scholarly journals Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Nobuhiro Tanaka ◽  
Kivanc Atesok ◽  
Kazuyoshi Nakanishi ◽  
Naosuke Kamei ◽  
Toshio Nakamae ◽  
...  
Keyword(s):  
Traffic Accident ◽  
Whiplash Injury ◽  
Vision Loss ◽  
Task Force ◽  
Double Vision ◽  
Eye Pain ◽  
Cervical Syndrome ◽  
Clinical Questions ◽  
Whiplash Associated Disorders ◽  
New Guidelines

Traumatic cervical syndrome comprises the various symptoms that occur as a result of external force such as that of a traffic accident. In 1995, the Quebec Task Force on whiplash-associated disorders (WAD) formulated the Quebec classification, with accompanying clinical practice guidelines. These guidelines were in accordance with the stated clinical isolated or combined symptoms of the syndrome: neck pain, headaches, dizziness, numbness of head or face, eye pain, vision loss, double vision, tinnitus, hearing loss, nausea, and numbness and/or weakness of extremities. In recent years, cerebrospinal fluid hypovolemia or fibromyalgia has been recognized as a major notable cause of a variety of symptoms, although many clinical questions remain regarding the pathology of this syndrome. Therefore, its diagnosis and treatment should be conducted extremely carefully. While the Quebec classification and its guidelines are very useful for the normalization and standardization of symptoms of traumatic cervical syndrome, in the future, we would like to see the emergence of new guidelines that better address the diversity of this disease.

Return of Spontaneous Respiration in an Infant Who Fulfilled Current Criteria to Determine Brain Death

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 518-520
Author(s):  
Ken Okamoto ◽  
Tsuyoshi Sugimoto
Keyword(s):  
Young Children ◽  
Brain Death ◽  
American Academy ◽  
Task Force ◽  
Spontaneous Respiration ◽  
American Academy Of Pediatrics ◽  
New Guidelines ◽  
Current Guidelines ◽  
Child's Brain

It is generally assumed that the child's brain is more resistant to insults leading to death. Current guidelines for brain death, therefore, avoid application of these standards to young children.1 The determination of brain death in children, however, has become increasingly important, and different sets of new guidelines for children have been recently published.1-4 Especially, the recommendations of a special task force, consisting of representatives from neurologic organizations and the American Academy of Pediatrics, were published in five major journals.4 Those primary distinctions were three separate longer observation periods depending on the child's age and the necessity for two corroborating electroencephalograms (EEGs) or one EEG with a corroborating cerebral radionucleotide angiogram.

A Woman With Subacute Painful Vision Loss

2021 ◽  
pp. 3-6
Author(s):  
Jiraporn Jitprapaikulsan ◽  
M. Tariq Bhatti ◽  
Eric R. Eggenberger ◽  
Marie D. Acierno ◽  
John J. Chen
Keyword(s):  
Optic Neuritis ◽  
Eye Movement ◽  
Immunoglobulin G ◽  
Vision Loss ◽  
Visual Fields ◽  
Corticosteroid Treatment ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Intravenous Methylprednisolone ◽  
Eye Pain

A 51-year-old White woman sought care for vision loss 1 week after a nonspecific upper respiratory tract infection. She reported pain in both eyes exacerbated by eye movement, which lasted for several days, followed by bilateral vision loss to the level of counting fingers–only vision. Optic neuritis was diagnosed, and she was treated with 1 g intravenous methylprednisolone for 3 days. Her vision improved substantially, and the pain resolved during the corticosteroid treatment. However, 1 week later, she woke up with right eye pain and vision loss. She was again treated with 5 days of intravenous methylprednisolone, with visual improvement nearly back to baseline. Two weeks later, she had recurrence of painful vision loss in both eyes. A diagnosis of chronic relapsing inflammatory optic neuropathy was made. Tests for serum angiotensin-converting enzyme, antineutrophil cytoplasmic antibody, antinuclear antibody, Lyme disease, syphilis, tuberculosis, and aquaporin-4-immunoglobulin G antibodies were negative. Serum was definitively positive for myelin oligodendrocyte glycoprotein-immunoglobulin G antibodies at a titer of 1:1,000. Myelin oligodendrocyte glycoprotein-immunoglobulin G–associated recurrent optic neuritis was diagnosed. After her diagnosis of recurrent corticosteroid-dependent optic neuritis associated with myelin oligodendrocyte glycoprotein-immunoglobulin G positivity, the patient was treated with 5 days of intravenous methylprednisolone. The eye pain resolved, and her vision returned to normal. At follow-up evaluation, the patient’s visual acuity, color vision, and visual fields were normal in both eyes, but there was mild bilateral optic disc pallor. She has not had recurrent demyelinating episodes while on chronic immunotherapy. Optic neuritis is an inflammatory demyelination of the optic nerve manifesting as acute to subacute vision loss, classically associated with pain with eye movement. The long-term prevention and prognosis depend on the cause of the optic neuritis.

scholarly journals Pediatric pancreatitis.Evidence based management guidelines of the Hungarian Pancreatic Study Group

2015 ◽  
Vol 156 (8) ◽  
pp. 308-325 ◽  
Author(s):  
Andrea Párniczky ◽  
László Czakó ◽  
Zsolt Dubravcsik ◽  
Gyula Farkas ◽  
Péter Hegyi ◽  
...  
Keyword(s):  
Task Force ◽  
Consensus Meeting ◽  
Study Group ◽  
Evidence Based ◽  
Management Guidelines ◽  
International Guidelines ◽  
The Past ◽  
Basic Reference ◽  
Clinical Questions ◽  
Evidence Based Guideline

Pediatric pancreatitis is a rare disease with variable etiology. In the past 10–15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant clinical questions were defined. (Evidence was classified according to the UpToDate®grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical questions were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. This guideline provides very important and helpful data for tuition of pediatric pancreatitis in everyday practice and establishing proper finance and, therefore, the authors believe that these guidelines will widely serve as a basic reference in Hungary. Orv. Hetil., 2015, 156(8), 308–325.

scholarly journals Update of EULAR recommendations for the treatment of systemic sclerosis

2016 ◽  
Vol 76 (8) ◽  
pp. 1327-1339 ◽  
Author(s):  
Otylia Kowal-Bielecka ◽  
Jaap Fransen ◽  
Jerome Avouac ◽  
Mike Becker ◽  
Agnieszka Kulak ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Task Force ◽  
Previous Treatment ◽  
Haematopoietic Stem Cell ◽  
Scleroderma Renal Crisis ◽  
Digital Ulcers ◽  
Eular Recommendations ◽  
Delphi Approach ◽  
The Usa ◽  
Clinical Questions

The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis and gastrointestinal involvement. Compared with the 2009 recommendations, the 2016 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressive SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc.

Burr Hole-Assisted Direct Transsylvian Venous Catheterization for Carotid-Cavernous Fistula Embolization: A Case Report

2020 ◽  
Vol 19 (2) ◽  
pp. E196-E200 ◽  
Author(s):  
Ritam Ghosh ◽  
Fadi Al Saiegh ◽  
Aria Mahtabfar ◽  
Nikolaos Mouchtouris ◽  
Omaditya Khanna ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Vision Loss ◽  
Venous Drainage ◽  
Burr Hole ◽  
Double Vision ◽  
Rapid Improvement ◽  
Type D ◽  
Transsylvian Approach ◽  
Increased Risk ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND AND IMPORTANCE Carotid-cavernous fistulas (CCF) are pathological connections between carotid artery branches and the cavernous sinus. They can lead to a variety of symptoms, such as chemosis and double vision, or more insidious events, such as vision loss and intracranial hemorrhage. Although these patients are often treated by endovascular means, we describe a case in which the patient's CCF was not able to be accessed by usual methods and required an open surgical approach. CLINICAL PRESENTATION The patient had progressive chemosis, double vision, and periorbital pain. Angiogram showed an indirect type D CCF with cortical venous drainage with a large sylvian vein that was directly draining the fistula. The patient did not have a dilated superior ophthalmic vein, and the petrosal sinuses could not be catheterized. Therefore, because of the patient's increased risk for intracranial hemorrhage, she was taken to the operating room for an image guided burr hole for direct catheterization of the sylvian vein. From this point, the fistulous point could be catheterized, and the CCF was embolized using onyx. Follow-up angiogram showed complete occlusion. CONCLUSION This is the first report in literature of an indirect CCF being treated through a transsylvian approach with onyx. This combined open-surgical-and-endovascular approach was necessary to get full resolution of the lesion, and patient had rapid improvement of symptoms.

Symptoms: Eye Pain and Vision Loss

2009 ◽  
Vol 31 (3) ◽  
pp. 12
Author(s):  
Jennifer L. Wiler
Keyword(s):  
Vision Loss ◽  
Eye Pain

scholarly journals Idiopathic Sclerosing Inflammation Presenting as Sinusitis

2012 ◽  
Vol 3 (2) ◽  
pp. ar.2012.3.0031 ◽  
Author(s):  
Henry P. Barham ◽  
Megan K. Dishop ◽  
Jeremy D. Prager
Keyword(s):  
Vision Loss ◽  
Inflammatory Lesion ◽  
Poor Response ◽  
Corticosteroid Treatment ◽  
Sinus Surgery ◽  
Infraorbital Nerve ◽  
High Dose ◽  
Rapid Improvement ◽  
Eye Pain ◽  
Recommended Treatment

Idiopathic sclerosing orbital inflammation is a rare finding that is poorly delineated, immune mediated, and causes severe symptoms and disability. It has been described affecting the orbit in addition to other sites within the head and neck, but has rarely been described presenting as sinusitis. A case report and literature review were performed. A 14-year-old girl with right-sided face and eye pain and pressure for >1 month presented 3 days after endoscopic sinus surgery for presumed acute sinusitis. She subsequently developed ipsilateral vision loss and hypesthesia of the infraorbital nerve. MRI revealed a mildly enhancing soft tissue intensity lesion extending from the right maxillary sinus into the pterygopalatine fossa and orbital apex through the inferior orbital fissure. Biopsy specimens of the lesion were consistent with a sclerosing inflammatory lesion. High-dose steroids led to rapid improvement in vision and pain; however, the patient was unable to tolerate steroid weaning because of recurrence of eye pain and headache. Repeat imaging showed progression of the lesion. Rheumatology was consulted and the patient's steroid therapy was altered and her medications were expanded to include azathioprine. The patient's symptoms improved and subsequent imaging showed a reduction in the size and extent of the lesion. Idiopathic sclerosing inflammation is characterized by primary, chronic, and immunologically mediated fibrosis. Patients typically have a poor response to corticosteroid treatment or radiotherapy. Immunosuppressive therapy in addition to corticosteroids is the recommended treatment.

Eye Pain and Double Vision

2008 ◽  
Vol 52 (4) ◽  
pp. 473-481
Author(s):  
Mark I. Neuman ◽  
Joshua Nagler ◽  
P. Jamil Madati
Keyword(s):  
Double Vision ◽  
Eye Pain

Different Opinions and Thoughts on the Management of Hyperbilirubinemia

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 974-974
Author(s):  
Jerold F. Lucey
Keyword(s):  
American Academy ◽  
Bilirubin Level ◽  
Task Force ◽  
Wide Spectrum ◽  
Standard Of Care ◽  
American Academy Of Pediatrics ◽  
The Subject ◽  
New Guidelines ◽  
High Bilirubin

What is the standard of care for an infant with a high bilirubin level? Numerous "guidelines" based on well-intentioned opinions certainly exist, but should these really define a standard of care? I don't think so. We still don't have enough solid evidence to make rules! After more than 40 years of research, Newman and Maisels are suggesting new guidelines for healthy fullterm infants. They have critically reviewed the evidence available and make some new recommendations. I was curious to learn the reactions of a number of "bilirubin experts" and the opinions of an American Academy of Pediatrics Task Force on the subject. I thought it might be worthwhile to have all of these published in the same issue to demonstrate the wide spectrum of opinions which exist.

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