A diagnostic challenge in an unresponsive refugee child improving with neurosurgery—a case report

ABSTRACT An unresponsive paediatric patient may present a diagnostic challenge for health professionals, as rapid identification of the cause is needed to provide proper interventions. The following report details a challenging diagnosis of unresponsiveness in a refugee child. In the migratory context, observed unresponsiveness states are frequently attributed to psychologic factors, and overlapping psychiatric classifications (resignation syndrome, functional coma and catatonia) are common. Our patient fell into an unresponsive state for 6 months after witnessing a traumatic event. Diagnostic workup for multiple medical comorbidities led to surgical intervention for tethered cord syndrome. Shortly after that, the patient’s responsiveness improved, putting to question her condition’s underlying cause. This case highlights the need for a biopsychosocial approach in such cases, reflected in thorough clinical examination and diagnostic investigations. A multidisciplinary perspective and expertise proved crucial and may help in the rehabilitation of children in similar situations.

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IgG4-related intracranial disease

The Neuroradiology Journal ◽

10.1177/1971400918806323 ◽

2018 ◽

Vol 32 (1) ◽

pp. 29-35 ◽

Cited By ~ 6

Author(s):

Shahine Goulam-Houssein ◽

Jeffrey L Grenville ◽

Katerina Mastrocostas ◽

David G Munoz ◽

Amy Lin ◽

...

Keyword(s):

Plasma Cells ◽

Surgical Intervention ◽

Case Series ◽

Hypertrophic Pachymeningitis ◽

Diagnostic Challenge ◽

Perineural Spread ◽

Related Disease ◽

The Third ◽

Igg4 Related Disease ◽

Intracranial Involvement

IgG4-related disease (IgG4-RD) is a multi-organ chronic inflammatory process caused by infiltration of IgG4-positive plasma cells in one or more organs. Intracranial involvement has only recently become better recognized. Our case series adds to the growing literature on the varying presentations of intracranial IgG4 by describing the clinical and imaging findings of three patients who presented to our institution with intracranial involvement. Our first patient presented with a mass-forming IgG4 pachymeningitis mimicking a sphenoid wing meningioma, which is to our knowledge the largest mass-forming pachymeningitis published in the literature. Our second case depicts another presentation of extensive IgG4 pachymeningitis involving both cavernous sinuses and surrounding Meckel’s caves. The third case describes a patient with presumed lymphocytic hypophysitis, which was later determined to be IgG4-related hypophysitis with concomitant pachymeningitis and perineural spread along the optic nerves. The delayed diagnoses in our cases illustrates the diagnostic challenge that clinicians face in differentiating intracranial IgG4-RD from other infiltrative diseases such as sarcoidosis, granulomatous disease, tuberculosis and lymphoma. Earlier consideration of IgG4-related hypophysitis and hypertrophic pachymeningitis in the differential diagnosis can prevent significant morbidity including unnecessary surgical intervention and organ failure secondary to extensive fibrosis.

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Transoral Approach to Open Reduction of a Traumatic Avulsion Fracture of the Genial Tubercle Associated With a Mandibular Symphysis Fracture: A Case Report and Literature Review

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1177/2472751220949407 ◽

2020 ◽

Vol 5 ◽

pp. 247275122094940

Author(s):

Danyon O. Graham ◽

Edward Nguyen ◽

Muammar Abu Serriah

Keyword(s):

Avulsion Fracture ◽

Surgical Intervention ◽

Plain Film ◽

Skin Incision ◽

Transoral Approach ◽

Diagnostic Challenge ◽

Mandibular Symphysis ◽

Posterior Displacement ◽

Plain Film Radiography ◽

Genial Tubercle

Genial tubercle fracture (GTF) is rare and represents a diagnostic challenge as plain film radiography often fails to identify the fractured segment. Traumatic avulsion of the genial tubercle in conjunction with mandibular symphysis fracture may lead to posterior displacement of the tongue with the potential for airway compromise and difficulty in speech and swallowing due to loss of tongue anterior suspension. Fine cut computed tomography (CT) scan is required to confirm the diagnosis and assist further management. To our knowledge, all published cases of surgical intervention in the management of avulsed genial tubercle combined with fracture of the mandibular symphysis used an extraoral approach via submental skin incision to expose the fractured segment. To the authors’ knowledge, this is the first report to describe a transoral approach in the surgical management of GTF associated with a mandibular fracture.

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Large Bowel Endometriosis Mimicking Colorectal Cancer

Case Reports in Medicine ◽

10.1155/2020/7014107 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Laís Marques Mota ◽

Bruno Salomão Hirsch ◽

Renato Seligman

Keyword(s):

Colorectal Cancer ◽

Gastrointestinal Tract ◽

Human Body ◽

Large Bowel ◽

Surgical Intervention ◽

Endometrial Tissue ◽

Differential Diagnoses ◽

Diagnostic Challenge ◽

Female Population ◽

Bowel Endometriosis

Endometriosis is characterized by the presence of endometrial tissue outside the uterus, with 1–7% prevalence in the female population. It is observed in various locations of the human body, and large bowel endometriosis is the most common extrapelvic site, affecting about 5 to 12% of all women who present endometriosis. This study aimed to report an interesting images related to stenosing large bowel endometriosis that was possible to be diagnosed only by surgical intervention. Hence, this pathology is a diagnostic challenge and should be remembered between differential diagnoses of nonspecific or even alarming symptoms of the gastrointestinal tract.

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Lymphoepithelial cyst of the pancreas. A case report

Scottish Medical Journal ◽

10.1258/rsmsmj.52.3.53d ◽

2007 ◽

Vol 52 (3) ◽

pp. 53-53

Author(s):

L Fraser ◽

OO Komolafe ◽

JR Anderson

Keyword(s):

Case Report ◽

Cystic Lesion ◽

Cystic Lesions ◽

Lymphoepithelial Cyst ◽

Invasive Procedures ◽

Diagnostic Challenge ◽

Distal Pancreas ◽

Ct And Mri ◽

Diagnostic Investigations ◽

The Ideal

We present the case of a 63 year-old male who presented with a cystic lesion of the distal pancreas. Excision and histology showed this to be a lymphoepithelial cyst. Cystic lesions of the pancreas represent a diagnostic challenge, especially when pseudocyst secondary to pancreatitis is excluded. These lesions can be broadly classified into benign, pre-malignant and malignant. Widely used imaging modalities such as CT and MRI are not able to categorically differentiate between these. More invasive procedures such as endoscopic US and FNA again do not give a cast-iron diagnosis. Our patient had a symptomatic cystic lesion in his pancreas which was excised after cross-specialty discussion. We advocate that this is the ideal way to treat patients with cystic lesions of the pancreas, with each case considered on its own merits as all current diagnostic investigations have their limitations.

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The Currarino Triad: Neurosurgical Considerations

Neurosurgery ◽

10.1227/01.neu.0000209945.87233.6a ◽

2006 ◽

Vol 58 (5) ◽

pp. 924-929 ◽

Cited By ~ 34

Author(s):

Pieter J. Emans ◽

Jasper van Aalst ◽

Ernest L.W. van Heurn ◽

Carlo Marcelis ◽

Gauke Kootstra ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Canal ◽

Chart Review ◽

Surgical Intervention ◽

Tethered Cord ◽

Retrospective Chart Review ◽

Risks And Benefits ◽

Chiari Type 1 Malformation ◽

Spine Imaging

Abstract OBJECTIVES: The Currarino triad, a relatively uncommon hereditary disorder, is often associated with tethered cord and anterior myelomeningocele. Little is known of the implications of these neuroanatomic malformations or of the neurosurgical attitude. The objective of this study is to identify the spinal cord and meningeal malformations associated with the Currarino triad and to discuss the risks and benefits of surgical intervention. METHODS: We analyzed the spinal cord malformations and the neurosurgical involvement with the Currarino triad by retrospective chart review. RESULTS: The Currarino triad neuroanatomic malformations were identified in five patients. The Currarino triad was associated with a tethered cord in three patients, a myelomeningocele in five patients, a syrinx in two patients, a fistula between the colon and spinal canal in two patients, and an Arnold-Chiari Type 1 malformation in one patient. CONCLUSION: Full spine imaging is required for all patients diagnosed with the Currarino triad. Magnetic resonance imaging of the head should be performed in every patient with neuroanatomic anomalies. Surgery of an anterior myelomeningocele is not necessarily indicated, only in the rare case in which the space-occupying aspect is expected to cause constipation or problems during pregnancy or delivery. Constipation directly after birth is seen in virtually all patients with the triad. Therefore, constipation cannot be used to diagnose a tethered cord syndrome nor indicate tethered cord release. Fistulas between the spinal canal and colon have to be operated on directly.

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Transvaginal uterine evisceration during labor in a Bengal queen

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116919872301 ◽

2019 ◽

Vol 5 (2) ◽

pp. 205511691987230

Author(s):

Mila Freire ◽

Mouhamadou Diaw

Keyword(s):

Physical Examination ◽

Surgical Intervention ◽

Patient Survival ◽

Uterine Prolapse ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Rapid Identification ◽

Urethral Catheterization ◽

Case Summary ◽

History Of

Case summary A 2.5-year-old Bengal queen was admitted with a 12-h history of a mass protruding from the vulva during labor. At that time, three healthy kittens had already been delivered. Physical examination identified the mass as a portion of the uterus that was eviscerated without eversion of the mucosa. Exploratory laparotomy revealed a vaginal vault rupture with a large portion of the uterus herniated through the tear and eviscerated through the vulva. Ovariohysterectomy was performed, and a dead fetus was removed with the uterus. Reconstruction of the vaginal rupture required careful dissection and urethral catheterization. The queen recovered without complications. Relevance and novel information Uterine evisceration through a vaginal tear is a very rare condition that sometimes is erroneously referred to as ‘prolapse’. Uterine prolapse and uterine evisceration may have similar presenting signs; however, proper identification and surgical correction is key when the uterus is eviscerated. This case highlights the importance of differentiating these two conditions and of rapid identification and surgical intervention for successful patient survival.

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Spinal dysraphism with tripedus morphology: A case report

Indian Journal of Case Reports ◽

10.32677/ijcr.v7i11.3158 ◽

2021 ◽

pp. 509-511

Author(s):

Mohd Monis ◽

Shagufta Wahab ◽

Divyashree Koppal ◽

Aiman Ibbrahim

Keyword(s):

Case Report ◽

Spina Bifida ◽

Vertebral Column ◽

Rare Case ◽

Surgical Intervention ◽

Spinal Dysraphism ◽

Tethered Cord ◽

Lower Back ◽

Rare Case Report ◽

Spinal Mri

This is a rare case report of a 5-month-old child with a complex spinal dysraphic state, and an accessory limb (tripedus morphology), accessory genitalia, and anal dimple. The child was brought to the hospital with an accessory limb arising from the back. On clinical examination, an accessory limb arising from the lower back with a partially developed foot with the presence of toes and nails was noted. Spinal MRI was advised which revealed dysraphic features including spina bifida with the low lying and posteriorly tethered cord with diastematomyelia along with a supernumerary appendage attached to the vertebral column having rudimentary bones resembling those of extremities. The presence of an accessory limb with spinal dysraphism is quite a rare anomaly. The condition can be treated by surgical intervention and involves excision of the accessory limb with adequate dural and paraspinal muscle cover.

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Rectal cancer mimic: a rare case of syphilitic proctitis

BMJ Case Reports ◽

10.1136/bcr-2020-235522 ◽

2020 ◽

Vol 13 (12) ◽

pp. e235522

Author(s):

Rajashri Veeresh Patil ◽

Iain Stephenson ◽

Cathy J Richards ◽

Yvette Griffin

Keyword(s):

Rectal Cancer ◽

Sexually Transmitted Infection ◽

Rare Case ◽

Surgical Intervention ◽

Secondary Syphilis ◽

Sexual History ◽

Diagnostic Challenge ◽

Rare Presentation ◽

Transmitted Infection ◽

Sexually Transmitted

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.

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05 Profile of a Geriatric Neurosurgical Service

Age and Ageing ◽

10.1093/ageing/afz103.02 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Kareena Malone ◽

Fiona Kinsella

Keyword(s):

Catchment Area ◽

Surgical Intervention ◽

Traumatic Event ◽

Service Planning ◽

Service Development ◽

Irish Population ◽

Complex Needs ◽

National Trauma ◽

Data Points ◽

National Profile

Abstract Background According to the 2016 CSO figures the age category of 65 and older saw the largest increase in the Irish population since 2011, rising by 102,174 to 637,567, a rise of 19.1%. This remains a major concern for a North Dublin teaching hospital as its catchment area has a 20% higher proportion of > 65’s and > 85’s than the national average. This catchment area profile has the potential to impact on the profile of the in-catchment admissions while the National profile will impact on the national specialities including neurosurgery. Aim To profile the geriatric neurosurgical population and provide insight that facilitates future service planning and delivery. Methods To accurately capture the data, all ward lists for the month of June and July 2017 were reviewed to identify appropriate patients. All patients on any ward within the hospital, under the care of a neurosurgeon, were included in the data collection. Patients in intensive care that did not transfer to the wards were excluded. Data points including age, sex, consultant, co-morbidities, mobility status and surgical intervention were captured. Results 120 patients ≥ 65 years were admitted to the neurosurgical service between June and July 2017; 45 (38%) between 60-69, 60 (50%) 70-79, 13(10%) 80-80 and two (2%) ninety years or older. The two most common reasons for admission were non-traumatic cerebral bleeds (N= 40; 34%) and cerebral tumours (N= 38; 32%). Patients had on average four co-morbidities, with cardiac being the most common. 17 patients were admitted post a traumatic event; 13 low impact falls, 3 high impact falls and one assault. The average LOS for these patients was 11.3 days. Conclusion This profile highlights the complex needs of this population and the increasing burden on existing neurosurgical resources as the population continues to age. Future resource allocation and service development, including the National Trauma Strategy, needs to consider the needs of the aging neurosurgical population.

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Simultaneous Repair of a Sinus of Valsalva Aneurysm and a Bicuspid Aortic Valve

The Heart Surgery Forum ◽

10.1532/hsf98.20121122 ◽

2013 ◽

Vol 16 (3) ◽

pp. 147

Author(s):

Rajeev Deva ◽

Paul Peters ◽

Terri Hall ◽

Pallav Shah

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Surgical Intervention ◽

Patch Repair ◽

Sinus Of Valsalva ◽

Valve Repair ◽

Sinus Of Valsalva Aneurysm ◽

Valve Pathology ◽

Early Surgical Intervention ◽

Diagnostic Investigations

Sinus of Valsalva aneurysms (SOVA) are rare cardiac abnormalities that are most commonly congenital in origin and frequently associated with aortic valve pathology. Unruptured SOVA are more frequently identified currently, owing to the increased use and accuracy of diagnostic investigations. Early surgical intervention is recommended to prevent complications. We describe a case of a young patient with an enlarging right SOVA and a regurgitant bicuspid aortic valve who subsequently underwent simultaneous patch repair of the SOVA and primary aortic valve repair.

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