Objective: Identify clinical and radiographic features of venous infarct as a presenting feature of COVID-19 in the young. Background: SARS-CoV-2 infection causes hypercoagulability and inflammation leading to venous thrombotic events (VTE). Although elderly patients with comorbidities are at higher risk, COVID-19 may also cause VTE in a broader patient population without these risks. Neurologic complications and manifestations of COVID-19, including neuropathies, seizures, strokes and encephalopathy usually occur in severe established cases of COVID-19 infection who primarily present with respiratory distress. Case description: Case report of a 29-yearold woman, with no significant past medical history or comorbidities, presenting with new onset seizures. Further questioning revealed a one-week history of headaches, low-grade fever, mild cough and shortness of breath, diagnosed as COVID-19. Imaging revealed a left temporoparietal hemorrhagic venous infarction with left transverse and sigmoid sinus thrombosis treated with full dose anticoagulation and antiepileptics. Conclusion: Although elderly patients with comorbidities are considered highest risk for COVID-19 neurologic complications, usually when systemic symptoms are severe, this case report emphasizes that young individuals are at risk for VTE with neurologic complications even when systemic symptoms are mild, likely induced by COVID-19 associated hypercoagulable state.
Child abuse is a disturbingly common finding in society today. In view of the high proportion of orofacial injuries seen in victims of child abuse, dentists are in a strategic position to recognize and report suspected cases. The present study of 347 dentists in Victoria, A u s t r a l i a , assessed the level of knowledge and attitudes among dental professionals on the important issue of child abuse. While a high level of interest was shown by the participants towards this issue, a need for further information and training in the recognition and reporting of child abuse was seen in the survey findings. While dentists at present are not legally mandated in all states of Australia to report suspected cases of child abuse, the dental profession is in a key position to play an active role in the identification and reporting of this substantial community problem.
We present a series of 10 hospitalized patients with confirmed coronavirus 2019 infections who developed severe neurovascular complications and discuss the possible reasons for these findings and their relationship to the novel Severe Acute Respiratory Syndrome coronavirus 2 infection. ABBREVIATIONS: ACE2 ¼ angiotensin-converting enzyme 2; COVID-19 ¼ coronavirus 2019; CRP ¼ C-reactive protein; CSS ¼ cytokine storm syndrome; ICU ¼ intensive care unit; LDH ¼ lactate dehydrogenase; PCR ¼ polymerase chain reaction; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 C oronavirus disease 2019 (COVID-19) is a predominantly acute respiratory disease caused by the novel Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). 1 In addition to progressive atypical respiratory system distress, other organ systems including the CNS may be affected in part due to the marked affinity of the virus for the angiotensin-converting enzyme 2 (ACE2) receptors. 2,3 Furthermore, a subgroup of patients with severe COVID-19 develop cytokine storm syndrome (CSS), characterized by hyperinflammation due to rapid accumulation of T-cells and macrophages, resulting in the release of massive levels of cytokines into the bloodstream to eliminate the offending pathogen, causing numerous clinical manifestations including atypical respiratory system distress and fever, progressing to widespread multiorgan dysfunction. 4-7 An increasingly recognized feature of COVID-19 infection is a thromboembolic diathesis, often resulting in brain ischemia, even in young patients despite anticoagulation/antiplatelet treatment. The comorbidity of pneumonia and thromboembolic complications in patients with COVID-19 may be explained, in part, by a causal relationship of severe inflammation and infection as precipitating factors. 6-8 Here, we present the neurovascular complications in 10 hospitalized patients with COVID-19 infection at our institutions. Available neuroimaging studies including head CT, head and neck CTA, and brain MR imaging were reviewed. Case Reports
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