Pitfalls in the determination of intracranial spread of complicated suppurative sinusitis

1996 ◽  
Vol 110 (7) ◽  
pp. 673-675 ◽  
Author(s):  
B. J. Conlon ◽  
A. Curran ◽  
C. V. Timon

AbstractWe present two cases of suppurative sinusitis that presented to our casualty department over a one-week period. Both patients suffered complications of the disease secondary to extension of the inflammatory process beyond the bony confines of the sinus. Neither of the patients had a previous history of sinus disease. The first patient deteriorated suddenly 24 hours after admission. The initial computed tomography (CT) scan failed to demonstrate a developing subdural empyema. This complication was confirmed following repeat scanning 24 hours later and the patient required urgent neurosurgical intervention and drainage. The second patient presented with periorbital cellulitis secondary to sinusitis and suffered a grand mal seziure on admission. Once again initial CT scan changes were subtle and significant intracranial extension was not noted until the subsequent magnetic resonance imaging (MRI) scan was performed.The purpose of this paper is to highlight the potential dangers over reliance on CT scanning in diagnosing early intracranial spread of sinus disease and we emphasise that the clinician must interpret any radiological investigations in light of the associated clinical findings.

Author(s):  
Juan Rodado ◽  
Irine Aragon

Background: Acute confusional syndrome is a current problem of special relevance among elderlypatients admitted to hospital medical services. The determination of its risk factors is an essential process in the development and implementation of programs to prevent this complication. Methods: With the mentioned aim we have carried out this case-control study as an analytical, observational, retrospective and transversal study, whose source population was integrated by 60 patients over age 65 according to inclusion and exclusion criteria and divided into two groups: with and without delirium. Discussion: Our analysis has confirmed the association between these factors and delirium: illness severity; previous history of Delirium (OR 10.6); mental status (OR 7.3); high risk medications (OR 6.9); renal failure (OR 6.5); medication at risk added (OR 6); physical status (OR 5.2); use of neuroleptics (OR5.1); anemia (OR 4.75); sodium alterations (OR 4.5); urinary catheter (OR 3.8); low albumin (OR 3.7); infection (OR 3.1). Conclusion: There is no relationship proved between acute confusional syndrom and the following factors: use of benzodiazepines, aggressive procedures, immobility, old age, dementia, diminished ADL skills, co-morbidity and polypharmacy, even if they have been identified as risk factors in previous studies. Hence, these results should be interpreted with caution.


2019 ◽  
Vol 38 (03) ◽  
pp. 199-202 ◽  
Author(s):  
Ricardo Lourenço Caramanti ◽  
Mário José Goes ◽  
Feres Chaddad ◽  
Lucas Crociati Meguins ◽  
Dionei Freitas de Moraes ◽  
...  

AbstractOrbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.


2004 ◽  
Vol 118 (6) ◽  
pp. 450-452 ◽  
Author(s):  
Chul Ho Jang ◽  
Young Ho Kim

This paper reports an unusual case in which aseptic meningitis presented with sudden sensorineural hearing loss (SSNHL) associated with intralabyrinthine haemorrhage (ILH). A seven-year-old girl presented with sudden right-sided hearing loss with dizziness. She did not have a previous history of bleeding disorders. This child was assessed using audiograms and magnetic resonance imaging (MRI). The patient's hearing loss was irreversible. Steroid therapy was not effective. SSNHL associated with ILH can be one of the negative prognostic factors in children.


2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Frederico Carvalho de Medeiros ◽  
Lucas Alverne Freitas de Albuquerque ◽  
Jose Eymard Homem Pittella ◽  
Renata Brant de Souza ◽  
Antonio Pereira Gomes Neto ◽  
...  

Introduction. Observation of open-ring enhancement in magnetic resonance imaging (MRI) is considered a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS). This finding is of great value in the differential diagnosis of tumefactive lesions.Case Report. We describe a 55-year-old white woman, with previous history of ovarian cancer and recent history of fatigue and bilateral retroorbital pain. Important bilateral visual impairment evolved over one month. Physical examination detected the presence of right homonymous hemianopia. Cranial MRI showed an expanding lesion with open-ring enhancement. Given the range of diagnostic possibilities, a stereotactic biopsy was performed, and histopathological examination was consistent with an active demyelinating disease. The patient was treated with 1 g of methylprednisolone and symptoms improved following a significant reduction in the lesion.Conclusions. We highlight the MRI results suggestive of pseudotumoral MS, especially open-ring enhancement, which is an important radiologic aspect to diagnosis and can assist in avoiding unnecessary biopsies.


1952 ◽  
Vol 9 (3) ◽  
pp. 129-140 ◽  
Author(s):  
A. Guttmann ◽  
F. A. Vandenheuvel

Investigations concerning the stability of a group of factors contained in cod liver residue and displaying vitamin B12 activity have led to the conclusion that under the conditions prevailing during the rendering process, as developed at the Atlantic Fisheries Experimental Station, little or no deactivation occurs. This is in sharp contrast with what occurs under more drastic conditions such as used in the alkali-digestion process.The study of the microbiological method used for the determination of vitamin B12 activity has shown that one step of the analytical procedure, namely, that phase during which the extraction of the sample is performed, is responsible for anomalous results. Deactivation occurs during this stage to an extent which varies according to the previous history of the material. The addition of thioglycolic acid or ascorbic acid during this period does not effectively protect the material unless culture medium is added as well. Medium alone is inefficient. Sodium bisulphite on the other hand exerts protection even in the absence of medium. This effect of sodium bisulphite applies not only to cod liver residue, but also to materials of diverse origin, mammalian viscera included. The data obtained show that vitamin B12 itself is not involved; presumably vitamin B12a and vitamin B12b are, although there is no direct evidence of their presence in cod liver.As a protection during extraction, 0.08 per cent to 0.1 per cent of sodium bisulphite calculated on the amount of wet material appeared to be optimum.


2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Ayeh Baghizadeh ◽  
Payam Mehrian ◽  
Poopak Farnia

Nontuberculous mycobacterial (NTM) pulmonary infections can be quite similar to tuberculosis, both clinically and radiologically. However, the treatment protocol is not similar. Mycobacterium simiae is a rare cause of NTM pulmonary infection. Herein, we aimed to evaluate and compare the computed tomography (CT) scan findings of M. simiae infection in lungs. For this reason, thirty-four patients (n=34) with M. simiae lung infection were retrospectively evaluated. Diagnosis was confirmed by American Thoracic Society (ATS) guidelines and CT scans were reviewed in both lung and mediastinal windows. The average age of patients was 63±14.54 years and 52.9% were male. The majority of patients had cough (91.2%) and sputum production (76.5%). Clinically, 41.2% of patients had previous history of TB (14/34), 38.2% had cardiac diseases (13/34), and 35.3% had diabetes mellitus (12/34). The most common CT findings in our study were nodular lesions (100%) and bronchiectasis (85.29%). Regarding the severity, grade I bronchiectasis was the most prevalent. Other prominent findings were tree-in-bud sign (88.2%), consolidation (52.94%), and lobar fibrosis and volume loss (67.6%). There was no significant zonal distribution of findings. In conclusion, nodular lesions and bronchiectasis are the most frequent features in CT scan of M. simiae pulmonary infection.


2020 ◽  
pp. 1-2
Author(s):  
Shivprasad Kasat ◽  
Ashish Deshmukh ◽  
Sunil Jadhav ◽  
Hafiz Deshmukh ◽  
Ashish Kendre

Aim: To study occurence of obstructive airway disease in treated patients of pulmonary tuberculosis. Materials and methods: 50 patients data collected from Respiratory medicine department, MGM medical college, Aurangabad, who visited OPD for various respiratory symptoms. It is ensured that patients who are participated in the study are non smokers. Previous history of pulmonary tuberculosis and treatment history is noted. Evidences of previous treatment and radiological images were collected. Each patient was subjected to a thorough clinical examination and spirometry. Results: Based on clinical findings, radiological findings, and spirometry findings, of the 50 patients studied, it is observed that 11(22%) patients had developed obstructive airway disease.4 (8%) patients have developed extensive fibrosis post tuberculosis. 3 (6%) patients have developed cavitation with fibrosis. 4 (8%) patients have developed bronchiectasis. Conclusion: It is not uncommon that obstructive airway disease occurs as a complication of post tuberculosis sequale. 22 percent of the patients studied, have developed different types of obstructive airway diseases. Many factors may influence in post tuberculosis complications such as extensiveness of parenchymal involvement, duration of illness, socio-economic factors. Obstructive airway disease can be a sequel of pulmonary tuberculosis and should be overlooked, especially in those patients complaining of dyspnea even in the absence of any history of smoking. Post-tuberculous obstructive airway disease as a cause of COPD in nonsmokers should be now more recognized in countries where the prevalence of pulmonary tuberculosis is still high.


2015 ◽  
Vol 4 (11) ◽  
pp. 205846011560324
Author(s):  
Thor Bechsgaard ◽  
Giedrius Lelkaitis ◽  
Karl E Jensen ◽  
Caroline Ewertsen

Sarcomas are rare tumors originating from soft tissue or bone. Diagnosis and treatment of sarcomas should be performed at specialized sarcoma centers, where patients are evaluated at a multidisciplinary tumor conference. We present a case where sarcoma was suspected from magnetic resonance imaging (MRI), but histology revealed a metastasis from thyroid carcinoma, although the patient had no previous history of thyroid malignancy and resection of the thyroid gland was without malignancy. Ultrasound-guided biopsy was possible due to cortical destruction and the multidisciplinary approach with re-evaluation of previous pathology and a thorough patient history enabled a final diagnosis.


1997 ◽  
Vol 6 (4) ◽  
pp. 327-334 ◽  
Author(s):  
Michael J. Higgins ◽  
David H. Perrin

In this study, joint reposition sense of the knee in a non-weight-bearing (NWB) state and that in a weight-bearing (WB) state were compared, and it was determined whether a significant relationship existed between knee displacement (KD) and joint reposition sense. The dominant knees of 8 male and 12 female subjects (age 19–26 years, M ±SD= 21.5 ± 2.06) who had no previous history of knee dysfunction were tested for accuracy of angular reproduction in the WB and NWB states. There was a significant difference in the accuracy of angular repositioning between the two conditions, with the WB test having less deviation from the predetermined angle. There was a weak relationship between KD and the ability to reproduce specific angles of the knee. These results suggest that the WB or closed chain state of the knee was more accurate in the determination of joint position sense than the NWB or open chain condition.


Author(s):  
Juan Rodado ◽  
Irine Aragon

Background: Acute confusional syndrome is a current problem of special relevance among elderlypatients admitted to hospital medical services. The determination of its risk factors is an essential process in the development and implementation of programs to prevent this complication. Methods: With the mentioned aim we have carried out this case-control study as an analytical, observational, retrospective and transversal study, whose source population was integrated by 60 patients over age 65 according to inclusion and exclusion criteria and divided into two groups: with and without delirium. Discussion: Our analysis has confirmed the association between these factors and delirium: illness severity; previous history of Delirium (OR 10.6); mental status (OR 7.3); high risk medications (OR 6.9); renal failure (OR 6.5); medication at risk added (OR 6); physical status (OR 5.2); use of neuroleptics (OR5.1); anemia (OR 4.75); sodium alterations (OR 4.5); urinary catheter (OR 3.8); low albumin (OR 3.7); infection (OR 3.1). Conclusion: There is no relationship proved between acute confusional syndrom and the following factors: use of benzodiazepines, aggressive procedures, immobility, old age, dementia, diminished ADL skills, co-morbidity and polypharmacy, even if they have been identified as risk factors in previous studies. Hence, these results should be interpreted with caution.


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