scholarly journals Misdiagnosis of Cerebellar Infarctions

2014 ◽  
Vol 41 (5) ◽  
pp. 568-571 ◽  
Author(s):  
Navdeep Sangha ◽  
Karen C. Albright ◽  
Hui Peng ◽  
Farhaan Vahidy ◽  
Amelia Boehme ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Cerebellar Infarction ◽  
Stroke Registry ◽  
Diagnosis Group ◽  
Intravenous Tissue Plasminogen Activator ◽  
Critical Components ◽  
Cerebellar Infarct ◽  
Specific Symptoms

AbstractBackgroundThis retrospective study addresses for the first time the differences in clinical features and outcomes between those individuals with a cerebellar infarct who were correctly diagnosed on initial presentation compared to those who experienced delayed diagnosis.MethodsA retrospective review was conducted of our stroke registry from 09/2003 to 02/2011. Forty seven patients had an isolated cerebellar infarction confirmed by MRI. Misdiagnosis was defined as the diagnosis given by the first physician.ResultsAmong 47 patients identified, 59.6% had delayed diagnosis. Five patients in the correct diagnosis group received intravenous tissue plasminogen activator, compared to none in the delayed diagnosis group. Complaints of weakness were protective from delayed diagnosis (OR 0.087, 95% CI 0.019-0.393, p=0.001).ConclusionPatients with an isolated cerebellar infarction need to be considered when patients present with acute non-specific symptoms. Critical components of the neurological examination are omitted which are imperative to diagnose cerebellar infarcts. A thorough neurological examination may increase clinical suspicion of an ischemic stroke.

scholarly journals High Grade Serous Carcinoma Presenting as a Huge Pelvic Mass with Normal Looking Ovaries: A Diagnostic Challenge for Pathologist

2020 ◽  
Author(s):  
Vaishali Walke ◽  
Amrapali Gaikwad ◽  
Madiha Shaikh ◽  
Balwant Kowe
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Pelvic Mass ◽  
Clinical Findings ◽  
Serous Carcinoma ◽  
High Grade ◽  
Diagnostic Challenge ◽  
Immunohistochemical Markers ◽  
Specific Symptoms

High-grade serous carcinoma represents 50-60% of all ovarian cancers and is the most common type of malignant surface epithelial tumour. Serous carcinoma is often diagnosed in the sixth and seventh decade, while the mean age for high-grade tumours is 63 year. It’s not only the non-specific symptoms like vague abdominal pain, nausea, gastrointestinal disturbances, but also the unusual presentation which is responsible for delayed diagnosis. This diagnostic delay can become the reason for increased mortality, despite advances in surgical management and chemotherapy. Here, authors discuss a case of 60-year-old postmenopausal women who presented with a huge pelvi-peritoneal mass and with grossly normal ovaries. Considering clinical findings and histomorphology, the possibility of malignant mesothelioma was considered as the first differential diagnosis; however extensive sampling of ovaries and supportive immunohistochemical markers helped us to arrive at a definitive diagnosis. The present case emphasises the importance of extensive tissue sampling and ancillary techniques in arriving at a correct diagnosis.

scholarly journals Occipital Condyle Fracture with Associated Hypoglossal Nerve Injury

2006 ◽  
Vol 33 (3) ◽  
pp. 322-324 ◽  
Author(s):  
Shaan Chugh ◽  
Kambiz Kamian ◽  
Bart Depreitere ◽  
Michael L. Schwartz
Keyword(s):  
Hypoglossal Nerve ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Occipital Condyle ◽  
Rare Injury ◽  
Occipital Condyle Fracture ◽  
Condyle Fracture ◽  
Occipital Condyle Fractures ◽  
Specific Symptoms

Occipital condyle fracture (OCF) is a rare injury that was first described by Bell in 1817. In fact, there have been only 96 more reported cases of occipital condyle fractures from 1817 to 1994 of which only 58 survived. Occipital condyle fractures can sometimes go unnoticed or under-diagnosed as they are not always evident on plain radiographs of the cervical spine. Also, in rare cases OCFs can cause damage to the hypoglossal nerve which passes through the hypoglossal canal which is near the occipital condyle. The presence of specific symptoms and clinical signs should lead to the correct diagnosis. This paper describes a patient who was diagnosed with OCFs, but not hypoglossal nerve damage until 20 days following admission to hospital. We point out many factors that contributed to this delayed diagnosis, which ultimately caused severe discomfort to the patient.

A Case Study of a Large and Rare Pleomorphic Liposarcoma in The Chest Area

2020 ◽  
Author(s):  
Yuanjun Cheng
Keyword(s):  
Delayed Diagnosis ◽  
Clinical Work ◽  
Radical Excision ◽  
Pathological Findings ◽  
Chest Tightness ◽  
Pleomorphic Liposarcoma ◽  
Left Chest ◽  
Specific Symptoms ◽  
Work Up

Pleomorphic liposarcoma rarely develops in the chest area. This report presents a primary pleomorphic liposarcoma that was discovered in the left chest area of a 74-year-old female patient. The patient had presented specific symptoms, including cough, chest tightness and shortness of breath. A radical excision of the tumor was performed. The tumor was extremely large (27 cm - 24 cm- 10 cm) and completely encapsulated. Upon histological examination, it was diagnosed as a giant, pleomorphic liposarcoma. Thereafter, non-specific radiological and endoscopic results during clinical work-up delayed diagnosis until post-operative histology were gathered. In this report, the case-specific clinical and radiological diagnostic challenges are discussed, as well as the relevant surgical and pathological findings.

Abstract TP34: Is there an Added Value for Vascular Imaging Prior to Administration of Intravenous tPA in Patients with Acute Middle Cerebral Artery Occlusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Ronen R Leker ◽  
Roni Eichel ◽  
John M Gomori ◽  
Tamir Ben Hur ◽  
Jose E Cohen
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Acute Stage ◽  
Added Value ◽  
Vascular Pathology ◽  
Stroke Severity ◽  
Imaging Studies ◽  
Stroke Registry ◽  
Intravenous Tissue Plasminogen Activator ◽  
Neurovascular Imaging

Background and objectives: Advanced neurovascular imaging with CT or MR angiography (CTA/MRA) adds information regarding the vascular pathology and prognosis but may delay treatment with intravenous tissue plasminogen activator (tPA) in patients with proximal middle cerebral artery occlusions (pMCAO). Methods: Patients with pMCAO included in our prospective stroke registry were identified. Stroke severity was measured with the National Institutes of Health Stroke Scale (NIHSS) and only patients presenting with NIHSS>10 were included. Patients underwent multi-parametric imaging studies whenever possible. Patients that underwent CTA/MRA were compared to those that only had a non-contrast CT prior to tPA. Disability was measured with the modified Ranking Scale (mRS) and shifts towards favorable outcomes (mRS≤2) were analyzed. Logistic regression was used to determine outcome modifiers. Results: We included 73 patients (median age 73, 52% men) with moderate-severe stroke (median admission NIHSS 14). Forty four patients had a neurovascular imaging study and 29 did not have such a study. There were no differences between the groups in risk factor profile or baseline characteristics including stroke severity and door to needle, door to imaging or imaging to treatment times. At 90 days post stroke there were no statistically significant differences in mortality or favorable outcomes between the groups. On multivariate analysis performance of CTA/MRA had no impact on the chances of obtaining favorable outcome at day 90 after stroke. Conclusions: Advanced neurovascular imaging studies do not delay treatment with tPA but do not impact the outcome of patients with pMCAO treated with tPA and may therefore be unnecessary in the acute stage prior to administration of tPA.

scholarly journals Stroke Simulation Improves Acute Stroke Management: A Systems-Based Practice Experience

2018 ◽  
Vol 10 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Tapan Mehta ◽  
Sara Strauss ◽  
Dawn Beland ◽  
Gilbert Fortunato ◽  
Ilene Staff ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medical Education ◽  
Acute Stroke ◽  
Simulation Training ◽  
Stroke Registry ◽  
Practice Experience ◽  
Intravenous Tissue Plasminogen Activator ◽  
Simulation Based ◽  
Comprehensive Stroke Center ◽  
Stroke Center

ABSTRACT Background  Literature on the effectiveness of simulation-based medical education programs for caring for acute ischemic stroke (AIS) patients is limited. Objective  To improve coordination and door-to-needle (DTN) time for AIS care, we implemented a stroke simulation training program for neurology residents and nursing staff in a comprehensive stroke center. Methods  Acute stroke simulation training was implemented for first-year neurology residents in July 2011. Simulations were standardized using trained live actors, who portrayed stroke vignettes in the presence of a board-certified vascular neurologist. A debriefing of each resident's performance followed the training. The hospital stroke registry was also used for retrospective analysis. The study population was defined as all patients treated with intravenous tissue plasminogen activator for AIS between October 2008 and September 2014. Results  We identified 448 patients meeting inclusion criteria. Simulation training independently predicted reduction in DTN time by 9.64 minutes (95% confidence interval [CI] –15.28 to –4.01, P = .001) after controlling for age, night/day shift, work week versus weekend, and blood pressure at presentation (> 185/110). Systolic blood pressure higher than 185 was associated with a 14.28-minute increase in DTN time (95% CI 3.36–25.19, P = .011). Other covariates were not associated with any significant change in DTN time. Conclusions  Integration of simulation based-medical education for AIS was associated with a 9.64-minute reduction in DTN time.

scholarly journals Report of a rare case of hand-foot-mouth disease in a adult woman with systemic arthritis

2016 ◽  
Vol 19 (4) ◽  
pp. 125
Author(s):  
Luciana Eloísa Da Silva Castro Nóbrega ◽  
Viviane Alves De Oliveira ◽  
Patrícia Teixeira De Oliveira ◽  
Éricka Janine Dantas Da Silveira ◽  
Ana Myriam Costa De Medeiros
Keyword(s):  
Infectious Disease ◽  
Rare Case ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Mouth Disease ◽  
Intestinal Infection ◽  
Mouth Diseases ◽  
Hand Foot Mouth Disease ◽  
History Of ◽  
Systemic Arthritis

<p>Hand-foot-mouth disease (HFMD) is a highly infectious disease, rare in adults which usually presents a painfull stomatitis. We describe a rare case of HFMD in a 34-year-old woman with medical history of recent intestinal infection and systemic arthritis with only oral and hands involvement. Additionally, we discuss diagnosis and treatment of this disease and reinforce the importance of the correct diagnosis because delayed diagnosis can cause spread of the disease.</p><p><strong>Keywords:</strong> Adult; Arthritis; Mouth diseases.</p>

Congenital Hepatic Vascular Anomalies

2019 ◽  
Vol 03 (03) ◽  
pp. 184-192
Author(s):  
Rush H. Chewning
Keyword(s):  
Venous Malformation ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Infantile Hemangioma ◽  
Epithelioid Hemangioendothelioma ◽  
Vascular Anomalies ◽  
Arterioportal Fistula ◽  
Imaging Characteristics ◽  
Treatment Knowledge ◽  
Congenital Hemangioma

AbstractCongenital hepatic vascular anomalies, following the classification system originally proposed by Mulliken and Glowacki and subsequently developed by the International Society for the Study of Vascular Anomalies, are characterized as either tumors or malformations. The former includes infantile hemangioma, congenital hemangioma, angiosarcoma, and epithelioid hemangioendothelioma. The latter includes arterioportal fistula, portosystemic shunt, arteriovenous malformation, and venous malformation. Despite this well-established system, there still exists confusion in terminology that can lead to delayed diagnosis or improper treatment. Knowledge of the clinical presentation and imaging characteristics of these entities, as well as the nosologic system for vascular anomalies, is essential in arriving at the correct diagnosis, which in turn informs proper treatment.

scholarly journals Delayed diagnosis of sarcoidosis is common in Brazil

2013 ◽  
Vol 39 (5) ◽  
pp. 539-546 ◽  
Author(s):  
Mauri Monteiro Rodrigues ◽  
Ester Nei Aparecida Martins Coletta ◽  
Rimarcs Gomes Ferreira ◽  
Carlos Alberto de Castro Pereira
Keyword(s):  
Delayed Diagnosis ◽  
Median Number ◽  
Medical Visit ◽  
Treatment Results ◽  
Level Of Education ◽  
Diagnosis Group ◽  
Radiological Staging ◽  
Impaired Lung Function ◽  
Tuberculosis Diagnosis ◽  
Systemic Symptoms

OBJECTIVE: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. METHODS: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed (≥ 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment). RESULTS: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis (≥ 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively). CONCLUSIONS: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.

Differentiating between peripheral and central causes of vertigo

1998 ◽  
Vol 119 (1) ◽  
pp. 55-59 ◽  
Author(s):  
Robert W. Baloh
Keyword(s):  
Vestibular Function ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Positional Nystagmus ◽  
Benign Condition ◽  
Central Lesion ◽  
Positional Vertigo ◽  
Cerebellar Infarct ◽  
Attacks Of Vertigo ◽  
Head Neck

The history usually provides the key information for distinguishing between peripheral and central causes of vertigo. Probably the only central lesion that could masquerade as a peripheral vestibular lesion is cerebellar infarction because vertigo and severe imbalance may be the only presenting features. MRI is indicated in any patient with acute vertigo and profound imbalance suspected to be the result of cerebellar infarct or hemorrhage. Patients with chronic recurrent attacks of vertigo often have normal examination results, including normal vestibular function in between attacks. The duration of attacks is most helpful in distinguishing between central and peripheral causes; vertigo associated with vertebrobasilar insufficiency typically lasts minutes, whereas peripheral inner ear causes of recurrent vertigo typically last hours. Positional vertigo nearly always is a benign condition that can be cured easily at the bedside, but in rare cases it can be a symptom of a central lesion, particularly one near the fourth ventricle. Central positional nystagmus is nearly always purely vertical (either upbeating or downbeating), and there are usually associated neurologic findings. (Otolaryngol Head Neck Surg 1998;119:55-9.)

scholarly journals Primary Ewing's Sarcoma of the Spine: Four Case Report

KYAMC Journal ◽  
2019 ◽  
Vol 10 (3) ◽  
pp. 164-167
Author(s):  
Md Mofazzal Sharif ◽  
Khaleda Parvin ◽  
Umme Iffat Siddiqua ◽  
A.Q. Mehedi Hassan ◽  
Jabed Hossain ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Correct Diagnosis ◽  
Surgical Excision ◽  
Cord Compression ◽  
Acute Paraplegia ◽  
Low Incidence ◽  
Specific Symptoms ◽  
Common Malignancy

Ewing's sarcoma is a common malignancy of the bone and soft tissues in pediatric patients. It mostly affects the long bones and pelvis, and less commonly the flat bones and vertebrae. Primary Ewing's sarcoma affecting the spine is very rare. The patient has non-specific symptoms for a prolonged period of time before the correct diagnosis is given. Patients can present with acute paraplegia due to spinal cord compression, which needs prompt surgical intervention. Early diagnosis and treatment are important for neurological recovery. The definitive management includes three main modalities: surgery, radiotherapy and combination chemotherapy. Adequate surgical excision may not be feasible because of anatomical limitations and local control is mainly achieved by radiotherapy. Because of the low incidence of these tumors, a multitude of therapeutic strategies have been employed with varying success. Currently there are no clinical guidelines outlining optimal management KYAMC Journal Vol. 10, No.-3, October 2019, Page 164-167

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