scholarly journals The Natural History of Facial Schwannomas: A Meta-Analysis of Case Series

2018 ◽  
Vol 80 (05) ◽  
pp. 458-468 ◽  
Author(s):  
Matthew Bartindale ◽  
Jeffrey Heiferman ◽  
Cara Joyce ◽  
Neelam Balasubramanian ◽  
Douglas Anderson ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Meta Analysis ◽  
Case Series ◽  
Tumor Location ◽  
Tumor Diameter ◽  
Facial Weakness ◽  
Nerve Segment ◽  
Level Data ◽  
History Of

Abstract Objective This study is to establish predictors of facial paralysis and auditory morbidity secondary to facial schwannomas by assimilating individualized patient data from the literature. Design A systematic review of the literature was conducted for studies regarding facial schwannomas. Studies were only included if they presented patient level data, House–Brackmann grades, and tumor location by facial nerve segment. Odds ratios (OR) were estimated using generalized linear mixed models. Main Outcome Measures Facial weakness and hearing loss. Results Data from 504 patients were collected from 32 studies. The geniculate ganglion was the most common facial nerve segment involved (39.3%). A greater number of facial nerve segments involved was positively associated with both facial weakness and hearing loss, whereas tumor diameter did not correlate with either morbidity. Intratemporal involvement was associated with higher odds of facial weakness (OR = 4.78, p < 0.001), intradural involvement was negatively associated with facial weakness (OR = 0.56, p = 0.004), and extratemporal involvement was not a predictor of facial weakness (OR = 0.68, p = 0.27). The odds of hearing loss increased with more proximal location of the tumor (intradural: OR = 3.26, p < 0.001; intratemporal: OR = 0.60, p = 0.14; extratemporal: OR = 0.27, p = 0.01). Conclusion The most important factors associated with facial weakness and hearing loss are tumor location and the number of facial nerve segments involved. An understanding of the factors that contribute most heavily to the natural morbidity can help guide the appropriate timing and type of intervention in future cases of facial schwannoma.

scholarly journals Neurenteric cyst of the temporal bone: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110679
Author(s):  
Timothy Fan ◽  
Ezer Benaim ◽  
Jorge Lee Diaz ◽  
Charles MacDonald
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Complete Resolution ◽  
Goblet Cells ◽  
Neurenteric Cyst ◽  
Rare Entity ◽  
Facial Weakness ◽  
History Of

Neurenteric cysts are rare, developmental malformations mainly found in the spinal canal. The authors report on a 29-year-old woman who presented with congenital left-sided hearing loss and a 9 days history of left ear pain and facial weakness (House–Brackmann IV). Radiological examination revealed a complex 7 mm cystic structure involving the petrous and mastoid portions of the left temporal bone. Intraoperatively, a red-brown multicystic mass was discovered and excised completely. Histologic findings showed simple columnar epithelium with goblet cells and bilayers of submucosal musculature, resembling normal intestinal linings. Post resection, the patient regained nearly full facial nerve capabilities (House–Brackmann II) with complete resolution of pain, but no changes to her hearing. The objectives of this case report are to describe the clinical, radiologic, intraoperative, and pathologic characteristics of an extradural temporal neurenteric cyst with sensorineural deficits to contribute to the growing knowledge regarding this rare entity.

scholarly journals Immune Thrombocytopenia Associated with COVID-19 - Case Series

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-14
Author(s):  
Ramil Fatkhullin ◽  
Vasily Shuvaev
Keyword(s):  
Immune Thrombocytopenia ◽  
Meta Analysis ◽  
Case Series ◽  
Cervix Uteri ◽  
First Episode ◽  
High Dose ◽  
Platelet Response ◽  
Pulmonary Infiltrates ◽  
High Dose Dexamethasone ◽  
History Of

Increased numbers of COVID-19 infection make the study of its systemic manifestations more and more important. Despite of SARS-Cov-2 main clinical respiratory syndrome other clinical infection signs as immune thrombocytopenia without respiratory failure were identified. We have seen case series of patients with thrombocytopenia and active COVID-19 infection during present epidemic outbreak. Patient 1, female, 31 years old was admitted at our hospital with ecchymoses, epistaxis, gingival hemorrhage and metrorrhagia. There were also signs of COVID-19 infection - fever up to 40oC, short of breathes with room air. The pulmonary infiltrates about to 25% were revealed by CT scan. The CBC parameters were as follows: WBC 8.9x109/l, Hb 11,2 g/dl, PLT 3 x109/l by microscopy. The patient was treated with high-dose dexamethasone 40 mg QD for 4 days. The treatment resulted to stable complete platelet response as 189x109/l in fourteen days after start of therapy. At that time, the cancer in situ of cervix uteri there was revealed by gynecologic examination, that was successfully local treated. Patient 2, female 30 years old presented epistaxis, metrorrhagia, cutaneous and gingival hemorrhagic syndrome as previous patient. There were WBC 6.4x109/l, Hb 12,6 g/dl, PLT 3x109/l by microscopy in CBC. She had no respiratory signs and abnormality in pulmonary CT. The COVID-19 infection was identified by PCR and antibody screening. The patient also received high-dose dexamethasone 40 mg QD for 4 days and yielded of platelet elevation to 25x109/l with no hemorrhagic syndrome in five days of treatment. Patient 3, female 68 years old with chronic course of immune thrombocytopenia and resistance to glucocorticoid, after splenectomy and presence of HBsAg. All relapses of thrombocytopenia in this patient were associated with virus infection. The first episode was in 2009, patient was treated with glucocorticoid with no effect. The complete platelet response was achieved after splenectomy. The relapse occurred in 2015 and was associated with acute respiratory distress syndrome (probably H7N9 flu). There treatment with prednisone 1 mg/day resulted to complete platelet response. At present time, the COVID-19 infection on this patient manifested with 75% of pulmonary volume lesions. At the recovery (25% of pulmonary infiltrates) the relapse of immune thrombocytopenia with cutaneous bleeding occurred. In CBC there were WBC 5.9x109/l, Hb 15,1 g/dl, PLT 5x109/l by microscopy. Given that history of therapy we treated this patient with high-dose dexamethasone 40 mg QD for 4 days and romiplostime 2 mqg/kg. The complete resolution of hemorrhagic signs and platelet response (65x109/l) was reached in seven days of treatment. Discussion. The virus-associated thrombocytopenia is usual in common practice. In recent COVID-19 infection outcome meta-analysis (G. Lippi et al. Clinica Chimica Acta 506 (2020) 145-148) the platelet count was significantly lower in severe course of disease. The presence of platelet below the lower limit was associated with fivefold of risk of severe COVID-19 and was a factor of mortality. The platelet decline could be as sign of disease worsening at one hand and have an own risk of mortality by bleeding at other hand. There is a need for guideline to thrombocytopenia management in COVID-19 patients. Now we are continuing to search and include the patients with COVID-19 infection and thrombocytopenia in our study. Disclosures Shuvaev: Novartis:Honoraria, Speakers Bureau;BMS:Honoraria, Speakers Bureau;Pfizer:Honoraria, Speakers Bureau.

scholarly journals The Natural History of Facial Schwannomas: A Meta-analysis of Case Series

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
John Leonetti ◽  
Matthew Bartindale ◽  
Jeffrey Heiferman ◽  
Cara Joyce ◽  
Neelam Balasubramanian
Keyword(s):  
Natural History ◽  
Meta Analysis ◽  
Case Series ◽  
History Of

scholarly journals Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Saad Alhumaid ◽  
Abbas Al Mutair ◽  
Zainab Al Alawi ◽  
Ali A. Rabaan ◽  
Raghavendra Tirupathi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Case Series ◽  
Incidence Rates ◽  
Effect Sizes ◽  
Cross Sectional ◽  
Randomized Controlled ◽  
Pooled Prevalence ◽  
History Of

Abstract Background Currently there is no systematic review and meta-analysis of the global incidence rates of anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines in the general adult population. Objectives To estimate the incidence rates of anaphylactic and nonanaphylactic reactions after COVID-19 vaccines and describe the demographic and clinical characteristics, triggers, presenting signs and symptoms, treatment and clinical course of confirmed cases. Design A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] statement was followed. Methods Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, and Nature) were searched from 1 December 2020 to 31 May 2021 in the English language using the following keywords alone or in combination: anaphylaxis, non-anaphylaxis, anaphylactic reaction, nonanaphylactic reaction, anaphylactic/anaphylactoid shock, hypersensitivity, allergy reaction, allergic reaction, immunology reaction, immunologic reaction, angioedema, loss of consciousness, generalized erythema, urticaria, urticarial rash, cyanosis, grunting, stridor, tachypnoea, wheezing, tachycardia, abdominal pain, diarrhea, nausea, vomiting and tryptase. We included studies in adults of all ages in all healthcare settings. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. Results Of the 1,734 papers that were identified, 26 articles were included in the systematic review (8 case report, 5 cohort, 4 case series, 2 randomized controlled trial and 1 randomized cross-sectional studies) and 14 articles (1 cohort, 2 case series, 1 randomized controlled trial and 1 randomized cross-sectional studies) were included in meta-analysis. Studies involving 26,337,421 vaccine recipients [Pfizer-BioNTech (n = 14,505,399) and Moderna (n = 11,831,488)] were analyzed. The overall pooled prevalence estimate of anaphylaxis to both vaccines was 5.0 (95% CI 2.9 to 7.2, I2 = 81%, p =  < 0.0001), while the overall pooled prevalence estimate of nonanaphylactic reactions to both vaccines was 53.9 (95% CI 0.0 to 116.1, I2 = 99%, p =  < 0.0001). Vaccination with Pfizer-BioNTech resulted in higher anaphylactic reactions compared to Moderna (8.0, 95% CI 0.0 to 11.3, I2 = 85% versus 2.8, 95% CI 0.0 to 5.7, I2 = 59%). However, lower incidence of nonanaphylactic reactions was associated with Pfizer-BioNTech compared to Moderna (43.9, 95% CI 0.0 to 131.9, I2 = 99% versus 63.8, 95% CI 0.0 to 151.8, I2 = 98%). The funnel plots for possible publication bias for the pooled effect sizes to determine the incidence of anaphylaxis and nonanaphylactic reactions associated with mRNA COVID-19 immunization based on mRNA vaccine type appeared asymmetrical on visual inspection, and Egger’s tests confirmed asymmetry by producing p values < 0.05. Across the included studies, the most commonly identified risk factors for anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines were female sex and personal history of atopy. The key triggers to anaphylactic and nonanaphylactic reactions identified in these studies included foods, medications, stinging insects or jellyfish, contrast media, cosmetics and detergents, household products, and latex. Previous history of anaphylaxis; and comorbidities such as asthma, allergic rhinitis, atopic and contact eczema/dermatitis and psoriasis and cholinergic urticaria were also found to be important. Conclusion The prevalence of COVID-19 mRNA vaccine-associated anaphylaxis is very low; and nonanaphylactic reactions occur at higher rate, however, cutaneous reactions are largely self-limited. Both anaphylactic and nonanaphylactic reactions should not discourage vaccination.

scholarly journals Unilateral internal auditory canal stenosis with progressive facial weakness

2012 ◽  
Vol 18 (2) ◽  
pp. 179-182
Author(s):  
Sathiya Murali ◽  
Arpana Shekhar ◽  
S Shyam Sudhakar ◽  
Kiran Natarajan ◽  
Mohan Kameswaran
Keyword(s):  
Hearing Loss ◽  
High Resolution ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Internal Auditory Canal ◽  
Facial Weakness ◽  
Profound Hearing Loss ◽  
Canal Stenosis ◽  
Temporal Bone Ct ◽  
Magnetic Resonance Imaging Mri

Internal auditory canal (IAC) stenosis is a rare cause of sensorineural hearing loss. Patient may present with symptoms of progressive facial nerve palsy, hearing loss, tinnitus and giddiness. High resolution temporal bone CT-scan and magnetic resonance imaging (MRI) are the important tools for diagnosis. No specific management has been devised. Here is presentation of a case of unilateral (left) IAC stenosis with profound hearing loss and progressive House Brackmann Grade III-IV facial weakness. The diameter of the IAC was less than 2 mm on high resolution temporal bone computed tomography (HRCT) scan. It was managed by facial nerve decompression by translabyrinthine approach in an attempt to prevent further deterioration of facial palsy. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12014 Bangladesh J Otorhinolaryngol 2012; 18(2): 179-182

scholarly journals COVID-19 Associated Pulmonary Aspergillosis: Systematic Review and Patient-Level Meta-Analysis

2021 ◽  
Author(s):  
Ruwandi M. Kariyawasam ◽  
Tanis C. Dingle ◽  
Brittany E. Kula ◽  
Wendy I. Sligl ◽  
Ilan S. Schwartz
Keyword(s):  
Cohort Studies ◽  
Excess Mortality ◽  
Meta Analysis ◽  
Case Series ◽  
Rank Test ◽  
Pulmonary Aspergillosis ◽  
Exact Test ◽  
Patient Level ◽  
Level Data ◽  
Antifungal Use

Rationale Pulmonary aspergillosis may complicate COVID-19 and contribute to excess mortality in intensive care unit (ICU) patients. The incidence is unclear because of discordant definitions across studies. Objective We sought to review the incidence, diagnosis, treatment, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA), and compare research definitions. Methods We systematically reviewed the literature for ICU cohort studies and case series including ≥3 patients with CAPA. We calculated pooled incidence. Patients with sufficient clinical details were reclassified according to 4 standardized definitions (Verweij, White, Koehler, and Bassetti). Measurements Correlations between definitions were assessed with Spearmans rank test. Associations between antifungals and outcome were assessed with Fishers Exact test. Main Results 38 studies (35 cohort studies and 3 case series) were included. Among 3,297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA (pooled incidence 9.5%). 197 patients had patient-level data allowing reclassification. Definitions had limited correlation with one another (ρ=0.330 to 0.621, p<0.001). 38.6% of patients reported to have CAPA did not fulfill any research definitions. Patients were diagnosed after a median of 9 days (interquartile range 5-14) in ICUs. Tracheobronchitis occured in 5.3% of patients examined with bronchoscopy. The mortality rate (50.0%) was high, irrespective of antifungal use (p=0.28); this remained true even when the analysis was restricted to patients meeting standardized definitions for CAPA. Conclusions The reported incidence of CAPA is exaggerated by use of non-standard definitions. Further research should focus on identifying patients likely to benefit from antifungals.

Independent Risk Factors of Catheter-Related Thrombosis (CRT) in Adult Cancer Patients: An Individual Patient-Level Data (IPD) Meta-Analysis of Randomized Clinical Trials and Prospective Cohort Studies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3814-3814
Author(s):  
Wael Saber ◽  
Teng Moua ◽  
Eliot C. Williams ◽  
Melina Verso ◽  
Giancarlo Agnelli ◽  
...  
Keyword(s):  
Prospective Studies ◽  
Meta Analysis ◽  
Multivariate Logistic Regression ◽  
Insertion Technique ◽  
Central Venous ◽  
Individual Patient Level ◽  
Level Data ◽  
Catheter Tip ◽  
History Of ◽  
Catheter Related Thrombosis

Abstract Purpose: Symptomatic catheter-related thrombosis (CRT) complicates roughly 5% of central venous catheter insertions in cancer patients. Recent studies have failed to show a reduction in CRT with routine use of pharmacologic thromboprophylaxis in all patients. We conducted a meta-analysis of individual patient-level data to identify independent, baseline risk factors of CRT that may help to select high-risk patients for prophylaxis. Methods: PubMed, EMBASE, CINAHL, CENTRAL, DARE, Grey literature databases were searched in all languages from 1995–2008. Only prospective studies and randomized controlled trials (RCTs) were included. The primary end-point was objectively confirmed symptomatic and asymptomatic CRT. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. Results: A total sample of 5636 subjects from 5 RCTs and 7 prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed (8%). In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICC), decreased CRT risk (OR = 0.43; 95% CI, 0.23–0.80). Alternatively, past history of deep vein thrombosis (DVT) (OR = 2.03; 95% CI, 1.05–3.92), subclavian venipuncture insertion technique (OR = 2.16; 95% CI, 1.07–4.34), and improper catheter tip location (OR = 1.92; 95% CI, 1.22–3.02), increased CRT risk. Conclusions: CRT risk is increased with using PICC catheters, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings.

MOTOR NEURON DISEASE: A CASE OF MISGUIDED THERAPEUTIC NIHILISM

2015 ◽  
Vol 86 (11) ◽  
pp. e4.124-e4 ◽  
Author(s):  
Alexander Rossor ◽  
Dragana Josifova ◽  
Robin Howard ◽  
Alifa IsaacsItua
Keyword(s):  
Hearing Loss ◽  
Nursing Home ◽  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Case Series ◽  
Missense Mutations ◽  
Facial Weakness ◽  
The Family ◽  
Peg Tube ◽  
Bilateral Deafness

We report the case of a 62 year old gentleman with sensorineuronal hearing loss beginning in the second decade. At the age of 40 he collapsed and was unable to walk more than a few metres. He was admitted to hospital and diagnosed with a motor neuron disease on the basis of an EMG. Examination at the time revealed bilateral deafness, facial weakness, dysphagia, dysphonia and both proximal and distal weakness.The family history was remarkable for two sisters who died of a similar condition in the second decade. In view of the combination of sensory neuronal deafness and a motor neuronopathy, a diagnosis of Brown Violetta Van Laera (BVVL) syndrome was made.A PEG tube was inserted and the patient was discharged to a nursing home for palliation. After several months, our patient discharged himself, reintroduced thickened fluids resulting in removal of the PEG tube. His clinical condition has continued to improve although he intermittently requires a wheelchair.Genetic testing of the SLC52A3 gene revealed two missense mutations (p.Glu36Lys and p.Val413Ala) confirming the clinical diagnosis of BVVL. SLC52A3 encodes a riboflavin transporter and in case series, riboflavin supplementation has halted or reversed the disease.

scholarly journals Chances of Improvement in Cases of Vestibular Schwannoma Presenting with Facial Nerve Weakness: Presentation of Two Cases and Literature Review

2018 ◽  
Vol 80 (01) ◽  
pp. 040-045
Author(s):  
Ahmed Rizk ◽  
Marcus Mehlitz ◽  
Martin Bettag
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Male Patient ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Neurophysiological Monitoring ◽  
Facial Weakness ◽  
First Case ◽  
The Brain

Background and Study Aim Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases. Methods and Results We are presenting two cases of VS with significant facial weakness. The first case was a 63-year-old male patient presented with 3 weeks' history of severe left-sided facial weakness (House–Brackmann [HB] grade V) and hearing loss. Magnetic resonance imaging (MRI) of the brain showed a tumor in the left internal auditory canal. Gross total removal with anatomical and physiological FN preservation was performed through a retrosigmoid approach under neurophysiological monitoring. FN function improved postoperatively to HB grade II after 16 months. The other case was 83-year-old male patient presented with sudden left-sided hearing loss and severe facial weakness (HB grade V). MRI of the brain 2.5 years before showed a left-sided (Class-T3A) cystic VS. The tumor was asymptomatic; wait-and-scan strategy was advised by the treating neurologist. Recent MRI of the brain showed approximately three times enlargement of the tumor with brain stem compression, extensive cystic changes, and suspected intratumoral hemorrhage. Surgery was performed; the tumor was subtotally removed through a retrosigmoid approach with intraoperative FN monitoring. The FN was anatomically preserved; however, physiological preservation was not possible. Severe facial weakness with incomplete lid closure persisted postoperatively. Conclusion Surgical treatment could be offered to cases of suspected VS presenting with facial weakness, as these cases may still have a chance for improvement especially in laterally located tumors.

Rhytidectomy After Parotidectomy

2017 ◽  
Vol 35 (2) ◽  
pp. 92-98
Author(s):  
Boris Paskhover ◽  
Benjamin C. Paul ◽  
David B. Rosenberg
Keyword(s):  
Patient Satisfaction ◽  
Facial Nerve ◽  
Intraoperative Complications ◽  
Case Series ◽  
Surgical Anatomy ◽  
Retrospective Case ◽  
Neck Lift ◽  
Parotid Surgery ◽  
History Of ◽  
Surgical Field

A history of prior parotidectomy is typically thought to substantially increase the risk of facial nerve injury for patients undergoing subsequent facelift surgery. For this reason, surgeons are often hesitant and may even elect not to perform facelift surgery on such patients. However, we have developed a safe and predictable operation for performing the post-parotidectomy rhytidectomy. Here, we present our rationale, approach, and results for performing this operation. This review is a retrospective case series. In total, 1200 facelifts from 2012 to 2016 performed by a single surgeon (D.B.R.) were reviewed. From these, 9 patients were identified as having had parotid surgery prior to rhytidectomy. Rhytidectomy was performed in 8 of 9 cases with a deep-plane, bilaminar approach. There were no intraoperative complications. One patient had a direct neck lift. There were no cases of revision. There were no cases of facial nerve damage including paresis or paralysis; 100% patient satisfaction was noted. Rhytidectomy with a deep-plane approach may be performed safely in patients who have undergone prior parotidectomy. Although there were no complications, revisions, postoperative asymmetry, or dissatisfaction in the patients in this study, it must be stressed that there is no substitute for a thorough appreciation of the surgical anatomy in combination with consideration of the changes to the surgical field that occur with parotid surgery.

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