1
|
Haq SH, Shah SR, Bux J, Le AS, Golzarian H, Mueller D, Sreenan JJ, Patel SM, Laird A, Cole W. To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis. IDCases 2023; 31:e01702. [PMID: 36747911 PMCID: PMC9898726 DOI: 10.1016/j.idcr.2023.e01702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Although well described in the current literature, Neurocysticercosis [NCC] remains an enigma when confronted by practitioners. This is in part due to the haphazard nature of the parasitic infection on the central nervous system [CNS]. These include single or multiple anatomic sites of infection, stage of parasitosis, and the resultant inflammatory response. As a result, NCC can present with a complex constellation of symptomatic presentations, making therapeutic regiments highly individualized. Despite intervention, other impediments may arise post-therapy due to the nature of the infection. We present a case of rapidly progressive symptomatic NCC that initially was successfully treated, however would eventually succumb to complications of ventriculitis.
Collapse
Affiliation(s)
- Syed H. Haq
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Jannet Bux
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Anh Si Le
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Daniel Mueller
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Joseph J. Sreenan
- Department of Pathology Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sandeep M. Patel
- Department of Interventional Cardiology, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Amanda Laird
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - William Cole
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
- Correspondence to: Department of Critical Care, St. Rita's Medical Center (Mercy), 730 West Market Street, Lima, OH 45801, USA.
| |
Collapse
|
2
|
Lu Y, Li X, Geng D, Mei N, Wu PY, Huang CC, Jia T, Zhao Y, Wang D, Xiao A, Yin B. Cerebral Micro-Structural Changes in COVID-19 Patients - An MRI-based 3-month Follow-up Study. EClinicalMedicine 2020; 25:100484. [PMID: 32838240 PMCID: PMC7396952 DOI: 10.1016/j.eclinm.2020.100484] [Citation(s) in RCA: 326] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increasing evidence supported the possible neuro-invasion potential of SARS-CoV-2. However, no studies were conducted to explore the existence of the micro-structural changes in the central nervous system after infection. We aimed to identify the existence of potential brain micro-structural changes related to SARS-CoV-2. METHODS In this prospective study, diffusion tensor imaging (DTI) and 3D high-resolution T1WI sequences were acquired in 60 recovered COVID-19 patients (56.67% male; age: 44.10 ± 16.00) and 39 age- and sex-matched non-COVID-19 controls (56.41% male; age: 45.88 ± 13.90). Registered fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were quantified for DTI, and an index score system was introduced. Regional volumes derived from Voxel-based Morphometry (VBM) and DTI metrics were compared using analysis of covariance (ANCOVA). Two sample t-test and Spearman correlation were conducted to assess the relationships among imaging indices, index scores and clinical information. FINDINGS In this follow-up stage, neurological symptoms were presented in 55% COVID-19 patients. COVID-19 patients had statistically significantly higher bilateral gray matter volumes (GMV) in olfactory cortices, hippocampi, insulas, left Rolandic operculum, left Heschl's gyrus and right cingulate gyrus and a general decline of MD, AD, RD accompanied with an increase of FA in white matter, especially AD in the right CR, EC and SFF, and MD in SFF compared with non-COVID-19 volunteers (corrected p value <0.05). Global GMV, GMVs in left Rolandic operculum, right cingulate, bilateral hippocampi, left Heschl's gyrus, and Global MD of WM were found to correlate with memory loss (p value <0.05). GMVs in the right cingulate gyrus and left hippocampus were related to smell loss (p value <0.05). MD-GM score, global GMV, and GMV in right cingulate gyrus were correlated with LDH level (p value <0.05). INTERPRETATION Study findings revealed possible disruption to micro-structural and functional brain integrity in the recovery stages of COVID-19, suggesting the long-term consequences of SARS-CoV-2. FUNDING Shanghai Natural Science Foundation, Youth Program of National Natural Science Foundation of China, Shanghai Sailing Program, Shanghai Science and Technology Development, Shanghai Municipal Science and Technology Major Project and ZJ Lab.
Collapse
Key Words
- 3D-T1WI, 3 Dimensional T1-weighted Images
- AAL-3, Automated Anatomical Labelling Atlas-3
- ACE-2, Angiotensin Converting Enzyme-2
- AD, Axial Diffusivity
- CNS, Central Nervous System
- COVID-19
- COVID-19, Coronavirus Disease
- CR, Corona Radiata
- CSF, Cerebral Spinal Fluid
- Central Nervous System Diseases
- DICOM, Digital Imaging and Communications in Medicine
- DTI, Diffusion Tensor Imaging
- Diffusion Tensor Imaging
- EC, External Capsule
- FA, Fractional Anisotropy
- FOV, Field of View
- GM, Gray Matter
- GMV, Gray Matter Volume
- HIV, Human Immunodeficiency Virus
- HSV, Herpes Simplex Virus
- JEV, Japanese Encephalitis Virus
- LDH, Lactate Dehydrogenase
- MD, Mean Diffusivity
- MPRAGE, Magnetization Prepared Rapid Gradient Echo
- Neuroimaging
- OB, Olfactory Bulb
- PCR, Polymerase Chain Reaction
- Prospective studies
- RD, Radial Diffusivity
- SARS-CoV, Severe Acute Respiratory Syndrome Coronavirus
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus-2
- SFF, Superior Frontal-occipital Fasciculus
- TBSS, Track-based Spatial Statistics
- TE, Echo Time
- TR, Repetition Time
- UF, Uncinate Fasciculus
- URTI, Upper Respiratory Tract Infection
- VBM, Voxel-based Morphometry
- WBC, White Blood Cell
- WHO, World Health Organization
- WM, White Matter
- WMV, White Matter Volume
Collapse
Affiliation(s)
- Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China (Y Lu, X Li, D Geng, N Mei, Y Zhao, D Wang, B Yin)
| | - Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China (Y Lu, X Li, D Geng, N Mei, Y Zhao, D Wang, B Yin)
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China (Y Lu, X Li, D Geng, N Mei, Y Zhao, D Wang, B Yin)
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China (Y Lu, X Li, D Geng, N Mei, Y Zhao, D Wang, B Yin)
| | - Pu-Yeh Wu
- GE Healthcare, MR Research China, Beijing, China (P Wu)
| | - Chu-Chung Huang
- Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (C Huang)
| | - Tianye Jia
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England (T Jia)
| | - Yajing Zhao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China (Y Lu, X Li, D Geng, N Mei, Y Zhao, D Wang, B Yin)
| | - Dongdong Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China (Y Lu, X Li, D Geng, N Mei, Y Zhao, D Wang, B Yin)
| | - Anling Xiao
- Department of Radiology, Fu Yang No.2 Hospital, Anhui, China (A Xiao)
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China (Y Lu, X Li, D Geng, N Mei, Y Zhao, D Wang, B Yin)
| |
Collapse
|