Rehabilitation in acute post COVID-19 symptoms with intracranial space occupying lesion: a case report

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2. Older people and those with underlying medical conditions like cardiovascular disease, diabetes, chronic respiratory disease or cancer is more likely to develop serious illness. Acute post COVID-19 patients will get a variety of problems with normal functioning. Rehabilitation could be an effective method for decreasing COVID-19's effects on patient health and function. A 20 years old, female was diagnosed with COVID-19 5 weeks ago, it had been reported shortness of breath, difficult clearing phlegm, headache, nausea and vomiting. The patient had a history of intracranial space occupying lesion (SOL), cerebello pontine angle (CPA) tumor 3 years ago, craniotomy resection of 4th ventricular tumour one year ago and a second craniotomy scheduled for 2021. Several exercises were scheduled for patients including prone position, respiratory muscle training, controlled breathing techniques, bronchial hygiene-airway clearance techniques, aerobic exercise, three times a week, exercises were scheduled. After having completed the exercise program for four weeks, exercise improved shortness of breath, phlegm expenditure, muscle strength, improve lung recoil, vital capacity, range of motion, patient balance and the patient's ability to maximize activity.

MORPHOLOGICAL SPECTRUM OF INTRACRANIAL SPACE OCCUPYING LESION AT TERTIARY CARE HOSPITAL-A CLINICOPATHOLOGICAL STUDY

Introduction: The annual incidence of CNS tumors ranges from 10 to 17 per 1,00,000 persons for intracranial tumors, [1] the majority of these are primary tumors. An “Intra-cranial space occupying lesion” (ICSOL)is dened as a mass lesion in the cranial cavity with a diverse etiology like benign or malignant neoplasm, inammatory or parasitic lesion, hematoma, or arterio-venous malformation.[3] Many non-neoplastic CNS lesions can clinically & radiologically simulate brain tumors. In such cases, histopathological [5] examination (HPE) can be helpful in differentiating between neoplastic and non-neoplastic etiologies. Aims and Objectives: This studywas undertaken to analyse theincidence and frequency of intracranial space occupying lesions, age and sex wise distribution, associated clinical symptoms and histopathological spectrum. Intracranial space occupying lesion biopsi Materials and Methods: es of 108 cases received indepartment of pathology, B.J. Medical College, Ahmedabad, during the period of March 2021 to August 2021. All specimens were preserved in 10% formalin and allowed to x for 24 hours, parafn embedded sections of 5 microns were cut. The hematoxylin and eosin stained sections of the CNS lesions were studied. One Hundred and Eight cases of Intracranial Spac Result: e Occupying lesions were studied, of which 8 (7.4%) cases were non neoplastic with 6 (75%) being cystic lesions and 2 (25%) were cerebral abscess. The neoplastic lesions comprised of 100 (92.6%) cases, which included 99 (99%) primary and 1 (1%) metastatic lesions. The most frequent type of CNS tumor was astrocytoma and oligodendroglioma (23 cases, 23%) followed by Meningioma (18 cases, 18%), pituitary adenoma (17 cases, 17%), Ependymoma(13 cases, 13 %) and metastatic tumor (1 case, 1%). The surgical pathologist plays an importa Conclusion: nt role in accurate diagnosis of various Intra [3] Cranial Space Occupying lesions which will be of immense help for patient prognosis and treatment.

P.028 Surgical Treatment for Idiopathic Intracranial Hypertension – Strategy for the Better Management

Background: Idiopathic intracranial hypertension (IIH) is a condition of increased intracranial pressure in the absence of a space-occupying lesion. The goal of this study is to investigate which factors may influence outcomes in order to improve surgical strategy. We hypothesized diabetes, hypertension, smoking, and obesity influence patients prognosis. Methods: This retrospective chart review included patients diagnosed with IIH who underwent surgical intervention. All patients receiving surgery between 2008 and 2018 were included, and divided into 2 cohorts. Cohort 1 representing favorable course and cohort 2 representing unfavorable course. Favorable course was defined as requiring single surgery for management. Unfavorable course required multiple surgical revisions. Results: Overall, 35/48 (73%) comprised the favorable group. Thirteen patients (27%) comprised the unfavorable group. Of the unfavorable group, 54% had LP shunts, with the remaining receiving VP shunts. There was no association between type of shunt and outcome. Common issues the unfavorable group encountered were persisting symptoms, infections, obstruction of shunt and replacement of shunt. Smoking and frequent follow-up were associated with unfavorable course. Gender, BMI, age, comorbidities and shunt type were not associated with outcome. Conclusions: We found smoking and patient follow-up had a significant association with unfavorable outcome. Other factors had no association with patient outcome.

Atypical involvement of central nervous system in classic Hodgkin lymphoma: a case report

Background Hodgkin lymphoma is a systemic disease that commonly involves the cervical, supraclavicular, and mediastinal lymph nodes. The involvement of central nervous system in Hodgkin lymphoma is extremely rare, and diagnosis is usually established using distinct morphological and immunohistochemical staining on the tissue biopsied. Extranodal presentation of HL is a rare occurrence. It has been evident that prognosis is encouraging in patients with disease that is limited to just central nervous system initially or as relapse, compared with involvement of multiple sites of relapse. Case presentation We herein report a case of a 35-year-old South-East Asian male with relapsed Hodgkin lymphoma. The patient developed a parotid gland lesion, cervical lymphadenopathy with significant weight loss, and intermittent night sweats. Along with spread to the central nervous system, there was a high suspicion of tuberculosis. Upon biopsy of his cervical lymph node, the patient was confirmed to have Hodgkin lymphoma. Immediate treatment began with six cycles of chemotherapy consisting of adriamycin, bleomycin, vinblastine, and dacarbazine. The patient received three cycles of chemotherapy consisting of ifosfamide, carboplatin, and etoposide but then was lost to follow-up. Five years later, the patient suffered a road traffic accident. Upon work-up, a right parietal space-occupying lesion with moderate cerebral edema and midline shift was found on computed tomography of the brain. The patient underwent resection of the space-occupying lesion of brain, with features consistent with classical Hodgkin lymphoma on histopathology examination. It is crucial for such lesions to be investigated meticulously to rule out any secondary disease process. Conclusion Relapsed Hodgkin lymphoma with central nervous system involvement is relatively rare with just over two dozen cases reported to date and is observed infrequently in developing nations. Therefore, space-occupying lesion should always be investigated, and biopsy of such lesions is gold standard to establish diagnosis. With timely appropriate therapy, complete remission can be achieved. However, large-scale studies would be prudent to explore the presentation, survival, and treatment options for patients with Hodgkin lymphoma involving the central nervous system.

A case report of anaesthesia for craniotomy in sitting position

Tumors in the posterior fossa can be done in lateral, supine, prone, sitting and in park bench positions. Depending on the exact position of the lesion and the technical preference of the surgeon, sitting position may be preferred. Sitting position grants best possible access to deeper structures with minimal retraction. However, maintenance of anaesthesia in this position for long duration pose some serious challenges to the anaesthesiologist including high risk of venous air embolism (VAE), hemodynamic instability and respiratory disturbances. Here, we present a case report of a 36year old male diagnosed with pineal gland space occupying lesion (SOL), operated in the sitting position under general anaesthesia. We discuss about anaesthetic management and possible complications that can be encountered.

A Rare Case of Bilobed Giant Peritoneal Loose Body

A 50-year-old male patient was referred to Department of Radiodiagnosis for evaluation of a longstanding intermittent abdominal pain associated with a palpable mass migrating in different quadrants of the abdomen and had gradually increased in size over last few years. The initial ultrasonographic (USG) evaluation revealed a well circumscribed bilobed hypoechoic pelvic solid space occupying lesion (SOL) with central calcific foci. Subsequent contrast enhanced computed tomography (CECT) imaging showed a 10.1 x 7.5 x 5.8 cm, bilobed non-enhancing pelvic mass with central dense calcific foci and concentric soft tissue layers of different attenuation. The mass was diagnosed to be a giant peritoneal loose body (gPLB) and confirmed by surgical exploration.