ABSTRACT
To date, only a few cases of intracranial infection related to severe acute respiratory syndrome‐coronavirus‐2 (SARS‐CoV‐2) were reported. Here we describe a case of coronavirus disease 2019 (COVID‐19) that was comorbid with purulent meningitis. A 62‐year‐old male patient was diagnosed with moderate COVID‐19 and had no fever or cough after treatment. However, he suffered from a head injury and experienced headache and fever immediately after the accident. Computed tomography (CT) of the brain showed bilateral frontal lobe contusion, subdural hematoma, and subarachnoid hemorrhage. In the following days, the patient suffered from recurrent fever, although chest CT did not show evidence of worsening of infection. Several lumbar punctures were made, confirming increased cerebrospinal fluid (CSF) pressure and karyocyte count. SARS‐CoV‐2 nucleic acid was not detected in CSF but revealed the presence of Escherichia coli. Thus, the patient was diagnosed with purulent meningitis, presumably caused by brain trauma or the immunologic dysfunction caused by COVID‐19, which was supported by the significant reduction of all kinds of immune cells. Since immunologic dysfunction is commonly presented in COVID‐19 patients, comorbidity with meningitis should be considered when a COVID‐19 patient presents with headache and fever. Lumbar punctures and CSF cultures may help in the diagnosis.
ABSTRACT
Two cases of Rhinocladiella mackenziei have been noted in our institute, the first case in 2015 (post-renal transplant) and the second case in 2021 (post-COVID infection). Both the patients had received immunosuppressants for varying dura-tion. Both the cases presented to the hospital with neurological deficit secondary to brain abscess. On initial assessment, the melanized fungus was noted which was later identified as Rhinocladiella on culture and further confirmed with molecular meth-ods. Both the cases were treated with injection of L AmB, voriconazole and 5FC for a prolonged duration and later discharged when the condition improved. The renal transplant patient was advised lifelong voriconazole since he would continue to be on immunosuppressants. To our knowledge, the second patient diagnosed post-COVID could be the first case report of invasive dematiaceous fungal infection in an apparently immunocompetent individual. Both cases also highlight the challenges in man-agement such as designing an appropriate regimen, deciding the optimum duration of antifungal therapy, and managing the toxicities associated with long-term antifungal use. R. mackenziei is a frequently fatal melanized neurotropic fungus known to carry almost 100% mortality despite the combination of antifungal agents and surgery. Central nervous system infections due to R. mackenziei have been exclusively reported from the Middle East, except for cases recently reported from India.
ABSTRACT
To boost or not to boost, that is the question—or rather, one of many questions regarding COVID19 vaccination in the United States. Do we mandate vaccination for everyone who is eligible? Should employers require that their employees be vaccinated? Should wealthy nations provide boosters for their own residents before other nations have been able to administer the primary series to theirs? Have we done all we can to produce vaccines as quickly as possible? Although this editorial cannot possibly answer all the questions related to vaccination, I will address one of particular interest right now—the use of booster shots.
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Plain Language SummaryHaving the issue of coronavirus disease 2019 (COVID-19) in mind, there is always a dilemma surrounding elective and non-urgent neurosurgical operations. The unanswered question is regarding whether there is any post-COVID-19 complications that hinder a patient from becoming a candidate for a neurosurgical operation. If that is the case, what should we do?In the present article, we report our single-center experience with an unusual bleeding during the operation of a huge cerebellar tumor in a girl previously infected with COVID-19. In the end, we recommend our experience to our colleagues. There are still some conditions that pediatric neurosurgeons may face in the context of coronavirus disease 2019 (COVID-19) which have not been fully addressed so far. Authors have postulated an ongoing inflammatory myocardial status in a significant proportion of patients who have recovered from COVID-19. We report our experience with a 10-month-old girl who had recovered form COVID-19 and had a case of fourth-ventricle mass in the midline of the posterior fossa. She was scheduled for microneurosurgical resection of the mass following the insertion of a ventriculoperitoneal shunt. There were no significant issues regarding the induction of anesthesia. A midline suboccipital approach was chosen, and the patient was fully prepared and draped. Suboccipital soft tissues and muscles were dissected layer by layer through the midline avascular line. A marked gush of blood off the midline was observed during the opening in Y of the dura mater. Then, we started to approach the occipital sinus. However, there was an unusual loss of ∼ 200 mL of blood lost from this area. Despite the proper packed-cell transfusion, the patient developed bradycardia and a sudden rhythm of asystole. The cardiopulmonary cerebral resuscitation (CPCR) was initiated immediately. Despite the maximal effort, the heart rate did not change and remained asystole. We recommend that pediatric neurosurgeons postpone the procedures to be performed in patients who have recovered from COVID-19 for more than one month after a thorough preoperative cardiac evaluation has been performed.
ABSTRACT
Increasing numbers of the papers indicate that SARS-CoV-2 also causes neurological symptoms;the underlying mechanism has not been elucidated yet. Hypothetic mechanisms to explain the CNS involvement of SARSCoV-2 include the neurotropic mechanisms and the cytokine storm developing during the disease process. A middle age female patient applied to the emergency department with complaints of eye pain, a double, foggy, and blurred vision and a severe throbbing headache. The outward gaze was found to be limited in her right eye. Nasopharyngeal swab for SARS-CoV-2 RNA was positive, radiological findings were supported the COVID pneumonia and diffuse sinonasal inflammation. Cranial imaging showed thickening and contrast involvement in the cavernous sinus in the postcontrast series. While shortness of breath improved, and the headache was completely resolved on the 10th day of treatment the right eye outward gaze restriction was continued. The control MRI reveals a significant reduction in cavernous thickening and contrast enhancement and complete resolution in dural thickening. In our case of COVID, cranial nerve involvement and pansinusitis developed without cytokine storm findings suggests that the virus has spread to the cavernous sinuses and dura by regional neighborhood. Neurological symptoms may appear as the first symptom of COVID.
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Background: Globally, COVID-19 is less prevalent in children than adults. However, in Indonesia, the number of infected children have been increasing rapidly. Objectives: To describe characteristics and outcomes of children with COVID-19 in West-Nusa-Tenggara Province, Indonesia. Methods: We retrospectively reviewed registries of children with confirmed COVID-19 collected by the Indonesian-Pediatric-Society, West-Nusa-Tenggara. Children diagnosed with COVID-19 by RT-PCR from March 2 to July 12, 2020, were included in the analysis. Results: Of 146 COVID-19-confirmed subjects, 47.9% were symptomatic, 45.2% were aged < 5 years old, 58.2% were male, 54.8% had a history of COVID-19 contact, and 2.7% (n = 4) died. Asymptomatic subjects had older median age (P < 0.01), longer median dura-tion of RT-PCR conversion (P < 0.01) than symptomatic children and 88.2% had a history of COVID-19 contact. Forty-eight (out of 55 hospitalized symptomatic subjects or 87%) were < 5 years old, had younger median age (P < 0.01), and 4 (7.3%) had a history of COVID-19 contact. They also had higher respiratory rate and body temperature (P < 0.01), lower oxygen saturation (P < 0.01), higher white-blood-cell counts (P = 0.01), and lower hemoglobin levels (P = 0.015) compared to the non-hospitalized symptomatic subjects. Forty-three (78%) hospitalized subjects were in severe and critical condition, 49 (89%) were pneumonia, and 28 (51%) had bilateral in-filtrates on chest X-ray. All registered deaths were due to acute-respiratory-distress-syndrome. Besides, all deaths were in hospitals without a pediatric-intensive-care-unit. Conclusions: In the present study, we identified both asymptomatic and symptomatic COVID-19 infected children. Most symptomatic COVID-19 cases were in children < 5 years old, presented with severe pneumonia, and few of them had a history of COVID-19 contact.
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AIMS: There are approximately four thousand neuro-oncology procedures in the UK per annum. Many of these result in tissue and biofluid specimens that are surplus to diagnostic requirement and can be collected as standard of clinical care. However, developing technologies and treatments for precision medicine require access to a range of individualised biospecimens paired with deep clinical phenotyping data. Here, we present Brain Surgical Tissue for Advanced Tumour Models (BRAINSTAT) programme, an infrastructure that has been established between Queen Elizabeth Hospital, Birmingham and the University of Birmingham, to collect, structure and store these resources and also maximise their value for research over the long-term. Using this approach our aim is to provide high-quality, annotated resources to help develop novel treatments for patients with brain tumours. METHOD: BRAINSTAT infrastructure allows: Prospective consent Biospecimens, including tumour tissue (brain and other primary in the case of metastasis), cyst fluid, dura, skin, CSF, blood (matched "germ-line" and for circulating cell free tumour DNA analysis), urine and saliva can be collected. Consent for long term follow-up, is either via clinic or NHS digital. More limited consent for non-oncological neurosurgical cohorts (e.g. epilepsy or vascular) and healthy volunteers allow healthy access-tissue and biofluids to be collected. B. Rapid transfer of fresh surgical tissue samples: Strong collaborative links and close physical proximity between operating theatre and laboratory allows rapid transfer of biospecimens minimising transit time. C. Standardised annotation across disciplines The RedCAP database system allows granular control over data-access, and each specialist research team is provided access only to the sub-sections relevant to them. All users must have Good Clinical Practice certification and GDPR training, prior to access of the BRAINSTAT database. RESULTS: Between 25/11/2019-16/03/2020 and 27/07/2020-16/11/2020, 65 patients were consented for BRAINSTAT at the weekly neurosurgical oncology clinic. (Recruitment gaps due to the SARS-COVID 19 pandemic). Pathological diagnosis of surplus tissue collected included: 37 high grade glioma, 3 low grade glioma and 16 brain metastasis including: (6 lung, 6 breast, 2 colorectal, 1 oesophageal, 1 endometrial). Meningioma (5 WHO I;1 WHO III) 1 patient undergoing anterior temporal lobectomy for hippocampal sclerosis contributed access tissue from the lateral neocortex. 1 patient had a non-neoplastic, non-diagnostic sample. All patients had matched "germline" blood samples. Median time from resection to arrival in the laboratory was 10 minutes (range 4-31). Standardised operating protocols to optimise this have been developed. Glioblastoma and breast-brain metastasis tumourspheres and cerebral organoids are currently being validated. CONCLUSION: Despite the challenges of the pandemic we have established a viable tissue pipeline from neurosurgical operating theatre to our university laboratories. We are developing clinically annotated human brain tumour cell lines, stem cells and 3D organoid models, principally for commonly encountered brain tumours such as glioma and metastasis. The research sets the foundation for a multitude of downstream applications including:-Building more complex organoid cultures e.g. by including other cell types such as healthy brain cells and endothelial cells allowing future experiments to more accurately model tumour growth.-Developing high-throughput, patient-specific drug screens of novel drugs and drug combinations using these 3D tumour models aiming to more effectively treat tumour proliferation and spread. These patient avatars will help inform and test more "stratified" personal medical treatments and will provide opportunities to allow earlier intervention with the aim of improving survival, coupled with a better quality of life.