Neuropsychiatric syndrome with myoclonus after SARS-CoV-2 infection in a paediatric patient

We report the case of a 12-years-old patient who subacutely developed a positive and negative myoclonus of limbs and face, drowsiness and memory deficits after getting infected by SARS-CoV-2. On admission, nasopharyngeal swab for SARS-CoV-2, brain and spinal MRI with and without contrast, EEG, chest X-ray and abdominal ultrasound were negative. CSF physical-chemical examination, culture, PCR testing for SARS-CoV-2 and other pathogens, and oligoclonal IgG bands were negative as well. A full panel blood test, including clotting, autoimmunity and paraneoplastic blood studies, did not show any alteration. The neuropsychological examination showed an impairment in memory, visual-motor coordination, inductive reasoning skills, attention, and concentration. The patient was first treated with clonazepam and then with intravenous methylprednisolone for five days, with poor response. For this reason, he then received a cycle of IVIG, thus reaching a gradual and complete recovery. To date, this is the first case of a COVID-19 associated myoclonus affecting a paediatric patient.

[Assessment of the risk of arm repetitive movements among workers in the motor vehicle glass finishing industry]

The aim of the study was to evaluate risk associated with biomechanical overload of the upper limbs in workers exposed to repetitive movements, employed to the finishing of glasses for motor vehicles. The risk assessment was performed using the OCRA method (OCRA index for every worker and Check-List OCRA for every workstation) and the results have been distributed for exposure levels. Altogether the results suggested the existence of risk associated with repetitive movements of the upper limbs and different risk classes (high, medium, light, very light). OCRA index and Check-List OCRA values showed together high risk in the workers with age and employment duration great (respectively 20.68% e 27.58% of workers), with especially involvement of the women, employed to jobs with high frequency.

ViVa: the virtual vascular project

The aim of the virtual vascular project (ViVa) is to develop tools for the modern hemodynamicist and cardiovascular surgeon to study and interpret the constantly increasing amount of information being produced by noninvasive imaging equipment. In particular, we are developing a system able to process and visualize three-dimensional (3-D) medical data, reconstruct the geometry of arteries of specific patients, and simulate blood flow in them. The initial applications of the system will be for clinical research and training purposes. In a later stage, we will explore the application of the system to surgical planning. ViVa is based on an integrated set of tools, each dedicated to a specific aspect of the data processing and simulation pipeline: image processing and segmentation; real-time 3-D volume visualization; 3-D geometry reconstruction; 3-D mesh generation; and blood flow simulation and visualization.

Acute cerebellar ataxia in children

Acute cerebellar ataxia is a benign syndrome usually occurring after an acute febrile disease. In a few cases neuroradiological investigations reveal cerebellar alterations. Clinical and neuroradiological involvement of the brain stem has rarely been reported in the literature. We present five cases of acute cerebellar ataxia. In two cases the cerebellar symptomatology was associated with neurological signs of brain stem involvement. CT scans did not show any pathologic findings in three patients. MRI disclosed cerebellar or brain stem alterations in all the patients. Clinical and neuroradiological findings allow differentiation of this pathologic entity from other demyelinating or dysmyelinating diseases. The value of MRI in detection and localization of the lesions and in following their evolution is emphasized.

Cervical dumbbell ganglioneuroma in an eighteen month old child. A case report

Dumbbell neurogenic tumors are unusual in children. The authors report an extremely rare case of cervical intraspinal ganglioneuroma with a contiguous paravertebral component in an eighteen month old female patient. Both the intraspinal and the extraspinal parts of the dumbbell tumor were totally removed during the same surgical session. A laminotomy was performed rather than a laminectomy in order to avoid postoperative spinal column deformation. The authors emphasize the importance of an early diagnosis in preventing irreversible neurosurgical abnormalities and for achieving better surgical results.

Intramedullary haemorrhage due to AVM located within the medulla oblongata in a three year old child. Case report

Intramedullary arteriovenous malformations are rare in childhood. Yasargil reports only two cases in children under ten years of age out of a total of forty-one cases of AVM operated on between 1967 and 1983 in which microsurgical techniques were used. The early symptoms of these lesions are those due to intramedullary or subarachnoid haemorrhage with neurological deficit, pain and/or weakness or numbness of one or more limbs. We report the case of an intramedullary haematoma due to arteriovenous malformation within the medulla oblongata in a three year old child admitted for cervical pain and right arm hypostenia. The CT scan and MRI showed an intramedullary expansive lesion with associated internal haematoma between C1-C7 level. Because of the rapid clinical deterioration upon the onset of right hemiparesis we procedeed to empty the intramedullary haematoma and to remove the intrabulbar AVM. A swift improvement of neurological deficit was observed along with a total regression of the symptomatology in a month's time. The excellent results reported in this case, very likely the only case in the literature occurring in a very small child at this spinal cord level, are mostly due to the early surgical treatment and to the exact information that MRI provided.