scholarly journals Appearance of cerebellar cyst following microvascular decompression to treat hemifacial spasm: a report of two cases and literature review

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052093211
Author(s):  
Yu Cui ◽  
Zhong-Xi Yang ◽  
Chun-Mei Wang ◽  
Zhan-Peng Zhu
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Rare Complication ◽  
Intracerebral Haematoma ◽  
Appropriate Treatment ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Safe Approach

Microvascular decompression (MVD) is an effective and safe approach for treating hemifacial spasm (HFS). Postoperative complications may include facial nerve palsy, hearing loss, intracerebral haematoma, and brainstem infarction. The occurrence of intracranial cyst following MVD is extremely rare, with few cases documented in the literature. Herein, the cases of two patients with HFS who developed ipsilateral cerebellar cyst following MVD are reported. The first patient was a 50-year-old male presenting with a 6-year history of HFS on the right side of his face. MVD was performed, and 12 days postoperatively he developed dizziness and nausea. Magnetic resonance imaging (MRI) showed a cyst in the ipsilateral cerebellum. Antibiotic treatment provided no benefit, and the cyst was drained. The second patient was a 44-year-old female presenting with a 4-year history of HFS on the right side of her face. MVD was performed, and 18 days following surgery, she developed dizziness and nausea. MRI showed an ipsilateral cerebellar cyst. Conservative treatment was applied and the cyst shrunk. At the 2-month follow-up appointment, symptoms were completely resolved in both patients. Cerebellar cyst is a rare complication following MVD. Timely diagnosis and appropriate treatment should be emphasized, and surgical treatment may be unnecessary.

scholarly journals Case report: Recovery after large intramyocardial dissecting haematoma of the ventricular septum—a rare complication of myocardial infarction

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
David Lovasz ◽  
Daniele Camboni ◽  
Judith Zeller ◽  
Christof Schmid
Keyword(s):  
Myocardial Infarction ◽  
Plaque Rupture ◽  
Rare Complication ◽  
Coronary Intervention ◽  
Ventricular Septum ◽  
Feasible Option ◽  
Life Threatening ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Abstract Background Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far. Case summary We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. The clinically inapparent haematoma was discovered during routine echocardiography and confirmed by both computed tomography (CT) and magnetic resonance imaging (MRI). With non-surgical treatment, the patient remained clinically stable. Repeated echocardiography showed gradual regression of the haematoma. Follow-up echocardiography 3 months after the initial diagnosis demonstrated no evidence of septal haematoma. Discussion This report suggests that even large intramyocardial haematoma may recede without operative intervention. Echocardiography, CT, and MRI are all helpful in quantifying the size of the haematoma. The appropriate management should be patient-oriented, depending on clinical stability and progression of the haematoma. Conservative treatment in clinically stable patients suffering from septal haematoma following MI and coronary intervention can be a feasible option.

scholarly journals Portal hypertension after prolonged use of trastuzumab emtansine: nodular regenerative hyperplasia with autoimmune features

2021 ◽  
Vol 10 (8) ◽  
pp. e10810817005
Author(s):  
Gustavo Vargas Borgongino Monteiro ◽  
Marcela Chagas Lima Mussi ◽  
Mateus Jorge Nardelli ◽  
Bruno Campos Santos ◽  
Cláudia Alves Couto
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Ductal Carcinoma ◽  
Rare Complication ◽  
Nodular Regenerative Hyperplasia ◽  
Trastuzumab Emtansine ◽  
Her2 Breast Cancer ◽  
History Of ◽  
The Right

We report a rare complication associated with prolonged use of trastuzumab emtansine (T-DM1) – a composed therapy for HER2+ breast cancer – presenting with laboratorial autoimmune features that could have delayed the diagnosis or led to misdiagnosis. A 55-year-old female was referred to the hepatologist with a computed tomography suggestive of portal hypertension for etiological investigation. History of invasive ductal carcinoma in the right breast undergoing treatment for 5 years. She had already undergone neoadjuvant chemotherapy, mastectomy, radiotherapy and adjuvant chemotherapy. By the time of metastatic diagnosis, she was in monotherapy with T-DM1 for 2.5 years. Upper endoscopy showed esophageal varices and portal hypertension gastropathy. Laboratorial tests revealed increased transaminases, hypergammaglobulinemia and positive antinuclear antibody. Liver biopsy was performed for autoimmune hepatitis differential diagnosis but revealed nodular regenerative hyperplasia. T-DM1 was discontinued. After a 2-year follow-up, the patient did not present any complications of portal hypertension, although persisted with esophageal varices.

scholarly journals Retrosigmoid Approach for Resection of Cerebellar Peduncle Cavernoma

2018 ◽  
Vol 79 (S 05) ◽  
pp. S420-S421
Author(s):  
Hussam Abou-Al-Shaar ◽  
Gmaan Alzhrani ◽  
Yair Gozal ◽  
William Couldwell
Keyword(s):  
Acute Onset ◽  
Middle Cerebellar Peduncle ◽  
Postoperative Mri ◽  
History Of ◽  
Horizontal Gaze ◽  
Cerebellar Peduncle ◽  
Magnetic Resonance Imaging Mri ◽  
Residual Blood ◽  
The Right

The case described in this video involved a 38-year-old man, who presented with a 4-week history of worsening acute-onset headache, nausea, double vision, and vertigo. On examination, he had impaired tandem gait and diplopia on right horizontal gaze. A computed tomography (CT) scan revealed a hyperdense lesion of the right cerebellopontine angle. Magnetic resonance imaging (MRI) revealed a nonenhancing middle cerebellar peduncle lesion that was isointense on T2-weighed imaging and hypointense on FLAIR imaging (Fig. 1A–B). The differential diagnoses for this lesion included cavernous malformation, thrombosed aneurysm, and neurocysticercosis. CT angiography was done preoperatively to rule out cerebral aneurysm. Surgical resection of the lesion was recommended to relieve his symptoms, to prevent further deterioration/bleeding, and to obtain a pathological diagnosis. The patient underwent a right retrosigmoid craniotomy for resection of the right middle cerebellar peduncle cavernoma (Fig. 2). The patient tolerated the procedure well with no new postoperative neurological deficit. Postoperative MRI depicted gross total resection of the lesion and expected residual blood in the resection cavity (Fig. 1C–D). The patient was discharged home on postoperative day 4. At his last follow-up appointment, 1 month after surgery, he reported complete resolution of his preoperative symptoms, including diplopia. The patient gave consent for publication.The link to the video can be found at: https://youtu.be/TRieS9DXbV4.

scholarly journals Drop Attack Treated by Microvascular Decompression of the Superior Vestibular Nerve

2021 ◽  
pp. 014556132110436
Author(s):  
Sanghoon Kim ◽  
Soo-Keun Kong ◽  
Jae Meen Lee ◽  
Se-Joon Oh
Keyword(s):  
Microvascular Decompression ◽  
Vestibular Nerve ◽  
Vestibular Evoked Myogenic Potentials ◽  
Anterior Inferior Cerebellar Artery ◽  
Mri Findings ◽  
Vestibulocochlear Nerve ◽  
Drop Attack ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

We report a case of cochleovestibular neurovascular compressive syndrome (CVCS)-induced drop attack treated with microvascular decompression (MVD) of the superior vestibular nerve. This report discusses the merits of surgical intervention through a review of related literature. A 58-year-old woman was referred to our clinic with a chief complaint of intermittent, strong, right-sided tinnitus lasting for a few seconds immediately prior to drop attack. Magnetic resonance imaging (MRI) showed bilateral neurovascular contact between the anterior inferior cerebellar artery (AICA) and the vestibulocochlear nerve. Based on MRI findings, history of present illness, and response to anticonvulsants, CVCS was suspected, and surgical decompression on the right side was subsequently performed. The patient became asymptomatic immediately after the surgery, and the vestibular-evoked myogenic potentials were normalized. No recurrence was reported during a 1-year follow-up period.

Microvascular decompression for hemifacial spasm: long-term results from 114 operations performed without neurophysiological monitoring

2008 ◽  
Vol 109 (3) ◽  
pp. 410-415 ◽  
Author(s):  
Mark Dannenbaum ◽  
Bradley C. Lega ◽  
Dima Suki ◽  
Richard L. Harper ◽  
Daniel Yoshor
Keyword(s):  
Hearing Loss ◽  
Effective Treatment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Intraoperative Monitoring ◽  
Significant Risk ◽  
Long Term Results ◽  
Neurophysiological Monitoring ◽  
History Of

Object Microvascular decompression (MVD) of the facial nerve is an effective treatment for hemifacial spasm (HFS), but the procedure is associated with a significant risk of complications such as hearing loss and facial weakness. Many surgeons advocate the use of intraoperative brainstem auditory evoked response (BAER) monitoring in an attempt to improve surgical outcomes. The authors critically assessed a large series of patients with HFS who underwent MVD without neurophysiological monitoring. Methods The authors retrospectively identified 114 consecutive patients, with a history of HFS and without a history of HFS surgery, in whom MVD was performed by a single surgeon without the use of neurophysiological monitoring. Postoperative outcomes were determined by reviewing records and through telephone interviews. At least 1 year of postoperative follow-up data were available for 91 of the 114 patients, and the median follow-up duration in all cases was 8 years (range 3 months–23 years). A Kaplan–Meier analysis showed that 86% of the patients were spasm free at 10 years postoperatively. Results There were no surgical deaths or major deficits, and complications included 1 case of postoperative deafness, 1 of permanent subtotal hearing loss, and 10 of delayed facial palsy, 2 of which did not completely resolve at last follow-up. The outcomes, rates of hearing loss, and other complications compared well with those reported in studies in which investigators used intraoperative monitoring. Conclusions The results suggest that MVD without neurophysiological monitoring is a safe and effective treatment option in patients with HFS. Although BAER monitoring may be a valuable adjunct to surgery at centers experienced with the modality, the absence of intraoperative monitoring should not prevent neurosurgeons from performing MVD in patients with HFS.

scholarly journals A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis

2021 ◽  
Author(s):  
Judith Wagemann ◽  
Sarah Keller ◽  
Maria de las Mercedes Noriega ◽  
Werner Stenzel ◽  
Udo Schneider ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Inflammatory Markers ◽  
Rare Complication ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Muscle Involvement ◽  
Adductor Muscles ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

ABSTRACT We report the case of a 39-year-old female patient with acute painful swelling of the left thigh and symmetric muscle weakness in both upper legs. The patient had a history of long-standing, poorly controlled type 1 diabetes which required dialysis. Serum inflammatory markers were highly elevated. Magnetic resonance imaging (MRI) indicated necrotic or inflammatory colliquation. As antibiotic therapy did not lead to clinical improvement, a successful anti-inflammatory therapy with prednisolone was initiated. Three months later, the patient presented with a new onset of progressive and painful muscle swelling of the right thigh. MRI showed pronounced swelling of the right adductor muscles and inflammatory markers were massively elevated. In the absence of autoantibodies or any infectious agents and the recurrent symptomatology, relapsing diabetogenic myonecrosis was diagnosed. Initially, clinical improvement could only be achieved with high-dose glucocorticosteroids. Intravenous immunoglobulins did not show an effect, whereas serological and clinical remission was achieved after we administered tocilizumab intravenously. Diabetic myonecrosis is a rare complication of long-term, poorly controlled diabetes mellitus. Acute muscle pain and elevated inflammatory markers should prompt suspicion. Contralateral muscle involvement is also suggestive of the disease. The optimisation of diabetes treatment is crucial in order to prevent further disease complications.

scholarly journals A rare complication developing after delivery: septic pelvic thromboembophlebitis

2020 ◽  
Vol 28 (1) ◽  
pp. 52-55
Author(s):  
Ersin Çintesun ◽  
Denizhan Bayramoğlu ◽  
Emine Uysal ◽  
Çetin Çelik
Keyword(s):  
Emergency Service ◽  
Rare Complication ◽  
Previous History ◽  
Ovarian Vein ◽  
Anticoagulant Treatment ◽  
Vein Wall ◽  
History Of ◽  
The Right ◽  
Tomography Scan

Objective In this case report, we aimed to discuss a septic pelvic thromboembophlebitis (SPT) case detected 20 days later who had the previous history of cesarean section and had an intrauterine stillbirth vaginally at 30 weeks of gestation. Case(s) A 24-year old patient, who admitted to the emergency service with the complaints of fever and pain in the lower right abdomen and was reported to have a 4 cm formation consistent with thrombus on the right ovarian vein wall in the computed tomography (ST), was hospitalized for follow-up and treatment. The patient whose thrombus showed remission in the check-up tomography scan after the broad-spectrum antibiotherapy and anticoagulant treatment was discharged on the 10th day. The treatment of the patient who did not develop any complication in the follow-ups was completed with recover. Conclusion In conclusion, SPT is a complication which is seen rarely in both obstetric and gynecologic practices. SPT is a disease which may lead to fatal outcomes by late diagnosis but satisfying results with early diagnosis. Abdominal pain and fever symptoms should come to mind in all cases after delivery or operation.

scholarly journals Unusual case of a giant lung abscess initially misdiagnosed and treated as an empyema

2019 ◽  
Vol 12 (5) ◽  
pp. e228849
Author(s):  
Joana Sofia Carvalho ◽  
Diogo Paixão Marques ◽  
Inês Oliveira ◽  
Ana Cláudia Vieira
Keyword(s):  
Bronchopleural Fistula ◽  
Final Diagnosis ◽  
Lung Abscess ◽  
Chest Ct ◽  
Appropriate Treatment ◽  
Ultrasound Findings ◽  
History Of ◽  
Respiratory Physiotherapy ◽  
The Right

We report the case of a 66-year-old man with dental infection who presented to our emergency department complaining of a 3-month medical history of chest pain and productive cough, in association with malaise, fever, weight loss and anaemia. His chest radiograph showed a nearly total opacification of the right hemithorax and chest ultrasound findings were suggestive of empyema, subsequently confirmed by a chest CT. The patient started appropriate treatment. A follow-up chest CT performed to rule out bronchopleural fistula revealed a large lung abscess. The patient had the final diagnosis of a giant lung abscess, which was initially thought to be an empyema because of the clinical and radiologic similarities with this entity. The initial misdiagnosis led to prompt percutaneous drainage of the lung abscess in addition to antibiotherapy and respiratory physiotherapy with a good final outcome, which suggests the efficacy of this approach in similar cases.

scholarly journals Coincident craniopharyngioma and unruptured aneurysm at the right M1- M2 segment of the middle cerebral artery. Case report 1

2019 ◽  
Vol 29 (01) ◽  
pp. 35-39
Author(s):  
Williams Escalante ◽  
Denis Isao Ueoka ◽  
Eduardo Andre Goulart de Alcântara ◽  
Anderson Rodrigo de Sousa ◽  
Paulo Henrique Pires de Aguiar ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Unruptured Aneurysm ◽  
Vascular Lesions ◽  
Resonance Imaging ◽  
Surgical Time ◽  
Appropriate Treatment ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

We report a case of coincident craniopharyngioma with an unruptured aneurysm at the right M1- M2 segment of the middle cerebral artery; and discuss the surgical approach to two different pathologies treated at same surgical time, as well as current theories to explain the coincidence or association between tumor and vascular lesions at the sellar and suprasellar regions. The patient was a 59-year-old woman; with a history of visual impairment and headache. Both lesions were identified by magnetic resonance imaging (MRI) and cerebral angiography, and were treated surgically. We suggest individualized treatment for each case, choosing the best neurosurgical approach to achieve an appropriate treatment of both pathologies in the same operative session.

Hepatic brucelloma: a rare complication of a common zoonotic disease

2020 ◽  
Vol 13 (12) ◽  
pp. e237076
Author(s):  
George Vatidis ◽  
Eirini I Rigopoulou ◽  
Konstantinos Tepetes ◽  
George N Dalekos
Keyword(s):  
Rare Complication ◽  
Surgical Excision ◽  
Coombs Test ◽  
Inflammation Markers ◽  
Laboratory Findings ◽  
Ct Guided ◽  
Rare Manifestation ◽  
Bone Marrow Cultures ◽  
History Of ◽  
The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

Sign in / Sign up

Export Citation Format

Share Document