Patients with coronavirus disease 2019 (COVID-19) typically present with respiratory symptoms, but little is known about the disease's potential neurological complications.
We report a case of ...Guillain–Barré syndrome (GBS) following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in association with leptomeningeal enhancement.
A 56-year-old woman presented with recent unsteadiness and paraesthesia in both hands. Fifteen days earlier, she complained of fever, dry cough and shortness of breath. Her chest X-ray showed a lobar consolidation and PCR was positive for SARS-CoV-2; she was admitted due to mild COVID-19 pneumonia.
In the first 48 hours of hospitalisation, she started to experience lumbar pain and weakness of the proximal lower extremities, progressing to bilateral facial nerve palsy, oropharyngeal weakness and severe proximal tetraparesis with cervical flexion 2/5 on the MRC scale. Full spine magnetic resonance imaging (MRI) showed a brainstem and cervical leptomeningeal enhancement. Analysis of cerebrospinal fluid (CSF) revealed albumin–cytological dissociation. Microbiological studies on CSF, including SARS-CoV-2, were negative. Nerve conduction studies were consistent with demyelinating neuropathy. She was treated with intravenous immunoglobulin, with significant neurological improvement noted over the next 2 weeks.
Leptomeningeal enhancement is an atypical feature in GBS, but could be a marker of its association with SARS-CoV-2 infection.
Background and purpose
Stroke assistance is facing changes and new challenges since COVID‐19 became pandemic. A variation on the patient influx might be one of the greater concerns, due to fewer ...people coming to emergency departments or coming too late. However, no data quantifying this have been published until now. The aim was to analyse the impact of the COVID‐19 epidemic outbreak on hospital stroke admissions and their characteristics in our region.
Methods
The data of every patient admitted to any hospital of our healthcare system with a diagnosis of ischaemic stroke between 30 December 2019 and 19 April 2020 were reviewed. Demographic and clinical data were recorded and compared between periods before and after the setting of the state of emergency secondary to the COVID‐19 outbreak.
Results
In total, 354 patients with ischaemic stroke were admitted in our study period. There was a weekly average of 27.5 cases before the setting of the state of emergency against 12 afterwards (P < 0.001). This drop in stroke cases occurred progressively from week 11, persisting in time despite the decrease in confirmed cases of COVID‐19. No differences in the proportion of intravenous thrombolysis (21.1% vs. 21.5%, P = 0.935) or endovascular therapy (12.4% vs. 15.2%, P = 0.510) were found, nor in other demographic or clinical characteristics except for median onset‐to‐door time (102 vs. 183 min, P = 0.015).
Conclusions
This observational study offers the perspective of a whole region in one of the countries more heavily stricken by the SARS‐CoV‐2 epidemic and shows that the decrease of stroke events, since the beginning of the COVID‐19 outbreak, happened globally and without any specific patient distribution.
Repeated Mechanical Thrombectomy in the Same Intracranial Artery Segment Tejada Meza, Herbert; Barrena Caballo, Maria Rosario; Guelbenzu Morte, Santiago ...
Journal of stroke and cerebrovascular diseases,
September 2017, 2017-Sep, 2017-09-00, 20170901, Letnik:
26, Številka:
9
Journal Article
Recenzirano
We report a patient with an important scenario that may arise in the management of an acute ischemic stroke: the need for a repeated mechanical thrombectomy in the same intracranial artery segment. ...The patient had a history of atrial fibrillation and a mechanical mitral valve replacement. In her first stroke, she had an occlusion of the proximal segment of the right middle cerebral artery; 58 days later, she presented with an occlusion in the same segment of that cerebral artery. In both instances, the thrombus was extracted by a stent retriever with good clinical and radiographic results. To the best of our knowledge, this is the first report of a repeated mechanical thrombectomy in the same intracranial artery segment using stent retriever devices.
To review imaging features of paragangliomas. To determine the usefulness of pre-operative embolization.
From January 1994 to December 2004, 30 patients at our institution were found to have 33 ...paragangliomas of the head and neck. They were evaluated with US, CT, MRI, and angiography.
Location distribution was: 16 carotid (1 case of bilateral and 2 of multi-centric presentation are reported), 14 in temporal bone, and 3 vagal. Embolization was performed in 22 cases. It was palliative in 2 cases and adjuvant to surgery (18) or to surgery and radiation therapy (2), resulting in a reduction of surgical complications. Eight patients were operated on and 3 rejected any treatment.
Imaging studies are essential in the differential diagnosis of head and neck masses. Pre-operative embolization is a major advance in the surgical management of paragangliomas because it decreases potential intra-operative bleeding.
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