Background: There is a debate over the origin of bleeding in case of spontaneous spinal epidural hematoma (SSEH). The most widely accepted theory is of venous origin. Since the epidural veins are valveless, there will be increased venous pressure transmitted from intrathoracic and intraabdominal compartments on straining, causing rupture. Another view is that only arterial bleeding can cause rapid compression of spinal cord, since the venous pressure is less than intrathecal pressure. There is a lack of consensus on treatment also. Most of the authors recommend urgent decompressive laminectomy. There is a recent trend towards less invasive options such as partial laminectomy and hemilaminectomy and conservative treatment. Aim, materials, and methods: Aim of this study is to review the theories about the origin of bleeding in spontaneous spinal epidural hematoma and the methods of treatment. Literature search was done in PubMed for theories of the origin of spontaneous spinal epidural hematoma and the treatment methods. Descriptive analysis was done. Case presentation: A 49-year-old male stoneworker presented with thoracic back pain of acute onset while doing work, followed by weakness of forearm and legs. He had paraplegia with grade 1 power of lower limbs. MRI showed posterior epidural hematoma from C3 to T4. Midline partial laminectomy was done from C5 to T2. Hematoma was evacuated. His power improved over 1 week. Later CT (computed tomography) angiography showed no vascular malformation. Conclusion: Cervical location and rapid development of weakness point towards arterial origin of spontaneous spinal epidural hematoma. Thoracic location and presence of peroperative venous ooze suggest venous origin. Partial or hemilaminectomy is recommended to reduce postoperative instability. Conservative treatment is preferred in case of coagulopathy.

Introduction It has been demonstrated experimentally that the coronavirus can enter the central nervous system through olfactory nerves and can even reach medulla. Neurological manifestations are observed more frequently in patients with coronavirus disease. Main text The aim of the review is to seek evidence for infection of the nervous system by the human coronavirus and study the neurological manifestations of the coronavirus and its treatment. A search was done in PubMed, Google Scholar, CrossRef, and Scopus. There is evidence for the coronavirus infection of the nervous system from experimental studies, autopsy reports, and clinical studies. The virus can damage the nervous system either by direct viral damage to the neural cells or by immunopathology. Cerebral edema, neuronal degeneration, encephalitis, meningoencephalitis, acute disseminated encephalomyelitis, Guillain–Barré Syndrome, Bickerstaff’s brainstem encephalitis, Miller Fisher syndrome, polyneuritis, toxic encephalopathy, and stroke can occur. The coronavirus has been demonstrated in the cerebrospinal fluid by polymerase chain reaction technique in infected patients. The abnormalities of the coagulation system increase the risk of cerebrovascular disease. Chloroquine analogs, lopinavir/ritonavir combination, remdesivir, dexamethasone, and immunoglobulin have been shown to be useful for the treatment. Conclusion There is substantial evidence for infection of the nervous system by the different strains of the human coronavirus. The coronavirus enters the nervous system either by the blood or from the olfactory nerves. The neurological diseases correlate with the severity of the coronavirus disease. The treatment is mainly supportive. The reports of patients with encephalitis, encephalomyelitis, and brainstem encephalitis show slow recovery. But a stroke has a high mortality.

Background:Capillary hemangioma is a rare tumor in spinal intradural location. Despite the rarity, early recognition is important because of the risk of hemorrhage. This is a case report of a woman who had capillary hemangioma of cauda equina.Case Description:A 54 -year-old woman presented with a low backache, radiating to the left leg for 2 months. She had left extensor hallucis weakness, sensory impairment in left L5 dermatome, and mild tenderness in lower lumbar spine. Magnetic resonance imaging (MRI) LS spine showed L4/5 intradural tumor, completely occluding canal in myelogram, enhancing with contrast, s/o benign nerve sheath tumor. L4 laminectomy was done. Reddish tumor was seen originating from a single root. It was removed preserving the root. Postoperatively, she was relieved of symptoms. MRI showed no residue. Histopathology showed lobular proliferation of capillary-sized blood vessels and elongated spindle cells. Immunohistochemistry showed CD34 positivity in endothelial cell lining of blood vessel and smooth muscle actin positivity in blood vessel muscle cells. HPR-capillary hemangioma.Conclusion:Although rare, capillary hemangioma should be in the differential diagnosis of intradural tumors. It closely mimics nerve sheath tumor.

Background and Objectives: There is no pharmacological treatment with proven e cacy against coronavirus disease-19. Certain micronutrients have roles in the maintenance of an effective immune system. From the point of view of public health, it will be good to adopt a nutrional strategy to enhance the immunity of the general population against viral diseases.Method and Study design: A review was done to now the evidence for the antiviral and immunomodulatory properties of micronutrients. A search was done in Pubmed, Scopus, and Google Scholar for the nutrients with proven effect against viral infection. Experimental studies, clinical studies, reviews, and meta-analyses were studied descripitively.Results: There are experimental studies about the effects of micronutrients against viral infection.Vitamins such as A, B6, B12, C, D, E, and folate, and trace elements such as zinc, selenium, iron, magnesium, and copper boost the immune response. The antioxidants like vitamin C and vitamin E can help in controlling the 'cytokine storm', produced by excessive in ammation. Vitamin D can increase antiin ammatory cytokines. Selenium and zinc can protect the lungs in acute respiratory distress syndrome.

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