Acute ischemic stroke in COVID-19: a case report

Corona virus disease (COVID-19) is an infectious disease caused by SARS-CoV-2 virus. It predominantly affects respiratory system causing fever, cough, and breathlessness. But it can also affect central nervous system. Clinicians must adopt methodical approach in investigating a patient with neurological manifestation. Early detection and treatment is required for neurological disease of COVID-19 to reduce post COVID neurological sequel.

Pneumococcal Meningitis Among Children in the Post-13-Valent Pneumococcal Conjugate Vaccine Era: Three Case Reports

We report three cases under two years of age, of meningitis due to Streptococcus pneumoniae in vaccinated children. Two grew non-typable strain and the third serotype 10A. All improved with no neurological sequel. Continued monitoring of the epidemiology of bacterial meningitis within the post13-valent pneumococcal conjugate vaccine introduction is warranted.

A prospective observational study to describe magnetic resonance imaging findings in perinatal asphyxia in terms of severity, outcome and neurological sequel in term and preterm babies

Background: Perinatal asphyxia is a significant cause of neonatal mortality and morbidity. MRI is useful for assessing the severity and pattern of brain injuries. There is less data of MRI findings of perinatal asphyxia from India and the subcontinents. This prospective observational study was done to describe MRI brain findings in neonates with perinatal asphyxia with respect to various determinants.Methods: Initial MRI brain was done when babies were stable after fulfilling inclusion criteria. Immediate outcome was assessed at the end of hospital stay. They were followed up for presence of any sequel up to 1 year. Repeat MRI brain was done in few selected babies. Data was collected and statistically analyzed.Results: Total 55 babies were included in the study (term 27, preterm 28). There were 9 babies in stage 1, 17 babies in stage II and 22 babies in stage III. MRI brain findings were normal in 8 and abnormal in 47 patients. There were Deep gray matter injury (DG) in 22, Para Sagittal subcortical white matter injury (PS) in 6, Germinal matrix haemorrage (GMH), intraventricular haemorrage (IVH) and Periventricular leucomalacia (PVL) in 12 and Mixed pattern of injury in 7 babies. Findings among 9 expired babies were: 4 (44.4%) DG, 2 (22.2%) GMH+IVH and 3 (33.3%) mixed. There was neurological sequel in 13 babies (48.1%). Babies with normal MRI initially had no sequel.Conclusion: Brain injury due to perinatal asphyxia follows several patterns according to gestational age and severity. Early and accurate recognition of these patterns with the help of MRI brain helps in managing the baby and predicting the prognosis.

Detection of Zika virus in paired urine and amniotic fluid samples from symptomatic and asymptomatic women and their babies during a disease outbreak: association with neurological symptoms in newborns

Paired maternal and newborn urine and amniotic fluid from 138 subjects collected during a Zika virus (ZIKV) outbreak was analyzed for ZIKV by gene amplification (RT-qPCR), and the findings were correlated with clinical symptoms and neurological anomalies in the babies. ZIKV was detected in 1 of 9 symptomatic women (11.1%) and in 19 of 129 asymptomatic women (14.7%). Neurological manifestations were present in 19 babies (13.7%), 10 of 20 (50%) positive and 9 of 119 (7.6%) negative (p < 0.001) for ZIKV. Twelve (8.6%) urines collected during gestation were ZIKV-positive; only 2 remained positive for ZIKV postpartum. Six (4.1%) newborn urines collected within 1 day of delivery were ZIKV-positive cases. In 3 of these cases, ZIKV was detected in mother’s urine pre- and postpartum and in both mother’s urine and babies’ urine. Four of the amniotic fluid samples (2.9%) were ZIKV-positive. Among ZIKV-negative babies with neurological sequel, 87.5% were female; in contrast, 72.7% ZIKV-positive babies with neurological abnormalities were male (p = 0.019). We conclude that during a ZIKV outbreak, clinical symptoms and ZIKV detection in biological fluids are poor predictors of infection and adverse neurologic sequel in newborns.

Role of Matrix Metalloproteinase-9 in Neonatal Hypoxic-Ischemic Encephalopathy

BACKGROUND: Neonatal encephalopathy is a heterogeneous syndrome characterised by signs of central nervous system dysfunction in the newborn. Matrix metalloproteinase-9(MMP-9) increases the blood-brain barrier permeability, and their inhibitors can reduce its damage. MMP-9 has been implicated specifically in cerebral ischemia. AIM: To measure serum MMP-9 in neonatal hypoxic-ischemic encephalopathy and evaluate its correlation to the severity of early prediction and treatment. METHODS: its case-control study. The serum concentration of MMP-9 was determined by ELISA in 100 hypoxic neonates and 50 healthy neonates of matched age and sex who served as controls. RESULTS: In our present study the serum MMP-9 level was significantly higher at p = 0.0001 in hypoxic-ischemic full-term newborns (176.7 ± 68.7 ng/ml)as compared to control newborn (69.4 ± 34.85 ng/ml)and it was significantly higher at p = 0.0075 in hypoxic-ischemic preterm newborn (171.2 ± 132.9 ng/ml) when compared to control newborn (72.54 ± 36.74 ng/ml),also MMP-9 was significantly higher at Sarnat stage III at p = 0.0001. CONCLUSION: Serum MMP-9 level was significantly higher in hypoxic-ischemic newborns, and significantly increased with severity, so we suggest that serum MMP-9 level is important for predicting neurological sequel and severity in neonatal encephalopathy.

Abstract 111: Analysis of Successful Resuscitation for an Emergency in School Demonstrates Contribution of Teachers and Proposes Issue for Location of Automated External Defibrillator

BACKGROUND: Considerable numbers of cardiac emergencies have been resuscitated without neurological sequel by public action of resuscitation and defibrillation. Since resuscitated cases are increasing also in Japanese schools, it is necessary to investigate factors for successful resuscitation. METHODS: Students resuscitated with AED were picked up from all issues in Mutual Aid Insurance System for Schools from 2005 to 2011. A total of 128 students were listed and classified to victims and survivors. Victims consisted of 62 cases that died or had brain sequel, and survivors consisted of 66 cases that recovered without sequel. Demography, causative disease, AED user, and the location of resuscitation in both groups were compared. RESULTS: Number of enrolled cases increased from 4 to 35 annually. School grade distribution is similar between two groups. Male to female ratio was 4.6 in victims and 2.1 in survivors (p=0.07). The most causative disease was cardiomyopathy (HCM) (22.6%) in victims, and ventricular fibrillation (VF) (28.8%) in survivors. They are the second in each other group. The third was congenital disease (8.1%) in victims, and long QT syndrome (LQT) in survivors (10.6%). In survivors, 6 cases were previously implanted ICD and 11 cases were implanted ICD after resuscitation and returned to school. Ambulance crew operated AED in 35.8% and 12.2% cases, and schoolteachers did in 64.2% and 87.8% of victims and survivors, respectively. Rate of successful resuscitation was significantly higher in cases operated by schoolteachers than that by ambulance crew (p<0.01). Concerning location of resuscitation, 62.9% of victims and 71.2% of survivors were resuscitated at athletic field or gymnasium. Prevalence of resuscitation at swimming pool in victims was 2/62(3.2%) and was significantly less than that in survivors, which was 9/66(13.6%) (p<0.05). Prevalence at classroom was 6/62(9.7%) in victims was significantly more than that in survivors, which was 1/66(1.5%) (p<0.05). CONCLUSIONS: AED operation by teachers improve prognosis of cardiac emergencies in Japanese schools. AED should be placed near athletic field, gymnasium, pool, and ideally on the way to school for possible student.

Tuberculous Meningitis in Adults: A Review of 160 Cases

Objective. This study aimed to evaluate epidemiological, clinical, laboratory, and neuroimaging features of 160 adult patients with tuberculous meningitis (TBM) according to “Thwaites’ diagnostic index.”Methods. The subjects of this retrospective study are the patients with TBM who were followed up between years 1998 and 2009 in a tertiary referral hospital. Diagnosis of TBM was based on clinical, laboratory, and neuroimaging signs and Thwaites’ diagnostic index.Results.Mycobacterium tuberculosiswas isolated from CSF in 59 of 148 patients. Seventeen percent of the patients died, 71% recovered completely, and 13% recovered with neurological sequel at the end of the sixth month.Conclusions. Despite new developments in laboratory or neuroimaging techniques, the diagnosis of TBM is still based on clinical features with the help of laboratory. Early diagnosis by suspecting TBM may prevent therapy delay and may result in decrease in the mortality and morbidity.

Tuberculous meningoencephalitis with severe neurological sequel in an immigrant child

ABSTRACTCentral nervous system tuberculosis (TB) is the most devastating manifestation of TB. It is a challenge for clinicians because of the diffi culty in making an early diagnosis and the severe consequences of delayed treatment. The aim of this report is to point out the relation between migration and TB based on a 14-year-old child with tuberculous meningoencephalitis (TBM) of an immigrant family. Migration, crowded living conditions and positive family history contribute to the severe course of TB as TBM and miliary TB forms. TB control may prevent these severe manifestations of the disease among immigrants. Prompt diagnosis with helpful early diagnostic tools like polymerase chain reaction in TBM is crucial due to the high mortality and morbidity.

MANAGEMENT OF CANDIDAL VERTEBRAL OSTEOMYELITIS – REPORT OF SIX CASES

From September 1994 to April 2001, we treated six cases of Candida spondylitis (five patients by surgery, and one by conservative approach). The age ranged from 16 to 60 years old. Four were men, and two women. The patients were associated with the following underlying diseases: one with renal failure, one with rheumatic heart with valve replacement, one with drug addiction, one apparently healthy patient, and two patients with leukemia. Because five patients had suffered from severe and persistent low back pain and had neurological deficits, anterior approach to debride the infected vertebral focus and strut bone grafting was performed. Additional posterior implant placement was performed in two cases, and anterior instrumentation in one case for further stabilization. Fluconazole was supplementary to amphotericin B in three patients. The other three patients received fluconazole. One patient had double spinal lesions — one in the lumbar, while the other in the thoracic T9–10 level caused paraplegia. Staged operation was performed, starting from lumbar and followed by operating over the thoracic lesion. Infection was under control, but the patient had partial neurological recovery (Frankel D). He died 54 months later due to poor general conditions, recurrent bacterial sepsis and pneumonia. In other five patients, infection was well under control and without neurological sequel. The treatment principles of Candida spinal infection are similar to those of pyogenic spondylitis. Anterior debridement of the infective focus and bone grafting are beneficial in controlling infection and achieving stable healing. Posterior instrumentation can be applied for further stabilization without compromising the control of Candida infection. Fluconazole was effective in treating Candida spondylitis, and it must be prescribed after surgery.