Cisternographic Pattern of Spontaneous Liquoral Hypotension

Cephalalgia ◽  
1990 ◽  
Vol 10 (2) ◽  
pp. 59-65 ◽  
Author(s):  
A Molins ◽  
J Alvárez ◽  
J Sumalla ◽  
F Titus ◽  
A Codina
Keyword(s):  
Bed Rest ◽  
Fluid Replacement ◽  
Pathophysiological Mechanism ◽  
Recumbent Position ◽  
Cell Counts ◽  
Csf Leakage ◽  
Previous Trauma ◽  
History Of ◽  
System Improvement ◽  
Isotope Cisternography

We describe five cases of headache due to spontaneous liquoral hypotension, the syndrome comprising sudden, intense and oppressive orthostatic holocranial headache. The headache improved in the recumbent position and was accompanied by nausea and sometimes vomiting. There was no history of lumbar puncture or previous trauma. CSF tension was low or negative. The CSF showed a raised protein content and increased red and white cell counts. CT scan was normal or showed a slit ventricular system. Improvement was complete three to eight weeks from onset. The treatment consisted of bed rest and oral and parenteral fluid replacement. An isotope cisternography carried out in all patients while the headache was present showed a cisternographic pattern characterized by a combination of premature elimination and failure to detect the isotope at the cerebral convexity. Scan images did not show CSF leakage at any site. This stereotyped reaction pattern suggests that CSF hyperabsorption is the most likely pathophysiological mechanism of this entity.

scholarly journals Post-operative compressive pneumocephalus: A rare complication of lumbar spinal drainage

2020 ◽  
Vol 10 (4) ◽  
pp. 127-128
Author(s):  
F Lakhdar ◽  
M Benzagmout ◽  
K Chakour ◽  
ME Chaoui
Keyword(s):  
Oxygen Therapy ◽  
Rare Complication ◽  
Rare Condition ◽  
Bed Rest ◽  
Fluid Replacement ◽  
Primary Surgery ◽  
Csf Leakage ◽  
Lumbar Spinal ◽  
Possible Cause ◽  
Inspired Oxygen

Compressive pneumocephalus is a rare condition, most often secondary to head trauma or surgery. We report post-operativecompressive pneumocephalus in a patient who underwent primary surgery for anterior clinoidmeningioma complicated by CSF leakage treated by lumbar spinal drainage. CT scanclearly demonstrates a compressive pneumocephaluswith the sign of the Mount Fuji. The patient was treated with definite bed rest and plenty of fluid replacement with good outcome. Compressive pneumocephalus is a serious, infrequent complication anda possible cause of postoperative worsening.Medical treatment combining highly inspired oxygen therapy and rehydration are sufficient to correct the condition.

scholarly journals 075 A case of spontaneous CSF rhinorrhea in a patient with marfan syndrome

2019 ◽  
Vol 90 (e7) ◽  
pp. A23.3-A24
Author(s):  
Viral Upadhyay ◽  
Salman Khan
Keyword(s):  
Cerebrospinal Fluid ◽  
Marfan Syndrome ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Bed Rest ◽  
Connective Tissues ◽  
Csf Leakage ◽  
Hereditary Disorders ◽  
History Of ◽  
Fluid Leak

IntroductionSpontaneous cerebrospinal fluid leak is uncommon condition and frequently associated with hereditary disorders of connective tissues. Nasal CSF leakage is extremely rare.1Methods and resultsWe present the case of a 40-year-old woman presented to hospital for few days history of postural headache associated with clear intermittent discharge from right nostril without any signs of meningism. There was no history of trauma. She has a background history of Marfan syndrome with associated complications of ASD repair at age 2, mechanical Aortic and Mitral valve replacement, aortic root repair, previous ST elevation MI with LV dysfunction, automated implantable cardioverter-defibrillator in situ, atrial fibrillation, and Hashimoto’s thyroiditis. Her regular medications are warfarin, bisoprolol and thyroxine. The clear nasal discharge was positive for β-2 transferrin confirming cerebrospinal fluid. Her CT Brain did not reveal any clear site of CSF leak. She had a flexible nasendoscopy which showed normal nasal passageway, no defect in nasal mucosa and no active CSF leakage. She was managed conservatively with strict bed rest and advised to minimise strenuous activity and heavy lifting.ConclusionSpontaneous cerebrospinal fluid leak is uncommon condition and frequently associated with hereditary disorders of connective tissues. Nasal CSF leakage is extremely rare.1 Testing β-2 transferrin has high sensitivity and specificity.2Initial treatment may include bed rest, oral or intravenous hydration, oral caffeine or corticosteroids.3 4 If conservative therapy fails, surgical repair with nasal endoscopic approach is recommended.2 5ReferencesOmmaya A, Di Chiro G, Baldwin M, Pennybacker J. Non-traumatic cerebrospinal fluid rhinorrhoea. Journal of Neurology, Neurosurgery & Psychiatry 1968;31(3):214-–225.Wang E, Vandergrift W, Schlosser R. Spontaneous CSF Leaks. Otolaryngologic Clinics of North America 2011;44(4):845–856.Milledge J, Ades L, Cooper M, Jaumees A, Onikul E. Severe spontaneous intracranial hypotension and Marfan syndrome in an adolescent. Journal of Paediatrics and Child Health 2005;41(1–2):68–71.Placantonakis D, Bassani L, Graffeo C, Behrooz N, Tyagi V, Wilson T, et al. Noninvasive diagnosis and management of spontaneous intracranial hypotension in patients with marfan syndrome: Case Report and Review of the Literature. Surgical Neurology International 2014;5(1):8.Spontaneous cerebrospinal fluid rhinorrhea. Medicine 2018;97(7):e9954.

Anterior Cruciate Ligament Rupture Associated with Cardiomyopathy in Three Cats

1991 ◽  
Vol 4 (01) ◽  
pp. 35-37 ◽  
Author(s):  
G. O. Janssens ◽  
D. L. Janssens ◽  
L. A. A. Janssens
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anterior Cruciate Ligament Rupture ◽  
Acl Rupture ◽  
Thoracic Radiography ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Previous Trauma ◽  
History Of ◽  
Anterior Cruciate

SummaryOver a period of 14 years, three cats with anterior cruciate ligament (ACL) rupture were seen in our practice. In all, the rupture had occurred without a history of previous trauma. All were treated surgically. All died within a period of 14 days. The reason of death was in all cases cardiomyopathy. We now suggest that cats with rupture of the anterior cruciate ligament undergo an electrocardiographic recording and eventually an thoracic radiography before surgery is considered. We also suggest that cats with ACL rupture should preferably be treated conservatively.

scholarly journals 690 Intracranial Hypotension Due to CSF Leak Secondary to Ventral Thoracic Osteophyte Complex: Resolution After Transdural Thoracic Discectomy and Dural Repair

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Kewlani ◽  
I Hussain ◽  
J Greenfield
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Bed Rest ◽  
Structural Defects ◽  
Csf Leak ◽  
History Of ◽  
Surgical Cure ◽  
Thoracic Discectomy ◽  
Herniated Discs

Abstract The hallmark symptom of spontaneous intracranial hypotension (SIH) is orthostatic headaches which manifests secondary to cerebrospinal fluid (CSF) hypovolaemia. Well-recognised aetiologies include trauma which includes procedures such as lumbar punctures and spinal surgery. More recently, structural defects such as bony osteophytes and calcified or herniated discs have been attributed to mechanically compromising dural integrity consequently resulting in CSF leak and symptom manifestation. A thorough literature review noted only a handful of such cases. We report the case of a thirty-two-year-old Asian female who presented with a one-month history of new-onset progressively worsening orthostatic headaches. Workup included MRI of the thoracic spine which revealed an epidural collection of CSF consequently prompting a dynamic CT-myelogram of the spine which not only helped to confirm severe cerebral hypotension but also suggested the underlying cause as being a dorsally projecting osteophyte-complex at level T2-3. Conservative and medical management including bed rest, analgesia, mechanical compression, and epidural blood patches failed to alleviate symptoms and a permanent surgical cure was eventually sought. The surgery involved T2-T3 laminectomy and osteophytectomy and at a 3-month follow-up, complete resolution of symptoms was noted.

Reliability of Total Nucleated Cell Counts in the Setting of Hip Arthroplasty

2020 ◽  
Author(s):  
Lauren N Pearson ◽  
Robert L Schmidt ◽  
Kenneth Cahoon ◽  
Christopher E Pelt
Keyword(s):  
Synovial Fluid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Metal Debris ◽  
Total Hip ◽  
Cell Counts ◽  
History Of ◽  
Joint Effusions ◽  
Automated Instruments ◽  
Automated Methods

Abstract Background Total nucleated cell (TNC) count and differential are used to classify joint effusions as inflammatory or noninflammatory. Further diagnostic evaluation and management is contingent on this classification. TNC count can be measured by automated analyzers or by manual assessment using a hemocytometer. Studies have raised concerns regarding the accuracy of TNC counts measured by automated instruments, particularly in the setting of joint arthroplasty. The objective of this study was to determine whether metallosis, a complication of total hip arthroplasty in which metal debris accumulates in periprosthetic tissues and synovial fluid, is associated with inaccurate TNC counts in synovial fluid. Methods We compared the accuracy of cell counts measured by the Sysmex XN-1000 and Beckman Coulter Iris iQ200 with the gold standard of manual assessment using a hemocytometer in synovial fluid from patients with suspected metallosis and in fluid obtained from controls from patients with native joints and a history of arthroplasty for other indications. Results TNC counts produced by automated analyzers were associated with increased levels of discordance (relative to manual counts) in patients with metallosis. Metallosis was not associated with increased levels of discordance for RBC counts or WBC differentials. The Sysmex XN flagged all but 1 metallosis sample for manual verification of the results. Conclusions Automated methods are generally reliable for analysis of synovial fluid. TNC counts can be inaccurate in the context of metallosis following total hip arthroplasty. Laboratories should correlate automated cell counts with a microscopic assessment of the specimen, as recommended by instrument manufacturers.

Perilymph Fistulas

1978 ◽  
Vol 87 (6) ◽  
pp. 797-803 ◽  
Author(s):  
George T. Singleton ◽  
Kathryn Nolan Post ◽  
Marc Simeon Karlan ◽  
Douglas G. Bock
Keyword(s):  
Discriminant Analysis ◽  
Effective Means ◽  
Bed Rest ◽  
Sudden Onset ◽  
Effective Control ◽  
Speech Discrimination ◽  
Mean Values ◽  
Long Duration ◽  
History Of ◽  
Physical Findings

Fifty-one patients suspected of having a perilymph fistula were evaluated. We postulated that many patients with predominantly vestibular complaints had unrecognized perilymph fistulas. An analysis was made of symptoms, physical findings, vestibular and audiometric test results in order to determine appropriate diagnostic criteria for the presence of perilymph fistulas. The patient population was divided into two groups, those with and without fistulas. Data from both groups were compared by mean values of variables, step-wise discriminant analysis, and factor analysis. A history of trauma with sudden onset of dizziness and/or hearing loss should alert the physician to a fistula. Findings of significance were positional nystagmus of short latency and long duration without import of nystagmus direction, canal paresis and reduced speech reception threshold with poor speech discrimination scores. Discriminant analysis correctly classified 19 fistula and 10 nonfistula cases explored operatively and identified two error judgments in 22 nonoperated cases. Bed rest for the first five days proved to be the most effective means of therapy. Surgical intervention with repair of the fistula by perichondrial graft provided effective control of vertigo more frequently than restoration of hearing.

A murine model of deep vein thrombosis Characterization and validation in transgenic mice

2005 ◽  
Vol 94 (09) ◽  
pp. 498-503 ◽  
Author(s):  
Linda Szema ◽  
Chao-Ying Chen ◽  
Jeffrey P. Schwab ◽  
Gregory Schmeling ◽  
Brian C. Cooley
Keyword(s):  
Deep Vein Thrombosis ◽  
Murine Model ◽  
Femoral Vein ◽  
Previous History ◽  
Bed Rest ◽  
Major Surgery ◽  
Vein Thrombosis ◽  
Transgenic Lines ◽  
History Of ◽  
Deep Vein

SummaryDeep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (>5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies. A transient direct-current electrical injury was induced in the common femoral vein of adult C57Bl/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p<0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121±0.018 mm3 vs. 0.052±0.008 mm3, respectively; p<0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.

scholarly journals SUN-934 A Rare Case of Hyperparathyroidism - Parathyroid Carcinoma, Atypical Adenoma, or Both?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Petra Krutilova ◽  
Harjyot Sandhu ◽  
Michael Salim ◽  
Janice L Gilden ◽  
Paula Butler
Keyword(s):  
Parathyroid Carcinoma ◽  
Rare Case ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Mitotic Rate ◽  
Fluid Replacement ◽  
Cancer Center ◽  
Subtotal Parathyroidectomy ◽  
History Of ◽  
The Right

Abstract Introduction: Parathyroid carcinoma (PC) is a rare endocrine malignancy. It accounts for &lt;1% cases of primary hyperparathyroidism (PHPT). We present a rare case of concurrent PC and atypical parathyroid adenoma (PA). Case presentation: A 72-year-old woman presented with 1-week history of generalized weakness, confusion, and auditory hallucinations. Her medical history was significant for PHPT known for 5 years, CAD and CHF. The patient appeared mildly volume depleted and was tachycardic (105/min). The rest of her physical exam was unremarkable. Calcium (Ca) was 15.1 mg/dL (8.4–10.2 mg/dL) and intact PTH 451.9 pg/mL (12–88 pg/mL). Her condition improved with aggressive fluid replacement, pamidronate, and cinacalcet. A sestamibi scan revealed increased uptake of bilateral parathyroid tissue. Fine needle aspiration (FNA) revealed PA. Surgical treatment was postponed for control of cardiac comorbidities. One month later, she presented again with symptomatic hypercalcemia. Her Ca was 16.1 md/dL and PTH 761.5 pg/mL. Initial medical management was followed by subtotal parathyroidectomy – three masses were removed (one on the right and two on the left). Final pathology revealed PC within the left parathyroid, the others were consistent with hypercellular parathyroid tissue. One month later, the patient underwent left hemithyroidectomy, right parathyroidectomy, and central neck dissection. PTH level dropped to 2.4 pg/mL and Ca level was 7.6 mg/dL after surgery. She was discharged home on Ca and vitamin D supplements. Pathology was sent to a referral cancer center and revealed PC vs. atypical PA within the right parathyroid. Discussion: PC is a rare endocrine malignancy. Further, there are not many cases of synchronous PC and PA or multifocal PC. Diagnosing PC preoperatively is challenging since it shares overlapping characteristics with PA. Patients with malignancy commonly present with larger tumor size, higher level of Ca (&gt;14.6 mg/dL), and PTH (5-fold higher than the upper limit of normal). Our patient had a history of multiple admissions due to symptomatic HC. She had no palpable neck masses on exam. Her initial FNA was consistent with PA. Hence, we presumed that her hypercalcemia was caused by PA. Establishing a definitive diagnosis of PC by frozen sections intraoperatively is difficult. Histopathologic findings of atypical cells, high mitotic rate, and cellular invasions can suggest the diagnosis, though they are often negative. Even postoperatively, pathologists often disagree on cytologic interpretation. However, differentiating PA and PC is important since earlier and more aggressive treatment is needed to reduce the morbidity and mortality in case of malignancy.

Delayed diagnosis of bilateral subdural effusions complicating intracranial hypotension in a patient presenting with post lumbar puncture headache

2021 ◽  
Vol 14 (2) ◽  
pp. e239559
Author(s):  
Saleheen Huq ◽  
Menaka G Iyer ◽  
Samson O Oyibo
Keyword(s):  
Lumbar Puncture ◽  
Delayed Diagnosis ◽  
Bed Rest ◽  
Viral Meningitis ◽  
Magnetic Imaging ◽  
Intracranial Complications ◽  
Life Threatening ◽  
History Of ◽  
Discharge From Hospital ◽  
Subdural Effusions

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7–14 days after the procedure requires further investigation to exclude life-threatening intracranial complications.

Genital Abnormalities in Infants Associated with Administration of Progesteroids to Their Mothers

PEDIATRICS ◽  
1960 ◽  
Vol 26 (1) ◽  
pp. 151-160
Author(s):  
Sheldon G. Leibow ◽  
Lytt I. Gardner
Keyword(s):  
Vaginal Bleeding ◽  
Bed Rest ◽  
Maternal Diabetes ◽  
Term Infant ◽  
Nph Insulin ◽  
Daily Dose ◽  
Calorie Diet ◽  
History Of ◽  
Infant Girl ◽  
First Time

PRESENTATION OF CASES Dr. Sheldon G. Leibow: Case 1. The first patient is an infant girl who was first seen here on October 6, 1958 at the age of 2 months by Dr. Gardner. She was referred for evaluation because of an enlarged clitoris present since birth. The child was born on August 5, 1958, the ninth pregnancy of a 39-year-old mother. Her mother had a history of three spontaneous abortions, two of which had preceded the birth of the patient. In view of this obstetric history, her mother was given hormone therapy in her second month of pregnancy (December 9, 1957). Treatment consisted of: U.S.P. desiccated thyroid, 65 mg/day; 17-alpha-ethinyl-19-nortestosterone (Fig. 1), 5 mg twice daily; and diethylstilbestrol 5 mg twice daily. On December 30, diethylstilbestrol was increased by 5 mg/day, once weekly, until a daily dose of 75 mg was achieved. The other hormones were continued at the original dosage. All therapy was discontinued in the thirty-fifth week of gestation. Two other developments of interest occurred during this pregnancy. Glycosuria was noted for the first time during the second month and was treated with a 1,500 calorie diet and 27 units of isophane (NPH) insulin daily. There was no antecedent history of maternal diabetes, and insulin was not required after termination of the pregnancy. The child's mother fell during her fifth month of pregnancy, developing some spotty vaginal bleeding which ceased promptly after several days of bed rest. A full-term infant weighing 3,430 gm was delivered on August 4, 1958.

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