Coinciding SARS-CoV-2 infection in HIV patients with cerebral toxoplasma

A massive and notorious impact of coronavirus disease 2019 (COVID-19) pandemic has affected communities worldwide, urging extra preventive measure, especially for individuals with comorbidities including those who are suffering from human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). We reported a case of a 45-year-old man with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HIV infection as well as toxoplasmosis. The patient presented to the hospital with decreased consciousness and stiffness on both hands and feet accompanied with loss of appetite, fever, and coughing. Since 2014, he had been diagnosed with HIV and undergone combined antiretroviral therapies. Toxoplasmosis was revealed by multislice computed tomography (MSCT) showing multiple rim-like lesion in cortex-subcortex of left temporal lobe along with surrounding perifocal oedema. Furthermore, the finding was corroborated by the contrasted image exhibiting rim enhancement patterns. The patient was also RT-PCR confirmed Covid-19. Following examinations, the patient received pyrimethamine with a loading dose of 200 mg. The management was continued with oral intake of pyrimethamine, clindamycin, folic acid, and vitamin B6 for maintenance dose. This case report suggests that HIV patient suffering from COVID-19 can be treated with antiretroviral therapies since the specific antivirus for SARS-CoV-2 has not yet available. We believe that this case report could contribute to more understanding on the development of clinical management for COVID-19 in HIV-positive patients.

Meningioma Infiltrative Accompanied by Organic Delusional Disorders

A B S T R A C TIntroduction. Meningiomas are primary extra-axial tumours of the central nervoussystem (CNS) with an incidence of 2 in 100,000 in adults. There is an estimate of a3: 1 female predominance of these tumours mainly due to the action of estrogen.Meningiomas are commonly associated with headaches, imbalances, visualdisturbances, and other neurological problems which can be very debilitating. Thiscase report will describe a case of a brain tumour accompanied by psychiatricdisorders. Case presentation. Mrs W, a 37 years old woman, a housewife, Javanese,Moslem, married, lower socioeconomic background, came with her family to theNeurology polyclinic because she experienced changes in behaviour since sevenmonths ago in the form of much silence, daydreaming, cannot communicate,sometimes talking to herself, eating drinking and bathing must be helped and served.Four months before being admitted to the hospital, because the patient's headachesworsened and the patient became increasingly withdrawn, accompanied by weaknessin both legs. From the results of CT-scan with contrast, the results showed that themeningioma infiltrates and perifocal oedema, which caused subfalcine herniation asfar as 2.73 cm to the right. Conclusion. Infiltrative meningioma is often accompaniedby mental disorders in the form of personality changes, depressive-like symptomsand neurological symptoms. Clinicians should be able to detect a brain mass so thatmanagement can be undertaken immediately.

Hypertrophic pachymeningoencephalitis associated with temporal giant cell arteritis

We report the rare case of an 80-year-old male patient with hypertrophic pachymeningoencephalitis that may be associated with temporal arteritis. The patient presented to our neurological department with a 2-week history of latent paresis and ataxia affecting his right hand. He had been diagnosed with temporal arteritis 12 years earlier. Brain MRI showed an enhancement of the left-sided frontoparietal meninges with oedema of the adjacent tissue of the precentral and postcentral cortex. A leptomeningeal biopsy was performed. An autoimmune-mediated immunoglobulin G4-associated hypertrophic pachymeningoencephalitis was diagnosed. The patient received a high-dose corticosteroid therapy and his symptoms gradually improved. Our results suggest that hypertrophic pachymeningoencephalitis may occur as a complication of giant cell arteritis and may cause central neurological deficits by cerebral perifocal oedema.

Analysis of risk factors for perifocal oedema after endovascular embolization of unruptured intracranial arterial aneurysms

Background. Endovascular embolization is a treatment of choice for the management of unruptured intracranial aneurysms, but sometimes is complicated with perianeurysmal oedema. The aim of our study was to establish incidence and outcomes of perianeurysmal oedema after endovascular coiling of unruptured intracranial aneurysms, and to reveal possible risk factors for development of this potentially serious complication. Methods. In total 119 adult patients with endovascular embolization of unruptured intracranial aneurysm (performed at Department for Interventional Neuroradiology, Clinical Center, Kragujevac, Serbia) were included in our study. The embolizations were made by electrolite-detachable platinum coils: pure platinum, hydrophilic and combination of platinum and hydrophilic coils. Primary outcome variable was perianeurysmal oedema visualized by magnetic resonance imaging (MRI) 7, 30 and 90 days after the embolization. Results. The perianurysmal oedema appeared in 47.6% of patients treated with hydrophilic coils, in 21.6% of patients treated with platinum coils, and in 53.8% of those treated with mixed type of the coils. The multivariate logistic regression showed that variables associated with occurrence of perianeurysmal oedema are volume of the aneurysm, hypertension, diabetes and smoking habit. Hypertension is the most important independent predictor of the perianeurysmal oedema, followed by smoking and diabetes. Conclusions. The results of our study suggest that older patients with larger unruptured intracranial aneurysms, who suffer from diabetes mellitus and hypertension, and have the smoking habit, are under much higher risk of having perianeurysmal oedema after endovascular coiling.

Brain and lung metastasis of alveolar echinococcosis in a refugee from a hyperendemic area

Alveolar echinococcosis (AE) of the liver with cerebral and pulmonary metastasis was diagnosed in a Tibetan monk who initially presented with severe headache to an emergency department in Germany. Multiple lesions with perifocal oedema and severe compression of the third ventricle were seen with computed tomography (CT) of the brain. Glioma or cerebral metastasis of a hitherto undiagnosed abdominal or pulmonary malignancy was suspected. CT scans of the lung and liver demonstrated further tumorous masses. Magnetic resonance imaging of the brain revealed the cystic nature of the cerebral lesions and the patient had a highly positive serology for AE. The echinococcal aetiology of the brain lesions was confirmed by PCR for this refugee from an area where two disease entities, AE and cystic echinococcosis, are hyperendemic.

Magnetic resonance imaging and computed tomography of neurocysticercosis

The typical radiological appearance of neurocysticercosis (NC) includes: small solitary or multiple non-enhancing lesions, small enhancing nodules, non-enhancing cysts without and at a later stage with perifocal oedema, racemose cysts in the subarachnoid space, cysts with ring enhancement and perifocal oedema, cysts with eccentric scolex (target sign, bull's eye sign) and nodular calcifications. MRI is more sensitive than CT (Figs 1 - 5) in the diagnosis of subarachnoid and ventricular forms of NC. CT is very sensitive in diagnosing cerebral forms and is more sensitive than MRI in the late stage of NC characterised by nodular calcifications. In patients with seizures, neurological deficit and mental deterioration CT remains the imaging method of choice. If the result of CT is negative or dubious MRI has to be considered. On CT small lesions are not visible especially if investigation is performed only with 10mm slices.

Preoperative Embolization for Meningioma Using Lipiodol

Four patient (3 males, 1 female) with meningioma treated by preoperative embolization using lipiodol since January 1997 were included in this study. Almost the same procedure was performed on them; superselective catheterization into feeders from the external carotid artery, slow infusion of lipiodol, and proximal occlusion with liquid coils. Duration between embolization and direct surgery varied (5–13 days). Three meningiomas resected 5 days after the embolization were successful but one resected after 13 days needed transfusion. Post operative complications were seen in two patients, one is lockjaw due to ischaemia of the temporal muscles, and the other is transient dilatation of perifocal oedema. The ischaemic effect and safety of lipiodol as embolic material are discussed.