Cranial CT Research Articles

Comparison of surgical and medical treatment in patients with spontaneous intracerebral hemorrhage

Aim: Intracerebral hemorrhage (ICH) is a subtype of stroke whose risk factors are chronic hypertension, amyloid angiopathy, anticoagulants, and malformations. Primary or spontaneous ICH constitutes a significant portion of hemorrhagic strokes. Management of ICH ranges from medical management to open surgery. In this study, surgical and medical treatments applied to the patients were compared with the Glasgow Coma Scale (GCS). Patients and Methods: A total of 32 patients with ICH were included in the study. Diagnosis was made by cranial computed tomography (CT) and magnetic resonance imaging (MRI) in all patients. Medical treatment was applied to 19 patients among the participants. Surgical treatment was applied to 13 patients. GCS points of patients presenting with intracerebral hematoma were recorded and compared at their first admission and after treatment. Results: In this study, a total of eight patients died, four of whom were followed up with medical treatment and four of those who underwent surgical treatment. Participants were examined in terms of pre- and post-treatment GCS scores according to the location of the lesion. As a result of the analysis of the data obtained, it was determined that there was a significant difference between the GCS values of the participants before and after the surgical and medical treatment. The mean GCS values of those who were treated medically were higher than those who were treated surgically. GCS values were very close to each other after treatment and no statistically significant difference was found between the groups. Conclusion: In the light of the findings obtained in the study, it was concluded that surgical treatment was not superior to medical treatment.

Exclusive color-coded duplex sonography of extracranial vessels reliably confirms brain death: A prospective study.

BackgroundTranscranial color-coded duplex sonography (TCCD) can be used as an ancillary test for determining irreversible loss of brain function (ILBF) when demonstration of cerebral circulatory arrest (CCA) is required. However, visualization of the intracranial vessels by TCCD is often difficult, or even impossible, in this patient cohort due to elevated intracranial pressure, an insufficient transtemporal bone window, or warped anatomical conditions. Since extracranial color-coded duplex sonography (ECCD) can be performed without restriction in the aforementioned situations, we investigated the feasibility of omitting TCCD altogether, such that the ILBF examination would be simplified, without compromising on its reliability.MethodsA total of 122 patients were prospectively examined by two experienced neurointensivists for the presence of ILBF from 01/2019-12/2021. Inclusion criteria were (i) the presence of a severe cerebral lesion on cranial CT or MRI, and (ii) brainstem areflexia. Upon standardized clinical examination, 9 patients were excluded due to incomplete brainstem areflexia, and a further 22 due to the presence of factors with a potentially confounding influence on apnea testing, EEG or sonography. A total of 91 patients were enrolled and underwent needle-EEG recording for >30 min (= gold standard), as well as ECCD and TCCD. The sonographer was blinded to the EEG result.ResultsAll patients whose ECCD result was consistent with ILBF had this diagnosis confirmed by EEG (n = 77; specificity: 1). Both ECCD and EEG were not consistent with ILBF in a further 12 patients. In the remaining two patients, ECCD detected reperfusion due to long-lasting cerebral hypoxia; however, ILBF was ultimately confirmed by EEG (sensitivity: 0.975). This yielded a positive predictive value (PPV) of one and a negative predictive value of 0.857 for the validity of ECCD in ILBF confirmation. TCCD was not possible/inconclusive in 31 patients (34%).ConclusionsThe use of ECCD for the confirmation of ILBF is associated with high levels of specificity and a high positive predictive value when compared to needle-electrode EEG. This makes ECCD a potential alternative to the ancillary tests currently used in this setting, but confirmation in a multi-center trial is warranted.Trial registrationhttps://www.drks.de, DRKS00017803.

Frequency, Causes and Findings of Brain Computed Tomography Scan at University of Lahore Teaching Hospital

Cranial computed tomography (CT) is the most generally utilized diagnostic method for the emergent evaluation of head trauma (TBIs) because it is readily accessible, quick, and sensitive for clinically relevant traumatic brain injuries as well as non-traumatic abnormalities. Objective: To determine the frequency, causes, and findings of brain computed tomography scan at The University of Lahore teaching hospital. Methods: A descriptive study was conducted at The University of Lahore Teaching Hospital. A sample of 202 brain CT scans from a total of 933 participants seen in the CT department was obtained using a suitable sampling technique. Data analysis was done using SPSS version 21.0. Results: There were 78 (38.6%) female patients and 124 (61.4%) male patients out of 202 total patients. The mean age of the patients was 47.1± 23 years. The most prevalent of them, brain atrophy, was observed in 63 (31.2%) of the patients. 51 (25.2%) patients had infarction, 36 (17.8%) had sinusitis, 24 (11.9%) had ischemic demyelination, and 16 (7.9%) had fractures and hemorrhages. In 8 (4.0%) patients, mastoiditis, tumors, and carcinoma were reported. 7 patients (3.5%) had cysts, 6 patients (3.0%) reported contusions, and 2 patients (1.0%) had abscesses. Conclusions: According to our research, the vast majority of individuals who underwent CT scans had a history of headache and falls and the most frequent observation in the patients was brain atrophy. Other major findings found were sinusitis and infarction.

Metastasis of Malignant Intracranial Meningioma to the Lung: Report of a Case and Review of the Relevant Literature

Background and Importance: Distant extracranial metastasis of meningioma is rare, and the pathophysiology of metastasis in meningioma remains a topic of debate. This study aimed to describe a patient who suffered from multiple pulmonary metastases of meningioma. Case Presentation: This report introduced a rare case of a 47-year-old female who presented with right hemiparesis. Cranial Computed Tomography (CT) demonstrated a homogeneously enhanced tumor in the left temporal lobe. The patient underwent tumor resection; the pathological result was found to be World Health Organization (WHO) grade I meningothelial meningioma. Recurrence of the tumor transpired after two years and a second operation was performed. WHO grade II atypical meningioma was diagnosed. Subsequently, the patient developed a chronic cough and her chest x-ray showed multiple lung masses. CT-guided biopsy of the right lung mass was performed. Finally, pulmonary metastatic meningioma was diagnosed. Conclusion: Distant extracranial metastasis and malignant transformation of meningioma involve the genetic alteration of a tumor, which should be studied further.

Prediction of stroke reconvalescence after coronary bypass surgery indicated by CT scan parameters.

Stroke in the postoperative time course after heart surgery remains a serious risk. Cranial computer tomography (CCT) is the first line option to detect severe intracranial damage. However, only few data are available to predict neurological outcome. Using visual rating scales (VRSs), this study addresses reliability and effectivity to indicate neurological status and likelyhood of improvement. In a single-center retrospective evaluation, 3719 patients underwent coronary bypass surgery. Because of a delayed recovery phase and neurologic deficits after cardiac surgery 109 patients had a cranial CT scan in the early postoperative period. The incidence of clinically relevant findings within the imaging was rated by an experienced neuroradiologist using two VRS,that is, the age-related white matter changes (ARWMCs) and the Mendes-Ribeiro visual rating scale (MRVRS). Both are computer-assisted measurement schemes to detect stroke-related intracranial damage. Follow-up was investigated with regard to clinical outcome and patient-related risk profiles. Of 109 patients with postoperative cranial CT scans due to prolonged recovery phases or proven neurological damage 44.5% had one cerebral defect in CCT imaging scans only. The others showed multiple defects. During hospital stay,92.3% experienced neurological improvement exposing reduced ARWMC, while 7.1% had no improvement and correlating high scores. Of both scales, the ARWMC-VRS demonstrated superior accuracy and discrimination. The preoperative ejection fraction (EF), arteriosclerotic degeneration of carotid arteries, and reduced glomerular filtration ratewere found to have a high correlation (r = 0.0005) with the latter group. In-hospital mortality of this cohort was 8.18%. Both the ARWMC and MRVRS were found to be appropriate. They reliably discriminate the groups of stroke patients after coronary artery bypass grafting (CABG) in the analysis of CCT images. When applied at the onset of neurological symptoms both scales are able to predict neurological reconvalescence upon hospital dismission. The ARWMC scale appeared superior as it demonstrated better accuracy and discrimination. The use of both VRS in patients with suspected stroke after CABG surgery can give insightful information toward a progression of neurological dysfunction or postoperative improvement.

Computed Tomography Predictors of Vascular Injury in Cranioencephalic Trauma Patients

Abstract Objective A frequent challenge for the neurosurgeon when treating a patient with cranioencephalic trauma is to determine whether the patient has a vascular lesion, when to suspect it, and what studies to request. In this context, the objective of the present study was to identify the variables on cranial computed tomography (CT) scans that predict vascular injury in digital subtraction angiography in patients with cranioencephalic trauma. Methods We conducted a cross-sectional study of patients with cranioencephalic trauma admitted to the Hospital Universitario del Valle between June 2016 and June 2019. Subjects with available simple CT images of the skull and digital subtraction angiography were included. Results A total of 138 subjects who met the inclusion criteria were identified. The average age was 32 years, 82% were men, and the most frequent mechanism of injury was firearm wound (59%). The variables associated with vascular injury were fracture of the base of the temporal skull and sphenoid fracture. Conclusion The presence of fractures of the base of the temporal skull and sphenoid fractures is associated with vascular injury in patients with cranioencephalic trauma.

Characterization of hearing-impairment in Generalized Arterial Calcification of Infancy (GACI)

Background and importanceHearing loss (HL) has been sporadically described, but not well characterized, in Generalized Arterial Calcification of Infancy (GACI), a rare disease in which pathological calcification typically presents in infancy.ObjectivesThis study aims to describe the clinical audiologic and otologic features and potential etiology of hearing impairment in GACI and gain pathophysiological insight from a murine model of GACI.DesignCross-sectional cohort study of individuals with GACI. Murine ossicle micromorphology of the ENPP1asj/asj mutant compared to wild-type.SettingClinical research hospital; basic science laboratory.ParticipantsNineteen individuals with GACI who met clinical, biochemical, and genetic criteria for diagnosis.Main outcomes and measuresClinical, biochemical, and radiologic features associated with hearing status.ResultsPure-tone thresholds could be established in 15 (n = 30 ears) of the 19 patients who underwent audiological assessments. The prevalence of HL was 50% (15/30) of ears, with conductive HL in 80% and sensorineural HL in 20%. In terms of patients with HL (n = 8), seven patients had bilateral HL and one patient had unilateral HL. Degree of HL was mild to moderate for 87% of the 15 ears with hearing loss. Of those patients with sufficient pure-tone and middle ear function data, 80% (8/10) had audiometric configurations suggestive of ossicular chain dysfunction (OCD). Recurrent episodes of otitis media (ROM) requiring pressure-equalizing tube placement were common. In patients who underwent cranial CT, 54.5% (6/11) had auricular calcification. Quantitative backscattered electron imaging (qBEI) of murine ossicles supports an OCD component of auditory dysfunction in GACI, suggesting loss of ossicular osteocytes without initiation of bone remodeling.Conclusions and relevanceHearing loss is common in GACI; it is most often conductive, and mild to moderate in severity. The etiology of HL is likely multifactorial, involving dysfunction of the ossicular chain and/or recurrent otitis media. Clinically, this study highlights the importance of early audiologic and otologic evaluation in persons with GACI. Novel findings of high rates of OCD and ROM may inform management, and in cases of unclear HL etiology, dedicated temporal bone imaging should be considered.

Using Smartphone to Evaluate Cranial Computed Tomography Videos: An Inter-Observer Study

Objective: Many clinicians receive Cranial Computed Tomography (CCT) images or videos by their smartphone. The aim of this study was to evaluate the reliability of the CCT videos that are shared through smartphone in the diagnosis. 
 Method: The CCT videos that were sent via WhatsApp were examined in 9 sections: soft tissue, bone structure, parenchyma, ventricle, vascular structures, middle ear, orbits, sinuses and the extra axial space. 
 Result: The CCT videos were analyzed in 9 sections; there was a perfect agreement among specialists in one of these sections, good agreement in 6 and poor agreement in 2. When compared with the gold standard, it was shown that 5 out of 9 sections could be an alternative to the gold standard. 
 Conclusion: It may be thought that evaluation of the CCT videos can be obtained with messenger applications such as WhatsApp, which is a cheap, fast and common application. But this study shows that diagnostic images and videos shared through the smartphone by a messenger application can not be an alternative to standard evaluations.

Surgical Treatment of Bilateral Chronic Subdural Hematoma.

Background Chronic subdural hematoma (CSDH) is one of the common clinical intracranial hemorrhagic disorders, accounting for 16%–20% of bilateral CSDH. At present, the surgical treatment of bilateral CSDH mainly includes drilling drainage and neuroendoscopic assistance. The main objective of this paper was to compare the effects of two surgical methods on CSDH. Methods 153 patients who were diagnosed with CSDH were included in this study. 79 patients were treated with bilateral drilling drainage, and the other 74 patients were treated with neuroendoscope-assisted drainage. The clinical data of the two groups were compared, and the surgical indexes, neurological function, cure rate, and recurrence rate of the two groups were compared. The operation indexes of patients include operation time, postoperative hematoma volume, hospital stay, extubation time, misplacement of drainage tube, recurrence, and hematoma clearance rate. Results All patients underwent CT examination one day after operation. The CT imaging detection of the two groups was generally good. The cranial CT was reexamined before discharge. The bilateral hematoma disappeared in 114 patients, the unilateral hematoma disappeared in 29 patients, a small amount of compensatory crescent very low-density shadow subdural effusion was observed on the other side, and a small amount of compensatory crescent very low-density shadow subdural effusion was observed on both sides in 10 patients. There was no space occupying effect and intracranial gas disappeared. Compared with neuroendoscopic assisted drainage, the operation time of drilling drainage patients was significantly shorter. The extubation time, drainage tube dislocation, recurrence rate, postoperative hematoma volume, and hematoma clearance rate of patients receiving neuroendoscopic assisted drainage were significantly better than those receiving drilling drainage. The Markwalder score and hospital stay between the two groups were not significant. Conclusions Drilling drainage and neuroendoscopic assisted surgery have good therapeutic effects on bilateral CSDH. The operation time of drilling drainage is shorter. Neuroendoscopic assisted surgery has more advantages in extubation time, misplacement of drainage tube, recurrence, postoperative hematoma volume, and hematoma clearance rate.

Role of personalized 3D printing in brain protection after decompressive craniectomy

Objective: To explore the application value of personalized three-dimensional (3D) printed protective cap in brain protection after decompressive craniectomy (DC). Methods: Fourty-five patients who underwent DC from January 2021 to October 2021 were selected, including 26 males and 19 females, aged 5-73 (50±13) years old. The brain CT data were imported into 3D Slicer software to rebuild the protective cap through 3D printing. The cap was worn on the head of the patient, thereby preventing secondary braindamage. The follow-up results were compared with 53 patients without protective capduring the same period. Results: There were no statistically significant differences in age, skull defect location and follow-up time between the two groups (all P>0.05).Among 45 patients, 47 brain protective caps (2 cases with bilateral skull defects) were successfully designed. The time for image post-processingand 3D printing was (21.2±6.0) min and (62.4±8.3) min, respectively. There were 6 cases of low compliance, 9 cases of moderate compliance, 32 cases of high compliance, respectively. Six cases with low conformity were redesigned and printed, 2 of 9 cases with moderate conformity were redesigned and printed, and the remaining 7 cases reached high compliance after grinding and packaging. In the current study, 45 patients with brain protective caps were followed up for 3 months, and no secondary brain injury occurred. However, among 53 patients without brain protective caps during the same period, 4 patients had secondary accidental brain compression. The incidence of injury was 7.5 %, and the difference was statistically significant (P<0.001). Conclusion: Brain protective cap designed based on cranial CT and 3D printing can be used in patients with skull defects to protect the brain tissue from secondary crush damage and has certain clinical value.

EPIDEMIOLOGY OF PERIORBITAL DERMOID CYST IN PEDIATRIC AGE GROUP

Background &#x0D; Very little is known about the periorbital dermoid cyst in Iraqi Kurdistan. Therefore, this study was undertaken in Sulaimani province to describe the defects in the area and report patients’ outcomes.&#x0D; Objectives &#x0D; The aim of this study was to identify the prevalence of Periorbital dermoid cyst among pediatric age group, characteristics of the lesion regarding location and presentation with management and its out come.&#x0D; Patients and Methods&#x0D; The case-series study involved 35 pediatric age group patients; who visited the clinical dermatological and neurosurgical centres, with a periorbital dermoid cyst from 2014 to 2018.&#x0D; Results&#x0D; Of the 35 patients who presented with a periorbital dermoid cyst, 18(51.43%) were female, and 17 (48.57%) were male—the age at presentation was mainly infancy. The lesion was situated on the right side in 18 (51.43%) patients and on the left side in 17 (48.57%) patients, and it was presented with a mass in 27 (77.14%) patients, drooping eyelid in seven (20%) patients, and dermoid sinus in one (2.86%) patient.&#x0D; The lesion was superficial in 24 (68.57%) patients and deeply located in 11 (31.43%). A Cranial CT scan was done in all patients; only five (14.29%) patients showed underline bone erosion. The lesion was progressively enlarged in 26 (74.29%) patients. Surgical excision was performed for all patients, except one, without recurrent complications.&#x0D; Conclusion&#x0D; Our view is that if diagnosed early, the dermoid cyst should be totally removed even in asymptomatic lesions because it enlarges and causes underline bone erosion and inflammation.

Luc’s Abscess: The Zygomatic Route of Infection from Cholesteatoma

Luc’s abscess is an uncommon complication of otitis media wherein a subperiosteal abscess develops into the temporalis muscle and follows the route of a pneumatized zygoma.1 In uncomplicated cases, surgical drainage and antibiotics are adequate management with mastoidectomy reserved for severe or complicated cases. We report a case of complicated Luc’s abscess presenting with many complications that required multiple surgical interventions. CASE REPORT A 23-year-old man had a three-month history of yellowish, mucoid, foul-smelling left ear discharge associated with multiple episodes of non-projectile watery vomiting (&lt; 1 cup each) and left-sided facial paresis. These symptoms were accompanied by ipsilateral hearing loss, tinnitus and dizziness prompting consult and admission to a secondary hospital. A cranial Computed Tomographic (CT) scan showed a cholesteatoma in the left ear. The facial asymmetry improved, vomiting was resolved with intravenous antibiotics, hydration, and an anti-emetic, and he was subsequently discharged. He continued to have recurrent, foul-smelling left ear discharge and left hemifacial paresis persisted. Left-sided otorrhagia and ipsilateral hemifacial paresis were subsequently associated with left hemifacial swelling, otalgia (VAS of 7/10, described as sharp), and decreased hearing, prompting an outpatient consult with a private ENT specialist. The symptoms persisted despite 7 days of oral ciprofloxacin, this time associated with drowsiness, neck pain and febrile episodes. The patient consulted in our institution and was advised emergency admission. He was admitted drowsy, coherent with GCS 15 (E4V5M6). The left temporal area was edematous and tender, extending to the ipsilateral post-auricular area inferiorly and frontal area superiorly. (Figure 1) Otoscopy revealed yellowish, foul-smelling, copious muco-purulent discharge and near-total perforated left tympanic membrane. The right ear had unremarkable otoscopic findings. Tuning fork tests at 512 Hz were consistent with sensorineural hearing loss in the left ear with House-Brackmann IV facial nerve paresis. Brudzinski and Kernig tests were negative with no signs of dysmetria, dysdiadochokinesia or dysarthria on cerebellar testing. Gram stain and KOH smears of the left ear discharge revealed C fruendii and fungal elements. High resolution temporal bone CT scan showed otomastoid disease on the left with automastoidectomy defect, associated subperiosteal and intracerebral abscess formation on the left, with otherwise unremarkable right temporal bone. (Figure 2)

LINC-06. Prevalence and outcomes of Autoimmune encephalitis in a tertiary hospital in Baguio City, Philippines

INTRODUCTION: Autoimmune Encephalitis is a debilitating neurological disorder that develops as a rapidly progressive encephalopathy, occurring usually less than 6 weeks, caused by brain inflammation. There are limited data on the autoimmune cases in the locality. This study aims to determine the prevalence and outcomes of patients with Autoimmune encephalitis cases admitted in a tertiary hospital in Baguio City, Philippines. METHODOLOGY: This is a descriptive retrospective cross-sectional study that reviewed health records of patients managed as autoimmune encephalitis in a tertiary hospital from January 2015 to December 2020. Descriptive Statistics using frequencies and percentages were employed in the study. RESULTS: A total of 21 patients were included in the study, majority of which were adolescent patients, with male predominance and are residing in rural areas. The most common clinical manifestation presented were fever, behavioral changes, generalized motor seizures, orofacial and limb dyskinesias. EEG revealed abnormal results in 14 patients (66.67%). Majority of patients had normal CSF analysis, while 2 (38.1%) revealed elevated CSF protein levels. Eight patients (38.1%) tested positive for anti-NMDAR titers. Most patients had normal ultrasound and cranial CT Scan (47.62%). The length of stay was more than 2 weeks and majority (80.95%) of patients were discharged improved. CONCLUSION: The prevalence of autoimmune encephalitis is 5/10,000 pediatric population in a span of 6 years which was noted to be increasing over time. The demographic and clinical profile maybe used as predictors of outcome of autoimmune encephalitis, hence, it can help in the management of the said disease.

Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Cerebral Paragonimiasis in Children.

ObjectiveTo investigate the computed tomography (CT) and magnetic resonance image (MRI) manifestations of cerebral paragonimiasis (CP) in children and to improve the understanding of the disease.MethodsThe cranial CT and MRI data of 12 children with positive intradermal tests for Paragonimus-specific antigens were retrospectively analyzed. Additionally, the lesion locations, morphology, and imaging characteristics were analyzed.ResultsThe lesions were located in the cerebral parenchyma in 12 cases, with 10 in the supratentorial area and two in the subtentorial area, among which three cases included involvement of the meninges. The morphology of the lesions was mainly nodular and striated, with clear or indistinct borders and varying degrees of surrounding edema. The lesions showed isodense or slightly hyperdense opacities on the CT scans, heterogeneous equal or slightly decreased signal intensities on the T1-weighted images (T1WI), heterogeneous equal or slightly increased signal intensities on the T2-weighted images (T2WI), and equal or slightly increased signal intensities on the diffusion-weighted images (DWI) in MRIs. In four cases, the cyst wall showed equal T1 and short T2 signals, and in six cases, the characteristic “tunnel sign” and “worm-eaten sign” were visible. The contrast-enhanced MRI showed strip-shaped enhancement in five cases, nodular or ring-shaped enhancement in three cases, linear enhancement in two cases, and uneven enhancement in two cases. The meninges adjacent to the lesions were thickened with significant enhancement in four cases.ConclusionCP was mostly located in the cerebral parenchyma with involvement of the adjacent meninges. CT and MRI scans had certain imaging characteristics, and the MRI may particularly be of great value for the diagnosis of CP.

Mutism. What to expect?

IntroductionMutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.ObjectivesOutline the importance of setting a differential diagnosis of mutism in the Emergency Room.MethodsReview of scientific literature based on a relevant clinical case.Results Male, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.ConclusionsMutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.DisclosureNo significant relationships.

Neuropsychiatric implications of covid-19 infection: A case report

IntroductionDuring the COVID19 pandemic numerous cases of neuropsychiatric complications were reported as a result of COVID19.ObjectivesPresentation of a clinical case and literature review of new cases of neuropsychiatric complications after SARS-CoV2.MethodsWe present the case of a 43-year-old woman in follow-up for 15 years borderline personality disorder who was diagnosed with SARS-CoV2 pneumonia without signs of severity. Throughout the admission the patient, who had no history of epilepsy or other neurological affections, presented up to 5 generalized tonic-clonic seizures during 15 days.ResultsIn the ECG was evidenced intercritical epileptiform activity predominantly right frontotemporal. No analytical alterations were observed, neither in the imaging tests (cranial MRI and CT). Lumbar puncture was normal. During the admission, he presents an affective deterioration, with generalized impoverishment, decreased functional autonomy and hearing voices without structured delusional ideation. No previous psychotic history. Her previous treatment with Sertraline 100mg was suspended and valproic acid was added (1300 mg/day) which, being insufficient in the control of seizures, was necessary to boost with Levetiracetam (1000 mg/12h). Risperidone 3 mg and Diazepam 5 mg/8h were added to control psychotic symptoms. In the subsequent follow-up, previous antipsychotic treatment was gradually discontinued. The patient evolved favorably without new psychotic symptoms and clinical stability was observed with euthymia.ConclusionsTaking care of these complications it is necessary to avoid misdiagnosing. It is essential to expand the study of this entities in the context of COVID19 in order to increase knowledge and to be able to carry out an adequate approach and follow-up.DisclosureNo significant relationships.

Conversion disorder in an 18-year-old boy: a case report

IntroductionConversion is the transformation of a conflict (unconscious) into a somatic symptom or a “non-verbal way of expressing psychological discomfort”, through somatizations. The disorder suggests a neurological or medical disease, associated psychological factors appear and is not produced intentionally.ObjectivesTo describe a case of conversion disorder.MethodsRetrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology.ResultsAn 18-year-old boy came to the emergency room for paralysis. He has anesthesia of lower limbs. He shows indifference towards this symthoms.He denies any stressful situation. On examination, no psychotic or affective symptoms were observed. Belle indifference. Blood tests and a cranial CT scan were performed without alterations, so the patient was admitted for study. The electromyogram, lumbar puncture and cranial magnetic resonance show negative results. Suggestion is carried out, proving effective and recovering gait and sensitivity. These episodes are repeated up to 4 times until finally, during an interview with the family, episodes of bullying come to light. We work in therapy with a diagnosis of conversion disorder.ConclusionsThe most frequent symptoms in conversion disorder are mutism, paralysis, anesthesia, blindness and seizures. It is usually monosymptomatic for each patient. Diferencial diagnosis with neurological pathology should be made.DisclosureNo significant relationships.

Clinical observation of 8 cases with central nervous system anaerobic infection diagnosed by metagenomic next-generation sequencing of cerebrospinal fluid

The current study summarized the clinical characteristics of 8 patients with central nervous system anaerobic infections who visited the Second Hospital of Hebei Medical University from June 2019 to June 2021. Among the 8 patients, 7 cases had headache and fever as the first symptoms, and 1 case had left-sided limb weakness as the first symptom. Four patients had a previous history of diabetes (1 patient had a history of tooth extraction before the onset of the disease), 1 patient had a previous history of sinusitis, 1 patient had a history of tooth extraction before the onset of the disease, and 2 patients had chronic extensive periodontitis or periapical periodontitis. Five cases showed abnormal intracranial and/or meningeal enhancement on cranial magnetic resonance imaging (MRI), and 1 case showed swelling of the whole brain tissue on cranial computed tomography (CT). After treatment, symptoms of 4 cases were improved, symptoms of 1 case were aggravated, and 3 cases died. Anaerobic infections can occur in various parts of the body:the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin and soft tissues. It is generally believed that anaerobic bacteria rarely cause central nervous system infection, therefore, anaerobic culture of cerebrospinal fluid is usually not performed. Moreover, anaerobic culture is affected by many factors, and thus it is difficult to obtain positive results. Metagenomic next-generation sequencing can identify multiple pathogens (viral, bacterial, fungal, or parasitic) from samples based on DNA and/or RNA sequences and has advantages in diagnosing anaerobic infections of the central nervous system. Prompt empirical antimicrobial therapy is essential for the prognosis of the patients.

P08 The difficulty of Pseudomonas aeruginosa eradication in a post-spinal anaesthesia meningitis

BackgroundMeningitis and ventriculitis due to Pseudomonas aeruginosa are uncommon. They are commonly secondary hospital-onset and typically related to neurosurgical procedure. Previous studies have shown P. aeruginosa to be responsible for 1%–18% of nosocomial meningitis cases. Both treatment failure and relapses are known to occur, and the recorded mortality is high, approaching 80% in some studies.ObjectivesWe report a case of P. aeruginosa meningitis in a 26-year-old woman following spinal anaesthesia for caesarean section, its clinical characteristics, treatment challenges in the era of high generation antibiotics and the outcomes.ResultsA 26-year-old woman was hospitalized after 1 week of her third child delivery by caesarean section with spinal anaesthesia and 3 days after high fever and headache. Lumbar puncture was performed immediately, and leucocyte cell count was 723 cell/dL with 94% segmented neutrophils. CSF glucose was very low, and protein was 420 mg/dL. P. aeruginosa was isolated and it was susceptible to all antibiotics of standard panel. Cranial and lumbar region CT scans were normal. We modified empirical treatment and started ceftazidime and gentamicin. Three days after de-hospitalization in improved condition, she had high fever and strong headache and came back to hospital. We started treatment with imipenem and ciprofloxacin and 2 months after we performed several lumbar punctures, cranial MRIs and changed different antibiotic regimens with third generation cephalosporins, aminoglycosides, carbapenems and colistin; her clinical situation such as headache and fever and CSF did not show any sign of improvement. Susceptible P. aeruginosa was isolated each time we examined her CSF. She decided to leave the hospital and 2 weeks after her headache worsened and a convulsive attack happened. The cranial MRI showed hydrocephaly and a white precipitate (pus) in the left lateral ventricle. An extraventricular drain helped to resolve hydrocephaly and intraventricular colistin was injected until CSF was sterilized. After 1 month she was in a very good condition and a ventriculo-peritoneal shunt was placed.Conclusions P. aeruginosa meningitis was associated with some treatment difficulties. Even after an early nosological and microbiological diagnosis and an appropriate choice of antibiotics, based on bacterial meningitis treatment criteria and antibiogram, we couldn't eradicate the bacteria from CSF. To achieve success in this nosocomial infection from a not careful asepsis, sometimes a prolonged antibiotic and local treatment with intraventricular or intrathecal therapy is needed.

125 Complex cortical visual impairments following bilateral occipital infarcts after traumatic brain injury

BackgroundSecondary brain damage following acute traumatic brain injury (TBI) contributes to increased morbidity and disability. Intracranial vasospasm is a less common cause for secondary brain damage. We report a case of a 73 year old man in whom post-traumatic vasospasm lead to bilateral occipital infarction.Case summaryThe patient was admitted with a severe TBI following a fall from height causing bilateral fronto-temporal haemorrhagic contusions. Ten days after admission he developed a fluctuating level of consciousness. Repeat cranial CT and angiography showed new bilateral occipital hypodensities and bilaterally multi-level vessel narrowing in the posterior circulation.The patient suffered from cortical blindness but regained gradually visual perceptual function over the next months. During this time a combination of Balint syndrome (simultanagnosia, oculomotor apraxia and optic ataxia), visual hallucinations and confabulation were observed. Neurorehabilitation was com- plicated by the complex nature of extensive cognitive deficit in combination with the visual impairments but enabled the patient to gain some insight and coping strategies.ConclusionsThis case highlights the complexities of neurorehabilitation following TBI and describes an unusual case of partially reversible cortical blindness. It further highlights the importance of recognising the impact of secondary brain damage after TBI.nicole.lichtblau@nhs.net