Case Report: Catatonia Associated With Post-traumatic Stress Disorder

We report here about a 12-year-old female patient who had two life-threatening accidents that led to post-traumatic stress disorder associated with catatonia. She had closed eyes, had urinary and fecal incontinence, and had been in an abnormal position for one and half month. Moreover, she had complications such as dehydration, malunion of the fractured arm, and deformities in hand and foot. After detailed psychiatric examination, neurological assessment, and laboratory investigation, the patient received successful treatment in the form of benzodiazepine injections, intravenous fluid, oral antidepressants, and six sessions of electroconvulsive therapy (ECT). We discuss the pathophysiology of catatonia, which remains elusive, and recommend evaluating catatonic children for any possible trauma during psychiatry assessment.

To determine the effectiveness of antiepileptic drugs in treatment of acute traumatic brain injury for preventing seizure.

Objectives: To determine the effectiveness of antiepileptic drugs in treatment of acute traumatic brain injury for preventing seizure. Study Design: Cross Sectional Study. Setting: Ziauddin Hospital, North Campus, Karachi. Period: 2014 to 2016. Material & Methods: Eighty diagnosed cases of traumatic brain injury were included in this study. Patients were examined physically and neurological assessment, with mental status was assessed by Glasgow Coma scoring. A blood sample was taken and Computed tomography was performed. Antiepileptic therapy was given for a period of one week minimally or 10 days maximally and patients were assessed clinically for seizures. All information was collected in the predesign proforma. Results: The patients median age was 25[16-43]. There were 70% male and 30% female. Rate of seizure was 6.3% (5/80) cases mortality was observed 5% (4/80) cases. Rate of seizure was significantly high in patients who had moderate TBI as compare to mild TBI (p=0.016). It was also significantly high in those cases who had diabetes and IHD. Rate of mortality was significantly high in seizure cases (p=0.0005). Conclusion: Prophylactic antiepileptic drugs are effective in decreasing the risk of early post-traumatic seizures in acute traumatic brain injury.These drug may provide an important and alternative treatment option for seizure prevention in acute TBI patients and prevent further brain damage.

Crawl Position Depends on Specific Earlier Motor Skills

Early assessment of motor performance should allow not only the detection of disturbances but also create a starting point for the therapy. Unfortunately, a commonly recognised method that should combine these two aspects is still missing. The aim of the study is to analyse the relationship between the qualitative assessment of motor development at the age of 3 months and the acquisition of the crawl position in the 7th month of life. A total of 135 children were enrolled (66 females). The analysis was based on physiotherapeutic and neurological assessment and was performed in the 3rd, 7th and 9th months of life in children, who were classified according to whether they attained the crawl position or not in the 7th month. Children who did not attain the crawl position in the 7th month did not show distal elements of motor performance at the age of 3 months and thus achieved a lower sum in the qualitative assessment. Proper position of the pelvis at the age of 3 months proved to be very important for the achievement of the proper crawl position at the 7th month. Failure to attain the crawl position in the 7th month delays further motor development. The proximal-distal development must be achieved before a child is able to assume the crawl position. Supine position in the 3rd month seemed more strongly related to achieving the crawl position than assessment in the prone position.

Acute Psychosis Due to Anti-N-Methyl D-Aspartate Receptor Encephalitis Following COVID-19 Vaccination: A Case Report

Anti-N-methyl D-aspartate (NMDA) receptor (anti-NMDAR) encephalitis has been reported after SARS-CoV-2 infection, but not after SARS-CoV-2 vaccination. We report the first known case of anti-NMDAR encephalitis after SARS-CoV-2 immunization in a young female presenting with acute psychosis, highlighting a rare potential immunological complication of vaccination against SARS-CoV-2 that is currently being distributed worldwide. The patient presented initially with anxiety and hypochondriacal delusions which progressed to psychosis and catatonia but returned to baseline with aggressive immunomodulatory therapy consisting of intravenous immunoglobulin, high-dose glucocorticoids, and rituximab. This study highlights that the workup of acute psychosis should include establishing a history of recent vaccination followed by a thorough neurological assessment, including for anti-NMDAR antibodies in blood and cerebrospinal fluid.

The influence of Electroacupuncture on a dog diagnosed with osteoarthritis: A case report

Electroacupuncture is a specific branch of acupuncture that uses electrical stimulation through the selected acupoints. Osteoarthritis is considered a complex condition associated with painful joints and locomotor dysfunction. The aim of this case report was to bring scientific support regarding the effect of electroacupuncture in a dog with chronic joint degeneration. An 11-year-old male German shepherd referred to the University of Agricultural Sciences and Veterinary Medicine of Cluj with severe pain in his hind limbs and around his back. Diagnosis based on a western examination, neurological assessment and radiographs indicated chronic osteoarthritis with hip dysplasia. From Traditional Chinese Veterinary Medicine based diagnosis was Kidney Qi Deficiency leading to Bony Bi Syndrome. For the last two years, the treated dog with Mavacoxib (single dose every month) did not show any significant improvement. A combination of a fine needle with dry acupuncture, electroacupuncture (30-40Hz alternated with 80-100 Hz) and aqua-acupuncture using Zeel (AP) was performed. During the winter, weekly treatment was planned, after that, every two weeks treatment with electroacupuncture and dry needle, for five months until the present. Since we started the acupuncture treatment, the dog is more active and enjoys playing again. We have managed to stop the administration of NSAID’s and improve his life quality. In the present study, we evaluated the effect of complementary medicine on a dog with chronic pain and joint degeneration. Electroacupuncture is a complex technique that requires special training; if used wisely, it can be an excellent complementary therapy for veterinary patients’ pain control.

A randomized control trial on early open patient department-based assessment tool for prediction of neurological outcomes at the age of 1 month of life in asphyxiated neonates who underwent whole body cooling at tertiary care hospital in Southern Rajasthan

Background: Therapeutic hypothermia (TH) is standard-of-care for infants with moderate to severe hypoxic ischemic encephalopathy (HIE) in developed countries. It should be implemented within 6 hours after delivery, and it has shown to significantly decrease the risk of brain injury in newborns exposed to perinatal hypoxemic ischemic insult with improved neurological outcomes. Objectives of the study were to assess early neurological outcome of neonates with moderate to severe birth asphyxia treated with TH.Methods: A randomized control trial was done in NICU of Balchikitsalaya, RNT medical college, Udaipur, on neonates with evidence of grade II/III HIE. We used phase changing material-FS 21, FS 29 to provide whole body hypothermia for 72 hours within 6 hours of birth and observed the babies for early neurological outcome. Results: A total of 60 neonates were enrolled in the study, 30 as cases, treated with therapeutic hypothermia and 30 as controls in normothermic environment. Neurological assessment was made on the basis of Thompson scoring and Ameil-Tison neurological assessment at term (ATNAT) at one month of age. We observed a better ATNAT score in TH group as compared to controls (p<0.05). Thompson score was significantly less in surviving neonates suggestive of better early neonatal outcome. Conclusions: Statistically significant data suggestive of better early neurological outcomes were seen in the cases treated with 72 hours of hypothermia. These babies not only had lesser Thompson scores, but also showed better tone, and Improved ATNAT scores at 1 month of age, making this study important as an early marker of neurological injury/morbidity in later life.

Case Report on Tuberculosis Meningitis-A Nurses Perspective

Mycobacterium tuberculosis is the bacteria that cause tuberculosis. If the infection is not treated immediately the bacterium passes via the circulatory system and spread other organs and tissues. Pathogen will travel to the meninges and causes inflammation of membranes called as tubercular meningitis. Here, the authors report a case of tuberculous meningitis a 42- years-old male patient with the chief complaints of low grade fever with chills since 1 month, headache in frontal region since 5-6 days, altered sensorium, breathing difficulty, reduced speech and left side weakness of the body since 1 day. After admitting in the ward all investigation done like MRI brain, ECG, lumbar puncture, blood tests etc. and he diagnosed as tuberculous meningitis. Patient admitted in AVBRH in ICU, investigations done, where patient was on NIV support, nasogastric tube, foleys catheter and it has been removed as patient was improving the condition and shifted in ward. Patient medical treatment in the ward was inj. C-tri 2 gm, Inj.levoflox 500 mg, inj. thimine 100 mg, Inj.Dexamethasone 10 mg, tab. Pan 40 mg, tab. Akt4 3, Inj.manitol, tab. Lorazepam. History collection, Physical examination, neurological assessment and nursing care plan were done after all treatment patient condition has been improved.

International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe

Background: Adverse neurological events during extracorporeal membrane oxygenation (ECMO) are common and may be associated with devastating consequences. Close monitoring, early identification and prompt intervention can mitigate early and late neurological morbidity. Neuromonitoring and neurocognitive/neurodevelopmental follow-up are critically important to optimize outcomes in both adults and children. Objective: To assess current practice of neuromonitoring during ECMO and neurocognitive/neurodevelopmental follow-up after ECMO across Europe and to inform the development of neuromonitoring and follow-up guidelines. Methods: The EuroELSO Neurological Monitoring and Outcome Working Group conducted an electronic, web-based, multi-institutional, multinational survey in Europe. Results: Of the 211 European ECMO centres (including non-ELSO centres) identified and approached in 23 countries, 133 (63%) responded. Of these, 43% reported routine neuromonitoring during ECMO for all patients, 35% indicated selective use, and 22% practiced bedside clinical examination alone. The reported neuromonitoring modalities were NIRS ( n = 88, 66.2%), electroencephalography ( n = 52, 39.1%), transcranial Doppler ( n = 38, 28.5%) and brain injury biomarkers ( n = 33, 24.8%). Paediatric centres (67%) reported using cranial ultrasound, though the frequency of monitoring varied widely. Before hospital discharge following ECMO, 50 (37.6%) reported routine neurological assessment and 22 (16.5%) routinely performed neuroimaging with more paediatric centres offering neurological assessment (65%) as compared to adult centres (20%). Only 15 (11.2%) had a structured longitudinal follow-up pathway (defined followup at regular intervals), while 99 (74.4%) had no follow-up programme. The majority ( n = 96, 72.2%) agreed that there should be a longitudinal structured follow-up for ECMO survivors. Conclusions: This survey demonstrated significant variability in the use of different neuromonitoring modalities during and after ECMO. The perceived importance of neuromonitoring and follow-up was noted to be very high with agreement for a longitudinal structured follow-up programme, particularly in paediatric patients. Scientific society endorsed guidelines and minimum standards should be developed to inform local protocols.

Neurological Assessment Skill Competency of Registered Nurses in Traumatic Brain Injury Patients: A One Group Pre-Post Design

ObjectivesTo assess the effect of educational pedagogy on the skill of nurses in neurological assessment of traumatic brain injury patientsMethodsThis one group pre-post-test study investigated the effect an educational pedagogy on 36 registered nurses of trauma center, general surgery and neuro surgery department of a tertiary care hospital. A 20 items validated competency checklist was used to assess the skill of nurses before and after educational training regarding Neurological (Glasgow Coma Scale) assessment of TBI patients.ResultsFrequency and percentages of demographic and professional variables were checked. 36 (100%) of the nurses showed incompetent skills practice and having scores from 0 to 13. post test results of the study illustrated that 7 (19.4 %) nurses having score 0 to 13 and had incompetent skill practices. 29 (80.6 %) nurses having score from 14 to 20 and had competent skills practice. mean ( of the posttest skills score was significantly higher than the mean ( of the pre test skills score. ConclusionBefore and after educational training there is significant paired mean difference in skill competency of nurses. Hence the educational intervention was effective in improving skills competency of registered nurses in neurological assessment.