Аcute transverse myelitis and Guillain – Barre overlap syndrome in a patient with СOVID-19

We report a case of transverse myelitis and Guillain–Barre syndrome (GBS) overlap in the 42-year-old patient with moderate course of Coronavirus disease 2019 (СOVID-19). Nasopharyngeal SARS-CoV 2 RT-PCR was positive. Severe neck pain developed in this patient on the 5-th day of СOVID-19. A few hours later weakness in the feet arised and then spread to the thighs and arms. Quadriparesis, arefl exia in all limbs, sensory loss below the level of T4 and bladder/bowel dysfunction were present. Pyramidal signs were negative. There was no increase of COVID-19 severity at the time of neurological signs development. Magnetic resonance imaging of the spinal cord showed the focal lesion in the C2-T1 segments, which was consistent with the features of longitudinally extensive transverse myelitis. Along with the myelitis, acute motor axonal polyneuropathy was diagnosed. This diagnosis of GBS was supported by ascending weakness with arefl exia, albumin-cytological dissociation in cerebrospinal fl uid and the data of neuroelectrophysiological examination. We proposed that both myelitis and GBS had disimmune nature associated with COVID-19. The other possible causes of damage to the spinal cord and peripheral nervous system were excluded.Immunotherapy with high dose of intravenous immunoglobulins was administered. Steroids also were used taking into account the myelitis. At the follow up in 4 months the motor functions were found to be improved nonsignifi cantly, the patient was still severe disabled.

Novel wrapping surgery for symptomatic sacral perineural cysts

OBJECTIVE Perineural cysts, also called Tarlov cysts, are dilatations of the nerve root sleeves commonly found in the sacrum. The majority of the cysts are asymptomatic and found incidentally on routine spine imaging. Symptomatic sacral perineural cysts (SPCs) that induce intractable low-back pain, radicular symptoms, and bladder/bowel dysfunction require surgery. However, the surgical strategy for symptomatic SPCs remains controversial. The authors hypothesized that the symptoms were caused by an irritation of the adjacent nerve roots caused by SPCs, and developed a wrapping surgery to treat these cysts. METHODS Seven patients with severe unilateral medial thigh pain and ipsilateral SPCs were included. Preoperative MRI showed that the cysts were severely compressing the adjacent nerve roots in all patients. After a partial laminectomy of the sacrum, the SPCs were punctured and CSF was aspirated to reduce their size, followed by dissection of the adjacent nerve roots from the SPCs. The SPCs were then wrapped with a Gore-Tex membrane to avoid reexpansion. RESULTS All 7 patients experienced substantial relief of their symptoms. The average numeric rating scale pain score was reduced from an average preoperative value of 7.9 to 0.6 postoperatively. Postoperative MRI showed that all cysts were reduced in size and the adjacent nerve roots were decompressed. Regrowth of the treated cysts or recurrence of the symptoms did not occur during the entire follow-up period, which ranged from 39 to 90 months. No complications were noted. CONCLUSIONS The authors’ new wrapping technique was effective in relieving radicular symptoms for patients with symptomatic SPCs. The results suggested that the symptoms stemmed from compression of the adjacent nerve roots caused by the SPCs, and not from the nerve roots in the cysts.

Vesikoureteraler Reflux beim Kind – eine Übersicht

ZusammenfassungDer vesikoureterale Reflux (VUR) beschreibt einen nichtphysiologischen Reflux der Harnblase in die Nieren. Während beim primären Reflux und jüngeren Kindern eine hohe Spontanheilungsrate besteht, ist diese beim sekundären Reflux deutlich geringer. Der VUR ist häufig mit einer „bladder bowel dysfunction“ assoziiert, die primär behandelt werden sollte. Hauptkomplikation ist die Refluxnephropathie mit Bildung von Nierennarben und nachfolgend möglicher Einschränkung der Nierenfunktion. Die Therapiemöglichkeiten reichen, abhängig von der klinischen Präsentation und den bestehenden Risikofaktoren, von abwartendem Verhalten bis zur offenen Chirurgie. Ein leichtgradiger VUR (Grad I–II) muss heute nicht mehr behandelt werden. Bei hochgradigem VUR und wiederholten Durchbruchsinfektionen ist die Indikation zur subureteralen Unterspritzung oder zur Ureterneuimplantation gegeben.

Recurrent UTI in Ventriculoperitoneal Shunted Children's

Objective: To determine the rate and the type of recurrent UTI in ventriculoperitoneal shunted children's admitted to Azady Teaching Hospital, Kirkuk.. Methods: From mid 2015 to end of 2020; UTI in ventriculoperitoneal shunted children's . Once infection was suspected , CSF (from shunt reservoir or from ventricular tapping), blood, and urine samples, analysis, and culture taken and empirical antibiotics were recommended. Results: 25.9% of patients with VP shunts had infections which represents 29.3% of the procedures. 40% of infected patients had recurrent episodes. 59.1% of infections occurred throughout the first two months following insertion. Single pathogen was isolated in each episode. E.coli represented 50% of isolated pathogens compared with 18.2% with Staphylococcus epidermidis. Conclusions: There is a high incidence of recurrent UTI in ventriculoperitoneal shunted children's in Azady Teaching Hospital, Kirkuk. when compared withother international centres. Gram negative organisms are the most common cause of the infection. Keywords: Urinary tract infection= UTI ,Renal scar.,BBD = Bladder Bowel Dysfunction; DMSA = dimercaptosuccinic acid; IV

Dating with a Diagnosis: The Lived Experience of People with Multiple Sclerosis

Multiple Sclerosis (MS) is a neurological condition which usually manifests between the ages of 20–40 years. This is a critical period for developing relationships, particularly romantic relationships. People with MS can experience sexual dysfunction, limb weakness, fatigue, pain, reduced mood and bladder/bowel dysfunction; potentially affecting their ability to participate in many meaningful activities, including those associated with romantic relationships, dating or engaging in sexual intercourse. Dating or starting romantic relationships can be difficult for people with physical disabilities as they can experience stigma, negative societal attitudes and the fear of requiring care from potential partners. Dating experiences of people with progressive conditions like MS have not been explored in detail. The aim of this study was to develop a rich understanding of how living with MS interacts with/influences dating and developing romantic relationships. The study used a descriptive phenomenological design and a purposive sampling strategy. Colaizzi’s descriptive phenomenological method was used to analyze the data (Colaizzi, 1978). Five females and two males, aged 23–51, participated in two online focus groups. Dating with a diagnosis of MS is a highly personal phenomenon, characterized by individual differences in values and experiences. Core to the phenomenon was personal decision-making about disclosure of the diagnosis and ongoing adaptation to the fluctuating nature of the condition with partners in new/developing relationships. The findings will help health professionals working with adults with MS understand this important aspect of their lives.

Recognition and management of bladder bowel dysfunction in children with autism spectrum disorder

Children with autism spectrum disorder (ASD) with rigidities, anxiety or sensory preferences may establish a pattern of holding urine and stool, which places them at high risk of developing bladder bowel dysfunction (BBD). BBD, despite being common, is often unrecognised in children with ASD. With this case report of a 7-year-old girl with ASD presenting with acute retention of urine, we attempt to understand the underlying factors which may contribute to the association between BBD and ASD. Literature review indicates a complex interplay of factors such as brain connectivity changes, maturational delay of bladder function, cognitive rigidities and psychosocial stressors in children with ASD may possibly trigger events which predispose some of them to develop BBD. Simple strategies such as parental education, maintaining a bladder bowel diary and treatment of constipation may result in resolution of symptoms.

Bullet retrieval from the cauda equina after penetrating spinal injury: A case report and review of the literature

Background: When gunshot injuries occur to the spine, bullet fragments may be retained within the spinal canal. Indications for bullet removal include incomplete spinal cord injury, progressive loss of neurologic function including injury to the cauda equina, and dural leaks with impending risk of meningitis. Case Description: Here, we present a 34-year-old male with a missile penetrating spinal injury to the cauda equina. In addition to the computed tomography scan demonstrating retention of a bullet in the left L1/2 disc space, the scan suggested likely dural injury. The patient underwent a decompression/instrumented fusion with retrieval of the retained bullet fragment. A laminectomy was performed from T12 to L3, and at L1 and L2, a large traumatic durotomy was identified and repaired. The patient, unfortunately, continued to have bilateral lower extremity plegia with neurogenic bladder/bowel dysfunction at 1-year follow-up. Conclusion: We discuss the operative management and provide an intraoperative video showing the bullet extraction and dural closure.

Successful intrathecal neurolytic block for the management of cancer pain in a 10-year-old child: a case report

Background Cancer pain management in children is challenging owing to their unique patient characteristics. We present the case of a 10-year-old girl whose cancer pain was successfully managed using an intrathecal neurolytic block. Case presentation The patient experienced severe cancer pain due to recurrent right ilium osteosarcoma. The tumor progressed rapidly despite chemoradiotherapy and gradually invaded the right lumbar plexus, which resulted in severe neuropathic pain in the right lower extremity. Systemic analgesics failed to attenuate the pain. We performed an intrathecal neurolytic block using 10% phenol-glycerol. The neurolytic block completely relieved her right lower extremity pain. After the block, the patient’s quality of life improved, and she spent her time with family. Conclusions The intrathecal neurolytic block successfully relieved the patient’s cancer pain. Successful intrathecal neurolytic blocks require meticulous pain assessment of individual patients, to avoid possible serious complications such as paresis/paralysis and bladder/bowel dysfunction.