Anton syndrome in posterior reversible encephalopathy syndrome followed by Guillain-Barré syndrome: A case report

Background and aims: Anton-Babinski syndrome is a rare condition due to occipital injury by different mechanisms, such as vasogenic edema in posterior reversible encephalopathy syndrome (PRES) resulting from bood-brain barrier (BBB) disruption. PRES has been rarely associated with Guillain-Barré syndrome (GBS). It has hypothesized that autonomic dysfunction in GBS might lead to BBB damage with consequent PRES before motor symptom onset. Another possibility is that BBB injury in PRES might trigger immune-mediated reaction leading to GBS. Methods: An 80-year-old woman was admitted to our emergency room (ER) after she developed two partial seizures, successfully treated with 5mg of intravenous midazolam. Her medical history was unremarkable except for previous SARS-CoV-2 disease. Results: After one hour from midazolam administration, the patient was still markedly confused. Examination revealed binocular blindness, without signs of optic neuropathy;despite being obviously blind, she denied any vision disturbance, a phenomenon known as visual anosognosia. Her blood pressure was 180/90mmHg. Brain MRI showed posterior alterations compatible with PRES. She was treated with antihypertensive and vision recovered after 24 hours. On day 3, she developed areflexia and proximal symmetrical weakness to both upper and lower limbs. Electromyography suggested recent motor poliradiculoneuropathy. Clinical picture was compatible with GBS and intravenous immunoglobulins were started, with gradual recovery. A 8-day follow-up MRI showed nearly complete normalization of posterior lesions. Figure 1 Conclusion: Anton syndrome is a possible rare presentation of PRES. Occurrence of unexplained weakness after PRES should raise suspicion of GBS in consideration of their pathophysiologic connection.

Learning Mathematics From Home During COVID-19: Insights From Two Inquiry-Focussed Primary Schools

In early 2020, due to the COVD-19 pandemic, Australian schools were closed and students began an unprecedented time of remote learning. The current study aimed to understand how teachers planned and implemented mathematics learning programs for their students, the challenges they encountered, as well as the degree to which their students were motivated or engaged when learning mathematics at home. Two teachers from two Australian primary schools who shared a similar contemporary teaching and learning philosophy emphasising inquiry-based learning were interviewed, and students were surveyed anonymously about their engagement (cognitive, emotional, social and behavioural) when learning mathematics from home. Findings indicated that both teachers were concerned about effectively catering for all students and assessing student progress and engagement with the tasks. Survey data revealed most students displayed positive engagement with remote learning experiences, except for the lack of opportunity to learn mathematics with and from their peers. © 2021 by the authors;licensee Modestum. This article is an open access article distributed under the terms and conditions ofthe Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/).

[Place of the respiratory physiotherapist in the Covid-19 crisis: Neuchatel experience]

The physiotherapy service became an important player in the care of patients with COVID-19 at Pourtales hospital (Neuchatel, Switzerland), illustrating its important role in the organization of acute care units. The workforce was increased, and the diaries extended (7/7d, 24/24h). Respiratory physiotherapists were largely involved in the initiation and the adaptation of the respiratory therapy in the units dedicated to Covid-19 patients (emergency, intensive care and pulmonology units), such as oxygen therapy and both invasive and non-invasive ventilation. Rehabilitation was also early initiated in order to limit the risk of intensive care unit-acquired polyneuromyopathy and to prevent physical deconditioning.

Non-invasive CPAP in mild and moderate ARDS secondary to SARS-CoV-2.

BACKGROUND: During the COVID-19 outbreak, a very high number of infected patients developed pneumonia and many of them complicated with acute respiratory distress syndrome. The optimal management of respiratory failure and the role of lung ultrasound imaging in the evaluation of efficacy of treatment are unknown. METHODS: In March 2020 we treated 18 patients with mild and moderate ARDS secondary to SARS-CoV-2 with non-invasive continuous positive airway pressure therapy (NI-CPAP). All patients underwent lung ultrasound imaging to verify the entity of lung recruitment after NI-CPAP initiation. RESULTS: After one hour of treatment we observed a significant improvement in PaO2/FiO2 ratio in 10 patients. Notably, only 50 % of them reached an effective improvement in lung aeration detectable with lung ultrasound. In the other 50 % or patients the improvement in PaO2/FiO2 might be related to blood redistribution and reverse of hypoxic vasoconstriction. CONCLUSION: NI- CPAP is a valid therapeutic option in mild and moderate ARDS secondary SARS-CoV-2. Lung recruitment detected by means of lung ultrasound is a relevant but not the exclusive mechanism that underlies the therapeutic efficacy of NI-CPAP in this clinical setting.