282 Skull base dural AVF mistaken as cervical myelitis: a series

2018 ◽  
Vol 89 (10) ◽  
pp. A42.2-A42
Author(s):  
Whittam Dan ◽  
Huda Saif ◽  
Pulicino Richard ◽  
Chandran Arun ◽  
Puthuran Mani ◽  
...  
Keyword(s):  
Skull Base ◽  
Protein Concentration ◽  
Cervical Cord ◽  
Surface Vessels ◽  
Elevated Protein ◽  
Life Threatening ◽  
Low Threshold ◽  
T2 Hyperintensity ◽  
Case Note Review ◽  
Csf Examination

BackgroundCervico-medullary spinal cord lesions are usually inflammatory (or rarely neoplastic). Dural arteriovenous fistula (DAVF) is considered very unlikely in the cervical cord, particularly if the history is of an acute myelopathy.MethodCase note review of five patients with skull base DAVF.ResultsAll were men aged 60–69 years. Four were symptomatic for a month or less, followed by acute deterioration over hours-7days, mimicking myelitis. MRIs showed extensive T2-hyperintensity and swelling in the cervico-medullary region. Worsening after corticosteroids occurred in 3/4 patients and one needed ventilation. Conspicuous and unambiguous cord-surface vessels were present in only one patient. Clinical suspicion prompted digital subtraction angiography (DSA) in the other four patients. Median time from initial MRI to diagnostic DSA and embolization was 28 days (7–91 days). All patients survived with good clinical recovery.Systematic retrospective review of MRIs showed lack of gadolinium enhancement in 4/5. CSF examination (n=4) showed normal leucocyte count in all cases and elevated protein concentration in 3/4 (0.6–1.2 g/L).ConclusionSkull base DAVF can mimic acute cervical myelitis. Steroids may prompt life-threatening clinical deterioration mistaken for ascending myelitis. A low threshold for angiography in the context of non-enhancing lesions and acellular CSF will facilitate earlier diagnosis and improve outcomes.

scholarly journals New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review

2021 ◽  
Vol 9 ◽  
pp. 232470962098630
Author(s):  
Riwaj Bhagat ◽  
Barbara Kwiecinska ◽  
Nolan Smith ◽  
Matthew Peters ◽  
Christopher Shafer ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Nasopharyngeal Swab ◽  
Onset Seizure ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Global Pandemic ◽  
Elevated Protein ◽  
T2 Hyperintensity ◽  
Elevated Protein Level ◽  
New Onset

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.

INFECTIOUS SKULL BASE OSTEOMYELITIS-STILL A LIFE-THREATENING DISEASE

2006 ◽  
Vol 27 (7) ◽  
pp. 1048
Author(s):  
Hamid R. Djalilian ◽  
Bahman Shamloo ◽  
Kunal H. Thakkar ◽  
Mojdeh Najme-Rahim
Keyword(s):  
Skull Base ◽  
Skull Base Osteomyelitis ◽  
Life Threatening

Attenuation of IL-2-induced multisystem organ edema by phalloidin and antamanide

1991 ◽  
Vol 70 (3) ◽  
pp. 1364-1368 ◽  
Author(s):  
R. Welbourn ◽  
G. Goldman ◽  
L. Kobzik ◽  
C. R. Valeri ◽  
H. B. Hechtman ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Side Effects ◽  
Bronchoalveolar Lavage ◽  
Protein Concentration ◽  
Interleukin 2 ◽  
Cell Junction ◽  
Elevated Protein ◽  
Intravenous Saline

Interleukin 2 (IL-2) is a potent cytokine with diverse effects, including the ability to stimulate lymphocyte differentiation into cells capable of lysing tumor. Its therapeutic efficacy is limited because of side effects such as breakdown of the microvascular barrier and edema. Control of the microvascular barrier is in part regulated by endothelial cell cytoskeletal contractile proteins. This study tests whether the cyclopeptides that maintain actin filament organization and distribution and reduce macromolecular flux across the endothelial cell junction in vitro would similarly maintain barrier tightness and prevent early edema produced by IL-2 in vivo. Anesthetized rats were treated at 30-min periods with intravenous saline (0.5 ml, n = 41), phalloidin (20 micrograms in 0.5 ml, n = 21), or antamanide, (20 micrograms in 0.5 ml, n = 21), starting 30 min before the 1-h infusion of 10(6) U of recombinant human IL-2 or saline. Six hours after the start of IL-2, there was edema in the saline/IL-2 group, as measured by increased wet-to-dry ratios (W/D) in the lungs, heart, and kidney. With saline/IL-2, bronchoalveolar lavage (BAL) fluid contained an elevated protein concentration and higher plasma thromboxane levels compared with controls. The number of neutrophils sequestered in the lungs was more than twice that of saline controls. Phalloidin significantly attenuated edema in lung and reduced BAL protein leak. Antamanide treatment was as effective in limiting lung and heart edema, but, in contrast to phalloidin, antamanide prevented kidney edema and did not lead to an alteration in the liver W/D. Antamanide also prevented BAL fluid protein leak.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Ulcer Disease in the Excluded Segments after Roux-en-Y Gastric Bypass: a Current Review of the Literature

2020 ◽  
Author(s):  
Gabriel Plitzko ◽  
Grégoire Schmutz ◽  
Dino Kröll ◽  
Philipp C. Nett ◽  
Yves Borbély
Keyword(s):  
Gastric Bypass ◽  
Remnant Stomach ◽  
Secondary Prophylaxis ◽  
Free Fluid ◽  
Ulcer Disease ◽  
Life Threatening ◽  
Definitive Solution ◽  
Low Threshold ◽  
Traditional Risk Factors ◽  
Threatening Situation

AbstractUlcer disease in excluded segments after Roux-Y gastric bypass (RYGB) is rare but can evolve into a life-threatening situation. The excluded segments exhibit a different behavior from that of non-altered anatomy; perforated ulcers do not result in pneumoperitoneum or free fluid, and therefore must be met with a low threshold for surgical exploration. The anatomical changes after RYGB impede routine access to the remnant stomach and duodenum. There are various options to address bleeding or perforated ulcers. While oversewing and drainage preserves the anatomy and forgoes resection, remnant gastrectomy offers a definitive solution. The importance of traditional risk factors such as smoking or use of non-steroidal anti-inflammatory drugs is unclear. Eradication of Helicobacter pylori and secondary prophylaxis with proton-pump inhibitors is advisable, albeit in double-dose.

Reconstruction of the skull base after tumor resection: an overview of methods

2002 ◽  
Vol 12 (5) ◽  
pp. 1-5 ◽  
Author(s):  
James K. Liu ◽  
Zahid Niazi ◽  
William T. Couldwell
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
Tumor Resection ◽  
Infectious Complications ◽  
Skull Base Tumors ◽  
Skull Base Reconstruction ◽  
Life Threatening ◽  
Dural Defects ◽  
Reconstructive Techniques ◽  
Do So

Successful surgical management of malignant skull base tumors depends on both tumor resection and reconstruction of the cranial base defect. The primary goals of skull base reconstruction are to repair dural defects, to prevent the development of cerebrospinal fluid fistulas, and to provide a protective barrier that isolates the intracranial contents from the nasopharynx and paranasal sinuses. Failure to do so can result in potentially life-threatening infectious complications. With modern skull base and reconstructive techniques, malignant tumors in this region, which were once deemed inoperable, can now be safely removed. The authors review the different modalities available for skull base reconstruction following tumor resection.

scholarly journals Atypical presentations of malignant otitis externa

2010 ◽  
Vol 124 (11) ◽  
pp. 1205-1208 ◽  
Author(s):  
Z Vourexakis ◽  
M-I Kos ◽  
J-P Guyot
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Skull Base ◽  
Diagnostic Criteria ◽  
Otitis Externa ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Diabetic Patients ◽  
Malignant Otitis Externa ◽  
Life Threatening ◽  
Atypical Presentations

AbstractIntroduction:Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical.Case reports:We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis.Discussion:The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

scholarly journals It’s never too late- spontaneous rupture of spleen and life-threatening hypovolemic shock in a patient recuperating from legionnaire’s disease

2021 ◽  
Vol 7 (2) ◽  
Keyword(s):  
Splenic Rupture ◽  
Hypovolemic Shock ◽  
Traumatic Rupture ◽  
Quadrant Pain ◽  
Legionella Pneumonia ◽  
Threatening Condition ◽  
Life Threatening ◽  
Legionnaires Disease ◽  
Low Threshold ◽  
Rupture Of The Spleen

Spontaneous non-traumatic rupture of the spleen in the setting of Legionnaires’ disease is very uncommon but a life-threatening condition. The splenic rupture can present within a few days after symptom onset with significant hypotension with drop in haemoglobin along with left side upper quadrant pain. Most of the cases described in the previous literature have presented within 0-11 (mean 4) days of the pneumonia but this case we are reporting presented after 3 weeks after being treated with Legionella pneumonia. The case also highlights an atypical presentation and emphasises the need to maintain a low threshold for diagnosis especially in resource constrained setting so that patient can be transferred at the earliest to a centre where appropriate corrective measures including surgery can be safely undertaken. Keywords: splenic rupture, pneumonia, hypovolemic shock

scholarly journals Do Not Miss the Tumor: A Novel Presentation of Osteosarcoma

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Michael DePalma ◽  
Sachin Gupta ◽  
Jie Nguyen ◽  
Divya Talwar ◽  
Alexandre Arkader ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Signs And Symptoms ◽  
African American Female ◽  
Racial Groups ◽  
Primary Malignancy ◽  
Treatment Delays ◽  
Life Threatening ◽  
Common Clinical Presentation ◽  
Primary Bone ◽  
Low Threshold

Antalgic gait is a common clinical presentation among pediatric patients and can have many different etiologies, with rare life-threatening etiologies including primary bone malignancies. Osteosarcoma is the most common primary malignancy of bone in pediatric and adolescent patients. The incidence rate of osteosarcoma has been reported as high as 5 to 7 per million among patients 19 years old or younger with males slightly more affected than females and African-Americans more than other racial groups. This report describes the case of a five-year-old African-American female who presented with an antalgic gait secondary to osteosarcoma in the left distal femur and follows her through treatment. In this case, the age is atypical as the peak incidence for osteosarcoma is around 16 years of age and is postulated to coincide with growth spurts. Osteosarcoma can have a range of presentations making it difficult to diagnose, which can cause delays in treatment and potential poor patient outcomes. Due to this, such a diagnosis must be included in the differential for patients presenting with antalgic gait. Because primary-care physicians and pediatricians may be the first medical providers to encounter patients with osteosarcoma, it is imperative that such clinicians are familiar with the signs and symptoms associated with osteosarcomas in order to reduce the risk of metastasis and disease progression and prevent treatment delays. Additionally, we believe these clinicians should have a low threshold to refer patients to orthopedists or oncologic specialists in the cases of persistent pain or inconsistencies with history, physical exam, and diagnostic studies. Finally, direct communication and discussion between radiologists and referring clinicians helps decrease delays in diagnosing of osteosarcoma and other life-threatening conditions.

scholarly journals Protein Concentration Determination in Latex Glove Using Biocompatibility Morphological Mean Test

2020 ◽  
Vol 2 ◽  
pp. 18-24
Author(s):  
Toa C. K. ◽  
Sim K. S. ◽  
Chan Y. K.
Keyword(s):  
Protein Concentration ◽  
Color Image ◽  
Protein Detection ◽  
Color Difference ◽  
Worst Case ◽  
Latex Glove ◽  
Standard Curve ◽  
Latex Gloves ◽  
Threatening Condition ◽  
Life Threatening

Latex gloves are seen as an indispensable item in the healthcare field because it offers superior protection for both the medical staff and patient against harmful substances. However, latex gloves with high protein concentration have a high possibility to induce latex allergy which in the worst case can lead to a life-threatening condition. To minimize the occurrence of an allergy reaction, the computerized Biocompatibility Morphological Mean (BMM) test for protein detection is proposed. This test initially goes through the chemical process to determine the protein that resides in the glove sample. After that, the sample is electronically converted into a digital image. Finally, the image undergoes color image processing for calculating the color difference values. These values are then plotted on a standard curve. A high correlation coefficient (R2>0.97) of the standard curve gives better accuracies. The proposed method only takes about 40 minutes to complete the test, while existing methods need at least 6 hours.

Post-traumatic orbitorrhea: An underestimated life-threatening complication following anterior skull base fractures

2019 ◽  
pp. 112067211986782
Author(s):  
Arnaud Martel ◽  
Nassim Bougaci ◽  
Jacques Lagier ◽  
Fabien Almairac ◽  
Arnaud Dagain
Keyword(s):  
Skull Base ◽  
Favourable Outcome ◽  
Anterior Skull Base ◽  
Full Thickness Skin Graft ◽  
Thickness Skin ◽  
Threatening Condition ◽  
Life Threatening ◽  
Upper Lid ◽  
Post Traumatic ◽  
Life Threatening Complication

Orbitorrhea is defined as a leak of cerebrospinal fluid from a cranio-orbital fistula. It is usually related to anterior skull base trauma. Orbitorrhea is an exceptional and life-threatening condition which should be promptly managed. We herein report the case of a right post-traumatic orbitorrhea following anterior skull base trauma. Conservative treatment was initially attempted. At 6 weeks, recurrence was noted, and the patient underwent neurosurgical management. A few months later, a secondary upper lid retraction was diagnosed and treated by full-thickness skin graft with favourable outcome. To our knowledge, fewer than 30 cases have been previously reported. Ophthalmologists should be aware of this life-threatening condition which could be underestimated.

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