Abdominal paresis and pseudo-hernia secondary to herpes zoster infection: A case report and systematic analysis.

Background: Abdominal pseudo-hernia secondary to herpes zoster infection is rare and the clinical features and factors affecting recovery remain poorly understood. Aim: We aimed to describe the clinical features of patients with abdominal pseudo-hernia secondary to herpes zoster infection and attempt to identify factors associated with poor recovery. Design: Literature review and retrospective Analysis. Methods: We report a case and performed a retrospective, systematic review of the demographic background, clinical characteristics and outcomes of patients with abdominal pseudo-hernia secondary to herpes zoster infection in the literature over 20 years (2001-2021). Results: We analyzed a total of 34 cases. The median age of the patients was 71.5 years. Most of the patients were male (n = 27, 79.4%). The most frequently affected dermatome was T-11 (n = 20, 66.7%). In four (12.5%) patients, abdominal pseudo-hernia started before the onset of rash. In all patients (n = 12, 100%) who underwent nerve conduction study and electromyography, there was electrophysiological evidence of acute denervation. Seven patients (20.6%) had imaging features suggestive of abdominal wall atrophy and denervation. The majority of patients had good recovery. The median follow-up time was 3 (15 days-12 months) months. Patients with pre-existing medical conditions (p = 0.03) were more likely to have a worse recovery. Conclusion: Abdominal pseudo-hernia is a rare complication of herpes zoster infection with a good prognosis for recovery, although patients with pre-existing disease appear to recover worse. In rare cases, it may occur before the onset of typical zoster rashes and should be suspected, especially in older, male patients with involvement of the lower thoracic dermatomes.

Encephalopathy as the Only Manifestation in Simultaneous Arterial Infarct and Cerebral Venous Sinus Thrombosis in Recent COVID-19 Infection.

BACKGROUND Emerging cases of SARS-CoV-2 infection associated with cerebral thromboembolism episodes manifesting as arterial strokes or cerebral venous thrombosis have been reported. However, the co-occurrence of arterial strokes and cerebral venous thrombosis is rare. CASE REPORT We report the case of a previously healthy young patient with recent SARS-CoV-2 infection, who presented with encephalopathy. His computed tomography venography and magnetic resonance imaging of the brain showed thrombosis of the vein of Galen and straight sinus, and arterial infarcts in both hemispheres. His inflammatory markers, D-dimer levels, and coagulation profile were normal. He was started on anticoagulation and recovered well. CONCLUSIONS Concurrent arterial and venous thrombosis can happen rarely in patients with SARS-CoV-2 infection, including patients who have recently recovered from COVID-19. Cerebral thromboembolism associated with SARS-CoV-2 can present with a variety of subtle clinical manifestations, including encephalopathy without focal neurological deficits. Inflammatory markers, D-dimer levels, and coagulation profiles can be normal, especially in patients with mild infection or who have recovered from the infection. Therefore, it is important to be vigilant and recognize this clinical entity so that the diagnosis can be made and treatment can be started promptly. However, larger and prospective studies are needed to determine the clinical outcomes, therapeutic benefits, and complications of concurrent arterial stroke and cerebral venous thrombosis associated with SARS-CoV-2 infection.

An Unusual Case of Stroke as the Initial Manifestation of Early Takayasu Arteritis with Normal Erythrocyte Sedimentation Rate (ESR): Diagnosis and Treatment.

BACKGROUND Takayasu arteritis is a rare systemic inflammatory vasculitis of granulomatous nature. The etiology of Takayasu arteritis is still unknown and it affects the aorta and its main branches. Takayasu arteritis is more common in Asians and women of childbearing age. However, ischemic stroke as the initial manifestation of Takayasu arteritis is uncommon. We report a young, stroke patient in early Takayasu Arteritis with normal ESR who improved with immunosuppressants. CASE REPORT A previously healthy young patient was admitted to hospital due to lethargy, limbs claudication, and altered mental status. The patient was also febrile, hypertensive, and her physical examination revealed carotid artery tenderness and a loud carotid bruit suggestive of carotid stenosis or an active inflammatory process. Her erythrocyte sedimentation rate was normal. Magnetic resonance imaging of the brain showed acute ischemic stroke and a computed tomography angiogram showed typical angiographic features, so the diagnosis of Takayasu arteritis with acute ischemic stroke was made. The patient's condition improved with corticosteroid therapy without residual neurological deficits. CONCLUSIONS In conclusion, stroke may rarely be the first symptom of Takayasu arteritis, and the ESR value may be normal even in early, active disease. A normal ESR value should not lead to false reassurance. A thorough clinical examination and angiographic features remain the criterion standard for the diagnosis of Takayasu arteritis. The mainstay of treatment for Takayasu arteritis consists of glucocorticoids and immunosuppressants. Further studies are needed to demonstrate the therapeutic benefit of antithrombotic and vascular intervention in this clinical entity.

Longitudinally extensive transverse myelopathy in spinal cord infarction.

Spinal cord infarction may present as longitudinally extensive myelopathy, similar to inflammatory myelitis such as neuromyelitis optica. Magnetic resonance imaging features such as diffusion-weighted imaging/apparent diffusion coefficient showing restricted diffusion and lack of contrast enhancement are helpful in the diagnosis of spinal cord infarction and differentiating them from inflammatory myelitis.

Orbital apex syndrome secondary to herpes zoster ophthalmicus: Clinical features and outcomes case report and systematic review.

BACKGROUND: This study aimed to describe the clinical features of patients with orbital apex syndrome (OAS) as a complication of herpes zoster ophthalmicus (HZO) and to identify factors associated with poor visual acuity outcomes. METHODS: We performed a systematic review and retrospective analysis of the clinical characteristics and outcomes of patients with OAS secondary to HZO reported in the literature over 42 years (1978-2020). RESULTS: We analysed 21 cases, 20 of which were identified in the literature, together with our patient. Their median age was 65 years, with equal involvement in both sexes. The median onset of OAS due to HZO was 10 days (range 1-28 days). The median time of treatment initiation was five days (range 1-21 days). All patients presented with reduced visual acuity, complete ophthalmoplegia, and ptosis. Most patients (17/21, 80.95%) were treated with systemic antiviral and corticosteroid therapy. Three (3/21, 14.29%) patients were immunocompromised. Recovery for ophthalmoplegia (19/21, 90.48%) and ptosis (16/21, 76.19%) was good. Half of the patients (9/18, 50%) showed poor vision recovery. Starting treatment more than 72 h after HZO onset (p = 0.045) was more likely to cause poor vision recovery. CONCLUSION: OAS is a rare, serious, and potentially late complication of HZO and continued observation up to and perhaps beyond four weeks is justifiable, if not encouraged. Early initiation of treatment with systemic antiviral and/or corticosteroids within 72 h of onset of HZO appears beneficial for the recovery of visual acuity.