Venom Induced Toxic Ventriculitis Resulting in Acute Reversible Communicating Internal Hydrocephalus, Acute Pituitary Haemorrhage, Acute Hypopituitarism, Acute Kidney Injury, Septicaemia, Cellulitis and DIC Due to Viper Bite in a Young Farmer: A Case Report

A young farmer, tenth standard student, helping his grandfather during holiday, developed anuria after viper bite. Because of headache, non-enhanced CT scan head was done on admission which showed a small pituitary haemorrhage with normal ventricles. Later, he had generalized fits and second non-enhanced CT scan head was repeated which revealed a small pituitary haemorrhage with dilated ventricles. He also had acute kidney injury, septicaemia, cellulitis and DIC. The serum level of TSH, free T3 & free T4 were low; thus, replacement was done. Cerebrospinal fluid study (protein, sugar, cells) including culture was normal. Renal replacement therapy (haemodialysis), platelets transfusion and antibiotics were given. He had torrential polyuria (urine output 12 liter per day) when he recovered from renal failure and it improved dramatically with desmopressin replacement. There was improvement in third non-enhanced CT scan head and fourth one was consistent with normal ventricle and reduction in size of pituitary haemorrhage.

Systemic coccidioidomycosis in a llama cria native to Missouri

A 3-mo-old male llama was examined because of a 4-wk history of lethargy and ill thrift. Clinical examination revealed subcutaneous masses in the left prescapular and right inguinal regions, mild ataxia, a slight head tilt to the right, and right ear droop. The cria died before clinical workup was complete. At autopsy, there was generalized lymphadenomegaly, a hepatic nodule, a midbrain mass causing rostral compression of the cerebellum, and internal hydrocephalus. Microscopic findings included pyogranulomatous lymphadenitis, meningoencephalitis, hepatitis, and bronchopneumonia. Intralesional fungal spherules, most consistent with Coccidioides spp., were identified in the lymph nodes, lung, and brain. Fungal culture, single-nucleotide variation genotyping real-time PCR, and DNA sequencing confirmed Coccidioides posadasii. The dam of the cria was native to Arizona and had been moved to Missouri ~2.5 y previously. Agar gel immunodiffusion assay of the herd revealed that only the dam was positive for Coccidioides spp.; 6 herdmates were negative. Computed tomography of the dam revealed multiple nodules within the lungs and liver, which were presumed to be an active coccidioidomycosis infection. This case of systemic coccidioidomycosis in a llama native to Missouri was presumably acquired by vertical transmission from the dam.

"Eppur si muove" - Clinical case: evolutionary "saga" during the last 6 years: posttraumatic subdural hematoma, decompressive craniectomy, right hemiplegia and aphasia, cranioplasty, hydrocephalus and porencephaly, post-traumatic encephalopathy - in remission

The case reports a 59-year-old male patient who suffered a severe head injury (affirmative by accidental fall from 3 m) with multiple hemorrhagic lesions (bifrontal, bioccipital, biparieto-temporal) and left cerebral subdural hematoma, requiring a large fronto- temporo-parietal decompressive craniotomy for the mass lesion evacuation. Cranioplasty was performed after 6 months. The paper synthesizes the evolution over six years of follow-up (12 in-patient admissions and 4 out-patient evaluations), like in a neurorehabilitation cinematographic “saga”. The posttraumatic encephalopathy had a peculiar evolution, sugestively compared with the humps of a camel: the brain injury (determined coma, right hemiplegia and mixed aphasia, intense psycho-motor agitation, severe dysphagia for solids and liquids, neurogenic bladder, anemia), was followed by a slowly progressive favorable neuro-psychological evolution (after the decompressive craniectomy). A brutal neurological fall-down was noticed after the cranioplasty, and finally a gradually favorable ascending trend, towards a global neuro-psichological stabilization (with an almost imperceptible sequelary ataxic hemiparesis). The paper discusses the pathophisiological aspects focused on the decompressive craniectomy and cranioplasty, correlated to the patient’s evolution. Complications of each neurosurgical procedures are succinctly depicted. The traumatic encephalopathy was complicated with post-traumatic seizures (therapeutically controlled) and active internal hydrocephalus with interstitial edema and an ischemic lesion. Finally it was a "happyend", with favorable clinical evolution, towards a stable and stationary normotensive asymmetric hydrocephalus, with a gigantic and deforming porencephaly. The paper advocates for a carefully follow-up and prompt intervention in order to prevent recurrences and/ or complications (secondary and tertiary prophylaxis). Keywords: traumatic brain injury, subdural hematoma, decompressive craniectomy; cranioplasty; internal hydrocephalus; post-traumatic encephalopathy; seizures; neurorehabilitation,

Severe Encephalitis in Infant with COVID-19: A Case Report

BACKGROUND: Encephalitis is a serious condition that contains neurological dysfunction cause by inflammation of the brain tissue. Etiological factors for the occurrence of this condition include infectious and non-infectious causes. CASE REPORT: We are presented 9-month-old infant referred to our clinic in convulsive status, fever, and disturbed consciousness. From anamnestic information, the infant has been febrile for 2 days with profuse vomiting initiating just before admission at the clinic. At the moment of admission in the clinic, the infant looked intoxicated with generalized tonic-clonic seizures, with shortness of breath and fever with a weakened reaction to painful stimuli. It was admitted in the Isolation Unit by the protocol of the clinic. Laboratory investigations were done. Due to the persistence of convulsive status, a computed tomography scan of the brain was performed with the finding of enlargement of the lateral ventricles, with intraventricular masses and pronounced internal hydrocephalus. The results of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from the infant were positive as well as the grandmother. The infant was intubated immediately and put on mechanical ventilation SIPPV. CONCLUSION: Our case report could suggest that SARS-CoV-2 infection may cause severe clinical symptoms, neurological manifestations, and encephalitis in infants.

Obstetrical Management of Hydrocephalic Fetal Monster in a Tharparker Cow: A Case Report

Hydrocephalus condition is described either as an external or an internal. In the external hydrocephalus (Vidya Sagar et al., 2010), fluid accumulates in the subarachnoid space exterior to the brain, whereas in the internal hydrocephalus fluid accumulates in the ventricles of the brain. There are several forms of congenital deformity in the bovine fetus. Among them, congenital hydrocephalus has been described in cattle (Purohit et al., 2006; Dar et al., 2012; Ravikumar et al., 2013; Tripathi et al., 2014; Prakash et al., 2016; Megahed, 2017; Chhetri et al., 2018 ) and buffalo (Salunke et al., 2001; Kumaresan et al., 2003; Pandey et al., 2010). The diagnosis of the condition is easy if the fetus is in an anterior presentation. In fetuses with very large heads, puncture of the head with a trochar is advocated to relieve dystocia, along with routine obstetric maneuvers (Salunke et al., 2001) Sometimes, the calf may be born normally (Vidya Sagar et al., 2010) or by cesarean section when required (Kumaresan et al., 2003; Megahed, 2017). This paper aims to report a case of fetal hydrocephalus delivered per vaginally after obstetrical management in a Tharparker cow.

Management of a patient with acute internal hydrocephalus, ventriculitis and bronchopneumonia

A 69-year-old patient, with a long history of lung tuberculosis, with lymphopenia was emergently admitted in our hospital for bronchopneumonia, ventriculitis, acute internal hydrocephalic. He was aggressively treated with iv Meropenem and Vancomycin, intraventricular high doses of Vancomycin, aerosols, Dexametazone with healing of internal hydrocephalus, ventriculitis and improvement of bronchopneumonia.

Diagnosis and treatment of internal hydrocephalus in dogs in relation to our own observations

Hydrocephalus is a congenital or acquired neurological disorder in dogs, associated with the excessive accumulation of cerebrospinal fluid (CSF). The factors contributing to hydrocephalus development are diverse and not always possible to determine. The aim of this article was to present two cases of the diagnosis and treatment of internal hydrocephalus in dogs. The observations included animals with neurological disorders of unknown origin. Internal hydrocephalus was diagnosed based on the results of magnetic resonance imaging, and the treatment of both patients comprised ventricular brain drainage. The surgical treatment was fully effective for one dog. For the other dog, a short-term improvement was followed by deterioration in condition due to occlusion of the ventriculoperitoneal drain, and the owners decided to euthanize the animal. The analysis of our cases led to the conclusion that congenital hydrocephalus is a disorder that challenges veterinarians in terms of diagnosis and therapy, due to limited access to advanced imaging techniques such as MRI or CT, and from the complicated nature of the surgical treatment. However, it should be noted that if the disorder is correctly diagnosed and ventricular brain drainage is adequate, the chances for successful functioning are significant.