Background: Acute necrotizing encephalopathy of children (ANEC) is a rare fulminant type of acute encephalopathy that mainly occurs in children with a characteristic clinico-radiological pattern. It is commonly preceded by viral infections. The condition carries a poor prognosis with high morbidity and mortality rates. We highlight the relationship between diagnostic multi-parametric magnetic resonance imaging (MRI) findings and correlate them with the clinical outcome of children with ANEC by enrollment of MRI scoring. Results: The thalami were involved in all 30 patients, brain stem in 80%, basal ganglia (13.3%), cerebral white matter (WM) in 73%, and cerebellar WM in 33%. Hemorrhage was present in 86.7% patients, edema 80%, and necrosis in 13.3%. We found that the patients having the highest MRI scores were in the poor outcome category; whereas the patients with lower MR score (1 or 2) had better outcomes. Statistically positive correlation (r= 0.1198) was found between the multi-parametric MR score and the outcome category. Conclusion: An extended multi-parametric MRI should be performed in ANEC, allowing early detection and scoring of the disease for better prognosis. There is a positive correlation between the clinical outcome and the MR scoring.

Background Multiple sclerosis is a chronic demyelinating disease of the central nervous system. It may lead to disability and cognitive impairment. Our study aimed at evaluation of the role of MR volumetry technique in detection of brain atrophic changes in patients with multiple sclerosis and its impact on disease prognosis. Results This study was carried out on thirty healthy control with mean age 26.23 years and thirty patients with remitting relapsing multiple sclerosis, with a mean age of 28.18 years. Patients with multiple sclerosis were distributed across six subgroups based on the z-score cut-off of − 1.96 for regional and whole brain atrophy. We found that 2 patients (6.6%) showed no thalamic or brain atrophy, 28 patients (93.3%) showed whole brain atrophy only and 10 patients (33.3%) showed both, thalamic and BP atrophy. No patients showed only thalamic atrohy, 4 patients showed whole brain atrophy with other structure atrophy rather than thalamus (13.3%), 10 patients with whole brain and more than one structure atrophy (33.3%). Relation between subgroups and degree of increase in the Expanded Disability Status Scale (EDSS) as well as presence of cognitive decline were assessed. No significant relation were found between RRMS patients subgroups with whole brain atrophy, subgroup with isolated thalamic atrophy or subgroup with multiple structure atrophy and increase of EDSS or cognitive decline. Conclusion We found that MRI volumetry is a very useful technique in the assessment of the atrophic changes that occur as a consequence of multiple sclerosis affecting the whole brain, deep grey matter as well as corpus callosum. Although our study did not prove significant relation between presence of brain atrophic changes and disability or cognitive impairment, presence of atrophy warrants careful clinical evaluation of those patients to detect any possible further progression of disability or cognitive decline.

Aim of work The type of traumatic peripheral nerve injury is a key factor for determining optimal treatment. Proper assessment of peripheral nerve injury facilitates appropriate treatment, significantly affects prognosis, and reduces disabilities. This study evaluated ultrasonography (US) to assess upper limb traumatic nerve injuries and compared the US with electrodiagnostic studies as the gold standard. Materials and Methods Participants were 69 adults (57 [83%] men, 12 [17%] women; mean age 36.3 ± 13.5 years) with a total of 96 peripheral nerve injuries (duration of 1 month–3 years). High-frequency US examinations and electro-physiologic studies confirmed upper limb peripheral nerve injury. Results Nerve discontinuation was diagnosed in 15 (15.6%) nerves; the cross-sectional area was increased in 33 (34.4%) nerves. Of 96 injuries, 54 (56.3%) were median, 24 (25%) were ulnar, and 18 (18.8%) were radial nerves. No statistically significant difference was found between US and electro-physiologic studies for nerve injury diagnosis (p = 0.054). Conclusion No significant differences were found between US and electro-physiologic studies for diagnosis of nerve injuries; however, US was valuable to assess surrounding tissue and supplied muscles. The capabilities to detect nerve injury and associated distal muscular, vascular, and other regional structures position the US as a complementary diagnostic tool.

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Background Worldwide, millions of people got COVID-19 infection since the start of the pandemic with a large number of deaths. Re-infection with SARS-CoV-2 is possible, because it can mutate into new strains as it is an RNA virus. The main objective of our study is to correlate between CT severity score of the patients re-infected with COVID-19 during the first and second attack and its clinical impact. Results We performed a retrospective cohort study. It was carried out on fifty symptomatic patients (11 females and 39 males). Their ages ranged from 38 to 71 years. We included only patients who were re-infected after more than 6 months of the first infection and showed clinical symptoms with SARS-CoV-2 PCR-positive test. We found that CT severity score was decreased in the second infection in 47 (94%) of our patients associated with decreased respiratory distress as well as oxygen requirements, while the CT severity score was increased in two patients and only one patient showed no change in CT score severity between two infections. Conclusion The reduction in CT severity score in the majority of re-infected patients suggested the role of the immunity developed from first infection in protection against severe lung affection in case of repeated infection even after 6 months despite poor immunity against re-infection.