Background and purpose
During the COVID-19 outbreak, the presence of extensive white matter microhemorrhages was detected by brain MRIs. The goal of this study was to investigate the origin of this ...atypical hemorrhagic complication.
Methods
Between March 17 and May 18, 2020, 80 patients with severe COVID-19 infections were admitted for acute respiratory distress syndrome to intensive care units at the University Hospitals of Strasbourg for whom a brain MRI for neurologic manifestations was performed. 19 patients (24%) with diffuse microhemorrhages were compared to 18 control patients with COVID-19 and normal brain MRI.
Results
The first hypothesis was hypoxemia. The latter seemed very likely since respiratory failure was longer and more pronounced in patients with microhemorrhages (prolonged endotracheal intubation (
p
= 0.0002), higher FiO
2
(
p
= 0.03), increased use of extracorporeal membrane oxygenation (
p
= 0.04)). A relevant hypothesis, the role of microangiopathy, was also considered, since patients with microhemorrhages presented a higher increase of the D-Dimers (
p
= 0.01) and a tendency to more frequent thrombotic events (
p
= 0.12). Another hypothesis tested was the role of kidney failure, which was more severe in the group with diffuse microhemorrhages (higher creatinine level median of 293 µmol/L versus 112 µmol/L,
p
= 0.04 and more dialysis were introduced in this group during ICU stay 12 versus 5 patients,
p
= 0.04).
Conclusions
Blood–brain barrier dysfunction secondary to hypoxemia and high concentration of uremic toxins seems to be the main mechanism leading to critical illness-associated cerebral microbleeds, and this complication remains to be frequently described in severe COVID-19 patients.
Abstract
Background
Neurological manifestations are common in patients with coronavirus disease 2019 (COVID-19), but little is known about pathophysiological mechanisms. In this single-center study, ...we examined neurological manifestations in 58 patients, including cerebrospinal fluid (CSF) analysis and neuroimaging findings.
Methods
The study included 58 patients with COVID-19 and neurological manifestations in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction screening and on CSF analysis were performed. Clinical, laboratory, and brain magnetic resonance (MR) imaging data were retrospectively collected and analyzed.
Results
Patients were mostly men (66%), with a median age of 62 years. Encephalopathy was frequent (81%), followed by pyramidal dysfunction (16%), seizures (10%), and headaches (5%). CSF protein and albumin levels were increased in 38% and 23%, respectively. A total of 40% of patients displayed an elevated albumin quotient, suggesting impaired blood-brain barrier integrity. CSF-specific immunoglobulin G oligoclonal band was found in 5 patients (11%), suggesting an intrathecal synthesis of immunoglobulin G, and 26 patients (55%) presented identical oligoclonal bands in serum and CSF. Four patients (7%) had a positive CSF SARS-CoV-2 reverse-transcription polymerase chain reaction. Leptomeningeal enhancement was present on brain MR images in 20 patients (38%).
Conclusions
Brain MR imaging abnormalities, especially leptomeningeal enhancement, and increased inflammatory markers in CSF are frequent in patients with neurological manifestations related to COVID-19, whereas SARS-CoV-2 detection in CSF remained scanty.
Cerebrospinal fluid abnormalities were frequent in patients with neurological manifestations related to coronavirus disease 2019, whereas severe acute respiratory syndrome coronavirus 2 detection in cerebrospinal fluid remained scanty.
Porocephalosis is the name given to human infection by Armillifer, which is rare, especially in European and North American populations. Among the few cases reported to date, most of them were ...described in the African community. Humans can become infected, for example, consuming undercooked meat from infected snakes. Herein we report the case of a 31-year-old male, originally from the Democratic Republic of the Congo, who was living in France for many years and presented with lower back pain and mild abdominal pain. Imaging showed multiple comma-shaped calcifications disseminated in the liver and the peritoneal cavity, without any additional feature. The patient reported regular consumption of snake meat during his travels in Africa, and thus the diagnosis of porocephalosis could be made. Doctors treating patients from endemic areas or traveling in endemic areas, particularly in Africa, should become familiar with this infection and consider it in the case of multiple calcifications on imaging. More cases of porocephalosis are likely to be seen in the future because of the increase in international travel.
Ischemic injury to the lumbosacral nerve roots and plexus is a rare condition resulting from thrombosis of one or several lumbar arteries.
As the arterial supply of the spine presents great ...variations between subjects, the clinical presentation of lumbar thrombosis is highly variable depending on the relative involvement of nerve roots, bones or muscles.
Diagnosis can be challenging, especially in the acute phase, as different structures can be simultaneously involved. The identification of an enlarged vessel centered in the area of tissue damage can help with the final diagnosis.
We present the case of a 59-year-old woman who presented with spontaneous incomplete cauda equina syndrome due to diffuse lumbar nerve root infarction. On imaging, acute lumbar artery thrombosis was confirmed, and in addition to nerve roots, adjacent vertebral and paraspinal muscle infarctions were also present.
Introduction
Fire death investigations attempt to determine whether a subject was alive or dead before the fire started. Therefore, it is essential to assess if the bone damage is traumatic or the ...result of exposure to heat. This observational study aims to expose the specific CT semiology of thermal bone lesions to allow the forensic radiologist to identify and distinguish them from traumatic lesions that would have preceded death.
Materials and methods
We retrospectively reviewed the CT findings of 25 bodies with thermal bone lesions for which a postmortem computed tomography (PMCT) was performed prior to an autopsy. Imaging findings were correlated to the autopsy data to identify the specific features of thermal bone lesions.
Results
Specific signs of thermal injuries to bone were identified on PMCT on all deceased cases. Thermal damages predominated in areas directly exposed to flames (rib cage, distal extremities) with less soft tissue coverage (“soft tissue shielding”). The mottled appearance of bone marrow was a constant sign of burned bones. Heat fractures such as trans-diploic fractures of flat bones and beveled (“flute-mouthpiece”) fractures of extremities seemed specifically related to thermal mechanism. In addition, we provided a better description of superficial cortical fissures of flat bones (“ancient Chinese porcelain”) and observed a “stair step” fracture of a long bone until now undescribed in radiological literature.
Conclusion
Thermal bone lesions have specific CT findings, different on several points from traumatic injuries. Their knowledge is essential for radiologists and forensic physicians to provide an accurate report of injury and conclusions.
We aimed to detect physiologic changes of leg muscle signal on magnetic resonance (MR) diffusion-weighted imaging (DWI) in asymptomatic subjects after repetitive plantar flexion exercises. In this ...monocentric prospective study, DWI of both legs were performed at rest and after exercise periods (5 min, Ex
5
: and 10 min, Ex
10
) in 20 active healthy subjects (mean age 31 years). The exercise consisted in repetitive plantar flexion of the right foot using elastic band, the patient being sited directly on the MR table. Both visual semiquantitative evaluations and quantitative (apparent diffusion coefficient, ADC; fractional anisotropy, FA) were performed in 5 leg compartments. Visually, signal changes involved mainly the fibular and gastrocnemius muscles and were considered intense after Ex
5
in 3 subjects, moderate only after Ex
5
in 10, and moderate only after Ex
10
in 4. No changes were visible in 3 subjects. Quantitative evaluation confirmed significant signal changes in the fibular (ADC: + 17.4%,
p
< 0.001; FA: -8.3%,
p
= 0.030) and gastrocnemius (ADC: + 13.7%,
p
< 0.001; FA: -11.4%,
p
< 0.001) muscles between rest and post-exercise MR. Plantar flexion exercises induce changes on DWI, especially in fibular and gastrocnemius muscles, which can be visually and quantitatively detectable in asymptomatic active subjects.
Trial registration
EudraCT 2008-A00694-51.
BackgroundSymptomatic trapeziometacarpal osteoarthrosis can be treated with an ultrasound-guided injection in the early stages. This cadaveric study aimed to assess the hypothesis suggesting enhanced ...accuracy and reliability of hand-held ultrasound (HHUS) injections compared to blind injections into the trapeziometacarpal joint (TMC).Materials and methodOur series included 20 fresh cadaveric hands, with a total of 20 TMC randomly assigned to two groups. In group A, 10 TMC received a blinded injection, and in group B, 10 TMC received an ultrasound-guided injection with HHUS. Methylene blue was injected, and anatomical dissection was performed to assess the intra-articular location of the dye. The injection was considered accurate if the intra-articular synovial fluid was stained after opening the articular capsule on the dorsal approach. If there was no injection, it was inaccurate. A statistical analysis was performed, and p <.05 indicated a significant difference.ResultsTwo thumbs were excluded during the study due to an existing trapeziectomy. In group A, 10 blind injections of TMC were performed, with 70% (7/10) of injections graded as accurate. In group B, eight ultrasound-guided injections were performed, with 75% (6/8) achieving accuracy. A Fisher's exact test was performed, and the results indicated no statistically significant difference in injection accuracy between the two groups (P = 1, odds ratio = 0.788).ConclusionHand-held ultrasound guided TMC injections were not more accurate than blind injections performed by an experienced hand surgeon. Nonetheless, additional studies with a larger sample and comparative studies with conventional cart-based machines are necessary to evaluate the potential of this newly accessible device.
According to guidelines, all patients with sarcoma must be managed from initial diagnosis at expert sarcoma centers. However, in everyday practice, the time interval to an expert center visit can be ...long, which delays presentation to an expert multidisciplinary tumor board and increases the risk of inappropriate management, negatively affecting local tumor control and prognosis. The advent of mobile health offers an easy way to facilitate communication and cooperation between general health care providers (eg, general practitioners and radiologists) and sarcomas experts. We developed a mobile app (Sar'Connect) based on the algorithm designed by radiologists from the French Sarcoma Group. Through a small number of easy-to-answer questions, Sar'Connect provides personalized advice for the management of patients and contact information for the closest expert center.
This retrospective study is the first to assess this mobile app's potential benefits in reducing the time interval for patient referral to an expert center according to the initial clinical characteristics of the soft tissue tumor.
From May to December 2021, we extracted tumor mass data for 78 patients discussed by the multidisciplinary tumor boards at 3 centers of the French Sarcoma Group. We applied the Sar'Connect algorithm to these data and estimated the time interval between the first medical description of the soft tissue mass and the referral to expert center. We then compared this estimated time interval with the observed time interval.
We found that the use of Sar'Connect could potentially shorten the time interval to an expert center by approximately 7.5 months (P<.001). Moreover, for half (31/60, 52%) of the patients with a malignant soft tissue tumor, Sar'Connect could have avoided inappropriate management outside of the reference center. We did not identify a significant determinant for shortening the time interval for referral.
Overall, promoting the use of a simple mobile app is an innovative and straightforward means to potentially accelerate both the referral and management of patients with soft tissue sarcoma at expert centers.
•PMCT complements EE results when no autopsy is performed.•PMCT can reveal a cause of death hidden from EE.•PMCT can strengthen a presumed diagnosis based on the clinical findings of EE.•Some ...specific injuries can be missed by PMCT.•The exclusion of traumatic lesions on PMCT is a key point to assess natural death.
Nowadays, post-mortem computed tomography (PMCT) has become an integral part of Forensic practice. The purpose of the study was to determine PMCT impact on diagnosis of the cause of death within the context of the external examination of the body, when autopsy has, at first, not been requested.
We reviewed the records of 145 cases for which unenhanced PMCT was performed in addition to the external examination of the body from January 2014 to July 2015 at the Institute of Forensic medicine in Strasbourg (France). We confronted final reports from forensic pathologist to the corresponding PMCT reports. Data were collected in a contingency table and the impact of PMCT on the final conclusions of the forensic pathologist was evaluated via a Chi2 test.
PMCT results significantly impact the final conclusions of forensic pathologist (p<0,001). In some cases, PMCT permits etiological diagnosis by revealing a cause of death hidden from external examination (mainly natural death) or by supporting the clinical findings of the forensic pathologist. In other cases (traumatic death), PMCT enables fast and exhaustive lesion assessment. Lastly, there are situations where PMCT may be ineffective (intoxication, hanging or some natural deaths).
Performing PMCT within the context of the external examination of the body when autopsy has, at first, not been requested could bring significant benefits in diagnosing the cause of death. The impact of PMCT varies depending on the circumstances of death.
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