We report a case of bifacial weakness with paresthesia, a recognized Guillain-Barré syndrome subtype characterized by rapidly progressive facial weakness and paresthesia without ataxia or other cranial neuropathies, which was temporally associated with antecedent coronavirus 2019 (COVID-19). This case highlights a potentially novel but critically important neurologic association of the COVID-19 disease process. Herein, we detail the clinicoradiologic work-up and diagnosis, clinical course, and multidisciplinary medical management of this patient with COVID-19. This case is illustrative of the increasingly recognized but potentially underreported neurologic manifestations of COVID-19, which must be considered and further investigated in this pandemic disease. ABBREVIATIONS: BFP ¼ bifacial weakness with paresthesia; CN ¼ cranial nerve; COVID-19 ¼ coronavirus 2019; GBS ¼ Guillain-Barré syndrome; HSV ¼ herpes simplex virus; Ig ¼ immunoglobulin; PCR ¼ polymerase chain reaction; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 S evere Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is the novel coronavirus responsible for the pandemic coronavirus disease 2019 (COVID-19). First identified in Wuhan, China, in late December 2019, 1 global transmission increased rapidly, with the first case of COVID-19 reported in the United States on January 19, 2020 2 and .1.34 million cases and nearly 81,000 deaths reported in the United States as of May 12, 2020. 3 While the typical presentation is respiratory symptoms (dry cough and dyspnea), a number of other associated symptoms have been described, including fever, diarrhea, abdominal pain, fatigue, and altered mental status. Potential neurologic manifestations are increasingly recognized but may be underreported. 4-8 A potential association between COVID-19 and Guillain-Barré syndrome (GBS) has been suggested in 2 recent editorial correspondences; 7,8 however, the temporal relationship of GBS antecedent to COVID-19 symptomatology raised a question of causality in 1 report. 7 In this brief report, we detail a case of bifacial weakness with paresthesia subtype
Imaging plays a critical role in diagnosing schwannomatosis, and a basic understanding of this syndrome is of interest to diagnostic radiologists. Moreover, it is imperative that radiologists be able to differentiate schwannomatosis from NF2 on imaging because there are significant differences in the management of these two diseases and clinical outcomes for affected patients.
By considering the applications of these principles and the stereotypical ways in which humans perceive visual stimuli, a radiology learner may incur fewer errors of diagnosis. This article serves to introduce several important principles of Gestalt theory, identify examples of these principles in widely recognizable fine art, and highlight their implications for radiology education.
CT use in children has increased rapidly for the initial evaluation of chest trauma, whereas CXR use has decreased. Despite this trend, CXR remains an acceptable screening tool to analyze which patients may require CT evaluation. A multidisciplinary approach is warranted to develop guidelines that standardize the use of CT and thereby decreases unnecessary radiation exposure to pediatric patients.
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