Percutaneous Endoscopic Removal of Cervical Foraminal Schwannoma via Interlaminar Approach: A Case Report

2017 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Guang-Yu Ying ◽  
Ying Yao ◽  
Fang Shen ◽  
Zong-Yang Wu ◽  
Chien-Min Chen ◽  
...  
Keyword(s):  
Case Report ◽  
Cervical Vertebrae ◽  
Tumor Resection ◽  
Lower Limbs ◽  
Spinal Nerves ◽  
Postoperative Mri ◽  
Spinal Neoplasm ◽  
Articular Process ◽  
First Case ◽  
Interlaminar Approach

Abstract BACKGROUND AND IMPORTANCE Cervical foraminal schwannomas commonly originate from spinal nerves that pass through the intervertebral foramen of the cervical vertebrae. Because of the proximity of this type of tumor to the vertebral artery and spinal nerves, surgical management remains a major challenge. Conventional open spine surgery usually requires the removal of the articular process and is supplemented by a simultaneous posterolateral spine fusion surgery. To decrease the associated risks of surgical complications by further reducing invasiveness, percutaneous spinal endoscopy may be used for resection of foraminal spinal neoplasm. CLINICAL PRESENTATION A 52-yr-old female who presented with neck pains with duration of 1 yr was admitted to our hospital. Physical examination revealed moderate rigidity in the neck and grade 5 muscle strength in both upper and lower limbs. Preoperative magnetic resonance imaging (MRI) scans demonstrated a left-sided lesion at the C3-C4 intervertebral foraminal area. Under C-arm fluoroscopy navigation and neuromonitoring, the endoscope was properly positioned on the same side of the tumor, and a small part of the left C3 inferior and C4 superior lamina were first removed by an endoscopic drill to enlarge the interlaminar space. Next, through an endoscopic working canal, the left intervertebral ligamentum flavum was removed to fully expose the tumor. The tumor mass was finally resected in a piecemeal approach. Postoperative MRI confirmed complete tumor resection. CONCLUSION This is the first case report of a total removal of a cervical foraminal schwannoma with a percutaneous spinal endoscopic procedure.

scholarly journals Silent Hypertensive Crisis in an Adolescent: First Case Report of Pediatric Pheochromocytoma from Indonesia

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110154
Author(s):  
Cahyani Gita Ambarsari ◽  
Eka Laksmi Hidayati ◽  
Bambang Tridjaja ◽  
Chaidir Arif Mochtar ◽  
Haryanti Fauzia Wulandari ◽  
...  
Keyword(s):  
Case Report ◽  
Hypertensive Crisis ◽  
Pediatric Nephrology ◽  
Tumor Resection ◽  
Secondary Hypertension ◽  
Antihypertensive Medications ◽  
First Case ◽  
History Of ◽  
The Right ◽  
Clinical Awareness

Secondary hypertension in children, to the rare extent, can be caused by endocrine factors such as pheochromocytoma, an adrenal tumor that secretes catecholamine. Only a few cases have been reported in the past 3 decades. To the best of our knowledge, this is the first case report of pediatric pheochromocytoma from Indonesia. We reviewed a case of a 16-year-old Indonesian boy with history of silent hypertensive crisis who was referred from a remote area in an island to the pediatric nephrology clinic at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Despite medications, his symptoms persisted for 14 months. At the pediatric nephrology clinic, pheochromocytoma was suspected due to symptoms of catecholamine secretion presented, which was palpitation, diaphoresis, and weight loss. However, as the urine catecholamine test was unavailable in Indonesia, the urine sample was sent to a laboratory outside the country. The elevated level of urine metanephrine, focal pathological uptake in the right adrenal mass seen on 131I-MIBG, and histopathology examination confirmed the suspicion of pheochromocytoma. Following the tumor resection, he has been living with normal blood pressure without antihypertensive medications. This case highlights that pheochromocytoma should always be included in the differential diagnoses of any atypical presentation of hypertension. In limited resources setting, high clinical awareness of pheochromocytoma is required to facilitate prompt referral. Suspicion of pheochromocytoma should be followed by measurement of urine metanephrine levels. Early diagnosis of pheochromocytoma would fasten the optimal cure, alleviate the symptoms of catecholamine release, and reverse hypertension.

scholarly journals Ibrutinib-associated sever skin toxicity: A case of multiple inflamed skin lesions and cellulitis in a 68-year-old male patient with relapsed chronic lymphocytic leukemia – Case report and literature review

2019 ◽  
Vol 26 (2) ◽  
pp. 487-491 ◽  
Author(s):  
R Ghasoub ◽  
A Albattah ◽  
S Elazzazy ◽  
R Alokka ◽  
A Nemir ◽  
...  
Keyword(s):  
Case Report ◽  
Growth Factor ◽  
Chronic Lymphocytic Leukemia ◽  
Male Patient ◽  
Skin Toxicity ◽  
Lymphocytic Leukemia ◽  
Lower Limbs ◽  
Pigmented Lesions ◽  
First Case ◽  
Factor C

Introduction Ibrutinib is an oral inhibitor of Bruton’s tyrosine kinase that is used for a variety of B cell hematological malignancies. Skin and subcutaneous tissue manifestations have been reported and were witnessed in up to 32% of the patients on ibrutinib. The mechanism in which ibrutinib can cause skin toxicities has been thought due to the inhibition of epidermal growth factor; c-Kit and platelet-derived growth factor receptor). Here, we report a case of an elderly chronic lymphocytic leukemia patient who developed multiple inflamed lesions and lower limb cellulitis in 100 days after initiating ibrutinib therapy. Case report A 68-year-old male patient with relapsed chronic lymphocytic leukemia was started on ibrutinib 420 mg orally daily following multiple lines of therapy. Three months following ibrutinib, the patient developed multiple hyper pigmented lesions over both forearms then over both thighs; buttocks and lower limbs. The lesions were labeled as ecthyma and cellulitis that started as papules, which progressed to pustules. Management and outcomes The patient required admission in which he received prolonged course of antibiotics. Biopsy from the wound showed soft tissue fragment infiltrated by acute and chronic inflammatory cells with necrosis; rare foreign body giant cells and granulation tissue formation; suggestive of abscess. Subsequently, ibrutinib was stopped permanently. Discussion This is the first case description of an ibrutinib-associated sever skin toxicity in Qatar. The provided information regarding the clinical descriptions of toxicity profiles in general and skin-based in particular is valuable information for daily clinical practice, especially when selecting the optimum first-line treatment for the patient.

Combination of Transforaminal and Interlaminar Percutaneous Endoscopic Lumbar Diskectomy for Extensive Down-migrated Disk Herniation

2017 ◽  
Vol 79 (01) ◽  
pp. 060-065 ◽  
Author(s):  
Kyung-Chul Choi ◽  
Jung Lee ◽  
Dong Lee ◽  
Choon Park ◽  
Jin-Sung Kim
Keyword(s):  
Complete Removal ◽  
Radicular Pain ◽  
Leg Pain ◽  
Disk Herniation ◽  
Disk Space ◽  
Postoperative Mri ◽  
First Case ◽  
Interlaminar Approach ◽  
Vas Scores ◽  
Magnetic Resonance Imaging Mri

Background and Study Aims The technique and instrumentation of percutaneous endoscopic lumbar diskectomy (PELD) have significantly improved. Thus its indications have been gradually expanding. Down-migrated disk, in particular, is regarded inaccessible by rigid instrumentation due to poor visualization and limited accessibility. We introduce a combination of transforaminal and interlaminar PELD for extensive down-migrated disk herniation at the L4–L5 level. Patients and Methods In the first case, a 48-year-old man had left L5 radicular pain. Magnetic resonance imaging (MRI) showed that L4–L5 disk herniation extended to the L5 lower end-plate level. In the second case, a 39-year-old man presented with right L5 and S1 radiculopathy. MRI showed right huge extensive down-migrated disk herniation from the L4–L5 disk space to the S1 pedicle level. Back pain and leg pain were measured using the visual analog scale (VAS). In the first case, transforaminal PELD with foraminoplasty removed the disk fragment from the L4–L5 disk space to the mid-L5 pedicle level. Interlaminar PELD removed the remaining disk below the mid-L5 pedicle. In the second case, first, contralateral (left) transforaminal PELD at L4–L5 removed disk fragments located at the subannular and subligamentous area as well as the upper part of the down-migrated disk herniation. Second, interlaminar PELD via an ipsilateral (right) L5–S1 interlaminar space removed the remains of the extensively down-migrated disk herniation. Results In the first case, the VAS scores for back and leg pain were improved from 6 and 8 to 2 and 1, respectively. Postoperative MRI showed complete removal of the disk fragment. In the second case, the VAS scores for back and leg pain improved from 7 and 9 to 3 and 1, respectively, after PELD. Postoperative MRI showed complete removal of a huge disk herniation. Both patients were discharged the day after PELD. Follow-up examinations showed no recurrence. Conclusions It is difficult to remove entire disk fragments using only a transforaminal or interlaminar approach for extensive down-migrated disk herniation. Therefore a combination of transforaminal and interlaminar PELD may be effective for extensive down-migrated disk herniation at L4–L5.

Rhabdomyolysis in a Civil Aviation Pilot

2020 ◽  
Vol 91 (11) ◽  
pp. 901-903
Author(s):  
Xincheng Liu ◽  
Xingxing Meng ◽  
Chuanyin Zhang ◽  
Jian Chen ◽  
Pengxiang Li ◽  
...  
Keyword(s):  
Case Report ◽  
Kidney Injury ◽  
Medical Intervention ◽  
Lower Limbs ◽  
Civil Aviation ◽  
Early Medical Intervention ◽  
Excessive Exercise ◽  
Lower Limb Muscles ◽  
First Case ◽  
Urine Alkalinization

BACKGROUND: Rhabdomyolysis is a potentially fatal disease caused by trauma, infections, and toxins. Rhabdomyolysis has not been reported in Chinese civil aircrew, but in our case report a male civil copilot contracted rhabdomyolysis after excessive exercise, showing potential for morbidity in pilots.CASE REPORT: After excessive exercise, a 29-yr-old male civil aviation copilot complained of serious myalgia and weakness in lower limb muscles and gross hematuria, whose values of alanine transaminase (ALT), aspartate transaminase (AST), myohemoglobin (Mb), creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), and -hydroxybutyrate dehydrogenase (-HBDH) were conspicuously increased. Magnetic resonance imaging showed abnormal signal intensities in the lower limbs. The patient was diagnosed with rhabdomyolysis. He was treated with hydration and urine alkalinization. When his condition was stabilized, the patient was discharged. After remaining asymptomatic for 3 mo and getting documentation of normalized lab results, he was granted a first-class medical certificate and returned to work.DISCUSSION: This was the first case of rhabdomyolysis reported in Chinese civil aircrew. Excessive exercise in an overweight pilot may induce rhabdomyolysis. This condition can be controlled and cured by early and effective treatment. Rhabdomyolysis could occur in a population suffering from overweight, obesity, or hyperlipidemia. This case fits in with several other cases of military pilots exercising excessively. The progression could lead to acute kidney injury without prompt and effective intervention. And common symptoms like muscular weakness or myalgia may induce sudden in-flight incapacitation, so early medical intervention should be adopted. Moreover, recurrence of rhabdomyolysis should be considered when resuming flying duties.Liu X, Meng X, Zhang C, Chen J, Li P, Wu X, Fan H. Rhabdomyolysis in a civil aviation pilot. Aerosp Med Hum Res. 2020; 91(11):901903.

scholarly journals Primary Synovial Sarcoma of the Orbit

2017 ◽  
Vol 9 ◽  
pp. 117917211770173 ◽  
Author(s):  
Pei Xu ◽  
Jianbin Chen
Keyword(s):  
Case Report ◽  
Synovial Sarcoma ◽  
Rare Case ◽  
Tumor Resection ◽  
First Year ◽  
First Case

Purpose: To describe the clinical, pathological, and immunohistochemical characteristics and therapies of a rare case of primary synovial sarcoma in the orbit. Design: Retrospective interventional case report. Participant: A 6-year-old girl with pathologically proven synovial sarcoma in the orbit. The diagnosis was confirmed by immunohistochemistry. Methods: The patient was treated with right lateral orbital and right temporal tumor resection, followed by chemotherapy. She was followed up every 3 months for 1 year. Results: The tumor was excised, and the patient received 5 courses of chemotherapy. She did well during the initial first-year follow-up with no recurrent signs. Conclusions: We reported the sixth case of primary synovial sarcoma in the orbit and the first case of a 6-year-old girl.

scholarly journals Progressive thoracolumbar scoliosis culminating in the diagnosis of young pompe disease: case report

2021 ◽  
Author(s):  
Tarcisio Rubens da Silva ◽  
Rayana Elias Maia ◽  
Taísa de Abreu Marques Nogueira
Keyword(s):  
Case Report ◽  
Muscular Dystrophy ◽  
Muscle Weakness ◽  
Cervical Vertebrae ◽  
Amorphous Material ◽  
Lower Limbs ◽  
Pompe’S Disease ◽  
Pompe's Disease ◽  
Disease Case ◽  
Alpha Glucosidase

Introduction: Pompe’s disease is a neuromuscular condition caused by a metabolic disorder of autosomal recessive inheritance. The deficit of acid alpha-glucosidase causes accumulation of glycogen in the lysosomes of the striated and cardiac muscle. It presents in childhood: hypotonia and cardiorespiratory impairment; but at late-onset: axial and waist muscle weakness. Case report: Patient, female, 20 years old, non-consanguineous parents, with good intra-uterus fetal mobility, was born by cesarean delivery weighing 3.7 kilograms and 51 centimeters. She first walked without support and spoke her first words at 13 months of age. By the age of 12, she started progressive thoracolumbar scoliosis and underwent posterior spinal arthrodesis two years later. During the follow-up, muscle weakness was found. Furthermore, she presented macrocephaly, high myopia, fusion of cervical vertebrae, progressive scoliosis, dolichostenomelia and joint hypermobility. Extensive investigation was carried out with laboratory tests that showed CPK elevation, imaging tests and mutation research for facio-scapular-humeral muscular dystrophy and type 2A waistband muscular dystrophy. The incisional biopsy found mixed muscle changes with deposit of amorphous material. Pompe’s disease was confirmed by a significant reduction in alpha-glucosidase activity. The patient evolved with weakness in the legs and fatigue on moderate efforts, but also weakness in the lower limbs, detachable on the right and hyporeflexia, on physical examination. Conclusions: Progressive thoracolumbar scoliosis, refractory to postural and surgical corrections, should be an alert for differential diagnoses. Changes in axial musculature can be suggested and Pompe’s disease, a potentially treatable condition, must become relevant.

scholarly journals Anterior Clinoid Metastasis Removed Extradurally: First Case Report

2018 ◽  
Vol 79 (02) ◽  
pp. e55-e62 ◽  
Author(s):  
Mirza Pojskić ◽  
Blazej Zbytek ◽  
Kenan Arnautović
Keyword(s):  
Case Report ◽  
Malignant Tumors ◽  
Tumor Resection ◽  
Disease Recurrence ◽  
Double Vision ◽  
Anterior Clinoid Process ◽  
First Case ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Background We report a case of isolated metastasis on the anterior clinoid process (ACP) mimicking meningioma. Clinical Presentation A 58-year-old male presented with headaches, right-sided visual disturbances, and blurred and double vision. The cause of double vision was partial weakness of the right III nerve, resulting from compression of the nerve by “hypertrophied” tumor-involved right anterior clinoid. Medical history revealed two primary malignant tumors—male breast cancer and prostate cancer (diagnosed 6 and 18 months prior, respectively). The patient was treated with chemotherapy and showed no signs of active disease, recurrence, or metastasis. Postcontrast head magnetic resonance imaging (MRI) showed extra-axial well-bordered enhancing mass measuring 1.6 × 1.1 × 1 × 1 cm (anteroposterior, transverse, and craniocaudal dimensions) on the ACP, resembling a clinoidal meningioma. Extradural clinoidectomy with tumor resection was performed via right orbitozygomatic pretemporal skull base approach. Visual symptoms improved. Follow-up MRI showed no signs of tumor residual or recurrence. Conclusion This is the first case report of a metastasis of any kind on ACP. Metastasis should be included as a part of the differential diagnosis of lesions of the anterior clinoid. Extradural clinoidectomy is a safe and effective method in the treatment of these tumors.

Intramedullary Ectopic Choroid Plexus: Report of a Rare Case

Neurosurgery ◽  
2005 ◽  
Vol 56 (4) ◽  
pp. E869-E869 ◽  
Author(s):  
Srinivas Dwarakanath ◽  
Ashish Suri ◽  
Ashok Kumar Mahapatra ◽  
Veer Singh Mehta ◽  
Meher Chand Sharma
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Choroid Plexus ◽  
Rare Case ◽  
Case Reports ◽  
Symptomatic Improvement ◽  
Lower Limbs ◽  
Intramedullary Lesion ◽  
First Case ◽  
Intramedullary Cyst

Abstract OBJECTIVE AND IMPORTANCE: Intracranial cysts containing an ectopic choroid plexus or choroid plexus-like tissue have seldom been described in the literature. However, there has been no report of a spinal intramedullary cyst containing an ectopic choroid plexus. This is the first case report in the available literature of an ectopic choroid plexus tissue in the spinal cord. CLINICAL PRESENTATION: A 30-year-old man presented with complaints of progressive descending weakness of both upper limbs and increasing stiffness of the lower limbs along with numbness of all four limbs without a history of any bowel or bladder disturbances. Examination was suggestive of a C5–T2 intramedullary lesion. Magnetic resonance imaging revealed a C6–T2 intramedullary cystic lesion along with a small anterosuperiorly placed lesion enhancing with contrast. INTERVENTION: A C6–T2 laminotomy and exploration of the intramedullary cyst and gross total microsurgical excision of the reddish vascular frond-like structure resembling the choroid plexus were performed along with a syringostomy. A laminoplasty with miniplates and screws was performed. Histopathological and immunohistochemical studies revealed a normal choroid plexus. The patient has been followed for 1 year and has demonstrated symptomatic improvement. CONCLUSION: Although there have been rare case reports of drop metastasis of choroid plexus papillomas in the spine, this is the first case report in the available literature of normal but ectopic choroid plexus tissue in the spinal cord.

scholarly journals TWO SYNCHRONOUS PITUITARY ADENOMAS CAUSING CUSHING DISEASE AND ACROMEGALY

2019 ◽  
Vol 5 (5) ◽  
pp. e276-e281 ◽  
Author(s):  
Melanie Schorr ◽  
Xun Zhang ◽  
Wenxiu Zhao ◽  
Parisa Abedi ◽  
Kate E. Lines ◽  
...  
Keyword(s):  
Case Report ◽  
Pituitary Adenomas ◽  
Protein A ◽  
Cushing Disease ◽  
Messenger Ribonucleic Acid ◽  
Postoperative Mri ◽  
First Case ◽  
S 100 ◽  
Biochemical Testing ◽  
Sellar Lesion

Objective: To report the first case of 2 synchronous pituitary adenomas, 1 corticotroph and 1 somatotroph, with distinct molecular lineages confirmed by differential hormone and S-100 protein expression. Methods: A case report followed by a literature review are presented. Results: A 68-year-old woman presented for evaluation of resistant hypertension. Biochemical testing demonstrated adrenocorticotropic hormone (ACTH)-dependent hypercortisolemia and growth hormone (GH) excess. Pituitary magnetic resonance imaging (MRI) revealed a 2 cm left sellar lesion consistent with a pituitary macroadenoma. The patient therefore underwent transsphenoidal surgery for a presumed cosecreting ACTH and GH macroadenoma. Tumor immunohistochemical staining (IHC) was positive for ACTH, but negative for GH. Postoperative biochemical testing confirmed remission from Cushing disease, but the insulin-like growth factor 1 (IGF-1) level remained elevated. Postoperative MRI demonstrated a small right sellar lesion that, in retrospect, had been present on the preoperative MRI. Resection of the right lesion confirmed a GH-secreting adenoma with negative ACTH staining. After the second surgery, the IGF-1 level normalized and blood pressure improved. Further pathologic examination of both surgical specimens demonstrated differential expression of S-100 protein, a folliculostellate cell marker. Reverse transcription polymerase chain reaction of messenger ribonucleic acid from the left sellar lesion was positive for ACTH and negative for GH, confirming the IHC results. Germline mutations in genes known to be associated with pituitary adenoma syndromes ( MEN1, CDC73, CDKN1A, CDKN1B, CDKN2B, CDKN2C, and AIP) were not detected. Conclusion: Although the pathogenesis of synchronous pituitary adenomas has not been fully elucidated, this case report suggests that they can have distinct molecular lineages.

scholarly journals Suspected Agomelatine-induced restless legs syndrome: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mustafa Abdul Karim ◽  
Nadeen Al-Baz ◽  
Sami Ouanes ◽  
Majid Alabdulla ◽  
Peter M. Haddad
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Case Report ◽  
Restless Legs Syndrome ◽  
Lower Limbs ◽  
Complete Relief ◽  
Restless Legs ◽  
First Case ◽  
Primary Disorder

Abstract Background Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by unpleasant and distressing sensations in the lower limbs that are more pronounced in the evening, commence or worsen at rest, and show partial or complete relief following movement. It can occur as a primary disorder, secondary to medical conditions or treatment with medications including but not limited to antidepressants or antipsychotics. Case presentation A 32-year old man with major depressive disorder showed partial response to Escitalopram 10 mg daily. Agomelatine 25 mg at night was added to Escitalopram to treat his residual depressive symptoms, namely insomnia and tiredness. Within two days he developed restlessness and unpleasant sensations in his legs which were worse at night. Symptom severity increased over the following days, prompting an urgent consultation a week later. The patient’s presentation met the criteria for RLS. Agomelatine was discontinued leaving the patient on Escitalopram alone. The patient’s symptoms improved within 24 h of stopping Agomelatine, with complete resolution four days later. There was no recurrence of RLS during follow-up. The patient scored 6 on Naranjo’s adverse drug reaction probability scale, indicating a probable adverse drug reaction caused by Agomelatine. Conclusions To the best of our knowledge, this is the first case report of suspected Agomelatine-induced RLS. Clinicians need to be aware of RLS to enable prompt diagnosis and management. We suggest adding Agomelatine to the list of agents that can potentially induce RLS.

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