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1.
Neurological Sciences ; 43(Supplement 1):S55, 2022.
Article in English | EMBASE | ID: covidwho-2174302

ABSTRACT

Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinic-radiological entity that may present with non-specific clinical symptoms, namely headache, visual disturbances, seizures and altered mentation. The typical neuroimaging finding is a symmetric vasogenic edema predominant in the subcortical parietal-occipital white matter. Case presentation: A 31-year-old pregnant woman with a history of gestational hypertension, underwent cesarean section after spinal-epidural analgesia. Later she complained about bilateral orthostatic headache so post dural puncture headache was diagnosed. Puerperium was complicated by fever associated with bilateral interstitial pneumonia (with a suspected SARSCoV- 2 etiology). Ten days after delivery, she developed a severe, frontal, non postural headache associated with hypertension (160/100 mmHg). On the following morning a generalized convulsive seizure occurred;during neurological evaluation she was conscious but very drowsy without other neurological signs. Magnetic resonance imaging (MRI) was performed and showed asymmetric hypersignal intense lesions in the cortical and subcortical fronto-parietal lobes and left temporal lobe in both the fluid-attenuated inversion recovery (FLAIR) sequence and apparent diffusion coefficient (ADC);these lesions were not recognized in diffusion-weighted imaging (DWI). There was also extensive signal abnormality in the bilateral cerebellar hemispheres and within callosal splenium;pathologic contrast enhancement was present in the corpus callosum and in left frontal cortical area. PRES was considered due to clinical presentation and neuroimaging;differential diagnosis included encephalitis (maybe related to COVID-19) and Reversible Cerebral Vasoconstriction Syndrome. Cerebrospinal fluid (CSF) analysis revealed mildly increased level of cell count (9 cells/muL, normal: <5 cells/ muL, 55,6% polymorphonuclear cells), normal proteins without glucose consumption;oligoclonal bands were not detected. CSF bacterial culture was negative as well as viral panel (included herpes simplex virus type 1 and 2, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus and SARSCoV2). MR angiography was negative for vasospasm. Antiepileptic and antihypertensive drugs were administered;follow-up brain MR performed in 10 days showed complete resolution of the lesions. The patient was discharged from hospital in good clinical conditions. Discussion(s): We present a tricky diagnosis of eclampsia-associated PRES. History of dural puncture and pneumonia were confounding clinical factors;atypical imaging findings (cerebellar and callosal lesions associated with contrast enhancement), on the other hand, could lead clinicians to diagnose other etiologies (such as hypoxic-ischemic injury or encephalitis). Conclusion(s): Since signs and symptoms of PRES are not specific, MRI is vital for diagnosis. Nevertheless, atypical imaging findings must be known in order not to mistakenly reject the diagnosis of PRES.

2.
Ann Med Surg (Lond) ; 84: 104852, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2095026
3.
Chest ; 162(4):A1128-A1129, 2022.
Article in English | EMBASE | ID: covidwho-2060777

ABSTRACT

SESSION TITLE: Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Superior sagittal sinus (SSS) thrombosis is a rare cause of stroke that is difficult to identify due to various clinical presentations. It is the most common form of dural sinus thrombosis, and common risk factors include hypercoagulable state, traumatic head injury, pregnancy/postpartum, and malignancy. More than 85 percent of adult patients have at least one risk factor for cerebral venous thrombosis. Some patients with SSS thrombosis do not have clearly identifiable risk factors, and this case highlights one such patient. CASE PRESENTATION: A 60-year-old Caucasian male with hypertension, hyperlipidemia, and a recent intracranial hemorrhage with residual left-sided weakness, presented to the emergency department with worsening left-sided weakness. Upon admission, his physical exam was notable for 4/5 strength in the left upper extremity and 2/5 strength in the left lower extremity. This was a reduction in strength from a baseline of 4/5 in the left upper and lower extremities. Labs on admission were normal except for high-sensitivity troponin of 86 and WBC of 14.5. UA with a small amount of blood. An initial CT brain without contrast showed no acute changes, evolutionary changes in the right frontal temporal lobe, and subtle curvilinear hyperdensity near a site of the intracranial hemorrhage identified in the prior month. This curvilinear hyperdensity was thought to reflect early parenchymal calcification. MRI brain without contrast showed new and evolving areas of abnormal signaling and an evolving hematoma with surrounding vasogenic edema, all of which are in the right lobe. There was no apparent diffusion coefficient correlate. Thus, MRI with contrast and MRV was recommended. EEG showed no evidence of epileptiform activity. Additionally, transthoracic echo demonstrated new non-ischemic cardiomyopathy with an EF of 35-40%. The diagnosis was ultimately made after the patient had a Magnetic Resonance Venography (MRV) which showed evidence of the SSS thrombosis and an indication that the previously visualized curvilinear hyperdensity is suspected to represent slowed flow within a surface vein. Heparin was started to recanalize the sinus and prevent thrombus propagation. After the appropriate treatment was started, the patient's weakness improved dramatically. DISCUSSION: Typically, patients with SSS thrombosis have identifiable risk factors like hypercoagulable states, traumatic head injuries, pregnancy/postpartum, malignancy, and more recently association with COVID-19 infection. In this case, since the patient lacked identifiable risk factors, the MRV played a key role in the diagnosis. CONCLUSIONS: Like our patient, 30-40 percent of patients present with an intracerebral hemorrhage. Differentials of SSS thrombosis should be considered in etiologies for intracerebral hemorrhage, especially when an identifiable cause is lacking, in order to avoid delays in treatment and resolution. Reference #1: Abdalkader M, Shaikh SP, Siegler JE, Cervantes-Arslanian AM, Tiu C, Radu RA, Tiu VE, Jillella DV, Mansour OY, Vera V, Chamorro Á, Blasco J, López A, Farooqui M, Thau L, Smith A, Gutierrez SO, Nguyen TN, Jovin TG. Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature. J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105733. doi: 10.1016/j.jstrokecerebrovasdis.2021.105733. Epub 2021 Mar 4. PMID: 33743411;PMCID: PMC7931726. Reference #2: Rehman A, Husnain MG, Mushtaq K, Eledrisi MS. Cerebral venous sinus thrombosis precipitated by Graves’ disease. BMJ Case Rep. 2018 Jun 4;2018:bcr2017224143. doi: 10.1136/bcr-2017-224143. PMID: 29866676;PMCID: PMC5990097. Reference #3: Nakase H, Takeshima T, Sakaki T, Heimann A, Kempski O. Superior sagittal sinus thrombosis: a clinical and experimental study. Skull Base Surg. 1998;8(4):169-74. doi: 10.1055/s-2008-1058178. PMID: 17171061;PMCID: PMC1656696. DISCLOSURES: No relevant rel tionships by Ken Johnson No relevant relationships by Nina Le No relevant relationships by Riaz Mahmood No relevant relationships by Ngoc Phan

4.
Radiol Case Rep ; 17(10): 3659-3662, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1967028

ABSTRACT

Myositis and myonecrosis are rare sequela of coronavirus disease 2019 (COVID-19). Until now, it has not been seen in muscles of the head and neck. We present a 22-year-old male with 4 months of retroauricular headaches following COVID-19 infection. Magnetic resonance imaging revealed rim-enhancing fluid collections in the bilateral masticator spaces which were sampled by fine-needle aspiration. We also discuss this case in the context of the current understanding of COVID-19-related myositis.

5.
Turkish Journal of Medical Sciences ; 52(2):405-412, 2022.
Article in English | EMBASE | ID: covidwho-1855908

ABSTRACT

Background/aim: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a rare clinicoradiological syndrome that typically presents with central nervous system symptoms such as loss of consciousness, seizure, headache, and ophthalmoparesis. Materials and methods: Here, we highlight the characteristics of this syndrome together with the clinical and MRI findings of 6 pediatric patients with MERS. Results: Between January 2017 and October 2020, 6 patients with MERS (3 boys and 3 girls) presented to our center. The mean age was 122 ± 54.6 (min-max: 44-180) months. None of the patients had a chronic disease. In our study, infectious agents were detected in 4 patients (66.6%), while noninfectious causes (one seizure and the other hyponatremia) were detected in two patients. All of our cases were discharged without any sequelae after an average of 12.1 ± 7 (min–max: 4–20) days of hospitalization. In 1 patient (case 6), control MRI could not be performed, and the radiological recovery of our other patients was shown to be between 14 days and 2 months. Conclusion: MERS is an acute encephalopathy with good prognosis and should be considered by neurologists in differential diagnosis due to its variable clinical presentation and specific MRI findings.

6.
Ann Med Surg (Lond) ; 77: 103662, 2022 May.
Article in English | MEDLINE | ID: covidwho-1800207
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(4): 359-365, 2021 Apr 25.
Article in Chinese | MEDLINE | ID: covidwho-827753

ABSTRACT

Objective: Pelvic high-resolution magnetic resonance imaging (MRI) has now become a standard method for evaluating the efficacy of neoadjuvant treatment for locally advanced rectal cancer (LARC). However, this traditional morphological qualitative assessment method based on T2-weighted imaging (T2WI) is not effective in predicting pathological complete remission (pCR). The purpose of this study is to investigate whether combining the magnetic resonance tumor regression grade (mrTRG) with apparent diffusion coefficient (ADC) can improve diagnostic value for pCR after preoperative neoadjuvant chemoradiotherapy (nCRT) of LARC. Methods: This was a diagnostic study. Clinicopathological data of 134 LARC patients who received nCRT and radical surgery in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed. All the patients underwent MRI which included T2WI and DWI sequences before and 8 weeks after nCRT. Two radiologists independently drew ROIs on T2WI and DWI to estimate mrTRG stage and calculate the mean ADC value. Receiver operating characteristics (ROC) method was applied to evaluate the predict value of mrTRG combined with mean ADC value for pCR. Results: Of 134 LARC patients, 85 were male and 49 were female with median age of 58 (28-82) years. After nCRT, MRI suggested 21 patients (15.7%) had clinical complete remission (cCR), e.g. mrTRG stage 1-2. Postoperative pathology revealed 31 (23.1%) patients had pCR. The evaluations of mrTRG and ADC value by the two readers were highly consistent, and the intra-group correlation coefficients were 0.83 (95% CI: 0.703-0.881) and 0.96 (95% CI: 0.989-0.996), respectively. There was a negative correlation between mrTRG and pCR (r(s)=-0.505, P<0.01), and a positive correlation between mean ADC value and pCR (r(s)=0.693, P<0.01). The ROC curve showed that mrTRG alone had a medium predictive value for pCR, with an area under the curve (AUC) of 0.832 (95% CI: 0.743-0.921); the mean ADC value had a higher predictive value for pCR, with AUC of 0.906 (95% CI: 0.869-0.962). The predictive value of the combined model of mrTRG and ADC value for pCR was significantly better than that of mrTRG alone (P=0.015), and the AUC was 0.908 (95% CI: 0.849-0.968). Conclusion: Both mrTRG and mean ADC value can be non-invasive methods to predict the efficacy of nCRT for LARC. Combining the mean ADC value with mrTRG can result in better pCR prediction.


Subject(s)
Neoadjuvant Therapy , Rectal Neoplasms , Aged , Aged, 80 and over , Chemoradiotherapy , Diffusion Magnetic Resonance Imaging , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Rectal Neoplasms/drug therapy , Rectal Neoplasms/therapy , Retrospective Studies , Treatment Outcome
8.
Radiol Case Rep ; 15(9): 1646-1649, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-635257

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a viral disease, also known as severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, December 2019. Respiratory manifestations from the induced acute lung injury were the most common reported findings. Few cases showed extrapulmonary manifestations. COVID-19-associated neurological manifestations have not been widely reported. In this report, we describe a case of encephalopathy in a patient with COVID-19 infection.

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