinations at 12 and 18 months evidenced infant's delayed motor function, hyperreflexia, tremors, and speech delay.

Acute Subdural Hematoma

Acute subdural hematomas are collections of acute blood in the subdural space. They usually present as a result of significant head trauma. They can occur spontaneously in relationship to an underlying hemorrhagic lesion such as tumor, arteriovenous malformation, or aneurysm. They are more likely to be associated with cortical injury than the epidural hematoma. Neurological symptoms on presentation are related to the underlying brain injury and/or mass effect. Acute subdural blood on CT scan is hyperdense, in a crescent shape, along the inner dural surface. Emergent surgical intervention via craniotomy is indicated in patients with at least 10 mm in thickness or at least 5 mm shift, or elevated ICP, or pupillary dilatations suggesting herniation, or progression of deficit based on the Glasgow Coma Score. Conservative management of small acute subdural hematomas may be done in select situations that include proper ICU monitoring for ICP elevations and neurological deteriorations.