COVID-19 and Malaria Co-infection; Same coin but different faces?

Background: As the COVID-19 pandemic spreads rapidly around the world, urgent action is needed to combat the new coronavirus, while other deadly diseases such as malaria cannot be ignored. The impact of the coronavirus on countries affected by malaria and, where possible, contribute to a successful response to COVID19. Our aim is to assess the possible link between Malaria and COVID-19 .Methods: This is a descriptive retrospective cross sectional study which was conducted among adult Sudanese COVID-19 patients admitted to the Universal and Ombada hospitals in the period (4th of April 2020 to the 15th of January, 2020). A total number of 87 patients were included. Results: Among the 87 patients 64.9 % were males while 35.6 were females. 27.6 % had a positive blood film. 64.7% of the malaria patients had p.falciparum while 35.3% had p.vivax. 52.9% of the patients showed positive RT-PCR for COVID-19 with 52.9 % showed positive CT findings . Generalized fatigability was observed in 52.9 % of the patients with malaria followed by headache, nausea, fever with chills, fever with shivering, vomiting and diarrhea in 42.5%, 36.8%, 20.7%, 12.6%, 9.2% and 9.2% respectively. In COVID-19 patients 85.1% had fever and generalized fatigability, followed by cough, headache, SOB , sore throat ,myalgia, chest pain and diarrhea. 13.79 % of malaria patients had malarial pneumonitis, followed by pulmonary edema, choleric malaria, thrombocytopenia and malaria induced hepatitis in 10.39 %, 9.2 %, 9.19 % and 6.9% respectively. 8.4% had cerebral malaria while 1.1% had cerebellar syndromes. 44.8 % had acute respiratory distress syndrome, 17.2% had heart failure, 8% had pulmonary embolism, 8% had stroke, 3.9% had encephalitis and 1.1% had convulsions.Conclusion: Malaria and COVID-19 have a possible link that they both share similar presentations and complications.

Reversible cerebellar oedema secondary to profound hypomagnesaemia

Magnesium is the second most abundant intracellular cation. Deficiency can cause several neurological complications, including cerebellar syndromes, with various MRI findings. These include cerebellar oedema, presumably through a similar mechanism to that in posterior reversible encephalopathy syndrome (PRES). People particularly vulnerable to deficiency include those with high alcohol consumption, excessive loss due to gastrointestinal pathology and those taking certain medications, including proton pump inhibitors. We report three patients with cerebellar syndromes associated with hypomagnesaemia. These cases support the previously reported association between hypomagnesaemia and reversible cerebellar dysfunction and illustrate the range of potential presentations. They highlight an uncommon but treatable cause of cerebellar ataxia that may present to acute neurological liaison services.

Meningioma of the Fourth Ventricle: Literature Review

Meningiomas are among the most common central nervous system tumors, with an incidence that ranges from 15% to 40% of intracranial tumors. Of these, only 0.5% to 3% are intraventricular, and the rarest of them occurs in the fourth ventricle.Fourth-ventricle meningiomas originate generally from the choroid plexus and have no dural adhesions. Most often, they manifest in young patients, around 41 years of age, with a possible predominance in females, through intracranial hypertension and cerebellar syndromes. The treatment consists of surgical resection, which commonly presents good results due to the characteristics of the tumor. So, for better preoperative planning, the radiological differentiation of the most frequent tumors in this location is important.The most common histologic subtypes are fibroblastic and meningothelial, both grade I according to the World Health Organization (WHO), although there are reports of tumors of grades II and III.We report a case of meningioma of the fourth ventricle operated in our institution, and we have conducted a literature review, through which we found that 57 cases have been reported so far, with the first one reported in 1938.

Disorders of Ocular Motility Due to Disease of the Brainstem, Cerebellum, and Diencephalon

This chapter reviews clinical features (with illustrative video cases) and pathophysiology of medullary lesions, including Wallenberg’s syndrome and oculopalatal tremor. Manifestations and pathophysiology of three cerebellar syndromes are described (flocculus and paraflocculus, nodulus and ventral uvula, dorsal vermis and fastigial nucleus), applying these principles to interpret the effects of developmental disorders (e.g., Chiari malformation), hereditary ataxia, paraneoplastic cerebellar degeneration, cerebellar stroke, and cerebellar tumors. Characteristics of pontine lesions are discussed, including lesions of the abducens nucleus, paramedian pontine reticular formation (PPRF), internuclear ophthalmoplegia (INO), one-and-a-half syndrome, slow horizontal saccades, and saccadic oscillations. The effects of midbrain lesions are summarized, including lesions affecting the rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF), interstitial nucleus of Cajal, posterior commissure, and more diffuse processes causing slow vertical saccades or vertical gaze palsy (dorsal midbrain syndrome), including Whipple’s disease. Effects of lesions affecting the superior colliculus, thalamus, and pulvinar are also discussed.

The Cerebellum and its Syndromes

discusses a wide range of cerebellar syndromes and links them to specific topographic areas of the cerebellum. The hereditary ataxic syndromes include spinocerebellar ataxia, the Louis-Bar syndrome, spastic ataxia of Charlevoix-Saguenay, and the syndrome of the dorsal vermis. Oculomotor syndromes of the cerebellum—the syndrome of the flocculus/paraflocculus (tonsil), characterized by downbeat nystagmus; the syndrome of the nodulus and uvula, resulting in periodic alternating nystagmus; the syndrome of the fastigial nucleus, responsible for saccadic dysmetria; and the pancerebellar syndrome, characterized by paraneoplastic opsoclonus or flutter—are illustrated by six case studies in this chapter.

Cerebellar Syndromes: A Medical Student Guide

The cerebellum is central to normal motor function and co-ordination, and can be frequently affected in a number of common disease processes. However, medical student teaching relating to cerebellar anatomy and pathology is lacking, leaving many graduates with a significant knowledge gap. Junior doctors need to be able to recognize ‘cerebellar syndromes’ on presentation to hospitals, and to identify and manage reversible causes rapidly and effectively. After review of relevant literature, a simple approach to the functional anatomy and practical classifications of common cerebellar pathology is presented here, with a focus on symptoms, signs and examination techniques essential to medical school final exams.