Context: Brain venous thrombosis (BVT) is uncommon and usually has a different clinic and treatment from cerebral arterial thrombosis. In this context, COVID-19 correlates with thrombogenesis with varied clinical repercussions. This report describes an unusual BVT case as a possible late complication of COVID-19. Case report: Male, 68 years old, athlete and healthy. April/2020: COVID-19 mild symptoms. February/2021: in road-running, he fell due to sudden left hemiparesis. Upon hospital admission: contacting, persistent headache. A week after, low level of consciousness and coma, when underwent right hemicraniectomy. Remains hospitalized. On examination: weak gestural communication, tracheostomy, enteral tube feeding, voluntary blinking. Maintains neutral cervical posture, masticatory automatisms, photoreactive isocoria, generalized rigidity, decorticated right hemiparesis, left hemiplegia. On imaging: hemorrhagic infarction on the right and mass effect due to obstruction of the Basal Rosenthal and Labbé veins and transverse sinus on the right, with venous blood flow in the rest of the hemisphere diverted to the ipsilateral internal jugular vein, by anastomotic veins of the occipital foramen and suboccipital venous plexus. Obstructed left internal jugular vein, with venous collateral flow from the left hemisphere via posterior intercavernous sinus and basilar plexus to the right internal jugular vein. Conclusions: To diagnose the venous etiology that resembled segmental occlusion of the right middle cerebral artery, CT angiography was required. Late evolution of COVID-19 has been identified by the persistence of symptoms for months. Although physical activity and possible dehydration may have contributed to BVT, a prothrombotic state correlated to COVID-19 cannot be discarded.
Objective: This study aimed at examining whether topical treatment of colon anastomosis with hyaluronic acid can influence the healing of colonic anastomosis in rats treated with systemic corticosteroid. Methods: Three groups of Wistar rats weighing 252 ± 7g were used, with six rats each, all submitted to anastomosis of the proximal colon: Group 1 - control rats, without treatment. Group 2 - rats treated with subcutaneous (s.c) corticosteroid, and topical application of 0.9% saline solution over the anastomosis. Group 3 - rats treated with corticosteroid s.c. and topical application of 0.4% hyaluronic acid (10 mg/ml) on colonic anastomosis. On the 7th postoperative day, under anesthesia and laparotomy, the anastomosis site was subjected to the determination of rupture pressure. Then, samples containing the anastomosis site were resected and fixed in 10% buffered formaldehyde and embedded in paraffin. Masson H-E and trichrome staining. Histometry evaluated the infiltration of inflammatory cells at the anastomosis site, using a numerical scale from 0 to 4. Continuous variables were assessed using the Tukey test. Differences considered significant with p<0.05. Results: All animals survived the experiments. There were no abscesses, fistulas and macroscopically detectable dehiscences in the anastomosis site. The weight of the animals on the 7th postoperative day showed a statistically significant difference (p<0.001) between the control (253.6±6.3g) and corticoid (221.6±15.4g) groups, as well as between the corticoid +. hyaluronic acid group (257.8±9.7g) and corticosteroids (221.6±15.4). There was no significant difference in the comparison between the control and corticoid + hyaluronic acid groups (p>0.05). In the analysis of intraluminal pressure of colonic anastomosis, there was a statistically significant difference when comparing groups 1 (286.8±9.9 mmHg) and 2 (155±6.0 mmHg), 1 (286.8±9,9 mmHg) and 3 (199.1±7.7) and 2 (155±6.0 mmHg) and 3 (199.1±7.7), with p<0.001 for all comparisons. Histopathological classification by the numerical scale: Group 1 - inflammatory response (H-E) grade 3 and collagen deposition by Masson Trichomic grade 1; Group 2 - inflammatory response (H-E) grade 4 and deposition of collagen and fibroblasts by Masson's Trichrome grade1\2; Group 3 - inflammatory response (H-E) grade 3 and deposition of collagen and fibroblasts by Masson's Trichrome grade 1\2. There was no significant difference between groups. Conclusion: The topical use of hyaluronic acid has a positive influence on the initial healing phase of colonic anastomosis in rats treated with systemic corticosteroid.
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