ABSTRACT
Backgrounds: To report the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination. Case presentation: A 39-year-old woman was referred and admitted to our hospital due to transient left visual field abnormality with left ophthalmalgia and headache 12 days after the first vaccination dose of SARS-CoV-2 (BNT162b2). On admission (Day 2), she presented with left ophthalmalgia and headache without any other neurological deficits including the movement of eyeballs, visual field, visual acuity, or nystagmus. MRI on Day 2 suggested slight left optic neural swelling;Gadolinium-enhanced MRI on Day 4 revealed left optic perineuritis. Test for serum anti-aquaporin 4 antibody was negative, whereas anti-myelin oligodendrocyte glycoprotein (MOG) antibody was positive. She was diagnosed with left optic perineuritis after SARS-CoV-2 mRNA vaccination. Her visual disturbance never recurred and her ophthalmalgia and headache subsided only with anti-inflammatory agents. Discussion(s): Many cases of optic neuritis associated with vaccinations have been reported except for SARS-CoV-2 BNT162b2 mRNA. To our knowledge, only one neuromyelitis optica case was associated with anti-MOG antibody. Therefore, we propose that SARS-CoV-2 mRNA vaccination may induce transient optic neuritis and perineuritis, associated with anti-MOG antibody in the present case. Conclusion(s): This is the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination.Copyright © 2022
ABSTRACT
Regional anaesthesia (RA) has an important and ever-expanding role in ambulatory surgery. Specific practices vary depending on the preferences and resources of the anaesthesia team and hospital setting. It is used for various purposes, including as primary anaesthetic technique for surgery but also as postoperative analgesic modality. The limited duration of action of currently available local anaesthetics limits their application in postoperative pain control and enhanced recovery. The search for the holy grail of regional anaesthetics continues. Current evidence suggests that a peripheral nerve block performed with long-acting local anaesthetics in combination with intravenous or perineural dexamethasone gives the longest and most optimal sensory block. In this review, we outline some possible blocks for ambulatory surgery and additives to perform RA. Moreover, we give an update on local anaesthesia drugs and adjuvants, paediatric RA in ambulatory care and discuss the impact of RA by COVID-19. Copyright © 2022 Elsevier Ltd
ABSTRACT
Objective: To study the radiological presentations of mucormycosis in the study cohorts.The patients were categorized as COVID-19 and diabetes millitus;COVID-19 and non-Diabetes;Non COVID-19 and non-diabetes and these cohorts were analysed. Background: There has been a recent surge of mucormycosis with COVID 19 infection particularly in patients with diabetes.Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the dissemination of fungal elements from the nasal cavity via perineural and perivascular routes.Fungal vasculitis results in internal carotid artery occlusion and cerebral infarction.Imaging features reflect the angioinvasive behavior of the Mucoraceae family, which cause necrotizing vasculitis and thrombosis resulting in extensive tissue infarction. Design/Methods: This was a Prospective observational study of Rhinoorbitocerebral mucormycosis cases presenting from May to July 2021 to our hospital.The clinical examination findings and neuroimaging features were assessed among the study cohorts. Results: Of the 544 patients the mean age of patients was 51.9 years with a male preponderance (71%).Uncontrolled hyperglycemia was present in 90% of all patients.Ethmoid sinus was the most common paranasal sinus involved by imaging( 86%).The most common site of extrasinus involvement was orbit (76%) and face (57%), followed by orbital apex, masticator space,pterygopalatine fossa.Intracranial extension with involvement of cavernous sinus was seen in 34% of patients, brain abscess(19.2%),internal carotid artery(17%),brain infarction(45.2%),meningeal thickening and enhancement(29.2%),bone and skull base(14%).The most common neuroradiological presentation seen in all cohorts was cavernous sinus thrombosis.The propensity for multiple cerebral abscess and skull base osteomyelitis was more in patients of Rhinoorbitocerebral mucormycosis with diabetes and COVID-19 cohort.Internal carotid artery involvement was predominantly seen in COVID-19 and non diabetic cohort.Limited sinonasal disease was more commonly seen in Non-COVID-19 and diabetes patients of mucormycosis Conclusions: Central to early diagnosis is a high index of suspicion by the clinician and the radiologist.The cavernous sinus was the most common site of intracranial involvement in our study.