BackgroundRotavirus is the most common cause of severe gastroenteritis in children under the age of 5 years worldwide. It is well recognised that rotavirus can cause signs and symptoms beyond the gastrointestinal tract, including neurological manifestations such as encephalopathy. Mild encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome that has been associated with rotavirus. We report a case of a 4-year-old boy with clinically mild encephalopathy, who had an isolated splenial lesion in the corpus callosum on neuroimaging, and rotavirus RNA detected in faeces. We use this case as an opportunity to review the literature on rotavirus-associated MERS.Case presentationA previously healthy 4-year-old boy presented with a 2-day history of vomiting, diarrhoea, and fever, complicated by reduced level of consciousness. Magnetic resonance imaging of the brain showed a marked hyperintensity in the splenium of the corpus callosum on T2 and diffusion-weighted images. Rotavirus genome was detected by polymerase chain reaction in a stool specimen, but not in the cerebrospinal fluid. The genotype was identified as G1P8. His clinical condition improved with gradual resolution of his symptoms. No neurological complications were evident upon discharge and the patient had no recurring symptoms or significant residual defects when followed up 2 months later.ConclusionMERS is a novel clinic-radiological syndrome first described in Japan. A transient splenial lesion with reduced diffusion that appears as a high signal intensity in diffusion-weighted MRI is the main diagnostic feature. Rotavirus is one of the most common agents associated with MERS, although to our knowledge only one previous case has been reported from Europe. The majority of patients appear to achieve full recovery following rotavirus-associated MERS, irrespective of treatment. This case, together with other published reports, supports the hypothesis that rotavirus-associated MERS is unlikely to be the result of direct viral invasion of the CNS. It has been suggested that MERS may be caused by intra-myelinic axonal oedema or local inflammatory cell infiltration; however, the pathogenesis remains incompletely understood.
The Izok Zn-Cu-Pb-Ag volcanogenic massive sulfide deposit is located 265 km south of Kugluktuk (Coppermine), Nunavut Territory, Canada, in the west-central Slave structural province. The Izok deposit is owned 100% by Inmet Mining Corporation and represents one of the largest undeveloped zinc-copper resources in North America. The Izok deposit is hosted within and near the top of a thick sequence of predominantly felsic pyroclastic rocks of late Archean age. The hanging-wall stratigraphy includes additional felsic volcaniclastic rocks, andesitic and basaltic flows, thin sulfide-rich iron formations, and turbiditic sedimentary rocks. The felsic volcanic rocks are intruded by intermediate dikes and sills, followed by gabbroic dikes and sills. Both intrusive suites are interpreted to be volcanic feeders to the overlying flows. All lithologies are subsequently cut by younger, irregular, granitic pegmatite and diabase dikes. The volcanic and sedimentary rocks are regionally metamorphosed to pyroxene hornfels grade. The massive sulfides occur within a large (kilometer-scale) Na-depleted sericitic alteration zone. The immediate footwall and hanging-wall rocks to the deposit are characterized by zones of muscovite-biotite-sillimanite, lesser chlorite-biotite-cordierite, and locally intense silicification and sodium metasomatism. All lithologies have been affected by younger Ca-metasomatism. As currently defined, the Izok deposit comprises a cluster of five complexly zoned composite lenses: the Northwest, North, Central West, Central East, and Inukshuk lenses. The first four lenses are amenable to open-pit mining, whereas the Inukshuk lens will require underground development. The total indicated mineral resource presently stands at 16.5 million tonnes with a grade of 2.2% Cu, 11.4% Zn, 1.1% Pb, and 60 g/t Ag. Inmet Mining Corporation is presently reviewing the economic feasibility of developing the property.
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