Bilateral Cerebral Venous Thrombosis with a Rare Presentation in a COVID-19 Patient: A Case Report / Trombose venosa cerebral bilateral com apresentação rara em paciente com COVID-19: Relato de caso

Since the COVID-19 pandemic started, millions of peoples are involved. The presentation of the disease varies from mild respiratory symptoms and multiple organ failure to coma and death. Neurological symptoms such as headache or seizure are also coincident with COVID-19. Thromboembolic events increase in COVID-19 patients due to hypercoagulability and inflammation, particularly in severely ill patients. Thrombosis may cause venous thrombosis, pulmonary embolism, or cerebral sinus venous thrombosis (CSVT). Cerebral sinus venous thrombosis is a rare phenomenon that is usually found in critically ill patients with bad prognoses. In the present case report, we present a 40-year-old man with COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR) who was admitted due to acute bilateral visual loss due to bilateral transverse sinus thrombosis. Pseudotumor cerebri disease was confirmed through high lumbar puncture. Early surgical intervention (optic nerve fenestration) was performed and, fortunately, his visual acuity improved. Cerebral sinus venous thrombosis is a rare incident in COVID-19 patients, but due to irreversible complications, an early diagnosis is fundamental. In any neurologic change in COVID-19 patients, CSVT must be considered. Also, prophylactic thrombolytic therapy should be kept in mind as the patient is admitted.

Desde o início da pandemia da COVID-19, milhões de pessoas estão envolvidas. A apresentação da doença varia desde sintomas respiratórios leves e falência de múltiplos órgãos até coma e morte. Sintomas neurológicos, como dor de cabeça ou convulsão, também coincidem com COVID-19. Os eventos tromboembólicos aumentam em pacientes com COVID-19 devido à hipercoagulabilidade e inflamação, particularmente em pacientes gravemente enfermos. A trombose pode causar trombose venosa, embolia pulmonar ou trombose venosa do seio cerebral (TVC). A trombose venosa do seio cerebral é um fenômeno raro, geralmente encontrado em pacientes gravemente enfermos e com mau prognóstico. No presente relato de caso, apresentamos um homem de 40 anos com COVID-19 confirmado por reação em cadeia da polimerase em tempo real (RT-PCR) que foi internado devido a perda visual bilateral aguda causada pela trombose bilateral do seio transverso. A doença pseudotumor cerebral foi confirmada através de punção lombar alta. Foi realizada intervenção cirúrgica precoce (fenestração do nervo óptico) e, felizmente, sua acuidade visual melhorou. A trombose venosa do seio cerebral é um incidente raro em pacientes com COVID-19, mas devido a complicações irreversíveis, um diagnóstico precoce é fundamental. Em qualquer alteração neurológica em pacientes com COVID-19, a TVCS deve ser considerada. Além disso, a terapia trombolítica profilática deve ser lembrada quando o paciente é internado.

Multiple Brain Abscesses by an Air Gun Shot: A Case Report

Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types ofmicroorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in nontraumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injurywith air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

An Unusual Dermoid Cyst of the Pineal Region: Case Report in a Child

Introduction The pineal gland is a common location for intracranial germ cells, but dermoids are not commonly observed in this area. In the present paper, we discuss the clinical and radiological features as well as the treatment and outcome of this cyst in a 6-year- old child with a pineal dermoid cyst. Case Presentation The patient presented with chronic headache 6 months before admission in 2018. On the first admission, an enhanced lesion with a small cyst was detected in brain imaging. Magnetic resonance imaging (MRI) of the brain at follow-up (2 months after the first presentation) showed enlargement of the cyst size with compression on the adjacent structures. Radical excision of the tumor was performed after the endoscopic biopsy due to pressure exerted on the adjacent structures. Conclusion Dermoid cyst should be considered as a differential diagnosis for enhanced lesions of the pineal region.