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Introduction: Pediatric brain tumors are the most common tumor in children after hematological malignancies. There is very few data about the epidemiology of pediatric brain tumors in India. Methods - This was a prospective and retrospective study in pediatric patients who had undergone surgery in our institute (JIPMER,Pondicherry). 80 cases were recruited and followed up for minimum follow up period of 1 year. The demographic profile was analysed and IHC markers were done for embroyonal tumors and glioma. Result(s): Pediatric brain tumors was equally distributed among male and females. (1:1) .Mean age of presentation was 10 years . 27.5 % of our cases were embryonal tumors,low grade glioma (16.25 % ) ,high grade glioma ( 12.5 % ) ,ependymoma and craniopharyngioma comprised 15 % of our cases each. Medulloblastoma comprised 23.75 % of cases Out of which 31.5 % had craniospinal metastasis at time of diagnosis. The most common location of SHH pathway medulloblastoma was cerebellar hemisphere and non WNT/non SHH was fourth ventricle. 45.45 % of patients with high grade glioma had recurrence .50 % of ependymoma cases were infratentorial. we had 2 cases of ganglioglioma ,one in the midbrain and other in temporal lobe .Gross total resection was achieved in 30 % ,Subtotal resection in 46.25 % and partial resection in 20 % of our cases. Outcome of patients at the end of 1 year for low and high grade glioma, ependymoma and craniopharyngioma were similar to western literature. Two patients acquired COVID 19 and died while undergoing treatment. Molecular markers like INI1, LIN28 A was highly sensitive and specific for diagnosing atypical teratoid rhabdoid tumor (ATRT) and embryonal tumor with multilayered rosettes (ETMR )respectively. Conclusion(s): Our study emphasizes the need of standardized and systemic cancer registries in India. (Figure Presented).
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Introduction and Aim: Post-covid syndrome is the group of nonspecific symptoms which are seen among the patients who have been recovered from COVID-19 and that persist over 4 weeks. Symptoms involve fatigue, breathlessness, cough, cognitive disturbances, depression and anxiety, many organs related symptoms, and the prominent features involve shortness of breath and inability to return to baseline activity level. Studies show that Pneumonia which is associated with the COVID-19 infections can lead to long-standing damage to the alveoli in the lungs and as a result scar tissues may develop which in the future can lead to long-term breathing problems. The aim of this study is to assess the effectiveness of osteopathic CV4 technique in post covid patients. Material(s) and Method(s): This is a pre-test and post-test experimental study conducted at Sri Sri University. In this study, 20 subjects both male and female, having mean age of 23.3 +/- 2.81 years were taken. After assessment of all inclusion and exclusion criteria, a brief history regarding COVID-19 and if present other respiratory disorders was taken. Following this, a 5 minutes window period was given to all participants before the collection of pre-test data. Result(s): When CV4 osteopathic technique was given to post-covid patients, there was a significant change in FVC, FEV1, PEF and pulse rate when compared to the pretest intervention data. However, the changes in oxygen saturation levels were not statistically significant. Conclusion(s): The results show that osteopathic CV4 technique alters the respiratory capacity in post covid patients.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.
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Objective: To describe a case of Anterior Spinal Artery (ASA) syndrome after vaccination -coincidence or causality? Background: As efforts to improve SARS-CoV-2 vaccination continue, more questions safety of the vaccination continues to be raised. Ischemic stroke, intracerebral hemorrhage, and cerebrovascular venous sinus thrombosis have been reported in the literature after COVID -19 mRNA vaccination. Although rare cases of acute transverse myelitis have also been reported, literature regarding post-COVID vaccination ASA syndrome is even rarer. Design/Methods: A 32-year-old female with no significant past medical history presented with acute onset of bilateral extremity weakness and numbness that started 2 weeks ago. Result(s): Patient was awake, alert, and oriented. Physical examination showed decreased tone in wrist bilaterally. Motor examination was normal except for 1/5 handgrip, 2/5 wrist, and 3/5 triceps bilaterally. Triceps and brachioradialis reflexes were absent bilaterally. Sensory examination showed absent pinprick sensations C7 and below. Vibration and proprioception sensations were intact. Patient was recently admitted at outside hospital for same complaint. Neurological work was unremarkable except of an enlarged 4th ventricle for which she underwent left frontal ventriculostomy. Lumbar puncture showed normal IgG index and negative serum NMO Ab. She was treated with IVIG for presumed inflammatory disorder with minimal improvement. Patient underwent a repeat neurological workup at our facility due to ongoing symptoms. EKG showed normal sinus rhythm CT head showed prominent 4th ventricle. CT spine were unremarkable. MRI of the brain showed Postprocedural changes associated with recent prior left trans frontal ventriculostomy catheter. MRI of the cervical and thoracic spine showed T2 hyperintense lesion extending from C3/4 to T1 with central predominance rostrally, whole cord involvement at C5, and with anterior predominance caudally with extent to the upper thoracic level of T1;shows patchy enhancement. TTE was unremarkable. Infectious and hypercoagulable workup was also unremarkable. Patient-reported receiving first dose of Moderna mRNA Covid vaccine 2 weeks prior to onset of symptoms. She was discharged to rehab on aspirin and atorvastatin. Conclusion(s): Our patient presented with symptoms and imaging consistent with ASA syndrome 2/2 infarct of an anterior spinal artery C5-T1. Extensive neurological, infectious, rheumatological, and hypercoagulable workup was negative for etiology. The patient had onset of symptoms after receiving her first dose of mRNA COVID-19 vaccine, however, unclear if the presentation is consistent with postvaccination vaccine ASA syndrome or idiopathic.
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Objective: NA Background: The etiology of MOGAD post-COVID-19 infection is not well understood and there are limited publications describing cases in pediatric patients. Here we report a case of a 14-year-old male with MOG antibody positive ADEM (Acute Disseminated Encephalomyelitis) and positive COVID-19 PCR. Design/Methods: NA Results: The patient presented to our hospital in December of 2020 with acute onset of ataxia and lower extremity weakness. His exam was pertinent for mild and symmetric weakness in bilateral hip flexors, dysmetria with ataxic gait, as well as bilateral patellar and ankle hyporeflexia. MRI brain showed symmetric areas of T2 signal hyperintensity, predominantly adjacent to the fourth ventricle as well as the peri-insular and frontal regions. MRI of the lumbosacral spine demonstrated T2 signal hyperintensity within the conus medullaris without enhancement. CSF studies revealed an increased white blood cell count of 74 (90% lymphocyte), elevated protein of 51, elevated kappa free light chain (0.12) and positive oligoclonal bands (3). He was also found to be serum anti-MOG antibody positive (1:100) and COVID-19 positive (PCR). He received 1000 mg of intravenous methylprednisolone daily for 5 days and 2 g/kg IVIG. He was subsequently placed on a 6 week taper of oral prednisone. 2 months after his initial presentation, his neurologic symptoms have completely resolved, and he has been asymptomatic since. Repeat MRI brain 4 months later showed improvement in his multifocal supratentorial FLAIR signal abnormalities. Conclusions: Here we describe a case of a 14-year-old male with MOGAD post-COVID-19, with complete resolution of his symptoms after high dose corticosteroid and IVIG treatment.
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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.