Post COVID-19 Lymphocytic Hypophysitis: A Rare Presentation.

Introduction: Lymphocytic hypophysitis (LH) is a rare autoimmune disorder involving the destruction of the anterior pituitary due to lymphocytic infiltration. The disease shows a female predominance, commonly affecting women during late pregnancy into the postpartum period. The etiology of LH has not been well established and is presumed to be autoimmune based on the histopathological findings of lymphocytic infiltration and postpartum cases. Lymphocytic hypophysitis has yet to be studied in the context of a patient status post-recovery from COVID-19. Since the initial outbreak, additional information regarding the symptoms and outcomes has emerged on the virus's effects on the nervous system. Case: We present a novel case of post-COVID lymphocytic hypophysitis in a pediatric patient at Dayton Children's Hospital. An 18-year-old previously healthy girl presented to the emergency department (ED) with acute onset headache and dizziness for 5 days. She had a history of symptomatic COVID-19 three weeks prior to the onset of current symptoms. Contrast enhanced magnetic resonance imaging (MRI) of the brain revealed diffuse thickening and enlargement of the infundibulum with homogenous contrast enhancement of the hypophyseal axis. Based on the suspicion for lymphocytic hypophysitis, she was started on Methylprednisolone 250 mg IV Q6hrs on day 1-3. Symptomatic clinical improvement was seen on day 3 with a significant decrease in the intensity of the headache. Conclusion: The case illustrates the varied presentation and neurological sequalae associated with the COVID-19 virus. The case described here is the first ever reported post-COVID manifestation of lymphocytic hypophysitis.

Utility of electroencephalogram in the pediatric emergency department.

INTRODUCTION: Electroencephalograms (EEG) can be helpful in evaluating patients presenting to the emergency department (ED). METHODS: We reviewed the charts of patients who had an EEG done in the ED at Dayton Children's Hospital in Dayton, Ohio from 2010 to 2018. We divided the indication for EEG into 6 categories, 1) suspected new onset seizures, 2) recurrent seizures, 3) altered mental status, 4) death, 5) non-convulsive status epilepticus, and 6) psychogenic seizures. We collected data on age, gender, suspected diagnosis, EEG result, outcome of the visit in terms of discharge versus inpatient admission, follow up of the patient with respect to a) diagnosis, b) medication, c) recurrent visit to the ED, and d) clinical outcome over a two-year follow up. We also collected data on the results of the subsequent video EEG in patients who had an EEG in the ED and determined whether the video EEG had the same results and/or added any additional information. RESULTS: We studied 162 patients (mean ± SD age 7.8 ± 5.8 years, 42.6% females) with routine EEG in the ED from 2010 to 2018. In 142 patients (87.7%), the EEG was helpful in confirming or ruling out the suspected diagnosis. For the indications of new onset seizures (n = 90), recurrent seizures (n = 48), acute mental status change (n = 22), and psychogenic seizures (n = 5), the EEG was useful in 91.1%, 81.3%, 81.8%, and 100% respectively. Of the 162 patients, 58 were discharged and 104 were admitted. For the 142 patients in whom the routine EEG was diagnostically useful, 59.9% were admitted, compared to 95.0% of the 20 patients in whom the EEG did not help in clarifying the diagnosis (p = 0.002). In 31 of the admitted patients, a video EEG was done. In the 31 patients who obtained video EEG, it did not add any additional information in 23 patients while in 8 patients (25.8%) the video EEG provided additional information that was useful for diagnosis and management. CONCLUSIONS: EEG done in the ED is a useful diagnostic tool that may prevent admission to the hospital. Video EEGs should be considered in patients where the diagnosis is uncertain despite obtaining a routine EEG in the ED.

Community Healthy Workers Fill in the Gaps for Participants Who Became Lost to Follow-up in a Healthy Start Program.

The purpose of this mixed methods study was to solicit information from Community Health Workers (CHWs) in order to further understand reasons for Healthy Start participants becoming lost to follow-up after delivery. Four CHWs from a local Healthy Start Program completed questionnaires for participants in their caseloads who had become lost to follow-up from the program (n = 146) between Sep 2018 and Jan 2020. The questionnaire included open ended items about ease of contact before and after delivery, changes in contact information, compliance with prenatal care visits, other life challenges (such as housing, legal, transportation, and family support), family size, living arrangements, working/student status, and substance use. Participants were categorized by ease of contact throughout participation into Easy (28.8%), Easy then Difficult (11%) and Difficult (60.3%). Responses to questions were reviewed and coded to identify common themes. Groups differed on: having a change in contact information, having challenges with transportation, having lots of help, having other children between 6 and 10 years old, compliance with prenatal care, and race being non-Black. Areas where groups differed may indicate possible reasons for participants becoming lost to follow up after delivery. The descriptive results from this study can help CHWs address these issues with participants during prenatal care, when they are easier to contact, to develop contingency plans for remaining in contact after delivery.