Posterior Reversible Encephalopathy Syndrome in a Patient With Microscopic Polyangiitis: A Case Report and Literature Review

Central nervous system (CNS) is rarely involved in microscopic polyangiitis (MPA). Here, we report a 14-year-old girl with MPA who developed new-onset seizures with deterioration of renal function. Her brain CT scan and MRI showed concurrent complications of intracerebral hemorrhage and posterior reversible encephalopathy syndrome (PRES). She got remission with combinations of methylprednisolone pulse, plasma exchange, regular hemodialysis, antiseizure and antihypertension medications. Furthermore, it is crucial to exclude the adverse effect of medications such as corticosteroid and biological therapy. We searched the literatures, retrieved 6 cases of MPA with PRES and summarized their clinical characteristics.

Hydrocephalus Surgery in Touba City (Senegal): 0% infection Preliminary study about 20 cases

Introduction: Infection is the most common complication encountered after ventriculoperitoneal shunt. The AIMS of this study is to evaluate the effectiveness of antibiotic therapy with protocol in the prevention of post-operative infections after ventriculoperitoneal shunt in our city. Patients and methods: We retrospectively study 20 hydrocephalus cases in one year. They were operated through the classic VP Shunt insertion technique and with the protocol adopted for shunt implantation. They received antibiotic therapy for ten days. Results: In one year we operated 95 patients,20 (21%) cases were hydrocephalus. There were 7 males et 13 females (ratio:0,53) . The age of patients ranged from 15 days to 12 years and the average age was 13,5 months. The average consultation time was 5,6 weeks. Clinically the most common sign were anterior fontanelle tense (100%) , macrocrania (60%) ,vomiting (80%) and sunset eye sign (80%) . Brain CT-scan was performed in all patient,66% of patients had Transfontanelle Ultrasonography and anyone hadn’t performed MRI. All cases underwent surgical treatment. only ventriculoperitoneal shunt was performed and the standard technique protocol to minimize infection was done during surgery. All of them received ceftriaxone 100mg/kg/day for five days then oral relay by thiamphenicol 50mg/Kg/day for five days. The follow up was good no infection was found (0%). Conclusion: Establishing an aseptic protocol for the shunt is essential to reduce the rate of postoperative infections. This result becomes better when we make a combination of antibiotic therapy and protocol. We can achieve infection rates to zero or less than 1% in case of association

Study of correlations between CT properties of retrieved cerebral thrombi with treatment outcome of stroke patients

Background All the patients with suspected stroke are directed to whole-brain CT scan. The purpose of this scan is to look for early features of ischemia and to rule out alternative diagnoses than stroke. In case of ischemic stroke, CT diagnostics (including CT angiography) is used mainly to locate the occlusion and its size, while the Hounsfield Units (HU) values of the thrombus causing the stroke are usually overlooked on CT scan or considered not important. The aim of this study was to demonstrate that the HU value is relevant and can help in better treatment planning. Patients and methods There were 25 patients included in the study, diagnosed with ischemic stroke in the middle cerebral artery (MCA) territory. In all patients, systemic thrombolysis was not successful and the mechanical recanalization was needed. The retrieved thrombi were also analyzed histologically for the determination of red blood cells (RBC) proportion. CT of the proximal MCA (M1) segment was analyzed for average HU value and its variability both in the occluded section and the symmetrical normal site. These CT parameters were then statistically studied for the possible correlations with different clinical, histological and procedure parameters using the Linear Regression and the Pearson correlation coefficient. Results Relevant positive correlations were found between average HU value of thrombus and outcome modified Rankin Scale (mRS), initial mRS, number of passes with thrombectomy device as well as RBC proportion. Conclusions Results of the present study suggest that measured HU values in CT images of the cerebral thrombi may help in the assessment of thrombus compaction and therefore better treatment planning.

Acute Severe Bilateral Visual Loss as Presenting Symptom of COVID-19 Infection

Introduction: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and is accompanied by extraordinary morbidity and mortality. Critically ill COVID-19 patients have frequent thrombotic problems and laboratory evidence of hypercoagulability. The spectrum of presentations and complications of COVID-19 is still evolving. We describe a patient with unusual visual symptoms as the presenting signs of COVID-19. Case Presentation: In this case report, we describe a patient who presented with acute severe bilateral visual loss and headache. On neurological examination, cranial nerves were normal. There was no motor and sensorial abnormality. While the patient was in the emergency room, he was tested positive for COVID-19 via nasopharyngeal swab polymerase chain reaction (PCR) as part of COVID-19 surveillance. An unenhanced brain CT scan showed infarction in the occipital cortex bilaterally due to ischemic stroke involving the Posterior Cerebral Artery (PCA). A few hours later, oxygen saturation was 42%, and a sudden decline of consciousness was observed, progressing to coma. The neurosurgery intervention failed to change the patient's status, and he was pronounced dead in the next few hours. Conclusions: This case illuminates a wide range of COVID-19-related symptomatology and highlights the need for clinicians to be aware of different clinical appearances associated with this infection.

Celiac disease with acute cerebellar stroke as first presentation: A case report

Celiac disease is an immune disorder occurring in response to ingestion of gluten in genetically predisposed individuals. It is a complex multiorgan disease with possible neurological involvement. Thrombotic events can occur but rarely as presenting symptom. We describe the case of a young man admitted to the Stroke Unit for worsening headache, nausea, vomiting, unsteadiness, dysarthria, and dysmetria. Brain CT scan showed an ischemic hypodense lesion of the right cerebellar hemisphere with compression of the adjacent IV ventricle. Studies to determine the etiology of stroke showed positive serology for celiac disease. On follow up he has completely recovered clinically. He is on gluten-free diet and the serology is now negative. Our case demonstrated that in young stroke, even without gastrointestinal symptoms, celiac disease should be considered a possible differential diagnosis and the appropriate serology test performed.

Extensive Intracranial Calcification in A Case of Hypoparathyroidism Which Presented With Generalized Tonic-clonic Seizure: A Case Report

Hypoparathyroidism is an endocrine disorder that can be congenital or acquired. Generally, hypoparathyroidism is characterized by hypocalcemia, hyperphosphatemia, and low or abnormal levels of Parathyroid Hormone (PTH). It can be asymptomatic or symptomatic. The symptoms include seizures, paresthesia, depression, psychosis, extrapyramidal manifestations, and increased intracranial pressure. In this case study, we reported a 40-yearold male patient who was admitted to the emergency department with generalized tonicclonic movements and urine incontinency. Laboratory investigations revealed hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels and in paraclinical studies, including Electroencephalography (EEG) and brain CT-scan, despite normal EEG, extensive intracranial calcification involving the basal ganglia, thalamus, white matter of the cerebral hemispheres, and subcortical area of the frontal and parietal lobes were observed on CT-scan.

Findings of brain computed tomography scan in motorcyclist patients with head trauma referred to Shiraz Shahid Rajaei Trauma Center in summer 2016

Background: Head trauma and subsequent traumatic brain injury are among the main causes of morbidity and mortality in Iran. The present study aimed to assess the abnormal findings of brain computed tomography (CT) scan in motorcyclist patients with traumatic brain injury. Materials and Methods: This retrospective cross-sectional study (July-September 2016) was conducted on all motorcyclist patients over 12 years who were referred for brain CT scan to the Emergency Department of Shahid Rajaei Hospital in Shiraz. Patients' archived medical files were reviewed, and a data collection form including age, gender, and findings related to acute trauma and incidental findings were completed. The obtained data were then statistically analyzed. Results: A total of 642 patients were enrolled. The mean age score of participants was reported as 33.61±17.12 years. All patients were male. A number of 51 (7.9%) patients had abnormal findings in their brain CT scans. The most-reported findings were skull-based (23%) and cranial linear (17%) fractures. No incidental findings (findings unrelated to acute trauma) were found. Moreover, 8 (15.7%) patients died with abnormal findings in their brain CT scans. Conclusion: Since in the present study, only 7.9% of the patients had abnormal findings in their brain CT scan and considering the comparison of the results of this research with those obtained in other similar studies, brain CT scan is highly used in this center.

Complicated Pneumococcal Meningitis: A Diagnostic and Therapeutic Challenge

Meningitis is an uncommon complication of head trauma. Vasculitis in bacterial meningitis is seen in 9–25% of adults while neurological deficits in bacterial meningitis are seen in about one-third of children. We report a 5-year-old boy, previously healthy who was admitted in March 2019 to Latifa Women’s and Children’s Hospital, Dubai, UAE, with pneumococcal meningitis. One day before presentation, he had a history of fall with head trauma while running at school. Initial brain CT scan was normal. Few hours after admission, the child was noticed to be drowsy with cold extremities and mottled skin. He was shifted to PICU and, ultimately, he required intubation and mechanical ventilation. The child continued spiking high-grade fever with deterioration in the neurologic status. His GCS deteriorated to 4/15 with decerebrations posture. He underwent serial brain imaging which revealed multiple chronic infarcts with hydrocephalic changes due to ongoing cerebral vasculitis. The child was started on steroid therapy on 28 April 2019 after which his condition improved at an incredible pace.

Foville Syndrome Due to Pontine Hemorrhage and Pontine Infarct: Case Series

Foville Syndrome is a rare clinical feature of stroke or brain hemorrhage. Few cases have been reported worldwide particularly in Asian, Indonesia, Aceh. Patient 1: We report the case of a female 64 years old patient, was admitted in the Neurology Department of Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, for an abrupt onset of right body side weakness two day before admission. That weakness was preceded by acute headaches and rotatory vertigo with vomiting. with hypertension history since 5 years. Physical examination found paralysis of right oculomotor movements with intact response of pupils to light, right trochlear nerve palsy, left ipsilateral facial nerve palsy, and right hemiparesis which constitute of Foville syndrome. The brain CT scan shown in the right pontine hypodensity area is pontine infarct. Etiological investigations done to chronic hypertension. Patient received antiplatelet therapy and control of vascular risk factors for secondary prevention (hypertension theraphy), and physiotherapy as treatment with clinical improvement. And she has been discharge 8 days later. Patient 2: 45-year-old right-handed female, was admitted in the Neurology Department of Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, for an abrupt onset of right body side weakness two day before admission. That weakness was preceded by acute headaches and rotatory vertigo with vomiting. with hypertension history since 5 years. Physical examination found paralysis of right oculomotor movements with intact response of pupils to light, right trochlear nerve palsy, left ipsilateral facial nerve palsy, and right hemiparesis which constitute of Foville syndrome. The brain CT scan shown spontaneous hemorrhage in the left pontine’s. Etiological investigations done to chronic hypertension. Patient received therapy control of vascular risk factors for secondary prevention (hypertension theraphy), and physiotherapy as treatment with clinical improvement. And she has been discharge 10 days later. The diagnosis and management of brainstem stroke bring a considerable burden to the healthcare system, the patient, the family members, and the society at large. The slow increase in the global burden of stroke has been steadily increasing.

An Overview of Definition and Approaches to Petroclival Meningioma

Meningiomas account for 20 to 25% of all intracranial tumors and 10% are seen in the posterior fossa. Petroclival tumors are defined as arising from the upper two thirds of the clivus, medial to the trigeminal nerve at the petroclival junction. Brain CT scan and MRI are routinely used to evaluate tumor anatomy. The petrous temporal bone is a hindrance to resection of these tumors. Oftentimes neurosurgeons are unskilled with the anatomy of the petrous bone, and so suboccipital and pterional routes are usually preferred. Some authors have encouraged using traditional neurosurgical approaches to these tumors. In this manuscript we review tumor location and approaches used for resection of these challenging tumors.