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Abstract Background COVID-19 is a pandemic disease responsible for many deaths worldwide. Many neurological manifestations have been described. We report a case of normal pressure hydrocephalus (NPH) 2 months after acute COVID19 infection, in a patient without other risk factors. Case presentation A 45-year-old male patient presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was progressive improvement after shunting, with complete resolution of symptoms. Conclusion Other infections such as syphilis, cryptococcosis and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association.

Neurocysticercosis is an endemic infeccion in Brazil, but the intramedullary cases are rare, 1,2% to 5,8% of all cases. There are only fifty cases reported until January of 2011. Intramedullary neurocysticerosis is a treatable pathology but if misdiagnosed it could lead to irreversible damage. Twenty eight year old female patient, previously healthy, was admitted due to a fall. She had progressive walking difficulties and impaired sensation in both lower limbs two months before admission. Contrast MRI revealed a round intramedullary cystic lesion at T2 e T3. The patient underwent laminectomy from T2 to T3, and the spinal cord was found locally swollen near the exit root at this level. A mielotomy was performed where a round protrusion was seen near the root. Histological examination of the resected sample showed cysticercosis. After surgical excision she received albendazol and streoids. The patient's neurological function postoperatively was unchanged. One week later, the motor power of her lower limbs were grade 4/5, and she could walk without special support. The function of anal sphincter and bladder regained without compromise. She was back to work. This reflects dramatically in an active portion of population since it affects mostly people between 20 to 45 years. So it still represents a challenge and this paper intend to show our experience and by that help future diagnostics.

Objective: The present study aims to define the main risk factors for infection in EVD implants performed in a public tertiary hospital in Belo Horizonte, Brazil. Method: The present study performed a retrospective review of 137 cases of EVD implants in 107 patients from January 2006 to December 2008. Of these cases, 25 patients had to be re-operated, totally 141 implanted shunts. Results: Forty-eight (45%) patients were male and 59 (55%) were female. The age ranged from 6 to 86 years of age (52.12 ± 15.51 years). The incidence of EVD-related infection was 32.7%, while the device permanence varied from 2 to 54 days (mean of 10 days). The EVDs that were maintained for more than 9.5 days, as well as the device changes proved to be statistically significant factors for cerebrospinal fluid (CSF) infection (p < 0.001). Antibiotic prophylaxis did not change the infection rate (p = 0.395). Conclusions: Risk factors for EVD infection included a continuing EVD permanence that lasted for more than 9.5 days and device changes. The present study concluded that there is no advantage for antibiotic prophylaxis regarding CSF infection with EVD implants.

Objectives: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality., Methods: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored., Results: A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores., Conclusions: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores., (Copyright © 2023 by the American Academy of Pediatrics.)

Objectives: To characterize demographic and clinical factors associated with pediatric acetaminophen overdose and identify risk factors for hepatocellular injury., Design: Retrospective 10-year chart review., Setting: Two regional children's hospitals., Materials and Methods: Records of patients examined because of acetaminophen ingestion from January 1, 1988, through December 31, 1997, were reviewed. Hepatocellular injury was defined as elevation of serum aminotransferase levels greater than 2 times the reference values. Severe hepatotoxic effect was defined as hepatotoxic effect with evidence of encephalopathy and/or coagulopathy., Results: Data from 322 patients (208 girls and 114 boys, aged 1-17 years) were obtained. Ingestions were intentional in 140 patients (median age, 14 years) and unintentional in 172 (median age, 2 years). Another 10 cases represented dosing errors with therapeutic intent (median age, 3.5 years). Twenty-seven patients had hepatocellular injury; of these, 4 had severe hepatotoxic effects and 1 died. Hepatocellular injury occurred in 10.0% of the dosing error group, 17.9% of the intentional group, and 0.6% of the unintentional group. No patients underwent liver transplantation. Hepatocellular injury was associated with presentation longer than 24 hours after ingestion (odds ratio [OR], 335.0; 95% confidence interval [CI], 40.8-275.0), age 10 to 17 years (OR, 36.9; 95% CI, 4.9-275.4), intentional overdose (OR, 37.2; 95% CI, 5.0-278.2), dose greater than 150 mg/kg (OR, 17.9; 95% CI, 2.3-139.2), and white race (OR, 2.8; 95% CI, 1.1-7.2)., Conclusions: Intentional and unintentional acetaminophen overdoses occurred with similar frequency. Therapeutic misadventure was relatively uncommon, as was hepatocellular injury. Practitioners should have greater suspicion of acetaminophen-associated hepatocellular injury in patients who present more than 24 hours after ingestion, older children, and those who have intentional ingestion.