Spontaneous Intracranial Hypotension Complicated by a Cerebral Venous Thrombosis Following an mRNA Covid-19 Vaccination: Coincidence vs Cause?

Spontaneous intracranial hypotension (SIH) is a rare cause of persistent headache, particularly among young and middle-aged people. A potentially life-threatening complication of SIH is a cerebral venous thrombosis (CVT). The authors present a case in which a patient presented with SIH complicated by CVT one week after receiving a booster dose of mRNA COVID-19 vaccine. According to our literature review, this is the first such case report. LEARNING POINTS: Spontaneous intracranial hypotension is rarely complicated by cerebral venous thrombosis (CVT).The majority of cerebral venous thrombosis cases post-COVID-19 vaccination occurred in patients administered with adenoviral vaccines. CVT following administration of mRNA COVID-19 vaccines is rare.Clinicians should consider COVID-19 vaccine-induced CVT in recently vaccinated patients; MRI plays an important role in accurate diagnosis.

Cerebral Venous Thrombosis and Acute Pulmonary Embolism following Varicella Infection.

Varicella infection is caused by varicella-zoster virus (VZV) and commonly presents as a self-limiting skin manifestation in children. VZV also causes cerebral arterial vasculopathy and antibody-mediated hypercoagulable states leading to thrombotic complications in children, although there are very few such reports in adults. Postulated causal factors include vasculitis, direct endothelial damage, or acquired protein S deficiency secondary to molecular mimicry. These induced autoantibodies to protein S could lead to acquired protein S deficiency and produce a hypercoagulable state causing venous sinus thrombosis. Here we report the case of a 26-year-old man who presented with cortical venous sinus thrombosis and acute pulmonary embolism following varicella infection. Both conditions responded to anticoagulation treatment. LEARNING POINTS: Varicella infection caused by varicella-zoster virus (VZV) can rarely present with thrombotic complications after a period of latency.Postulated causal factors include vasculitis, direct endothelial damage, and acquired protein S deficiency secondary to molecular mimicry.The prognosis of post-varicella thrombosis is good, but a prothrombotic screen after recovery to diagnose hereditary prothrombotic states is advisable.

FT-IR spectroscopy, intra-molecular C-H⋯O interactions, HOMO, LUMO, MESP analysis and biological activity of two natural products, triclisine and rufescine: DFT and QTAIM approaches.

The present study deals with two natural products, triclisine and rufescine which are extracted from the Amazonian wines but ubiquitous in nature. The quantum chemical density functional method at B3PW91/6-311+G(d,p) level is used to obtain the equilibrium geometries of these molecules. The quantum theory of atoms-in-molecule approach is employed to study various intra-molecular C-H⋯O interactions within these molecules. We have also performed vibrational analyses of triclisine and rufescine at their equilibrium geometries and presented the complete assignments of the significant vibrational modes. The calculated vibrational frequencies are shown to be in perfect agreement with the experimentally observed FTIR spectra of molecules under study. In addition, the electronic properties of these molecules are also discussed with the help of HOMO-LUMO and MESP surfaces and a number of electronic as well as thermodynamic parameters are calculated which are closely related to their chemical reactivity and reaction paths. The biological activities of both molecules have also been predicted which highlight their pharmacological importance.

Role of whole-body magnetic resonance imaging in the evaluation of extrapulmonary tuberculosis in immunocompetent patients.

OBJECTIVE: The aim of this study was to evaluate the role of whole-body magnetic resonance imaging (WB-MRI) in imaging of extrapulmonary tuberculosis. METHODS: Eighteen patients with single-site extrapulmonary tuberculosis were evaluated with contrast-enhanced dedicated MRI of the clinically symptomatic site followed by WB-MRI using contrast-enhanced 3-dimensional (3D) modified DIXON technique (m-DIXON) and diffusion-weighted WB imaging with background body signal suppression (DWIBS) sequences. Studies were read by 2 experienced radiologists, and additional lesions seen on WB-MRI were separately charted. RESULTS: Of 18 patients, 14 were found to have asymptomatic involvement of other organs on WB-MRI. In 5 patients, the information was helpful in choosing an easily accessible site for biopsy/aspiration. Postcontrast 3D m-DIXON was better in picking up brain and lymph nodal lesions, whereas DWIBS was better in detecting vertebral lesions. CONCLUSIONS: Whole-body MRI may be used for assessing the asymptomatic involvement of other body organs in tuberculosis. The combination of postcontrast 3D m-DIXON and DWIBS is complementary and may provide a road map for biopsy of accessible lesions.

Significance of various pulmonary and extrapulmonary abnormalities on HRCT of the chest in scleroderma lung.

Patients with systemic sclerosis (SSc) are routinely investigated with high-resolution computed tomography (HRCT) chest for early detection and accurate characterization of complicating interstitial lung diseases. Though the primary aim of HRCT is to delineate the burden of pulmonary involvement and to characterize the nature of fibrosis to potentially help guide management, it provides an opportunity to evaluate extrapulmonary manifestations, particularly the dilated pulmonary artery, esophageal dilatation, and pericardial abnormalities which have their own clinical significance. The aim of this article is to discuss the significance of various pulmonary and extrapulmonary abnormalities that may be identified on HRCT chest of SSc patients.

Oesophageal dilatation on high-resolution CT chest in systemic sclerosis: what does it signify?

OBJECTIVE: To evaluate the significance of oesophageal dilatation on high-resolution CT (HRCT) chest in patients with systemic sclerosis. METHODS: We retrospectively retrieved the database of patients with systemic sclerosis seen at our hospital between January 2008 and January 2009. A total of 50 patients (46 women and four men) who had HRCT chest, pulmonary function testing and echocardiography within 1 month were included in the study. Peak pulmonary artery (PA) pressures and pulmonary function testing were charted. The HRCT chest was interpreted by a chest radiologist. Oesophageal dilatation was defined as a luminal coronal diameter of ≥9 mm in infra-aortic oesophagus. Extent of ground glass, reticulation and honeycombing was objectively scored. RESULTS: Statistical analysis using independent t-test showed that diffusion capacity of carbon monoxide was significantly lower (P = 0.042) and peak PA pressures were significantly higher (P = 0.045) in patients with oesophageal dilatation (n = 29) as compared with those without oesophageal dilatation (n = 21). The two cohorts had no significant difference in their total lung capacity and HRCT determined extent of interstitial lung disease. CONCLUSION: Patients with oesophageal dilatation on HRCT chest had significantly lower diffusion capacity of carbon monoxide and higher peak PA pressures, which suggest that these patients tend to have more severe pulmonary vascular disease.

Predictors of pulmonary hypertension on high-resolution computed tomography of the chest in systemic sclerosis: a retrospective analysis.

PURPOSE: To evaluate the imaging features on high-resolution computed tomography (HRCT) of the chest and the clinical parameters that are associated with pulmonary hypertension in systemic sclerosis. We specifically investigated whether main pulmonary artery (MPA) diameter and burden of lung fibrosis are predictors of pulmonary hypertension in these patients. METHODS: We retrospectively retrieved the database information of patients with systemic sclerosis seen at our hospital between January 2007 and December 2008. A total of 75 patients had HRCT of the chest, pulmonary function testing (PFT), and echocardiography within 6 months of each other. The echocardiography images were reviewed by a level-3 echocardiographer, and 29 cases were excluded because of suboptimal evaluation of pulmonary artery (PA) pressure. Peak PA pressures and PFT of the remaining 46 cases (43 women and 3 men) were charted. The PFT included total lung capacity (TLC), diffusion capacity of lung for carbon monooxide (DLCO) and the ratio of forced expiratory volume in one second and forced vital capacity (FEV1/FVC). The HRCT of the chest of each patient was read by a chest radiologist. The extent of ground glass, reticulation, and honeycombing was objectively scored. The maximum diameter of the main pulmonary artery (MPAD) and ascending aorta were measured. The ratio of main pulmonary artery diameter and ascending aortic diameter (MPAD/AD) and ratio of main pulmonary artery diameter and body surface area (MPAD/BSA) were also calculated. RESULTS: Statistical analysis done by using a multivariate model showed that the calculated fibrotic score strongly correlated with peak PA pressures (P < .001). MPAD (P = .0175), and the ratio MPAD/AD (P = .0102) also showed a statistically significant correlation with peak PA pressures. By using stepwise regression analysis, the fibrotic score was found to be the most reliable independent predictor of pulmonary hypertension. CONCLUSION: HRCT-determined severity and extent of pulmonary fibrosis may be helpful in screening for pulmonary hypertension in patients with systemic sclerosis.

Case Report: Anteromedial temporosphenoidal encephalocele with a clinically silent lateral bony defect in the greater wing of the sphenoid.

Anteromedial temporosphenoidal encephalocele is the least common type of temporal encephalocele. It commonly presents with spontaneous cerebrospinal fluid rhinorrhea in adults. This article presents the CT cisternography and MRI findings of one such case, which also had an associated clinically silent defect in the greater wing of the sphenoid on the same side.